Olympic Hurdler Isn’t Letting Disease Stand in His Wayhttp://www.nytimes.com/2016/07/08/sports/olympics/aries-merritt-hurdler-kidney-transplant.html?action=click&pgtype=Homepage&version=Moth-Visible&moduleDetail=inside-nyt-region-2&module=inside-nyt-region®ion=inside-nyt-region&WT.nav=inside-nyt-regionBy JERÉ LONGMAN JULY 7, 2016
NYTimes.com
EUGENE, Ore. — At the 2012 London Olympics, Aries Merritt of the United States won a gold medal in the 110-meter hurdles. Several weeks later, he shattered the world record in 12.80 seconds, his braids gathered in a ponytail, his left leg jabbing over each hurdle like a celebratory finger.
A year later, Merritt faded to sixth at the 2013 world track and field championships in Moscow. He had none of his usual acceleration over the final five of 10 hurdles. This was his strength, late speed, little deceleration. Something was wrong.
By October 2013, Merritt felt tired, drowsy. Food passed quickly through him. His ankles began to swell. He pressed his fingers against his legs and the indentation remained, he said, “like a marshmallow.”
Alarmed, he went to the emergency room at the Mayo Clinic in Phoenix, where he had recently moved. Doctors discovered that he had a rare, acute and rapidly progressing kidney disease known as collapsing focal segmental glomerulosclerosis, or collapsing FSGS. His kidneys had minimal function and were scarred and as wrinkled as prunes.
The disease was complicated by an infection called parvovirus B19, which can suppress the production of red blood cells and cause severe anemia.
Dr. Leslie F. Thomas, the kidney specialist who treated Merritt, said the cause of collapsing FSGS in the hurdler was not known. Had the disease progressed unabated for a “few months,” Thomas said, Merritt would probably have experienced complete kidney shutdown and needed dialysis or a transplant to survive.
“The day I met him, he was almost already there,” Thomas said Tuesday night in a telephone interview with The New York Times and Sports Illustrated.
Treatment options were limited, Thomas said, partly because track and field’s world governing body declined to permit Merritt to use diuretics and the blood- boosting drug EPO, which are banned as doping agents.
His kidney function improved temporarily, but the disease continued to progress. Merritt also became anemic. Last Sept. 1, he had a transplant with a kidney donated by his older sister. Remarkably, four days earlier, he won a bronze medal at the world track and field championships in Beijing. Merritt’s kidney function was less than 20 percent at the time, Thomas said, and he carried five or six extra pounds of fluid over the hurdles “like weights on his legs.”
“I mean, that’s like crazy,” Thomas said with an astonished laugh.
Beginning Friday, Merritt will attempt to qualify for another Olympic team at the national track and field trials, with the aim of winning a second gold medal in August at the Summer Games in Rio de Janeiro.
He has seldom raced this season. His speed has not fully recovered, and each time his trail leg clears a hurdle, his right thigh slaps against his abdomen, leaving him with a numbing, tugging feeling and the occasional spasm. The pain was so sharp in the winter that he could not compete in the indoor season.
Still, Merritt, who will turn 31 on July 24, said: “I need to go to Rio. If I can run, I need to be able to defend my title. I need to make a way out of no way.”
He has joined a relatively small group of athletes who have returned to the top of their game after having kidney transplants, including the former N.B.A. players Alonzo Mourning and Sean Elliott.
“In my line of work, I feel like I see a lot of amazing things,” said Thomas, who heads a division of rare kidney diseases at the Mayo Clinic in Phoenix. “This one really takes it. It’s incredible that somebody who has a kidney transplant is doing what he’s doing.”
On Tuesday night, Merritt sat just off the lobby of his hotel, speaking with two reporters. He raised his T-shirt, displaying the crescent scar that runs for about six inches along his abdomen. He was ebullient and forthcoming and spoke with a layman’s expertise made professional by trauma.
The diagnosis of kidney disease in the autumn of 2013 left Merritt stunned, angry and devastated. Collapsing FSGS may have some genetic predisposition, and African-Americans seem most vulnerable. Merritt remembers this stark assessment by Thomas: “Your kidneys look like death.”
Thomas said he told Merritt that treatment would probably not work. And it seemed unlikely to the doctor that Merritt could continue his hurdling career in his condition. Intervention with corticosteroids can lead to swelling and weight gain. The drugs also usually sap a person’s strength, Thomas said, and build fat rather than muscle.
Dialysis was an option, but Merritt said he did not want to be tethered to a machine. He also worried that his body could not handle both dialysis and training. “I just wasn’t going to give up that easily,” he said.
To try to improve Merritt’s kidney function, Thomas treated the parvovirus with intravenous immunoglobulin therapy, known as IVIG. Each weekday morning, Thomas and Merritt said, treatment lasted four to five hours. The therapy continued for months, from November 2013 through the spring of 2014.
Training remained difficult. Merritt said he felt weak from a lack of oxygen- carrying red blood cells. Sometimes he needed 30 minutes to recover between sprints of 150 meters. Walking up a flight of stairs at his apartment in Phoenix, Merritt said, “felt like I ran three miles, all out.”
Still, as his kidney function improved to about 60 percent, he returned to the international circuit in the summer of 2014. His races were cathartic, if not particularly fast.
“I wanted to get away from hospitals,” he said.
Eventually, Merritt’s kidney function began to deteriorate again. Last year, he dropped to 160 pounds, 10 pounds below his current weight. He said he was allowed only limited amounts of protein, sodium and potassium, which his kidneys struggled to filter. His legs cramped.
In June 2015, Merritt said, a transplant became his only option. He phoned his older sister, LaToya Hubbard, 38, in Marietta, Ga. They had discussed it.
“Are you still serious about giving me the kidney?” Hubbard remembered her brother asking.
“Yeah, of course,” she replied. “What are you talking about?”
He explained the urgency of the situation. Hubbard immediately called the Mayo Clinic to begin the process of determining whether she was a match for a transplant. She was.
Toy is the nickname Merritt has for his sister. She is eight years older and, as they grew up outside Atlanta, Merritt said, “She toughened me up for the harsh reality of the world.”
Now, LaToya sensed disbelief on the other end of the phone.
“I’m not going to say I was disappointed,” Hubbard said in a telephone interview. “It was more like, wow, what can I do to help my brother? I just decided to do what I could do.”
A date for the transplant was set for Sept. 1. Beforehand, Merritt competed in the world championships in Beijing. He said he felt exhausted as the three rounds of the hurdles progressed, and he plied himself with caffeine from energy drinks. Somehow he took third place, an achievement that, given the circumstances, might have been more impressive than winning an Olympic gold medal.
“A lot of it was because I thought it was probably going to be my last time running ever again,” Merritt said. “And so I just pulled a rabbit out of a hat, essentially.”
If that was to be his last race, he said, he could retire satisfied. But the transplant went smoothly, and Merritt resumed training seven weeks later. Quickly, though, a hematoma developed on the transplanted kidney, he said, formed as his trail leg kept striking his stomach. A second surgery was needed to reset the kidney deeper inside his abdomen, he said. More training time was lost.
He is still playing catch-up. But training has felt encouraging. He drinks about two gallons of water a day to keep his kidney hydrated and has only minor dietary restrictions. His doctors are concerned about the Zika virus in Rio, Merritt said, because he is taking drugs that suppress his immune system, and they have asked him to reconsider competing in the Games if he qualifies.
He would wear long sleeves and insect repellent, Merritt said, but skipping the Olympics, his sport’s most visible competition, is not an option for him. It is important to strive for another gold medal, he said, and to show “everyone around the world your story and your struggle.”
His sister and mother were scheduled to arrive here Thursday for the track and field trials. If Merritt wins in Rio, Hubbard joked, he can keep the gold medal. All she wants is to take half of his victory lap.
“He has a part of me,” Hubbard said. “He has something that is helping him, like he has the best kidney in the world right now.”
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