“She’s a machine!”
Julio Sandez is speaking admiringly of his wife, Vanessa, and her keep-going, don’t-stop attitude.
“She’s super strong,” he continued. “She projects tremendous energy. She’s always pushing herself, to see how far she can go.”
It can be quite helpful to have that kind of motivation in Vanessa Sandez’s line of work. A 4th grade public school teacher with 20 years in the classroom, this self-described “control freak” from San Dimas, California, knows how to control a class, whether in person or during this pandemic-induced, remote-learning era, via computer screen.
“You find ways to keep them entertained,” she laughed.
No doubt COVID-19 has complicated millions of lives, with juggling remote work — or lack of it — home-bound kids and all the virus-related anxieties. But for the Sandez family (including two boys, in the 3rd and 5th grades), an additional challenge cropped up. Early in 2020, Vanessa Sandez realized something was wrong with her health.
“My nipple was bleeding, and I felt a lump,” she said.
Busy as she was, Sandez ignored her symptoms until Julio insisted she visit a local urgent care. An ultrasound revealed “something,” she was told. A subsequent biopsy proved “indecisive.” Unacceptable answers for the Type A schoolteacher.
“I needed to know,” she insisted.
On advice from a friend, Sandez reached out to City of Hope, asking specifically for Laura Kruper, M.D., chief of the Division of Breast Surgery. Kruper repeated the imaging, did another biopsy and discovered what the first group of doctors had not: cancer cells requiring a lumpectomy.
Vanessa Sandez had discovered something as well: a surgeon she could talk to.
“She [Dr. Kruper] was amazing,” Sandez said. “So caring. She gave me a hug, really listened and answered every one of my questions.”
The feeling was mutual.
“She’s so lovely,” Kruper said. “Very positive and a real trouper.”
At first, Sandez wanted just the minimum surgery necessary. It was already March and lockdowns were looming, which meant her teaching duties would soon change dramatically. This was not the time for major surgery and a long recovery, she felt. She needed to keep going.
But after the lumpectomy and a “re-excision” (“It was hard to see in the operating room if we’d cleared all the cancer,” said Kruper, explaining the second procedure), Sandez wanted to understand why, at the age of 40, she was going through this at all. Most women who develop breast cancer are 50 or older. Sandez had her suspicions. Several relatives had cancer; one aunt had been stricken at age 48. Was this hereditary?
“I was concerned,” she remembers, “not just for me, but for my boys.”
Genetic Testing Gives Insight
Genetic testing revealed that Sandez did not carry the now-famous BRCA1 or BRCA2 mutations associated with high cancer risk. But she did possess an anomaly called ataxia-telangiectasia, mutated. Women with ATM can have as high as a 50% lifetime risk of developing breast cancer, along with an elevated risk of pancreatic cancer.
Her thinking changed right then and there. “Minimum” wouldn’t be good enough anymore. She chose to undergo a bilateral mastectomy and reconstruction, even though cancer cells had been found only on one side. She talked it over with husband Julio who, after the initial shock, gave total support. “It’s about her health and longevity,” he said. “That’s all that mattered.”
Her surgeon understood, too.
“It’s a personal choice and she was completely justified, given the risk,” asserted Kruper. “Why walk around constantly looking over your shoulder, wondering when or if another breast cancer would strike?” Without the so-called “prophylactic” procedure (removing healthy tissue that may or may not eventually develop cancer), Sandez would face a lifetime of uncertainly, not to mention an endless schedule of MRIs and other scans.
Sandez took that all into account, plus one more thing.
“I’m a chicken, and a very nervous person,” she said. “I didn’t want to face any more surgery after this, especially later in life when recovery might be harder.” For that reason she also agreed to an increasingly common option: immediate reconstruction during the same procedure, rather than waiting.
“Immediate reconstruction with a breast implant is always preferable to delayed reconstruction,” said James S. Andersen, M.D., chief of the Division of Plastic Surgery at City of Hope and a veteran of thousands of procedures.
The remaining challenge was getting it all done while guarding against COVID-19.
Surgery was scheduled for May, and when the Sandezes arrived they found a much different campus compared to the bustling place they’d seen only a few weeks earlier.
“It felt like a ghost town,” recalled Vanessa Sandez. “No families. No people milling around. No noise!”
But plenty was going on. City of Hope’s strict safety protocols were now in place. Mandatory masks. Health screenings. Virus tests before most procedures (Sandez tested negative before surgery). All of it carefully designed to keep patients and staff safe while maintaining quality of care.
The hardest part was the strict no visitor policy.
“That was really tough,” recalled Julio. “When someone you love is sick, you want to be there for them. But all I could do was drop her off. I felt so helpless. But we’re adults. We learn to cope. And I knew she was in good hands.”
Better than good. True to the institution’s “body and soul” philosophy, City of Hope staffers worked hard to keep Vanessa Sandez’s spirits up and keep Julio in the loop.
“They were phenomenal, so professional,” said Sandez. “Over and over again they said how sorry they were that Julio couldn’t be there. And they kept calling him with updates. Every step of the way.”
Bottom line, Sandez was able to have successful surgery in the middle of a global pandemic. “City of Hope took every precaution to make sure I was 100% safe,” she said, and her inner “chicken” added, “I was never scared because of COVID-19.”
Several months into recovery, Sandez is doing well and, as Julio describes it, she’s reverting to “machine” mode, once again “pushing herself to do more each day, to see how far she can go.” They are “super happy” with the care they both received.
“From my very first phone call to City of Hope, I could tell the difference.” Julio said. “They were so helpful, right from the get-go. Right at the start when I was worried about paperwork, they said, ‘Don’t worry, we’ll take care of everything.’ The day you get there they give you an orientation. Who else does that? They made everything painless.
“That,” he smiled, “was the cherry on top.”