Roger Worthington, P.C.

Gloria Serrins is a 54 year-old mother of three beautiful daughters who lives in Mission Viejo with her husband, Phil, to whom she has been married for 31 years. Outgoing, vivacious, and completely dedicated to her family, Gloria now finds herself in a scenario that on one could have predicted.

In July, 2007 Gloria realized that something was wrong with her health. Vigorous, athletic, and normally full of energy, she could feel that something was out of synch, but didn’t know what it was. At first Gloria thought it might be the flu, but that didn’t explain the constant discomfort she felt whenever she was seated.

The discomfort caused her to fidget, and ultimately to have problems sleeping. Since Gloria always slept on her right side, it was too painful to lie down.

Trouble in paradise

Gloria and Phil were approaching their 31st wedding anniversary and he had set up a cruise to Alaska. Normally engaged and excited to be doing things with “the love of her life,” Gloria simply couldn’t muster any excitement about being away from home. The trip was extremely important to Phil so that they could celebrate their marriage, and also because Phil’s father had died at an early age after a lifetime of hard work. “I made up my mind early on that I’d take those extra minutes, hours, and days to be with my family. I miss my father every single day, and vowed that the only thing we really have in life—time—I would share with Gloria and the girls.”

Phil Serrins adores his wife, and he had sacrificed an 80-hour week career track to lead a lifestyle that would let him be there for them. Whether it was the school play, a family weekend trip, or traveling for soccer games, Phil and Gloria pulled together for thirty-one years, always in the same direction, always with the same goals in mind, always bound together by love.

Gloria vowed not to say anything to Phil about the pain because she knew that if he had any inkling, he would cancel the cruise and have her in front of a doctor immediately. The cruise was terrible, with Gloria’s discomfort descending into misery, compounded by an inability to sleep more than a couple of hours each night. Gloria was still afraid to say anything because Phil had developed a pain in his right eye during the trip and she was petrified that they would both be sick at the same time. Unable to withstand the pain any longer, she told Phil when they returned to California, after having endured almost unbearable pain and sleep deprivation on an ocean-bound cruise.

Web detective

Just as she had known he would, Phil whisked Gloria to St. Joseph’s, where a CT scan, MRI, and x-ray revealed spots on her lung. Dr. Brian Palafox was unable to conclusively diagnose, so Phil took charge. He got on the Internet and began consulting with doctors who he knew through his chiropractic practice.

Dr. Palafox affirmed that the only way to get a conclusive diagnosis was via a tissue biopsy. On Oct. 15 Gloria went in for surgery and, and the surgeon performed the biopsy and a talc pleurodesis. Subsequent immunohistochemical staining confirmed mesothelioma, biphasic type. When the Serrins learned that the oncologist recommended by Dr. Palafox only saw one mesothelioma case per year, they decided to continue looking.

Gloria was diagnosed with bi-phasic pleural mesothelioma on October 16, 2007.

Following her diagnosis, Gloria consulted with Dr. Cameron in Los Angeles, and Dr. Rusch and Dr. Pass in New York. All three surgeons determined that Gloria as not a candidate for surgery because of the cell type and advanced stage of her disease. Gloria began treating with one of the nation’s leading medical oncologists, Dr. Vogelzang at the Nevada Caner Institute in Las Vegas.

Despite an aggressive and arduous regimen of chemotherapy, Gloria consulted with Dr. Cameron again after her doctors determined that the Alimta/cisplatin regimen was not working. Unfortunately, she was still ineligible for surgery. Although a different chemo cocktail showed no progression of the tumor, it failed to show that the tumor had shrunk, either.

Chemotherapy has been discontinued, and five weeks from now she will do another CT scan to look into additional treatment. Gloria is struggling her hardest to keep the cancer at bay.

An American family

Gloria was born in 1953 in Goeppening, Germany, the daughter of a U.S. WWII army veteran and a German national. Her father, Francisco “Frank” Carillo, brought the family to the U.S. that same year, and the family relocated in southern California.

Gloria and Phil’s first daughter, Ricki-Ann, was born in1980. The family moved to Mission Viejo because Phil was studying to be a chiropractor. Gloria and Phil’s second daughter, Stacy, was born in 1981, and their daughter Lindsey was born in 1984. After Lindsey’s birth, Gloria became a full time housewife.

The dynamic and loving Serrins family has been built in large part by the unstinting love and devotion of Gloria. The unique character of each daughter was carefully nurtured so that each grew up to be a mature and responsible adult. Ricki-Ann loved being outside, and never played with dolls but liked sports, bikes, and action. Ricki-Ann played little league baseball as the only girl on her team, and later became an accomplished soccer player. Stacy loved play with Gloria’s jewelry, makeup, and clothing. At age three she entered dance school, and learned tap and ballet. Gloria would drive Ricki-Ann to soccer practice and Stacy to dance class and had to coordinate the transportation so no time was wasted. Stacy danced until she was twelve. The family never missed going to one of Stacy’s recitals.

Like her older sisters, Lindsey was always busy with sports and dance, and Gloria spent all her time taking care of the three girls. Gloria would volunteer at the girls’ elementary school until eventually she was at the school every single day. With three daughters at the same school at the same time, she helped the teachers any way she could. Gloria took care of other children as well, and when she became familiar with the kids and their parents she’d set aside Friday as the day to take her daughters and their friends to lunch at Taco Bell. The kids loved having Gloria in the classroom, and Phil would often come by the school on his lunch break. The daughters loved having their parents around at school.
Ricki-Ann graduated from the University of Maryland on a soccer scholarship.

Ricki-Ann is an assistant soccer coach at Tulane University in New Orleans. Stacy attended Santa Barbara City College where she studied art and dance. Stacy graduated from beauty college and works as an esthetician at the Montage Resort at Laguna Beach. Lindsey was recruited to UCLA for their crew team, and graduated in 2005 as a history major. She now works as an elementary school teacher in New Orleans, near her older sister. All three daughters attribute their success to their nurturing, involved, and tireless mother. Gloria’s devotion and dedication to her family, and her extraordinary toughness, are exemplified best when she says, with no trace of pride, “All three of my girls were natural childbirths. I didn’t want it any other way.”

After thirty-one years of marriage, Gloria and Phil have grown together spiritually and emotionally. They both love to garden and spend their weekends together in the yard. With numerous flowers in the yard, the centerpiece is Gloria’s rose garden. Gloria loves crafts, decorating, wildlife, and dogs. She has a blue-gold macaw that chatters gregariously in their home, and two Australian shepherds, Berkeley and Mac. She and Phil love to take their daily promenade around the neighborhood, and they enjoy walking along the nearby nature trails and wilderness areas.

“Gloria always kept things in check and kept me on track,” Phil says in disbelief, shaking his head at the catastrophic calamity that has befallen his family. “She was the one who was reasoned and even-handed with the kids. She never rushes to judgment or breezes past things. Gloria sees life, where most people just run through it. If she’s on skis, she won’t race down the mountain, but will stop and look at the trees and the animals, and even at the snow. We go to movies all the time. While the kids were growing up it was about Gloria being there to see them and raise them. We went to every school function, not just to be supportive but to be together. And now…” his voice trails off, “…this.”

This was written by Lois Schwarting, regarding her husband’s experience with Alimta/cisplatin chemotherapy for his mesothelioma.

Marty got Alimta/cisplatin. Carboplatin is a little bit easier on the body, or at least easier on the kidneys. Here’s some things to do to prepare for the chemos! If your husband has more trouble with being constipated than he does having loose stools, buy a stool softener and have ready for him. Here in the states we can easily get Dulcolax and that is what Marty uses.

Now, with Alimta Marty was to take folic acid something like 600 to 1000 mcg or 1 mg each day for one week prior to chemo. We bought 400 mcg tablets at COSTCO–anyhow, he took one tab in a.m. and one tab in evening since two to take for good dosage. I have decided to scan his calendar for last May (2007) and you can see how I marked calendar so be sure to have him taking his meds properly! Guess better to know what your husband is going to be given as chemo b4 tellyouwhat all….

Ah! Anyhow, using Alimta/cisplatin…Day before, day of and day after chemo - dexamethasone to be taken twice day. Day following chemo go back to doc office for Neulasta shot (this is to increase white blood cells to help fight off any infection or bacteria from ANYTHING - because the chemo is hopefully going to destroy all cells, including cancer ones, but it is not “smart enough” to detect the good red and white cells are needed so destroys them too. So, reason for the Neulasta and also the B12 shots the doc will give you as necessary! Anyhow the Neulasta shot can cause bone pain and/or body rash or itching, so we were told to buy over-the-counter Claritin D & Aleve and Marty was to take one tablet of each after receiving the Neulasta shot - we bought on way home and he swallowed them with water when we got home. He took one of each of those tablets the day of the Neulasta shot and one of each tab on all three days following. Marty did not have any bone pain, and he did not have any rash. Some times he would have some itching, but slight.

To begin with, Marty had his chemo on Thursday. One week we switched it to Friday, and so he went back for his Neulasta shot on Monday, and it didn’t seem to make any difference.

Now, on the calendar, you will see where I had written blood draw on Wednesdays. That is because he was to have his blood drawn the day prior to chemo infusion. If his blood counts were too low, the doctor would not have given him chemo the next day. However, he never had that problem and always was able to get the chemo every 21 days until he had a total of 7 infusions.

Marty was released from hospital, Mar 9, 2007.

On Mar 14, 2007 he went to doctor office and agreed to chemo and we were told which meds used and given Rx for dexamethasone. Marty was given a B12 shot and we were told to get the folic acid and he was to start on that the same day so he would be on it for one week prior to chemo. (also, be aware that ALWAYS schedule and plan to take Folic Acid (FA on my calendar notes) every day and mark out at least 21 days from the day of chemo — NO MATTER WHAT… Because even at the end of chemotherapy, the patients are to take folic acid for 21 days following last Alimta chemo treatment.

Be sure you have a prescription for compazine (brand name) was given for nausea - JUST IN CASE! We got that filled, as well. Oh, note that I wrote compazine on the days of chemo as well as the day following chemo. YOU DO NOT WANT TO WAIT UNTIL NAUSEA SETS IN AND THEN TRY TO FIGHT IT. TRY TO WARD IT OFF BY TAKING THE COMPAZINE AFTER YOU GET HOME THE DAY OF CHEMO, AND TAKE EVERY 4 HOURS TIL BEDTIME. NEXT A.M. start the day off with compazine and continue every 4 hours. If not trouble with nausea, could discontinue taking it.
Ask for a prescription of Ondansetron Orally Disintegrating Tablets (ODT) - they are a bit expensive and may have to get prior approval by insurance. We had to! I’d actually gotten these before we were to go on a cruise in case Marty might have problems with nausea even though would be off chemo by then. We happened to have in the house already when he got the “dry heaves” and I gave him a tablet and it stopped the dry heaves RIGHT NOW! YEP, RIGHT NOW IT WORKS!

FOOD: I made puddings and soups and gravy with WHOLE MILK (not less fat or fat free) and even used HALF & HALF. I tried whipping cream but it was so rich and thick it was yuck or not good! The texture more like ice cream! Anyhow, I hope you like to make home made food, Marjory. If so, cook lots of fresh vegetables and protein foods. It is better for your husband to eat small portions several times a day — try to get him to eat every 3 hours or so. Use plastic sandwich bags or some small containers to freeze little “meals” for your husband to eat “on demand”…. if you have food put away in the freezer from each meal you cook, you can say: “I have ________, _________, ___________ and __________ tell me which one you want! Then, you can just reheat and give him a meal.” At first Marty liked sweets, and I’d made triple batches of strawberry/rhubarb cobbler and would freeze packages of it. I’d make puddings. Bought all kinds of fresh fruits. Had bought Ensure for him. After his second chemo he no longer wanted to eat sweets - the “taste buds” on the tongue are affected by chemo! He liked salty foods! Like pork roast cooked with sauerkraut. Dill pickles.

He has ALWAYS wanted to eat eggs and though you will read to make sure you cook the eggs until they are “hard” we did not abide by that!

If your husband likes deviled eggs (cut the hard-boiled egg in half, scrape out the yolk and mix with “stuff” then place back in the hard-cooked white of the egg) - fix some of them for him. At first I would mix the yolk with mayonnaise and little bit of mustard and maybe bit of chopped onion for more flavor. When he wanted “salty” or “sour” type, then I would add some vinegar to the yolk.

Anyhow, EVERY SINGLE MORNING SINCE CANCER WAS DIAGNOSED, I have fixed him two eggs “over easy” (with the yolk still runny), two slices of bacon, one slice of wheat bread, and gravy made with milk or half and half and the bacon drippings. He has ALWAYS LIKED THAT. Before cancer I did not cook breakfast for him. I worked and he often times would not even eat breakfast. Since “Mr. Meso” breakfast is his FAVORITE MEAL of the day, and so I always fix it for him about 1/2 hour after he awakens.

For a full profile on Marty and Lois, click here.

David Theobold is a 50 year-old machinist supervisor who works in Anaheim, California. An affable Englishman with an infectious smile and engaging manner of speech, David grew up in Sheffield and moved to California as a young man. He immediately took to the lifestyle in southern California, preferring it to the rain and clouds of his native England. Starting at the entry level in his machine shop, David worked his way up to supervisor through persistence, hard work, ability, and brains. Before long he became a citizen, never forgetting his English roots or his passion for soccer.

From childhood until a few years ago David could always be found on the soccer field, where his speed and durability made him valuable at any position. After a leg injury severely curtailed his playing time, he put more emphasis into coaching, and has become a source of expertise and authority for local players. Keeping in touch with the close-knit community of British residents in the Anaheim area, David has always been one of the first to organize events, donations, support, and outreach to his countrymen and their families in times of trouble. Click here for complete story.

San Pedro, CA - October 29, 2007

Marty Schwarting, 73, stands 6-2 and weighs 130 pounds. The mesothelioma tumor inside his chest has compressed a lung and sapped much of his physical strength, but his brilliant, alert mind and excited, dynamic way of speaking still resonate.

His wife Lois is tough, energetic, powerful, and tender, and she casts a loving glance at Marty. “We’ve just celebrated our twentieth anniversary. He’s my best friend. He’s the best friend I’ve ever had.”

“She’s always ten steps ahead,” Marty says, unable to hide his affection. “I would have died from this meso a long time ago without her.” Together this resilient couple has spared no effort to find the best possible treatment for his asbestos cancer, and they’re both holding out hope for the best.

Active, undaunted by obstacles and complications, and full of faith, Marty and Lois continue down a path that was forced upon them.

Bending with the wind, hard as steel

Mesothelioma visits itself, always as a calamity, on more than 4,000 people in the U.S. alone. The toll it takes is so much more than lost lives. It contorts families and loved ones to the breaking point.

At the age of 53 Lois went to Gateway Community College in Phoenix, Arizona and completed a one-year, eighteen-hour credit course in medical transcription, graduating with top grades and making the president’s list for academic achievement. She worked at a multi-specialty clinic for two years, before her success and decision to sign on with a nation-wide transcription service, allowing her to work as a subcontractor at home. This would end up being a blessing in their lives, giving her a detailed knowledge of medicine and of the medical system.

Lois and Marty met in mid-life while single, became friends, fell in love, and married. Their life together had extraordinary balance. An electrician who worked in home and business construction, Marty was always up early and in the winter he would make sure that Lois’s car was started and warmed before she left for work. A tremendous cook and homemaker, Lois kept Marty topped off with the freshest food, made by hand, from the heart.

It ain’t allergies, Doc

Lois’s life was about to change forever. “One day Marty complained that he was having trouble breathing, and you know what? Marty never complains. Then one day I saw him sitting down catching his breath. Marty never sits down to catch his breath. And he was only coming back from across the street where he’d just checked the mail.”

Lois finally told Marty that if he were feeling bad, he should see the doctor. That March consultation resulted in a diagnosis of allergies and perhaps an asthma condition. “It would be several months later when his life was probably saved by not having a shopping cart at Costco,” Lois says. “We were standing at the register and Marty remembered he had to go back and get a 36-pack of Pepsi. It was 500 feet to the back of that store, and he walked back without a cart because Marty could certainly carry it without a cart! He had to stop twice coming back, and he was gasping and wheezing when he got back to the register with that pop!

“It all became clear to me at that moment. My Marty was sick, and we were going to find out why and get him well.” Lois’s eyes blaze, and her mouth sets thin and hard as if in granite.

The ensuing x-ray showed Marty’s right lung completely eclipsed, floating in a mass of fluid. The pulmonologist tapped Marty on the back and it made a hollow, thumping sound. “Sounds just like a ripe watermelon, huh?” he said.

“If you say so,” Lois answered.

Running the paper gauntlet

The doctor set Marty up to go to the hospital to get the fluid drained. They drained two liters, and scheduled him to come back to drain another two liters on the following day.

The battle had just begun-the battle of the forms. The first obstacle was getting authorization for a CT scan. “They learned a different vocabulary pretty quick,” Lois says, “and ‘can’t’ wasn’t part of it.”

“I had to really bird-dog it,” Lois continues. “I had to call the CT tech at home, who fortunately I knew from church. I faxed the approval to her clinic and she got it scheduled. Otherwise, we’d still be waiting. But I have a word for things like that, when people drop into your life and help you. It’s better than a good thing. It’s a God thing.”

With an aggressive and concerned doctor on their side, one who understood the importance of speed and the rapidity with which mesothelioma advances, he got Marty in to see a surgeon right away, and Lois and Marty felt like they were finally winning the bureaucratic battle.

The surgical pathology report confirmed malignant pleural mesothelioma, but Lois was undaunted

“I was always interested in cancer,” says Lois. “When I worked at the clinic they called me the oncology queen because I always did the oncology transcriptions for the doctors. I made sure they gave me the oncology tapes, so I could keep up with the patients’ conditions.”

While in the hospital for thoracoscopic biopsy and partial pleurodesis, the Schwartings met with oncologist Dr. Jack Cavalcant of Desert Oncology in Mesa, Arizona. He currently has a mesothelioma patient who has survived for three years since diagnosis. (She still lives! )

Lois talked to Dr. Cavalcant at their consultation and said, “Surely you see how thin Marty is,” wondering if Marty would be able to withstand the chemotherapy.

Dr. Cavalcant was a good judge of men. “He has a strong, powerful body for his size, and a tough, tough spirit. He’ll get through it just fine.”

After draining more fluid and discharging Marty to home on March 9, they scheduled their first chemotherapy treatment for March 22.

“As soon as he was diagnosed I started Googling,” says Lois. “I saw that after diagnosis people typically live 4 to 12 months. I kept searching, and found Ron Simkins’s story, and read it. I called Janet, his wife, to see if she would talk. Janet answered the phone. I told her that I’d just found out that Marty had meso and that I was calling her because of her husband’s story on the Internet. We talked for a long, long time. She referred me right away to ACOR and to MARF.”

Hard landing

Lois reflects on the importance of the Internet. “There’s a lot of information out there on mesothelioma, lots of it good and useful. Even if you don’t have a background in medicine, you can sift through the material and come up with information you need to help make some of these tough decisions.”

Lois’s pragmatism is checked for a moment as she runs it all through her mind again, at light speed, for the millionth time today. Then she’s back.

After chemo Marty would sleep but only doze, mostly in the recliner. His only movement was walking to the restroom, dinner table, or back to the bedroom. Some days he couldn’t so much as cross the street to get the mail.

Marty reflects on his situation, and breaks in, his clear, articulate speech grasping the various threads of cancer, of chemo, of his relationship, of his changed state. “Chemo knocks everything out of you. I’m not capable of doing the things I used to do but don’t want to give up doing them. It’s hard. I took care of everything.”

Lois follows his train of thought. “He resents anyone doing his work. Marty used to do everything, fix everything.”

“That’s what makes you so distraught,” Marty agrees. “I get forced out by lack of stamina and strength.”

Then the radiologist’s office calls to set up an appointment, calling Lois to her battle station. She rattles off ½ dozen medications, his exact weight, contraindications, and quizzes the caller about various items. She calendars the appointment, confirms the pick up time for the contrast, finds out when to ingest it and whether he should eat before the appointment, then reconfirms everything. Twice. “It helps when you speak their language,” she says with a smile.

Brave new world

“I’m interacting with doctors and their staff all the time. I call them if they’re not responsive, change them if they’re not putting us first or doing everything they can. One of our friends we met through ACOR told me about Dr. Vogelzang in Las Vegas. He’s a fine man and a brilliant doctor. He returned 24 e-mails on a Sunday-24! Marty wasn’t a candidate for surgery because the cancer had already invaded his chest wall, but we felt it was really worthwhile doing a consultation with Dr. Vogelzang.”

After seven cycles of chemotherapy over twenty-one weeks, Marty has been through a lot. “Days 3-10 after the chemo I’m a basket case. My fifth and sixth chemos were the ones that zapped me the worst. No energy, in a daze, in a fog. I’d tell anybody facing this cancer to be prepared for the down cycle. Because it’s coming. You start feeling good, then you get beat down again. It’s cumulative after a while.”

Food is crucial, Lois adds. Simple, delicious, fresh, and homemade food is another part of this complex anti-cancer equation, arming the body with nutrients, vitamins, and calories so that it can tolerate the chemo and fight back against the tumor. “I keep a freezer full of easy, quick foods that I’ve prepared so he can have good food on demand! Chemo kills his appetite, so when he’s ready to eat there’s got to be something right then, right there.”

Lois adds, “It’s simple, but you can make a difference in cancer treatment by focusing on healthy food. You’ll tolerate the treatment better, feel better, and have a stronger body with which to fight the cancer.”

Keeping the future alive and bright

Shortly after his diagnosis, Lois and Marty, undaunted, followed through on their long awaited 14-day cruise/tour to Alaska. It was Marty’s dream.

The next trip will be to Ft. Lauderdale and Hollywood, Florida, to visit two of Marty’s high-school buddies from Long Island. “We keep planning. You have to have something to shoot for.”

“When people get diagnosed with mesothelioma, they are overwhelmed,” says Lois. “But they don’t have to be. The Internet, and meso support groups out there can provide information and resources. Ask questions, be confident, trust your judgment. If you like a doctor, work with him. If you don’t, switch. The hardest thing about meso is that it tries to tell you that you’re not in control of your destiny. But you are. You just have to wrench it back.

Lois is preparing to run by her daughter’s house and drop off some things. Since it will be rush hour in Phoenix on the way home, she and Marty will enjoy a round-about detour, traveling through the desert and along a canyon route they’ve not driven since before meso. “We’ll soldier on,” Lois says. “We’ll take it one day at a time, and enjoy each day, each hour, each minute that we’re together.”

Marty smiles and squeezes her hand. Their eyes meet, and you know they’ll never give up.

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All Systems Go!

In one hour, 68 year-old Kermit Kelley was about to undergo life-altering surgery. It was nine a.m. in the pre-op staging area at UCLA’s David Geffen School of Medicine. A steady stream of nurses and doctors had been visiting Kermit since seven o’clock, hooking him up to this, inserting that.

Since his diagnosis with malignant mesothelioma in July, 2007, Kermit and his wife Kerry had pored over the medical literature. They asked all the questions: Should he have chemotherapy? If so, when—before surgery or after? Should he even have surgery? If so, what surgery? The extra-pleural pneumonectomy (EPP), in which the diaphragm, tumor and lung are amputated? Or the pleurectomy/decortication (P/D), in which the doctor removes only the tumor and spares the lung?

Sifting for a solution

The answers were not clear cut. “We knew that lots of doctors liked the EPP,” said Kerry. “But we hated the idea of losing Kermit’s lung. Why take out the lung if it’s healthy and free from cancer? It just didn’t make any sense.”

Bring it on! Kermit Kelley and wife Kerry await final instructions before surgery. UCLA’s David Geffen School of Medicine, September 27, 2007.

The Kelleys learned that the EPP was widely considered to be the surgical standard of care. “Sure, it’s the standard,” said Kerry. “But what does that mean? The standard for every breast cancer used to be a radical mastectomy, and now we know how wrongheaded that was. I’m no doctor, but I’ve got common sense, and some things just don’t feel right.”

They knew that neither operation would cure Kermit’s mesothelioma. Both operations, even if performed by a world-class surgeon like Dr. Cameron, would leave microscopic malignant cancer cells in the chest cavity. They learned that recurrence was virtually certain, that it was a matter of “when” rather than a matter of “if.”

“Then we found out that the EPP can sometimes actually speed up the spread of the disease. That really scared us. Why would we do a surgery that takes away a healthy lung and helps the cancer grow in other parts of his body? It didn’t add up.”

The Kelleys were troubled that if they had the EPP, the risk of cancer spreading might increase, since the surgeon typically removes the entire diaphragm, a cutting process which can create holes through which malignant cells metastasize elsewhere by spilling into the peritoneum.

Since the tumor’s recurrence is a virtual certainty, what if it cropped up in the only good lung after the other lung had been removed? What then? The evidence began to tilt in favor of Dr. Cameron’s pleurectomy/decortication.

Straight talk

The Kelleys consulted with Dr. Robert Cameron, director of the Mesothelioma Program at UCLA.

“I liked him right away,” said Kermit. “Forthright. No sugar-coating. Compassionate. Objective. A man you can respect after the first five words come out of his mouth.”

Encouragement: Dr. Cameron advises Kermit of test results showing the tumor had encased the lung and locked up the diaphragm. Game plan: liberate the lung, restore normal lung function.

Adds Kerry, “Dr. Cameron didn’t promise a cure or tell us that his surgery was always better than the EPP. He laid out the facts—because of all the other parts of therapy and other factors and such, you can’t scientifically say one is better than the other. But he did say he would try to buy us some time.”

If the surgery succeeded, the post-operative period would allow them to also pursue complementary therapies such as immunotherapy with interferon alpha. Dr. Cameron explained that the published survival data did not clearly favor the EPP over the pleurectomy. He advised that more articles were being published that questioned the presumed merits of the EPP over the P/D, much as surgeons years ago began to question and later discard the strategy of performing a radical mastectomy for every breast cancer.

The Kelleys were also impressed with quality of life issues after the surgery. “I’ve got a good heart, but I was concerned about putting more stress on my ticker if I only had one lung,” Kermit said.

Kermit, a career water works contractor in the public and private sector for over thirty years, knew the value of hard work. “Sometimes doing the job right means working harder and longer. You know that on the job site, but you don’t ever think about it like that with surgeons. You know, it’s true. Sometimes the difference between doing a good surgery is kind of like doing a good piece of carpentry, the guy who is more patient and has more experience and knows his tools better and knows his wood better is the guy who does the better job. You don’t think of working on a lung the same as working on a cabinet, but I suppose when you get down to it, maybe it is.”

Search and destroy: Dr. Cameron (R) and Dr. Peng (L) opening the chest. The thick rind of tumor was immediately evident.

The Kelleys learned that the EPP was a simpler procedure that took 3-4 hours, whereas Dr. Cameron’s surgery was more complicated, and often took 4-9 hours, depending on whether the tumor had invaded the chest wall, heart sac, or diaphragm. Kermit read that each procedure cost about the same, but that Medicare paid the surgeon more for the easier EPP than for the longer, more arduous P/D.

Crossing the Rubicon

“That did it for me,” Kermit said. “Dr. Cameron is willing to work twice as long for less money because he believes the pleurectomy is the way to go. If I’m going to let a doctor stick his hands into my chest, I want the hands of a skilled craftsmen who’s not afraid of hard work. That’s how I was raised.”

Kermit decided that he could more effectively pursue the healing process with two healthy lungs rather than one, quarterbacked by a doctor who was not afraid of a hard day’s work, who was an expert surgeon, and who was committed to helping his patient from start to finish. “I didn’t want a surgeon who would cut and run. I know this is a long haul. I wanted a doctor who would help us with options after surgery.”

Adds Kerry: “We believe it all came down to quality of life. With two healthy lungs he has a better chance of recovering from the surgery and has a better chance of living a high quality of life.

A tumor that slowly suffocates

Thoracic surgery is one of the surgical specialties whose practitioners are often regarded with awe. These are the men and women who operate on and around the heart and lungs, the organs that more than any except the brain symbolize humanity and life. The P/D begins by cutting open the chest, clipping out a rib, and spreading open the chest wall.

In a healthy person, such a procedure would reveal the lung and diaphragm, working together to pump air into the oxygen-hungry body. But in Kermit’s case, the open chest revealed a smooth, red, thick rubbery blanket that encased the entire lung and stuck like cement to the chest wall.

The massive mesothelioma tumor had grown around his lung, compressed it, and finally collapsed it. He had only one lung working now, and the void in his chest testified to the power and destructive force of the relentless tumor.

Stripping away the serpent

Dr. Cameron first explored the extent of the tumor with his hand, inserting it into Kermit’s chest. Although the PET scan had depicted the tumor as small to moderately sized, reality proved far different. As it slowly strangled his lung, the cancer had also latched onto the lining of his heart and his diaphragm. Inveigling itself with a complex network of veins and arteries, the giant tumor had positioned itself so that removing it might be more dangerous than leaving it alone.

The devil by its horns: After stripping the tumor off the chest wall and lung apex, Dr. Cameron holds a flap of tumor. Fours hours to go.

It became clear in an instant why so many surgeons prefer the EPP and eschew the P/D: patience and skill. Working the tenacious and deadly tumor away from the organs and arteries had to be done millimeter by millimeter. The patience, concentration, and methodical repetition required to strip away the cancerous blanket are monumental. It takes all of that, plus nimble fingers, which are probably the surgeon’s best tumor-stripping device.

Uncertainty was another factor. What if after all the hard work of chiseling the tumor off the chest wall and diaphragm it turned out the tumor had trespassed – i.e., contaminated – the actual lung lobes? If the surgeon simply amputated the entire tumor-encoated lung, without daring to strip it off, and it later turned out the lungs were tumor free, well, by that time it would be too late. More risk, more tedious labor were the only certainties. But, with all big risks comes great pay-offs.

Dr. Cameron’s legendary stamina was evident after the first few hours passed. Never leaving his patient’s side for even a second, he carefully and laboriously performed his delicate work. As other members of the surgical team finally succumbed to fatigue or shift’s end, Dr. Cameron remained at the helm of his ship, calmly, patiently, firmly guiding the hulk of his surgical team to its final destination: peeling away the cancer within

Dr. Richard Peng, an enormously talented young surgeon from Orange County, worked in tandem with Dr. Cameron, following his guidance and working with extraordinary care and precision within the narrow confines of the chest cavity. Dexterously using his surgical tools as he sutured together a patch of bovine diaphragm to replace the pieces of diaphragm lost to the tumor, Dr. Peng displayed the same level of focus and complete absorption as his mentor. They had to, as stripping away tumor off of a 2 mm thick sheet of muscle is like cutting glue from the surface of a balloon without puncturing it. Dr. Cameron and Dr. Peng were well aware of the risks of nicking the diaphragm and thus providing a portal through which the malignant cells could travel to the gut.

Out, out!: Dr. Cameron holds the thick, rubbery tumor after meticulously scraping it off the thin diaphragm muscle.

The beating heart

Kermit’s tumor, however, had decided to throw Dr. Cameron a curve. In addition to its insidious growth along the lung and diaphragm, it had snaked its way up to the pericardium, the delicate sac that encloses the human heart. Removing the tumor without damaging the pericardium was crucial to keeping the cancer off of the heart. In a worst-case scenario a patient can live with only one lung—the same can obviously not be said for the heart.

By now the operation was six hours long, and at a time when most people would collapse simply from having to stand in one place for so long, Dr. Cameron was just as focused and fresh as the moment he’d begun—never mind that he had left the operating room the prior evening at midnight. Never moving from his patient’s side, he and Dr. Peng carefully began what can only be described as a procedure that is delicate beyond belief.

The attempt succeeded, and the heart was safe.

The home stretch

A full seven hours into the surgery, Dr. Cameron moved to the final part of the operation: removing the tumor from the lung itself. This part of the surgery has often been called “impossible” by experienced thoracic surgeons, since the tumor creeps down into the deep folds and fissures that separate the different lobes of the lung. With a smile, Dr. Cameron showed the “impossibility” of this aspect of the surgery, using the most sophisticated and delicate instrument ever created: his index finger.

Gently moving his finger into the fissures, he easily lifted out the tumor. Soon enough the entire cancer was peeled back like the diseased rind of an orange and removed from Kermit’s chest. Beneath the cancerous blanket lay a big, pink, healthy lung, waiting to step up in its lifelong service to the body’s blood. With a twist of the anesthesiologist’s knob that poured life-giving oxygen into the collapsed lung, the lung filled with air and swelled up to recapture its former space within the chest.

Dr. Cameron watched for a moment, and then said with a smile, “Look at that. A perfectly good lung. Why would anyone want to cut that out and throw it away? I think it looks pretty good right where it is.”

Let my lung breathe!: Dr. Peng holding the tumor while Dr. Cameron peels the tumor from the lung.

About nine hours after opening up Kermit’s chest, Dr. Cameron and Dr. Peng removed the four-pound tumor in one piece from the cleaned up chest cavity. “Fruits of their labor?” Not exactly. The fruit of their labor was still inside Kermit’s chest, where it belonged, a pink plum of a human lung, ready to return to action. Not a bad pay-off for a few extra hours of hard labor, especially for Kermit and his family.

Mesothelioma patients giving back

Kermit’s desire to educate patients, doctors, and the world about mesothelioma and its treatment is a common thread that runs among victims of asbestos poisoning. John McNamara, a mesothelioma survivor like Kermit who was also treated by Dr. Cameron, decided that he would lend a hand as well. John and his wife T.C. bought an apartment in Los Angeles, furnished it, and made it available to any mesothelioma patient seeking consultation or treatment from Dr. Cameron.

This generous donation made the Kelleys’ initial visit and surgery in Los Angeles possible. Generosity tends to spread. Like the McNamaras, the Kelleys before and after the surgery expressed their wish to help educate others about Dr. Cameron’s surgery. “We’d like others to know about the surgery,” said Kermit, who agreed to having his surgery photographed. “I don’t think of myself as either a ‘guinea pig’ or a ‘trailblazer.’ I’m just a guy who’s making the best of a bad situation. I’ve learned a few things from patients before me, and I hope to contribute my own story. “

Working together, and coordinated through the Pacific Heart, Lung, and Blood Institute, the McNamaras and Kelleys have helped turn another page in the treatment and education about this disease.

www.mesothel.com

www.rogerworthington.com

Dennis Archer was exposed to asbestos for more than 29 years while working at a power station.

But it was not until December 2005 the grandfather realised it had affected his health, when he developed a cough and was diagnosed with bilateral pleural thickening of the lungs.

He and thousands of other sufferers nationwide are now waiting to discover if they will continue to receive compensation and benefits.

“I never thought about it too much until I developed the cough,” said the 56-year-old, now a taxi driver.

“My children and wife live in constant fear that I may develop an even more serious asbestos-related illnesses like the fatal cancer mesothelioma.

“It is like living with a whole range of potential death sentences.”

Full story here.

Information about mesothelioma medical and legal options provided by the Law Office of Roger G. Worthington, P.C., www.mesothel.com.