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Thomas: Abdominal Pain associated with Pancreatic Cancer

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Thomas: Abdominal Pain associated with Pancreatic Cancer
Thomas: Abdominal Pain associated with Pancreatic Cancer

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A 58 year-old gentleman, previously healthy, has been recently diagnosed with cancer of the pancreas after months of abdominal pain. Unfortunately, the tumor is not operable but he is eligible to undergo chemotherapy. In order to control the pain, his oncologist puts him on pain medication along with stool softeners since these analgesics tend to cause constipation. In the following weeks, as he starts his first cycle of chemotherapy, the pain initially improves, but slowly escalates requiring pain medicine dose increases. When the Supportive Care physician at The Peregrine Institute is consulted, the patient is suffering not only of uncontrolled pain but of intractable constipation, lack of appetite, nausea when ingesting his pain medication and increasing fatigue and depression. He had to go to the Emergency Room two nights prior to receive an enema. Because of the high emotional impact this disease has had on him and his family, he prefers not to complain of these problems and to focus on getting through each cycle of chemotherapy, which is hard enough as it is but during this visit, he learns that many of his symptoms are commonly related to the pain medications and that the intensity of pain does not typically correlate with progression of the cancer or response to chemotherapy. He feels validated knowing that this scenario is not uncommon at all and he is able to freely discuss his concerns. He is prescribed an alternative regimen for pain and constipation, counseled on nutrition and massage therapy and is scheduled for a follow-up appointment in one week. As instructed, he calls the Institute in two days to tell us how the regimen is working. Unfortunately, his pain is still severe, nausea is better and constipation is too early to know. He is now scheduled for an injection called the Celiac Plexus Neurolysis performed at the Institute under sedation. It is a needle-based technique that deposits alcohol among the nerves of the pancreas causing them to degenerate. The result is not only profound pain relief but also an acceleration of the bowel transit ultimately improving the pain and the constipation. He now needs much lower doses of analgesics and feels infinitely better. As his condition naturally goes through ups and downs, The Peregrine Institute continues to offer alternatives to improve his quality of life and function.

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