Like most 12-year-olds, Mischa Melby loves to run. She runs up the stairs. She runs in gym class. She does have to walk in the hallways at school. But if given the option, she likely would run there, too.
While running comes naturally for most children, for Misha it was a hard-fought achievement. "I didn't know how to run," she says.
But after a journey that lasted for years and brought her from an orphanage in China to North Dakota to Mayo Clinic and involved several surgeries — including a heart transplant and months of cardiac rehabilitation — the pre-teen is not only running but jumping, swimming and biking on a tandem cycle with her dad.
Kasara Mahlmeister, a clinical exercise physiologist in Mayo’s Cardiovascular Health Clinic, along with the rest of the staff in cardiac rehab worked with Mischa after her heart transplant. They witnessed Mischa transform from a frail, frightened child to an active kid with a healthy attitude.
"When she first came to us, you could tell she was scared," Mahlmeister says. "She was shy. She didn't smile. When she left, she knew all of us by name. She was smiling, and she even had a little sassiness with some of us. It was fun working with her."
For Mischa, the fun was just beginning.
Adopted from China in 2011 when she was 6 years old, Mischa was born with a double outlet right ventricle in her heart. The heart defect went untreated throughout her early years. When Mischa captured her parents' hearts in the orphanage, she had a slightly bluish pallor, weighed 22 pounds and was barely functional.
"When we first got her, she had nothing," says her mother, Karen. "She had no Chinese language. She didn't even know how to drink water from a cup. She had never touched green grass and was terrified of walking on it. She was terrified of animals. I was prepared for her to have delays for the rest of her life."
Before Mischa left the orphanage, she underwent heart surgery that increased her blood oxygen saturation level to 70 percent. As soon as possible on returning to their home in Williston, North Dakota, the family made the 14-hour drive to Mayo Clinic's Rochester campus, where Mischa was seen in the Department of Cardiovascular Surgery. Mayo Clinic surgeons performed a surgery known as the Fontan procedure to further increase the amount of oxygen in her blood.
While that surgery increased Misha's energy, she continued to lag physically and mentally behind her peers. A few years later, Mischa developed protein-losing enteropathy, or PLE, which causes protein to be shed into the intestines. The condition has no cure.
"Once you start losing protein, you start putting on fluid," Karen says. "She could put on 15 pounds of fluid in two weeks. She could hardly breathe with all that fluid and had to have it drained off."
Her family made regular, 28-hour roundtrip visits to Mayo Clinic to have the extra fluid drained. They knew that course wasn't sustainable.
"It’s difficult to live with PLE," Karen says. "She didn't have long left without receiving the gift of a heart transplant."
Mischa was placed on the waiting list for a new heart. Her family relocated to St. Cloud, Minnesota, to be closer to Mayo Clinic when a heart became available. In March 2017, the call came. Under the direction of Mayo Clinic cardiothoracic surgeon Joseph Dearani, M.D., Mischa received her new heart.
Just 10 days after her heart transplant, Mischa was discharged from the hospital to Rochester's Ronald McDonald House.
"She had no complications at all. Her recovery was remarkable," Karen says. "It was pretty obvious right away, even before we got back to Ronald McDonald House, that things were starting to change."
Mischa's energy level increased. Her coloring became normal, and the brain fog that had surrounded Mischa her entire life began lifting.
She also began attending cardiac rehab sessions three times a week. At first, the sessions were daunting.
Before long, however, Mischa began to look forward to cardiac rehabilitation. The sessions, designed specifically for her, included using a Nintendo Wii balance board to play games like downhill skiing. Mischa used a timer given to her by her therapists to keep track of her lap times. A personal identification badge, like those her therapists wore, was created for Mischa, and she wore it faithfully to her sessions each day.
"Doing her exercises became the most important part of her day," Karen says. "She'd get dressed way ahead of time and be ready to go. It was just like a whole new world opening up for her."
Mahlmeister says that the rehab specialists strive to make the sessions fun.
"We design the program around the patients and their interests because it's important to get their activity level back," Mahlmeister says. "It's going to improve their overall quality of life, so we want to do the best we can to give an overall good experience."
Mischa's rehab team asked her what things she wanted to do and goals she'd like to set. Mischa's number one goal was to be able to run around with the kids at school.
"She had never run before," Karen says. "And she actually started running, as well as jumping and climbing stairs. She loves her new freedom to do things."
Karen says the support provided by Mischa’s therapists accelerated her rehabilitation.
"The cardiac rehab people, they were amazing, right from the time of your greeting there," she says. "It was really a wonderful experience, and it helped her with her recovery."