GUEST BLOG: Meso Patients Eligible for Access Pass to National Parks and Federal Recreation Areas

Streamby Sandy Robb

Many of you have in previous years posted pictures about your travels around the country, and many seem to enjoy the national parks and other federal facilities. With summer coming, there may be a way for you to save some money while enjoying those beautiful areas.

As you are aware, the Social Security Administration classifies malignant mesothelioma as the basis for a disability determination. One of the benefits that attach to that status is the availability of a free, lifetime Access Pass that allows free entry and numerous discounts at national parks, federal recreation areas, and facilities managed by the Forest Service, the National Park Service, Fish and Wildlife Service, Bureau of Land Management, and Bureau of Reclamation. Generally, the Access Pass means that the person and his or her vehicle (up to 4 adults) will be admitted free to the national parks, wildlife refuges, national forests, and other facilities run by these agencies.

The savings allowed by the pass can be quite substantial. To put it into perspective, both Yellowstone National Park and Yosemite National Park charge $30 entrance fees per day, but both are free to Access Pass holders. In addition to park admission benefits, the Access Pass entitles the passholder to discounts on amenities, campgrounds, boat launches, guided tours, and so on. Each facility will have its own guidelines for discounts. It should be noted that the pass is not honored everywhere; for example, the Access Pass is not accepted at Gettysburg. An overview of the Access Pass is available at

Anyone who has been rated as disabled by the SSA (or the VA) can obtain the Access Pass, either at one of the facilities authorized to issue them on-site, or through the mail. The mail-in application costs $10.00, while the in-person version is free.  The list of facilities is long, and can be found at The mail-in application is found at

To obtain a pass you must have identification to verify that you are a U.S. citizen or permanent resident, such as a US passport, a US state or territory driver’s license, or birth certificate or a permanent resident card (Green Card). Also, you will need documentation of your permanent disability.  Acceptable forms of proof include:

  • A statement signed by a licensed physician attesting that you have a permanent physical, mental, or sensory impairment that substantially limits one or more major life activities, and stating the nature of the impairment;
  • A document issued by a federal agency, such as the Veteran’s Administration, which attests that you have been medically determined to be eligible to receive benefits as a result of blindness or permanent disability;
  • Proof of receipt of Social Security Disability Income (SSDI) or Supplemental Security Income (SSI); or
  • A document issued by a state agency (e.g., the vocational rehabilitation agency) that attests that you have been medically determined to be eligible to receive vocational rehabilitation agency benefits or services as a result of medically determined blindness or permanent disability.

If you’re in doubt about what to supply, contact the issuing agency.

Enjoy your travels, and be sure to share your photos with us when you go.

GUEST BLOG: Post-Treatment Stretching Techniques

Stretchingby Carol Michaels

Stretching is one of the basic components of fitness. Stretching improves your range of motion, which is the degree of movement that can be achieved without pain. Elongating the muscle and fascia by stretching improves circulation, increases elasticity of the muscle, increases oxygen to the muscles, and helps the body to repair. It increases the circulation of blood to the muscles and prevents tight muscles, which have less blood flow. The blood carries oxygen that the muscle needs for energy. Blood flow also removes lactic acid and carbon dioxide, which cause inflammation.

Stretching should be performed every day, after receiving medical clearance. The older you are, the more important daily stretching is to maintain flexibility. Commit to stretching regularly so that you gradually improve your posture, range of motion, and flexibility. It will help you manage the stress and anxiety of the disease.

First, warm up for 5-10 minutes by marching in place or use a stationary bicycle while swinging your arms. Stretching is more effective when warm. The muscles and tendons are easier to lengthen when warm. Then perform the stretching exercises daily in the beginning of your recovery if possible. Use only smooth, controlled non-bouncy movements.

All movements should be done slowly and with great concentration. Try to reach the maximum pain-free range of motion possible for you. Do the stretches slowly and allow the tissue to lengthen. Hold the stretch until you feel a little tension, but not to the point of pain. The goals are to restore joint mobility and break down residual scar tissue.

At first, you might suffer from fatigue and low endurance and might only be able to exercise for a short period of time. Every day you can lengthen the session. Patience and practice will pay off. As you get stronger, you can increase the length of your sessions.

Once you have achieved an acceptable range of motion, it is usually necessary to continue your stretching program so you can maintain that range of motion. If you have had radiation, stretching is very important to help keep your body flexible. Radiation typically causes additional tightening and can impact the affected area for a year or longer after the treatment is finished.

The Recovery Fitness® program uses a combination of active stretching and static stretching. In active or dynamic stretching, the stretch is held for 1-2 seconds and repeated 10 times. In static stretching, the stretch is maintained for approximately 10-30 seconds and can be repeated several (2-3) times. You should move in and out of each stretch slowly and smoothly.

The following is an example of shoulder flexion active stretching: Bring the arm upward and hold for 1-2 seconds and then lower it back to your starting position. Repeat 10 times. With each repetition, raise the arm higher until you feel tension, but not pain. Exhale as you bring your arm up and inhale as you bring your arm down.

Active stretching is used in the beginning of your session. You can then begin to hold the stretch longer and alternate between static and active stretching. Our muscles work in pairs: one muscle works or contracts, while the other relaxes or lengthens. As your stretching session progresses you will determine how long to hold the stretch. The amount of time one should hold a stretch depends on the individual. By listening to your body and using common sense, you will be able to determine what feels good and what works best. Stretching, especially active or dynamic stretching helps you to get ready for any physical activity. Examples of dynamic stretches are walking lunges, squats, and arm circles. Dynamic stretching acts as a warm-up to reduce injuries, get the muscles warm, and improve performance.

Some tips:

  • The brain and nervous system work together in every stretch, and every repetition causes neuromuscular education. By thinking about the movement and concentrating on the affected muscle, we rewire the injured or tight muscle. Be mindful of the movement and its purpose.
  • Slowly lengthen the muscle to a comfortable length while using relaxation breathing
  • The stretches should feel good. Hold the stretch until you feel tension. As you hold the stretch the muscle will relax and you will be able to increase the stretch. Each day it will get easier and you will see your flexibility improve.
  • Modify the stretches to take into account your day-to-day pain and fatigue levels. Do not worry if you are less flexible on a particular day. Just do your best and modify the stretch as needed. You might only be able to perform a few of the stretches on a particular day, or you may need to decrease the length of your session. You may also modify your flexibility routine by reducing the amount of time the stretch is held or changing the number of repetitions performed.
  • Stretching can be performed while standing, sitting, or lying on the floor. Most can even be done in bed.
  • Add a variety of angles to each stretch. For example, if you perform a shoulder stretch with your arm parallel to the floor, try doing the same stretch with the arm at an angle pointing toward the ceiling.
  • Stretching improves posture.
  • Each movement helps to move lymph through the body.
  • Stretching improves movement patterns and decreases the chance of developing over-use injuries.
  • Stretching with relaxation breathing reduces stress.
  • Stretching increases feelings of well-being. You are able to perform your daily activities more easily and with less pain.

Radiation treatment can cause additional tightening. Ongoing flexibility exercises are always recommended to those who have had radiation so that they are able to maintain their range of motion and all of the benefits that good flexibility brings.

Learn more about fitness for cancer patients in our previous articles by Carol Michaels: First Steps to Starting an Exercise Program and Relaxation Breathing, Stretching, and Initial Exercise Precautions.

Carol Michaels FitnessCarol Michaels is a cancer exercise specialist and creator of the Recovery Fitness cancer exercise program. Recovery Fitness is taking place at Morristown Medical Center and several other facilities in New Jersey. Michaels also wrote “Exercise for Cancer Survivors,” a resource for cancer patients going through surgery and treatment.

Preliminary Results of Immunotherapy Drug Show Promise for Mesothelioma Patients

VaccineThe Meso Foundation is optimistic about the results of the Phase 1b trial of pembrolizumab for PD-L1-positive advanced solid tumors, which were announced at the most recent meeting of the American Association for Cancer Research (AACR).

Dr. Evan W. Alley, MD, PhD, co-director of the Penn Mesothelioma and Pleural Program, reported the results of a Phase 1b trial of pembrolizumab for PD-L1-positive advanced solid tumors at the AACR Annual Meeting on Sunday. Of the twenty-five patients with mesothelioma who were treated as part of the study, 28% experienced tumor shrinkage and another 48% had prolonged stabilization of their disease. The drug was also demonstrated to be safe, with no patients discontinuing treatment as a result of side-effects.

”These results are quite exciting, and provide further proof of principal that this class of drugs, known as checkpoint inhibitors, are effective for mesothelioma,” noted Dr. Lee M. Krug, Chair of the Board of Directors for the Meso Foundation. “Hopefully this study will encourage much larger trials in this disease.”

Pembolizumab is an antibody that blocks the inhibitory effects of PD-1, thereby boosting the immune system’s activity. In cancer, high tumor expression of PD-L1 is linked with more aggressive disease and a poorer prognosis, and PD-L1 expression was used to select patients for this study. PD-1 inhibitors have already shown great promise in melanoma, renal cell carcinoma and lung cancer, demonstrating both tumor shrinkage and durable responses. Pembrolizumab (KeytrudaTM) is FDA approved for the treatment of advanced melanoma.

In May, the Meso Foundation will be hosting Dr. Alley in an interview, as part of the Meet the Mesothelioma Experts series. More information about the series is available at

2015 Symposium to be Co-Hosted with the NCI and Held at the NIH

International Symposium on Malignant MesotheliomaThis year, the Meso Foundation has partnered with the National Cancer Institute (NCI) to co-host the International Symposium on Malignant Mesothelioma. As a result, the conference will be hosted on the grounds of the National Institutes of Health (NIH) in Bethesda, Maryland. The NIH is one of the world’s foremost medical research centers.

This conference is geared to attendees from all walks of life, including patients and their families, advocates, medical professionals, those who have lost loved ones to mesothelioma, and scientists. The Symposium provides a unique setting for everyone in the meso community to come together, learn about mesothelioma and its treatments from renowned experts, build friendships and socialize.

The Symposium will be held from March 2nd through 4th at the NIH and the Hyatt Regency Bethesda. Daytime Symposium sessions will be held on the NIH campus, while evening dinners will be held at the Hyatt Regency Bethesda. The NIH campus is located only a few minutes away from the hotel, and we will provide shuttles between the two locations in the morning and afternoon of March 2nd and 3rd. Symposium attendees can also travel between the locations via Metro (stops are convenient to both the hotel and the NIH) or by taxi.


Sessions will cover a range of topics about pleural and peritoneal mesothelioma, treatments, clinical trials, surgery, prevention, as well as support groups, well-being and community sessions. A mesothelioma Advocacy Day will be held on Capitol Hill on Wednesday, March 4th. View the full Symposium agenda here.

In addition to our science and treatment sessions for the general public, this year’s Symposium includes a two-day special session for scientists and medical professionals. Nearly 100 mesothelioma experts will come together to share their work, and find collaborative opportunities, in an effort to speed up mesothelioma advances. The scientists and medical professionals in attendance will be available during sessions common to both groups, such as lunches and dinners, to answer any questions and to socialize. A recap and “translation” of the sessions for scientists and medical professionals will be presents on Tuesday evening in the main Symposium session for the general public.

It is a privilege and an honor to host our Symposium on the campus of the National Institutes of Health, and we hope to see you all at the event. Learn more about the Symposium at or register here.

Message to Pharma: Large Trials in Mesothelioma are Possible

Dr. Lee Krugby Lee Krug, MD, Memorial Sloan Kettering Cancer Center

This month, a notification was sent to investigators on the DETERMINE Trial that accrual will be completed by the end of October. DETERMINE is an international, randomized trial comparing treatment with an immunotherapy drug called tremelimumab to treatment with placebo as second or third line therapy in patients with malignant mesothelioma. The trial opened in May, 2013, and in just 17 months will have enrolled 564 patients! This is a notable achievement. To put this in perspective, the last phase III of this magnitude testing vorinostat in a comparable group of patients (VANTAGE Trial) took 5 1/2 years to enroll 660 patients. There are differences between these two trials that could have accounted, in part, to the more rapid accrual. In DETERMINE, 2/3 of the patients receive the study drug, 1/3 get placebo, while in VANTAGE it was half and half. Also, immunotherapy drugs such as tremelimumab have garnered tremendous excitement in the oncology field due to their promising results in numerous cancers such as melanoma skin cancer and lung cancer. Yet, despite these differences, this accomplishment of completing a trial of this size in such a short period of time should be a wake-up call to the pharmaceutical industry. Historically, drug companies have been reluctant to undertake large trials in mesothelioma due to concerns about feasibility and slow accrual. But this trial demonstrates the potential. Patients with mesothelioma urgently need better treatments, and with only one chemotherapy regimen approved, there is a tremendous opportunity to impact the outcomes for these patients. So here is the message to pharma: Large trials in mesothelioma are possible, and the community of patients with mesothelioma is eager to participate.

Lee M. Krug, MD, is an Associate Attending Physician in the Division of Thoracic Oncology, Department of Medicine at Memorial Sloan-Kettering Cancer Center in New York, New York where he completed a fellowship and chief fellowship in medical oncology. Dr. Krug is the Director of the Mesothelioma Program at Memorial Sloan-Kettering Cancer Center. Read more about Dr. Krug’s work here.