All Out Fight With Mesothelioma
Ted Cichocki (pronounced "che-hockey"), a 67 year old former pipefitter and 39-year employee at Inland Steel in East Chicago, Indiana, was diagnosed with malignant mesothelioma of the pleura on November 20, 2000. Ted and his wife Jackie reside in Schererville, Indiana, in the extreme northwest corner of the state.
Around December, 1999, Ted noticed that he was getting short of breath. He consulted with his family physician, Dr. Willardo, in Hammond, Indiana. A chest film showed the presence of fluid in the right chest cavity. Dr. Willardo referred Ted to a cardiologist, Dr. Praksah N. Makam. Dr. Makam performed a stress test which showed no cardiovascular abnormality. Dr. Makam referred Ted to a pulmonologist, Dr. Thomas Papin, at the Munster Medical Center in Munster, Indiana. Dr. Papin took a chest film which revealed the presence of fluid on the right side.
At Dr. Papin's behest, Dr. John E. Jordan performed a thoracentesis in January, 2000. The procedure produced 86 ounces of brownish-tinged fluid. A chest film taken after the thoracentesis showed that there was some fluid remaining. A week later, Ted returned for a needle biopsy and repeat thoracentesis, which produced another seventeen ounces of fluid. Both cytology on the fluid and pathology on the biopsy were negative.
Ted felt well enough after the second thoracentesis to vacation in Florida, where he played golf. He remained asymptomatic until July, 2000, when a persistent cough appeared. He returned to Dr. Papin, who took another chest film, which was "clean;" Dr. Papin could not see any fluid on the x-ray. Dr. Papin prescribed antibiotics.
Ted continued with no complaint until the middle of November, when he returned to Dr. Papin, who this time referred him to Dr. Mateo V. Guanzon at the Munster Community Hospital. Around November 17, 2000, Dr. Guanzon performed a right-sided thoracotomy with thoracoscopy, biopsy and doxicyclin insufflation at St. Margaret's Hospital in Hammond, Indiana. Ted recalls that Dr. Guanzon immediately after the surgery expressed his opinion that this was mesothelioma. Pathological testing performed at St. Margaret's confirmed the diagnosis of malignant mesothelioma of the pleura on November 20. When Dr. Guanzon advised the Cichockis of the diagnosis, he kept repeating, "It's inoperable, and you've got to get it treated." Ted remained hospitalized until November 25.
While Ted was hospitalized at St. Margaret's, he was referred to a Dr. M. Y. Ali, an oncologist in Munster. Dr. Ali's partner, Dr. Keralavarma, would also talk to him. Dr. Ali and Dr. Keralavarma wanted to administer chemotherapy through a port, but Ted wished to explore his treatment options. He turned to the Internet, and found Dr. Nicholas Vogelzang of the University of Chicago. It took two and one-half weeks before Dr. Vogelzang could see Ted. Dr. Vogelzang told Ted that he was a good candidate for surgery, and recommended Dr. Harvey Pass, Dr. David Sugarbaker, and Dr. Valerie Rusch.
Ted chose to try Dr. Pass first because of his proximity. To Ted's surprise, Dr. Pass returned his phone call promptly and personally, but was unable to schedule an appointment until January 4 because of a planned vacation. Dr. Pass ordered a pulmonary function test, chest CT scan, and a qualitative percussion scan.
On Monday, February 19, 2001, Dr. Pass began the pleurectomy. As he made his initial incision, he discerned disease outside the chest in the subcutaneous tissue which had not been revealed on prior tests. This was confirmed on frozen section analysis and by intraoperative photographs. As the aim of the EPP was to halt the advance of the tumor beyond the pleura, there was no point in proceeding further. Dr. Pass aborted the procedure and closed the chest. The next day, Dr. Pass told Ted that he should return to Dr. Vogelzang for chemotherapy, to obliterate as much of the tumor as possible.
Ted scheduled an appointment with Dr. Vogelzang on Wednesday, March 7. In the meantime, he got on the telephone with Ray Wadas and Rodney Steenbergen, who both praised the compassionate care at San Antonio's Cancer Therapy and Research Center (CTRC), and its ALIMTA (R) (pemetrexed disodium) trial. This trial is different from most, in that it is not blind; rather, patients admitted to the trial are guaranteed administration of the chemotherapy as long as the tumor shows no signs of significant growth. Patients report good results with Alimta, which does not have the troubling side effects of hair loss and severe nausea associated with traditional chemotherapies.
Ray cannot say enough nice things about the staff at CTRC. He says that the staff hugs him when he comes in; he says, "They treat you like you're human in Texas." His tumor has shrunk, and he feels pretty good.
This office wrote Ted's doctors and Stephanie Hodges, the nurse coordinator for CTRC's clinical trials, in order to help Ted obtain treatment there. Stephanie first suggested that Ted seek admission to a closer, similar trial ongoing at the University of Indiana. However, it turned out that the Indiana trial had only one slot open, and they were looking for a candidate with kidney problems, which Ted did not have. Ted contacted Stephanie again, and scheduled a consultation in San Antonio. Ted reached out to this office for help as he scrambled to gather together his most recent medical records.
Ted and Jackie traveled to San Antonio full of hope. But when a CTRC physician examined Ted, he found that Ted's oxygen level was too low; his lungs were operating at 50% of capacity, and were possibly filled with fluid. Ted's physical condition would have to improve before he could participate in the Alimta trial, much less travel back and forth between Indiana and Texas.
Indeed, on the airplane ride home, Ted began experiencing severe shortness of breath. He was gasping for air and the flight attendant had to bring him oxygen. Ted says it was quite a scene.
On his return home, Ted scheduled an appointment at the University of Chicago with Dr. Vogelzang for Wednesday, March 28. Because Ted's oxygen levels were down so low (at 84), Dr. Vogelzang wanted to start Ted on traditional chemotherapy right away, in order to try to reduce the size of the tumor, with the plan of shifting to experimental chemotherapy if Ted responds favorably. Dr. Vogelzang administered Gemczar and Adriamycin the same day. Ted says he reacted "pretty good", although he did have "the dry heaves" and nausea immediately after the chemo, and heavy night sweats for a couple of nights. Ted also has noticeable swelling in his legs.
The plan is for Ted to get his present chemotherapy every two weeks for a total of three cycles, at which point he'll have a CT scan to see if the tumor has been reduced. If Ted responds favorably to this chemo, Dr. Vogelzang will then switch him into one of the trials.
Ted and Jackie have six children, all adult, and twelve grandchildren. All of their children live nearby, except one who lives in Florida. Pictures of their children and grandchildren adorn their home. In addition to enjoying their family, the Cichockis loved golfing together. Now, they know that their future together is filled with uncertainty.
Ted Cichocki is a fighter. He knows that the odds are against him, but he is going to do everything he can to survive -- for Jackie, his children, and his grandchildren. Our thoughts and prayers are with him on his journey for hope.
*** POSTED APRIL 9, 2001 ***
Mr. Ted Cichocki passed away on August 5, 2001
