October 7th 2009

Good Afternoon!

>

> Thank you all for your concern and prayers for Ray. We have just received some news...good and bad, and wanted to share it.

>

> I am going to try and explain things the best I can and as simply as I can, since we have learned a lot of new things and vocab, I want to be able for you to understand it as well, so you know what I am saying!

>

> Earlier, I think I mentioned a little thing called a Meld Score. A meld score is a number that the transplant doctors get from blood test to determine where the patient ranks as far as needing a transplant.

>

> This may help understand and explain it better:

>

> (End stage liver disease is the new "politically correct" term for Cirrhosis)

> What is MELD? How will it be used?

> The Model for End-Stage Liver Disease (MELD) system was implemented February 27, 2002 to prioritize patients waiting for a liver transplant. MELD is a numerical scale used for adult liver transplant candidates. The range is from 6 (less ill) to 40 (gravely ill). The individual score determines how urgently a patient needs a liver transplant within the next three months. The number is calculated using the most recent laboratory tests.

>

> Lab values used in the MELD calculation:

> * Bilirubin, which measures how effectively the liver excretes bile;

> * INR (formally known as the prothrombin time), measures the liver’s ability to make blood clotting factors;

> * Creatinine, which measures kidney function. Impaired kidney function is often associated with severe liver disease.

>

> Within the MELD continuous disease severity scale, there are four levels. As the MELD score increases, and the patient moves up to a new level, a new waiting time clock starts. Waiting time is carried backwards but not forward. If a patient moves to a lower MELD score, the waiting time accumulated at the higher score remains. When a patient moves to a higher MELD score, the waiting time at the lower level is not carried to the new level. The clock at the new level starts at 0. (Example: Patient has a MELD score of 15 and has been at level 11-18 for 100 days. With new laboratory tests, the patient’s MELD score is 22. The patient moves to a new MELD level of 19-24. The patient’s waiting time at this new level starts at 0 days). Waiting time is only used as a tie-breaker when patients have the same MELD score.

>

> The four MELD levels are:

> * greater than or equal to 25

> * 24-19

> * 18-11

> * less than or equal to 10

> We met with his hepatologist as well as the liver transplant team yesterday, and found out the results of the Meld score test today. Ray was scored at a 13. While this is not bad, per say, it is not so good either. You must score at least a 15 to be put on the list for a transplant. So thankfully we are not at that level right now. However, if your score is a 10 or higher, the next step is to go for an over night stay at Piedmont for an evaluation. They should be calling us in 1-2 weeks to set up that stay for us. During his evaluation, he will undergo many test to make sure he is healthy enough to withstand a transplant. The evaluation will include: lab work, radiology tests such as MRI, Chest Xray, Bone density scan, Cardiology test such as EKG and Echocardiograms, and pulmonary tests.

>

> The Wednesday following his overnight stay, all his results will be reviewed by the selection committee of the transplant team and they will then determine at that point what will be the next step for him/us!

>

> We were able to meet with members of the transplant team yesterday and it went very well. We met: 1 of the 4 surgeons, 1 of the 2 social workers, 1 of the 2 nutritionists, and our Liver Transplant Coordinator. We had a great impression of them all and were very satisfied with their knowledge and care.

>

> The social worker has suggested that we highly consider fund-raising to help with medical bills that obviously already started coming in and will continue from this point on. If we do make it to the actual transplant, the post transplant medications range from $11.00 to $3,315.65 dollars (before insurance) but with several being around $1,000.00 and others being in the high hundreds for just a 30 day supply, we will def. have some out of pocket costs. There are 8-11 post op. meds he will have to have.

>

> We hopefully plan to start some sort of fund-raising by the beginning of next year, if not sooner. Ray and I could never ask for money, so we are hoping to plan some fun events! I will def. keep everyone updated so when the time comes, if you would like to participate in what ever we are raffling or selling,(what ever the Lord allows us to do) you will know the details! If you have any ideas for fund raising that would suit our situation, please please feel free to let me know! We have just began brainstorming!

>

> Thank you all again for so much love, support and prayers!

> God IS in control.

>

> Love,

> Krystle