As Julie, Ricki's daughter, wrote in the introduction, Ricki has had a successful run since his initial transplant. Only in the last year has he deteriorated. His major issues now are slowly progressive liver failure which had led to moderate kidney failure. It has been a long process deciding which factor is causing the other problem. Complicating things is a chronically low blood count which has contributed to his fatigue and lack of energy.
For the past several months, he has been extremely limited in what he could physically do and has had little to no appetite. He has lost significant weight. He has spent the past year seeing his multiple physicians and specialists in Austin and San Antonio, trying to find answers. His first transplant was done at the University Medical Center in San Antonio and this initial pre-transplant evaluation was done there. Since his first transplant, Ricki has been to Johns Hopkins in Baltimore and has had evaluation and surgical procedures done there. He, and we, have found the care at Johns Hopkins to be exceptional. He has always felt that if he required another transplant, he would have it done at Hopkins.
After completing the transplant evaluation in San Antonio, he wanted to have an evaluation done in Baltimore. Jodi and Briann, Ricki's sisters, went to Austin and drove with him to Baltimore. Within two weeks of his arrival there, it was decided that he qualified to be listed for transplant. The surgical team was careful to discuss with him that he was facing what would be a very technically difficult surgery. His previous transplant, complicated by abdominal adhesions from his previous multiple abdominal surgeries necessitated by his Crohn's Disease all contribute to making this surgery difficult. In spite of this, the entire surgical team feels that the risk is worth the benefit and he has been listed for transplant. After a year of feeling bad, Ricki also feels that the potential benefit is worth the risk.
It was decided that Ricki would stay in Baltimore awaiting transplant and would likely remain in Baltimore for a year or so after transplant. Fortunately, Jodi lives in Baltimore and has a two bedroom condo.
Julie and Jason, Ricki's children were both in Baltimore this weekend to visit. Unfortunately, over the weekend, Ricki became more somnolent, fatigued and confused. When they could not get him awakened, they took Ricki to the ED at Hopkins. His labs were particularly abnormal with a very high ammonia level. Ammonia is a waste product formed in the gut from metabolism of proteins. When a person has liver disease, they are unable to process the ammonia and it builds up in the blood. It is toxic to the central nervous system and causes lethargy, confusion leading to seizures and coma. It must be treated to be lowered. After 24 hours of treatment in hospital, Ricki is doing better. He is more alert today and was able to eat. I anticipate that he will remain in the hospital for a couple of days until he has stabilized and is able to go back to Jodi's. I am planning to travel to Baltimore to be with Ricki and Jodi this weekend.
We share all comments and emails with Ricki, as he feels up to hearing them. Please feel free to comment. He does enjoy hearing from you.
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