CONTACTS 

SUBJECTS
CA 15-3 46 Rises from 37 Reversing Prior Trend Reported Last Month
CA 15-3 Cancer Marker Breast

0404 -
0404 -    ..
0405 - Summary/Objective
0406 -
040601 - Follow up ref SDS 45 0000. ref SDS 42 0000.
040602 -
040603 - CA 15-3 has risen 25% from 37 to 46.  Some investigators consider a
040604 - 25% rise significant. ref SDS 0 I56K  the doctor advised that CA
040605 - 15-3 can vary due to factors other than relapse of cancer, such as a
040606 - cold (diet - eating and drinking were not discussed today), and
040607 - therefore, the current levels do not indicate relapse. ref SDS 0 GJ5M
040608 - This advice may align with guidance from the American Society of
040609 - Clinical Oncology (ASCO), which seems to say that levels below 100 are
040610 - not suggestive, ref SDS 0 YV6M  ASCO cautions that CA 15-3 often has
040611 - false-positive results, and so should be considered only in relation
040612 - to other clinical data. ref SDS 0 I56K  the doctor reported that
040613 - clinical data from the CT scan found no evidence of cancer.  Like the
040614 - PET scan in January, the CT scan found a number of non-specific issues
040615 - that may be reaction to radiation treatment. ref SDS 0 LK5L  Further
040616 - monitoring is recommended. ref SDS 0 GJ69  Follow up CT scan was
040617 - therefore scheduled for April.  Results will be discussed in a meeting
040618 - with the doctor in May.  The doctor observed favorable results
040619 - today for treatment of cellulitus and other symptoms. ref SDS 0 KW5F
040620 -
040621 -
040622 -
040623 -
040624 -
040625 -
040626 -
040627 -
0407 -

SUBJECTS
CA 15-3 46 25% Rise from 37 Cancer Biomarker Doctor Advises No Signa

0903 -
0904 - Discussion
090501 -  ..
090502 - Recovery Progress CA 15-3 Cancer Marker Rises 25% from 37 to 46
090503 - CA 15-3 Cancer Marker Reverses Trend and Shows Increase of 25%
090504 -
090505 - Follow up ref SDS 45 SM6M, ref SDS 42 SM6M.
090507 -  ..
090508 - The doctor submitted results of the latest blood test on 030214
090509 - showing the CA 15-3 cancer marker has increased from 37 to 46,
090510 - reversing the drop reported on 030109....
090511 -
090512 -          030220......... 46 H............. 030220, ref SDS 0 5E6L
090513 -          030106......... 37 H............. 030109, ref SDS 45 SM6M
090514 -          021202......... 41 H?............ 021204, ref SDS 41 SP5G
090515 -          021102......... 36 H?............ 021113, ref SDS 40 Y65I
090516 -          021023......... 33 H?............ 021023, ref SDS 39 SQ5I
090517 -          020930......... 33 H?..29........ 021002, ref SDS 38 SQ5I
090518 -          020917......... 36 H?............ 020924, ref SDS 37 SQ5I
090519 -          020717......... 59 H?............ 020726, ref SDS 36 YN5K
090520 -          020629......... 75 H ............ 020705, ref SDS 34 UX6I
090521 -          020608........  67 H ............ 020614, ref SDS 30 0001
090522 -          020603........ 108 H ............ 020607, ref SDS 28 X67F
090523 -          020511........ 117 H ............ 020603, ref SDS 27 PJ4J
090524 -          020419......... 81 H ............ 020430, ref SDS 23 7N5H
090525 -          020321......... 85 H ............ 020405, ref SDS 13 6T8K
090526 -
090528 -  ..
0906 -
0907 -
0908 - Analysis
0909 -
090901 - 25% Rise CA 15-3 Cancer Marker Does Not Alarm Doctor
090902 -
090903 - The doctor said he is not concerned that a 25% rise in CA 15-3 from 37
090904 - to 46, per above, ref SDS 0 SM6M, may indicate increased carcinoma
090905 - activity and distant metastasis, which he explained during the meeting
090906 - on 020321. ref SDS 11 6R5X  There was no discussion of ASCO guidance
090907 - saying several investigators describe 25% change in CA 15-3 as
090908 - significant. ref SDS 0 I56K  Rising CA 15-3 by 25% appears to justify
090909 - a reciprocal assessment of concern to balance assessment on 030109
090910 - that a 10% drop shows favorable effects of treatment. ref SDS 45 GJ5M
090911 - The doctor explained that the CT scan found no evidence of emerging
090912 - metastasis. the doctor's reliance on test data appears to be supported
090913 - by ASCO report dated 960516. ref SDS 0 SZ4G
090915 -  ..
090916 - The doctor related that CA 15-3 breast cancer marker can vary for many
090917 - reasons, and so the rise today does not signal concern that treatments
090918 - may have not accomplished the objective of eliminating cancer growth.
090919 - The doctor gave an example of someone having a cold could cause CA
090920 - 15-3 to rise independent of cancer activity.  Millie has a cold today,
090921 - so under this theory, CA 15-3 might now be further elevated, since no
090922 - cold symptoms were evident at the time the blood sample was taken
090923 - about a week ago.  There was no discussion today of other factors that
090924 - may impact CA 15-3 such as eating and drinking, an injury, a headache,
090925 - psycological stress, etc., which aligns with silence in the ASCO
090926 - report, shown below, indicating studies so far have not isolated other
090927 - factors. ref SDS 0 SZ4G
090929 -  ..
090930 - Will continue blood tests, per planning below for next visit in May.
090931 - ref SDS 0 M28G
090932 -
090933 -
090934 -
090935 -
0910 -

SUBJECTS
ASCO Report 960517 Bio Cancer Marker CA 15-3 FDA Approval 960329 Ear

1403 -
1404 - 2148
140501 -  ..
140502 - ASCO 1996 Report CA 15-3 Offers Some Guidance Not Definitive
140503 -
140504 - Research on CA 15-3 shows a report dated 960517, ref OF 9 0001,
140505 - published by the American Society of Clinical Oncology.....
140506 -
140507 -      http://www.asco.org/asco/shared/asco_print_view/1,1168,_12-002032-00_18-0011475-00_19-0011511-00_20-0010,00.html
140509 -  ..
140510 - Appendix with citations and biblography is segmented and stored
140511 - separately. ref OF 10 0002
140513 -  ..
140514 - The ASCO report has a section...
140515 -
140516 -                  CA 15-3 as a Marker for Breast Cancer
140517 -
140518 - ...which explains that on 960329 the Food and Drug Administration
140519 - approved the Tru-Quant BR RIA test (Biomira Diagnostics, Toronto,
140520 - Canada) for the early detection of recurrent disease in breast cancer
140521 - patients who have stage II and stage III disease. ref OF 9 GR37
140523 -  ..
140524 - Generally the report seems to indicate CA 15-3 is used to show failure
140525 - of treatment, and consequent need for further treatment.  There is
140526 - discussion of elevated CA 15-3 conditions, but nothing expressly
140527 - states how the baseline of "normal" is established for determining
140528 - "elevated."  There is nothing in the report on variations of "normal"
140529 - between patients.  The value of 100 is mentioned, ref SDS 0 YV6M, and
140530 - the report discusses a condition 5 - 10 times normal is cause for
140531 - alarm. ref SDS 0 ZL4X  Nothing is discussed about conditions that
140532 - impact CA 15-3 other than cancer, for example diet, a wound, bump on
140533 - the head, exercise, a cold or the flue, mentioned by the doctor,
140534 - per above. ref SDS 0 S36J  The report clearly says CA 15-3 must be
140535 - evaluated in relation to other clinical data, ref SDS 0 I56K, and
140536 - cannot stand alone for evaluating response to treatment. ref SDS 0
140537 - 6H4H
140539 -  ..
140540 - Information is needed from the doctor for updated studies since
140541 - 1996.
140542 -
140543 -           [On 070329 McNeil Lehrer Newshour television broadcast cites
140544 -           biomarker testing as advanced form of early cancer
140545 -           detection. ref SDS 49 GJ5M
140547 -  ..
140548 - The report offers following guidance...
140549 -
140550 -     1a. Present data are insufficient to recommend CA 15-3 for
140551 -     screening, diagnosis, staging, or surveillance following primary
140552 -     treatment. Although an increasing CA 15-3 level can detect
140553 -     recurrence following primary treatment, the clinical benefit is
140554 -     not established; therefore, it cannot be recommended. ref OF 9
140555 -     GR47
140557 -      ..
140558 -     1b. Present data are insufficient to recommend routine use of CA
140559 -     15-3 alone for monitoring response to treatment. But, in the
140560 -     absence of readily measurable disease, an increasing CA 15- 3
140561 -     level may be used to suggest treatment failure. ref OF 9 GR54
140563 -  ..
140564 - This guidance raises the question of what constitutes an "increasing
140565 - CA 15-3 level"?
140566 -
140567 -          Does a 10 fold increase from 2 to 20 impart greater or less
140568 -          significance than a 20% change from from 50 60; or a 25%
140569 -          change say from 37 to 46 versus 22 to 30?  What about the
140570 -          significance of trends, and acceleration?  Somebody must have
140571 -          crunched some numbers that clarify context for describing a
140572 -          condition as "elevated."
140574 -  ..
140575 - ASCO guidance continues....
140576 -
140577 -     CA 15-3 is a serum cancer antigen that has been used in the
140578 -     management of patients with breast cancer. Its low detection rate
140579 -     in early stage disease indicates that CA 15-3 cannot be used to
140580 -     screen or diagnose patients with breast cancer. It has been widely
140581 -     used to monitor the effectiveness of treatment for metastatic
140582 -     cancer. Large, prospective, controlled clinical trials were not
140583 -     conducted before widespread marketing of the test. Thus, the
140584 -     available data do not convincingly demonstrate that CA 15-3 can be
140585 -     used alone to determine the response of a patient to treatment.  CA
140586 -     15-3 may be used to provide additional information suggesting that
140587 -     a patient is responding to or failing treatment. ref OF 9 GR77
140589 -      ..
140590 -     Screening. CA 15-3 has been evaluated for its ability to determine
140591 -     diagnosis, prognosis, monitor therapy, and predict recurrence of
140592 -     breast cancer following curative surgery and radiotherapy.
140593 -     Multiple studies have shown that the incidence of CA 15-3
140594 -     elevation increases with an increasing stage of the
140595 -     disease.160-171  Nine percent of women with stage I and 19% of
140596 -     women with stage II breast cancer have elevated CA 15-3 levels.
140597 -     The incidence of abnormal values increases to 38% and 75% for
140598 -     patients with stage III and IV, respectively.  Low CA 15- 3 levels
140599 -     do not exclude metastases, and a given CA 15-3 level cannot be
140600 -     used to determine the stage of disease.172  When CA 15-3 is
140601 -     evaluated before surgery in patients with primary breast cancer,
140602 -     levels have not correlated with prognosis.173,174, ref OF 9 QR9M,
140603 -
140605 -  ..
140606 - 5 - 10 Times Elevated Ca 15-3 Above Normal Could Indicate Relapse
140607 -
140608 -     Very high CA 15-3 levels tend to indicate advanced disease, and a
140609 -     value 5 to 10 times normal could alert a physician to the presence
140610 -     of metastatic disease. CA 15-3 levels are highest in patients with
140611 -     liver or bony metastases,168,175-177 and increasing numbers of
140612 -     metastatic sites correlate with increasing CA 15-3 levels.177,178
140613 -     Several investigators have suggested that CA 15-3 is a
140614 -     particularly sensitive method for detecting osseous
140615 -     metastases.168,175, ref OF 9 LV5F
140617 -      ..
140618 -     For a marker to be valuable in screening for cancer, it would have
140619 -     to detect early-stage disease in an asymptomatic population and be
140620 -     infrequently elevated in patients without cancer. Elevations have
140621 -     been observed occasionally in healthy subjects (5% to 6%) and more
140622 -     often in individuals with benign diseases, especially those of
140623 -     hepatic origin, in which false-positive elevations have been
140624 -     observed in 30% of patients.161,179
140625 -     ref OF 9 EW5N
140626 -
140628 -  ..
140629 - 100 and Below Typical Level CA 15-3 for Benign Disease
140630 -
140631 -     Typically, such CA 15-3 levels do not increase above 100 U/mL, as
140632 -     documented in more than 1,220 patients with benign diseases.179
140633 -     This level of nonspecific elevation will give false-positive
140634 -     results when attempting to use CA 15-3 in screening or in
140635 -     diagnosis. ref OF 9 M36L
140637 -      ..
140638 -     The low incidence of CA 15-3 elevation in early-stage cancer
140639 -     indicates that it cannot be used in screening or in diagnosis.
140640 -     One can use Bayes' theorem to calculate the predictive value of a
140641 -     positive test in an asymptomatic woman.  The prevalence of breast
140642 -     cancer increases with age, but remains fewer than 400 new cases
140643 -     per 100,000 women per year.  Incorporating this worst-case
140644 -     prevalence (0.004), the specificity (5% to 6% elevation in healthy
140645 -     women), and sensitivity (9% for stage I and 19% for stage II), the
140646 -     predictive value of a positive test is 0.7% for stage I and 1.5%
140647 -     for stage II cancer.  Among individuals with benign disorders (who
140648 -     may have CA 15-3 levels up to 100 U/mL), the incidence of
140649 -     false-positive elevations will be even greater.  Thus, in the
140650 -     general population, far more false-positive than true-positive
140651 -     results will be observed in using CA 15-3 in screening.  Similar
140652 -     reasoning limits the use of CA 15-3 in diagnosis, where the
140653 -     prevalence of cancer is higher, but the incidence of
140654 -     false-positive elevation is increased as well.  Although the use
140655 -     of CA 15-3 in screening has never been tested in large prospective
140656 -     trials, such trials with CEA in colon cancer and CA 125 in ovarian
140657 -     cancer, have confirmed the inability of these serum markers to
140658 -     detect cancer in a reliable way.180-183, ref OF 9 NPPT
140660 -  ..
140661 - Elevated CA 15-3 Signals Relapse over 2 - 9 months period....
140662 -
140663 -     Indicator of asymptomatic recurrence.
140664 -
140665 -     A number of studies have addressed the question of whether CA 15-3
140666 -     can monitor patients for recurrence following breast cancer
140667 -     surgery.164,165,168,179,184-191 Twelve studies were reviewed: one
140668 -     trial was level of evidence III; six were level of evidence IV;
140669 -     and five were level of evidence V. In seven trials, the data were
140670 -     reported in sufficient detail to allow summation of the
140671 -     results.164,179,184,185,187,190,191 Among 1,672 patients, 352
140672 -     recurrences were noted. Among these, 235 (67%) had CA 15-3
140673 -     elevation before or at the time of recurrence. Among the 1320
140674 -     patients without recurrence, 1,218 (92%) had normal CA 15-3
140675 -     values. The one level III trial by Safi et al164 reported CA 15-3
140676 -     elevations in 149 of 205 patients (73%) with recurrence, and a 6%
140677 -     false-positive rate among 466 patients without recurrence.  Thus,
140678 -     this study parallels the findings in the larger group: 67% of
140679 -     patients with recurrent disease, and 8% of patients without a
140680 -     recurrence will have an elevated CA 15-3 level. The mean lead time
140681 -     from marker elevation to clinical diagnosis of relapse ranges from
140682 -     2 to 9 months. ref OF 9 WR4L
140683 -
140685 -  ..
140686 - Relapse Not Strong Indicator CA 15-3
140687 - Micrometastatic Disease Ca 15-3 Not Sensitive Finds Large Tumors
140688 -
140689 -     Thus, one would predict that the sensitivity in detecting
140690 -     recurrent, small volume metastases would be low for both CA 15-3
140691 -     and CEA, and that neither can serve as an indicator of a true
140692 -     early relapse. ref OF 9 P08H
140694 -      ..
140695 -     There are three major obstacles to using CA 15-3 in monitoring
140696 -     postoperative patients. The first, and most important, is that the
140697 -     low incidence of CA 15-3 detection in early-stage disease suggests
140698 -     that the marker is not sensitive enough to detect micrometastatic
140699 -     disease, and that an increase in the marker level during the
140700 -     postoperative period will indicate only a large tumor burden.
140701 -     ref OF 9 H18M
140703 -      ..
140704 -     Third, the efficiency can be questioned. Thirty percent of
140705 -     patients with a documented recurrence do not have elevated CA 15-3
140706 -     levels. ref OF 9 M54F
140708 -      ..
140709 -     Two of three patients are followed without a recurrence.  Eight
140710 -     percent of those without a recurrence have an elevated CA 15-3
140711 -     (false-positive) at some point. If patients were followed, as in
140712 -     the report by Safi et al,164 with values every 3 months and a
140713 -     median of 51 months until recurrence, 17 tests would be obtained
140714 -     for each patient before recurrence is documented by an increasing
140715 -     CA 15-3 level.  Thus, for every two recurrences detected, one will
140716 -     be missed, 153 negative samples will be obtained, and 12
140717 -     false-positive values will require evaluation along the way.  For
140718 -     such a test to be worthwhile, it would have to be very inexpensive
140719 -     (including the cost of evaluating the false-positives reported).
140720 -     These three obstacles suggest that, at the present time, CA 15-3
140721 -     should not be used in the routine monitoring of patients following
140722 -     surgery for breast cancer. ref OF 9 474J
140723 -
140725 -  ..
140726 - Clinical Data Required to Confirm CA 15-3 Indicator
140727 - 25% Rise Required for Significant Change in CA 15-3 Cancer Marker
140728 - CA 15-3 Increasing Shows 80% Correlation with Progressive Disease
140729 -
140730 -     Summing the numbers from these trials suggests that 66% of
140731 -     patients show decreases in marker levels in the presence of
140732 -     responding disease, 73% of patients show stable levels in the
140733 -     presence of stable disease, and 80% show increasing levels in the
140734 -     presence of progressive disease. Several investigators required a
140735 -     25% percent change in the level of CA 15-3 to indicate a
140736 -     significant change.  The data suggest that there is a good general
140737 -     correlation between changing CA 15-3 levels and response to
140738 -     therapy in metastatic cancer, but that it cannot be relied on in
140739 -     the absence of confirming clinical data. ref OF 9 B75N
140740 -
140742 -  ..
140743 - Discordant (Unreliable) Results 34% Observed Using CA 15-3
140744 -
140745 -     There is a strong correlation between the response to treatment
140746 -     and the change in CA 15-3 level. However, for all three response
140747 -     categories (response, stabilization, and progression of disease),
140748 -     a sizeable proportion of discordant results have been observed.
140749 -     Indeed, the greatest error will occur in the most important
140750 -     clinical setting: removing a patient from effective therapy
140751 -     because of incorrect information from a tumor marker test, which
140752 -     could occur in 34% of cases.
140753 -     ref OF 9 463I
140755 -      ..
140756 -     Some of these false-negative results may be caused by a transient
140757 -     increase in marker, which is often observed shortly after the
140758 -     initiation of effective treatment. ...could be avoided by waiting
140759 -     a number of weeks to draw marker levels after the initiation of
140760 -     chemotherapy.198,199, ref OF 9 QD4I
140761 -
140763 -  ..
140764 - CA 15-3 Not Recommended to Monitor Therapy
140765 -
140766 -     These results suggest that routine use of the CA 15-3 to monitor
140767 -     the course of therapy of breast cancer cannot be recommended.  In
140768 -     exceptional circumstances, such as in the presence of osseous
140769 -     metastases, which are difficult to evaluate clinically, the marker
140770 -     level may be able to support the clinical estimates of disease
140771 -     status. However, the marker cannot, in any situation, stand alone
140772 -     to define response to treatment. ref OF 9 PF5L
140774 -      ..
140775 -     The recommendation mirrors findings for another marker for breast
140776 -     cancer, CEA. ref OF 9 1G88
140777 -
140778 -
140779 -
140780 -
140781 -
140782 -
140783 -
1408 -

SUBJECTS
PET Scan Findings Show Previous Metastatic Lymphadenopathy No Longer
Distant Metastasis New Nonspecific May be Post Treatment Trauma Infla
CT Scan Performed for Comparison with PET Scan to Evaluate New Metast
CT Scan Findings Show Previous Metastatic Lymphadenopathy No Longer A

1806 -
180701 -  ..
180702 - CT Scan Shows No Evidence of Carcinoma Activity
180703 -
180704 - Follow up ref SDS 45 LK5L, ref SDS 43 0001.
180705 -
180706 - the doctor submitted results of the CT scan test performed on
180707 - 030128....
180709 -      ..
180710 -     Patient
180713 -      ..
180714 -     CT of the Chest
180718 -      ..
180719 -     History
180721 -      ..
180722 -     Breast cancer with recent PET scan demonstrating increased uptake
180723 -     in the left lung apex.
180725 -      ..
180726 -     Findings
180728 -      ..
180729 -     TECHNIQUE:  5 mm collimations with intravenous contrast.
180731 -      ..
180732 -     There is diminished volume of the left lung.  In the left lung
180733 -     apex, there is irregular pleural-based opacity at the periphery
180734 -     which extends to the center of the lung apex where there is an
180735 -     approximately 8 mm irregular nodular opacity.  There is also
180736 -     irregular pleural-based opacity in the anterior aspect of the
180737 -     upper lobe.  There is also a 2 mm pleural-based nodule at the
180738 -     posterior lobe.  There is also a 2 mm pleural-based nodule at the
180739 -     posterior base segment of the left lower lobe best seen on images
180740 -     #37 and #38.
180742 -      ..
180743 -     There is a 10 mm lymph node in the right paratracheal region.
180744 -     There is also a few less than 5 mm lymph nodes scrattered
180745 -     throughout the mediastinum.  There is no evidence of hilar
180746 -     lymphadenopathy.
180748 -      ..
180749 -     Irregular stranding is present in the left axilla.  There is no
180750 -     evidence of lymphadenopathy.
180752 -      ..
180753 -     Images of the upper abdomen demonstrate the presence of a
180754 -     simple-appearing liver cyst.
180756 -      ..
180757 -     Impression
180758 -
180759 -     1.  Pleural-based irregular opacities as well as parencymal-based
180760 -         irregular opacities in the left lung apex and in the anterior
180761 -         aspect of the left upper lobe as described above. ref SDS 0
180762 -         GJ55  These changes are suggestive of post radiation/
180763 -         inflammatory changes given its very irregular appearance.
180764 -         However, because malignancy cannot be excluded based on
180765 -         imaging findings, continued follow-up is recommended.
180767 -          ..
180768 -     2.  A few small lmph nodes in the mediastinum which do not meet
180769 -         the criteria for malignancy.
180771 -          ..
180772 -     3.  No evidence of axilary lymphadenopathy.
180773 -
180774 -           [On 020508 follow up CT scan test reports 2 new 1 CM lymph
180775 -           nodes in the axilla. ref SDS 47 SP5S
180776 -
180778 -      ..
180779 -     Signed informed consent was obtained.
180784 -      ..
180785 -     DD:  030128 DT:  030128 PZW
180786 -
180787 -
180789 -  ..
1808 -
1809 -
1810 - Analysis
1811 -
181101 - The doctor advised that the report on the CT test, per above,
181102 - ref SDS 0 LK5L, aligns with results of the PET scan reported on 030109
181103 - indicating no evidence of cancer activity and no distant metastasis.
181104 - ref SDS 45 GK61
181106 -  ..
181107 - He feels elevated CA 15-3 is an anomaly, per above, ref SDS 0 GJ5M,
181108 - and seems to rule out possibility of activity occurring beyond the
181109 - scope of the CT scan that tested the chest, ref SDS 0 IG9K, for
181110 - example in the brain.
181112 -  ..
181113 - The doctor scheduled another CT scan in April, 2003 for follow up, as
181114 - recommended by the report. ref SDS 0 GJ69
181115 -
181116 -      [On 030508 CA 15-3 elevates another 20% from 45 to 54, and CT
181117 -      scan testing shows 2 new masses of approximately 1 CM in area
181118 -      where lymph nodes were removed and found to be cancerous on
181119 -      030312. ref SDS 47 GK51
181121 -  ..
181122 - Schedule next meeting with the doctor in May and will have CA
181123 - 15-3 blood test a week prior.
181125 -  ..
181126 - Following the meeting with the doctor, we went to the medical
181127 - imaging department, and schedued the CT scan for April.
181129 -  ..
181130 - Kaiser will submit notice of the date set for the CT scan test.
181131 -
181132 -
181133 -
181134 -
181135 -
181136 -
1812 -

SUBJECTS
Swelling Left Side Under Left Arm Likely Caused by Draining Lymph Nod
Cellulitus Mild Diagnosed Treated with Antibiotics
Cellulitus Causes Redness of the Skin Treated with Antibiotics
Redness Appears Less Severe Indicating Progress from Treatment for C

2106 -
210701 -  ..
210702 - Physical Symptoms Reduced
210703 -
210704 - Follow up ref SDS 45 KW5F, ref SDS 42 KW5F.
210705 -
210706 - Millie advised that her energy level seems to be up.  Discomfort in
210707 - the left shoulder, arm and side, reported on 030109, has dissipated.
210709 -  ..
210710 - Neck stiffness has remained about the same.  This could be related to
210711 - life-style.  Falling asleep while sitting up watching television
210712 - places a strain on the neck.
210713 -
210715 -  ..
210716 - Redness Appears Less Severe Indicating Progress from Treatment
210717 - Cellulitus Causes Redness of the Skin Treated with Antibiotics
210718 -
210719 - Follow up ref SDS 45 0T6N
210720 -
210721 - The doctor examined the breasts and advised that redness of the
210722 - left breast observed on 030109, ref SDS 45 KW5F, and diagnosed as
210723 - cellulitus, which was treated with antibiotics, ref SDS 45 GK7T,
210724 - appears to have been reduced.  There was no discussion today of
210725 - "firmness" that was also reported on 030109. ref SDS 45 KW5F
210727 -  ..
210728 - As a result no further treatment was prescribed today.
210729 -
210730 -    [On 030606 redness reported again. ref SDS 48 7C6W
210731 -
210732 -
210733 -
210734 -
210735 -
2108 -

SUBJECTS
Dry Cough Possible Bronchial Infection Treated with Antibiotics

2203 -
220401 -  ..
220402 - Dry Cough for Two Weeks May Indicate Mild Bronchial Infection
220403 -
220404 - Follow up ref SDS 45 H24K
220405 -
220406 - This matter has ended.
220407 -
220408 -
220409 -
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SUBJECTS
Breast Firmness About Surgery and Radiation Area Typical Result
Radiation Treatment Completed Chemotherapy Schedule Phase II Called L

2404 -
240501 -  ..
240502 - Breast Firmness Results from Surgery Scar Tissue and Radiation
240503 -
240504 - Follow up ref SDS 45 SG7J, ref SDS 42 SG7J.
240505 -
240506 - Millie explained that firmness of the breast where radiation was
240507 - performed has remained.  the doctor said this is a normal side
240508 - effect of treatment.
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