Mon, Feb 4, 2019 at 08:01 PM

New physician and the latest technology lead to good-news diagnosis

Raymond Cox is glad Dr. Benjamin Shepard is on the medical staff at Marshall Medical.

You may have read this story in local newspapers over the holidays - a "good news" story we're glad to share here. 

When Raymond Cox believed he had pancreatic cancer with only months to live, he accepted his pending death as God’s will for him. But when Dr. Benjamin Shepard dug deeper to find an accurate – and far less fatal - diagnosis surprised him with the hope of long life, he was thankful to live. 

“I had prepared myself that I was going to pass away,” Cox said. “I think he is an awesome doctor.”

Instead of confirming the bad news, Dr. Shepard called to give his patient a surprising diagnosis of autoimmune pancreatitis, an incredibly rare but very treatable condition. 

“I was able to call him and the first thing I said to him was, ‘Raymond, you can put your Christmas tree up this year,’” Dr. Shepard recalled saying in December. “I was really happy about that. I don’t get to make that many of those kinds of phone calls. Most of the phone calls I make are telling folks they have cancer, unfortunately.”

Cox, a truck driver for 30 years, began losing weight and falling earlier in 2018. Very yellow with jaundice when he went for blood work, he was sent straight to the hospital. A CT scan didn’t show anything on his pancreas and only dilated bile ducts in the liver. An appointment was made with Dr. Shepard, a gastroenterologist with a background in cancer care. 

“We kind of knew we were in trouble,” said Cox’s wife of 48 years, Judy.

Dr. Shepard determined Cox had painless jaundice, which he said usually indicates pancreatic cancer in anyone over 50. Because of complications in the bile duct and concerns about the pancreas, Dr. Shepard took a look at the mass with an endoscopic ultrasound, a new technology recently added at Marshall Medical.

‘It didn’t look good because it was encasing an artery,” he said. “That’s not what you want to see.”

He biopsied the 28-millimeter mass and put a stent in the bile duct. 

Didn't look good

“I told him it didn’t look good,” said Dr. Shepard. 

Unexpectedly, the pathology came back negative for cancer. Both Dr. Shepard and Pathologist Dr. James Lee were left scratching their heads. Knowing there were a few conditions that could masquerade as pancreatic cancer, Dr. Shepard decided to bring Cox back for further testing. 

“All of those other things are much better than pancreatic cancer,” he said. “They are very, very rare.”

One is autoimmune pancreatitis, which occurs in only three in 100,000 people, and only 10 percent of that number would also have a bile duct involvement. When Dr. Shepard tested for that, the results were off the charts. 

Autoimmune pancreatitis is difficult to diagnose because its symptoms are very similar to those of pancreatic cancer. It requires a test for elevated levels of an immunoglobulin called IgG4, produced by the immune system.

Dr. Shepard used larger needles for the second biopsy and got more tissue so the pathologist could use a stain necessary for diagnosis.

“I have to credit Dr. Lee because this is difficult to get a good lab specimen on,” he said. “He put the IgG4 stain on it and it lit up. It was very typical of that diagnosis and disease process.”

It was the first time Dr. Shepard had ever seen autoimmune pancreatitis in a patient.

“It’s incredibly rare,” he said. “I’ve looked for it many times. We always hope to see it. I’ve always wanted to diagnose it because it’s way better than the above. This, in light of what he could have, is a gift. It’s treatable with steroids. It’s not a fatal disease.” 

An autoimmune disease like lupus and rheumatoid arthritis, the condition would make someone very sick without treatment. An inflammatory disease will continue to worsen, causing fatigue and continuing jaundice.

“I’m really happy for him” Dr. Shepard said. “I’m really happy for his wife and his family.”

Relief in a big way

The Coxes, naturally, were extremely relieved. 

“We were very joyful,” Judy said. “We just kept our faith and put our trust in Dr. Shepard.”

She praised the physician who personally called her husband almost every day through the ordeal. 

“Whoever was instrumental in bringing him here gave this area a blessing,” she said. 

John Anderson, administrator at Marshall South, commended the work of Dr. Lee and Dr. Shepard, both of whom were hired within the past two years. He noted the financial investments made to equip Dr. Shepard to make breakthrough diagnoses such as this one. You can read more at this technology in this recent issue of HealthConnections.

“He brought the expertise with him so we bought the equipment to allow him to use it,” Anderson said. “We are all very happy for Mr. Cox and his family in getting the wonderful news.”

The Coxes are not convinced another doctor would have done or would have been able to do what Dr. Shepard did. 

“He went the extra mile,” she said. “He was excited to get to give us good news instead of bad. 

Cox now believes there is a divine reason for his death sentence being overturned, even though he said he was looking forward to a reunion with the couple’s deceased son and only child, Jody. 

“I was fortunate to be put there with Dr. Shepard,” he said. 

For his part, Dr. Shepard played down his role in the happy ending. 

“They’re giving me a lot of credit but I’m just doing my job.”