Angela Graham

Accessible, Specialized Rare Cancer Care: Angela’s Story

Angela Graham, 59, felt fine. But her annual bloodwork showed elevated levels of liver and pancreatic enzymes.

Angela needed an endoscopic retrograde cholangiopancreatography (ERCP) procedure to identify the source of the problem. An ERCP uses X-ray and an endoscope — a long, lighted tube guided through the esophagus — to diagnose blockages or other issues in the liver, gallbladder, bile ducts or pancreas.

“My doctor in Maysville recommended the procedure. St. Elizabeth Healthcare was the closest in-network provider available to do an ERCP,” says Angela, who lives in Fleming County on a cattle farm with her husband, James.

Looking back, Angela views her referral to St. Elizabeth as a blessing — and as the springboard for months of exceptional, team-based Cancer Care that followed.

“I thank God every day for my St. Elizabeth doctors and nurses,” Angela says.

Skilled Surgical Specialists

Angela scheduled her ERCP with St. Elizabeth Gastroenterologist Aditya Kalakonda, MD, at St. Elizabeth Healthcare Florence Hospital, roughly two hours from her home. However, before the scheduled date, she suffered a severe gallbladder attack that sent her to the St. Elizabeth Emergency Department in Florence.

St. Elizabeth Emergency Physicians admitted Angela to the hospital. They stabilized her condition so that General Surgeon Harish Nirujogi, MD, could remove her gallbladder. Following Angela’s gallbladder surgery, Dr. Kalakonda performed the ERCP. It confirmed the presence of a blockage in her gastrointestinal (GI) tract.

During her six days in the hospital, Angela and her husband felt seen and supported by their entire St. Elizabeth care team, she says.

“My husband had to drive back and forth every day to tend to the cattle and the farm. It was a challenging time for all of us,” Angela says. “But Dr. Nirujogi and all the nurses recognized my husband when he was here. They would go out of their way to speak to him and try to make us both feel as comfortable as possible.”

Compassionate Cancer Care

Follow-up tests confirmed the blockage spotted during the ERCP as a cancerous tumor. Angela’s care team referred her to Brent Xia, MD, a Surgical Oncologist at St. Elizabeth Healthcare Edgewood.

To treat the cancer, Dr. Xia recommended that Angela undergo a Whipple procedure (also known as a pancreaticoduodenectomy). This surgery involves the removal of the pancreas and surrounding organs.

“They removed the head of the pancreas, the bile duct, a piece of my stomach and dozens of lymph nodes,” Angela explains.

During the procedure, Dr. Xia also identified and repaired a softball-sized hernia that Angela did not know she had. The surgery lasted six and a half hours.

“Actually, my recovery from the Whipple procedure felt easier than my recovery from gallbladder removal surgery,” Angela says. “Dr. Xia couldn’t get over how fast I progressed afterward and how quickly I was back up and around.”

A biopsy of the tumor later identified it as ampullary cancer. This rare form of cancer begins as a growth in the ampulla of Vater (also known as the hepatopancreatic ampulla). The ampulla of Vater is the part of the GI tract where the bile and pancreatic ducts join and empty into the small intestines.

Throughout the entire process, Dr. Xia was attentive and accessible. These qualities made what could have been a scary process much more bearable.

“Dr. Xia called me on a Sunday after church to check on me and see if I was doing OK,” Angela recalls. “That just blew me away.”

Putting Cancer Behind Her

Once she recovered from the Whipple surgery, Angela next turned to care from Hematologist and Medical Oncologist Ivan Bedoya Apraez, MD. Dr. Bedoya charted a plan for 12 rounds of chemotherapy across seven months.

“They threw everything at me but the kitchen sink,” she says. “They explained that this was an aggressive, invasive cancer.”

Even through heavy doses of chemotherapy, Angela felt relatively strong and well.

“Food didn’t taste good to me during those treatments, but overall, that was very minor compared to what I was expecting,” she says. “Thankfully, I wasn’t terribly nauseated or bedridden, and for the most part, I carried on with my usual activities.”

Angela feels that working with the comprehensive care teams at St. Elizabeth made her recovery easier since each team communicated well with the others. Plus, she says the two-hour drive each way from her home to St. Elizabeth was more than worth it, to ensure shorter appointment wait times and expert care.

“If I had tried to stay closer to home at a smaller, rural hospital, I would have likely faced waits of a month or six weeks each time,” she says. “St. Elizabeth was really good about scheduling my follow-up appointments with multiple doctors on the same day, since they knew we were driving from so far away.”

“Dr. Bedoya and all of the nurses have been so kind throughout the entire process,” Angela adds. “He’s run recent PET scans and an MRI and CT scan, and all those have come back with no signs of cancer. I’ll follow up with him regularly to ensure everything continues to look good.”

Now, just a few weeks past her final chemotherapy treatment, Angela is looking ahead to the freedom to return to one of her favorite pastimes: gardening.

To limit infection risk during treatment, she had to restrict her exposure to the farm’s cattle and any freshly dug soil. But now that she’s cleared to resume tending her garden, she’s looking forward to getting her hands dirty and growing backyard vegetables.

Angela is also an avid crafter and quilter. Her hobbies helped her stay busy and positively focused during months of cancer treatments.

“I did what I could to keep my mind occupied on other things,” she says.

Angela’s pleased to have the all-clear to return to helping her husband with the farm’s cow herd.

“I love my cattle,” she says. “Most of them are like pets, and they greet us every day like cats or dogs would.”

The Value of an Annual Physical

Annual physicals and routine blood screens can sometimes catch certain cancer indicators before physical symptoms appear. Stay on top of your yearly wellness visits by scheduling an appointment with your Primary Care provider today.