One Patient's Cautionary Tale: "Get your tests done."
“My urologist said he couldn’t operate until I had the cyst checked out,” Daniels relates. So he went to see Geoffrey Block, MD, Eisenhower Health’s interventional gastroenterologist at the time, who performed a biopsy that determined the cyst was not cancerous. Daniels was cleared to undergo prostate cancer treatment, which was successful.
Because a small percentage of pancreatic cysts can potentially turn into cancer, however, Dr. Block recommended that Daniels have annual MRI scans to monitor the cyst. This surveillance continued until Dr. Block relocated in 2019.
“Fast forward to 2021 and it was time for a screening colonoscopy,” Daniels says. “I went to see Dr. Conti (Board Certified Gastroenterologist James Conti, MD) and he also asked me about my pancreatic cyst. I told him that Dr. Block had been monitoring it and there’d been no problems, but I hadn’t had it scanned since Dr. Block left.
“Not a good idea to ignore it”
“Dr. Conti told me in no uncertain terms that it wasn’t a good idea to ignore it,” Daniels relates. “He said a new interventional gastroenterologist had joined the practice and that he was going to refer me to him in order to resume surveillance of the cyst right away.”
The advanced procedures Dr. Kanagala performs include endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). EUS is a diagnostic procedure that combines upper gastrointestinal (GI) endoscopy and ultrasound to examine the inside of the digestive tract; it can detect pancreatic cancer, colon cancer, inflammatory bowel disease, pancreatitis and other issues that cause abdominal pain. ERCP is a procedure that combines upper GI endoscopy and X-rays to treat problems of the bile ducts, pancreatic duct and gallbladder without invasive surgery.
The first thing Dr. Kanagala did was order an MRI scan of Daniels’ pancreas. It turned out that in the two-plus years since Daniels’ last imaging test, things had changed — and not for the better. The MRI revealed a new lesion in the center of Daniels’ pancreas.
“When a lesion or spot in the pancreas is detected, there’s always a level of concern as to what it may be,” Dr. Kanagala says. “I explained to Mr. Daniels and his wife that we would do an endoscopic ultrasound and biopsy the new lesion using needle aspiration. While this spot could be another cyst, I painted a broad picture of what we’d do if it turned out to be cancer.
“It takes some level of mental preparation to understand the game plan at a time like this, and I didn’t want him to feel as if I’d simply make a diagnosis and move on,” Dr. Kanagala continues. “I wanted to make sure he felt his hand was being held even if I wouldn’t be the one treating him if it was, indeed, cancer. I assured him we would get to the bottom of it.”
The biopsy
“He was amazing,” Daniels says of Dr. Kanagala during their first in-person interaction. “He sat down with me and my wife Gail and said, ‘Hey, we’ve got this.’ And I’ll never forgot how he said that if this did turn out to be cancer, I could live without a pancreas. That was tremendously reassuring.”
Daniels underwent the EUS and biopsy procedure in July of 2021.
“Dr. Kanagala uses the ultrasound guidance to target the lesion, then works the lumen to stick the needle into the tumor to aspirate tissue samples,” says Daniels. “It’s incredible to me that you can stick a tube down someone’s throat and do all that.”
If Daniels sounds like he knows his way around medical terminology, it’s because he spent his professional life in the medical filtration device industry, doing sales, marketing and, eventually, heading a $100 million company based on Long Island, New York. In a small-world story, he even called on Eisenhower Medical Center in 1975, when the Rancho Mirage campus consisted of only two buildings. He retired in 2018, a transition precipitated by his prostate cancer diagnosis.
“I learned that Dr. Kanagala did something during the procedure I’d never seen before,” Daniels continues. “He brought someone from the pathology lab right into the operating room with him and as he aspirated the tissue samples during my biopsy, he had them put the samples on slides to make sure that pathology had adequate tissue to make a diagnosis.”
The biopsy revealed that the new lesion in Daniels’ pancreas was cancerous. Daniels gives Dr. Kanagala high marks for the way in which he imparted that information.
“There’s technical skill and there’s also bedside manner — the way he talks to a patient about really bad news,” Daniels says. “Dr. Kanagala was uplifting as well as very highly skilled, technically.”
“A hard diagnosis”
“That’s very kind of him,” Dr. Kanagala says on hearing how Daniels characterized his bedside manner. “Pancreas cancer is a hard diagnosis for anybody to hear. Their world changes, crumbles. It brings us to suddenly understand that from this moment on, you have to learn how to live in the present moment and value each moment for its worth in order to get any sense of peace or stability.
“Mr. Daniels was inspiring to me,” he continues. “He was very stoic in my clinic. He sat there and absorbed the news, then turned his focus to figuring out the best course of action.”
That course of action included surgery and chemotherapy. Daniels underwent what’s called a subtotal pancreatectomy in which a major portion of his pancreas, along with his spleen, was removed, followed by a three-month regimen of chemotherapy. Since then, he has undergone quarterly imaging scans to monitor his condition. “Pancreatic cancer is a disease you have to stay on top of,” he says.
Remaining optimistic
When we spoke in early October, Daniels’ most recent scan had detected another small lesion in his pancreas. He was anticipating that he would undergo another surgery and some additional chemotherapy. He remains optimistic about the future and looks forward to spending time with his wife of fifty years, his two sons aged 46 and 48, and his twin 17-year-old grandsons.
“We found this cancer early,” Daniels says. “If it wasn’t for Dr. Conti figuratively whacking me upside the head [about monitoring his pancreatic cyst] and Dr. Kanagala being there and being a highly skilled interventional gastroenterologist, I would have lived in the dark until it was too late.
His advice to someone who may be putting off certain medical tests?
“Don’t take your health for granted even if you feel good,” he says emphatically. “Get your tests done and see if something’s going on. Everything is so much more treatable when it’s caught early and with today’s medical advances.
“Also, find the best doctors you can and be proactive if you need to find a specialist,” he adds.
For more information, call 760.773.2882, or visit EisenhowerHealth.org/GI.
