Multiple Organ Transplant Due to Gastric-Intestinal Pseudo-Obstruction

Darryl Wallis is a 32-year-old pharmacist in Toronto, Canada. Because of a genetic mutation called MHY11, Darryl was born with a constellation of problems with his gastrointestinal tract.The extremely rare condition Darryl was born with is known as gastric-intestinal pseudo-obstruction. When Darryl was 20, he received a quadruple organ transplant, which included his stomach, small and large intestines, liver and pancreas. Darryl is now the father of a son who has also been diagnosed with the same genetic mutation. Today we’ll talk with him about how this condition has affected his life, his support for organ donation in Canada and what it was like to wait for multiple organs. He'll also tell us about how he is doing today and what it's like to be the recipient of multiple organs.

Transcript

spk_0:   0:00
Theo

spk_1:   0:05
Gorski and the host of Heart to Heart with Anna. This is the fifth episode of Season 12. Our theme this season is organ donation and transplantation. I'm very excited for today's show, which features Darrell Wallace, an amazing survivor. Today's show is entitled Multiple Organ Transplant due to gastrointestinal pseudo obstruction. In. The first segment will talk to Daryl about what gastrointestinal pseudo obstruction is and what it has meant to him. The second segment will involve talking to Darryl about his transplant experience and in the third segment will discuss why advocacy and awareness of organ donation are so important to Daryl. Darrell Wallace is a 32 year old pharmacist in Toronto, Canada. Because of a genetic mutation called M Y H 11 Darryl was born with a constellation of problems with his gastrointestinal track. When Darrow was 20 he received a quadruple organ transplant, which included his stomach, small and large intestines, liver and pancreas. Additionally, doctors removed his spleen. Darryl is now the father of a son who has also been diagnosed with the same genetic mutation. Welcome to heart to heart with Anna Darryl. Hi,

spk_2:   1:21
Anna. Thanks so much for having me on I'm happy to be here.

spk_1:   1:24
Well, I'm happy that your mom told me about you and put us in touch with one another, said, Let's get started. First of all, can you tell me what gastrointestinal pseudo obstruction has meant in your life?

spk_2:   1:37
Sure. So, like you said, I was born with a condition called gastrointestinal pseudo obstruction, which essentially meant that my stomach did not absorb nutrients and my intestines couldn't process the food that I ate. And as a result, around the age of one, I stopped growing and started showing signs of significant malnutrition. So my abdomen was very distended. I couldn't keep any solid foods down, and I basically stopped growing.

spk_1:   2:02
Wow, that's really scary. Your poor mother.

spk_2:   2:05
Hey, I'm sure it was really frightening for her, because at the time there wasn't really anything like this. There weren't many reported cases, so it was all very new and very scary for both her and my siblings, who were just a couple of years older than I would have been at that point.

spk_1:   2:22
Now, did your siblings also go through this?

spk_2:   2:25
No. None of the other members of my family have anything similar to what I have sort of a new mutation in me. So I'm the only member of my family affected.

spk_1:   2:35
Wow. Okay, so you have two older siblings.

spk_2:   2:38
I have three older sisters, actually.

spk_1:   2:40
Three older sisters. Okay, so three other little mothers and then you come along, the only boy and your poor mom is trying to figure out what is going wrong. You stopped growing. So what happened?

spk_2:   2:55
So we were originally from Sardinia. So the closest big medical center was Toronto. The doctors in Sardinia didn't really have any idea what was going on. They basically said you need to go somewhere where the doctors might be able to help and they couldn't really figure out exactly what was wrong. But the only solution they could come up with at that point, what's to stop me from taking in all food by mouth and just feed me by intravenous foods? So?

spk_1:   3:24
So it wasn't even a g tube. What? It work? It had to be introduced.

spk_2:   3:28
Exactly. Yeah, because my stomach wasn't absorbing in the nutrients. It wasn't like they could just put it into the stomach, had to bypass the whole G I tract.

spk_1:   3:37
Wow. Oh, my gosh! And How many years ago was this?

spk_2:   3:41
Well, it was when I was a year old. So about 30 years ago.

spk_1:   3:44
Wow. OK, so this was probably something. It was really out of the ordinary, even for those doctors to deal with. Exactly. Okay.

spk_2:   3:54
And so the doctors basically said, we don't really know what's wrong. We don't really know how to fix it. The only hope really is was just to go on t p n which was the Ivy Foods until the advances in medicine would allow for a transplant of so many organs at once.

spk_1:   4:14
Wow. So they knew that it was going to require multiple organs to be transplanted in order to be successful.

spk_2:   4:20
Exactly. Because the stomach wasn't working and the intestines weren't working, so they couldn't just replace the stomach. They couldn't just replace the intestines. And because he couldn't do that you tube feeds. There wasn't a whole lot they could do aside from those I defeats.

spk_1:   4:35
Now, you said you had ivy feeds. Did that mean that they put like a port in you or something like that? Or would you constantly hooked up to some machine

spk_2:   4:44
they put in the central venous line, which is kind of like a PICC line. If you know what that is, it goes in the arm. Except it goes directly into the large, basically being a cave right, right around the heart. So and that say there permanently. And I just had takes about 14 16 hours to do the infusion of the food overnight. So that would happen overnight every night. And I would be on talked during the day to go to school on Dworkin whatnot.

spk_1:   5:12
Wow. So you started at one year of age. And how long did you have to have this food done this way?

spk_2:   5:19
That was all the way up until the transplant, which happened when I was 20 years old. So about 20 years to

spk_1:   5:25
wow. Now, did that prevent you from being able to do things that other normal little boys do? Ocean sing or more, Cause you're normal. You just have this feeding issue. But Children who don't have this feeding issue do like having overnight sleepovers with other friends,

spk_2:   5:42
right? So yes and no. Like, I guess I had a relatively normal upbringing. My spleen was sort of chronically enlarged, so my parents never let me play sports like hockey. That might have a higher risk. But I did play baseball while I was growing up, and as far as sleepovers go, had them at our house, where we had all the infusion supplies. But it was not something that I could ever go to her friend's house overnight, for example.

spk_1:   6:09
Wow, this sounds like a major life changing experience except for you. Since you had a sanctuary year, this was just your normal

spk_2:   6:18
Exactly. It was unusual, but for me, it all seems like a relatively normal. My parents, of course, did the best they could to try to expose me toe, you know, multiple different environments. So we went camping in Algonquin Park, which is a large park in Ontario, once or twice. And we, instead of using an I V infusion pump, we would use a gravity method to do the feeds overnight on. Then we did manage to travel overseas a couple times toe France and England, but that, as I'm sure you can imagine, it required a lot of preparation both here and abroad to make sure that everything was going smoothly.

spk_1:   6:57
Okay, Wow, You said you had three older siblings and you had all of your feeds intravenously at night. What happened during mealtimes, like breakfast and lunch and dinner? Did you sit down with everybody?

spk_2:   7:12
It depended. So my parents sometimes obviously would encourage me to come down with the family even if I wasn't eating just because the whole family was there and it was the time to talk and go over your day, just like with every other family. But there would be some days where I, you know, I had already seen enough of my sister. If I didn't didn't need t see them anymore. So I would just, you know, stay upstairs and read or study or that kind of thing. So they did try to encourage as much. Uh, I guess bonding is Mealtime can often be a on opportunity for that. But it was never something that I was actively participating in the eating portion.

spk_1:   7:48
Well, and then I guess the next question I have as a person who studied speech pathology in college, I would imagine that when you finally did get the transplants and then you started to put food in your mouth. Did that seem strange to you?

spk_2:   8:04
Yes, I suppose like it was Mlle or just I guess, the fact that I had to eat 345 times a day. Even to this day, I still struggle to eat enough to fuel my body when you're not used to eating, it is a rather time consuming activity or can be yet

spk_1:   8:23
s.

spk_2:   8:23
So, you know, it took me a while to get used to forks and knives and spoons and, you know, everything like that. But at this point, I've had almost 12 years of practice, so I'm getting a little bit.

spk_1:   8:35
I'm sure you're just fine. Does having this mutation necessarily mean that you definitely will develop the gastrointestinal pseudo obstruction? Or does it just mean that you have a markers? I guess what I'm worried about is your son. Since you said that, it looks like he has the marker. Does this necessarily mean that he will definitely get the same disease?

spk_2:   8:59
Right. So it's a good question that they don't really have a precise answer to. I have had some genetic testing done which came up with this mutation. There are only a handful of reported cases of people with this mutation showing symptoms of a gastrointestinal like symptoms. Most of the mutations in this gene caused aortic issues. So aortic dissection tze and rather severe symptoms like that.

spk_1:   9:27
Yeah, that's really scary.

spk_2:   9:28
Only five or six cases of gastrointestinal pseudo obstruction caused by this genetic mutation, and I actually only have a mutation in one of the genes where everybody has two copies of every gene. So I'm so far the only reported case of one genetic mutation causing gastrointestinal symptoms. So it's hard to say whether it will down the line The fact my son, he has shown similar symptoms to what I did when I was younger. But he is continuing to grow, and he's just about two years old now, still growing. But he did have some pretty significant abdominal distention at around a year and 1/2 and he still, I guess, struggling with absorption of some foods. But you started on a couple of new medications, changed his formula, and that's because you know some pretty significant weight gain lately. So we're pretty hopeful for the future

spk_1:   10:24
when that sounds very promising, and it seems like you're kind of helping to write the history books here. Darryl.

spk_2:   10:30
Yeah, it's I guess, not something you hope to have to do. But if you can provide something

spk_0:   10:37
that people can look to you and say, Hey, something's for

spk_2:   10:41
there are positive outcomes then that could be helpful.

spk_5:   10:45
Hot industry We're offering us a mechanical hot, and he said, not a day that I've had enough to give it to someone worthy. My father promised me. A golden dressed twirling held my hand and asked me where I wanted to go. Whatever strive for conflict that we experienced in our long career together was always healed by humor.

spk_6:   11:05
Heart to heart With Michael Please join us every Thursday at noon. Eastern as we talked with people from around the world who have experienced those most difficult moments,

spk_0:   11:16
you are listening to heart to heart with Anna. If you have a question or comment that you would like addressed our show, please send an email to Anna Dworsky at Anna at heart to heart with anna dot com. That's Anna at heart to heart with anna dot com Now back to heart to heart with So

spk_1:   11:35
Darryl. Before the break, we were talking about your condition gastro intestinal pseudo obstruction and you told me that when you were 20 you got your transplants that first of all, how many hospitals in Canada actually operate on people with your condition?

spk_2:   11:52
So I did a bit of research before the show because I didn't actually know the answer definitively to this question. But at this point, it's still only two hospitals in all of Canada that do multi organ transplants. There's the Toronto General Hospital in Toronto and the University of Alberta Hospital in Alberta. So there's a couple dozen hospitals in Canada that do various organ transplants. So be it kidneys or livers or lungs. But those are actually the only two sites in Canada that do these multi organ transplants.

spk_1:   12:25
And when you had yours 12 years ago, was there only one site that was doing it?

spk_2:   12:31
I don't actually know whether the University of our Bertha was at that point doing these multi organ transplants, But I happen to be going to school at the University of Toronto, which was a bonus because my doctors were there in the hospital there. So it

spk_1:   12:44
actually

spk_2:   12:44
worked out pretty well.

spk_1:   12:45
That doesn't work out well. Well, how long did you have to wait for your organs. You had it when you were 20 with you actually waiting that 19 years.

spk_2:   12:54
Well, I wasn't actually on the transplant list until about a year before I got the organs. My health had slowly been deteriorating for maybe about a year prior to getting on the list. But until that point, I wasn't what you would consider sick enough to get onto the transplant list because the risk from the surgery was just too high

spk_1:   13:14
tow. Yeah, I mean, multiple organs like they're talking about. That must be tremendous risk for infection and for all kinds of problems with rejection. Did all of the organs have to come from the same donor?

spk_2:   13:27
I don't think it was strictly speaking, you know, a medical requirement that they come from one donor. But I would imagine it would have been incredibly difficult to coordinate getting different organs from different donors all at the same time.

spk_1:   13:39
Yeah,

spk_2:   13:40
and if they had tried to spread it out, doing multiple surgeries over several months, for example, that would've been probably just too impractical. And, like you said, the risk of infection would have been dramatically increased.

spk_1:   13:50
Right, Right. So I'm assuming all of your organs. Stick come from one. Don't.

spk_2:   13:55
Exactly. So they basically took out his whole stomach and intestinal tract and took it with him. Put it into me, and they had to take out my splitting just because it was not physically enough room to make all of his organs fit, presumably because he was a little bit larger.

spk_1:   14:09
Wow. And you said that your spleen had been distended for quite a while, anyway. Was there a problem with your spleen? There wasn't

spk_2:   14:19
any specific problem with it that I know of. I don't know if it was. Just may be overworked because of the ivy feeds. That's kind of what caused will say the rapid decline in my health was the T P N. Feeding overnight is all process your delivery, so it puts a lot more stress on the liver. So I was mostly at risk of imminent liver failure, which is why I needed the transplant more urgently and theoretically, they could have done just a liver transplant, but that wouldn't have cured the underlying issue. So they wanted to do everything all the ones.

spk_1:   14:53
That's just amazing, that they knew you would have to have so many of the organs that all of those organs became available. It sounds like within a year,

spk_2:   15:02
yes, about a year after going on the most.

spk_1:   15:05
Mmm. Wow. So if you hadn't received the transplants, what would that have meant for your quality of life?

spk_2:   15:12
Well, at the time of the transplant, like I said I was getting Guess you take sicker and sicker and sort of nearing what you see. And you know, somebody who has either cirrhosis or hepatitis C where they're extremely jaundiced. And I have very low energy and was basically tired all the time. So without the transplant, 100% I would have died on I was on, like I was on T p N overnight 14 hours every night. But I was still going to school up until the day before my surgery.

spk_1:   15:44
How could you do that, Darryl? I know. When I was a student in school, I worked and went to school and I didn't have 14 hours to stay still. Do something. Could you study while you were doing a TV?

spk_2:   15:56
Yeah. So it wasn't It wasn't painful or anything like that. I could be in my room at my desk hooked up to the teepee and getting that infusion and then studying at the same time. It did kind of limit whether I would be ableto work during university. But I have enough studies to get through that. I didn't really have time to work while I was at school, so you worked out okay? It basically forced me to be in my room studying for larger portions of the day.

spk_1:   16:23
And you said that you were really fatigued, which is one of the ways they knew that things were deteriorating. You were able to go to classes like you needed thio. Yeah,

spk_2:   16:33
I was in my first year of pharmacy school at the time of my transplant. I had done two years of undergrad, so I had done some of the prerequisites for the firm's E program. So it meant that they only had eight classes to post to the tenants of the other student side. So give me a little bit of a break.

spk_1:   16:50
Yeah, absolutely. Now I know my son had surgery when he was 17 and you think that if a person has surgery, when they're that young that they'll bounce back from it but it actually took him a whole year before he recovered. He didn't even have a transplant. He just had a revision to his Fontanne and a couple other procedures. How long did it take you to fully recover from such a massive transplant

spk_2:   17:19
while the transplant was in November and I was in the hospital for two months after the initial transplant? My guy that just before my birthday in January, And then I have to go back for about another month because of some complications. But I started school or restarted school, I guess in the following September. So just about, I guess, 10 months before I went back to school

spk_1:   17:41
and how did you feel? Did you feel like you had a lot more energy? Because now you have these new organs and they were working better.

spk_2:   17:49
I guess I felt better for sure, like 100% better. It wasn't as good as I am today. I did still have a Knauss Timmy, and at that point, when I first went back to school, I was still getting two beads because I hadn't fully started eating by mouth. I did have a G tube so that still kind of limited what I could do. But within a year, they took out the G tube, took out the Austin me. And that night was after that, basically making significant progress towards we'll call it a quote. Normal life. So, you know, it took a little while, but I got there. Indian.

spk_1:   18:25
Yeah, well, it's pretty amazing. OK, so for those of us who don't know what in Austin me is, I think I know what it is, but I'm not 100% sure. So

spk_2:   18:33
yes. So because of the surgery they did, they replaced all of my intestines, and they basically needed to give them a chance to, well, say, integrate into my body and get used to that new environment before forcing all of this food through them. So what they do is they detach? Just in my case, it was from the small intestine and basically make a port in the abdomen. And so the stool consent there, as opposed to having to go through the entire intestinal tract. And that just gives the body a chance to adjust those new organs before being forced with all that extra work.

spk_1:   19:09
Wow. Okay, so I was wrong. And what I was thinking and lost to me is so I'm glad you explained that

spk_2:   19:15
there are different types of onto me. So there's basically dependent on where in the intestinal tract that they detach.

spk_1:   19:23
Okay. And so it took a while for your body. I can imagine. Look, this got to be, like, a major trauma to the body to have all those organs taken out and your spleen, and then all of a sudden have a whole bunch of other organs put in. Now, you said before you went in, you were John. Just as soon as you had the new organs. Did the John just go away?

spk_2:   19:45
Yeah. Within about two weeks, my skin was back to, ah, perfectly normal color, which I guess at that point, it hadn't been for probably a year and 1/2 2 years. I've been pretty jaundiced. So that was the most immediate change that you could notice.

spk_1:   20:02
It sounds like it was really unbelievably life changing for you, though, because now all of a sudden you could process things differently than before you had the surgery. Is that right?

spk_2:   20:15
Exactly. So I could eat meals. Normally, I could go out during the day. I could go out at night. I wasn't limited in terms of where I could go on when I could do where is before with the DP on overnight it very much lended where I could physically go and what I could do. This gave me basically a whole new world of freedom

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spk_1:   21:55
Daryl Before the break, you were telling us about how this transplantation of multiple organs totally change your life. It's really amazing to May everything that you went through and actually how quickly you recovered because I wouldn't expect you to be able to go back to school, especially something as rigorous as pharmacy school in less than a year. I just commend you. That's just amazing. Tell us, Yeah, I just I really am amazed. Girl, tell us why sharing your story is so important to you.

spk_2:   22:26
Well, I've always been, I guess, a little introverted, generally a shy person. I wouldn't say that I was embarrassed of such, but I think mostly kept my condition to myself because I thought people might treat me differently. You're feel sorry for me, and I kind of feel like most people have their own problems to deal with and don't really need anyone else toe look after, so to speak. But lately working as the firm's. This has made me realize how much people like to share their stories and how much comfort you can give a patient when you can say to them, Look, I've been where you are I've been there, it gets better and you basically kind of help them through. So by sharing my story with more, people were hoping that A It will show people that things do get better, things can improve. There's always hope. And ideally, by sharing it, I would like people to be more likely to be organ donors as well. The reality is that thousands of people that I ever you're waiting for a transplant and even those who maybe don't die have a severely reduced quality of life. Well, they're waiting for a transplant. So if we can increase the amount of organ donors we have, that would impact hundreds and thousands of people.

spk_1:   23:45
Absolutely. Because it doesn't just affect the individual himself, as I'm sure you know. But your parents were affected. I'm sure your sisters were affected. I don't think you were married by then.

spk_2:   23:57
No, not

spk_1:   23:57
right. But for people who are married, their spouses, their Children I mean, there's a ripple effect, wouldn't you say

spk_2:   24:04
for sure. Like you said, it's not just the person waiting for the transplant that is affected. It's everyone in their circle, from their family to their friends. Toe everybody, you're going

spk_1:   24:17
right. And then, especially for you, you were in school. So I'm sure your professor, since you were in college and when you were employed Elvis, that your employer could be affected. So there definitely is a long lasting effect and a far reaching effects. So I commend you for letting other people know and also stressing the importance of organ donation. I've devoted a whole season to organ donation transplantation. I think it is extremely important for people to know, and I don't think enough people are talking about it. So tell us about your advocacy efforts and what you hope to accomplish.

spk_2:   24:54
Well, like you said, I tried to talk to as many people now in my day to day basis about the importance of organ donation, and I'd like to thank you again for having me on to share my story because it's platforms like this that allow me to reach a much larger audience than before because Certainly I can talk to my patients that work. I can talk to my friends, but to be on a podcast that goes out to thousands of people and then they talk to their friends and they talk to their family just helps the impact grow exponentially

spk_1:   25:23
right. And also, since we'll be on iTunes and YouTube stitcher spree curb LA talk radio. The great thing is that if there's somebody in, say, the Netherlands or Israel or Africa and they have this condition which you wouldn't normally come in contact with those people, they can search on the Internet, put in these terms that seem pretty unusual. The gastrointestinal pseudo obstruction. I imagine if most people type that in, all they might get is journal articles. And so it will be exciting when my awesome Web master, Brenda, puts that title in, and it'll be on our website as well as all the other places that I just mentioned. You give people hope all over the world as long as they have a computer and they can type it in. Hopefully they'll find your podcasts and they'll definitely this is such a hopeful story. They'll definitely feel inspired by your story, and it will give them a sense that there is some hope to be had, because I think that's the thing. That's the scariest, don't you? Just not knowing.

spk_2:   26:25
Yeah, exactly. When you're waiting for the organs, you never know when they're coming if they're coming, how you're gonna feel the next day or the week after, So it's scary being in the dark, basically. So to know that other people have been through the same kind of situation that you have makes it seem a little bit less scary. Shed some light on the situation,

spk_1:   26:45
so I don't have many friends who have had multiple organ transplants. I only know a couple of people who have. I have a lot more friends who have just had a heart transplant, and I know for those people that they have to go through annual testing, a biopsy, usually to make sure that the organ is not being rejected. Do you have to have biopsies of all of your organs,

spk_2:   27:04
so I don't typically have biopsies of all of the organs. They do the intestines biopsies once a year just to check because they're the hardest to detect any changes in those organs for the liver taken. Just monitor blood work for the stomach. There's a very much lower risk of rejection with the stomach, and it's something that would be pretty obvious right away with regard to me eating. But with the intestines, it's a little bit harder to see what's going on there. Which is why most people who have colon cancer, for example, have colonoscopies every couple of years just because it's a harder area to monitor. But aside from those biopsies, it's not. It's not a whole lot of monitoring, aside from regular routine blood work and nearly check ups just to make sure everything is on track.

spk_1:   27:54
And didn't we say that you also had a pancreas transplant?

spk_2:   27:59
Yeah, so that's kind of interesting. It wasn't a true transplant as such. They just left mine where it waas and they added in it kind of came along with the donor's organ. So I, in fact, have two pancreas is, which is somewhat interesting, I suppose, Um,

spk_1:   28:16
yeah, that is got an interesting Darryl and part of the reason I had to take your spleen out to give you some more room.

spk_2:   28:23
Exactly. Is the pancreas is a pretty small organ, but yeah, I've got two and they're just sitting there plugging along.

spk_1:   28:30
Wow. Okay, So for people who don't know anything about transplants, many people think that when you get a transplant, your fixed and everything is fine. Kind of like the bionic man. And you're probably too young to remember the Bionic Man. But when I was a kid, the bionic man was a TV show. Look, I'm

spk_2:   28:48
familiar with that.

spk_1:   28:49
Never leave majors. He was the bionic man and then later there was a bionic woman. But anyway, what would you tell somebody who's waiting for an organ or multiple organs about what they can expect?

spk_2:   29:03
So I think the most important thing while waiting for a transplant is to stay hopeful. I definitely spent a lot of time being sick and the long time waiting for a transplant. But I never really lost hope and never gave up. I think if you reach a point where you give up hope, your body can kind of sense that and your health will decline rapidly. And even though after the transplant there was still a long road to full recovery, maintaining that hope throughout the process really helped. And after the transplants, not like you're immediately 100% and everything is peachy. The medications that you have to take to prevent New York and rejection do weaken the immune system and make you more susceptible to all kinds of infections. It's very important to do everything you can tow, stay healthy and maintain your strength both mentally and physically.

spk_1:   29:58
Oh, I think that's excellent advice because, yeah, you do need that hope. But help alone is not gonna make it work. You do have to put the effort in there. Make sure you take your medications regularly. How many medications do you take a day?

spk_2:   30:11
At this point, I'm actually only taking 21 an anti rejection medication and the other just to help control stomach acid. But immediately after the transplant, I was probably on 14 medications that day.

spk_1:   30:23
Wow. But there again, that's a message of hope that even if you start out with a lot of medications and a strict schedule for your medications, that eventually it can get better.

spk_2:   30:34
Exactly. Yeah, initially, obviously there's a lot more going on in it. It seems overwhelming, but you just have to trust the process. Trusted doctors. And eventually things do improve. And like they have returned toe as much of a normal life is I've ever had in my entire life.

spk_1:   30:51
That's amazing. Thank you so much for coming on the show today, Daryl. And for sharing your experience with us. This is just amazing. Yeah,

spk_2:   30:59
thanks so much for having me. It's been really great.

spk_1:   31:01
Well, great. That does conclude this episode of Hart to Hart within. And thanks for listening today. My friends find us on iTunes and

spk_4:   31:09
soups. Perfect.

spk_1:   31:10
Remember, my friends, you are not alone.

spk_0:   31:14
Thank you again for joining us this week. Way Hope you have been inspired on Empowered to become an advocate for the congenital heart defects community Heart to heart with Anna with your hose down, Jaworski can be heard every Tuesday at 12. Noon eastern time.