Nurse practitioner Gracie Hoal listens to George McDermott's heart

Gracie Hoal, a nurse practitioner at VA’s Comprehensive Mesothelioma Center in Los Angeles, takes a listen to George McDermott, an 84-year-old Korean War Veteran who served in the Navy. Photo by Svetlana Kotova

Malignant Pleural Mesothelioma (MPM) is an aggressive, incurable cancer that is diagnosed in roughly 3,000 Americans each year. One third of those Americans are Veterans.

The quiet killer you don’t see coming

“MPM is caused by exposure to asbestos, which is why such a disproportionate number of Veterans get it,” said Gracie Hoal, a thoracic surgery nurse practitioner at the West Los Angeles VA Medical Center (VAMC). “A lot of Veterans worked with or around asbestos during their time in the military.”

Hoal said asbestos was used extensively in Navy ships, for example. “And, even if you weren’t in the Navy,” she said, “chances are you were transported on a Navy ship to wherever you were being deployed.”

“Everything throughout the ships had asbestos,” said Leonard Carpenter, who spent four years and four months in the Navy during the 1960s. “We used it for everything. We just didn’t know it was killing us. It was every place on the ship. Even when I was sleeping in my bunk, there was a water pipe right next to me, right beside me. It was covered with asbestos insulation.”

Help is a phone call away

Hoal said not many Veterans know that VA can provide state-of-the-art treatment for MPM, including specialized surgery and radiation —as well as novel therapies like cryoablation (killing cancer cells with extreme cold) and immunotherapy (stimulating the immune system to fight disease).

“We’re trying to get the word out that we’ve developed a comprehensive mesothelioma center here at our West Los Angeles VA Medical Center,” she explained. “We have internationally recognized physicians here who specialize in the treatment of asbestos-related MPM.”

“We even have a TeleHealth program that allows us to see patients virtually, and to actively participate in a patient’s care even over a great distance,” Hoal said.

The mesothelioma center in West Los Angeles is headed by Dr. Robert B. Cameron. His team includes doctors and nurse practitioners who specialize in the areas of pathology, radiation, pulmonary (lung), oncology (cancer) and anesthesia. All have extensive experience with diagnosing and treating MPM.

“We want people to know that we’re here,” Hoal said, “and that we can help them.”

Tricky business

The nurse practitioner warned, however, that the disease can be difficult to diagnose, and is often prone to misdiagnosis.

“It can be tricky, because it’s a rare form of cancer,” she said. “Many doctors simply don’t have a lot of experience with it.”

“A lot of times your doctor will think it’s something else,” she continued. “That’s the worst thing that can happen. When you go undiagnosed, the disease has time to progress —and it’s a relentless disease. It can progress to a point where it becomes very difficult to treat.”

In addition to its relentless nature, MPM is a disease with a lot of patience: it takes a long time to develop to a point where you might begin to notice it. The asbestos that Leonard Carpenter breathed in during his four years in the Navy, and during the many years he worked as an electrician after military service, didn’t make its presence known until decades later.

“I went to my VA clinic here in Iowa because I had back pain,” said the 71-year-old. “I thought it was kidney stones. They sent me to the VA hospital in Iowa City. At the hospital they did a biopsy and told me I had MPM.

“Getting diagnosed early like that saved my life,” he said.

No cure

Asbestos, cameron

Dr. Robert Cameron heads the mesothelioma center in West Los Angeles.

Dr. Robert Cameron, who runs the mesothelioma center at the West Los Angeles VAMC, said the disease —even if detected early— is incurable.

“We can’t cure it, but if we catch it soon enough, we can manage it,” he explained. “It can be managed like other chronic diseases, such as high blood pressure or diabetes.

“As Gracie said, it’s a relentless disease,” he added. “But we’re relentless in treating it. We can not only extend Veterans’ lives significantly, we can help sustain a really good quality of life.”

Gracie Hoal said that without the right treatment, a patient’s life expectancy is six to nine months. “But, if you’re in the hands of a specialist, we can increase your life expectancy three-fold,” she said. “In fact, we have mesothelioma patients we began seeing six years ago —and even longer— who are still alive today. A good specialist can make all the difference.”

The best in the business

After Navy Veteran Leonard Carpenter was diagnosed at the Iowa City VAMC, his daughter Carol promptly stepped in and found the best specialist she could possibly find.

“Dr. Cameron was awesome,” said Carol Beck. “He puts you at ease. He made my parents feel very comfortable —they were both out in Los Angeles for four months. After four months of treatment, my dad is now basically cancer-free. I think that’s an incredible feat.

“Dr. Cameron is also conducting stem cell research,” she noted. “That gives me a lot of hope for my dad.”

“He’s more than a surgeon,” her father observed. “He’s a scientist. And he has a good bedside manner.”

Less is more

Gracie Hoal said Cameron specializes in the type of surgery in which only the tumor is removed, not the entire lung.

“This is now universally accepted as the best surgical option,” she explained, “and it’s something Dr. Cameron has been advocating for more than 20 years. We feel that saving the lung does not adversely affect cancer treatment, but does result in a much better quality of life for the patient. So only the tumor is removed. Then we use radiation to kill any remaining cancer cells.”

Invariably, however, the cancer reappears. It might return after a year, or it might not return for five or 10 years.

“It always comes back,” Hoal said. “You can’t stop it from coming back, so we need to monitor you routinely. If we find the cancer has returned, we often simply freeze those cells (cryoablation) before they can expand. So the key is regular monitoring.”

Leonard Carpenter said VA is definitely keeping a close eye on him.

“Next month I’ll be getting a scan in Iowa City,” he said. “They’ll send a CD of that to Dr. Cameron. He’s got a whole team out there in Los Angeles; but he’s the head of the team. He’s pretty sharp.”

Hoal is urging VA physicians throughout the country to contact the Comprehensive Mesothelioma Center in West Los Angeles immediately if they even remotely suspect their patient may have the disease.

“Just put in an inter-facility consult,” she said. “We’ll review everything and get back to you quickly. We’ll be happy to help you with a diagnosis. If you want, we can recommend a course of treatment. And if you feel your facility can’t offer the same level of care that our mesothelioma center can, just give your patient a referral and send them to us.”

You’re in good hands

Hoal said patients with a referral from their local VA hospital don’t have to worry about the expense of traveling to Los Angeles for specialized treatment.

“Once you get your referral, VA will pay for everything,” she said. “Your local VA hospital will pay for your flight out here. We’ll pay for your flight back home once you’ve been treated.”

But where will you stay while you’re undergoing treatment in an unfamiliar city?

“While you’re here with us, we’ll house you, [and] we’ll take care of you,” Hoal said. “We have a Fisher House here on campus and a brand new West Los Angeles Hotel set to open soon.

“And even if our on-campus housing is full,” she added, “we have a contract with local hotels. We’ll even pay for your taxi ride from your hotel to our center. We’ll take care of all those logistics for you.”

You can contact the Comprehensive Mesothelioma Center by calling Almaz Tesfasilase, the cardiothoracic surgery case manager for the West Los Angeles VAMC, at (310) 268-4543.

cramer-bwfrTom Cramer is a former newspaper reporter who now works as a feature writer for VHA’s Office of Communications in Washington, DC.  He lives in Columbia, Maryland with his wife Eileen.


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Published on Aug. 4, 2014

Estimated reading time is 7.3 min.

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  1. Joyce Buck August 21, 2014 at 3:55 pm

    My husband who had MPM was a patient of Dr. Robert Cameron for approximately seventeen months, after being misdiagnosed by local doctors. This remarkable doctor performed my husband’s surgery, lasting over thirteen hours, painstakingly removing the malignant tumor.

    I challenge anyone to find a more skillful, brilliant and dedicated surgeon in the complicated treatment of MPM.

  2. Mike Sutherland August 18, 2014 at 6:52 pm

    Hi, I am one of Dr. Cameron’s patients. I was diagnosed with the disease at Sharps Hospital. They first sent me to a younger Doctor with no experience. He missed diagnosed me which delayed my treatments. This let the cancer grow to a higher level making it much tougher to treat. When he finally drained the fluid in my lung he thought he had found mesothelioma. At an appt. he told me and my wife I had 3 to 4 months to live. I had been researching on the internet and found Dr. Cameroon to be the most experienced Dr. on the west coast. I based this on the number of surgeries performed. Meanwhile I had made an appt. at Sharps with an older more experienced oncologist.
    He agreed to send me up to Dr. Cameron. I believe mesothelioma is a very difficult surgery and needs to be done by the guy who has done the most surgerys. Practice makes perfect. It is not just Dr. Cameron’s experience but it is also the team of radiologist and so on that work with him. They also haved honed their trade by seeing and working on hundreds of patients with this disease. This is a big surgery and then 5 weeks of radiation, who do you want doing this? I think I can safely say that this group is the best in the business and I am certainly happy I found them, and I thank all of them. I know my stage of this disease is not a good thing and the cancer is coming back (2 and a half years). Hopefully technology can help me, but until then I am glad Dr. Cameron is taking care of me. I also respect Dr. Cameron’s dedication to research, but I also respect the fact that while everybody else is working on years of no result research Dr. Cameroon stopped to put something in place that works for mesothelioma patients. He then returned to research working on technologies and equipment that may improve outcomes for mesothelioma patients

  3. Robert Cameron, MD August 15, 2014 at 1:20 pm

    You can contact the Comprehensive Mesothelioma Center by calling Almaz Tesfasilase, the cardiothoracic surgery case manager for the West Los Angeles VAMC, at (310) 268-4543 and we can review your father’s case and if appropriate, he could come to our center.

  4. Shajjad August 5, 2014 at 12:36 am

    How we can contact with Dr. Robert Cameron ! Can i get his contact info for taking a consultation for my father ?

    • AC August 10, 2014 at 2:48 am


      Cameron is very good. Not sure he’s the best though. Dr. Harvey Pass or Robert Taub have a lot more experience I believe.

      • Robert Cameron, MD August 15, 2014 at 1:18 pm

        I don’t know what qualifications you have to pass judgement on who is “good” and who is “best” but I have as much experience as almost anyone. I have a lot of respect for Dr. Pass but Dr. Taub is a medical oncologist who has treated primarily peritoneal mesothelioma and is not the same specialist as Dr. Pass or myself. Our center has multidisciplinary representation within the VA which is identical to the Center that I head at UCLA and this is unique within the VA as there is not an organized center for this disease anywhere else. Within the VA, we can provide the best care for Veterans. Furthermore, we have actually developed new therapies which, if you know about mesothelioma, there have been no others. We developed cryoablation which is one of the most successful treatments for patients with persistent or recurrent local disease.

    • PMC August 15, 2014 at 2:21 pm


      You may contact Dr. Cameron’s office at (310) 470-8980. He sees patients in consultation at his Los Angeles, California clinic located at:
      10780 Santa Monica Boulevard Suite 100 Los Angeles, California 90025-7613

  5. penny gay larsen August 4, 2014 at 1:17 pm

    The Va said I dont have cancer. That great. I was a engineman in the US Navy aborad ship Uss Point Loma Agds-2 Mar of 1982-1985 In the ship yard twice. Everytime I have surgey. I quit breathing,. When I have a knee replace in 2008. there said I had scar in my lung. I am a ex smoker. I quit in 2001. I am heavy and there said that why a have breathing problem. The Va. said I have astma and then said I don,t. When I cough i cough so deep it hurt my lung. and upper back hurt. Something I get cough I have to use my inhalter. My ship was on the list that ship for having asbesto and said mesothelioma. if I dont have it now can I get it later? And what so I look for.

    • Robert Cameron, MD August 17, 2014 at 1:44 pm

      Mesothelioma typically doesn’t occur for years (up to 60 years later!!) This is because of the inflammation that the fibers generate that eventually turn cells into cancer cells. The symptoms are listed above and can include coughing, shortness of breath and chest pain/discomfort. If you have an x-ray with unexplained fluid in your chest you should HAVE A BIOPSY as analysis of the fluid is notoriously inaccurate.

  6. john cosgrove August 4, 2014 at 10:53 am

    since I found out about this cancer I do worry about having it…..I do have a bad back,constant pain,had three kidney stones where the pain only eased after they came out…..never knew I had them till then….my back seem’s to be doing better since I wrecked a motorcycle in 2007,everything re-aligned…..but I was a engineman aboard ship,baiscly repaired every machine out side the engine room….is there any way to tell from blood work or piss test’s?…chest x-ray’s used to be very common,now unheard of…had a mri,a couple,….I just have a lot to do now,not ready to die,if it can be stopped with early detection and modern medicine

    • Robert Cameron, MD August 17, 2014 at 1:42 pm

      please see the answer above about symptoms and the use of chest x-ray and chest CT scans to assess your risks.

  7. John Fisher August 4, 2014 at 10:45 am

    I also worked in the boiler rooms on a heavy cruiser during the Korean war. In addition, I have been diagnosed with asthma. I do wonder if I might have Mesothelioma? I do not know what the indications are for this disease.

    • Robert Cameron, MD August 17, 2014 at 1:41 pm

      The indications or “signs” of the disease are usually three things: shortness of breath, chest discomfort/pain or coughing. Anyone who has been exposed or thinks they have been exposed should have yearly chest x-rays and at least a baseline CT scan of the chest to assess for changes consistent with asbestos exposure.

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