Hamish – Interview 34

Hamish was diagnosed with pancreatic cancer in 2006. He had a Whipple’s operation, then chemotherapy. His quality of life has been good but the cancer has come back in an area near the pancreas. He is about to start more chemotherapy.

In May 2005 Hamish decided that he needed to lose a bit of weight so he started exercising more than usual. He started to lose weight, which he thought was great, but then in September he started to get abdominal discomfort. He also had diarrhoea and very smelly poo.

By Christmas Hamish decided that he was losing too much weight and the symptoms were far worse, so he went to see his GP, who did a blood test. Hamish went back and saw a different GP who looked at the blood test results. He told Hamish that he probably had pancreatic cancer and that it was the worst cancer to have. This was a huge shock to Hamish and to the family.

Hamish had an ultrasound scan, and then a CT scan, which showed that the tumour was quite large. It was in the tail of the pancreas. In April 2006 Hamish had a laparoscopy and a biopsy of part of the pancreas. The consultant was positive and decided to operate quickly, so three days later Hamish had a Whipple’s operation.

Hamish did not find the operation particularly painful because he had an epidural, but after surgery he couldnt eat without vomiting. He managed to eat after about 10 days. Hamish had about three weeks in hospital and then went home to recuperate. After six weeks he was able to walk two or three miles every day.

Hamish was then fit enough to start chemotherapy. He had six months of chemotherapy, having monthly cycles of three weeks of gemcitabine (infusions once a week) and then one week off treatment. Hamish didnt experience serious side effects of chemotherapy. Occasionally he felt a bit shivery, but felt well most of the time. After the chemotherapy finished, Hamish’s quality of life was good. He was able to do activities that he enjoyed, like golf.

In about October 2009 Hamish felt unwell and experienced abdominal pain and bowel problems once more. He went back to see his doctor, who told him to carry on with life, but in January 2010, after a CAT scan, the consultant thought there was more cancer in the pancreas.

The consultant wanted to wait for about six weeks to make sure he was right. Meanwhile, he put Hamish on a course of antibiotics, which made Hamish feel sick and made it hard for him to eat. Hamish lost more weight. More tests showed that the cancer had come back the tumour had grown. Hamish wasnt entirely surprised, but he felt disappointed.

Hamish was having trouble getting food through his stomach, so Hamish started intravenous chemotherapy again in 2010. However, his white blood count was so low that his doctor stopped this treatment after a couple of weeks. Doctors were worried about infection.

When we met Hamish, he was still losing weight and very uncomfortable and bloated at times. He takes Creon and an antacid pill when he eats to help digestion. He suffers from diarrhoea and constipation. At times his stomach and bowel problems keep him awake at night, which is tiring. He suffers from pain due to colic. He finds that if he takes peppermint water before he eats this helps to prevent bloating and discomfort.

Hamish is about to start another form of chemotherapy, capecitabine, which involves pills rather than an intravenous infusion. He can take these pills at home. Hamish hopes that this will shrink the tumour again. Hamish told us he feels weak and frustrated because he can’t do all the things he used to do, but most of the time he enjoys life. He appreciates the support he receives from the medical team and his family and friends. He thinks it is very important to keep a sense of hope.

We spoke to Hamish in 2010

The recurrence didnt surprise Hamish. He recognised that he had survived longer than many others…

Age at interview 76

Gender Male

Age at diagnosis 72

So what was your reaction when you heard that the tumour had grown again?

I was fairly certain it was because of the way I’d lost all the weight.

And from my previous experience I thought, Yes, you know, there’s no other reason that it should be doing this So
It wasn’t a huge surprise to you then?

No, it wasn’t a surprise. It was a disappointment. Very much of a disappointment.

Of course.

But I thought, Well, it’s there. You know, I’ve had three or four years, for heaven’s sake, and that’s a lot more than most people get [laughs].

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Hamish told his GP about his symptoms. After a blood test the GP told Hamish that he probably had…

Age at interview 76

Gender Male

Age at diagnosis 72

So which month did you start to think there must be something wrong?

September, October time.

And that’s when you thought that it was mainly due to your slightly smelly bowel motions?

Yes, very smelly and the fact that then I started losing weight, I thought, This is grea, because I was losing two or three pounds a week. I never thought I had cancer or something like that, no.

And when you first went to the GP you told him this. What was his reaction?

Blood sample.

Straight away?

Yes.

He didn’t try you on any other treatment first?

No. I gave him the signs and he said, Well, we will get a blood sample first.

So that was that, and he was obviously right.

And from the blood sample did he give you, he didn’t give you a diagnosis at that point?

He said, It looks like pancreatic cancer But then they put me on an ultrasound and that showed it up quite clearly.

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When Hamish had a recurrence he lost a great deal of weight. His abdomen was distended, and he…

Age at interview 76

Gender Male

Age at diagnosis 72

About last August I started getting into trouble again with my tummy and generally feeling weak and not myself. So back I went to the doctor and eventually, in January they decided that, yes, there was a spot there, after having done a CAT scan, on the pancreas again.

So this would have to be treated but he wanted to make sure and would leave it for another six weeks to see what, how it developed and what would happen. During that time he also put me on a course of antibiotics, which blew me up and made it almost impossible for me to work, to eat and I lost a lot of weight. And then in March we went off to the States to stay with family for a few weeks, where I really wasn’t able to eat anything or very, very little and I was losing as much as four or five pounds a week. So we came home early and went straight back to the original hospital, where I had the operation done, where they examined me and did some further tests. It certainly showed that the tumour had grown. I was having trouble with getting the food through my stomach, which was causing a lot of [um] unpleasant problems in that area.

And that’s where we are at the moment. My basic problem, actually, over the last six months I’ve gone down from about fourteen and a half stone to, I’m now down to eleven.

So it’s holding my trousers up [laughs] I do get a lot of trouble with my tummy, which they reckon, must be coming from the tumour because it’s irrational in the way it behaves, I cannot get to a regime which maybe works for more than two days and then it blows up again and does something else. So that in itself has been a problem.

By blow up’ you mean you feel distended?

Very distended, yes, yes, and suffer from diarrhoea one minute and constipation the next.

So that that has been unpleasant and it’s lowered my value of life, I suppose.

My quality of life. Somewhat but I’m here and still fighting.

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Hamish was first given gemcitabine but his blood counts fell so low that capecitabine capsules…

Age at interview 76

Gender Male

Age at diagnosis 72

From there, we progressed a little bit slowly really, until about the beginning of May, when it was decided, yes, I should definitely go back on the same treatment that I had before but, unfortunately, when we started that, my white blood cell count went right down so after two goes at it they had to abandon that. And now I’m going to start next week on another treatment. it’s actually one that was used previous to the one that they tried before and we’ll have to wait and see what happens.

Is that a different sort of chemotherapy?

it’s a different type of chemotherapy on pills rather than on intravenous, yes.

So now you are going to start a different sort of chemotherapy. Did you say a tablet, capecitabine?

Yes, capecitabine.

In oral form?

Oral form, yes. So I’m taking that, starting Monday and we’ll see. Unfortunately, it’s not as effective as the gemcitabine. So I lose some of that ability of that too, but they can only shrink the tumour, or hold it back, as it were.

They can’t remove it as such.

Have the doctors explained why you can have this sort of chemotherapy but not the other one?

Yes, because with the gemcitabine my white blood count wouldn’t hold up. it’s right down. He said, it’s very dangerous because of infection. So we’ll try this one He was talking about doing radiation on the main part of the tumour but it has spread round some of the peritoneum.

And he said, That’s happened so there’s no point So we’ve got to go down this route.

So will they give you the tablets to bring home or do you have to take them at the hospital?

No, I picked them up today [laughs].

Ah, so you can start taking them at home.

Yes.

And is that once a day or twice a day?

I take four in the morning and four in the evening.

Once a week or every day?

Every day and that’s for two weeks. And then I have a week off and repeat the process for six months.

Ah, okay and we hope there aren’t any side effects or has he told you to expect any?

Yes, well, he doesn’t know. He’s hoping not. There are side effects to it, different side effects, but in terms of my cell count.

Good. That’s good.

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Hamish had a laparoscopy under general anaesthetic. During the operation the surgeon biopsied the…

Age at interview 76

Gender Male

Age at diagnosis 72

They gave me a biopsy first.

Was that with an endoscopy? Down your throat?

No, no, that was a, I forget what you call it, but they go in with cameras and have a look and take samples.

Oh, were you did you have an anaesthetic for that?

Yes.

So you had a laparoscopy?

Laparoscopy, yes.

Would you mind saying a little bit about having a laparoscopy?

I didn’t really know much about it. The consultant concerned just came up, he said, We’re going to do this And I think I was in the theatre for about an hour or so. Came out and I was home the next day with two little holes in me [laughs].

So they did it, with a sort of scope was it?

Yes, and then before I left, that was that was on the Wednesday, it’s coming back now, and on, he said, We want you back on the Saturday to operate And explained what he was going to do.

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