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Pancreatic Cancer: When a Pain in the Back Becomes a Pain in the Heart

Pancreatic Cancer: 7 Lessons From My Father’s Story

Twenty-eight years ago, a seemingly ordinary complaint of back pain led to an unexpected diagnosis that changed our family forever. This is the story of my father’s pancreatic cancer, a major operation, an unexpected complication, and three more precious years together.

Twenty-eight years ago, I received a phone call from my father, Anastacio B. Gayao Sr.

Now, if you knew my dad, you would understand why that call immediately got my attention.

My father was not a complainer.

He belonged to that generation of Filipinos who believed that if an arm fell off, you picked it up, tucked it under the other arm, and calmly finished your chores before mentioning it to anyone.

He was tough, disciplined, and remarkably healthy.

So when he called complaining of pain in his right mid-back, alarm bells went off in my physician’s mind.

After asking him several questions about the nature of the pain, I felt there was enough reason for concern to refer him to a gastroenterologist colleague Dr. Leroy Hightower in Abilene, Texas for further evaluation.

A few days later, the phone rang.

It was my colleague.

“Larry,” he said, “the ERCP shows your dad has pancreatic cancer.“

For a moment, I was speechless.

As a physician, I knew exactly what those words meant.

As a son, I wished I didn’t.

Finally, I managed to ask, “Where do we go from here?”

His answer was immediate.

“I’ll refer him to an oncology surgeon at Baylor Medical Center in Dallas.”

A Pancreatic Cancer Diagnosis That Hits Like a Thunderbolt

The news was heartbreaking.

Dad was 79 years old, but he hardly fit anyone’s picture of an elderly cancer patient.

He still enjoyed playing tennis with people half his age. His mind remained razor sharp. Every day, he studied his Bible and actively participated in church Bible discussions.

He was physically active, mentally engaged, and spiritually grounded.

He seemed to be doing everything right.

Yet cancer had quietly taken up residence in one of the most hidden organs in the body.

That is one reason pancreatic cancer is so feared.

Unlike many other cancers, pancreatic cancer often doesn’t announce its arrival with obvious symptoms. There is no early warning siren, no flashing dashboard light.

It sneaks in through the back door.

The pancreas lies deep within the abdomen, making early tumors difficult to detect. By the time symptoms become noticeable, the disease may already have advanced.

Unfortunately, that is precisely what makes this cancer so challenging.

The Whipple Procedure: A Seven-Hour Surgical Marathon

At Baylor Medical Center, the surgeons recommended a Whipple procedure, formally known as a pancreaticoduodenectomy.

This is one of the most complex operations in modern abdominal surgery.

The pancreas sits at a busy intersection of the digestive system, closely connected to the small intestine, bile duct, and gallbladder.

Because of this anatomical arrangement, a tumor in the head of the pancreas can involve nearby structures.

During a Whipple procedure, surgeons remove the head of the pancreas, the duodenum (the first portion of the small intestine), the gallbladder, and part of the bile duct. Depending on the surgical approach, a portion of the stomach may also be removed.

The remaining organs are then carefully reconnected to restore the flow of food, bile, and digestive enzymes.

It’s not just surgery.

It’s advanced plumbing, carpentry, engineering, and medicine rolled into one!

The operation can take several hours. Dad’s surgery lasted seven hours.

When it was over, the surgeons believed they had successfully removed the cancer.

We were relieved.

But the journey wasn’t over.

The Unexpected Battle: Sepsis After Surgery

About a week after surgery, Dad developed a high fever.

Blood cultures revealed sepsis, a potentially life-threatening complication of infection.

He was immediately started on intravenous antibiotics and transferred to the intensive care unit.

As both a physician and a son, those were difficult days.

The fever persisted despite aggressive treatment.

The medical team continued searching for the source of the infection.

Finally, a CT scan of the abdomen revealed the hidden culprit: an intra-abdominal abscess.

A guided needle aspiration was performed to drain the infection.

Within days, the fever began to disappear.

Sometimes medicine resembles detective work more than science. You gather clues, rule out suspects, and keep digging until you uncover the truth.

Thankfully, the right diagnosis and intervention turned things around.

Dad recovered.

A Remarkable Comeback: Three More Years of Life

Over the following months, Dad gradually regained his strength.

He returned to many of the activities he loved. In fact, he went on to live another three years after his pancreatic cancer surgery, eventually returning to the Philippines after two years.

Ironically, pancreatic cancer was not what ultimately ended his life.

At age 82, he succumbed to pneumonia that unfortunately was diagnosed too late.

For our family, those extra years were a priceless gift.

Years of conversations.

Years of family gatherings.

Years of Bible discussions.

Years we might never have had.

Sometimes medicine cannot add decades to life.

But it can add precious moments, and sometimes those moments mean everything.

Pancreatic Cancer: Why It Remains So Deadly

Pancreatic cancer doesn’t always receive the same public attention as breast, colon, or lung cancer.

Yet it remains one of the most serious cancer diagnoses a person can face.

The pancreas lies deep within the abdomen, making early tumors difficult to detect. Unfortunately, there is no established routine screening test recommended for people at average risk.

Some symptoms that deserve medical attention include:

  • Upper abdominal or back pain: Persistent discomfort that may radiate toward the back.

  • Unexplained weight loss: Losing weight without trying.

  • Loss of appetite: A noticeable change in eating habits.

  • New-onset diabetes: Particularly when it occurs unexpectedly in someone without typical risk factors.

  • Jaundice: Yellowing of the skin or whites of the eyes.

  • Fatigue: Persistent tiredness or weakness without an obvious explanation.

  • Digestive changes: Nausea, bloating, or other unexplained digestive problems.

These symptoms do not necessarily mean pancreatic cancer. Many have far more common explanations.

However, persistent, unexplained, or unusual symptoms deserve proper medical evaluation.

And remember: the absence of symptoms does not guarantee the absence of disease.

Understanding Pancreatic Cancer Risk Factors

Pancreatic cancer is influenced by several factors. Some are beyond our control, while others offer opportunities to reduce risk.

Factors we cannot easily change:

  • Advancing age

  • Family history of pancreatic cancer

  • Certain inherited genetic mutations and syndromes

Factors we can potentially influence:

  • Cigarette smoking

  • Excess body weight and obesity

  • Type 2 diabetes and metabolic health

  • Chronic pancreatitis

  • Certain lifestyle and dietary patterns

One important distinction: not everyone with these risk factors develops pancreatic cancer, and some people develop it without any identifiable risk factors.

The goal is not to create fear, but to understand where prevention and early medical evaluation may help.

Chronic Inflammation: A Piece of the Bigger Picture

Over the years, researchers have increasingly recognized the role of chronic inflammation in several long-term diseases.

Unlike acute inflammation, which is the body’s normal response to infection or injury, chronic inflammation can persist and contribute to tissue damage.

Chronic pancreatitis, for example, is an established risk factor for pancreatic cancer.

Obesity and metabolic disturbances are also associated with changes in inflammatory and hormonal pathways that may influence cancer risk.

Think of inflammation as a small fire.

When it burns briefly to fight infection or heal an injury, it serves a useful purpose.

When it smolders for years, however, it can damage tissues and contribute to disease.

Inflammation is not the single common cause of all cancers, but understanding its role is an important part of modern preventive medicine.

The Soda Connection: More Than Just Empty Calories?

A few years ago, headlines attracted attention with a provocative claim:

“Just two sodas a week may increase pancreatic cancer risk.”

Where did that come from?

The finding originated from the Singapore Chinese Health Study, which followed 60,524 participants for up to 14 years.

Researchers identified 140 cases of pancreatic cancer during the study period.

They found that participants reporting two or more soft drinks per week had approximately 87% higher relative risk of pancreatic cancer compared with those who did not drink soft drinks.

Interestingly, the group consuming at least two soft drinks weekly actually averaged about five drinks per week.

The researchers adjusted their analysis for several potential confounding factors, but the findings still require careful interpretation.

An important caution: Association does not establish causation.

This was an observational study, not a clinical trial. It cannot establish that drinking soda directly causes pancreatic cancer.

The relatively small number of pancreatic cancer cases also limits how confidently we can interpret the results.

Researchers have proposed several possible biological explanations involving blood sugar, insulin, and metabolic health. However, these mechanisms have not established that soda consumption directly causes pancreatic cancer.

So, should we throw every soda machine into the nearest river?

Not necessarily!

But there are good reasons to reduce sugar-sweetened beverages.

Excessive consumption contributes to excess calorie intake, weight gain, and increased risk of metabolic problems, including type 2 diabetes.

As I often tell patients:

Your body was designed to run on water much better than it was designed to run on liquid candy.

That’s a lifestyle lesson worth remembering, even without the pancreatic cancer headlines.

Seven Lessons My Father’s Pancreatic Cancer Taught Me

Looking back, my father’s experience left me with seven important lessons.

1. Listen to your body.

A new symptom, especially in someone who rarely complains, deserves attention. Don’t automatically dismiss persistent or unusual pain as simply part of getting older.

2. Don’t delay medical evaluation.

Back pain is common and usually has ordinary explanations. But when something doesn’t fit the usual pattern, further investigation may be necessary.

3. Know the limitations of early detection.

Pancreatic cancer is difficult to diagnose early, and routine screening is not recommended for everyone. People with significant family or inherited risk may need specialized evaluation.

4. Understand your risk factors.

Smoking, obesity, chronic pancreatitis, and certain inherited conditions are among the recognized risk factors. Knowing your family history and discussing concerns with your physician matter.

5. Take complications seriously.

Cancer surgery is not the end of the medical journey. Dad’s postoperative infection and abscess reminded us how important it is to recognize and treat complications promptly.

6. Never underestimate resilience.

Despite major surgery, sepsis, an ICU stay, and a prolonged recovery, Dad demonstrated remarkable courage and determination.

7. Treasure the time you are given.

As physicians, we often measure success in months or years of survival. Families measure it differently.

One more Christmas.

One more birthday.

One more Bible study.

One more conversation.

Where Do We Go From Here? Prevention, Awareness, and Hope

The same question I asked the gastroenterologist 28 years ago remains relevant today:

“Where do we go from here?”

We go toward prevention.

We go toward healthier lifestyles.

We go toward reducing avoidable health risks.

We go toward maintaining a healthy weight, exercising regularly, avoiding tobacco, controlling blood sugar, and choosing foods that nourish our bodies.

We go toward paying attention to our bodies and seeking medical evaluation when something feels wrong.

But we must also recognize the limitations of what lifestyle changes can accomplish.

Healthy habits can reduce certain risk factors, but they cannot guarantee protection against pancreatic cancer. Nor should people blame themselves when cancer develops.

Medical knowledge about pancreatic cancer has advanced since my father’s diagnosis. Surgical techniques, chemotherapy, targeted treatments, and other emerging approaches have expanded treatment possibilities.

Research continues to explore ways to detect the disease earlier and improve survival.

And we go toward hope.

A Father’s Legacy: More Than Three Extra Years

My father’s story reminds me that behind every cancer diagnosis is not simply a disease but a person.

A father.

A mother.

A spouse.

A friend.

A child of God.

As a physician, I understand the limitations of medicine. We cannot always prevent disease, reverse its course, or change the final outcome.

But sometimes we can intervene, provide more time, restore meaningful activities, and give families opportunities to create memories they would otherwise have missed.

My father was blessed with three more years after his pancreatic cancer surgery.

For our family, those years were not merely additional time on a calendar.

They were gifts.

And for that, I remain profoundly grateful.

Because sometimes the greatest measure of medical success is not how many years we add to life, but how much life we add to those years.


“Sometimes the greatest measure of medical success is not how many years we add to life, but how much life we add to those years.”

Dr Laurence T Gayao MD
Laurence T Gayao MD, DABFM, BCEM I For The Good Life

For The Good Life | Healthy Aging • Lifestyle Medicine • Health Wisdom • Inspiring Stories

Medical note: This article shares a personal family experience and general health information. It is not a substitute for individual medical advice. Persistent or unexplained symptoms should be evaluated by a qualified healthcare professional.

Quadruple Bypass Surgery: What This Retired ER Doctor Learned as a Patient

When the ER Doctor Became the Patient

My Unexpected Detour to a Quadruple Bypass Surgery

Retirement sounds wonderful when you are working.

You imagine sleeping late, traveling whenever you want, spending more time with family, pursuing hobbies, exercising, and finally having enough time to do all those things you kept postponing while working.

Then you actually retire.

And after about four months, I discovered something nobody had warned me about:

Retirement can get boring!

At age 68, I retired from my job as an emergency physician at Arlington Memorial Hospital. Our ER had about 50 beds and saw roughly 75,000 patients a year. After decades of working in emergency medicine, suddenly I had nowhere to go at 7 a.m., no patients waiting for me, no ambulance radios going off—and nobody asking me to decide whether someone needed a CT scan five minutes ago.

At first, it was wonderful.

Then I started looking at the clock.

A lot.

I had started my health and fitness blog, and I was keeping myself busy with exercise, hobbies and other interests. But apparently, my internal emergency-medicine clock had not received the retirement memo.

So I did what any retired emergency physician with too much free time might do.

I went back to work.

Retirement… With a Few ER Shifts Thrown In

I began working a few days a month covering emergency departments at small rural hospitals around Texas.

It sounded like a good compromise. I wasn’t going back to the crazy pace of a large urban ER. I would work occasionally, make a little extra money, see some patients and then return to my peaceful retired life.

There was only one problem.

Rural emergency medicine can be anything but peaceful.

At a small hospital, you might find yourself caring for a critically ill patient with only a nurse and a medical assistant immediately available. If someone needs to be intubated, a chest tube inserted, or another lifesaving procedure performed, you’re the person who has to do it.

And if the patient needs a higher level of care?

You call for a helicopter or ambulance and wait.

That waiting can feel very long when someone is critically ill.

Things become even more complicated when several critically injured patients arrive at the same time.

One night stands out in my memory. We had nine Mexican nationals involved in a severe motor-vehicle accident.

Nine critically injured people.

In a small rural ER.

Let’s just say all hell broke loose.

That’s a story for another day.

In the large medical-center ER where I had previously worked, a situation like that would still have been serious, but there would have been several emergency physicians working, plenty of nurses and paramedics, respiratory therapists, specialists and immediate access to surgery and other services.

In the rural ER, you quickly realize that the cavalry isn’t necessarily coming.

Sometimes, you are the cavalry.

After about three months, I decided I had enough.

My retirement needed to be retired from emergency medicine.

The Sweet Spot

I eventually found a much better arrangement.

I began working in the emergency department of an orthopedic and spine hospital only about six miles from our home.

It was a much more relaxed environment.

Most of the patients were there for orthopedic problems or postoperative complications. Occasionally someone would show up with an unrelated medical emergency, but there were two larger hospitals only about a mile away.

That made a huge difference.

I could still practice medicine, but I wasn’t constantly wondering whether the next ambulance would bring me a disaster movie.

This turned out to be the sweet spot.

I had time to write, exercise, garden, pursue my hobbies, travel and spend time with family.

We took two or three months of vacation each year. We visited grandchildren living in different states, including two who were in Thailand. I attended alumni reunions, helped organize medical missions and stayed involved with friends and former classmates.

Life was good.

Actually, life was really good.

And for about nine years, I enjoyed this semi-retired lifestyle.

Then one evening, my heart decided it wanted to make a dramatic entrance.

The Night My Heart Changed the Schedule

I was attending a medical school reunion in Washington, D.C.

I was having a great time catching up with five of my classmates and their spouses. We were talking, laughing and enjoying one another’s company—the usual reunion activity where you discover that 50 years have passed but somehow everyone still remembers the same stories.

Then suddenly, I didn’t feel right.

I became weak and dizzy.

I went to the bathroom, splashed some cold water on my face and looked in the mirror.

Nothing.

I still felt lousy.

I returned to my classmates and told them that Edith and I needed to go back to our hotel room because I wasn’t feeling well.

Once in the room, I lay down and checked my pulse.

It was fast.

And irregular.

As an emergency physician, I didn’t need a medical school refresher course to recognize the pattern.

I thought I was having atrial fibrillation with a rapid heart rate.

I told Edith to call 911.

Within minutes, several of my fellow alumni showed up at our hotel room. Even the college dean, who happened to be a cardiologist, came to check on me.

He asked a few questions and examined me.

Then he essentially confirmed what I had already suspected.

“Yep. Looks like atrial fibrillation.”

It’s a little humbling when your reunion suddenly turns into a mini medical conference about you.

The EMS team arrived, performed an EKG and confirmed the diagnosis. I was transported to Georgetown University Medical Center, where I was given medication—a beta blocker—to slow my heart rate.

Fortunately, my rhythm returned to normal, and so did I.

They made sure I wasn’t having a heart attack and eventually discharged me.

I thought that was the end of the story.

It wasn’t.

Not even close.

The Test That Changed Everything

When I returned home, I made an appointment with my cardiologist, Dr. Ane Saleemi.

He ordered a cardiac stress test.

During the test, he repeatedly asked me whether I was having chest pain.

“No.”

Again:

“Any chest pain?”

“No.”

Again:

“Are you sure you don’t have chest pain?”

“No.”

Apparently, my heart was keeping a secret that I hadn’t been invited to hear.

The stress test showed an abnormality.

Dr. Saleemi recommended a cardiac catheterization.

A few days later, he performed the procedure.

Afterward, when I was fully awake, Dr. Saleemi came in to talk with me.

He had good news.

And bad news.

The good news?

My heart muscle was strong and functioning well.

The bad news?

I had four significantly blocked coronary arteries.

Four.

Apparently, my heart had been quietly running a four-lane highway with most of the lanes closed.

Why hadn’t I experienced chest pain?

Dr. Saleemi explained that because I had remained physically active, my heart had developed collateral circulation—alternative small blood vessels that helped provide blood flow around the blocked arteries.

That was fortunate.

But it wasn’t enough to solve the problem.

I needed a quadruple coronary artery bypass graft (CABG).

Suddenly, the retired emergency physician who had spent decades taking care of critically ill patients was going to become one.

From Doctor to Patient

On August 13, 2023, I underwent quadruple coronary artery bypass surgery.

The next day, I woke up with tubes coming out of places I didn’t even know could have tubes.

There were tubes in my nose, tubes on both sides of my chest, a urinary catheter, several IV lines and various other pieces of medical equipment.

As a physician, I had seen this many times.

As a patient?

Let’s just say the view from the other side of the bed is completely different.

My postoperative recovery became complicated, and I spent about six weeks going in and out of the hospital.

The hardest part wasn’t necessarily the surgery itself.

It was losing my independence.

Before surgery, I was exercising regularly, lifting weights, walking outdoors and taking care of things around the house.

Suddenly, I needed help with simple things.

Walking.

Bathing.

Getting dressed.

Even ordinary activities that I had never thought twice about became major accomplishments.

That experience changed me.

Walking in the Patient’s Shoes

As physicians, we spend years learning how to diagnose disease, order tests, prescribe medications and perform procedures.

But there is one thing no textbook can completely teach you:

What it feels like to be the patient.

Going through my own health crisis gave me a much better understanding of the mental, emotional and physical struggles patients experience when their health suddenly changes.

Patients aren’t just looking for treatment.

They need encouragement.

They need reassurance.

They need someone to listen.

They need someone to explain what is happening without making them feel like a medical problem on a chart.

And sometimes they simply need somebody to sit beside them and say:

“You’re going to get through this.”

No matter how sophisticated healthcare becomes, no technology can completely replace the human touch.

This experience also gave me a much deeper appreciation for nurses.

I had always respected nurses, of course. But being dependent on them for basic care gives you an entirely different perspective.

They are there when you’re scared.

They’re there when you’re uncomfortable.

They’re there when you need help getting out of bed.

And sometimes they’re there when you are not particularly pleasant because you’re tired, frustrated and hurting.

They still come back.

That’s what good nursing is.

Learning to Slow Down

Recovery also taught me something that doesn’t come naturally to me:

Patience.

I wanted to get stronger quickly.

I wanted to exercise.

I wanted to get back to doing everything I had done before.

My body, however, apparently had its own recovery schedule.

It didn’t care about my timetable.

I learned that pushing harder isn’t always better.

Sometimes the smartest thing you can do is slow down, listen to your body and give it time to heal.

Three years later, I’m not quite where I was before surgery in terms of strength and exercise tolerance.

But I can walk.

I can exercise.

I can do chores around the house.

I can work in our garden.

And I can enjoy life.

My doctors have even given me one important piece of advice:

Don’t climb ladders to trim tree branches or clean the gutters.

Apparently, surviving quadruple bypass surgery only to fall off a ladder would be a rather embarrassing way to end the story.

So I listen.

Mostly.

What I Am Most Thankful For

Today, one of the things I am most grateful for is that my mind is still working well.

I can still learn.

I can still be curious.

I can still figure out new technology—although sometimes the technology seems determined to test my patience.

And that’s how this retired physician ended up writing a health and lifestyle blog and learning things about artificial intelligence, websites, social media and digital technology.

Not bad for an old ER doctor who once thought retirement would simply mean more time to watch television.

I still have a lot to learn.

But perhaps that’s part of The Good Life.

You don’t have to stop learning because you’ve gotten older.

You don’t have to stop trying new things.

And you certainly don’t have to let a setback convince you that your best days are behind you.

The Lessons Behind the Bypass

My parents taught me something early in life that has stayed with me:

If you want something, you have to work for it.

They also taught me resilience—to keep going when things don’t go according to plan, to learn from failures and setbacks, and to get back up after life knocks you down.

My bypass surgery gave those lessons a much deeper meaning.

Life will throw things at us that we never expected.

Sometimes it’s an illness.

Sometimes it’s losing a job.

Sometimes it’s a financial problem.

Sometimes it’s simply getting older and realizing that the body doesn’t quite cooperate the way it used to.

We can’t always control what happens to us.

But we can control how we respond.

For me, faith has been an important part of that response.

During those difficult weeks of recovery, I kept reminding myself that God was with me—even when I didn’t understand why I was going through it.

And slowly, one step at a time, I got better.

The Good Life Isn’t a Perfect Life

I’ve come to realize that The Good Life doesn’t mean a life without problems.

It means finding meaning, gratitude and purpose despite the problems.

It means appreciating the ability to get up in the morning.

It means enjoying a conversation with an old friend.

It means spending time with family.

It means planting something in the garden and watching it grow.

It means taking a walk.

It means learning something new.

It means laughing at yourself occasionally.

And yes, it means knowing when to stay off the ladder.

My journey from emergency physician to retired physician, from doctor to patient and from illness back to recovery has taught me something I probably should have known all along:

Health is precious. Independence is precious. Time is precious.

And sometimes the best way to appreciate them is to have them temporarily taken away.

Today, I’m still here.

Still learning.

Still writing.

Still gardening.

Still exercising.

Still occasionally arguing with technology.

And still sharing what I’ve learned with friends and readers of For The Good Life.

After all, I may be retired from the emergency room.

But apparently, I’m not retired from life.

And that’s a pretty good thing.

For The Good Life
Laurence Gayao MD, DABFP, BCEM | For The Good Life