Document MMpoGpDdpGBkLvLnbNXBmEbb7

PLAINTIFF'S EXHIBIT DUP-2180 :n cf pulmonary and :al dare medicine Augus University of Arkansas for Med ica l Sciences Deoartment.of Incus:-'a; Relations D'v'sien of Irdustr'al Accidents Information'and Assistance Bureau A7~EN7ID,N: Ms. Diane Sustillos 52; Golden Gate Avenue San Francisco, CA 941C2 RE: GAMS ?56-44-07 J'JP ' Dear Ms. Bustillos: I Slot 555 4301 # Warxram w.!?' Rock. Arxansas .501) 651-5525 5 was seen in our Dhest Clinic on June 12, 1981 for evaluation of asbestosis as requested in your letter of March 26, 1581. ______ related that he was first exposed to asbestos beginning in 1948 wnen ne oegan working as a journeyman lagger. The following year, ne became a mechanic and remained in that occupation for 14 years during which time he had no asbestos exposure. From 1951 through 1956 he returned to his previous job as a Tagger,continuing the same kind of exposure he had had previously. He joined Dupont in 1956, and had heavy primary exposure to asbestos until 1967. About two years ago <9 Hp began having exertional dyspnea, whicn has been slowly progressing. Currently he states that he is able to ascend one flignt of stairs, "Shovel dirt about five minutes, or walk about two b'ocks before being limited by dyspnea. He described his dyspnea as a feeling that he can move air appropriately, but "cannot get enough oxygen". He stated that his dyspnea resolved after about half hour of rest. He denied cough, sputum production, hemoptysis, and wheezing. He smoked approximately two packages of cigarettes daily for 30 years, stopping two years ago when he was informed of the hign risk of malignancy due to smoking and asbestos exposure together. K^denied allergies. He had a past history of peptic ulcer disease, for-which he had taken cimetidine, but he was taking no medications at the time that he was seen. .* S. Physical examination revealed a well-developed,'well-nourished white an who appeared to be his stated age and was in no distress. Examinaticr of the chest revealed no adventitious sounds, normal breath sounds, and no abnormal 1 ties on percussion. The liver spanned 10 cenimeters to percussion, and there was mild right upper quadrant tenderness. The abdomen was otherwise normal. There was no clubbing of the fingers, [cyanosis, nicotine staining of the fingers, or edema. There were no otner abnormalities noted on physical examination. i PA and lateral chest x-rays revealed an extensive area of thickened 'pleura on the.left, wnich nad slightly increased in size in concarisen ,witn an x-ray made in 1579. There was a smal#l approximately 14 x 4 centime-tar area of pleural thicxening on the right, and ca'o'oat'on ' zf the diapnragm was visible on the right side. Resting arter^a: p.oed gases were Pa02 of 87 rmiHg, PaCOj of 34 imHg and pH of 7.41. loircretry ana lung volumes dene oy nelium dilution are shewn on tne encased , reoert. T'ne lung volumes were normal; tne FEVi/FVC ratio was s:ignt_.y eecreased to 735. The studies were interpreted as snowing a - border!tna_obstruct!ve cefect. An electrocardiogram demonstrates 'neemp. 'ric.nt bundle branen blccx wi tnout other.abnormal i ties. ial Opportunity Employer REDACTED DU 036482 ^ - ~^C <- -- division df pllwcnarv and CRITICAL CARE HEDIDINE RE: JAWS *56-44- Page 2 Aug us GC, 1361 3323 An exercise test was perfo^ed on June 19, 1981 at Little Rccx Veterans Acministratfon Hospital Py Dr. McKencree E. McNabb, a member of this Division. A cocy of tne report is enclosed. The pertinent findings were that tKKHHKUfo had normal cardiopulmonary function, including arterial oxygen saturation during exercise, and that he had a -crmal tolerance to exercise. During the exercise test he reacned only 53; of tne maximum breathing capacity predicted on the basis of tne FEY,. It is notade that during initial steady state testing at low worn 1 rates he had abnormally nigh ventilation, and that during subsequent testing at the same work rate he had normal ventilation. This suggests a pnycnogenic etiology for the initial hyperventilation. A single breath carbon monoxide diffusing capacity was performed at Little Rock Veterans Administration Hospital on June 19, 1981. The results was 26 ml/min/rnnHg, the predicted value being 30. This is considered to be a normal value. Arterial blood gases drawn within two seconds of cessation of Taximal exercise were as follows: Pa02 97 irmHg, PaC02 34 iranHg, and pH 7.41. The change from the resting blood gases represents a normal response to exercise. On the basis of his chest x-ray findings and his history, it is clear beyond any reasonable doubt that has asbestos!s. The slight decrease in FEVi/FVC ratio noted is more likely relatec to his long history of cigarette smoking than to his_asbestosis exposure. In any casev that degree of obstructive spirometrfc defect would not be expected to result in disability or, Indeed, insignificant symptoms. I believe that experiences the symptom he describes, and \ that his life Is significantly altered by them.: Thorough evaluation I does not reveal a phys-loloqic basis. I believe that they are largely eSgngenS origin, and Ahe~~-elated' 'that nd ftAs asbestosis w__h_i_c_h___h_e Tinas _e_x_t_r_e_m__e_l_v_Jthreatening. I trunk nil symptoms are probably increased by his relative Inactivities causing deconditioning, which, in turn, increases his symptoms. In sumary, I think his symptoms are due to his asbestos exposure and tne resulting asbestosis, although I think the mechanism of symptom production is / psychologic, not physiologic. I would recocmend follow up examinations in the future, to pr^ar-1y consist of chest x-^ay's. Obviously, the reason for this is fat me so the] ecma cannot be comoletely excluded ir> any point in time, anc t.ne only practical way to detect its occurrence would be to ncta a change on serial cnest x-rays. In aCdition, it provides a means *cr detection of bronchogenic carcinoma, for which is a: increased risk. The only treatment other tnan the follow uc examf-af I ~culd recommend would oe an effort to overcome the respiratory^ S..-P'. probably. I should t.nink that t.ne best way to aoproacn this oulo oe REDACTED DU 036483