the lawyer writer

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Thursday, March 24, 2005

Hangover Central

I was very hungover today. I am often hungover. This is not necessarily because I go out drinking every night (I don't), but because of a physical ailment. Allow me to tell you my sad story.

When I was a young, hardy lass, I could drink like a Greek sailor. Actually, I could drink with Greek sailors, as was the case one night in Tijuana. (Two Greek sailors, one Swedish-American masseuse, her nondescript friend, and a fellow freshman who played football, to be specific). All the drinks a freshman gourmand picks: cheap tequila, Captain Morgan's Spiced Rum, Everclear, Kahlua and cream. I was tiny, and I could drink my weight in liquor, and don't think I didn't tell everyone (including my parents) about it.

The tolerance waned over the course of college, and stalled as I got my M.A. But then there was law school. Ah, the drinking we did. There wasn't one Irish bar that didn't know my name. Or, at least, vaguely recognized me. To this day, I think that law and liquor and inextricably linked (and the number of alcoholic lawyers may prove my point).

But then it happened. One day I couldn't get out of bed. I was really sleepy. Really, really sleepy. I couldn't wake up. I felt swollen. My lovely doctor friend Sanjay took me to the emergency room (Sanjay is an opthomologist, but for me he's a general practitioner, part-time shrink, and has been known to do a little backalley stitches removal). After the standard two-hour emergency room wait, the lovely doctors there told me the unfortunate truth--at the age of 23, I had contracted Mononucleosis (aka Glandular Fever). You know, the kissing disease that you're supposed to get when you're, um, twelve. Symptoms: sleep all day and all night, feel like crap.

Since it was, indeed, the kissing disease, I turned to "B," the man I was kissing during this period. "B.," I said in a friendly way, "have you given me mono?" B. looked shocked. "Me, no! Have YOU given ME mono?" He paused. "After all, you can get mono drinking out of a water bottle. Maybe you drank out of someone else's water bottle at Legal Aid." Well, that made me think. I was working at Legal Aid. It might actually be a germy place. I looked at him, and he looked at me winningly.

What can I say, I'm a sucker. I figured I drank out of a germy Legal Aid water bottle. Never mind that he was barely able to stay awake and his friends told me that he was running a fever. What did I know?*

Well, when you get mono at 23, your body takes a long time to recover. I tried to go back to drinking a couple weeks later, when I felt awake. I nearly passed out from the headaches, stomaches and general bodily rebellion. The doctor said I should take about six months off of drinking, which I did. (More or less. Don't judge me!) After that, I was at zero alcohol tolerance.

Now, friends and family, you know how hard I have worked to build that tolerance back up. And I like to think I have done a bang-up job. However, it has all come with a price, and that price is the Morning After Hangover Curse.

The Morning After Hangover Curse is this: regardless of how much or how little I drink, I get a hangover. The symptoms can be mild: dry mouth, dehydration, mild headache, fatigue, general malaise. On bad days, like today, it's serious headache, ugly queasiness, exhaustion, extreme grumpiness and a desire to do penance.

Allow me to say that mono does affect the liver, often permanently. People complain of getting too cold or too hot in situations where, before the mono, they were fine. My point is this: I am not a big baby. This is a physiological condition.

I have learned much about preventing a hangover. Here are my Thirteen Rules of Preventing a Hangover.

1. Drink clear liquor (vodka for me--Stoly, Grey Goose or Cirac)

2. Alternate with water towards the end of the night.

3. No matter how tired you are, stay up an extra half-hour before going to bed.

4. One or two slices raisin bread, buttered.

5. Lots more water before bed, along with...

6. Pedialyte (unflavored is the least obnoxious. Drink half a bottle) Gatorade will do in a pinch, but it's not the same.

7. One Advil. Two if you're a big person.

8. Get eight or so hours sleep. Use a girly sleepmask if necessary.

9. Morning: coffee is key. Have one cup upon waking. Maybe two. Chase it with some Cheerios for the fiber. Drink some water. Then go back to sleep.

10. Upon waking the second time, put on one of those cooling blue gel-masks over your eyes. Pray for forgiveness.

11. Soon after, have one or more of the following: cheesy omelet w/ onions, jalepeno, salsa; slice of pizza with garlic; quality mac & cheese with black pepper; nachos, anything from Taco Bell.

12. Keep active as to not give into the urge to curl up in ball and moan. But not too active.

13. No hair-of-the-dog bullshit. Stay sober for the rest of the day and night. Drink water consistently.

Now you know. You too will be able to drink excessively and manage your inevitable hangovers, as I do.

(*B. disappeared soon after, and I discovered that he had had mono-like symptoms before mine had manifested. We saw each other on the street five years later, and pretended not to recognize each other. Ah, New York dating).

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Anonymous Anonymous said...


Asbestos is made up of microscopic fibers that may become airborne
when asbestos containing materials and products are damaged or
disturbed.

Most asbestos fibers are invisible to the unaided human eye because
their size. When asbestos fibers get into the air they may be inhaled
into the lungs or swallowed into he digestive system where they can
cause significant health problems. The word "asbestos" is derived from
a Greek adjective meaning inextinguishable.

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and blue. Brown and blue asbestos are most commonly associated with
mesothelioma.

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crocidolite, tremolite, anthophyllite and actinolite.

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heat and flame. This included clothing, such as gloves, to stuffing
asbestos insulation into electrical conduit, to using asbestos to make
fire proof cloth for use in power plants or petroleum refineries.

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ceiling tiles and wall board. Any home built before 1978 probably
contains asbestos somewhere.

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result in the development of deadly cancers, particularly
Mesothelioma.
Mesothelioma has a latency period of 20 to 50 years after the first
exposure to asbestos. It is estimated that there will be about 250,000
cases of Mesothelioma before 2020.

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year, mostly in men over the age of 40. About 4,000 People die from
Mesothelioma every year, the rare cancer caused by asbestos exposure.
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industrial sites, homes, schools, shipyards and commercial buildings
in the U. S.

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than 6,000 Asbestos companies. These same companies knew of the
dangers for many years before ever warning the public of those risks.
It is thought that around eight million people in the United States
have been exposed to asbestos over the past half a century, and many
more cases - are expected to be reported in the next 25 years.

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eleven million U.S. workers had been exposed to asbestos by that date.
In fact, by 1970, it is estimated that some 25 million tons of
asbestos were used in the U.S.

Asbestos And Mesothelioma

Mesothelioma is a rare form of cancer that is caused by exposure to
asbestos. Mesothelioma cancer comes from inhaling or digesting
asbestos dust particles. Mesothelioma is a life-threatening disease
and should not be left untreated. Most cases of mesothelioma begin in
the pleura or peritoneum.
Mesothelioma cancer occurs in the thin layer of tissue that covers
your internal organs (mesothelium). The mesothelium is a membrane that
covers and protects most of the internal organs of the body. It is
composed of two layers of cells: One layer immediately surrounds the
organ; the other forms a sac around it.
The mesothelium produces a lubricating fluid that is released between
these layers, allowing moving organs (such as the beating heart and
the expanding and contracting lungs) to glide easily against adjacent
structures.
Mesothelioma is most common in the pleura (outer lining of the lungs
and chest cavity), but it may also occur in the peritoneum (the lining
of the abdominal cavity) or the pericardium (a sac that surrounds the
heart).
Most people who develop mesothelioma have worked on jobs where they
inhaled asbestos particles, or they have been exposed to asbestos dust
and fibre in other ways, such as by washing the clothes of a family
member who worked with asbestos.
There are funds available for asbestos victims.

Asbestos Exposure

Millions of Americans and people all over the world have been poisoned
by toxic levels of asbestos, putting them at risk for mesothelioma,
asbestosis, lung cancer, and other deadly diseases that are directly
caused by the inhalation of asbestos fibers.

Before the grave dangers of asbestos were known, and even for years
after the dangers were known, asbestos was used in literally thousands
of products that humans and animals encounter every day — particularly
in building components such as ceiling and floor tiles, walls, bricks
and stucco, and in automotive parts such as brakes and clutches.

People who worked in the asbestos industry or in fields in which
asbestos is used as a component of a product are most at risk for
mesothelioma.

Many individuals who have mesothelioma labored for years or even
decades in jobs that required frequent contact with asbestos. When
this mineral is mined, processed, woven, sprayed or otherwise
manipulated, its microscopic fibers can be released into the air,
where they may be inhaled, initiating the development of mesothelioma.

Asbestos exposure occurs when the asbestos that is in the products
becomes damaged. Once damaged, the asbestos fibers are released into
the air. The fibers are microscopic, smaller even than a grain of
pollen, and invisible to the naked eye. The asbestos fibers, if
inhaled or ingested, can become lodged into the body where it can
create severe medical problems.

Approximately 100,000 people in the United States have died, or will
die, from asbestos exposure related to ship building.

There were approximately 4.3 million shipyard workers in the United
States during WWII; for every thousand workers about 14 died of
mesothelioma and an unknown number died from asbestosis.

Occupations that have high rates of asbestos exposure include ship
builders, oil refinery workers, steel workers, power plant workers,
Navy shipyards, pipe fitters, auto workers, railroad workers and
construction workers.

Asbestos Symptoms

Asbestos symptoms include shortness of breath due to pleural effusion
(fluid between the lung and the chest wall) or chest wall pain, and
general symptoms such as weight loss.

Asbestos Signs and Symptoms:

abdominal pain
bowel function problems
chest wall pain
weight loss
pleural effusion, or fluid surrounding the lung
shortness of breath
fatigue or anemia
wheezing, hoarseness, or cough
blood in the sputum (fluid) coughed up (hemoptysis)
Asbestos Signs and Symptoms in Severe Cases:

blood clots in the veins, which may cause thrombophlebitis
disseminated intravascular coagulation, a disorder causing severe
bleeding in many body organs
jaundice, or yellowing of the eyes and skin
low blood sugar level
pleural effusion
pulmonary emboli, or blood clots in the arteries of the lungs
severe ascites
Asbestos and Asbestosis

Asbestosis is a scarring of lung tissue caused by the inhalation of
asbestos fibers. A portion of the fibers reach the alveoli (air sacs)
where oxygen is transferred into the blood. Asbestos activates the
lung's immune system and starts a reaction best described as an
inflammatory process.

Scavenger white blood cells (macrophages) try to break down the
asbestos (phagocytosis) but are not successful, causing other cells
(fibroblasts) to grow and form connective-tissue-based scars.

The formation of scar tissue or collagen in the lungs is known as
fibrosis. The scar tissue slowly builds up, often reducing the lung's
ability to deliver oxygen to the blood and remove carbon dioxide
(reduced diffusion capacity). The total lung capacity or TLC may also
be reduced. In severe cases, the impairment of lung function can
strain the heart, or even result in heart disease, such as right-sided
heart failure or "cor pulmonale."

The inflammatory process starts within hours or days after inhalation
of asbestos and injury at the cellular level begins shortly
thereafter. In people who develop asbestosis, the inflammatory process
continues to progress, fueled by indestructible asbestos fibers, even
after exposure to asbestos ceases.

This asbestosis inflammatory process may continue undetected for
decades causing no pain or respiratory symptoms. In many people, the
process eventually produces symptoms-breathing abnormalities and
radiographic changes. Usually, the first symptoms are shortness of
breath and a dry cough. These symptoms often precede abnormalities on
chest x-ray or pulmonary function tests. The period between exposure
and diagnosis is called "latency" and may range from 10 to 50 years.

Asbestosis is a chronic inflammation of the lungs. The inflammation is
a direct result of exposure to asbestos. Asbestosis is a progressive
disease with no cure. The inflammation causes shortness of breath,
which will get progressively worse as the disease progresses.
Physicians can treat some of the symptoms of asbestosis with auxiliary
oxygen, but it will not cure the disease. Death due to asbestosis
occurs by respiratory failure.

Asbestos and Smoking
Unlike lung cancer, there is no association between mesothelioma and
asbestos cancer and smoking.
Smoking does not appear to increase the risk of mesothelioma and
asbestos. However, the combination of smoking and asbestos exposure
significantly increases a person’s risk of developing cancer of the
lungs.

The Kent brand of cigarettes used asbestos in its filters for the
first few years of production in the 1950s and some cases of
mesothelioma and asbestos have resulted. Smoking modern cigarettes
does not appear to increase the risk of mesothelioma and asbestos.

The combination of smoking and asbestos exposure significantly
increases a person's risk of developing cancer of the airways (lung
cancer, bronchial carcinoma).

If you do smoke, stop. In addition to mesothelioma and asbestosis,
there is research that indicates that those who suffer from asbestos
exposure and smoke are at a greatly increased risk of developing
mesothelioma and asbestos lung cancer.

Asbestos Historical Usage

The name Asbestos was given to this mineral by the Ancient Greeks. The
word “Asbestos” literally means inextinguishable.
The Greeks termed asbestos the "miracle mineral" because of its soft
and pliant properties, as well as its ability to withstand heat.
The Greek geographer Strabo and the Roman naturalist Pliny the Elder
noted that the material damaged lungs of slaves who wove it into
cloth.
Asbestos became increasingly popular among manufacturers and builders
in the late 19th century due to its resistance to heat, electricity
and chemical damage, its ability to absorb sound.
By the mid 20th century asbestos use included fire retardant coatings,
concrete, bricks, pipes and fireplace cement, heat, fire, and acid
resistant gaskets, pipe insulation, ceiling insulation, fireproof
drywall, flooring, roofing, lawn furniture, and drywall joint
compound.
Asbestos has been mined and used commercially since the late 1800s. It
was used widely used during World War II.
Asbestos Facts:

By 1970, it is estimated that some 25 million tons of asbestos were
used in the U.S.
A history of asbestos exposure in the workplace is reported in about
80 percent of all mesothelioma cases.
Eight million people in the United States have been exposed to
asbestos over the past half a century.
Studies estimate that approximately 3,000 different types of
commercial products include asbestos.
The National Institute of Health in 1978 estimated that eight to
eleven million U.S. workers had been exposed to asbestos by that date.
Through 2003, more than 700,000 People had filed claims against more
than 6,000 Asbestos companies.
Many building materials used in both public and domestic premises
prior to the banning of asbestos may still contain asbestos.
The U.S. Occupational Safety and Health Administration (OSHA) set
limits for acceptable levels of asbestos exposure in the workplace.
In 2005, 2.2 million tons of asbestos were mined worldwide. Russia was
the largest producer with about 40% world share followed by China and
Kazakhstan.
The first documented death related to asbestos was in 1906. In the
early 1900s researchers began to notice a large number of early deaths
and lung problems in asbestos mining towns.
The term Mesothelioma was not used in medical literature until 1931,
and was not associated with asbestos until sometime in the 1940s.
Asbestos exposure becomes a health concern when high concentrations of
asbestos fibers are inhaled over a long time period.
Asbestos was used in the first 40 floors of the World Trade Center
towers causing an airborne contamination among lower Manhattan after
the towers collapsed in the attacks on September 11th, 2001
Inhaled asbestos fibers remain in the body and cannot be expelled.
Because of this, the fibers can easily penetrate body tissues and may
deposit themselves in airways and in the lung tissue.
It is estimated that 27.5 million Americans were exposed to asbestos
between 1940 and 1979.
Mesothelioma has a latency period of 20 to 50 years after the first
exposure to asbestos.
Many asbestos-containing products remain in buildings, ships,
industrial facilities and other environments where the fibers can
become airborne.
Mesothelioma from asbestos occurs more often in men than in women and
risk increases with age, but this disease can appear in either men or
women at any age.
Family members and others living with asbestos workers have an
increased risk of developing mesothelioma, and possibly other asbestos
related diseases.
If you are a grieving family member or executor of the will of a
person who has died from asbestos-related disease or mesothelioma, you
may be eligible to file a claim as well.

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4:07 AM  
Anonymous Anonymous said...

mesothelioma Mesotheliomais a form of cancer that is almost always caused by exposure to Asbestos In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart the pericardium (a sac that surrounds the heart or tunica vaginalis.
Most people who develop
mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. Washing the clothes of a family member who worked with asbestos can also put a person at risk for developing Mesothelioma Unlike lung cancer, there is no association between mesothelioma and smoking but smoking greatly increases risk of other asbestos induced cancer.Compensation via
Asbestos funds or lawsuits is an important issue in
mesothelioma The symptoms of
mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis, which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural
mesotheliomaSymptoms of peritoneal
mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal
mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
chest wall pain
pleural effusion, or fluid surrounding the lung
shortness of breath
fatigue or anemia
wheezing, hoarseness, or cough
blood in the sputum (fluid) coughed up hemoptysis
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:
abdominal pain
ascites, or an abnormal buildup of fluid in the abdomen
a mass in the abdomen
problems with bowel function
weight loss
In severe cases of the disease, the following signs and symptoms may be present:
blood clots in the veins, which may cause thrombophlebitis
disseminated intravascular coagulation a disorder causing severe bleeding in many body organs
jaundice, or yellowing of the eyes and skin
low blood sugar level
pleural effusion
pulmonary emboli, or blood clots in the arteries of the lungs
severe ascites
A
mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs
Diagnosing
mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for
mesothelioma A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of
mesothelioma A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude
mesothelioma it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure
If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of
mesothelioma A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
There is no universally agreed protocol for screening people who have been exposed to
asbestosScreening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for
mesotheliomaThe level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening. Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells
Incidence
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year. For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades. It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[ Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.
asbestos
is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven.
asbestos
has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
The combination of smoking and
asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer bronchial carcinoma). The Kent brand of cigarettes used
mesothelioma in its filters for the first few years of production in the 1950s and some cases of
mesothelioma have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.
Some studies suggest that simian virus 40 may act as a cofactor in the development of mesothelioma.
Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with
asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of
asbestos exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for
mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with
asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villiages in Turkey have death rates of 51% attributed to erionite related
mesotheliomaExposure to
asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.
The documented presence of
asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to
asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.
Commercial
asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.
Family members and others living with
asbestos workers have an increased risk of developing
mesothelioma and possibly other asbestos related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to asbestosMany building materials used in both public and domestic premises prior to the banning of
asbestos may contain
asbestos Those performing renovation works or activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue
asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to
mesothelioma radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although
mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel.
Radiation Therapy when given alone with curative intent has never been shown to improve survival from
mesothelioma The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy is the only treatment for
mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery. This trial was the first to report a survival advantage from chemotherapy in malignant pleural
mesothelioma showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.
Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.
In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer.
mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

What is the mesothelium?
The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs to glide easily against adjacent structures.
The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The
mesothelioma tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.
What is mesothelioma?
mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs.
cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.
How common is mesothelioma?
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.
What are the risk factors for mesothelioma?
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.
Who is at increased risk for developing mesothelioma?
asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.
The risk o f asbestosrelated disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.
There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to
asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
What are the symptoms of mesothelioma?
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to
asbestos Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis
How is
mesotheliomadiagnosed?
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the
cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the
cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
How is
mesotheliomatreated?
Treatment for mesothelioma depends on the location of the
cancerthe stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Surgery is a common treatment for
mesotheliomaThe doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural
mesotheliomaa lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Stereo Tactic Radiation Therapy also called radiotherapy, involves the use of high-energy rays to kill
cancercells and shrink tumors Radiation therapy affects the
cancercells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the
cancercells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat
mesotheliomaare given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation Therapy and surgery may also be helpful in relieving symptoms.

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