NADINE Cousins existed on one small meal a day for almost two decades. The medical student put it down to simply having a small appetite, but her friends feared she was suffering from an eating disorder.
The truth only emerged this year when Cousins was rushed to hospital: she had a cyst on her spleen that had grown over the years to the size of a football.
After keyhole surgery to remove the cyst – thought to be the first of its kind in the UK –
Cousins is enjoying three square meals a day for the first time in her life.
Cousins, 19, from Blairgowrie, Perthshire, would only ever eat small portions, typically getting by on just one meal a day because she never felt hungry.
However, when Cousins began experiencing severe pains and vomiting earlier this year, she was admitted to Ninewells Hospital, Dundee, where tests revealed a huge cyst that she had probably been born with and had been growing ever since.
It was taking up so much room inside her body that food was remaining in her stomach and not being properly digested. In such a severe case doctors would usually have no option but to remove the whole spleen under open surgery, an invasive procedure that leaves the patient on medication for the rest of their life.
Cousins said yesterday that she was delighted with the success of the procedure, and added that she was glad to be enjoying her food again.
"For my birthday, three days after the operation, my boyfriend took me out for dinner and I ate a whole plate of pasta and a chocolate cake for dessert," she said.
She has even avoided putting on weight and has dropped a dress size since the operation because the cyst had made her abdomen so large.
"People did think I had an eating disorder but I was just never hungry. My parents were constantly getting on at me to eat. But if I ate a lot one day, for example going out for a meal with friends, I could go the whole day without food," she said.
Cousins admitted her lack of appetite had never made her worry that she might have an underlying medical condition despite her medical training. "It never crossed my mind. A lack of appetite was just normal.
"When I fell ill it was really worrying because at first the doctors did not know what the growth was.
"My case was so unusual they weren't sure at first how they were going to treat it.
"I am so glad they were able to do the keyhole surgery and leave half of my spleen. It has made such a difference to my life. It means I don't have to take antibiotics every day for the rest of my life. And I don't have a big scar, which means I can wear a bikini on the beach and not worry about it. I am also enjoying my food again. I now know what it feels like to be hungry and to feel full."
The spleen, which is located in the abdomen, plays an important role in the immune system. People can live without a spleen, but their resistance to infection is lowered.
But consultant surgeon Francesco Polignano, an expert in laparoscopic surgery at Ninewells Hospital, performed a procedure that had never been attempted before, removing the cyst and just part of the spleen, using keyhole surgery.
He managed to remove the growth through an incision the size of a snooker ball.
He explained: "In Nadine's case this large cyst was causing significant compression on her stomach. She was probably born with it, and when it got larger as she grew, it caused trouble.
"This is an advanced and extremely specialised procedure for benign conditions in children or young people, in which the spleen is still crucial in fighting infections that can otherwise become lethal. Preserving part of the spleen safeguards its immune function and avoids the lifelong requirement for antibiotics and vaccinations.
"This is a very rare operation, and we were delighted to have successfully performed it by minimal invasive surgery and to have avoided a total splenectomy. To the best of my knowledge, I am not aware that any similar procedure, where half the spleen is removed rather than the whole, has been performed before through keyhole surgery in the UK."
To remove the cyst, Polignano made a small 5cm incision in Nadine's abdomen and inserted a plastic bag over the cyst. He ruptured the growth to allow fluid to drain away, then removed it along with half of her spleen that it was attached to.
Tayside is at the forefront of medical advances in keyhole surgery. The technique was largely pioneered in Dundee by Professor Sir Alfred Cuschieri, by whom Polignano was trained.
The advantages to Nadine and other patients are that the operations leave smaller scars, offer a much shorter recovery time and are less likely to lead to infection following the procedure.
The full article contains 837 words and appears in Scotland On Sunday newspaper.
