Month: April 2009

For the past decade, the City of San Francisco has been working with the Lennar Corporation to redevelop the Hunters Point Naval Shipyard (HPNSY) into a new residential community.  Unfortunately, these plans have been mired in controversy due to the presence of toxic asbestos dust and other carcinogenic materials at the former Navy shipyard.  Residents of the surrounding neighborhood fear that they may be exposed to asbestos, PCBs, and other harmful substances as a result of construction activities at the site, and there have been a number of serious protests in opposition to the development.  In 2007, Lennar was even sued by two of  its own former executives, who claimed that the company maintained a “code of silence” to discourage employees from raising questions about potential health violations at the site.
On the other hand, state and city officials have long contended that the project is safe.  Both the California Department of Health and the Bay Area Air Quality Management District investigated the issue in 2007, and found that Lennar was taking adequate steps to protect surrounding residents against the hazards of asbestos.  This finding was confirmed by a draft EPA report obtained by the San Francisco Chronicle on January 5, 2010, which found that Lennar’s dust control program was effectively minimizing the generation of asbestos dust, and limiting asbestos exposure in the surrounding community.

However, many residents are still not convinced.  They point out that Lennar was recently fined over $515,000 for major dust-control violations.  Bay Area air district officials found that Lennar had failed to properly calibrate its dust monitoring equipment, so that the company could not accurately measure the levels of asbestos dust in the air.  Lennar was also cited for failing to maintain wash stations to remove asbestos dust from vehicles leaving the site.

Asbestos At Hunters Point

Hunters Point Naval Shipyard, also known as Treasure Island Naval Station-Hunters Point Annex, was a major center for the building, repair, and servicing of Navy vessels from World War II through 1976.  Like every other Navy shipyard during this era, Hunters Point Naval Shipyard contained literally tons of asbestos materials.  Most surface vessels from the 1940s through the 1970s required asbestos insulation on the piping and equipment, as did nuclear-powered submarines.  Hundreds of thousands of workers and Navy veterans were exposed to asbestos at Hunters Point, including many former clients of Galiher DeRobertis & Waxman.  Interestingly, Clifford Owen Galiher, the father of our founder Gary Galiher, was stationed at Hunters Point during his military career.

The Navy ceased most operations at Hunters Point in 1976, and the shipyard was listed for closing in 1991.  Unfortunately, asbestos continues to be a serious hazard at the former Navy shipyard.  Although more than 226,000 square feet of asbestos-contaminated materials were removed from the Hunters Point shipyard in 1990, there is still a great deal of asbestos on the site.  In addition, Hunters Point is located on a site where there is naturally-occurring serpentine asbestos in the soil.  As a result, the people who live in the surrounding community are at significant risk of neighborhood exposure to asbestos during construction activities at the site unless dust control measures are strictly followed.

Being diagnosed with mesothelioma is understandably a frightening and stressful time for patients, their families and loved ones.  Besides coping with medical issues and treatment plans, there are a myriad of practical matters to consider.  One of the most pressing issues is deciding what to do about accommodations when it becomes necessary to travel to a medical center in a distant city, especially if for an extended period of time while undergoing testing, surgery, and other treatment and follow-up care.  The cost of hotel rooms, even at special “medical rates,” can mount quickly, especially when the visits are frequent or prolonged.  Dr. David Sugarbaker, the director and founder of the International Mesothelioma Program (IMP), and his entire team have made it part of their mission to address this concern for the patients they treat.

“The House”

There is a wonderful place right across the street from the main entrance to Brigham and Women’s Hospital (BWH) in Boston, Massachusetts, affectionately referred to by mesothelioma patients and their families as “The House.”  It is a haven of sorts, a place where patients and their families can live while they are in Boston undergoing treatment at the International Mesothelioma Program, and they soon find that it offers far more than shelter.

Attorneys from the Galiher law firm recently met with Dr. Sugarbaker and other doctors and researchers at the International Mesothelioma Program and had the opportunity to visit the “Meso House,” as it is fondly referred to by many patients and families.  The house is a Boston triple decker located at 48 Francis Street.  The 4,400 square foot house is owned by the hospital and, after renovation and remodeling, opened in the summer of 2008.  The families of mesothelioma  patients who are undergoing treatment can stay there for a modest donation of $30 per night.  It is expected that they will stay for two weeks or more, before, during, and after mesothelioma surgery.  Gary Galiher had high praise for the house:

“The House is extremely comfortable and convenient for the patients and their families since it is right across the street from the entrance to the hospital.  It is very nicely decorated and has a full kitchen with everything the families need to prepare their meals.  One of our clients has been there for over three weeks now.  He and his wife feel as though it’s a ‘home away from home’ for them.”

Each of the three floors accommodates three families, except the first floor which accommodates two.  Each family has its own fully furnished bedroom.  They share a comfortable living room, as well as a walk-out back deck with table and chairs and a fully equipped kitchen with all major appliances.

The “Instant Support System”

Here families and patients have a chance to meet each other and to share their experiences.  On-site housing coordinator Cristin O’Rourke calls the house “an instant support system.”  Wives get together at the end of the day.  People who are going through the same thing meet, encourage, and support each other.  This is a time that can be lonely and frightening.  Here, some of the burdens are lifted, the load is made lighter, and the sense of isolation is replaced by a sense of connection and shared bonds.

Attorney Gary Galiher found that, “Our client and his wife have become very close to the other families with whom they share the house.  Theirs is a unique experience and one these families and caregivers so intimately understand.  Each family has a sense of what the other is going through and provides a special kind of support.”

Families can take meals together and relax in the living room.  They can retire to the peace and privacy of their quarters for needed rest.  It offers respite for caregivers, who often find that their responsibilities are now 24/7, as they gather at the end of the day, perhaps just to share a moment or two with someone who knows what they are going through.  The journey is a long one, but it need not be taken alone.  They have friends.  People care.  And their medical team is right across the street.  Its team members are part of “The House” too, as its nurses, counselors, chaplains, and social workers cross Francis Street, seeing to the care of their patients and their loved ones.

A Beautiful Home

“The House” is not merely a house, it is a beautiful home for patients and families, many of whom find themselves far away from their own homes in a strange city with very cold winters.  “The House” thus becomes a haven, a place where the emotional support and care of those it shelters is  paramount.  The on-site housing coordinator, Cristin O’Rourke, is there to look after the guests’ needs and to help with their concerns.  Upon arrival, each family is given a “resource packet,” which has helpful information on an array of subjects, including information about the city, transportation, the location of pharmacies, worship, and entertainment.

For reservations, contact social worker Charlene Haouiliya at (617) 732-5500, ext. 32819.

One of the most significant problems in the treatment of malignant mesothelioma is that the tumor can be resistant to many traditional forms of chemotherapy drugs.  This drug resistance varies from patient to patient.  Hence, weeks and even months of chemotherapy treatment could be wasted on a patient with malignant mesothelioma if that person’s tumor is particularly resistant to the type of drug being administered.

The International Mesothelioma Program (IMP) at Brigham and Women’s Hospital in Boston, Massachusetts is developing a new treatment aid that may assist physicians in prescribing the most appropriate form of chemotherapy for their mesothelioma patients.  This tool is called the Extreme Drug Resistance (EDR) assay.

Extreme Drug Resistance (EDR) Assay

To do an EDR assay, physicians at Brigham and Women’s Hospital remove a mesothelioma tumor fragment during surgery (extrapleural pneumonectomy or pleurectomy/decortication) and send it to the laboratory of Oncotech, Inc. in Tustin, California.  The cultured tumor is then tested against various chemotherapy drugs that are commonly prescribed for malignant mesothelioma.   Brigham and Women’s Hospital has Oncotech expose the tumor to Cisplatin, Gemcitabine, a combination of Cisplatin and Gemcitabine, and Vinorelbine.  As of now, Alimta, which is a drug frequently used to treat mesothelioma, cannot be used in the EDR assay, but the technical problems associated with Alimta in this test are being worked out, according to Dr. William Richards, Operations Director of the Brigham and Women’s Hospital Tissue and Blood Repository.

Oncotech then determines whether the mesothelioma tumor for that particular patient is resistant to each of the chemotherapy drugs or the combination of drugs.  If the EDR assay shows that a cultured tumor is extremely resistant to a particular drug, then there is a 99 percent probability that the tumor in the patient will also be resistant to that drug or drug combination.

Next Step: Clinical Trial Testing

According to Dr. Gavin Gordon, co-director at the Brigham and Women’s Hospital Thoracic Surgery Oncology Laboratory, the EDR assay for malignant mesothelioma must still be tested in a clinical trial for it to be approved as part of the treatment protocol.  There are case reports where the predictive value of the EDR assay has shown a very high correlation between the in vitro test and actual drug resistance in the patient.

In a published case report from the Kobe University Graduate School of Medicine in Japan, physicians used a test similar to the EDR assay called the collagen gel droplet embedded culture-drug sensitivity test (CD-DST) to identify the correct treatment for malignant pleural mesothelioma in a 63 year old woman.  The CD-DST test showed that the patient’s tumor was particularly sensitive in vitro to Gemcitabine and Vinorelbine.  Based on this result, her physicians selected these chemotherapy agents for her treatment.

The EDR assay test could be an invaluable tool in the treatment of malignant pleural mesothelioma and peritoneal mesothelioma, diseases that have shown a wide variability in response to different chemotherapy agents.