After undergoing turmoil in her personal life, Cherie Millford-Smart was forecasting a transformation for herself in 2015. As a nurse, first on her list was a healthier lifestyle that included losing weight and bringing her cholesterol under control.
An outdoor enthusiast, Millford-Smart began to spend more active time outside. She played beach volleyball with friends, went mountain biking, skiing and embraced the runner’s high. She ran her first half marathon, crossing the finish line at the La Jolla Half Marathon in two hours and 20 minutes and in the process brought her cholesterol levels to normal.
On Oct. 1, 2015, Millford-Smart was on pace for a banner year when she was offered a job as a pediatric nurse. She started her nursing career decades earlier working with children and she wanted to return to that role.
“I had never felt better than I did that weekend,” said Millford-Smart. “It’s like I got my old self back.”
Around that same time she noticed excessive bruising — her friends and family noticed as well. Get that checked, they told her. She had been feeling lethargic but otherwise healthy, which made her suspect leukemia. Not having experience with cancer she didn’t want to self-diagnose.
Millford-Smart had worked as a nurse in a neonatal intensive care unit, an emergency department, surgery, cardiac catheter lab, and most recently, as a peripherally inserted central catheter (PICC) nurse inserting a soft, long catheter into a patient’s vein for long-term intravenous delivery of antibiotics, medications, blood draws and more.
She set up a doctor’s appointment for Monday, hoping if it was bad news, the test results wouldn’t be available until she returned from a long-awaited vacation to South America. Her plane was scheduled to leave on Wednesday. She never reached the airport.
That Monday night, the exuberance of all the positive changes of the year imploded when a doctor called back with her results and urged her to check in to the emergency department. She had acute myeloid leukemia and was a high risk for spontaneous brain bleed. It was Oct. 5, just days after being offered her dream job, which she now had to turn down.
Days later, updating her friends on Facebook, Millford-Smart wrote, “I thought I had climbed Mt. Everest earlier this year (referring to life changes) but I was wrong and only made it to base camp. So, beginning tomorrow, I will be starting the ascent up the great Mt. Everest for real with my first dose of chemotherapy.”
Millford-Smart has a dream of climbing the real Mt. Everest one day — she just hadn’t planned for 2015 to put this mountain of an obstacle in front of her.
“It was very unreal to see my coworkers garbed up in scrubs. I looked up at them from a bed in a patient’s gown and said, ‘This is just a training video, right?’” said Millford-Smart. “It was hard to be a nurse lying on the bed being taken care of. I’m used to being the caregiver.”
She watched as her coworkers inserted a PICC line into her arm — following the same meticulous steps she would take to place the catheter into the arms of the ill — so that she could begin treatment for cancer. For the next three weeks she didn’t leave her room. Not for lack of physical capacity but because she was emotionally unable.
“I didn’t want to be part of the cancer population,” said Millford-Smart. “I was in denial. Even when I still had my hair I didn’t walk around because I didn’t want to be associated with cancer.”
Two weeks after her first chemotherapy treatment she finally accepted her situation and she started walking laps around the blood and marrow transplant floor at UC San Diego Health. Turns out that 26 laps equals one mile. Some days she walked three miles or 78 laps. She kept count using a board and turtle magnet and would periodically reverse the pattern for stimulation.
During those gentle strolls, she met other patients. The first person she spoke with was a young woman whose sluggish pace and bowed head revealed her fragility, moving Millford-Smart. They passed each other a few times before making eye contact and finally exchanged names.
“Can I walk with you?” Millford-Smart asked her new friend. “She was really down. I encouraged her and was her cheerleader. ‘We’ll do it together,’ I told her.”
And so, in her typical love for life, Millford-Smart harnessed her strength and humor to endure six months of hospitalization and a blood and marrow transplantation (BMT). She became everyone’s champion and regaled all as she walked laps in a Wonder Woman onesie and other costumes to elicit smiles and chuckles.
“Yes, I was making fun of the situation but it’s how I got through it,” said Millford-Smart. “It relieves a lot of pressure for patients, their families and their care team. I made people smile that no one else had.”
Through bouts of unexpected setbacks and victories she joked and kept her friends and family — whom she called Team Sherpa — close. Their support was her lifeline as she ascended to the pinnacle of her journey.
To the surprise of many people, a patient’s journey with cancer doesn’t end at the top of their mountain. They still have to make a return trip to a “new normal.” Transitioning to that stage for a patient isn’t always easy and they need support, as Millford-Smart did.
“When faced with a life or death diagnosis, patients live day-by-day for what could be a year or more focused on being cured,” said Eleanor Flores, nurse practitioner and a member of the UC San Diego Health’s BMT Survivorship Program.
Life after cancer treatment can bring complications with lifestyle or results in the onset of other disorders or diseases. Some people have left their jobs and don’t know how to reintegrate to everyday life.
The BMT health care team, and other cancer programs at Moores Cancer Center at UC San Diego Health, have established survivorship programs that use a holistic approach to transition a patient from active cancer treatment to healthy survivorship based on the patient’s unique needs.
For patients in the BMT program, they can enroll in the survivorship program 12 months after transplant. Clarinda Henning, RN, is program coordinator while
Divya Koura, MD, is the director. Together with Flores, the trio works with social workers and experts in other areas, including dermatology, psychology, pulmonology, ophthalmology and more to create post-transplant wellness plans to improve quality of life and increase survival for patients. These plans are shared with the patient’s primary care physician to ensure everyone who treats the patient understands that person’s needs.
“For a lot of people, the post treatment issues are just as difficult as the therapy,” said Koura, a bone marrow transplant physician. “It’s an aspect that is underappreciated. Survivorship is a fulltime job. It’s hard getting back to a new normal. Our job is to help them get there."
Patients who undergo a bone and marrow transplant have a 30 percent lower life expectancy compared to the general population, said Flores. They are at risk for developing chronic diseases and one out of 5 will develop a life-threatening condition.
One patient was suffering from post-transplant graft versus host disease — a condition that occurs when the donor cells attack the recipient’s cells. His care team was focused on controlling the condition but other complications, like hip and back pain, iron overload, osteoporosis, treatment induced diabetes and other conditions were not being addressed.
The survivorship team was able to help with these other complications while his physician focused on the most pressing issue.
“We recommended additional tests and one-by-one treated or corrected some of the other conditions. Our goal is to prevent or detect complications early,” said Flores. “We also focus on quality of life with ongoing physical, emotional and mental support.”
Millford-Smart understands the value of the survivorship program both from the nurse’s perspective and from a patient’s point of view.
“During the first six weeks after diagnosis I couldn’t visualize where I’d be in one year,” said Millford-Smart. “All I imagined was my funeral and writing letters to say goodbye. I’m now considering going back to work part time and returning to running. But, to stay healthy, I’m listening to my doctor about what’s next and when. The survivorship program is another form of support. To be followed by your doctors and nurses during survivorship is for our benefit. They’re always there to listen.”
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BMT Survivorship Program