CONTACTS
SUBJECTS
Meeting with Doctor at Kaiser Review Rising CA 15-3 Cancer Marker Di
CA 15-3 54 Rises from 45 Reversing Prior Trend Reported Last Month
0504 -
0504 - ..
0505 - Summary/Objective
0506 -
050601 - Follow up ref SDS 50 0000. ref SDS 49 0000.
050602 -
050603 - Meeting today a month ahead of schedule responds to patient request
050604 - last week for examination of red rash suddenly flaring up again on the
050605 - left breast, and growing lump under left arm. The doctor examined the
050606 - growing lump under Millie's arm where surgery was performed for cancer
050607 - on 020312, and advised this is most likely scar tissue, based on
050608 - experience examining other patients, and on testing. ref SDS 0 N66U
050609 - Doctor's examination today found no significant inflammation of left
050610 - breast. ref SDS 0 7C6W Millie asked about risk factors for relapse,
050611 - and whether her age at 67 is deterring Kaiser from resuming aggressive
050612 - testing with biopsy, PET and CT scans to evaluate need for further
050613 - treatments? ref SDS 0 NE7L The doctor said that withholding treatment
050614 - on the basis of age is against the law. ref SDS 0 NE84 He noted
050615 - Millie is in the category of high risk for relapse, and that close
050616 - attention is being given for symptoms and tests that signal the need
050617 - to resume treatment. ref SDS 0 NE4G Millie's health and vigor are
050618 - characteristic of a strong person age 50, which clearly supports
050619 - aggressive follow up treatment. This will be evaluated again next
050620 - month in July. ref SDS 0 NE57
050621 -
050622 -
050623 -
050624 -
050625 -
050626 -
050628 - ..
0507 -
0508 -
0509 - Discussion
0510 -
051001 - Recovery Progress CA 15-3 Cancer Marker Rises 20% from 45 to 54
051002 - CA 15-3 Cancer Marker Reverses Trend and Shows Increase of 20%
051003 -
051004 - Follow up ref SDS 50 SM6M, ref SDS 49 SM6M.
051005 -
051006 - Blood test reported during the meeting on 030508 showed CA 15-3 cancer
051007 - marker increased from 45 to 54, continuing the rise reported on
051008 - 030220, now up 20% in a few months....
051010 - ..
051011 - 030503......... 54 H............. 030508, ref SDS 50 SM6M
051012 - 030403......... 45 H............. 030403, ref SDS 50 SM6M
051013 - 030220......... 46 H............. 030220, ref SDS 49 5E6L
051014 - 030106......... 37 H............. 030109, ref SDS 47 SM6M
051015 - 021202......... 41 H?............ 021204, ref SDS 43 SP5G
051016 - 021102......... 36 H?............ 021113, ref SDS 42 Y65I
051017 - 021023......... 33 H?............ 021023, ref SDS 41 SQ5I
051018 - 020930......... 33 H?..29........ 021002, ref SDS 40 SQ5I
051019 - 020917......... 36 H?............ 020924, ref SDS 39 SQ5I
051020 - 020717......... 59 H?............ 020726, ref SDS 38 YN5K
051021 - 020629......... 75 H ............ 020705, ref SDS 36 UX6I
051022 - 020608........ 67 H ............ 020614, ref SDS 32 0001
051023 - 020603........ 108 H ............ 020607, ref SDS 30 X67F
051024 - 020511........ 117 H ............ 020603, ref SDS 29 PJ4J
051025 - 020419......... 81 H ............ 020430, ref SDS 25 7N5H
051026 - 020321......... 85 H ............ 020405, ref SDS 15 6T8K
051027 -
051029 - ..
0511 -
0512 -
0513 - Analysis
0514 -
051401 - 20% Rise CA 15-3 Cancer Marker Does Not Alarm Doctor
051402 -
051403 - Follow up ref SDS 50 GJ5M, ref SDS 49 GJ5M
051404 -
051405 - Discussed CA 15-3 in connection with treatment planning below.
051406 - ref SDS 0 NE7L
051407 -
051408 -
051409 -
051410 -
051411 -
0515 -
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
2 New 1 CM Masses in Area of Prior Surgery for Lymph Nodes CT Scan Fi
Distant Metastasis Not Reported in CT Test on 030508
1108 -
110901 - ..
110902 - CT Scan Shows No Evidence of Carcinoma Activity
110903 -
110904 - Follow up ref SDS 50 LK5L, ref SDS 49 LK5L.
110905 -
110906 - Discussed CT scan test results reported on 030508, ref SDS 50 SP5S, in
110907 - relation to increased symptoms, see below. ref SDS 0 N66J
110908 -
110909 -
110910 -
110911 -
110912 -
1110 -
SUBJECTS
Redness Breast Skin Thickening Firmness Diagnosed as Scaring Healing
1403 -
140401 - ..
140402 - Redness Breast Reduced Thickening Skin Not Evidence of Recurrance
140403 -
140404 - Follow up ref SDS 50 7C6W, ref SDS 49 0T6N.
140405 -
140406 - Last week sudden severe redness on Millie's left breast led to
140407 - requesting an emergency meeting to examine this condition in advance
140408 - of the next regularly scheduled meeting in July, also, cited in
140409 - relation to increased discomfort from a lump under the left arm,
140410 - discussed below. ref SDS 0 Y45M
140412 - ..
140413 - The doctor examined Millie's breasts and commented that coloration of
140414 - both breasts now appears to be similar and that there is no pronounced
140415 - "redness" as observed a week ago. It seemed during the meeting that
140416 - coloration was reduced in the left breast in relation to last week,
140417 - which was a great relief. The doctor described the condition as
140418 - slightly flushed, typical of post-radiation effects, and largely
140419 - similar to the right breast.
140420 -
140421 - [On 041117 Doctor Benz in a 2nd opinion from UCSF Medical Center
140422 - explained that IBC symptoms vary in intensity that wax and wane.
140423 - ref SDS 65 OS6W
140425 - ..
140426 - Previously, on 030109 a PET scan test reported mild diffuse uptakes in
140427 - the upper left chest wall. ref SDS 47 L66M At that time, the doctor
140428 - observed redness of the left breast, ref SDS 47 KW5F, and diagnosed
140429 - cellulitus. ref SDS 47 0T6N Antibiotic treatment was prescribed,
140430 - ref SDS 47 GK7T, and a month or so later the doctor reported this
140431 - seemed effective, since then red coloration appeared less pronounced,
140432 - ref SDS 49 0T6N, up until last week when things flared up again. Now,
140433 - today, inflammation has thankfully subsided again.
140435 - ..
140436 - Today, the doctor noticed thickening of the skin that causes firmness
140437 - in the left breast, and attributed this to normal scaring and healing
140438 - from surgery and radiation, similar to the report on 030109.
140439 - ref SDS 47 KW5F
140440 -
140441 - [On 030710 temporary redness of the breast can be caused by
140442 - medication, and since the condition has not persisted, this
140443 - indicates that observed "redness" does not indicate cancer
140444 - recurrance. ref SDS 52 7C6W
140446 - ..
140447 - [On 040318 redness in left breast treated for cellulitus, delays
140448 - starting chemotherapy treatment for cancer. ref SDS 57 IM6J
140450 - ..
140451 - [On 040429 breast cancer diagnosed in breast skin will require
140452 - masectomy surgery treatment after 4 - 6 months chemotherapy to
140453 - reduce redness of skin; tumor board review pending. ref SDS 58
140454 - 4K5J
140456 - ..
140457 - [On 040504 during brief meeting prior to chemotherapy treatment,
140458 - The Doctor mentions inflammatory breast disease. ref SDS 59
140459 - UR6M
140461 - ..
140462 - [On 040517 the pathology report on the biopsy diagnoses metastatic
140463 - Carcinoma involving dermal lymphmatics consistent with
140464 - inflammatory carcinoma of the breast. ref SDS 60 6T5G
140466 - ..
140467 - [On 040517 research on the Internet indicates that in addition to
140468 - redness, another symptom of inflammatory breast cancer is
140469 - thickening of the skin, ref SDS 60 S65H, which might be described
140470 - as firmness first reported on 030109. ref SDS 47 KW5F
140471 -
140472 -
140473 -
140474 -
1405 -
SUBJECTS
Lump Under Left Arm Bigger More Sensitive to Touch Discomfort Increa
Quality of Life Treatment Objective Metastatic Cancer Not Cure Prolo
Exercise Millie Asks If Rising Cancer Symptoms Should Cause Reducing
Symptom New Lump Under Arms where Cancer Surgery Performed on 020312
Lump Under Left Arm Scar Tissue Cancer Harder to Touch Small Isolate
Discomfort Due to Exercise Stretching Scar Tissue
2108 -
210901 - ..
210902 - Cancer Relapse Not Diagnosed Maintain Life Style Exercise
210903 - Lump Under Left Arm Very Definite But Not Charasteric of Cancer
210904 - Routine Life Work Exercise Positive Attitude Healthy Immune System
210905 - Life Style Maintain Normal Exercise Cancer Recurrance Not Diagnosed
210906 -
210907 - Follow up ref SDS 50 7C84.
210908 -
210909 - Millie said that in addition to redness in the left breast,
210910 - ref SDS 0 7C6W, the area under the left arm has become increasingly
210911 - more sensitive to the touch, and there is greater discomfort during
210912 - activity, especially exercise at the gym, which she is doing 3 - 5
210913 - times a week. These symptoms seem to be getting worse, since the
210914 - meeting on 030508, ref SDS 50 7C84, and so, together with increased
210915 - inflammation in the left breast, this meeting was requested in advance
210916 - of the regularly scheduled examination next month.
210918 - ..
210919 - PET testing on 021218 was reported on 030109 to show mild diffuse
210920 - uptakes in the left axillary, ref SDS 47 L66M, and CT testing on
210921 - 030428 reported last month on 030508 small 1 cm lyhmph nodes in the
210922 - left axilla. ref SDS 50 VM8N
210924 - ..
210925 - Millie asked if these "dots" line up with discomfort under the left
210926 - arm, and should vigorous exercise be avoided; or, should she cut back
210927 - on normal activities?
210929 - ..
210930 - The doctor asked if it is painful using the left arm for normal
210931 - activity, including exercise.
210933 - ..
210934 - Millie explained the problem is more of a "tug" under the left arm
210935 - that does not occur when raising the right arm. Since it is new and
210936 - different, "worrisome discomfort" is a better description than "pain."
210938 - ..
210939 - The doctor advised that until there is actual pain patients should
210940 - maintain normal activities that fit their overall capacities. Since
210941 - there is no evidence of cancer, Millie can continue routine work and
210942 - exercise that maintain a postitive, forward looking attitude. An
210943 - active life going to work and engaging family and friends doing daily
210944 - routine of normal life, with regular exercise all help maintain the
210945 - body's natural immune system, that is under attack by both cancer and
210946 - chemotherapy treatment to fight cancer.
210948 - ..
210949 - [On 070301 research ANC blood counts neutropenia weakens immune
210950 - system; when ANC fall below 500 causes severe risk of disease and
210951 - infection. ref SDS 86 R13I
210953 - ..
210954 - Keeping active with an agenda of things to do and engaging other
210955 - people creates positive synergy with medical care that greatly aids
210956 - recovery by allowing time for treatment to be effective. Patients who
210957 - disengage from normal activities on the job and at home, create
210958 - negative synergy from worry, stress, and anxiety about having a life
210959 - threatening disease, causing patients to give up on performing the
210960 - rigours of treatment and continuing exericse essential for recovery,
210961 - discussed again below. ref SDS 0 5B4H
210962 -
210963 - [...below, the doctor cites Millie's good health aided by vigorous
210964 - exercise enables vigorous treatment of cancer, rather than concern
210965 - to reduce treatment due to frailties of age. ref SDS 0 NE57
210967 - ..
210968 - [...below, the doctor explains chemotherapy treatments accumulate
210969 - to eventually cause more harm than good. ref SDS 0 NE84
210971 - ..
210972 - [On 031205 doctor commended patient's good habits maintaining
210973 - general good health through sensible diet and exercise are factors
210974 - that stabalize and control advance of disease. ref SDS 55 GW8F
210976 - ..
210977 - [On 041019 Doctor Guardino made a similar recommendation during a
210978 - meeting at Stanford Cancer Center. ref SDS 64 NN6N
210980 - ..
210981 - [On 050609 article reports study found exercise repairs some of
210982 - the cumulative damage chemotherapy causes to the immune system;
210983 - this prolings effectiveness of chemotherapy treatment to aid
210984 - recovery from breast cancer, ref SDS 74 F88M; quality of life from
210985 - strength and range of motion are obvious benefits of exercise.
210986 - ref SDS 74 F93X
210988 - ..
210989 - [On 060217 patient experiences emotional trauma from dramatic
210990 - recovery; status NED, strength, vigor, engagement return, but
210991 - adjustment needed from emotional shock; primary care physician
210992 - makes referral to BMS for counseling, and recommends continuing
210993 - exercise, and normal activity to ease adjustments. ref SDS 78 Y642
210995 - ..
210996 - [On 060810 Millie ANC 1408 blood counts too low refused treatment
210997 - becuase immune system weakened by chemotherapy, ref SDS 81 5K4F;
210998 - conflicts case study showing Millie's patient history getting
210999 - chemotherpay regularly when blood counts low. ref SDS 81 5K4F
211001 - ..
211002 - [On 070301 research ANC blood counts neutropenia weakens immune
211003 - system; when ANC fall below 500 causes severe risk of disease and
211004 - infection. ref SDS 86 R13I
211006 - ..
211007 - [On 080401 Millie notified NP of plans for returning to work under
211008 - advice of the doctor in order to improve chances of recovery from
211009 - cancer. ref SDS 90 5E9R
211011 - ..
211012 - [On 080501 exercise and fitness increases after starting
211013 - Carboplatin chemotherapy on 2nd arm of clincial study Millie
211014 - treated on referral at UCSF. ref SDS 91 FW5J
211016 - ..
211017 - [On 080807 Millie released from medical disability leave by UCSF
211018 - to return to work at NP after demonstrating recovery from 4th
211019 - relapse of cancer. ref SDS 93 HX8G
211021 - ..
211022 - [On 080918 favorable examination and testing despite missing 20%
211023 - of treaments and lower dose of chemotherapy attributed to
211024 - increased fitness from increased exercise that strengthens the
211025 - immune system to resist cancer. ref SDS 94 3E4G
211027 - ..
211028 - [On 081018 report in seminar that recent research indicates
211029 - exercise improves recovery from cancer and resists recurrence by
211030 - 60%. ref SDS 95 IT68
211032 - ..
211033 - The doctor examined the lump under Millie's left arm. He commented
211034 - that the lump is now very definite, whereas in the meeting on 030508
211035 - the doctor did not notice the lump at that time. ref SDS 50 7C9G
211036 -
211037 - [On 040713 doctor examines lump under left arm and reports that
211038 - swelling seems significantly reduced, indicating favorable
211039 - response to chemotherapy treatment. ref SDS 62 RW9H
211040 -
211042 - ..
211043 - Symptom Growing Lump Under Arm Indicates Scar Tissue Not Cancer
211044 - Pea-like Cluster and Firmness Indicates Cancerous Lumps Not Present
211045 - Scar Tissue from Surgery and Radiation Diagnosis for Lumps Under Arm
211046 -
211047 - The doctor explained that he has examined many patients with similar
211048 - lumps. He drew a diagram on the marking board showing the lump he
211049 - feels under the left arm is just beneath the surface of the skin. The
211050 - doctor noted that the CT scan report, reviewed during the meeting on
211051 - 030508, showed two (2) new 1 CM masses in the lymph node area under
211052 - the left arm, ref SDS 50 SP5S, which he feels are deeper in the body
211053 - than the "surface" lump examined today. The CT scan, therefore, did
211054 - not "see" this lump because it is too soft.
211056 - ..
211057 - [On 030710 new CT test showed that lymph nodes in left axilla
211058 - increased in size from 1 CM to 1.5 CM. ref SDS 52 VM7I
211060 - ..
211061 - The Doctor pointed to the tip of his nose as an example of
211062 - firmness connoting cancer that produces an image detected in CT scan
211063 - testing. He also explained that cancer often seems like several
211064 - small, isolated peas, rather than a single large cushy soft mass that
211065 - characterizes the lump under Millie's arm today.
211067 - ..
211068 - This is all good news.
211070 - ..
211071 - The doctor noted that these criteria together with the location of the
211072 - lump directly beneath where the incision was made for surgery on
211073 - 020312, ref SDS 10 0001, are, therefore, more indicative that the lump
211074 - is scar tissue and not cancerous. He further seemed to indicate that
211075 - discomfort during exercise is a positive sign, because it shows Millie
211076 - is stretching the scar tissue. Without exercise, healing scar tissue
211077 - diminishes range of motion. As a result, he is pleased to hear about
211078 - mild discomfort, because this means good patient practice that aids
211079 - recovery from surgery scar tissue.
211080 -
211081 - [On 040713 doctor examines lump under left arm and reports that
211082 - swelling seems significantly reduced, indicating favorable
211083 - response to chemotherapy treatment. ref SDS 62 RW9H
211085 - ..
211086 - Millie asked about the prospect that hard, cancerous material might be
211087 - occurring beneath the scar tissue? In other words, could there be
211088 - both cancer forming that can be treated, as well as scar tissue that
211089 - may be concealing cancer?
211091 - ..
211092 - The doctor said that may be possible but is very unlikely, based on
211093 - available data.
211095 - ..
211096 - [On 040429 breast cancer diagnosed in skin will require masectomy
211097 - after 4 - 6 months chemotherapy to reduce redness of skin; tumor
211098 - board review pending. ref SDS 58 4K5J
211099 -
211100 -
211101 -
211102 -
211103 -
2112 -
SUBJECTS
CA 15-3 Kaiser Close Attention Cancer Marker 54 Increase 50% Since E
2903 -
290401 - ..
290402 - Tests Requested Immediately for Cancer Enables Timely Treatment
290403 - Treatment Timely Attention Prevent Cancer Cascading Out of Control
290404 - Relapse Symptoms Require Immediate Tests Treatment to Control Disease
290405 - Symptoms Require PET Test and Biopsy Evaluate Relapse Control Disease
290406 -
290407 - Follow up ref SDS 50 7C98.
290408 -
290409 - Millie cited 20% rise in CA 15-3 reported during the meeting on
290410 - 030508, per above, ref SDS 0 SM6M, together with new reports of red
290411 - rash spreading on the left breast, just examined, ref SDS 0 7C6W, and
290412 - the CT scan test that found new masses having formed, discussed above.
290413 - ref SDS 0 N66J Recent research on the Internet showed cases where
290414 - there was relapse that required additional treatment following
290415 - occurrence of similar indicators. Such indicators together with high
290416 - risk conditions in the pathology report following surgery on 020312,
290417 - ref SDS 10 7V61, require increased attention in light of the doctor's
290418 - review in a meeting on 020321 that pointed out metastatic carcinoma
290419 - tumor infiltrating through the capsule into the perinodal fatty
290420 - tissue, left breast sentinel lymph node. ref SDS 13 4U8X
290422 - ..
290423 - The doctor said that Millie's patient history, including rising CA
290424 - 15-3 cancer marker, definitely deserves attention. That is why he
290425 - agreed to a meeting today on short notice, a month prior to the follow
290426 - up meeting previously scheduled for July. The doctor indicated that,
290427 - at this time, there is not sufficient evidence from tests and clinical
290428 - examinations that suggests progression of disease requiring treatment
290429 - for recurrence.
290430 -
290431 - [On 050311 the doctor plans to follow up to get feedback from the
290432 - surgeon on a consultation for surgery, because worsening symptoms
290433 - deserve attention. ref SDS 69 PB6J
290435 - ..
290436 - [On 050729 doctor maintains aggressive chemotherapy treatment to
290437 - avoid another relapse, based on another rise in CA 15-3.
290438 - ref SDS 75 VP4N
290440 - ..
290441 - [On 071023 Doctor Rugo at UCSF explains cancer marker increase
290442 - from 56 in May to 74 in October guides looking more carefully and
290443 - does not suggest cut off of 80 for consideration of treatment
290444 - regimen. ref SDS 89 V65R
290446 - ..
290447 - Millie became emotional. She is worried her cancer is spreading, and
290448 - asked about doing a biopsy, and PET scan to test immediately for signs
290449 - of cancer in addition to severe red rash on her left breast discussed
290450 - today, per above, ref SDS 0 7C6W, and also discomfort under the left
290451 - arm, which required an emergency examination today, per above,
290452 - ref SDS 0 Y45M, in order to begin treatment that attacks new cancer
290453 - before it grows out of control?
290455 - ..
290456 - The doctor advised that his oncology team is paying close attention to
290457 - start Millie's treatment in time to prevent cancer from spreading out
290458 - of control to a point that cannot be treated effectively. He
290459 - emphasized that delaying treatment without careful monitoring risks
290460 - allowing cancer to become so severe that nothing can help the patient.
290462 - ..
290463 - The doctor feels at this time that monitoring with a biopsy is still
290464 - not necessary to test for cancer, as discussed last month on 030508,
290465 - ref SDS 50 7C98 The doctor feels next month will be a good time to
290466 - order biopsy and PET scan tests, based on results of the CT test
290467 - already scheduled for the end of the month. He feels that if the CT
290468 - test reveals problems or is unclear, then a biopsy can be ordered, and
290469 - another PET scan test can update fidings for the PET scan test on
290470 - 021228, and analysed in a meeting with the patient on 030109.
290471 - ref SDS 47 GK51
290473 - ..
290474 - There was discussion that good intentions of busy people to take
290475 - future action often get derailed, because people cannot remember how
290476 - small details that are separated by time and distance line up to
290477 - signal actionalble issues. As the saying goes, things "fall through
290478 - the cracks," and "get lost in the shuffle," reviewed on 950204.
290479 - ref SDS 1 0550 A one month delay proposed today stretches into two,
290480 - then three months go by while damage accumulates making recovery more
290481 - and more difficult. Without continuing attention, people forget until
290482 - suddenly a critical mass of unintended consequences explodes an
290483 - initially small problem into major crisis, calamity, catastrophy.
290485 - ..
290486 - The doctor assured that this will not happen in this case.
290487 -
290488 - [On 030710 the doctor deferred biopsy and PET scan tests.
290489 - ref SDS 52 WS3M
290491 - ..
290492 - [On 030710 the doctor explained theory and practice to delay
290493 - follow up treatments until observable symptoms of metastasis
290494 - appear. ref SDS 52 RU4P
290496 - ..
290497 - [On 030915 patient requests PET scan and other tests to schedule
290498 - treatment of rising symptoms. ref SDS 53 7C6W
290500 - ..
290501 - [On 040517 inflammatory breast cancer diagnosed in pathology
290502 - report of biopsy taken from left breast. ref SDS 60 736K
290504 - ..
290505 - [On 090205 Doctor Johnson trying to improve communication with
290506 - UCSF on referral treatment, so that Millie does not "fall through
290507 - the cracks. ref SDS 96 278T
290508 -
290509 -
290510 -
290511 -
2906 -
SUBJECTS
Chemotherapy Levels Steady Effective Treatment Balanced Against Chem
Chemotherapy Side Effects Accumulates to Eventually Cause More Harm
CA 15-3 Kaiser Close Attention Cancer Marker 54 Increase 50% Since E
Recurrence Metastatic Cancer Cure Impossible Due to High Risk Factor
4006 -
400701 - ..
400702 - Age Not Factor Testing to Diagnose and Treat Cancer Patients
400703 - Chemotherapy Accumulates to Eventually Cause More Harm that Good
400704 - Treatment Timely Attention Prevent Cancer Cascading Out of Control
400705 - Side Effects Treatment Accumulate Cannot Be Tolerated Cause More Harm than Cancer
400706 -
400707 - Millie asked if her age at 67 is limiting the doctor's treatment, and
400708 - related having seen reports that doctors, HMOs and insurers have
400709 - arbitrarily avoided care for older patients in order to allocate
400710 - greater resources to treat younger people?
400712 - ..
400713 - The doctor said that allocating treatment on the basis of age is
400714 - against the law.
400715 -
400717 - ..
400718 - Steady Dose Level Chemotheray for Effective Treatment Recover Cancer
400719 - Exercise Increases Fitness Blood Counts Rise Strengthens Immune System
400720 -
400721 - The doctor explained that infirmities from loss of fitness increase
400722 - with advancing age. Patients need a steady level of chemotherapy in
400723 - order for treatments to be effective recovering from cancer. Several
400724 - factors make this difficult.
400726 - ..
400727 - Cancer treatments compound infirmities of age, because chemotherapy
400728 - drugs are "poisons" that attack cancer, but also kill healthy cells,
400729 - discussed above. ref SDS 0 LZ3L Therefore, treating cancer reduces
400730 - the body's natural process of bone marrow replenishing blood counts
400731 - that maintain the immune system. WBC and neutrophils are primary
400732 - components of Absolute Neutrophils Count (ANC). Chemotherapy has
400733 - "side effects" that continually lower ANC. As the the immune system
400734 - weakens, risks increase for cancer to cascade out of control,
400735 - requiring more chemotherapy, which in turn further weakens the immune
400736 - system. Reducing immunity also increases risk of disease and
400737 - infection that become more lethal than cancer, e.g., pneumonia.
400738 -
400739 - [On 030710 doctor discussed a theory of delaying treatment for
400740 - cancer until patients suffer symptoms of cancer. ref SDS 52
400741 - FZ55
400743 - ..
400744 - [On 040416 Doctor Johnson explained again that cancer patients
400745 - need a steady level of chemotherapy in order for treatment to
400746 - be effective. ref SDS 61 6T7F
400748 - ..
400749 - [On 060721 Kaiser implemented policy to maintain dose level of
400750 - chemotherapy for effective cancer treatment. ref SDS 80 KP6J
400752 - ..
400753 - [On 101228 1007 Millie's son diagnosed Hodgkin's Lymphoma
400754 - having difficulty maintaining blood counts after chemotherapy;
400755 - got blister; trying to exercise, needed blood transfusion to
400756 - continue treatment despite dose reduction. ref SDS 97 X88L
400766 - ..
400767 - Doctor Johsnon explained synergy of compounding dynamics reduce
400768 - ability of older patients with inevitable declining exercise and
400769 - fitness to endure aggressive chemotherapy that enables recovery from
400770 - cancer sufficient to have a normal to near-normal quality of life.
400771 - The doctor further explained that regular exercise, like hiking that
400772 - Millie is doing, stimulates bone marrow to produce new blood, which
400773 - maintains the immune system that resists cancer, enables aggressive
400774 - treatment, and prevents diseases that otherwise kill cancer patients.
400776 - ..
400777 - [On 041019 Doctor Guardino recommended Millie stay active on
400778 - the job, and exercie, during a meeting at Stanford Cancer
400779 - Center. ref SDS 64 NN6N
400781 - ..
400782 - [On 050609 article reports study found exercise repairs some of
400783 - the cumulative damage chemotherapy causes to the immune system;
400784 - this prolings effectiveness of chemotherapy treatment to aid
400785 - recovery from breast cancer, ref SDS 74 F88M; quality of life
400786 - from strength and range of motion are obvious benefits of
400787 - exercise. ref SDS 74 F93X
400789 - ..
400790 - [On 060810 Millie ANC 1408 blood counts too low refused
400791 - treatment becuase immune system weakened by chemotherapy,
400792 - ref SDS 81 5K4F; conflicts case study showing Millie's patient
400793 - history getting chemotherpay regularly when blood counts low.
400794 - ref SDS 81 HV45
400796 - ..
400797 - [On 070301 research ANC blood counts neutropenia weakens immune
400798 - system, ref SDS 86 O59H; ANC below 500 causes severe risk of
400799 - disease and infection. ref SDS 86 R13I
400801 - ..
400802 - [On 080502 Millie shows good response to treatment on clinical
400803 - study cetuximab and Carboplatin; tolerating Carboplatin
400804 - Chemotherapy enables exercise that helps maintain blood counts
400805 - along with Neupogen. ref SDS 92 ZD9O
400807 - ..
400808 - [On 080502 after 7 years of chemotherapy treatment, Millie
400809 - having trouble maintaining blood counts to get additional
400810 - treatment; exercise and Neupogen trying to solve problem.
400811 - ref SDS 92 NL4W
400813 - ..
400814 - [On 081018 report in seminar that recent research indicates
400815 - exercise improves recovery from cancer and resists recurrence
400816 - by 60%. ref SDS 95 IT68
400818 - ..
400819 - [On 140508 1133 WBC 9.5 increased 50% from prior lab on 140201,
400820 - after hiking 888 miles, generally 11 miles a day. ref SDS 99
400821 - Y65F
400823 - ..
400824 - The doctor noted that Millie's lifestyle of fitness hiking 3 - 8 miles
400825 - a day, 4 - 5 times a week, about 30 miles, enables aggressive
400826 - chemotherapy despite advancing age. He encouraged staying active on
400827 - the job, engaged with family, and keeping fit, as much as possible in
400828 - the face of debilitating side effects of cancer and chemotherapy,
400829 - also, discussed above. ref SDS 0 LZ3L
400830 -
400831 - [On 050609 article reports study found exercise repairs some of
400832 - the cumulative damage chemotherapy causes to the immune system;
400833 - this prolongs effectiveness of chemotherapy treatment to aid
400834 - recovery from breast cancer, ref SDS 74 F88M; quality of life
400835 - from strength and range of motion are obvious benefits of
400836 - exercise. ref SDS 74 F93X
400838 - ..
400839 - [On 070607 Millie Cellulitis recurrence from exercise to
400840 - maintain fitness and strengthen immune system to resist
400841 - cancer. ref SDS 88 6A7J
400843 - ..
400844 - [On 080918 favorable examination and testing despite missing
400845 - 20% of treaments and lower dose of chemotherapy attributed to
400846 - increased fitness from increased exercise that strengthens the
400847 - immune system to resist cancer. ref SDS 94 3E4G
400849 - ..
400850 - [On 081018 report in seminar that recent research indicates
400851 - exercise improves recovery from cancer and resists recurrence
400852 - by 60%. ref SDS 95 IT68
400854 - ..
400855 - Standard of care for cancer tests blood counts the day before and/or
400856 - the day of treatment to verify the strength of the immune system so
400857 - that the patient can safely receive treatment. If counts are too low,
400858 - then treatment may be delayed until another test shows rising blood
400859 - counts that signal recovery of the immune system to withstand further
400860 - attack by chemotherapy. Sometimes the dose of treatment is reduced so
400861 - that the patient continues to attack cancer and prevent metastatsis
400862 - from cascading out of control. Patients may receive complementary
400863 - treatment with neupogen that accelerates the rate of blood counts
400864 - increasing.
400866 - ..
400867 - [...below, Millie asks about age again as grounds for not
400868 - treating current symptoms; doctor cites Millie's general health
400869 - from commitment to regular exercise enables aggressive
400870 - treatment. ref SDS 0 NE5G
400872 - ..
400873 - [On 050729 doctor attributes symptoms pulmonary embolism
400874 - shortness of breath, fatigue, heavy chest, ref SDS 75 JP9J, to
400875 - loss of fitness from not exercising due to debilitating effects
400876 - of chemotherapy treatment for cancer, ref SDS 75 RZ4I; doctor
400877 - cites Millie's lifestyle of fitness contributing to ability to
400878 - recover from cancer. ref SDS 75 Y85G
400880 - ..
400881 - [On 060607 Millie hospitalized diagnosed with pneumonia.
400882 - ref SDS 79 PR5R
400884 - ..
400885 - [On 060810 treatment denied ANC blood count slightly below
400886 - Kaiser criteria for safe treatment while CA 15-3 cancer marker
400887 - rising. ref SDS 81 5K4F
400889 - ..
400890 - [On 060810 case study shows Millie's good health from life
400891 - style of exercise permits aggressive treatment despite low
400892 - blood counts. ref SDS 81 HV45
400894 - ..
400895 - [On 070116 protocol for cetuximab clinical study requires
400896 - weekly blood tests for normal cancer care. ref SDS 83 5U7Z
400898 - ..
400899 - [On 070201 UCSF scheduled blood tests every 4 weeks rather than
400900 - weekly, because Millie randomized to get treatment with only
400901 - cetuximab. ref SDS 84 XR40
400903 - ..
400904 - [On 070301 example ANC low blood counts; cetuximab clinical
400905 - study weekly treatments not enough time for bone marrow to
400906 - replenish blood, wicked problem because cancer spreading
400907 - requires increasing chemotherapy which reduces blood counts;
400908 - weakening the immune system increases risk of contracting other
400909 - infectious diseases. ref SDS 86 D24M
400911 - ..
400912 - [On 070516 patient reports working out training hard in the gym
400913 - to build fitness. ref SDS 87 TN3M
400915 - ..
400916 - [On 070607 Millie suffers recurrence Cellulitis
400917 - inflammation envelopes left arm trauma complications
400918 - lymphedema, high fever possibly from working out and
400919 - training too hard in the gym. ref SDS 88 ZH6I
400921 - ..
400922 - [On 080502 after 7 years of chemotherapy treatment, Millie
400923 - having trouble maintaining blood counts to get additional
400924 - treatment. ref SDS 92 NL4W
400925 -
400927 - ..
400928 - Exercise Stimulates Bone Marrow Blood Creation
400929 -
400930 - The doctor explained that maintaining fitness through regular exercise
400931 - stimulates blood creation that maintains and strengthens the immune
400932 - system. Cancer causes fatigue, tiredness, weakness, and feeling
400933 - "lousy," which leads to reducing exercise, causing loss of fitness and
400934 - shortness of breath with normal exertion which are common side effects
400935 - of prolonged chemotherapy.
400937 - ..
400938 - [On 040614 exercise stimulates process of bone marrow creating
400939 - new blood that maintains immune system; but, age and treatment
400940 - for cancer with chemotherapy sap energy to reduce energy; since
400941 - chemotherapy reduces blood counts, reducing the rate of blood
400942 - creation delays treatment which increases risk of cancer
400943 - cascading out of control and that other diseases will infect
400944 - the patient's weakened immune system. ref SDS 61 6T7F
400946 - ..
400947 - [On 050609 article reports study found exercise repairs some of
400948 - the cumulative damage chemotherapy causes to the immune system;
400949 - this prolings effectiveness of chemotherapy treatment to aid
400950 - recovery from breast cancer, ref SDS 74 F88M; quality of life
400951 - from strength and range of motion are obvious benefits of
400952 - exercise. ref SDS 74 F93X
400954 - ..
400955 - [On 070607 Millie Cellulitis recurrence from exercise to
400956 - maintain fitness and strengthen immune system to resist
400957 - cancer. ref SDS 88 6A7J
400959 - ..
400960 - [On 081018 report in seminar that recent research indicates
400961 - exercise improves recovery from cancer and resists recurrence
400962 - by 60%. ref SDS 95 IT68
400964 - ..
400965 - [On 101228 1007 Millie's son diagnosed Hodgkin's Lymphoma
400966 - having difficulty maintaining blood counts after chemotherapy;
400967 - got blister; trying to exercise, needed blood transfusion to
400968 - continue treatment despite dose reduction. ref SDS 97 X88L
400970 - ..
400971 - Harmful side effects of chemotherapy drugs accumulate in all patients.
400972 - Many scenarios arise, when, at some point, a particular drug is no
400973 - longer effective, and/or cannot be tolerated because of debilitating
400974 - side effects that sap energy, vitality, and even interest in life.
400975 - This is a bigger problem for older, infirm, and inactive patients,
400976 - than for younger people, who can exercise regularly to maintain the
400977 - immune system; but, eventually continuous chemotherapy accumulates
400978 - side effects in all patients that become debilitating.
400980 - ..
400981 - [On 110124 2110 Peggy called and reported that Millie's
400982 - son, Ron Junior, age 56, died from heart attack while in
400983 - hospital for another blood transfusion to recover from low
400984 - blood counts caused by chemotherapy to treat cancer
400985 - diagnosed in November 2010, as Hodgkin's Lymphoma.
400986 - ref SDS 98 PL4F
400988 - ..
400989 - The doctor explained that switching treatments can reduce accumulation
400990 - of side effects. Each patient reacts somewhat differently to
400991 - chemotherapy based on body chemestry and other factors, e.g., fitness,
400992 - age, prior illness, etc. When a chemotherapy agent becomes
400993 - intolerable or ineffective, the doctor switches to another treatment
400994 - that might be better tolerated and still effective for a particular
400995 - type of cancer - breast, lung, pancreas, esophageal, etc. This is
400996 - experimentation switching among a short list of proven agents, like
400997 - Millie was switched to Taxotere last year on 020603, because her
400998 - cancer resisted treatment with AC. ref SDS 29 WO4O
400999 -
401000 - [On 041130 Doctor Johnson was upset being asked for a list of
401001 - chemotherapy treatments available at Kaiser for Millie to recover
401002 - from cancer, ref SDS 66 YR8F; he scribbled a list on tissue torn
401003 - from the examination table. ref SDS 66 FY5F
401005 - ..
401006 - [On 070105 1040 Doctor Johnson prescribes cetuximab that is a new
401007 - kind of therapy targeted to the genetic profile of cancer, and so
401008 - kills cancer better than chemotherapy, and enables quality of life
401009 - during treatment, because "targeted" treatments kill only cancer,
401010 - and do not kill healthy cells, so there are no painful side
401011 - effects that occur with chemotherapy, thus providing recovery from
401012 - cancer with quality of life. ref SDS 82 JE7N
401014 - ..
401015 - Many patients recover enough to end chemotherpay, at least for awhile.
401016 - In rare cases, cancer is "cured." The patient never relapses,
401017 - discussed further below. ref SDS 0 589J Often patients achieve
401018 - remission where there are no symptoms for months even years. Most
401019 - often patients recover enough to take a break from treatment,
401020 - sometimes called a "treatment holiday." When treatment ends or is
401021 - paused for at least a few weeks, most side effects dissipate, enabling
401022 - patients to live normal to near normal lives while off treatment.
401023 -
401024 - [...below, doctor notices Millie is in excellent condition from
401025 - life style of regular exercise. ref SDS 0 NE57
401027 - ..
401028 - [On 031205 doctor commended patient's good habits maintaining
401029 - general good health through sensible diet and exercise are factors
401030 - that help stabalize and control advance of disease. ref SDS 55
401031 - GW8F
401033 - ..
401034 - [On 050422 patient diary of side effects. ref SDS 71 JY3N
401036 - ..
401037 - [On 050516 during treatment for relapse when patient contracts
401038 - IBC, one of the most severe forms of cancer, Kaiser pauses
401039 - treatment with capecitabine (Xeloda) because debilitating side
401040 - effects make death seem better than continuing treatments.
401041 - ref SDS 72 AQ6G
401043 - ..
401044 - [On 050520 patient makes remarkable progress toward recovery from
401045 - IBC, ref SDS 73 025H; doctor reduces dose of capecitabine (Xeloda)
401046 - by 25% to experiment finding a level of treatment the patient can
401047 - tolerate, while being effective to continue recovery. ref SDS 73
401048 - V43H
401050 - ..
401051 - [On 050729 side effects escalate, very difficult to tolerate
401052 - again, even with 25% reduced dose on 050520, ref SDS 75 DS5J,
401053 - doctor maintains strength of capecitabine (Xeldoa) for two (2)
401054 - more treatments to guard against another relapse. ref SDS 75 VP4N
401056 - ..
401057 - [On 050729 Kaiser's pharmacist reports practice of starting
401058 - patients with maximum dose of chemotherapy drugs, then reduce to a
401059 - level the patient can tolerate. ref SDS 76 407N
401061 - ..
401062 - [On 070218 energy increases, shortness of breath, fatigue,
401063 - weakness subside 10 weeks after ending treatment for 3rd relapse
401064 - of IBC with Taxotere and cacecitabine; Millie is exercising in the
401065 - gym again, playing tennis 2 days her pulse reached 144.
401066 - ref SDS 85 N05H
401067 -
401068 -
401069 -
401070 -
4011 -
SUBJECTS
Mutated Cancer Becomes Increasingly Resistant to Treatment Biology T
4603 -
460401 - ..
460402 - Timely Change Treatment When Cancer Mutated and Disease Progresses
460403 - Mutated Cancer Becomes Increasingly Resistant to Treatment
460404 - Cancer Mutates Resists Treatment Requires Change to Treat New Mutation
460405 -
460406 - The doctor explained that cancer cascades quickly out of control
460407 - without timely treatment, including switching chemotherapy agents,
460408 - when side effects of a particular drug can no longer be tolerated, and
460409 - when effectiveness declines because cancer cells mutate over time into
460410 - a form that resists treatment.
460412 - ..
460413 - Cancer is a biological growth of mutated DNA cells that attack, rather
460414 - than sustain life. New cancer cells vary slightly under a theory of
460415 - evolution that drives biological gene mutation.
460416 -
460417 - [On 040312 lectures on 21st century science describe "genes
460418 - mutate" as the basis for a theory of evolution in biology,
460419 - ref SDS 56 JT9K, which further reflects a theory of emergence in
460420 - the universe arising from random numbers. ref SDS 56 V47I
460422 - ..
460423 - Some variations of new cancer cells resist the drug prescribed to
460424 - treat the cancer. Over months, and hopefully years, eventually a
460425 - resistant variant expands and replaces the original disease that has
460426 - been mostly suppressed if not totally died out from treatment. At
460427 - this stage, cancer "progresses" because firstline treatment is no
460428 - longer effective, and so must be changed to secondline drug agent that
460429 - can attack the mutated cancer cells. Selecting secondary, and
460430 - tertiary treatment appears to be a matter of trial and error. Mutated
460431 - cancer becomes increasingly difficult to treat by any method.
460432 -
460433 - [On 040318 primary care physician explains treatment with
460434 - drugs in clinical trials implements Kaiser's standard of care
460435 - for oncology by allowing the doctor to hold in reserve
460436 - powerful established drugs until needed to prolong quality of
460437 - life. ref SDS 57 DG4X
460439 - ..
460440 - [On 041117 UCSF 2nd opinion cites Millie likely to relapse.
460441 - ref SDS 65 OU5V
460443 - ..
460444 - [On 041130 the doctor explained strategy for starting and changing
460445 - protocols in treating relapse of IBC with a new drug trial.
460446 - ref SDS 66 028N
460448 - ..
460449 - Changing treatment protocols, discussed above, ref SDS 0 RY5J, are
460450 - judgement calls, which the doctor makes on a case-by-case basis in
460451 - consultation with the patient, and colleagues under Kaiser's Team Care
460452 - practice. The goal of case management for metastatic disease is to
460453 - stretch out use of a limited number of available treatments to enable
460454 - long term effectiveness for quality of life, rather than overload the
460455 - body all at once, which prevents prolonged care.
460457 - ..
460458 - [On 030616 research shows emotional challenges of recovering from
460459 - cancer. ref SDS 51 0001
460461 - ..
460462 - [On 030710 treatments are delayed and witheld in reserve to
460463 - stretch out and prolong quality of life until cancer progresses to
460464 - a point where treatment will have maximum effect. ref SDS 52 FZ55
460466 - ..
460467 - [On 030710 treatments become less effective with each relapse,
460468 - switching to another drug occurs sooner until no drugs are
460469 - effective. ref SDS 52 IV4N
460471 - ..
460472 - [On 031010 article reports 50% of breast cancer patients relapse
460473 - within five (5) years, which underscores importance of timely
460474 - discovery and treatment to prevent cancer from getting out of
460475 - control. ref SDS 54 GX8K
460477 - ..
460478 - [On 040318 Millie's triple negative status limits drugs for
460479 - treatment; clinical trials expand drugs for treating metastatic
460480 - cancer. ref SDS 57 DG4J
460482 - ..
460483 - [On 040517 inflammatory breast cancer (IBC) diagnosed in pathology
460484 - report of biopsy taken from left breast. ref SDS 60 736K
460486 - ..
460487 - [On 040517 research found IBC is a rare, aggressive, and most
460488 - lethal form of breast cancer that requires timely treatment
460489 - targeted for the IBC disease. ref SDS 60 LK8L
460491 - ..
460492 - [On 040517 case study developed, ref SDS 60 S66O, for treatment
460493 - planning, ref SDS 60 S79G, and consideration of lessons learned.
460494 - ref SDS 60 PW8F
460496 - ..
460497 - [On 040713 doctor examines lump under left arm and reports that
460498 - swelling seems significantly reduced, indicating favorable
460499 - response to chemotherapy treatment. ref SDS 62 RW9H
460501 - ..
460502 - [On 041130 the doctor explained treatment strategy to avoid using
460503 - combinations (couplets) of drugs in order to lengthen the time for
460504 - treatment, as patient tolerance for side effects forces change to
460505 - a different drug among a limited number of drugs available for
460506 - cancer. ref SDS 66 5X4J
460508 - ..
460509 - [On 041130 the doctor provided a list of chemotherapy drugs which
460510 - can be tried to stretch out the opportunity for recovery and/or
460511 - quality of life beyond the period when side effects become
460512 - intolerable for any particular drug treatment. ref SDS 66 FY5F
460514 - ..
460515 - [On 050609 article reports study found exercise repairs some of
460516 - the cumulative damage chemotherapy causes to the immune system;
460517 - this prolongs effectiveness of chemotherapy treatment to aid
460518 - recovery from breast cancer, ref SDS 74 F88M; quality of life from
460519 - strength and range of motion are obvious benefits of exercise.
460520 - ref SDS 74 F93X
460521 -
460522 -
460523 -
460524 -
460525 -
460526 -
4606 -
SUBJECTS
Bad News Doctor Discussion with Patient Communication Sensitive to L
Quality of Life Treatment Objective Metastatic Cancer Not Cure Prolo
5104 -
510501 - ..
510502 - Bad News Discussion Sensitive to Tollerance for Emotionally Traumatic
510503 - Feel Good Management Sensitive Low Tolerance Cancer Managed Not Cured
510504 - Quality of Life Sensitive Low Tolerance Truth Use Feel Good Management
510505 - Cure Metastatic Cancer Not Goal Relapse Requires Control and Management
510506 -
510507 - Follow up ref SDS 50 7C98.
510508 -
510509 - The doctor advised that good practice caring for cancer patients
510510 - requires being sensitive to emotional tolerance for bad news. Most
510511 - cancer is not "cured" in the traditional sense, discussed above,
510512 - ref SDS 0 435J, but rather is managed for quality of life, cited last
510513 - month on 030508. ref SDS 50 7C98 Some patients become so distraught
510514 - by knowledge that cancer is not "cured" that they give up efforts to
510515 - manage, control, and stabalize disease, which, if performed, often
510516 - enables patients to lead a normal or near normal life for many years.
510518 - ..
510519 - Negative attitudes of fear and lost hope reduce ability to cope.
510520 - Despair devolves toward inactivity, which weakens the immune system.
510521 - Patients become sickly suffering a widening range of ailments, causing
510522 - the patient to reduce and even stop implementing treatment guidance.
510523 - This has dire and opposite dynamics of a positive attitude and healthy
510524 - life style, discussed earlier. ref SDS 0 LZ3L Doctors therefore often
510525 - explain pathology and prospects only generally in order to maintain
510526 - patient emotional strength and resolve to undergo treatment.
510528 - ..
510529 - The doctor said that he has always viewed Millie's cancer as more
510530 - likely to relapse, requiring multiple treatments in the mode of case
510531 - management for metastatic cancer, rather than outright cure, because
510532 - of facts discussed today, per above. ref SDS 0 NE7L The doctor
510533 - complimented Millie for being proactive by doing independent research
510534 - to learn about risks for relapse. The doctor gave assurance that
510535 - Kaiser's medical team is paying close attention to avoid losing
510536 - control of Millie's condition, discussed above, ref SDS 0 N27L, by
510537 - early discovery and timely treatment of advancing disease. ref SDS 0
510538 - VY7G
510539 -
510540 - [On 030710 the doctor explained theory and practice to delay
510541 - follow up treatments until observable symptoms of metastasis
510542 - appear. ref SDS 52 FZ55
510544 - ..
510545 - [On 031010 article reports breast cancer relapses in 50% of cases
510546 - within 2 years. ref SDS 54 IM6N
510548 - ..
510549 - [On 031205 doctor commended patient's good habits maintaining
510550 - general good health through sensible diet and exercise are factors
510551 - that stabalize and control advance of disease. ref SDS 55 GW8F
510553 - ..
510554 - [On 040318 biopsy on lumps in the neck show cancer, confirmed by
510555 - CT tests; patient regresses from stable to recurrence. ref SDS 57
510556 - 8R6M
510558 - ..
510559 - [On 041018 meeting at UCSF relapse of metastatic cancer likely.
510560 - ref SDS 63 EO3Y
510562 - ..
510563 - [On 041117 UCSF 2nd opinion cites Millie likely to relapse.
510564 - ref SDS 65 OU5P and ref SDS 65 OU5V
510566 - ..
510567 - [On 041209 Stanford 2nd opinion cites 66% risk for relapse without
510568 - consideration for out of capsule finding. ref SDS 67 SN6K
510570 - ..
510571 - [On 041210 patient's daughter asks why her mom's cancer cannot be
510572 - cured; doctor explains treatment goals for quality of life.
510573 - ref SDS 68 9Q7H
510575 - ..
510576 - [On 050826 surgeon in Kaiser's Oakland office explains mastectomy
510577 - surgery for patients with metastatic cancer limited to regional
510578 - disease and no evidence of distant metastasis fits a curative
510579 - treatment model for stage III cancer. ref SDS 77 947O
510580 -
510581 -
510582 -
510583 -
5106 -
SUBJECTS
Recurrence Metastatic Cancer Cure Impossible Due to High Risk Factor
5403 -
540401 - ..
540402 - Kaiser Relies on Patient Symptoms to Determine Treatment for Relapse
540403 - Reasonable Testing Timely Treatment to Control Disease
540404 - Physically Fit Patients Good Candidates for Aggresive Cancer Treatment
540405 -
540406 - Follow up ref SDS 50 7C98.
540407 -
540408 - Millie asked again about age, per above, ref SDS 0 XR7I, and recalled
540409 - the doctor's comment during the meeting on 030508 about focusing care
540410 - to maintain quality of life during a patient's demise. ref SDS 50 7C98
540411 - Millie said she is focused on getting things done. This requires
540412 - taking reasonable steps for recovery to avoid an early exit, rather
540413 - than diverting effort from treatment in order to experience a "soft
540414 - landing" under a rubric for "quality of life."
540416 - ..
540417 - The doctor said that Millie at age 67 chronologically has the body of
540418 - a strong, healthy woman of 50, and so is a good candidate for full,
540419 - aggressive treatment. He emphasized again the importance of normal,
540420 - active lifestyle. Commitment to regular exercise, discussed above,
540421 - ref SDS 0 XQ3N, reduces frailties that often impair treatment. This
540422 - gives the doctor flexiblity to prescribe chemotherapy on a regular
540423 - schedule for maintaining dose levels that make treatment effective
540424 - for Millie.
540426 - ..
540427 - [On 030710 testing has not established recurrence; CA 15-3 test
540428 - continues rising to 68, ref SDS 52 XX4G; doctor relates that when
540429 - CA 15-3 reached 80 in another patient, this signaled need for
540430 - action. ref SDS 52 WS42
540432 - ..
540433 - [On 030710 doctor comments again that Millie's fitness aids
540434 - treatment prospects from maintaining dose levels. ref SDS 52 FZ4N
540436 - ..
540437 - [On 031205 doctor commended patient's good habits maintaining
540438 - general good health through sensible diet and exercise are factors
540439 - that help stabalize and control advance of disease. ref SDS 55
540440 - GW8F
540442 - ..
540443 - [On 040318 recurrence diagnosed based on pathology report from
540444 - biopsy taken of neck, ref SDS 57 8R6M, CT test found evidence of
540445 - two prominent nodes in the neck, ref SDS 57 GJ69, CA 15-3 rises
540446 - another 10 points to 70. ref SDS 57 GJ5M
540448 - ..
540449 - [On 040517 inflammatory breast cancer diagnosed in pathology
540450 - report of biopsy taken from left breast. ref SDS 60 736K
540452 - ..
540453 - [On 040517 case study developed, ref SDS 60 S66O, for treatment
540454 - planning, ref SDS 60 S79G, and to develop lessons learned.
540455 - ref SDS 60 PW8F
540457 - ..
540458 - [On 040614 chemotherapy and age reduce blood counts that degrade
540459 - immune system, ref SDS 61 6T7F; Millie's fitness gives flexibility
540460 - to prescribe effective chemotherapy treatment. ref SDS 61 356L
540462 - ..
540463 - [On 050422 patient diary of side effects. ref SDS 71 JY3N
540465 - ..
540466 - [On 050609 article reports study found exercise repairs some of
540467 - the cumulative damage chemotherapy causes to the immune system;
540468 - this prolings effectiveness of chemotherapy treatment to aid
540469 - recovery from breast cancer, ref SDS 74 F88M; quality of life from
540470 - strength and range of motion are obvious benefits of exercise.
540471 - ref SDS 74 F93X
540473 - ..
540474 - [On 050729 side effects escalate, very difficult to tolerate
540475 - again, even with 25% reduced dose on 050520, ref SDS 75 DS5J,
540476 - doctor maintains strength of capecitabine (Xeldoa) for two (2)
540477 - more treatments to guard against another relapse. ref SDS 75 VP4N
540479 - ..
540480 - [On 060721 treatment advanced ahead of regular cycle to accomodate
540481 - Kaiser's schedule, because patient's fitness gives flexibility on
540482 - treating patient with low blood counts. ref SDS 80 UZ4F
540484 - ..
540485 - [On 060810 treatment denied ANC blood count slightly below
540486 - Kaiser criteria for safe treatment while CA 15-3 cancer marker
540487 - rising, ref SDS 81 5K4F; case study shows Millie's good health
540488 - from life style of exercise permits aggressive treatment
540489 - despite low blood counts. ref SDS 81 HV45
540491 - ..
540492 - [On 070218 energy increases, shortness of breath, fatigue,
540493 - weakness subside 10 weeks after ending treatment for 3rd relapse
540494 - of IBC with Taxotere and cacecitabine; Millie is exercising in the
540495 - gym again, playing tennis 2 days her pulse reached 144.
540496 - ref SDS 85 N05H
540498 - ..
540499 - [On 070301 example ANC low blood counts; cetuximab clinical
540500 - study weekly treatments not enough time for bone marrow to
540501 - replenish blood, wicked problem because cancer spreading
540502 - requires increasing chemotherapy which reduces blood counts;
540503 - weakening the immune system increases risk of contracting other
540504 - infectious diseases. ref SDS 86 D24M
540506 - ..
540507 - [On 080501 exercise and fitness increases after starting
540508 - Carboplatin chemotherapy on 2nd arm of clincial study Millie
540509 - treated on referral at UCSF. ref SDS 91 FW5J
540510 -
540511 -
540512 -
540513 -
540514 -
540515 -
5406 -