Multidisciplinary team, patient fight off leukemia and its complications every step of the way

Multi (many) disciplinary (of or related to a particular field of study): It's a word describing the team approach to patient care at Holden Comprehensive Cancer Center at The University of Iowa.

Unless you require the focused expertise of several diversely specialized health care providers, it's just another word. But for leukemia patient Jamie Heuer, the approach was an integral part of a miraculous recovery. In fact, his experience epitomized the concept of multidisciplinary care&emdash;physician specialists coming together to plan the most effective treatment strategies (rather than patients having to visit different specialists individually).

In early 2000, Heuer, 38, a Muscatine, Iowa, resident who owns his own construction business, was referred to Mercy Iowa City by his local physician after experiencing symptoms including ear problems, weight loss, fatigue, and double vision. After testing blood and marrow samples, doctors diagnosed him with acute lymphoblastic leukemia&emdash;a rapidly progressing cancer that starts from white blood cells in the bone marrow.

"It completely blindsided us," Heuer says. "I had no history of cancer in my family, didn't smoke, and didn't drink much. I had always been completely healthy."

"I was in shock," says Heuer's wife, Tracy. "I started crying right away. But Jamie took me by the arms and said, 'Stop it. We'll beat this.'"

Heuer was transferred to UI Hospitals and Clinics, where he was seen by the Cancer Center's acute leukemia service and initially treated in the chemotherapy unit. "The disease went into short-term remission, but all the information we learned from our laboratory specialists who studied his leukemia cells and their chromosomes told us that Jamie needed a bone marrow transplant. Fortunately, his brother (Bret) was found by the Histocompatibility Laboratory to be a perfect match," says Roger Gingrich, M.D., Ph.D., director of the Adult Blood and Bone Marrow Transplantation Program.

The transplant was performed in September 2000. "There were a variety of complications, some understood, some enigmatic," Gingrich says. Still, things looked good enough for Heuer to be discharged&emdash;but he wouldn't be home for long.

"Jamie was readmitted in October 2000 with graft-versus-host disease, fistula between the colon and bladder, and renal failure," Gingrich says. "Bone marrow transplant patients face many potential hurdles, but it's rare to have as many complications as he did. It might be normal to have one infection, but he had four at the same time. He required naso-gastric tube feeding to survive. It was almost too much, but Jamie has an amazing reservoir of spirit and determination."

For 26 days late that year, Heuer was in a coma in the Medical Intensive Care Unit. "At one point, I was advised to start planning his funeral," Tracy says. "But Jamie kept his promise. Three days later, on December 5, he woke up."

Heuer began 2001 on dialysis, deaf (antibiotic treatments had led to the loss of his hearing), and still fighting off resistant bacteria, but he slowly regained his strength. Tales of his battle against cancer have spread; he was dubbed "The Miracle Guy" at the 2003 Bone Marrow Transplant Reunion.

In addition to a bone marrow transplant for leukemia, Jamie Heuer has undergone several other procedures since 2001, all with the help of multidisciplinary teams of experts at University of Iowa Hospitals and Clinics:

• In 2003, surgical specialists from the Department of Surgery repaired his bowel and removed his colostomy
• In 2004, he received a kidney transplant (again, the donor was his brother) from specialists within the Department of Surgery
• In 2005, his hearing was restored with a cochlear implant by the Department of Otolaryngology&emdash;Head and Neck Surgery.

"I do just about everything now that I used to and I love to play with my kids. Everything's great," Heuer says. "The treatment I received could not have been better."

George Weiner, M.D., Cancer Center director and Heuer's leukemia physician, says, "We promote and nurture multidisciplinary cancer care. Jamie's restored health is a perfect example of what multidisciplinary medical care can do."

Family Heroes
Jame Heuer's (center) quest for survival has benefited enormously from the generosity of his brother, Bret (left), who donated bone marrowfor transplantation, as well as a kidney; and his wife, Tracy, who has provided invaluable emotional support.