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Month: February 2014

Dealing With Grief After Losing Loved One - Mesothelioma Help

Family of Mesothelioma Patient Faces Tough Decisions

This week we continue to follow a woman who is recovering from surgery after being diagnosed with mesothelioma. She has been struggling more than expected, and the family is trying to come to terms with the extended care needed to get their loved one back on her feet. The patient is critically ill and has many medical issues that need to be managed, and her family members are feeling lost.

They remember being told something about their loved one facing potential complications from surgery, but nothing could have prepared them for all this. Serious infections, respiratory issues, and most upsetting to them, the patient is very depressed and has lost all hope. Everything is a major effort- from acknowledging her family to asking for water- and it is painful for them to watch.

When things do not go as we expect and medical decisions need to be made, the most important thing a family member can do is to listen and to keep in mind what the patient told you in the past. What are their wishes? Those difficult “what if” and “I never want xxx care” conversations are all running through your mind. It is vital at this point in your loved one’s illness, that you remember their wishes and keep the lines of communication open with your healthcare team.

Now, it is excruciating to watch their family member struggle to talk and to perform the most basic human functions and they can’t believe that she will ever get better. The truth is while some patients do recover, some may not. Recovery goals are set each day in the ICU, and measuring the patient’s progress against them is one way to assess how the patient is progressing.

In our patient’s case, after two family meetings involving the health care team, some decisions are made. After much discussion and listening and praying the family has decided to keep going with treatment and to re-evaluate in one week. Now, the family is praying for improvements in their loved one.

Although to let you realize how grave the situation is, the decision has been made not to perform CPR if her heart stops. From the medical standpoint the treatment and care is aggressive, and the medical team likes to know they have exhausted all options. From the family’s perspective, they would like to see their loved one comfortable and at rest.

Next week we will offer an update as we continue to follow this patient.

If you have questions about your mesothelioma treatment or any aspect of your mesothelioma care, please contact us.

Know more about Mesothelioma and how you can deal with it.

Chest Cold May Sign of Mesothelioma

My father has always been a very hard worker who would not stop until his projects were finished.

As long as I can remember he has worked long hours, often overtime on Saturdays, and although Sunday was his day off, he would still be busy doing some kind of repair or home improvement around the house.

It was not as if he was keeping himself busy to avoid his family, he was doing all this hard work for us. In his mind, Dad is a provider; a provider for his wife and children and he could not rest until he felt accomplished.

Even when Dad would feel sick he would refuse to miss work or even stop to go to the doctors. I remember back when he was diagnosed the first time with cancer, it took him a while to finally listen to Mom’s suggestion to go to the doctor to get the odd looking mole on his leg checked out. Same with this time around, he was not feeling well for weeks, or possibly even months since he never complained of any ailment.

It took him until he could hardly sleep at night because of his difficulty with breathing and the heaviness in his chest before he would go to the doctor. It was about a week before he went that I remember having a conversation with him about how work was going and what their yard looked like after Hurricane Sandy hit. He mentioned he was feeling like he had a chest cold that he could not kick.

He rarely would ever show weakness or even mention if he was not feeling 100 percent. He had told me that he already tried an antibiotic to get rid of his nagging ‘chest cold,’ but there was no improvement after completing his prescription. I told him maybe he needed to go back to the doctor to be tested for pneumonia or some other lung issue. He finally did, I don’t know if he took Mom’s and my advice, or if he was tired of feeling short of breath, but he finally went.

Our family doctor then admitted him to the hospital to have his lungs drained of the fluid found. At the time, I didn’t think much of his admission to the hospital, and I was denying the fact that this was anything serious. They ended up keeping him in the hospital for a few days after draining the fluid to await the biopsy results of the lung tissue and fluid. My mother had asked my brother, Adam, and me to come home. So that weekend Adam drove home from Penn State, and I drove home from Philadelphia, to see Dad with the rest of the family.

When I saw him, I could see how sick he really looked. That’s when I realized that something was up, I wasn’t sure what, but it definitely was not a chest cold. The doctor met with us that night while we were all there and explained that the biopsies showed cancer cells, but he was not sure what type of cancer. He assumed it to be melanoma that had reappeared after all these years as stage IV in the lungs. There was still more testing to be done, and samples had to be sent out for further investigation, because he wanted to rule out all other cancers.

We were devastated. We were confused. We were scared. Everything you can imagine that goes through a family members’ minds when they get this kind of news, hit us. We sat in the waiting room together: Mom, Andrew, Adam and me. We cried. We hugged. We sat in silence. We said that we would not show Dad that we were upset or weak. We had to be strong for him and what was to come.

We calmed ourselves down and went back into the hospital room that night and sat with him, making small talk and being cheerful despite the news. I remember I had some students’ papers that I had been grading while sitting there that Sunday with my family, watching football on the small hospital television screen before the doctor had come in. I got them back out and started sharing some of the funny things my students had written. It’s true what they say, “Kids say the darndest things.”

I got a little chuckle out of my parents to ease the mood and left that night to go back to Philadelphia feeling very upset, but also satisfied with that evening that we all spent together. I used to take time with my family for granted, sure that my parents would never get older or get sick. Now, I’ve realized that I should be cherishing every moment that we are all together.

The next day my father was sent home to rest for a few days before heading back to work. Later that week my parents received the phone call from the doctor with the results from the biopsies. It was NOT Stage IV melanoma. It was a cancer that we have never heard of before -it was Mesothelioma.

Check in next week for the continuation of my blog: “Where do we go from here?”

Dad's Enthusiasm For Mesothelioma Advocacy

Daughter Reflects on Life With Don Smitley

Over these past few months, I’ve been reflecting on what it was like growing up with my Dad. I had told many people that I would have rather had 30 short years with him as my father than 100 with someone else. I mean that from the bottom of my heart. My Dad was the perfect father to me.

Dad was a special kind of dad. He was fun, goofy, and never afraid to look silly to make me smile. We were watching some home movies over Christmas where Dad and I were walking our dogs. Then, I decided to walk Dad. I put the chain around his waist and drug him all over the place. Some neighbors who were outside asked him what he was doing and he just laughed and said, “I’m getting walked!” He was constantly doing things like this. When he saw that I was happy, he was happy too.

Even though I danced my whole life, Dad wanted me to try out all different sports. Not necessarily by being on an official team, but with him. We spent hours outside playing baseball, kickball, and throwing a football around. I never exceled at any of these activities, but looking back, he was trying to help me become more well-rounded (or maybe to just be able to play games with the other kids). Plus, he liked chuckling at me when I would kick as hard as I could and miss the ball completely.

We were always going on adventures together. Whether it was taking a ride in the mountains or trying to bake cookies at home, he made even the most seemingly ordinary activity special. My Mom worked late one night a week; I was never in bed on time those nights. It became a game to see if I could get ready and be “asleep” under the covers by the time she got home. We never made it.

You would think that these things would have changed a bit as I got older, but they didn’t. Every Saturday morning was our time. Mom would be at work, and we’d be off. We would go out to breakfast, shopping, up to the mountains, for ice cream, do a project at home, and visit family… all in the same day. Those days are such precious memories for me.

Dad was more than just fun. We always had the kind of relationship where we could talk about anything. I know I have said before that he gave the greatest advice of all time, but it bears repeating. No topic was off limits for us: school, work, faith, we discussed it all. He always knew exactly what to say. If he wasn’t sure, he would tell me to let him think about it and he would let me know what he came up with later. And he always did.

I could write a book or 50 about Dad and his kindness, generosity, and genuine love for life, God, and his family. He was perhaps the single most powerful influence on my life. He didn’t just tell me how to live a good life, he showed me. This is a true testament of the life of the most amazing person I’ve ever known, and I was blessed to be able to call him “Dad.”

Know more about Mesothelioma and how you can deal with it.

Jobs in Naval Shipyards That Put Civilian Workers at Risk of Mesothelioma

Civilians have worked in naval shipyards for decades – often working side by side with enlisted men and women. Many of these shipyard workers are now suffering from mesothelioma or other asbestos-related diseases. Although there are many different types of jobs in which veterans and civilian shipyard workers may have been exposed, these five are among the most common:

1. Electricians. Electricians commonly worked on naval ships installing wiring systems, fixing and upgrading existing electrical systems, replacing older fuse boxes with circuit breaker boxes and repairing electrical equipment, generators and transformers. They also installed motors on pumps, electrical wire, boxes, fuses and conduit. They also were exposed to asbestos from pumps and turbines. Electricians likely encountered asbestos that was used as insulation wrap around conduits, electrical transformers and piping as they worked in enclosed workspaces. According to the National Institute for Occupational Safety and Health, electricians are one of the largest construction trades associated with malignant mesothelioma mortality.
2. Machinists. The Navy has employed shipyard machinists for decades to work on equipment to be installed above and below deck in ships, including:
  - installing steam boilers, winches, propellers and propulsion motors
  - making gaskets and seals
  - overhauling pumps
  - overhauling valves
  - using portable grinders

The types of equipment machinists worked with produced heat and generally contained asbestos gaskets and packing. Many had asbestos coverings. Working with asbestos material generates asbestos dust. It was very common for machinists to wear aprons and gloves when handling hot materials.

Steamfitters/Pipefitters/Insulators. Pipefitters and steamfitters installed and maintained the pipe systems for propulsion and heating. They handled asbestos gaskets and seals. Insulators cut and installed asbestos insulation in bulkheads and hulls.
Painters. Professional painters worked in naval shipyards and on ships and may have been exposed to asbestos, as many of the products they used contained asbestos additives. Those include textured paints, caulks, spackling and joint compounds. They may have been exposed when sanding, scraping, taping and preparing surfaces for painting. They also worked in areas with asbestos-containing equipment including pumps and valves.
Welders. Welders were employed at naval shipyards to weld equipment and pipe. Welders may have used gloves when welding. Welding rods may have also contained asbestos. A 2010 study published in the American Journal of Industrial Medicine identified welders as among the highest risk occupations for developing mesothelioma.
Engineers. Engineers were commonly involved in the design, construction and renovation of naval ships and were often present at job sites to oversee the process. These engineers now have a higher occupational risk of contracting mesothelioma.

All of the above jobs may have exposed veterans and Navy civilian workers to asbestos and are at risk of developing mesothelioma. Veterans were likely to be exposed to asbestos as late as the 1990s – only 20 years ago.

Failure to Warn Can Make Manufacturers, Distributors & Sellers Liable

Asbestos manufacturers, distributors and sellers knew that asbestos products increased the risk of developing mesothelioma. However, they failed to warn shipyard workers about these known dangers.

This failure makes manufacturers liable for asbestos-related injuries – even if your exposure occurred 20, 40 or 60 years ago. The statute of limitations for most asbestos lawsuits doesn’t begin to toll until you discover that you’ve been injured – not when you were exposed.

Contact an experienced mesothelioma injury lawyer today to analyze your situation and determine your legal options so that you can make an informed decision about what’s right for you and your family.

Testimony of Dr. Philip Landrigan

TESTIMONY BEFORE

United States Senate
Committee on the Judiciary

by Philip J. Landrigan, MD, MSc, DIH

Professor of Occupational and Environmental Medicine
Chairman, Department of Community and Preventive Medicine
Professor of Pediatrics
The Mount Sinai School of Medicine

“A Fair and Efficient System to Resolve Claims of Victims for Bodily Injury Caused by Asbestos, and Other Purposes”

April 26, 2005

Mr. Chairman and Members of the Committee on the Judiciary,

I am pleased to appear before you today to review the impacts that asbestos has had on the health of American workers, and to discuss the legislative remedies that have been proposed for dealing with the asbestos epidemic.

My name is Philip J. Landrigan, MD, MSc, DIH. I am a physician, a board-certified specialist in occupational medicine, and Chairman of the Department of Community and Preventive Medicine in the Mount Sinai School of Medicine in New York. I am Editor-In-Chief of the American Journal of Industrial Medicine. I am President of the Collegium Ramazzini, an international scientific society in occupational and environmental medicine. I have had many years of experience of dealing with the clinical manifestations and studying the epidemiology of the diseases caused by asbestos. A copy of my biographical sketch is appended to this testimony.

The late Irving J. Selikoff, MD, the “Father of Asbestos Research in the United States”, was one of the founders of the Department that I now chair at Mount Sinai. This Department contains New York’s largest clinical facility in occupational medicine and one of the nation’s largest research and training programs in occupational health, a program that Dr. Selikoff established 30 years ago. We have been designated by the National Institute for Occupational Safety & Health (NIOSH) as the major provider of diagnostic services to the men and women who worked at Ground Zero, the site of the World Trade Center in the terrible days and weeks that followed the attacks of September 11, 2001. We have now examined over 12,000 of those workers – police officers, firefighters, construction workers, paramedics, and building cleaners. Many of them were exposed in their work to asbestos.

The testimony that I shall be presenting today reflects the collective knowledge and experience of our occupational medicine group at Mount Sinai, and most especially the thoughts of my colleague, Stephen Levin, MD, Director of the Selikoff Center for Occupational and Environmental Medicine.

The Asbestos Epidemic

Asbestos has been and continues to be an occupational and environmental hazard of catastrophic proportion. Asbestos has been responsible for over 200, 000 deaths in the United States, and it will cause millions more deaths worldwide. The profound tragedy of the asbestos epidemic is that all illnesses and deaths related to asbestos are entirely preventable.

Clinical and epidemiologic studies, many of them initiated by Dr. Selikoff at Mount Sinai, have established incontrovertibly that asbestos is a human carcinogen. All forms of asbestos are carcinogenic. Asbestos has been shown to cause cancer of the lung, malignant mesothelioma of the pleura and peritoneum, cancer of the larynx and certain gastrointestinal cancers. Asbestos also causes asbestosis, a progressive fibrotic disease of the lungs.

Asbestos has been declared a proven human carcinogen by the Environmental Protection Agency (EPA) and by the International Agency for Research on Cancer of the World Health Organization.

Asbestos and cigarette smoke are powerfully synergistic in the causation of lung cancer. Nonsmoking asbestos workers have five times the background risk of lung cancer. Smokers who have had no exposure to asbestos have 10 times the background risk of developing lung cancer. But asbestos workers who also smoke have 55 times the background risk of lung cancer. This is the classic and best-studied example in the medical literature of a synergistic interaction between two proven human carcinogens.

New use of asbestos has almost completely ended in the United States and in most other developed nations as a result of government bans and market pressures. Those forces were stimulated by the epidemiologic studies that I have noted above and by the release of information on the carcinogenicity of asbestos that previously had been suppressed by the asbestos industry. By contrast, extensive and aggressive marketing of asbestos continues in the developing world, where sales remain strong and worker protections are too often weak.

Problems with the Proposed Fairness in Asbestos Injury Resolution Act

The proposed Fairness in Asbestos Injury Resolution Act contains serious scientific problems as currently written. It creates criteria for assessing the causation of disease by asbestos that are not based on scientific evidence and that are not consistent with current knowledge in occupational medicine.

Difficulties with the proposed exposure criteria

The bill contains medically unsupported requirements for minimum duration of exposure to asbestos.

Contrary to the requirements for minimum duration of exposure set forth in the bill, there is clear evidence from carefully conducted epidemiological studies that exposures to asbestos for even one month under heavy exposure conditions can increase the risk of lung cancer two-fold and also increase the risk of death from asbestosis.

The requirement for 5 or more weighted years of exposure to asbestos to establish a diagnosis of asbestosis is not supported by scientific evidence.

Also unsupported by the published medical literature are the minimum requirements set forth in the bill of 8, 10 or 12 years of exposure for establishment of asbestos causation in a case of lung cancer.

The bill contains a medically unsupported proposal for discounting exposures to asbestos.

The bill establishes three exposure classifications:

Moderate exposure for persons who worked in areas that experienced “regular airborne emissions of asbestos fibers”,
Heavy, for persons who worked in direct installation, repair or removal of asbestos, and
Very heavy for those who worked in primary asbestos manufacturing or a WWII shipyard

Each year worked in these categories counts as 1, 2 and 4 years respectively.

However, these years of work are discounted depending on when they occurred. Every year of exposure that occurred after 1976, no matter what was the level or circumstance of occupational exposure, counts as only one half of a year. Every year of exposure that occurred after 1986 counts as only one tenth of a year.

The plan to discount exposures from 1976-1986 by half is without medical or scientific basis. Many workers had exposures during this period that were no different in intensity from those that preceded 1976.

Similarly, discounting post-1986 exposures to 1/10 the accumulated years is without medical or scientific basis. Removal or other disturbance of asbestos in place has yielded exposure levels in the past two decades that are no different from those encountered before 1986 or 1976.

It may be illustrative to see how application of this proposed discounting formula will work when applied to the situation of individual cases. It would appear, for example, that no claims for lung cancer level VII (with bilateral plaques, without asbestosis), will be paid for anyone with “moderate” exposure to asbestos prior to 1972. Or put another way, a person with lung cancer could have worked in areas with “regular airborne emissions of asbestos fibers” since 1973 and still not quality for compensation under this bill because he or she would fail to meet the substantial exposure criteria set forth in the bill.

Specifically, for lung cancer level VII (with bilateral pleural disease) a claimant would need 12 years of weighed exposure (pg 82). Only those exposures that occurred before 1976 would count at full value. If exposure for a lung cancer victim with pleural disease started in 1972, it would take 30 years of exposure to meet this 12-year exposure requirement. For every year later that the person started occupation exposure (1973, 1974 etc) it will take an extra 10 years of occupational exposure to meet the criteria for compensation in the bill. Thus a person with lung cancer and pleural plaques who began occupational exposure to asbestos in 1974 would need 52 years of work exposure (through 2025, or “until” 2026) to meet the 12-year weighted exposure criteria in the bill.

For cancers other than lung (malignant level VI) the proposed situation is still more difficult. A person with colorectal, laryngeal, esophageal, pharyngeal or stomach cancer would need 15 years of weighted occupational exposure to asbestos to qualify for compensation under this bill for any of those diseases. If all of that person’s exposure occurred after 1976 it would take 105 years to meet the criteria. This would seem an unattainable goal.

Difficulties with the proposed diagnostic criteria

The bill contains medically unsupported criteria for diagnosis of non-malignant disease.

The requirement that pleural disease be bilateral to be considered the consequence of exposure to asbestos is not warranted by medical evidence. Asbestos-related scarring often develops unevenly and almost always begins unilaterally. Miller and Lilis showed a clear relationship between degree of pleural scarring and loss of FVC independent of whether the pleural changes were bilateral.

The criteria set forth in the bill require that there be no evidence of obstructive airway disease (i.e. that the FEV1/FVC ratio be >= 0.65) in order to compensate for loss of FVC is not consistent with the medical literature. There are many cases of combined restrictive and obstructive disease in workers with airway disease and asbestos-related scarring.

The bill contains medically unsupported criteria for diagnosis of cancer

I am deeply troubled by the requirement that no lung cancer case will receive compensation without evidence of “bilateral pleural plaques, bilateral pleural thickening, or bilateral pleural calcification” (pg 82), or grade 1/0 asbestosis (pgs 83-84). In other words, lung cancer in a person who has been exposed to asbestos but who does not have asbestos-related scarring in both lungs will not be compensated, even if there is unilateral scarring/calcification. This is problematic for two reasons; one, is that many cases of lung cancer caused by asbestos occurs without any radiographic evidence of pleural plaques or asbestosis; asbestosis is not a necessary precursor to asbestos-induced lung cancer. Moreover, requiring that the damage be bilateral, has no basis in biology or medicine.

In summary, the proposed Fairness in Asbestos Injury Resolution Act establishes barriers to the diagnosis of asbestos-related disease that are arbitrary, that are not based in science, that are not based in medical knowledge, and that would appear, almost without exception, to make extremely difficult – indeed, well nigh impossible – any diagnosis of causation of disease by asbestos.

The approach to the diagnosis of disease caused by asbestos that is set forth in this bill is not consistent with the diagnostic criteria established by the American Thoracic Society. If the bill is to deliver on its promise of fairness, these criteria will need to be revised.

I shall be pleased to answer questions.

Philip J. Landrigan, M.D., M.Sc.
Chair, Department of Community and Preventive Medicine
Director, Center for Children’s Health and the Environment
Mount Sinai School of Medicine
New York, NY

Philip J. Landrigan, M.D., M.Sc. is the Ethel H. Wise Professor and Chair of the Department of Community and Preventive Medicine of the Mount Sinai School of Medicine in New York City. He holds a Professorship in Pediatrics at Mount Sinai. He directs the Mount Sinai Center for Children’s Health and the Environment. He is a board-certified specialist in pediatrics, general preventive medicine and occupational medicine.

Dr. Landrigan obtained his medical degree from the Harvard Medical School in 1967. He interned at Cleveland Metropolitan General Hospital. He completed a residency in Pediatrics at the Children’s Hospital Medical Center in Boston. In 1977, he obtained a Master of Science in occupational medicine and a Diploma of Industrial Health from the University of London.

From 1970 to 1985, Dr. Landrigan served as a commissioned officer in the United States Public Health Service. He served as an Epidemic Intelligence Service Officer and then as a medical epidemiologist with the Centers for Disease Control in Atlanta. While with CDC, Dr. Landrigan served for one year as a field epidemiologist in El Salvador and for another year in northern Nigeria.

Dr. Landrigan is an elected member of the Institute of Medicine of the National Academy of Sciences. He is Editor-in-Chief of the American Journal of Industrial Medicine and previously was Editor of Environmental Research. He has chaired committees at the National Academy of Sciences on Environmental Neurotoxicology and on Pesticides in the Diets of Infants and Children. Dr. Landrigan’s report on pesticides and children’s health was instrumental in securing passage of the Food Quality Protection Act of 1996.

In New York City, he served on the Mayor’s Advisory Committee to prevent Childhood Lead Paint Poisoning and on the Childhood Immunization Advisory Committee. He is Chair of the New York State Advisory Council on Lead Poisoning Prevention. From 1995 to 1997, Dr. Landrigan served on the Presidential Advisory Committee on Gulf War Veteran’s Illnesses. In 1997 and 1998, Dr. Landrigan served as Senior Advisor on Children’s Health to the Administrator of the U.S. Environmental Protection Agency. He was responsible at EPA for helping to establish a new Office of Children’s Health Protection.

Dr. Landrigan served from 1996 to 2005 in the Medical Corps of the United States Naval Reserve and rose to the rank of Captain. He served overseas with the Navy in London, Singapore, Korea and Ghana and was Officer-in-Charge of the West Africa Training Cruise, a medical humanitarian mission to Senegal that saw over 11,000 patients in rural West Africa in July, 2004. He has been awarded the Navy Commendation Medal (2 awards), the National Defense Service Medal, and the Secretary of Defense Medal for Outstanding Public Service.

To read more about asbestos related law in the United States information can be found here.

Sources:

Selikoff Center for Occupational and Environmental Medicine.
http://www.mountsinai.org/patient-care/service-areas/occupational-health
International Agency for Research on Cancer of the World Health Organization
http://www.iarc.fr/
American Thoracic Society
http://www.thoracic.org/