The first things you notice about Victoria Pouchés are her infectious smile and laughter. She credits her positive attitude with helping her successfully fight cancer.

Diagnosed with late stage ovarian cancer in October of 2013, she was once told by doctors to start preparing for hospice care. But the strong, independent woman was determined never to give up. The feisty 60-year-old from Lodi continued her long and courageous battle, and after being enrolled in an immunotherapy clinical trial at UC Davis Comprehensive Cancer Center, her biomarkers today do not show detectable levels of cancer in her blood, and she’s regaining her strength and stamina that once let her run marathons.

Victoria is now on a quest to spread awareness about this disease and save other women’s lives. She credits the clinical trial for saving her life.

“I felt very fortunate, very blessed. Maybe for some people it would be a scary thing for them to try something there is not data on,” she said. “I guess my thoughts were, I had nothing to lose, I had everything to gain. Medical science is growing by leaps and bounds, so why not?”

The beginning

It’s not an understatement to suggest that a small note card saved Victoria’s life. Her daughter, Heather Anderson, had attended a JAGS Solanki Memorial Fund fundraiser for ovarian cancer and brought home a little note card that listed the various symptoms of ovarian cancer, known as the “whispering signs,” which are often difficult to detect.

When Victoria started feeling unwell, she couldn’t pinpoint what was wrong.

“I just noticed a little bit of bloating and that I was tired. I didn’t really think there was anything wrong with me, to be honest. After Heather brought home that card, I thought ‘maybe.’ The bloating increased, and I still thought, maybe it’s a blockage down there.”

A single woman without health insurance in the days before the Affordable Care Act, Victoria went to Planned Parenthood to be checked out. A sonogram revealed large amounts of fluid in her abdomen.

Without a doctor, Victoria returned to Planned Parenthood and was sent to have blood work at another doctor’s office. During the visit, Victoria says she was repeatedly asked by the doctor if she was an alcoholic.

“I kept saying, ‘no, I’m not an alcoholic.’ I guess because of the fluid buildup and that kind of bloating, that’s a common sign with liver failure that would be associated with alcoholism.”

To her relief, the results from the blood work came back and her liver and kidneys checked out OK.

However, the symptoms didn’t go away. Over the next month, the bloating became so bad that it deformed her belly. She visited a local emergency room early one morning and hours later was told that she had late stage ovarian cancer.

Victoria’s daughter, Heather, was able to get to her mother’s side before she received her diagnosis. Being raised as an only child by a single mother, the two are very close. She was in the room when the doctor delivered the news.

“I was just in shock. I don’t even know that I cried,” Heather said. Mom was like: ‘Well, at least I know what we’re dealing with now.’”

Victoria was released with a number to San Joaquin General Hospital.

Despite the diagnosis, Victoria had yet to have a biopsy confirming the cancer.

At San Joaquin General, a doctor finally performed a biopsy on Victoria and the results confirmed the diagnosis.

Heather said confronting this disease head on was a difficult process. “No one in my family has ever had cancer. I have never dealt with a death in my family, I wasn’t sure what to do.”

That’s when they decided to to contact the JAGS Solanki memorial fund for ovarian cancer to get some guidance.

Victoria says she received good care at San Joaquin General before she was transferred to UC Davis. “I have nothing but good things to say about them,” she said about the staff at San Joaquin.

From November of 2013 through January of 2014 Victoria underwent several rounds of chemotherapy at San Joaquin General. It was also during this time that the JAGS Solanki Memorial Fund put Victoria in touch with the gynecological oncology department at UC Davis in Sacramento.

In February of 2014, she was transferred to UC Davis, where Dr. Alvarez performed a two-part surgery on Victoria. It lasted seven hours.

The first past was the debulking surgery. “I have heard it described as they take everything out of you but the heart and lungs, and they go through everything and cut and cauterize and remove tumors along with all your female stuff and they have to go through the bowel and intestines and everything in that area,” said Victoria, who spent a week in the hospital.

The surgery left her with a huge scar on her abdomen. The second part of the surgery was installing a port, which would send chemo treatments directly into her stomach. It made her stomach blow up like a balloon.

“I used to call it my chemo baby,” she said

The doctors thought the cancer was in remission, but two months later, the cancer returned in a more aggressive form and by October, Victoria was back in treatment.

The cancer had spread to her lymph nodes and chemotherapy was no longer working.

With her life in limbo, she opted to participate in a clinical trial.

“She had advanced ovarian cancer and she tried the accepted, the gold standard of surgery and chemo but she was recurring very quickly with every chemo we attempted,” Dr. Alvarez said.

In October 2015, she landed in the ER again, this time with congestive heart failure. “I am rushed to the emergency room by ambulance because I can’t breathe. And all those doctors thought I should start hospice and I said ‘I don’t think so.’”

The clinical trials

The immunotherapy clinical trial Victoria is on has given her her life back. A year ago, she was bedridden. Now she goes for daily walks with her friend Adriana Crolley.

“I am thankful for every day. With my diagnosis, I should have been dead a year ago.”

Now she travels up to UC Davis every two weeks for infusions. It’s a days-long process. The first day she goes up to have her blood drawn and the following day her vitals are checked and blood test results are reviewed.

“They are reading it all, I let them tell me how I am doing,” she said. “I don’t want to know all the side effects, I don’t want that pre-set in my mind.”

After the exam, the nurse readies her port for the infusion. Once connected, she lies on her bed for an hour, as the medicine slowly drips into her system. A device connected marks the progress. It’s a slow process. And after the infusion is done, she stays for two hours for observation.

All trial participants are closely monitored. She has an EKG every six weeks, along with other scans. Every six weeks she also sees Alvarez, who monitors her progress.

Victoria feels extremely fortunate to be part of the trial. “We want to make cancer a disease you can live with,” she refers to Dr. Alvarez as her Batman, her superhero, for saving her life.

Most women are not diagnosed with ovarian cancer until it’s too late. The symptoms are vague, and many women are unaware of what the warning signs are. The bloating, discomfort, feelings of fullness.

The five-year survival rate for ovarian cancer has remained poor, according to BioMed Central, hovering around 44 percent through the 2000s.

Alvarez explained what a Phase 1 trial is.

“When we have new medicines that we want to bring to that we think may help people there is an apparatus to test them to see if they are safe and if they work,” he said. “If we have a drug we have that we think may work — we work out the dose we may use, the toxicity in humans, we’re answering questions of if it’s safe, and is it safe to move forward? You look for an efficacy signal in the phase one. It’s not an end point of trial — we do not judge success or failure.”

“The side effects are auto-immune — we’re messing with ability of the immune system to fight itself,” he said. Some of the side effects are inflammation of the colon and thyroid glads.

Victoria has been one of the success stories to come out of this clinical trial.

Prior to development of the Phase 1 cancer research program at UC Davis, patients had to travel to UCSF or Stanford if they had advanced cancers. Travel is not easy for this patient population for multiple reasons so a Phase I program closer to home was important. And it was with the development of this program that the Sacramento Citywide Oncology Phase 1 program (or SCOPE) was established.

Staying healthy

Victoria has always tried to maintain a healthy lifestyle. She used to run marathons. She reads books on the nutritional benefits of various foods. “I try to help my blood tests by nutrition.”

In her kitchen, she carefully cuts up tomatoes, cucumbers, onions and the ingredients to make herself a Greek salad. She takes daily walks with her friend Adriana Crolley. She has laid out a three-mile route along Lodi Lake. Even though sometimes she fights nausea and is dry heaving her way to the walk, she makes sure she walks every morning.

She thinks food plays a big role in ones' health. "If you’re eating a lot of processed foods, it’s not gonna be good. And sugar. They say sugar is not good for cancer at all. Sugar is really high on the list. Don’t do sugar. Every once in a while, do I go and have some sugar? You betcha! Certain parts of me say you have to kinda enjoy it a bit too. If i feel like I really crave some sugar I try to make it a healthier sugar like 70% cocoa chocolate. I try to help my sugar with more with fruit and know it natural fruit sugar and not not processed sugar. But do I eat chocolate? You bet!"

Crolley said of her friend: "She is a strong lady, very determined. And a fighter. I think it's because of that and the treatment she's getting, that she is doing as good as she is right now. She doesn't complain, she has a great attitude. She said 'sometimes when people see me they think I am healthy and don't know that I am not.' They don't see how the rest of her day is. She is nauseous every morning. They see her at her best, because she has to be rested before she goes out. She makes the best and most of everyday. She is an inspiration to me. She has a bright spirit."

“It’s important for me that I do those walks — they help me not be depressed, it keeps me moving and it keeps helping me healthy in heart and spirit and body wise too, that’s where my energy goes.” She thinks her positive attitude has a lot to do with her success against the disease.

“I pretty much take each day I have as a blessing. Because I know, experiencing this, I don’t plan for the future, I kind of live in the moment, because all that can change for me at any given time."

“She has outshone everyone in her response. She has had a complete response — she has no evidence of cancer,” Dr. Alvarez said.

But Dr. Alvarez cautions that it doesn’t mean she is cured. ‘There could be no curative options. But she can be on it as long as she can continue in the trial.”

Heather Anderson, her daughter, adds: “It’s saved her life thus far, at this point — she literally was considering having hospice come in — that’s where she was. Stage four, spread throughout the body. Most women don’t make it past five years. We feel very fortunate, it has worked for her.”

But she understands the cancer can come back. “We don’t really know what to expect. One day it can stop working. For now, we just go 'Wow! It’s working.'”

John Anderson, her son-in-law, agrees.

“She shouldn’t be here. She is the wonder child of UC Davis,” he said.

Dr. Alvarez does not want to understate the importance the women (and men) that participate in the clinical trials have on the medical progress being made.

"The only way we have made great strides for women with ovarian cancer and the women volunteering for trials - their work and braveness that have helped so many women live longer lives, and it gives hope to improvements and future cures. Without trials and willing women we don't have that."

Giving thanks

“I have a poem on my fridge that I kind of live by. That it’s all about attitude. That it’s 90 percent of how I perceive it, and 10 percent of what actually happens. So I think it’s the fact that you have to want to fight, you have to be willing to accept. ... I think I started to get better a lot inside when I just accepted it was OK that I have cancer. When you no longer are mad about having it. When you’re like, ‘OK I have this. So now what? I have it. Life goes on.’”

Heather describes her mother as a very strong woman.

“She’s always been strong woman and she was a single mom. She always took care of me and I always admired her for that,” she said.

Victoria says the trial has been a life saver for her. She also credits her faith and God with her success.

“What I tell people is that you know, who knew that having congestive heart failure would be a Godsend? And it really was. I kept saying I feel a thousand years old. I felt like I could hardly lift my arm. That’s how weak I felt. So to go from that to walking in the park each morning, it pretty much like a miracle. I think first of all the big C word scares everybody, no matter what cancer it is. It totally shocks you. My first reaction was when they told me, I was in disbelief. ‘Naah!’ I was a healthy person, I lived a healthy lifestyle, I ate healthy, I exercised. I even did different natural things that would be cancer preventers.”

“You can’t realize how much trauma the human body can take and bounce back. God created an amazing piece of machinery. The human body is an amazing machine, you can do some pretty brutal things to it and it will bounce back,” she said, laughing. “I felt like it was very brutal when I was cut from stern to stern and epidural running into your back. And you have this thought: ‘Am I really going to make it through this? And you find you do. And then you can hardly remember what this was like. It becomes a faded past.

“Four years ago, I probably would have been dead! I don’t have any complaints. they have done a great job of keeping me going. And I think it can bring hope for women with this disease because statistically it’s not a nice thing.”

SIGNS & SYMPTOMS OF OVARIAN CANCER:

•Vaginal bleeding (particularly if you are past menopause) or abnormal discharge from the vagina

•Pain or pressure in the pelvic or abdominal area (the area below your stomach and in between your hip bones.)

•Swollen or bloated abdomen

•Feeling full quickly while eating.

•A change in your bathroom habits, such as having to pass urine very badly or very often, constipation, or diarrhea.

PREVENTION

There is no way to prevent ovarian cancer; however, the following may help reduce your chances of getting ovarian cancer:

Factors that may decrease chances of getting ovarian cancer:

- Having used birth control pills for more than five years.

- Having had a tubal ligation (getting your tubes tied), both ovaries removed, orhysterectomy (an operation in which the uterus, and sometimes the cervix, is removed).

- Having given birth

- Breastfeeding

Factors that may increase your chances of getting ovarian cancer:

-  Personal or family history of cancer (especially ovarian or breast cancer)

-  Testing positive for either the BRCA1 or BRCA2 gene mutation, which increases the risk of ovarian and breast cancer

- Over age 55

- No pregnancies

- Menopausal hormone replacement therapy

- Endometriosis

SOURCE: www.ocrf.org Ovarian Cancer Research Fund

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