Mesothelioma and Other Asbestos Related Disease Information

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Asbestos - General Information

Asbestos, the general term for a group of a fibrous, hydrated, magnesium silicate minerals, forms fine, slender flaxy fibers that are fire resistant, insoluble and weavable. Asbestos is used as a heat resistant insulator and in cement and in furnace and hot pipe coverings, filter mediums, fireproof gloves and brake linings.

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Chemistry and Use of Asbestos

Chrysotile, or white asbestos, is the one serpentine (snake-like in appearance) form of asbestos, so designated because of the coiled appearance of its fibers. Main commercial uses of chrysotile includes asbestos cement products (e.g., pipes, gutters, tiles, roofing), insulation, fireproofing, reinforced plastics (e.g., fan blades, electric switchgear), textiles, friction materials, paper products, filters, and some spray-on products. Ninety-five percent of the world's asbestos production derives from chrysotile. The amphiboles are comprised of amosite (brown asbestos), crocidolite (blue asbestos, used mostly in cement), anthophyllite, tremolite (used in stucco), and actinolite. Crocidolite and actinolite occur more rarely than the other three, but appear in a more useable form. Exposure to asbestos occurs in both occupational and nonoccupational settings. In industrialized countries, human exposure is most likely due to occupational exposure in the mining, milling, transport, and manufacturing industries.

During World War II, a major source of exposure to asbestos was shipyard work. The significance of this today is that there is a 20-year latency period for appearance of symptoms related to asbestos exposure. Thus symptoms in these shipyard workers have begun to appear within the last two decades or so.

In the post-World War II period, the major source of asbestos exposure in the workplace is the construction business, where asbestos is used to insulate boilers, hot and cold air ducts, acoustical tiles and in cement. Although used under more guarded conditions today, a major source of exposure is in old buildings that were built when guidelines for asbestos use were less strict. When these buildings are torn down or renovated, they liberate asbestos fibrils into the air. Asbestos is also used in the automotive industry in brake linings and in chemical and electrical work.

There are also instances of general environmental exposure. In addition to the problems of pollution from outright dumping of asbestos waste, elevated asbestos levels are found in areas surrounding asbestos processing plants. More importantly, brittle asbestos breaks off from insulation in air vents and tiles and becomes airborne and easily inhaled. As a naturally occurring mineral, asbestos is present in ground water, and owing to its use in pipes, is present in many drinking water supplies.

Indirect occupational exposure, also known as bystander exposure, most often occurs in workers whose trades require them to be in close vicinity to others working with asbestos or asbestos-containing materials. This includes carpenters, plumbers, welders, scrap metal workers, and electricians, all of whom are at risk for fiber exposure due to the proximity of their location to asbestos. Familial exposure is common among families of asbestos workers who bring home asbestos on clothing. Domestic exposure occurs primarily through the laundering of fiber-laden work clothes in the home setting.

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Toxic Concentration of Asbestos

Asbestos is a very brittle material that readily elaborates small particles of fiber, or fibrils. These fibrils can be ingested or inhaled (more often the latter). Their potential to cause disease is directly related to their size and shape. Asbestos fibrils deposit in the lungs according to gravity. Because the curvilinear chrysotile fibers have an effective wider diameter, they are less likely to be cleared from the lungs through respiration. Amphibole fibers, on the other hand are more parallel in shape, and so fibrils from them deposit more easily in the terminal airways of the lungs.

Asbestos fibers are recognized carcinogens. It is hard to establish a toxic dose for them since symptoms take decades to manifest. There are threshold limit values, or permissible exposure levels (PELs) however, based on the amount of fibers 5 microns or longer found in a cubic centimeter of air. Originally 5 fibers/cc in 1971, this threshold was reduced to 2 fibers/cc in 1976. In 1986, this level was lowered by a factor of 10 to 0.2 fibers/cc on an 8-hour time waited average (TWA). It was thought that this new PEL would prevent 75 cancer deaths per year among the million and a half workers regularly exposed to the mineral. Currently, the strictest occupational exposure limits are 0.1 fibers/cc of air, and are estimated to be associated with lifetime risks of 5 per 1000 for lung cancer and 2 per 1000 for asbestosis. From studies in the United States and Great Britain, chrysotile has been shown to be the form of asbestos primarily associated with increased risks of lung cancer and mesotheliomas.

The carcinogenic effect of asbestos has recently been recognized among workers employed in the pulp and paper industry, in which asbestos exposure was previously not considered to be a major health hazard. Although world production of asbestos has declined dramatically in recent years, particularly in the United States and Europe, increases have occurred in Asian nations and developing countries. For this reason, the Collegium Ramazzine, a nonprofit agency headquartered in Italy, which was established to develop public policy in environmental and occupational medicine, is calling for an international ban on the mining and use of asbestos in all countries. Chile has been the first country to ban the importing of asbestos; this was followed by 10 of the 15 European Union states which have almost completely prohibited the use of asbestos. The debate on banning asbestos is a heated one, spurring emotions on both sides of the international community.

It should be noted that except in a few instances where risks associated with asbestos exposure could be clearly linked to proximity to an asbestos refinery, there is no PEL calculated for neighborhood exposures to asbestos. This is because the level of exposure in the general environment is several orders of magnitude less than is met in concentrated form in the workplace. However, the inconclusiveness of toxicological studies based on asbestos exposure in the general environment (except in cases of blatant pollution with asbestos containing materials) and the uncertainty over the ultimate effect that asbestos has on the individual exposed to the mineral over the span of a lifetime makes it impossible to rule out the potential toxicity of even minute traces of asbestos.

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Metabolism and Elimination of Asbestos

Some asbestos fibers penetrate the skin and cause asbestos ''warts.'' More often, though, fibers are inhaled or ingested. Most fibers larger than 5 microns that reach the lungs are exhaled through respiration or cleared through mucociliary transport. Some pass through the gastrointestinal tract and are excreted with the urine and feces. Fibers that stay in the body, though, are not metabolized. They stay permanently in the lung alveoli, where they become coated with a protein to form asbestos bodies; or in the larynx, the peritoneal space and the bowel wall. One recent study demonstrated that asbestos fibers are able to reach areas in the peritoneal cavity where some mesotheliomas (a type of malignant tumor of the chest wall) develop.

The presence of asbestos bodies in the lungs is considered the hallmark of asbestos exposure. These retained asbestos fibers can cause pathological changes in tissues many years after asbestos exposure has ceased.

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Asbestos Poisoning Resulting in Disease

Although it has been suggested that a single intense exposure to asbestos can predispose a person to mesothelioma, there is no such thing as acute asbestos poisoning. Depending on the amount of asbestos a person is exposed to over a specific duration of time, it may take anywhere from 15 to 30 years before a person shows symptoms of asbestos related disease. The three diseases most commonly associated with asbestos exposure are asbestosis, mesothelioma and lung cancer.

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Although the most benign of the three diseases, asbestosis is still a chronic lung disease associated with interstitial fibrosis in the lungs and pleural fibrosis or calcification. Within hours of deposition in the lungs, asbestos fibers evoke a macrophagic reaction in the small airways, within the alveoli (small sacs in the lungs where gas exchange occurs), and the interstitium. Fibers less than 3 microns are phagocytosed by activated macrophages, then carried to the lymphatic system, where they are eventually drained into the pleural space. Longer fibers are phagocytosed incompletely, and become the core of what were originally known as ''asbestos bodies'', but are now referred to as ''ferruginous bodies'' (to reflect the fact that other mineral fibers may undergo coating in the lungs).

Symptoms of asbestosis usually do not become overt until 15 years after initial exposure. Asbestosis is often referred to as a monosymptomatic disease, because the earliest and most distressing symptom is dyspnea (difficulty in breathing). Dyspnea occurs initially upon heavy exertion, then at progressively diminishing levels of effort as the disease progresses. Later, the patient suffers from a nonproductive or productive cough and fleeting pains in the chest. In most cases, however, the cough is dry and often occurs with distressing spasms. In patients with a productive cough, the sputum contains asbestos bodies. Anorexia may occur early but it is usually seen with cyanosis (blue discoloration of the skin due to lack of oxygen) in advanced cases.

Basal crackles (fine crisp sounds in the lungs) are an early distinctive feature heard through the stethoscope on physical examination of the lungs. They are usually unaffected by coughing, appear at first, at mid to late inspiration, and then eventually during most of inspiration, and have a high-pitched quality. Many patients with asbestosis show a reduction of the vital capacity because of a reduced elasticity of the lungs, whereas the expiratory volume is not affected. Hyperventilation is associated with considerable tachypnea (increase in respiratory rate). Clubbing of the fingers (a fingernail deformity found in many lung diseases) and occasionally the toes may also develop in some patients.

The posteroanterior chest radiograph remains a primary tool in the initial diagnosis of asbestosis. In prolonged cases of asbestosis, the presence of bronchiectasis (a chronic destructive disease of the bronchi) may be demonstrated roentgenologically. However, x-rays of fibrotic changes in the lungs do not always correlate with extent and severity of disease. Early fibrotic changes are seen better by HRCT, especially subpleural parenchymal changes that are obscured by pleural fibrosis on the chest x-ray. In general, the radiologic features of well-developed disease are seldom a diagnostic problem; it is the interpretation of less marked changes that is much more subjective, requiring the use of ILO films and HRCT.

Diagnosis of asbestosis for legal accountability requires the use of criteria that varies with the legal administrative system used. Most published criteria recommend histopathology (examination of lung tissue obtained from a lung biopsy) as the best method to establish the diagnosis. In its absence, however, the following criteria are followed: (1) a history of asbestos exposure; (2) a lag time between exposure to asbestos and detection; (3) evidence on the chest x-ray or HRCT scan of lung fibrosis; (4) a restrictive lung function profile; (5) bilateral inspiratory crackles; and (6) the presence of clubbing of the fingers, toes, or both. Of these criteria, history and clinical evidence (e.g., radiographic or HRCT) are considered essential to the diagnosis, and the others confirmatory.

Asbestosis is a progressive disease leading to incapacity with a bad prognosis. There is no specific treatment. Symptoms are treated as they arise. Death is usually caused by cardiac failure.

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Mesotheliomas are rare cancers of the chest wall (pleural mesothelioma) and abdominal cavity (peritoneal mesothelioma) that appear to be caused only by asbestos exposure. They are closely associated with exposure to crocidolite and amphibole forms more than to chrysotile. One recent study reported that the risk of mesothelioma was found to be 88 times greater in men and 799 times greater in women, respectively, compared to world background incidence rates, in a rural population of Turkey with environmental exposure to asbestos-contaminated soil mixtures (white soil). Mesotheliomas begin to appear 15 to 20 years after asbestos exposure and are seen in greatest profusion 25 to 35 years afterward. They are rapidly fatal, claiming the lives of 5 to 10 percent of all insulation workers.

Mesotheliomas are not dose-related, and it is not certain if they develop from a specific level of exposure or if one type of asbestos is more likely to cause the disease than another. Its first symptoms are pain at the site of the lesion. In the case of pleural mesothelioma, the tumor, the accompanying fibrosis and edema all contribute to dyspnea. Cough, basal rales and clubbing of the feet are commonly seen. A peritoneal mesothelioma may increase girth at the waist, diminish appetite, cause anorexia or cause ascites (fluid retention in the peritoneal cavity). X-rays reveal mediastinal displacement, pleural thickening and superimposed nodules. Although peritoneal mesothelioma often spreads to the pleural region, it is not usual for pleural mesothelioma to invade the peritoneal space. Persons with pleural mesothelioma usually live no more than two years after diagnosis, those with peritoneal mesothelioma even less.

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Lung Cancer

Asbestos exposure may potentiate a number of cancers, including bronchial cancer, stomach cancer and intestinal cancer. Most recently, asbestos has been linked to lung cancer. Initially it was believed that asbestosis had to precede lung cancer. Current opinion is that lung cancer can occur in the absence of asbestosis, although there are dissenting views on the subject. Smoking is not linked to malignant mesothelioma, but it is accepted that the synergistic effects of cigarette smoking and asbestos exposure increase the risk of lung cancer by a factor of 50, and the smoking of more than one pack of cigarettes a day by a factor of 87.

Lung cancer presents as chest pain and swelling, and if it affects the laryngeal nerve a change of voice. It is more likely to occur in the lower part of the lungs, and for that reason it is often masked by the fibrotic scarring associated with asbestosis.

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There is little one can offer for asbestos related diseases except symptomatic and palliative (treatment of pain and discomfort associated with disease) treatment. Surgery for mesothelioma is usually fairly radical and only a few patients derive any benefit from x-ray or chemotherapy or combined therapies. Less than 10 percent of patients live five years and most die in less than two years. The life expectancy for asbestos related diseases has been increased to about the age of 60. Ironically, though, the increased life expectancy leaves many of those affected by asbestos at greater risk of developing lung cancer. The prognosis for lung and other asbestos related cancers is the same as if those cancers had not occurred in the presence of asbestos exposure.

The reason for such inefficacious treatment protocols and poor prognosis is that it is impossible to remove the source of disease -- the asbestos itself -- once it has lodged in the body. By the time disease becomes symptomatic years, and often decades of damage have occurred. For this reason, the best treatment is preventive. Workplace controls limiting exposure to asbestos have been implemented over the latter half of the 20th century, resulting in a decreased risk of developing asbestosis and a greater chance of survival from cancer.

The 1986 OSHA standards established for exposure to asbestos in the workplace are unusual in that they are the first time an attempt has been made to impose different and more stringent regulations on the construction industry owing to the relative differences in job site requirements that distinguish it from more stable and regular industries such as insulation and shipbuilding. It is expected that studies of environmental and neighborhood exposures of asbestos in air, food and drinking water will continue to be explored in the future.

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Mesothelioma and Asbestosis Lawsuits

After a positive mesothelioma diagnosis, or diagnosis of other asbestos related disease, and having begun the treatment plan that your doctor has recommended you should turn your attention to protecting your rights to bring a claim against those companies which created or caused exposure of asbestos to you. Mesothelioma and asbestosis are diseases that are related to inhaling of asbestos fibers. There are approximately 3,000 new cases of mesothelioma diagnosed each year. The majority of mesothelioma and asbestos related diseases strike men who have worked with products containing asbestos fibers. Companies used asbestos in their products because the asbestos was very inexpensive, was very useful in its purpose, and allowed the companies who sold the asbestos containing products to make substantial profits for many years. Many of the manufacturers of the asbestos containing products were well aware of the hazards and dangers of asbestos to the users of their products but chose to ignore the dangers of asbestos in favor maintaining higher profit margins on their products. In order to not chill the market for their products, manufacturers did not warn users of the hazards and dangers of asbestos leading to mesothelioma and other asbestos related diseases.

If you have mesothelioma or other asbestos related disease, you have a right of recovery against the manufacturers, distributors, and retailers of the products containing asbestos which you used or were exposed to prior to the onset of the disease. The attorneys at Jim L. Culpepper & Associates, P.C. can assure you that your rights will be protected and you and/or your estate will receive the maximum recovery to which you are entitled based upon the losses, injuries and damages which you and your family suffer as a result of the mesothelioma or other asbestos related disease.

It is important that you act as quickly as possible to contact Jim L. Culpepper & Associates, P.C. after your diagnosis of mesothelioma or other asbestos related disease in order that your rights may be protected. The statute of limitations provides that claims for mesothelioma and other asbestos related diseases must be brought within a certain period of time by the filing of a lawsuit, otherwise all of such claims by the individual or by their estate will be barred, and no recovery will be possible. Determining which statute of limitation applies, and when the time period begins to run, depends on the applicable law, circumstances, and jurisdiction in which the claim will be brought.

Another reason to move very quickly after the diagnosis and commencement of treatment of the mesothelioma or other asbestos related disease is so that you and your family can work with the attorneys at Jim L .Culpepper & Associates, P.C. to identify the manufacturers, distributors, and/or contractors who are responsible for exposing you to products which contained asbestos. We will need to obtain from you as much information as possible concerning the times which you may have been exposed to asbestos during your lifetime. Based upon the information that you provide we may need to investigate other sources, identify manufacturers, distributors and/or contractors whose products and/or services may have caused you to be exposed asbestos. Many times the company actually responsible for exposing you to asbestos has changed its name, been merged with other companies, or has been acquired by other companies who do business today under different names. We will use our many resources to locate the proper parties who are responsible for exposing you to asbestos.

Once the responsible companies have been identified a lawsuit will be filed in the appropriate jurisdiction setting forth a claim on your behalf and/or on behalf of your estate to recover for your injury, losses and damages suffered as a result of the mesothelioma or other asbestos related disease. The compensation which you are entitled to receive include such elements as:

          Past and future medical expenses;
          Past and future loss of earnings;
          Past and future pain, suffering, mental anguish;
          Past and future physical impairment and disability;
          Past and future loss of household services;
          Past and future loss to husband and wife relationship and other family relationships;
          Other damages as provided under the laws of the state in which the claim is filed.

The amount of recovery in claims and lawsuits for mesothelioma and other asbestos related diseases depends upon a number of factors. Except for certain types of asbestosis cases, cases involving mesothelioma have a higher expected recovery. A claim based upon mesothelioma disease has a potential for recovery of $500,000 to $6,000,000. In some mesothelioma cases the recovery can be much greater. The recovery in asbestosis cases may vary from a nominal amount to several millions of dollars depending upon the extent of the disease and the prognosis. Of course in any claim the amount which is actually realized in a claim depends upon funds being available either by insurance coverage or the resources of the companies who are named as defendants in such claims.

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Do you have a claim based on mesothelioma or other asbestos related disease?

In order to optimize the recovery in a mesothelioma case or other cases involving asbestos related disease it is important to have competent attorneys who are experienced in handling product liability litigation including claims for disease and injury caused by asbestos containing products. The attorneys at Jim L. Culpepper & Associates, P.C. assure you that your case will be handled with the highest professional standards looking only to your interest and the interest of your family as the purpose and objective of pursuing such claims for you.

In order to obtain more information concerning mesothelioma and asbestos related claims and lawsuits, please, fill out the information below in order that we may assist you in making the best decision for you and your family in connection with any claim that you may have for mesothelioma or other asbestos related disease.

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