Our journey started just over 3 years ago. On July 17, 2021 James was jaundiced so we went to the ER. At the ER we were told he had liver disease. It was recommended that he stop drinking and eat healthy to help his liver recover and to follow up with a hepatologist. We made an appointment with Dr. Gallati in the medical center. Dr. Gallati ran multiple tests including bloodwork, MRI, and an ultra sound of James liver. James was told he had cirrhosis of the liver. The cirrhosis at the time was classified as compensated. In the compensated stage, a persons liver is able to cope with the damage and perform the basic functions that the body requires of the organ. We were told he did not require medications at this stage. The jaundice soon faded and we carried on with life as usual. James quit drinking on July 17, 2021, the very day of the original diagnosis. I am so very proud of the man I am blessed to call my husband.

Fast forward 2 years and a few months. At the end of November 2023, I got a call from James phone. His coworker had called me from his phone saying James needed to go to the ER. He was confused and could not figure out how to open his phone to call me. I raced to pick him up and off we went to the Houston Methodist ER. The triage nurse called a stroke code in the triage room which brought an onslaught of various Physicians and medical professionals. He was whisked off to for multiple tests. The helplessness and fear I felt in that moment was indescribable. I hit my knees and prayed unable to stop crying. A very kind doctor held me up and escorted me to a private room to wait for James. James was soon admitted to the hospital. After all the tests, James was given a diagnosis of hepatic encephalopathy (HE). HE is a medical condition caused by increased ammonia levels in his brain. This is a complication of decompensated liver cirrhosis. Decompensated liver cirrhosis is the stage where the liver is not able to perform basic functions and remove toxins from the body. James stayed in the hospital overnight and was given medication to help rid his body of the ammonia. The medication worked quickly and we were able to go home on a combination of medications to help combat HE. 

When the hepatologist (liver doctor) came in the hospital I remember asking him if James would need a liver transplant. He said that he would recommend he be evaluated for a liver transplant. So once we got home, we got the ground running with finding a Physician to help us through this process.  
 

James did not want to go back to Dr. Gallati. He did not feel comfortable with him. So we searched for a new doctor. James found Dr.Noureddin and scheduled a transplant consult with him.  We were given an appointment at the end of December 2023. Dr. Noureddin is the Director of the Houston Liver Institute and a transplant hepatologist affiliated with Houston Methodist.  I often refer to Dr. Noureddin as our angel. Because he is so much more than a Physician. He takes his time with us, always treated us as though we were his main priority, and gone above and beyond to get James the medical care he needed. We began more testing through Dr. Nouredden. The testing required to get the transplant evaluation is immense. It requires a colonoscopy, endoscopy, MRI, and bloodwork. 

We were in the process of getting all of the required tests to be able to send the transplant hospital the tests to be accepted to be evaluated by Houston Methodist transplant center.  James' bloodwork had shown his potassium was low so he was given a prescription for potassium which he began taking on a Friday. Then James had another medical emergency. He began vomiting blood the next (Saturday)evening. This is January 2024. We called Dr. Noureddin and he instructed us to go to the ER. James hemaglobin levels were low so he got a admitted to the hospital again due to concerns of internal bleeding. This internal bleeding can be caused by varices which is a complication of portal hypertension associated with Liver Disease. James was hospitalized for 5 days because his hemaglobin level kept decreasing. James had an upper GI endoscopy Monday morning. The did not find any esophageal varices. So although Cat Scan had shown several large esophageal varices, none were seen on the endoscopy. The GI doctor explained that this was because his varices were on the outside of his esophagus. The varices on the outer side of the esophagus do not typically bleed. But nonetheless there was no bleeding in his upper GI tract. So James won another night in the hospital and began prepping for a colonoscopy the next morning. If you know James, you know he is ALWAYS hungry! He was not able to eat anything beginning Sunday evening to prep for the endoscopy. So now, the prep for the colonoscopy required another day/night of no food. That Monday he had the colonoscopy. And no bleeding was found and our prayers were answered. But that just brought on another test. There is a small area between between the upper GI tract and lower GI tract that the endoscopy and colonoscopy probes can not reach. So he had to swallow a giant pill camera that would take pictures of James GI tract as it moved through. He was finally able to eat 4 hours after he swallowed the pill camera so he was happy. That found no bleeding. Our angel, Dr. Noureddin, stayed in constant contact with the hospital Physicians and with me to ensure James was getting the appropriate tests and medical care. At the time, he was at the Houston Methodist downtown location and we were at the West location. But he made sure James was taken care of to his specifications. James wouldn't be where he is without him. 

James hemaglobin numbers finally began to rise and the general consensus was that the potassium had aggravated James stomach lining and caused the emesis with blood. So they discontinued the potassium. The good thing about the hospitalization was that ALL of the required tests to get the transplant consult sent of to the transplant center were complete. 

So we follow up with Dr. Noureddin in his office. He said James was likely a candidate for a living donor transplant and that he was sending the paperwork off to the transplant clinic after many months of anxiety and fear. This process is long and HARD. It's a marathon, not a race. 

The process went like this. Dr. Noureddin sent off the referral to the transplant hospital. The transplant hospital has to review the tests and agree that he needs to be evaluated. Then we wait for the transplant hospital to get the consultation approved through our insurance. So fast forward to April when we FINALLY get the call that everything was approved through insurance and we could schedule the transplant evaluation in May!

 The evaluation lasted 2 full days. James and I had to attend a liver transplant education class. They drew about 30 vials of blood. We met with the social worker, dietician, and financial advisor. James had a pulmonary function test, an MRI, a bone design test and a panorex. We met with the transplant cardiologist team as well as the transplant surgical team. The cardiologist said that James would have to have a heart cath procedure to check the pressures and vessels in his heart. That procedure would have to be scheduled in the cath lab. We were able to get an appointment for that in June. The prepped James and I went back to the waiting room. I lost it. I cried and cried and cried my eyes out in a corner in the waiting room. EVERYTHING was riding on this heart cath procedure. If the cardiologist said his heart wasn't strong enough for surgery, that would have been it and he would not have been a candidate for a transplant. My heart couldn't take the pain. FINALLY, the cardiologist came out to tell me that everything went fine and he would send the results to the transplant team 😭🙌

So now we have to wait for the transplant team to review James medical tests and approve him for the transplant. And finally in July, we got the news. He was approved!!!! The weight of the world was lifted. The surgery would have to be approved by the health insurance and then they would place James on the list. 

James' MELD score has ranged from 11-14. Which is considered too low to get a deceased donor liver. But because of the complications he was experiencing from liver failure, they placed us with the living donor transplant team. So now we search for a living donor. 

Houston Methodist just started doing living donor transplants. They have brought in 2 very highly regarded living donor transplant surgeons from the east coast who have done hundreds of living donor transplants. 

So here we are. James continues on medication for the hepatic encephalopathy to control his ammonia levels. He is also on lasix for ascites. And we just keep praying that God will hold us in his favor.