Welcome to the Mesothelioma Help Aspen Nurse interview session. We're privileged to be talking to a doctor and two nurses with mesothelioma experience. Lisa Hyde-Barrett who has been a thoracic surgery nurse for nearly 25 years and has had the privilege of caring for countless mesothelioma patients over the years offers key medical information to the readers.
Ellie Erickson has been working in the surgical intensive care unit at Brigham and Women's Hospital since 1985. Before then she worked in the cardio-thoracic ICU and the ICU float pool. She earned her diploma in nursing from the Mount Auburn Hospital School of Nursing in 1978 and earned her B.S.N. from Wooster State College in 1982.
Dr. DeSilva [inaudible 00:01:05] at Loyola University Medical Center and professor of surgery at the Stritch School of Medicine in Chicago. He is the co-director of the lung cancer program and the director of the international Midwestern mesothelioma program Cardinal Bernadine's Cancer Center. So we'd like to start off first asking you Doctor DeSilva what program you're currently working on?

So my program is really comprehensive program. We have both chest, thoracic pleural mesothelioma as well as abdominal mesothelioma. Under a larger umbrella that we call regional therapy treatment for mesothelioma. And regional therapy really means heated chemotherapy. Applied to both the chest cavity, abdominal cavity with another surgeon, by the name [Pappas 00:02:03]. He's the general surgeon, I'm the thoracic surgeon in the program.
To our knowledge it's probably the first program to be so comprehensive [inaudible 00:02:13] Midwest. And we're very proud of it because many programs have thoracic or abdominal but most of the programs do not have a purely thoracic or abdominal combined. So we're happy about that and that's why we're working on creating, which we heard before, a team approach. So we have a multi-disciplinary clinic with medical oncologists, radiation oncologists, thoracic radiologists. I'm afraid to say most of them are seasoned, very experienced radiologists which is so important in the detection of mesothelioma [radiologicaly 00:03:00] speaking. We also have a dietitian. We have two nurses that help us to navigate the system. So we're beginning to put all that team together. The chemotherapy pleural effusion part of it, it's been already in place, even before I got here by Dr. Pappas. And they use the same system that I used, the [inaudible 00:03:18] when I was at the [inaudible 00:03:18]. So for me it really is the same procedure, we're just creating and uniting, putting together those two areas the abdominal and thoracic together under one umbrella. So we're very happy with our program.

Thank you for that. I guess the next thing we'll do is jump right in and whoever wants to answer this can take it away. The first question we have is, how is mesothelioma diagnosed?

It's a very good question. Most of the patients they present with what we call either a dry cough that's caused by a pleural effusion or shorten of breath. They just get short of breach because the effusions pushing on the lungs. Effusion is water around the lungs, right? So for those who, not clear what effusion means, it's just water around the lungs pushing on to the lungs. So most of the patients present with that, they get treated for awhile, doesn't go away and when they re-present a few months later, it may be too advanced of stage. So for us, the most important diagnosis is a very [synced 00:04:38] into the mesothelioma clinician.
What I mean by that, if someone has a high index of suspicion, something doesn't look right for pleural effusion. Patient's too young or there's no [inaudible 00:04:50] or something is not really clear why the patient has an effusion, should pursue aggressive diagnosis. And most of the places they do, let's say a [inaudible 00:05:02], a drainage with a needle, negative. Well we know that 50% of effusions will be negative anyways. So we recommend more aggressive therapy approach, diagnostic approach such as a biopsy, [inaudible 00:05:15], a pleuroscopy, which is a camera into the space and then biopsy it.
So the really clue for it is patient presents with a sort of not clear reason why they have an effusion. And you should jump at it instead of saying, well it's a cold or it's a pneumonia that's resolving, pursue further diagnostic modality.

Are you, do you plan on doing the abdominal and the thoracic together? Or just following the patient? Or how many cross over?

So, what we're planning to do if they come in predominantly with abdominal disease then we'll take care of the abdominal disease first and then follow the patient and see if anything were to develop in the chest. On the other hand, if [inaudible 00:06:18] present with chest disease predominantly, then we'll do the chest first and follow them knowing that the percentages of patients will present with abdominal metastasis, or spread through the abdomen. And then treat them when that happens. So by having the program set up so that we can see the patients together we keep close eye, myself on the chest point of view, and Dr. Pappas from the abdominal point of view, both looking at the scans very closely.

Mm-hmm (affirmative).

And I think that's the best for the patient because, I'm not abdominal surgeon, I've been trained as a general surgeon, but that's all he does is abdominal cancer surgery so he's more accurate at diagnosing cancer than I am in the abdominal and vice-versa the chest. So we'll do the chest first if the disease is predominantly in the chest or (pause) do the abdomen first if the disease is predominantly in the abdomen.

Mm-hmm (affirmative).

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