Newswise — Despite a diagnosis of stage IV pancreatic cancer and ongoing chemotherapy, Mike Levine boarded a plane this past weekend destined for Kona, Hawaii, where he will compete in one of the most grueling of physical competitions: the Ironman World Championship.

On October 14, Levine will join hundreds of other elite athletes to swim 2.4 miles, bike 112 miles and run 26.2 miles all in one day. Cheering him on will be his wife Jan, friends and Paul Fanta, MD, a pancreatic cancer expert with Moores Cancer Center at UC San Diego Health who has been treating Levine since 2016.

Unlike the other competitors, Levine will compete while enduring the side effects of chemotherapy and a Whipple procedure — a surgery that removes parts of several gastrointestinal organs in order to excise tumors of the pancreas.

“I’m excited, and I just want to get across that finish line and tell everybody out there that’s got cancer, that’s facing any debilitating disease like this, wage hope. Live your dreams,” said Levine. “You’re still alive. Just have passion about the life that you have.”

Hope can be hard to come by when a person has been diagnosed with a cancer in which just 8 percent of patients survive past five years. Pancreatic cancer is rare, compromising only 3 percent of all new cancer cases, but it is the third leading cause of cancer death in the United States. In part, this is because it is difficult to detect early.

Surgery is the only treatment option, but because of metastasis (or the spread of disease), less than 20 percent of patients are candidates for surgery. And even when surgery is successful, it only provides long-term, disease-free survival in 3 to 4 percent of patients.

Levine was first diagnosed in 2015. He had surgery, but his hope waned when the cancer returned and spread to his lungs. He and Jan began the emotional process of end-of-life planning. As they drafted a last will and testament, the pair sought a second opinion at Moores Cancer Center.

There, Fanta told the couple to plan a cruise while he worked on a new plan to treat Levine’s cancer. Within three months, Levine’s cancer responded to new treatment and the couple took a cruise to Alaska.

“Mike came here fairly short of breath. He couldn’t complete a sentence. He was coughing all the time. He had diffuse metastatic disease throughout his chest and he came to us in need of treatment,” said Fanta. “He’s done extremely well to the point where he re-discovered his sport and passion, which is participating in triathlons.”

Levine receives chemotherapy two consecutive Tuesdays, followed by a three-week break. The cycle will likely continue for the rest of his life. But so far, his body is tolerating it very well, enough that Levine trains for Ironman the day following chemotherapy.

“When the minimal side effects wear off, I feel as normal as anybody else,” said Levine. “I can go out and hammer on my bicycle. I can go out and swim two miles in the pool.”

It did not start off that way. Levine was spending most of his time on the couch feeling depressed. That all changed when friends within the San Diego triathlon community rallied behind him. They introduced Levine to 1982 women’s Ironman World Champion Kathleen McCartney.

In January, McCartney invited Levine for a spin. His return to cycling started off with a short and slow ride that required him to stop regularly to catch his breath. But a spark lit and Levine was reminded of his love of the sport. He competed in Ironman twice in the ‘80s after watching McCartney’s inspirational and dramatic win on television.

It had been more than a decade since Levine competed in a triathlon, but as he and McCartney began to ride together more often, the idea of competing one more time struck them both. Levine submitted an application to the event requesting special consideration. He was accepted and named an ambassador athlete.

To prepare, McCartney became his partner and coach. At the peak of training, Levine and McCartney were swimming six miles, cycling up to 200 miles and running as many as 35 miles per week.  

“We are kind of reinventing what training means because Mike is going somewhere where no one has ever gone before,” said McCartney. “He's a stage IV pancreatic cancer patient on chemo for life, and he's doing the Ironman this year. And so it's been very interesting trying to figure out, you know, how does one train for the Ironman when you have those challenges? Basically, what we decided is that he just needs to simply do as many hours of training as his body will allow, but every day that's a new decision and sometimes even modified while we are out training.”

McCartney, Fanta and Jan are confident in Levine’s ability. He’s ready they said.

“He's got a lot of life left in him, and he's going to do great over in Kona. He needed this. He really did. It gives him a smile. It gives him a quick step that makes him get on that bike. It makes him stand tall again,” said Jan. “What an inspiration. And he's doing it for so many other people.”