Nick Pifani survived pancreatic cancer | Whipple procedure | folfirinox | proximal jejunum

DESCRIPTION

What began as severe GI issues for Nick Pifani led to a diagnosis of Stage III pancreatic cancer.  The tumor surrounded the superior mesenteric artery, ruling out surgery as an option.  Instead, doctors went with folfirinox, an aggressive form of chemotherapy.  When that didn’t help much, he went on radiation treatment.  It moved the tumor far enough away from the artery that surgery could be safely done.  A competitive runner, Nick addressed his cancer journey like a difficult race.  He eventually returned to work, resumed running and re-learned his old dietary habits. Nick shares his story with the @CancerInterviews podcast.

In January 2017, Nick Pifani of Delran, New Jersey began feeling a lot of GI distress.  Things got so bad he ended up in an emergency room.  His health worsened when he began eating less, sleeping less and had extreme back pain.  That brought on a second trip to the ER.  They thought there might be something wrong with his gall bladder, but an ultrasound indicated the gall bladder was fine.  Next was a CT scan that revealed a sizeable mass on Nick’s pancreas.

To learn more, Nick’s family doctor ordered an MRI.  Several hours later, doctors called him to confirm he had Stage III pancreatic cancer.  He was next hit with the news that his cancer was inoperable be it surrounded the superior mesenteric artery and vein, making surgery impossible.  Instead, doctors opted for an aggressive form of chemotherapy called folfirinox. 

Nick Pifani experienced the symptoms one associates with chemotherapy.  They included fatigue, the metallic taste of food and cognitive issues.  Not only did the chemo take a toll, but it did little to attack the tumors on his pancreas.  So, his care team switched to a regimen of radiation treatment.  It helped, but it took one more step to position Nick for surgery.

Through a Whipple procedure, known specifically as a Pylorus Preserving Whipple procedure, to remove the tumors, they took out his gall bladder and a third of his pancreas.  They also removed the proximal jejunum, which connects the pancreas and the small intestines.

The final step was the surgery itself, which was a success, which thrilled Nick Pifani, knowing that at one point his cancer was determined to be inoperable.  He was in a great deal of pain, but went through physical therapy.  As he did that, he learned how to eat the foods he had to give up during chemotherapy.  Eventually, he could run again, and he began to approach the competitive level he maintained prior to his diagnosis. 

By way of advice, Nick Pifani says it is important to know your body, and if diagnosed, to know the symptoms.  His knowledge of the symptoms led to early detection, which in his mind, made the difference between his being diagnosed as Stage III and not Stage IV.

Additional Resources:

Support Group:

Pancreatic Cancer Action Network (PanCAN): https://www.pancan.org

TRANSCRIPT

Bruce Morton: Greetings and welcome to the @CancerInterviews podcast.  I’m your host, Bruce Morton.  Our guest on this episode needed three different types of treatment, but he is living proof that one can be diagnosed with Stage III pancreatic cancer and survive and flourish.  He is Nick Pifani of Delran, New Jersey, who has not only survived pancreatic cancer, but is doing plenty to help those who have been diagnosed.  So, now let’s hear his story, here he is, and Nick, welcome to Cancer Interviews.

Nick Pifani: Thank you, Bruce, it’s a pleasure to be here.

BM: Nice, it’s our custom to start off by learning more about our guests, and their lives outside of their cancer journey.  So, if you would, tell us a bit about where you are from, what you do for work, and when time allows for fun, what you do.

NP: Sure, Bruce.  I live in Delran, New Jersey, and my wife and I have been in the area for 16 years.  I work for Mastercard, I have been with the company for about eight years and I run part of the Merchant Loyalty business for Mastercard, and in my spare time, I like to run, any excuse I can get to run and train, I love to do that, and pretty much spend time with my family, and love to watch both my kids play sports.

BM: And your job.  What’s the best part of it?

NP:  The best part of my job, honestly, I love working with our partners.  We build a lot of new products at work and to be able to build products with our customers, that’s probably the most fun.

BM: We do have some people listening and watching who are runners.  As you look back, what are some of your best running and racing experiences?

NP: I always have to go with one of the first races I ever ran.  I ran the Pittsburgh Marathon and for any runners out there, I strongly recommend the Pittsburgh race.  It is a challenging course, but at the same time, it is a beautiful course.  You get a chance to run across three different bridges, and I would say if you get an opportunity to run it, you should do that.  I would say the hardest race I ever ran the ironman, 70.3-mile race in Syracuse.  I never really realized how many hills were in Syracuse, but I found that out when I did my race.

BM: I would say the same thing about Pittsburgh.  A lot of people might not link Pittsburgh with steep hills, but if you go to the Northside part of Pittsburgh, plenty of hills.

NP: Yes, definitely the case.  I recall running across one of the bridges and hearing all the sighs, because as you are running across, you could see the massive hills that are awaiting you on the other side.

BM: Now let’s hone in on your life before you were diagnosed, especially when you’re telling me you were running competitively.  It sounds like at that time, you were in pretty good health, yes?

NP: Yeah, I was probably in near perfect health before diagnosis.  Wasn’t on any medication, didn’t need a pharmacy.  Generally, the question for me was how many miles I was going to be running in a specific week or many miles was I going to be swimming or biking, so, for me, life before my illness was probably pretty boring from a medical standpoint.

BM: But, at some juncture, at some stage, you must have known that something wasn’t quite right.  What wasn’t quite right, and how did it manifest itself?

NP: It is almost five years ago now, but it is still pretty vivid for me.  It probably started in late January of 2017, when I noticed I started getting a lot of GI distress.  When that started, I just picked the phone up, called my family doctor and said told him I had been noticing these GI issues over the past, and asked if there was a GI specialist he could recommend so I could get looked at because I could tell something was a little bit off, but unfortunately when you want to find a good doctor it takes a little bit of time, so I had to wait about four weeks and didn’t quite make it to that point.

BM: But at some point, what was going wrong, and led to a diagnosis?.  Take us through that chain of events.

NP: I finally made an appointment with a GI specialist, which I had to cancel because I ended up in the emergency room.  What really led us there was that every time I ate, I was in absolute distress.  I had lots of pain in my abdominal area, plenty of GI issues, and what started happening was, I started eating less.  I didn’t quite catch on to it at first, but there was this fear of eating a meal because I knew what was coming next.  What really amplified it was two nights in a row I which I just couldn’t sleep because I had extreme back pain.  I was getting up in the middle of the night to take a warm, hot shower to calm the pain down a bit so that I could go back to bed and try to sleep.  Then after one of those nights, I went out in the morning and tried to go for a run.  For me, I could run five miles in my sleep, and on this morning, I couldn’t even make it down the hill from my front door.  I had to stop and turn and at that point, I knew that something was seriously wrong.

BM: What then led to the diagnosis?

NP: After another night of sleeplessness, especially with all the back pain, my wife and I sat down in the middle of the night, and she said she would go to work in the morning, she is a teacher.  I would get the kids off to school, then I would go to the ER.  When I went to the ER, explained my symptoms and checked in, they could tell I was in a lot of pain, and they asked me many of the typical questions.  When they understood I wasn’t there for the pain, I was there because I knew something was wrong and I was looking to get that figured out, so when they took me back, they thought it might be a gall bladder, so they did an ultrasound.  When they did the ultrasound, they said the gall bladder was not a problem, so they would do a CT scan, thinking there might be an appendix issue.  They did the CT scan, I sat and waited a little while and then the doctor came in and turned the TV off.  When he turned the TV off, I knew something was really wrong, because I was watching it, and he wanted my undivided attention.  That’s when he revealed that I had a sizeable mass on my pancreas that needed further study to determine what was going on.

BM: When you heard that news, did you think of a family history coming into play?

NP: At the time I was unaware of anybody else in my family having any kind of a history.  I think where my mind went right away was that I looked up the symptoms of pancreatic cancer and the signs, and I almost felt like I wrote them because the majority of them, I was experiencing.  I will say the next day, my family doctor made sure I got a priority MRI to help understand and get more study of that mass.  Several hours later, they called to confirm that it was indeed pancreatic cancer.  That’s when I began to look for a care team that would treat me.  Shortly after that, I learned that my first cousin had been diagnosed with pancreatic cancer just weeks before me.

BM: For anybody who has been diagnosed with cancer, getting that terrible news is exactly that.  It’s a singular moment and not in a good way.  But it sounds like in your case, you were prepared for this bad news. 

NP: I had a history of cancer in my family.  I watched my mom battle cancer for years, my father is a two-time survivor of cancer, he’s still alive, and being by myself, I had a moment to kind of collect my thoughts, but I have got a wife and two kids that need me.  I would just say it is a runner’s mentality, so I said I needed to prepare myself for what we need to do and let’s get ready and meet it head on.

BM: It’s interesting you bring up the running component.  Some years ago, I was fortunate enough to have a private audience with a great distance runner from an earlier era, Marty Liquori.  We were talking about the final stages of a race, the last 400 meters, the last 200 meters, and he said in that situation, you have to have the “heart of a predator.”  It sounds like you had the heart of a predator in how you addressed your cancer journey, like, ‘This is my opponent. and I am going to beat it.’

NP:  Yeah, I would definitely say that.  One of my all-time idols is (distance runner) Steve Prefontaine.  He would talk about the difference between he and other runners he would beat, and he would say his opponents didn’t have the guts to endure the pain to get through the race and do what it takes to win.  I will definitely say being a runner, being able to compartmentalize and break down things certainly helped me.  My goal was to take on my diagnosis head on, and it really was to win.  I told my kids I don’t have any intention on losing, I have an intention on winning.  I was very honest with them, and I told them that if things would change, I would let you know, but my plan is, I’m goin’ anywhere. 

BM: Let’s get to the next step in this journey, the treatment phase.  What was the first thing you encountered?

NP: What I quickly learned was that my cancer was inoperable because the cancer was surrounding the superior mesenteric artery and vein, so surgery was not an option.  I had folfirinox, which was a very aggressive chemotherapy.

BM: How difficult was that?

NP: It was probably the most difficult thing I have ever gone through, to be very honest.  I don’t claim to be Superman, although at times, although at times maybe I felt like Superman because I could run and train really well, but I would give you the analogy that when I had chemotherapy, I felt like Clark Kent.  I was lethargic and I was kinda beat up from treatment probably on average for about five days to the end of that specific cycle, so that was really aggressive, I had to learn how to cope with it.  I needed to learn how to rest and sleep, and then when I started feeling better, I would go out and I would run, or I would get on the bike and keep as physically fit and active as I could throughout my journey. 

BM: And what was food consumption like because I have heard from many people undergoing chemotherapy, that food can taste like metal.

NP: That is definitely true.  I remember the metallic taste and if you drank something cold during the chemo, it was almost like glass in your throat, so it was a little bit of a learning experience.  My rule of thumb was whatever tasted good for me, so I had a phase where I just wanted pizza.  Frankly, that’s what I ate many days.  I just tried to figure out what worked well for me, and I went with it, and by trial and error I just eliminated the things that disagreed with me.

BM: That addresses your palate, but what about your mind?  Many times we hear from people undergoing chemo, that to some extent, they suffer from ‘chemo brain.’  Was that part of your experience?

NP: Yeah, I definitely recall a little bit of fogginess in the brain and sometimes I felt like I had to write things down.  For me, I tried to run almost every day, and if it was slower, it didn’t matter because it was just a matter of getting my run in and I wasn’t going to let cancer have its way.  To be honest, running was a stimulant for my brain.  It also became a reason to know that, maybe it took me a little bit longer, I had to go a little bit slower, but I made it and I finished, and I wasn’t going to let it beat me that day.  It built my morale up, it kept me mentally strong, and it helped keep me focused.

BM: Chemotherapy was not the only treatment that you underwent during your journey.  What happened after chemotherapy?

NP: After about six sessions of the chemotherapy, the doctors noticed my body wasn’t responding.  The chemo took a toll on me, so they changed me over to radiation for five and a half weeks.  For me, the radiation was targeted to the specific areas where my tumors were at, and it was just a couple minutes a day, five days a week.  With that, I have to say, I did much better.  I would go to radiation treatment at six ‘clock in the morning, I would come home, I would put my shoes and I would go out and run.  Even during that time, I did so well that I went back to work during radiation because I didn’t feel the same effects that I had during chemotherapy.  Yes, I was a little bit fatigued and tired, maybe my stomach was a little bit queasy at times, but I was really looking to just try to keep a semblance of my life to be somewhat normal by keeping myself busy.

BM: It sounds like you were able to run during chemo and you were able to run during radiation, but what was eating like?

NP: What I found was, there were certain foods that I just couldn’t eat anymore, so I started eliminating meat from my diet.  I found that anytime I was eating meat products it caused a lot of stomach distress.  Fortunately for myself, seafood was a really good option for me, and I just happened to love seafood, so I quickly changed my diet to keep my stomach feeling good and keeping my body feeling good.

BM: Now, the radiation, it sounded like the radiation helped, but it was not the final step in your journey.  What happened next?

NP: After radiation concluded, I had a new CT scan done.  I took those results to the original surgeon, the surgeon I met with when I was diagnosed.  He reviewed the scans and the pictures, and he told me the treatment was quite effective.  He believed the tumor moved enough away from the artery and vein to attempt surgery.  We had to wait about an additional 30 days just to make sure all the treatment had left my body before they would attempt a Whipple procedure.

BM: For somebody who could be a candidate for pancreatic cancer or someone who has been diagnosed, they might want to know more about a Whipple procedure.  What can you tell us?

NP: There are different variations of the Whipple procedure, but the one that I had was the Pylorus Preserving Whipple procedure.  They didn’t touch my stomach.  Since the tumor was at the head of my pancreas, they removed about a third of my pancreas.  Then they also removed my gall bladder as well as the jejunum, which kind of connects everything to your pancreas and your small intestines, so they basically took those pieces out and they re-plumbed me back together.  While they did that, they also did a clinical trial where they did a saline wash in case there were any microscopic types of cancer particles in there.  They did that along the way.

BM: At this point, once the Whipple procedure was done, how did you feel with no gall bladder or anything else that was removed?

NP: I went in for surgery.  That last thing I remember was around 7:00 a.m., and when I remember opening my eyes and I was in the ICU, I had this fear that they had opened me up and then discovered they couldn’t perform the procedure.  I didn’t realize that was 12 hours after the procedure, I was just waking up and the procedure was done.  I would say at first, I was a little nervous.  Then we were waiting for all the results.  When I first woke up, I was obviously well medicated during that time, and I was relatively relaxed.  When I woke up the next morning, they got me quickly out of bed and I was definitely hurting for the next couple of days, but once I had the surgery it is almost like I had to teach myself how to eat again.  That’s because you have to eat in very small portions and break things down.  You have to be very careful.  It’s about eating frequent meals and smaller meals, so it really did take a lot of patience in the beginning.  I had learned that my surgery was quite successful, so for me, I just looked at some of the differences as a minor inconvenience because the story and the script had changed for me.

BM: I now want to channel a bit of your running prowess into this story.  At some point right around this juncture that you are thinking you are starting to get the upper hand on pancreatic cancer.  Is that fair to say?

NP: Definitely so.  I would say at that point, I probably saw the finish line tape and I knew I was coming through it first.  I honestly felt that when I met my surgeon for the second time and that I was going to be a candidate for surgery, to me, that’s where the game really changed.  I felt like, wow, I went from like six months prior, of being inoperable to being operable and when I came out of the surgery, the next day, I told them to take me to physical therapy.  I want to pass physical therapy so I can walk as much as possible because my surgeon to keep moving helps recovery.  I was counting the days, but for me, that’s when all my family, all my friends everywhere, I would say they were just rallying in my corner extra loud because they knew the tide was changing and they could tell that things were looking up for me.

BM: You had mentioned family and friends when the cancer journey was kind of getting over the hill in a good sort of way; but what about when things were tough, what were your family and friends like by way of support?

NP: They were incredible.  A day didn’t go by when I didn’t get phone calls, texts or cards in the mail from family and friends.  I would say in the beginning, I was the one who stopped them from crying and telling them it was going to be okay, but that’s all right because they cared about me and they knew it was a tough diagnosis, so they were there for me and honestly, I think they were just so thrilled and happy to hear that surgery was going to be an option because they knew for me that surgery meant the possibility of actual going in remission.  They were just beyond words, exciting for me, my wife and my kids.

BM: You’ve gotten now to the point of survivorship.  Just how did that feel to know you had been hit with this very formidable opponent and you had gotten the best of it?

NP:  Still trying to grasp that, to be honest.  You get one of the worst cancers and the worst type of it, and it’s a scary thing.  But for me, it’s probably a bit bittersweet because the five-year survivor rate for pancreatic cancer is just ten percent.  I get a reminder of that all the time because I lost a cousin to pancreatic cancer.  Then I learned of another cousin that passed away a few years prior to that had pretty much the same symptoms so we were pretty sure she had the same thing; then we lost my uncle a year after my diagnosis.  So, I really do understand how lucky I am because today unfortunately,  the way the numbers stack up, my outcome is not typical.  We don’t take that for granted and we celebrate the day I got my Whipple surgery almost like my second birthday because that’s the day that things changed for me, dramatically for me.

BM: Is there anything you and your wife do to celebrate this milestone?

NP: A lot of times my wife will decorate my door.  I’ll wake up in the morning, I’ll go downstairs, and I’ll see my office door is decorated.  We look at the Purple Stride event that PanCAN has as a celebration event as well.  We stride in the Philadelphia Purple Stride every year, so we do that together.  I would say in general, not a day goes by, we don’t need a calendar to remind any of us what day I was diagnosed, what day I had my Whipple surgery, we know all those things.  I think, honestly, Bruce, we don’t take the little things for granted anymore.

BM: Now, let’s talk about the organization you referenced, PanCAN.  How did you find out about PanCAN, what does it do for you and how do you give back?

NP: I stumbled upon PanCAN by accident.  When I first got diagnosed, the numbers didn’t look too good.  Some folks were telling me I only had six months, nine months to live.  I was looking for a 5K to run and I stumbled upon the Purple Stride event.  I thought to myself, ‘I’ll show them, I will register for this 5K event, and I am going to show up and I am going to win it, to tell everyone, I told you so.’  When I signed up, I started putting my fundraising efforts up on Facebook, then I went in to my first chemotherapy session.  I don’t remember a whole lot after my first one because it really hit me hard, but I came home and about four days later, I got an e-mail from one of my first bosses.  He said, “Hey, Nick, you better raise your fundraising goal because you already beat it.”  I looked at it and in a handful of days we raised $10,000 for PanCAN.  I had gotten some phone calls from some of the folks at PanCAN national.  The Philadelphia affiliate of PanCAN actually surprised me the first day of chemotherapy, they brought sort of a CARE bag for me, the nurses brought it to me, and honestly, that’s how we got introduced.  Ever since, I feel like they are part of my second family, I hold a sponsorship chair position for the Philadelphia affiliate, which is a way of giving back.  I am a co-chair of the Survivor Council at PanCAN, and frankly, you know, the one thing I wish I would have known is, I wish I would have known about PanCAN earlier, you know, earlier in the journey because it would have helped me from an education standpoint, and maybe helped in some of the things I had to do on my own.

BM: You mentioned the education piece with PanCAN.  For the person who has learned they may be a candidate for pancreatic cancer, or the person just diagnosed, what are some of the things PanCAN can do for them?

NP: The top thing is, they offer patient services, they’re free.  They can call in to a tollfree number and they can tell that person a little bit about themselves, what their journey, they get a case manager assigned to them, and panCAN can not only help the person that’s going through cancer, but they can also help any of the caregivers along the way.  They can help navigate, understand what doctors might be available, what specialists might be available in their area.  Honestly, that’s a key component because many folks who get diagnosed, they struggle, they don’t know where to start, and panCan Patient Services can be that bridge to help them get connected to the right person right away because pancreatic cancer is not something you have a lot of time with.  You need to get on top of your treatment plan in a smart way, right from the beginning.

BM: If somebody wanted to access the many items you mentioned, Nick, is there a web address they can contact?

NP: Sure.  They would go to https://www.pancan.org

BM: All right, Nick, we are going to wrap things up, when we are at this stage, we ask the same question of our guest.  If you found yourself in a one-on-one situation with someone who has just been diagnosed with pancreatic cancer or someone who has learned they could be diagnosed, if you had a message for that person and the message contained one overarching point, what would that be?

NP: I would say, know your body and understand the symptoms.  I look back at things, I ask myself if I could have known about something happening to me a little bit earlier than I did.  I think, now that I have had time to reflect on that, understanding and knowing what the symptoms are and knowing what is not typical for yourself, I think, is a key indicator.  I was fortunate enough that I was not diagnosed at Stage IV, so being diagnosed at Stage III at least was a little bit earlier for me and gave me an opportunity to get that upper hand.

BM: Okay.  A tremendous story from you, Nick, one that had a happy ending, and it’s a happy story that continues.  You can still run, you can still run hard, looks like you have your appetite back and a great story and a lot of information.  Then there’s that web address which we want to mention one time, that’s pancan.org.  Nick, thanks very much for being with us.  Really appreciate the time.

NP: Thanks so much, Bruce, it was a real pleasure.

BM: And that’s going to wrap up this episode of Cancer Interviews.  We hope what you heard can be informative to you or a loved one, so until next time, we’ll see you on the down the road.

SHOW NOTES

TITLE: Nick Pifani, Stage Three Adenocarcinoma Survivor – Delran, New Jersey, USA

Nick Pifani needed three different treatment regimens, but survived Stage Three pancreatic cancer.  It took chemotherapy, then radiation treatment, then a Whipple surgical procedure, but he is in remission and has resumed his active pre-diagnosis life of running, swimming and cycling.

Additional Resources:

Support Group: Pancreatic Cancer Action Network    www.pancan.org

Time Stamps:

04:31 Nick noticed gastrointestinal problems.

06:15 He then experienced increased back pain.

08:50 Learned of a mass on his pancreas.

10:03 Nick was told he had pancreatic cancer.

13:30 Began his treatment regimen with chemotherapy.

17:14 Treatment was switched from chemo to radiation.

20:10 Nick underwent surgery with a Whipple procedure.

23:16 Felt he was getting the upper hand on pancreatic cancer.

26:40 Shares the thrill of survivorship.

KEYWORDS (tags):

pancreatic cancer

superior mesenteric artery

cancer

chemotherapy

cancer interviews

pylorus preserving whipple procedure

cancerinterviews.com

proximal jejunum

bruce morton

radiation treatment

nick pifani

folfirinox