Kelly was busy breastfeeding, working and raising her son Caleb, along with her husband Jeff. Ready for next steps, she was excited to grow her family. When she was just shy of 7 weeks pregnant, Kelly came in to see her OB/Gyn, Lisa Karamardian, M.D., F.A.C.O.G., Jeffrey M. Carlton Endowed Chair in Women’s Health in honor of Dr. Anne M. Kent, to confirm the happy news that she was indeed pregnant with her second child.
“While she was in the office, she mentioned that she felt something, and when I examined her, I knew right away that we needed to get some imaging,” Dr. Karamardian said. “Kelly had mastitis while she was breastfeeding, and she felt there might be some residual inflammation, but we knew it was important to evaluate her. That got the ball rolling.”
Diagnosing and staging cancer in pregnant women is more complicated due to the pregnancy and the breast density. However, specialists at Hoag, like breast radiologist Dr. January Lopez, were ready and engaged to quickly workup Kelly’s breast mass.
With the help of her father, a prominent OB/Gyn professor in California, Kelly sought out the opinions of several experts at different centers, some of whom recommended more conservative approaches to diagnosis and treatment. Dr. Karamardian notes, “Our job is to educate patients and help them down the right path and facilitate that journey, and in Kelly’s case, this journey was complex, deciding between lumpectomy or mastectomy in early pregnancy.”, Kelly and Jeff ultimately decided to continue her care at Hoag, where they felt comfortable.
“I’m surrounded by the best care,” Kelly said. “I’m so blessed to have such a close-knit group who genuinely care about me as a person.”
One of the deciding factors in Kelly and Jeff’s decision to stay close to home for their care was the fact that Hoag was able to quickly facilitate and workup her mass. Heather Macdonald, M.D., medical director of the Hoag Early Risk Assessment Program and the Hoag Breast and Ovarian Cancer Prevention Program, is an OB/Gyn who specializes in breast surgery.
“Kelly bonded with Dr. Macdonald right away because she has taken care of pregnant women in her training,” Dr. Karamardian said.
Kelly’s surgical team also included a plastic surgeon, Dr. Ali Qureshi – another way Hoag differentiated itself in the couple’s eyes. “Many pregnant women are told they cannot have reconstructive surgery. It’s one of the many misleading things that are said to pregnant women that is simply not the case,” Dr. Macdonald said.
Kelly’s surgical team recommended a mastectomy, a more aggressive approach than what other surgical teams in the area advised. Hoag’s recommendation turned out to be the right call, as the surgery revealed that Kelly had stage 3 triple-positive breast cancer, a more invasive and extensive cancer than predicted.
Hoag’s multidisciplinary approach brought together her oncology team, obstetrics team and maternal-fetal medicine team which decided as a group that she could safely undergo her mastectomy. This meant that Kelly was already 12 weeks pregnant when she learned she would need far more extensive cancer treatment than she had imagined.
Her team then worked exhaustively to create a treatment plan that could fight her cancer while protecting her baby. “I feel so grateful, because due to the continued research and development of drugs to fight breast cancer if I had gotten triple-positive breast cancer 10 or 20 years ago, the outcome of my prognosis would have been completely different,” Kelly said. “But now there are all these chemotherapy and immunotherapy drugs. I was also able to get a chemo during pregnancy that has been proven safe for the baby.”
“There is a misconception that pregnant women will be put in a position of choosing to continue their pregnancy or undergo cancer treatment, and so some wait until after they have delivered to check out any disconcerting lumps,” Dr. Macdonald said. “What Kelly’s situation highlights is that we can safely and effectively treat pregnant women for breast cancer. We can take care of the woman and protect her pregnancy.”
“Every cancer is different because every woman is different. We also change at every stage of our lives, especially during pregnancy,” Dr. Macdonald said. “We tailored a treatment specific to Kelly during pregnancy and post-pregnancy that could protect her baby while fighting her cancer,” she said. “She was an amazing patient to work with because her attitude and positivity were so vital to the success of her treatment plan.”
Kelly credits her faith in God and her trust in her medical team with her positivity: “Throughout this whole experience, I had my doctors, and I had my faith. So, I just had a sense of peace throughout all of this. Yes, I was scared, but I never thought I was going to die or that I was going to lose my baby.”
She took to Instagram to document her journey, posting pictures of herself in a cold cap to minimize hair loss. Sharing the images of her mouth sores. Detailing post-surgical pain and chemotherapy sessions. The good, the bad, the ugly. And… always, the grateful.
“I call them ‘God’s winks,’ little signs that God is showing me, ‘Kelly, you’re not alone,’” Kelly said in one video post.
Kelly said she posted her journey to serve as an inspiration and source of hope for others. But that doesn’t mean that every post was cheerful. In one of Kelly’s posts, she detailed how thankful she was that her older child, Caleb, was going to have a sister. Having both a boy and girl was a blessing to her based on the fact that she would most likely not have another child, she explained, because she will have to remain on hormone blockers for five to 10 years to help keep her cancer from returning.
“I went from all the hormones you have after birth to chemo-induced menopause to medically induced menopause,” she said. “[Dr. Karamardian] helped me figure out how to best manage the symptoms. I did a bone scan recently to make sure that my bones are healthy. I wouldn’t have known to do that if it weren’t for her, because I’m only 36.”
Women have reached out to Kelly to tell her that she has been an inspiration on their own breast cancer journeys. And family members have told Kelly that her story has inspired them to get genetic testing (her family does not carry the BRCA gene mutations associated with breast and ovarian cancer although breast cancer runs in her family) and to stay current on mammograms.
“My version of therapy was sharing my stories on social media. I felt that if I went through all this and could help someone else, that would make it worth it,” she said.
The stories she shared include the work of her multidisciplinary team at Hoag, which met regularly to consult on every aspect of her care – no matter what. Kelly’s entire team collaborated throughout her pregnancy. “Dr. Louis Vandermolen, her medical oncologist, met on Zoom even while on vacation,” Dr. Macdonald said. “Everyone was so diligent, Dr. Karamardian, Dr. Menashe Kfir, her maternal fetal medicine specialist. There was tight coordination amongst all of us.”
Kelly’s team banded together to determine the timing of her chemotherapy treatments and the managing of her port placement, blood thinners and everything else – right down to her baby’s delivery date.
“All of us determined together what was the best time to deliver Kelly,” Dr. Karamardian said. “Dr. Vandermolen was keen on there not being a gap in her care, and we wanted the baby to develop as long as she could. We gave her steroids to develop the baby’s lungs before inducing her at 36 weeks and five days.”
On Sept. 7, 2022, Kelly, Jeff and Caleb greeted little Blair, who was born perfect without complications.
“She went through everything with me – three biopsies, a mastectomy, port placement surgery, spine MRI, five rounds of chemo, three infections, three days in the hospital, two blood transfusions, 17 shots to boost white blood cells, and 67 blood thinner shots,” Kelly wrote on her Instagram feed announcing Blair’s birth. “The name Blair means ‘From the field of battle.’”
Blair will grow up knowing that she has a family history of breast cancer – and that she’ll have to start getting mammograms earlier than most women, likely in her mid-20s. She will also know that she has the best medical team around her, people who took extra care to protect her health while helping her mom beat cancer. The team at Hoag.
In one post, Kelly pictures Dr. Karamardian holding newborn Blair in the hospital.
“She has been my guide, leading me through all the tough decisions and conversations on my new reality,” Kelly wrote. “God knew to place her in my life in both the best of times and the hardest of times, and I couldn’t be more thankful.”
