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Pregnant, With Cancer

Pregnant, With Cancer

On 3 Nov 2016, in

Doctors devise a unique treatment to save a new mother’s life.

By Jacob Luecke

There’s really no rhyme or reason to pregnancy symptoms. Morning sickness, fatigue, food aversions — as far as anyone can tell, it mostly comes down to luck.

As she carried her first child earlier this year, Tanna Niemeier seemed to have especially bad luck. She found herself suffering a painful hemorrhoid outbreak — a problem some moms face while pregnant.

“That’s just one of the joys of pregnancy,” Tanna remembers being told. 

But these hemorrhoids seemed different. As she neared her third trimester, the pain kept getting worse. It became so bad that Tanna was soon at Boone Hospital Center for emergency hemorrhoid removal surgery. 

After the surgery, Tanna returned home to Fayette to recover. 

With the hemorrhoids taken care of, the incident seemed destined to be remembered as just a bump in the road of life — a road Tanna had been racing down over the last year. 

Just 12 months earlier, Tanna had been planning for her wedding. Not long after her marriage to Zach, the couple found out Tanna was pregnant.

They were thrilled by the news. So were their families. 

“Everyone was just super excited,” she says. “Zach and I were nervous, but we were excited, too. It was our first child. We were just preparing and getting ready.”

As Tanna recovered at home the day after her hemorrhoid surgery, she was eager to get back on track. She wanted to focus on the upcoming arrival of her child.

But the next day, everything changed. Tanna was resting at home when her phone rang. It was her obstetrician, Elizabeth Wilson, MD, with Women’s Health Associates

Dr. Wilson told Tanna that doctors had discovered a potential problem in the tissue removed during her surgery. A pathology report indicated it could be lymphoma, a cancer of the lymph nodes.

Tanna felt numb.

“The first thing I asked her was ‘Is that bad?” Tanna says. “She was saying ‘Yes, it’s bad.’ That’s pretty much all I remember. I think I ended up blacking out, and Zach finished the call.”

The plan

Soon, Tanna was at Missouri Cancer Associates, where oncologist Elangovan Balakrishnan, MD, used a blood test to confirm the cancer. Even worse, Dr. Balakrishnan diagnosed it as a rare, very aggressive form of non-Hodgkins lymphoma called Burkitt’s lymphoma, which can be fatal if left untreated.

“Me and my husband, we were just a mess,” Tanna says. “So many questions were running through our heads, ‘This was our first child, and what was going to happen to her? Am I going to be here for her after all this?’” 

Fortunately, Tanna’s cancer appeared treatable. Her painful hemorrhoids and resulting surgery had led to the cancer being discovered early. Yet, the case presented an unusual test for Tanna’s physician team.

“It is very uncommon to treat pregnant patients for cancer,” says Dr. Balakrishnan. “When it comes to Burkitt’s lymphoma, it is extremely rare.”

Part of the puzzle included selecting anti-cancer drugs that wouldn’t harm Tanna’s baby. This required careful research by Tanna’s doctors, as some common drugs used against fast-growing cancers like Burkitt’s lymphoma can also attack growing babies in the womb.

Even some standard radiology scans were off limits.

“We have to be extremely careful about treating pregnant patients because of the risk of exposure to the baby,” Dr. Balakrishnan says. “PET scans can’t be done to stage the cancer. CT scans can be risky also because of the risk of exposing the baby to radiation. So we decided to use MRI for staging. We had to closely work with her obstetrician. Treating the mom without any harm to the baby is vital here.”

In crafting a treatment plan, Tanna’s Boone Hospital doctors held physician meetings to get input from their peers. They also consulted lymphoma expert Amanda Cashen, MD, at Siteman Cancer Center in St. Louis.

Working together, the physicians designed a plan that would unfold in three stages. First, Tanna would undergo two rounds of chemotherapy using carefully chosen drugs that are acceptable for use during pregnancy. However, for the third round, Tanna would need an anti-cancer drug called methotrexate, which is not safe to use while pregnant. So, between the second and third rounds of chemotherapy, doctors planned to induce labor. That meant Tanna’s baby would be born five weeks early. However, it also meant Tanna could receive her final round of chemotherapy without concern for her baby’s safety.

“Dr. Balakrishnan and I talked regularly about Tanna’s care,” Dr. Wilson says. “We discussed the timing of her delivery — when best to induce and deliver regarding the choice of chemotherapy meds. Of course, our goal is having a healthy mom and a healthy baby, and in this case we had to cross-check every plan of treatment.” 

As her doctors devised their plan, Tanna began to make peace with her situation. She felt determined to stay positive and to win this battle.

“I thought, ‘Well, it’s here, there’s nothing we can do about it, so now I’m just going to fight it and beat it,’” Tanna says. “I want to be there for my daughter and my husband. I chose that I wasn’t going to fear it.”

The battle

Each of Tanna’s chemotherapy treatments required a five-day stay at Boone Hospital’s Stewart Cancer Center. Her room was set up to allow Zach to stay by her side. 

During this time, Tanna says her caregivers did everything they could to help her feel at home. She became especially close to three nurses: Mung Chin, Becca McGuire and Lauren McDonald. Tanna says these nurses would check on her even on days when they weren’t assigned to care for her. 

To help Tanna avoid feeling cooped up, her caregivers encouraged her to take walks through the hospital.

“The nurses were so great,” she says. “I wasn’t allowed to leave the hospital, but I joked that I could give out free tours of Boone Hospital after walking around so much.”

Every morning, caregivers monitored Tanna’s baby. She also had weekly ultrasound scans. All tests indicated that the baby was coping well with the chemotherapy.

Tanna, too, was doing well. She found that chemo didn’t bother her as much as she expected. She hoped that her mild reaction to chemo might mean she could sidestep the hair loss cancer patients commonly experience. But that wasn’t the case. 

“My hair was extremely long,” she says. “One day I was fine, and the next day it was coming out in clumps. I freaked out. I told my husband to cut it, shave it and get it over with.”

As Tanna progressed through her first two rounds of chemotherapy, her induction date was approaching. Even with everything that was happening, Tanna and Zach hadn’t lost the excitement they felt to meet their child. 

However, they also knew that their child would likely need extra care due to early delivery and exposure to chemotherapy drugs. Doctors had told the couple that their baby would likely need to spend a few weeks in Boone Hospital’s level-III neonatal intensive care unit, or NICU.

Tanna and Zach arrived at the Boone Family Birthplace for the induction on a Sunday night. The next evening, April 25, their baby arrived – a girl. They named her Charlotte Alene.

Tanna says it was amazing to see her daughter for the first time.

The family and their caregivers were also amazed by how healthy Charlotte looked at birth. Tests showed that, in fact, she was in great health. She wouldn’t need to go to the NICU after all.

Finally home

Once Tanna and Charlotte were cleared to leave the Boone Family Birthplace, it was time for Tanna to return to Stewart Cancer Center for her final round of chemotherapy.

This time, both Zach and Charlotte stayed beside Tanna. While it’s unusual to have a baby staying on the cancer treatment floor, Boone Hospital caregivers went out of their way to make it work.

“I joked that she already went though two rounds of chemo so what’s one more?” Tanna says.

Her caregivers borrowed a bassinet from the hospital’s birthplace and brought it to Tanna’s room, so Charlotte would have a place to sleep. They also kept the family stocked with diapers, wipes and formula — Tanna had hoped to breastfeed, but the anti-cancer drugs made that impossible.

When the final week of treatment ended, Tanna and Zach could finally go home with their baby.

Over the coming weeks, the couple began to settle in as new parents. However, cancer still lingered in their minds. They would have to wait a month to see if the three-stage plan her doctors had designed was successful.

On May 23, she returned to Boone Hospital for a PET scan. It showed that Tanna’s cancer was gone. Tanna says it was surreal to hear that news.

“We were so excited. It was the best news ever,” she says. “It almost felt unreal because everything happened so fast, and then it was gone so fast.”

Her physicians shared in the family’s joy.

“I can’t express how happy and excited everyone was on that day,” Dr. Balakrishnan says. 

Just weeks later, as Charlotte was beginning her second month, Tanna says her daughter was doing great, even if she was a bit small for her age. 

“She smiles a lot, she’s more alert and she’s getting bigger,” Tanna says.

Tanna was regaining her strength and preparing to return to work. Her hair was still short, but it was growing back. Life was returning to normal — a new normal as a mother. It felt good just to be here. 

“This was a true success story,” Dr. Wilson says. “Who knows, perhaps having the pregnancy and the lymphoma at the same time produced the dramatic symptoms that led to the surgery and discovery of Tanna’s lymphoma. Finding it early gave us the best chance to make sure this courageous and lovely mama would be around for her precious little girl.”

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