“We’re going to Disney World!” That’s what all the winners say, right? When the big game is over and the team has won the championship, the winners say, for a few promotional dollars, I’m sure, “We just won the championship, and we’re going to Disney World!” Well, that’s been one of our goals on this journey – to “win” so we could go to Disney World!

Let me recap the first few parts of the journey for those that are new to the story. My wife, Becky, was diagnosed with a fatty liver several years ago, a.k.a., Non-Alcoholic Fatty Liver Disease (NAFLD). In late 2022, that diagnosis was updated to NASH (Non-Alcoholic Steatohepatitis), now being renamed as MASH (Metabolic Dysfunction-Associated Steatohepatitis).1 It was a bit of a surprise because we always felt like a fatty liver diagnosis was similar to elevated cholesterol numbers or a diagnosis of obesity at your annual wellness check. It’s a thing, but it’s not really something to worry about. After all, it’s estimated that 25% of Americans have a fatty liver, even though less than 2% are actually diagnosed.2 They’re not all progressing to liver disease and failure, right? Yes, most of us should eat healthier. We should lose a few pounds. We should, but… we don’t.

Unfortunately, one of the biggest lessons of that first leg of our journey was that Becky’s liver disease progression timeline turned out to be the exception rather than the rule. A disease that usually takes a year or more to progress from one stage to the next, rapidly advanced through all four stages to a fully decompensated liver within a year. That was an amazingly challenging roller coaster ride. As we completed this part of the journey in late 2023, Becky was in ICU and on the list for a liver and kidney transplant.

That brought us to the second leg. This part of the road was like a cliffslide drive with no guard rails. We were on the edge of our seats for most of the trip. Becky spent about four weeks in ICU before getting her new liver and kidney and another couple weeks after. From there she went to an in-patient rehab facility. We learned how to manage things at home while she continued to recover. It was a relatively short drive along the cliff, but it was physically and emotionally draining for both of us. Spending two and a half months away from home for any reason is rough for most people. Spending them in an atmosphere of uncertainty at a hospital is rougher.

The third part of the journey was more like a trip down Lombard Street in San Francisco—filled with twists and turns. It was a long year of recovery while trying to understand what it meant to be a transplant recipient. We navigated new challenges and celebrated successes including a mini-vacation to Colorado as Becky regained some strength. As this leg went on, we realized the recovery part of this journey was going to look a little different than we had expected, but we were still moving forward. You can read more about those first three parts of the journey in my previous articles.3 That brings us to November of 2025 when we will celebrate two years since Becky’s transplant, and I thought I’d share an update on our journey.

First, it didn’t take us long after Becky’s one year anniversary to figure out that each leg of this journey was going to be a little different than the last. One of the challenges is that the road keeps changing. Sometimes it’s a familiar route. Usually it’s not. Sometimes the road is paved and well marked. More often it is not. The first speed bump on this leg wasn’t even transplant related. Becky has dealt with shoulder pain for many years and in 2024 her orthopedic doctor recommended a shoulder replacement. With some reluctance, the transplant team approved, and she had a reverse total shoulder replacement4 in December of 2024. The good news is that even though the first few months of recovery were difficult, the surgery was successful and Becky is now pain free in that shoulder.

Shortly after the shoulder issue was taken care of, we found ourselves navigating a new section of the recovery road. In the summer of 2025 Becky made her fourth trip to the Emergency Room within a year for a small bowel obstruction (SBO).5 We were trying to understand what kind of new detour we were on. It’s generally not a good thing when the surgeon on duty at the ER starts to recognize you and knows your history. Over the course of these visits we learned that SBOs are most commonly caused by adhesions. These adhesions are bands of scar tissue from previous abdominal surgeries which cause deformations and restrictions of the small intestine. That seemed to make sense since Becky had recently had transplant surgeries.

Well, not so fast. For those not familiar with anatomy (like me), liver and kidney surgeries are not in the abdomen. This was most likely scar tissue that had been forming over the years prior to her transplant as a result of various other abdominal surgeries Becky had had. After all, she had everything from a C-section to a hysterectomy, with a gall bladder removal and a couple other abdominal surgeries between. During Becky’s fourth visit to the ER, the surgeon recommended that he perform an endoscopic procedure to see if he could find the adhesion or adhesions causing the restriction and free things up. Due to the large amount of scar tissue, he was not able to accomplish anything endoscopically, so this resulted in yet another abdominal surgery. It’s sort of a catch-22 since doing surgery ultimately results in more scar tissue. However, in Becky’s case, this seemed like the best alternative since repeated SBOs and trips to the ER present additional risks, especially for a transplant recipient. We felt like we were headed back in the right direction. Becky didn’t have any new SBOs for four months after the procedure.

Had we finally made it back onto a smooth road? Were we finally returning to a more stable state? Yes and no. There were still more challenges. We had a few more pit stops to make.

Over the course of the summer (after the surgery), Becky started feeling consistently tired. Not just tired, but she lacked any energy and started feeling weak. She frequently used the word “exhausted”. This was likely the result of anemia the transplant team had been treating over the last year. The transplant team determined the steps they had been taking weren’t effectively treating the condition. Anemia is actually a common risk factor for kidney transplant recipients with one study showing that up to 45% of patients can become anemic a year or more after transplant.6 In order to avoid multiple trips from Austin to Dallas for further tests, diagnosis, and treatment, Becky’s transplant team was able to coordinate with a local clinic to get her evaluated and treated for her anemia close to home. She has had an initial round of infusions and recently had some follow-up bloodwork to see where things stand. We’re waiting for the results. Although Becky’s general energy level seemed to have improved, it’s still not where she would like it to be.

Pit stop number two came in early November. Becky started feeling the all-too-familiar symptoms of another SBO. Was that possible? After going through a fairly invasive surgery just a few months ago, could there already be more scar tissue forming and causing more restrictions? There was only one way to find out. We headed back to the ER. The diagnosis was less than definitive, but familiar. The CT scan showed a “possible partial small bowel obstruction”. By now, we knew the drill. They placed an NG tube to drain fluid from the stomach and relieve pressure on the bowel. That was followed up later with contrast to track progress through her GI tract. About 24 hours later, things were improving. After going through the normal progression of liquid diet to soft foods and so forth, Becky was released a couple days after we came into the ER. Not great, but not terrible. Unfortunately, we don’t really know the root cause. Are there more adhesions from new scar tissue? Is there some other type of natural restriction? Are there more diet restrictions in Becky’s future? I suspect this is a part of the road we’ll be going down again.

There is one more bump in the road that we haven’t been able to navigate yet. Becky was diagnosed with osteopenia7 last year. This is no real surprise since it has a genetic component, Becky’s mother had osteoporosis and her brother has osteopenia. With everything else going on, we haven’t navigated the referral paperwork and insurance part of this path yet. There are more infusions in Becky’s future once we do. We’re working on it.

So, here we are. We’ve been driving down a year-long version of Lombard Street without Google Maps to tell us when the next turn is coming. Becky’s second year post-transplant has been anything but uneventful. We’ve had more than our share of Emergency Room visits, and we’ve had to learn more things about how to recognize and treat issues when we don’t quite recognize the road signs. We’re still learning.

The good news is that Becky’s new organs have been doing well, and we’re extremely thankful for that. We feel it is no small coincidence that Thanksgiving weekend is Becky’s transplant anniversary. Her liver function looks great every time she has bloodwork done. Her kidney numbers aren’t quite as consistent, but so far there has been no indication of any damage to the new kidney. It just requires a little extra attention and a few extra prayers.

After all that, we’re calling year two a victory! We have successfully completed another leg of the journey! In fact, we made our trip to Disney World last month! We had a great time with our kids and grandkids in Florida, and even though the road keeps changing, we’re looking forward to navigating it for many more years.