"At age 60, I feel grateful for my life every day."
BRCA postive breast cancer, bowel surgery, mastectomy, oophorectomy
— Alison Kovalchik
Alison Kovalchik believes that her positive mindset, staying active, her fantastic friends, supportive family and her faith all played a positive role in her life.
“In 2016, I turned 60 years old but I tend to believe I am still in my thirties,” Alison shares. “I have two incredible and supportive children. My son is 29 years old and works in the field of anthropology and archaeology, and is an avid mountain biker. My daughter is 27 years old. She is a voice-over actor and Pilates instructor and artist.”
Alison has always led a very busy life; raising her children, working as an art teacher, employed in the field of graphic art, teaching religious school, and catering and singing with the volunteer choir on Friday nights at her synagogue. In 2013, Alison's medical issues forced her to stop working and go on disability, but she still expresses her creative talent with her artwork. “This is a huge part of my spirit. I now create wire and bead kippot (yarmulkes) for women, jewelry and Hamsas for wall art,” Alison says, “I also love to read when I'm too tired to create. I'm learning to pace myself, but need to make myself happy. This gives me the strength to heal and to continue to move forward.”
Alison was tested for the BRCA gene mutation that increases an individual's risk of developing breast cancer in March 2013 by her OB/GYN, in Wilkes-Barre, PA. "I met the parameters for genetic testing because I am of Ashkenazi Jewish descent and I have first and second degree maternal relatives who had breast cancer; including my mother and her brother,” she explains “In May, 2013, I received the results that I tested positive for BRCA 1. I truly did not expect for it to be positive. But, in retrospect, the break I received was getting tested and getting an answer. Otherwise I would never have known nor been able to be proactive.”
After learning she carried the BRCA mutation, Alison turned to her OB/GYN for guidance.
“My OB/GYN immediately told me to go to Fox Chase Cancer Center in Philadelphia because they have a Risk Assessment Program. His office arranged for me to be seen by a genetic counselor in a few days,” Alison recalls. “The counselor was very informative and reviewed as much of my family history as I could provide.”
Alison learned that her children have a 50% chance of carrying the BRCA mutation and should be tested. “My siblings and their children were also advised to be tested. My daughter's test results were negative and my son will be tested in the future,” Alison adds.
Learning she carried the BRCA 1 mutation left Alison reeling and she wanted to be seen by a group of doctors with vast experience with this mutation. “I have to admit that I was wary," shares Alison who sought several opinions. "Because of my multiple health issues, doctors often described me as 'complicated.' I was worried that I would continue to be considered a ‘problem patient.’ I was getting nowhere.”
Alison’s health issues include lupus, fibromyalgia, multiple cardiac issues, severe reflux which has damaged her lungs, previous lung ulceration, COPD, gastroparesis (slow motility of stomach), colonic inertia (very slow motility of colon), hypogammaglobulinemia (low IGG levels) which makes her susceptible to infections for which she receives weekly SubQ gamma globulin infusions, severe osteoporosis and more. “Even though Fox Chase is a cancer center, their staff considers the patient as a whole person. This is something I hadn’t encountered and to me is a true miracle,” says Alison.
"Fox Chase Cancer Center’s team of doctors worked as a team to treat me."
Before she could begin treatment for her genetic mutation, Alison met with Earl D. King, MD, a pulmonologist at Fox Chase. “Dr. King finally gave me a sense of relief. If I had any reservations about seeing yet another pulmonologist it was completely dispelled after meeting Dr. King,” she explains. “He immediately put me at ease. He performed further pulmonary function tests on me and confirmed, as well as believed me, about the difficulties I had with breathing, even while just sitting. He is the type of doctor who does not want to step on any other doctor’s toes and tried to work with my then-pulmonologist.”
Upon evaluation, Dr. King recognized that Alison's GI condition needed to be addressed first. “I was so worried that I'd have to find another hospital to be treated for my GI issues. But Dr. King assured me I could be cared for at Fox Chase - even if I didn't have cancer," explains Alison.
She made appointments with two specialists at Fox Chase - David S. Weinberg, MD, MSc, a gastroenterologist and Paul G. Curcillo, MD, FACS, a surgeon. Until these issues were resolved, she would not be able to have the surgery needed for the BRCA 1 mutation. Due to lung scarring, Alison was considered a high-risk surgical candidate. “This makes it more difficult to have anesthesia. The cardiac issues are another concern," explains Alison. Because of her compromised health, Alison would most likely be unable to tolerate the aggressive chemotherapy used to treat patients with this mutation. Therefore, preventive surgery was recommended - specifically a prophylactic bilateral mastectomy and a salpingo-oophorectomy; removal of the ovaries and fallopian tubes.
Dr. Curcillo, Dr. Weinberg and Dr. King worked collaboratively to develop an individualized treatment plan. She continues to be seen every six months for checkups, including a mammogram and a breast MRI.
Alison is grateful to Dr. Weinberg who is patient and thorough with her care. “Dr. Weinberg is wonderful and kind and knowledgeable about motility issues,” she says. “He was attentive to my GI issues and he referred me to Dr. Curcillo, who has been incredible. My team of doctors work really well together! I've rarely seen this happen.”
In April 2015, Dr. Curcillo performed a temporary ileostomy while his partner (and wife), Stephanie A. King, MD,performed a salpingo-oophorectomy at the same time. Dr. King is a gynecologic oncologist. "First items checked off the list," Alison chuckles. One year later, in April 2016, Dr. Curcillo reversed the ileostomy, fixed the peristomal hernia, and created a temporary colostomy closer to the beginning of the colon.
“Dr. Curcillo emphasized that I could call him at any time if there was a problem, day or night and I did need to do so. He was kind, gracious and understanding and was able to address my concerns and I was fine,” Alison adds.
As of May 2016, Alison is faring well and is being scheduled for a prophylactic bilateral mastectomy. “My friends and family continue to tell me that I haven’t looked this healthy in years. I am feeling more like I did many years ago,” she explains. Her Fox Chase team now includes Sameer A. Patel, MD, FACS, a plastic and reconstructive surgeon.
"My doctors gave me my life back; in all ways."
"Dr. Patel outlined everything and described two different options of implants vs. no implants. Each of the doctors wants to be certain that the implants don’t hinder my breathing since they will go behind the chest muscle. Since I have COPD, this can be an issue. I trust my team at Fox Chase. My doctors gave me my life back; in all ways, not only with the BRCA mutation risk. I know I’m in the best hands for my care. I want to especially thank Dr. Curcillo for making my ostomies temporary so they could be reversed if the procedures did not remedy my medical issues. He thought through my treatment plan and allowed for options if I would have needed them.”