It was small. Tiny really – about the size of a pencil eraser. But it itched…and itched…and itched. So Vicki Heidle did what comes naturally – she scratched it.
In doing so, she set in motion a chain of events that not only gave the 67-year-old Clinton woman the scare of her life but also the strength to face it, thanks to an understanding and empathetic Covenant Health oncology team from Fort Sanders Regional Medical Center and Thompson Oncology Group.
The itch was the only hint Heidle would ever get before the small lesion just right of her spine was diagnosed as Stage III melanoma, the rarest
form of skin cancer but also the most aggressive.
After the biopsy, her dermatologist sent her to Dr. Paul Dudrick, a Premier Surgical Associates surgical oncologist at Fort Sanders Regional.
“I had never met him, but he sat there and talked to me like there was not another person in the world he would ever have to see,” said Heidle, a program specialist at Oak Ridge Associated Universities.
“He explained what it was, what the staging was, what I could expect. I went in scared to death, and I came out feeling not quite so frightened because he was absolutely wonderful.”
“The bottom line is you’ve got to put yourself in their position,” said Dr. Dudrick. “There’s an impact to this illness that you have to take into account. All good doctors do that. My medical school (St. Louis University School of Medicine) was Jesuit and they really wanted everybody to have that empathy that you really only get by asking what you would do if you yourself were sitting on the other side.”
Not only was Dudrick’s relaxed demeanor reassuring to Heidle, but so was his professional knowledge. “He had a plan. He set up a plan for what we were going to do and how he was going to address it,” said Heidle. “That is so much better than trying to deal with it in a vacuum. It was realizing that he was going to be able to do something to help. That made it not so much of a mystery, knowing that he had a plan of action.”
In a single, same-day surgery on July 1, 2014, Dudrick removed the lesion and took tissue samples from sentinel lymph nodes under her left arm. Within days, the sampling revealed the melanoma was also in the lymph nodes under Heidle’s right arm. A second same-day surgery to remove those lymph nodes took place days later.
Working in cooperation with Thompson Oncology Group’s Dr. Thomas Repine, who had previously treated Heidle for unrelated iron infusions, Dr. Dudrick then placed a port for Heidle’s chemotherapy treatments.
“Dr. Repine did the same thing as Dr. Dudrick,” said Heidle, praising the oncologist’s reassuring professionalism. “He said, This is not a death sentence. This is not good, but it could be worse.’ He took the time explain the staging and what actions we’d take.”
One of those actions was to enroll Heidle into a clinical trial as quickly as possible. The adjuvant treatment trial compares ipilumumab, an up-and-coming medicine that boosts the immune system through activation of “T” cells, to Interferon (IFN), the protocol drug given five days a week for four weeks via infusion, followed by self-injections three times a week for a year.
“Interferon works by mainly turning up the immune system to fight the cancer,” said Dr. Repine. “It involves one month of daily intravenous therapy, followed by subcutaneous shots for a year. During this time, multiple side effects are expected, including low blood counts, feeling like you have the flu all the time and sometimes, dysfunction of the liver.”
Because of the excitement around the newer trial medicine’s possible effectiveness and potentially less toxic side effects, Dr. Repine had hoped Heidle would receive the newer medicine. As it turned out, she did not receive the new cancer drug and is now nearing the end of those thrice weekly injections. But by participating in the trial, she has found herself the center of attention.
“It was an unknown and it did make me a little nervous,” she said. “But I thought, ‘You know, if there’s a chance that it’ll be good for me and help somebody else, then why not?”
“The importance of participating in clinical trials cannot be overstated,” said Dr. Repine. “People like Ms. Heidle are helping all of us advance the fight against cancer.”
“It’s pretty awesome the level of care that I’ve had – it’s pretty amazing,” Heidle said.
“That’s the way a multi-disciplinary approach is supposed to be, says Dr. Dudrick.
“If she had a problem, we’d present her case at conference and talk about what we would do,” he said. “We meet weekly as a group with the oncologists, radiologists, pathologists. It’s a multi-disciplinary conference and that’s where we discuss the care of patients who have new diagnoses or new developments, so that it’s not just one doctor handling their care. That’s pretty standard here.”
“Everything has been so seamless, so coordinated since Day One. They all work so well together. They really, really have,” said Heidle. “There are a lot of times I have to trot out to the doctor, but that’s OK. Every little thing, every little blood level and count, they check. They’re really on top of things. To not even be in the same office, they communicate really well. You know, if you have to have cancer, this is the way to do it – with all of the support.”