Ann-Marie’s story: more than a leukemia survivor

hree years ago while working crazy hours and preparing for her wedding, Ann-Marie Servos was really tired, so she went to the doctor for a checkup, fully expecting to be told to get more sleep and stop stressing.

By the next morning, Ann-Marie had five missed calls from her doctor calling to say there was something critically wrong with her blood levels and to go straight to the ER.

Over the next few days, she was checked into the hospital, underwent a battery of tests and was diagnosed with acute myeloid leukemia and acute lymphoblastic leukemia. She did not go home again for more than 40 days.

“The key was to imagine that you are red bouncing ball, sitting on shelf high above the floor and every day, someone will knock you off that shelf and your only job is to bounce high enough to get back on,” one of her doctors explained.

Three months later, she received a peripheral stem cell transplant.

I think the point of surviving cancer is to thrive Click To Tweet

Before cancer, Ann-Marie was working in commercial real estate. After her transplant, she felt a drive to pursue a new career. She graduated from nursing school in September, 2014.

“I looked up the definition of survivor and it said, ‘to remain alive or in existence,’” she said. “But I think the point of surviving is to do more than that. It is to thrive and I now have so much more to fight for.”

Ann-Marie on her wedding day.
Ann-Marie on her wedding day.

Want to know more about acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL)? Ann-Marie’s hematologist, Dr. Carlos Ramos, tells us what we need to know.

What are AML and ALL?

AML and ALL are different forms of acute leukemia, which is a very aggressive cancer of the blood. Depending on the specific type of blood cell affected, the leukemia is called AML or ALL.

How many people are diagnosed with these two cancers a year?

In the United States, there about 13,000 new cases of AML and 5,500 new cases of ALL diagnosed per year.

What are some of the symptoms?

Symptoms of leukemia
Symptoms of leukemia.

Most symptoms are caused by the disruption of normal blood and bone marrow functions. Patients can have: 

  • Low red blood cells, known as anemia. They will feel weak or fatigued.
  • Low platelet count, which can lead to bleeding.
  • Low white blood cells, which can make the patient prone to getting infections and fevers.

How do you treat these cancers?

Treatment is usually very intensive and includes chemotherapy, radiation therapy and a bone marrow transplant.

To become a donor for bone marrow/stem cell transplant, sign up for the national registry known as Be the Match or sign up by going to the Gulf Coast Regional Blood Center here in Houston.

Prostate cancer: knowing your risk and treatment options

One of the important aspects of men’s health is awareness about prostate cancer, which is the second most common cancer among men in the United States. Dr. Brian Miles, urologist at Houston Methodist Hospital, says this year approximately 30,000 men will die from prostate cancer, but when detected early, it can be cured.

September is Prostate Cancer Awareness Month, so I sat down with Dr. Miles who helped answer some common prostate-related questions.

What is the prostate? 

The prostate (part of the reproductive system) is a small gland in men about the size of a walnut that rests below the bladder. The purpose of the prostate is to produce seminal fluid that provides nutrients for the sperm.

 What are some risk factors for prostate cancer?

  • Age: The risk of prostate cancer increases with age and is most common in men over the age of 50

    Diagram courtesy of CDC.gov
    Diagram courtesy of CDC.gov
  • Race: African American men have a greater risk of prostate cancer
  • Obesity
  • Family history: If prostate cancer runs in your family, you have an increased risk

 What are some of the symptoms?

Prostate cancer usually grows very slowly, often not causing signs or symptoms until it is more advanced. Symptoms may include:

  • Inability to pass urine
  • Difficulty starting or stopping the urine flow
  • Pain or burning during urination
  • Blood in your urine
  • Pain in lower back, upper thighs or hips
  • Erectile dysfunction

What is the difference between prostate cancer and benign prostate hyperplasia (BPH)?

BPH can often be confused with prostate cancer. It is an enlarged prostate gland and occurs in almost all men as they get older. BPH is not cancer. However, some of the symptoms are similar to those of prostate cancer. The physician can often diagnose by doing a physical exam, conducting a urine test or a digital rectal exam.

What does an elevated PSA mean?

If you are a man over 50, your urologist should conduct the prostate-specific antigen (PSA) test. PSA is an enzyme produced by prostate cells. An antigen is simply a protein that can be identified for a particular organ. An elevated PSA alerts the physician or urologist to the possibility the patient may have prostate cancer.

Prostate cancer is the second most common cancer among men in the United States Click To Tweet

How does the urologist diagnose prostate cancer?

At Houston Methodist, we are now using enhanced technology to better and more precisely detect and diagnosis prostate cancer. The MRI ultrasound fusion decreases the number of biopsies needed to make a diagnosis, and this technology allows for a more precise treatment plan. The technology helps urologists see areas that are highly suspicious for cancer within the prostate by merging the MRI image onto the existing ultrasound image.

What are my treatment options?

For men diagnosed very early, treatment may not immediately necessary, instead active surveillance or regular follow ups may be recommended. Other treatment options include:

  • Radiation therapy
  • Hormone therapy
  • Surgery
  • Chemotherapy

Our physician-researchers lead more than two dozen prostate cancer clinical trials at Houston Methodist Cancer Center

What you need to know about melanoma

A single black dot can cause a lot of damage. One Houston Methodist employee never knew what was under her toenail polish until a pedicurist pointed it out. After a couple of weeks, she decided to have it checked out, only to be wheeled straight into the OR. It was melanoma, and it had spread to the bone.

Not all skin cancer is created equal. Melanoma can hide from you. It can live in or under your skin, hair and nails and make discovery very difficult. Melanoma can also happen without provocation. For these reasons, early detection through self or professional examinations are extremely important.

According to Dr. Paul Friedman, dermatologist at Houston Methodist Hospital, “It’s important to personally check your skin once a month and see a dermatologist once a year for a full examination. For self-examination, a full-length mirror and a hand mirror can help you see the tricky areas.”

What is Melanoma?

Although skin cancer is the most common cancer in the United States, melanoma accounts for less than 2 percent of all skin cancer cases. The disease is the most aggressive form of skin cancer. Melanoma begins in the melanocytes, which are found on the lower part of the epidermis. The disease can occur anywhere on the body and usually beings in a mole.

Melanoma has four stages. In stages 1 and 2, the tumors grow in thickness. By stages 3 and 4, cancer has spread to the lymph nodes and other parts of the body.
Melanoma has four stages. In stages 1 and 2, the tumors grow in thickness. By stages 3 and 4, cancer has spread to the lymph nodes and other parts of the body.

People exposed to natural or artificial sunlight (tanning beds) for long periods of time have an increased risk of developing melanoma. Other risk factors include: fair skin, history of sunburns, many moles, family history of melanoma, or history of unusual moles.

Where should you look?

Skin is the largest organ in the human body. The skin of an average adult has a surface area of over 21 square feet; that’s a lot of space for melanoma to develop. For men, about one out of every three melanomas is found on the back, but some common, hard-to-find places melanoma can hide in both men and women are:

  • In between the toes
  • On the soles of feet
  • On palms
  • On the scalp
  • Behind the ears
  • Inside the mouth
  • Under fingernails and toenails
  • On and between the buttocks
  • Around the genital area

Seeing that some of these places are very personal, self-examination is the way to go. For other areas, such as behind the ears and in the scalp, you’ll need to find someone to help you, such as a family member or close friend.

What should you look for?

Melanoma can come in many different shapes and sizes. A simple rule can help you in your search: ABCDE. If you answer yes to any of these, you should schedule a doctor’s appointment for further examination.

When examining your skin for melanoma, keep in mind asymmetry, border, color, diameter and evolution Click To Tweet

A is for Asymmetry: is one half of the mole shaped different from the other?

B is for Border: are the edges of the mole irregular, ragged, or blurred?

C is for Color: is the mole more than one color?

D is for Diameter: is the spot larger than about ¼ inch (the size of a pencil eraser)?

E is for Evolving: has the mole changed in size, shape, or color?

Melanomas can be tricky to find, but it’s important to look for them.

Alma’s battle with triple negative breast cancer

For a woman living a healthy lifestyle, Alma Delia Sanchez, a resident of Tampico, Tamaulipas, Mexico, was shocked to discover a lump on her breast was later diagnosed as triple negative breast cancer. With little information on breast cancer for young women in Mexico, Sanchez immediately took to the internet. She and her husband found Dr. Angel Rodriguez, a breast medical oncologist who specializes in triple negative at Houston Methodist Hospital.

Love heals; surround yourself with people who love you or can give you lots of love, support and empathy during your journey,” Sanchez said. “Live fearlessly; fear is one of the lowest vibrations we can have.”

I spoke with Sanchez about her journey, inspiration and ways to motivate yourself when battling with cancer.

Q. Before being diagnosed with triple negative breast cancer, had you ever heard of this type of cancer?

No, I had never heard of triple negative breast cancer before. My cousin passed away from triple negative but it was never mentioned the type of breast cancer, only that it was a very aggressive type. Living in Mexico, there are many campaigns that promote self-breast exams, specifically in October. However, these campaigns are usually targeted at women over the age of 40 and the words triple negative are never mentioned. Triple negative does not depend on estrogen, progesterone or the HER2 to fuel it and grow.

Q. The word cancer can be daunting. How did you cope when you heard the news?

I first heard the news with my husband and my initial reaction was this could not be true. I told my husband the results had to be wrong. When the doctor explained my diagnosis in detail it all started to sink in. I was shocked that at my age and with my healthy lifestyle, I had cancer. I was able to find a great breast oncologist, surgeon and plastic surgeon in Houston that I felt safe and in great hands.

Live fearlessly; fear is one of the lowest vibrations we can have Click To Tweet

Q. Living such a healthy lifestyle, did you ever imagine being diagnosed with breast cancer?

No, even though there is a history of breast and ovarian cancer on my mother’s side of the family, I thought my great habits would save me. I have been a vegetarian since middle school and have exercised all my life, alternating between weight training, swimming and yoga. I have never smoked and very rarely have consumed alcohol. I always assumed my healthy habits would be my passport to good health and a long, happy life.

Q. Once you learned a little more about triple negative, what went through your head?

I was very scared at first. I googled triple negative breast cancer and everything that came up mentioned the words “really aggressive,” “deadly type of breast cancer,” “metastasis” and “doctors don’t know what fuels the cancer.” Sitting in front of my laptop crying, I couldn’t help but think about how much life I had left to live and how my baby girl still needed me.

Q. Walk us through your journey once being diagnosed.

Five days after my lumpectomy of what my doctor thought was a benign cyst, I received the lab results that said it was cancer. A week after hearing the news my husband and I flew to Houston in search for Dr. Angel Rodriguez. After visiting with the surgical oncologist, the recommendation was for me to get a double mastectomy.

alma-familypic
For Alma, family and love are two important elements when one is battling cancer.

There were some problems with the insurance company and I decided to undergo a left nipple sparing mastectomy with immediate reconstruction with a tissue expander. My diagnosis after the mastectomy was stage 2A, high grade, triple negative breast cancer with no lymph node involvement. I decided to return home to Mexico to start chemotherapy following the exact treatment that was suggested at Houston Methodist.

My hair started to fall out and I turned into this bald and chubby person that I just could not recognize in the mirror. I knew my life was at stake, but I asked why me? The first chemotherapy treatments were very hard. I had a dream one night. God said love could heal all and me. I am certain now that in our darkest moments we are never alone.

After completing my eight rounds of chemo, I was able to undergo surgery and the reconstruction. While it seems like I am about to finish my journey, it feels more like a new beginning.

Q. What would you say to women today who have recently been diagnosed or going through treatment?

The first thing I would say to someone who was recently diagnosed, get in touch with your emotions. Take time to feel sad, get angry and cry.

Once getting over the initial shock, surround yourself with loving and positive people. Be kind to yourself. If they are currently undergoing treatment, I know it is not a walk in the park. Rest and try to meditate as often as you can. Write about your experience, share your journey, talk to other breast cancer patients and know this too shall pass. Make it a mission to make it a healing journey for the body and soul. Get informed about the options you have for treatment. Choose a team of physicians you trust and form a relationship with them.

Finally, whatever path you choose, feel at peace with that decision.

Sanchez continues to reach out to the cancer patient community to motivate and inspire to be brave, help others understand that suffering is not necessary to grow and help women realize life is so beautiful that it is all worth it.

The importance of bone marrow donation: Chen’s story

Every year, more than 12,000 patients in the United States are diagnosed with life-threatening diseases such as leukemia or lymphoma for which a marrow or umbilical cord blood transplant from an unrelated donor may be their best or only hope of a cure.

Chen Gong is one of them.  A year ago, she was working well over 40 hours a week at an oil and gas manufacturing company doing paperwork in the supply chain department. During her free time, Chen would hang out with friends or go shopping with her mom. These days, she’s still spending a lot of time with her mom – but from a hospital bed at Houston Methodist Hospital, desperately waiting for one unknown person to give her a life-saving bone marrow donation.

Dr. Swaminathan Iyer, hematologist at Houston Methodist Cancer Center, says a staggering 70 percent of patients in need of a transplant do not have a matching donor in their family. They depend on an unrelated bone marrow donor or umbilical cord blood unit.

This illustration shows cells in bone marrow which produce approximately 500 billion blood cells per a day, supporting the body’s immune system.

In the Asian community, more than 720,000 potential donors exist, but that’s only 7 percent of the entire bone marrow donor registry. The numbers aren’t much better for African-Americans or Hispanics, and they’re even more dismal if you’re of mixed race.

A staggering 70% of patients in need of a bone marrow transplant do not have a matching donor in their family Click To Tweet

Chen, a 26-year-old native of Shanghai, China hates the thought of others seeing her sick but at the same time, she needs to find a donor who might help rid her body of recurrent acute myeloid leukemia. Chen was diagnosed in the summer of 2013 after she noticed red spots appearing on her legs. After her initial treatment seemed to work, Chen’s leukemia relapsed this March. She recently finished a round of chemotherapy and now she’s waiting to see if her blood count goes up.

Waiting is the hardest part. I sleep a lot because there isn’t much else to do, and it’s like I have to feel worse before I can get better. I still have a lot I want to do. I want to get married and have a family.

No one in Chen’s immediate family is a full match, which is the ideal candidate who would provide a perfect genetic match. Chen’s dad is a half match, but her medical team at Houston Methodist Cancer Center want to hold off, as her immune system might reject the marrow.

Chen and her Houston Methodist physicians, including oncologist Daniel Lehane, M.D., are hoping that more people, especially minorities, between the ages of 18 and 44 will join the registry. If you’ve thought about joining but haven’t made the decision yet, Dr. Iyer wants people to understand the following:

  • It’s a simple cheek swab. You don’t actually donate until you are a match for a patient
  • You don’t have to be the same blood type, but there are 10 markers in your DNA that have to match the recipient
  • Bone marrow donations are not painful. Donors are typically under general anesthesia during the withdrawal of liquid marrow from the back of the pelvic bone. Donors go home the same day and are back to their usual routines within a few days with only a small amount of discomfort.

Learn how you can donate bone marrow for a patient like Chen.

H1N1 flu, ECMO and lungs: Crystal’s story

The 2013-14 flu epidemic reached alarming levels in Houston. Because of the damage the H1N1 flu inflicts on the lungs, many patients were placed on extracorporeal membrane oxygenation (ECMO), a lifesaving technique that oxygenates the blood outside of the body. Most ECMO patients are sedated to give their lungs time to heal. That’s why I was so surprised when I walked into Crystal Johnson’s room in the Cardiovascular Intensive Care Unit (CVICU) at Houston Methodist Hospital – she was awake and watching TV.

Crystal was 21 when we met in early January 2013. When she was 14, Crystal had received chemotherapy that would cause severe damage to her lungs to treat a cancerous tumor on her liver. After Crystal and her mother, Tracy, moved from Opelousas, Louisiana, to Houston in 2012, Crystal’s lungs began to decline and she dealt with a series of collapsed lungs. Crystal didn’t get a flu shot, so she had no immunity to the virus when she was around family members recovering from the flu. Upon her return to Houston, Crystal tested positive for H1N1 and was admitted to Houston Methodist Hospital.

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Extracorporeal membrane oxygenation (ECMO), is a lifesaving technique that oxygenates the blood outside of the body. Most ECMO patients are sedated to give their lungs time to heal.

Since Crystal was still testing positive for H1N1 at my first visit, I stopped at the doorway to gear up – a plastic gown, mask and gloves. I can still remember her labored breathing, SpongeBob blanket, and half-finished Duck Dynasty puzzle. I met Cindy, a CVICU nurse, who had become so attached to Crystal that they texted – even when Cindy was off duty. While Crystal’s body was receiving enough oxygen via ECMO, her lungs still labored to breath, so it was hard for her to talk. That first day, she mostly listened while Tracy and Cindy told me her story.

On my way home from work that night, I cried. I cried because I was so incredibly blessed, while this amazing young lady spent every moment fighting to breathe and live. My problems didn’t seem so big anymore.

After several weeks in the hospital, Crystal finally tested negative for H1N1, but the damage was done. She was immediately placed on the lung transplant list as one of the most severe cases in the nation. One day, I stopped by for a visit and Tracy told me a transplant coordinator had called early that morning with the news that Crystal might have donor lungs. I spent the day waiting with them for news. Crystal was nervous that she wasn’t going to get lungs that day. We reassured her that lungs were coming – the doctors were checking to make sure the lungs were just right for her.

Then, it was time. Cindy gave Crystal a hug and a kiss on the forehead. Tracy shed a few tears. In the moment Crystal knew she was getting lungs, she was peaceful.

All of Tracy’s family was in Louisiana, and I couldn’t leave her alone. So, after a long day of waiting for news, Tracy was called back to see the doctor. The doctor said the surgery had gone well and that Crystal was going to be fine.

After surgery, Crystal returned to the CVICU for monitoring as she adapted to her new lungs. I continued to stop by with the latest issue of a celebrity news magazine or to chat about the latest episode of Duck Dynasty and the crazy antics of Crystal’s favorite Robertson – Uncle Si. It was during a conversation about Skittles that it struck me – we were actually talking. Until then, our conversations consisted of me asking questions and Crystal writing answers or Cindy translating for me.

That was the last time I saw Crystal in the hospital. When I went back to the CVICU for a visit, they told me Crystal had gone home. Now that she isn’t fighting to breathe, Crystal finally has a chance to live her life.

Genetic mutations: knowing your cancer risk

Just a few decades ago, mothers would have considered certain topics off limits when talking with their daughters.  Today, these kinds of conversations are less taboo, especially when it comes to talking about family medical history. Take time to ask about your family’s medical history, especially for breast and ovarian cancers.

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Mutations can be inherited from either parent and may be passed on. Each child of a genetic carrier has a 50 percent chance of inheriting the mutated gene.

Your family’s health history may mirror your own and give you a heads up on what you to expect. For example, the likelihood of developing common gynecological conditions such as endometriosis and polycystic ovary syndrome greatly increase if a close female relative, such as your mother or aunt, has a history of the condition. Tejal Patel, M.D., leads the high-risk clinic at Houston Methodist Cancer Center and says mothers can influence their daughters screening choices across their life span.

When cancer is present in a family, genetic counselors play a prominent role in helping families understand their risk.  Many of us have heard about BRCA gene mutations that can produce hereditary breast-ovarian cancer syndrome in affected families. Patel says mutations in BRCA1 and BRCA2 genes account for only five to 10 percent of all breast cancer cases in women, but the goal is to find the mutation in women before they develop cancer. Patients with either BRCA mutation have a 55 to 87 percent higher lifetime risk of developing breast cancer of (compared to a general population risk of 10 to 12 percent), as well as a 20 to 40 percent higher lifetime risk of developing ovarian cancer (compared to a general population risk of less than two percent).

“High-profile figures, like actress Angelina Jolie, have brought this topic to the forefront. Now it is up to all women to continue to increase awareness,” says Patel.

Patel stresses that a simple blood or saliva test can tell a woman whether she’s at a higher risk of developing breast or ovarian cancer.  In some cases, a woman with a negative genetic test may still be considered to be at an increased risk of developing breast cancer.  There are other gene mutations (besides BRCA 1 and 2) that may also increase a woman’s risk of developing cancer.  Knowing the risk can help both the patient and the doctor make more informed decisions about a health plan before cancer has a chance to develop.

Patients with BRCA mutations have a 55% to 87% higher lifetime risk of developing breast cancer Click To Tweet

Women should talk with their physicians about testing for hereditary breast and ovarian cancer syndrome if they have personal or family history of the following:

  • Breast cancer at age 50 or younger
  • Ovarian cancer at any age
  • Male breast cancer at any age
  • Ashkenazi Jewish ancestry and a personal or family history of breast or ovarian cancer
  • Two breast cancers in the same person or on the same side of the family
  • Triple negative breast cancer at age 60 or younger
  • A previously identified BRCA1 or BRCA2 mutation in the family

Mutations can be inherited from either parent and may be passed on to both sons and daughters. Each child of a genetic carrier, regardless of sex, has a 50 percent chance of inheriting the mutated gene from the parent who carries the mutation. That means half of the people with BRCA gene mutations are male.

Patel says men should consider testing if they have a personal history of breast cancer, a family history of breast or ovarian cancer, or a family member with a BRCA1 and BRCA2 mutation. Although male breast cancer is rare, men who carry BRCA mutations are more likely to develop breast cancer and prostate cancer.