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

August 19, 2006

08 02 04 61 06081901

Ms. Margaret Rubino
New Patient Coordinator
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.


Rod Welch
Post Script

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:
  1. Doctor Lisa Bailey
  2. Doctor Nima Grissom