Gracie Hoal, a nurse practitioner at VA’s Comprehensive Mesothelioma Center in Los Angeles, takes a listen to George McDermott, an 84-year-old Korean War Veteran who served in the Navy. Photo by Svetlana Kotova
Malignant Pleural Mesothelioma (MPM) is an aggressive, incurable cancer that is diagnosed in roughly 3,000 Americans each year. One third of those Americans are Veterans.
The quiet killer you don’t see coming
“MPM is caused by exposure to asbestos, which is why such a disproportionate number of Veterans get it,” said Gracie Hoal, a thoracic surgery nurse practitioner at the West Los Angeles VA Medical Center (VAMC). “A lot of Veterans worked with or around asbestos during their time in the military.”
Hoal said asbestos was used extensively in Navy ships, for example. “And, even if you weren’t in the Navy,” she said, “chances are you were transported on a Navy ship to wherever you were being deployed.”
“Everything throughout the ships had asbestos,” said Leonard Carpenter, who spent four years and four months in the Navy during the 1960s. “We used it for everything. We just didn’t know it was killing us. It was every place on the ship. Even when I was sleeping in my bunk, there was a water pipe right next to me, right beside me. It was covered with asbestos insulation.”
Help is a phone call away
Hoal said not many Veterans know that VA can provide state-of-the-art treatment for MPM, including specialized surgery and radiation —as well as novel therapies like cryoablation (killing cancer cells with extreme cold) and immunotherapy (stimulating the immune system to fight disease).
“We’re trying to get the word out that we’ve developed a comprehensive mesothelioma center here at our West Los Angeles VA Medical Center,” she explained. “We have internationally recognized physicians here who specialize in the treatment of asbestos-related MPM.”
“We even have a TeleHealth program that allows us to see patients virtually, and to actively participate in a patient’s care even over a great distance,” Hoal said.
The mesothelioma center in West Los Angeles is headed by Dr. Robert B. Cameron. His team includes doctors and nurse practitioners who specialize in the areas of pathology, radiation, pulmonary (lung), oncology (cancer) and anesthesia. All have extensive experience with diagnosing and treating MPM.
“We want people to know that we’re here,” Hoal said, “and that we can help them.”
The nurse practitioner warned, however, that the disease can be difficult to diagnose, and is often prone to misdiagnosis.
“It can be tricky, because it’s a rare form of cancer,” she said. “Many doctors simply don’t have a lot of experience with it.”
“A lot of times your doctor will think it’s something else,” she continued. “That’s the worst thing that can happen. When you go undiagnosed, the disease has time to progress —and it’s a relentless disease. It can progress to a point where it becomes very difficult to treat.”
In addition to its relentless nature, MPM is a disease with a lot of patience: it takes a long time to develop to a point where you might begin to notice it. The asbestos that Leonard Carpenter breathed in during his four years in the Navy, and during the many years he worked as an electrician after military service, didn’t make its presence known until decades later.
“I went to my VA clinic here in Iowa because I had back pain,” said the 71-year-old. “I thought it was kidney stones. They sent me to the VA hospital in Iowa City. At the hospital they did a biopsy and told me I had MPM.
“Getting diagnosed early like that saved my life,” he said.
Dr. Robert Cameron heads the mesothelioma center in West Los Angeles.
Dr. Robert Cameron, who runs the mesothelioma center at the West Los Angeles VAMC, said the disease —even if detected early— is incurable.
“We can’t cure it, but if we catch it soon enough, we can manage it,” he explained. “It can be managed like other chronic diseases, such as high blood pressure or diabetes.
“As Gracie said, it’s a relentless disease,” he added. “But we’re relentless in treating it. We can not only extend Veterans’ lives significantly, we can help sustain a really good quality of life.”
Gracie Hoal said that without the right treatment, a patient’s life expectancy is six to nine months. “But, if you’re in the hands of a specialist, we can increase your life expectancy three-fold,” she said. “In fact, we have mesothelioma patients we began seeing six years ago —and even longer— who are still alive today. A good specialist can make all the difference.”
The best in the business
After Navy Veteran Leonard Carpenter was diagnosed at the Iowa City VAMC, his daughter Carol promptly stepped in and found the best specialist she could possibly find.
“Dr. Cameron was awesome,” said Carol Beck. “He puts you at ease. He made my parents feel very comfortable —they were both out in Los Angeles for four months. After four months of treatment, my dad is now basically cancer-free. I think that’s an incredible feat.
“Dr. Cameron is also conducting stem cell research,” she noted. “That gives me a lot of hope for my dad.”
“He’s more than a surgeon,” her father observed. “He’s a scientist. And he has a good bedside manner.”
Less is more
Gracie Hoal said Cameron specializes in the type of surgery in which only the tumor is removed, not the entire lung.
“This is now universally accepted as the best surgical option,” she explained, “and it’s something Dr. Cameron has been advocating for more than 20 years. We feel that saving the lung does not adversely affect cancer treatment, but does result in a much better quality of life for the patient. So only the tumor is removed. Then we use radiation to kill any remaining cancer cells.”
Invariably, however, the cancer reappears. It might return after a year, or it might not return for five or 10 years.
“It always comes back,” Hoal said. “You can’t stop it from coming back, so we need to monitor you routinely. If we find the cancer has returned, we often simply freeze those cells (cryoablation) before they can expand. So the key is regular monitoring.”
Leonard Carpenter said VA is definitely keeping a close eye on him.
“Next month I’ll be getting a scan in Iowa City,” he said. “They’ll send a CD of that to Dr. Cameron. He’s got a whole team out there in Los Angeles; but he’s the head of the team. He’s pretty sharp.”
Hoal is urging VA physicians throughout the country to contact the Comprehensive Mesothelioma Center in West Los Angeles immediately if they even remotely suspect their patient may have the disease.
“Just put in an inter-facility consult,” she said. “We’ll review everything and get back to you quickly. We’ll be happy to help you with a diagnosis. If you want, we can recommend a course of treatment. And if you feel your facility can’t offer the same level of care that our mesothelioma center can, just give your patient a referral and send them to us.”
You’re in good hands
Hoal said patients with a referral from their local VA hospital don’t have to worry about the expense of traveling to Los Angeles for specialized treatment.
“Once you get your referral, VA will pay for everything,” she said. “Your local VA hospital will pay for your flight out here. We’ll pay for your flight back home once you’ve been treated.”
But where will you stay while you’re undergoing treatment in an unfamiliar city?
“While you’re here with us, we’ll house you, [and] we’ll take care of you,” Hoal said. “We have a Fisher House here on campus and a brand new West Los Angeles Hotel set to open soon.
“And even if our on-campus housing is full,” she added, “we have a contract with local hotels. We’ll even pay for your taxi ride from your hotel to our center. We’ll take care of all those logistics for you.”
You can contact the Comprehensive Mesothelioma Center by calling Almaz Tesfasilase, the cardiothoracic surgery case manager for the West Los Angeles VAMC, at (310) 268-4543.
Tom Cramer is a former newspaper reporter who now works as a feature writer for VHA’s Office of Communications in Washington, DC. He lives in Columbia, Maryland with his wife Eileen.