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65-year-old Joyce McCain believes everything happens for a reason – even breast cancer. Join Joyce and her radiation oncologist, Chirag Shah, MD, as they talk about a special type of radiation treatment designed to treat Joyce’s breast cancer and protect her heart – and the pre-radiation testing that revealed another hidden cancer. 

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Woman Fighting Breast Cancer Thankful after Radiation Prep Uncovers Second Hidden Cancer

Podcast Transcript

Kyle: Welcome to The Comeback. I'm your host Kyle Michael Miller. During this episode we're talking with Joyce McCain who considers breast cancer a blessing in disguise after a unique type of radiation uncovered another hidden cancer. Joyce’s Cleveland Clinic Radiation Oncologist Dr. Chirag Shah will join us as well. But first here's Joyce in her own words.

Joyce: My name is Joyce McCain. I'm 65 years old and originally from Flint, Michigan. In the spring of 2018 I was diagnosed with early stage breast cancer. Before the surgery I decided to have a special type of radiation. It was designed to protect my heart as well as treat the cancer. During preparation for the radiation doctors noticed a spot on my kidney. Before the radiation I was diagnosed with kidney cancer as well. It was so unexpected. I had my kidney removed and then continued radiation for breast cancer. I'm done with the treatment and I am currently cancer free and can't wait to get back out on the golf course.

Kyle: Joyce, Dr. Shah thank you guys so much for being here today.

Joyce: Thank you.

Dr. Shah: Thank you for having me.

Kyle: Joyce, you have had quite an eventful year. Probably not exactly what you were expecting. How are you feeling today?

Joyce: I'm feeling good today. I'm feeling great today.

Kyle: Joyce at the beginning of the year you had a mammogram and you found out you had cancer in your left breast. What do you remember about that day when doctors told you the news?

Joyce: Yeah, the day I was diagnosed, I just remember the words that it was cancer and that you need to find a surgeon and all I remember is the word cancer. Things start going through my head, started getting nervous and then I said, you know, I told her, I said you know what? I'm not claiming this. You know, I'm not going to let this happen, not going to let it get the best of me and from that point on I guess I've been praying and working and just trying to do the things that I'm supposed to do to get through this. And like I say I've just been, I’ve just been truly blessed with the people around me, my friends, my co-workers, my church family, my physician especially, you know, my primary physician Dr. Shah. I mean, I've just been blessed with good people, medical, you know in my family and friends. It’s just been, I don't know. It’s been a strength to me I couldn't have made it without all of the support from everyone.

Kyle: Dr. Shah, Joyce opted for a lumpectomy and part of her treatment plan is radiation which is where you come into play but they're sort of a unique story about how you got connected to Joyce.

Dr. Shah: So I, obviously I am breast cancer radiation oncology at the main campus, and I specialize in heart sparing radiation and I got a call from my wife. My wife happens to be a family doctor at the Cleveland Clinic as well and she happens to take care of Joyce and so Joyce came to see her and, reasonably so, said you know they told me I need radiation and I'm scared about radiation and my heart which is the right thing to do. So for patients, that's what they should be asking. And, you know, she asked my wife if there's anyone she knew they might be able to help.

Kyle: She said, I think I know a guy, right?

Dr. Shah: And she said, I think I know a guy. And so Joyce came down and we talked and we had a really good talk. And at the end of the day I saw someone who was passionate about a lot of the things that she loves in her life and the people in her life. And so we were able to kind of talk about a plan that maximized her chance of taking care of this cancer but also kept her doing all the things that are important to her and protecting her heart and lungs so that she could continue to do all of those activities moving forward.

Kyle: Talk to me a little bit about heart sparing radiation treatment. Why do patients need it and how does it work?

Dr. Shah: Sure. So, when we started giving radiation for breast cancer, frankly speaking, we didn't know about the risks to the heart particularly when we had left breast cancers. And what we started learning especially in the last 10 years is that there were consequences when we used radiation to women on the left side particularly because the heart sits right underneath the left breast and chest. And so there was data shown that the higher doses to the heart were likely associated with higher rates of heart problems. And so at that time, I started at the Cleveland Clinic and we started working on ways to protect the heart and the simplest way is to use a patient's own body to help us. When a patient takes a breath in their breast and chest lifts up but the heart tends to stay exactly where it was. And with radiation, distance equals dose, meaning the further I can get two things apart the less dose I can give to them. So what we have patients do, and what we had Joyce do, was we had her, at the time of the radiation planning CAT scan, breathe in. And at that point we saw a separation. We measured that and calculated the dose to her heart. And then each day of treatment we replicated that. So we've also created a structure, so how we plan things is how we deliver it every day. So heart sparing is only important if you can actually match what you planned. So, we've developed that as part of our course of treatment as well.

Kyle: Now I know that you did a simulation for this a few times before actual treatment. And Joyce what do you remember about the simulation you guys did?

Joyce: Well, I was a little nervous. You go into the simulation and lay and they… as I described it to one of my friends, I said, it's just so strange because they go, your hands are up, your feet are tied, they put a thing on your, it’s just like what is going on? What are they doing? And then they started out and they say, OK hold your breath and see how long you can hold your breath. And so, I want to say, they started it like about 18 seconds or something like that. And I did it, and I say OK, now can you go to 20? Can you make it? Well, can you go to…and then by the time it was through we went up to 22 seconds, that was my match, 22 seconds. And so from there every time I went and then they marked me, you know they marked my body, in certain areas to make sure that when I came back each time I was in that exact position. And so they did that and it was after that, the simulation, where we had got everything in place, it’s where when I got through, they came and they said doctor wants to talk to you. So, it's like okay, I thought we were going to talk about golf or something.

Dr. Shah: I tell people that sometimes things happen for a reason and as the director of the breast program people often follow me in my clinic and on the day of Joyce's scan I had a radiologist with me which doesn't normally happen. But I had a radiologist with me at the time of the simulation, which is also a CAT scan, and so we were doing the CAT scan and one of the technicians asked me, Dr. Shah what do you think about that? I'm looking and I said that, you know, this kidney doesn't look right. And the radiologist said, Dr. Shah, that kidney doesn't look right, I agree with you. So, you had three people looking at this and saying the kidney doesn't look right. And Joyce has already been through a lot with the surgery and everything else and you know I said I think we have to talk to her about this today. We don't delay on anything. And so, I talked to her, and that same day, about 20 minutes later, she was in another CAT scanner getting a specialized dedicated scan to look at her kidney. And that led to the next step of her journey. And we stopped radiation planning at that time and we led her to the next step of her journey.

Joyce: He helped me with that too. When I went in he says you know Joyce, he says, I'm not done. He says, I'm going to be straight with you. He says we saw something and he explained to me what he saw and everything. He says, I want you to go in and we’re going to get you set up with a CAT scan. So we did that and then he called me, I would say probably about an hour, hour and a half later, and he told me, he said it is cancer. He says it's larger than what we had thought it was. And so he says but you go on, because the next morning I was leaving going on a golf trip. He says you go on your golf trip. He says I’ll make sure everything is set up. And he, I mean, he pretty much, like I said, he was support. He recommended a urologist for me and I just can't tell you how grateful I am to everybody. To set up and because, I knew that I couldn’t have a clue as to who to call or what to do. And it just seemed like everything just fell in place pretty much. When I got home that day from him I was pretty upset. It was scary. And I put on this big, yeah yeah, yeah, you know, come on we’re going, we’re going and you know they're all looking at me like, Joyce you sure you want to go? Are you sure you want to do this? Yes, we're going to do this. We've planned it, they came, had some people from Indy and from Michigan were at my house, were going to spend the night there. And, matter of fact, actually when he called we were out to dinner. And I walked out to a restaurant and I came back in and it's like, everything okay? And I said, it’s all going to be okay, right? It's going to be okay.

Kyle: How do you wrestle with a double cancer diagnosis? I mean, that's a lot to take on.

Joyce: It is a lot. Like I say, I pray a lot and I keep faith and trust in the Lord that he was going to make everything, make it right for me because it had to be him that stepped in to put all of this in place for me to begin with beginning with Dr. Shah, his wife, beginning with her for her to recommend and say okay, this is where to go, because even when I first found out and I was like, oh Lord Momma, what am I to do? Because before my mother, she passed a couple of years ago, and she had retired. She's 37 years as an operating room technician. So whenever something happened at home, she knew all the doctors, she knew who to refer me to, and like this is okay, my first time because before now I was never on any medication, I wasn’t on anything and I was like okay so what do you do? It's like, when they told me I needed a surgeon and I called to make the appointment, and they said well, you’ve got to pick a surgeon and I said, you know what? I don't know who to pick. And this is what I told the lady on the phone, I say you recommend me to who you would recommend your momma to.

Shah: That's absolutely the right thing to say.

Joyce: That's what I told her and so she recommended Dr. Pratt. And when I told Dr. Shah who she had recommended she was okay with her. And so that's why I went to Dr. Pratt and the whole journey through all of this, I think everybody that hit my path were so…seemed like they were so concerned and they were so... all of that makes it a lot easier to take.

Kyle: Dr. Shah is kidney cancer related to breast cancer at all?

Dr. Shah: No. These are completely unrelated cancers, unexpected and really very fortuitous that the CAT scan caught it because there was no reason to test her for kidney function. She was having no symptoms, felt great.

Joyce: I felt fine. Like I said, I was getting ready to go on a golf vacation.

Dr. Shah: So, it was completely fortuitous. And, to Joyce's point, one of the reasons I do what I do as an oncologist is, I think what we all do as oncologists, is we treat people as if how we want our families treated. So, Joyce talked about how she feels grateful for that. But, I try to tell her and everyone else that that's what I'm supposed to do, is every day I treat people, and I think we all do, how we'd want our mothers treated, right? You treat people as if you want your mother treated that way. If I had to tell my mom that news, I'd be asking when the next day she'd see the surgeon is. And so that's what we did. I got her to the surgeon who I thought would take great care of her and we got her in ASAP and I think you were in the operating room within like less than ten days.

Joyce: Yeah, it's quick. It was pretty quick.

Dr. Shah: So, that's how we want our family treated, and that's how I wanted Joyce treated.

Kyle: It's almost like your steps were ordered. Each step was ordered for you to move into the next thing that you needed to be treated for, you needed to go through, to get healthy.

Joyce: You just said it, order my steps, spiritual.

Kyle: Joyce, how did you how do you stay so positive? Because even throughout your entire journey you really just were focused on healing and focused on getting better. Where does that positivity come from?

Joyce: It may come from my upbringing. As far as being positive, things that have happened in my life, because, I guess, one thing that we were always taught is that the one thing about is that when you're looking forward you can always find something wrong but you should always try to concentrate on the things, the positive parts of your life, and concentrate on that and try to go forward. And, I guess, through that and with prayer and just trusting in the Lord, it keeps me positive. I don't like to be negative because it seems like when you have negative energy around you negative things happen to you.

Kyle: It’s almost like it attracts?

Joyce: Yeah, and the more positive you are, the more positive people you draw to you, the more positive energy there is and I guess it has all to do with my upbringing, things that have happened in my life experiences that I've gone through, that I've seen. When I've been negative, not saying that I've always been a positive person, that you can feel it in those things and you start being positive and lifting yourself up, good things happen.

Kyle: Dr. Shah, probably makes it a little bit easier to treat patients who are positive and who are believing that the best is yet to come.

Dr. Shah: Yeah, I think that it also validates what you do, right? For me, with Joyce, the conversation was always, what are we looking forward to? What is the next step? It wasn't, what am I going through now? It was, this is what we're going for, right? To play golf next season, to start dancing, to spend time with family and that's the most rewarding thing in what I do is seeing that, and talking to Joyce, even now, about what she's planning to do because, for me, the whole purpose of treatment is to get her doing what she's supposed to be doing and she was always forward looking. And that, as a physician, it's highly rewarding and it's also, it creates a relationship like her and I have now and obviously everything so far has gone wonderful and we're lucky for that and I look forward to hearing all about Joyce's adventures!

Kyle: And she's even going dancing this weekend.

Joyce: Yes, I am. I'm going dancing in Dayton this weekend.

Kyle: Joyce, have you ever played a game called Go Fish?

Joyce: Yes.

Kyle: We're going to do a little version of that here. We have a fish bowl in studio and there are three questions in there. So, if you want to open up the top of the fish bowl. You can dig in there. Pull out the question. Read it and give us your answer.

Joyce: Okay, what advice do you have for others? Well, the one thing that I say is, the number one advice, is to listen to your body and to follow up, as far as medical is concerned, is to go and take your yearly, especially women, go take your yearly mammograms because that was one thing that I almost messed up on because I took my mammogram and when they sent me the letter and told me I needed to come back because they needed, it wasn’t clear because of density, I didn't go back right away. And then Dr. Shah left me a message, and told me, Joyce you need to go do that follow up, and at first I was like, yeah well, I don't have time, I'll make time and so finally I did it and probably had it not been even for her following up with me and making me, saying you need to go for that. I probably would've waited till my next year to go for my regular because I always did my yearly’s. Like I said, I just think that they should make sure they go do their mammograms and listen to their bodies and especially too because when they found my kidney cancer. And you know, Dr. Shah, he says, you don't have any pain? And I'm like, I don't feel any pain. But now sometimes when I think back... I think I probably had a little that I probably thought came with old age, arthritis, this or that.  But you just have to listen to your body and follow up with everything. That's my suggestion, is to follow up.

Kyle: All right, going to have you dig in two more times. Pull out the second question.

Joyce: What's one thing you cherish now? I cherish life, my family, and my friends. I cherish life as a whole, life, quality of life.

Kyle: What's your favorite thing to do with your family and friends?

Joyce: I just love when we get together. We talk, we eat. I love to cook for my family. We do a lot of eating. I love just listening to my brothers when they get together. I have four brothers and I always tell everybody that I have four brothers. You get the four of them together and it can be, I don't care what the subject is, they're going to find four different sides to that one subject. And I just to like sitting and listening to them and I just love being with family, friends and love being with my son and I just love life, all aspects of life. I do, I love life and I truly love the quality of life that I have now that I can go out and I can do the things and enjoy the things that I've been enjoying for these years. That I'm still able to do it, and plan on doing it for years.

Kyle: One more question before we close for today.

Joyce: What song helped you through? My mother, when she was living, she was in a choir and the one song she always sung, and I listened to it, I can hear her singing it all the time is, I am Climbing Jacob's Ladder. That song, I can't sing so I'm not going to, but I just hear her, I am climbing and you have to keep climbing and climbing. You know we are all soldiers of the Lord.

Kyle: Dr. Shah, do you have any final thoughts before we close today?

Dr. Shah: I think Joyce said it best. I mean, she's always had faith and she's always trusted us, which you know, is humbling. When someone trusts you with the things that are most important in keeping her with the people that she's most important to be with. So, what I would say is thank you to Joyce. Thank you for challenging me to do better every day and for being such a wonderful patient.

Kyle: Joyce, Dr. Shah thank you so much for taking time to talk to us today. And thank you everybody for listening. You could find additional podcast episodes on our website clevelandclinic.org/podcasts, on iTunes, Sound Cloud, Stitcher and Google Play.

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The Comeback

A medical journey can be a transformational point in someone’s life. Tune in as Cleveland Clinic patients, together with their physicians, share experiences of perseverance and determination. In their own words, hear how these health heroes have made the ultimate comeback.

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