CONTACTS
SUBJECTS
Meeting the doctor
CA 15-3 54 Rises from 45 Reversing Prior Trend Reported Last Month
CA 15-3 68 Rises from 54 Continuing Trend of Past Few Months
0705 -
0705 - ..
0706 - Summary/Objective
0707 -
070701 - Follow up ref SDS 50 0000. ref SDS 49 0000.
070702 -
070703 - Recent CT scan test shows favorable results of "stable" nodes, which
070704 - have increased in size by 50% since tests two months ago, and which
070705 - have not been identified as cancer. ref SDS 0 SP5S Persistant skin
070706 - thickening on left breast likely due to radiation; requires clinical
070707 - evaluation of dermal lymphatics for known cancer. ref SDS 0 GJ69 CA
070708 - 15-3 cancer marker continues to rise, now at 68. The doctor indicated
070709 - today that a CA 15-3 level of 80 is cause for concern. ref SDS 0 WS42
070710 - Follow up chemotherapy and radiation treatments are typically not used
070711 - until observable symptoms appear. Proactive treatment is avoided at
070712 - Kaiser to ensure maximum effect, based on an immunity theory of cancer
070713 - that says after once being treated, further treatments become
070714 - progressively less effective. ref SDS 0 OW3O This thoery of practice
070715 - was not supported by literature. ref SDS 0 FZ78 Dizziness appears to
070716 - be caused by a blockage in the ear, and is scheduled to be treated
070717 - tomorrow. ref SDS 0 WS47 Next visit with the doctor will be in two
070718 - (2) months, and at that time further testing will be considered based
070719 - on CA 15-3 and clinical evaluation of symptoms. ref SDS 0 WS3M
070720 -
070721 -
070722 -
070724 - ..
0708 -
0709 -
0710 - Discussion
0711 -
071101 - Recovery Progress CA 15-3 Cancer Marker Rises 30% from 54 to 68
071102 - CA 15-3 Cancer Marker Reverses Trend and Shows Increase of 30%
071103 -
071104 - Follow up ref SDS 50 SM6M, ref SDS 49 SM6M.
071105 -
071106 - Blood test reported during the meeting on 030710 showed CA 15-3 cancer
071107 - marker increased from 54 to 68, continuing the rise reported on
071108 - 030220, now up 30% in a few months....
071110 - ..
071111 - 030708......... 68 H............. 030710, ref SDS 0 SM6M
071112 - 030503......... 54 H............. 030508, ref SDS 49 SM6M
071113 - 030403......... 45 H............. 030508, ref SDS 49 SM6M
071114 - 030220......... 46 H............. 030220, ref SDS 48 5E6L
071115 - 030106......... 37 H............. 030109, ref SDS 46 SM6M
071116 - 021202......... 41 H?............ 021204, ref SDS 42 SP5G
071117 - 021102......... 36 H?............ 021113, ref SDS 41 Y65I
071118 - 021023......... 33 H?............ 021023, ref SDS 40 SQ5I
071119 - 020930......... 33 H?..29........ 021002, ref SDS 39 SQ5I
071120 - 020917......... 36 H?............ 020924, ref SDS 38 SQ5I
071121 - 020717......... 59 H?............ 020726, ref SDS 37 YN5K
071122 - 020629......... 75 H ............ 020705, ref SDS 35 UX6I
071123 - 020608........ 67 H ............ 020614, ref SDS 31 0001
071124 - 020603........ 108 H ............ 020607, ref SDS 29 X67F
071125 - 020511........ 117 H ............ 020603, ref SDS 28 PJ4J
071126 - 020419......... 81 H ............ 020430, ref SDS 24 7N5H
071127 - 020321......... 85 H ............ 020405, ref SDS 14 6T8K
071128 -
071130 - ..
0712 -
0713 -
0714 - Analysis
0715 -
071501 - 30% Rise CA 15-3 Cancer Marker Does Not Alarm Doctor
071502 -
071503 - Follow up ref SDS 50 GJ5M, ref SDS 49 GJ5M.
071504 -
071505 - Discussed CA 15-3 in connection with treatment planning below.
071506 - ref SDS 0 WS42
071507 -
071508 -
071509 -
071510 -
071511 -
0716 -
SUBJECTS
PET Scan Findings Show Previous Metastatic Lymphadenopathy No Longer
Metastasis New Nonspecific May be Post Treatment Trauma Inflammatory
CT Scan Performed for Comparison with PET Scan to Evaluate New Metas
CT Scan Findings Show Previous Metastatic Lymphadenopathy No Longer
2 Lymph Nodes Nodules Increased Size 50% from 1 to 1.5 CM Referenced
CT Scan Findings Show 2 New 1 CM Masses in Area of Prior Surgery for
Distant Metastasis Not Reported in CT Test on 030508
CT Scan Findings Show 1 CM Masses Increased to 1.5 CM 50% Growth
CT Test Reports Findings Persistant Left Breast Skin Thickening May
Breast Redness Diagnosis Changed from Cellulitus to Radiation Reacti
1712 -
171301 - ..
171302 - CT Scan Shows No Evidence of Carcinoma Activity
171303 -
171304 - Follow up ref SDS 50 LK5L, ref SDS 49 LK5L.
171305 -
171306 - The doctor submitted results of the CT scan test ordered on
171307 - 030508, ref SDS 49 GK65, and performed on 030626....
171309 - ..
171310 - Patient
171313 - ..
171314 - CT of the Chest
171318 - ..
171319 - History
171320 -
171321 - Intravenous contrast enhanced scans were taken through the
171322 - CHEST on the spiral scanner for evaluation of 1 CM nodule, L
171323 - axilla. This patient was injected and monitored by the
171324 - technologist. Standard dose of Omnipaque 300 was infused
171325 - intravenously. No reaction was recorded.
171327 - ..
171328 - Comparison: 030428 CT
171329 -
171330 - Reported in the record on 030508. ref SDS 49 LK5L
171332 - ..
171333 - Findings
171334 -
171335 - There is persistent dermal thickening of the left breast and
171336 - chest wall, presumably due to prior radiation therapy.
171337 - However, invasion of the dermal lymphatics from known breast
171338 - cancer can present similarly. L lumpectomy residuals persist
171339 - unchanged. There is left axillary adenopathy with nodes
171340 - measuring on the order of 1.5 cm or less in diameter similar to
171341 - the former study, but there is slight increase in the
171342 - reticulation of the left axillary fat.
171343 -
171344 - [...below, patient describes occassional discomfort
171345 - under left arm, ref SDS 0 XX4G; doctor diagnosis
171346 - symptoms from CT test and patient report as scar
171347 - tissue. ref SDS 0 347J
171349 - ..
171350 - [On 040517 patient handed pathology report on biopsy
171351 - of left breast that diagnoses metastatic carcinoma
171352 - involving dermal lymphmatics consistent with
171353 - inflammatory carcinoma of the breast. ref SDS 64 U18N
171355 - ..
171356 - [On 040517 research found explanation of inflammatory
171357 - breast cancer (IBC) reflects findings in CT test today
171358 - of thickened breast skin, inflammation, regional
171359 - metastasis. ref SDS 64 S65H
171361 - ..
171362 - [On 041104 doctor reports analyst called and alerted
171363 - the doctor about pulmonary emboli to ensure that a
171364 - serious condition is not overlooked. ref SDS 69 RZ4I
171365 - Why didn't the analyst in this case also call the
171366 - doctor to alert about finding 3 symptoms of IBC?
171368 - ..
171369 - On 030508 the report for CT scan test on 030428 found
171370 - small lymph nodes measuring less than 1 CM in size
171371 - located in the left axilla that were not present on the
171372 - prior examination ref SDS 49 VM8N The subsequent test on
171373 - 030626 shows the size increased from less than 1 CM to
171374 - now 1.5 CM in findings today. ref SDS 0 VM7I; this slight
171375 - increase in absolute size indicates significant growth of
171376 - 50%. This report today of growing adenopathy in the left
171377 - axilla may align with PET scan test on 021218 reported in
171378 - the meeting on 030109 that cited mild diffuse increased
171379 - uptakes at the region of the left axilla, left upper
171380 - chest wall, and left supraclavicular. ref SDS 46 L66M
171381 -
171382 - [On 031205 CT test has no remarks on disposition of
171383 - lymph nodes expanding by 50% to 1.5 CM; they just
171384 - disappeared. ref SDS 55 AA37
171386 - ..
171387 - [On 040227 asked about evident conflict in the record;
171388 - at that time computers were down, so the doctor will
171389 - make a review when the computer is restored to
171390 - service, and report on the results. ref SDS 57 YE4F
171392 - ..
171393 - [On 040318 prior CT tests could not be found in
171394 - Kaiser's computer nor in the medical chart to resolve
171395 - conflicts on expanding axillary lymphadenopathy,
171396 - ref SDS 59 ZE5O; new CT tests and a biopsy report
171397 - showing regional metastatic disease in the neck change
171398 - focus from diagnosis to planning for treatment.
171399 - ref SDS 59 H28F
171401 - ..
171402 - [On 040517 Millie diagnosed with inflammatory breast
171403 - cancer, ref SDS 64 7D6F, research indicates swelled
171404 - lymph nodes in the neck and swelled lymph nodes under
171405 - the arm are symptoms of IBC. ref SDS 64 M67I
171407 - ..
171408 - [On 040812 doctor explains conflicts in test reports
171409 - reflects general laxity for precision measurements
171410 - because medical practice does not have the diligence
171411 - for accuracy that is common to engineering work.
171412 - ref SDS 66 T761
171414 - ..
171415 - [On 041230 similar pattern of possible 50% growth in
171416 - size of swelled lymph nodes signal relapse.
171417 - ref SDS 70 B58M
171419 - ..
171420 - [On 060428 read medical test findings - case study
171421 - doctors limited time prevents reading findings to
171422 - correlate clinically for discovering symptomatic
171423 - trends that enable proactive case management; there is
171424 - only enough time to read summaries that present the
171425 - gist of findings. ref SDS 79 VG5L
171427 - ..
171428 - Lung windows show stable, parenchymal interstitial opacities at
171429 - the left apex and ventral, subpleural lingula. There is a
171430 - tiny, stable, non-calcified 3mm pulmonary nodule in the
171431 - peripheral right middle lobe (image #42) closely associated
171432 - with the major and minor fissure. No other pulmonary
171433 - parenchymal nodules are detected. No hilar, mediastinal or
171434 - right axillary adenopathy is identified. No pleural lesions
171435 - are detected. The heart is normal in size.
171437 - ..
171438 - Impression
171439 -
171440 - 1. Persistant left breast and chest wall skin thickening may be
171441 - from prior radiation therapy, but invasion of the dermal
171442 - lymphatics from known breast cancer can present similarly.
171443 - Correlate clinically.
171445 - ..
171446 - Skin thickening left breast attributed to radiation therapy aligns
171447 - with PET test on 021218, and reported on 030109. ref SDS 46 GJ69
171449 - ..
171450 - Since the doctor gave this report to Millie during the meeting, there
171451 - was not enough time today to absorb findings for thorough discussion
171452 - of the possibility that "...invasion of the dermal lymphatics from
171453 - known breast cancer can present..." similar symptoms.
171454 -
171455 - [...below, Doctor Johnson explains that Millie does not
171456 - need immediate treatment, ref SDS 0 7C6W; Millie asks for
171457 - biopsy to get more evidence on need to start treatment.
171458 - ref SDS 0 5E7J; the doctor related Kaiser policy to delay
171459 - treatment until patient's quality of life seems affected.
171460 - ref SDS 0 FZ55
171462 - ..
171463 - [On 031205 CT test report does not correlate with prior
171464 - findings in test on 030626 to alert doctor on progression
171465 - of disease, ref SDS 55 GJ69; doctor evaluates patient
171466 - condition "Great." ref SDS 55 829L
171468 - ..
171469 - [On 040207 patient complains stiff neck and lump.
171470 - ref SDS 56 WP7L
171472 - ..
171473 - [On 040227 examination showed only slight reduction in
171474 - swelling, so biopsy ordered by Head and Neck specialist.
171475 - ref SDS 57 0001
171477 - ..
171478 - [On 040309 biopsy diagnoses breast cancer recurrence.
171479 - ref SDS 58 0001
171481 - ..
171482 - [On 040318 inflammation left breast treated for
171483 - cellulitus; treatment for cancer delayed pending
171484 - resolution of inflammation problem. ref SDS 59 IM6J
171486 - ..
171487 - [On 040402 diagnosis inflammation left breast changed from
171488 - cellulitus to reacation from radiation; patient cleared to
171489 - begin chemotherapy treatment for cancer. ref SDS 60 IM6J
171491 - ..
171492 - [On 040419 during minor surgery to install port catheter
171493 - for chemotherapy treatments, patient asks surgeon to
171494 - evaluate inflammation on left breast; surgeon performs
171495 - punch biopsy left breast. ref SDS 61 789F
171497 - ..
171498 - [On 040517 biopsy on left breast diagnoses IBC.
171499 - ref SDS 64 6T5G
171501 - ..
171502 - [On 051021 mastectomy surgery performed left breast based
171503 - on biopsy tests performed on 051012, which found no
171504 - evidence of IBC, and inflammation consistant with minimal
171505 - to mild radiation effect. ref SDS 74 7B4O
171507 - ..
171508 - 2. Persistent left axillary adenopathy with slight increase in
171509 - reticulation of the left axillary fat.
171511 - ..
171512 - 3. Stable parenchymal opacities left lung, thought to be
171513 - inflammatory in nature.
171515 - ..
171516 - 4. Stable, tiny pulmonary nodule right middle lobe.
171518 - ..
171519 - Signed informed consent was obtained.
171520 -
171524 - ..
171525 - DD: 030630 DT: 030630 SH
171527 - ..
171528 - Discussed CT scan test results in relation to overall symptoms below.
171529 - ref SDS 0 GI4H
171530 -
171531 -
171532 -
171533 -
171534 -
1716 -
SUBJECTS
CT Test Reports Skin Thickening Left Breast May be Reaction to Radia
No Clinical Observable Symptoms of Cancer Delays Commencement of Sec
Doctors Do Not Have Time to Analyse Test Results for Developing Trea
Doctors Not Enough Time Follow Kaiser Guidelines for Medical Practic
Time Not Enough for Doctors to Implement Good Medical Practice
Lump Under Left Arm Grows 50% from 1 CM to 1.5 CM in 30 Days
CA 15-3 Not Recommended by ASCO Published Guidance to Evaluate Breas
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
Redness Breast Skin Thickening Firmness Diagnosed as Scaring Healing
3413 -
341401 - ..
341402 - Redness Skin Requires Treatment But Not Breast Skin Thickening
341403 - CA-15-3 Rising Cancer Marker Does Not Signal Need to Treat Relapse
341404 - Kaiser Relies on Patient Symptoms to Treat for Relapse Not CA 15-3
341405 - Skin Thickening Episodic Redness Attributed to Radiation Treatments
341406 -
341407 - Follow up ref SDS 50 7C6W, ref SDS 49 7C6W
341408 -
341409 - The doctor advised that he did not have time to analyse test results
341410 - for developing treatment strategy and to prepare for the meeting
341411 - today, which aligns with report on 990625 that limited time makes
341412 - following Kaiser's guidelines for medical practice a continuing
341413 - challenge. ref SDS 1 2652
341415 - ..
341416 - The doctor reviewed CT test results on Kaiser's computer screen, per
341417 - above. ref SDS 0 LK5L
341419 - ..
341420 - The doctor noted that the CT scan test report saying "persistent left
341421 - breast and chest wall skin thickening may be from prior radiation
341422 - therapy...," ref SDS 0 VM7I, does not require further work to assess
341423 - comment in the report saying that....
341424 -
341425 - ...invasion of the dermal lymphatics from known breast cancer
341426 - can present similarly. Correlate clinically. ref SDS 0 GJ69
341428 - ..
341429 - Millie asked if PET testing or a biopsy discussed during the meeting
341430 - last month on 030606, ref SDS 50 P97J, can test skin thickening on the
341431 - left breast for relapse of cancer? What does Kaiser's guidance
341432 - require for responding to test reports that say to "Correlate
341433 - clinically"? Would a biopsy or PET test, which have previously
341434 - identified cancer help in this case to evaluate starting treatment
341435 - immediately to prevent cancer from spiraling out of control?
341437 - ..
341438 - The doctor noted that observable symptoms of severe redness of the
341439 - skin is a sign of cancer. He feels this has not occurred, based on
341440 - examination today showing that redness in the left breast has subsided
341441 - again since Millie's report of significant inflammation, as found by
341442 - the doctor on 030606. ref SDS 50 7C6W
341444 - ..
341445 - On 030109 the doctor observed red coloration and firmness of the left
341446 - breast, and diagnosed cellulitus. ref SDS 46 KW5F A few months ago
341447 - severe "redness" in the left breast appeared again, and led the
341448 - patient to request a meeting several weeks prior to the scheduled
341449 - date. The doctor's examination at that time on 030606 found severe
341450 - redness in the left breast had receeded. ref SDS 50 7C6W He, also,
341451 - cited skin thickening in the left breast. ref SDS 50 O16M
341453 - ..
341454 - Millie is worried treatment will be delayed too long to be effective,
341455 - so she won't have a chance to recover. She became emotional asking
341456 - the doctor to start treatment or at least do more testing, as
341457 - recommended in the CT test report. She requested a biopsy and/or a
341458 - PET scan, which was deferred last month on 030606 until today in order
341459 - to evaluate findings from the CT test. ref SDS 50 XR70
341461 - ..
341462 - The doctor indicated that the record of episodic redness, and now the
341463 - CT test report of skin thickening on the left breast that may
341464 - correlate to cancer, ref SDS 0 VM7I, are most likely attributed to
341465 - radiation treatments. He feels that the caution in the report to
341466 - consider...
341467 -
341468 - invasion of the dermal lymphatics from known breast cancer
341469 -
341470 - ...along with a 30% rise in CA 15-3, reported today, ref SDS 0 SM6M,
341471 - does not require, action at this time to test further for progression
341472 - of cancer in order to start treatment in time to be effective.
341473 -
341474 - [On 040318 redness in left breast occurs, treated for cellulitus.
341475 - ref SDS 59 IM6J
341477 - ..
341478 - [On 040402 skin firmness, redness left breast persist; diagnosis
341479 - changed from cellulitus to reaction from radiation treatments in
341480 - August 2002; steriods prescribed to treat breast redness; patient
341481 - cleared to begin chemotherapy treatments on Taxol and Avastin
341482 - trial. ref SDS 60 IM6J
341484 - ..
341485 - [On 040419 redness persisted, biopsy taken of left breast.
341486 - ref SDS 61 789F
341488 - ..
341489 - [On 040429 the surgeon advises pathology report on biopsy
341490 - diagnoses cancer. ref SDS 62 C155
341492 - ..
341493 - [On 040504 the doctor mentions inflammatory breast disease
341494 - during 5 minute consultation prior to treatment in the
341495 - chemotherapy clinic. ref SDS 63 WI8F
341497 - ..
341498 - [On 040517 the pathology report on the biopsy diagnoses metastatic
341499 - Carcinoma involving dermal lymphmatics consistent with
341500 - inflammatory carcinoma of the breast. ref SDS 64 6T5G
341501 -
341503 - ..
341504 - Axillary Left Side Increasing Lymphadenopathy Sensitive Discomfort
341505 - Lump Under Left Arm Very Definite But Not Charasteric of Cancer
341506 -
341507 - Follow up ref SDS 50 Y45M, ref SDS 49 7C84.
341508 -
341509 - The doctor said the CT scan report on 030625 showing "stable" under
341510 - Impression, ref SDS 0 CD6M, is "favorable." The doctor did not
341511 - discuss new findings of left axillary adenopathy where lymph "nodes"
341512 - under the arm in the left axilla reported on 030508, seem to have
341513 - grown 50%, from 1 to 1.5 CM, over the past few months. ref SDS 0 VM7I
341515 - ..
341516 - Millie reported occassional discomfort now under the left arm during
341517 - exercise, following the report on 030606, ref SDS 50 Y45M, when the
341518 - doctor found by examination a definite lump. ref SDS 50 N66U
341520 - ..
341521 - At that time on 030606, the doctor indicated Millie's symptoms reflect
341522 - scar tissue from surgery on 020312. ref SDS 50 N66J
341524 - ..
341525 - Today, CT test findings of persistant left breast and chest wall skin
341526 - thickening that may be from prior radiation therapy, and noting that
341527 - invasion of the dermal lymphatics from known breast cancer can present
341528 - similarly, and so recommends the doctor "correlate clinically,"
341529 - ref SDS 0 GJ69, and further patient reports today of rising discomfort
341530 - were described by the doctor during the meeting as consistent with
341531 - surgical scar tissue, discussed previously on 030606. ref SDS 50 N66J
341533 - ..
341534 - As a result, the doctor deferred consideration of biopsy to evaluate
341535 - starting treatment requested by Millie, per above. ref SDS 0 T64L The
341536 - doctor scheduled another visit in two (2) months, and decided to
341537 - forego another PET scan test until the next examination, when the CA
341538 - 15-3 test will be reviewed again.
341539 -
341540 -
341541 -
341542 -
3416 -
SUBJECTS
CA 15-3 80 Signaled Relapse Need for Action Treating Another Patient
4103 -
410401 - ..
410402 - CA 15-3 80 Signaled Need for Action Treating Another Patient
410403 -
410404 - The doctor cited an example of another patient he is treating where
410405 - the blood test cancer marker varied up and down over a period of
410406 - several years. When CA 15-3 reached 80 this signaled cancer activity
410407 - that required changing course by the medical team. He, also, pointed
410408 - out again today that CA 15-3 is not a recommended criteria for
410409 - evaluating progression of disease, confirming prior discussion on
410410 - 030508. ref SDS 49 M28G
410411 -
410412 - [On 031205 the doctor cited elevated CA 15-3 test as grounds
410413 - for classifying patient condition as "stable" rather than
410414 - "complete response" (CR). ref SDS 55 GJ5M
410416 - ..
410417 - [On 050214 after CA 15-3 rises to 78 doctor planned to change
410418 - treatment if CA 15-3 rises again. ref SDS 71 D183
410420 - ..
410421 - [On 071023 Doctor Rugo at UCSF explains cancer marker increase
410422 - from 56 in May to 74 in October guides looking more carefully and
410423 - does not suggest cut off of 80 for consideration of treatment
410424 - regimen. ref SDS 91 V65R
410426 - ..
410427 - ASCO criteria calling for reliance on rising CA 15-3 to assess relapse
410428 - appears to support patient concerns today, based on the document
410429 - submitted by the doctor on 030508. ref SDS 49 CA4M
410431 - ..
410432 - CA 15-3 testing in this case has not varied up and down. It has
410433 - increased steadily over a period of 4 months. Without treatment, CA
410434 - 15-3 will reach 80 on the next visit in September, shown by the record
410435 - above. ref SDS 0 SM6M This seems to align with periodic rise in
410436 - redness of the left breast that led to an early meeting on 030606.
410437 - ref SDS 50 7C6W Rising CA 15-3 fits the trend of 50% growth in lymph
410438 - nodes under the left arm, discussed above in relation to CT testing,
410439 - ref SDS 0 VM7I, Since the doctor indicates today that CA 15-3 at a
410440 - level of 80 caused alarm in another patient, ref SDS 0 WS42, can the
410441 - Kaiser "system" take action to avoid another "alarm" of impending,
410442 - possibly irreperable, harm to the patient that avoids the risk of
410443 - cancer cascading out of control, as warned by the doctor on 030606?
410444 - ref SDS 50 NE84
410445 -
410446 - [...below, doctor explains strategy of withholding treatments
410447 - to stretch out quality of life by maintaining potency of
410448 - chemotherapy drugs. ref SDS 0 OW3O
410449 -
410450 -
410451 -
410452 -
4105 -
SUBJECTS
Case Study CA 15-3 Biomarker Breast Cancer Criteria Application for
4703 -
470401 - ..
470402 - CA 15-3 ASCO Criteria Breast Cancer Biomarker Case Study
470403 - Biomarker Case Study CA 15-3 ASCO Criteria Breast Cancer
470404 -
470405 - There have been conflicting understandings applying CA 15-3 cancer
470406 - marker for diagnosis to guide treatment in Millie's case...
470407 -
470408 - 1. First meeting primary care physician at
470409 - Kaiser orders blood test; prescribes
470410 - initial treatment plan chemotherapy 4
470411 - cycles AC, radiation, 4 cycles
470412 - Taxotere............................... 020321, ref SDS 12 6SWS
470414 - ..
470415 - 2. CA 15-3 85 for blood test on 020321
470416 - baseline starting adjuvant
470417 - chemotherapy........................... 020405, ref SDS 14 6T8K
470419 - ..
470420 - 3. AC chemotherapy begin treatment for
470421 - cancer................................. 020423, ref SDS 21 0001
470423 - ..
470424 - 4. CA 15-3 rises from 85 to 118 consistent
470425 - with PET scan test showing increased
470426 - cancer activity doctor changes
470427 - treatment to Taxotere after
470428 - 2 cycles of AC......................... 020603, ref SDS 28 4X5K
470430 - ..
470431 - 5. CA 15-3 37 falls from 41 10% decline
470432 - signals response to treatment
470433 - though 25% above target
470434 - level of 29............................ 030109, ref SDS 46 GJ5M
470436 - ..
470437 - 6. CA 15-3 46 rise 25% from 37 for some
470438 - reason does not signal progression
470439 - of disease requiring work plan to
470440 - treat recurrence....................... 030220, ref SDS 48 GJ5M
470442 - ..
470443 - 7. CA 15-3 cancer marker can vary for reasons
470444 - other than progression of disease;
470445 - Kaiser cites someone with a
470446 - cold................................... 030220, ref SDS 48 S36J
470448 - ..
470449 - 8. ASCO report 960517 CA 15-3 indicates
470450 - when treatment fails................... 030220, ref SDS 48 PQ7T
470452 - ..
470453 - 9. ASCO does not present factors that
470454 - impact CA 15-3 other than cancer;
470455 - there is no mention of having a
470456 - cold................................... 030220, ref SDS 48 SZ4G
470458 - ..
470459 - 10. ASCO CA 15-3 100 signals recurrence
470460 - treatment failed need work plan for
470461 - chemotherapy........................... 030220, ref SDS 48 ZL4X
470463 - ..
470464 - 11. Doctor advises that ASCO standards do
470465 - not recognize CA 15-3 cancer marker
470466 - for evaluating breast
470467 - cancer................................. 030508, ref SDS 49 M28G
470469 - ..
470470 - 12. Doctor cites documentation on ASCO standards
470471 - that indicate CA 15-3 evaluates recurrence,
470472 - which is an issue managing Millie's case,
470473 - and so seems conflicting with representation
470474 - that CA 15-3 rising more than 50%
470475 - from 33 to 54, raises no
470476 - concerns............................... 030508, ref SDS 49 CA4M
470478 - ..
470479 - 13. Emergency meeting rash on left breast
470480 - doctor advises that rising CA 15-3
470481 - deserves attention to evaluate
470482 - recurrence............................. 030606, ref SDS 50 NE7L
470484 - ..
470485 - 14. CA 15-3 doctor advises again ASCO does
470486 - not recognize cancer marker to evaluate
470487 - breast cancer.......................... 030710, ref SDS 0 WS42
470489 - ..
470490 - 15. CA 15-3 80 doctor's criteria at Kaiser
470491 - for taking action to treat progression
470492 - of disease recurrence breast
470493 - cancer................................. 030710, ref SDS 0 WS42
470495 - ..
470496 - 16. CA 15-3 only diagnostic for Millie because
470497 - IBC does not register with PET and CT
470498 - image testing, except thickened
470499 - skin which occurs with other
470500 - maladies............................... 040517, ref SDS 64 S65H
470502 - ..
470503 - 17. UCSF requested documentation from Kaiser
470504 - to authenticate accuracy patient's comment
470505 - during a 2nd opinion consultation that
470506 - CA 15-3 dropped to 39 on 041007 indicating
470507 - cancer subsided because patient
470508 - responded to treatment on
470509 - Taxol bevacizumab (Avastin)
470510 - drug trial............................. 041018, ref SDS 67 L16Q
470512 - ..
470513 - 18. CA 15-3 not used by UCSF to evaluate
470514 - progression of disease and response to
470515 - treatment.............................. 041018, ref SDS 67 KX5L
470517 - ..
470518 - 19. CA 15-3 not used by Stanford Cancer
470519 - Center to evaluate progression of
470520 - disease and response to
470521 - treatment.............................. 041019, ref SDS 68 Y15N
470523 - ..
470524 - 20. CA 15-3 300 signals IBC cascading out
470525 - of control............................. 060711, ref SDS 80 Q36F
470527 - ..
470528 - 21. Case study CA 15-3 rising seems conflicting
470529 - with image CT PET scan test findings of
470530 - no metastatic cancer; however, may tests
470531 - report symptoms of IBC like dermal and
470532 - skin thickening, lymphadenopathy
470533 - in left axillary and
470534 - supraclavicular........................ 060711, ref SDS 80 YU6M
470536 - ..
470537 - 22. CA 15-3 erratic over several months
470538 - doctor determines disease progresses
470539 - IBC 3rd relapse with Taxotere and
470540 - capecitabine chemotherapy
470541 - treatment.............................. 061201, ref SDS 82 GJ5M
470543 - ..
470544 - 23. CA 15-3 rises aligns spreading IBC rash
470545 - left to right brease requires changing
470546 - treatments............................. 070105, ref SDS 84 GJ5M
470548 - ..
470549 - 24. CA 15-3 history increasing and delay
470550 - getting results of newer blood testing
470551 - at Kaiser created concern at UCSF in
470552 - combination with evident expanding IBC
470553 - rash about changing treatment; schedule
470554 - another blood test and meeting in
470555 - a week to evaluate changing
470556 - treatment.............................. 070301, ref SDS 86 OL5M
470558 - ..
470559 - 25. CA 15-3 drops dramatically aligns with
470560 - perception IBC subsiding intensity
470561 - despite spreading of disease, UCSF
470562 - meeting cancelled to consider
470563 - changing treatment..................... 070308, ref SDS 87 FO6H
470565 - ..
470566 - 26. CA 15-3 research indicates biomarkers
470567 - effective indicators of
470568 - cancer................................. 070328, ref SDS 89 0001
470570 - ..
470571 - 27. CA 15-3 33 drops dramatically aligns
470572 - with IBC rash significantly subsiding
470573 - showing patient responding to
470574 - treatment.............................. 070329, ref SDS 90 Q48G
470576 - ..
470577 - 28. CA 15-3 rise from 56 in May to 74
470578 - in October using Kaiser Laboratory
470579 - with 10 point differential from
470580 - UCSF lab deserves attention for
470581 - looking more carefully, does not
470582 - signal consideration of treatment
470583 - regimen................................ 071023, ref SDS 91 V63L
470584 -
470585 -
470586 -
470587 -
470588 -
470589 -
470590 -
4706 -
SUBJECTS
Chemotherapy Become Less Effective Cancer Becomes Immune to Chemothe
No Clinical Observable Symptoms of Cancer Delays Commencement of Sec
Chemotherapy Less Effective Cancer Becomes Immune to Chemotherapy So
Fitness Exercise General Health Positive Attitude Millie Has Conditi
No Clinical Observable Symptoms of Cancer Delays Commencement of Sec
5407 -
540801 - ..
540802 - Fitness Helps Maintain Dose Levels for Effective Treatment
540803 - Chemotherapy Treatments Become Less Effective Over Time
540804 -
540805 - The doctor drew a diagram on the marking board showing
540806 - correlation between rise of CA 15-3 over time, which reflects
540807 - Millie's condition, per above, ref SDS 0 KV59, and the emergence
540808 - of observable symptoms that relapse (progression) is occurring,
540809 - which have not yet occurred in Millie, as noted above.
540810 - ref SDS 0 XX4G
540812 - ..
540813 - The doctor remarked how well and fit Millie looks, and that she
540814 - has no symptoms of physical nor emotional distress from suffering
540815 - recurrance, repeating prior comments on 030606 discussing the
540816 - importance of fitness for enabling aggressive treatment,
540817 - especially in older patients. ref SDS 50 NE57
540819 - ..
540820 - In fact Millie's weight has dropped about 10 pounds in the past
540821 - two (2) months, evidently due to continued regimen of aggressive
540822 - exercise relative to her age group. An example is evident from
540823 - pictures of a recent vacation. Millie and her daughter Pam
540824 - recently visited Canyon Ranch, a health spa in Arizona, and spent
540825 - the week exercising and relaxing, reported in another record
540826 - today. ref SDS 52 0001
540827 -
540828 - [On 031205 the doctor cited patient fitness as important
540829 - factor in quality of life. ref SDS 55 GW8F
540831 - ..
540832 - [On 040614 patient general health, strength, lifestyle of
540833 - exercise help recover from cancer treatments giving doctor
540834 - flexibility allowing treatments when blood counts do not meet
540835 - standing guidelines. ref SDS 65 356L
540837 - ..
540838 - [On 070218 energy increases, shortness of breath, fatigue,
540839 - weakness subside 10 weeks after ending treatment with
540840 - Taxotere and cacecitabine; Millie exercising in the gym,
540841 - playing tennis. ref SDS 85 MS7O
540842 -
540843 -
540844 -
5409 -
SUBJECTS
Strategy Theory of Medical Practice Withhold Treatment of Rising Sym
Treatment Less Effective Cancer Mutates Resists Treatment Biology Th
5804 -
580501 - ..
580502 - Theory Medical Practice Delay Treatment Until Patient Suffers
580503 - Treatment Cancer Withhold Until Patient Suffers Maintain Potency
580504 - Chemotherapy Drugs Less Effective With Succeeding Progressions
580505 -
580506 - Follow up ref SDS 50 N27L.
580507 -
580508 - Last month on 030606 the doctor explained that patients need a
580509 - steady dose of chemotherapy in order for treatment to be
580510 - effective recovering from cancer. ref SDS 50 JP7G
580512 - ..
580513 - The doctor explained a theory of oncology practice that delays
580514 - and witholds treatment until clinical symptoms impair quality of
580515 - life, e.g., actual pain and suffering, rather than perform
580516 - proactive treatment based on test results that seemingly indicate
580517 - cancer is progressing, per above. ref SDS 0 RU4P The doctor
580518 - noted cancer becomes progressively immune to all treatment agents
580519 - over time.
580520 -
580521 - [...explained further below on strategy to stretch out
580522 - treatments to prolong quality of life. ref SDS 0 L35L
580524 - ..
580525 - [On 040318 primary care physician explains treatment with
580526 - drugs in clinical trials implements Kaiser's standard of care
580527 - for oncology by allowing the doctor to hold in reserve
580528 - powerful established drugs until needed to prolong quality of
580529 - life. ref SDS 59 DG4X
580531 - ..
580532 - [On 090423 0830 Doctor Hsu applies standard of care for
580533 - oncology by delaying use of "2-bullets" with radiation and
580534 - hyperthermia holding them in reserve while Doctor Rugo
580535 - experiments with clinical trials to find "maintenance" drugs
580536 - that treat Millie's cancer as a chronic disease. ref SDS 92
580537 - UH3G
580539 - ..
580540 - Changing chemotherapy drugs, discussed with the doctor on 030606,
580541 - ref SDS 50 N27L, decreases the period that treatment is
580542 - effective. For example, a patient might be treated for a year
580543 - with a drug, and then disease progresses. Switching to another
580544 - drug may stop progression of cancer, but for a shorter period,
580545 - say 9 - 10 months. Each change in treatment shortens the period
580546 - of effectiveness. Therefore, if the first treatment is not
580547 - successful in eliminating cancer from the system, then treatment
580548 - strategy shifts from cure to containment by delaying treatment to
580549 - a time that will have maximum effect on prolonging life. This
580550 - means a second round of treatment will be performed later in the
580551 - growth cycle, rather than being proactive trying to "cure"
580552 - cancer.
580553 -
580554 - [On 030915 the doctor indicated that some cancers are
580555 - amenable to proactive treatment for prevention of serious
580556 - conditions, however, breast cancer is not well suited to
580557 - treatment for avoiding remission. ref SDS 53 4Z9Y
580559 - ..
580560 - [On 031009 article reporting study on letrozole says that
580561 - tamoxifen used to prevent relapse of estrogen-based breast
580562 - cancer becomes increasingly less effective over a period of 5
580563 - years, and so lends support to the doctor's analysis
580565 - ..
580566 - [On 070315 Millie in 2nd cycle of 4th chemotherapy drug on
580567 - clinical study at UCSF getting treatment for IBC with
580568 - cetuximab; UCSF cites 80 year old patient treated on the
580569 - clinical study for 10 months before progression of disease.
580570 - ref SDS 88 6A9K
580571 -
580573 - ..
580574 - Strategy Stretch Treatment Metastatic Cancer Don't Lose Control
580575 - Withhold Treatment to Lengthen Period Chemotherapy Effective
580576 - Medical Treatment Cancer Withhold Stretch Potency Chemothearpy
580577 -
580578 - This theory assumes that if the first phase of treatment, which
580579 - Millie began on 020423 after meeting on 020405, ref SDS 14 6SWS,
580580 - does not achieve remission, then the patient has general
580581 - metastatic cancer. The goal treating metastatic cancer is no
580582 - longer "cure" in the form of remission, as pointed out during the
580583 - meeting on 030606, but quality of life. ref SDS 50 589J The
580584 - strategy to maintain quality of life is to stretch out inevitable
580585 - metastasis by stretching out treatments for maximum potency. If
580586 - follow on chemotherapy were performed now to treat onset of
580587 - symptoms, the doctor seemed to be saying, this will not be any
580588 - more successful than the first treatment, and will likely be less
580589 - effective in reducing advance of metastasis.
580590 -
580591 - [On 090423 0830 Doctor Hsu applies standard of care for
580592 - oncology by delaying use of "2-bullets" with radiation and
580593 - hyperthermia holding them in reserve while Doctor Rugo
580594 - experiments with clinical trials to find "maintenance" drugs
580595 - that treat Millie's cancer as a chronic disease. ref SDS 92
580596 - UH3G
580597 -
580598 -
580599 -
580600 -
5807 -
SUBJECTS
Strategy Theory of Medical Practice Withhold Diagnosis Bad News Pati
6503 -
650401 - ..
650402 - Withhold Diagnosis for Positive Attitude on Treatment for Cancer
650403 -
650404 - The doctor explained that quality of life, along with ability to
650405 - absorb aggressive cancer treatments that maintain life, requires
650406 - a positive attitude, as Millie has demonstrated in her battle
650407 - against cancer. Doctors constantly strike a balance between
650408 - informing patients of evolving medical conditions so the patient
650409 - can be an effective partner getting treatment, but avoiding
650410 - unnecessary alarm about details that may frighten and disturb
650411 - patients into giving up on treatment and life.
650412 -
650413 - [On 040429 meeting with surgeon reported biopsy made
650414 - findings of new cancer but the pathology report was not
650415 - submitted that diagnosed IBC and this diagnosis was
650416 - withheld from the patient. ref SDS 62 F66N
650418 - ..
650419 - [On 040504 primary care physician withholds patient
650420 - diagnosed with IBC one of the most aggressive forms of
650421 - breast cancer. ref SDS 63 WI8F
650423 - ..
650424 - [On 040517 primary care physician submits biopsy without
650425 - discussion and continues to withhold notice that IBC
650426 - diagnosed and presents major change in patient status
650427 - from stage II to stage IV. ref SDS 64 6T5G
650429 - ..
650430 - [On 050520 patient letter discusses very bad side effects
650431 - of Taxotere and capecitabine chemotherapy that makes death
650432 - seem like a good option. ref SDS 72 VP3N
650434 - ..
650435 - [On 061020 primary care physician withholds findings in CT
650436 - test of heart disorder Cor Pulmonale enlarged right
650437 - ventricle. ref SDS 81 VJ4J
650439 - ..
650440 - [On 061208 primary care physician withholds diagnosis of
650441 - lung cancer. ref SDS 83 G25K
650443 - ..
650444 - Millie asked about professional authority for this theory in
650445 - light of the doctor's concern during the meeting on 030606 that
650446 - delayed treatment risks cancer cascading out of control?
650447 - ref SDS 50 NE84 What do authorities say about delaying treatment
650448 - of symptoms discussed today, per above, ref SDS 0 RU4P, until
650449 - physical distress is observed in order to maintain treatment
650450 - potentancy? Kaiser's Healthwise Handbook reviewed on 990625
650451 - presents a policy for a doctor/patient partnership that describes
650452 - requirements for timely, accurate, commuication, as essential for
650453 - effectived care. ref SDS 1 3190 Kaiser also has a policy of
650454 - submitting the medical chart with doctor progress notes for
650455 - patient review. ref SDS 1 TD5S Does this mean there are two sets
650456 - of records: one disclosed to the patient and another on the
650457 - actual condition for medical management?
650458 -
650459 - [On 040318 distant metasis diagnosed based on biopsy showing
650460 - recurrence; discussed advantage of 2nd opinion. ref SDS 59
650461 - AW6M
650463 - ..
650464 - [On 041230 Millie relapsed again due to delay in getting
650465 - treatment.
650467 - ..
650468 - [On 050727 Millie has complete response to treatment.
650469 - ref SDS 73 YY7F
650470 -
650471 -
650472 -
650473 -
650474 -
650475 -
6505 -
SUBJECTS
Find Authority for Theory Strategy Medical Practice Withhold Treatme
Strategy Theory of Medical Practice Withhold Treatment of Rising Sym
Find Authority None that Supports Strategy Medical Practice Theory W
7805 -
780601 - ..
780602 - Find Professional Support to Withhold Chemo Treatments
780603 -
780604 - The doctor initially cited professional support for a theory and
780605 - practice of withholding treatment to maintain potency,
780606 - ref SDS 0 FZ55, based on Kaiser's...
780607 -
780608 - "Patient's Guide, Follow-up Care for Breast Cancer."
780609 -
780610 - ...which he discussed previously on 030508, ref SDS 49 M28G He
780611 - then looked through the Patient Guide and noted that the theory
780612 - of delayed treatment and reduced effectiveness of treatments
780613 - related today, per above, ref SDS 0 FZ55, is not actually set out
780614 - in the hand book. When a search could not find support, the
780615 - doctor then commented that there may not be any literature
780616 - documenting this practice, because it is "common knowledge."
780617 -
780618 - Review of the record does not show disclosure of this "common
780619 - knowledge" by the doctor on any prior visit, nor by other
780620 - consultants who have worked with Millie over the past 18
780621 - months at Kaiser, nor is it set out in any of the literature
780622 - provided by and recommended by Kaiser for the patient to
780623 - review in understanding treatment options.
780624 -
780625 - [On 031009 report of study showing Letrozole (manufactured
780626 - under the names Femara and Arimidex) is a new class of
780627 - drug treatments that reduce relapse of breast cancer in
780628 - 43% of patients treated with taxmoxifen for estrogen based
780629 - cancer. ref SDS 54 0001
780631 - ..
780632 - [On 031009 article reporting study on letrozole says that
780633 - tamoxifen used to prevent relapse of estrogen-based breast
780634 - cancer becomes increasingly less effective over a period
780635 - of 5 years, and so lends support to the doctor's
780636 - analysis today. ref SDS 54 I08M
780637 -
780638 -
780639 -
780640 -
780641 -
780642 -
7807 -
SUBJECTS
Dizziness Caused by Blockage in Ear Treatment Prescribed by Doctor Ro
Survivor Patients Dislike Phrase Survivor Feelings in Treatment Recov
Ear Blockage Causing Dizziness Treatment Prescribed by Doctor Robert
8305 -
830601 - ..
830602 - Dizziness Lying Down and Rising Treatable, Not Indication of Cancer
830603 -
830604 - Millie complained of dizziness the past few days, beginning about
830605 - Monday, while still on vacation in Arizona.
830606 -
830607 - 1. Laying down on stomach and rising causes no problem.
830609 - ..
830610 - 2. Laying down on back causes no problem, but rising causes
830611 - dizziness and some loss of orientation for a few moments.
830613 - ..
830614 - 3. Laying down the right side causes no problem, and getting up
830615 - causes no problem.
830617 - ..
830618 - 4. Laying down on the left side causes immediate and noticeable
830619 - dizziness, and getting up dizziness continues for a few
830620 - moments.
830622 - ..
830623 - Doctor Johnson examined Millie and noticed a blockage in the left ear.
830624 - He feels this most likely accounts for dizziness symptoms. Treatment
830625 - was prescribed for "bilateral ear washing". It will be performed by a
830626 - doctor tomorrow at Kaiser OA 1100. Doctor Johnson also prescribed
830627 - some ear drops. These were obtained from the pharmacy, and this
830628 - evening administered ear drops to prepare for treatment at the
830629 - hospital tomorrow.
830630 -
830631 - [On 030915 treatment was effective relieving dizziness.
830632 - ref SDS 53 WS47
830634 - ..
830635 - [On 060217 dizziness symptoms occurred again following mastectomy
830636 - surgery on 051021, and subsequent recovery from IBC, and return to
830637 - vigorous exercise. ref SDS 76 PT4K
830639 - ..
830640 - [On 060308 similar treatment was not effective relieving dizziness
830641 - symptoms. ref SDS 77 TO9G
830643 - ..
830644 - [On 060428 doctor notified dizziness symptoms continue; decide to
830645 - defer further treatment pending recovery from prior treatment.
830646 - ref SDS 78 PT4K
830647 -
830648 -
830649 -
830650 -
830651 -
830652 -
830653 -
830654 -
830655 -
830656 -
8307 -