Linda and James Louis
Linda Louis first went to the emergency room at Swedish Hospital Medical
Center in Seattle, Washington in October of 1997 because she was having
chest pains and difficulty breathing. She was diagnosed, incredibly, with
asbestosis -- although she was never a construction worker. In November,
she went to the First Hill Medical Diagnostic Imaging where she had CT
scans of the chest, pelvic and abdomen. The doctors found an abnormality
that was suspicious for an active disease process, including neoplasm.
Linda's doctors recommended a pleural biopsy in order to reach a definitive
diagnosis. Dr. Muramoto, a pulmonary disease specialist at the Swedish
Hospital did a fine needle biopsy. The initial diagnosis was pleural mesothelioma.
Linda was only 46 years old. She never worked directly in a metal or buildings
trade. In view of the clinical picture, Dr. Bruce Kulander, a pathologist,
wanted second opinion. He sent the specimens to Dr. Samuel Hammar of Bremerton,
Washington for a second opinion. Dr. Hammar is widely regarded as a leading
expert on detecting asbestos related malignancies.
Dr. Hammar performed a number of tests in order to rule out mesothelioma.
All three tests revealed that the histologic appearance of the tumor was
characteristic of an infiltrating epithelial neoplasm. The immunophenotype
of the tumor was characteristic of an epithelial mesothelioma. Dr. Hammar
described the results of his evaluation as follows:
"The majority of mesotheliomas that I see in women occur in those
that have domestic bystander exposure to asbestos. In a woman who is this
young, one would have to question to see what her father or perhaps grandfather
did and whether she had any bystander exposure to asbestos while she was
a child growing up. There also are cases of idiopathic mesothelioma that
occur in women more frequently than in men. I have also seen mesotheliomas
in about six women who have smoke Kent cigarettes between 1952 and 1956
which was the time period that the cigarettes contained about 10 milligrams
in the filter which is referred to as a Micronite filter.
The other issue that always comes up in a relatively young person like
this patient is what is the treatment for mesothelioma. There is no easy
answer to that question, although in somebody this young, I think there
would be many institutions who would at least try to stage her with respect
to see if she would be a candidate for an extra pleural pneumonectomy.
I know there is a surgeon now at the University of Washington who has
teamed up with Dr. Doug Wood and is doing this type of surgery.
The other big centers in the United States that do extra pleural pneumonectomies
are the Brigham & Women's Hospital in Boston (Dr. David Sugarbaker),
Sloan-Kettering in New York City (Dr. Valeri Rusch) and at the NIH. The
surgeon at the NIH (Dr. Harvey Pass) has recently moved to Detroit Michigan
and I believe he is at Wayne State University. He is the other person
in the United States that performs this procedure. As far as I know, there
has never been a control trial to see if pleural pneumonectomy is more
effective than conservative therapy. Despite this, I have reviewed cases
on an estimated ten people who have had pleural pneumonectomies who are
alive with no evidence of disease about four years after the surgery was done.
In general, prognosis is better in women vs. men, young people vs. old
people, people that have good performance status vs. those that do not,
and people who have epithelial histology vs. those that have either mixed
histology or pure sarcomatoid mesotheliomas or pleomorphic mesotheliomas."
It was time for Linda to take action. She saw Dr. David Wood at the University
of Washington, Seattle, Washington, on January 16, 1998, for a pre-operative
evaluation. Dr.Wood ordered at CT scan. His impressions revealed a large
right sided mediastinal mass extending from the apex of the right hemithorax
to the level of the right hilum extending into the subcarinal region and
prevertebral soft tissues of the lower chest. The test indicated that
the mass crossed the midline and encircled three-quarters of the diameter
of the aorta. The tumor also appeared to encircle the mid and distal portion
of the esophagus and anteriorly displaces the distal trachea and carina.
There was no evidence of airway compression. The right subclavian artery
and vein appeared encircled by the mass. There was no evidence of subclavian
vein obstruction. The mass abutted the upper and mid-portions of the trachea,
approximately one-half of the diameter of the trachea.
On January 28, 1998, Linda had a medical consultation with Dr. Wood's
assistant who reviewed the tests that she had completed earlier in the
month. The assistant recommended against surgery because of the size of
the tumor. He suggested that they attempt to shrink the tumor with chemotherapy
and then try to remove the tumor. Dr. Wood was the team leader, however,
and Linda was prepared to follow his advice. Linda and her family waited
anxiously for the final word from Dr. Wood.
On Friday, February 6, 1998, Linda received a call from Dr. Woods at the
University of Washington Medical Center, Seattle, Washington. She had
been scheduled for surgery. Bright and early Monday morning, February
9, 1998, Linda, along with her husband, James, went to the hospital. The
surgery was scheduled for 9:00 a.m. At 2:30 p.m. they wheeled Linda into
the recovery room. Linda stayed in the critical care unit for two full
days. She slept most of the time, waking only when the nurses and doctors
came to check on her.
On Wednesday, she was given her first meal. Linda was having trouble with
constipation and she was given Mexatrait to help. That was a mistake.
She became violently ill with vomiting and diarrhea. All Wednesday night
and through Thursday she spent going back and forth to the bathroom. She
ran a fever. All of this with three (3) tubes in her arm. Because of her
reaction to the medication, she was drinking Resource, a high nutrient
The three IV's in Linda's arm are cefazolin (an antibacterial drug),
dextrose and dupanume. She states that she is getting stronger every day,
but has not yet taken the "long walk " to the end of the hall.
She was hopeful that when the doctors visited with her on Friday, February
13, 1998, they would give her permission to take the walk.
She told us that the doctors were able to remove 97% of the tumor. According
to Linda, Dr. Woods is planning to treat the other 3 % with chemotherapy
and radiation. She has been told that the surgical team was quite impressed
with her stamina and strength during the surgery. There was no irregular
heart beat or drop in blood pressure during the surgery or postoperative period.
Linda does not yet know when she will be released from the hospital, but
she is busy making plans. Her sister and other members of her family are
coming to see her this week.
Prior to her surgery, Linda shared with us her thoughts:
February 3, 1998
"I have a worried husband and daughter who are afraid of the possibility
of losing me to this asbestos cancer. My husband has been searching the
Internet bringing home article after article and he's been talking
to different people when he learns that they know something about asbestos.
Its not easy for them these days and it's not easy for me either.
I say these things because they are true. I had an everyday happy home
with laughter and smiles. When we all got together it was so good that
one of my brothers had just came to live with us to get a better job for
himself. You can't imagine how hard this was to lay something like
this on him when he arrived. So now my whole family is worrying about
me and I have 9 sisters and 2 brothers.
You know it's hard on me because I had been preparing to go to college
to get some retraining for a different job and then I wake up with chest
pains too hard too bare. So you go to the emergency room and you find
this out that something like this has happened to you. And you are in
shock and you want to know how could this happen to you when you never
work with it or around it [asbestos]. And you have been going getting
check ups regularly and why no doctor every found this in you or didn't
they care. I can't stand talking about it I find myself crying all
the time now and still trying to figure out why didn't these people
care about my life and other people lives when they manufactured this
asbestos stuff for people to work with.
I have a four year old granddaughter who I probably will not see grow up
why because somebody didn't care about people like me and our health.
Our lives have been turned up side down. I wake up sometimes at night
to find my husband watching me as I sleep because I have breathing problems.
We use to go jogging together. I can't do that any longer because
just walking from my bedroom to the kitchen has me gasping for air. I
use to run with my granddaughter racing her I can't do that anymore
or push her on her training wheel bicycle that she got last Christmas
or with her on the living room floor I can't do that anymore because
I no longer have the air in my lungs to do these things like I use to.
So once again I have to pick myself up again and this time though I am
fighting for my life. My husband and I are suppose to be looking forward
to his retirement from the Navy and planning our long trips but now we
are planning around whether I will be around when he retires. I am sad
and hurt when I look at him and he's sitting down looking like he
is in a deep thought with tears in his eyes. Then I have to think of something
funny to say to him to snap him out of his frame of thought. My husband
is usually a happy type of person and I would give anything to have that
happy guy back again. Before this we had just did a family reunion in
California with his family and his sister & brothers from Louisiana
it was great we drove down. My family has one in Florida this July coming.
Will I make it to go? I don't know. But I keep praying and I have
turn it over to God."
We are pursuing the Louis' legal action in Florida, where she was exposed
to asbestos that had contaminated her ex-husband's work clothing.
POSTED FEBRUARY 17, 1998
Mrs. Louis passed away on February 14, 2000