16 Year Cancer Check-Up!!!

Although I technically have 16 more days to go before my actual bone marrow transplant anniversary (woohoo!), this past week I ventured over to the survivorship clinic at Dana-Farber Cancer Institute for my 16 year cancer check-up.

A little over 16 years ago… 

Yes, I am considered a survivor but the funny thing about being a leukemia-survivor (as with many cancers), is that you never really go back to ‘normal.’  The last time I saw a general practitioner for anything other than a referral to a cancer center was well over 16 years ago, as my oncologist and team of physicians at Dana-Farber now address all of my health needs.  I have a cardiologist (heart issues), an endocrinologist (hormone issues), a dermatologist (skin issues), and even a special dentist who specializes in post transplant issues such as manifestations of graft versus host disease in the mouth and mouth cancers- both of which are concerns for me.



The Oncology Appointment
The appointment with my oncologist went very well.  Not only is he dedicated to the survivorship field and paving the way in post-transplant care issues, but he too is 15 years out from a bone marrow transplant for leukemia.  Overall, the outcome was good and all of the test results were promising- CBC, Differential (reports on the different types of white blood cells and amount of each kind in my blood), Chemistries all looked mostly normal.  My platelets were low but that is the norm for me.  Although it is not of concern, platelets are used to help your body clot so due to the pregnancy and possibility for surgery, I verified the specific type of blood products I require in the event that they were needed down the road.  “Irradiated, Leukopoor Blood Products ONLY.”  In non-science terms, all red blood cells, platelets, etc that are infused into my body need to be free of white blood cells (leukopoor).  Since this, and my confusing blood type, are important for anyone to know if they’re giving me blood products, the task of getting a medic alert bracelet has been moved up on the priority list.  
The Cardiology Appointment
Over the past 1 1/2 years, I have seen my cardiologist at least four times.  Not only do I have to contend with the cardiac issues that can haunt leukemia and transplant survivors, but my family history is not stellar either.  My cholesterol is through the roof regardless of what I eat and I’m pretty sure my extended family independently supports the cardiac surgeons of the US.  Thus, my cardiologist is particularly fond of our conversations.  Of course, this time around, we had the added bonus of discussing a twin pregnancy.  The good news is that my echocardiogram (think ultrasound for the heart) looked good overall (sample echo below). 

My ejection fraction, the measure of how well your heart is pumping blood to your body- or simply put how well your heart works, actually went up.  That was incredibly good news!  The echo also showed some valve regurgitation, which means at certain spots in my heart, blood is flowing the wrong way through the valves which are intended to keep the blood moving in the correct direction.

Valve regurgitation is not a new thing for me but there appeared to be some increase in regurg at each of the valves.  Although this made me a little nervous, my cardiologist explained that this is normal when your blood volume increases as much as mine is to accomodate not one but two babies.  As you can imagine, the blood volume will continue to grow as the babies do and for that reason, we schedule another echo and appointment in a couple months just to be proactive.  I was given clearance to go for walks again and that is exactly what I did!

The Week Ahead…
As we approach my official BMT anniversary and cancer-free day, I have my fair share of appointments and fundraising.

Fundraising: As you know, I started out this Boston Marathon training season much stronger than last year- in other words, I was actually training.  However, with the knowledge that I was pregnant with twins, my OB and cardiologist immediately cancelled my plans of running.  However, they could not cancel the fundraising.  In fact, I am more determined to raise my goal of $16,000 (for 16 years cancer-free).  This is where you come in!  I know, there are a lot of folks fundraising, many who fundraise to fight cancer but this one is different.  First and foremost, you can win sweet stuff- over $3,000 worth of vacations, clothing, art, etc.  Second and more importantly, 100% of the donations go directly to funding ground-breaking cancer research at one of the nations premier cancer centers.  The accomplishments thus far have included things such as cancer vaccines, new lung cancer therapy, a new drug to prevent cancers through fat reduction, and even the life changing drug imatinib that changed the treatment of CML from a bone marrow transplant to a daily pill.  Click on the links to donate and win some stuff!

Appointments: I have yet another skin exam with my dermatologist and check-up with my dentist.  The appointment with my endocrinologist is also on the horizon.  However, I am most excited for my ultrasound and OB visit.  Being as type-A as I am, I have tried to let go but still love having little check-ins to see what the two of them are up to.  Update to follow…

The twins one month ago!

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Miracle Twins!?!

I’m pregnant with IDENTICAL TWINS!  Although hard to believe, our first miracle baby, Augustus, is going to become a big brother this summer.  


The Back Story
For those of you who are not already aware, I spent over 13 years of my life being told that I was infertile as a result of my leukemia treatment, which included harsh chemos, total body irradiation, and a bone marrow transplant.  In the midst of planning a cross-country bike trip to raise the necessary money to allow my husband and I to have kids we recieved some exciting news – I was pregnant!  That baby who we now lovingly call Gussy, earned himself the nickname “miracle baby” as his mere existence defied most expert opinions.  About 6 months ago, we revisited the fertility specialists to assess the possibility for Gussy to have a sibling.  The outlook was bleak as it looked like I was in or at the very least, approaching early ovarian failure (a common side effect of cancer treatment).

Twins!?!
“Do you see them both?” the ultrasound tech said.  “Both?” Donny and I said in unison.  While we were expecting to see our new little one in the early stages of development, we were not expecting two little ones developing.  But there they were.  

The Details
The world of twins is far more complicated than I could have ever imagined.  As a biology major, I had a firm understanding of fraternal vs. identical (aka monozygotic) twins.  However, there are a few different set-ups for identical twins, all of which make a huge difference as the little ones develop.  Since the first ultrasound was so early (7 weeks), the physicians could not be certain of the exact type of twins that I was carrying.  They knew that the babies were in one chorionic sac (that’s the outside one).  This also meant that they were sharing one placenta.  


However, we did not find out until the next ultrasound that they were in two separate amniotic sacs, which means they are officially monochorionic, diamniotic.  I know… this is getting a little scientific.  In summary, the twins are in their own sacs with their own amniotic fluid and this is a good thing.  Because they share a placenta, things have the potential to get a little complex down the line and for that reason, I have ultrasounds every other week.  

In Good Hands
You may be wondering, what happened to Hilary’s marathon training.  Sadly, I have not been able to run with my DFMC teammates for over a month.  On my last run I was aware that I was pregnant and had been given the green light on running the marathon provided I trained consistently.  However, the Wednesday following that 14.4 mile run I was put on a temporary hiatus.  The thing is, each baby that is added into the womb increases a woman’s risk of going into cardiac arrest by 4 times.  So, a second baby is all it takes when you already have cardiac issues due to chemo for the doctors to hault the training and more importantly, my family and me to question my safety.  Fortunately, I’m in good hands.  I now visit the special ‘monochorionic twins clinic’ every other week and nothing is getting past my obstetrician.  My diet has been changed to support the twins and my heart will continue to undergo testing to ensure a healthy pregnancy for all three of us.

Growing Quickly
Most of us don’t remember our time in the womb and I’m confident that’s a good thing.  So, here’s a status update on the twins…

The twins posses all of their major organs and even have vocal chords, teeth, and fingerprints.  Although I don’t have an official measurement, they’re about 2.9 inches long.  Their head to body ratio is decreasing with their heads comprising only about 1/3 of their body.  All of the weight that I’ve put on is due to growing placenta and wedding cake because they each only weigh approximately .81 ounces.  Here’s their most recent picture.  You can see one on the left laying on its back and the other on the right turned face-down.  Despite how the photo appears, they’re not actually about to lay on each other due to the membrane that separates them but there’s no doubt they’re in close quarters.