MM Gaining Momentum

In the early spring of 1998, David began to feel tired and run down. This was highly unusual for David, who was normally robust and full of energy. He noticed shortness of breath while performing simple tasks. His family physician ordered chest films, a CT scan and an MRI. These tests revealed a mass located on the left side of his chest. A biopsy was performed, and the mass was shown to be malignant sarcomatoid mesothelioma. Pathologists at IMPATH Laboratories in New York City also reviewed David's biopsy tissue and concurred with the diagnosis.

David and his family were shocked by the diagnosis. Like most mesothelioma patients, they had never heard of "mesothelioma." This did not deter them. David may have been scared initially, but he soon found his strength and sought information on treating this type of tumor. The Dallys realized that in order to find a cure, they would have to consult with the best doctors in the country. This would also require diligent research, plenty of travel, and unwavering faith.

David's search for a cure led him from his home in Ohio to Pittsburgh and Philadelphia, Pennsylvania, then to New York and finally to Boston. In Philadelphia, he consulted with Dr. Dan Sterman at the University of Pennsylvania regarding Gene Therapy. From there he met with Dr. Valerie Rusch at Memorial Sloan Kettering in New York City regarding surgical and "tri-modal" options. His next and most critical stop was in Boston, where he met and was treated by Drs. David Sugarbaker and Michael Jaklitsch. David has now returned to Ohio, and is preparing for possible post-operative radiation therapy and/or chemotherapy in Pittsburgh.

GOES TO PITTSBURGH...

David and his family's travels began in June with a visit with Dr. Dennis Meisner at the Shadyside Hospital in Pittsburgh, Pennsylvania. The doctors in Pittsburgh ruled out an invasive procedure, such as pleurectomy or lobectomy, and they did not recommend a radiation or chemotherapy regime. The doctors opined that the tumor was not surgically treatable and had invaded his lymphatic system, but referred him to Memorial Sloan Kettering Cancer Center and Dr. Valerie Rusch in New York City. David wanted a second opinion. It's good that he did.

GOES TO PHILADELPHIA...

On July 10, David visited the University of Pennsylvania in Philadelphia. At UPENN, David met with Dr. Daniel Sterman in hopes of qualifying for the Gene Therapy program offered at UPENN. After his work-up, David was accepted into the program, but the earliest available start date was in October, nearly three months away! David did not want to wait that long, so he continued his search for treatment by traveling to New York.

GOES TO NEW YORK...

On July 15, David met with Dr. Valerie Rusch at Sloan-Kettering Memorial Hospital in New York City for a surgical consultation. Dr. Rusch's impressions were that David was in fact a candidate for an extra-pleural pneumonectomy (which included removal of his lung). After Dr. Rusch had described the nine hour surgical procedure--extra-pleural pneumonectomy with resection of all of his ribs on his left side along with his diaphragm-- David did not feel that it was the right treatment for him. One get's attached to one's lung, especially when it is a healthy, vital, irreplaceable organ. The tumor was in the pleural space.

GOES TO BOSTON...

As part of their research, David and his wife Donna had reviewed this website, and learned about Dr. David Sugarbaker in Boston. Impressed with Dr. Sugarbaker's credentials and track record, David and Donna flew to Boston to meet with the famed surgical oncologist at Brigham and Women's Hospital.

After Dr. Sugarbaker read the chest films, CT scan and MRI, it was his opinion that the "ball type" tumors were confined to the left lobe, with an additional tumor located on the pericardium (heart sac lining). Dr. Sugarbaker advised David that he was a candidate for resection. The good news was that the tumor was not diffuse, therefore, they would not need to remove his entire left lung and left pleura. All things considered, this was the best news they had heard in many months.

On July 29, David underwent surgery at Brigham and Women's Hospital. The surgeons resected the left chest wall, inclusive of the largest portion of the tumor, and resected ribs two, three, and four with reconstruction of the chest wall utilizing a Gore-Tex patch. The surgery was a high-risk procedure because of the location of the tumor. The tumor abutted the left internal mammary bed, the mammary vein and the pericardium. The tumor had also invaded the intercostal region between the second, third and fourth ribs. Another risk factor for David was previous heart by-pass surgery. David understood these risk factors, but chose to proceed anyway. He realized that there were no guarantees of a cure, but there was a good chance the surgery would rid his body of the tumor.

At the initial consultation, Dr. Sugarbaker determined that to safely resect the portion of the tumor involving the pericardium, a posterolateral thoracotomy would be required (thoracotomy performed with an incision to the side and behind the lungs). After exploration, Dr. Sugarbaker determined that as he had originally thought, the posterolateral thoracotomy would have to be performed at a later date because of the length and involvement of the surgery, the need to remove two or three additional ribs for maximum exposure, and involvement of the veins and possible damage to the heart.

The portion of the tumor involving the chest wall and pleura were successfully removed. The "good news" was that the tumor had not invaded the lymphatic system. Dr. Dennis P. Orgill assisted Dr. Sugarbaker with the insertion of the Gore-Tex patch. The Gore-Tex patch was used to give support to the chest wall where the ribs had been removed. To secure the Gore-Tex patch to the chest wall and to allow David's chest to expand and contract as naturally as possible while breathing, a posterior portion of the major pectoral muscle was used to cover the Gore-Tex mesh.

David's first surgery was completed on the afternoon of July 29. By nine o'clock that evening, David was fully awake and visiting with hospital staff and family. He felt fairly good, had no pain and slept soundly the entire night. On the morning of July 30, David had breakfast and the nurses got him out of bed. With the aid of a walker, he walked down the hall and around the nurse's station. He was wearing a heart monitor. As he was walking, the nurses noticed a significant change in his EKG. David returned to bed immediately, and shortly thereafter he learned that he had had a heart attack.

David remembers the moment: "I had no symptoms or pain and didn't realize I had a heart attack." Tests showed that David had developed a blood clot in the mammary artery. The blood clot had caused the heart attack. To remove the clot, David underwent an angioplasty, and an additional stent was inserted into the vein. David attributes the lack of pain and symptoms to his being on an epidural IV drip for pain.

Dr. Sugarbaker later informed David of the outcome of the surgery, and the need for an additional surgery to remove the tumor close to his heart. David agreed and the second surgery was scheduled in six weeks. Before the second surgery, the cardiology team at Brigham & Women's put David through extensive heart tests. The cardiologist, Dr. Landzberg, wanted to make sure that David's heart had healed and was ready for more surgery. David was given a treadmill stress test. After eighteen minutes on the treadmill, no problems arose, and David was given a "green light" for surgery.

On September 9, 1998, David underwent surgery to "excise the pericardial based tumor of the left chest including an en bloc wedge resection of the left upper lung lobe." During the surgery, Dr. Michael Jaklitsch examined David's lungs using a Bronchoscope. His lungs appeared normal internally, which meant the tumor had probably not trespassed inside either lung. This was good news. Dr. Jaklitsch removed the mass, which he described as an isolated "ball" type mass of malignant sarcomatoid sub-type mesothelioma. The doctors also found extensive pleural plaquing, a sure sign that David Dally had been heavily exposed to asbestos. David tolerated the procedure well.

Following the surgery, David received twenty-four hour nursing care. As a normal part of post-operative treatment, the nurse turned David to one side and delivered soft blows to David's back with cupped hands. This procedure is used to assist patients in clearing the mucus from their lungs after surgery.

Immediately following this treatment, a dozen nurses and doctors appeared around David's bed. He was alarmed by the swarm of medical personnel. David had begun to hemorrhage internally at the site where the tumor was resected. The drainage tubes in his chest were flowing with blood. David was immediately intubated, and with the aid of a ventilator, his lungs were hyper-inflated so that they pressed against the internal surgical site. The doctors hoped that the bleeding would stop because David was not strong enough to undergo additional surgery so soon. Luckily, the procedure was successful, and the internal bleeding stopped.

The next day, September 10, 1998, while in ICU, David suffered another myocardial infarction (heart attack). Can this brave man please get a break!! Heart catheterization was performed which revealed thrombosis (the existence or formation of a blood clot). The blood clot was removed and another stent was placed in his heart vein. Although David now had three stents in the one vein of his heart, his cardiologist gave David a good prognosis for recovery.

Although he has endured extensive testing, two surgeries, and several heart attacks, David has miraculously kept his spirits high and his sights set on the future. He realizes that he must focus all his energy and faith on recovering and healing. He feels that "Dr. Sugarbaker and his team are top notch dedicated professionals. I have been given the best possible treatment and care at Brigham & Women's, the 'medical Mecca' of the Northeast," according to David. I would not hesitate to recommend them to anyone."

The first time David saw Dr. Sugarbaker, Dr. Sugarbaker placed all of David's chest films and CT scans on viewers in his office and went through them one by one with David, answering questions and showing David where the tumor was located. Dr. Sugarbaker was so in-depth that David learned how to read his own CT scan.

When asked, "What would you tell other patients facing the same ordeal?" David responds, "Get to see Dr. Sugarbaker as fast as you can if you need surgery! Don't waste time! Too many people get shuffled around and put off, as I was. They place their lives in the hands of doctors who would have the disease run it's course. They offer no real treatment options other than a little chemotherapy or radiation therapy to control pain and slow tumor advancement. People need to take charge of their medical well being."

David is also thankful that his cousin recommended my office. Dave's cousin, from Seattle, is a fierce bike race against whom I have had the privilege of competing (in fact, we nearly came to blows!). My friend and adversary asked David to call me. When he did, I gave him a list of medical experts and David chose Dr. Sugarbaker. It feels great to help educate good people like David Dally. David freely admits that before he hired us he did not care much for attorneys. Happily, he says that he's changed his mind.

David is currently regaining his strength and stamina at home in Ohio. David has an appointment with Dr. Sugarbaker on November 3, 1998 to discuss the merits of "pinpoint" radiation therapy in possible combination with chemotherapy. According to David, Dr. Sugarbaker believes that he removed the entire tumor, but he advised radiation therapy to insure that no stray malignant cells remain. Since the Dally's live in Ohio and Dr. Sugarbaker is in Boston, Dr. Sugarbaker has suggested that if the radiation therapy is necessary, it can be administered in Pittsburgh by one of Dr. Sugarbaker's colleagues.

Dr. Sterman's office has also contacted David about Gene Therapy. Dr. Sterman is starting a new program and has asked David if he would like to be included since he was previously approved. David has decided to wait and see if any tumors return before assessing his need for Gene Therapy.

David and his wife Donna have tried very hard to maintain a positive attitude during this ordeal. They are using money that they had saved for retirement in order to make ends meet and pay the medical expenses not covered by their insurance. Donna, a school teacher, has taken a leave of absence so she can care for David. Together, their goal is to get David well enough so he can eventually return to work and have an active, normal family life. The Dally's recently adopted an eight-week old female Airedale puppy. Both David and Donna are excited about the new puppy. Donna thinks it will give them something to think about other than David's illness. The puppy will also be a good companion for walking, cuddling and playing. David already has the puppy on a rigorous training schedule.

David's diagnosis of mesothelioma, and his subsequent surgeries and complications, have had a major impact upon his marriage and his family. David states that his marriage has served to help him survive his ordeal. "Donna is my best friend and she has been with me the whole time." Their two daughters have also been supportive during each battle. Their youngest daughter, Dana, is currently in college. Dana flew to Boston to be with her Dad and Mom even though she could only stay for a few days before returning to school. David says, "My family has been beside me all the time. I cannot imagine not having my family to lean on during this entire ordeal. It has been more than any person could handle alone."

When asked what has helped him survive, David responds, "Dr. Mike Landzberg, my cardiologist at Brigham & Women's." Dr. Landzberg, the head of David's cardiology team, visited David every day after his first and second surgeries. David says, "Dr. Landzberg talked to me and gave me words of encouragement which were vital to my survival." At the time of David's second surgery, Dr. Landzberg was scheduled to go on vacation. Dr. Landzberg canceled his vacation plans so he could be there if David needed him. As it turned out, Dr. Landzberg was needed. Dr. Landzberg even gave David his home telephone number. Even now, Dr. Landzberg periodically calls David and Donna to check on them and track David's progress.

David returned to Boston on November 9, 1998 for a follow-up examination with Dr. Sugarbaker. Chest films indicate that there is no recurrence of any tumors. More good news is that there has been no permanent damage to David's heart by the two (2) heart attacks her suffered following the two (2) surgeries. David is undergoing cardiac rehabilitation to strengthen his heart and is making plans to return to work in the near future.

Dave was exposed to asbestos during the Navy in the 1960's at the Brooklyn Naval Shipyard, among other places. He was also a boiler operator and supervisor at Mobay Chemical Company.

** POSTED NOVEMBER 17, 1998 **

Mr. David Dally passed away on February 18, 2000