Sharing Mayo Clinic: Allma says goodbye to diabetes after kidney and pancreas transplant

Sharing Mayo Clinic: Allma says goodbye to diabetes after kidney and pancreas transplant

By
Dana Sparks

August 25, 2019

For decades, Allma Johnson managed her diabetes with insulin and diet. But at 43, her heart and kidneys were failing as a result of the disease, and she needed a kidney and pancreas transplant. Today, thanks to the transplant she received at Mayo Clinic, Allma's diabetes and its devastating complications are gone.

When Allma Johnson was diagnosed with Type 1 diabetes at 15, she knew her life would be forever changed. An active high school student involved in marching and concert band, Allma had to begin daily ins u lin injections.

For years, the injections were all she needed to manage her disease. In her 30s, she transitioned to an insulin pump, along with a continuous glucose monitor. A few years later, she returned to daily injections and routine blood sugar checks. Together with a healthy diet, they kept her diabetes in check.

But in early 2015, when she was 43, Allma began to experience troubling symptoms. "I started noticing swelling in my ankles that slowly progressed to my calves," Allma says.

Those symptoms signaled the beginning of a downward spiral in Allma's condition that took a serious toll on her heart and kidneys. Her need for specialized care led Allma to Mayo Clinic, where she eventually received a kidney and pancreas transplant that restored her health and allowed her to bid goodbye to her diabetes for good.

A rapid decline

Allma's leg swelling in 2015 landed her in a hospital emergency department in Las Vegas, where she lives. The news wasn't good. "They removed 8 to 10 pounds of fluid from my body, and told me I had congestive he a rt failure," she says.

As a result of that diagnosis, Allma started receiving care from a local cardiologist. But two months later, while at work one day, she began having serious breathing problems and ended up back in the emergency department, where she received more bad news. She had stage 3 kidney failure.

"About one-third of patients with Type 1 diabetes develop kidney disease and eventually kidney failure. These patients are typically prime candidates for a kidney and pancreas transplant."
Hasan Khamash, M.D.

Allma was referred to a local nephrologist for treatment. She began taking medications to improve her kidney function, and she followed a strict diet that limited her salt and water intake, as well as phosphorus, protein and potassium. But those measures didn't work. Within two months, Allma's kidney failure progressed to stage 4.

"The doctor told me I needed to prepare for dialysis. I was just in shock," Allma says. Then, in the summer of 2016, Allma learned she would need a kidney and pancreas transplant. Her doctor recommended she go to Mayo Clinic in Arizona for a transplant evaluation. In early fall 2016, Allma moved in with her mother and stepfather and made an appointment with Hasan Khamash, M.D., a Mayo Clinic nephrologist.

"About one-third of patients with Type 1 diabetes develop kidney disease and eventually kidney failure," Dr. Khamash says. "These patients are typically prime candidates for a kidney and pancreas transplant."

Based on her kidney function, she fit the criteria for a transplant. But Allma's poor heart function stood in the way. During her first meeting with Dr. Khamash, Allma learned her heart's ejection fraction — a measure of the percentage of blood the heart squeezes out with each beat — had been as low as 30%. Dr. Khamash told her it had to be at least 45% to have the transplant.

"Kidney failure and diabetes can affect heart function," Dr. Khamash says. "With kidney failure, you have a buildup of fluid and toxins in the body, which reduces the ejection fraction of the heart."

Over the next several months, they worked to improve Allma's ejection fraction. By February 2017, it was high enough for her to qualify for a transplant, and Allma's name was place on the transplant waiting list.

"Dr. Khamash is very calm and approachable," Allma says. "He explains things very thoroughly and in a way that anyone can understand. He's a great person."

A grueling wait

Knowing it could be several years before a kidney and pancreas became available to her for transplant, Allma maintained her hope and faith with the knowledge that a new beginning was coming. To help her cope with the wait, she made sure to be well-prepared.

"I was concerned because I didn't know what was going to happen," Allma says. "I kept my phone in my hand and a few personal items ready. I knew I had to be ready to go whenever I got the call that organs were available."

"I pushed hard because I needed to have a sense of normalcy. I refused to let what was happening get the best of me."
Allma Johnson

As Allma waited, more challenges cropped up. She became severely anemic and had to take medication to help her bone marrow produce red blood cells. She also had weekly iron infusions.

"I kept getting worse every day and felt so fatigued. I could barely perform daily tasks like brushing my teeth," Allma says. "I pushed hard because I needed to have a sense of normalcy. I refused to let what was happening get the best of me."

In June 2017, Allma began dialysis. A month later, her ejection fraction dipped to 28%. Because of that, she was inactivated on the transplant list. She could no longer work and retired from her position with the U.S. Postal Service. "I felt like I was just dying," Allma says. "I made my funeral arrangements and wrote my obituary."

But her Mayo care team was determined to get Allma to a point where she could receive her transplant. In August 2017, Allma spoke with Brian Hardaway, M.D., a Mayo Clinic cardiologist, who told her that better dialysis and fluid removal could improve her heart function.

"We work very closely with our heart failure colleagues," Dr. Khamash says. "This collaborative environment is key to success in having these patients transplanted, so they can have a shot at a better life."

The new treatment plan made a difference. In March 2018, Allma went in for a follow-up visit with her local cardiologist. Her heart function finally was normal. She was reevaluated for a transplant at Mayo. On June 28, 2018, she was cleared to be put back on the transplant waiting list.

"I began to cry and thank God. I was full of gratitude," Allma says. "To celebrate, I went to one of my favorite restaurants in Vegas."

A fresh start

Three days later — and 31 years to the day after being diagnosed with diabetes — Allma got the call that would save her life. There was a kidney and pancreas available for her.

"Driving to Mayo, I'm thinking: 'This is the day. I'll never have to go through this stuff ever again.' I felt a peace that was indescribable," Allma says. "This is where I was supposed to be. I was going to have a new lease on life. I felt joy, but was sad and prayerful thinking of the person that gave so freely. I was thinking of his or her family and their loss."

On Aug. 1, 2018, Allma received a kidney and pancreas during a nine-hour surgery with transplant surgeons Andrew Singer, M.D., Ph.D., and Winston Hewitt, M.D. Afterward, while she was in recovery, she couldn't believe what she heard the doctors and nurses saying. "They said I didn't need dialysis," Allma recalls. "I had no signs of diabetes, and my heart was fine."

"I can't begin to explain the joy I have every morning I awake and don't need an insulin injection or to undergo dialysis."
Allma Johnson

Allma was discharged from the hospital a week later. She stayed in Phoenix for two-and-a-half months to receive follow-up care and then returned home to Las Vegas, free from all her previous medical concerns.

"It was the first time that I was able to say that I feel good. I never knew what the experience of feeling good was like," Allma says. "I can't begin to explain the joy I have every morning I awake and don't need an insulin injection or to undergo dialysis."

That's just the type of feedback Dr. Khamash enjoys most. "Hearing those words is very gratifying," he says. "We're fortunate to work in a field of medicine where we can see the change in a patient's life in front of our eyes."

For her part, Allma's extremely grateful for the care she received at Mayo. "The staff was full of compassion from day one. Everything is awesome," she says. "I tell people, 'If you need anything, go see someone at Mayo.' I'm glad I chose them."

In addition to trying to get back to work full-time, Allma, who sings professionally on occasion, is finding her voice. She continues to grow in her musical calling and hopes to audition to be a vocalist for a Las Vegas theatre group that gives hope to patients in critical care.

"Someone might be in my same situation, waiting on a transplant or treatment. I want to be able to uplift and support them and say, 'Hey, I've been there, too,'" Allma says.

Working toward those new goals and enjoying life without serious health concerns has given Allma a fresh take on her future. "I see life in a whole new way. I'm an overcomer. Every day I give thanks to God and to my donor," Allma says. "I keep pushing forward toward the mark of greater. I feel amazing!"

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