THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
Date: Tue, 23 Aug 2005 15:06:50 -0700
08 02 04 61 05082302
Ms. Mary NLN
Secretary
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.