Day 1 at the Duke Oncology Clinic: November 11, 2010

As the button on the Duke Oncology Clinic employee says:

CANCER SUCKS

Today we had my first appointment at Duke with the medical oncologist, Dr. S. Yousef Zafar and his team.  Although the initial wait in the lobby of the Oncology department was an extended one, I enjoyed the free cookies that they have out for everyone. Jeff however, abstained and only looked at me with his often seen look of disapproval. (Please note, that it is Jeff, not me that is typing this).  They also had complimentary soft drinks, coffee, tea and water.  After filling out an extended electronic survey of my physical and mental state, we settled in to people watch.  Of course, the moment that I went to the bathroom, they called my name. 

First came the obligatory weigh-in, temperature & blood pressure vitals.  However, the rather short nurse had to call in reinforcements to measure my height as she could not reach up to the top of my head.  From there we were taken to the examination room where I was first interrogated by Dr. Zafar’s nurse and then the oncology resident.  The resident, who speaks highly accented English, proceeded to do a physical exam as well.  We were then left to wait for the “real” doctor.  It really was not that long before Dr. Zafar came into the room with his resident and discussed what he knows thus far and what we will still have to wait to find out.

What he knows:  The CT scan and ultra-sounds show a mass on my pancreas.  The conclusion is most likely pancreatic cancer. However, that diagnosis cannot be verified until there is a biopsy.  The mass has obstructed the duct leading from the pancreas that flows to the liver and is filtered out to the rest of the body.  With this obstruction, the bilirubins are building in my system.  This is the cause of my jaundiced appearance (my skin is yellow).  The obstruction has to be alleviated.  This can be done by inserting a stint into the pancreas to open the duct allowing it to work more normally.  This needs to happen sooner rather than later.  The procedure involves going down the throat to the pancreas. However, if the opening in the duct is completely closed, then the stint isn’t possible.  In that event, the surgeon will need to go through the side of the torso and insert a tube that will be exposed to the outside of the body, allowing the pancreas to drain.  The biopsy will also be performed by going down the throat to the pancreas.  The best case scenario is that the biopsy and stint can be done at the same time on an “out-patient” basis.  The appointment for the biopsy & stint placement will be made ASAP.  Hopefully by early next week, both will have been completed. 

What he doesn’t know: Only the biopsy will confirm whether or not the mass is cancerous.  That conclusion will determine the course of treatment. He did say that if cancerous, the typical course of treatment was: Chemo/Radiation, then surgery, then more chemo.

Where from here: I have an appointment with Dr. Zafar next Thursday, where hopefully, the biopsy results will be in, my bilirubin level will be down due to stint or tube and at that time, we will learn what the course ultimately will be.

Everyone that we came in contact with today at Duke was upbeat, positive and seemed to care.  Jeff and I both left with a good feeling about Dr. Zafar and his team, as well as the future.