Pregnant with cancer

Being six months pregnant in Charleston in July can be trying. Heather Toeppner had resigned herself to the heat. What she hadn’t counted on, though, was the cancer diagnosis.

On her first prenatal visit, all checked out well on her breast exam. Around her 32nd birthday, she was cleaning out a closet, and in reaching up, noticed a lump about the size of a walnut. “It was a pretty palpable mass. It felt like it literally grew overnight.”

She didn’t have an appointment until July 1 to see her obstetrician, and she had a “babymoon” trip planned out of the country, so she decided she would get it checked out when she got back. “I didn’t have a care in the world. Throughout my entire pregnancy, my breasts changed so much, so I didn’t even think anything of it. I just assumed it was a milk duct or something that had lost its way. You never think it’s cancer.”

When she went to see her obstetrician, she showed her the lump and was urged to get an ultrasound, just so they could rule out anything serious. “I was surprised she was that invested in it – that made me worry.”

Her obstetrician’s concern convinced her to get it checked out, and she subsequently had a biopsy. On July 5, she learned it was cancer.

“I was in denial and shock. I was just a mess. I thought what does this mean for the baby? There was a lot of crying and questions. What stage was I? Did it spread? Am I going to die?”

Toeppner, a nurse and transfusion stewardship officer at the Medical University of South Carolina (MUSC), was set up with a nurse navigator and medical specialists at Hollings Cancer Center (HCC), where she tried to balance work and preparing a nursery with new appointments with oncology specialists. Surgery was rapidly scheduled. Fortunately, the 3-centimeter tumor had not spread to her lymph nodes. After surgery, she was able to return to work within two days.

But there were other concerns. Her tumor was tested and found to be a more aggressive grade-3 type. Her doctors urged her to plan for a scheduled induction at 39 weeks because waiting full term would delay starting chemotherapy. Toeppner, who had initial plans of a more natural delivery, had the decision taken away from her. She went into labor at 35 ½ weeks. On August 10 at 1:20 a.m., her son, Noah, was born after four hours of labor.

A range of emotions from joy to fright flooded through her. Toepnner worked with her oncologist to see if she could still delay her chemotherapy just a little bit.

“I just wanted to recover and bond, and I didn’t want to jump into chemotherapy. I wanted to breastfeed, which wasn’t advised by my oncologist. I was a new mom, though. I felt cheated. I breastfed for about 7 weeks and pumped and stored as much as I could.”

At the end of September, Toepnner began her chemotherapy regimen consisting of 16 weeks on infusions followed by an additional 22 rounds of radiation therapy. It was a happy, but extremely tough period, she recalls.

“I’ll be honest,” she says, describing the rollercoaster ride of highs and lows she experienced that year. “It took me a long time to get over how much cancer had robbed me of so many ‘motherhood goals’ and experiences, including breastfeeding, which I had to stop prematurely due to chemotherapy treatment. I also didn’t feel like myself, because I couldn’t identify with the woman I saw in the mirror – a bald and fatigued mom – a cancer patient.”

Survivors’ Fit Club

Then Toeppner got a little help from some friends.

Melanie Slan, program coordinator of outreach and patient support services at HCC, mentioned the Survivors' Fit Club, a wellness program for breast cancer survivors, that the cancer center offers in partnership with the MUSC Wellness Center. She asked her radiation oncologist Jennifer Harper, M.D., whether she should apply. Not only did Harper agree, she let her know it was her brain child.

Several years ago, a group of HCC researchers were conducting a clinical trial on the impact of dietary education, exercise and weight loss on breast cancer outcomes. In order to obtain grant support, they reviewed the literature, which strongly suggested a correlation, and presented it to a breast cancer clinical trial group on which Harper serves. Harper also knew of a highly successful program at the Wellness Center called the Healthy Charleston Challenge, a popular 12-week weight loss and wellness competition.

“I thought a program similar to the Healthy Charleston Challenge would be a tremendous opportunity for our population of breast cancer survivors to make healthy lifestyle changes, which could directly impact their breast cancer outcomes,” she says. “We had the resources to make this program possible through the facilities and expertise of the MUSC Wellness Center and the funding provided to the HCC breast program through the philanthropic organization Racquets for Recovery.”

Toeppner, for one, is glad Harper had the idea.

“I was always physically active, and while I worked out when pregnant, it was with limitations,” she said. When she got diagnosed, she was in her third trimester, and she just hit a wall. “I decided I was done. I was going to wallow in my sadness. I had lost all motivation to do my activities.”

Toeppner didn’t want to stay stuck there. “I needed a bare-bone, basic kick-my-butt boot camp and something to get me started. I needed the camaraderie and support group, as well as the personal training.”

It turned out to be a lifeline for her. “The biggest part has been the accountability. I don’t get to say at the end of the day, ‘I’m tired' or 'I’m just going to go home.’ And there’s the mom-guilt,” she says about the struggle between taking care of herself and being with her son. The good part of the club is that the other participants notice if she’s not there, and she gets more energized by doing it.

“You leave and think, ‘OK, I feel better. I never leave the gym and think, ‘Oh, that was awful – I’m a worse person for doing that.’ You have those endorphins to help you through the rest of the day.”

She’s learning more about nutrition, both to be healthier and in relation to her cancer diagnosis, as she is estrogen-progesterone positive. “We talk about foods that may be higher in estrogen – we all have to be careful we don’t invite estrogen back into our bodies. You know, we spent all this time removing it, and your diet can affect your levels. It’s also more about clean eating – trying to get down to the bare bones of ingredients. Making small changes can go a long way. If there’s a chemical I can’t pronounce, I shouldn’t buy it.”

The exercise sessions are tailored to what each participant feels she can do. Small talk between the interval training circuits they do gives them a therapeutic outlet. “We talk about our battle wounds a lot, like when military men get together and talk about war. We went through a very traumatic experience. There are emotional and physical scars left on you. Unless you’re knee deep in it, you don’t have a clue. I don’t talk a lot about it with people because the level of empathy is not going to be anywhere near the level of a survivor. It’s just a lot of ‘aww’ – side head tilt. That’s why support groups are so effective – no one knows better.”

Toeppner says she’s beginning to feel like her old self again, shedding her pregnancy weight and feeling her energy and mood rebounding.

“You feel like you’re fighting again – when you’re doing physical activity and you’re in that group. It’s always in the back of your mind why you’re doing it – trying to fight for your previous life.”

Mother's Day