Shortly after her 12th birthday, Julianna Viveiros of Mooresville, North Carolina, noticed “a few lumps” on the back of her neck.
Initially, her pediatrician attributed the swollen lymph nodes to cat-scratch disease, a bacterial infection spread by cats. But Viveiros’ symptoms only worsened.
“I started having a lot of joint pain and trouble breathing, so my pediatrician ordered blood work. They noticed my platelet counts were significantly off and I knew something was wrong.”
Her hunch was right. A follow-up procedure, known as a bone marrow biopsy, revealed the seventh grader had acute lymphoblastic leukemia (ALL). Doctors use the procedure to diagnose and monitor certain diseases, including cancer.
At moments like this, “it’s hard for parents not to lose their minds,” said Dr. Jessica Bell. “It’s hard for the clinic team, too, because we know that families have to go through a terrible time to see a positive outcome.”
Years of treatment and a few setbacks would follow, but it was no match for the tenacious young girl – now a research scientist who is eyeing another lifechanging milestone.
Childhood leukemia can be successfully treated
ALL is the most common type of childhood cancer in the U.S., with roughly 3,000 new cases each year in people under age 20. It is a cancer of the white blood cells, which are designed to fight infection and help protect the body against disease.
Common symptoms of ALL – bone or joint pain, enlarged lymph nodes and shortness of breath – can occur when the leukemia cells crowd out the normal blood-making cells in the bone marrow, Bell said.
A pediatric oncologist for more than 10 years, Bell experiences the highs and lows of a child’s cancer journey alongside families who seek care at St. Jude Affiliate Clinic at Novant Health Hemby Children’s Hospital – the only St. Jude Children’s Research Hospital affiliate clinic in the Carolinas.
We specialize in pediatric oncology and hematology.
The Memphis, Tennessee-based organization specializes in treating children with cancer and other life-threatening diseases. Since opening in 1962, treatments invented at St. Jude have helped increase the overall childhood cancer survival rate in the U.S. from 20% to more than 80%.
Childhood leukemias are fast-growing and potentially fatal, but most children and teens who receive treatment will survive – a reminder that chemotherapy works.
“I’ve heard people say that chemotherapy is barbaric. I understand it’s a very blunt weapon, but before we had chemotherapy these children just died. Thankfully, we don’t have that perspective now,” Bell said.
‘A lucky pair of socks’
After her cancer diagnosis in early 2010, Viveiros’ family knew she needed treatment – and fast. They trusted the St. Jude Affiliate Clinic at Novant Health. Their trek up and down I-77, about 60 miles roundtrip, became a near daily occurrence for the first year as doctors went to work.
When working with young patients, Bell makes a point of framing the discussion in ways that will keep children and teenagers engaged. “I always referred to Julianna’s treatment as her lucky pair of socks. What did we need to do to keep the lucky socks on her feet?” she said. “Those were the types of discussions I had with her family and it was a really unique thing. We kept our humor, but the north star was getting her successfully through treatment.”
Treatment began with a month-long round of intensive chemotherapy, followed by seven additional months of less rigorous chemo. But that was just the beginning.
“Dr. Bell always described it to me as mowing the grass. ‘You cut the grass, but that doesn’t mean you’re finished. You might have to pick out some rocks. If weeds grow back, you need to kill them again.’ She always put it in terms I understood,” Viveiros said.
Eight months of chemotherapy was followed by two weeks of low-dose prophylactic (or preventative) radiation – a decision Bell did not take lightly but was “forced to do to prevent relapse.”
Here’s why: Even in small amounts, radiation has the potential to cause memory loss, attention deficit disorder and decreased cognition – the mental processes of gaining knowledge and comprehension.
“We are always cognizant of the possibility for lasting consequences, especially when you talk about someone so young who has a lot of learning potential,” Bell said.
Life-saving treatments close to home
The first year of intense treatment was behind her, but Viveiros, then a teenager, faced two additional years of “standard maintenance therapy.” Chemotherapy is still administered, but on a schedule that doesn’t require daily hospital visits, allowing the 13-year-old to go back to school.
She attributed the superhero strength to keep fighting, in part, to her own personal Wonder Woman – her mom, Jill.
“She worked full-time as the plant manager of a manufacturing company, but she was with me at almost every doctor’s appointment and hospital visit. It must have taken a superhuman attention to detail to pull that off,” Viveiros said.
She also found strength in her care team, who quickly became honorary family members to her, parents Jill and Horace, and younger sister Jenna.
“For the first year, I was at the hospital almost every day, but it didn’t feel scary. Everyone was always so warm and inviting. It just felt like going to visit family,” Viveiros said.
Expected effects and a couple of surprises
While necessary to keep the cancer from growing, the years of treatments she endured did not come without side effects. The teen experienced things like nausea, flu-like symptoms, occasional mood swings, high blood pressure, high blood sugar and weight gain due to steroids.
But then there were developments no one saw coming. Viveiros developed neurological stroke-like symptoms, discovered when she was doing artwork at the clinic and could no longer move her hand. Defined medically as encephalopathy, Bell sees this in less than “one or two patients a year.”
Even more unusual was the amount of bone damage she incurred from a steroid medication. At just 15, Viveiros had both hips replaced and two partial shoulder surgeries. While a “small amount of bone damage is fairly common in teenagers” who receive these therapies, Bell could not think of another patient who experienced it to that severity.
Treatments stepped down around the time of Viveiros’ 16th birthday and she went on to graduate from high school. Regular check-ups since then have shown no signs of disease progression, Bell said, and Viveiros has an “extremely low” chance of relapsing.
‘It’s a real sign of hope for other people’
Now 24, a lot has happened since the Mooresville seventh grader received her unthinkable diagnosis. The N.C. State University graduate, who lives in Raleigh, earned her Bachelor of Science in biochemistry with a triple minor in business, biotech and bio manufacturing.
Today, she’s a research and development scientist at a medical laboratory that performs COVID-19 testing.
“When I think about what Julianna is doing now, it’s a real sign of hope for people who undergo these really intense therapies,” Bell said. “Many parents are worried their children won’t go on to have productive and fulfilling lives, and she’s an example they can.”
While Viveiros’ road to better health wasn’t short (or easy), her advice to others battling cancer is to keep fighting. “Stay positive, even when there’s nothing to be positive about it. You’ll have good days and bad days. Do your best to focus on the good days and just try to get through the bad ones. Try to remember, it will get better.”
And on the inevitable “bad days” when the going gets tough, consider what Bell just got in the mail – a wedding invitation from Viveiros and her fiancé, Kenneth.
“Working with this age group is so special because I get to see them go through so many significant life changes … from learning how to drive, their first relationship, going to college, having kids or getting married. It’s one of the most fun and rewarding parts of what I do,” Bell said.
The college sweethearts plan to wed in the fall and look forward to their honeymoon.