THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
Date: Fri, 19 Aug 2005 09:27:07 -0700
08 02 04 61 05081901
Ms. Sheridan L. Tinker
New Patient Coordinator
University of California San Francisco
Carol Franc Buck Breast Care Center
1600 Divisadero, Second Floor
San Francisco, CA 94115
2nd Opinion Surgery on IBC ***********
Doctor Benz examined Millie last year on Oct 18, and wrote an
opinion to assist the oncologist at Kaiser in managing Millie's
care. Kaiser eventually implemented recommendations in UCSF's
2nd opinion. After some ups and downs, Millie has made a strong
recovery, and now needs further guidance on whether to have
surgery, being discussed by Kaiser.
Doctor Benz 2nd opinion indicated that UCSF could provide further
comment, as needed. Millie wants UCSF's comment now, because
Doctor Benz stated in his 2nd opinion letter that there was no
role for surgery,
based on her condition at that time. A 2nd opinion from
said there might be a role for surgery
after regression of inflammation. Therefore, Millie wants
further review of the surgery option based "full" regression of
inflammation that has subsequently occurred at this time, after
implementing Doctor Benz's treatment ideas, as reported by the
surgeon at Kaiser
on July 27, 2005.
You were very effective last year scheduling support by UCSF and
in coordinating to transmit the doctor's opinion, so I am hopeful
you can work your magic again and find a doctor with experience
treating IBC to comment on Millie's case.
Schedule - Millie's primary care physician at Kaiser indicated in
a meeting on July 29 that surgery after mid-September is the time
frame. We need input prior to that, because Millie will have to
make a decision. She wants an opinion letter, like Doctor Benz
issued last year, to help guide her decision, as well as input
that might further support Kaiser in prescribing treatment,
Millie may not need to come in for a visit, because the record is
very detailed in this case. She is available for examination, if
needed, until August 27, when she leaves for Chicago, and returns
on Sep 8.
Since this is vacation time, it may be hard to get people
involved on short notice. Doctor Benz would be perfect, since he
has already worked on the case, and Kaiser has implemented his
earlier recommendations. However, if Doctor Benz is not
available another doctor with experience treating IBC patients
should be okay.
If UCSF needs additional payment for this follow up project,
please let me know the details.
You can forward this letter to your doctor candidates for
consideration of following issues....
chronology of patient history
with diagnostic test
reports is listed in the record on August 12, 2005, and with
precision links to original sources.
Millie is currently being treated at Kaiser, originally diagnosed
in February, 2002, and treated with surgery (lumpectomy), then
drugs and radiation during 2002. There was no treatment during
2003. On June 14, 2004 Millie was diagnosed with IBC; symptoms
may have appeared as early as December 2002. Within the past few
weeks, Millie's condition has improved markedly following six (6)
cycles of Taxotere and capecitiabine (Xeloda), as recommended by
Doctor Benz. On August 19 (today) she will start another cycle,
then treatments will be paused for surgery, if she decides to
are beginning to impact tolerance for
treatment, so a break is timely, as discussed with the primary
care physician on July 29, 2005.
On November 4, Millie was removed from treatment with the Avastin
trial due to pulmonary emboli. On January 4, 2005 treatment
resumed with AC, implementing recommendations in a 2nd opinion by
Doctor Guardino at Stanford, and as shown in a treatment plan
developed on December 20, 2004. On March 29, 2005 after 4 cycles
of AC, Kaiser changed the treatment to Taxotere and capecitabine
(Xeloda), implementing recommendations in the UCSF 2nd opinion.
At that time CA 15-3 elevated to 100, inflammation had spread
toward the neck, and cancer blisters had appeared on the left
breast. Six (6) cycles of Taxotere and capecitabine yielded
marked improvement, leading the primary care physician to ask the
surgeon at Kaiser to schedule a mastectomy.
The surgeon on two (2) occasions indicated limited experience
performing mastectomy with IBC, and noted that IBC is a very rare
disease affecting less than 1% of breast cancer patients.
Criteria for when IBC patient is ready for surgery.
On July 27, the surgeon indicated that Millie is
ready for surgery
based on visual observation that prior severe inflammation has
fully regressed, where the left breast now looks like the right
breast. CA 15-3 has dropped from over 100 to below 37, the
lowest point in 4 years of treatment. On the date of the
examination, CA 15-3 bounced back to 46. There are two pending
tests which will be reported today, and another CA 15-3 blood
test was taken this morning in connection with routine testing
for Coumadin treatment. These additional "dots" may show a
positive or negative pattern. (see chronology of
patient history for updates)
Another question is the scope of surgery. Millie has discussed
having both breasts removed, as much for personal convenience to
avoid the bother of protheses, but also to provide a source of
healthy tissue for the left breast. Since inflammation extended
toward the neck above the breast for a few weeks prior to
starting treatment with Taxotere and capecitiabine at the end of
March, the surgeon has indicated there is an issue of how much of
the breast and surrounding tissue to remove.
Details of this
discussion with the surgeon are
shown in the record of patient history for July 27, 2005.
Finally, Millie wants comment on
surgery will do more good than harm,
based on excellent analysis by the surgeon on
July 27. Since at this time there is no evidence of distant
metastasis, and only regional metastasis seems to be involved,
would an operation increase the chances of longevity and quality
Mil is very grateful for Doctor Benz and the work at
UCSF that assisted her in recovery from a difficult situation
this past March. If we don't get a chance to work with the
doctor and your team again, just want to commend the
professionalism and high standard of care.
Please call or reply to let me know progress on working this
Last year Doctor Benz had trouble accessing links, and this
caused problems developing a case history for his analysis. He
did an excellent job under the circumstances, but we want to
facilitate review this time around. Typically, when you click a
link, if it opens a blank page, it means your browser "timed out"
going through the UCSF firewall. Click the "Refresh" or "Reload"
button on the browser, and that should give you instant,
into patient history. This will save a lot of time.
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