lineHope connecting you to a network of support

HOPE FOR TWO...THE PREGNANT WITH CANCER NETWORKSPRING 2016

Hope for Two...The Pregnant with Cancer Network is

an organizationdedicated to providing women diagnosed with cancer while pregnant

with information,support and hope.

We serve women of all socioeconomic, ethnic and religious backgrounds world-

wide. Volunteers with a history of cancer while pregnant are the main-

stays of our support network. We

strive to remove barriers to women

obtaining complete and accurate information

about their options for dealing with cancer

while pregnant.We respect and support

every woman’s per-sonal decisions without

judgement.

MissionStatement

Patty Murray...M e s s a g e f r o m t h e C h a i r w o m a n

I n s i d e2 my story

5 the little mama that could

5 donation

6 ask the therapist

8 Lymphoma Diagnoses/ Treatment in Pregnancy

10 oncology massage

11 special deliveries

A year or so ago my 20 year old son Patrick, who I was pregnant with when diagnosed with advanced stage breast cancer, gave me the idea for this article. He asked, “Was your pregnancy a great incentive to fight even harder than you might have otherwise?” I have tangentially touched upon this topic, when I shared with you my mantra, “I have no option but to live.” Each time one of those fearful thoughts would creep into my mind, I would repeat that phrase over and over again. In the middle of the night, I would peer into my two little

We are braver than we believe

See “CHAIRWOMAN’S MESSAGE” continued on page 7.

GuidingValues

“children’s bedrooms, stare at them while they were sleeping, and know that I just had to be around to be their mom. But I have never really attacked the question that Patrick posed. The answer is a re-sounding, “Yes, I fought all the fiercer because I was pregnant!-” Each time I rubbed my belly I said, “I have to make it because I so want to be his mom forever!”

Once I got over the initial shock of being diagnosed with cancer while pregnant and processed the fact that what should have been one the happiest times in my life became a virtual nightmare, I be-gan to view it as a blessing. This realization then became a source of strength. I heard similar views from many Hope for Two members. They say, “If it wasn’t for my pregnancy, perhaps I wouldn’t have listened to my symptoms and been diagnosed so early.” Or, “Thank God I was pregnant because the pregnancy hormones speed up the cancer’s growth and it may have been left unnoticed for years.” Some may think that this is a Pollyanna-like approach- wearing rose colored glasses, but I think not. When given a choice between thinking positively or negatively, I always choose the positive option. If you are wrong, then you lose nothing. But if you choose the negative option and then are wrong, all

the damaging effects of negativity- higher blood pressure, depression, mental fog, increased pulse rate- have unneces-sarily harmed you.

Also, being diagnosed with cancer while pregnant only heightens what all mothers wish for themselves and their children- to dream of their child going to school, graduating from high school, and other wonderful milestones. When my son was five months old, a nurse tried to rob me of those dreams, but I wouldn’t let her. When I was done with my last chemotherapy, I marched into my surgeon’s office to have my port removed. That nurse said that I would have to keep it in for at least a year, because with my grade and stage of cancer I probably will have a metastasis within the year. I told my husband, “This thing is coming out today!” It was the will to be there for my children that gave me the strength to fight and to be so convicted that day.

and stronger than we seem!

Part 1BY LINDSAY COULTER

It was my 30th year! My husband and I had decided in May 2014 we would begin trying to have a baby. And sure enough, in July, we were blessed to find out that we were expecting. Ironically, the months leading up to my cancer diagnosis were some of the healthiest months of my life. And upon finding out that we were pregnant, I followed all the “rules.” I used the right nail pol-ish, avoided really hot showers, didn’t eat blue cheese or sunny side up eggs or lunchmeat….I was a rule following fool when it came to all of these things!

One very important rule you read in the books is to get your teeth cleaned during the second trimester. During this cleaning, my dentist checked a spot on the bottom part of my tongue that he had made a note to follow up on the next time I was in. It was still there so he recommended that I go for a biopsy and assured me the entire time it was just precautionary and he was sure it was nothing.

While waiting to hear about the biop-sy results, my husband and I went about our daily lives. On Sunday we moved into a new house, on Monday at 18 weeks pregnant we found out we were having a BOY (yay!) and on Thursday morning, my oral surgeon called to inform me that the biopsy came back as CANCER. My world stopped. As I am sure that everyone who ever hears that they have “The Big C” does. I even had to call a co-worker into my office during the call to witness the news. Cancer? At 30? While pregnant? But I followed all the rules, mapped out our plans, did things the “right” way, CANCER?

L i n d s a y C o u l t e r & K e r r i B r o o k smy story

The oral surgeon explained that it was Squamous Cell Carcinoma and she had already made an appointment with an ENT/Surgical Oncologist that afternoon. We scheduled the surgery for two weeks later. We consulted with a high risk obstetrician/gynecolo-gist to go over the risks involved with surgery. While it’s extremely scary to undergo surgery while pregnant, they still recommended the same course of action due to this type of cancer being typically aggressive in younger people. Studies show that tongue cancer can be quite aggressive.

On November 18, at 20 weeks preg-nant, I went in for the surgery. I was only in surgery for about four hours and the baby did just fine! Dr. Kim re-moved about one quarter of my tongue and about thirty lymph nodes. After surgery, I was able to eat and drink fairly well so I was able to go home after only two days.

We celebrated our first Thanksgiv-ing in our new home a week later while waiting for the full pathology report. Finally, we heard from Dr. Kim. The good news was that the lymph nodes were all clear. Thank God! The not so good news was the pathologists saw that the cancer was growing in an ag-gressive manner. Dr. Kim’s recommen-dation was that we should remove half

of my tongue, a surgery called a hemi-glossectomy and that I should undergo chemo and radiation after delivering a month early.

My world was immediately sent into a tailspin. Half of my tongue? Chemo? Radiation? I thought we were out of the woods! This is when I decided I needed some extra support. I Googled “Cancer While Pregnant” and Hope for Two’s website came up. I was astonished that there was an organization like this one. I immediately completed the form requesting a support person and just a few days later I was connected with Kerri Brooks. I hate to say that I was “relieved” to read Kerri’s cancer jour-ney, it makes me feel a bit insensitive. But I can tell you that her words and experience certainly made me feel less alone and comforted, especially after the news of a second surgery. Kerri’s honesty, optimism and sense of humor were some of the first things I valued in her. She didn’t hold back about what was going to happen. She counseled me on the toll it takes on your family, es-pecially your husband. But all the while she was a symbol of hope for me. She got through this (having her treatments while pregnant I might add…yea, she’s one tough cookie!) and so would I.

The surgery was scheduled for December 26. At the doctor’s recom-mendations, I would deliver around 35 weeks and begin six weeks of chemo and radiation the following week. This was all so scary and quite emotional. As a mother, you never want to put your child in any type of danger and you want to protect them from all harm. Knowing that I would be enduring a nine to ten hour surgery, have a trache-ostomy, a feeding tube, be on pain med-ications for some time and now have to

real stories of women diagnosed with cancer during pregnancy

SPRING 2016PAGE 2

“KERRI’S HONESTY, OPTIMISM AND SENSE OF HUMOR WERE SOME OF THE

FIRST THINGS I VALUED IN HER. SHE DIDN’T HOLD BACK ABOUT WHAT

WAS GOING TO HAPPEN. SHE COUNSELED ME ON THE TOLL IT TAKES ON YOUR

FAMILY, ESPECIALLY YOUR HUSBAND. BUT ALL THE WHILE SHE WAS A

SYMBOL OF HOPE FOR ME.”

husband, family and friends each and every day.

When Kerri and I first connected, she told me that she had grown up about an hour away from where I lived and would be coming to that area the next summer for a family reunion. So this past July we did get to meet! It was such a won-derful moment being able to hug Kerri. She had been there for me through some of the toughest moments that the cancer and treatments brought and also the joyous moment of Carson’s arrival. I can’t even express how thankful I was in that moment. I had come across a quote by C.S. Lewis that describes mine and Kerri’s connection “Friendship is born at that moment when one person says to the other, “What? You too? I thought I was the only one.” If you must find yourself in such an overwhelming situa-tion such as being diagnosed with cancer while pregnant, it is a blessing to know that there is always hope. Kerri helped me see that and I will always be thank-ful for our special bond.

Part 2BY KERRI BROOKS

I am so proud to be representing such a wonderful organization as a support person for Hope for Two. I can remem-ber when I happened upon the site...pregnant with cancer, I can’t even remember what I had searched for in my moment of being scared...I mean preg-nant with cancer, I never imagined those words to ever fit in the same sentence! To know there were others out there that had gone through or were going through it with me was the first comforting feel-ing I had had since my cancer diagnosis!

I am a 43 year old mother of one 16 year old stepchild: Carolyn, one highly dramatic 5yr old: Kaylee and one highly

PAGE 3SPRING 2016

deliver early…I could not get the guilt out of my head of what danger I would be putting my unborn son in. My hus-band was a little more level headed and matter a fact about this. So on Friday, December 26, I had my second surgery. The baby did great through everything. I got to hear his heartbeat and movements two times each day through a Non-Stress Test. He was such a trooper!

I recovered quite well from surgery and before we knew it, it was time to be induced. Our son, Carson Richard Coulter, was born on February 16 at 7:21pm. He was 7lbs. 12oz. and 21 inches long. For being a month early, he was completely healthy. We went home as a family.

A week later I started the treatments. The chemo and radiation were ex-tremely hard. And each time I started to experience something new Kerri was there with a suggestion or solution to the problem. As most cancer survivors would probably agree, you really don’t understand it unless you’ve lived it. And knowing that Hope for Two’s network and resources were there if I needed them brought a comfort that can’t be explained. It took me about three months to fully recover and get back on my feet. I could have never got through it alone and I thanked my lucky stars for my

energetic 2yr old: Maddie. I was first diagnosed with tongue cancer in June of 2009...I remember thinking tongue cancer?!? You can get cancer in your tongue! I had my first surgery on July 2, 2009: removal of the tumor in my tongue and a radical neck dissection to remove thirty-three lymph nodes (and salivary glands...however I was not aware of that until radiation)! All was good, no nodes showed any signs of cancer. My doctor said the tongue was a result of smok-ing...great glad I was peer pressured into that lovely habit! I remember being so angry at myself. After almost three years go by and my tongue began to hurt again. August 2012, I leave my school’s open house early (I am a teacher) to go to my checkup...my tongue had been hurting for about a month, I was in total denial! I remember the doctor looking in my mouth and saying “it’s back, dam-mit”! I was not prepared for him to cuss! I missed the first two weeks of school to have another surgery to remove more of my tongue...this time I was released to go home after I proved I could eat a cracker...a cracker are you kidding me! It was then I learned that I had a differ-ent strand of tongue cancer, not caused by smoking but one that was striking

“FRIENDSHIP IS BORN AT THAT MOMENT WHEN ONE PERSON SAYS

TO THE OTHER, “WHAT? YOU TOO? I THOUGHT I WAS THE ONLY ONE.”

- C.S. LEWIS

Lindsay Coulter with son, Carson.

Kerri Brooks’s daughter, Madeline.

SPRING 2016PAGE 4

m y s t o r y c o n t i n u e d . . .

women between the ages of 20 to 40, it just so happened I got both strands...well lucky me! But this time life did not go on, I was in a lot of pain, my tongue hurt all the time and the nagging pain in my ear was ever so present AND I found out I was pregnant! I went to my doctor several times and then a week or two into December I had another checkup....I reported that I had ear, tongue, mouth, throat pain...his face spoke volumes, I wanted to puke I was so scared...he looked in, once again “it’s back, dam-mit”! What, it’s back BUT I’M PREG-NANT. I could tell he did not know what to say to me...And he stated that I would more than likely need radiation after more surgery...BUT I’M PREGNANT! I was by myself that day, didn’t expect that it would be back, so I told my husband not to worry! Still don’t know how I drove an hour home that day...I remem-ber feeling numb! I had surgery in Janu-ary of 2013 to remove more tongue. Then came the follow up appointment...okay so it’s stage 2 right...the doctor states well, we are going to get to that…well, it was quite deep and very aggressive...and, and...tell me...doctor states it is STAGE 4...silence, I could feel the tears well-ing up in my eyes...stage 4...BUT I’M PREGNANT!

That is when I reached out to Dr. Elyce

Cardonick through the Hope for Two site. She was fantastic, she told me everything to ask, to say, to know. She was unbe-lievable, I would call her and she would call me back within 20-30 minutes...the info/advice she gave me was phenome-nal! There was no option of waiting until after the baby was born because of the stage. I knew it would be difficult and as a mother I did not want to put my baby at risk, but I also wanted to be around and watch both of my girls grow up. I started radiation and chemo in February of 2013. I had seven rounds of chemo once a week and 35 rounds of radiation over a seven week period. My last treatment was on March 29, 2013. That is when it all kicked my butt...I struggled with the pain and having to take the strong pain medi-cation while I was pregnant. On April

11 I started to get really bad cramps and spotting...well now I know I was in labor. Maddie Sue was born on April 12 weighing in at 4 lbs. exactly. She was breathing on her own and looked like a little beautiful porcelain doll! Maddie had to spend a month in NICU due to the fact that she was struggling with feed-ing. Maddie came home on May12 which was Mother’s Day. It all just seemed like a higher power was definitely with us, guiding us, providing us with strength! I am happy to report that Maddie, “my little tough cookie” is in fabulous health. My last PET scan was clean as well as my most recent CT scan. It is only the constant aching fear I live with now!

Becoming a support person for Hope for Two was something I decided I would do as soon as I found the organization. They had not had anyone with my specif-

ic type of cancer and they did not think they would...that was in October of 2014. By December of 2014 they contacted me about a woman that was pregnant with TONGUE CANCER. Then I felt so heart-broken for this first time mother that was going through an ordeal of a lifetime, the same struggle that I had not even fully recovered from yet. You can imagine my surprise when she told me she was from Pennsylvania and that she grew up not far from where I lived when I was a child. We were so connected! The thing about being a support person is that you are helping someone going through the same struggles that you went through…BUT what they do not understand is that they are helping you in more ways than they could ever imagine. Being able to email and text with one another reminded me that I was not alone. It let me know that what I had struggled with was real because she was struggling with some of the same things. I was scared that talking about my cancer would bring it back…silly I know, but what Lindsay did for me was make me stronger and more confi-dent and PROUD to be a survivor. But more importantly it gave me a friend that knew, she got it, she understood, she felt what I felt...we had ridden the same roll-er coaster with the same twists and turns and we were both tougher for it! I was so excited when my family chose Penn-sylvania for our family reunion. That meeting was an amazing event in my life, so much emotion and joy! Below is the poem that I wrote for her and attached the children’s book The Little Engine that Could...I figured she could read the poem to her son to explain to him what all his tough little mama went through to get him here safely (see next page).

Would you like to share the story of your pregnant with cancer journey? Con-tact us: info@hopefortwo.org.

Read more inspirational stories by Hope for Two members on our website: www.hopefortwo.org/survivor_stories.php

“THE THING ABOUT BEING A SUPPORT PERSON IS THAT YOU ARE

HELPING SOMEONE GOING THROUGH THE SAME STRUGGLES THAT YOU WENT THROUGH…BUT WHAT THEY DO NOT

UNDERSTAND IS THAT THEY ARE HELPING YOU IN MORE WAYS THAN

THEY COULD EVER IMAGINE.”

Lindsay Coulter and Kerri Brooks withtheir babies.

PAGE 5SPRING 2016

“t e s t i m o n i a l

I’m very appreciat ive of the

support and gif ts you have sent .

Thank you for your thoughtful-

ness and for connect ing me with

my support person.”

-PAM C., AUSTRALIA

If you are receiving our newsletter by mail and wish to receive it electronically, or to unsubscribe,

please contact us at info@hopefortwo.org.

Hope for Two member Linda Abundez’s daughter, Abigail.

The Little Mama That CouldBY KERRI BROOKS

The day she heard, she cried tears of joy:a new little bundle a beautiful baby boy!

A time to be happy a time to be gladbut suddenly stricken with an obstacle that made her sad!

Tongue cancer, what’s that, why me, no way! I have big plans; I don’t understand what you doctors say!

To help the little mama fight they came up with a plan,and even though she was scared she said “I think I can!”

She was brave, she was fierce, she fought with all her might!Soon she was kissing her baby boy and hugging him tight.

She continued to kick cancer in the butt,chemo, radiation she felt sick in her gut.

But the love all around her and her beautiful songave her the strength to continue even though it was not fun!Now she feels better, some days she never thought she would

and looking back on her fight she says “I knew I could!”

DonationWe wish to extend our sincere thanks to The Josefine Teneback Charitable Fund at Schwab Charitable for their gracious grant in memory of Hope for Two member and support woman Shannon Szameitat.

Hope for Two Member Annie Lee and son, Logan.

SPRING 2016PAGE 6

Hope for Two member Juliette Graziano with daughter, Janiya.

a s k t h e t h e r a p i s t

Chris is a licensed clinical social worker, Vice-Chairwoman of Hope for Two…The Pregnant with Cancer Network Board of Directors and a co-author of the Hope for Two Volunteer Support Woman Training DVD.

I am struggling to manage my toddlers’ normal everyday growth and development as I undergo treatment for breast cancer while pregnant. I feel distanced from him and am worried he will grow up scarred from my inability to give him all he needs right now.

I do not know how you could not be struggling to care for your toddler while simultaneously undergoing treatment for cancer during your pregnancy. Keep in mind that the QUALITY of the time you spend with him is what is most important, not necessarily the quantity. If possible, consider using a day care for two days a week so you can rest and/or receive treatment without feeling he is being ignored. When friends/family ask what they can do to help, ask them to read to your little one, or go for a walk, or give a bath. The more people who love your child, the more he will thrive. You cannot do it all. What he will remember about this time is your consistent love for him. Creating a safe and loving environment is the priority and that can be a shared responsibility.

Q:

BY CHRISTINE BYLEWSKI

A:

Hope for Two member Najla Clark with daughter, Maymuna.

Hope for Two member Patty Heltzen’s son, John.

PAGE 7SPRING 2016

If you live in the Western New York area and would like to serve on the Hope for Two

Board of Directors, please contact Patty Murray at info@hopefortwo.org.

Hope for Two member Mariah Yates’s son, Silas.

Hope for Two member Ashley Bos’s son, Declan.

Two years ago, when I was diagnosed with my second breast cancer, my daughter Molly shared with me the following saying on a card that I carried with me for over a year.

I hung onto those words during the initial dark days and I turn to them today as I once again defeat cancer.

May we keep on tapping into that strength that breaks through during times of struggle; and when we find we have some extra, may we share it with others and bolster those that are running a bit low. Until next time, be strong, and always remember to hope!

c h a i r w o m a n ’ s m e s s a g e c o n t i n u e d . . .

t e s t i m o n i a l

“IF EVER THERE IS TOMORROW WHEN WE’RE NOT TOGETHER, THERE IS SOMETHING YOU MUST ALWAYS

REMEMBER--YOU ARE BRAVER THAN YOU BELIEVE, STRONGER THAN YOU SEEM, AND SMARTER THAN YOU THINK.”

-CHRISTOPHER ROBIN TO WINNIE THE POOH

“I wanted to say thank you to you and everyone for making The Pregnant

With Cancer Network possible . I t is t ruly an invaluable resource.”

ANNIE L., CALIFORNIA

Hope for Two member Jennifer Pacifico’s daughter, Charlotte.

SPRING 2016PAGE 8

Lymphoma Diagnoses/ Treatment in Pregnancy

BY ELYCE CARDONICK, MD, FACOG

cated about the trimesters of pregnancy and that the majority of the development of the fetal organs occurs during weeks three to twelve, so if possible chemo-therapy is best avoided at this time. Meanwhile, surgery can occur during any stage of pregnancy, as can the majority of investigative studies. However, as in this case with the gallium scans, radiologic

studies that will not change the treatment course of the cancer during pregnancy are best delayed until postpartum. If a study needs to be done to clarify a diagnosis, or to gauge the correct treatment, again the oncologist should consult with the obstetrician or a radiology department at their hospital to discuss possible fetal exposures from the test in question. For example, if an MRI can provide the same information as a CT scan, the former is preferred during pregnancy. (If not, a CT scan is not contraindicated during pregnancy). Another example is that a MUGA (multiple uptake gated acquisi-tion) scan, also done in nuclear medicine to check heart function prior to beginning certain types of chemotherapy, is routine in non-pregnant patients. Patients who are pregnant also need to be sure their heart is healthy before starting anthra-cycline chemotherapy; however, the oncologist can gain the same information about heart health from an echocardio-gram or ultrasound of the woman’s heart.

It was September of 1997, beginning the second year of my fellowship in Maternal Fetal Medicine when I got the call. The risk management department of my hospital was calling to ask if I would perform a termination of pregnancy on a patient at 10 weeks gestation with newly diagnosed Hodgkin’s disease. This was quickly followed by a phone call from the hospital’s nuclear medicine department where this patient was being scheduled for a gallium scan for Hodgkin’s disease and did I know she was pregnant?! I called the oncologist and asked if hav-ing a gallium scan for newly diagnosed Hodgkin’s disease would change his management, or if information gleaned from that test could be acquired by other tests without radiation. The oncologist said “No, this will not change her man-agement, but I always do this test before treating patients with Hodgkin’s disease and I need to manage her the same way as other patients with HD.” This in fact started my journey creating the Cancer and Pregnancy Registry. While it is true that my wish is that pregnant women with cancer receive the same cancer therapy as non-pregnant women if possible (to avoid suboptimal treatment) some aspects of cancer diagnosis and care need to be modified for the pregnant patient. I ex-plained to the oncologist, in this case you are treating two patients, not just one, and the response was no, I am treating her the same way as my other patients with Hodgkin’s disease.

It is not unusual for an oncologist to have never met a patient who is pregnant at the time of a cancer diagnosis, just as it is not unusual for an obstetrician to have never met a pregnant patient with cancer. The key is that there needs to be communication between these two services. The oncologist needs to be edu-

Information is gained about the woman’s heart using a test that has decreased risks to the fetus, without at all increasing the risks to the pregnant patient.

So what happened with this patient? We cancelled the gallium scan and scheduled instead a meeting with this brave couple who did not wish to terminate their preg-nancy, the oncologist, myself, my mater-nal fetal medicine director and the ethics board of the hospital. We reviewed stud-ies where pregnant women who termi-nated their pregnancies had the same five year prognosis as women who continued their pregnancies. We also discussed pub-lished cases of women with Hodgkin’s disease who received chemotherapy dur-ing pregnancy and the children were born healthy. Yes, there were certain unknown risks, such as long term consequences for the children, but no study supported termination and given that Hodgkin’s disease is amenable to chemotherapy, we could not justify delaying treatment until her delivery.

Eighteen and a half years later, this little guy is applying to college! He has competed in sports, done well in school and has met developmental and physi-cal milestones. At the time of this ethics debate, although there was information available in 1997 about women who received chemotherapy during preg-nancy, the information mostly included how these children appeared at birth- normal without birth defects, normal birthweights, but limited follow up as they were growing older. Would they go through puberty normally? Would they do as well in school as their unexposed siblings? Currently in the Cancer and Pregnancy Registry we follow 344 wom-en who were diagnosed with cancer dur-ing pregnancy. Of these, over 250 have received chemotherapy during pregnancy.

“IT IS NOT UNUSUAL FOR AN ONCOLOGIST TO HAVE NEVER MET A PATIENT WHO IS PREGNANT AT THE

TIME OF A CANCER DIAGNOSIS, JUST AS IT IS NOT UNUSUAL FOR AN OBSTETRICIAN TO

HAVE NEVER MET A PREGNANT PATIENT WITH CANCER. THE KEY IS THAT THERE NEEDS TO BE COMMUNICATION BETWEEN

THESE TWO SERVICES.”

PAGE 9SPRING 2016

Not only do we request birthweight information and have any birth defects reported, but on a yearly basis we follow the overall development and the physical growth of the children. When we are able to raise funding, developmental testing is more formally performed by a licensed psychologist. As published in the Ameri-can Journal of Obstetrics and Gynecolo-gy, 35 children exposed to chemotherapy during pregnancy performed equally well compared to 22 children whose mothers were diagnosed with cancer in pregnancy but did not require treatment other than surgery during pregnancy.

There are 35 women in the Cancer and Pregnancy Registry diagnosed with Hodgkin’s disease, 16 with Non-Hodg-kin’s Lymphoma. Patients with Hodg-kin’s disease present similarly to non-pregnant women with this disease- cough, unexplained itching, and enlarged lymph nodes above their collar bone. A biopsy of these enlarged lymph nodes, or a chest x-ray with shield performed during a work up of the cough usually leads to the diagnosis. The average age of patients in

the Registry with Hodgkin’s disease is 31 years, and diagnosis was most commonly at 16 weeks of pregnancy. The age of the patients with Non-Hodgkin’s disease at diagnosis was 29 years of age, at 19 weeks of pregnancy most commonly. The most common type of Hodgkin’s disease in the Registry is Nodular Sclerosing, which is the same as in the non-pregnant population. Nine patients were advised to terminate their pregnancies. Sometimes, even non-pregnant patients with Hodg-kin’s disease do not require immediate chemotherapy. If the patient is advanced in her pregnancy, treatment can often be delayed. If however treatment would be started in a non-pregnant patient with the same presentation, then treatment should begin after the first trimester. ABVD (Adriamycin [doxorubicin], Blenoxane [bleomycin], Velban [vinblastine], and DTIC [dacarbazine]) is the regimen most commonly studied during pregnancy. Maternal survival has been similar to non-pregnant women with the same stage at the time of diagnosis.

Presentation of Non-Hodgkin’s Lym-phoma can be more challenging during pregnancy. Sometimes these cancers present during pregnancy with ovarian masses or bilateral massive breast en-largement. (This is not the typical breast engorgement of normal pregnancy). Whenever unusual masses are present on both sides of the body, i.e. both breasts or both ovaries, before removing such masses, a biopsy should be performed for a diagnosis. If NHL is confirmed, treat-ment itself will help to shrink the masses, they will not require surgical removal. Unlike Hodgkin’s disease, this is not of-ten delayed, except for avoiding the first trimester. The treatment of NHL during pregnancy includes CHOP (Cyclophos-phamide [also called Cytoxan/Neosar], Doxorubicin [or Adriamycin], Vincris-tine [Oncovin] and Prednisone), with or without Rituxan. Rituxan, or rituximab is an antibody against a protein primarily found of the surface of immune system B-cells which it destroys. Newborns

exposed to rituximab during pregnancy were found to have low B-cell counts at birth, but had spontaneous B-cell recov-ery at six to nine months. Investigators have assessed exposure of children’s B-cell function looking at the child’s production of different antibody titers after standard vaccinations for tetanus, diphtheria, hepatitis B, measles, mumps and rubella. Protective immunity and sufficient level of serum antibodies were observed for all tested antigens. In fact, no serious infectious complications have been documented in neonates exposed to rituximab.

A single article in the literature sug-gested that CHOP with R (Rituxan [ritux-imab]) led to preterm deliveries in all three of their treated cases. We compared the rate of spontaneous preterm labor and delivery in women in the Registry exposed to CHOP versus CHOP+R and found no difference in preterm labor or number of weeks of pregnancy at the time of delivery. Treatment of the pregnant woman with Hodgkin’s or Non-Hodgkin’s Lymphoma should mimic how non-pregnant women with the same dis-ease are treated. Newborns do best when their mothers are healthy.

Dr. Elyce Cardonick, MD, FACOG, is a maternal-fetal medicine specialist practicing at Cooper University Hospi-tal, New Jersey, and is a member of the Hope for Two Advisory Board. She is the creator and Director of the Cancer and Pregnancy Registry, maintaining the data and publishing the outcomes. She is available to consult with women and/or their physicians to address medical ques-tions pertaining to their specific cancer and pregnancy situation. For more infor-mation, visit: www.cancerandpregnancy.com or call 1.877.635.4499 (toll free) or 1.856.342.2491.

Hope for Two member Donna Trammell’s daughter, Deonna.

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Massage therapy has long assisted expectant mothers with aches, pains, nausea, and fatigue. As a mother to be with can-cer, you may think that having a massage is something out of reach for you. This is not the case. There are therapists with advanced training that can help ease those common symptoms and who understand cancer and cancer treatment and its side effects. What is oncology massage?

Oncology massage came about in the 1980’s when a few therapists made it their mission to help people with cancer. One of the first pioneers of this work was Gayle Macdonald, MS, LMT. She found massage had a positive impact on people being treated for cancer. Many have found much joy in serv-ing this deserving group. Oncology massage is a gentle and slow therapy that takes into consideration the various chal-lenges that a person going through cancer treatment experi-ences. The therapist is trained in oncology terminology, types of treatments and their side effects. Each session is adapted to the person’s needs and treatment plan. The session times vary according to each client’s needs. Some may benefit from a 30-minute session and others find a 1-hour session is just right. This is something that can be adjusted and tailored for you. The therapist will keep in contact with the client’s oncologist to confer whether the client is a good fit or if there is anything the therapist needs to know to tailor the sessions; but just hav-ing your doctor’s go ahead does not replace the importance of having a therapist with advance training in oncology massage. The therapist is trained to position the clients for maximum comfort and to accommodate port sites, surgical sites, etc. Through various studies done over the years, massage therapy for clients with cancer may help to reduce fatigue, reduce pain, reduce nausea, decrease anxiety, and increase a feeling of well-being. Think of this as a mini-vacation. This is a great time for mom and baby bonding time in a safe and nurturing setting; a chance to slow down and have a measure of control in your path toward healing. This is a chance to leave the clini-cal at the door and just experience the wonder of your preg-nancy and your body’s power to grow this precious life.

The Society for Oncology Massage is a great resource in finding a qualified therapist in your area. If there is not a therapist in your area listed, they have a worksheet that can guide you to finding a therapist that is qualified to work with you: http://www.s4om.org/clients-and-patients/is-your-thera-pist-trained.

Oncology MassageFIND A THERAPIST:

United States Society for Oncology Massage: www.s4om.orgCanada: https://secure.rmtao.com/ United Kingdom: http://www.gcmt.org.uk/

ABOUT THE AUTHOR:Deidre M. Medina, LMT has been a licensed massage thera-

pist since 2005. She has a passion for working with patients living with cancer and helping expectant mothers through massage therapy. She is also a birth doula supporting families through pregnancy and providing physical and emotional sup-port through the birth. She believes in the importance of moms having a choice in how they birth and empowering women in the Western New York area.

www.adeidremedinamassage.com Deidre has an office at Village, 140 Elmwood Ave, Buffalo, NY 14201.

BY: DEIDRE M. MEDINA, LMT

Hope for Two member Stephany Cross’s daughter, Hope.

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NAJLA CLARK gave birth to MAYMUNA in December 2014 (5 lbs. 13 oz.)

ASHLEY BOS gave birth to Declan Kevin in April 2015 (5 lbs. 15 oz.)

PATTY HELTZEN gave birth to John in June 2015 (6.08 lbs.)

MONIKA ALLEN gave birth to Eva in July 2015 (6 lbs. 10 oz.)

NORINA SCHIRRIPA gave birth to Francesca Hope in August 2015 (6 lbs. 9 oz.)

SUSAN BUZBY gave birth to Autumn Hope in October 2015 (7 lbs. 10 oz.)

LINDA ABUNDEZ gave birth to Abigail Faith in October 2015 (6 lbs. 7 oz.)

ANNIE LEE gave birth to Logan in January 2016 (7 lbs. 6 oz.)

STEPHANY CROSS gave birth to Hope McKinnley in January 2016 (5 lbs. 12 oz.)

JULIETTE GRAZIANO gave birth to Janiya Noelle in February 2016 (5 lbs. 8 oz.)

MARIAH YATES gave birth to Silas in February 2016 (6 lbs. 14 oz.)

JENNIFER PACIFICO gave birth to Charlotte Grace in February 2016 (7 lbs. 3 oz.)

DONNA TRAMMELL gave birth to Deonna Antonease in March 2016 (6 lbs. 2 oz.)

Hope for Two member Susan Buzby with daugher, Autumn.

Hope for Two member Norina Schirripa’s daughter, Francesca.

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Materials published in Hopeline are not intended to provide medical advice, which should be obtained from a qualified physician. Information and ideas included do not necessarily reflect the views and opinions of all members.The Hopeline newsletter is produced by Hope for Two member Jodie Orzechowski. Jodie dedicates her time to the newsletter because the photos and stories are inspiring and comforting. The newsletter is a way for her to pay it forward.

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