Josh had been experiencing minor symptoms and sought out care on numerous occasions over a few years, but his family physician told him that he was “too young, too healthy” to have anything serious going on.

Upon returning from their honeymoon, Josh’s wife (then a medical resident) recommended that he see a GI and insist on a colonoscopy. Josh met with a GI who agreed to schedule a colonoscopy. They thought it would reveal Crohn’s disease or ulcerative colitis. Cancer never crossed their minds.

Married for just 39 days, Josh remembers waking up from his colonoscopy to his GI with tears streaming down his face and his wife crying, as he learned he had cancer.

Since his wife was on an oncology rotation, they worked quickly to schedule Josh for scans. They ran into a radiation oncologist colleague of his wife’s who immediately reviewed the scans and confirmed Josh had cancer.

Josh received a stage IIb rectal cancer diagnosis at age 31 in June 2013. Less than a year later, he received another devastating blow as he was told that the cancer metastasized to his liver.

From 2014 through 2020, Josh traveled from North Carolina to Memorial Sloan Kettering in New York where he underwent chemotherapy, radiation, surgeries, an HAI pump, and immunotherapy, for five recurrences. In April 2020, Josh received lifesaving living donor liver transplant at UPMC, after which he became cancer free.

Josh shares his story to encourage other young survivors to hold hope for the future – a future of family and life after colorectal cancer.

Q: Did you or your medical team introduce the idea of fertility preservation?

A: My medical team immediately brought up the subject of fertility preservation.

Because stage IIb colorectal cancer has a 92% chance for a cure and because of my age, my medical team wanted to aggressively attack the cancer, but at the same time, they sought to ensure that I had the option of building a family in the future.

I had a two-week window of opportunity to plan and preserve my fertility.

My medical team told me it would be best if I went to a sperm cryobank facility (which collects, stores, and freezes the sperm) before I began radiation and chemotherapy.

Q: What guidance did you receive about fertility preservation?

A: Either my wife or treatment team recommended the fertility preservation facility, which was located two-and-a-half hours away. We traveled there three times before I began treatment.

My wife and I knew we wanted children, and we initially planned to have biological children, so fertility preservation was important to us.

Q: Did you use IVF to build your family?

A: In 2014, we tried IVF twice, and unfortunately, we did not have success. Come to find out though, it wasn’t failing because of my cancer history. My wife and I wouldn’t have had success with IVF either way.

At the time and in the moment, we were both really disappointed because we wanted to build our family naturally.

But it just wasn't meant to be. The more that we learned about colorectal cancer, genetics, and that our kids would be screened early because of potential risks, we saw it as a blessing in disguise. As we learned more, the fear of passing colorectal cancer on to a child and them potentially facing the risk and challenges that we had became increasingly real.

Going through the scans and the screenings was brutal for my wife and me. We couldn’t imagine watching a child go through that.

The genetics component is what led us to the adoption route. Ultimately, our goal was to become parents. My wife says, “We had to reassess our goals. Is our goal to be pregnant? Or is our goal to parent?” We decided our goal was to parent, which helped bring acceptance to other paths.

We received so much support from friends and family who were excited for us to become parents, and we are extremely fortunate for our amazing adoption experiences.

Q: What did your adoption journey look like?

A: We have finalized two domestic adoptions. Both were newborns. However, because the situations were unique, the stories are different.

It took us six months to learn about adoption processes before we were emotionally ready to commit to pursuing adoption. Our oldest daughter was born in 2016. Our youngest daughter was born in 2021.

With both adoptions, we used an adoption consultant. This is not an agency but a team that provides adoption-based education, helps navigate the home study process, and typically creates your family profile book. Many consultants also share adoption opportunities with their clients as well.

With our oldest, we were an active waiting family for two weeks before receiving the email that held the details for what would become our perfect match.

In the first two weeks, we had received a few opportunities, had applied to be presented to a mom pregnant with twins but withdrew our profile before being shown.

The next day, we received an email about a birth mom due in two months, basic prenatal history, and a beautiful picture of the birth mom.

My wife immediately knew this was our match. We stayed up all night finalizing our profile book and mailed it off the next morning. It was just one of those gut feelings.

We matched two weeks later and had an introduction call with birth mom, which lasted three hours. The connection was instant.

She asked us to be present at delivery, asked us to name her, and wanted all the pictures we had preparing for baby! She encouraged us to have a baby shower and invited us to meet in person and attend an ultrasound appointment. We both were present for delivery!

She wanted to bless a family – who couldn’t have a child – with a child. And that’s what she did. She wanted her child to have a better life than she was capable of giving her at the time.

With our youngest, we again used an adoption consultant. Our wait was a little longer. We were a waiting family for five months this time – still not long.

Using a consultant usually decreases wait times. We applied for maybe five to 10 opportunities, but each “no” just meant our perfect “yes” was coming.

We received a late-night email, which outlined a “healthy baby girl born two days prior” on a Sunday.

It was a simple “yes!”

We emailed over our request to present to the birth family and again, we just knew! Two days later, we received the call that we were chosen, and she was waiting states away for us to arrive so she could be discharged from the hospital. We immediately packed up and drove more than 12 hours to meet our baby.

We have open adoptions with both birth families. This was our personal preference after learning about all adoption types.

Q: Were there concerns or challenges related to colorectal cancer that affected the adoption process for you?

A: I had always wanted a family, and with the initial diagnosis, the fear that it may not happen was crushing. But my biggest fear was not being here to watch my children grow, especially to an age where they would remember me.

Q: All adoptions require a home study, which also comes with a physical. How did you approach this?

A: A home study requires a physical exam and usually asks if a person had specific diagnoses. If yes, then a physician statement is required. Ultimately, the systems that oversee and govern adoptions are trying to assure the child has the opportunity to be raised by healthy parents in a safe home, which is where the home study comes in.

It’s a somewhat frustrating process when it comes to the medical history because a “normal” life expectancy isn’t really guaranteed for anyone. But, that’s what the documentation needs to say in order to have an approved home study.

Having the support of our treatment team helped in creating a letter for our home study that minimized concerns for my overall health. We crafted this alongside them, disclosing the required details but also emphasizing my physical ability to parent and positive prognosis.

The home study document is not shared with birth mothers. Once home study approved, a document is created that shows you are approved to parent, and the courts require this to legally finalize an adoption.

Agencies have access to home study documents, but for domestic adoptions, if home study approved, they cannot deny you the option to work with them based on your medical history.

I’d caution anyone who receives negative feedback regarding your health history to find an agency or consultant who is supportive. We were not asked once home study approved.

You do not need to disclose your health history to a birth family. That will be a personal decision you need to make during a match/preplacement, post-placement, or at all.

Q: Did you ever feel frustrated or hopeless during your adoption journey?

A: Both adoption processes moved very quickly, so we didn’t feel frustrated or hopeless.

However, at the hospital following the birth for our oldest daughter was the most stressful time because we didn’t feel welcome at the hospital. The birth mom was great. But the hospital environment was not positive. We’ve talked with other people who have had that same experience and feeling at the hospital as we did.

The birth mother was extremely helpful and responsive, and she really made the adoption go smoothly.

With our younger daughter, we were matched very quickly.

We didn’t have the same interactions with the birth mother as we did for our first daughter, because we were matched after she was born. The hospital experience was smoother and less stressful. Ironically, we were in the same hospital and the same postpartum room as we were with our older daughter.

Emotionally, the adoption process can be nerve-wracking, just like a pregnancy. You worry about the baby. You worry about birth mama and her emotional and physical well-being. You worry about an adoption disruption. And you have all the same worries any new parent has! But once you’ve met your baby, it’s immediate love and peace.

Q: Were you concerned that an absent biological connection might affect bonding issues?

A: Any concerns I had about not being able to connect because my girls are not genetically mine were fleeting. My daughters are my daughters.

Our older daughter looks just like me, and her personality is a blend of both my wife's and my personalities.

Our younger daughter is a different race, and her facial expressions are all mine. Her personality is 100% my wife’s personality.

The love and bond my wife and I have with our daughters is unbreakable.

My two greatest roles in life are that of husband and father.

Q: In hindsight, is there anything you wish you had done differently?

A: In retrospect, I wish my daughters could have been closer in age. My older daughter wanted a sister, but I also wish we had a little more time for her to warm up to the idea.

As we drove to meet our younger daughter, we had to pick up diapers, a car seat, and clothes. We had nothing for her because we were matched so quickly.

With our older daughter we had time to prepare and paint her nursery. For our younger daughter, we had no time. It was a completely different scenario.

There was literally no time to shift that spotlight from our older daughter to her younger sister who required so much time and attention because that’s what babies require.

Q: What are your hopes and dreams?

A: I just want to see my girls grow up.

I hope from a society and patient standpoint that treatments continue to evolve, with more ways to help young people beat this disease.

I would highly recommend any patient considering growing a family through adoption do it because you don't know what treatments will come along.

Because of a transplant four years ago, I’ll be four years with no evidence of disease, and I am looking forward to watching both my girls grow up.

I feel extremely thankful, fortunate, and blessed.

Q: Are there resources available for family-building post-cancer?

A: My wife and I weren’t aware of any resources to help with family-building, but there are a few programs and resources available to help. Some programs (such as the Expect Miracles Foundation SAMFund Family Building Grant) accept applications only within a brief window.

• Alliance for Fertility Preservation
• FORCE
• Livestrong Fertility

3 thoughts on “Family-building Through Adoption”