12/06/2019
The following is a letter from the son of one of our managers. Our manager, David, and his family have undergone and continue to undergo concern for Jeriel.
I am Jeriel David, a tenth-grade high school student. I completed my ninth grade with a 4.00 GPA. My ambition is to become a Software Engineer, and this is my story.
Sometime early February this year I had a nosebleed while I was in my classroom at School. My teacher asked me to report myself to the school health room. Upon arriving at the health room. The nurse administered cold compression to stop the bleeding. Unfortunately, the bleeding did not stop beyond 30 minutes. The school nurse considered this as abnormal and requested my dad to pick me up to seek medical attention. Upon which a Nurse Practitioner from the nearby school-based Health and Wellness clinic ordered blood work at Quest Diagnostic. The initial findings from Quest Diagnostic pointed unusual elevation of protein and a very low count of platelets. Considering the findings, the Nurse Practitioner referred me to the Hematology Department at Children’s Medical Center Washington DC.
So, I visited the Children’s Hospital on Feb 28, 2019. After the initial consultation with the Senior Hematologist, she ordered another round of extensive bloodwork. As soon as the bloodwork became available, the hematologist referred me to another specialist at the Gastroenterology department aka GI. When I enquired about me being seen by the other specialist, the hematologist informed that she is suspecting something not right with my liver as indicated by several factors in the recent blood work.
So, I went to see the Gastroenterologist on Mar 31, 2019. After an immediate consultation, the doctor ordered a further round of blood work to narrow down the findings to ascertain specific liver disease pointers. The subsequent bloodwork raised more alarm while specifics were still unclear. Thus, the GI specialist decided to do yet another round of thorough blood work on May 30, 2019. Upon confirming her findings, the GI specialist ordered an abdomen ultrasound procedure on June 6, 2019. The ultrasound indicated that the liver is enlarged with heterogeneous echotexture and enlarged spleen. The report also indicated that there is slow flow in the portal veins, and the diminished phasicity of the hepatic venous waveforms are indicative of portal hypertension and possibly cirrhosis.
Finding no cohesion between the bloodwork marker’s and ultrasound, the GI specialist ordered a CT Angio Abdomen on July 10, 2019. The CT findings once again pointed out the following findings: 1). Sequela of cirrhosis and portal hypertension that includes hepatosplenomegaly, liver surface nodularity, heterogeneous parenchymal enhancement, upper abdominal and retroperitoneal adenopathy. 2). Patent hepatic vasculature, with enlargement of the portal and splenic veins.
Upon reviewing both the ultrasound and the CT scan findings, the GI specialist ordered another round of bloodwork on August 1, 2019, to narrow her findings to ascertain the prognosis. Once again, the blood work markers did not seem to arrive at any specific prognosis. It was then that the doctor advised me that I need a liver biopsy for proper prognosis and scheduled the same on August 28, 2019. The final pathologic diagnosis indicates liver parenchyma with abnormal nodular architecture and extensive bridging fibrosis on trichrome stain (stage 4), which means that the liver is in pre-cirrhotic/cirrhotic phase. I was also informed that it is difficult in the cirrhotic phase to assess the early etiology of liver disease. Scattered plasma cells are present in the inflammatory infiltrate which makes an initial autoimmune pattern possible. Based on these findings the Children’s GI specialist reached out to another GI specialist at Georgetown University Hospital Washington DC for a second opinion on the above findings and later confirmed it on September 15, 2019, that there is some consensus that there may be an immune component of the liver disease.
Based upon these findings, I’m right now being prescribed with Ursodiol 500mg and Imuran 50mg. In the meanwhile, waiting to be waitlisted for a liver transplant at Georgetown University Hospital and I’m also waiting for Mephyton 5mg (Vitamin K) to increase blood clotting level since my liver is very sick.
Frontline Community Services is a non-profit organization which provides person centered support for individuals with intellectual and developmental disabilities.
