Frank Dens and granddaughter
In June of 1997, Frank Dens began to have difficulty breathing. He felt
a deep pain on his right side accompanied with a nagging, aching cough.
A chest x-ray showed a very large right pleural effusion. In fact, the
effusion filled up about two-thirds of his thoracic cavity between the
visceral and parietal pleura. Frank's doctors in Roseville, California
drained two (2) liters of fluid from his chest. Frank, at the age of 68,
and his wife Barbara were both worried.
A few days after the fluid was drained, Frank had a thoracotomy (a surgical
incision in the chest wall) so that a biopsy could be taken. His doctors
performed a pleurodesis with talc. The objective of this procedure was
to create a fibrous adhesion between the parietal and visceral pleura.
The insertion of talc into the pleural space was supposed to obliterate
the space, leaving the two linings bonded together. The talc treatment
seemed to improve Frank's breathing and pain. Unfortunately, his relief
was short-lived. The doctors advised Frank that the pathologist had determined
the cause of the effusions and the news was not good. Frank had epithelial
Frank and his family set out to learn what "mesothelioma" was
and how to fight back. The internet led Frank to a surgical oncologist
in San Francisco by the name of
Dr. David Jablons at USCF/Mt. Zion Medical Center. Dr. Jablons is a board-certified cardiothoracic
surgeon whose specialty is thoracic oncology. He trained under Dr. David
Sugarbaker at Brigham and Women's Hospital and Dr. Valeri Rusch of
Memorial Sloan Kettering. On July 15, 1997, Mr. Dens met Dr. Jablons for
the first time. Dr. Jablons was impressed with Frank's physical well-being.
Frank's pain was manageable, his weight was stable and he was otherwise
very healthy and active. His breath sounds were clear on the left and
moderately diminished throughout the right chest. His heart beat was strong
and regular. Dr. Jablons' overall assessment of Frank was that he
was in the early stages of epithelial mesothelioma, either a stage I or
stage II. Under the circumstances, this was good news, as it gave Frank
more options from which to choose.
Dr. Jablons discussed each option with Frank. At the University of California
San Francisco, they currently have a very aggressive and modern approach.
Here is a summary of their protocol. First, the surgeons perform a pleurectomy
/ decortication. Second, during surgery, the doctors administer radiotherapy.
Third, following surgery, the doctors again adminster 3-D (three-dimensional)
conformal radiotherapy. In addition, they adminster combined agent CAP
(Cytoxan, Adriamycin and Cisplatin) chemotherapy. With this multi-modal
method, an excision (cutting away) is made in the pleura (the serous membrane
around the lung) and the surface layer of the lung or part of the surface
lung tissue is removed. Layers of other organs, such as the diaphragm,
where the tumors may have invaded are also removed. During the surgery,
the disease is treated with the application of radiation therapy. The
surgeons then administer postoperative radiation and chemotherapy.
On July 22, 1997, Frank went to the Northern California P.E.T. Imaging
Center. He was given eight (8) millicuries of F-18 FDG by IV injection
and a whole body imaging was conducted thirty (30) minutes later. Two
more 30-minute scans were conducted which concentrated on the chest and
upper abdomen. The findings were favorable. They confirmed the presence
of two densities in the right lung only.
Frank met Dr. Mack Roach III, Associate Professor of Radiation Oncology
at Mt. Zion, on July 25, 1997. They discussed the plan, which called for
intraoperative radiotherapy and a three-dimensional conformal boost after
he received the pleurectomy and decortication. After reviewing the protocol
with Frank, Dr. Roach agreed that Frank was a suitable candidate. Frank
was determined to go for it.
Following his thoracotomy and talc pleurodesis, Frank was in a quasi-holding
pattern. Not exactly "homeostasis" but under the circumstances
he was doing well. Dr. Jablons decided to act quickly before Frank's
symptoms and fluid had a chance to return. They scheduled Frank Dens for
surgery on July 30, 1997. However, two days before his surgery, Frank
had a routine chest x-ray which revealed the formation of a new left pleural
effusion. Mesothelioma is like a shark that never sleeps, always feeding.
Dr. Jablons was forced to scratch the original surgery and opted for more
reconnasiance via thoracoscopy. A thoracoscopy is a diagnostic examination
of the pleural cavity done with a "telescope-like" instrument
connected to a video camera. They removed and sent specimens of serous
effusion and pleural plaque to pathology. The tumor was back, and the
tumor was advancing.
When Frank woke up, he reached over to touch the bandage, "...but
there wasn't one. I thought it was the end of the line. My wife, Barbara,
was thinking the same thing. She said that she knew I would not have a
good feeling when I found out I didn't have the operation." He
had prepared himself for the surgery. Now he would have to wait again.
Frank did not wait long. Three weeks later, in August, Frank returned to
the Dr. Jablon's operating table. They had tracked the tumor's
invasion and now were ready to fight back. After applying general anesthesia,
Dr. Jablons inserted a Foley catheter and perfomed a flexible bronchoscopy,
which allowed the doctors to look carefully inside both the left and right
lungs. Remember, Dr. Jablons had been concerned that the disease had spread
to Frank's left lung and it was mandatory that he scrutinize the left
lung for any evidence of tumors before he proceeded with the radical pleurectomy
and decortication. Dr. Jablons performed a pleurectomy / decortication
(removal of the pleura along the inner chest wall and covering of the
lung, where most of the tumors are located). It was a long and difficult
procedure. He also performed a mediastinal (in the middle) lymph node
dissection and radiated areas of visible tumor.
A day after the surgery, Frank's chest was clear and his heart showed
normal sinus rhythm with no displacement or murmurs. The doctors intended
to extubate (remove the chest tubes), place Frank on a regular diet and
move him from the ICU to the regular acute care floor.
On the second and third day, Mr. Dens continued to recuperate. The chest
tubes continued to be drained, resulting in 650 cc on day two and 430
cc on day three. A moderate air leak was detected. He got out of bed for
a short walk.
September 1, 1997, was day four of Frank's recovery. He had slightly
decreased breathing sounds on his right throughout the right lung field.
His extremities showed no clubbing, edema or cyanosis (blue, gray or purple
discoloration). An EKG presented a slightly irregular heartbeat, but Frank
assured doctors that this type of thing had happened before and that he
was under no medication to correct it. They removed the epidural catheter
and Mr. Dens was switched over to Vicodin for pain management.
Just five (5) short days from his surgery, Frank was sent home with instructions
to resume his normal activity as tolerated and to avoid heavy lifting.
Pain medications of Vicodin and Motrin were prescribed.
On September 16, 1997, Frank visited Dr. Jablons' office for a followup.
According to Dr. Jablons, Frank was doing very well and had made a strong
recovery in a short time. Frank's blood pressure was 118/68 and his
heart rate was 100. He had some discomfort surrounding the incision but
the Vicodin helped control the pain. Frank's chest x-ray showed some
moderate pleural thickening and loculated fluid collection at the base
of the right lung, but this was said to be a common side effect following
the type of surgery Frank had. One of the most impressive observations
made by Dr. Jablons was that Frank's lung was greater than 99% fully
expanded throughout the chest cavity.
Today, Frank is at home. On Tuesday, November 11, 1997, he had his last
radiation treatment. He had endured twenty-five treatments in total. He
was relieved to be at home, as he had to drive one hundred-eighty (180)
miles round trip from his home in Rocklin to San Francisco for each treatment.
According to Frank, "The worst part of the radiation treatment was
the drive through San Francisco at the peak of rush hour traffic and the
thirty to forty-five minute wait to cross the bridge." But the treatments
are not over. On November 14, 1997, Frank was scheduled to visit with
his doctor about the scheduling of his chemotherapy regimen.
Frank will rest a bit before he starts his chemotherapy. It has been decided
that he will wait until after the first of the year to start. Frank looks
forward to the time when he can live his life on his own terms and not
as a cancer patient. He says that he "...has some pain in his back.
The nerves and muscles in his back went through three (3) operations and
they are still trying to find their mates." The doctor told Frank
that pain should subside in about another month.
Frank has "voluntarily changed his diet". In other words, Barbara
has him on "her diet", the one with very little meat. He says
he eats lots of fruits and vegetables. They have moved into a new house
to be closer to their children. He spends most of his time tinkering in
the garage. He has no trouble keeping busy.
He recalls his experience with Dr. Jablons as "wonderful". "Dr.
Jablons is energetic and very knowledgeable. He makes you want to try
hard to live. Carolyn, his nurse, is so nice and encouraging. She takes
the time to answer all your questions and elaborates on her answers so
that you really know what she is saying." Frank has no doubts that
he made the right decision, and adds that he would "do it all over
again". In the meantime, he is thinking positive, staying busy and
living each moment.
POSTED NOVEMBER 18, 1997
Mr. Frank Dens passed away on December 3, 2000
Barbara Dens has joined a support group to help her get through this. The
nights are the hardest for her right now, when she looks over at Frank's
chair and she knows he is not coming back. Barbara did have family around
her for the holidays which helped, but they were still hard. She has a
friend whose husband also died of mesotheliom, so she talks to her frequently.
Mrs. Dens knows it's just going to take time.