MM Patient Interviews Several Surgeons, Chooses Dr. Pass

In December of 1997, Sylvin Pickner decided he could no longer ignore his nagging cough. He saw his family physician, who diagnosed Sylvin with pneumonia and prescribed antibiotics. The symptoms, however, continued. A few months later Sylvin returned. This time, he was treated for asthma. Eventually the cough subsided but now he began to experience shortness of breath. He was unable to bend over to tie his shoes.

On February 18 1998, a chest film showed fluid on his lung. Doctors at his HMO in Portland, Oregon, drained the fluid on February 20th and again on February 27th. In early March, Sylvin underwent a thoracoscopy and talc pleurodesis. The diagnosis was mesothelioma. The doctors in Portland did not recommend any invasive procedures. This particular surgeon advised that he had rarely operated on mesothelioma patients. The local doctors advised that Sylvin's tumor was Stage III.

The Pickners were not convinced. Mrs. Pickner began researching the treatment options for mesothelioma patients. They also wanted a second opinion and more sophisticated diagnostic testing. Sylvin was 55 years young, very robust and determined to put this unfolding saga behind him.

On March 18, 1998, Evelyn found our website. She learned of Dr. Harvey Pass in Detroit. She contacted Dr. Pass on the same day. Dr. Pass is no ordinary doctor. He does not put patients on hold and does not ignore their calls. He warmly received Evelyn's call for help and offered to review Sylvin's records and make recommendations.

Detroit, Michigan is not exactly next door to Portland, Oregon. The Pickners wanted to know if there were qualified surgical oncologists in the Pacific Northwest. With such a high incidence of mesothelioma among shipyard, paper mill, aluminum plant and construction workers in the Oregon and Washington, it would seem logical that the local hospitals would be equipped to treat this terrible asbestos cancer.

We knew of two doctors in Seattle who had operated on our clients in Seattle: Dr. Ralph Aye at the Swedish Hospital and Dr. Douglas Wood at the University of Washington Medical Center. That same day she sent Sylvin's x-rays and CT scans to Dr. Pass.

In the meantime, we coordinated with the doctors at his HMO to forward Sylvin's tissue specimens to Dr. Sam Hammar in order to rule out or corroborate the diagnosis. Dr. Hammar is a pathologist on the United States-Canadian Mesothelioma Board.

On April 2nd, Dr. Pass offered to speak to the Pickner's doctors in Portland. Dr. Pass at this point had not excluded a pleurectomy even though a pleurodesis was done. To shed light on what options were available, Dr. Pass advised that he would need updated pulmonary function tests and a special nuclear medicine scan. If the tests proved favorable, Dr. Pass thought it would be reasonable for the Pickner's to travel to Detroit for a complete work-up, including surgery. Dr. Pass was willing to work with the Oregon oncologists for post surgery therapies.

On April 6, Sylvin underwent additional Pulmonary Function Testing as well as a Nuclear Medicine Scan in Portland, Oregon. Both Dr. Aye and Dr. Wood agreed to meet with the Pickners on a fast track basis and appointments were scheduled.

Dr. Wood advised that he and his colleague Dr. Vallieres had developed a tri-modal protocol for mesothelioma. In a nutshell, the protocol incorporated three stages. First, the patient undergoes two to three cycles of induction chemotherapy (pre- operative or adjuvant), which would take about 5 to 6 weeks. The drugs used are Methotrexate, Vinblastine and Cisplatin. Second, Dr. Wood performs an Extra Pleural Pneumonectomy (EPP). And third, after the operation, the patient is treated with neutron beam radiation (as opposed to electron beam, which might result in higher morbidity). Neutron radiation is available only in a limited number of hospitals. The prevailing technology relies on photon and electron beams.

The Pickners then set up appointments with Dr. Aye and Dr. Wood. They brought with them a list of questions and concerns for each interview, including questions like:

1. How many Extra-Pleural Pneumonectomy's (EPP) have your performed?
2. How many of your patients who have undergone the (EPP) have survived?
3. Of the survivors, how many of them have had a recurrence?
4. What is the average survival time for your MM patients post surgery?

On April 14, the Pickners met with Dr. Aye at the Swedish Medical Center in Seattle, Washington. They were impressed with Dr. Aye both professionally and personally. Dr. Aye had performed the EPP on approximately six (6) patients. All of his patients survived the surgery.

The next day, on April 15, the Pickners met with Dr. Wood at the University of Washington Medical Center. Dr. Wood discussed with them the aggressive multi modality protocol for management of mesothelioma. Dr. Wood introduced the Pickners to his associate Dr. Eric Vallieres, who authored the protocol for the management of mesothelioma at the University of Washington. The Pickners learned that the protocol was relatively new and that five or six patients were participating in the program.

Dr. Wood noted that Mr. Pickner's tumor was in an early stage. He was not Stage III. Dr. Wood was impressed with the Pickner's knowledge of the disease and the various treatment options. He understood that the Pickners were eager to learn so that their final decision was as informed as possible.

After further research and continued communications with Dr. Pass, the Pickners decided to undergo the procedure with Dr. Pass in Detroit, who has performed surgery on approximately 100 mesothelioma patients over the course of his career. Sylvin is tentatively scheduled for surgery in Detroit on May 12, 1998. Dr. Pass' staff has arranged to work with the local doctors in Portland for post surgery follow-up and chemotherapy.

** POSTED APRIL 28, 1998 **

June 18, 1998

Sylvin went to see Dr. Harvey Pass and had surgery on May 12, 1998. Dr. Pass performed a pleurectomy instead of the EPP. Dr. Pass removed the pleura on and around the right lung. He also removed some suspicious lymph glands and portions of the diaphragm. It was his opinion that the cancer tumor was localized in the pleura and therefore the EPP was not indicated.

Sylvin is recovering at this time from the surgery. The initial pain post surgery has diminished. He has recently finished his first two weeks of chemotherapy using Dr. Pass' protocol. For Sylvin the protocol is Intravenous Cisplatin the first five days, Tamoxifen tablets twice a day and interferon injections three times a week for 35 days. A second round will follow.

Sylvin has been extremely ill but is looking forward to feeling better in the coming weeks as the effects of the Cisplatin wear off. Today was the first day he could keep down solid foods.

** POSTED JUNE 19, 1998 **

Mr. Sylvin Pickner passed away on August 16, 1999