Cancer through COVID-19: What it means when you face a tumor and a pandemic

The diagnosis came on a Monday at precisely 1:04 p.m. The call from the doctor lasted only six minutes, but in a matter of life or death, it felt like a lifetime.

"This is treatable," the doctor started. Then came several minutes of conversation Jennifer Brantley could barely comprehend, her mind stuck on one horrific word. Before the doctor hung up, she said one last thing: "We’re now going to get you cancer-free."

Cancer.

Brantley hoped those syllables would never would be connected to her health. But on Oct. 7, 2019, they were. Her tumor, embedded in the shoulder muscle just behind her right armpit, stretched 2 inches wide and more than 4 inches long.

Getting rid of it would mean months of chemotherapy and radiation to shrink it before an hourslong surgery to remove it. An operation was scheduled for March 25, 2020 — just as the COVID-19 pandemic hit the United States with brute force.

Brantley had no way of knowing then that on her surgery day she would be fighting for her life against both a tumor she could feel and a pandemic. In the aftermath, it would be the ability to receive care through calls on her computer that would keep her safely isolated in recovery at home.

'I'm more than cancer'

Brantley's legs circled in rhythmic pulses on the elliptical the day she first noticed a pain. She hadn’t been on the exercise machine in several months, so when her shoulder hurt, she figured it was a pulled muscle. 

But when she reached her hand around to massage the sore area under her arm she felt a bump. "You need to get that looked at," her husband said.

Life had more important plans. She and her husband were moving their daughter to college for the first time. Their son's college football season had just started. Work required her attention. So Brantley gave it a few weeks, assuming it would resolve on its own.

But the pain didn't go away. When she finally visited her neighborhood walk-in clinic in mid-September, they sent her immediately to see an orthopedic doctor.

"Blood drained from his face when he felt it," Brantley said of the visit.

He sent her for an X-ray and MRI. Before she even made it the 15-minute drive home, the doctor reached out to her again. "You have a mass either in your nerve or your muscle," he said. "We don’t know what it is. Don’t Google anything. Don’t try to self-diagnose."

The biopsy later revealed that she had a myxofibrosarcoma, a soft tissue tumor. Cancer.

The treatment ahead would make her fatigued and nauseated. It would change the way she looked, causing her hair, her eyebrows and her eyelashes to fall out. But she wanted her friends to know she was the same person.

"Don’t treat me like a cancer patient," she told them. "I’m more than cancer."

She was still a mom and a wife. She still had her job as a partner at a Nashville public relations firm. She still loved sports, the outdoors and camping. She wouldn't stop cooking or reading. She still appreciated a good purse, a great pair of shoes and a comfy sweater.

"Want to send me a card, please do," she wrote in an Oct. 20 entry on the blog she kept during her cancer journey. "Want to bring me a bottle of wine, that’s fine, however, alcohol is a no-no during chemo. So maybe bring me some Ginger Ale, Sprite or yummy Dasani Black Cherry water. We can have a glass together, and toast to a healthy 2020 for our family."

She also welcomed hugs, she said, "as long as you and everyone in your household is healthy and has had the flu shot."

But those comforting embraces would soon become another no-no in a complicated and frightening 2020.

Severity sets in — both for treatment and the virus

Treatment began with chemo. For eight hours on Mondays, Tuesdays and Wednesdays, Brantley sat in the Infusion Center at Vanderbilt University Medical Center as poisons were injected into her bloodstream.

The other four days of the week were "really bad days," Brantley said.

Her body and mouth smelled like chemicals. She was hungry but so sick she couldn't eat. Most days, dry toast and crackers were all she could stomach. She developed mouth and throat ulcers. She threw up. And then, she did it all again. 

Round two of chemo was 100 times worse than round one. After treatment, she didn't leave her bed for 10 days. She had four rounds total. She lost 50 pounds. But the drugs did their work. Her tumor shrank. She moved on to radiation. Twenty-five treatments in all.

The worst part was having to drop what she was doing at work to get to Vanderbilt for the treatments, which left her skin only slightly irritated. At night, she applied Curel lotion to soothe the area and took Tylenol to alleviate shoulder aches.

As the coronavirus spread across the nation, Brantley made the decision to start working from home before many companies suggested it. She worried about her safety.

Then on March 11, the World Health Organization officially declared a pandemic. On March 12, Brantley went for her pre-operation appointment. 

She had a CT scan, an MRI and an appointment with a surgeon. She had her blood drawn and met with an anesthesiologist. When her blood work came back showing a low count that made her particularly vulnerable, the physician's assistant came over to her immediately: "You do not need to walk around without a mask and gloves on."

That's when she knew how serious COVID-19 was. She did not leave her house again until surgery.

'I was in survival mode'

Twenty-five stitches held together a 12-inch incision on her right side.

The chemo and radiation treatments had done their work. Her tumor was 95% dead when doctors removed it, and her scans showed no signs of spread.

But "cancer free" did not mean she was in the clear.

With her immune system severely compromised, she was scared of the virus outside.

The morning of her surgery, her husband dropped her off outside the hospital, leaving her to go in alone as a safety precaution. After a temperature check at the main entrance to the hospital, she sat in the socially distancing waiting room by herself.

She was at the hospital 24 hours. After surgery, her husband again met her outside to take her home. Her cancer was gone; now she had COVID-19 to contend with.

"I was in a survival mode," she said.

The first step in her recovery meant physical therapy appointments to help her move her arm. She met them with trepidation. The coronavirus was a real threat, and being in a crowded medical setting seemed dangerous. 

But her doctors had an option to keep her safe — telehealth therapy, her visits done over Zoom call. Brantley couldn't say no.

"To me," she said, "it was a lifesaver."

'A fighting chance'

Brantley treated her first telehealth visit just like she would an in-person doctor visit. She wrote down a set of questions and wore loose clothing, so she could easily access and show her incision.

She set up her iPad in her bedroom and made sure she had privacy away from her family. But not everything went right the first time.

Though she had Zoomed many times for work since the pandemic hit, she hadn't done so from her tablet. When she got on the call, she could hear the doctor, but the doctor couldn't hear her. Brantley hadn't tested the audio.

"I'll call you," the doctor said.

So their first session, they used the tablet for video and a phone for audio. Each time she had another appointment, Brantley learned better how to prepare.

She realized it helped to have the exercises that her physical therapist planned to use emailed to her before the appointment. That way she could have the right equipment in place — an umbrella for arm lifts and a towel to help with stretching. She learned to set her computer or tablet up so she could see the screen from the floor where she did the exercises.

And she became one of many who safely received medical care at home.

Amid the pandemic, hundreds of thousands of people turned to telehealth to continue to care for themselves. The relaxation of medical privacy restrictions during the crisis allowed for more virtual consultations to take place. Patients could share their symptoms and get clinical advice from a doctor via phone or live video.

From March 16 through May 15, BlueCross BlueShield of Tennessee processed 307,218 telehealth claims. That compared with 6,258 claims during the same period the previous year. 

There were patients like Brantley, recovering from severe health traumas with compromised immune systems, and others who sought mental health support. Brantley's own physical therapist was pregnant and also welcomed being able to work from home through telehealth to keep her safe.

"Doing therapy at home allowed me to get my legs back under me," Brantley said, "and have a fighting chance to face whatever is thrown at me next."

Looking ahead

Brantley continues to recover. Her hair is growing back with a beautiful silver sheen. Her strength is returning. She celebrated her 52nd birthday by raising $2,000 for a nonprofit that helps with sarcoma research and support. She goes on daily walks with her husband and daughter to help clear her mind and build her muscles.

Other than wandering around her neighborhood, she has left the house only twice since March 10 — once for her pre-op and once for her surgery. 

Her physical therapy has progressed to where she needs to see someone in person. 

It still scares her, particularly as virus numbers tick back up as the city reopens.

But, she said, "I'm going to have to make peace with that."

After cancer, she's ready for whatever comes next.

Reach Jessica Bliss at jbliss@tennessean.com or 615-259-8253 and on Twitter @jlbliss and please support local journalism.

Tips to prepare for a telehealth visit

As the coronavirus pandemic intensified, Jennifer Brantley had cancer surgery. In the days and weeks that followed, she feared for her health. She chose telemedicine appointments for post-op examinations and physical therapy so she wouldn't have to risk going in public with a compromised immune system.

Here are her recommendations, as shared with BlueCross BlueShield of Tennessee, to help you prepare if you use telehealth:

1. Give yourself enough time for the initial setup

• Ask the nurse or staff setting up the appointment what app or website they use for telehealth so you can plan enough time to get your computer or device set up.
• Download the appropriate app or visit the website before the day of your first telehealth appointment in case you have questions.
• If the app or site allows, test your speakers and microphone ahead of time to make sure you can hear and be heard.

2. Prepare others in your home for the appointment

• Find a quiet place for your visit, and let people in your home know when you need them to avoid interrupting you.
• Consider sending a reminder message a few minutes before the appointment is scheduled to start.
• If you have children or pets that might disrupt your conversation or distract you, consider finding a place for them somewhere in your home where they can’t be heard or finding an activity for kids to work on.

3. Treat the appointment like a normal in-office visit

• Make sure you have a list of questions to ask your provider during the visit.
• Wear loose-fitting clothes in case you need to show any incisions, wounds or potential issues to your provider.
• Have a notepad and pen to write down any instructions provided or consider allowing someone to sit in on your telehealth appointment to help you take notes if you need it.

For more tips from Brantley, visit the WellTuned blog by BlueCross BlueShield of Tennessee: bcbstwelltuned.com/2020/05/07/real-story-how-to-prepare-for-a-telehealth-visit.