Pediatrics employee doing well post-transplant
Editor's note: Theresa Merkal, a cystic fibrosis patient of MUSC's
Patrick A. Flume, M.D., and MUSC Department of Pediatrics employee, has
received a double-lung transplant and breathes much easier these days.
Theresa worked full-time at MUSC for more than a year and remains a temporary
contract employee.
by Claire Dattilo
43rd Airlift Wing Public Affairs
Theresa Merkal was diagnosed with cystic fibrosis at age 2. Like 30,000
other Americans with CF, she struggles to live with the most common fatal
hereditary disease among Caucasians, according to the American Lung Association.
CF is the result of a defective gene that causes the body to produce an abnormally thick, sticky mucus that obstructs the lungs and other organs, creating respiratory and digestive problems.
An individual must receive two defective genes, one from each parent, to have CF, and more than 10 million Americans who are carriers of the gene have no symptoms.
There is no known cure for the disease, and only half of those with CF survive to age 31, according to the Cystic Fibrosis Foundation. Theresa is 27.
Theresa
Merkal, with husband 2nd Lt. Brian Merkal.
Theresa said her husband, 2nd Lt. Brian Merkal, of the 43rd Security Forces Squadron, Pope Air Force Base in Fayetteville, N.C., is her unwavering supporter. He reels off CF facts from memory and has a detailed mental catalog of his wife’s progress.
They have known each other since high school, and after he served four years with the Marines, they married. He was stationed at Barksdale AFB, La., when her lungs were at their worst.
She was living in Charleston, under the care of Patrick Flume, M.D., MUSC's Department of Pulmonary and Critical Care-Allergy and Clinical Immunology, when her situation became severe enough for him to place her on a lung transplant waiting list. Flume referred Theresa to Duke Hospital in Durham for a double lung transplant operation.
To be closer to the hospital, Lt. Merkal received humanitarian orders to Pope AFB in December.
As time passed, the Merkals were forced to face the possibility of losing the battle to CF.
When the situation became dire, a new set of lungs were finally found, and Theresa received the greatest Christmas gift she could imagine—a chance to breathe again.
The realities of CF are not pretty. Patients deal with severe lung infections, digestive problems and malnutrition at an early age, according to the CFF.
Despite all of this, Theresa said she manages to keep a positive perspective and a smile on her face.
“I never heard her complain that she has CF,” Flume said. “She might have complained about the symptoms, like any of us do, but never did she ask why she had CF. She is an absolute joy, and it is because of people like her that I enjoy going to work every day.
Theresa
Merkal
“She has always had a smile on her face, even when supremely uncomfortable,” he said. “She is a straight-shooter; she likes it honest and without fluff. She knows about CF, and she knew that having a transplant was an option in her future.”
The Merkals met in high school and started dating after graduation. Lt. Merkal entered the Marines and knew shortly after enlisting he was going to marry her. He hesitated because he did not think there was a sufficient health care system within the military to help her.
Lt. Merkal’s apprehensiveness to the quality of care and support Theresa would get as a military spouse was soon quelled by a commander who introduced him to several special-need family programs.
“Theresa was doing fairly well, so I looked into the (Air Force) ROTC program. It was my ROTC commander who told me about the humanitarian moves,” he said.
The Humanitarian Reassignment Program allows members to apply for reassignment consideration to resolve severe short-term problems involving a family member.
The programs used by the Merkals allowed Theresa to be close to facilities like MUSC and Duke, while Lt. Merkal continued fulfilling the missions at Barksdale and Pope.
In November, Theresa’s condition worsened with such severity that she rapidly moved up the organ transplant list.
“Her window of opportunity was closing quickly,” Lt. Merkal said. “Her lung functions were 20 percent and sometimes lower toward the end.”
Flume, who has treated Theresa since 1994, referred her to Duke for the transplant when her conditioned worsened.
“Theresa had very severe lung disease prior to the transplant,” Flume said. “Lung transplantation is not considered a ‘cure’ for CF, and there are many risks and complications, including death, after transplant. We only consider lung transplantation for someone who is going to die of their lung disease in a relatively short period of time.”
With time against her, she waited for a suitable donor while her lungs continued to deteriorate.
Finding a donor can be lengthy. The U.S. Department of Health and Human Services Web site notes that there are more than 83,000 people on the organ transplant list, and half of those will die while waiting.
“I’ve known someday I would be sick enough to need one, and have felt I wanted one,” Theresa said despite the odds in finding a donor.
On Dec. 15, she got the call that two lungs were available. She reported to the Duke Transplant Center that morning, and after an eight-hour surgery, she was ready to begin a life with new lungs.
Only six days later, Theresa was released from the hospital. The average stay for a bilateral transplant patient is 12 days, said Scott Palmer, M.D., Duke lung transplant program director.
“She was doing so well they did not want to keep her. It was incredible,” Lt. Merkal said.
“Many of our patients are getting out quickly. It is pretty dramatic,” Palmer said.
Theresa was home for Christmas, and for the first time in more than a year, she was able to breathe without her oxygen tank.
With the operation behind her, Theresa now faces a long road to recovery. Lt. Merkal continues work at Pope AFB while she lives in Durham so the hospital can monitor her progress.
Just four weeks after the operation, Theresa’s lung function is almost 70 percent and rising.
“Before the transplant she could not walk 10 feet without stopping to rest,” Lt. Merkal said. “Her lung function was horrible. Now she has no respirator and was walking just two weeks after the transplant. It has been just remarkable.”
Theresa is now able to walk a mile in 20 minutes and expects a long, successful future with her new lungs.
Palmer said she has a very good chance of living an excellent life that would not have been possible without a transplant.
“What an incredible gift it was for someone to check off that box on an organ donor card,” he said.
She is now able to look forward to new ambitions and plans to walk the 4.5 mile Cooper River Bridge Walk in Charleston in April.
The Merkals also hope to attend their upcoming 10-year high school reunion.
“We have not had a vacation since I have been in the Air Force,” Lt. Merkal said.
And the trip to see friends and family instead of a hospital will be
a breath of fresh air for them both.
Reprinted with permission from Air Force Link, Pope Air Force Base,
Fayetteville, N.C.
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