DAVID | Journal | CaringBridge

Journal

Journal entry by SUNNY BRIDGE

Although David has had some better days since starting the targeted therapy, as I mentioned in the previous update, unfortunately those improvements have not continued or even been sustained. Last week he began to experience very low oxygen concentrations with even the slightest exertion. When another transfusion did not ameliorate this issue, I was directed to take him to the ER Monday evening for evaluation, where he was eventually admitted to the hospital for the night. While still in the ER a CT scan with contrast was scheduled, originally just for his lungs, but since one was already scheduled for the following Monday to include his entire torso, I suggested they go ahead and do the more complete scan. The nurse practitioner agreed, so we have our information now.

David's regular oncologist, Dr. McFarland, happened to be on call at the hospital--thank God--so we were able to meet with him Tuesday morning. The news was not good. The cancer is progressing. The Lynparza has not or at least not adequately helped and has been discontinued. Worse, David is now too weak for any other chemo, so all treatment has been stopped and home hospice has begun. Much worse, Dr. McFarland does not expect David to make it even until Christmas. He predicts four to six weeks more at best. He always reminds us he would love to be proven wrong, but I know he's been doing this a long time. 

I was able to bring David home from the hospital late Tuesday afternoon, and the meetings and equipment deliveries from hospice took up Tuesday evening and much of yesterday. Worst of all, the hospice nurse told me (not David) that based on her first impression of David's condition (and years of experience), I should prepare myself for the timeline to be on the short end, or even shorter, than Dr. McFarland suggested. Our hearts are breaking, as you may imagine. 
 
My two biggest fears have been that David's pain would be unbearable toward the end or that he would have a sensation of suffocation due to the lung issues. Both Dr. McFarland and Tonya, David's hospice nurse, assure me that neither will happen. His pain will not necessarily increase much and even if it increases some, hospice is very good at managing pain. As far as the lungs, a more powerful oxygen concentrator has been delivered that will take care of his oxygen needs. As he nears the end, he will sleep more and eat/drink less, but he will be at peace. That is our prayer now.

Of course, we would LOVE a last-minute complete healing, but it appears that will be happening in heaven not here on earth. I take comfort in knowing his suffering will be over and he will be in the perfect presence of God and away from all the evil, hatred, and random tragedy that are so prevalent in our world these days. 

We are sustained as well by your kind thoughts and prayers. Your supportive comments here on CaringBridge, emails and cards are always appreciated. I'm afraid phone calls and/or visits are not manageable at this time. Thank you for understanding. What a gift it is to know how many of you hold my beloved David in your hearts and minds. It has been, and continues to be, a joy and a privilege to share my life with this dear man.
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Journal entry by SUNNY BRIDGE

By Tuesday, David will have been on Lynparza, the new targeted therapy, for six weeks, and I do still feel it seems to be helping him. Nothing terribly dramatic, but he's definitely had more good days than in the weeks before he started this treatment. We are very grateful to have this option.

So far, the most noticeable side effect is the peripheral edema. His feet and ankles swell to the point that they need to be elevated and/or he needs to wear compression socks. The prescribed diuretic seems not to be helping much yet. Unfortunately, his lungs do better when he sleeps on an incline, so having both his chest AND his feet elevated means he's trying to sleep while imitating a taco shell. Not ideal.

Another side effect is anemia, and David had to have his first blood transfusion on the 19th. As you may or may not have noticed, I'm learning a lot, but until this came up, I somehow thought a blood transfusion involved replacing all of his blood with someone else's blood--yup, like an oil change! Okay, at least we can laugh about my ignorance. Turns out he got only one unit of blood that day (added to his own, of course). Presumably, it will happen again, possibly with some regularity. On the plus side, he did seem pretty perky for several days directly following the transfusion. Courtney was visiting for the weekend and definitely saw an improvement over the last time she was here a few weeks ago. The past few days he has had less energy, but did actually ask to go to church this morning, so we hooked him up to his portable oxygen and went. Nice to get him out of the house for something other than a doctor's appointment. Labs tomorrow, as well as an appointment with Dr. McFarland, so we'll know more then--whether he's needs more blood or whatever.

So . . . full disclosure . . . Friday night I had a major meltdown, where I was so angry at cancer in general and what it has done to our life, I crashed around a while, heaving Ensure bottles into the recycling bin and slamming a door or two. Lots of weeping. David endured it all with grace and compassion, dear man, but of course, I felt terrible to have put him through it. Finally texted a friend for urgently needed prayer and dropped into bed where I slept until well into the morning. MUCH better now, I'm happy to report, and I guess one raging tantrum in fourteen months isn't super terrible. The gratitude for each day is definitely more palpable when I'm well-rested. 

If you're praying, please pray that this treatment is managing to kill the wretched cancer cells (or at least as many as possible), that the peripheral edema would ease up. And why not? Let's go crazy and pray that his left lung would IMPROVE noticeably. While you're at it, certainly thank God that his right lung is still working well. 

Here are some lyrics from Lauren Daigle's song, "O'Lord" that are ministering to me these days:

Though times it seems
Like I'm coming undone
This walk can often feel lonely
No matter what until this race is won
I will stand my ground where hope can be found
I will stand my ground where hope can be found

Oh, O'Lord O'Lord I know you hear my cry
Your love is lifting me above all the lies
No matter what I face this I know in time
You'll take all that is wrong and make it right

Your strength is found 
At the end of my rope
Your grace it reaches to the hurting
Still through the tears and the questioning why
I will stand my ground where hope can be found
I will stand my ground where hope can be found

I still really appreciate your encouraging comments, texts, emails, phone messages. No pressure, but if you have a moment, know that it helps. You are treasured, dear ones!
  
Whether or not you have a moment for an encouraging word, I can assure you . . . 
I will stand my ground where hope can be found.
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Journal entry by SUNNY BRIDGE

Lots going on since the last update. David was well enough to join Chelsea, Brian and me for a lunch out nearby to celebrate Chelsea's birthday this past Saturday. He was on his portable oxygen and didn't eat more that a bite or two, but still he was with us, alert and sharing in the conversation. Then on Sunday afternoon he agreed to a little drive up into the foothills to enjoy the fall colors and the beautiful day before Monday's early snowstorm. He was awake the whole time and we had some conversation, some silence, and both enjoyed it very much. So a very nice weekend. 

By Monday evening David's breathing seemed a bit labored after climbing up from downstairs, so he had another chest x-ray on Tuesday afternoon. Since the left lung is now almost completely hidden in the x-ray, it seemed time for another thoracentesis. It was scheduled for Wednesday late morning, after labs and an appointment with Dr. McFarland. 

Unfortunately, the thoracentesis was unsuccessful this time, and the reason is not completely clear. The pleural fluid appears to be loculated (in pockets) now, which makes it difficult to drain, and there seem to be some other issues as well with his left lung. After the failed thoracentesis, a CT scan was ordered, but even that left questions unanswered. Does he have a sub-clinical pneumonia or has the cancer progressed? So now Dr. Depriest, the pulmonologist, has ordered an antibiotic and a steroid and another chest x-ray in two weeks. On the plus side, as long as David stays on oxygen, he maintains an adequate oxygen level and is not in any kind of distress. 

After the CT scan, he had an ultrasound to rule out a DVT (blot clot in his lower leg or legs), since he has had a great deal of swelling, especially his left foot and ankle. The ultrasound did not find a DVT, so that's good news. The once-a-day blood thinner injection is doing its job. No need to switch back to twice a day injections. David is VERY happy about that! Peripheral edema is a predicted side-effect of the Lynparza, so that seems to be all that is going on there. Consequently, a diuretic has been added to his basket of meds. 

Another side effect of the Lynparza is anemia, and his lab numbers do seem to indicate that, so between the loss of muscle mass, the pain meds and the chemo, and now anemia, he does spend a great deal of time dozing on the couch. Could be worse, so we're grateful he is reasonably comfortable and as I reported last time, he's awake more often and for longer periods than before starting the Lynparza, so I'm still optimistic that it is helping.

The current challenge is to get the next month's worth of Lynparza. Dr. McFarland increased the dose, but it was unfortunately after next month's shipment had already been sent. For some reason they couldn't let that arrive and simply send a few more later, they had to recall the shipment. So as I write this we are stuck in limbo, waiting for FedEx to return the lower-dose monthly supply to the North Carolina pharmacy, so Medicare will allow a new higher-dose monthly supply to be shipped. Meanwhile Dr. McFarland wanted us to start the increased dose yesterday evening, so he will finish all we have Sunday night. We need the new box of Lynparza to arrive no later than 9 a.m. Monday or he'll be late for or miss a dose.  

Sorry so verbose! But if you're praying, these are the current concerns.

On the plus side, since we ALWAYS want to remember the plus side, while meeting with Dr. McFarland, we mentioned Chelsea and Brian's wedding plans for May 26th (which is also the 40th anniversary of the day David and I met--WOOHOO!) and our friends Pascale and Jacky potentially coming from France sometime in the spring. We asked him if we were being overly optimistic that David would still be here with us by then, and he seemed actually surprised. He assured us that he really feels that even if the Lynparza doesn't do as much as we hope it will, there are other chemotherapy options. He seems at least as optimistic as we are. So although none of us can tell the future, we are encouraged. Meanwhile, as always, we know every day is a gift and we celebrate it and we thank God for it. And as always, we thank you, dear ones, for your continued thoughts and prayers.
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Journal entry by SUNNY BRIDGE

Not much to report yet, really, but wanted to give a quick update. David continues to tolerate the Lynparza pretty well. And although it's pretty subtle, I feel like I'm seeing a slight improvement in his overall condition: a little more engaged, awake during a bit more of the day, actually occasionally asking for a specific food, rather than just willingly (or reluctantly) drinking an Ensure whenever I put one in front of him. He has gained a couple of pounds back and is holding steady with that. The occasional confusion he demonstrated a few times (possibly due to being asleep so much and only partly noticing whatever was going on) has not happened recently. Nothing dramatic, but I'm encouraged.

Lab results on the 28th were pretty good: liver numbers a bit better, other numbers good or stable, and the CA 19-9 tumor marker number went up only a little to 2650, from 2220. New labs will be done on the 11th. We're hoping to see the CA 19-9 begin to go down a bit one of these days.

It's really too early to tell much, but ". . . the wise man celebrates what he can." (Amor Towles in A Gentleman in Moscow) As I've mentioned before, we absolutely celebrate what we can, even if I, at least, cannot claim any great degree of wisdom.

With all the tragedies so much in the news these days, we are so grateful for each day together, even as we pray for comfort for those who have so suddenly and brutally lost a dear one. Thank you for the light that you add to our life in the midst of this dark time in our world.  
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Journal entry by SUNNY BRIDGE

David has now been on the Lynparza for eight days, and so far no noticeable side effects. A tiny hint of nausea a couple of times, easily managed. We make sure he takes it after drinking an Ensure, breakfast (and evening snack) of champions. Okay, I don't really know about ALL champions, but David lately is drinking Ensure for breakfast, lunch, dinner, and then right before the evening dose of Lynparza). Very little other food appeals, so I am very grateful for the Ensure--lots of nutrients, including vitamins, protein, and calories that he needs. He's even managed to put back on a couple of pounds and is holding steady, as the doctors have asked him to do if possible.

No back spasms in the past few days. Woohoo!

The pleural effusions continue to be a problem, and he has to be on oxygen 24-hours a day at the moment. He doesn't seem to mind it, but then again, he is sleeping, I'd estimate, at least 20 hours out of every 24. He's scheduled for another thoracentesis tomorrow morning. Remember, this is when they drain the fluid from around his left lung. On the plus side, his right lung is fine.

Also a plus, he asked to take a little walk outside yesterday, and he hasn't been up for that in a while. We enjoyed a short, easy stroll on the golf course in the crisp fall evening and then back inside. Lovely.

Not so good is that the CT scan from the 13th showed some growth of what appeared to be a couple of tumors in his left lung, from 2 mm to 4 mm and another previously 3 mm, now 5 mm. Also, there are some other issues with his left lung that are causing pain and breathing trouble. Not completely clear on what is going on there. We are still hoping the Lynparza will begin to shrink all tumors and improve his breathing, but it will take a while to tell how/if it's working. We have an appointment tomorrow for labs and a consultation with one of Dr. McFarland's assistants, so may have a little more info tomorrow, but even the original chemo that worked so well took more than a week to show improvement. I'm trying to be patient and stay hopeful.

If you're praying, please pray that the Lynparza continues to be tolerated and, of course, that it works! Also that David's pain, currently requiring round-the-clock painkillers, would diminish. 

As always, we are grateful for every day and for you! 
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Journal entry by SUNNY BRIDGE

As it happened, David never did get the Aspira catheter. He was finally scheduled for Wednesday afternoon the 13th, and I was allowed to stay with him in the room, at least for the prep, but when Dr. Depriest did the ultrasound, he couldn't find a big enough pocket of fluid in the front to safely insert the catheter. There seemed to be plenty of fluid in the back, so sudden change of plans, another thoracentesis. One of the nurses asked Dr. Depriest if I was really allowed to stay, and when I told her that I was always in the room for thoracentesis and that this was the fifth one I'd watched, Dr. Depriest joked, "Yeah, she's going to DO the next one!" Anyway, I appreciate that I'm allowed to stay, as I learn all kinds of things I find valuable as David's caretaker. Dr. Depriest took out another 1000 cc's of fluid, which of course helps David's breathing, then sent David for a CT scan, but we haven't heard results of that yet.

Speaking of breathing, though, it turns out David does not always need oxygen during the day, so that's good news.

The muscle spasms in his back come and go. We would prefer they GO forever! He has a prescription muscle relaxant, but then he can barely form words, so that's not ideal. 

BEST NEWS: We finally have jumped through all the hoops for the new targeted therapy chemo drug, Lynparza* (actually Olaparib, the generic version, but everyone says Lynparza because it's easier to say). It is set to arrive here to our house by FedEx tomorrow. We do have his new lab numbers, as a baseline before starting the Lynparza, and his liver numbers were not quite as good and his CA 19-9 continues to creep up -- 2220 this time. We are very much hoping to begin to see better numbers with the new treatment. If it works well enough, David may not need the Aspira catheter at all.

We are so grateful for this opportunity for David to have this promising drug. If you're praying with us, we're offering thanks for this drug, and of course for each new day together. We would like the periodic back spasms to diminish or ideally never come back! We're asking that the side effects (reportedly similar to other types of chemo he's already had) be minimal and/or manageable. And of course we are asking that the new chemo WORK! 

Thank you, dear ones, for continuing to keep us in your thoughts and prayers! 

*EXTRA INFO FOR THE CURIOUS: In case you're interested, here's how it works: Olaparib is a PARP inhibitor, which stops an enzyme (PARP) from repairing broken strands of DNA. In normal cells, Olaparib will stop the damaged DNA from repairing itself, but there are other ways of fixing DNA using BRCA1 and BRCA2 proteins so these normal cells can still survive. However, cancer cells without BRCA1 or BRCA2 protein can't carry out these repairs. The combined effect of knocking out both DNA repair mechanisms is so severe that the cancer cells die. (Yes, please!) 
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Journal entry by SUNNY BRIDGE

Good news today:

We are awaiting a call for the time of the procedure today to insert the Aspira catheter to manage the pleural fluid at home. It couldn't happen yesterday because we had to stop the blood thinner a day ahead. 

We've now got small oxygen tanks and a shoulder pack, so David can actually leave the house should the need or the desire arise, although we're hoping the catheter may minimize his need for oxygen.

Medicare has approved the Lynparza, which is excellent, because our income is too high for the assistance programs (but not quite high enough to comfortably afford $8000+ per month!). Even with Medicare, it won't be cheap. The first month should cost us around $2400, but that we can do. Then less each following month, I think, until the new year starts new deductibles, etc. Ah, the joys of figuring out the intricacies of Medicare, in all its parts, supplements, "donut holes"! Still, VERY happy that we at least HAVE insurance! We have to go to another "chemo education" session and sign consent for this new drug, which is still chemo, but in pill form (12 per day -- YIKES). Then it can be ordered. He'll probably start on it next week.

Many thanks, as always, for keeping us in your thoughts and prayers! 
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Journal entry by SUNNY BRIDGE

So sorry! I know it has been a while since my last update. We had a busy weekend with family in town and Chelsea and Brian getting engaged. Exciting and fun, but busy.

Then with David, things have been so much in flux, I kept thinking I'll write an update when I find out about _____ (whatever new piece of information we were awaiting). But his condition and his treatment plans kept changing so fast, that time never came. Since I've had a few inquiries, I decided I should write as much of an update as I can. 

Chemo was put off again, since Dr. McFarland says it's time to stop the FOLFOX, and at the very least switch to gemzar and cisplatin. He prefers to put David on Lynparza, the PARP inhibitor, but we're still trying to get it through insurance or by some other affordable means. I had a call about an hour ago from someone from UC Health, I think (but weirdly, a California phone number), saying that as a result of Dr. McFarland's appeal of the original denial, it has now been approved, but I was so discombobulated, I didn't adequately clarify what that means. Approved by Medicare? Not sure. Trying to confirm everything through the Cancer Center right now. Lynparza is not without risks and side effects, but does seem the most promising treatment, so hopefully he will be able to start that soon. I had heard that without insurance it would cost $8000 per month, but am finding more encouraging pricing information today. Again something to be confirmed. 

The pleural effusions continue to be a problem, to the degree that Dr. Depriest (the pulmonologist) recommends David have an Aspira drainage catheter put in, so we can keep the fluid drained without going in for thoracentisis. That will likely happen today, or tomorrow at the latest. This may also help David keep his oxygen levels up where they need to be. As of last Thursday night, he has been on oxygen at home, originally just for overnight while he was sleeping, because I could pester him and get him to breathe deeply enough to get over 90% during the day. But even that is not working now, so he's on oxygen 24 hours a day at the moment.

Then, the wretched back spasms came back a few days ago. Seem to have tapered off again now, but the fear of another makes him walk around very gingerly and keeps him almost completely sedentary, which can't possibly be helping.

The pain meds are keeping him reasonably comfortable, but make him sleep a lot. I'd far rather have him asleep than in pain, so that's okay with me.

If you're praying, please pray that all these procedures, approvals, treatments would go well, in whatever way is best for David. If the Lynparza is best for David, please pray that it be covered by insurance enough that we can afford the copay, or that the price without insurance is within our reach. 

We are so aware of so many suffering pain, hardship, fear, danger, loss all over the world, and we are especially aware on this anniversary of 9/11 of how hard this life can be. The stories of kindness and compassion and the thought of you dear ones lift us up. We are profoundly grateful that you would spare a thought and/or a prayer for us at this time. 

 
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Journal entry by SUNNY BRIDGE

We were pretty apprehensive about what today's news might be, but we were actually rather encouraged, both by lab results and by Dr. McFarland. While it was a bit of a blow a few weeks ago, to find out that David has been disqualified for clinical trials due to the melanoma (now completely removed), we knew all along that he only had a 3 out of 5 chance of getting the actual meds and not the placebo.

It's also true that David has not been as well recently as he was when we went to France, but the news is not nearly as dire as we feared. His liver function numbers are all continuing to significantly improve, and his CA 19-9 number just came in, slightly improved from last time -- 1350 (compared to 1440 two weeks ago). The great thing about this is that it means the chemo is still working to a certain extent. We had feared that it was no longer working at all. 

The results of the CT scan were also better than expected in light of how he's been feeling--no real change since April. Of course we'd love to see the cancer shrinking even more, but we're grateful for no real change, especially with all the breaks in treatment between then and now. That's a victory already, that the chemo is keeping the cancer in a bit of a holding pattern. (Except for the pleural effusions, but those are being managed.)

Certainly the increased 5-FU dose has been hard on David. Only today did he begin to feel better from the last round, and he was due to have another round tomorrow. Usually he has four or five tough days, then begins to improve. We were both dreading submitting him to another round so soon after he started to feel a bit better. Dr. McFarland agrees that David should have another week off (8 days, in fact). Meanwhile he's going to try to get the PARP inhibitor (I thought it was PALP, but I was mistaken) drug for David (the one in the trial). Something about "on compassionate grounds," so if you're praying, lift that up. It sounds like a promising drug. If he does not succeed, David will have another round of chemo on Wednesday the 6th, either the FOLFOX, but without the extra bolus, or possibly he'll be switched to another cocktail.

We were not at all sure what sort of news we would get this afternoon, even fearing that we would hear that this is the beginning of a downward spiral, but Dr. McFarland does not feel we are there yet. Certainly, each day is impossible to predict, but for now we continue to have hope that David will have more good days. I promise we are grateful for every one.

And of course, we are grateful for you, dear ones, for continuing with us and keeping us in your thoughts and prayers.
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Journal entry by SUNNY BRIDGE

Today marks one year from the day David's cancer was discovered, so we are celebrating. I'm so grateful that he is still here with me. I posted much more on MovableAssets.com, so check that out if you'd like.

Tomorrow (Friday) is David's next CT scan, but we won't get results until probably Monday afternoon. The chemo is getting harder to tolerate, so some decisions will need to be made. All prayers will be appreciated.

Thanks, as always, for keeping us in your thoughts and prayers!
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Journal entry by SUNNY BRIDGE

I know it says, "David Bridge: Author" on the home page, but for now I'll be doing the authoring. I will see if I can get David to add a message now and then.

In case you didn't get Thursday's email, our life of adventure has taken a sudden and difficult turn. Here's the preliminary background info, which was originally part of an email sent to the prayer chain at church:

Some of you may have heard that David is in the hospital. Scary as the threat of blood clot(s) that sent us to the ER Wednesday evening, the actual news was even worse. Yes, there are multiple clots in his lungs and in his lower legs, but during the CT scan, other even more serious problems were noted. His pancreas is enlarged, and is possibly the origin of a metastatic cancer, multiple lesions were noted in his liver and various other places--we're not completely clear about everything yet. Anyway, not good.

The clots are being managed, and a needle biopsy of one or more of the lesions in his liver was done midday Thursday. Latest word is that the cells do appear to be cancer cells, as expected, but the origin of the cancer and the stage are yet to be determined. We expect to hear on Monday. Crazy as it sounds, we're hoping for colon cancer, since that's the most manageable of the three probable diagnoses. Or if not that, then the "better" version of pancreatic cancer. We'll let you know.

David was almost allowed to go home this afternoon, but he had some pain near the biopsy site after his first hallway stroll, and it was decided to keep him in the hospital for another night, just to be sure all is well, and the transition from the IV blood thinner to the injections has been managed. Since they are 12-hour intervals, it has actually worked to our advantage to delay until 6:30 in the evening. The original 2 p.m. / 2 a.m. schedule was not terribly appealing. Anytime you can avoid having to set an alarm to wake up and inflict and/or experience pain, that's a bonus. We're appreciating bonuses wherever we can find them at the moment. 

Another bonus is that the doctors, nurses, and support staff have all been wonderful. David, most of the time, has been able to be his usual joking self, and we already feel we have friends here at the hospital. We are certainly aware that this will be a whole new journey and we are just getting started. Your continued prayer and messages of hope will be very much appreciated.

Specifically, please pray for the doctors’ skillful diagnosis and attention to detail, wisdom for all of us to know the best next steps, healing for David, of course, and peace and comfort for all of us, including our daughters, Courtney, Brittany, and Chelsea. 

Thank you for your overwhelming love and support. We've had so many warm and encouraging emails and texts, we can't begin to answer them individually. We are trying to stay in the present moment, and not waste a lot of energy fearing the future, but we are still not quite up for phone calls or visits. Thank you for your continued understanding. -- With love and gratitude, David and Sunny

  





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DAVID’s Story
Welcome to our CaringBridge website. We are using it to keep family and friends updated in one place. In short: After some weeks / months of low energy, increasing shortness of breath, and lingering discomfort, a blood test revealed an imminent risk of blood clot which sent us immediately to the ER.  While there, a CT scan revealed multiple clots in his lungs, an enlarged pancreas and multiple lesions in his liver and possibly other places as well. This has now been confirmed to be stage 4 pancreatic cancer, specifically adenocarcinoma. We appreciate your support and words of hope and encouragement. Thank you for visiting.

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