For Galveston retiree, compassionate cancer care close to home is key to recovery

After his wife, Carolyn, died, Charles Meyer struggled to keep going. The future had lost its luster.

He had retired from a 45-year career with a vehicle and equipment leasing company in Fort Bend County, and the couple had purchased a condo in Galveston near the seawall. But instead of sharing sunsets and beach walks with Carolyn, he was spending his late 70s grieving and seemed to have less and less energy.

"I just really couldn't function, and I didn't want to eat," Meyer said.

One day, he was sitting in his chair with his feet elevated when he noticed a problem.

"I looked down and my feet were completely yellow," he said.

A trip to the emergency room at The University of Texas Medical Branch (UTMB Health) brought more bad news.

Ampullary cancer.

"I was sort of in shock," Meyer said. "I've heard that sometimes a man passes away right after his spouse dies. And I said, 'OK, well, I guess I'm in line for that.'"

But his daughter, his sister, and Dr. Raj Vaghjiani, a UTMB surgical oncologist, encouraged him not to give up.

At their first appointment, Vaghjiani was concerned that Meyer would not be able to tolerate the required surgery to remove the tumor in his ampulla. The Whipple procedure, a long and complex operation, involves the reconnection of digestive organs after the tumor is removed. Ampullary cancer is rare and develops in a small structure where the bile duct and pancreatic duct empty into the small intestine. The ampulla envelops the bile duct, so tumors in that part of the digestive tract restrict bile flow and can cause yellow skin and eyes.

"He had lost a lot of nutrition, a lot of weight," Vaghjiani said. "I was seriously worried about him making it through. But then his daughter and sister, who are super involved, said 'You don't understand; he was hyperfunctional before this all started. So, at baseline, his health is really quite good.'"

Luckily, Meyer's biopsy results suggested he was a candidate for immunotherapy. The UTMB care team recommended beginning treatment with pembrolizumab, a drug that trains the immune system to identify and destroy cancer cells.

"The nice part about immunotherapy is that it's really well tolerated," Vaghjiani said. "So it doesn't knock the wind out of you. You can eat, and you're not losing a bunch of weight. On the whole, it's much less severe than chemotherapy."

While Meyer was undergoing immunotherapy, he also focused on nutrition, strength, and stamina. He completed weekly prehabilitation sessions with a UTMB physical therapist just minutes from home.

"Surgical prehab, in my mind, has a few components," Vaghjiani said. "Number one is activity level. I try to have patients walking as much as humanly possible. I give them a goal based on the person, but in an ideal world, everyone's walking at least a mile a day. Number two is light resistance exercises. We know that maintaining muscle mass is extremely important. So I tell patients, 'I don't need you to be a bodybuilder, but I need you to start doing some resistance exercises.' It's good for maintaining muscle mass, but you also just recover much better if you've been doing light resistance exercises."

Vaghjiani said that while prehabilitation before surgery is not a new concept, particularly in cardiology, it is becoming more common in oncology. Meyer and his family embraced the challenge.

"They tackled it; they had a diet plan and an exercise and walking plan," Vaghjiani said. "His daughter and sister were monitoring him. He hit the ground running and had a really good prehab story."

Over the next few months, Meyer regained some weight and strength and received good news from his medical team.

"Functionally, the immunotherapy completely dissolved his tumor by the time he was ready for the operation, which was outstanding," Vaghjiani said.

But Meyer still needed the Whipple surgery, and he found that recovery much more challenging.

"I think a lot of it had to do with my wife passing because life wasn't that great anyway," Meyer said. "But Dr. V is really special. He came in every day. It didn't matter - Saturday, Sunday, even Thanksgiving Day. He was great. He would not just stand over you and talk. He would sit down with you."

After a week, Meyer was miserable.

"I said, 'Doc, I don't like this. I'm ready to quit,'" Meyer said. "And he said, 'No, you've only given me one week. Give me two, and if you still feel that way, OK.'"

After two weeks, Meyer was feeling better and was discharged to recover at home.

"I was very lucky," Meyer said. "My daughter and my sister took care of me. They alternated each week. My daughter was taking leave. My sister is retired. They were with me 24/7 for about two months."

But without Dr. Vaghjiani, Meyer is not sure he would have made it through. "I feel I owe my life to Dr. V, possibly more so mentally than physically," Meyer said.

For Vaghjiani, considering the whole patient is key to a successful treatment process.

"If you are given a cancer diagnosis and then told everything you know and love in your community isn't going to help you, and that you need to travel seven hours away to a city you've never even have been to, that's hard to grapple with," Vaghjiani said.

This is especially true for patients who don't feel equipped to deal with their disease. Advanced age, poor overall health, financial concerns, and reluctance to travel can affect patients' willingness to seek treatment.

Vaghjiani sees patients at UTMB Health clinics in Angleton, Lake Jackson, League City, and Galveston and considers each patient's personal circumstances.

"Part of our mission is to make surgical oncology more accessible by being available to folks in their community. Patients are more likely to engage in their care, even if they eventually need surgery at a specialty center like Galveston, when their first meeting is in their own community," he said.

Early diagnosis can be difficult in digestive cancers because symptoms can be vague and common.

"Listen to your body when something feels wrong. Engage with your providers early," Vaghjiani said. "If you do get a diagnosis, seek out people whose values in treating your cancer align with your own. Really have that deeper conversation of, 'This is what I want out of my cancer care.' It's not just about taking the tumor out. That human connection is probably the biggest thing."

For Meyer, Vaghjiani's support was a critical asset as he dealt with the painful combination of grief and cancer. At the time of his diagnosis, he found himself dreading most days without Carolyn.

"I didn't really care about living," Meyer said. "I just decided my daughter wasn't ready to be an orphan."

Meyer emphasized the importance of each patient taking ownership of their own journey. Recovery is not linear. Mental health can be a huge challenge. Patients should listen to their doctors and then make a decision with their loved ones about how to proceed.

After such extensive treatment, patients can continue to make progress for months - even years.

"I don't dread life now," Meyer said. "I live it."