It just didn't add up.

It was fall 2018, and Michael Skaggs was growing more and more frustrated and worried about physical symptoms he could not explain.

Skaggs, then 48, and his wife Missy, are models of healthy living. Both are nurses at a hospital near their home in Fenton, Michigan. They eat right, don't smoke and are avid runners. Each have completed multiple marathons, including the Detroit marathon that October.

Despite doing everything right, Skaggs found himself plagued by persistent abdominal pain, cramping and tiredness. "I'm normally a high energy guy," he says, "We couldn't figure out why I felt so lousy and exhausted."

By the end of the year, things had not improved. Skaggs saw his primary care physician in January 2019 for a thorough evaluation. Over the following months, he underwent repeated blood tests and imaging studies, made several trips to the emergency room, and was even hospitalized.

"Despite so many attempts, we weren't getting to the bottom of it," recalls Skaggs. "All the while I kept getting worse. I lost a lot of weight, and eventually, I couldn't even run anymore. That was a very disappointing setback for us."

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At this low point, desperate for answers and out of ideas, Skaggs made an unexpected connection through a conversation with a coworker. "It was kind of a fluke 'friend-of-a friend' thing," he remembers. "She had a neighbor who was a patient of a Michigan Medicine surgeon who he thought might be able to help."

Skaggs had a frank discussion with his doctor about their lack of progress, informing him that he and Missy intended to cast a wider net and involve Michigan Medicine in their search for a diagnosis.

A new expert

In May, Skaggs met with that surgeon for the first time. Christopher Sonnenday, M.D., M.H.S., is the surgical director of liver transplantation and executive vice-chair of surgery. He specializes in pancreatic and hepatobiliary (liver, gallbladder and bile duct) surgery, surgical oncology and liver transplantation.

"That first appointment was so impressive, and so reassuring," Skaggs remembers. "Dr. Sonnenday had already reviewed all of my past imaging and tests, so by the time we met, he knew my case better than I did."

"When I reviewed the images and heard Michael's story, I suspected pancreatic cancer," Sonnenday says. "I told them right then that we needed to prove it so we could treat it."

An endoscopic ultrasound and biopsy confirmed the diagnosis, and led to consultation with Rogel Cancer Center colleagues, including medical oncologist Mark Zalupski, M.D., who specializes in the treatment of pancreatic cancer.

"I know it was difficult for Michael and Missy to hear that diagnosis," Sonnenday says, "But by that point, after so much uncertainty, I think it was also a relief to be headed in a definite direction."

Why wasn't his pancreatic cancer diagnosed sooner?  Pancreatic tumors most commonly form at the head of the pancreas, blocking the bile ducts. As a result, the first visible symptoms usually indicate jaundice, a yellowing of the skin and the whites of the eyes, and dark urine.

SEE ALSO: How Surgeons Are Working to Improve Outcomes for Patients with Pancreatic Cancer

Skaggs' tumor was located in the body of the pancreas. "While it's not rare, it is a somewhat less common location," explains Sonnenday. Tumors in the body of the pancreas result in less obvious symptoms. Because symptoms like abdominal pain and tiredness mimic other conditions, this type of pancreatic cancer is notoriously hard to diagnose. "The right tests had been done, but the findings were not interpreted properly."

The location of Skaggs' tumor made treating his cancer more difficult too. But given Skaggs's otherwise excellent health, Sonnenday and Zalupski recommended an aggressive treatment path, beginning with chemotherapy and radiation, followed by surgery.

"Whenever possible, the multidisciplinary treatment of pancreatic tumors like this one follow this protocol," explains Sonnenday. "Not only do chemotherapy and radiation help control the disease and increase the chances of getting clean margins when removing the tumor, but they tend to indicate which patients are most likely to do well with surgery.

As they had hoped, Skaggs tolerated the six months of chemotherapy and radiation very well. "I soon began regaining weight and strength, and went back to running," Skaggs says, "even finishing a half marathon 10 weeks after chemotherapy." 

Equally encouraging were his pathology reports. He was fortunate that, despite how long it took to diagnose his cancer, his tumor remained localized, with no evidence of metastatic disease when treatment began.

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"After chemotherapy and radiation, we observed a significant treatment effect," adds Sonnenday. "With much of the tumor now dead, it made it much easier to remove the remaining tumor with clean margins."

Sonnenday performed surgery in December, removing not only the tumor, but Skaggs' spleen, gallbladder and lymph nodes, and performing a vascular reconstruction. The complicated procedure required rerouting blood flow to the liver from the celiac artery, the first major branch off the aorta in the abdomen.

It took significantly longer for Skaggs to rebound from the extensive surgery than from the chemotherapy. "They told me it could take up to a year, but based on my experience after chemotherapy, I think I was overconfident," he says. "I thought I'd be back to running in time to train for a marathon in November. That didn't happen, but Dr. Sonnenday, who is also a runner, was convinced that I would eventually run another race."

He was proven right in August, when Skaggs finished a 10-mile race in Flint. He would go on to finish a half marathon in Lansing the following month.

While he still struggles with a few nutritional and gastrointestinal issues, Skaggs' recovery continues to progress. "I know how fortunate I am to have beat the odds," he says. "I was here to walk my youngest daughter down the aisle in September, and our first granddaughter is due at the end of the year."  

Lessons learned

Skaggs says the biggest lesson others can learn from his story is to listen to your body.  "Don't let anyone minimize your symptoms or give up on finding answers. Keep pushing, and don't hesitate to seek out a second or even a third opinion," he says.

Sonnenday agrees with those takeaways, and adds a few more:

"As doctors, we need to really listen to our patients, and trust them," he says. "I teach our residents and fellows that if a patient tells you something is wrong, believe them. We may have advanced tests and incredible technology, but the patient's story will always lead us to the diagnosis.

"The other lessons Michael Skaggs taught me are ones we should all take to heart every day," he continues. "A positive outlook, perseverance and the support of family and friends are the most powerful weapons we have when handling adversity. He showed incredible humility about his illness, and he refused to be defined by it. He's an inspiration, and I'm lucky to have helped care for him."