FLANAGAN — Allie Ruff is the happiest she's been since she was diagnosed with breast cancer at age 25.
"This is the best place I've been in since the diagnosis," the 29-year-old woman.
She looked down to the infant that she held closely in her arms and smiled.
Beating cancer and becoming a mother in less than four years would be wonderful enough for the rural Flanagan woman who — with her husband, Dave — had wanted a child for several years.
What makes the journey sweeter is how their daughter, Ava Jo, got here — thanks to the love of a co-worker who volunteered to be the Ruffs' gestational carrier. That means Josie Wiles of Pontiac was a surrogate, becoming pregnant with Allie's implanted embryo and carrying the fetus for nine months to full term until delivery on Aug. 26.
"Josie and her family are amazing," Allie said.
"She has been a blessing," Dave, 29, said of Josie. "It's been such a dream come true."
"I'm happy that I was able to help," Josie, 36, said simply.
Allie and Dave married on April 9, 2011.
In October 2012, Allie found a lump in her left breast while doing a breast self exam. After a mammogram, ultrasound, biopsy and further testing, she was diagnosed on Nov. 1, 2012, with breast cancer, specifically invasive ductal carcinoma. That meant that the cancer had broken through the wall of the milk ducts in the breasts and had spread to other breast tissue.
While invasive ductal carcinoma can affect women of any age, it's rare among young women, said Lyndi Alberts, a nurse practitioner with Mid Illinois Hematology & Oncology Associates in Normal. She also is a friend of Allie's.
"Unfortunately, we are seeing more and more in the younger population," Lyndi said. "I'm not sure why."
"That first day was difficult," recalled Allie, who was working as a dental assistant in Pontiac at the time. "I cried a lot. Then I went into action mode, meeting with doctors, nurses and counselors."
"I was in shock at first," said Dave, who manages Ruff Brothers Grain Company in Gridley. "We were 25. The thought of something taking her wasn't on our radar.
"My job was to be her rock," he continued. "I had faith that things were going to be all right, that we still had a long life together."
Because the cancer was stage 2 and had spread to the lymph nodes, Allie had a total mastectomy of her left breast on Nov. 27, 2012.
Allie and Dave wanted a child. Knowing that Allie would have an increased risk of infertility after chemotherapy, the couple did fertility rescue at Sher Fertility's Central Illinois clinic in Peoria.
Allie took medication to stimulate production of eggs. Then several of her eggs were surgically retrieved, combined with Dave's sperm to create embryo, which then were frozen.
"That was a scary time," Allie admitted. "The cancer was hormone-driven. So was I fueling the cancer (by taking the medicine)?"
Chemotherapy at the Community Cancer Center in Normal began on Jan. 18, 2013. Side effects were hair loss, feeling as if she was in a fog and weight gain.
"My focus was making her feel normal and keeping her around people who would look through her treatments and see the real Allie," Dave said.
"We never let cancer stop us," Allie said. "I didn't want cancer to define who we were."
Chemo was followed by radiation, which ended in September 2013. Her final breast reconstruction surgery was in 2014.
"Being in your 20s and diagnosed with breast cancer is heartbreaking," Lyndi said. "But she has done extraordinarily well. Her positive attitude helps."
Allie began on Tamoxifen last year to reduce the risk of the cancer recurring.
"Tamoxifen shuts the hormones down," she said, which conflicted with the Ruffs' goal to have a child.
"Her cancer fed off the hormones," Lyndi explained. "If Tamoxifen was withheld and if she were to become pregnant, there would be a higher risk of the cancer recurring."
In addition, Tamoxifen shouldn't be taken by anyone pregnant, trying to get pregnant or breastfeeding because the drug can damage developing embryos.
Allie recently began taking Lupron to reduce her amount of estrogen, also an effort to cut the odds of cancer recurrence. However, Lupton shouldn't be used by someone pregnant or breastfeeding because it can cause birth defects.
"I might be on the medicine for 10 years," Allie said. "Did we want to wait for 10 years to have a baby? We knew that we weren't willing to try immediately and take the risk of the cancer returning."
The Ruffs concluded that surrogacy would be the best approach to reduce the risk of the cancer returning and to have a healthy child. Lyndi and other medical professionals agreed. The Ruffs looked into it and discovered that it could cost $80,000 to $90,000 to hire a surrogate.
"We couldn't afford that," Dave said.
Allie, who was working as a medical office assistant at an OSF HealthCare general surgeon's office in Pontiac, mentioned her quandary to a co-worker in February 2015 when another co-worker who had become a friend overheard. It was nurse Josie Wiles.
"I approached her and said 'If you want a surrogate, I'll do it," Josie recalled.
"I had three uncomplicated pregnancies," Josie explained. "For me, pregnancy isn't hard."
"That's Josie," said her husband, Bill. "She's a very giving person."
"I thought she was just being nice," Allie recalled. "My honest reaction was 'If you're just saying it, don't say it again.'"
Dave said, "I didn't take it seriously. During Allie's cancer journey, people would open their mouths and say all sorts of awkward things. I understand. They were nervous." He thought this was another example.
Over the next few weeks, Allie would look over at Josie and say, "You can take it back now." Josie didn't.
In March, the Ruffs decided to take Josie up on her offer.
"I told Bill, 'Hey, I volunteered to be a surrogate.' He said 'You'll get pregnant again on purpose?' I said 'Yep, but the baby doesn't come home with us this time.'"
"I wasn't surprised because that's her personality," Bill said. "I never had an issue supporting it."
The Ruffs and Wiles — including their children Kalynn, 16; Kristian, 13; and Kooper, 7 — went out to dinner and hit it off.
Still, the children were uncomfortable with the idea for awhile.
"At first, Kalynn thought it was weird," Josie recalled. "Then she got excited about being a baby sitter."
"Kristian said, 'Isn't it going to be cheating on Dad?' So we explained to him how it works," Josie said.
Asked what he thinks now, Kristian said of his mother, "It's a very generous act and she's a nice lady."
Josie had general and gynecological physicals and all four adults met with a counselor — individually, as couples and as a group.
"They wanted to make sure that we were mentally and emotionally stable and all on the same page," Josie said.
"Josie did this out of the goodness of her heart," Allie said. "She did it for nothing (no money)."
Attorneys for both families drew up legal documents that were signed by both couples.
The good news
Josie gave herself estrogen shots to prepare her body for pregnancy and, on Dec. 15, an embryo was inserted into her uterus.
A blood test a couple weeks later came back positive, indicating that Josie was pregnant.
"I cried in disbelief," Allie said.
"The pregnancy was easy but I was uncomfortable by the end," Josie said.
The delivery at OSF Saint James-John W. Albrecht Medical Center in Pontiac went smoothly. Ava Jo (her middle name is for Josie) was 8 pounds and 20½ inches long. She was handed to Allie, who held her.
"I wanted that immediate skin-to-skin contact and it was at that moment that it all hit me," Allie said.
"Seeing Allie's and Dave's faces the first time they saw her (Ava Jo), that was priceless," Josie said. "To see that look on someone's face when they meet their baby for the first time, that was awesome for me."
"I had no separation anxiety," Josie said. "But I see Ava and Allie and I'm pumping milk so she can be breastfed. If I couldn't see her and be involved, maybe I would have some separation issues."
Josie is taking seven weeks of maternity leave and Allie is taking a 12-week family medical leave of absence.
"I feel amazing — the best point I've been in since the diagnosis. I feel blessed, even when she's (Ava's) doing this," Allie said as Ava cried.
"Long term, I want to stay healthy, keep cancer away, raise our little girl and see where life takes us," Allie said.
Dave said the message of the story is "Don't give up hope. When things are darkest, it's not the end of the story."
"She (Josie) has given us the gift of being parents," Dave said. "We didn't think we could get that gift. We are forever in her debt."
"My goal in telling my story," Allie said, "is let people know that there really is happily ever after."