Patient Relieved To Be Eligible For Pleurectomy

Gene was in the United States Navy from 1956 until 1978. Gene served on board several ships including the USS Intrepid, USS Midway, USS Coral Sea, USS Norton Sound and USS Monecea. Gene began his military service as a boiler technician working on boilers. Gene slowly moved up the ranks to become a supervisor of the boiler rooms, fire rooms, new recruit trainer, and finally in charge of the entire ship's maintenance management. During Gene's Navy service he was also in many shipyards along the California and Washington coastlines. While at the shipyards and aboard ship he would oversee the repairs to the boilers and fire rooms on commissioned and recommissioned ships. Gene's service require him to be in the boiler and fire rooms aboard ship for literally hours each and every day inhaling asbestos fibers from the pipecovering, refractory, cement, fireproofing, block and other boiler insulation materials.

Beginning in 1978, after a Honorable Discharge from the Navy, Gene was employed with several different companies that conducted boiler inspections in power plants and refineries throughout the western United States. Gene would inspect boilers at facilities that were in various stages of repair or new construction. Gene pursued this line of work until 1994. Currently and since 1994, Gene has been employed as a senior energy specialist with a well known property and casualty company which inspects power plants, refineries and chemical plants.

Gene began having pneumonia-like symptoms in September, 1998, which continued into October. Having had pneumonia before, Gene felt sure that was his problem. He had a hacking dry cough that persisted. He went to his primary care doctor, Dr. David Gallagher on October 16. He was first diagnosed with pneumonia and prescribed antibiotics. When the symptoms did not improve, Dr. Gallagher referred Gene to Dr. Theodore Bacharach, a pulmonologist at Sutter Auburn Faith Hospital in Auburn, California for further testing and evaluation.

On October 22, Gene had a CT scan and chest films taken at Sutter Auburn. Dr. Bacharach then drained two (2) quarts of fluid from his right chest cavity. The preliminary cytology report suggested lung cancer; however, after additional histochemical staining, an addendum report confirmed a diagnosis of probable malignant mesothelioma. Seven (7) days later, on October 29, Gene had another three (3) quarts of bloody fluid drained. A chest tube was left indwelling which allowed the fluid in Gene's chest to drain freely. Further cytology examination of the cells in this fluid were found to be reactive for mesothelioma. Dr. Bacharach had originally suspected mesothelioma based on the results of the CT scan and chest films taken earlier. When the drainage was clear in color, bleomycin (an anti-tumor agent used in treating various carcinomas of the skin, head, neck and lungs) was instilled in an attempt to bond the pleural membranes and thwart reaccumulations of pleural fluid.

On November 13, Gene met with thoracic surgical oncologist Dr. Robert Cameron at UCLA Medical Center in Los Angeles, California. Dr. Cameron recommended that a biopsy be performed for further analysis. In addition to mesothelioma, Dr. Cameron also suspected bilateral pulmonary asbestosis. Dr. Thomas Roschak, the oncologist at Sutter Auburn also advised a follow-up biopsy. On November 17, Gene had more fluid drained as well as a fine needle biopsy. The pleurodesis had not been successful. The pathologist at Sutter Auburn Faith Hospital diagnosed papillary clusters of atypical and malignant cells consistent with malignant mesothelioma.

Gene also contacted Dr. David Jablons at the UCSF/Mount Zion Medical Center in San Francisco for a consultation. Dr. Jablons and Dr. Cameron are colleagues who collaborate on several research projects. They are the only two highly regarded surgical oncologists with mesothelioma treatment expertise in California. There was a question as to whether or not the tumor had spread from the right dorsal-medial area next to the pericardium to the left lung pleural space. Dr. Jablons ordered a Positron Emission Tomography scan (PET) and requested Staging of the disease. This was done on Tuesday, December 1, at the Northern California Positron Emission Tomography Imaging Center in Sacramento, California. The test results indicated that the mesothelioma was Stage II, epithelial subtype involving the pleural of the right lung. The diaphragm was not involved. The test results further showed that there was thickening of the left lower pleural. These finding were consistent with metastases to the left pleura from the right lung, however, localized pleural plaquing could not be ruled out.

For insurance and proximity purposes, Gene made an appointment with Dr. David Jablons on December 4, for a preliminary surgical evaluation. The test results suggested that the cancer had spread to the left pleura; this meant that, unfortunately, a right pleurectomy would not be truly effective. This scenario left only chemotherapy, which was not a happy prospect for the McKelvies. The issue remained: was there actual metastatic tumor or was the abnormality on the left side merely plaquing? The only way to truly find out was to perform surgery. The McKelvies held their breath and hoped for the best.

On December 9, Gene underwent a thoracotomy on his left lung. Dr. Jablons took a biopsy of the left lung. GOOD NEWS! The tissue was benign for tumor! Surgery was now a viable option. This was a great relief, as the alternative would have required desparate measures. Dr. Jablons then proceeded to take another biopsy of the right lung which came back with the same diagnosis - mesothelioma. During the thoracotomy, Dr. Jablons performed the talc pleurodesis since Gene had ten (10) pleural effusions. With the new information that the mesothelioma did not involve the left lung, Gene was clear to have the pleurectomy, decortication and intrapoperative radiation therapy of the right lung. Dr. Jablons advised Gene that the surgery would not be a cure, but would substantially set the clock back on the progression of disease.

Gene underwent extensive surgery on February 4, 1999 at UCSF Stamford Medical Center. Dr. David Jablons was the surgeon. The surgery consisted of a right thoracotomy, radical pleurectomy, decortication, intraoperative radiation therapy, resection of the diaphragm, wedge resection, medial segment of the right middle lobe and wedge resection, medial basilar segment and wedge of the superior segment of the right lower lobe. The thoracotomy revealed that Gene had dense and significant amounts of tumor on the parietal pleura extending well into the hilum and thoracic inlet down to the costophrenic angle of the diaphragm. He also had dense infiltrative tumor which was removed in complete visceral pleurectomy.

With diligence and persistence, Dr. Jablons removed all visible tumor. The diaphragm was grossly invaded but the tumor did not penetrate through. The intraoperative radiation therapy consisted of three fields. Radiation to the fissures, the diaphragm, and pericardiophrenic junction. Overall the surgery was difficult due to the extent of the tumor and as a result of adhesions from the prior talc pleurodesis. Although an extraordinary amount of tumor was present, Dr. Jablons was pleased with the success of the surgery.

Nobody looks forward to a radical surgery. But the McKelvies did. For several days the McKelvies were very worried that the abnormality in the left pleural space was a metastatic tumor. If this proved to be the case, the McKelvies would not have been eligible for surgery. However, a battery of medical tests proved that the suspected mass was a pleural calcification (which is also caused by asbestos). This revelation cleared the way for the surgery, which the McKelvies, under the circumstances, welcomed.

Gene is now recovering at home with his wife Janice.

*** POSTED MARCH 23, 1999 ***

Mr. Russell McKelvie passed away on September 13, 1999