New Cancer Patient Managing Pain Issues

Posted by julie23 @julie23, Mar 22, 2023

I am 61 and diagnosed with pancreatic cancer in mid-January. I have had a long history with gallstones and kidney stones and was having what I interpreted as kidney stone pain through the past year. The new feature to my pain was that I experienced chest pain, which I told the doctors I saw reminded me of the pain that I had when my bile duct was blocked. The first time the bile duct pain concern I complained of showed in my chart was April 2022. It's nice that they checked my heart, but I'm still confused about why they didn't look at the bile duct until they did a CT for the kidney stones in December and noticed excessive bile duct dilation.

At any rate, they did a CA19-9 blood test at the end of December and it was really high. In early January, they did an MRI which showed a pancreatic head mass. They were going to wait to do an EUS/ERCP at the end of January but I pushed to have it done sooner so I was able to get it done in mid-January. The endoscopist could tell it was cancer at that time, but it took an additional eight biopsies to get confirmation. The mass is around 2 x 3 cm (I think since I'm American and on pain meds not sure of the metric conversion) but it has not spread. Two lymph nodes are working overtime.

When I was 54, I left my home state of Iowa to join the Peace Corps in Moldova for a brief time and then moved to Louisiana to attend graduate school. Call me crazy, but I wanted to see different parts of the world and I'm glad to have had the experiences and to have helped some people. I expected to work until I was 70 in order to pay for my adventures. However, I ended up with this disease far from my grown children and much of my family. I don't think it will work out asking them to come to support me for as long as needed. So far, they have been really generous with their time, but it will inevitably get more difficult for them.

I have had a lot of pain issues already despite the cancer being caught early. I had a sudden jump in pain severity after the first chemo but since it is cancer pain and not nausea/diarrhea it is not related to chemo. This week, after going through several weeks of severe pain accompanied by inability to really eat, I have been started on the patch pain relief. My main question for this post is really about the pain. It seems like it's unusual to have pain so early and I wondered

* does this bode poorly for my chances?
* my doctors have said that when the chemo has a chance to shrink the tumor, the pain should get better. Anybody have that happen?
* how do you know when you can get off the patch?

Thank you.
Julie

Interested in more discussions like this? Go to the Pancreatic Cancer Support Group.

No answers on pain, but thank you for sharing your story and I am impressed with your self advocacy, pushing for answers and moving your treatment along.

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I have pancreatic cancer. Been through 8 rounds of chemo. The tumor has shrunk and the pain is less. I walk a lot and that might be helping.

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I was diagnosed about the same time as you and before I started chemo I ended up with bile duct problems. A stent was put in to get the bile flowing and soon I was able to start chemo. I had a lot of pain issues early on and ended up in ER several times. I had 8 chemo treatments and then 15 radiation treatments then surgery was scheduled. Had to have the biliary stent replaced then had a CT to ensure I was ready for surgery. Had biopsy on bone and lungs and found metastasis in a few spots. Surgery was canceled. I still had pain issues and now I am working with a pain management specialist. She has helped me a great deal. Please stay on top of your treatments. Get ahead of the delays that can pop up. I am now on chemo to keep me going. Surgery is no longer an option. My wife and I are praying for a miracle and trusting God to do what we cannot. I’m praying for you and trusting God in your case also. Keep your family close. Mine has been a life saver.
May God bless you and see how you through this journey.

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@julie23, I wanted to check in and see how you are doing and if your pain has improved. Have you had further chemo? Has that helped to shrink the tumor and reduce the pain as it did for @marciak9?

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@colleenyoung

@julie23, I wanted to check in and see how you are doing and if your pain has improved. Have you had further chemo? Has that helped to shrink the tumor and reduce the pain as it did for @marciak9?

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Sorry it has been so long since I posted this reply. I have been a little depressed about being sick for so long. One thing that is hard to describe to people is how expectations of life as healthy folks can interfere with feeling sick for months on end. I keep waiting for those "good days" and I guess I have them. But they fall far short of my expectations of what a "good day" should be. I have had two more rounds of chemo and am looking at the fourth round on Monday (4/24/23). After the fourth round, they will do a CT and I should have more information.

Pain has improved now that they have prescribed a long-term fentanyl patch. It was amazing to be pain free for periods of time. Made a huge difference in how desperate I felt. Still dealing with nausea, but it is easier to battle when you aren't deciding between feeling like a claw hammer is stuck in my back versus vomiting. Sometimes I just have to choose vomiting.

I've begun making plans with my family to move my treatment to Iowa and it is a lot. Over the past month it has become extremely clear that having a deep bench of support is really important. Thank you all for your posts - your replies here as well as on other posts. I appreciate you!

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@meb49

I was diagnosed about the same time as you and before I started chemo I ended up with bile duct problems. A stent was put in to get the bile flowing and soon I was able to start chemo. I had a lot of pain issues early on and ended up in ER several times. I had 8 chemo treatments and then 15 radiation treatments then surgery was scheduled. Had to have the biliary stent replaced then had a CT to ensure I was ready for surgery. Had biopsy on bone and lungs and found metastasis in a few spots. Surgery was canceled. I still had pain issues and now I am working with a pain management specialist. She has helped me a great deal. Please stay on top of your treatments. Get ahead of the delays that can pop up. I am now on chemo to keep me going. Surgery is no longer an option. My wife and I are praying for a miracle and trusting God to do what we cannot. I’m praying for you and trusting God in your case also. Keep your family close. Mine has been a life saver.
May God bless you and see how you through this journey.

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I am so sorry to read about how things have gone for you. How are you doing now?

I hope you and your wife are continuing to pray for a miracle and trusting God. I am adding my prayers to yours, hoping that even my little contribution will add up.

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Thank you very much for your prayers. We continue to trust God for the final outcome. My oncologist placed me on a different chemotherapy that I am genetically qualified for. He said that less than one percent of pancreatic cancer patients have the required genetic markers. The new chemo is normally used on breast cancer patients but it has shown promise for patients like myself. The side effects seem to be worse than the other three chemo treatments that I had earlier in my treatment but we are thankful that I am able to try something that targets this cancer. We have hope in the Lord for complete healing and full recovery. Your prayers are more than little contributions. Thanks again.

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@julie23

Sorry it has been so long since I posted this reply. I have been a little depressed about being sick for so long. One thing that is hard to describe to people is how expectations of life as healthy folks can interfere with feeling sick for months on end. I keep waiting for those "good days" and I guess I have them. But they fall far short of my expectations of what a "good day" should be. I have had two more rounds of chemo and am looking at the fourth round on Monday (4/24/23). After the fourth round, they will do a CT and I should have more information.

Pain has improved now that they have prescribed a long-term fentanyl patch. It was amazing to be pain free for periods of time. Made a huge difference in how desperate I felt. Still dealing with nausea, but it is easier to battle when you aren't deciding between feeling like a claw hammer is stuck in my back versus vomiting. Sometimes I just have to choose vomiting.

I've begun making plans with my family to move my treatment to Iowa and it is a lot. Over the past month it has become extremely clear that having a deep bench of support is really important. Thank you all for your posts - your replies here as well as on other posts. I appreciate you!

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Julie, I'm encouraged that the long-term fentanyl patch is working to get you pain free periods of time.

As for managing symptoms, mixed with exhaustion and depression, I'd like to tag @gingerw and @IndianaScott on this discussion too. They know first hand what it is like to need a deep bench of support and even with that support "how expectations of life as healthy folks can interfere with feeling sick for months on end. " Your choice of words really resonate with me.

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@meb49

I was diagnosed about the same time as you and before I started chemo I ended up with bile duct problems. A stent was put in to get the bile flowing and soon I was able to start chemo. I had a lot of pain issues early on and ended up in ER several times. I had 8 chemo treatments and then 15 radiation treatments then surgery was scheduled. Had to have the biliary stent replaced then had a CT to ensure I was ready for surgery. Had biopsy on bone and lungs and found metastasis in a few spots. Surgery was canceled. I still had pain issues and now I am working with a pain management specialist. She has helped me a great deal. Please stay on top of your treatments. Get ahead of the delays that can pop up. I am now on chemo to keep me going. Surgery is no longer an option. My wife and I are praying for a miracle and trusting God to do what we cannot. I’m praying for you and trusting God in your case also. Keep your family close. Mine has been a life saver.
May God bless you and see how you through this journey.

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I pray that you are surrounded by the presence of the Holy Spirit to give you peace. Keep trusting in the Lord. My husband was diagnosed in early Feb. with PAC. He is going through Folfironox but will have to have a reduced dosage as it put him in the hospital after only 4 treatments. We are also trying Metabolic Oncology - using High Dose IV VC and a handful of off-label Meds that show promise at helping to starve the cancer and weaken it so the chemo. can be even more effective at killing it. I would encourage you to read the Jane McClennan book "How to Starve Cancer". It can give you additional weapons against this disease and more hope.

Beth

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How It's Going

I thought about making a new post with news but wanted to keep this together in a "how it started" ... "how its going" way. I have completed 4 rounds of chemotherapy for which I was awarded a new CT! (think of Bob Barker on Price is Right if you want the humor part of that statement). I think it's a great result - no spread with a small bit of improvement. Unfortunately, I have lost 35 pounds over the course of treatment and am still struggling with dizziness and nausea. I still take a Percocet or two each day to manage breakthrough pain. I'm pretty weak.

The HemOnc suggested today after the CT review that we might be better off to do WIPPL surgery instead of the next four cycles of chemo, then move back to chemo after the WIPPL. Of course, this sounds like a good idea to me. I know the surgery will be hard, but I want so badly to get this cancer thing out of me. I will be meeting with the surgeon on Wednesday to hear what he thinks. I'm feeling somewhat celebratory.

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