Atlanta man learns he has ‘heart attack’ of cancers after mysterious bruising
9/06/2016, Winship Cancer Institute of Emory University, AJC.com
A few days after Ruben Diaz and his family traveled from their home in Honduras to visit relatives in South Carolina during the 2013 Christmas holidays, he noticed a bruise on his arm.
He didn't give it much thought.
On the day after Christmas, a larger bruise appeared on his leg. He had no other symptoms, such as fever or fatigue, but the brown bruise was about the size of an apple.
"That one started to scare me," he said.
His brother-in-law, who is an internist, arranged for Diaz to have blood tests at a lab. During a family dinner later that day, he received a call with the results and quietly told Diaz he needed to go to the hospital right away.
"I didn't even see him leave," said his wife, Vicki Brannon Diaz. "I went upstairs to get the kids settled when my sister came up and said, 'You need to sit down.' And I just knew."
The diagnosis was acute promyelocytic leukemia (APL).
Diaz and his family turned to Dr. Anand Jillella, an expert on APL and the associate director for community outreach at Winship Cancer Institute of Emory University in Atlanta, for treatment.
‘How long do I have?’
Before they met Dr. Jillella, doctors in South Carolina were perplexed by his condition. When Diaz's wife joined him at a South Carolina hospital, she remembers seeing a group of doctors surrounding him and asking questions.
"I walked into the room and saw five white coats that all said 'oncology' on them. And I said to myself, 'This is not good,'" she said.
The on-call doctor believed it was APL. Because of its swift onset, APL is considered the "heart attack" of cancers.
When a patient has APL, their bone marrow produces too many cells called promyelocytes. When too many of them gather in the marrow, promyelocytes crowd out healthy blood cells. If there are not enough healthy cells, patients are at great risk of infection or bleeding.
"The first question that came into my mind is: ‘How long do I have?’ ” Diaz said.
His South Carolina doctor contacted Dr. Jillella, a national leader in bone marrow transplantation and APL. Dr. Jillella assists doctors at smaller hospitals to set up proper treatment for APL patients.
"Ruben’s doctor said Dr. Jillella was one of the four experts in the world on this form of leukemia, that he's dedicated his career to APL, and we were in the best of hands," Brannon Diaz said.
Her husband started chemotherapy the next day, receiving medication and blood transfusions to get his blood cell counts under control.
"The day after he was admitted, Dr. Jillella called and talked to Ruben," she said. "He said, 'The first thing I want to tell you is you're going to be fine.' A real peace came over Ruben and soon he was laughing, smiling."
Since APL needs to be treated immediately, Diaz spent the next five weeks in South Carolina for treatment, but was in constant contact with Dr. Jillella.
Withholding treatment could have been detrimental. Only decades ago, an APL diagnosis often meant certain death. But APL now has a cure rate of about 90 to 95 percent if appropriate treatment begins immediately.
"The thing with APL is that if you get them through the first month, it's basically a home run," Dr. Jillella said.
Strength in difficulty
Breaking the news to their then-middle school twins, Ian and Maya, was one of the couple's toughest moments.
"The only time I saw Ruben cry was when the kids came in, we all cried," Brannon Diaz said. "My sister said the kids are going to need to express it, but no pity parties. The kids will take their cues from how you handle it, so try not to let them see you break down."
After his initial five-week treatment in South Carolina, Diaz took a two-week break. He then started outpatient treatment for another four weeks.
In many cases, it's more cost effective and easier on the patient to receive treatment close to home.
"They call and I can email it to them right away or text it to them," Jillella said. "I can talk to them and say, 'This is what we do, these are the next steps.’"
Diaz used his laptop and cell phone to continue working as vice president of manufacturing for Delta Apparel, an active wear manufacturer and distributor. The South Carolina-based company has operations in countries such as Honduras.
As the treatment in South Carolina neared an end, the couple had to decide their next step. They could move to either South Carolina or to Atlanta.
Since one option was for Diaz to continue his eight-month outpatient treatment at Winship under Dr. Jillella's direct supervision, they chose Atlanta.
The twins continued their education online through their school in Honduras, even after the family moved to Atlanta in April 2014. They started eighth grade at North Gwinnett Middle School in fall 2014.
"They turned in everything on time," Brannon Diaz said."We taught them you don't get to use this as an excuse to be late, to feel sorry for yourself. We're going to get through this challenge and move on."
Close and personal care
Diaz drove to Winship, located in DeKalb County, for chemotherapy on Monday through Friday mornings, and then headed to his office in Gwinnett County to work in the afternoon. A four-week on/four-week off course of treatment continued for several months.
He met with Dr. Jillella at least once a week, sometimes more,when he was at Winship's infusion center.
"We had set appointments, but many times he came to see me when I was getting my chemo," Diaz said. "He would ask me how things were going, discuss my numbers (such as blood counts). And he was always available by phone or email if we had questions."
Dr. Jillella emphasizes that a team approach is a large part of a patient's success. For instance, his team of physicians, nurses, and research staff came up with a collaborative approach that decreases mortality from 30 percent to about five percent. He found that some physicians who treat patients with APL may not be familiar with the potential complications that can develop during treatment. Dr. Jillella took a very detailed treatment algorithm and boiled it down to a three-step process that can be easily shared.
Diaz finished his chemotherapy treatment at Winship in August 2014 and is in remission. He is working to lose the last half of the 20 pound she gained due to prescription steroids.
Dr. Jillella and Diaz meet every three months and blood tests are done to ensure he remains in remission.
"Ruben is the kind of guy who doesn't cry about it. You go on and you fix it," Brannon Diaz said. "That was his mentality the whole time."
She admits that she has worried about her husband remaining cancer-free, but Dr. Jillella eased her fears.
"He asked what was worrying me, and I said, 'What if it comes back?'" Brannon Diaz said. "He told me you can worry today if it's going to come back tomorrow, or you can be happy today. If it does come back, this is what we'll do. So why sit around and worry?"