VCU news

By Shira Pollard
Children’s Hospital of Richmond at VCU

In many ways, Keymonte is a typical 11-year-old boy – he loves music, dancing and basketball. And thanks to the expertise and dedication of a multidisciplinary team at Children’s Hospital of Richmond at VCU, today he is able to enjoy all of those things despite rare health problems that he’s faced since birth.

In 2010, CHoR identified a critical need for better access to pediatric kidney care in Central Virginia. In response to this gap in care, CHoR expanded its nephrology program, hired a multidisciplinary team of specialists, opened satellite clinics from Fredericksburg to Williamsburg for increased access to care, and tripled appointment availability.

These efforts have resulted in expert care for thousands of children from Virginia – and afar – including Keymonte. The program has more than 3,000 outpatient visits and 1,500 inpatient encounters a year, and U.S. News & World Report ranked the nephrology (kidney care) program at CHoR No. 28 in the nation in the new 2014-15 Best Children’s Hospitals rankings.

“Since the 2013 survey, our national ranking has risen significantly from 50 to 28, acknowledging the expertise of our team and excellent outcomes of the program,” said Leslie G. Wyatt, senior vice president of children’s services and executive director of CHoR.

The Best Children’s Hospitals rankings highlight U.S. News top 50 U.S. pediatric facilities in cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and gastrointestinal surgery, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology, and urology. Eighty-nine hospitals ranked in at least one specialty, based on a combination of clinical data and reputation with pediatric specialists.

National ranking – local families

What does a national ranking mean for local families?

For Keysville, Virginia, resident Towanda Bagley, the ranking signifies strength and a healthy future for her son, Keymonte. Bagley and her son travel nearly 160 miles round-trip to CHoR from Keysville.

“What makes him unique is that despite multiple surgeries, countless dialysis visits and months spent in the hospital – nothing fazes him,” said Timothy Bunchman, M.D., professor and chief of CHoR’s Division of Nephrology. “He’s always been a polite, funny and cool kid – who has great dance moves.”

He also is one of just a few hundred children in the world to receive both a kidney and heart transplant.

“We have been coming to CHoR since he was a baby,” Bagley said.

“Keymonte was born with a congenital heart defect called tricuspid atresia,” said William Moskowitz, M.D., vice chairman of clinical operations at CHoR and professor and chief of CHoR’s Division of Cardiology. “While a normal heart has four chambers, Keymonte’s heart only had three. Tricuspid atresia prevents blood from flowing through the heart and into the lungs to get oxygen. Keymonte’s condition caused him to tire easily and restricted his level of activity due to shortness of breath.”

Moskowitz and his team monitored Keymonte as he grew older and performed multiple procedures to address his condition, including a Fontan procedure that enabled his body to receive the oxygen it needed by diverting venous blood from the body to the pulmonary arteries without passing through his very small right ventricle.

“When Keymonte was 8-years-old his heart started to get stronger but that’s also when we discovered that his kidneys were starting to fail,” Bagley said. “His kidney ultrasounds showed he wouldn’t live very long without a kidney transplant.”

Keymonte was born with renal dysplasia, a congenital condition unrelated to his heart condition that over time caused his kidneys to function at just 30 percent.

Children with kidney problems require continuous comprehensive care, from frequent lab work and clinic visits, to multiple dialysis appointments per week. CHoR’s revitalized nephrology program was specifically developed to provide families like Keymonte’s with a multidisciplinary approach to care. Keymonte’s kidney care team includes nephrologists to meet his medical needs, a nurse educator to help his family understand the diagnosis and treatment, a social worker to meet school-related and support needs, and a dietitian to teach him about proper nutrition.

“We spent so much time on clinic visits, dialysis trips and hospital stays,” Bagley said. “Sometimes you go to the doctor and you feel like they are just doing their job, but CHoR really cares and they have genuine concern for Keymonte’s health. Everyone on the team treats him like their own child.”

“The elevation of our national ranking comes from a team effort across all of CHoR,” Bunchman said. “Patients like Keymonte require comprehensive care from multiple pediatric specialists and benefit from collaborative efforts that are available at full-service children’s hospitals like CHoR.”

Two times stronger

It took a large team to get Keymonte to where he is today. Specialists from cardiology, nephrology, cardiothoracic surgery, critical care medicine and transplant surgery collaborated to create a care plan for Keymonte’s future.

The team could not provide Keymonte with a kidney transplant to replace his failing kidney given the condition of his heart. The stress of a kidney transplant would require his heart to move a large amount of fluid throughout his body, which could cause his heart to fail.

The team decided Keymonte would need a healthy new heart before he could receive a kidney transplant.

On Oct. 26, 2012, Keymonte received his new heart. He spent several months recovering from open heart surgery in CHoR’s pediatric intensive care where he remained on dialysis as his kidneys continued to fail.

On July 17, 2013, Keymonte received a new kidney, and a new outlook on life.

“I’m sad someone died, but it means a lot that their kidney helped me live,” Keymonte told  Bunchman just one week after his kidney transplant.

Bunchman and his team attribute Keymonte’s excellent prognosis to his mother.

“When your child is going through a medical crisis, you can throw your hands up, or you can do everything in your power to help them thrive,” Bunchman said. “Mom is very active in her son’s care. She calls us with questions and follows instructions to the T – all the while making sure Keymonte is happy and isn’t missing out on being a kid.”

“Keymonte is stronger than ever,” Bagley said. “He’s got so much energy. He loves to show off his dance moves and he’s really looking forward to attending Shaka Smart Basketball Camp this summer.”

 

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