440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700

Date: Tue, 23 Aug 2005 15:06:50 -0700

08 02 04 61 05082302

Ms. Mary NLN
Administration Department
Medical Practice
1700 California Street #550
San Francisco, CA 94109
Subject:   2nd Opinion Surgery IBC Patient Millie

Dear Mary,

Millie is a 69 year old patient at Kaiser in Walnut Creek. She is seeking a 2nd opinion on whether to approve surgery on the left breast, originally treated with lumpectomy surgery on March 12, 2002; and then reexcission a few weeks later on March 27.
After initial surgery in March 2002, Millie was given two (2) treatments of AC; her condition worsened, so she was switched and got two (2) treatments with Taxotere. In July and August, 2002, she had six (6) or so treatments with radiation, then four (4) more treatments of Taxotere, ending in December 2002. She received no treatment in 2003; testing, examinations, and the patient all reported during 2003 episodic activity under the left arm, and inflammation of the left breast. On June 14, 2004 she was diagnosed with IBC.
Millie relapsed in February 2004. She complained of lumps and stiffness on the left side of the neck. A biopsy was positive. On April 20, 2004 she began treatment with Avastin and Taxol on a trial. There was favorable response to treatment, until November, when she was removed from the trial because pulmonary emboli was diagnosed in a CT test report on 041104. In January 2005 she began treatment with AC, and had four (4) treatments, making a total of six (6) including the original two (2) in 2002. Disease progressed, so on 050329, Mil was switched to Taxotere and capecitabine (Xeloda). She responded well. After 5 cycles, the primary care physician at Kaiser recommended surgery. On August 19, she began the 7th, and at this time final, cycle with Taxotere and capecitabine, and has been cleared for surgery at Kaiser. Chemotherapy treatments have been paused while working through the surgery issue. Side effects have been difficult the past few cycles. She is at work today as a secretary in San Francisco.
Millie wants a 2nd opinion on being ready for surgery, and on the scope of surgery based on inflammation that extended beyond the breast toward the neck in March, though at this time seems to have fully regressed.
Millie also wants a 2nd opinion on whether surgery is a good choice for her overall.
Chronology of patient history with links into test and pathology reports is shown in the record on August 12, 2005.
You can scroll to the bottom to the most recent events, including scans and reports.
Please call to discuss next steps.


Rod Welch
Copy to:
  1. Millie