When the first petrochemical plant came to West Virginia in 1920, the locals found themselves on the cutting edge of this newfangled industry. Union Carbide had chosen Clendenin, West Virginia for this honor…and the people rejoiced.
Five years later, when the plant’s needs grew so large that they had to relocate, operations moved to South Charleston’s Blaine Island area adjacent to the Kanawha River, seemingly the ideal spot for a petrochemical company to do its thing and continue to expand.
A cancer diagnosis is a blow at any age. For senior citizens, however, dealing with cancer is especially hard, particularly for those individuals who might be facing the multiple medical concerns that come with aging, including a host of other diseases and disorders.
Mesothelioma cancer, quite frequently, is diagnosed among those who would fall into the category of “senior” adults. This is because the disease possesses what is referred to as a long latency period; the time that passes between exposure to the mineral and the development of the disease can be quite lengthy, often as long as 50 years.
75% Of Mesothelioma Among Senior Citizens
That means many of the disease’s victims have progressed into their later years by the time the cancer is discovered. The American Cancer Society notes that the average age of diagnosis in 69 and estimates say about 75 percent of all cases are among senior adults. A large number of these individuals were probably exposed during service to the military while others were sickened due to occupational exposure. Many probably don’t even recall working with the material.
Nonetheless, mesothelioma is a difficult cancer to battle at any age and a diagnosis of this disease means a tough road ahead for the senior and his family members and friends.
The Day-to-Day Trials of the Disease
Seniors with mesothelioma, by the time they are diagnosed, have probably already begun to slow down and are most likely having a tough time with day-to-day responsibilities.
If the victim is working, he may need to cease employment. Because meso causes breathing problems and other symptoms that can be quite debilitating, even simple tasks begin to present a challenge, including shopping, cleaning, and maybe even taking a walk with friends. For seniors who’ve always been quite active, this change may cause a great deal of depression and anxiousness.
At this point, it is usually necessary for family members to play a more active role in the life of the mesothelioma patient. Sometimes family members choose to move in with their loved one or have their loved one move in with them. When that’s not possible, it’s often necessary to hire in-home help or assistance with things like getting to doctor’s appointments or treatments.
When the disease has progressed to end-stage and it’s difficult for the patient’s family to offer proper care on their own, the family members – along with the patient – will need to talk about hospice and other end-of-life issues. Usually, however, it’s a good idea to address these issues ahead of time so that it’s not necessary to make spur-of-the-moment decisions about care.
Financial Issues Associated with Mesothelioma
From diagnosis to treatment, mesothelioma is an extremely expensive disease. Medical bills pile up rapidly and can be overwhelming. Some seniors are fortunate enough to have retained good medical insurance – sometimes from a past employer – that will cover most of the costs of cancer treatment. However, others will need to turn to Medicare or Medicaid (which won’t cover everything) and may find themselves short when it comes to compiling funds to pay their astronomical medical bills.
Again, family members may need to enter the picture here and help with the bills. However, if that’s not possible, caregivers may need to spend time searching for resources that can help cover the cost of care. In many cases, victims and their families have chosen to file suit against those responsible for the asbestos exposure, hoping to gain compensation that will help pay for those exorbitant medical bills and make up for loss of income. This is a viable option, in many cases, and should be carefully considered.
Cancer can be a painful disease. Oncologists report that most of their patients identify some degree of cancer-related pain while dealing with the disease and its treatments. Unfortunately, for mesothelioma patients, pain is often a major symptom and one that elicits the most fear in a newly-diagnosed patient.
The amount and severity of pain related to any kind of cancer varies, of course, with each individual case. Some mesothelioma patients will report that they have a constant, gnawing pain, often in their chest or somewhere else close to the root of their cancer. It may not be severe, but it’s always there, causing a good deal of discomfort and interfering with everyday activities.
Others, unfortunately, deal with much more severe pain, especially as their disease progresses. This is debilitating pain that confines the patient to bed and prompts the need for immediate intervention.
Both kinds of pain can be treated and there’s no reason that cancer patients need to live with this symptom throughout their struggle with their disease. That’s why most hospitals – and certainly all of the country’s best cancer centers – offer pain clinics to address the varying needs of their patients.
Locating Pain Management Services
A good oncologist will warn you about pain at the onset of your diagnosis. He or she doesn’t do that to frighten the patient but rather to make them aware that there may be a need to address the pain with more than a few doses of ibuprofen or acetaminophen.
It’s good to have information on pain management in place even before the need arises. On the other hand, some patients might be already dealing with pain at time of diagnosis, so for that patient, pain management info is essential.
As mentioned, many hospitals or cancer centers have their own pain clinic. If so, that will most likely be the first one recommended by the oncologist or other member of the patient’s medical team. There are also plenty of doctors who are not associated with a particular hospital that specialize in pain management. There may be one of these private practices near your home.
Regardless of the location, you’ll want to locate someone who is an EXPERT in pain management, not just a general practitioner who offers to help you control your pain. You’ll find that some of these experts specialize in treating cancer patients but most work with a wide variety of patients, including those with chronic diseases like arthritis.
What to Expect From A Mesothelioma Pain Clinic
Each patient will begin with a thorough evaluation of their cancer and the symptoms caused by both their disease and its treatment, such as chemotherapy and radiation. At that point, a regimen for pain relief will be devised and the patient will need to come back for a second appointment to get the ball rolling.
Pain management specialists usually offer a variety of different strategies for addressing pain. Often, prescription strength pain relievers are involved but other options such as nerve blocks might be suggested. In many cases – and certainly more often than in the past – these specialists suggest non-pharmacologic options for pain relief.
These are often referred to as “alternative” treatments and might include massage, chiropractic, acupuncture, and other such options. Many patients swear by these complementary treatments and note that they prefer them to taking even more medication.
It’s often a good idea for caregivers to be educated as to the pain relief methods recommended for their loved one or the person in their care as this responsibility may eventually fall into their lap.
Also, patients shouldn’t hesitate to contact their pain management specialist if the regimen offered to them is simply not working. There are many options available and some may work better than others for particular mesothelioma patients.
While it’s true that not everyone who is exposed to asbestos gets sick, what’s also true is that not everyone who is sickened by asbestos exposure gets mesothelioma…at least not immediately. But many asbestos related health issues are mesothelioma precursors.
The results of years of asbestos exposure manifest in a variety of different ways. For some individuals, little warning is given before the mesothelioma diagnosis becomes a reality. For others, the ailments we describe below may be what appears first.
Some may not lead to cancer. Others may. But all clearly indicate the dangers of exposure to asbestos and asbestos-containing materials and are potential mesothelioma precursors.
Pleural Plaques
The Centers for Disease Control note that some 50 percent of all individuals who are/were regularly exposed to asbestos develop scarring on their lungs. In medical terms, the scars are referred to as pleural plaques. Pleural plaques usually don’t present any specific symptoms and many who suffer from them are totally unaware that the scars are present.
Often, they’re discovered during x-rays for something totally unrelated or may be found during the scans that many asbestos-exposed individuals receive annually.
Pleural plaques do not indicate the presence of cancer but they certainly prove that asbestos exposure can affect one’s health. Usually, when doctors spot these plaques, they will order further testing just to be sure that no cancer cells are present.
Pleural Effusion
Pleural effusion is the build-up of fluid that occurs between the visceral and parietal layers of the pleura, which is the lining of the lungs. Effusion can cause much physical discomfort and can make it quite difficult to breathe.
To relieve this problem, a doctor may choose to drain the area but without a surgical procedure known as pleurodesis, the fluid may return. The doctor will also want to test the fluid for the presence of cancer cells.
Asbestosis
Asbestosis is very common among individuals who have been exposed to asbestos on a regular basis. Similar to mesothelioma, it often takes a few decades for the symptoms of asbestosis to appear. These symptoms are similar to those of asbestos-caused cancer and include:
1. Shortness of breath (mostly while active but, in the later stages, even while resting) 2. Chest pain 3. Low tolerance for physical activity 4. Cough that produces phlegm 5. Clubbing of the fingers (in severe cases)
Many individuals mistaken the early symptoms of asbestosis for another more common ailment, such as a cold, bronchitis, or pneumonia. Symptoms of this disease, however, tend to develop over a long period of time and don’t “go away”, as would be the case with cold symptoms.
Asbestosis isn’t necessarily an indication that the victim will eventually develop mesothelioma, but that possibility is indeed present. However, the asbestosis patients who are most likely to eventually be diagnosed with asbestos cancer are those who smoke and continue to do so, despite their diagnosis. Smokers are encouraged to stop smoking IMMEDIATELY upon diagnosis or if they suspect they have asbestosis.
Asbestos-exposed individuals who believe they may have any of these asbestos-related diseases need to schedule an immediate check-up with their doctor or specialist. Those already diagnosed with any of the above ailments should maintain a regular schedule of medical examinations, x-rays, and pulmonary function tests so as to keep an eye out for the presence of mesothelioma in the future.
Mesothelioma is a cancer of the mesothelium, the thin tissue that covers the lungs, heart, and other internal organs. Nearly all cases of this fatal disease are caused by exposure to asbestos. Often, the cancer takes decades to appear and, when it does, it has already reached Stage 3 or 4, making it especially difficult to treat.
Therefore, most victims of mesothelioma face a grim prognosis. Most typically survive 12 to 18 months from the time of diagnosis. Treatments, both conventional and experimental, may extend the life of mesothelioma patients, but there is no cure at this time.
Common Treatment Options
The following are the most common treatment options for pleural mesothelioma, cancer of the lining of the lung:
• Extrapleural pneumonectomy (EPP) – The most aggressive type of mesothelioma surgery, EPP involves the removal of the lung along with its coverings and the associated coverings of the heart and diaphragm. It is followed by chemotherapy and radiation. It is reserved only for the healthiest of patients and involves much risk and a very long recovery period.
• Pleurectomy/decortication – This is surgery to remove the lining of the lung and, hence, the cancer cells found in the lining. In this type of procedure, the lung itself is preserved. Pleurectomy is usually followed by chemotherapy. This surgery is an option for patients whose limited heart and lung function prevent them from undergoing EPP.
• Chemotherapy/Radiation – Patients who are not candidates for any type of surgery may benefit from chemotherapy and radiation to shrink the tumor. These treatments are often used for “palliative” purposes as well, helping to lessen some of the very uncomfortable symptoms of the disease.
Surgery, chemotherapy, and radiation are also used to treat peritoneal (abdominal) mesothelioma, and pericardial (heart) mesothelioma.
Author DeeDee Moore notes in her book, Dealing with Mesothelioma Cancer, that these interferon trials did indeed extend the lives of some meso patients.
“Treatment regimens involving immunotherapy have yielded variable results,” she explained. “Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.”
More recently, however, Interferon Alpha has taken on the role of a maintenance drug. At a conference for the Society of Thoracic Surgeons in 2006, Dr. Robert Cameron – a leading expert on the treatment of mesothelioma – presented proof that Interferon Alpha as “maintenance therapy” showed promise. Cameron noted that the median survival of patients receiving interferon alpha after undergoing pleurectomy with decortication followed by surgery was 37 months. Therefore, Cameron and his colleagues at UCLA concluded that interferon alpha, as a maintenance therapy, does indeed have a survival benefit.
Continuing Research
Malignant mesothelioma remains one of the most frustrating forms of cancer for researchers and for oncologists who face victims of the disease each day. It is highly recognized that none of the current treatments will provide a cure for the disease but it is the hope of researchers that continued research and more clinical trials will be integral in the discovery of drugs or therapies that will prolong the lives of sufferers of asbestos-caused cancer. Only time will tell.
No one who was alive at the time will ever forget the tragedies that occurred on September 11, 2001. It was a day that showed the true face of terrorism and one that affected not only the people of the United States but also others around the world.
There were obvious casualties that day. Nearly 3,000 died as a result of the falling of the World Trade Center towers and the acts of violence at the Pentagon and in the fields of central Pennsylvania. But as the weeks, months, and years went by, other less-obvious casualties occurred.
Many of the first responders who were on call that day, particularly in Manhattan, later developed a variety of respiratory diseases and died. One of those diseases was mesothelioma.
Where was the Asbestos?
Any time a building collapses, particularly an older building, the potential for asbestos exposure is present. When the so-called Twin Towers fell, millions and millions of tons of debris rained down on Manhattan; everything from paper to steel was part of the mix. Included also in the debris were toxic materials, not the least of which was asbestos.
Only part of the World Trade Center contained asbestos. When construction began on the towers, there was already some controversy brewing in regards to asbestos use and the danger of exposure to the mineral. Because of that, only about half of the North Tower was constructed using asbestos materials. The South Tower contained no asbestos.
Still, when they fell, asbestos materials were everywhere and first responders – including firefighters, police, and EMTs – were regularly wading through it to find survivors and, later, the bodies of those who perished.
Other scenarios in other parts of the country have been similar. An old building burns or collapses and asbestos is strewn all around the area. It could be months (or even longer) before the debris is disposed of, and anyone involved in rescue, recovery, or clean-up might be exposed.
First Responders and Mesothelioma
EMTs and others in similar jobs know they are at risk every time they’re out on a call. They can be shot or otherwise attacked. Perhaps they might be exposed to a dangerous, contagious disease. But few first responders probably think about asbestos when heading out to a building collapse or similar tragedy.
As the years went by more and more EMTs, police, and firefighters noticed severe breathing problems and many were eventually diagnosed with asbestosis, lung cancer, or mesothelioma cancer.
The dangers aren’t limited to the events of 9/11, however. This exposure could happen at any time. That’s why it’s always necessary for first responders to wear protective gear when heading to a disaster that could expose them to asbestos fibers, which can be inhaled and penetrate the area around the lungs, causing eventual tumors to form.
A potentially toxic scene should never be entered until masks or respirators are in place, and any supervisors who insist it is safe to proceed without such are putting lives at risk with their negligent behavior.
If you know a first responder – EMT, police officer, firefighter – who is battling mesothelioma because of on-the-job exposure, consider doing some research on the reason for the asbestos exposure and don’t hesitate to investigate legal options that may result in compensation for these injuries and suffering.
Noun
1. Electricity
a) A material of such low conductivity that the flow of current through it is negligible.
b) Insulating material, often glass or porcelain, in a unit form designed so as to support a charged conductor and electrically isolate it.
A person or thing that insulates.
The definition of an insulator is fairly straightforward, whether you’re talking about the actual insulating material or the person that is responsible for installing those materials. Insulators – in both contexts – have been around for centuries, but the insulation we most closely relate to in the 20th and 21st centuries became essential around the time of the Industrial Revolution, when newfangled machinery needed to be insulated for reasons of temperature stabilization.
Of course, those same issues remain a concern today and it’s that need to protect workers and others from dangerous conditions that keeps our insulation contractors in business, performing tasks such as wrapping machinery of various types, pipes, or wires, or perhaps placing insulation in walls, floors, or ceilings.
Being an Insulation Worker
According to the Bureau of Labor Statistics (BLS), there were about 52,000 employed insulation workers in the U.S. in 2012.1 The BLS notes that these insulators spend a lot of time standing, bending, and kneeling, often in confined spaces.
This work doesn’t come without risk. “Small particles from insulation materials, especially when sprayed, can irritate the eyes, skin, and lungs,” the bureau adds in its description of what insulation workers do.
While today’s spray insulation can certainly cause respiratory problems, insulation products of old often were much more dangerous because they contained asbestos, a toxic mineral that could also cause respiratory problems – very serious ones that may include mesothelioma cancer.
How Insulation Workers Are Exposed
Prior to the mid-1970s, many insulation products contained asbestos. The mineral was used in these products because it is a good conductor of heat and its use could prevent burns, fires, and other catastrophes. Hence, it was used to wrap pipes in places like steel mills, refineries, and other industrial facilities, if often was found wound around electrical fires, and was even used in materials such as attic insulation for homes.
Some materials that might have been in an insulator’s cache of asbestos-containing products include:
insulation workers during the middle to later years of the 20th century were likely exposed to many of the materials mentioned above, manufactured by many of the companies listed here, including those who knew there products were toxic but did nothing to solve the dilemma. While there were reasonable substitutes for asbestos available for use, companies opted to continue using the toxic material because it was inexpensive and readily available.
The result has been generations of insulation workers who have developed lung-related problems, including asbestosis, mesothelioma, and various types of lung cancer. Today’s insulators are still at risk, especially when working on older properties – residential, commercial, and industrial.
Many of these manufacturers have been successfully sued in a court of law in regards to their negligence while others have declared bankruptcy and then set up asbestos trusts, offering compensation to those harmed. For more information, consult an experienced asbestos attorney if you or a family member has been sickened while working as an insulator.
We’ve all done some painting in our lifetimes. Maybe it was that first apartment of yours – the one with the lime green walls. Or perhaps you’ve tackled larger projects, like the exterior of your home. Some DIYers love to paint, others hate it. Still, there are many individuals that make their living as painters, coming to the rescue of those of us who simply dislike the task.
Since the post-war housing boom of the 1950s, U.S. painters have been kept quite busy when it comes to residential jobs. Some painters also specialize in commercial applications, employed by businesses small and large to paint everything from walls to water towers.
In many ways, painting can be quite a dangerous job, involving working at great heights, working in poorly insulated areas, and – not least of all – working around asbestos-containing materials.
Where’s the Asbestos?
Those not involved in the painting industry but be surprised to learn that many paints once contained asbestos. In addition, a wealth of compounds, protective coatings, and other items regularly used by painters also once contained asbestos. As a matter of fact, these items – manufactured as early as the 1930s up until the mid-1970s – often contained quite sizeable amounts of the toxic mineral.
Some of the companies that manufactured these asbestos-containing supplies included:
• National Gypsum
• Eagle-Picher
• GAF
• Celotex
• United States Gypsum
Other items used by painters or encountered by painters while on-the-job also included tape (such as Raymark’s “Allbestos” tape) and wallboard products such as those made by Johns-Manville or National Gypsum.
For painters who regularly worked on exteriors of homes or other buildings, exposure to shingles, siding, and roofing meant the likelihood of inhaling asbestos. Even today, one can identify thousands upon thousands of U.S. homes that still feature asbestos siding or shingles, making the job of removing them quite dangerous. These asbestos products may have been manufactured by the companies noted above as well as:
• Carey
• Ruberoid
• Keasbey & Mattison
• And many others!
Avoiding Asbestos
Painters have always been responsible for more than just putting a coat of color on a wall or other surface. These tradesmen must do a plethora of preparation when charged with a particular painting job. That means doing things like scraping, patching, filling, caulking, sanding, and anything else necessary to produce a suitable finished product. It is often during these tasks that painters were (or will be) exposed to dangerous asbestos dust. Whenever asbestos-containing materials are compromised, inhalation becomes a very real problem.
That means painters should ALWAYS wear protective gear when working in an environment that may include asbestos-containing products. This also means that painters should carefully assess each project before beginning, especially if the job involves working in an older home or commercial location where asbestos products are likely to still be present. Furthermore, the painter who’s working with asbestos materials should ALWAYS change clothes and (if possible) shower before heading home. It isn’t unusual for asbestos dust to gather on clothes and on the body, meaning unnecessary secondary exposure could occur with poor habits.
Mesothelioma and Painters
Many painters of decades past have learned of the dangers of asbestos exposure years and years after practicing their trade. Some have already been diagnosed with mesothelioma or other related diseases, such as asbestosis. If you believe that you or a loved one was exposed to dangerous asbestos while on-the-job and you or your family member is suffering from an asbestos-related disease, contact an attorney today to learn of your legal rights for compensation.
In the world of asbestos exposure, there are those that emerge unscathed, there are others who wind up with mesothelioma cancer, and then there are some who walk away with a lung disease known as asbestosis.
The latter, while not a form of cancer, can be just as debilitating as mesothelioma though it carries a better prognosis and victims can often live with the disease for years.
That’s not to say, however, that those stricken with asbestosis won’t have a tough road ahead of them.
What Causes Asbestosis?
Just like mesothelioma, asbestosis is caused by exposure to and inhalation of asbestos fibers. The disease is commonly linked with the amphibole form of the mineral, which boasts thin, straight fibers rather than the curly ones associated with the more toxic serpentine variety.
Inhalation of these sharp fibers scars the lungs, causing thickening and hardening of lung tissue and making breathing difficult.
Symptoms of Asbestosis
Like mesothelioma, it can take some time for asbestosis to develop and for it to be diagnosed. Patients will often undergo a large amount of testing before a determination is made. However, every case is different and some people with asbestosis will suffer few symptoms while others are plagued with debilitating ones.
• Shortness of breath
• Tightness in the chest
• A productive and persistent cough (one that produces mucus)
• Chest pain
• Loss of appetite
• A crackling, dry sound in the lungs, most evident when inhaling
When a patient who was exposed to asbestos appears with these symptoms, doctors will most likely determine a diagnosis through lung function tests, x-rays or other imaging tests, and perhaps a biopsy (to rule out mesothelioma).
Dealing with Asbestosis
There is no cure for asbestosis but it is treatable. Some patients will be able to lead very normal lives with treatment while others may find that their disease continues to progress and becomes more difficult to control.
Those with asbestosis will want to take whatever steps are necessary for loosening the music in their lungs so that can be expelled.
That might include something as simple as pounding on the chest or back to loosen the mucus or sitting/laying in a position that helps drain the mucus. Other options include medications that thin the mucus.
When the disease progresses, victims may decide they need oxygen to help them breathe. Severe cases may be candidates for lung transplants.
Furthermore, anyone with asbestosis who smokes cigarettes should cease smoking immediately. Smoking aggravates the disease. Worse, however, is the fact that a smoker with asbestosis has a much higher chance of developing mesothelioma than an asbestosis victim who does not smoke.
Preventing Asbestosis
For workers of today, preventing asbestosis is much simpler. Individuals who might encounter asbestos on-the-job should always wear protective gear. Furthermore, compared to asbestos use of old, there is little asbestos used in the U.S. in the 21st century, so exposure is much less likely.
However, those working in old factories or homes, or with older automobiles should always be on the lookout for the material.
If you regularly worked with asbestos in the years before about 1980, you may be a prime candidate for the disease or you may have already been diagnosed with it. Tens of thousands of individuals were unknowingly exposed to the toxic mineral during their work lives and are now suffering from this and other related diseases.
If this describes you, remember that you may have some legal recourse in regards to this negligent exposure. For more information, consult an experienced attorney about potential compensation for your suffering.
If you’re currently involved in asbestos-related litigation or if you’ve been doing some investigation into the possibilities of filing an asbestos-related lawsuit, you’ve probably come across some information about asbestos trusts.
Perhaps you’re a little confused as to what these trusts are and who might benefit from them. Below we’ve offered a bit of introductory information about these trusts in hopes that you’ll be able to better understand how they work.
What’s an Asbestos Trust?
Throughout the years, many companies that were responsible for asbestos injuries and were subsequently bombarded with lawsuits filed for bankruptcy and then bankruptcy reorganization, which – when successful – protects them from lawsuits but allows them to stay in business. These companies can be large – like Johns-Manville, W. R. Grace, and Pittsburgh Corning – or much smaller.
The U.S. Bankruptcy code then allows for the creation of so-called “asbestos trusts”, funds into which these companies must deposit monies in amounts large enough to handle current and future asbestos claims. Courts must approve the amount that is to be set aside, based on former claims as well as the potential for further litigation against the company. Economists and legal experts are brought in to help with the determination. The first numbers submitted don’t always meet with the court’s approval so sometimes it takes years and years for the trust to finally be established.
Who Operates the Asbestos Trust?
Once an asbestos trust fund is put into place, it is removed from the hands of the particular company responsible for depositing the funds. The company does not review claims made against the trust nor do they decide who gets the money and who doesn’t.
Instead, the trust is operated by a “trustee”, an appointed person or persons who make the decisions for the trust. However, the trustee(s) must follow certain pre-designated procedures to make these determinations so that all decisions are made in a fair and equitable manner.
What is Needed to File a Claim?
To file an asbestos trust claim, you’ll need much of the same information as you’d need to file any other litigation.
• Confirmation of diagnosis – You’ll need to show that you’ve been to a doctor or doctors and that you are definitively suffering from an asbestos-related disease. Most likely, there will be forms to be filed by these physicians or statements to be signed. The physicians will also need to determine to what extent asbestos exposure contributed to your disease.
• Proof of exposure – Plaintiffs filing for compensation from a trust fund will need to establish proof of who was responsible for their exposure. Items such as witness statements and employment records may be needed as well as other similar documentation. It may take some time to assemble this needed documentation.
Can You File a Trust Claim and a Lawsuit?
Rules about asbestos trust claims and the legal process vary from state to state, but mesothelioma victims should know that filing for funds from a trust could affect the outcome of a lawsuit and the amount of compensation received overall.
Only an experienced asbestos attorney can guide you towards the path that will provide you with the most positive outcome for you and your family members.