Nancy Blair Nancy LBlair

First post: Mar 9, 2019 Latest post: Jul 3, 2019
Welcome to our CaringBridge website. We are using it to keep family and friends updated and we will try to keep it up as we go along. 

Last summer Nancy began having some nausea and vomiting, but nothing more specific. A trip to her primary care doctor got her started on a trial of a medicine to treat acid reflux, but without notable change. The nausea and vomiting would come and go without any other symptoms until last fall when I (heather) noticed that she was starting to look jaundiced (yellow skin and eyes related to a liver dysfunction). She was also eating less and losing some weight. She had an appointment that week with her endocrinologist, who is top notch, so we decided to talk to her about it. We didn’t have soon as the doctor came into the exam room she noticed the yellowing. She sent mother for some blood work. That was on a Friday.

On Saturday we had a fun day with friends with a nice dinner out, but ended the night with mother being sick again. Just at that same time a call came in from her endocrinologist and, between the bloodwork and mother’s vomiting, she suggested we go to the Emergency Room, so we did. 

A CT scan in the ER revealed a mass on her pancreas. She was admitted into the hospital and a gastroenterologist was consulted. The next day they took her and placed a stent in her bile duct and did a biopsy/some brushings of the bile duct. The biopsy came back negative but they kept her in the hospital until the liver issues started to resolve, then she was discharged home with plans to follow-up as an outpatient. 

The nausea and vomiting came and went during the time we waited for her to follow-up with the gastroenterologist and have a more permanent stent placed. In an outpatient procedure about 8 weeks later, the gastroenterologist (GI doc) replaced the stent and went ahead and biopsied the pancreas again. Again it came back negative. That was good news but didn’t explain hervsymptoms or the mass. The GI doc didn’t think a local surgeon would address the mass that remained on mother’s pancreas because of her overall health/severe lung disease so he referred us to a specialized surgeon at Emory, Dr. Maithel. 

We went to Emory where they did an MRI and then we saw the surgeon. Instead of addressing the pancreas, he met us with news that they saw a spot on her liver. Despite the two negative biopsies she’d had in Chattanooga, Dr. Maithel was concerned that the pancreatic mass was indeed cancer and that the spot on her liver was where it had metastasized (spread). They arranged for an MRI guided liver biopsy there at Emory to confirm or deny his suspicion. Fortunately, upon closer inspection during the biopsy, the spot wasn’t really a “spot” but just an inflamed area that came back negative for cancer. That was exciting news, but still didn’t explain the pancreatic mass or the continuing problems with eating and vomiting, so it was back to explore the pancreas. This time a third biopsy was done at Emory and the news wasn’t as positive: preliminary pathology indicated that it was pancreatic cancer. Not the news anyone wanted to hear. 

When the doctor came out and told me, he suggested that she follow-up again with the original Emory specialized surgeon, Dr. Maithel.  They would arrange that as soon as possible. Then, in the recovery room when mother had come out of the sedation, she was also told the terrible news that like her younger brother Paul and her mother, she too had pancreatic cancer. 

The following week we got the call from Dr. Maithel at Emory confirming the final pathology results and letting us know that due to her severe lung disease, she was not a candidate for surgery to remove the mass. Instead, he suggested we see a local medical oncologist to talk about treatment options. We already knew who that would be: Dr. Michael Stipanov. He was the oncologist who so wonderfully treated dad and who also took over Uncle Paul’s (mother’s younger brother) care last summer when Paul moved back in with us. 

We met with Dr. Stipanov last week (March 7, 2019). He confirmed what we already knew: pancreatic cancer is a terrible diagnosis with no great treatment options even in the best case scenario. However, with mother’s frail health and severe lung disease, the options were further limited. He presented three options: 
1) pursue no treatment, but instead seek the assistance of Hospice care
2) chemotherapy, but he had serious reservations about this option. There are single and multiple drug regimines that can be used, but not without side effects. He would give a single drug regimine a try if she really wanted to, but he was afraid it would be too much in her weakened state and with hercompromised lungs. 
3) possible radiation/stereotactic radio surgery: consult a radiation oncologist to see if she would be a candidate for SRS (stereotactic radiosurgery) or radiation to try to target the mass on the head of her pancreas. This would not be curative, but would attempt to slow/stop the growth of the cancer in as little as a few sessions. 

The last option is what he recommended and what mother has decided to do, so that is where we are now: waiting for a referral to one of the local radiation oncologists. The story will continue...

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