Take Charge

Emerald's Story

August 23, 2016

Emerald-and-family.jpg Emerald and her family.

Emerald is really good at taking care of other people.

A wife, mother of two and registered nurse, she spent 10 years working at a Pinellas county hospital – at one point even serving as her supervisor's health care surrogate through a cancer diagnosis.

But when it came to her own health, Emerald says she spent most of 2015 making excuses not to see a doctor. She had back pain after a car accident in February. Moving the family a few months later made it worse. Maybe it even caused that occasional pain under her ribs. Sure, she'd gained a few pounds and got a little out-of-breath sometimes. But with her 40th birthday approaching and a scorching summer to scuttle her fitness routine, it was understandable.

After a layoff forced her back into the job market, Emerald found herself sitting in an HR office, staring at her feet in high heels for the first time in years. Her swollen ankles became a wakeup call. Fearing trouble with her heart, she went to a walk-in clinic.

"No problem," Emerald recalls the results. But the nurse in her wasn't convinced. With her insurance soon to run out, she wanted answers. A visit to a colleague's medical practice yielded a thorough history and exam, along with CT scans that showed the unexpected. Emerald had a mass on one of her adrenal glands, just above the kidney.

"I got that news the day before my 40th birthday cruise," says Emerald. "My friends who flew in from Chicago to celebrate wound up spending a girls' bonding weekend on dry land, holding me up and trying to ease my fears."

In the meantime, Emerald's scans were making their way through the hands of family, friends and friends-of-friends. One of them – the wife of a physician – suggested that Emerald see someone at Moffitt Cancer Center where her husband works.

"That was on a Thursday, and the following Tuesday I had an appointment with Moffitt surgeon Dr. Ricardo Gonzalez," says Emerald. Her husband, mother and brother-in-law tagged along for moral support. "They kept telling me – there's no way this is going to be cancer. And the nurse in me knew the chances are slim that an adrenal mass will be malignant.

"But when Dr. Gonzalez came in with my scans, the look on his face made my heart sink," says Emerald. "He said – I'm so sorry this is happening to you. The scans show a big mass, 10 by 12 centimeters (roughly four by five inches). This is adrenal cancer, and it's already invaded both the inferior vena cava and the renal veins that drain your kidneys.

"In my brain, it sounded like the adult voices in those old Charlie Brown cartoons," Emerald recalls. "All I heard was ‘cancer - wa-wah-wa-wah – chemo – wa-wah-wa-wah.' All I could think of was my kids, 8-year-old Sofia and 12-year-old Spiro. Will I be around to see them grow up?

"I was so shocked. I remember blurting out, ‘Can you help me or not?' And he said, ‘We're going to try. I'm sending you to my friend Dr. Jeff Russell, an oncologist here at Moffitt, to see if we can shrink this enough with chemo to do surgery.' "

Bigger is Not Better

Emerald and her surgeon and nurse
Dr. Ricardo Gonzalez, Emerald and nurse, Dana Johnson

Masses on the adrenal gland are not uncommon and not necessarily cancerous. Many cause no symptoms and often go undetected. According to the American Cancer Society (ACS), about one in 20 people whose unrelated health problems require abdominal imaging like CT scans will show evidence of an adrenal gland mass. But when that mass measures more than 5 to 6 centimeters (about 2 inches), it is assumed to be malignant. ACS estimates 200 people per year will receive this diagnosis. Biopsies are rarely used to confirm the diagnosis, as it may actually increase the risk that a potential cancer will spread.

"It's like an egg yolk," says Emerald. "If you puncture that mass, you can spread the cancer. Thank God the people at Moffitt know all those risks. This experience has been horrible, but I've had so many blessings like that along the way."

Emerald and nurse
Emerald and nurse, Pam Lowry

Including, she says, being referred to Moffitt oncologist Jeff Russell. "That first day I met Dr. Russell and his nurse Pam Lowry, I knew I was at the right place. Dr. Russell said our goal is to extend your life for you, your kids and husband. He and Pam treated me like I was family. They would hold my hands and cry along with me. I went through six rounds of chemo with CT scans in between. They'd do the scans on Thursdays and Pam would always call me with the results so that I didn't spend the weekend worrying. I now know that chemo doesn't always work for adrenal cancers. But mine shrank by half."

And that was enough to attempt its removal. On April 29, 2016, Dr. Gonzalez performed exploratory surgery. "He didn't know what he'd find, if it had spread, until he got in there," Emerald explains. The tumor's growth into her renal veins was especially worrisome. "There was a real chance I would lose both of my kidneys and be on dialysis. But Dr. Gonzalez got that mass out of me. I can't say enough about him or all the people at Moffitt. I owe them my life."

Emerald's cancer journey didn't end there. She faces three years of oral chemotherapy to reduce her risk for recurrence. In July 2016, she also began radiation treatments at Moffitt in the care of radiation oncologist Sarah Hoffe. Says Emerald, "I've just met her, and I love her already. I'll be there every day for six weeks.

"What I've learned through this experience is to listen to your body. Don't ignore the warning signs. Just because you are young doesn't mean it can't happen."

She also hopes her story will inspire others to turn to Moffitt for answers about their warning signs. "As a nurse, I've seen a lot of places that treat cancer, but nothing like what I found at Moffitt. Nothing compares to its Infusion Center. Everyone there is cheering you on. There's a camaraderie and unspoken bond when you get in the elevator with someone who's wearing the same scarf on their bald head – the sense that we can do this. Walking into Moffitt is like getting a warm hug."

Just what you need when the unexpected hits home.