How a Mary Greeley and McFarland Clinic team swiftly came together to help a breast cancer patient through the biggest health crisis of her life.
By Steve Sullivan
To call Barbara Sanden a “breast cancer survivor” would be an understatement.
Those three words just don’t say enough about everything Sanden faced and survived with the support of a committed, coordinated team from Mary Greeley and McFarland Clinic.
Diagnosis and Decision
Sanden was a nurse for 32 years at Boone County Hospital and worked primarily in medical surgical. She and her husband, Bob, a retired machine operator, have been married for 53 years and have three daughters and nine grandchildren. In July, Sanden was diagnosed with breast cancer after her annual mammogram.
“I was shocked because neither my mother nor grandmother had breast cancer, and it is sometimes hereditary,” she said.
In her early 70s, Sanden was relieved to get the diagnosis now rather than when she was younger because “there have been so many advances in breast cancer treatments like chemo, radiation, and immunotherapy. That made me feel lots better.”
Sanden was diagnosed by her primary care physician, Dr. Brian Mehlhaus, who is with Boone County Hospital, and referred to Mary Greeley. Sanden chose to have a mastectomy. She met with Dr. Joseph Merchant, an oncologist, and Dr. Shane Hopkins, a radiation oncologist, to plan her post-surgery treatment. Both physicians are with the William R. Bliss Cancer Center, a service of Mary Greeley and McFarland Clinic.
“Dr. Hopkins and Dr. Merchant spelled things out so clearly. They went over all the choices and gave me a chance to ask questions,” she said. “That’s reassuring.”
A few weeks after her diagnosis, Sanden was scheduled for her mastectomy. She was understandably nervous, particularly since she had had an adverse reaction to anesthesia several years ago.
She was on the table in a Mary Greeley operating room, incision lines already drawn near her right breast. Anesthesia was administered, and then something went wrong.
The surgical team knew that Sanden had a past bad experience with anesthesia, but techniques had changed over the years and a decision was made to proceed with the surgery. Shortly after the induction of anesthesia her blood pressure dropped significantly. The surgery was immediately stopped, and the operating room quickly filled with people providing immediate support, and a few prayers.
Sanden made it to have surgery another day. Getting to that day took a lot of work.
“People said, ‘Hello,’ and I think that’s the last thing I remember,” said Sanden about that first surgery. “I woke up in the ICU on a breathing tube.”
Something must have gone wrong just like last time, she thought. When the tube was removed, her family verified her suspicions.
“I was depressed. You plan on something, and you hope to get through it in one go, and then you have to wait,” she said.
She was especially anxious because her mammogram looked good last year, but a year later she was facing breast cancer. Sanden knew she was dealing with something invasive.
After her blood pressure dropped, a team of people were called to the operating room, including Dr. Jason Rasmussen, a McFarland Clinic cardiologist with the Mary Greeley Cardiology Clinic. He ordered an echocardiogram and medication to stabilize Sanden. Tests showed she had an artery that was 90 percent blocked. A stent was put in at Mary Greeley’s Cardiac Cath Lab. Sanden went home, going through a month of cardiac rehab to build up her strength before she had a rescheduled mastectomy.
"It took my body a while to get over all that," she said. "It was probably a week before I felt myself again."
Meanwhile, Dr. Brenda Kruse, the anesthesiologist who was part of Sanden’s surgical team, went to work to ensure the next surgery was successful.
“I give Dr. Kruse a lot of credit,” she said. “She spent hours looking at my charts to figure out for sure what happened and how to make sure it didn’t happen again.”
“She told me that she was ‘allergic’ to anesthesia but didn't have any idea if it was specific drugs or a combination of drugs. She just said that she had experienced a ‘bad reaction’ and ended up in intensive care with a breathing tube,” Kruse said.
The previous incident occurred many years ago at another hospital and records weren’t immediately available. Anesthetic drugs are typically well tolerated, said Kruse, so a decision was made to proceed with the usual agents. Sanden reacted badly again, and, once again, landed in the ICU on a breathing tube. Her situation was complicated by the discovery of her heart ailment.
“It actually was fortunate that this revealed itself during this hospital visit,” said Kruse. “If the cardiac issue had developed when she was out in the community, it might not have gone well. As it was, she was in our OR with many helping hands and equipment immediately available. And the OR staff is and always has been willing to jump in wherever and whenever needed for the benefit of our patients.”
Kruse did research, pulling the records that were available and getting information from Sanden’s previous surgery, making comparisons among the records for drugs used to see what might have been the inciting factor.
She identified one anesthetic drug that was common to all the surgeries and potentially a second one, an antibiotic. Sanden provided information about some of the drugs that had overlapped among the surgeries as well, indicating that she had received some of them since, without any similar issues.
“Barbara was an exceptional patient and very helpful throughout the whole process,” said Kruse.
Sanden also visited with Dr. Ed Nassif, a McFarland Clinic allergist, to gain further insights into her drug reactions.
“When she returned for her second visit to have her mastectomy with us, I had designed an anesthetic that avoided all the potential triggers, the allergist had prescribed some preoperative meds to help decrease any allergic reactions, and this anesthetic went well for her,” Kruse said. “We all worked together and included her in the conversations in order to make that happen.”
The second surgery went as hoped. Sanden continues to work with the Cancer Resource Center, another service of the Bliss Cancer Center.
“My cancer navigator Michelle (Reichert) has been wonderful. She checks on me frequently and gives me a lot of moral support,” Sanden said.
She monitors her heart health with Dr. Rakshak Sarda, an Iowa Heart cardiologist who also treats patients in Mary Greeley’s Cath Lab. Sanden walks her driveway each morning to keep her heart in good shape.
After everything she’d been through, Sanden faced one more major medical decision. After her adverse reactions to strong medications, did she really want to have chemotherapy? The answer she decided was “no.” Instead, she is doing a course of radiation treatments only.
Barbara Sanden’s reaction to anesthesia drugs was unusual. Here is further explanation from Dr. Brenda Kruse, McFarland Clinic anesthesiologist, on the low risks associated with anesthesia drugs.
“These types of complications are not common at all since most anesthetic drugs are well tolerated. Far and away, the most common reaction to anesthesia is nausea and vomiting, which might happen upwards of 25 percent of the time, and is easy to treat or prevent. Anesthesia is typically very safe. A lot of that has to do with the preparation that anesthesiologists and operating room staff do ahead of time investigating what conditions the patient has; determining what equipment and perhaps extra monitors we might need; what the surgery entails as far as positioning, access, location, and length; and any other specific issues that might impact the surgery itself or the immediate recovery. It helps to have access to a patient’s previous anesthetic records, because sometimes the patient is unaware of what exactly the problem was.”