A Story of Faith: The Pregnant Mother Who Had Cancer, Heart Failure and Two Strokes in One Year
A patient reflects on a long and unexpected medical journey with little chance of survival, and how she reclaimed life.
Plymouth local Cindy Karadsheh Soave’s blood ran cold when she felt a lump in her breast. But what doctors initially dismissed as the pregnant woman’s “milk coming in” developed into a long medical journey involving aggressive cancer, heart failure and a brain hemorrhage.
A 36-year-old woman with no family history of breast cancer wouldn’t have been a prime suspect for harboring abnormal breast cancer cells, but as time passed, she just didn’t feel right.
“I couldn’t get a mammogram because of the pregnancy,” says Soave. “But I visited my doctor again and pressured him to do another exam, because I knew something was wrong.”
The ultrasound that followed in June 2017 confirmed hormone receptor-positive and HER2-positive breast cancer. Her current University of Michigan Rogel Cancer Center oncologist, Catherine Hall Van Poznak, M.D., notes that HER2 positive breast affects only about 20% of women with breast cancer and that pregnancy-associated breast cancer isn’t common.
“It was devastating news, especially having a baby on the way,” says Soave. “Family means everything to me and the idea of not being there for my husband and our girls was unimaginable.”
After being told chemotherapy was safe in the second trimester of pregnancy, Soave started a course of chemotherapy treatments. The first step of the chemotherapy regimen was completed in October. In November, she delivered her baby at St. Joseph Mercy in Ann Arbor. She resumed the next step of the chemotherapy treatments three weeks after the successful birth of her second girl.
A domino effect
Just months later, in January 2018, Soave had a terrible cough and rapid pulse of 120. That same gut feeling of something being wrong prompted her to head to the emergency department where she found out she was in heart failure.
And in Soave’s case, her heart failure was from a weakened heart muscle. An ejection fraction measures how much blood inside the heart’s left ventricle is pumped out with each heartbeat, and a normal ejection fraction should be more than 55%. Soave’s ejection fraction was incredibly low at only 26%. Her doctors thought her poor heart function was likely due to damage from her cancer treatment, or possibly her pregnancy or a viral infection.
Soave, now a mother of a 2-year-old and a 2-month-old, had to stop her anticancer therapy because it could’ve had a negative impact on her heart function. She then needed to take heart medication to combat impeding heart failure.
“I couldn’t believe how quickly my life changed,” says Soave. “I had been perfectly healthy my whole life, never took medication for anything, and now I’m losing my hair, in and out of hospitals, and I could die from the cancer I can’t treat anymore, if not heart failure.”
Even with medication, Soave’s heart wasn’t getting any better. Her blood pressure remained low and she felt out of breath going up her stairs. She was then rushed back to the Emergency Department, where she was found to be in cardiogenic shock with her ejection fraction having dropped to 13%. After being immediately rushed to Michigan Medicine’s intensive care unit, she met Matthew Konerman, M.D., a cardiologist at the Frankel Cardiovascular Center.
“I knew her best chance at survival was with a left ventricular assist device (LVAD) and being put on a transplant list,” says Konerman. “But she wasn’t eligible for a transplant due to her cancer.”
After further examination, Francis Pagani, M.D., a cardiac surgeon at the Frankel CVC, discovered the right side of Soave’s heart was damaged enough that she might also need a right ventricular assist device (RVAD), but the team wouldn’t know until they operated.
“Soave’s case was unique, and we had to be very cautious. No matter what the team decided to do, she was still in a high-risk situation,” says Konerman. “We knew she had to have an LVAD though we were worried she would need an RVAD as well to support her right ventricle.”
Soave’s healthcare team decided that implanting both the LVAD and RVAD were her best bet, which Konerman says only approximately 3% of patients require at the same time. She spent months in the hospital afterwards, trying to figure out what the next move would be since RVAD devices aren’t compatible for outpatient use, and she couldn’t be discharged with one.
“We had to believe that with the right medications and time, her heart might recover,” says Konerman.
After two months in the ICU, Soave made the difficult decision to get a mastectomy in hopes of stopping the spread of the cancer.
“The bad news never ended,” says Soave. “It was the true definition of a nightmare and I had no idea what life would be like after this.”
More bad news
After a few months of friends and family visiting, Soave got the call everyone had been praying for. Imaging showed her right ventricle recovering, which meant there was a possibility of being taken off the RVAD and discharged.
The RVAD removal surgery was successful and after a few months home with the LVAD and new heart medication, Soave received the news that her left ventricle was also healing and she could be taken off the LVAD, too.
“We do not commonly see heart function improve to allow for LVAD removal. LVAD therapy is usually a bridge to heart transplant or a permanent therapy. This was a rare case,” Konerman says.
She thought her luck was really turning around.
But what happened next could’ve never been anticipated. Soave had a transient ischemic attack, or a mini-stroke. The temporary interruption of blood flow to her brain prompted surgeons and other experts across cardiology, oncology and other specialties to meet and extensively discuss clearing Soave for LVAD removal, with the risks being much greater now.
The team ultimately decided to continue with plans for LVAD removal and the morning after Soave received the news, she suffered a subarachnoid hemorrhage, an aneurysm rupture, which led to a brain bleed. This resulted in another long hospital stay.
Soave had slurred speech and lost all sensation on the left side of her body. She spent months trying to teach herself how to walk and feed herself again. The brain bleed made her LVAD removal an even bigger risk, but eventually her third heart surgery in a year would successfully go forward and she went home pump-free.
“Ever the optimist, she would get awful news and ask, ‘what’s the solution and how are we going to get there?’” says Konerman. “Her friends and family never left her side. Their love for each other and their faith in their religion was so inspiring to me.”
“I never spent a single night in the hospital by myself,” says Soave. “Someone always took off work so they could be with me. It was a long journey, and I’m so grateful I had that support system. I couldn’t have gotten through this without them.”
“Being pregnant with my daughter saved my life”
Beating out all odds, Soave is now asymptomatic of any cardiac conditions and has an ejection fraction of 49%. She participates in cardiac rehabilitation and follows up with her care team every three to six months. She’s receiving antiestrogen therapy and Van Poznak, her oncologist, notes that there are “no signs that the breast cancer is present.” Soave even ran a Susan G Komen 5K with friends and family last May.
“The story of Cindy Soave should be one about determination through incredible hardship,” says Konerman. “It’s patients like her that remind me how passionate I am about my work.”
Soave currently takes a hormone drug to keep her cancer at bay, and plans to get breast reconstruction surgery after giving her body a break from all her procedures.
“I feel so blessed to experience God’s healing. That I could be a testimony for being your own biggest healthcare advocate,” says Soave. “I didn’t always understand the pain and suffering, but it was my job to persevere.”
She adds that she believes being pregnant with her daughter saved her life.
“I think I felt my lump because of her,” says Soave. “God sent me her so I could find the cancer early, and now I’m alive.”