Health trap of asbestosis

By SHANNON DININNY for the Missoulian

Doctor for W.R. Grace's defense testifies patients' behavior such as smoking exacerbated illnesses

The red, spiral-bound notebooks kept by family members tell the story of Margaret Vatland' s losing battle with asbestosis in the closing months of 1995. With meticulous detail, they chronicle the appetite loss, the breathing difficulty, the almost-hourly medication.

7 p.m., Oct. 11. 1995 -- " Didn' t eat much for dinner -- maybe two bites. Still having an awful time breathing.''

" There' s no way for one person to take care of this,'' said her daughter Gayla Benefield. " It takes around-the clock care. What is required is the care given to a newborn infant, a critically ill infant.''

By spring, Margaret Vatland had died of complications associated with asbestosis, a progressively degenerative disease caused by the entrapment of tiny, indestructible asbestos fibers in the lungs. Her husband died of asbestos-related illness more than two decades earlier.

There' s no healthy type of asbestos, but it was Vatland' s misfortune, and that of dozens of people in Libby, to be exposed to tremolite asbestos, an extremely toxic odorless, tasteless and almost invisible mineral fiber that infiltrates the lungs to lodge in the air sacs or puncture the pleura, or lining of the lungs. During the next 15 to 20 years, the latency period for asbestosis, scar tissue slowly builds around the fibers that cannot be expelled, impairing the lungs' capacity to absorb life-giving oxygen.

Coughing doesn' t help. Medication can only alleviate discomfort. There is no cure.

Stuart Cannon knows all this. He, too, has asbestosis, although you wouldn' t know it by looking at him. At 60, he seems to be the epitome of health. He smiles easily and laughs heartily. The geisha girl tattooed on his left forearm -- a relic of his youthful days in the Navy -- dances as he moves his arms while he talks.

" I knew asbestos was in the dust, but didn' t know it was dangerous until the ' 70s or ' 80s,'' said Cannon, who like many of Libby' s asbestosis patients, including Margaret Vatland' s husband, worked at W.R. Grace' s vermiculite mine, in which asbestos was an unwanted byproduct.

Several others have been diagnosed with mesothelioma, a rare, malignant cancer of the lung cavity almost always associated with asbestos exposure. As their lawsuits against Grace indicate, Cannon and dozens of others in Libby believe their exposure to asbestos comes from their work at Grace' s mine and mill.

Some family members of workers believe they are ill as a result of their exposure to asbestos dust the workers brought home on their clothes. Still others believe they were exposed as children while playing in piles of vermiculite waste.

Dr. Alan C. Whitehouse, a pulmonologist in Spokane, has testified in several lawsuits that he has diagnosed more than 200 Libby residents with asbestosis. They are now all his patients. Dr. Whitehouse did not return repeated attempts to interview him for this story, and Grace' s medical expert said the company' s lawyers told him not to comment.

The medical facts about asbestos related diseases are fairly straightforward, but one question to emerge in the Libby lawsuit is the degree to which patients' own behavior may have exacerbated their illnesses. Dr. Dorsett Smith, who has testified on behalf of W.R. Grace, has stated that factors such as obesity and heart disease can contribute to patients' symptoms.

The most obvious and serious contributing factor is smoking, medical experts say. " The combination of smoking and asbestos exposure creates a multiplicative chance of developing lung cancer. That number is going to depend on the intensity of exposure,'' said Dr. Gregory Wagner, director of the Division of Respiratory Disease Studies at the National Institute for Occupational Safety and Health in Morgantown, W.Va.

Wagner said that in one important study, insulation workers who smoked and were heavily exposed to asbestos over long periods of time were 50 to 90 times more likely to develop lung cancer. Smokers not exposed to asbestos are 10 times more likely to get lung cancer.

Cannon, who began smoking two packs a day at age 21, smoked for more than 30 years, making him a good candidate for developing lung cancer -- in addition to his asbestosis. Cannon expects his treatment for asbestosis to cost nearly $800,000 for the course of his life. That cost includes his twice-yearly doctor examinations -- he recently cut his care to one $400 annual visit because he is without medical insurance -- medical tests, medication, eventual home care and refurbishing his home for accessibility when he requires it.

Symptoms he can expect as the disease progresses include appetite loss, chest pain, hoarseness and coughing blood. In many cases, asbestosis weakens the body to the point that it cannot fight secondary infections -- a fact that allows some doctors to state that asbestosis itself does not kill.

" As with any chronic lung disease, it' s quite common that the immediate cause of death may be one thing, while the underlying cause of death could be another,'' Dr. Wagner said. " Asbestosis can kill people. On the other hand, you can' t assume that someone is going to automatically die from diagnosis of asbestosis.''

In August, Cannon was forced to purchase an inhaler,the first medication he has had to buy to treat the disease. The 30-day treatment costs $60. He said he hopes his veterans' benefits will defray the cost of medications, but he' s relying on a recent settlement with W.R. Grace to cover some, but not all, of the costs.

" Libby is a small town, and in a small town, people think small, so the settlements are small,'' he said. "The settlements are nothing, but our expenses will be just as large as if we were in a large city.''

The terms of the settlement prevent Cannon from discussing specifics. However, he said that with 40 percent of the money going to his lawyers and about another $50,000 needed to cover other legal expenses, the settlement will only cover all of his medical needs if he invests wisely and has a little luck. `

` At this point, I' m one of the more fortunate because I can still do things. But no one has ever gotten better,'' he said.