Austin gets second surgeon for cancer treatment that saved woman in hospice care

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In the summer of 2015, Joy Brooks threw a “Kick the Bucket” party with all of her friends and family at her neighborhood park on Buchanan Lake.

“It was sad, but charming,” says Brooks. “I was so grateful to see all those smiley faces.”

Her husband, Kevin, cooked 12 rack of ribs and a brisket. They decorated it with buckets of daisies because she would soon “grow daisies”. They had a skeleton piñata. People swam and water ski in the lake.

By the time of the party, however, she was too ill to eat that barbecue. She was receiving palliative care and began to donate items such as jewelry and other special items.

Brooks at 58 was diagnosed with a rare cancer called pseudomyxoma peritonei, which started in her appendix before spreading to an ovary and then to the entire peritoneum, the lining that covers the abdominal wall and all of its organs.

In June 2015, she was told that her tumors had grown too large and too spread out to be removed. She entered palliative care.

Then her daughters searched the internet for treatment options and found Dr. Rebecca Wiatrek, a surgical oncologist with Texas Oncology Surgical Specialists in Austin, and learned about a possible treatment. Hyperthermic intraperitoneal chemotherapy washes the abdomen with heated chemotherapy after removing as much cancer as possible.

The need for this type of treatment is increasing and Texas Oncology has hired a second specialist to perform hyperthermic intraperitoneal chemotherapy.

“We are developing a program here where we can become a point of reference for this,” Wiatrek said. “That doesn’t happen in a city of this size.”

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Not an easy treatment

The processing is incredibly laborious. Wiatrek should get rid of as much cancer as possible by removing large tumors first, then scraping the lining. Sometimes parts of organs, such as parts of the intestines or stomach, need to be removed due to the amount of cancer and how these organs are involved.

“You can take out what the person can live without,” says Wiatrek. “You should only leave a little in your abdomen, like the liver and small intestine, the rest of what you can take out, but we are trying to preserve as many organs as possible,” to facilitate recovery.

This cancer is not like most tumors that grow with a good blood supply and respond well to chemotherapy given by the vein.

Instead, this cancer is more of a gelatinous substance that does not depend on the blood supply to grow. This makes traditional chemotherapy ineffective.

“It’s one of those weird cancers,” says Wiatrek. “It’s mostly mucus that doesn’t have any cells in it. It’s fat cells gone bad.”

People have tried other therapies for this cancer, but “none have worked,” says Wiatrek. “We are getting very good results that way.”

The surgery to remove the cancer and then wash the abdomen with hot chemotherapy usually takes around 10 hours, but Wiatrek did one that lasted up to 9 pm.

“It’s definitely a marathon,” says Wiatrek. Because it takes a lot of work, Wiatrek says she can only do one of these surgeries per week. With a second surgeon, Texas Oncology will be able to do two per week.

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Dr. Rebecca Wiatrek is a surgical oncologist at Texas Oncology.

Symptoms can easily go unnoticed

This cancer is usually slow growing and the symptoms can easily go unnoticed. Brooks, who had been a meter reading for Pedernales Electric Cooperative, was very active, but she recalls having severe cramps that seemed to be coming from her ovaries. They didn’t come all the time, maybe once every six weeks or every two months.

In October 2014, she went to the hospital for knee surgery. She was having complications and doctors thought she had a blood clot, but a CT scan revealed a lump on her appendix.

She was so focused on recovering the knee that she didn’t really focus on what the doctor was trying to tell her. During a follow-up appointment, she was referred to the MD Anderson Cancer Center in Houston, but was not listed until February 2014.

In Houston, she was told her cancer was growing slowly and that she would be back in June to have the tumor removed. When she arrived in June, her cancer had spread and the tumor around her ovary, which she didn’t realize, had grown too big to remove.

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Joy Brooks and her husband, Kevin, are grateful for every day they now spend together after surviving cancer of the abdominal lining, appendix and ovaries.

“It means I’m going to die,” Brooks thought. They suggested doing chemotherapy for cancer around the ovary, but it wouldn’t work for cancer along the peritoneum. “Why do I have to fight ovarian tumor if (peritoneal cancer) is going to kill me?” Brooks said.

Brooks had a son-in-law who had cancer, underwent chemotherapy and did not survive. She didn’t want that. She wanted to focus on the time she had left.

“I didn’t think there was a place to go,” she said.

She and her family hosted her farewell party.

“I wanted to see everyone I knew and loved before I got too sick,” she says. “I was downhill quickly. I was having difficulty breathing and couldn’t eat much at once.”

The mass of cancer in her abdomen weighed on everything.

She says that at this time she was depressed and often stayed in bed. “No one wants to say goodbye to their family,” she said. “It was sad.”

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Joy and Kevin Brooks say they are enjoying every day now.  Joy has even less stamina than before the cancer, but she is thankful that she found a cure.

Children find a doctor in Austin

Brooks had been researching online for treatments. She often found options in England or Boston, but was too weak to travel at this point.

After his kids found this treatment and Dr Wiatrek just down the street in Austin, Wiatrek was able to see Brooks quickly and start talking to him about hyperthermic intraperitoneal chemotherapy.

It’s intensive therapy that often takes a few office visits for the patient to really understand everything, Wiatrek says.

At this point, Brooks had no other treatment options, but questions were raised as to whether she was strong enough to have surgery.

“I knew if I could squeeze the tumor out and it could heal, it would come out,” Wiatrek says. “It was going to be a long healing process.”

Wiatrek was unable to operate on Brooks right away. “She was extremely malnourished,” says Wiatrek. “When you don’t have nutrition, you don’t get well.”

The tumors, especially the one in Brooks’ ovary, were large and growing on her intestines, making it difficult for her to eat. Brooks was weak from not being able to eat much for weeks.

Friends and family gathered in the summer of 2015 to say goodbye to Joy Brooks at her Kick the Bucket party ahead of her new cancer treatment.  The children hit a skeleton piñata and collected candy.

Wiatrek told Brooks that she needed to regain her strength by drinking the nutritional supplement Ensure for three weeks.

“I could only drink 2 ounces at a time,” Brooks says, but she did.

Wiatrek says if there was a way to make this work, she would. “I’m the type with a half-full glass,” Wiatrek says, but “this has to be the right candidate.”

Wiatrek knew Brooks was a fighter. “Even when she was really sick, she had a lot of determination,” says Wiatrek. For example, Brooks went on her dates with Wiatrek even when she shouldn’t have physically been able to. “There is a lot of mental toughness,” says Wiatrek.

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Joy Brooks, right, had her sister Pam move in with her for a year to help care for her after her cancer treatment.

Healing takes time

Brooks says she was not afraid of the operation. “I just left it in the hands of God,” she said. She tried to see some rest in it.

Brooks’ operation lasted nine hours. “The (cancerous) cells were pretty much everywhere,” says Wiatrek.

While Wiatrek eliminated as many cells as she could and felt like she got it all, “there’s always a chance that some of these cells could be left behind,” Wiatrek explains, which is why the heated chemotherapy treatment inside the abdomen is so key.

Patients have repeated examinations, first every two months, then every six months, then annually to see if any cancer has come back. Sometimes they have to repeat the surgery and the chemotherapy treatment.

With Brooks, Wiatrek didn’t have to remove anything that would be essential to his digestive system.

The healing has been slow. Brooks was in the hospital 45 days after the operation. She was kept under heavy sedation and doesn’t remember much for the first few weeks. At one point, his intestines were jumping through the surgical wound that was struggling to close. Wiatrek brought her back for surgery to secure her bowels. She received stem cell therapy to help with the healing.

She also developed fluid in her lungs which had to be drained.

Joy Brooks now has rescue dogs which are part of her recovery.

Brooks, however, was able to continue healing at home, including wound care.

“It was a very long ordeal,” said Brooks, but it was not without moments of joy. On her birthday in October of the same year, her second granddaughter was born. It wasn’t a birthday she expected to see, and “I didn’t think I was going to live long enough to see this baby born,” Brooks says. She has since had a third grandchild.

“I’m only a testament to the power of divine intervention and stubborn children and a doctor who wouldn’t give up,” Brooks said.

With every scan she has to check for cancer, there has been good news. “Every year the we move away, the more we feel like it’s never coming back for her,” says Wiatrek. “Joy’s result was tremendous. “

Brooks has since returned the hospice bag she received.

“We are blessed,” says Brooks. “We’re just grateful. When you go through something like we’ve been through, you are grateful for everyone in your life and you are grateful for your faith.

In December 2015, just four months after the life-saving operation, Joy Brooks and her husband Kevin traveled to Hawaii to meet their new granddaughter.  She was still recovering from the surgery.


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