THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
August 19, 2006
08 02 04 61 06081901
Ms. Margaret Rubino
New Patient Coordinator
Admissions
University of California San Francisco
Medical Center
Carol Franc Buck Breast Care Center
1600 Divisadero, Second Floor
San Francisco, CA 94115
..
Subject:
2nd Opinion Doctor Benz Meeting Augus 21 0930a
Dear Margaret,
This confirms our discussion on August 9th. Millie will meet with Doctor Benz
at UCSF on Monday, August 21 at 0930.
..
Mil's letter to UCSF on July 25th sets out a summary of patient history, and
issues
to be addressed in a 2nd opinion. When we talked on the 9th,
you seemed comfortable accessing
patient history
online, and planned to
support Doctor Benz as needed in order to avoid handling a lot
of printed documents.
..
This letter draws attention to
recent changes
in Millie's condition. She
started treatment again with Taxotere and capecitabine on July 21. Her
condition worsened in that the red rash of IBC spread and intensified. We
requested an emergency meeting to consider changing treatments. The next day
on August 8th, we met with a backup doctor (primary was on vacation), there
seemed to be a sudden
lessening of IBC rash. The doctor decided to continue the
prescribed protocol. Two days later regularly scheduled treatment was delayed
due to low blood counts, but CA 15-3 spiked from 71 to 87 over a 4 week period.
Since then, Millie had another treatment on August 14th, and got another CA
15-3 test the next day. Yesterday, we learned this cancer marker has now
dropped to 73 in just a six day period, which aligns with continued improvement
in red rash subsiding. All good news.
..
At this time, there seems to have been a delayed response to treatment, which
is very favorable. Millie may be on the mend again.
..
Objectives for UCSF 2nd opinion are to consider
future scenarios for treatment
strategy, as listed in the prior letter on July 27th, and deemed helpful by
Doctor Benz. Previously, treatment completely cleared inflammation. Kaiser
recommended a mastectomy, which was done on October 21, 2005. If current
treatment clears the rash, CA 15-3 drops back into the 30s, can treatment end
until progression? Are there proactive steps to prevent or extend the time to
progression?
..
On September 9, 2005 Doctor Bailey mentioned that Doctor Parks at UCSF may
have a
drug trial
underway which might help Millie.
..
Doctor Bailey also discussed a work-up for
hypercoagulable state
based on
pulmonary emboli diagnosed on November 4, 2004, at that time attributable to
the Avastin trial. Subsequent family history involving treatment for relapse
of her oldest son, and possible findings of
genetic factors
reported on July 22nd, update Doctor Bailey's earlier review.
..
We look forward to visiting wtih Doctor Benz again, and will bring some of
Kaiser's printed documents, in case Doctor Benz needs verification.
By copy I am updating Doctor Bailey, and Doctor Grissom, both recommended by
USCF last year, and who were exceptional in assisting Millie and Kaiser
consider surgery, which Kaiser insisted be performed.
.. Copy to: