THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com


S U M M A R Y


DIARY: June 6, 2003 04:30 PM Friday; Rod Welch

Millie meeting at Kaiser on increase in new lump, plan cancer treatment.

1...Summary/Objective
2...Recovery Progress CA 15-3 Cancer Marker Rises 20% from 45 to 54
3...CA 15-3 Cancer Marker Reverses Trend and Shows Increase of 20%
4...20% Rise CA 15-3 Cancer Marker Does Not Alarm Doctor
5...CT Scan Shows No Evidence of Carcinoma Activity
6...Redness Breast Reduced Thickening Skin Not Evidence of Recurrance
7...Cancer Relapse Not Diagnosed Maintain Life Style Exercise
8...Lump Under Left Arm Very Definite But Not Charasteric of Cancer
9...Routine Life Work Exercise Positive Attitude Healthy Immune System
10...Life Style Maintain Normal Exercise Cancer Recurrance Not Diagnosed
11...Symptom Growing Lump Under Arm Indicates Scar Tissue Not Cancer
12...Pea-like Cluster and Firmness Indicates Cancerous Lumps Not Present
13...Scar Tissue from Surgery and Radiation Diagnosis for Lumps Under Arm
14...Tests Requested Immediately for Cancer Enables Timely Treatment
15...Treatment Timely Attention Prevent Cancer Cascading Out of Control
16...Relapse Symptoms Require Immediate Tests Treatment to Control Disease
17...Symptoms Require PET Test and Biopsy Evaluate Relapse Control Disease
18...Age Not Factor Testing to Diagnose and Treat Cancer Patients
19...Chemotherapy Accumulates to Eventually Cause More Harm that Good
20...Treatment Timely Attention Prevent Cancer Cascading Out of Control
21...Side Effects Treatment Accumulate Cannot Be Tolerated Cause More Harm than Cancer
22...Steady Dose Level Chemotheray for Effective Treatment Recover Cancer
23...Exercise Increases Fitness Blood Counts Rise Strengthens Immune System
24...Exercise Stimulates Bone Marrow Blood Creation
25...Timely Change Treatment When Cancer Mutated and Disease Progresses
26...Mutated Cancer Becomes Increasingly Resistant to Treatment
27...Cancer Mutates Resists Treatment Requires Change to Treat New Mutation
28...Bad News Discussion Sensitive to Tollerance for Emotionally Traumatic
29...Feel Good Management Sensitive Low Tolerance Cancer Managed Not Cured
30...Quality of Life Sensitive Low Tolerance Truth Use Feel Good Management
31...Cure Metastatic Cancer Not Goal Relapse Requires Control and Management
32...Kaiser Relies on Patient Symptoms to Determine Treatment for Relapse
33...Reasonable Testing Timely Treatment to Control Disease
34...Physically Fit Patients Good Candidates for Aggresive Cancer Treatment


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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 - Synergy of compounding dynamics reduce ability of older patients with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400768 - inevitable declining exercise and fitness to endure aggressive                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
400769 - chemotherapy that enables recovery from cancer sufficient to have a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400770 - normal to near-normal quality of life.  The doctor further explained                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400771 - that regular exercise stimulating bone marrow to produce new blood,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400772 - therefore helps maintain the immune system that resists cancer, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400773 - also enables aggressive treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
400775 -         ..
400776 -        [On 041019 Doctor Guardino recommended Millie stay active on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
400777 -        the job, and exercies, during a meeting at Stanford Cancer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
400778 -        Center. ref SDS 64 NN6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400780 -         ..
400781 -        [On 050609 article reports study found exercise repairs some of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400782 -        the cumulative damage chemotherapy causes to the immune system;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400783 -        this prolings effectiveness of chemotherapy treatment to aid                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400784 -        recovery from breast cancer, ref SDS 74 F88M; quality of life                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400785 -        from strength and range of motion are obvious benefits of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
400786 -        exercise. ref SDS 74 F93X                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400788 -         ..
400789 -        [On 060810 Millie ANC 1408 blood counts too low refused                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
400790 -        treatment becuase immune system weakened by chemotherapy,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
400791 -        ref SDS 81 5K4F; conflicts case study showing Millie's patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
400792 -        history getting chemotherpay regularly when blood counts low.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400793 -        ref SDS 81 HV45                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
400795 -         ..
400796 -        [On 070301 research ANC blood counts neutropenia weakens immune                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400797 -        system, ref SDS 86 O59H; ANC below 500 causes severe risk of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
400798 -        disease and infection. ref SDS 86 R13I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400800 -         ..
400801 -        [On 080502 Millie shows good response to treatment on clinical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
400802 -        study cetuximab and Carboplatin; tolerating Carboplatin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
400803 -        Chemotherapy enables exercise that helps maintain blood counts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400804 -        along with Neupogen. ref SDS 92 ZD9O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
400806 -         ..
400807 -        [On 080502 after 7 years of chemotherapy treatment, Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400808 -        having trouble maintaining blood counts to get additional                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
400809 -        treatment; exercise and Neupogen trying to solve problem.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
400810 -        ref SDS 92 NL4W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
400812 -         ..
400813 -        [On 081018 report in seminar that recent research indicates                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400814 -        exercise improves recovery from cancer and resists recurrence                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400815 -        by 60%. ref SDS 95 IT68                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400817 -         ..
400818 -        [On 140508 1133 WBC 9.5 increased 50% from prior lab on 140201,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400819 -        after hiking 888 miles, generally 11 miles a day. ref SDS 99                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
400820 -        Y65F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
400822 -  ..
400823 - The doctor noted that Millie's lifestyle of fitness hiking 3 - 8 miles                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400824 - a day, 4 - 5 times a week, about 30 miles, enables aggressive                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
400825 - chemotherapy despite advancing age.  He encouraged staying active on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400826 - the job, engaged with family, and keeping fit, as much as possible in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400827 - the face of debilitating side effects of cancer and chemotherapy,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
400828 - also, discussed above. ref SDS 0 LZ3L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400829 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400830 -        [On 050609 article reports study found exercise repairs some of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400831 -        the cumulative damage chemotherapy causes to the immune system;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400832 -        this prolongs effectiveness of chemotherapy treatment to aid                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400833 -        recovery from breast cancer, ref SDS 74 F88M; quality of life                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400834 -        from strength and range of motion are obvious benefits of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
400835 -        exercise. ref SDS 74 F93X                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400837 -         ..
400838 -        [On 070607 Millie Cellulitis recurrence from exercise to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400839 -        maintain fitness and strengthen immune system to resist                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
400840 -        cancer. ref SDS 88 6A7J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400842 -         ..
400843 -        [On 080918 favorable examination and testing despite missing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
400844 -        20% of treaments and lower dose of chemotherapy attributed to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400845 -        increased fitness from increased exercise that strengthens the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400846 -        immune system to resist cancer. ref SDS 94 3E4G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
400848 -         ..
400849 -        [On 081018 report in seminar that recent research indicates                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400850 -        exercise improves recovery from cancer and resists recurrence                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400851 -        by 60%. ref SDS 95 IT68                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400853 -  ..
400854 - Standard of care for cancer tests blood counts the day before and/or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400855 - the day of treatment to verify the strength of the immune system so                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400856 - that the patient can safely receive treatment.  If counts are too low,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400857 - then treatment may be delayed until another test shows rising blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400858 - counts that signal recovery of the immune system to withstand further                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400859 - attack by chemotherapy.  Sometimes the dose of treatment is reduced so                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400860 - that the patient continues to attack cancer and prevent metastatsis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400861 - from cascading out of control.  Patients may receive complementary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
400862 - treatment with neupogen that accelerates the rate of blood counts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
400863 - increasing.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
400865 -         ..
400866 -        [...below, Millie asks about age again as grounds for not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400867 -        treating current symptoms; doctor cites Millie's general health                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400868 -        from commitment to regular exercise enables aggressive                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
400869 -        treatment. ref SDS 0 NE5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
400871 -         ..
400872 -        [On 050729 doctor attributes symptoms pulmonary embolism                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400873 -        shortness of breath, fatigue, heavy chest, ref SDS 75 JP9J, to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
400874 -        loss of fitness from not exercising due to debilitating effects                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400875 -        of chemotherapy treatment for cancer, ref SDS 75 RZ4I; doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400876 -        cites Millie's lifestyle of fitness contributing to ability to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400877 -        recover from cancer. ref SDS 75 Y85G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
400879 -         ..
400880 -        [On 060607 Millie hospitalized diagnosed with pneumonia.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400881 -        ref SDS 79 PR5R                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
400883 -         ..
400884 -        [On 060810 treatment denied ANC blood count slightly below                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400885 -        Kaiser criteria for safe treatment while CA 15-3 cancer marker                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400886 -        rising. ref SDS 81 5K4F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400888 -         ..
400889 -        [On 060810 case study shows Millie's good health from life                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400890 -        style of exercise permits aggressive treatment despite low                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
400891 -        blood counts. ref SDS 81 HV45                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400893 -         ..
400894 -        [On 070116 protocol for cetuximab clinical study requires                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400895 -        weekly blood tests for normal cancer care. ref SDS 83 5U7Z                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
400897 -         ..
400898 -        [On 070201 UCSF scheduled blood tests every 4 weeks rather than                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400899 -        weekly, because Millie randomized to get treatment with only                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400900 -        cetuximab. ref SDS 84 XR40                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
400902 -         ..
400903 -        [On 070301 example ANC low blood counts; cetuximab clinical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400904 -        study weekly treatments not enough time for bone marrow to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
400905 -        replenish blood, wicked problem because cancer spreading                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400906 -        requires increasing chemotherapy which reduces blood counts;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400907 -        weakening the immune system increases risk of contracting other                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400908 -        infectious diseases. ref SDS 86 D24M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
400910 -         ..
400911 -        [On 070516 patient reports working out training hard in the gym                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400912 -        to build fitness. ref SDS 87 TN3M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
400914 -         ..
400915 -        [On 070607 Millie suffers recurrence Cellulitis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400916 -        inflammation envelopes left arm trauma complications                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
400917 -        lymphedema, high fever possibly from working out and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
400918 -        training too hard in the gym. ref SDS 88 ZH6I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400920 -         ..
400921 -        [On 080502 after 7 years of chemotherapy treatment, Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400922 -        having trouble maintaining blood counts to get additional                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
400923 -        treatment. ref SDS 92 NL4W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
400924 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400926 -  ..
400927 - Exercise Stimulates Bone Marrow Blood Creation                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400928 - 
400929 - The doctor explained that maintaining fitness through regular exercise                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400930 - stimulates blood creation that maintains and strengthens the immune                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400931 - system.  Cancer causes fatigue, tiredness, weakness, and feeling                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
400932 - "lousy," which leads to reducing exercise, causing loss of fitness and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400933 - shortness of breath with normal exertion which are common side effects                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400934 - of prolonged chemotherapy.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400936 -         ..
400937 -        [On 040614 exercise stimulates process of bone marrow creating                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
400938 -        new blood that maintains immune system; but, age and treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400939 -        for cancer with chemotherapy sap energy to reduce energy; since                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400940 -        chemotherapy reduces blood counts, reducing the rate of blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400941 -        creation delays treatment which increases risk of cancer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400942 -        cascading out of control and that other diseases will infect                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400943 -        the patient's weakened immune system. ref SDS 61 6T7F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
400945 -         ..
400946 -        [On 050609 article reports study found exercise repairs some of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400947 -        the cumulative damage chemotherapy causes to the immune system;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400948 -        this prolings effectiveness of chemotherapy treatment to aid                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400949 -        recovery from breast cancer, ref SDS 74 F88M; quality of life                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400950 -        from strength and range of motion are obvious benefits of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
400951 -        exercise. ref SDS 74 F93X                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400953 -         ..
400954 -        [On 070607 Millie Cellulitis recurrence from exercise to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400955 -        maintain fitness and strengthen immune system to resist                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
400956 -        cancer. ref SDS 88 6A7J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400958 -         ..
400959 -        [On 081018 report in seminar that recent research indicates                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400960 -        exercise improves recovery from cancer and resists recurrence                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400961 -        by 60%. ref SDS 95 IT68                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400963 -         ..
400964 -        [On 101228 1007 Millie's son diagnosed Hodgkin's Lymphoma                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400965 -        having difficulty maintaining blood counts after chemotherapy;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
400966 -        got blister; trying to exercise, needed blood transfusion to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400967 -        continue treatment despite dose reduction. ref SDS 97 X88L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
400969 -  ..
400970 - Harmful side effects of chemotherapy drugs accumulate in all patients.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400971 - Many scenarios arise, when, at some point, a particular drug is no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
400972 - longer effective, and/or cannot be tolerated because of debilitating                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400973 - side effects that sap energy, vitality, and even interest in life.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
400974 - This is a bigger problem for older, infirm, and inactive patients,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
400975 - than for younger people, who can exercise regularly to maintain the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400976 - immune system; but, eventually continuous chemotherapy accumulates                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
400977 - side effects in all patients that become debilitating.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400979 -         ..
400980 -        [On 110124 2110 Peggy called and reported that Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
400981 -        son, Ron Junior, age 56, died from heart attack while in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400982 -        hospital for another blood transfusion to recover from low                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
400983 -        blood counts caused by chemotherapy to treat cancer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
400984 -        diagnosed in November 2010, as Hodgkin's Lymphoma.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
400985 -        ref SDS 98 PL4F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
400987 -  ..
400988 - The doctor explained that switching treatments can reduce accumulation                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400989 - of side effects.  Each patient reacts somewhat differently to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
400990 - chemotherapy based on body chemestry and other factors, e.g., fitness,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
400991 - age, prior illness, etc.  When a chemotherapy agent becomes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
400992 - intolerable or ineffective, the doctor switches to another treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
400993 - that might be better tolerated and still effective for a particular                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400994 - type of cancer - breast, lung, pancreas, esophageal, etc.  This is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
400995 - experimentation switching among a short list of proven agents, like                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
400996 - Millie was switched to Taxotere last year on 020603, because her                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
400997 - cancer resisted treatment with AC. ref SDS 29 WO4O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
400998 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
400999 -     [On 041130 Doctor Johnson was upset being asked for a list of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
401000 -     chemotherapy treatments available at Kaiser for Millie to recover                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
401001 -     from cancer, ref SDS 66 YR8F; he scribbled a list on tissue torn                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
401002 -     from the examination table. ref SDS 66 FY5F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
401004 -      ..
401005 -     [On 070105 1040 Doctor Johnson prescribes cetuximab that is a new                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
401006 -     kind of therapy targeted to the genetic profile of cancer, and so                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
401007 -     kills cancer better than chemotherapy, and enables quality of life                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
401008 -     during treatment, because "targeted" treatments kill only cancer,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
401009 -     and do not kill healthy cells, so there are no painful side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
401010 -     effects that occur with chemotherapy, thus providing recovery from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
401011 -     cancer with quality of life. ref SDS 82 JE7N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
401013 -  ..
401014 - Many patients recover enough to end chemotherpay, at least for awhile.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
401015 - In rare cases, cancer is "cured."  The patient never relapses,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
401016 - discussed further below. ref SDS 0 589J  Often patients achieve                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
401017 - remission where there are no symptoms for months even years.  Most                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
401018 - often patients recover enough to take a break from treatment,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
401019 - sometimes called a "treatment holiday."  When treatment ends or is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
401020 - paused for at least a few weeks, most side effects dissipate, enabling                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
401021 - patients to live normal to near normal lives while off treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
401022 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
401023 -     [...below, doctor notices Millie is in excellent condition from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
401024 -     life style of regular exercise. ref SDS 0 NE57                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
401026 -      ..
401027 -     [On 031205 doctor commended patient's good habits maintaining                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
401028 -     general good health through sensible diet and exercise are factors                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
401029 -     that help stabalize and control advance of disease. ref SDS 55                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
401030 -     GW8F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
401032 -      ..
401033 -     [On 050422 patient diary of side effects. ref SDS 71 JY3N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
401035 -      ..
401036 -     [On 050516 during treatment for relapse when patient contracts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
401037 -     IBC, one of the most severe forms of cancer, Kaiser pauses                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
401038 -     treatment with capecitabine (Xeloda) because debilitating side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
401039 -     effects make death seem better than continuing treatments.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
401040 -     ref SDS 72 AQ6G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
401042 -      ..
401043 -     [On 050520 patient makes remarkable progress toward recovery from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
401044 -     IBC, ref SDS 73 025H; doctor reduces dose of capecitabine (Xeloda)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
401045 -     by 25% to experiment finding a level of treatment the patient can                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
401046 -     tolerate, while being effective to continue recovery. ref SDS 73                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
401047 -     V43H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
401049 -      ..
401050 -     [On 050729 side effects escalate, very difficult to tolerate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
401051 -     again, even with 25% reduced dose on 050520, ref SDS 75 DS5J,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
401052 -     doctor maintains strength of capecitabine (Xeldoa) for two (2)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
401053 -     more treatments to guard against another relapse. ref SDS 75 VP4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
401055 -      ..
401056 -     [On 050729 Kaiser's pharmacist reports practice of starting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
401057 -     patients with maximum dose of chemotherapy drugs, then reduce to a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
401058 -     level the patient can tolerate. ref SDS 76 407N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
401060 -      ..
401061 -     [On 070218 energy increases, shortness of breath, fatigue,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
401062 -     weakness subside 10 weeks after ending treatment for 3rd relapse                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
401063 -     of IBC with Taxotere and cacecitabine; Millie is exercising in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
401064 -     gym again, playing tennis 2 days her pulse reached 144.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
401065 -     ref SDS 85 N05H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
401066 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
401067 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
401068 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
401069 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
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 -