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Why You Need a POLST if You Have Malignant Mesothelioma

POLSTDoctor’s office forms, hospital test forms, insurance forms. When you have malignant mesothelioma, you get handed lots of clipboards and wind up filling out lots of forms.  But there is one form you need to make your sure you fill out.  That’s the Physician Orders for Life-Sustaining Treatment known as the POLST.

As a patient with malignant mesothelioma, there are many things in your life that are not in your control.  But the POLST helps give you control over one very important thing – your medical care.  The POLST also helps you talk with your healthcare team and your loved ones about your choices.  It can help prevent you from receiving unwanted or ineffective medical treatment.  In this way, the POLST can help spare your family the anguish of not knowing what type of medical procedures to say yes or no to. It makes sure that your wishes are known and honored.

The decisions documented on the POLST form include whether to:

  • Attempt cardiopulmonary resuscitation,
  • Administer antibiotics and IV fluids,
  • Use a ventilator to help with breathing, and
  • Provide artificial nutrition by tube

Where can I get a POLST form?

You can request the form from your doctor. The form can also be found at www.caPOLST.org

Is the POLST required by law?

Filling out a POLST form is entirely voluntary, but as of 2009, California law requires that the physician orders in a POLST be followed by health care providers.

Does the POLST form replace the Advance Care Directive?

The POLST form complements an Advance Directive and is not intended to replace that document. You still need an Advance Directive to appoint a legal health care decision-maker.

What happens to my POLST form after it is completed and signed?

The original POLST form should stay with you at all times.

  • In a hospital, your POLST will be in your medical record or file.
  • At home, place your POLST in a visible location so it can be found easily by emergency medical personnel – usually on a bedside table or on the refrigerator

Kazan Law First to Support Upcoming iMig 2014 Conference for Mesothelioma Research

iMig 2014 Cape TownMesothelioma research, like all scientific research, does not happen without funds. Although funds for mesothelioma research come from government agencies, universities and hospitals, it is no secret that money from private sources helps get the ball rolling either through funding the grant application process, additional staff positions, purchasing state-of-the-art equipment or helping to support conferences where researchers from all over the world can sit together and really discuss ideas.

That’s why our firm Kazan, McClain, Satterley & Greenwood, A Professional Corporation is proud to be the first law firm to step up and provide substantial financial support for the upcoming 12th biannual International Conference of the International Mesothelioma Interest Group. (iMig)

We are pleased to continue to sponsor the International Mesothelioma Interest Group (iMig 2014) when it convenes in Capetown, South Africa this October, just as we did in Boston in 2012, Kyoto in 2010, Amsterdam in 2008 and Chicago in 2006.

Recently, our support for iMig has grown beyond our role as a sponsor. We were honored that four abstracts from Kazan Law were chosen for poster presentation at iMig’s 2012 Boston conference.  Ours were the only papers out of hundreds submitted for presentation that were submitted by attorneys.  The information we presented was based on 20 years of experience with asbestos trust funds and 40 years representing asbestos victims. As we focus on the fight for justice for each of our clients, the entirety of our discoveries in this process brings to light implications which we believe are of benefit to the greater good of all mesothelioma cases. It was a privilege to share them.  You can see a three-minute video of me explaining their significance here.

iMig is comprised of independent international scientists and clinicians with the mission of working to understand, cure and prevent mesothelioma.  The iMig conference is one of the most important meetings where scientific information on finding greater treatment solutions for mesothelioma is presented and discussed. Because we want to see an end to the suffering caused by mesothelioma, our firm has been a generous supporter for years. Our commitment to this cause and this conference is unwavering. We give substantially and we give early.

Four Ways the Affordable Care Act Can Help With Mesothelioma Treatment

Affordable Care ActIf you need mesothelioma treatment, the Affordable Care Act may be a way to help you get the care you need now and for the future.  Unless of course, the foes of providing health care for all Americans succeed in taking it away.

As of this writing, the Affordable Care Act also known as the ACA, still stands.  (It is also known as Obamacare because President Obama has become so identified with his firm support for this measure.)  So if you are in need of mesothelioma treatment, the ACA may offer the best way for you to get it.

But you need to get going.  According to the federal government’s own website HealthCare.gov you need to enroll by February 15 for coverage starting March 1.  Also:

  • Open enrollment ends March 31.
  • If you haven’t enrolled in coverage by then, you generally can’t buy health coverage until the next open enrollment period for coverage the following year.
  • If you don’t have health coverage during 2014, you may have to pay a penalty.

Here are four reasons from the American Cancer Society why the Affordable Care Act can help you with mesothelioma treatment:

1) More cancer survivors can now get care – The program provides immediate access to coverage for people in every state who have been uninsured for six months or more and have cancer or another pre-existing condition.

2) No more “doughnut holes” – The ACA is finally closing the Medicare Part D “doughnut hole”.  Immediately after enactment, the law provided a $250 rebate to seniors who hit the coverage gap in Medicare’s prescription drug program.  In addition, Medicare beneficiaries will receive discounts on brand-name drugs next year.

3) The well won’t run dry – Health plans will be banned from setting lifetime dollar limits on coverage, ensuring that people with cancer have access to needed care throughout their lifetimes. Annual dollar limits on coverage will be tightly restricted for most plans and will be eliminated altogether in 2014. Patients will no longer have to put off treatments waiting for the new plan year to start.

4) In sickness and in health – Just like marriage, your health plan now takes a vow to you when they take your business.  As of this week, health insurers will be barred from dropping people from coverage when they get sick.  In other words, you can’t lose your insurance for developing mesothelioma.

Major reforms to health care can seem confusing and even overwhelming. The American Cancer Society has a staff of trained experts available to answer questions 24 hours a day at 800.227.2345. Also check the government’s website for help and sign-up information.

The debate on reforming health care is far from over, but these four real-world benefits alone can have a positive impact on mesothelioma patients, bringing us all one big step closer to access to affordable,  health care for all Americans.

Gratitude and Scientific News from the University of Chicago’s Mesothelioma Research Program

mesothelioma researchEven though I have been a mesothelioma attorney for many years, I never get used to the heartbreak of each and every one of my mesothelioma clients.  As I get to know each client and their families, they become more than clients.  Each becomes a face I will never forget; a suffering human being who came into my life near the premature end of theirs to seek help and justice.  And even though I am a mesothelioma attorney, my biggest wish is that there would be no more mesothelioma clients.  No more suffering and pain to individuals and their families from the callously negligent exposure to asbestos from the mesothelioma client’s employer.

That is why I also closely follow medical mesothelioma research and have our firm’s charitable foundation financially support mesothelioma research that someday will help to prolong their lives.

In 2006, I was in Chicago attending a meeting of the International Mesothelioma Interest Group.  One of the speakers was a key mesothelioma medical researcher from the prestigious University of Chicago medical school.  Hedy Lee Kindler MD is a top international cancer expert and one of the best around for mesothelioma.  In fact, she is the director of the Mesothelioma Research Program at the University of Chicago and a recent president of the International Mesothelioma Interest Group.

I spoke with Dr. Kindler who was also treating several of our clients. I was so impressed with the novel approaches she and her team were taking and decided to recommend to our Board of Directors that we financially support their work through the firm’s charitable foundation. And every year, I receive a wonderful summary of the research that contribution is helping to fund.

Dr. Kindler and her colleague Dr. Ravi Salgia now are evaluating a signaling pathway – molecules that kickstart cell activity – which appears to play a pivotal role in cell growth in malignant mesothelioma. Their goal of blocking this pathway could prove to be crucial to developing new mesothelioma therapies.

Other researchers in the program are carrying out studies using over 100 mesothelioma tissue samples and cells from the University of Chicago’s Thoracic Tumor Bank.  These studies also will help clarify how specific pathways get activated in mesothelioma and how genetically-engineered drugs can target them.

“The opportunities in our clinical research program to deliver focused targeted therapies give us confidence that we will play a critical role in improving survival and outcomes for mesothelioma patients. Your partnership continues to help us achieve our shared vision,” states my annual thank you letter.

I am proud to be part of that vision.

Mesothelioma Treatment and Medicare

mesothelioma treatmentBecause it may take decades for symptoms of malignant mesothelioma to develop to the point that it can be diagnosed, it is highly likely that a person suffering from mesothelioma could be over 65.  And if a mesothelioma patient is over 65, it is possible that he or she is on Medicare.  But you could be eligible for Medicare benefits if you require mesothelioma treatment even if you are under 65.

Medicare is the federal government’s healthcare program intended primarily for older Americans. It covers qualifying individuals age 65 or older. But it also covers people under age 65 who are disabled and suffering from serious illnesses like mesothelioma.

When a worker who has paid a sufficient amount into the Social Security system becomes unable to hold a job for at least 12 months, he or she is eligible for Social Security disability (SSD) benefits. If you meet the criteria for disability, you could begin receiving Medicare two years after being approved for SSD.

But if you receive a personal injury legal settlement, you may have to use part of it to repay Medicare for your mesothelioma treatment. Medicare refers to their reimbursement right as a “reimbursement claim” but it is basically the same as a healthcare lien. Federal law requires all parties to “consider Medicare’s interests” in third party settlements where Medicare has made what are called “conditional payments” for injury-related care.

The term “conditional payments” describes the injury-related healthcare payments Medicare made for your mesothelioma treatment, although another party caused – and is legally responsible for – your injury. Medicare pays for your care on the condition that the responsible party’s funds will be used to pay the program back for your treatment.

A federal law called The Medicare Modernization Act of 2003 requires you and your attorney to inform Medicare that they made a “conditional payment.” Your attorney should request a conditional payment summary, then analyze, review and resolve Medicare’s claims for reimbursement. At Kazan Law, we work hard for our clients and part of that is making sure that you do not get stuck using your settlement to pay medical bills that have been inflated in anticipation of a settlement claim.  When we obtain large settlements for our clients, we also see to it that they get to keep as much of it as possible by carefully examining insurance and Medicare itemized claims and medical bills, and negotiating appropriate deductions for the value of our efforts in collecting the funds so that typically our clients end up paying less than half the claimed amount.

Scientists Rejuvenate Immune System to Attack Mesothelioma

mesothelioma researchOne of the dangers of asbestos-related diseases, such as malignant mesothelioma, is that you may not know you’re sick until you develop symptoms. This process can take between 20 and 50 years, and by the time you notice problems, most treatment options are limited to palliative care.

The long latency periods of these diseases mean that many patients are advanced in age. Scientists think this may be a problem because the cells of the immune system behave differently as people age, and this may not be helpful in cases of cancer.

But what if scientists could somehow reverse the aging process of these immune cells? Researchers from Australia may have succeeded in doing that very thing.

How does the immune system work?
Your immune system is quite a powerful weapon, designed to protect your body from bacteria, fungi and viruses. These cells are also tasked to scavenge and clean up injured or damaged cells, including cancerous cells. Experts say that if the immune system turned against us, we wouldn’t stand a chance.

So how exactly does the immune system work? There are two main types of cells:

  • Phagocytes are cells that “eat” potentially harmful matter, such as pathogens and damaged cells. Granulocytes, dendritic cells and macrophages are all considered phagocytes. Macrophages in particular are known for eating larger matter
  • Lymphocytes are white blood cells that “learn” to recognize different types of harmful cells so they can attack them more effectively. They can identify viruses, bacteria and cancer cells. B-cells and T-cells are both considered varieties of lymphocytes.

The different parts of the immune system usually work together. For example, macrophages not only eat harmful matter, but they also put the other cells of the immune system on alert in case there’s some type of infection.

Researchers make old cells young
Researchers from Australia’s Curtin University theorize that cancer is particularly prevalent among older individuals because their macrophages become less active, and therefore cannot help the immune system kill off malignant cells. They say this may be especially true of mesothelioma and lung cancer.

This concept also led them to explore what would happen if they could make the macrophages of older individuals act like those of younger subjects. For their experiment, they looked at young and old mice, both groups of which were initially healthy. After the scientists exposed them to mesothelioma cells, they noticed the immune systems of the older mice were more sluggish to respond. However, after the researchers treated them with a certain drug, the macrophages of the older mice became active and helpful again.

Scientist Connie Jackaman had this to say to Science Network in Western Australia:

“Immune dysfunction is not permanent and in fact can be restored to function similarly to a young immune system. The public may be interested to know that as they get older it is not necessarily all downhill. The next step for our research group is to see if we can target macrophages in a live model and induce tumor regression in elderly immune systems.”

In the U.S., more than 7,300 individuals die every year because of malignant mesothelioma or asbestos-induced lung cancer. The long latency periods of asbestos-induced diseases mean that their incidence probably won’t peak for another 10 years or so. This is true for the U.S., the U.K. and Australia.

These trends are what motivate scientists in their search for a cure for asbestos-related diseases, and they’re what motivates us at Kazan Law to keep fighting for our clients.

New Surgical Procedures for Cancer Patients Limit the Danger of Complications

mesothelioma treatmentRecently, I noticed an article published by Cure Magazine that talked about the different innovations that are allowing cancer surgery patients to recover more quickly with fewer complications.

What are the standard surgical procedures?
Before I get into highlights of the article, I think it’s important to delve into the types of surgery that doctors may use to treat non-small cell lung cancer. The National Cancer Institute lists the following four types:

1. Wedge resection removes the tumor, as well as some of the healthy tissue that surrounds it.
2. Lobectomy cuts out an entire section of the affected lung.
3. Pneumonectomy gets rid of an entire lung.
4. A sleeve resection removes part of the bronchus, which is the airway that connects the windpipe to the lung.

Surgery for small cell lung cancer may be more complicated because this form of the disease often affects both lungs at the same time. The lymph nodes may be abnormal, as well. In either case, patients may need to undergo additional treatments with radiation or chemotherapy.

Regardless of the type of surgery that doctors use, there are always risks for post-operative complications. These include pain, blood clots, nerve damage and infections. However, scientists are trying to improve surgical procedures to curb the danger.

New tools are helping doctors
Traditionally, doctors operate on cancer through open surgery, which means that they make incisions that are large enough to provide visual and physical access to the tumor. The risks associated with open surgery can be reduced if the incisions are smaller.

To that end, doctors can use a variety of tools to reach malignant tissues while causing minimal damage to the healthy areas. These may include laparascopes, which are tiny telescopic cameras that let doctors see inside patients, and surgical robots that doctors can control remotely. Also, a procedure known as natural orifice translumenal endoscopic surgery, or NOTES, allows clinicians to insert tools through a patient’s body via flexible endoscope, which is a tube that creates a passageway when it goes through the mouth.

“Minimally invasive procedures now represent about half of all cancer surgeries we do,” Eric Grogan, M.D., told Cure Magazine. “Ten years ago, 95 percent would have been traditional open surgeries. The minimally invasive approaches have changed the risks-benefits ratio a bit because it has slightly reduced the risk of the operation.”

Although these innovations reduce tissue damage, they still carry the risk of blood clots and infection. In order to tackle the former, more doctors are prescribing blood-thinners to be taken after surgery.

Infection control is a little bit more complicated and requires more work. This includes the prescription of antibiotics, blood glucose monitoring, controlled-warming of a patient’s body after surgery and careful administration of anesthesia during an operation, which is important for the prevention of pneumonia.

Asbestos exposure is a real public health threat. Every year, asbestos-induced lung cancer claims the lives of about 4,800 individuals in the U.S., as estimated by the Environmental Working Group. That number is expected to increase over the next 10 years or so.

Fortunately, it looks like surgical options are becoming safer for patients. However, let’s not let that diminish the importance of curbing asbestos use and production.

Vitamin-Drug Combo May Help Treat Mesothelioma

mesothelioma treatmentRecently, I learned about a team of researchers in Italy who are working on a new combination treatment that brings together vitamin C, the chemotherapy agent gemcitabine and EGCG, which is an antioxidant found in green tea.

On the surface of it, this may sound like a strange approach to treating mesothelioma. However, the paper, which was published in the journal PLOS ONE, suggests researchers found promising results.

Looking at the individual components
Before we get into the details of what the scientists did in the laboratory, it may help first to understand what components they were working with.

First, there’s the use of antioxidants. These are nutrients that help stabilize the destructive forces of free radicals, which are molecules that degrade the cells in your body, drive the aging process and increase the risk of cancer. Free radicals come from all over the environment: air pollution, ultraviolet radiation, unhealthy food – even the simple act of food metabolism in the body creates free radicals. However, antioxidants help neutralize the effects of free radicals.

Vitamin C, which is also known as ascorbate or ascorbic acid, is a popular example of an antioxidant. You consume this nutrient every time you eat any of a large variety of fruits and vegetables.

Green tea also has antioxidants, including EGCG, which belongs to a class of plant molecules known as polyphenols.

Usually, in the context of cancer care, antioxidants are discussed as a preventive measure. However, previous studies convinced the scientists from Italy that vitamin C and EGCG may actually be able to act directly against tumor cells. For their study, the researchers combined these two antioxidants with the chemotherapy drug gemcitabine. This medication interferes with cancer cells’ ability to replicate the DNA that they need to reproduce and grow, thereby curbing the growth of malignancies. Currently, doctors prescribe gemcitabine for diseases such as breast cancer, ovarian cancer, pancreatic cancer and non-small cell lung cancer.

Researchers test-drive their drug-antioxidant combo
The researchers’ goal for this study was to find a possible new treatment for mesothelioma, a disease that currently has no cure. In the laboratory, they combined vitamin C, EGCG and gemcitabine. They referred to this mixture as Active Nutrients/Drug, or AND. In order to test the effects of AND, the scientists created both cell models and rodent models of mesothelioma.

In the cell model, they observed that the individual components of AND seemed to work in a synergistic manner, with each active ingredient enhancing the effects of the others, causing the diseased cells to die.

In the mouse model, the researchers found that AND reduced the size of the animals’ tumors, decreased the number and size of metastases, and prevented abdominal bleeding.

“Here we show that a triple combined treatment based on EGCG, ascorbate and gemcitabine (AND therapy) reduces mesothelioma growth and metastasization,” the researchers wrote in PLOS ONE. “Due to the lack of side effects, we propose that this combined therapy should be evaluated in other preclinical and clinical models.”

Because this experiment was conducted using cell and animal models, it may be years before scientists evaluate the performance of AND in human clinical trials. Still, this study is important because it provides the foundation for a potential new way to tackle mesothelioma.

We at Kazan Law look forward to the future direction of this work.

Mesothelioma can Cause Heart Complications

mesothelioma treatmentAt Kazan Law, we know that the effects of mesothelioma on the body can be far-reaching. I recently came across a report in the Indian Journal of Pathology and Microbiology, which published a case report detailing a mesothelioma patient who developed atrial fibrillation, or AF. The Japanese doctors who treated him theorized that the heart complication was a result of physical crowding caused by tumors in his chest.

Growths in the chest can interfere with health
The authors of the study noted that advanced cases of pleural mesothelioma can lead to the growth of mediastinal masses or tumors. Doctors from MedStar Washington Hospital Center describe the mediastinum as the area of the chest that is between the lungs. Small masses may not cause any symptoms, but sometimes, mediastinal tumors can cause chest pain, persistent cough, difficulty swallowing, trouble breathing, fever, night sweats or unexplained weight loss.

Doctors can diagnose the presence of a mediastinal tumor by conducting a chest x-ray, CT scan or biopsy. They may also perform a mediastinoscopy, which inserts a super-thin camera into the chest cavity for a visual inspection.

Usually, a mediastinal growth can be controlled with the help of surgery.

What is AF?
A danger associated with any tumor is the possibility that the abnormal tissue growth can disrupt the function of any surrounding organs. In the case of a mediastinal tumor, the heart can be affected.

The authors of the case study found that, in one patient, a mediastinal tumor that grew out of mesothelioma may have caused AF.

Here’s what you need to know about AF: The American Heart Association describes it as a condition in which the normal rhythm of the heart is disrupted, and the top two chambers of the organ do not beat effectively. As a result, blood can pool in these chambers and form clots. These clots can cause a stroke if they block the circulation of blood to important areas of the body.

Furthermore, AF can lead to heart fatigue, chronic fatigue, poor circulation and other problems.

People who have AF sometimes describe feeling a fluttering sensation in their chest, but one of the dangers of this condition is that symptoms are not always obvious, and patients may not be properly diagnosed for some time.

Doctors find a possible new cause of AF
It turns out there was another interesting case that caught my attention – in Japan, doctors treated a 70-year-old man who was diagnosed with mesothelioma at the age of 66. When he was admitted to the hospital for the last time, he showed evidence of a mediastinal tumor, AF and other problems. He eventually died 29 days later.

The medical exam that followed his death revealed that several of his organs and major blood vessels were impacted by the mediastinal tumor and other growths. AF was a likely result of this interference.

“AF due to a mediastinal tumor can be cured by surgical excision of the tumor,” the doctors wrote. “Although the treatment of advanced mesothelioma is difficult, chemotherapy using pemetrexed and cisplatin, antibody-based therapies targeting epidermal growth factor receptor, and immunotherapy have been attempted recently. Advanced mesothelioma can cause AF, and the reduction in the tumor size using such therapies may prevent AF. It is important to diagnose mesothelioma at an early stage.”

This is just one more reason why global efforts to ban the use and production of asbestos are important, and why we at Kazan Law believe so much in what we do.

Cancer Center Recruiting Mesothelioma Patients for Clinical Trial Showing Encouraging Results

mesothelioma treatmentWhen it comes to medication, sometimes the way that doctors administer it is an important factor that can affect its effectiveness. One active area of scientific research aimed at developing better treatments for malignant mesothelioma involves exploring different methods of delivering drugs.

For example, Genelux, a pharmaceutical manufacturer based in California, is working in collaboration with the Memorial Sloan Kettering Cancer Center to evaluate the performance of GL-ONC1. The researchers want to know how effectively the agent can treat diseases such as mesothelioma and non-small cell lung cancer after doctors deliver it directly into the intra-pleural cavity of patients who develop malignant pleural effusions.

Current treatments fall short
Experts from the National Cancer Institute say that the treatments most suited for mesothelioma may partly depend on the stage of one’s disease. For example, if you are in the earliest stages of the illness, doctors may recommend surgery to remove the abnormal pleural lining and portions of other tissues in order to minimize the amount of malignant tissue that is present. This may be combined with radiation therapy as well as chemotherapy, both of which help further eradicate the cancerous cells.

In the advanced stages of the disease, surgery may no longer be an option.

Although these treatments may help alleviate the symptoms of your disease while extending survival time, they cannot cure mesothelioma. This underscores the need for better approaches to this illness.

Pleural effusions may provide a window
In order to develop a better treatment for respiratory malignancies caused by exposure to asbestos, scientists at Genelux created GL-ONC1, which is a modified form of the vaccinia virus that produces green fluorescent protein (GFP) in the body after it is activated. The GFP allows medical providers to track the medication’s activity.

Researchers at Genelux designed GL-ONC1 as a regimen for patients who develop malignant pleural effusions, which affect about 30 percent of individuals who have respiratory cancers. The NCI described this medical complication as an abnormal accumulation of fluid in the pleural space that envelopes the lungs. If not treated properly, a pleural effusion may cause chest pain, cough and shortness of breath.

Previous studies to evaluate GL-ONC1 suggested that the agent is safe in humans who have other types of cancer. This new trial will deliver the drug candidate as a single dose to patients who develop pleural effusions because of diseases such as mesothelioma. The goal is to further verify safety while determining the best dose for intra-pleural delivery.

Clinical trial will benefit everyone
The current trial on GL-ONC1 will ultimately enroll a maximum of 54 patients, all of whom will have to undergo video-assisted thoracic surgery and pleural biopsies. Like all clinical trials, there is a risk of failure. However, regardless of whether the experiment produces the desired results, scientists will gain valuable knowledge into how to tackle respiratory cancers.

At Kazan Law, we appreciate the value of these experiments. If you are interested in participating in this or any other clinical trials, talk to your doctor. You can also consult the NCI or the American Cancer Society, both of which carry information on the latest ongoing studies.

Remember that not all individuals with a particular disease may be eligible for specific clinical trials. Furthermore, you may not see the positive results you want. However, your participation would promote the work to help future patients.

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