Chicken Enchiladas and Pancreatic Cancer

William Ramshaw

• Blocked bile duct leads to pancreatic cancer diagnosis
• Whipple procedure to remove part of my pancreas and my gallbladder
• Radiation and chemotherapy after surgery

My first word was “taco.”

Back as far back as I can remember I rode shotgun in my Dad’s red Chevy pickup down to Mexicali to pick up a bag of tacos for supper. Hence, back in 2013 I was bewildered after going out to lunch to a Mexican joint for a couple of chicken enchiladas on a Friday and ending up out of sorts over the weekend.

The next week I got in to see my doctor who ordered what he called “routine” tests. He thought maybe I’d picked up a bad bug known as Clostridium difficile, or C. diff for short. In looking back on this, I think doctors only order routine tests when they don’t want a patient to think something “non-routine” might be going on with them.

Not a week later I turned yellow. An emergency CT scan led to a trip to the ER, where I was admitted with a blocked bile duct. An upper GI scoping was done to insert a stent into my bile duct, to open it up. Unbeknownst to me, a tiny tissue sample was also taken. Three days later the GI doctor stopped by my hospital room and flatly told me, “I’m sorry, you have a malignancy.” The fact that not even a doctor used the C-word terrified me.

Following my stenting, I developed severe pancreatitis (inflammation of the pancreas). I couldn’t eat anything, so I was put on total parenteral nutrition (TPN for short), a type of liquid food fed through an IV via a percutaneous indwelling central catheter (PICC) line.

Despite multiple CT scans, an MRI, and an ultrasound exam, the doctors could not find my tumor. Only after another doctor scoped me using a special ultrasound probe was the one-inch tumor next to my bile duct located. My diagnosis: stage IIb pancreatic cancer. Had my bile duct not been blocked, forcing me to the ER, it is doubtful I would be a pancreatic cancer survivor.

Before I was discharged from the hospital, one of the hospitalists (hospital doctors) stopped by my room and asked, “Who’s your oncologist?” I had no idea what an oncologist was. I soon learned this was code for cancer doctor.

Pancreatic Cancer Treatment Starts with a Whipple Procedure

Based on the hospitalist’s referral I was matched up with a superb surgical oncologist, someone I didn’t know at the time. But I heard that people from states away clamored to see him. Based on a review of my chart he determined I had pancreatic cancer and would require a Whipple procedure, where the top third of my pancreas would be removed along with my gallbladder.

With my pancreas settling down, eight weeks later I had my Whipple procedure, followed by three weeks in the hospital. Afterward, hit by a truck is an understatement. Run over repeatedly is more apt. Infection after infection chased one another. I was treated with exotic concoctions of antibiotics. At one point I had six pumps on my IV pole. Top-heavy, I had to be careful not to dump it on my mandatory floor walks.

Next Step: Chemotherapy

Out of the hospital again, I got my port. Being a former sailor who had always enjoyed port visits, this was not a port I wanted to visit.

On a pre-chemo visit, my medical oncologist told me I would be treated with Gemzar (gemcitabine) and 5-FU (fluorouracil). Wanting to know more about my treatments I asked her, “Why that, why not Captain Crunch and Froot Loops?” (Yes, I really asked this.) She understood my question and disappeared out of the exam room, coming back minutes later with three photocopied pages from her doctor’s cancer book. I didn’t know oncologists had these things. Up until this point, I thought they brewed up some chemo concoction. Only through this did I discover the science of cancer. Not to be blunt but Symptom A + Symptom B = Treatment C, period.

From the pages she gave me I found out I would be treated under FDA Study RTOG 97-04, the first pointed information I had to begin to understand the mess I was in. This study, based on 451 patients, told me I had a less than 20 percent chance of seeing five years. Being a numbers guy with a modicum of statistics training, these stats alarmed me but I accepted them for what they were. I’m not a number—I am me.

Thirty radiation treatments followed, six weeks in total. I got weekends off for good behavior. Alone, suspended on an elevated bed, the linear accelerator’s giant head swung around me making an eerie grinding and snapping noise as it shot me from six angles. My treatment usually only lasted 15 minutes but sometimes if something went bonkers with the machine or worse, a patient ahead of me, I found myself waiting for hours. Part of this treatment included a nifty chemo pump that dumped 5-FU into me 24/7 via my port; 5-FU is a type of chemo agent supposed to make my pancreatic cancer cells more susceptible to radiation, or so the Memorial Sloan Kettering Cancer Center said in a clinical trial (for rectal cancer).

Following my radiation, I had six Gemzar doses, one every other week, for twelve weeks in total. If my blood counts were too low, my medical oncologist reduced the dose to what she thought was appropriate. When I asked her how this would affect my outcome she replied, “We don’t know.” I appreciated her honesty. Her frank answer helped me understand the mystery of cancer treatments. For everything that is known, there is so much unknown.

Some Bumps but Glad to Be Here

There is so much more to my story. I needed multiple procedures to fix things gone wrong with my Whipple procedure. I have osteoporosis compliments of my abdominal radiation. My diabetes is worsening. I have written a memoir called Gut Punched! Facing Pancreatic Cancer, about my treatment.

Besides receiving superb care, I was a highly proactive patient who asked question after question, and then more. I believe this contributed to my thus far successful outcome.

One thing about being a pancreatic cancer survivor: You don’t let your guard down for a minute. My six- month oncology visits still scare the hell out of me. But I can say, I am elated to be cancer-free six years after completing my treatments.

William shared his thoughts on life after treatment in “Sometimes Life Hits You in the Head” and tells his story in the video “I Can Really Do This.“