Last Thoughts Before Surgery

The Road to Recovery

‘You wanna move mountains, go ahead
I think I’ll suffocate instead
A change of scenery won’t tame
The endless earthquakes in my head

So I’ll suffer through
A means to an end, it’s all I can do’

This will be my final post before I go into surgery on Friday. I would imagine that it will be at least a week before I post again, if not longer. I’ve been told that I will be on a high-dependency ward for the first few days. Once I am cleared from that ward, I will be moved to a more routine one for around a week. Of course, it all depends on what is done during the procedure, how well I recover and whether there are any complications along the way. If a Whipple procedure is possible, the impact will be much greater on my body than the NanoKnife.

As the dietician told me, the Whipple involves the surgical team creating 3 new joins in the digestive system. Hearing the phrase ‘new joins’ in relation to your digestive system is a little unnerving; I can’t say that it is an attractive prospect of surgery. The fact that the Whipple would probably be my best chance at getting rid of the cancer however, makes the concept of having new joins in my digestive system a very attractive thing indeed. Join me up, doc… that felt a little weird to type.

Cancer is always pulling you in a million directions. Your standard of life changes so much that you find yourself feeling grateful to be eligible for major surgery, strangely looking forward to potentially having your digestive system rearranged like a hamster run. Of course, the alternative, to not have an operation and allow the cancer to grow inside your body unabated, is most definitely not better. Imagine telling myself a year ago, “Hey Dan, in 12 months you’ll be eight months into treatment for stage 3 pancreatic cancer and looking forward to an operation,” I’d probably have replied with a laugh and a “Who would look forward to major surgery?” I also thought I was immune to things like cancer 12 months ago because nobody in my family has had it. I thought I was invincible so long as I was either training for an ultra-marathon, or actually running one. Turns out that running ultra-marathons doesn’t actually make you immune to cancer. It probably makes your body a little bit better at fighting it, though, so it was still worth something. Hopefully. I enjoyed it anyway so it was worth every second.

I say that I’m looking forward to surgery. I’m not. That probably isn’t a surprise. It would be short-sighted to not acknowledge what a privileged position I am in to be offered this opportunity, though. There are people that read this blog regularly who are not in the position I am in, some who have been definitively told they are inoperable. My surgeon told me that to the majority of oncologists/surgeons, I may have been deemed to be inoperable given the circumstances, but luckily I am with a forward-thinking and optimistic team who do see opportunity here. I am grateful for that, and thus, am looking forward to being afforded such an opportunity. Am I looking forward to going through it, though? Hell no. Am I looking forward to putting my family through it? Hell no. It isn’t good for anyone involved, but it has the potential to change everything.

With a Whipple procedure unlikely to be a possibility, it’ll probably be NanoKnife. Although that carries a smaller recovery time, it still requires the surgeon to cut into my abdomen and play around with the organs there. Clamping this, cutting that; the scene doesn’t inspire a lot of enthusiasm in my brain. Then I remember that one of the things being cut is the tumour itself, and all of a sudden I get all evil and masochistic. “Do your worst, surgeon! Make him pay!” I feel like rubbing my hands together and snarling as I grin, staring at my own stomach. I’d only be cursing my own body, though, and I will eventually pay a price for whatever is done to the tumour. Whether that price is recovering from a successful removal, or recovering from electric pulses being applied to my pancreas, is yet to be seen. Either way, I’m sure it is going to suck at least a little bit in the days, weeks and possibly months afterwards.

I don’t like the war analogy when talking about cancer, but it can be hard to ignore. It’s hard not to liken yourself to someone fighting against an enemy force, even though you feel like a bystander in that war the majority of the time. You attend appointments, anticipate scan results and cower whenever the hospital calls you, but you don’t do a lot else to contribute to the process. Your war is usually with yourself – keeping your head up, finding a way through the painful days and doing your best to sleep well at night. It’s a war of attrition, but the cancer doesn’t have a brain to disadvantage it. Your brain will do everything in its power to attack you. Mine has been telling me that my neck is swollen, that it’s got in my lymph nodes and that my abdomen hurts more than usual. Sometimes, I wonder who’s side it’s really on.

It doesn’t help ignore the war analogy when you find yourself packing your bag the night before, knowing you have a critical period ahead of you. Last night, I was packing my bag and responding to all the lovely messages I’ve been sent. The war analogy felt real. Now, as I write this, I sit in the car on the way to hospital. It’s mostly silent… anticipation hangs in the air. I get the feeling that people feel more anxious than they’re letting on; you can sense it as we sit listening to the music playing from the speakers. Everyone is a sitting duck in their own head.

Anna has the password to the blog’s Twitter account, so that’s probably the best place to find an update soon on how things have gone. Thank you to everyone for the support. I will get back to all of the blog comments once I’m feeling well enough post-surgery! Thank you for continuing to read and I hope I’ll be coming back with some positive things to say next time I’m writing.

Inspiring Stories from a Pancreatic Survivor

Nigel – Just after being diagnosed with Pancreatic Cancer at age 72

The universe has been up to its old tricks again. A woman named Julie left a comment on my Strava a few days ago, saying, “Hi Dan. My Dad had the same as you. Would it help you to talk to him? He was really into his fitness when he got diagnosed. It helped massively with his treatment. He would be happy to help you x”. I was certainly interested but had no idea what to expect. Nothing could have prepared me for my conversation with Nigel and his fascinating story.

Nigel was diagnosed with pancreatic cancer at 72. I believe 72 is the average age of someone diagnosed with the disease, despite me previously claiming it was 76. When I spoke to Ali Stunt, CEO of Pancreatic Cancer Action, she said it was about 72. It was a damning diagnosis at that age, and Nigel’s was no different. He was told it was inoperable and given 8 months to live. He didn’t accept this, though and insisted on treatment. The doctors offered him Folfirinox, the same treatment that I am on. It sounds like they had to deliver it slightly differently to me. Nigel spent 12 hours at the hospital on his treatment days; I assume this is to give his body more time to process the drugs.

After 6 months of chemotherapy, apparently of which Nigel sailed through (his daughter Julie gave a slightly different account, but I’m not picking sides), the doctors were utterly floored by the chemotherapy’s effects on the tumour. Apparently, a 30% reduction in size would be good, but he had achieved closer to 54%. They couldn’t believe it. All of a sudden, Nigel was being considered for surgery. Julie told me they wanted to see how fit his body was to understand if it would withstand surgery. To do this, they asked him to attend a session where he would be asked to run on a treadmill and measure his heart rate. Nigel has kept himself fit his whole life, and it is evident from his pictures. Julie told me that he showed up in his complete workout kit, expecting an intense workout session. He was ready for anything, never mind a measly surgery. Fast-forward to 2022, Nigel is approaching his 3-year clear scan at The Christie. Even better, he has the same specialist as I do.

In spite of the fact that this story is incredible, inspiring and frankly, insane, that isn’t even the most remarkable thing about Nigel. The man is a national treasure. After meeting him, I wasn’t the slightest bit surprised that cancer didn’t manage to better him. He is the most positive person I have ever spoken to, and the effect it had on me was priceless. It took a 40-minute conversation on the phone, and I felt like a new person. “If someone tells you that you have 8 months to live, you need to enjoy your time even more. Why would you spend that time being miserable when it won’t change anything anyway?” It is rhetoric that I preach on this blog, but seeing someone living and breathing it to such an extent is so refreshing.

I am so grateful that Nigel’s daughter Julie reached out to me and put me in contact with him. The story is so unlikely for pancreatic cancer that you’d assume it was fictional, but it isn’t. I am sure there is so much more to it than I am aware of, and it would make a superb blog. I get the impression that Nigel would see that as a waste of time, though. “Some people spend all their time feeling miserable in support groups after being diagnosed. I never got that.” He made me laugh a lot, even when I didn’t necessarily agree with him, although I wasn’t sure when to take him entirely seriously. His sentences produce a smile, each one laced with flippancy and confidence towards cancer, life and everything in between.

Meeting Nigel made me think a lot about my approach to fighting cancer. I am at a different stage to him, and I cannot see into the future to see how things end up for me. But it made me realise that I don’t need to know the future to understand the best approach to fighting cancer. It is not about fighting the cancer at all; it’s about grasping onto the things that make you feel happy and continuing on with life as usual to the best of your ability. Right now, the significant limitations on me are due to the chemotherapy drugs and their effect on my body. I am running again, though, I’m managing to view wedding venues with my fiance, and I am managing to get enough effort together to bake and cook plenty of food. Alongside all of this, I’ve started a blog that I am really enjoying writing, something I would not have done if not for being diagnosed.

It can be an interesting exercise to think about what you have been spending mental effort on recently. What has bothered you the most in the past 7 days? How quickly did you resolve the worry, or is it continuing? Lately, there have been quite a few things on my mind, cancer and non-cancer. The surgery is a constant worry for me – whether I will get to a point that they offer it to me, how well I will manage to recover from it and whether the surgeon will be able to remove enough of the pancreas to stop it coming back. For the most part, I realise that these things are natural worries, but I also know that worrying about them offers minimal benefit to me. Worrying about it won’t make it better, change the outcome, or influence my body towards any different conclusion. Worrying about it at night and letting fear cripple my existence could actually make those thoughts more likely to come true. Stress is deadly on the body and mind, and my body is under a lot of physical stress right now anyway; it doesn’t enjoy having the cancer either based on my heart rate during my runs.

So my pledge to myself is to prioritise enjoying myself and being happy. Nigel is living his life without fear, and I can’t imagine him expending any mental effort, energy or stress on things he doesn’t see value in. I hope to meet him in person eventually as I would love to write more about him. I think anyone could learn a lot from him. Life is too short, and when you have pancreatic cancer at 28, life really can feel short. No better time to enjoy it than now.

So today, I went out and ran my 4 miles (I did 4.2 actually), I went to the dentist, and tonight I am going to view a wedding venue. The dentist was good fun – there’s nothing wrong with my teeth. Glad to know there’s an area of my body living carefree in the cancer period. Regarding the wedding venue, we’re curious to see if the ‘C’ card really can save you money on things – we’re hoping so. I’ll have to update on that in another blog titled ‘The Benefits of Cancer’… it’s likely going to be a short post.