In early 2020, Heather Moffitt was busy planning a dream trip to Australia with her family.
First, a global pandemic canceled the trip.
A year later, the surprise diagnosis of metastatic breast cancer pushed it back again.
By the summer of 2021, Moffitt was barely able to leave her chair on the ground floor of her home. Australia was all but canceled for good.
“There has to be something,” Moffitt said after putting a hospital bed on the ground floor of her home. “It can’t be ‘stay in your chair the rest of your days.’”
“This is a cancer thing”
Moffitt was initially diagnosed with stage 0 breast cancer in 2017. After undergoing two surgeries, she had been told that annual mammograms should keep an eye on what her doctors called the least aggressive, least invasive breast cancer she could have.
Like a number of people, Moffitt spent the 2020 COVID lockdowns working out. In August, she felt her hamstring tear while exercising and started physical therapy, but it didn’t seem to provide any relief from the pain. Moffitt said she began struggling to walk and a “weird pain” was moving into her back. By November, she was struggling with pain all over her body. Her annual mammogram that month was clear.
Doctors told her again in January 2021 that the pain she now felt radiating in her ribs was likely from exercising. She restarted physical therapy. The pain only got worse, rehab wasn’t working, and Moffitt said she was “really frustrated.”
In March, Moffitt could barely move due to “excruciating pain.”
“I could sit in one chair, in one position, with heat. That was about it for being comfortable,” Moffitt said.
Moffitt wasn’t able to get in for an MRI for at least two weeks due to the ongoing COVID lockdown. During that time, she was standing in her kitchen when she felt her vertebrae collapse.
“My husband had been worried for a while,” Moffitt said, adding that he kept saying, “this is a cancer thing.”
Moffitt wasn’t as worried.
“I had a stage 0, non-invasive cancer,” Moffitt said. “I had a clear mammogram in November. I figured it was orthopedic, or maybe it was nerve-related or MS.”
The vertebrae collapse changed her mind.
“There’s a whole team for people like me”
The results of an MRI in May 2021 “weren’t a huge surprise,” Moffitt said. The breast cancer had metastasized and tumors that had spread to her spine had caused spinal cord compression.
While radiation started right away, a huge backlog for her local, understaffed neurosurgeons put a consultation with them on hold.
By the time she completed five sessions of radiation, she started losing sensation in her big toes, then couldn’t control her feet, and finally started to drag herself with a rollator walker.
Meanwhile, the focus was on disease management and confirming the type of cancer.
“They don’t usually spread,” Moffitt said of her initial 2017 cancer diagnosis, well-differentiated papillary breast carcinoma. “I’m the ‘lucky’ unicorn.”
Moffitt was only able to go from her chair, to the bathroom, to the hospital bed in her home. She couldn’t go up or down stairs and she said that “getting out of the house was almost impossible.” Her physical therapist called her a “huge fall risk” and told her she shouldn’t leave the chair.
Crutches helped by giving her hope. Moffitt found a therapist for spinal rehab to relearn balance, foot control, standing, and walking.
In January 2022, Moffitt was told by her local doctors that her disease was too extensive for surgery and that kyphoplasty, a minimally invasive procedure that uses balloons and bone cement to strengthen the vertebrae, was out of the question due to tumor locations.
Moffitt said at this point due to spinal rehab, she could potentially travel to explore treatment options elsewhere.
“I look it up and there’s a whole center for brain and spine metastasis [at Duke],” Moffitt said. “There’s a whole team for people like me.”
Coming to Duke
Moffitt said she first spoke with New Patient Coordinator Eris Worlds to make an appointment and have her records transferred before her first appointment at Duke in April 2022.
“Eris, Scott (Pollard), Dr. (Carey) Anders, they’re brilliant,” Moffitt said.
At her appointment at Duke Neurosurgery, Moffitt met with Brice Painter, a physician assistant and Duke Center for Brain and Spine Metastasis clinical program manager. While Painter agreed that kyphoplasty was unsafe for her, Painter told her there were surgical options to discuss with neurosurgeon Rory Goodwin, MD, PhD.
“When she presented to our clinic, she complained of persistent upper back pain, issues with walking and balance and imaging that showed destruction of the spine vertebral bodies in multiple areas as well as a kyphotic deformity (an abnormal curve forward),” Goodwin said.
The multi-disciplinary team of Drs. Anders and Goodwin, Scott Floyd, MD, PhD; Trey Mullikin, MD; and John Kirkpatrick, MD, PhD, created a comprehensive treatment plan for Moffitt with “the best chance of treating her spine, while focusing on alleviating her symptoms,” Goodwin said.
After six hours in surgery, 14 screws, two rods, and one cage, Moffitt’s surgery was complete. She regained a little of the four inches of height she had lost after the vertebrae collapse and recovered well. Moffitt then underwent stereotactic radiosurgery (SRS) for precise radiation treatment of the few remaining tumors in her spine.
From Surgery to Sydney
“It’s a whole category of daily things I had to negotiate that I don’t even have to think about now,” Moffitt said. She no longer worries about what kind of chair she’ll sit on or how long she’ll be walking. “I feel the best I’ve felt in years.”
When her husband asked in 2021 if she wanted to try to go to Australia the following year, she told him, “You might as well have asked me if I want to go to the moon. Australia felt like Mars.”
By late summer 2023, after a clear follow-up appointment at Duke, that all changed.
“To even have it on the table was wild,” Moffitt said.
In December 2023, Moffitt hiked in hot, humid rainforests, walked hours and hours around cities, and sat on the ground for 12 hours to have the perfect viewing spot for the fireworks in Sydney ringing in 2024.
“Surgery was the difference,” she said. “It allowed me to have this amazing experience. Seeing the fireworks in person, being there with my family. It was just incredible. It wouldn’t have been possible without the team at Duke.”