On November 20, 2012 we had our first transplant appointment after both Nicole’s cardiologist and her PH specialist believes the time for this has come. It was also agreed upon that she would go to the center that is local as opposed to the one 2 1/2 hours one way from our house.
In December she had a CCTA and TEE to get some pictures of her heart. The question is can she just have a double lung transplant or does she need a lung/heart transplant. Nicole has a large 2 1/2 cm size VSD (which is a hole between the right and left ventricle of the heart) as well as two or three other smaller VSD’s. She also has a PFO which is like an ASD (artial septal defect which is in the top part of the heart) but instead of a hole it is a flap. She also has Eisenmengers Syndrome which is reverse shunting of the heart. On Jan. 2nd, 2013 she had a right heart catheterization to round out the cocktail of tests.
Last week we had our first appointment back to the center since these tests. The lung director came in and told Nicole and I based on the tests they performed they believe she needs a heart/lung transplant. Let me tell you, this was like a kick in the gut… it was like the day of her diagnosis three years ago except for I didn’t lose my breath. We have always known that she would need a lung transplant but as the cardiologist said it would be “years down the road” . I didn’t realized that was only a mere three years after diagnosis in Jan. 2010. I tried so hard to keep my composure because I have to be strong for Nicole but I failed and some tears leaked out. The nurse caught on to this and got me some tissues. I think the doctor could tell too. Nicole was sitting in the middle of the room in her wheelchair and I was in the back so she had her back to me.
The doctor went on to explain that the reasoning for this is that while her heart is repairable it would take too much time to do this and they are under a time frame as the lungs have to be in the body within six to seven hours. I record all of Nicole’s appointments but haven’t been able to listen to this one yet. It was my understanding that Nicole’s PH specialist, her cardiologist, the two doctor’s at the transplant center and a pediatric heart surgeon (who we haven’t met) were going to get together and discuss the options. I was under the impression that this had happened. According to the cardiology nurse the meeting that was originally scheduled one of the doctor’s at the center had a transplant and only the other transplant doctor and the PH specialist showed up for the meeting. It was never rescheduled. It’s my understanding that the cardiologist doesn’t agree with this recommendation and believes that the heart can be repaired and she would only need lungs. They have even tossed out that I should go for a second opinion in Gainesville or Miami.
I don’t know what to believe. We also saw the social worker at this appointment. Nicole was diagnosed with generalized anxiety disorder (GAD) and obsessive complusive disorder (OCD) in 2005 and takes Zoloft for this. She sees a psychiatrist and a counselor/therapist. The social worker said that all the things that would be a concern for them we are already taking care of since she doesn’t have any drug, alcohol or cigarettes addictions. The doctor asked for the name of her counselor which I gave to him. He also said that he would like Nicole to start talking about her feelings toward transplant with her and also he wanted her to do research about it.
They are also going to get a mentor for her which is somebody who has had a lung or a lung/heart transplant. He also wants a conference with Rick and I and the social worker and it is my understanding that this would be without Nicole present which would allow me to ask questions that I wouldn’t ask in front of Nicole. She also needs to get another 6MW, a diagnostic test used to measure how well a medicine is working. It is basically what its name implies–a six-minute walk. She walks for six minutes at her own pace and they will log in the distance to see if she can walk farther than the last time she had one. I’m not sure if she will be able to get this done at rehab or we will have to go back to the transplant center. She also needs more bloodwork which we will go to the hospital for on Thursday. I don’t remember what the bloodwork is for though. I think and hope they will check her potassium as this is like a yo-yo going up and down.
I got a call that evening from Nicole’s counselor asking if I would give her verbal permission to talk with the doctor as he had already called her. I did give this and I can because I have power of attorney for Nicole and have since the day she turned 18. She sees her counselor the first full week of March so hopefully she will let us know what the doctor wants her to do.
This has been very emotional for both Rick and I as well as the rest of the family. I know it has for Nicole also but she usually has delayed reactions to trauma or stress. It will manifest itself in some way.
I have looked at some statistics for heart/lung transplants and in 2011 the estimated number of heart/lung transplants in the US was 30. The cost of the procedure was $1,248, 400. This is the lowest number of all the transplants listed. According to a 2010 study that assessed the long-term outcomes of people who have had a heart-lung transplant they found that:
70% will survive for one year
50% will survive for two years
39% will survive for five years
I’m not impressed with these statistics. I had a hard time coming to terms with a 50% 5 year survival rate for a double lung. I guess the biggest question for me is does the benefits out weigh the risks and I can’t say that I truly believe this.
One of my concerns is that Nicole believes that she will be “normal” if she gets a transplant and I don’t know if this is realistic. I heard Helene Campbell say on the Ellen show after her double lung transplant this it wasn’t a cure but a treatment and this is very true. Nicole will not have the illnesses anymore, nor will she have to be in a wheelchair because she can’t walk long distances or be on oxygen 24/7 but there is a lot of other things that she will have to do for life. The first two years after transplant is filled with a lot of tests, bloodwork, clinic visits, rehab etc. but her quality of life will be better so they tell me.
I wrote up to this point on my blog this morning. It automatically goes to my facebook page. I am going to say things here that I wouldn’t want seen on facebook or my blog as while I know this site is public I know that Nicole and/or Rick would likely never come here. One of the biggest fears that I have regarding the heart/lung transplant, other than the grim statistics, is the very real fact that she could die. I can look at her now with her illness and even though it is terminal and it is progressive and the drugs she takes will only slow down the progression, without making the disease better it seems I can deal with this better. A transplant is like a kick in the face which a major, major, surgery that could surely cause her death. I can barely handle walking into the recovery room and seeing Nicole coming out of sedation after a cath. or sitting in the waiting room for this two-hour procedure. I don’t think I can handle seeing her hooked to a ventilator or having all sorts of tubes and machines attached. I can’t believe that I wrote the whole blog up to this point without breaking down into tears and now they are flowing like water. How do I as a parent watch my child go through this?
I had joined a heart/lung transplant page/group on facebook a while back. I really didn’t go in there at all but yesterday I went and asked what type of fundraising did they do to cover transplant expenses as Nicole has Medicaid and it is my understanding that they will cover 80% which leaves us to come up with the rest. I also posted a short little snippet about Nicole being diagnosed at 15 and now we find out she needs heart/lung transplant.
I got a response from this lady who has had a heart transplant (I’m not sure why she needed one) who works with a transplant organization who supplies mentors to other in the transplant process. She friended me on facebook as well as sent me a private message to get my address to send me a packet of information. She is also suppose to hook me up with a caregiver who has gone through the transplant process.
She said something that totally blew me away which was “I’m now a professional patient advocate, specializing in transplants.” I didn’t know there was such a thing but it is really something I should be as well as a lot of other patients/caregivers. My question to her will be how did she become this.
There was also another lady in her 30′s who had the exact same diagnosis as Nicole and she had a heart/lung transplant eight years ago and has even had a child since then. She gave me her blog which I will read in depth in my free time. She gives me a lot of hope as well as another lady who had a heart/lung transplant–I believe it was 16 years ago.
As much as I love hearing these wonderful stories I know they don’t all end happily. I guess this is really where my faith and trust in God will come in even though I don’t feel like this most days because it is such a struggle most days with hardships always coming at me whether it is related to Nicole’s health or other areas of life. It seems like I have more hardships than blessings but I know this is because of my self-pity and woe is me.
I am truly blessed and need to remember this.