While taking his morning walk in August of this year, Powell White noticed
that he was short of breath. He also felt some pain in his back, just
below his right shoulder blade. About eight weeks earlier, he had developed
a dry cough that had become progressively worse. Although he is only 56
years old, the combination of these three symptoms made Powell suspect
something was wrong.
On August 19, 1998, Powell visited his primary doctor for a routine physical
exam. He received a clean bill of health. Powell became concerned, however,
when his shortness of breath and back pain grew worse. On August 31, Powell
returned to the doctor. After a review of the symptoms and another physical
exam, the doctor gave Powell a prescription for antibiotics.
By September 3rd, Powell's condition had not improved and he began
to have trouble sleeping. He returned to his family doctor, who prescribed
sleeping medication. Five days later, Powell's back and chest pains
became more intense. His doctor prescribed a different antibiotic. On
September 11th, Powell again called the doctor to report that his condition
was not improving. The doctor sent Powell to the hospital for a chest film.
Upon viewing the x-ray, the doctors ordered Powell to go to the emergency
room right away. The chest film had revealed a large right-sided pleural
effusion needing immediate attention. A thoracentesis was performed, and
approximately three liters of fluid were drained from Powell's chest.
Powell was then referred to a pulmonary specialist. The pulmonologist performed
another thoracentesis and ordered a CT scan. The CT scan revealed an extensive
mass in the pleural space of Powell's right lung. The size, location
and diffuseness of the mass raised the spector of malignant mesothelioma.
To be certain, a pleural biopsy was performed, which later confirmed the
diagnosis of diffuse malignant mesothelioma of the sarcomatous variant,
with a possible epithelial component.
On September 25, 1998, Powell had a chest MRI to ascertain the extent of
the tumor, and determine Powell's suitability for an extra pleural
pneumonectomy (EPP). The MRI showed the tumor involved two areas: (1)
the right lung base especially over the diaphragm, and (2) the anterior
aspect of the right upper lobe. In addition, several mediastinal lymph
nodes appeared enlarged.
Before making a decision about how to proceed, Powell wanted a second opinion.
He scheduled an appointment with Dr. Douglas Wood, a surgical oncologist
with the University of Washington Medical Center in Seattle, Washington.
Dr. Wood confirmed the mesothelioma diagnosis. Dr. Wood determined that
Powell was a candidate for EPP, and suggested that Powell speak with his
colleague Dr. Eric Vallières, also with the University of Washington.
Dr. Vallières is the thoracic surgeon in charge of the mesothelioma
program at the University of Washington Medical Center. Eighteen months
ago, Dr. Vallières initiated (click here) a Phase III trial which
addressed the tri-modal approach to treating diffuse malignant mesothelioma
of the pleura. Using this approach, induction chemotherapy is followed
by radical surgery, then adjuvant fast neutron radiation therapy.
On October 15, Powell had another pleural effusion drained. According to
Powell, the thoracentesis relieves his chest and back pain somewhat. However,
Dr. Vallières had informed him that the procedure was risky and
should be used sparingly. According to Dr. Vallières, sarcomatous
mesothelioma is very aggressive and will follow the thoracentesis needle
channel and spread outside the thoracic cavity. In addition, thoracentesis
creates scar tissue which may prevent optimum distribution of the chemotherapy agents.
Having agreed to the tri-modal therapy at the University of Washington,
Powell received his first chemotherapy treatment on October 26th. Powell
states that he is feeling okay, and is not experiencing any side-effects.
Powell will receive chemotherapy every Monday for the next four weeks.
At the end of four weeks, he will have completed his first cycle of chemotherapy.
At the end of the second chemotherapy cycle, a CT scan will be performed.
If the tumor is responding to the chemotherapy, Powell will receive another
cycle before undergoing surgery and radiation. If the tumor is not responding
to the chemotherapy, Powell will have the extra pleural pneumonectomy
followed by neutron radiation therapy.
Powell, his wife Mary Ann, their two daughters and five grandchildren all
hope the tri-modal therapy will get rid of the tumor. The Powell family
realizes that they have just begun a long journey with an uncertain destination.
POSTED DECEMBER 2, 1998
Mr. Powell White passed away on June 20, 2000