Wife And Mother Confronts Curse Of Father's Clothes
Many years ago, when Annette Skelton was a child, her father worked around asbestos and carried the poisonous dust home on his clothes and hair. Today, Annette is 58 years old, married since 1978, with a 34 year-old son -- and she has mesothelioma. She can no longer work as a title officer. Her husband Bill must increasingly spend more time caring for Annette and less time supporting the family as a surveyor. Years after hugging her father and washing his seemingly harmless clothes, Annette reflects on an unintended and horrible legacy of love.
Her troubles began in March 2001, when she started feeling pain in her lower left back. She went to her family doctor at the Urgent Care Center of the Family and Industrial Medical Center in San Luis Obispo, California. Her physician told her it was probably a muscular or skeletal problem and sent her home. In early June 2001, however, a cough or a sneeze felt like a knife in her rib cage. She returned to her primary care physician on June 12, and he took a chest film showing a pleural effusion. He immediately referred Annette to a pulmonologist.
SYMPTOMS TROUBLE ANNETTE, ELUDE HER PHYSICIANS
Annette consulted with the pulmonologist on June 15, who said there were many potential reasons for her symptoms but quickly ruled out cancer. He prescribed Prednisone. Her pain disappeared, and a chest film in mid-July seemed to show that the pleural effusion was gone. Two weeks later, however, the pain had returned, and Annette was short of breath as well. She returned to her pulmonologist for another chest film. He told her that there was not enough fluid in her chest to justify action and that the effusion would "go away."
In August, not convinced that the fluid would simply go away, Annette returned to Urgent Care and had another chest film taken. A doctor there examined the film and said it ruled out cancer, but her voice betrayed concern. Annette called her pulmonologist, explained the situation to him, and he met her at the Sierra Vista Hospital Emergency Room. He examined the film and also ruled out cancer.
Annette next presented with the same symptoms to the physician's assistant who served as her primary contact in her pulmonologist's office. The physician's assistant diagnosed anxiety and prescribed Paxil. In mid-September, the physician's assistant ordered a thoracentesis. Prior to that procedure, Annette underwent a sonagram. Her pulmonologist stated that the sonagram results showed that there was too little fluid in the pleural cavity to prevent lung damage during a thoracentesis, and denied authorization for the procedure.
Annette continued to have extreme difficulty sleeping, and her breathing while laying down was labored. She called her primary physician in the hope that he would provide a referral, so that she could seek treatment and a second opinion as to her condition in San Francisco at a research institution or a university hospital. He told Annette that her pulmonologist was the best pulmonary specialist available and refused the referral. At this point, Annette began experiencing sharp pains in the area of her shoulder blade.
FOLLOWING HER INSTINCTS, ANNETTE INSISTS ON ACTION
Annette tried to cope with the symptoms, but in mid-November could no longer and returned to Urgent Care. After having a chest film taken, she dropped the film off at her pulmonologist's office, telling the staff there: "Tell him to do something." Shortly thereafter, he ordered an exploratory thoracoscopy. The procedure was performed on December 18, 2001, at the Sierra Vista Regional Medical Center in San Luis Obispo. During the procedure, the surgeon observed pleural thickening. He harvested tissue samples for pathological testing and insufflated talc to adhere the pleura to the chest wall and prevent the return of pleural effusions. After the surgery, Annette's family was advised that while a definitive diagnosis would have to await testing by the pathology laboratory on the biopsied tissue, it was suspected that she had mesothelioma. On December 26, 2001, the pathology laboratory confirmed the diagnosis of malignant pleural mesothelioma, epithelioid type.
Annette was referred to an oncologist who subsequently referred her to Dr. David Jablons at Mt. Zion Medical Center in San Francisco, California, who ordered a CT scan. Annette consulted with Dr. Jablons on January 15, 2002. After reviewing the available data, Dr. Jablons opined that her mesothelioma was Stage I and that she was a suitable candidate for surgery. Dr. Jablons advised that he would not commit to a pleurectomy (removal of tumor and pleural linings, sparing the lung lobes) or pneumonectomy (removal of linings, tumor and lung lobes). Instead, he would open her up her chest, assess the extent of the tumor's encroachment, and make the decision intra-operatively. She would need to place her trust in Dr. Jablon's medical judgment.
A STRATEGIC RETREAT
There are many doctors who feel that any treatment for mesothelioma is futile, and accordingly advise their patients to get their affairs in order, take a long vacation and try to enjoy the limited time left. This was not the advice Dr. Jablons gave. But Annette and Bill had long dreamed of vacationing in Ireland and Scotland, and, still reeling from the shock of Annette's diagnosis -- and the prospect of a radical and painful surgery -- the couple decided to regroup together, away from the pressures of work, in Ireland's green rolling hills and the Scottish highlands. The land and the people they met restored the Skeltons' sense of vigor and hope. The separation in time and place gave them peace with their decision -- they would go forward with the surgery, trading short term pain for longer term survival.
After three weeks abroad, they returned, ready for the next step.
MOVING FORWARD, ON A PAINFUL ROAD TO RECOVERY
On March 6, Dr. Jablons operated. He spared the lung, instead performing a pleurectomy with decortication, a procedure in which the pleural lining is peeled away from the lung, along with as much of the tumor that is encasing it as possible. Dr. Jablons scraped away as much tumor as he could see from the pleura, Annette's diaphragm, and her pericardial sac. During the grueling ten-hour procedure, she required two pints of blood infusions to keep her alive.
A "champion" patient, Annette emerged from the hospital a mere five days after surgery. She recovered as much as her treatment protocol allowed at home, but there really was no rest for her. Annette returned to San Francisco on April 23 to begin radiation therapy. This therapy aimed to radiate and kill the cancerous cells in the pleura while sparing her other organs and healthy somatic cells. She underwent treatments five days a week for six long weeks. She has been consulting with her San Francisco oncologist, Dr. Jahan, who lost his own father to mesothelioma, and she felt reassured that he had the expertise and the compassion to assist her through this painful time.
Annette wondered how this treatments would affect her husband, her son, and her grandchildren. She became a grandmother again on April 15, when her son, Michael, had his second child -- another girl -- and Annette wants to play an important part in her granddaughters' lives for years to come. Until her diagnosis, she had also been a vibrant and active member of her local parish. She participated in mass as a eucharistic minister and served on several liturgical committees. Faith has always been an integral part of the Skeltons' life; now, more than ever, faith sustains them as they met looming challenges every day that would shake anyone's resolve to the core.
It is, in many ways, a family problem. Annette misses her father and would not trade her time with him for anything, but, of course, she wishes those responsible had tried to warn workers like her father and their families of the terrible dangers of asbestos.
In August, she completed her last radiation treatment. Dr. Jahan began to complete the paperwork necessary for her to begin using Alimta on a compassionate use. Since her surgery in March, Annette quit her job and started doing the things she loves most. Annette said, "she didn't want her life to end sitting behind a desk." She attends daily Mass and participates in a Bible study at her church. She also helps with her two granddaughters at the same time caring for her mother.
In December, Annette had her first Alimta treatment. She did not experience any side effects and says, "It was a breeze!" Her next two treatments were a different story. She suffered nose bleeds after the second treatment, and nausea after the third treatment. Her CT scan take after the second treatment showed a marginal improvement. But Annette in her always upbeat way continues, "I will take any bit of improvement I can, just as long as nothing new shows up."
Her fourth treatment is scheduled for Monday, February 3, 2003 and of course she prays that it goes like the first treatment did.
Annette credits Dr. David Jablons for her extended life. Dr. Jablons tells her that she is his "star patient" and that he is going to keep her alive until they find a cure. Once Annette completes the cycle of Alimta, then Dr. Jablons tells her that her next step will be Iressa, once that becomes available.
Annette's voice is filled with hope and enthusiasm. She wants everyone to know she's ALIVE ! She is grateful that she can continue to attend daily mass, enjoy shopping, visiting with friends and spending every minute she can with her grandchildren.
*** POSTED FEBRUARY 6, 2003 ***
