Gallstones, new onset diabetes, pancreatic cancer?

[lacui91]

Hi! This post is very longwinded so apologies in advance - thank you to those who make it through to the end lol

Last February my dad 66M was diagnosed with gallstones and a hardened gallbladder at an ultrasound appointment after experiencing months of pain sometimes before but more regularly after eating.

A year later, so about two or so months ago, he was finally invited to a pre-op appointment. However, when he was there he was diagnosed with type 2 diabetes so they can't operate on him until it's under control.

Due to other unrelated health issues (nerve pain in his foot that is linked to his back) my dad for the last 3-4 months has been undergoing numerous blood tests all which confused his GP as the markers would come back each time almost completely differently. He was warned that he may be pre-diabetic a few weeks prior to his pre-op appointment anyway, which came as a surprise as he had changed his diet last year when he was diagnosed with gallstones. He was then sent his blood sugar levels and they have very steadily raised over the last 12 months.
Around about the time he was warned about possibly being pre-diabetic, he was urinating a lot more, was constantly thirsty and extremely fatigued (more so than usual as he's a full time carer for my mum). Over the last 7 weeks he's lost quite a bit of weight.

He doesn't experience the same debilitating stomach pain he had prior to being diagnosed with gallstones (he’s extremely cautious with what he eats) but he has the odd pain or discomfort in his upper stomach area. He’s currently in gabapentin for his feet pain as well as omeprazole and has been for 20+ years due to his acid reflux (far too long, I know) as well as propranolol. He smoked for around 50 years but hasn't done in around 6 years, and gave up drinking 7 years ago.

Prior to his gallstones and hardened gallbladder diagnosis last year, I was concerned about it possibly being pancreatic cancer. Now, after doing some research since his sudden type 2 diabetes diagnosis, it seems like all three are often interlinked at that diabetes and gallstones can be a precursor or in the case of the former, a symptom.

In quite a short time, as stated above he was told that he was pre diabetic, then type 2 diabetic, and now pre type 1 diabetic. About three weeks ago the diabetic nurse prescribed him metformin and also gave him an at home kit to monitor his blood sugar levels. To begin with, his levels were often as high as 18 (he was also extremely tired around this time) but now he is on four metformin a day, he’s around 6-10 with the odd exception. He also feels a lot more awake and alert than weeks prior.

He was then booked in for a CT scan after a referral from the original surgeon who said in his letter that he “has suddenly developed evidence of diabetes with a raised HbAc, and wondering whether we should image his pancreas gland. I completely agree, and I have requested a CT scan. It could be that there is no problem with the pancreas and this is a physiological diabetes, but of course there is a chance that this could relate to his gallstones for example with subclinical recurrent acute pancreatitis, or occasionally an abnormality within the pancreas itself.”

He attended his CT scan on the 18th, and two days later was contacted and booked in a consultation with a different surgeon (still an upper GI wall surgeon, though the lead in the department) for the 26th (yesterday). However, on the 24th, they contacted him again and asked for him to do another CT scan and a blood test in place of attending his consultation. They explained that this was going to be a more detailed scan and that it had expanded so it went from his chest to his pelvis. This time he was also given a load of water to expand his stomach. Unfortunately because of the dye he couldn’t get his bloods taken afterwards, so he went in first thing this morning.

A couple of hours later, they rang him and booked him in to finally have a consultation with I’m presuming the surgeon next Tuesday (April 1st). They said this was the earliest they could get him in as they were going to be discussing his case at a meeting preceding his appointment. They also asked if he was going to be bringing someone along with him, which I’m guessing doesn’t mean it’s great news.

I’m in a bit of a panic mode right now, so sorry about such a muddled post. I don’t want to expect the worst but do want to prepare myself for bad news. Is them asking if he’s bringing someone with him to the appointment a standard precursor to bad news?

Thanks again to those who made it to the end of this very long post!!

sorry, but yes likely to be bad news, especially when he was told if he would be bringing someone with him l

The meeting with colleagues would I think be an MDT which are usually held to look at test results and treatment plans for suspected or diagnosed cancer patients

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Thanks for replying!

I think when she mentioned the meeting today she referred to it as their ‘weekly meeting’. Following his first CT scan last week, they rang him up only a few hours afterwards and said that his scan would be discussed in their weekly meeting so they couldn’t book him in till after it had taken place. The way it was referred to sounded as if it was a common occurrence in their department. We also know there was at least one meeting that took place prior to any of these findings when he was being treated only for his gallstones and was awaiting his gallbladder removal surgery. But you may be right regardless - thank you again for replying x

Depends, could be due to bad news. Or, maybe due to age, they might think it’s best he has someone just in case he needs assistance providing information or taking correct information away. It’s hard, many older people are completely on the ball and zero issue, whereas many others, even though they seem okay and say ‘yes, I understand’, you just know don’t really do it’s of benefit for there to be a family member there who does.

Fingers crossed it's good news but take someone with you was what they told me Mum before her pancreatic cancer. I really hope your Dad will be fine.

Hi, thanks for replying. I’m praying this is the case - the situation is complex as is so hopefully they just want another pair of ears. I was slightly wrong in my first post, they didn’t ask if he was going to bring someone in but rather advised him to. Hopefully this point still stands though. Thanks again for the reassurance. x

My mum went through something very similar last year, including the sudden onset of type 2 diabetes and unexplained weight loss. We were told to prepare for the worst, and that they expected it was pancreatic cancer.

Thankfully, it was not. She has chronic pancreatitis, and she’s doing so much better now her diabetes is under control, and she’s settled into the medication needed for her pancreas.

I really hope for the best for your dad xx

Oh thank god for your mum! Amazing that she’s doing so much better now. I’m really hoping this is what it is, paired with his gallstones and hardened gallbladder. Your comment has made me feel a lot better, so thank you. x

The waiting is the worst part. I woke up feeling okay-ish this morning but just now my dad received confirmation of his appointment through the post. I saw the line “you will be seen by a member of the clinical team” and had a mini spiral - I thought he was going to be seeing the surgeon who was supposed to do his gallstones. I’m getting too in my head about it but it’s so hard not to.

I agree, the waiting for us was so hard. I felt sick the whole time it was going on. I had sleepless nights worrying about her. It’s such an awful thing to wait through. I truly do hope for the best for your poor dad. Xx

It is a possibility yes, especially with the rapidly rising hbaic.
its usual to hold a Multidisciplinary meeting before the patient’s appointment.
It may not be, but I’d prepare for the worse.
Take a notebook with you so you can record information as details tend to go right over patients heads
Warm wishes to you and your DF

Thanks for responding. They referred to the meeting as their weekly meeting so I don’t think it the one preceding his appointment at least is solely about him.