CONTACTS 

SUBJECTS
Radiation Treatment Scheduled to Begin with Consultation at Mt. Diabl
Meeting at Mt Diablo Medical Center Regional Cancer Cent
Avacados Healthy Food for Cancer Recovery Diet

1205 -
1205 -    ..
1206 - Summary/Objective
1207 -
120701 - Follow up ref SDS 24 QB5Q.
120702 -
120703 - The doctor gave Millie some printed handouts on radiation treatment
120704 - for cancer.  One explains that radiation treatment is "designed" by
120705 - the physician.
120707 -  ..
120708 - Another article in a health magazine or brochure explained that a
120709 - healthy diet improves chances of recovery from various diseases.  The
120710 - only food listed for resisting cancer was avocados.  At long last,
120711 - good news that something tasty is also healthy.
120712 -
120713 -     [On 070307 nutrition food chart lists avocados for a number of
120714 -     health benefits, but does not list cancer. ref SDS 35 KM7G
120716 -  ..
120717 - The doctor citied consultations she has had with the primary care
120718 - physician in Oncology at the Kaiser Walnut Creek hospital, following
120719 - the meeting on 020628, ref SDS 24 QB22, and she seemed to have
120720 - invested time for researching details of Millie's prior treatment and
120721 - testing, including fluctuations in CA 15-3, reported most recently on
120722 - 020705. ref SDS 26 UX6I
120724 -  ..
120725 - The doctor said she is not familiar with CA 15-3 testing, but is
120726 - aware this has concerned the doctor.
120727 -
120728 -     [On 020726 the primary care physician is relying on radiology
120729 -     support for backup and 2nd opinion to assess tests for diagnosis
120730 -     and treatment ideas. ref SDS 29 YO6K
120732 -  ..
120733 - The doctor said that research consulting with the oncologist and
120734 - reviewing case history were helpful for developing a radiation plan to
120735 - treat Millie.  She seemed aware that Millie has completed phase 1 of
120736 - chemotherapy treatments, consisting of 2 cycles with AC, planned
120737 - originally to have 4 treatments on 020405, ref SDS 7 549R, but was
120738 - switched on 020610 to Taxotere for the last 2 treatments, because of
120739 - rising CA 15-3. ref SDS 20 WO4O
120741 -  ..
120742 - The doctor showed Millie the PET Scan film and pointed out a darkened
120743 - area that indicates increased blood activity in the armpit area
120744 - suspected of ongoing metatasis.  She differentiated this in the PET
120745 - Scan from normal areas where blood collects in the heart and urinary
120746 - areas.
120747 -
120749 -  ..
120750 - Radiation 6-week Treatment Plan Increased from Original 4-week Plan
120751 -
120752 - Doctor Moini advised today that Millie will get 6-weeks of radiation.
120753 - The doctor explained that increasing radiation from 4-weeks to a
120754 - 6-weeks treatment plan was based on recent consultation with Millie's
120755 - primary care physician at Kaiser.
120757 -  ..
120758 - Millie recalled initial planning at Kaiser on 020321 indicated
120759 - standard protocol is four (4) weeks of radiation, ref SDS 4 51GN  This
120760 - was confirmed on 020405. ref SDS 7 6SWY  More recently a week ago on
120761 - 020628 the primary care physician at Kaiser advised that radiation
120762 - treatment would occur for 4 weeks. ref SDS 24 QB69
120763 -
120764 -        [On 020723 first radiation treatment at Mt Diablo. ref SDS 28
120765 -        0001
120767 -         ..
120768 -        [On 020726 primary care physician disclosed having ordered 2
120769 -        weeks additional radiation because Millie's condition seems
120770 -        more complex than most stage II breast cancer cases.
120771 -        ref SDS 29 MO37
120773 -         ..
120774 -        [On 060808 backup doctor reports risks of increasing cancer
120775 -        from exposure to medical radiation for CT and PET scan testing,
120776 -        ref SDS 34 3T7L; submits research article saying full-body CT
120777 -        scans for diagnostic scanning is not recommended, ref SDS 34
120778 -        LS9F, and that benefits of prescribed diagnostic testing far
120779 -        outweigh risks of side effects. ref SDS 34 MV37
120781 -         ..
120782 -        [On 060808 Millie discussed reports of public concern that
120783 -        medical radiation increases risks of cancer; could radiation
120784 -        for treatments and PET scan testing of breast cancer in August
120785 -        2002 have caused secondary inflammatory breast cancer (IBC),
120786 -        where symptoms were diagnosed by PET scan test on 021218.
120787 -        ref SDS 34 0Z5N
120789 -         ..
120790 -        [On 060808 Internet article posted by National Institute for
120791 -        Health (NIH) cites secondary cancer is a potential side effect
120792 -        from exposure to medical radiation by large parts of the body,
120793 -        ref SDS 34 HT61, and describes improved technology, practices
120794 -        reduce risks of medical radiation to far below benefits.
120795 -        ref SDS 34 IK31
120797 -  ..
120798 - Change in radiation, increasing from 4 to 6 weeks, may reflect
120799 - adjustments based on hightened concern about limited effect of
120800 - chemotherapy in reducing the CA 15-3 cancer marker, noted by the
120801 - doctor on 020603. ref SDS 20 0001
120802 -
120803 -        [On 020726 primary care physician at Kaiser reported that
120804 -        Millie presents a more complex case than most patients with
120805 -        breast cancer. ref SDS 29 MO37
120806 -
120807 -
120809 -  ..
120810 - Radiation Layout Minimize Harm to Other Tissue and Organs
120811 -
120812 - Doctor Moini explained procedures for directing radiation at an angle
120813 - through the targeted area to minimize impact on other tissue, e.g.,
120814 - heart, lung, etc.  She seemed to indicate that radiation would be
120815 - directed from the back to treat the lymph node area under the arm,
120816 - rather than toward the arm pit through the entire body.
120817 -
120818 -
120820 -  ..
120821 - Date Start Radiation Treatment on 020723
120822 -
120823 - The doctor plans to begin radiation treatment in about three (3) weeks
120824 - after the last chemotherapy treatment, which was on 020701.
120825 - ref SDS 25 0001
120827 -  ..
120828 - She scheduled a meeting tomorrow with a technician to design specific
120829 - alignment for radiation treatment.
120831 -  ..
120832 - Radiation treatments will then start on 020723.
120833 -
120834 -     [...below, notified family of schedule. ref SDS 0 JX8J
120835 -
120836 -     [On 020723 radiation treatments started. ref SDS 28 0001
120837 -
120838 -     [On 020924 radiation reported completed on 020910. ref SDS 30 0J7H
120839 -
120840 -
120842 -  ..
120843 - Monitor Effectivenss Evaluate Adjustments Treat Spread of Cancer
120844 -
120845 - There was discussion about continuing to monitor the CA 15-3 marker to
120846 - assess effectiveness of radiation treatments, as discussed previously
120847 - with the doctor on....
120848 -
120849 -    Asked about procedures for monitoring
120850 -    effectiveness of treatments............... 020321, ref SDS 4 535J
120852 -     ..
120853 -    CA 15-3 identified as method for
120854 -    effectiveness of treatment................ 020405, ref SDS 7 6T8K
120856 -     ..
120857 -    Treatment adjusted based on CA 15-3
120858 -    and PET Scan results...................... 020603, ref SDS 20 0001
120860 -  ..
120861 - The doctor said her practice is to avoid monitoring progress and
120862 - effectiveness of radiation until after prescribed treatments are
120863 - completed, in this case eight (8) weeks, based on a two (2) week delay
120864 - in starting treatment and six (6) weeks of treatment.  She seemed to
120865 - indicate this is different from chemotherapy which is a systemic
120866 - treatment that benefits from continuing tests for making adjustments,
120867 - as the doctor did on 020603, and considered again on 020628.
120868 - ref SDS 24 YT7K
120870 -  ..
120871 - There was discussion about whether metastasis could be forming in
120872 - other parts of the body not being treated by radiation, and whether a
120873 - PET Scan and/or CA 15-3 testing would increase chances of early
120874 - recognition for taking proactive action?
120876 -  ..
120877 - The doctor feels further testing can wait for another eight (8) weeks
120878 - or so.
120879 -
120880 -     [On 020726 the primary care physician at Kaiser concurred that
120881 -     further testing can be done after radiation treatment is
120882 -     completed. ref SDS 29 GF5K
120884 -  ..
120885 - Since Millie has a meeting with the doctor to review progress on
120886 - 020726, scheduled during the meeting on 020628, ref SDS 24 ZO8J, it
120887 - might be useful to have a blood test and/or PET scan sometime prior to
120888 - that date in order to support analysis for planning going forward.
120889 -
120890 -     [On 020726 CA 15-3 has dropped to 59 fro 75, showing favorable
120891 -     progress, but the doctor still concerned. ref SDS 29 0001
120892 -
120893 -
120894 -
1209 -

SUBJECTS
Opinion

1303 -
130401 -  ..
130402 - Opinion from Radiologist Hard to Prepare Because Not Enough Time
130403 -
130404 - The radiologist was asked about sending a letter to the patient
130405 - confirming important details related during the meeting today on
130406 - consultations and review of the medical chart that guided design of
130407 - the radiation treatment plan presented today, per above. ref SDS 0
130408 - 0001
130410 -  ..
130411 - The radiologist said she will consider this, but noted there is not a
130412 - lot of time for confirming plans and communication with patients to
130413 - follow up examinations.  The radiologist explained that most patients
130414 - prefer to rely on talking things over during examinations, like today,
130415 - because conversation is faster and easier than writing reports,
130416 - reading documents and handling paperwork.
130418 -  ..
130419 - This aligns with Doctor Connolly's report at Kaiser on 990625.
130420 - ref SDS 1 1978
130422 -  ..
130423 - The radiologist said today that she has an email address, but doctors
130424 - get so many emails from other doctors and staff that there is not
130425 - enough time to review communication from patients to verify
130426 - understandings about symptoms, treatment and medication, as called out
130427 - in the Kaiser Healthwise Handbook, reviewed on 990625. ref SDS 1 4185
130428 - The radiologist said follow up meetings are a good time for patients
130429 - to ask questions.  This aligns with the nurse who reported on 020402
130430 - similar practice for the primary care physician at Kaiser. ref SDS 5
130431 - C24N
130432 -
130433 -     [On 040614 the doctor confirmed practice to avoid email
130434 -     communications from patient, and advised patients to call the
130435 -     advise nurse on treatment matters. ref SDS 31 O53O
130437 -      ..
130438 -     [On 041202 Doctor Parsley used email for timely, accurate
130439 -     coordination between patient, primary care physician and surgeon
130440 -     on follow up for emergency treatment at Kaiser that found simple,
130441 -     punch biopsy wound failed to heal over 8 months. ref SDS 32 426W
130443 -      ..
130444 -     [On 051121 Kaiser email support for doctor/patient partnership
130445 -     communication. ref SDS 33 V25O
130447 -      ..
130448 -     [On 091208 1300 Doctor Stewart reports that email is not effective
130449 -     for feedback to verify accuracy of communication in order to avoid
130450 -     medical mistakes at the VA. ref SDS 36 D169
130452 -  ..
130453 - Email about patient diagnosis and planning treatment could be copied
130454 - to patients as one way to reduce the burden on over worked doctors to
130455 - communicate with patients within the time available.  This would
130456 - provide talking points so that patients are prepared for meetings
130457 - with the doctor.
130458 -
130459 -     [On 020726 the primary care physician at Kaiser is relying on the
130460 -     radiologist at Mt Diablo for a second opinion about evaluating
130461 -     medical history and planning treatment. ref SDS 29 MO37
130462 -
130463 -
130464 -
130466 -  ..
1305 -
1306 -
1307 - 1939
1308 -
130801 - Sent notice to family on progress, saying...
130802 -
130803 -    Millie completed her 4th cycle of chemotherapy on 020721.
130804 -    ref SDS 25 0001
130806 -     ..
130807 -    She will start radiation treatment in about 2 weeks on 020723, per
130808 -    above. ref SDS 0 4P5M  This will continue for 5 days a week over 6
130809 -    weeks, which is a change from the original plan.
130811 -     ..
130812 -    Following radiation, another 4 treatments of chemotherapy are
130813 -    scheduled once every three (3) weeks, per planning on 020321.
130814 -    ref SDS 4 51CX
130816 -     ..
130817 -    As shown by the record, there are good days and bad days. Millie is
130818 -    handling each day with grace and strength, setting a good example
130819 -    for all of us, as we are all in training for future infirmities.
130820 -    Mil's work and exercise ethic are a big plus in providing the
130821 -    physical and emotional stamina to give the body a fighting chance
130822 -    in warding off contagion.
130824 -     ..
130825 -    Your prayers, good wishes, cards and letters are greatly
130826 -    appreciated.
130827 -
130828 -       [On 020714 got letter from Rob wishing Millie well. ref SDS 27
130829 -       0001
130830 -
130831 -       On 020715 Bob Bronis received the letter, and will discuss with
130832 -       Drisc.
130834 -        ..
130835 -       On 020715 Candi Suddjian received the letter.
130836 -
130837 -
130838 -
130839 -
130840 -
130841 -
130842 -
130843 -
130844 -
130845 -
130846 -
1309 -
1310 -