For Dave Smith, New-Onset Diabetes Preceded a Pancreatic Cancer Diagnosis

Written By Julia Brabant
December 2023

Current Status: Cancer Free Since October 23

Many people outside of the medical profession don’t know that new-onset diabetes can be a symptom of pancreatic cancer, but Dave Smith’s now-daughter-in-law, Erin, did. Her own father’s experience with pancreatic cancer began exactly the same way, so she urged Dave to seek medical attention without delay. 

Dave found out he was diabetic when he was recovering from a successful herniated disc surgery and his doctor scolded him for gaining weight. The doctor recommended he try to lose about 15 pounds through a combination of diet and exercise, and Dave took that advice seriously, starting a low-carbohydrate, low-sugar diet while ramping up his physical activity. 

Before long, he’d dropped almost 30 pounds, and the rapid weight loss, coupled with the Type 2 diabetes diagnosis, raised concerns in Erin, his son’s wife, and the rest of the family. Dave returned to his doctor, sharing that he’d lost more weight than he’d intended or wanted to. He mentioned the similarities between his current symptoms and those of people with pancreatic cancer.

His doctor tried to calm his fears, noting that Dave appeared healthy overall and that the substantial weight loss was a likely result of Dave giving his diet a major overhaul. The doctor noted that there weren’t many options or methods available for detecting pancreatic cancer at an early stage.

Dave then found himself in a tough position. He was continuing to lose weight rapidly, but he didn’t have the option of loading up on sugar or carbs to help put weight back on due to his diabetes. He decided to see a different doctor to get another opinion.

Dave’s new doctor thought he should have a CT scan due to the rapid, ongoing weight loss. The same day Dave had the scan, he developed a new symptom – notable pain in his lower left back and abdomen.  Dave’s doctor said his scan results, too, were concerning and had him go to a GI doctor for more tests.

The GI doctor said Dave’s CA 19-9 numbers, which can detect tumor-associated antigens in the blood, were sky-high. He recommended Dave have an endoscopy, which can help detect certain digestive problems.

When Dave’s anesthesia wore off and he awoke from the procedure, his doctor delivered the news.

“I’m really sorry, but you have a malignancy,” the doctor had said.

That said, there was some “good” news, too – there wasn’t any evidence the cancer had spread anywhere else, meaning Dave had a chance of being a surgical candidate.

“I knew the gravity of the situation,” Dave said. “I also knew that God had a plan for me, and whatever His will was, would be.”

Knowing now what he was facing, Dave sought care at the Memorial Sloan Kettering Cancer Center in New York City.

There, doctors delivered sobering news – Dave was not currently a candidate for surgery, after all, because he had a tumor in the tail of his pancreas and another in the neck of it. His team decided to start him on an aggressive chemotherapy regimen with the hopes of improving his condition enough for surgery to become possible.

He began chemotherapy with FOLFIRINOX. Overall, the side effects Dave experienced were mild, but he did develop severe gastrointestinal issues at one point, landing him back in the hospital for a week-long stay. There, he experienced all the side effects he didn’t have during chemotherapy and dropped significantly more weight.

Ultimately, doctors determined he had C. diff, an infection likely caused by an antibiotic he took prior to chemo.  C. diff is a type of intestinal infection that can be especially serious in people who already have compromised immune systems.

Dave was actually relieved to hear that, because he was afraid the symptoms he’d been experiencing were the result of his cancer spreading. Despite the C. diff hurdle, he urged his care team to continue to treat his cancer aggressively.

The course of treatment continued to work, too, with Dave’s CA 19-9 numbers plunging and both tumors shrinking considerably. His CT scans looked good, and he asked his doctors if he might be able to stop his current 12-round chemo regimen halfway through for surgery.

His team recommended he complete the chemo regimen in its entirety first, and after getting several differing opinions, Dave agreed. There were concerns that, should complications arise during surgery that made it impossible to complete, he wouldn’t be able to get back on chemo.

So, he continued chemotherapy. At one point, Dave’s white blood cell counts dipped too low, requiring him to take injections and work extra hard to bounce back. After completing 10 rounds of chemo, Dave’s team decided to schedule him for surgery, which would take place following the 12th and final round.

“I’d been marking different milestones – get to Easter, get to Labor Day,” Dave said. ““I was excited to have a surgery date on the calendar.”

Two weeks after completing his last chemo treatment, on Oct. 23, 2023, Dave had a distal pancreatectomy and splenectomy, a procedure used to remove tumors from certain parts of the pancreas (along with the spleen). He felt surprisingly at peace heading into the surgery, noting the time on the clock (12:30 pm) and hoping he wouldn’t come to until much later, a sign of a successful surgery.

Dave awoke at 4:45 p.m. to doctors telling him his surgery had been a success. At one point during chemo, scans indicated one of his tumors was in close proximity to a blood vessel, potentially complicating things. Yet, during surgery, once doctors got a closer look, they determined the chemo had worked well enough to disengage the tumor from the vessel – leading to a less-complex procedure.

Dave’s follow-up pathology reports showed clear margins and no lymph node involvement – both great signs.

“I’m not out of the woods, but at this juncture, things are looking good,” he said. “We weren’t expecting the news to be as good as it was.” 

Currently, Dave has become insulin-dependent, and he also has ongoing neuropathy, which can cause numbness, weakness and pain, particularly in the feet and hands. He also feels immense gratitude for his care team, including his oncologist at Sloan Kettering, Dr. Devika Rao, M.D., his surgeon, Dr. William R. Jarnagin, and his broad network of friends and family members.

“Having this support system of family, friends and faith – it brought out my emotions more than thinking I didn’t have much time left on this earth,” Dave said. “It really puts things in perspective in terms of how much joy I have in my life and how blessed I’ve been.”

Early in the treatment process, Dave had genetic tests done to see if he had any potentially dangerous gene abnormalities he might pass along to his kids. The tests didn’t reveal any obvious causes for concern. Dave and his wife, Kim, have also become regular donors to pancreatic cancer research and advocacy organizations, as well as supporters of cutting-edge pancreatic cancer programs at several New York hospitals.

As Dave continues to recover from surgery and reflect on the past year, he’s quick to credit God for giving him a sense of peace, and his family and friends for their support. He’s especially grateful to his daughter-in-law, at whose urging he sought medical treatment in the first place.

“I thank her regularly,” he said. “I’m grateful I didn’t disregard her advice; I’d never forgive myself if I had ignored it.”

Dave also makes a point to appreciate each day he has with his loved ones. “You can’t take a single day for granted – I will not, and I do not,” he said. “I don’t know how many days I have ahead, but I know I’m going to make the most of them.”

Dave has shown no sign of cancer since his October 2023 surgery.