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1. Unwelcome Diagnosis

Life is full of unforeseen surprises, and my recent health crisis was as unexpected as if I'd stepped off a curb and into the path of a bus.

During the last 10 days of January, 2012, I gradually began experiencing some general nausea and bloating after eating, and for the first time in my life, I started having a few episodes of night-time gastric reflux. Initially, antacids and acid blockers seemed to offer some relief, but by the end of the month, I was vomiting nightly and starting to experience some constipation.

On February 2, I was sedated and an upper GI endoscopic exam was performed here in Tyler. The procedure revealed that my stomach was greatly distended and the inner lining was inflamed. No gastric or duodenal ulcers were seen, and the bile and pancreatic ducts appeared normal. So, a diagnosis of chronic gastritis was made. I was instructed to avoid NSAIDS like ibuprofen and naproxen, and I was prescribed a low-fiber diet and twice-daily doses of Prilosec to lower the acid burden on my stomach.

At first, this regimen seemed to work although the daily meals of cream of wheat and chicken noodle soup quickly became tiresome. But toward the end of February, I was again experiencing cramping in my upper abdomen after meals, and the nightly vomiting and gastric reflux had resumed.

So, on March 1, I swallowed some barium for the fluoroscope, and the test revealed a greatly narrowed area in my duodenum, or upper small intestine, just below the stomach. Concurrently, a CT scan uncovered no masses near the narrowed area, and it was thought that the "pinching" of the duodenum was possibly due to some congenital anomaly that for some reason waited 59 years to reveal itself.

The next day, another upper GI endoscopic exam was performed. My stomach was even more distended than the month before and nearly a gallon (six pounds!) of old food and liquid was pumped out. The endoscope was threaded down into the duodenum to the point of the narrowing. The stricture was so complete that even a pediatric endoscopic tube could not be passed through it. Additionally, an endoscopic ultrasound was performed -- this is sort of an inside-out sonogram of the abdomen -- and as with the CT scan, no mass or tumor could be seen, only a narrowed portion of my intestine.

It was decided that since I'd lost 20 pounds of body weight and my low blood protein levels indicated I was in a malnourished state, I should be hospitalized and fed intravenously for a week prior to exploratory surgery. During this time, I was only allowed ice chips orally and was given 2000 calories IV every 24 hours to bring my system back to normal.

At 5 a.m. on March 8, I was wheeled out of my hospital room and transferred downstairs where a surgery was scheduled to investigate the duodenal "kink" and correct it. A contingency plan called for the removal of any tumor and the entire duodenum, should cancer be discovered. This surgery, called a Whipple procedure, is the current gold standard in dealing with cancer of the pancreas, bile duct, or duodenum. The surgeon, Dr. Duane Andrews, is the only person doing Whipples in East Texas, and his 50-60 procedures yearly puts him in the top five in Texas.

As bad luck would have it, a single solitary tumor on the head of the pancreas was found to be putting pressure on my duodenum. So in a 9-hour Whipple procedure, 2/3 of my pancreas was removed, as well as the entire 11 inches of my duodenum and the bottom portions of my stomach and bile duct. This allowed Dr. Andrews to remove the tumor and most of the surrounding tissue for biopsy. Finally, the middle portion of my small intestine, the jejunum, was reattached to the stomach, and the bile and pancreatic ducts found new homes on the jejunum as well.

The pathology report on the biopsy indicated that I have pancreatic adenocarcinoma. The 20 lymph nodes harvested during the Whipple surgery revealed tumor invasion in the nine lymph nodes closest to the primary cancer, but distant lymph nodes were all clear. My liver and lungs are cancer-free as well.

However, it is likely that some cancer cells still remain in the area, and these will hopefully be addressed with chemotherapy to commence in April. Further surgery cannot be ruled out, but is unlikely.

I was released from the hospital the evening of March 17 after a rapid and problem-free recovery. I am back home now and eating anything and everything, just as in the old days. As of March 22, I've regained 5 pounds and am walking a mile a day with our pugs, Elmo and Teddy.

It is difficult to put a positive spin on a diagnosis of pancreatic cancer. Patrick Swayze, Michael Landon, and Steve Jobs are some notable people who have succumbed to this terrible disease.

However, in my case, I have some encouraging evidence that may promise a more favorable outcome. My cancer was a solitary mass that was caught early and successfully resected.

Follow-up chemotherapy carries a reasonable expectation of a long remission or perhaps even a cure. I do not smoke, and I drink only the occasional glass of red wine. I am not overweight, nor do I suffer from diabetes or chronic pancreatitis either. At age 59, I am 13 years younger than the average pancreatic cancer patient. So, I lack the usual complicating health issues that come with this disease

Statistically, eighty percent of all pancreatic cancers are discovered too late. They have already metastasized to distant organs and are so complex that no Whipple surgery or tumor removal is feasible. Treatment is palliative only and the cancer progresses rapidly. So, I'm already ahead of the 80 percent of patients who have no hope for their cancers.

I am determined to beat this disease. My case file is being reviewed by specialists in Dallas and at Johns Hopkins in Baltimore.

If further surgery is recommended to clean up the tumor site, I am a willing patient. The chemotherapy protocol is fairly straightforward, but if there are any therapeutic studies in progress that offer some promise, I will happily participate.

Rest assured that no stone will be left unturned as I begin my journey back toward perfect health. I have the full support of my family, my faith, and friends too numerous to count. Thus, I surely cannot fail.

I will update this website from time to time as developments occur, good or bad. Meanwhile, I would very much appreciate that everyone keep me in their thoughts and prayers during the months ahead.

Fondest Regards,
David Baxter

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Dr. Baxter's Blog

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