When Life is in the Balance, Excellence Means Everything


Wesley White leans forward and in all seriousness says: “I have absolutely no doubt that a burrito saved my life.” So begins the Texas native’s story of how a quick bite launched him on a journey that swung from a brush with death to a new life with a fellow survivor.

It was the first week in April 2013 that White noticed strange bruises on his back as he changed out of his gym clothes following his daily workout. He was only 30, physically active and considered himself healthy. In fact, he hadn’t seen a doctor in 10 years.

Although he thought the bruises were odd, he wasn’t overly worried. The next day he took his car shop colleagues to a “hole-in-the-wall” eatery for a traditional meal of burritos before their annual trek to the Lonestar Round Up car show in Austin the first Friday of the month. White’s first bite slid painfully down his throat. “Felt like I was swallowing a potato chip whole.”

By Monday, he was doubled over with abdominal pain. He visited a local doctor, who did blood tests and ordered a CT scan. The scan revealed a hole in his stomach and a perforated colon.

“By the grace of God, the burrito you ate cut you open,” he recalls the doctor telling him.

White didn’t follow the doctor’s logic. How could it be good news? The doctor explained that if he hadn’t ended up in the emergency room, he likely wouldn’t have had the tests that revealed a more life-threatening issue that needed to be addressed — before it was too late.

“You’ve also got leukemia.”

White needed immediate treatment for cancer. He was quickly admitted to the hospital to begin chemotherapy.

By the time White was diagnosed with cancer, April Ingram had been at the same hospital for almost two months. She was fighting an aggressive and advanced case of leukemia, discovered when she visited a doctor for jaw and ankle pain that had gradually intensified over two weeks. She, too, was just 30 years old and never suspected she might have cancer.

After several months of intensive chemotherapy, both White and Ingram, who are members of Blue Cross and Blue Shield of Texas, were scheduled for bone marrow transplants performed by the team at the Texas Oncology-Baylor Charles A. Sammons Cancer Center in Dallas.

They are among the more than 20,000 Americans a year diagnosed with blood-cell cancers that require bone marrow or stem cell transplants. Even with a registry of millions of donors, about 3,000 of those awaiting transplant die because they cannot find a suitable bone marrow match.

Even with a transplant, others die from infections that ravage their immune-suppressed bodies after the procedure.

Centers of excellence

The Texas Oncology-Baylor cancer center has collaborated with the adjoining Baylor T. Boone Pickens Cancer Hospital to develop a “center of excellence” for adult bone marrow transplants. That term generally means a health care institution has established a concentration of clinical expertise and assembled interdisciplinary teams to deliver comprehensive care around a specific condition or procedure.

 


Identifying the highest quality, most cost-effective providers in key specialties is critical in getting the best outcomes.

Baylor is also a Blue Distinction Center for adult bone marrow transplant. The designation is awarded by the Blue Cross and Blue Shield Association to medical providers that meet measures of quality, safety and outcomes for specialty care, such as transplants, spine surgery and cancer care.

Recognizing facilities that consistently meet high standards of care helps health insurers and employers guide members when they need high-stakes, high-cost medical care. It’s also one tool that helps insurers and employers address the significant variation in quality and costs.

Blue Cross and Blue Shield members, depending on their plan, may have lower out-of-pocket costs when they choose a Blue Distinction Center — an added incentive to choose high-performing providers.

Centers of Excellence - When Life Is in the Balance

White works in his custom car shop while recovering from intensive chemotherapy administered after his stem cell transplant.

“Identifying the highest quality, most cost-effective providers in key specialties is critical in getting the best outcomes – both for individual members and for the health care system as a whole,” says Brad Bare, divisional vice president of network strategies for the Blues Plans in Illinois, Montana, New Mexico, Oklahoma and Texas. “From cancer care to maternity to transplants, we focus on taking a ‘quality first’ approach.”

The average cost of bone marrow transplant ranges from $410,000 for an autologous transplant (using stem cells from the patient’s own body) to more than $800,000 for an allogenic transplant (using stem cells from a donor), according to the analytics firm Milliman Research.

Expertise proves critical

The Texas Oncology-Baylor cancer center possessed a level of expertise that proved critical for White.

Stem cell transplants involve killing off the diseased blood cells with chemotherapy and then replenishing the supply with healthy cells through an IV line. If the new cells come from a donor, certain proteins in the blood must be a close match so that the transplanted cells don’t attack the cells in the patient’s body.

There wasn’t a perfect donor for White. At the time, however, cancer doctors were refining an approach using blood from a 50 percent match — which often can come from a parent or a child. In his case, his mother was his donor.

The challenge is stopping the donated stem cells from attacking cells in the new body and causing serious complications, says his oncologist, Dr. Estil Vance — or, as he puts it, “getting the immune systems to get along.”

The solution, which has now become more common, was an intense round of chemotherapy delivered after the transplant to kill the potentially harmful cells. “Fifteen years ago if someone told me you could do that, I would have said, ‘No, that’s impossible,’” Vance says.

When Ingram arrived at the Texas Oncology-Baylor cancer center, she was feeling good. Just weeks before when the cancer center called to let her know they had found a suitable donor, she had cheerfully told them she felt great and didn’t think she needed a transplant anymore.

“They said ‘No, we still need to do this,’” she says with a laugh.

Centers of Excellence - When Life Is in the Balance

When she lost her hair during treatment, Ingram embraced the opportunity to try on some different hair styles with wigs.

Other than nausea associated with post-procedure chemotherapy and intense bone pain from a white blood cell booster she dubbed “Satan’s spawn,” Ingram said she recovered more quickly than many patients do.

White also recovered without complications after his transplant. He promptly replaced his car shop’s toxic benzene-based chemicals, which are known to cause cancer, with rubbing alcohol and acetone liquids. He had been working with the caustic chemicals since childhood, when he built and raced cars with his father.

Love intervenes

Ingram’s infectiously positive personality and the blue wig she donned to mask chemotherapy-induced hair loss endeared her with staff and patients — and caught White’s eye.

But they didn’t meet until an annual gala for Texas Oncology patient survivors. White was a keynote speaker, and Ingram was among a group who gathered around him to ask questions afterward.

Ingram, who describes herself as a “loud introvert,” enlisted a friend to approach White and say, “My friend wants to talk to you.” They hit it off that night and have been together ever since.

They were married March 17, 2017, and many of the cancer center’s staff, doctors and previous patients attended the wedding. Everyone knew both of them very well because the doctors share the same interdisciplinary team, Vance says.

“We all adored them,” Vance says. “It was more like family than because they were patients.”

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