THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: March 18, 2002 11:20 AM Monday; Rod Welch

Surgeon reports pathology on biopsy, schedule meeting with Oncology.

1...Summary/Objective
2...Surgery Needed to Remove More Lymph Material
3...Treatment Required Immediate Action by Oncology
4...Team Care Practice Oncologist Lead Coordinator Services for Millie
5...Oncology Meeting Scheduled 020321 1430
6...Surgery Meeting Coordinate with Oncology at 020321 1445
7...Gordon Pool Contacted Discussed Results of Surgery
8...Marilyn Called and Cheered Millie
9...Cancer Research on Testing and Treatment
.............Novel breast cancer tests in pipeline
......PET scan
......Applications for Oncology Apply to Breast Cancer....
......Bone scan
.........Procedure for Bone Scans
.........No special preparation is required before the bone scan.


..............
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CONTACTS 

SUBJECTS
Doctor's Comments Following Surgery
Pathology Report Shows Cancer Need Follow Up Surgery Chemo Therapy
Oncologist Meeting 020321 1430 Meeting with Surgeon Bumped to after M
Pathology Report Shows Cancer in Lymph Nodes Causing Lump Under Left

0806 -
0806 -    ..
0807 - Summary/Objective
0808 -
080801 - Follow up ref SDS 7 0000 ref SDS 6 0000.
080802 -
080803 - The surgeon called to report preliminary results of pathology from the
080804 - operation on 020312.  Report confirmed expectation that further
080805 - treatment is needed, including follow up surgery.  Scheduled meeting
080806 - with oncology, for 020321 1430. ref SDS 0 A155  The surgeon was very
080807 - helpful in accomodating this meeting, and will see Millie after
080808 - meeting with the oncologist, also, on 020321 to schedule the follow up
080809 - surgery.
080811 -  ..
080812 - Submitted ref DIT 1 0001 to Pam with copy to Ron Jr., and to Steve,
080813 - suggesting they call their mom in advance of the meeting on Thursday
080814 - to let her know everyone is pulling for her.  Did not link to this
080815 - record, but explained gist of what transpired.
080816 -
080817 -
080818 -
080819 -
080821 -  ..
0809 -
0810 -
0811 - Progress
0812 -
081201 - Millie answered a lot of email this morning.
081203 -  ..
081204 - She went to exercise class at 0800.  She saw Ron Jr., and Pam.  Ron
081205 - did not have enough time to visit after the exercise class.  Pam
081206 - loaned a DVD with a movie for Millie to watch.
081207 -
081209 -  ..
081210 - Surgery Needed to Remove More Lymph Material
081211 -
081212 - Follow up ref SDS 7 5V7I.
081213 -
081214 - The surgeon called about 1120 to discuss results from the pathology
081215 - report on tissue removed during surgery last Tuesday on 020312.
081216 - ref SDS 6 0001
081218 -  ..
081219 - The surgeon indicated that the report indicates follow up surgery may
081220 - be advisable to remove more cancerous material.  The report evidently
081221 - does not say that "clear margins" were achieved, and so the surgeon
081222 - feels that more work is needed to accomplish this requirement.  This
081223 - aligns with understandings from surgeon's comments following the
081224 - operation on 020312. ref SDS 6 Q78M
081225 -
081226 -     [On 020319 Kaiser called to schedule surgery for 020327.
081227 -     ref SDS 8 5V7I
081229 -      ..
081230 -     [On 020321 "margins" are mentioned in the pathology report
081231 -     received from the primary care physician in Oncology; correlation
081232 -     to requirement for additional surgery is not clear. ref SDS 9 9N4J
081233 -     and further. ref SDS 9 MG5I
081235 -  ..
081236 - The doctor also advised that chemotherapy may be prescribed by the
081237 - oncologist because the pathology report on the biopsy says that lymph
081238 - node tissue removed during the operation on 020312 is cancerous, and
081239 - was "out of capsule," confirming comments by the surgeon after the
081240 - operation. ref SDS 6 7V61  The surgeon said this condition requires
081241 - immediate action to begin treatment.
081242 -
081243 -
081244 -
0813 -

SUBJECTS
Treatment Immediate Action Required by Oncology Based on Pathology R

1803 -
180401 -  ..
180402 - Treatment Required Immediate Action by Oncology
180403 - Team Care Practice Oncologist Lead Coordinator Services for Millie
180404 -
180405 - The surgeon asked Millie if the Oncology Department has notified her
180406 - about meeting to begin treatment, per the biopsy report? ref SDS 0
180407 - AZ10
180409 -  ..
180410 - Millie said the oncologist has not called.
180412 -  ..
180413 - The surgeon explained that Kaiser provides team care support.  The
180414 - Surgery Department and the Oncology Department collaborate and closely
180415 - coordinate to ensure timely medical services for cancer patients.  The
180416 - surgeon suggested that Millie take the initiative and contact Kaiser
180417 - to schedule an immediate visit with Oncology to get started on
180418 - treatment.  The surgeon further advised that the Oncologist will
180419 - submit the pathology reports, explain findings and discuss treatment
180420 - planning, as Kaiser's Team Care lead for coordinating future care by
180421 - Kaiser in Millie's case.
180422 -
180423 -      [On 020321 primary care physician in Oncology submitted pathology
180424 -      reports and discussed findings. ref SDS 9 MA5K
180426 -  ..
180427 - The surgeon indicated a schedule for follow up surgery to achieve
180428 - clear margins for breast surgery can be discussed during the meeting
180429 - with Millie on 020321 at 1445.
180431 -  ..
180432 - Kaiser's Team Care medical management practice was reviewed on 990625.
180433 - ref SDS 3 2784
180435 -  ..
180436 - The surgeon indicates today that the oncologist will be the team
180437 - leader or manager who is the point of contact to assist Millie in
180438 - coordinating Kaiser resources.
180439 -
180440 -      [...below, Diane says the oncologist will become Millie's primary
180441 -      care physician. ref SDS 0 6Z7F
180443 -       ..
180444 -      [On 020321 oncologist has been assigned to be Millie's primary
180445 -      care physician. ref SDS 9 MA3F
180446 -
180447 -
180448 -
180449 -
180451 -  ..
180452 - Oncology Meeting Scheduled 020321 1430
180453 -
180454 -
180455 -
1805 -
1806 -
1807 - 1251
1808 -
180802 -  ..
180803 - Millie called Kaiser to schedule meeting with oncologist, per telecon
180804 - with the surgeon...
180805 -
180806 -                        925 295 4318
180807 -
180808 - ...she left a message on the voice mail relating understandings from
180809 - the doctor that the oncologist needs to meet with Millie to develop a
180810 - treatment plan.
180811 -
180813 -  ..
1809 -
1810 -
1811 - 1458
1812 -
181201 - Diane called back.
181202 -
181203 - She has called the oncologist department and talked to Becky....
181205 -                         ..
181206 -                        925 295 4030
181208 -  ..
181209 - Diane understands that the oncology department has something in the
181210 - computer about contacting Millie for a meeting with the oncologist.
181212 -  ..
181213 - Diane said that going forward the oncologist will be Millie's primary
181214 - care physician to lead the Kaiser Team Care medical resources helping
181215 - Millie evaluate treatment options.  This aligns with notice from the
181216 - surgeon, earlier today. ref SDS 0 XJ65
181218 -  ..
181219 - Diane suggested that Millie call back and ask for Oncology to schedule
181220 - a meeting.
181222 -  ..
181223 - Millie was getting tired, and wanted to take a nap.  She asked me to
181224 - call Oncology and schedule the meeting recommended by the surgeon this
181225 - morning.
181226 -
181227 -
181228 -
181230 -  ..
1813 -
1814 -
1815 - 1513
1816 -
181601 - Called Kaiser Oncology Dep at Walnut Creek...
181602 -
181604 -                         ..
181605 -                        925 295 4030
181607 -  ..
181608 - Talked to Sharee.
181610 -  ..
181611 - Explained Becky's suggestion to call, based on the call this morning
181612 - from the surgeon, who is planning a follow up operation for getting
181613 - clear margins. ref SDS 0 5V7I
181615 -  ..
181616 - Sharee commented that clear margins are critical for treating cancer,
181617 - and suggested waiting to schedule a meeting with Oncology until after
181618 - the operation so that the surgeon can discover the number of active
181619 - nodes.  Sharee said this would be useful for meeting with the
181620 - oncologist.
181621 -
181622 -        [On 021204 Sharee was Millie's nurse for chemotherapy treatment
181623 -        in the Infusion Clinic. ref SDS 12 LY3G
181625 -  ..
181626 - We discussed benefits of Oncology making a review of the pathology
181627 - report in order to set priority for scheduling tasks, based on the
181628 - scope of the problem, and comments by the surgeon this morning
181629 - indicating that the initial surgery found cancerous nodes, per above.
181630 - ref SDS 0 AZ10
181632 -  ..
181633 - Sharee asked why the surgeon has not notified Oncology with a report
181634 - calling for priority to expedite treatment?
181636 -  ..
181637 - We reviewed the surgeon's request this morning for the patient to
181638 - contact Oncology, ref SDS 0 XJ65, and alert the department to review
181639 - the pathology report in order to set priority in the case.
181641 -  ..
181642 - Sharee agreed to review the pathology report, and asked to hold the
181643 - line for a minute.
181645 -  ..
181646 - A few minutes later, Sharee came back on line.
181648 -  ..
181649 - Sharee feels the pathology report indicates Millie should meet with
181650 - the oncologist immediately, and prior to surgery on 020327, as
181651 - recommended by the surgeon this morning, per above. ref SDS 0 AZ10
181652 - She has discussed the report with colleagues, and the Department now
181653 - feels that this case requires immediate action.
181655 -  ..
181656 - First available date time to meet with....
181657 -
181659 -
181660 - ...at...
181662 -             ..
181663 -            020321 1430
181665 -  ..
181666 - We reviewed the record showing that the surgeon has scheduled a
181667 - meeting with Millie, also, on 020321 1445.
181669 -  ..
181670 - Sharee said the next available meeting would be on...
181671 -
181672 -            020326
181673 -
181674 - ...and after that it would be...
181675 -
181676 -            020329 1430
181678 -  ..
181679 - Oncology clinic is on 2nd floor of medical clinic.
181681 -  ..
181682 - Sharee suggested that under the circumstances of Millie's pathology
181683 - report, just reviewed by Onconology, per above,
181684 - it would be advisable to
181685 - try to meet with the doctor on 020321 1430 and coordinate with the
181686 - surgeon about joining that meeting with the oncologist at 1430, or if
181687 - she is not available to join the meeting in progress as previously
181688 - established time of 1445.
181690 -  ..
181691 - Sharee said the oncologist location is near the surgery clinic, so it
181692 - would not be difficult to combine these meetings.
181694 -  ..
181695 - We considered the advantage of the oncology department coordinating
181696 - with surgery, based on Diane's explanation that the oncologist will be
181697 - Millie's primary care physician, and will take the lead coordinating
181698 - Kaiser's Team care practice for Millie's case, per above. ref SDS 0
181699 - 6Z7F
181701 -  ..
181702 - Sharee explained that until Millie has the first meeting with the
181703 - doctor assigned in oncology on 020321 1430, the oncologist has yet not
181704 - become the primary care physician.  As a result, oncology cannot
181705 - discuss with surgery coordinating meetings, findings, and plans. to
181706 - avoid duplication, confusion, and errors from overlooking critical
181707 - details treating the patient.
181709 -  ..
181710 - She feels therefore it would be helpful for the patient to provide
181711 - coordination at this time, rather than the Team Care primary
181712 - physician.
181713 -
181714 -     [On 020321 oncologist assigned Primary Care Physician for Millie,
181715 -     did not have time to collaborate with surgery under Kaiser's Team
181716 -     Care practice. ref SDS 9 MA3F
181718 -      ..
181719 -     [On 050204 there was not enough time for collaboration between
181720 -     Oncology and Surgery under the Team Care practice. ref SDS 13 RD3M
181722 -      ..
181723 -     [On 050311 the doctor has not seen the report from the surgeon,
181724 -     ref SDS 14 UH3O; doctor calls surgeon asks for another examination
181725 -     to report on performing surger to remove pockets of resistance to
181726 -     chemotherapy. ref SDS 14 XQ41
181727 -
181728 -
181729 -
181731 -  ..
181732 - Surgery Meeting Coordinate with Oncology at 020321 1445
181733 -
181734 -
1818 -
1819 -
1820 - 1534
1821 -
182102 -  ..
182103 - Called Diane back.
182104 -
182105 -                        925 295 4318
182106 -
182108 -  ..
182109 - Explained Sharee's idea for a joint meeting.
182111 -  ..
182112 - Diane will contact the surgeon about joining the meeting at 1430 or at
182113 - 1445, or bumping the meeting currently set for 1445 to 1500 or 1515,
182114 - etc.
182115 -
182116 -
182117 -
182119 -  ..
1822 -
1823 - 1604
1824 -
182401 - Diane called back.
182402 -
182403 - She talked to the surgeon.  The surgeon cannot attend the meeting at
182404 - 1430 with the oncologist due to other commitments.
182406 -  ..
182407 - The surgeon suggested attending the meeting with the oncologist at
182408 - 1430, and when it ends, come to the surgery clinic.  The surgeon will
182409 - make time to see Millie whenever the meeting ends with Oncology.
182410 -
182411 -
182412 -
182414 -  ..
1825 -
1826 -
1827 - 1606
1828 -
182801 - Called Sharee in Oncology.
182802 -
182803 - Confirmed meeting with the doctor in Oncology for...
182805 -                        ..
182806 -                       020321 1430
182807 -
182808 -
182809 -
182810 -
182811 -
182812 -
182813 -
182814 -
1829 -

SUBJECTS
Gordon Poole Called to Explain Results of Surgery
Coordinate Work Issues Nixon Peabody
Flowers Gordon Pool at Nixon Peabody Millie Called and Thanked Grodon
Chang, Cathy Nixon Peabody Millie Called and Thanked Cathy for Flower

2406 -
240701 -  ..
240702 - Gordon Pool Contacted Discussed Results of Surgery
240703 -
240704 - Follow up ref SDS 7 8KPQ.
240705 -
240706 - Millie called Gordon this morning and thanked him and Mrs Pool for the
240707 - flowers they sent.
240709 -  ..
240710 - Millie called Cathy Chang and thanked her for flowers.
240711 -
240712 -
240714 -  ..
2408 -
2409 -
2410 - 1934
2411 -
241101 - Gordon called back.  He called from the train going home using a cell
241102 - phone.  Connection was a little difficult.
241104 -  ..
241105 - Millie gave him an update from discussions with the doctor and plans
241106 - for meetings on this Thursday.
241108 -  ..
241109 - Gordon encouraged Millie to eat well.
241111 -  ..
241112 - He was pleased that Millie's family is closely involved.
241113 -
241114 -
241115 -
241116 -
241117 -
241118 -
2412 -

SUBJECTS
Marilyn Sogolo Called

2503 -
250401 -  ..
250402 - Marilyn Called and Cheered Millie
250403 -
250404 - Millie explained news from the doctor and plans for a meeting with
250405 - oncologist.
250406 -
250407 - They visited for about 15 minutes, and Millie laughed quite a bit
250408 - during this call, indicating Marily did a good job.
250409 -
250410 -
250411 -
250412 -
250413 -
250414 -
250415 -
250416 -
2505 -

SUBJECTS
Tests and Research to Discover More Cancer to Expedite Treatment

2603 -
260401 -  ..
260402 - Cancer Research on Testing and Treatment
260403 -
260404 - Ann Blackman visited Millie yesterday and brought research she did
260405 - when she, ref SDS 6 KV4O, was treated for breast cancer in 1998.
260406 -
260407 - One publication....
260408 -
260410 -          ..
260411 -         Outlook
260412 -         Publication of the Susan G. Komen Breast Cancer Foundation
260413 -         5005 LBJ Freeway, Suite 370
260414 -         Dallas, TX, 75244
260415 -         972 855 1600
260416 -         ..
260417 -         Editor:  Emily Downward, CHES
260419 -  ..
260420 - Ann brought the Fall 1998 publication.
260422 -  ..
260423 - Tests discussed in the publication include....
260424 -
260425 -      Clinical breast examination looking for new
260426 -      lumps, redness or swelling
260427 -
260428 -
260429 -      MRI - Magnetic Resonance Imaging
260430 -
260431 -         Information on the Internet....
260432 -
260433 -            http://www.msnbc.com/news/724648.asp?0si=-#BODY
260435 -          ..
260436 -         Provides an article....
260437 -
260438 -             Novel breast cancer tests in pipeline
260439 -
260440 -             The search for better imaging techniques, blood screens
260441 -
260442 -             Seems to be dated 020315.
260444 -          ..
260445 -         The article says in part that novel methods of imaging tumors
260446 -         ....will need to be combined with tests that detect genes gone
260447 -         haywire or screens that look for biological markers that
260448 -         accompany tumor development, growth and spread, he said.
260450 -          ..
260451 -         MRI doesn't consistently find microcalcifications, minute
260452 -         calcium deposits that may indicate a small tumor, the NCI
260453 -         says.
260455 -       ..
260456 -      PET scan
260457 -
260458 -            [On 020319 Pam called to remind about asking the doctor
260459 -            about this method. ref SDS 8 0G6M
260460 -
260461 -      Information on the Internet at.....
260462 -
260463 -            http://www.nationalpetscan.com/petref.htm
260464 -
260465 -      ...explains
260467 -                        ..
260468 -                       Positron Emmission Tomography
260469 -
260470 -       ...at an other location...
260471 -
260473 -             ..
260474 -            http://www.nationalpetscan.com/petovew.htm
260475 -
260476 -      ..
260477 -      Positron Emission Tomography (PET) provides unique
260478 -      diagnostic information which may alter patient management and
260479 -      reduce the total cost of patient care.  It produces images of
260480 -      molecular-level physiological function which can be used to
260481 -      measure many vital processes, including glucose metabolism, blood
260482 -      flow and perfusion, and oxygen utilization. With these images,
260483 -      physicians can identify normal and abnormal states.
260485 -       ..
260486 -      PET tests extend capabilities of advanced imaging modalities.
260487 -      Like MR and CT, for example, it uses proven tomographic
260488 -      algorithms to display data as cross-sectional images in any
260489 -      plane. And like nuclear medicine, these images represent the
260490 -      distribution of internal radiotracers.
260492 -       ..
260493 -      Unlike anatomical imaging modalities, such as CT and MR, PET
260494 -      permits assessment of chemical and physiological changes related
260495 -      to metabolism. This is important because functional change often
260496 -      predates structural changes in tissues. PET images may therefore
260497 -      demonstrate pathological changes long before they would be
260498 -      revealed by modalities like CT and MR.
260499 -      ..
260500 -      Benefits of PET Scan tests include....
260501 -
260502 -       •  Early diagnosis
260503 -
260504 -       •  <RO6I Monitoring therapeutic efficiency
260505 -
260506 -          Manage therapy by monitoring response to a given regimen and
260507 -          providing early feedback on its efficacy. This can help
260508 -          reduce or avoid the cost of ineffective treatments or
260509 -          unnecessary hospitalization.
260510 -
260511 -             [On 020326 Carol Meyer raised therapy evaluation.
260512 -             ref SDS 10 GQ7H
260513 -
260514 -       •  Eliminate invasive procedures
260515 -       •  Replacement of multiple tests
260516 -       •  Pre-surgical assessment
260517 -       •  Identification of distant metastases
260518 -      ..
260519 -      PET uses unique radiopharmaceuticals, or "tracers," labeled
260520 -      with isotopes which are the basic elements of biological
260521 -      substrates. These isotopes mimic natural substrates such as
260522 -      sugars, water, proteins, and oxygen. As a result, PET will often
260523 -      reveal more about the cellular-level metabolic status of a
260524 -      disease than other types of imaging modalities.
260526 -       ..
260527 -      PET can quantify physiological and biochemical measurements in
260528 -      vivo. Although a simplified qualitative mode is available, PET
260529 -      images can be acquired quantitatively to reflect the actual
260530 -      amounts of tracer in the regions of interest.
260532 -       ..
260533 -      Applications for Oncology Apply to Breast Cancer....
260534 -
260535 -      Detecting axillary lymph node involvement
260536 -
260537 -      Breast cancer is currently the most common malignancy detected
260538 -      among women. The most important factor determining long-term
260539 -      prognosis is the involvement of the axillary lymph nodes.
260540 -      Currently, dissection (ALND) is the technique of choice for
260541 -      making this determination. However, it is an invasive procedure
260542 -      requiring a hospital stay, and has the potential for long-term
260543 -      complications.
260544 -
260545 -          [On 020321 Millie diagnosed with lymph node issues.
260546 -          ref SDS 9 5O5F
260547 -      ..
260548 -      Another Internet location says....
260549 -
260550 -          http://www.biomed.org/pet.html
260551 -      ..
260552 -      PET imaging is very accurate in differentiating malignant
260553 -      from benign growths, as well as showing the spread of malignant
260554 -      tumors.  PET imaging can help detect recurrent brain tumors and
260555 -      tumors of the lung, colon, breast, lymph nodes, skin, and other
260556 -      organs. Information from PET imaging can be used to determine
260557 -      what combination of treatment is most likely to be successful in
260558 -      managing a patient's tumor.
260560 -       ..
260561 -      Another location says...
260562 -
260563 -        http://www.mcghealthcare.org/radiology/PET_Scan/pet_scan.html
260565 -       ..
260566 -      PET is used mostly in patients with brain or heart conditions and
260567 -      cancer, PET helps to visualize the biochemical changes taking
260568 -      place in the body, such as the metabolism of the heart muscle.
260569 -      ..
260570 -      The record on 930427 shows Lucille Johnston received a CT
260571 -      scan test that revealed brain cancer, ref SDS 2 0001, after
260572 -      initially complaining of problems in her leg that occurred when
260573 -      she was working out to prepare for a walk across the Golden
260574 -      Bridge from San Francisco to Sausalito, reported on 930327.
260575 -      ref SDS 1 8Q5L
260576 -
260577 -          [On 020321 Doctor ordered tests to investigate distant
260578 -          metastasis for diagnosis and treatment planning, but did not
260579 -          order a PET scan test.
260581 -           ..
260582 -          [On 020405 Millie asks about testing the brain for distant
260583 -          metastasis; oncologist did not order this test. ref SDS 11
260584 -          FX5H and ref SDS 11 QA5G
260585 -
260586 -
260588 -  ..
260589 -
260590 -      Bone scan
260591 -
260592 -         Information on the Internet at.....
260593 -
260594 -              http://radiology.bidmc.harvard.edu/kinds_of_exams/nuclear/boneScans.html
260596 -          ..
260597 -         Bone scans are studies that detect local changes in bone
260598 -         metabolism. Because these changes can often be seen before any
260599 -         changes are detected on X-ray, the bone scan is considered
260600 -         more sensitive than X-rays for the detection of certain
260601 -         fractures, infections, and tumors in the bone.
260602 -
260603 -            [On 020321 oncologist ordered bone scan for Millie.
260604 -            ref SDS 9 GJ5M
260605 -
260607 -          ..
260608 -         Procedure for Bone Scans
260610 -          ..
260611 -         You will receive an injection of a radioactive substance,
260612 -         usually in your arm.  This material travels through the
260613 -         bloodstream, into the soft tissue, and then concentrates in
260614 -         the bones.  The injection feels like any needle stick you
260615 -         might receive when blood tests are done, but other than that
260616 -         you will not feel anything from this injection.  We may take
260617 -         some images at the time of the injection or we may wait for a
260618 -         few hours before we begin taking pictures.
260620 -          ..
260621 -         Most of the bone scan images will be done approximately three
260622 -         hours after the injection. The pictures usually take a total
260623 -         of 30-60 minutes. There are a number of ways we can take
260624 -         images, but often the imaging uses a gamma camera positioned
260625 -         above and below you. The camera will scan the entire length of
260626 -         your body.
260627 -         ..
260628 -         A SPECT (tomographic)....
260629 -
260630 -             An acronym for Single Photon Emission Computed Tomography.
260631 -             A nuclear medicine procedure in which the gamma camera
260632 -             rotates around the patient and takes pictures from many
260633 -             angles, which a computer then uses to form a tomographic
260634 -             (cross-sectional) image. The calculation process is
260635 -             similar to that in X-ray Computed Tomography (CT) and in
260636 -             Positron Emission computed Tomography (PET).
260638 -  ..
260639 -                http://radiology.bidmc.harvard.edu/kinds_of_exams/glossary.html#SPECT
260640 -
260641 -         .... study may be done to look at a particular area of your
260642 -         body in detail. This involves an additional 30 minutes of
260643 -         imaging while the camera rotates 360 degrees around you. In
260644 -         some instances X-rays may be needed to clarify bone scan
260645 -         findings.
260647 -  ..
260648 -         ..
260649 -         No special preparation is required before the bone scan.
260650 -         You will be asked to drink fluids in the three hours between
260651 -         injection and scan and to empty your bladder frequently. This
260652 -         helps to clear the injected material from your soft tissue and
260653 -         improves the quality of the bone scan.
260655 -          ..
260656 -         After the exam, the nuclear medicine physician will evaluate
260657 -         the images and discuss them with your physician. Your
260658 -         physician will explain the results to you.
260660 -          ..
260661 -         Nuclear medicine procedures are very safe. The radioactive
260662 -         material is quickly cleared from your body. The radiation dose
260663 -         from this test (0.13 rem) is similar to most routine X-ray
260664 -         procedures.
260665 -      ..
260666 -      Chest xray
260668 -  ..
260669 -      CAT scans of....
260670 -
260671 -          brain
260672 -
260673 -          chest
260674 -
260675 -          abdomen
260677 -             ..
260678 -            [On 020321 oncologist ordered CT Scan test for the abdomen,
260679 -            not brain and chest at this time. ref SDS 9 6T5H
260680 -
260682 -       ..
260683 -      Ultrasounds of the...
260684 -
260685 -          liver
260686 -      ..
260687 -      Blood count such as...
260688 -
260689 -          CBC (complete blood count)
260690 -
260691 -          CEA (carcinembryonic antigen)
260692 -
260693 -          CA 15-3
260695 -             ..
260696 -            [On 020321 oncologist ordered further blood tests.
260697 -            ref SDS 9 6T8K
260698 -
260700 -  ..
260701 - Symptoms of cancer returning...
260702 -
260703 -      Bone pain that gets worse over a few days, most common sites
260704 -      being the spine and hips.
260706 -       ..
260707 -      Cough or difficulty breathing.
260708 -      ..
260709 -      Weight loss and lack of appetite.
260711 -       ..
260712 -      Headaches or problems with balance.
260714 -       ..
260715 -      New lumps, bumps or redness on the chest wall on the site of the
260716 -      original breast cancer.
260717 -
260719 -  ..
260720 - Research on the Interent at.....
260721 -
260722 -
260724 -  ..
260725 - Provided a phone number for the...
260726 -
260727 -                  ..
260728 -                  Cancer Information Center
260729 -
260730 -
260731 -                        800-422-6237
260732 -
260734 -  ..
260735 - Located at....
260736 -
260737 -
260738 -    http://www.openseason.com/annex/library/cic/X0008_cantests.txt.html
260739 -
260740 -
260741 -
260742 -
260743 -
260744 -
260745 -
260746 -
260747 -
260748 -
260749 -
260750 -
2608 -
































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