Thursday, January 20, 2011

The Act of God in Many Ways...

I mentioned in a blog the other day that a friend's daughter, Meredith, underwent a pancreas and kidney transplant here in Houston. I am happy to report that she is doing very well so far, as his her kidney donor. I am asking that everyone keep them in your prayers due to the long road ahead that Meredith has with anti-rejection meds, etc. She will no longer be a type 1 diabetic though. This is going to be a LONG blog today but worth the read! I am so happy for her family right now. Although I have not met Meredith personally, her mom Judy, has provided me with comfort and great advice in the past when it came to Lily. Meredith's brother is also a type 1. Her kidney donor is a woman from Judy's church...I am continuously amazed at people's generosity...this woman gave a kidney to someone. Wow.

Update as of today:
Things continue to go smoothly. Meredith did very well yesterday. She got out of bed and into a chair for an hour. She had a little trouble with pain last night, mainly because she would fall asleep for a while and not press the button on the pump that gives her pain medication until the pain was bad enough to wake her up. Overall it was a good night though. It's already been a busy morning. The physical therapist got her out of bed and she walked about 20 feet and then sat in the chair for another hour. All of the doctors have already visited and are very pleased with her progress. Her creatinine is down to 1.0, within the normal range. They are planning to start decreasing her insulin infusion over the next few days to allow the pancreas to start working. The Nephrologist started her back on blood pressure medication because her BP has creeped back up again, mostly due to pain and the volume of fluids they are giving her. The most exciting thing for her was to have the tube removed that was placed in her nose and into her stomach. So, I think most of the excitement for today is already done, although she'll probably get out of bed another time or two later on. I spent a little while visiting with Kim yesterday. She was doing very well other than the expected pain. Her remaining kidney function was completely normal. We're hoping that Meredith gets out of the ICU before she is discharged so they can be together on the same floor and visit some. God definitely blessed us with an amazing donor who provided a perfect kidney.

Meredith's Story as told by her husband on April 3rd, 2010:
For those that are reading this and aren’t familiar with our family, I’ll start with an introduction.  I’m Jason Kelly, and I’m writing this from Kandahar, Afghanistan, my home for the past 3 months.  My wife of 7 years is Meredith and she is the subject of my writing…more about her in a moment.  She is the wonderful mother of our two sons, Quinn who is 4, and Keegan who is 2.

I’m writing this as a plea for prayers and to provide some insight in regards to Meredith’s medical struggles.  As a background, when she was 10 years old Meredith developed Type I or Juvenile Diabetes.  This disease involves the inability of the pancreas to produce insulin resulting in the need for insulin replacement indefinitely for survival.  The long term complications of diabetes are numerous.  In 2005 and 2007 our sons were born prematurely following very complicated pregnancies as a result of the diabetes and preeclampsia.  We now have two healthy and wonderful sons, but Meredith’s body paid a high price.  After Keegan’s birth she developed congestive heart failure (which is now completely resolved) and since then we have never been able to get her blood pressure under control, despite the use of as many as six blood pressure medications at one time.  One of the long-term consequences of diabetes is kidney damage.  A consequence of poorly controlled high blood pressure can also be kidney damage, which in turn can result in further problems with high blood pressure.  We’ve known for a couple of years that Meredith’s kidney function was headed in the wrong direction.  This deterioration seemed to speed up about the time I left for Afghanistan in late December.  We decided that nothing significant was likely to occur during my 6 month deployment so I proceeded with my commitment.  Unfortunately we were wrong.  Meredith’s blood pressure, which had stabilized for several months began to worsen again.  During my absence she moved from our home in Wichita Falls down closer to family in Houston.  She went through the difficult process of finding a new set of medical providers and ultimately underwent a kidney biopsy about a month ago.  We hoped this would give us some insight into why she was having so much trouble with her kidneys and lead us towards a solution.  The only insight we received was that they were just about done functioning and the only solutions were eventual dialysis and transplant.

So, that wasn’t exactly the news we were praying for.  We expected kidney failure eventually, but we didn’t expect it to be so soon.  However, in some ways we’d been looking forward to a kidney transplant because that meant that she could possibly get a pancreas transplant as well.  As I mentioned previously, in Type I diabetes, the pancreas no longer produces insulin.  A new pancreas can cure the diabetes and halt the progression of other complications.  It wouldn’t reverse the kidney damage that has already occurred but it could prolong the survival of the kidney transplant.  Fortunately, Houston boasts the biggest medical center in the world and one of the few locations where simultaneous kidney/pancreas transplants are performed.
Well, we were optimistic that since she was in the perfect location for the transplant things might go smoothly.  Unfortunately insurance and some unexpected turns stood in the way.  Tricare is the insurance company that provides health insurance for military families.  The insurance program is great in many ways.  It is provided to us at no cost and in most cases provides 100% coverage.  Unfortunately, it is not popular among physicians because it does not reimburse them very well at all.  Many providers do not accept Tricare because of this and those that do accept it often only do so out of a sense of obligation to the military.  We expected some headaches from the insurance side but with only just a little stress Meredith was able to obtain a referral to the transplant team at Hermann Hospital - right where she wanted to be.  Last Wednesday she had her initial evaluation from which she left reassured, but also fearful.  I’ll save the details of what a transplant involves for a later post but it is by no means an easy path.  Unfortunately, in terms of longterm survival it is the only viable option once the kidneys stop functioning.
Her oldest brother, Ryan, accompanied her to the initial appointment to undergo tests to determine whether he could be a donor for the kidney.  Kidney transplants from living donors are much more successful than those from deceased donors so we prayed that Ryan would be a match.  Pancreas transplants can only come from deceased donors.  Meanwhile the lab at Herman ran several tests on Meredith to look at how resistant her body would be to potential donors.  She left the appointment encouraged because the team felt she would probably be fairly easy to match and regardless of whether her brother was a match it would probably only be a matter of weeks before a match was found for both organs.  I started making preparations to return home so I could be there when a match was found.  We were expectantly awaiting the results of a lab test referred to as the PRA.  This provides a rough estimate of what percentage of potential donors Meredith’s immune system would reject. We were optimistic that this number would come back in the 10-20 range.
Two days later, last Friday, the call came in with the PRA...79.  This means that Meredith is not compatible with 79% of potential donors.  Again, not the news we were looking for.  The team had her father come in to be tested as well because they knew it would be difficult to find a match and we would need to test any immediate family members that are able to donate.  So, again we waited on test results.  This Monday the results returned...neither Ryan or Mike were a match.  Immediate family members tend to be the best matches and now that option was not available.  So, that leaves Meredith with a deceased donor or someone outside of the family who is willing to undergo surgery and part with a kidney.
Before the bad news of the past few days could really even sink in things took another unexpected turn.  Meredith was scheduled for a day of extensive testing this Thursday.  She still had to be accepted as a transplant candidate.  The presence of other medical conditions that could decrease the chance of transplant success must be excluded.  Wednesday afternoon she got another call from the transplant team.  They could no longer provide her with medical care because her referral from Tricare was no longer approved.  She would need to find another transplant team that was in the Tricare network.  As I woke up Thursday morning in Afghanistan to read her e-mail about this I decided this must be a cruel April Fool’s joke she was playing on me, but no, it was true.  After already carrying the burden of a several days worth of bad news Meredith had to start making phone calls to determine what happened and where to turn next.  She has a great Case Manager at Tricare and a great coordinator with the transplant team.  However, this went well above them.  Hermann Hospital management was no longer willing to provide medical care to her.  I was shocked that it wasn’t a problem with Tricare but as it turns out it partly was.  As I mentioned earlier, Tricare does not have a favorable reputation when it comes to reimbursements.  Well, based on their previous experience with Tricare, Hermann apparently no longer accepts Tricare patients for transplants.  The options are significantly limited when it comes to facilities that perform dual pancreas/kidney transplants and suddenly the facility with the team that we feel gives Meredith the best chance for success will no longer treat her.  It seemed rather ironic that I am serving my country in Afghanistan yet the insurance made available for my family is not good enough to be accepted by Hermann Hospital, the hospital where I received most of my medical training.
Fortunately, I’ll wrap this up with some great news. Meredith and her mom made a few phone calls to some influential figures in the Houston area, including U.S. Congressman John Culberson. Within just a few hours Meredith received a phone call from Hermann letting her know that things were back on again. She even received a phone call from the CEO of Hermann who felt it was important to personally let her know of the change so she would not have to worry about it over the Easter weekend. We are extremely grateful to everyone that helped out with this and to the Hermann staff for accepting Meredith’s case. I’m not quite sure why this hurdle arose and fell the way it did but we thank God for allowing it to fall and that Meredith will be able to continue working with one of the most experienced kidney/pancreas transplant teams.  So, that’s where we are in the process for now.  We remain optimistic and faithful that things will continue down the road to a successful transplant in the near future.  Please keep Meredith and our family in your prayers


  1. WOW!!!!!!!!!!!!!!!! OMGsh...what a story!!!! The journey to get to this wow wow...I am praying. PRAYING PRAYING PRAYING!

    Please keep us updated.

  2. WOW...I started reading earlier and just finished up on this "visit". Please keep us updated on Meredith. She sounds like quite a gal...from a terrific family.

  3. WOW! Amazing story. I will be praying for them both.