Pregnant with cancer

May 09, 2018
Heather Toeppner and Noah
Heather Toeppner was six months pregnant with her son, Noah, when she was diagnosed with breast cancer. Photos by Dawn Brazell

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.

Heather Toeppner
Hoeppner regularly works out with Survivors' Fit Club and on her own. She feels that the exercise helps with the emotional and physical recovery.

“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

The last year has taught Toeppner  that nobody could prepare her for cancer. “Ironically, they also say the same about motherhood. This past year we’ve endured successes, along with a fair share of obstacles. The silver lining is and has always been my once-in-a-lifetime opportunity to be a mom to Noah, putting my heart and soul into this very role.”

She has experienced profound changes, she says.

“What I have found as a result is a deeper and more honest connection with who I am – finding that balance as an individual, as a parent and as wife.”

Toeppner’s new normal is to savor each moment and milestone with Noah before it passes her by. “I surround myself with nothing but love and support from my husband, family and close girlfriends. I have even met a few amazing moms locally and across the country who are also balancing the challenges of being a new mom and cancer treatment.”

Especially as new moms, women have a tendency to push their health care needs to the side as they care for their infant, she says.  On top of everything, Toeppner was diagnosed with post-partum depression. One in 5 moms will experience a perinatal mood and anxiety disorder during and/or after pregnancy, she says. “The level of depression I experienced was far more debilitating then the 16-week chemotherapy schedule. Yes, I just compared depression to cancer, and here’s what I learned: The first step is recognition.”

Heather, Dan and baby Noah Toeppner
On Mother’s Day, Toeppner, Noah and her husband, Dan, will participate in the 15th annual Mom’s 5K Run/Walk.

Right around Thanksgiving, when her son was 3 months old, she began having unexplainable, intermittent crying spells. She had a very difficult time verbalizing her immediate feelings, so she wrote them down – every emotion and inner thought she was having. She shared this with her obstetrician, with whom she had grown very close during her pregnancy. She also took advantage of an MUSC Women’s Health walk-in clinic every Wednesday from 8 to 10:30 a.m. for postpartum moms who need an initial evaluation. She became involved with a local support group, Postpartum Support Charleston.

“I couldn’t believe the amount of support I received that first morning and the subsequent months after. I immediately felt connected with these women and knew I had nothing to be ashamed about.

For Mother’s Day, Toeppner, her husband, Dan, and Noah will be participating in the 15th annual Mom’s 5K Run/Walk hosted by Postpartum Support Charleston at the MUSC Stadium on Daniel Island. Toeppner also will be taking some down time with her son, who just turned 9 months old.

A giant smile erupts on her face as she describes him. “I love to watch him evolve into this tiny independent person. He’s sitting up, crawling, standing and grabbing everything in sight. Naturally, he’s super curious about everything. His bright blue eyes, baby babble, giddy laughter and big smile – two bottom teeth and all – just melt my heart every single day.”