CONTACTS 

SUBJECTS
Oncologist Meeting 020321 1430 Meeting with Surgeon Bumped to after M
Oncologist Schedule Meeting for Continuing Treatment

0504 -
0504 -    ..
0505 - Summary/Objective
0506 -
050601 - Follow up ref SDS 10 0000, ref SDS 8 0000.
050602 -
050603 - The doctor has not submitted a treatment and recovery plan to confirm
050604 - discussions on 020321.  Diagnosis in the pathology report from surgery
050605 - on 020327 indicates clear margins were achieved. ref SDS 0 QV8I
050606 - Testing so far has not shown evidence of further cancer (distant
050607 - metastasis). ref SDS 0 5L6K  The doctor ordered another blood test
050608 - prior to beginning chemotherapy treatments, ref SDS 0 6T8K, scheduled
050609 - to start on 020423. ref SDS 0 549R  Radiation will be directed at the
050610 - tumor and lymph node areas. ref SDS 0 6SWY  Taxotere will be used for
050611 - the final chemotherapy, rather than the standard protocol using taxol.
050612 - ref SDS 0 555X  The pharmacist was introduced and explained treatment
050613 - procedures.  Several prescriptions were issued for medication to help
050614 - tolerate side effects of chemotherapy. ref SDS 0 ZY4J  Opportunities
050615 - to continue working were discussed, and it was determined that a
050616 - period to 021001 should be allocated to evaluate impact of treatments
050617 - including susciptability to illness.  The doctor prepared documents
050618 - for extending SDI leave. ref SDS 0 539I
050619 -
050620 -
050621 -
050622 -
050623 -
050624 -
050625 -
050626 -
0507 -

SUBJECTS
Oncologist Primary Care Physician

0703 -
0704 - Discussion
070501 -  ..
070502 - Primary Care Physician Team Leader Oncologist
070503 -
070504 - Follow up ref SDS 10 MA3F.
070505 -
070506 - Millie asked questions from the record on 020321, but did not review
070507 - the record for feedback called out by the Kaiser Healthwise Handbook,
070508 - reviewed on 990625, ref SDS 3 4752, based on Michelle's comments on
070509 - 020402 that the doctor is too busy to follow Kaiser's guidelines.
070510 - ref SDS 15 J56J  During the meeting today, the doctor noted that
070511 - Millie has a lot of questions.
070513 -  ..
070514 - the doctor advised that he will see Millie occassionally during
070515 - the coming months of treatment.  As primary care physician, Millie
070516 - can call the doctor for treatment of specific issues.
070518 -  ..
070519 - No written analysis and schedule of treatments has been submitted by
070520 - the doctor.  There was no discussion today about this matter, as shown
070521 - in the record on 020321. ref SDS 10 A63O
070523 -  ..
070524 - the doctor will be coordinating the nurses, who administer the
070525 - chemo therapy treatments, on the evident condition of Millie, and so
070526 - can schedule a meeting as needed.
070528 -          ..
070529 -      •  Nutritionist is available every Monday to tailor a diet to
070530 -         specific patient needs.
070531 -
070532 -            Who contacts the patient and at what stage in the treatment
070533 -            is the patient notified about dietary changes, per Carol
070534 -            Meyer's letter on 020326? ref SDS 12 GQ93
070536 -             ..
070537 -            During the meeting with the Pharmacist, Ross provided a
070538 -            number of documents that discuss diet. ref SDS 0 GF6M
070539 -
070540 -
070541 -
070542 -
0706 -

SUBJECTS
Community Support Groups Recommended to Pool Experience and Advice fo

0803 -
080401 -  ..
080402 - Community Support Groups
080403 -
080404 - Follow up ref SDS 10 LU6O.
080405 -
080406 - Millie plans to contact community support.
080407 -
080408 -
080409 -
080410 -
0805 -

SUBJECTS
Pathology Report and Testing Needed to Guide Treatment Options Radiat
Pathology Report Shows Cancer Need Follow Up Surgery Chemo Therapy Ba
Pathology Report Review with Oncologist
Pathology Report 020312 Review with Oncologist
Pathology Report Biopsy Taken 020304
Pathology Report on Surgery Today 020312
Pathology Report from Surgery on 020327

1409 -
141001 -  ..
141002 - Pathology Report Review with Oncologist
141003 -
141004 - Follow up ref SDS 10 MA5K.
141005 -
141006 -        Millie asked about the doctor's comments and notations made
141007 -        during the meeting on 020321 concerning the surgery and related
141008 -        pathology report dated 020312, ref SDS 10 5O5F, that says in
141009 -        part...
141011 -             ..
141012 -        B.  Three out of three lymph nodes positive for metastatic
141013 -            disease, tumor involves the capsult, but does not extend
141014 -            into the perinodal fatty tissue, left axillary tissue.
141015 -            ref OF 2 00WP
141017 -         ..
141018 -        During the meeting on 020321 the doctor hand wrote the
141019 -        following in the right margin of this report dated 020312....
141020 -
141021 -                                4/4 LN +
141023 -         ..
141024 -        Today, the doctor explained this notation refers to both
141025 -        para A which says carcinoma was diagnozed in the sentinal lymph
141026 -        node, ref OF 2 PPTP, and in 3 out of 3 lymph nodes, as shown in
141027 -        para B, so this adds up to 4 out of 4 lymph nodes.
141028 -
141030 -         ..
141031 -        Clear Margins Reported for Surgery on Left Breast 020327
141032 -
141033 -        Follow up ref SDS 13 Q78M.
141034 -
141035 -        The doctor submitted a copy of the pathology report for the
141036 -        surgery on 020327. ref OF 6 0001  The diagnosis says that NO
141037 -        RESIDUAL CARCINOMA was found. ref OF 6 PPTP
141039 -         ..
141040 -        This seems to accomplish the objective explained by the
141041 -        surgeon following surgery on 020327. ref SDS 13 Q78M
141042 -
141043 -            [On 020405 the surgeon reported same understanding
141044 -            from pathology report. ref SDS 17 0001
141045 -
141046 -
141047 -
141048 -
141049 -
1411 -

SUBJECTS
Lymph Nodes N1 Metastasis to Movable Ipsilateral Axillary Lymph node(
Metastasis in 1 to 3 lymph nodes, any more than 0.2 cm and all less t

1604 -
160501 -  ..
160502 - Stage IIA Cancer 90% Chance Survival 5 Years No Treatment
160503 -
160504 - Follow up ref SDS 10 6Q6N.
160505 -
160507 -     ..
160508 -    Pathlogic Classification (pN)
160509 -
160510 -    Millie asked about the doctor's comments on 020327 concerning
160511 -    the AJCC Cancer Staging Handbook in relation to the pathology
160512 -    reports. ref SDS 10 634E.
160513 -
160514 -        the doctor highlighted the section pn1bii for Pathologic
160515 -        Classification (pN) shown on page 163 of the AJCC Cancer
160516 -        Staging Handbook that says....
160517 -
160518 -            Extension of tumor beyond the capsule of a lymph node
160519 -            metatasis less than 2 cm in greatest dimension, ref OF 4
160520 -            01WT
160522 -         ..
160523 -        The doctor explained that this classification is not a factor
160524 -        in identifying the stage grouping, also shown on page 163 of
160525 -        the AJCC Cancer Staging Handbook, as noted in the record on
160526 -        020321. ref SDS 10 3Z4N
160527 -
160528 -
160529 -
160530 -
160531 -
1606 -

SUBJECTS
Prognosis Good and Bad Factors for Treatment and Recovery Extending L
T1 Stage IIA Tumor is a Good Factor
Her2/neu * - Negative a Good Factor
MIB1 16% - Bad Factor
Angiolymphatic No Evidence -- Good/Bad????
N1 - out of capsule - Bad Factor
ER/PRO - Negative - Bad Factor
DNA 1.6 - Bad Factor

2410 -
241101 -  ..
241102 - Prognosis - Good and Bad Factors Affecting Survival and Treatment
241103 -
241104 - Follow up ref SDS 10 R97G.
241105 -
241106 - No questions were asked about this matter.
241107 -
241108 -
241109 -
241110 -
2412 -

SUBJECTS
Irregular Heart Beat During Surgery o 020327
Heart Scan Test Ordered to Evaluate Irregular Heart Beat During Surge

2604 -
260501 -  ..
260502 - Irregular Heart Beat - Nuclear Medicine Test
260503 -
260504 - Millie submitted the EKG report received on 020327 following surgery
260505 - for reexcision. ref SDS 13 HX7H
260506 -
260507 - the doctor examined the EKG report, and seemed to indicate the
260508 - results are not likely a critical factor in treatment and recovery.
260509 - He ordered a heart scan test that will be performed by Nuclear
260510 - Medicine in advance of starting chemo therapy treatment on 020423.
260512 -  ..
260513 - Following this meeting, Millie took the paper prepared by the doctor
260514 - to Nuclear Medicine to schedule the heart scan test.
260515 -
260516 -     [On 020412 heart scan test was performed by Nuclear Medicine at
260517 -     the Walnut Creek Kaiser hospital. ref SDS 18 0001
260518 -
260519 -     [On 020424 Millie received results of heart scan test. ref SDS 24
260520 -     PD7J
260521 -
260522 -
260523 -
260524 -
260525 -
260526 -
2606 -

SUBJECTS
Cancer Tests and Research
Testing for Distant Metastasis Spread of Cancer
Testing Cat Scan CT Abdomen for Distant Metastasis Spread of Cancer
Brain Cancer Test Not Scheduled for Distant Metastasis Using CT or PE

3006 -
300701 -  ..
300702 - Testing for Distant Metastasis - Spreading of Cancer
300703 -
300704 - Follow up ref SDS 10 FX5H, ref SDS 8 QS5H.
300705 -
300706 -     1.  Cat Scan (CT) Test Schedule for 020409
300707 -
300708 -         This test will be performed on 020409, as shown in the record
300709 -         on 020329 at 0930. ref SDS 14 QJ7G
300710 -
300711 -         Millie asked about testing the brain for distant metastasis
300712 -         per the record on 020321? ref SDS 10 6T5H
300714 -          ..
300715 -         the doctor indicated a test on the brain is performed when
300716 -         the patient complains of pain in the head area.
300718 -          ..
300719 -         The record on 930427 shows Lucille Johnston received a CT scan
300720 -         test that revealed brain cancer, ref SDS 2 0001, after
300721 -         initially complaining of problems in her leg that occurred
300722 -         when she was working out to prepare for a walk across the
300723 -         Golden Bridge from San Francisco to Sausalito, reported on
300724 -         930327. ref SDS 1 8Q5L
300726 -          ..
300727 -         There was no discussion of this record today in relation to
300728 -         doing a CT Cat Scan test in this case.
300729 -
300730 -             [On 020430 CT Cat Scan test shows 1 CM cyst on liver, and
300731 -             blood test shows CA 15-3 81 down from 85; still too high,
300732 -             doctor orders PET Scan test. ref SDS 26 PD7J
300733 -
300734 -
300735 -
300736 -
300737 -
3008 -

SUBJECTS
Testing Bone Scan for Distant Metastasis Spread of Cancer

3103 -
310401 -  ..
310402 - Follow up ref SDS 10 GJ5M.
310403 -
310404 -     2.  Bone Scan Test - Favorable Verbal Report
310405 -
310406 -         Background and procedures for bone scan testing is reviewed in
310407 -         the record on 020318. ref SDS 8 A327
310408 -
310409 -         This test was performed by Nuclear Medicine at the Walnut
310410 -         Creek Kaiser facility on 020402.
310412 -          ..
310413 -         the doctor advised that the results of the test have not
310414 -         yet been posted to the computer.
310416 -          ..
310417 -         During the meeting he called a phone number, and got a voice
310418 -         recorded report that seemed to be favorable.
310420 -          ..
310421 -         the doctor indicated that he draws from the voice
310422 -         message that the bone scan showed no indication of additional
310423 -         cancer, i.e., distant metastasis, per the AJCC Cancer Staging
310424 -         Handbook reviewed on 020321. ref SDS 10 6R6I
310425 -
310426 -            Would like to get a printed copy of the bone scan test
310427 -            results.
310428 -
310429 -               [On 020424 Millie reported receiving results of bone
310430 -               scan test. ref SDS 24 PD7J
310431 -
310432 -
310433 -
310434 -
310435 -
310436 -
3105 -

SUBJECTS
Testing Blood for Distant Metastasis Spread of Cancer
Testing Blood for Distant Metastasis Spread of Cancer Shows CA 15-3 i

3304 -
330501 -  ..
330502 - Follow up ref SDS 10 6T8K.
330503 -
330504 -
330505 -     3.  Blood Laboratory Tests
330506 -
330507 -         Results of tests from blood taken on 020321, ref OF 5 0001,
330508 -         show Millie has....
330509 -
330511 -               ..
330512 -              CA 15-3......... H...... 85 U/ML  (   -<  31)
330514 -               ..
330515 -         .... ref OF 5 LU9J
330517 -          ..
330518 -         the doctor indicated that CA 15-3 at 85 is higher than he
330519 -         would like to see.  It should be dropping following surgery on
330520 -         020327 that completed removal of cancer from the left breast,
330521 -         per diagonsis of clear margins, per above. ref SDS 0 QV8I
330523 -          ..
330524 -         the doctor seemed to say he has seen some readings up to
330525 -         3,000, and often the CA 15-3 factor is below 35.
330527 -          ..
330528 -         The doctor ordered another blood test prior to beginning chemo
330529 -         therapy on 020423 to see if the CA 1503 factor has declined.
330530 -         the doctor prepared a Laboratory Requestion and entered
330531 -         under....
330532 -
330533 -                           Blood Gases
330534 -
330535 -         ....and
330537 -                            ..
330538 -                           Other
330539 -
330541 -             ..
330542 -            x  CA 15-3
330543 -
330544 -         ...to get an updated condition prior to commencing
330545 -         chemotherapy treatment on 020423.
330547 -          ..
330548 -         This test can be done at any Kaiser facility by merely merely
330549 -         presenting a Kaiser card and the test requisition prepared by
330550 -         the doctor today.
330552 -          ..
330553 -         Current plan is to this done at the Park Shadelands facility
330554 -         in Concord OA 020418.
330555 -
330556 -             [On 020419 blood test taken at Park Shadelands.
330557 -             ref SDS 21 0001
330558 -
330559 -             [On 020430 CA 15-3 81 down from 85; still too high, doctor
330560 -             orders PET Scan test. ref SDS 26 PD7J
330561 -
330562 -
330563 -
330564 -
3306 -

SUBJECTS
PET Scan for Distant Metastasis Spread of Cancer Not Recommended by D
Distant Metastasis Spread of Cancer to Other Areas of the Body No Ass

3604 -
360501 -  ..
360502 - Follow up ref SDS 10 QA5G.
360503 -
360504 -     4.  PET Scan Test Not Scheduled, Maybe Used in Future
360505 -
360506 -         There was no discussion of a PET scan for evaluation and
360507 -         analysis of treatments planned so far, as discussed on 020318.
360508 -         PET scan procedure are used to monitor response and provide
360509 -         early feedback on efficacy of treatment, ref SDS 8 KO5O, per
360510 -         Millie's question below about evaluating treatment.
360511 -         ref SDS 0 GZ8K
360513 -          ..
360514 -         Millie asked about testing the brain for distant metastasis,
360515 -         per the record on 020318 showing that PET imaging is very
360516 -         accurate in differentiating malignant from benign growths, as
360517 -         well as showing the spread of malignant tumors. ref SDS 8 S36M
360519 -          ..
360520 -         Per above, the doctor will consider this issue later if
360521 -         specific symptoms arise. ref SDS 0 P26O
360522 -
360523 -             [On 020430 CT Cat Scan test shows 1 CM cyst on liver, and
360524 -             blood test shows CA 15-3 81 down from 85; still too high,
360525 -             doctor orders PET Scan test. ref SDS 26 PD7J
360527 -              ..
360528 -             [On 020430 CA 15-3 81 down from 85; still too high, doctor
360529 -             orders PET Scan test. ref SDS 26 PD7J
360530 -
360531 -
360532 -
360533 -
360534 -
360535 -
3606 -

SUBJECTS
Treatment Recovry 9 Month Program Chemo Therapy and Radiation
Reexcision Surgery on 020327 to Obtain Clear Margins on Pathology of

3804 -
380501 -  ..
380502 - Treatment Requires Surgery, Chemo Therapy and Radiation for 9 Months
380503 -
380504 - Follow up ref SDS 10 FX7F.
380505 -
380506 -     1.  Reexcision on 020327
380507 -
380508 -         This is the surgery scheduled by the surgeon to get
380509 -         "clear margins" in a call on 020318, ref SDS 8 5V7I, and
380510 -         further on 030219. ref SDS 9 5V7I
380512 -          ..
380513 -         There was no discussion today about findings on 020312 that
380514 -         guide treatment toward reexcission surgery.
380516 -          ..
380517 -         the doctor indicated the pathology report for the surgery
380518 -         on 020327 shows the surgery was effective in achieving clear
380519 -         margins, per above. ref SDS 0 QV8I
380521 -          ..
380522 -         He examined the surgery area and noted the incision is healing
380523 -         well.
380524 -
380525 -              [On 020408 the surgeon reported surgery on 020347
380526 -              was successful. ref SDS 17 0001
380527 -
380528 -
380529 -
380530 -
380531 -
380532 -
3806 -

SUBJECTS
Chemo Therapy 4 Cycles Adriamycin (AC) and Cytoxan 1 Treatment a Mont

3903 -
390401 -  ..
390402 - Follow up ref SDS 10 6SWS.
390404 -          ..
390405 -         Treatments Begin on 020423
390406 -     2.  Chemotherapy Treats Distant Metastasis; Radiation Treats Tumor
390407 -
390408 -
390409 -         4 cycles of Adriamycin and Cytoxan (AC) over 4 months.
390411 -          ..
390412 -         The doctor clarified today that these treatments will occur
390413 -         once every three weeks.
390415 -          ..
390416 -         Today, the doctor prepared documents to begin treatments
390417 -         on 020423.
390418 -
390419 -             [On 020423 Millie had first treatment. ref SDS 23 0001
390420 -
390421 -             [On 020603 doctor determines from CA 15-3 tests and PET
390422 -             scan tests that Adriamycin and Cytoxan (AC) is not
390423 -             achieving required results, and so decides to make a
390424 -             change and use Taxoter for the remaining 2 treatments on
390425 -             phase 1 prior to radiation. ref SDS 27 WO4O
390427 -          ..
390428 -         On 020318 research indicates PET scan tests are used to
390429 -         monitor patient response and provide early feedback on
390430 -         efficacy of treatment. ref SDS 8 KO5O
390432 -          ..
390433 -         Millie asked about assessment of treatments and ideas for
390434 -         alternatives in the event prescribed drugs are less effective
390435 -         than expected or needed, as posed by Carol Meyer on 020326?
390436 -         ref SDS 12 IK7N
390437 -
390438 -             [On 020425 side effects minimal so far. ref SDS 25 0001
390440 -              ..
390441 -             [On 020430 CA 15-3 81 down from 85; still too high, doctor
390442 -             orders PET Scan test. ref SDS 26 PD7J
390444 -          ..
390445 -         The doctor seemed to indicate that nurses will be observing
390446 -         the patient during treatments, and the patients will report on
390447 -         how they feel to the nurses.
390449 -          ..
390450 -         The doctor indicated he will not see Millie again for several
390451 -         months unless a specific problem occurs.
390452 -
390453 -             [On 020430 the doctor schedules meeting with Millie on
390454 -             020513 1100 to evaluate results of PET Scan test ordered
390455 -             on 020430. ref SDS 26 PD7J
390456 -
390457 -
390458 -
390459 -
390460 -
390461 -
390462 -
3905 -

SUBJECTS
Radiation Treatment for 4 Weeks 4 Days Per Week

4003 -
4004 -   ..
400401 - Follow up ref SDS 10 51GN.
400402 -
400403 -
400404 -         Radiation over 1 month
400405 -
400406 -         The meeting on 020321 indicated that radiation treatment would
400407 -         occur over a period of 4 weeks. Treatment will be five days a
400408 -         week for four weeks.
400410 -          ..
400411 -         Today, the doctor indicated radiation will be directed at
400412 -         the left breast area where the tumor was discovered and
400413 -         removed, and radiation will also be directed under the left
400414 -         arm where lymph nodes tested positive for carcinoma, per the
400415 -         pathology report reviewed on 020321. ref SDS 10 JE8H
400416 -
400417 -             [On 020628 radiation treatment scheduled to begin on
400418 -             020708. ref SDS 28 QB5Q
400420 -              ..
400421 -             [On 020708 radiologist increases radiation treatment above
400422 -             original plan. ref SDS 29 TV4I
400423 -
400424 -
400425 -
400426 -
400427 -
400428 -
400429 -
400430 -
4005 -

SUBJECTS
Taxotere Chemo Therapy 1 Treatment Per Month Over 4 Months

4103 -
4104 -   ..
410401 - Follow up ref SDS 10 6SXX.
410402 -
410403 -
410404 -         4 cycles of Taxotere over 4 months
410405 -
410406 -         This will be the same schedule as the first chemo therapy
410407 -         treatments, once every three (3) weeks, per above. ref SDS 0
410408 -         6SWS
410410 -          ..
410411 -         The doctor initially said today that the 2nd phase of
410412 -         chemotherapy treatment following radiation would use Taxol.
410414 -          ..
410415 -         On 020321 the doctor submitted pages 162 and 163 torn from the
410416 -         AJCC Cancer Staging Handbook and the doctor entered handwrtten
410417 -         notations on the back of these pages to document Kaiser's
410418 -         treatment plan, and this included a notation to use "Taxotere"
410419 -         for phase II treatment. ref SDS 10 51CX
410421 -          ..
410422 -         The doctor clarified standard protocol for diagnosis in this
410423 -         case is to use "Taxol."  He further explained that Taxotere is
410424 -         a new treatment, and today he feels his first instinct to use
410425 -         Taxotere is okay afterall, and commented that Taxotere is
410426 -         easier to tolerate than Taxol.
410427 -
410428 -              [On 040318 the doctor explained oncology practice to make
410429 -              clinical trial referrals for new drugs that target cancer
410430 -              and are easier to tolerate. ref SDS 30 DG6H
410432 -          ..
410433 -         There was no discussion about participating in clincial trials
410434 -         of new, experimental treatments cited in the record of the
410435 -         first meeting on 020321, ref SDS 10 O49J, and no discussion
410436 -         of clinical trial results for Taxotere.
410437 -
410438 -
410439 -
410440 -
410441 -
4105 -

SUBJECTS
Evaluation and Questions on Treatment Planning

4303 -
430401 -       ..
430402 -      Treatment Planning and Evaluation - Questions
430403 -
430404 -      Follow up ref SDS 10 535J.
430405 -
430406 -      Additional Questions Suggested by Millie's Niece, Carol....
430407 -
430408 -      Millie asked the doctor about alternatives in the event
430409 -      prescribed drugs are not effective, per Carol's letter on 020326.
430410 -      ref SDS 12 IK7N
430411 -
430412 -          the doctor seemed to indicate that the treatment plan for
430413 -          Millie meets the protocols for stage II cancer, except using
430414 -          Taxotere is an adjustment.
430415 -          ..
430416 -          There was no indication today of alternative treatment
430417 -          plans.
430419 -       ..
430420 -      Millie asked how long will it take before he knows if treatment
430421 -      is being successful; 6 months post chemo, or when, per Carol's
430422 -      letter on 020326? ref SDS 12 GQ7H
430423 -
430424 -          the doctor indicated that Kaiser will monitor Millie's
430425 -          condition and input form the patient contribute to recovery
430426 -          assesement.  Limited time today left this question largely
430427 -          still pending.
430429 -       ..
430430 -      Millie asked what tests will be performed during the 9 months of
430431 -      treatment plan to assess progress of treatment, and whether to
430432 -      adjust course prior to completion of planned treatments, related
430433 -      in Carol's letter on 020326? ref SDS 12 6J7K
430434 -          ..
430435 -          the doctor mentioned again that the treatment plan
430436 -          for Millie meets the protocols for stage II cancer, except
430437 -          using Taxotere is an adjustment.
430439 -           ..
430440 -          There was no indication today of alternative treatment plans.
430442 -           ..
430443 -          Above, the doctor explained that CA 15-3 is a blood test that
430444 -          is monitored. ref SDS 0 6T8K
430445 -
430446 -
430447 -
430448 -
430449 -
430450 -
430451 -
430452 -
430453 -
430454 -
430455 -
4305 -

SUBJECTS
Chemo Therapy Side Effects of Treatment and Discuss Tolerance Medicat
Doctor (Ross) Zan Sorooshian, Pharm.D., BCOP Pharmacist Explained Che
Questions on Treatment Planning

4705 -
470601 -  ..
470602 - Side Effects of Chemo Therapy, Tolerance Measures and Medication
470603 - Pharmacist Explains Chemo Therapy Treatment Prescribes Medication
470604 - Meeting Doctor Doctor Zan Sorooshian (Ross) Oncology Pharmacist
470605 -
470606 - Follow up ref SDS 10 A63O.
470607 - ..
470608 - the doctor introduced Ross, whose business card shows...
470609 -
470610 -
470611 -                 Zan Sorooshian, Pharm.D., BCOP
470612 -                 Oncology Pharmacist
470613 -                 Kaiser Permanente Medical Group, Inc.
470614 -                 1425 South Main Street
470615 -                 Walnut Creek, CA  94596
470616 - //
470617 -                 925 295 5438
470618 -
470619 - //              Email:  hormozan.sorooshian@kp.org
470621 -  ..
470622 - Ross took Millie, Pam and I to another room for orientation on chemo
470623 - therapy treatments, as the doctor explained on 020321. ref SDS 10
470624 - 6T34
470625 -
470627 -       ..
470628 -      Preparing for Treatment, Tolerating Chemotherapy and Radiation
470629 -
470630 -      Follow up ref SDS 10 JP7I.
470631 -
470632 -      There was not enough time to review specific questions suggested
470633 -      by Carol Meyer shown on 020321, ref SDS 10 JP7I, although some of
470634 -      the issues Carol raised were addressed during the meeting today
470635 -      with Ross.
470636 -      ..
470637 -      Each treatment lasts about 2 hours, as medication is fed
470638 -      intravenously into the patient.
470639 -      ..
470640 -      Ross reviewed possible effects of losing hair and ill
470641 -      feeling, including nausia, vomiting and headaches following chemo
470642 -      therapy treatments, and noted that different people have varying
470643 -      after effects, which aligns with the doctor's comments on
470644 -      020321. ref SDS 10 6434
470646 -       ..
470647 -      Ross explained that chemotherapy attacks the while blood cells in
470648 -      order to attack cancer.  This lowers the immune system, so it is
470649 -      important during treatment to avoid conditions that are conducive
470650 -      to desease, such as crowds.
470651 -
470652 -          [On 020425 no adverse side effects so far. ref SDS 25 0001
470653 -      ..
470654 -      Ross prepared prescriptions to relieve discomfort following
470655 -      treatments, and he prescribed medication to relieve anxiety from
470656 -      the prospect of suffering and decline associated with cancer.
470657 -
470658 -          [On 020405 Millie taking medications to tolerate treatments.
470659 -          ref SDS 25 0001
470660 -      ..
470661 -      A "port" is sometimes used for administering chemo therapy
470662 -      when treatments are frequent and/or the patient's viens are not
470663 -      conducive to conventional intravenous application.
470664 -      ..
470665 -      Treatments in this case will be administered every 3 weeks,
470666 -      which is ample time for conventional intravenous treatments using
470667 -      a needle. Ross will ask the head chemotherapy nurse about the
470668 -      need for a port based on examination of the veins to make sure
470669 -      they are okay for conventional treatment.
470670 -      ..
470671 -      Ross submitted a blue folder with about 5 or 6 pamphlets on
470672 -      chemotherapy.
470673 -
470674 -           1.  Hints for eating when you have nausea and vomiting
470675 -
470676 -           2.  Hints for eating when you have loss of appetite or altered
470677 -               tastes
470679 -                ..
470680 -           3.  Eating Well During Cancer Treatment
470682 -         ..
470683 -        No analysis or guidance was offered during the meeting to
470684 -        address Carol Meyer's questions on 020321 about applying
470685 -        general information to this case.
470687 -       ..
470688 -
470689 -           4.  Chemotherapy drug information sheet on AC
470690 -
470691 -               AC is most often used to treat breast cancer
470692 -
470693 -               Adriamycin (Doxorubicin)
470695 -                ..
470696 -               Cyclophosphamide (Cytoxan)
470698 -       ..
470699 -
470700 -           5.  Patient Information Chemotherapy and the cells
470701 -
470702 -           6.  Information for Chemo Patients
470703 -
470704 -           7.  Chemotherapy and You
470705 -               A Guide to self-help during cancer treatment
470707 -                ..
470708 -           8.  Radiation Therapy and You
470709 -               A Guide to self-help during cancer treatment
470710 -
470711 -
470712 -
4708 -

SUBJECTS
Chemo Therapy Side Effects of Treatment and Discuss Tolerance Medicat
Working During Treatment Disability for Beginning to Evaluate Reactio
SDI Working During Treatment Disability for Beginning to Evaluate Rea
SDI Coordinate Submission Obtain Information from Office Nixon Peabod

5306 -
530701 -       ..
530702 -      Working During Treatment Not Advised Until 021001
530703 -
530704 -      Follow up ref SDS 10 539I.
530705 -
530706 -      Ross concurred with Carol Meyer's comments in a letter on 020326
530707 -      noting that chemotherapy drugs bring the immune system causing
530708 -      increased risk of getting ill especially around lots of people.
530709 -      ref SDS 12 EU5F
530711 -       ..
530712 -      Commuting on BART from Concord to San Francisco for about an hour
530713 -      twice a day presents exposure to "crowded" conditions.
530715 -       ..
530716 -      Ross advised that increased risk due to side effects of cancer
530717 -      treatment, per above, ref SDS 0 ZY4J, make it standard practice
530718 -      to avoid the demands and conditions of work away from home for
530719 -      the next number of months until experience shows no specific
530720 -      reactions to treatments occur, including recurrence and distant
530721 -      metastasis.  Ross explained that since diagnosis shows additional
530722 -      treatment is required, time away from work needs to be extended
530723 -      from the 020412 date that the surgeon set for the initial
530724 -      surgery to remove the tumor on 020321.
530725 -      ..
530726 -      Based on the nine (9) month treatment plan of chemotherapy,
530727 -      radiation, medications, tolerance and exposure issues, the
530728 -      doctor prepared Kaiser Permanente form 98082 dated today, 020405,
530729 -      in three copies for...
530730 -
530731 -
530732 -                       Visit/Verification Family Leave
530733 -                      Health Care Provider Certification
530735 -       ..
530736 -      The doctor extended leave from work to 021001.
530737 -
530738 -         [On 020417 received request from State for supplemental
530739 -         certification. ref SDS 19 0001
530740 -
530741 -         [On 020418 call from Kaiser on processing SDI certification.
530742 -         ref SDS 20 0001
530743 -
530744 -
530745 -
530746 -
530747 -
5308 -

SUBJECTS
Meeting Staff Chemotherapy Treatment Center Patients can Have Family

5403 -
540401 -       ..
540402 -      Chemotherapy Treatment Center Staff and Procedures
540403 -
540404 -      Ross showed the area where chemotherapy will be administered and
540405 -      introduced Janet who is one of the nurses.
540406 -
540407 -      There were about 4 or 5 people receiving treatments.  Janet
540408 -      explained that patients can have a family member or friend sit
540409 -      with them during treatments.
540410 -
540411 -          [On 020419 Marilyn arrived from Chicago to visit with Millie
540412 -          for the period ahead. ref SDS 22 0001
540414 -           ..
540415 -          [On 020423 Millie had first chemotherapy treatment.
540416 -          ref SDS 23 0001
540418 -           ..
540419 -          [On 020425 no adverse side effects so far. ref SDS 25 0001
540420 -
540421 -
540422 -
540423 -
540424 -
540425 -
540426 -
540427 -
540428 -
540429 -
540430 -
5405 -