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EmilysDad
08-05-2009, 01:02 PM
It's hard for us to believe that Emily's heart transplant was six months ago. We returned to Children's for Emily's 6 month check up and biopsy this week. Her biopsy was again a 0, meaning no rejection. We were very happy and relieved to have her getting past this milestone with flying colors. She has gained back the weight she lost and looks great.

We can't say the biopsy day went smoothly, but they got it done, and the results were good. As we were told, even though you are scheduled to be first case (7 am) and turn your life upside down to get there on time does not prevent sick babies being born and emergencies over the weekend. Or to have one of the cath labs break down. Our 7 am test became a 12 pm test, with the fun extra five hours of fasting. Ugh. At about four hours into waiting, when it seemed calm and they were threatening to get ready to take her in, she smiled at us and said, "If this was an episode of 'House', I'd have a seizure right now."

But she did well, it was good to see some of our transplant team friends. Better yet, we got out of there and were able to have a fun dinner in Boston with friends.

She still struggles with low energy and nausea at times, but overall is doing well. She has found that CoQ10 (Ubiquionone) seems to give her more energy. That makes sense since her underlying pathology is mitochondrial, and CoQ10 acts on the electron transport chain in mitochondria.

The summer is speeding by. Emily is working very hard to finish AP World History and 10H English. We're proud of her for finishing three courses in June with a 90+ average despite missing 88 days of school last year. It will come down to the wire to be a junior when September 10th rolls around but we're confident she will pull it off.

Emily has a trip to Chicago planned for August 19th to see family right after the AP World test. She feels a little like her summer was stolen away by having to catch up for all the school she missed.

We also had a fun time in Boston doing her first college visit to BU. The conclusion was that BU is a great place, and she definitely loves the idea of college! So we've gone from heart failure through transplant to planning for college in less than a year. Do you think she'll have anything to say in her college essay that speaks to her ability to persevere?

Hope you are all having a great summer.

Deb and Bob

Cynaburst
08-05-2009, 03:13 PM
All I can say is that any college will be very lucky to get Emily. I'll bet those admissions counselors will be falling all over themselves to get at her!

Great news, and thanks for keeping us posted.

Midge Rollins
08-05-2009, 03:41 PM
I am so happy for all of you. These milestones are very important and I am just thrilled (to tears) to hear her story. She is one neat kid. I know biopsies do not always go as planned, I bet she was fit to be tied. Tell her hi.

steve75
08-05-2009, 03:57 PM
What an inspiring story you have to tell. You should be proud of your daughter's strength, courage and resilience. Thank you for sharing. We are glad to hear things are going so well!

purple_ness1
08-05-2009, 05:42 PM
thats so good to here shes doing well
wish it was summer here

Margi

LindaSo
08-05-2009, 06:31 PM
Thanks for sharing, this is another great report !! Glad all is well.
Linda

THW
08-05-2009, 06:56 PM
So glad to get this great update. I bet she does feel like her summer was stolen, but she can be proud of her resilience and hard work.

Give her a pat on the back from her HCMA family!
Theresa

mbcube
08-05-2009, 08:24 PM
Wow - You just made my day. Thanks for the update!

Linda
08-05-2009, 08:38 PM
It's great to read this wonderful news - thanks for taking the time out of your new lives to continue to encourage and share with the rest of us.

Linda

Bucky
08-05-2009, 11:03 PM
As we say here in the Southwest....Fantastico!!!! Bravo!!! Que Bueno!!!!

Hi to the family. So good to hear that Emily is doing so well. Looks like life is slowly returning to normal. What happenings a year brings, eh?

All the best.


Doug

Shelly
08-06-2009, 01:29 AM
That is wonderful. I can only imagine how Emily feels. What a year you all have had.

I have been curious about the biopsy, how is that done? Is it a long test, etc. This disease has certainly caused me to get a little more educated in areas I never really thought about.

Blessings to you all.

EmilysMom
08-06-2009, 08:49 AM
Thanks everyone for your comments. We are very relieved to have gotten to this point with no evidence of graft rejection.

Shelly-
One of the best ways to get early detection of rejection is to take a piece of the heart tissue in a transplanted heart and look at it directly to see if there is evidence of white blood cells attacking the tissue. The routine (if you can call it routine) biopsies are done through the carotid artery. They put a catheter in the neck and guide it into the heart using flouroscopy. With the catheter in the heart, they can directly measure pressures and also take a small snip of tissue to use for the biopsy. The patient is typically awake or mildly sedated and the procedure takes about and hour. Honestly it sounds scary and horrible, but kids seem to get used to it. The worst part for Emily is getting the IV put in. They numb up the entry spot on the neck, and give them enough pain med to keep them comfortable.

A similar catheterization method is used, through the groin, to access both sides of the heart to measure pressures on both sides. This is sometimes done in diagnosis of heart patients.

Shelly
08-11-2009, 11:31 PM
Deb,

Thanks for the info. I was wondering if it was an actual biopsy of the heart tissue. It seems odd to me to be awake during such a procedure. I was awake during my cardiac cath, but that seems different.

With each step we take on our journey we grow just a little bit, whether in strength or knowledge. It is just wonderful to hear about every successful event.

Thanks for sharing your good news.I hold you all in my prayers.

EmilysMom
08-12-2009, 06:14 AM
The procedure is a cardiac cath. They take a little snip of tissue while the catheter is in the heart.

gfox42
08-12-2009, 09:16 AM
Deb,
I'm delighted to hear the news! I hope you folks are celebrating.

Cheers,
Gordon

Pam Alexson
08-12-2009, 07:27 PM
Deb and Bob and especially Emily... this is just the greatest news and I am happy to share in your joy and in Emily's journey of life.

Pam

Eileen2345
08-16-2009, 01:45 PM
I am very happy for Emily and for the whole family.

Emily will live a long and wonderful life.


:D


Many, many hugs to all.

mbcube
08-16-2009, 11:20 PM
Glad to hear the update. The researcher that invented the rejection test (out of Stanford I think), just died about a month ago. Its amazing that they haven't found a more simple or less invasive test in the last 40 years!

http://med.stanford.edu/ism/2009/july/billingham.html

EmilysDad
08-17-2009, 06:48 AM
Glad to hear the update. . Its amazing that they haven't found a more simple or less invasive test in the last 40 years!

http://med.stanford.edu/ism/2009/july/billingham.html

Marc,

There is a blood test that is undergoing testing. Hopefully, it will replace most of the biopsies, which over time are implicating in damaging the tricuspid valve.

For more on the blood test, see http://cardiactransplantresearch.cumc.columbia.edu/PDF/A%20Gene%20Expression%20Test%20to%20Detect%20Rejec tion%20of%20the%20Heart_Allomap%20molecular%20test _11mar06.pdf

Lisa Salberg
08-17-2009, 11:02 AM
Great news for Emily! Thank you for sharing!!
Best to all!
Lisa

angall
08-17-2009, 07:18 PM
Marc
Yes, there is a less invasive procedure to indicate a rejection. It is a simple blood test called an allomap. I had an allomap last year, but when one was scheduled for me to have one this June, the docs office did a preauthorization and they were told that as of Sept.2008 BC/BS and some other insurance companies do not pay for that procedure. Therefore, if you are covered under an insurance plan that does not cover an allomap, a heart biopsy is proformed.

EmilysDad
08-17-2009, 08:27 PM
This procedure has not been calibrated for pediatric heart transplants, so it's still off in the future for the kids

THW
08-17-2009, 11:38 PM
Esther (or anyone else),
Just curious, why would it not be covered but a traditional heart biopsy would? Is it some how more expensive or are the results less reliable? Just wondering.
Theresa

EmilysDad
08-18-2009, 05:24 AM
It's not an insurance issue--the procedure requires calibration with traditional biopsies. They do the gene testing on people who are also undergoing biopsies so that they can use the biopsy to interpret the genetic test results. This was done with 600 adults before it was approved for screening adults. The same level of research has not been completed with children.