Noelle Gatlin survived Stage II pancreatic cancer | Whipple procedure | pancreatic duodenectomy

DESCRIPTION

Noelle Gatlin had to endure a lengthy, multi-step process, but she survived Stage II pancreatic cancer.  A visit to an emergency department revealed a mass near her pancreas. She was transferred to a hospital, where a second CT scan resulted in her diagnosis.  Her care team placed a duodenal stent in Noelle, then a bile duct stent.  She next underwent a 12-infusion chemotherapy regimen with folfirinox.  Then she was ready for a Whipple procedure, a pancreatic duodenectomy, which was a success.  Noelle says because she took care of herself before, during and after treatment, she believes she is now in better health than she was before her diagnosis.

In July 2022, Noelle began to experience symptoms associated with food poisoning.  At an urgent care, she was diagnosed with gastric reflux, but when stomach became distended, her husband urged her to go to an emergency department.  That’s where a CT scan revealed a mass near her pancreas.  She was next transferred to a hospital.  Wanting very much to vomit, but unable to, with the aid of an NG tube, her stomach was pumped.  She underwent another CT scan, then an endoscopy, after which a doctor told her she had Stage II pancreatic cancer. 

A duodenal stent was placed in her small intestine so that food could go around where her tumor had closed off her intestinal tract.  Noelle then had a bile duct stent placed from her liver.  Before she could undergo surgery, she went on a 12-infusion chemotherapy regimen with folfirinox. 

Months later came the Whipple Procedure.  Hers was a pancreatic duodenectomy.  Her gallbladder, the top 20 percent of her pancreas and the first section of her small intestine was removed.

The surgery was a success, and soon Noelle Gatlin returned to her job as a special education teacher in Riverton, Utah.  She followed instructions from care team and already enjoyed an active lifestyle.  This is why she believes her health today is better than it was prior to her diagnosis.

Additional Resources:

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

TRANSCRIPT

Bruce Morton: Greetings and welcome.  This is the @CancerInterviews podcast and I’m your host, Bruce Morton.  Our guest on this episode survived Stage II pancreatic cancer, but to get to survivorship, she had to go through a lengthy, multi-step process.  She is Noelle Gatlin of Riverton, Utah, and this is her story.  Noelle, welcome to Cancer Interviews.

Noelle Gatlin: Thanks for having me.

BM: Before we get to your cancer journey, we would like to learn about you and your life outside of cancer.  If you would, tell us a little bit about where you are from, what you have done for work and what you like to do for fun.

NG: My name is Noelle Gatlin.  I am originally from Southern California, from the Long Beach area.  Lived there until I went to college at Brigham Young, from where I graduated.  I am a special education teacher.  I have been doing this since 2007.  I stayed home with my children for a few years, then went back to teaching.  I absolutely love what I do.  Being a special ed teacher is the best job ever.  For fun, I like walking, swimming, and I am an amateur, intermediate bass player.  I love to play the electric bass guitar.

BM: Yours has been a lengthy journey, but let’s start at the start.  From a health perspective, when did you begin to feel abnormal?

NG: I noticed around July 24, 2022 that I had what I thought was food poisoning.  My initial symptoms were food poisoning.  I have had that before, so that is where my head went first.  You don’t go too far from a bathroom.  So, I spent about a week pretty much doing that, but I soon found myself in an urgent care.  My gut was distended and the urgent care doctor said I had gastric reflux.  I had never heard that before.  I was a healthy, 49-year-old woman and I had just been kayaking the week and I walk three miles a day.  Another week went by, I went back to work as a teacher, felt pretty miserable all week.  I started eating less and less.  I made an appointment with my primary care.  By the beginning of the next school week, around August 8, it started to affect my sleep.  I could not lay down because I would get reflux.  I would feel like I want to vomit, but I couldn’t vomit.  That was kind of a miserable sensation.  I eventually took a morning off on August 10.  When I woke up from my nap, my husband said he couldn’t watch this anymore and that I had to go the emergency room.  I took a shower, we went to the ER.  That’s when my life changed.

BM: So, you went to the ER and what happened next?

NG: They x-rayed my stomach and my stomach was massive, just huge.  This should just not be happening.  They gave me a CT scan and that’s when the mass showed up.  Initially, they weren’t sure whether the mass was on my stomach or my pancreas.  The sent the results to the Huntsman Cancer Institute at the University of Utah.  They knew I was going to be transferring to a hospital before the night was over.  I soon in a bed at Huntsman. 

BM: We’re confident you’ll be able to learn some tips and tools to help you through your cancer journey, but first we’d like to invite you to please give us a ‘like,’ leave a comment or review below and share this story with your friends.  Kindly click on the Subscribe button below and click on the bell icon, so you’ll be notified when we release our next cancer interview.  Ad we want to remind you that on Cancer Interviews, we do not give out medical advice.  If you seek medical advice, please consult a licensed health care professional.

Noelle, it sounds like you were in the hands of licensed health care professionals when you went to the Huntsman Center.  What happened after you arrived there?

NG: Within half an hour, I had two very kind nurses come into my room and tell me doctors had ordered an NG tube, and if you have never had an NG tube, NG stands for nasogastric, it is a tube that goes through your nose to pump your stomach.  I would say it was the most unpleasant part of my treatment, but still remaining was the Whipple Procedure, which we will get to later.  It takes two nurses to do this.  I was a little surprised when they handed me a bucket, but I learned really quickly what the bucket is for.  I didn’t know I had a deviated septum on my left side, so they went to the right side of my nose.  They give you a cup of water to keep your epiglottis open, a nurse shoves the tube down my throat.  I did not know a woman my size could vomit that much, but it turns out a woman my size can vomit that much.  It was hard to sleep with that thing going down my throat, and soon they started pumping mystomach and that was my first day.

BM: From there, what led to your diagnosis?

NG: They did another CT scan the next day confirming there was a mass.  They were learning toward the pancreas, but they needed an endoscopy to confirm where it was; so, the next morning I went next door to the University of Utah hospital for the endoscopy.  I walked there with my orderly.  I knew something was going on because the doctor was waiting for me when I woke up.  That’s when he announced, “I’m sorry, but Mrs. Gatlin, you have pancreatic cancer.”  He was very nice about t and explained what the next steps were going to be, but it was a gamechanger.

BM: August 2022 was an unforgettable month for you and not necessarily in a good way.  There were many boxes for you to check between diagnosis and treatment.  What were some of those boxes and how did you go about checking them?

NG: Once I got back to my room at Huntsman, I was visited by nurses, social workers, member of the oncology team regarding what was going to happen next.  The first thing was that I was going to meet a medical oncologist.  He went over my need to get a port placement and a PET scan, and we are going to start with those steps and go from there.  Based on where my tumor was, they needed the PET scan to determine I didn’thave any metastasis.  First thing up was the PET scan.  It revealed that the tumor was confined just to the head of my pancreas.  A lymph node on the left side of my neck did flag.  I was told my by care team that there were about six things that could make that lymph node light up, including my kids having a cold the week before, which two of them did.  By August 26, I was also jaundiced because tied to the endoscopy.  It revealed the tumor that had closed off my small intestine completely which is why my stomach got pumped.  While I was in endoscopy, they put it in a duodenal stent so I could keep eating.  The stent worked, but it did cut off access to my bile duct, so I had a bile duct stent placed, which started working right away.  I went home the next day.  On Monday, August 29, I was back in the hospital for a lymph node biopsy and port placement.  They did them both in the same procedure.  Fortunately, the pathology came back on the lymph node very quickly and it was benign.  That’s the difference between pancreatic cancer Stage II and Stage IV.  If I had cancer in the lymph node, I would have been put in palliative care and I would have been disqualified from a Whipple Procedure.  Once my jaundice was cleared and my liver back up to speed, I was able to start chemo on September 9.

BM: Your chemo consisted of folfirinox.  What was the toughest part of the folfirinox?

NG: I had twelve infusions of folfirinox.  We went straight through because of the midpoint, in November, I had developed a blood clot on my left lung.  I think the toughest part of the folfirinox was the irinotecan , because it is a cocktail of different chemo drugs, about five of them.  You go home wearing a chemo pump with that one for two days; but the irina tee can is the toughest part of having the infusion.  I always took the aloxi as a buffer.  People who take this are pretty much guaranteed that they are going to vomit or have a bowel movement pretty quick.  I was fortunate it was the bowel movement.  I knew within fifteen minutes I was going to be up and in the bathroom.  I learned if I walked every ten or fifteen minutes, it mitigated some of the symptoms, such as my eyelids fluttering.  As the chemo goes on with folfirinox, I was told by my oncologist I would get neuropathy and I definitely had it in my fingers and in my throat.  I couldn’t drink a glass of cold water, I couldn’t touch a glass of cold water without it burning.  And it’s progressive.  After the first infusion, it didn’t affect me at all.  I could drink a cold soda with no problem.  But my onocologist said it was only a matter of time until I would suffer the side effects.  He was right.  By the time I went through my twelfth infusion of folfirinox, the neuropathy went to my hands and would last a good ten days and in my feet for two or three days.

BM: Folfirinox is part of chemotherapy and part of chemotherapy is hair loss.  To what degree did you suffer hair loss?

NG: I knew having a cancer diagnosis and having chemo, I knew my hair was gonna go.  Three weeks out was when the first big clump of hair came out, and I concluded this is real and here we go. It didn’t bother me because I knew it was part of the deal, and as my hair started thinning more and more, I just started cutting it shorter and shorter.  By the time I was done with chemo, my hair was about an inch long and you could definitely see some bald spots, but I understood that as part of the deal.  This may sound weird, but I didn’t cry about the hair until it had started to grow back in and my hair had become long enough for the curl pattern to return.  That’s when I cried.  I realized I am here and I am back.

BM: Sounds like tears of joy, but let’s move on to April 2023, which is when you began your surgical procedure.  Could you tell us what that entailed?

NG: I had a Whipple Procedure.  They are all a little different depending upon what parts of you they are taking out.  For me, the technical term for this was the pancreatic duodenectomy.  So, the chemo had been very effective for me.  My tumor had shrunk to three to four percent of the original size, so that was fabulous.  They were able to save more of my pancreas, so my surgeon, she took the top 20 percent of my pancreas, off the head of the pancreas, I lost the first section of my small intestine because the tumor had been rubbing up against the pancreas.  She took out my gall bladder because she didn’t want to nick any veins or arteries that were close to all those organs.  She also took out 20 lymph nodes from my body cavity, just to hedge the bet because pancreatic cancer is very aggressive.  The first two years after you get the tumor out, the recurrence rate is about 80 percent.  So, I am missing a few parts, but I am doing all right.

BM: Let’s talk about those first two years after the procedure.  Physically, what was life like?

NG: I actually think I am extremely fortunate.  One of the things that helped tremendously before I got cancer was I was already in pretty decent shape.  I would walk three miles a day.  My oncology team encouraged me during treatment to keep up with exercise as often as I felt able.  By December of 2022, my pre-opt team asked if instead of three miles a day, could I walk four?  I said sure I thought I could do that in the next few months leading up to my procedure, and I was able to do that. It helps when you wake up and you get walking and get moving as soon as you can.  By doing that, after my surgery, it saved me a lot of discomfort and grief. I know it is not the same thing for everybody, but my life, with the exception of having to be careful about the oils I eat, essentially my life went back to normal.  I was teaching school again five weeks post-op.  I haven’t stopped since.  This summer I walked a 10K.  I am actually in better shape now than before I got cancer.  Honestly, I think it is because I got cancer that I take better care of myself.

BM: That’s outstanding.  That’s outstanding that you have survived, and outstanding that physically you are better now than before your diagnosis.  Now I am sure, Noelle, that you got plenty of support from family and friends, but there was an external source of support for you during your cancer journey, and that was and is the Pancreatic Cancer Action Network.  Could you tell us about PanCAN, what it has done for you and what it can do for others.

NG: Absolutely.  So, while I was sitting in my hospital bed in August of 2022 with my diagnosis, my parents were with me in the hospital room.  My mom Googled, “How Do I Help Someone Survive Pancreatic Cancer?” and she got PanCAN, and we started reading survivor stories on their website. For me, that was a go-ahead, and we decided to roll with it.  It gave me a lot of courage to start my fight, and they also have wonderful patient services able to anyone, patients and caregivers.  There is a phone number, you give it a call, you get a case manager and they are fabulous.  Mine was so helpful with everything.  So, I started my volunteer journey even before my Whipple Procedure.  I knew what I wanted to do when I got out of the hospital.  PanCAN has a lot of information about what the symptoms are.  Should you get checked?  Do you have a family history?  They are really great with the information.  Another thing PanCAN does is that if patients can’t afford their treatment, they help with financing that. 

BM: If somebody wants to access the PanCAN website, the address very simply is https://www.pancan.org.

NG: Right.  They are based in California and have people there to answer questions to get you connected.  They can help with clinical trials.  Anything that a patient needs or has questions about clinical trails, they can help.  It’s pretty fabulous.

BM: Our guest if Noelle Gatlin of Riverton, Utah.  She survived Stage II pancreatic cancer, living proof that if you are diagnosed with pancreatic cancer that, you, can get to survivorship.  Noelle, we are about to wrap up, and we will finish with the question we usually finish with and it goes like this.  Imagine your crossing paths with someone who has just been diagnosed with pancreatic cancer or has learned they might be so diagnosed.  You might have a lot of things you would want to say to this person, but if there is one part of your message that you wanted to make sure got through to that individual, what would it be?

NG: Honestly, I think that no matter what you hear, there is always, always, always reason for hope, for joy and for gratitude.  Cancer is a monster.  It is not a master.  The experience either defines you or refines you, but is how you see it and always your choice.  No matter what you hear, never give up on the things that bring you joy and hope in your life because they will see you through on even the toughest days, the toughest scans.  You can look in your family’s eyes and there’s your hope, there’s your reason.

BM: Outstanding.  That’s a terrific story and sage advice.  Noelle Gatlin, thanks for sharing your story and thanks for being with us on Cancer Interviews.

NG: Thank you again for having me, Bruce, this was wonderful.  I appreciate it.

BM: And we want to remind you as we always do when we conclude, that if you are on a cancer journey, you are not alone.  There are people out there like Noelle Gatlin, and organizations like the Pancreatic Cancer Action Network, that are there to help.  So, until next time, we’ll see you on down the road.

Additional Resources:

Support Group:

Pancreatic Cancer Action Network  https://www.pancan.org

SHOW NOTES

TITLE: Noelle Gatlin, Stage Two Pancreatic Cancer Survivor – Riverton, Utah, USA

It required a lengthy, multi-step process, but Noelle Gatlin survived Stage II pancreatic cancer.  Her journey began with symptoms resembling food poisoning.  She went to the emergency department with a distended stomach, where a CT scan revealed a mass in the vicinity of her pancreas.  Noelle was sent to a hospital, where with the aid of an NG tube, her stomach was pumped.  An additional CT scan led to her cancer diagnosis.  She had a duodenal stent placed in her, then a bile duct stent, underwent a 12-step chemotherapy regimen with folfirinox.  Noelle was then ready for a pancreatic duodenectomy, a successful procedure.  She says, incredibly, because of the care she took of herself before, during and after treatment, her health today is better than it was before her diagnosis.

Additional Resources:

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

Time Stamps:

01:25 Noelle began to experience food poisoning symptoms.

02:58 A visit to the emergency department revealed a mass near her pancreas.

06:30 Received her diagnosis.

09:10 She was given a duodenal stent, then a bile duct stent.

10:02 Noelle describes her chemotherapy regimen with folfirinox.

13:36 Her surgery included a Whipple Procedure.

14:55 Remembers her first two years after treatment.

21:07 Noelle’s advice to those diagnosed with pancreatic cancer.

KEYWORDS (tags):

pancreatic cancer

gastric reflux

endoscopy

duodenal stent

bile duct stent

folfirinox

whipple procedure

pancreatic duodenectomy

ng tube

deviated septum

neuropathy

aloxi

irinotecan

noelle gatlin