TOM'S STORY
LIFE AT STAGE III CKD: When Tom was initially diagnosed with Stage 3 Kidney Disease, we were stunned to learn there were no treatments. He didn't feel bad or have any pain. Every six months or so he would get a blood test, and the nephrologist dragged out something that looked like a slide rule to determine how much decline had occurred. They look at creatinine and BUN and a calculated number called eGFR. This estimated how much kidney function is left. We weren't given anything to do, except come back in 6 months.
WHY ARE THERE NO TREATMENTS FOR CKD? We've pieced this together from much research of our own. If you choose to just focus on Tom's story, feel free to skip this section. Before 1982, most kidney patients died. When dialysis machines first became available in 1982, governments all over the world stepped in to provide this care to end-stage renal patients. The US did this through a specialized Medicare system (something like the Veterans Administration). Because lifespans were only increased to 3-5 years on average, it was never intended as a long-term treatment. It was also a hugely expensive proposition with limited access to machines. They rationed care to try to help as many as possible stay alive. Public dollars were all funneled into developing this system.
For private researchers, the opportunity seemed closed for kidney disease and research drifted away to other more open-markets, such as heart disease, cancer and HIV. The evidence of this shift over the last 40 years is astounding. So many treatments and drugs have been developed to help heart, cancer and patients with many other conditions. Sadly today, research is still woefully behind, with <2% of national research budgets dedicated to kidney disease. With an estimated 360,000 people suffering from CKD, and 6% of the whole Medicare budget dedicated to dialysis for 1% of Medicare patients with ESRD, and kidney failure listed as the 9th leading cause of death - there finally seems to be some interest in research. Fortunately, some treatments and very early stage technology for end-stage kidney disease are finally emerging. Stem cells may help CKD patients in the next 5-10 years. There might be an artifical kidney down the road. A recent executive order is helping put focus on kidney disease and donation. Maybe someday there will be treatments for CKD and new options for ESRD patients. For Tom, it is sadly too little, too late.
"YOU NEED A TRANSPLANT": When Tom’s number hit less than 20%, his doctor said, “you should consider a kidney transplant. Here's some booklets to read. The nurse will give you some 800 numbers on the way out”. Could there be a less compassionate way to tell a patient they needed a life-saving transplant? We thought we’d get a referral. We thought they would help us through this next step. Nope. Go to Dr. Google to get yourself a kidney. We even had to come back and fight to get the referral we needed to proceed. We hope that our experience was just another outlier and doesn't happen to anyone else.
THE INITIAL CRACK BETWEEN CARE SYSTEMS: After much research, we decided to go with UW Health in Madison, as they have the best kidney transplant statistics of all locations within 100 miles. We began an unexpected fight with our own local doctors (where they don't do transplants at all, and shouldn't be defensive) to get some tests that UW Health needed Tom to take. The GP, nephrologist and cardiologist each pointed fingers at the other. Apparently no one wanted to take responsibility. These were simple ordinary tests. Finally a cardiologist scheduler took pity on us and helped us get the last test scheduled – a cardiac stress test.
SURPRISE KIDNEY FAILURE: The week before the test, his kidneys unexpectedly began to shut down. We had no idea what was happening. Tom didn't want to eat. His energy was gone. In retrospect, we wish we had been armed with knowledge of at least some warning signs. Once again, Tom's "Outlier Status" got us. No one had told us this could happen. So we didn’t know what to look for or that it even was kidney related. Our trip to the ER on Memorial Day, 2018 revealed the devastating news. His kidney function was down to 5%.
HEMO-DIALYSIS HELL: The hospital installed a dialysis catheter into Tom's heart - a less than ideal solution as it is so prone to infection. No showers for now :(. After five days he was released to do hemo-dialysis (blood transfer) at his preassigned dialysis center. The only available option was Tuesday-Thursday-Saturday - every week.
Every doctor described Tom’s kidney condition as stage 5 – end stage renal disease (ESRD). They said he would be on dialysis until he got a transplant or died (the typical life span on dialysis is only 3-5 years – less than breast cancer). However, the hospital released him as “Stage 4, with Acute Failure”. This proved to be a crucial difference in both the subsequent treatment and outcome. So now we faced this unknown world of dialysis. And the dialysis center began treating him as a “Stage 4 Acute”, telling us he could get better. We were so confused.
When we arrived for treatment, we had a social worker give us a stack of papers to sign – essentially consigning Tom’s kidney care in its entirety to the specialized Medicare system. You can't get dialysis anywhere else unless you are in ER or the hospital - and even then, it is nurses from this system that come into the hospital to perform the service. No one else in any clinic, hospital system or doctor office is trained, paid or authorized to do it. Even if they wanted to. Keep reading to see how this is a crack that Tom also fell into on his journey.
Once assigned to a center, you cannot see your regular kidney doctor anymore. You see the doctor assigned to that clinic when they tell you he is coming. If you are lucky and like your nephrologist, they will have rounds at your dialysis clinic.
If you haven’t been to a dialysis center, they are eye-opening. In our case, it was a big room with several chairs, similar to a blood donation center. There is no place for visitors to sit while their loved ones get treatment. In some cases, little kids are sitting next to elderly people, almost everyone with needles sticking out of their arms connected to big machines. By need and to eliminate waste, the process is exactly the same for everyone, regardless of variation in condition (each machine is set up to deliver the individually-prescribed treatment). We were reminded of a milking parlor – cows come in and go out. You start to see the same ones. Medicare only pays for 3 times a week, even though other countries have had better longevity with 4 or 5 times a week.
Tom’s hemodialysis proved to be an excruciating ordeal. The hospital release prescription specifies a "target weight" so dialysis can remove excess fluid the kidneys aren't able to remove. Fluid retention (and not being able to pee) is a terrible side effect in most kidney-failure patients. Did we mention that Tom had no extra fluid buildup? And he had no problems peeing? His target weight was set in the hospital while his was in a gown and still very sick. At the dialysis center, weight is taken while fully clothes with shoes. You can see this train coming, can't you? Tom's machine tried to pull excess fluid out his blood and cells when Tom had no extra to give. No one in the dialysis center was authorized to change this prescription. Even the technicians cried when he suffered extreme cramps in his legs and feet during the treatment. Sometimes they just stopped treatment. One time the technician even offered to drive him home. The treatments also made him totally exhausted, so 6 of the 7 days a week he was either suffering treatments or recovering. Both of our lives revolved around this terrible situation.
A simple change from a doctor could have helped. But he wasn’t scheduled to see his assigned doctor on his assigned day for 6 more weeks. Why? Because he was admitted on the 5th of the month. Turned out the dialysis center sets the doctor schedules for the upcoming month at the end of each month. We missed it. So Tom wouldn’t even be put on the schedule to see a doctor until the end of the month. And then the schedule put him at the end of the next month to see a doctor for the first time. Lesson – if you have to go on dialysis, do it on the third week of the month. It took a lot of push back and temper tantrums to try to adjust the target weight for Tom outside of this standardized procedure. We never got it to a comfortable level for Tom and he suffered for three months until he was able to move to peritoneal dialysis (PD) at home.
TWO SURGERIES, ONE SUCCESS: To get away from the dangerously infection-prone heart catheter and eventually beyond the terrible hemo-dialysis, Tom underwent dual surgeries. The surgeon created a fistula (a graft between an artery and vein in his lower arm designed to make it balloon up enough to be stuck with two needles 3x/week) and installed a peritoneal dialysis (PD) catheter in his gut. After 10 days, the fistula clogged up and failed to develop into anything usable. Fortunately, the PD catheter healed up and was ready to use in a couple of weeks.
INSURANCE FIGHT ONE...WE LOST: Together, we were assigned to 6-8 weeks of peritoneal dialysis training while Tom continued hemo-dialysis. We couldn’t go to the PD center closest to our house, because the company neglected to update their insurance when they bought this clinic from a private doctor. Same company. Different locations. Not covered by our insurance. So we drove 40 miles every other day, on the exhausting days between hemo-dialysis. Finally we were deemed competent enough to follow the exacting directions to go home to do peritoneal dialysis (PD).
ROUND ONE - PD BY MACHINE: By August 2018, Tom was now hooked up to a dialysis machine that pumps fluid in and out his gut cavity (the peritoneum). He was tied to this machine with a 20’ cord pumping 10 liters of fluid in and out for 10 hours every single evening & night, every day of the week. Every day he had to record and report weight, blood pressure, temperature and dialysis stats. This took a good chunk of time out of our normal schedules. Fortunately on PD, he didn’t have as many cramps and wasn’t so exhausted. So during the day he was free to do more things. But even the best dialysis of any kind only returns 15-20% of normal kidney function, so a lot of toxins remain to cause havoc with his brain, heart, blood vessels and remaining kidney function. A lot of days disappeared under a cloud of feeling crummy. Neither of us were able to travel for weeks. Eventually Tom was confident and competent enough to handle the hook ups and disconnects by himself. The machine is 70 lbs. and the supplies for each day weigh about 22 lbs. It all fits on a cart and needs containers to keep supplies as sterile as possible. We never figured out how he could travel with all of this – so Tom couldn’t visit family or go anywhere. He was in “dry dock” along with the boat.
CAMPAIGN FOR A KIDNEY DONOR: During all of this time, Karen started a campaign to find Tom a kidney. She is not a direct match, and Tom’s type O is hard to find in kidney donor circles. Type O blood is a universal donor, so people who have it can donate to any other blood type (assuming antigens and antibodies match). Donations from Type O’s typically go to their own loved ones, regardless of blood type. So Karen hired a social media company to spread the word, and sent letters to family and friends. She posted on Facebook, implored “shares”, created posters and over 100 bumper stickers to send to friends and family around the U.S. A few dear people applied at UW Health but were not able to donate due to health reasons.
MIRACLE #1: In December, 2018 Tom experienced a miracle. Even though no one thought it possible, his doctors noticed that his kidneys had improved. ENOUGH TO STOP DIALYSIS!!! His kidney function had improved to around 20%. No one predicted this at all. The nurses and doctor called him a miracle man. Even so, he was given an estimated 6 months to 2 years before his kidneys would decline enough to require dialysis again. We suddenly had freedom and hope. We were able to travel again to visit family. Tom looked forward to launching his boat and taking care of the yard again after being so sick. This was like a life-sentence removed, even though we knew it was likely temporary unless we found a living donor match.
THE UNBELIEVABLE CRACK: And this is where we fell into the crack between the Medicare dialysis system and the regular medical care system. Tom still had the PD catheter embedded in his gut. His kidney doctor referred him to the surgeon to take it out, but the surgeon wisely refused. Twice. (They still charged us the $50 co-pay…) After some discussion, both doctors agreed the catheter needed to be flushed regularly to keep it viable. It’s a very simple procedure. Because Tom was no longer considered a patient in the Medicare dialysis system, our PD dialysis clinic refused to perform the flush “for legal reasons”. Because the regular medical world doesn’t have the training, supplies or legal authority, they couldn’t do it. So Tom had a catheter they refused to take out and refused to properly care for it. Even Tom's doctor was stumped and angry. After 2 months of no care, we were about to go on a PR campaign with the TV station, when Tom’s kidney doctor managed to convince a sympathetic nurse at a different dialysis center to do it (the one we originally tried to get in but couldn’t because of insurance mix-ups). Tom got flushed properly for three months as a “pre-dialysis” patient, when her management cracked down on her and she had to stop helping Tom. There is no Medicare code for flushing a PD catheter and being “pre-dialysis” doesn’t qualify as a real patient for some obscure legal reason. Back in the crack with no care.
ROUND 2 - BACK ON PD DIALYSIS: The only alternative was to commit Tom back into the dialysis system. His kidney function had declined to less than 15%, so it probably was close to needing dialysis anyway. He and Karen’s freedom lasted seven months. Fortunately this time, he needs less dialysis, so he’s doing five nights a week and is not tied to a machine with less fluid transfer. So some travel eventually may be possible. But the diagnosis is grim, with no one expecting any improvement again. Only steady decline until his kidneys stop working altogether, and he will need more and more time and more aggressive dialysis. Eventually he will need to go back to hemo-dialysis to live, unless the toll on his other organs is too much and he doesn’t survive.
WE ARE BLESSED & LOOKING FOR MIRACLE #2: We know of so many other people, some of our loved ones, who have fought or are fighting terrible diseases. We feel blessed that Tom is not suffering in a lot of pain or facing imminent death. We believe that somehow, we have been put on this path for a reason. The journey has not been easy, sometimes comically and sometimes tragically unbelievable. We have met many compassionate caregivers and brave people. Our eyes have been opened to a system that is surprisingly antiquated and frustratingly rigid. But we have hope that our journey will transition with a new kidney from an unbelievably generous and kind living donor. Something we can never repay directly. But we are determined to somehow pay it forward.
Thank you for taking time to read this life story and for considering taking the next step to help us save Tom’s life.
WHY ARE THERE NO TREATMENTS FOR CKD? We've pieced this together from much research of our own. If you choose to just focus on Tom's story, feel free to skip this section. Before 1982, most kidney patients died. When dialysis machines first became available in 1982, governments all over the world stepped in to provide this care to end-stage renal patients. The US did this through a specialized Medicare system (something like the Veterans Administration). Because lifespans were only increased to 3-5 years on average, it was never intended as a long-term treatment. It was also a hugely expensive proposition with limited access to machines. They rationed care to try to help as many as possible stay alive. Public dollars were all funneled into developing this system.
For private researchers, the opportunity seemed closed for kidney disease and research drifted away to other more open-markets, such as heart disease, cancer and HIV. The evidence of this shift over the last 40 years is astounding. So many treatments and drugs have been developed to help heart, cancer and patients with many other conditions. Sadly today, research is still woefully behind, with <2% of national research budgets dedicated to kidney disease. With an estimated 360,000 people suffering from CKD, and 6% of the whole Medicare budget dedicated to dialysis for 1% of Medicare patients with ESRD, and kidney failure listed as the 9th leading cause of death - there finally seems to be some interest in research. Fortunately, some treatments and very early stage technology for end-stage kidney disease are finally emerging. Stem cells may help CKD patients in the next 5-10 years. There might be an artifical kidney down the road. A recent executive order is helping put focus on kidney disease and donation. Maybe someday there will be treatments for CKD and new options for ESRD patients. For Tom, it is sadly too little, too late.
"YOU NEED A TRANSPLANT": When Tom’s number hit less than 20%, his doctor said, “you should consider a kidney transplant. Here's some booklets to read. The nurse will give you some 800 numbers on the way out”. Could there be a less compassionate way to tell a patient they needed a life-saving transplant? We thought we’d get a referral. We thought they would help us through this next step. Nope. Go to Dr. Google to get yourself a kidney. We even had to come back and fight to get the referral we needed to proceed. We hope that our experience was just another outlier and doesn't happen to anyone else.
THE INITIAL CRACK BETWEEN CARE SYSTEMS: After much research, we decided to go with UW Health in Madison, as they have the best kidney transplant statistics of all locations within 100 miles. We began an unexpected fight with our own local doctors (where they don't do transplants at all, and shouldn't be defensive) to get some tests that UW Health needed Tom to take. The GP, nephrologist and cardiologist each pointed fingers at the other. Apparently no one wanted to take responsibility. These were simple ordinary tests. Finally a cardiologist scheduler took pity on us and helped us get the last test scheduled – a cardiac stress test.
SURPRISE KIDNEY FAILURE: The week before the test, his kidneys unexpectedly began to shut down. We had no idea what was happening. Tom didn't want to eat. His energy was gone. In retrospect, we wish we had been armed with knowledge of at least some warning signs. Once again, Tom's "Outlier Status" got us. No one had told us this could happen. So we didn’t know what to look for or that it even was kidney related. Our trip to the ER on Memorial Day, 2018 revealed the devastating news. His kidney function was down to 5%.
HEMO-DIALYSIS HELL: The hospital installed a dialysis catheter into Tom's heart - a less than ideal solution as it is so prone to infection. No showers for now :(. After five days he was released to do hemo-dialysis (blood transfer) at his preassigned dialysis center. The only available option was Tuesday-Thursday-Saturday - every week.
Every doctor described Tom’s kidney condition as stage 5 – end stage renal disease (ESRD). They said he would be on dialysis until he got a transplant or died (the typical life span on dialysis is only 3-5 years – less than breast cancer). However, the hospital released him as “Stage 4, with Acute Failure”. This proved to be a crucial difference in both the subsequent treatment and outcome. So now we faced this unknown world of dialysis. And the dialysis center began treating him as a “Stage 4 Acute”, telling us he could get better. We were so confused.
When we arrived for treatment, we had a social worker give us a stack of papers to sign – essentially consigning Tom’s kidney care in its entirety to the specialized Medicare system. You can't get dialysis anywhere else unless you are in ER or the hospital - and even then, it is nurses from this system that come into the hospital to perform the service. No one else in any clinic, hospital system or doctor office is trained, paid or authorized to do it. Even if they wanted to. Keep reading to see how this is a crack that Tom also fell into on his journey.
Once assigned to a center, you cannot see your regular kidney doctor anymore. You see the doctor assigned to that clinic when they tell you he is coming. If you are lucky and like your nephrologist, they will have rounds at your dialysis clinic.
If you haven’t been to a dialysis center, they are eye-opening. In our case, it was a big room with several chairs, similar to a blood donation center. There is no place for visitors to sit while their loved ones get treatment. In some cases, little kids are sitting next to elderly people, almost everyone with needles sticking out of their arms connected to big machines. By need and to eliminate waste, the process is exactly the same for everyone, regardless of variation in condition (each machine is set up to deliver the individually-prescribed treatment). We were reminded of a milking parlor – cows come in and go out. You start to see the same ones. Medicare only pays for 3 times a week, even though other countries have had better longevity with 4 or 5 times a week.
Tom’s hemodialysis proved to be an excruciating ordeal. The hospital release prescription specifies a "target weight" so dialysis can remove excess fluid the kidneys aren't able to remove. Fluid retention (and not being able to pee) is a terrible side effect in most kidney-failure patients. Did we mention that Tom had no extra fluid buildup? And he had no problems peeing? His target weight was set in the hospital while his was in a gown and still very sick. At the dialysis center, weight is taken while fully clothes with shoes. You can see this train coming, can't you? Tom's machine tried to pull excess fluid out his blood and cells when Tom had no extra to give. No one in the dialysis center was authorized to change this prescription. Even the technicians cried when he suffered extreme cramps in his legs and feet during the treatment. Sometimes they just stopped treatment. One time the technician even offered to drive him home. The treatments also made him totally exhausted, so 6 of the 7 days a week he was either suffering treatments or recovering. Both of our lives revolved around this terrible situation.
A simple change from a doctor could have helped. But he wasn’t scheduled to see his assigned doctor on his assigned day for 6 more weeks. Why? Because he was admitted on the 5th of the month. Turned out the dialysis center sets the doctor schedules for the upcoming month at the end of each month. We missed it. So Tom wouldn’t even be put on the schedule to see a doctor until the end of the month. And then the schedule put him at the end of the next month to see a doctor for the first time. Lesson – if you have to go on dialysis, do it on the third week of the month. It took a lot of push back and temper tantrums to try to adjust the target weight for Tom outside of this standardized procedure. We never got it to a comfortable level for Tom and he suffered for three months until he was able to move to peritoneal dialysis (PD) at home.
TWO SURGERIES, ONE SUCCESS: To get away from the dangerously infection-prone heart catheter and eventually beyond the terrible hemo-dialysis, Tom underwent dual surgeries. The surgeon created a fistula (a graft between an artery and vein in his lower arm designed to make it balloon up enough to be stuck with two needles 3x/week) and installed a peritoneal dialysis (PD) catheter in his gut. After 10 days, the fistula clogged up and failed to develop into anything usable. Fortunately, the PD catheter healed up and was ready to use in a couple of weeks.
INSURANCE FIGHT ONE...WE LOST: Together, we were assigned to 6-8 weeks of peritoneal dialysis training while Tom continued hemo-dialysis. We couldn’t go to the PD center closest to our house, because the company neglected to update their insurance when they bought this clinic from a private doctor. Same company. Different locations. Not covered by our insurance. So we drove 40 miles every other day, on the exhausting days between hemo-dialysis. Finally we were deemed competent enough to follow the exacting directions to go home to do peritoneal dialysis (PD).
ROUND ONE - PD BY MACHINE: By August 2018, Tom was now hooked up to a dialysis machine that pumps fluid in and out his gut cavity (the peritoneum). He was tied to this machine with a 20’ cord pumping 10 liters of fluid in and out for 10 hours every single evening & night, every day of the week. Every day he had to record and report weight, blood pressure, temperature and dialysis stats. This took a good chunk of time out of our normal schedules. Fortunately on PD, he didn’t have as many cramps and wasn’t so exhausted. So during the day he was free to do more things. But even the best dialysis of any kind only returns 15-20% of normal kidney function, so a lot of toxins remain to cause havoc with his brain, heart, blood vessels and remaining kidney function. A lot of days disappeared under a cloud of feeling crummy. Neither of us were able to travel for weeks. Eventually Tom was confident and competent enough to handle the hook ups and disconnects by himself. The machine is 70 lbs. and the supplies for each day weigh about 22 lbs. It all fits on a cart and needs containers to keep supplies as sterile as possible. We never figured out how he could travel with all of this – so Tom couldn’t visit family or go anywhere. He was in “dry dock” along with the boat.
CAMPAIGN FOR A KIDNEY DONOR: During all of this time, Karen started a campaign to find Tom a kidney. She is not a direct match, and Tom’s type O is hard to find in kidney donor circles. Type O blood is a universal donor, so people who have it can donate to any other blood type (assuming antigens and antibodies match). Donations from Type O’s typically go to their own loved ones, regardless of blood type. So Karen hired a social media company to spread the word, and sent letters to family and friends. She posted on Facebook, implored “shares”, created posters and over 100 bumper stickers to send to friends and family around the U.S. A few dear people applied at UW Health but were not able to donate due to health reasons.
MIRACLE #1: In December, 2018 Tom experienced a miracle. Even though no one thought it possible, his doctors noticed that his kidneys had improved. ENOUGH TO STOP DIALYSIS!!! His kidney function had improved to around 20%. No one predicted this at all. The nurses and doctor called him a miracle man. Even so, he was given an estimated 6 months to 2 years before his kidneys would decline enough to require dialysis again. We suddenly had freedom and hope. We were able to travel again to visit family. Tom looked forward to launching his boat and taking care of the yard again after being so sick. This was like a life-sentence removed, even though we knew it was likely temporary unless we found a living donor match.
THE UNBELIEVABLE CRACK: And this is where we fell into the crack between the Medicare dialysis system and the regular medical care system. Tom still had the PD catheter embedded in his gut. His kidney doctor referred him to the surgeon to take it out, but the surgeon wisely refused. Twice. (They still charged us the $50 co-pay…) After some discussion, both doctors agreed the catheter needed to be flushed regularly to keep it viable. It’s a very simple procedure. Because Tom was no longer considered a patient in the Medicare dialysis system, our PD dialysis clinic refused to perform the flush “for legal reasons”. Because the regular medical world doesn’t have the training, supplies or legal authority, they couldn’t do it. So Tom had a catheter they refused to take out and refused to properly care for it. Even Tom's doctor was stumped and angry. After 2 months of no care, we were about to go on a PR campaign with the TV station, when Tom’s kidney doctor managed to convince a sympathetic nurse at a different dialysis center to do it (the one we originally tried to get in but couldn’t because of insurance mix-ups). Tom got flushed properly for three months as a “pre-dialysis” patient, when her management cracked down on her and she had to stop helping Tom. There is no Medicare code for flushing a PD catheter and being “pre-dialysis” doesn’t qualify as a real patient for some obscure legal reason. Back in the crack with no care.
ROUND 2 - BACK ON PD DIALYSIS: The only alternative was to commit Tom back into the dialysis system. His kidney function had declined to less than 15%, so it probably was close to needing dialysis anyway. He and Karen’s freedom lasted seven months. Fortunately this time, he needs less dialysis, so he’s doing five nights a week and is not tied to a machine with less fluid transfer. So some travel eventually may be possible. But the diagnosis is grim, with no one expecting any improvement again. Only steady decline until his kidneys stop working altogether, and he will need more and more time and more aggressive dialysis. Eventually he will need to go back to hemo-dialysis to live, unless the toll on his other organs is too much and he doesn’t survive.
WE ARE BLESSED & LOOKING FOR MIRACLE #2: We know of so many other people, some of our loved ones, who have fought or are fighting terrible diseases. We feel blessed that Tom is not suffering in a lot of pain or facing imminent death. We believe that somehow, we have been put on this path for a reason. The journey has not been easy, sometimes comically and sometimes tragically unbelievable. We have met many compassionate caregivers and brave people. Our eyes have been opened to a system that is surprisingly antiquated and frustratingly rigid. But we have hope that our journey will transition with a new kidney from an unbelievably generous and kind living donor. Something we can never repay directly. But we are determined to somehow pay it forward.
Thank you for taking time to read this life story and for considering taking the next step to help us save Tom’s life.
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