With Help from Her Family, Friends and Providence, Inoperable 53 Year-Old Hotel Manager Evaluates Experimental Therapies and Chooses Gemcytabine. Dearborn, MI

Around October, 1999, 53 year-old housewife and hotel manager Carol Miller began feeling sick, with flu-type symptoms. She developed a deep, dry cough. Initially, Carol got a prescription for antibiotics over the telephone. Sometime between Christmas and the first week of January, she saw her personal physician, who sent her to the Emergency Room of Grace Sinai Hospital in Detroit, Michigan.

At Grace Sinai, Carol's doctors took chest films and "tapped" her left lung. The fluid from the thoracentesis was very dark. Cytological tests detected the presence of "reactive" cancerous cells. Her doctors told her she had cancer. They discharged her from the hospital pending a CAT scan scheduled at Garden City Hospital, in Garden City, Michigan around January 13. The CAT scans were taken and then delivered to Grace Sinai Hospital, where they were interpreted and the results given to Carol on the morning of January 14.

The doctor at Grace Sinai told her that there was an obstruction near the superior vena cava (the large vein to the right of the heart), three tumors on the lining of the left lung, and also an enlarged lymph node on the middle right side, under the breast. Carol was re-admitted to Grace Sinai that day. She consulted with a thoracic surgeon at Grace Sinai, Dr. Bloom. He felt it was mesothelioma based on the CAT scans. Because Dr. Bloom strongly suspected that this was mesothelioma, he did not want to perform a thoracotomy, but rather referred Carol to Dr. Harvey Pass at Karmanos Cancer Institute in Detroit, Michigan. Dr. Bloom knew Dr. Pass was renowned for his expertise in treating mesothelioma patients.

Carol met with Dr. Pass on January 20. Dr. Pass put the CAT scan films on the viewbox and showed Carol the thickness of the lung lining. He also pointed out two lymph nodes which were bigger than normal. He told Carol that she also had a blood clot in the neck, which was caused by insufficient oxygenation. Dr. Pass explained that in order to verify node involvement in Carol's case, he would have to make an incision at the base of the throat and use a flexible bronchoscope to examine her. Dr. Pass did so on January 27 at Harper Grace Hospital (the hospital adjunct to Karmanos Cancer Institute), harvesting biopsy material from the lymph nodes. The pathology department examined this material and diagnosed mesothelioma.

After surgery, Dr. Pass said that the cancerous lymph node biopsies were definitely related to the thickening on the left lung. He determined that the cancer originated in the pleural cavity and had spread to the lymph nodes. He said that given the node involvement, chemotherapy was the only option. He mentioned a new and experimental chemotherapy which Carol would probably qualify for. Dr. Pass did not promise a "cure" (and he does not have a crystal ball), but his opinion was that the chemotherapy could prolong Carol's life beyond the seven months which she could expect if she did nothing. Dr. Pass scheduled an appointment for a week later.

The Millers met again with Dr. Pass on February 3. Dr. Pass told the Millers that Carol's was a rare case: her mesothelioma had apparently spread through the lymphatic system, which would tend to indicate the cancer was advanced, and yet there was relatively very little tumor. He offered Carol two options:

First she could participate in a single, blind, randomized Phase III study of mulit-targeted antifolate (ALIMTA^(R) (pemetrexed disodium)) plus Cisplatin versus Cisplatin only, to be administered once every three weeks, for three series. Second, she could participate in a Phase II study of Gemcytabine and Cisplatin. The deadline for enrolling in the studies was six days later. Impressed with the results Jim Dougherty and Charlie Baker had obtained with ALIMTA and no surgical intervention, the Millers would have chosen administration of MTA plus Cisplatin over Gemcytabine and Cisplatin. However, there was only a 50 percent chance Carol would receive ALIMTA as part of the blind study.

Carol considered asking Dr. Pass to administer ALIMTA plus Cisplatin on a humanitarian basis; she was willing to sign any waiver or release necessary. However, further inquiry with Dr. Pass revealed that Carol's other option looked very promising. Carol had heard about the Gemcytabine and Cisplatin "cocktail" which had been used with dramatically good results with Allan "the Big O" Ostling.

Allan Ostling's story appears elsewhere on this website, but the highlights bear repeating here: less than a week after meeting Allan for the first time, Dr. Pass performed exploratory surgery with the intent of performing a pleurectomy. However, during surgery Dr. Pass found that the cancer was more extensive than revealed by the CAT scans. The tumor had invaded the right lung, and the lymph nodes tested positive for tumor activity. Dr. Pass had no choice but to remove the lung. About one month later, on November 2, 1999, Allan began to experience discomfort and bloating in his abdomen. An ultrasound ordered two days later by Dr. Pass detected the presence of fluid in the abdomen. His doctors removed about three liters of fluid from the abdomen via paracentesis. Eight days later, Allan underwent a repeat paracentesis, with another three liters removed.

On November 17, 1999, the day he testified in his lawsuit against the asbestos manufacturers, the situation was grim for Allan Ostling. His abdomen was distended, and his color gray. He had no appetite, and had lost 31 pounds. Nevertheless, Allan underwent chemotherapy with the Gemcytabine and Cisplatin cocktail. He did not give up.

The results were astonishing. On CAT scan, the fluid build-up in Allan's abdomen known as ascites had disappeared. The swelling in his stomach disappeared. His color improved, and he regained some of the weight he lost. He recently felt good enough to go to dinner with his wife Jackie, and even had a couple of beers.

Apprised of the Ostlings' experience, the Millers chose the Gemyctabine and Cisplatin study. But Carol Miller would need every ounce of her courage for the unanticipated consequences of her chemotherapy.

On Friday, February 11, 2000, after initial administration of the Cisplatin/Gemcytabine cocktail at Harper Grace Hospital, Carol's whole upper body began to swell. By Sunday, her head was so grotesquely swollen that she could not hear or see. Her arms, chest and neck were swollen as well. She was taken Sunday to Harper Urgent Care. Doctors there explained to her that because the tumor in the lymph node was compressing the vena cava, the fluids pumped in during chemotherapy flowed up through the arteries, but could not return and were trapped.

Carol was released from Harper five days after her admission. During her entire stay, even at night, she had to stay in a seated position. A vascular surgeon examined her regarding placing a stint, but determined that her body was growing other veins, making a "bypass" itself. Carol's left lung was also full of fluid. Approximately a quart was drained via thoracentesis. She was given blood thinner shots.

By February 17, the swelling was down, except in Carol's left arm, and she was doing much better. On February 25, doctors drained another 2800 ccs of fluid from Carol's left lung, through a catheter in her back, while at the same time administering the chemotherapy. Carol suffered a collapsed lung during withdrawal of the catheter, purportedly because of an error in the catheterization. She was literally hunched over, screaming with pain for 30 minutes.

Despite these two unfortunate incidents, Carol reports that she has suffered only slight nausea from the chemotherapy, and is actually feeling better than when she started chemotherapy.

Carol will tell you that she has no hobbies other than working very hard and spoiling her four grandchildren. She was exposed as a child to the asbestos-contaminated clothing of another hard worker, her father, who built large industrial smokestacks and furnaces in the Detroit, Michigan area from the 1940s through 1975. Of course, Carol's father had never been warned of the dangers of asbestos, and was heartbroken to learn that he had been an unwitting agent of his daughter's disease.

Faith sustains this family. About three years ago, Carol's daughter Shawn became friends with the daughter of a man named Fred Ockerman. Shawn now feels that it was "divine providence" that she became friends with the daughter of a mesotheliotic. From what she learned from her friend, Shawn was able to help her parents make good choices in stressful circumstances. Shawn cites providence again in the way her mother was pointed early on to Dr. Harvey Pass, who in her view has exceeded his reputation as a caregiver and mesothelioma treatment expert.

Our prayers for continued healing go to Carol and her family.

*** POSTED MARCH 14, 2000 ***

Mrs. Carol Miller passed away on September 24, 2000