The miracle of modern medicine

By WILLIAM K. ALCORN

alcorn@vindy.com

POLAND

Matthew Hiznay should have died Sept. 2, 2011. The Poland man “coded” twice that day with respiratory failure in the medical intensive-care unit at the Cleveland Clinic.

Fluid in the sac around his heart and in his lungs caused by a rare form of lung cancer, and swollen lymph nodes constricting his airway were the

culprits.

Hiznay, a second-year student at the University

of Toledo College of Medicine, had entered the hospital Sept. 1 to begin

chemotherapy.

During the next 20 days, he went from stopping breathing twice to walking out of the Cleveland Clinic

on his own, his cancer

under control.

On Nov. 10, he learned

his cancer was in remission.

“At no other time in the history of mankind could this have happened. It was just his moment,” said Dr. Nathan Pennell, Hiznay’s thoracic oncologist.

Between Sept. 1 and 21, an amazing confluence of events — his mother, Mandie, calls it divine

intervention — saved the medical student’s life multiple times.

On Sept. 2, emergency surgery was performed by Cleveland Clinic ICU surgeons to drain fluid from around his heart and lungs — there wasn’t time to wait 15 minutes to assemble a thoracic team — and gave him a chance to live and fight his cancer.

The same day, Aug. 26, that Hiznay, 24, was diagnosed with an aggressive cancer — anaplastic lymphoma kinase (ALK)-positive nonsmall cell lung cancer (NSCLC) — a new drug developed by Pfizer was approved by the Food and Drug Administration.

The drug, Xalkori, changed a unique and rare form of lung cancer from a probable death sentence to a controllable illness.

Hiznay’s cancer is caused by a genetic mutation in which a chromosome breaks in half and flips on itself. The fusion protein that results from the new gene, which is incorrectly made and is “on” all the time, causes cancer, doctors said.

Xalkori targets the out-of-control fusion protein, Dr. Pennell said.

Hiznay’s saga began with some shoulder and chest pain in late June and early July 2011. He attributed a persistent mid-July cough to a summer cold.

But when his girlfriend, Ally Stojkoska, massaged his sore left shoulder, she noticed a knot.

“The lump got bigger day-by-day, and with my knowledge of anatomy I knew there were lymph nodes there,” Hiznay said.

He went to his family doctor, who made a preliminary diagnosis of a lung disease, sarcoidosis.

“I’m thinking, I’m 24. I’m a lifelong nonsmoker. It’s not cancer. I’m not supposed to get cancer,” Hiznay said.

The lymph node was removed Aug. 12, and when he went Aug. 17 to have the stitches removed, he was sent to the Cleveland Clinic. The news was grim.

“It was 85 degrees ... a beautiful summer day. I’ll never forget it,” he said.

A CT scan showed the cancer had spread from the left lung to the right lung, to all the lymph nodes in his chest, and to one lymph node in his stomach, but fortunately not to his brain.

“The hill got really steep, really fast,” Hiznay said.

“Because of my medical training, I knew in the back of my mind it could be cancer, but I didn’t really think it would be,” he said.

When doctors gave him the diagnosis, he was with his mother. “We both cried,” he said.

He researched and found the survival rate for Stage 4 lung cancer was 15 percent.

“That’s the last time I looked online for treatment or anything else about the disease. You never want to have cancer, but lung cancer you really don’t want,” he said.

Despite the diagnosis, Hiznay didn’t think he was going to die. “I thought, ‘OK, move forward and let’s treat this,’” he said.

“I have a very strong faith in God. I never said why me, but neither did I know how it would end,” Hiznay said.

Before the chemotherapy treatment began Sept. 1, another event occurred that nearly killed him and and ultimately also saved him.

Hiznay said Dr. Pennell checked him over before starting the chemotherapy.

“He thumped my chest and there was no echo. He thought I had pneumonia, which meant I could not start chemo. I remember sinking in the chair. I wanted to start fighting,” Hiznay said.

On Sept. 2, he was to start treatment for pneumonia, and a nurse found him in respiratory failure. He was dying.

He was placed on a ventilator in the medical intensive-care unit, where he stopped breathing a second time before his condition stabilized.

Doctors discovered a buildup of fluid around his heart and in his lungs caused by the cancer and lymph-node swelling that constricted his airways and caused his lungs to collapse.

Fortunately, when Hiznay came to the clinic for chemotherapy, he looked so ill that Dr. Pennell, a solid-tumor oncology specialist, admitted him.

Draining fluid from the sac around his heart and in his lungs was done on an emergency basis by MICU physicians.

“That was the most-urgent issue, but there were lots of other things going on at same time: Chest tubes were inserted to drain his lungs, and he developed a blood clot and was put on blood-thinning medicine. ... If he had been at home when all this happened, he would have died,” Dr. Pennell said.

Hiznay had dodged another bullet.

He was stabilized, but there was concern about brain damage because of the lack of oxygen when he stopped breathing.

He regained consciousness, but he couldn’t talk because of the ventilator.

Stojkoska was at his bedside. Frustrated, he grabbed his girlfriend’s hand and tried to write something on it. Realizing he wanted to communicate, he was given a pad to write on.

His first scribble note asked who won the preseason game between the Cleveland Browns and the Chicago Bears.

“That’s when we knew he didn’t have brain damage,” said his mother, able months later to laugh about the moment.

On Sept. 5, Hiznay started chemotherapy to buy time until test results came back positive for ALK. Treatment with Xalkori was started, and he walked out of the hospital on his own Sept. 21 with an appointment Nov. 10 to be retested for cancer.

“I was more nervous for that than when I was diagnosed,” he recalled. “Dr. Pennell said, ‘You’ve had a complete response to the drug. You are in remission,’” Hiznay said, wonder in his voice.

Hiznay’s case has been extraordinary from the very beginning, Dr. Pennell said.

“It was terrible luck he was struck with the cancer at his age, but an incredible stroke of good luck that the medicine he needed was available to him the same week he was diagnosed. Xalkori had been used in clinical trials, but Matt was much too sick for a clinical trial,” Dr. Pennell said.

But getting Xalkori was another question.

The drug was so new that Hiznay’s insurance company was unprepared to deal with paying for it on an urgent basis. In addition, it was available through only three mail-order pharmacies, Dr. Pennell said.

It took an incredible effort by a lot of people to get Hiznay covered.

Several people in the Cleveland Clinic’s financial office worked nonstop all day. Pfizer approved Hiznay for its assistance program, and his insurance covers the rest of the cost of Xalkori, which is about $9,600 a month, Dr. Pennell said.

All this was done in one day. It was the ultimate team effort that really saved this young man’s life, the doctor added.

“I thank God. If I’d gotten my lung cancer six months earlier or if there had been a different cause of the cancer, I’d probably be dead,” Hiznay said.

Instead, the former saxophone player in the Poland Seminary High School Band and high school track and cross-country participant is learning how to play the piano while he rehabs and regains his strength before going back to medical school this fall.

He tells his story whenever he can — he says it is therapeutic; and he plans to participate in his first American Cancer Society Relay for Life this year.

“It was a wild and crazy ride,” said the future doctor, who agrees with Dr. Rendell Ashton, who helped direct Hiznay’s care in the MICU, that his experience will give him a unique perspective with his patients. Dr. Ashton is a pulmonary, allergy and critical-care medicine specialist.

“I shadowed Dr. Ashton my first time back to the Cleveland Clinic. He said a lot of people die in the MICU and told me I was the sickest patient he ever saw there come out alive. I got very emotional,” he said.

“I’ll share with my peers at Toledo. ... And when I put on my white coat, I can tell patients I’ve been there, I understand, and we’ll help you,” Hiznay said.

“I can’t wait to be able to sit down with someone and tell them, ‘You are in remission.’”