I'm sorry to hear this. I'm not any kind of medical expert, just a patient, so please take what I'm about to say with many grains of salt. I also am a stage 4 patient. I was originally diagnosed 3/29/23 via endoscopic ultrasound and declared stage 4 on 4/6/23 after a laparoscopy. I was 70 at the time.

When I was diagnosed, my (first) oncologist told me I had "one year, two years, three years" to live and that I'd be "feeling it in a month or two." As you can see, I'm nearly at my one-year mark. I am in no pain; I don't even take Tylenol. I finished my 20th chemo round on Tuesday 2/20. We have agreed that I'll do chemo as long as I wish and as long as we get good results. FYI, I'm on the modified Folfirinox regimen, dosed at 60 percent of the typical level. What I mean to say is, there is hope, and others on this board will say this too. But fighting pancreatic cancer is hard work. It's a real slog.

* Which chemo treatment will your wife receive? What is the dosing level? My oncologist was going to dose me at 100 percent of typical, but then realized I was 70. He said the dosage hadn't been tested on people as old as I was, so he reduced round 1 to 80 percent. Even with that, it was awful; it made me very sick. Beginning with cycle 2, he reduced the dose to 60 percent of typical. So ask about your wife's dosage level, and talk about what would be best for her.

* Do you have a palliative MD on her case? At my cancer center, every patient is automatically referred to a palliative MD. This is not for hospice care. This MD is in charge of managing symptoms and side effects of cancer diagnosis and treatment. He/she can do a lot to help her feel more comfortable.

* Re the nausea and weight loss, whether you have a palliative MD right now or not, make sure your wife's oncologist knows about her extreme nausea, and ask them about medications and management techniques. She will (or should) get a lot of premedications before chemo that are designed to minimize nausea. I get Zofran, dexamethasone and Emend. At home, I was told to alternate Zofran and Compazine tablets for two-three days after chemo. Keep a lined trash can near her at all times. Also, be sure that she receives adequate fluids so she doesn't get dehydrated. There are lots of posts on this board about diet ideas, so I won't go into those. Besides, you don't have time today! In general, keep meals very small and more frequent. I emphasized bland foods at first, and I also had a lot of food jags that kept my husband running to get those strange things I suddenly craved. I lost weight at first too, but have gained it back and a bit more besides.

I hope some of that helps. Ask questions, make notes, do research. The chemo nurses are tremendous resources, so you can talk to them at the infusion lab today as well. Ask your MD about these issues and anything else that comes up. If you need a second or third opinion, push for that. If you need to consult with an MD at a pancreatic cancer center of excellence, push for that. But as you already know, time is of the essence, and starting treatment ASAP is key. I hope today goes well for both of you.