CONTACTS 

SUBJECTS
Cancer Discoverd Uner Millie's left Arm Where Lymph Nodes Were Previo
CA 15-3 from Blood Test on 020511 is 117 Elevated from 81 Indicating
Chemotherapy Not Effective New Blood Test Orderded Changed Treatment
Brain MRI Test Ordered because PET Scan Did Not Include Brain
CA 15-3 107 Down from High of 117 Change Chemotherapy Treatment to Ta

1307 -
1307 -    ..
1308 - Summary/Objective
1309 -
130901 - Follow up ref SDS 18 0000, ref SDS 17 0000.
130902 -
130903 - The doctor confirmed understandings from the meeting on 020603 that
130904 - results of PET scan test on 020529 showing evidence of metastasis in
130905 - left axilla, where surgery was performed on 020312 and on 020327, and
130906 - where Millie has complained of continuing discomfort, is "localized"
130907 - to the arm pit area.  He said that all of the tests done so far do not
130908 - show evidence of observable "distant metastasis," as defined in the
130909 - handbook he reviewed in the meeting on 020321. ref SDS 3 FX5H
130910 -
130911 -      [On 020726 MRI on spine shows no evidence of distant metasis.
130912 -      ref SDS 24 NU4F
130914 -  ..
130915 - The doctor submitted results of the MRI brain scan performed on
130916 - 020617. ref SDS 21 0001  He said this is only a preliminary report,
130917 - but it is favorable.  During the meeting he called a colleague on the
130918 - Kaiser staff, who either prepared the preliminary report or was
130919 - familiar with the preparation of the final report that has been
130920 - completed, but is not yet available.  The doctor used the speaker
130921 - phone so that Millie could hear the discussion.  The colleague
130922 - confirmed that the final report confirms impressions from the version
130923 - that the doctor is reviewing with Millie today.  The report says....
130925 -             ..
130926 -            [On 060711 MRI on 060708 to evaluate for cancer as a result
130927 -            of persistant dizziness and rising CA 15-3 reports there is
130928 -            no prior MRI study on the brain for comparison, overlooking
130929 -            the MRI reported today. ref SDS 26 6G6F
130931 -       ..
130932 -      The ventricles and subarachnoid spaces appear normal for age. The
130933 -      brain parenchyma shows normal structure and signal intensity.
130935 -       ..
130936 -      Throughout there are no signs of subacute or chronic intracranial
130937 -      hemorage.  No mass lesions, mass effect or areas of abnormal
130938 -      contrast enhancement are identified.  Flow void is noted in the
130939 -      intracranial internal carotid and vertebral basilar arterial
130940 -      systems.
130942 -       ..
130943 -      Visualized paranasal sinuses and orbits appear within normal
130944 -      limits.
130946 -       ..
130947 -      Impressons - Normal MRI of the brain.
130949 -  ..
130950 - The doctor explained this information indicates there is no evidence
130951 - of distant metastasis in the brain, as discussed on 020321.
130952 - ref SDS 3 FX5H
130953 -
130954 -      [On 020924 Millie suffered pain her left arm and leg that could
130955 -      have been related to problems in the brain, but seem more likely
130956 -      to have been caused by excessive exercise in combination with
130957 -      degeneration in the spine that comes with aging. ref SDS 25 RPVS
130958 -
130959 -
130961 -  ..
130962 - The bone test taken on 020613 was reviewed and did not reveal signs of
130963 - cancer or other problems....
130964 -
130965 -      Evaluation was for osteoporosis.
130966 -
130967 -              Ostopenia was diagnosed.
130969 -       ..
130970 -      Lumbar spine and total left or right hip bone mineral
130971 -      density (BMD) were calculated using a dual energy x-ray
130972 -      absorptiometry hologic QDR 4500 Elite machine.
130974 -       ..
130975 -      For each BMD value, A "Z" score representing the number of
130976 -      standard deviations of the patient's BMD from the expected
130977 -      age-matched cohort and a "T" score representing the number of
130978 -      standard deviations of the patient's BMD from the average peak
130979 -      BMD in a 30-year-old race-and-gender-matched group was derived.
130981 -       ..
130982 -      Osteopenia is defined as a T score between but excluding -1.0
130983 -      and -2.5 or below.
130984 -
130985 -            Spine BMD =            0.890 GM/CM2
130986 -            Spine T-score =       -1.4
130987 -            Spine Z-score =       +0.4
130988 -  ..
130989 -            Total hip BMD =        0.819 GM/CM2
130990 -            Total hip T score =   -1.0
130991 -            Total hip Z score =   +0.3
130993 -       ..
130994 -      Study Quality:  Good and analysis is technically adequate.
130995 -
130997 -       ..
130998 -      Impression:
130999 -
131000 -         Bone material density calculated for the lumbar spine is
131001 -         statistically consistent with osteopenia.
131002 -
131003 -         Bone mineral density calculated for the total hip is
131004 -         statistically normal.
131006 -  ..
131007 - The doctor said an impression from the bone density test showing a
131008 - condition of osteopenia is not a concern requiring treatment nor a
131009 - complicating factor for cancer.
131010 -
131011 -      [On 020726 MRI on spine shows degeneration consistent with 66
131012 -      years, referal not made, prescribe exercise and over-the-counter
131013 -      medication for mild arthitis. ref SDS 24 I95S
131015 -  ..
131016 - The doctor reviewed implications of the CA 15-3 cancer marker having
131017 - elevated from 81 to 117, and now has dropped to 67.  He feels that
131018 - even though this drop occurred before switching chemotherapy treatment
131019 - from AC to Taxotere, he wants to continue with Taxotere.
131021 -  ..
131022 - The doctor ordered another blood test for CA 15-3 to continue
131023 - monitoring this marker.  Millie will have the blood test tomorrow.
131024 -
131025 -      We want results of this test to verify results reported for the
131026 -      test on 020608, which the doctor describes as troubling today.
131027 -
131028 -         [On 020705 got results, CA 15-3 on 020629 has elevated
131029 -         slightly to 75, up from 67 on 020608. ref SDS 22 UX6I
131031 -          ..
131032 -         [On 020726 CA 15-3 from subsequent test dropped from 75 to 59.
131033 -         ref SDS 24 SQ5I
131035 -  ..
131036 - The doctor related that the pattern of CA 15-3 test results for Millie
131037 - is unexpected in relation to his experience with other breast cancer
131038 - patients, and so this is a troubling, complex condition that requires
131039 - continued monitoring.
131040 -
131041 -         [On 020708 radiologist increases radiation treatment above
131042 -         original plan. ref SDS 23 TV4I
131044 -          ..
131045 -         [On 020708 radiologist defers further testing until completion
131046 -         of radiation treatment in eight (8) weeks. ref SDS 23 WU3L
131048 -          ..
131049 -         [On 020726 doctor discloses Millie's case was submitted to the
131050 -         Tumor Board for guidance on erratic CA 15-3 results.
131051 -         ref SDS 24 WF42
131053 -          ..
131054 -         [On 061020 primary care physician feels patient profile has
131055 -         too many issues for a 5-year medical case of secondary
131056 -         inflammatory breast cancer (IBC), cellulitus, lymphedema,
131057 -         pulmonary embolism, broken finger. ref SDS 27 MO4K
131059 -  ..
131060 - As a result, the doctor scheduled a follow up meeting with Millie on
131061 - 020726 at 1600.
131063 -  ..
131064 - The doctor seemed to say at one point that the steep drop in CA 15-3
131065 - from 108 to 67 after starting treatment with Taxotere, while very
131066 - positive, is suspicious, raising the prospect of error in testing
131067 - process and/or reporting results.
131069 -  ..
131070 - At another point in the discussion, he seemed to indicate that a steep
131071 - drop is expected in the beginning following surgery and/or after
131072 - beginning chemotherapy, which did not occur for Millie under treatment
131073 - with AC.  In fact the CA 15-3 declined only slightly, then shot up
131074 - steeply, which led to the PET scan and discovery of local carcinoma
131075 - under the left arm while being treated with Adriamycin Cytoxan (AC),
131076 - reported on 020603. ref SDS 18 0001
131077 -
131078 -         [On 020705 CA 15-3 has elevated slightly from 67 to 75.
131079 -         ref SDS 22 UX6I
131081 -  ..
131082 - The doctor said that AC has been the leading chemotherapy treatment
131083 - for breast cancer for several years, but Taxotere is beginning to gain
131084 - greater acceptance.
131086 -  ..
131087 - The doctor wants to avoid continual swings in treatment.  Having
131088 - switched from AC to Taxotere, he wants to stay with Taxotere even
131089 - though there is no evidence that Taxotere has any impact on recovery
131090 - in light of the fact that the drop in the CA 15-3 factor occurred from
131091 - a blood test on 020608, prior to the switch from AC on 020610.
131093 -  ..
131094 - The doctor explained that AC has a cumulative impact on the heart, and
131095 - so is only given for a limited number of treatments, about 12.  He
131096 - feels that by changing to Taxotere, this leaves open the option to use
131097 - AC later, if there is evidence that the patient is not responding as
131098 - expected.
131100 -  ..
131101 - The doctor scheduled a follow up meeting to review progress on 020726
131102 - as a result of modifications to the original treatment plan on 020321.
131103 -
131104 -     [On 020708 radiologist increased radiation treament plan from four
131105 -     (4) to six (6) weeks. ref SDS 23 TV4I
131107 -  ..
131108 - Millie asked about getting another prescription for the medicine she
131109 - takes to prepare for Taxotere treatment, and for a few days after each
131110 - treatment?  She is about out of pills.
131112 -  ..
131113 - The doctor prepared a prescription for a refill on this medicine that
131114 - is taken with meals for two days prior to treatment and another two
131115 - days following treatment.
131117 -     ..
131118 -    After the meeting, we went to the pharmacy on the same level, and
131119 -    filled the prescription.
131121 -     ..
131122 -    The pharmacist reviewed instructions, explained previously by
131123 -    the doctor.
131124 -
131125 -
131126 -
131127 -
131128 -
131129 -
131130 -
131131 -
131132 -
131133 -
1312 -

SUBJECTS
Radiation Treatment for 4 Weeks 4 Days Per Week
Radiation Treatment Scheduled to Begin with Consultation at Mt. Diabl

1504 -
150501 -  ..
150502 - Radiation 4-week Treatment Planning Referral to Mt Diablo
150503 -
150504 - Follow up ref SDS 5 6SWY.
150505 -
150506 - The doctor advised today that Millie now needs 4-weeks of radiation
150507 - treatment, per planning on 020321, ref SDS 3 51GN, and discussed again
150508 - in more detail on 020405. ref SDS 5 6SWY
150509 -
150510 -         [On 020708 radiologist increases radiation treatment from
150511 -         4-week original plan to 6-weeks of treatment. ref SDS 23 TV4I
150513 -  ..
150514 - Radiation will be performed on referral to Mt Diable hospital, because
150515 - Kaiser cannot perform the work.  He will contact Mt Diablo hospital
150516 - after the meeting today, and make arrangements to schedule Millie for
150517 - treatment,
150519 -  ..
150520 - Millie should get a call today or tomorrow from Mt Diablo to set a
150521 - specific schedule.  The doctor asked Millie to call him tomorrow, if
150522 - she does not hear from the hospital on this.
150523 -
150524 -         [On 020726 primary care physician at Kaiser relying on
150525 -         radiology physician on referral at Mt Diablo for 2nd opinion
150526 -         support and backup to assess tests for diagnosis and treatment
150527 -         ideas. ref SDS 24 YO6K
150528 -
150529 -
150531 -  ..
1506 -
1507 -
1508 - 1544
1509 -
150901 - Millie received a call from Mt. Diablo hospital.
150902 -
150903 - The attendant scheduled a meeting with the radiologist on 020708 1500
150904 - for a consultation on starting radiation treatment.
150906 -  ..
150907 - Two (2) days later on 020710 0900 Millie will visit Mt. Diablo
150908 - hospital for prepartion and perhaps the first treatment.
150910 -  ..
150911 - Treatments will then proceed 5 days a week for 4 weeks, per planning
150912 - on 020405. ref SDS 5 6SWY
150913 -
150914 -         [On 020708 radiologist increases radiation treatment from
150915 -         4-week original plan to 6-weeks of treatment. ref SDS 23 TV4I
150916 -
150917 -
150918 -
150919 -
150920 -
150921 -
150922 -
150923 -
150924 -
150925 -
1510 -
1511 -