Nurse practitioner discovers remedy that team of medical specialists missed

Double transplant patient back on road to recovery after primary care examination

Tim Leach is a testament to the importance of having a primary care clinician. The 59-year-old retired restaurant manager got a new lease on life when he received a new heart and liver in 2018.

Joining the Navy at 17 to follow in his father’s footsteps, Tim had a career running restaurants after leaving the service. He played competitive air hockey (he’s among the top 100 best air hockey players in the world and has competed professionally) and practiced Judo.

Despite his active lifestyle, family history of heart disease caught up with him at 45. That’s when he had the first of six heart attacks in less than a decade. The sixth landed him on the heart transplant list.

After nearly four months in the hospital, Tim received a heart and a liver from the same donor. Tim’s liver was damaged from the strain of trying to compensate for his faulty heart.

Everything was going well for about two years until his body started rejecting the liver.

“After the transplants, I felt healthy,” Tim said. “But I slowly started getting weaker and weaker.” He became so short of breath he couldn’t walk across a room without getting winded.  His team of medical specialists l couldn’t identify the cause of Tim’s breathing problems.

Tim’s wife Crystal Leach is the clinic administrator at WellMed at East Houston, in Houston, Texas. When Tim started experiencing problems, Crystal turned to Nurse Practitioner Lizette Vela for advice.

“After watching the amazing care she gives our patients, I confided in her my husband was getting weaker and weaker,” Crystal said. “He had been hospitalized several times without any definitive answers and his shortness of breath was really scaring me.”

Tim, who hadn’t had a primary care visit in two decades, joined the clinic as a patient. NP Vela started examining him. She learned he had COVID-19 a while back and she initially though Tim might have pneumonia.

But Tim’s lungs sounded good and a chest X-ray came back clear. Then, NP Vela saw in Tim’s medical history that he had esophageal varices in the past.

Esophageal varices are enlarged veins in the esophagus, caused when blood flow to the liver becomes blocked and is forced to go through smaller blood vessels.

NP Vela put two and two together. She ordered a full blood panel, which confirmed her suspicions: Tim’s hemoglobin count was extremely low. He was severely anemic.

“Veins in Tim’s esophagus were filling with blood. On occasion, one would burst, and he wouldn’t know. The blood went into his belly,” NP Vela said. “His hemoglobin was so low he couldn’t walk across the room without heaving breaths and hanging on to something.”

Tim immediately received blood transfusions. He eventually had four separate procedures to have the varices banded, which involves using tiny rubber bands to cut off the flow of blood to eliminate the enlarged vein.

Esophageal varices, which usually are caused by liver disease, resulted from Tim’s body rejecting his donated liver a few years after the transplant, putting him back on the transplant list.

Though Tim’s case was resolved thanks to his new primary care provider, the outcome might have been different if Crystal had not sought NP Vela’s advice.

“I saw my transplant coordinators on a regular basis, but then they’d send me to a different specialist if I had a problem,” Tim said. “You aren’t going to call your heart surgeon and tell him you’re not feeling well, so it’s nice to have Lizette.”

Tim now sees NP Vela for regular, timely primary care visits.

“Where I’m at physically right now, it’s a complete change from where I was four to five months ago,” Tim said. “I’ve dealt with a lot of medical caregivers over the past six years, some who listen to me and some who just talk at me.”

“Lizette is one of the ones who listens, and it’s nice to be heard.”