THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
rodwelch@pacbell.net



November 8, 2005

03 00050 61 05110803




Dr. Christopher C. Benz, MD
Professor of Oncology
Medical Oncology Department
University of California San Francisco
Medical Center
Carol Franc Buck Breast Care Center
1600 Divisadero, Second Floor
San Francisco, CA 94115
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Subject:   Millie's Progress Implementing 2nd Opinion
Consultation on October 18, 2004 Treating Secondary IBC
Second Opinion Received on November 17, 2004
Status - Disease-free Pending Further Testing

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Dear Doctor Benz,

On July 27th, Millie's primary care physician recommended mastectomy following favorable response to treatment with Taxotere and capecitabine, which you had recommended late last year. Since testing showed no evidence of continuing disease, due diligence required asking for follow up comment, based on your opinion stating there is no role for surgery in her case. UCSF reported on August 23rd that you made referral to Doctors Grissom and Bailey for surgical expertise.
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Millie got excellent support from Grissom and Bailey, relying in part on your prior opinion, and leading to surgery on October 21, that implemented proposals for an innovative solution.
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Good news - on October 27th, Kaiser advised that testing shows Millie is disease-free. Today, we learned that her CA 15-3 cancer marker has suddenly and dramatically dropped to 34, down from 45 the past three (3) months; 34 is the lowest level in Millie's four (4) year ordeal. This seems quite a miracle! Millie appreciates that disease may recur; but, for now, we are grateful she is off treatment and recovering well. In sum, recovery was accomplished by implementing your ideas on systemic treatment, and when testing eventually showed no evidence of disease, Kaiser proposed surgery. Treating a stage IV patient for secondary IBC with surgery, when there is no evidence of disease, suggests Millie may provide lessons learned from patient history.
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Congratulations for playing a pivotal role in Millie's recovery. You and UCSF deserve a well done for quality advice on treatment and referral, demonstrating personal and organizational integrated management.

No response required.

Sincerely,



Rod Welch
rodwelch@pacbell.net
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Post Script

If time permits, please comment on biopsy of surgical tissue finding DCIS, and in relation to Kaiser's report of disease-free status. Removal of disease with surgery on October 21, may account for decline of CA 15-3, per above.