Jennifer Miller's Story She fought for her baby, and to overcome leukemia. Jennifer Miller had the glow of an expectant mother in fall of 2002. She and her husband, Greg, were eager for the birth of their first child and ready for the challenges of parenthood. In the coming weeks and months, Jennifer would face obstacles that most pregnant women could never imagine, as she battled for her own life and the life of her unborn child. In the process, she inspired many doctors, nurses and staff at the James P. Wilmot Cancer Center with her strength and grace. “She’s an amazing person and I am totally in awe of her,” says Wilmot oncology nurse Patti Murray, R.N., B.S.N. Approaching her third trimester of pregnancy, Jennifer suffered from escalating pain in her hips and back. The expectant parents feared that Jennifer was going into early labor. Greg took her to the Emergency Department at Highland Hospital, where doctors discovered something even worse. Jennifer was diagnosed with acute lymphocytic leukemia, a type of blood cancer known as ALL. And she needed treatment immediately. “I was very calm at that point,” Jennifer recalls. “However, people around me were spinning out of control. My parents were shaken…their pregnant, 27-year-old daughter had cancer and was given a 30 percent chance of long-term survival. It was unreal.” Weighing the Risks At Wilmot Cancer Center’s inpatient unit, the Millers spent that first night conferring with hematologist J.J. Ifthikharuddin, M.D., high-risk obstetricians, and several other specialists, to review options and assess the challenges that lie ahead. “ALL is an aggressive disease and it needs to be treated aggressively. If you hold back treatment, you can make it worse,” says Ifthikharuddin, assistant professor of hematology/ oncology. ALL affects about 5,000 people every year in the U.S., mostly children and aging adults. Jennifer’s multidisciplinary team of experts exchanged ideas and investigated the optimal treatment plan for her leukemia. The doctors looked at every medication that would normally be prescribed, how the drugs might affect the baby and whether alternate drugs were available that could be just as effective without any impact on the unborn child. Research shows that many chemotherapy agents are safe for pregnant women. However, most studies have focused on pregnant women diagnosed with breast cancer, which is far more common than leukemia. “There was a lot of coordination throughout her pregnancy and leukemia treatment,” says Ruth Anne Queenan, M.D., the obstetrician. “We talked about the chemotherapies, the timing of her chemotherapy cycles, and when we consider delivering the baby rather than expose him to another round of chemotherapy.” When Jennifer began the first of her chemotherapy infusions, she got very sick and suffered liver failure. Doctors worried that her reaction could hide pregnancy complications. “We watched for infection because her immune system was suppressed. We worked closely with the hematologists in assessing her symptoms and test results,” remembers Queenan, associate chair of Obstetrics and Gynecology. “Angel Nurse” The side effects and complications put the Millers on a rough ride. Jennifer was immediately hospitalized for more than a month, and during that period, Jennifer credits “angel nurse” Patti Murray, with helping ease the stress. At the time, Murray was senior nurse manager for the 6-3400 oncology unit. “She knew exactly what we were feeling and helped calm us down when we needed it. She really supported us through the process,” says Jennifer. “Patti was so in-tune to what was happening to all of us and even remembered my birthday.” The day that Jennifer turned 28, Murray brought linens and china and crystal place settings from home. She had ordered a gourmet dinner for Jennifer to share with her husband as part of her birthday celebration. “You don’t expect that kind of treatment and it was amazing to have her on our side,” Jennifer says, adding that the friendship continues today. Murray says she was inspired by Jennifer’s positive attitude and focus on the goal of survival. “She’s a fighter and she fought hard,” Murray says. “To see her today, I’m in awe of her. She faced so many things that most people with cancer don’t have to deal with.” “Healthy, Feisty Baby” Surprises continued for Jennifer. Her water broke in mid-January, about 12 weeks before her April 18, 2003, due date. Queenan’s team was able to delay delivery for about a week. But Noah Gregory Miller was born Jan. 31, 2003, weighing just 2 pounds, 7 ounces. “He was healthy and a feisty little guy,” Jennifer says proudly. Noah spent three months in the Neonatal Intensive Care Unit at Golisano Children’s Hospital at Strong as his lungs matured, which is common for infants born prematurely. “I continued to go in and get my chemo every day. I’d go to the NICU to see him in the mornings, leave in the afternoon to get my treatment, and go back to see him until evening.” Spirits were high in May 2003 when the Millers took their son home from the hospital. The new parents were excited to introduce him to the nursery that they had lovingly prepared. Jennifer had yearned for the time when she could care for him. As she progressed through her second year of chemotherapy, Jennifer felt twinges and then sharp pains in her hips. Doctors diagnosed avascular necrosis, caused by extended steroid use. The standard treatment for leukemia includes prednisone, a common steroid, as part of the chemotherapy mixture. Although steroids are effective at combating disease, they also block blood flow to the bones. Jennifer’s hip joints were eroding. “It’s a rare complication, especially for someone as young as Jennifer. It was a tremendous challenge for us and we really wanted to find a way to solve this problem,” Ifthikharuddin says. The pain grew worse. A once athletic, energetic educator, Jennifer was eventually confined to using crutches and then a wheelchair for 18 months. She struggled to care for Noah, who was then a mobile toddler, even with her mother’s generous support. Restoring Quality of Life Joint replacement was the answer, but Jennifer’s diagnosis put her at risk of life-threatening infection and some orthopaedists were reluctant to do the procedure. Chemotherapy shuts down a patient’s immune system, and any infection, never mind a surgical procedure, is risky. Allen D. Boyd, M.D., chief of adult reconstructive surgery in Orthopaedics, was willing to try. “Here’s a woman who was wheelchair-bound and suffering continuous pain. What kind of quality of life was that for her?” says Boyd, director of the Evarts Joint Center at Highland Hospital. “Her immune system was compromised and we needed to be extremely cautious in our planning and execution.” Boyd and Ifthikharuddin put their heads together to help Jennifer through the surgery without infection – and she came through with flying colors. Her hips were replaced, one at a time, in January and April of 2004. But later that year, as she was still recovering from her hip surgeries, Jennifer’s bone deterioration continued in her shoulders. Richard Miller, M.D., professor of Orthopaedics, joined Boyd and Ifthikharuddin to strategize how to replace those joints in July 2004 and January 2005. Amazingly, over a 12-month period, after completing three years of chemotherapy, Jennifer endured four joint replacement surgeries. It was a painful journey. But today, Jennifer can chase speedy Noah around their Fairport home, she’s returned to work as an elementary speech language pathologist at Brooks Hill School, and she relishes time with her family.