First journal entry The original reason for going to the doctor was for lower abdominal pains that were not constant but showed up usually late in the day and sometimes kept me up all night. My primary physician couldn't find anything evident via blood samples, and physical exams. She then recommended a two week treatment of Nexium to see if it was just stomach problems that may be taken care of by the Nexium. Two weeks later, with no relief, I went back to my primary physician and told her that the Nexium had not provided relief, but that I had noticed that when I had taken some ibuprofen for a lower back pain that the abdominal pain had also went away. I thought this somewhat unusual because I would have thought if it were a true stomach problem that the ibuprofen would probably have aggravated it vs. helping it. I told her that I had some concern that the problem could be a hernia and she said that given the location and the fact that the ibuprofen seemed to help that a hernia was a possibility and she did an examination for that. She did not find anything, but also given my size, she said that a hernia would be harder to detect. Her next suggestion was for me to see a general surgeon to let him examine for a possible hernia or something else. So, off to the general surgeon (as you've noticed, I've not used names here.... if needed, I can supply them). The general surgeon did a much more extensive exam (deeper probing) and was still not able to find anything consistent with a hernia or anything else (at least he didn't say anything at the time). He wanted me to have an abdominal CT scan to see if it could be a deep hernia or something. So, off to the CT scan and wait for the surgeon to get back to me. The surgeon got back to me on Friday 3/21. With what to me, as an afterthought now, seemed to be very poor "bedside" manners, he called me on the phone as I was out and about for the day and told me he had "some good news and some not so good news". The good news was that I didn't have a hernia. The not so good news was that they had discovered a growth on the tail of my pancreas along with possible spots on the liver. He said that he wanted to do an MRI to get more info and would schedule that for early the next week. I was basically in shock at that particular moment and couldn't even think of any questions to ask. After telling Karen the conversation (we were in the car), we decided to call back and tell the surgeon that we were only 5 minutes away and would like to meet with him to ask a few more questions. He agreed and we were there and in his office a few minutes later. He explained that the growth was approximately 10x8cm and that there were questionable spots on the liver. He said that the growth could be a cyst and that the spots could be just shadows. He also said that worst case could be that it was pancreatic cancer and that it could have metasteszed (sp?) to the liver already in which case there's very little that can be done. He drew some blood for lab work and got his nurses working on scheduling the MRI. This was all at 4PMish on a Friday afternoon. You can imagine we had a wonderful weekend. The MRI was scheduled for the following Thursday and he said he would have the results and meet back with us on Friday. On Friday 3/28, we met with the surgeon and he said that the growth was definite (I'm not sure of the size) and that the liver showed lesions consistent with metatastic cancerous growth. Also that the markers in the bloodwork (think it's CA19-9) which should normally be in the 300-400 range (think that was the number) was over 7000 which was also a strong indication of pancreatic cancer. At this point he said there was nothing more that he could do for me and that I needed to see an oncologist as soon as possible. He got his nurses working on that and was able to get us into Raleigh Oncology and Hemotology that afternoon. So, now on to the oncologist. The oncologist said that all of the bloodwork and scans, and all info that he had indicated pancreatic cancer. He said there was a slim chance that it could be lymphoma or Hodgkin's and that we would need a biopsy in any case to determine the treatment plan. He did say that pancreatic cancer is terminal, but danced around the question of life expectancy. By this time, it was after 5PM (again on a Friday) and too late to get the biopsy scheduled. He said that he would get someone to schedule it first thing Monday morning and get back to me. As you can imagine, we had another wonderful weekend. The needle biopsy was scheduled for Tuesday morning at Rex and the oncologist said that he would get it pushed and get back to me on Wednesday as he was going to be out of town on Thursday. The biopsy went OK other than they told me I wasn't a good breather. You have to take breaths exactly the same each time so that they can see where to move the needle via the CT scan. The oncologist called on Wednesday morning and said that the pathologist thought that at first glance the biopsy didn't appear to be standard run-of-the-mill pancreatic cancer, and that that could be a good thing. He said they needed more time to study it and we would therefore meet on Friday. So, on Friday 4/4, I'm back to the oncologist. He came in and said that the diagnosis was indeed pancreatic cancer. The somewhat different things that the pathologist saw was squamous (sp?) cells that don't always appear as standard cancer cells. He laid out three (actually more given combinations) possible plans of attack. He said that I was the healthiest looking patient that he's ever had come in with pancreatic cancer. He said that I was not outwardly symptomatic and that I was very young for this type of cancer (median age is over 60). He said we could do nothing and wait until I got symptomatic to start treatment (not what he would recommend). He said we could go with the standard treatment, which is a drug called GEMZAR that has relatively low side effects, but is also relatively low in results (10% shrinkage of the tumor). The third option was a more aggressive regimen called GTX. It's a combination of drugs, the first being GEMZAR, the second is Taxotere, and the third is Xeloda (or maybe Xoleda). He said if it were him (and he's roughly the same age), the third option would be his choice (and he said we could do combinations of two vs. three, etc....). I told him that I wanted to get a 2nd opinion before I started treatment and he was OK with this.... he said he would get a 2nd opinion himself and that a week or two was not going to be a big problem. We immediately started making calls and gathering all of the pertinent documents and scans and slides and whatever. Within a few hours, we had enough together to get an appointment at Duke or a 2nd opinion for tomorrow (4/10). All of this was again on a Friday.... so another great weekend. I guess that's about it.... that's where things stand right now. We go to Duke tomorrow, and in typical denial fashion, we've put off getting all of our questions together. We're going to work on that tonight. One of the questions will be about JH and any programs that may be going on there, including working to shrink the tumor to the point that surgery might be an option.