Contractor Builds His Treatment Plan

Don and Peggy McShane were living the good life.

After a long and successful career building houses in Southern California, Don had begun to enjoy the fruits of his labors. They played golf. They visited their cabin on the Arizona border near Lake Havasu. Don loved flying his Bonanza to various towns through California and lunch with his pilot friends.

And there were the grandchildren 15 of them, all young and eager to play and explore. Don and Peggy logged many an hour in the bleachers at baseball and basketball games cheering on their little heroes. Sports had always played a big part in the McShane family. Don did not smoke, ate his fruits and vegetables, and got plenty of exercise.

In late Spring of 2003 Don noticed that he was having trouble keeping up with Peggy on their two and a half mile walk along the foothills of the Angeles National Forest. He felt like he was gasping for air and in constant need of a breather. In June, his shortness of breath concerned him enough to go see his cardiologist for a work-up and stress test, which resulted in hospitalization. Unfortunately, this was the harbinger of many trips to the hospital to come.

Gradually, Don began feeling better and his exercise level improved. However, in August his shortness of breath came back, even worse than before. He returned to his cardiologist, who took a chest film. The chest film revealed a large left pleural effusion. He was admitted to Glendale Memorial Hospital for further workup, including a CT-scan of the chest and left chest thoracentesis on August 26, 2003. Approximately 1300 cc of red-yellow pleural fluid were removed during the procedure. Immunohistochemical stains performed upon tissue found within the fluid were strongly compatible with malignant mesothelioma.

Mesothelioma? Don and Peggy had never heard of it, although they knew that Don had worked with and around asbestos products for many years as a carpenter and contractor.

Although Don obtained some relief after doctors drained fluid from the linings of his lungs, he continued to wheeze, gasp for air during exercise and cough up phlegm. Normally robust with a hearty appetite, Don began to lose weight dramatically. All Don's activities came to an end.

Don's daughter, familiar with the medical community in Los Angeles, arranged through Don's oncologist, Dr. Figlin, for Don to consult with Dr. Robert Cameron at the UCLA Medical Center in Los Angeles, California.

Dr. Cameron felt Don was a suitable candidate for pleurectomy and decortication. On September 25, 2003, Dr. Cameron performed a bronchoscopy, partial pleurectomy and pulmonary decortication, reconstruction of the diaphragm and radical mediastinal lymph node dissection. The surgical notes, summarized here, tell the tale of a bulky asbestos tumor that was on the move. The tumor had surrounded the lung and obliterated the parietal and visceral pleurae. Dr. Cameron surgically removed as much bulky tumor as reasonably possible, careful not to puncture the diaphragm, lung and pericardium. The tedious surgery required Don to be under anesthesia for nine hours. Dr. Cameron diligently removed every speck of the tumor he could see. The immunohistochemical analysis of the pleural mass taken from the partial pleurectomy confirmed the diagnosis of malignant mesothelioma, epithelioid type. Fortunately, his lymph nodes were clean finally, a good break. Don was left with a ten-inch scar running from the top of his left shoulder blade around his left side.

At Don's October 17, 2003 followup visit with Dr. Cameron, he appeared to be recovering from his surgery. He complained of some shortness of breath upon exertion such as walking two or three blocks, as well as pain. He also told Dr. Cameron that he had a constant weakness. Dr. Cameron scheduled postoperative radiation to start in midNovember. Dr. Cameron also requested that a CT scan be done prior to his return visit which was scheduled for late January.

Don began a series of 4500 cGY of postoperative standard single daily fraction external beam radiation sessions on November 12, 2003. He suffered from seconddegree burns on his back and chest. Still, he weathered through the therapy, completing all 25 treatments, the last on December 18, 2003. Don was determined to use every medical tool available to zap every malignant mesothelioma cell swirling in his chest cavity.

Over the next several weeks, Don tried to regain his strength as he readied himself for his next visit with Dr. Cameron. Don met with Dr. Cameron on January 26, 2004, to monitor his progress and assess his suitability for the next step in his treatment plan, chemotherapy. Fortunately, his post surgery CT-scan did not show that the tumor had recurred a very frightening but realistic concern for all post surgical mesothelioma patients. As a routine, Dr. Cameron recommends chemotherapy (Alimta/Cisplatin) treatments to either delay recurrence or stabilize tumors that have recurred. Because of Don's severe weakness, pain and continued weight loss, Dr. Cameron was unable to recommend chemotherapy at that time. In addition to weakness and weight loss, Don complained of increasing shortness of breath, which he had experienced upon exertion, moderate anorexia, fevers, and increased night sweats. Don was having trouble sitting still. He felt a constant need to get up and move as the pain began to set in. Dr. Cameron requested another CT/PET scan be done prior to his third follow-up visit.

Concerned that he was not taking all the steps necessary to combat the return of the tumor, Don turned to another oncologist for advice. The oncologist agreed that if Dr. Cameron saw no evidence of the disease in the January CT scan, then he should consider holding off on pursuing chemotherapy. The oncologist told Don that since he had started the radiation therapy so soon after the surgery, his body didn't really have time to heal and was vulnerable to infections and worse.

Don's motor doesn't do well on "idle." He likes to stay active. Unfortunately, the tumor and the treatments have taken their toll on Don's physical strength. He frets about his inability to twist the cap off a water bottle. He has no appetite and states, "If Peggy didn't make me eat, I probably wouldn't." However, as a diabetic he forces himself to eat. He complains of potshots of pain which force him to move constantly.

Although weakened by mesothelioma, Don's drive is strong tough as a combat boot, so the saying goes. He does not like to complain. He does not want pity. He wants to get well, and he wants the companies responsible for stealing his golden years to be held accountable.

"Let me tell you, when I was running my projects I worked right alongside my crew most times. I had no idea the asbestos dust swirling around would later come back to haunt me, and Peggy."

During a recent deposition, Don, a former vice president of national construction for a large storage company, talked about his managerial responsibilities. At each job site, whether it was an excavation of a condemned building or construction of a new facility, it was his duty and obligation to make the safety of his workers his first priority. Don's opinion was that if a company executive knew about, or should have known about, a dangerous condition that could harm workers and bystanders on the job, he should be held accountable for such injuries. Don spoke directly to every chief executive officer of every manufacturer of asbestos-containing products when he testified, "You are responsible for my wife, my family, the retirement years that I'm not going to have. Therefore, I don't think you did a very good job of supervising your products."

After testifying for a day, Don felt drained. That night Peggy rushed him to the ER again because of weakness and shortness of breath. He met the same doctor who originally diagnosed him with mesothelioma. Don was diagnosed with pneumonia a potentially fatal lung disease for a man with mesothelioma. For the next three days, Don remained hospitalized. Throughout his stay, his wife at his side. Don spoke to his doctors about his determination to get released on Sunday so he could continue his deposition Monday.

A proud, self-reliant 76-year-old loving husband, stricken with asbestos-caused mesothelioma in his prime, with post surgical pain and radiation therapy related weakness, dreading tedious cross-examination from robotic asbestos company defense lawyers, in the hospital with serious pneumonia, but wanting out so he could finish what he started. The deposition was not at all enjoyable. In fact it was stressful beyond words. But for a man of principle, a man who was taught to finish what he started, whose love of life is exceeded only by his love of family and faith, it was a duty he was determined to see through.

After completing the deposition, Don again wound up in the hospital with pneumonia in both lungs. He was in the hospital another ten days. He is now at home trying to gain some strength and on oxygen continually.

We wish the best for this wonderful couple, Don and Peggy. It's a testament to his strength of courage that Don is working hard to get back into good enough shape where he can withstand the full-body assault of aggressive chemotherapy.

*** POSTED JUNE 29, 2004 ***

Mr. Don McShane passed away on September 18, 2004