EDINBURG — Eight years ago, Mercedes Rivas began vomiting consistently. Her doctors kept telling her it was food poisoning, but that wasn’t the case.
Rivas was suffering from kidney failure, a common condition among those living in the Rio Grande Valley.
It wasn’t until she ended up in the emergency room that a nephrologist, otherwise known as a kidney specialist, told her that her kidneys were failing. She was diagnosed with Wegener’s syndrome, a rare autoimmune disorder that targets the lungs and the kidneys.
“The doctor that came in said, ‘Your kidneys are going out,’” the now 52-year-old remembered Thursday.
The single mother of two began a six-month chemotherapy treatment soon after, hoping it could stop, or at least slow down, the degeneration of one of her most vital organs.
The kidneys serve a dual function, Dr. Mourad Alsabbagh said Thursday. When working properly, they rid the body of excess fluids and toxins created by metabolic reactions when digesting food.
“The kidney is kind of a strange organ,” the medical director at the Renaissance Transplant Institute said. “It is important to sustain a normal life, but unfortunately you don’t really have symptoms until the (disease) is very, very advanced.”
Renal, or kidney, failure will usually go undetected and undiagnosed. It is asymptomatic, he said, which means patients don’t usually know there’s a problem until they are properly diagnosed by a physician who will test their urine and blood samples.
Rivas didn’t know it then, but she and her sister would eventually become vital in ushering much-needed healthcare services to South Texas.
KIDNEY TRANSPLANTS IN SOUTH TEXAS
Before last month, anyone seeking a kidney transplant had to travel at least four hours to San Antonio or beyond.
No hospital in the Rio Grande Valley could offer a kidney transplant — even though plenty of people here require such services.
Transplants are highly regulated in the United States, Alsabbagh said. In order for a hospital to obtain permission to even attempt such a procedure requires a green light from UNOS, the United Network for Organ Sharing.
Doctors Hospital at Renaissance, the largest physician-owned hospital in the country, initially obtained permission from UNOS to perform transplants in December 2016.
The permission was the first hurdle DHR had to overcome. Then, there was certification from the Centers for Medicare and Medicaid Services.
In order to obtain a green light from the federal government, DHR had to undergo an extensive review, perform three successful transplants and pass an onsite inspection.
The certification is essential not only for patients with Medicare and Medicaid, but also for those with private insurance.
“Before (certification), a lot of insurance companies were not allowing us to do the evaluation because we were not CMS certified,” Alsabbagh said. “So they were telling us, ‘Yes, we would approve your evaluation. We’ll pay for the work, but we can not do this until you are certified.’”
Rivas’ chemotherapy worked — for a while, at least.
But two years ago, one of her kidneys shut down and she was placed on dialysis.
“My body never ever accepted the dialysis,” Rivas said. “It never adjusted.”
The 52-year-old was routinely in and out of the hospital on a monthly basis, sometimes weekly, all while her condition worsened.
“I was slowly dying. I could feel it,” Rivas said. “I would walk a little bit and I would feel tired. I was in bed most of the time. I would go to work, come home and sleep.”
Last year, she ended up in the intensive care unit.
“I was in ICU for a whole week, and I said, ‘I don’t want any more dialysis. I can’t do this anymore,’” Rivas recalled. “I was always tired. I was always asleep. I didn’t have the energy for anything. So I said I can’t no more. I can’t just keep fighting like this.”
Soon after, her sister Maricela Atwater underwent testing to see if she was a match for Rivas.
Atwater moved from Michigan and left her job to donate a kidney to her sister.
“I’ve seen her — the way the sickness took over her. It was hard,” Atwater said Thursday. “She looked like she was tired and wanted to give up already.”
After five months of testing, and one heartbreaking rescheduling issue, Rivas became the fifth person to receive a kidney transplant at DHR.
There are almost 30,000 people with kidney disease living in South Texas, and of those, almost 5,000 are undergoing dialysis.
“So this area is really in significant need,” Alsabbagh said. “You might say almost every other family has a patient with kidney failure. And these are the people who are diagnosed.”
Because of the disease’s nature, there are many others who have yet to be diagnosed.
“I guarantee those numbers double the actual number,” the nephrologist said.
Diabetes and hypertension account for about 70 percent of patients with renal failure, Alsabbagh estimated. And in the Rio Grande Valley, the incidence of these conditions is very high.
Diabetes rates in the United States fall between 25 to 30 percent. In South Texas, it’s close to 40 percent, Alsabbagh said.
“That’s why people with diabetes and hypertension are routinely checked for kidney function,” he said. “Again, to control the diabetes and hypertension, is the key for controlling the deterioration of the kidney.”
Currently, there are 90 people on DHR’s waiting list for a kidney transplant, and that number is expected to go up very soon now that the hospital obtained the certification from CMS.
Last month, CMS surveyors came in unannounced to conduct the onsite review of the hospital’s policies, processes and conditions. They also reviewed the six successful transplants the hospital had already performed, including Rivas.
“They came at nine and they left by four, and they said no deficiencies — didn’t even give recommendations,” Alsabbagh said. “I’ve worked in five hospitals so far, and I want to say, it almost never happens that CMS comes (to) a facility and they don’t give recommendations.”
Alsabbagh believes the hospital will be able to perform about 60 transplants within a year.
“In this area we have a potential to compete with bigger places like San Antonio and Houston because we’re not missing any element,” he said. “We have the team. We have the administrative support. We have the surgeons. We have the physicians, and we have the pharmacists and all the keys of success in this field.”
‘SECOND CHANCE AT LIFE’
Rivas woke from the surgery and immediately felt different.
“I woke up practically new,” she said. “I was talking away.”
Though she doesn’t remember what she was saying.
“I did feel alive. I remember that,” Rivas said. “I do remember waking up and laughing.”
Shortly after, the sisters shared an emotional reunion at the hospital.
“My sister did walk in and it kind of hit her,” Rivas remembered. “She walked in and looked at me and her whole body started shaking. They had to take her out.”
Atwater was overcome with emotion.
“It was exciting ‘cause she was just sitting there, talking and laughing,” she said about Rivas. “And her skin color changed. Everything. It was — wow. It was a blessing.”
It’s been two months since the procedure, and they both feel great, they said. Atwater is managing her diet and her weight now that her body depends on one kidney and Rivas is trying to slow herself down as directed by Alsabbagh.
“I’m a jogger, so I tell him I need to get out,” she said laughing. “I’m ready to take off running and do marathons, and he tells me to just slow down a little.”
Alsabbagh signed paperwork Thursday that will allow her to return to work at McAllen High School this week.
“She’s going to go back to work like a normal person,” her nephrologist said. “That doesn’t happen to patients in dialysis.”
“I get to live a normal life again, and I’m going to live it to the fullest,” Rivas said. “I’m very, very grateful. This is my new birthday — my second chance at life.”
Atwater continues to search for employment. She was unable to get family medical leave at her previous post because she hadn’t worked there long enough, she said.
“Would I do it again? Yes, I would,” she said. “It was well worth it, actually.”