CONTACTS 

SUBJECTS
Meeting Doctor Assess Treatment Review Progress after 2 Chemotherapy

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 42 0000, ref SDS 38 0000.
040502 -
040503 - Completed 1st phase of treatment to recover from IBC relapse.  AC
040504 - treatments do not seem to have been effective.  CA 15-3 made another
040505 - significant rise over the past 4 weeks. ref SDS 0 GJ5M  There is some
040506 - improvement in healing the biopsy wound; IBC coloration may be worse.
040507 - ref SDS 0 025H  Doctor reported patient cannot start phase 2 of the
040508 - recovery plan because the protocol nurse found grounds not to qualify
040509 - Millie for the new drug trial protocol the day before treatment was
040510 - scheduled to start. ref SDS 0 028N  As a substitute, the doctor
040511 - prescribed continuing with two (2) treatments of AC, which will make a
040512 - total of six (6) treatments using this drug.  The doctor scheduled a
040513 - test for heart damage that can be a side effect from getting more than
040514 - four (4) cycles of AC. ref SDS 0 J544
040515 -
040516 -
040517 -
040518 -
040520 -  ..
0406 -
0407 -
0408 - Discussion
0409 -
040901 - Agenda for Work Plan After 2 Treatments of AC
040902 -
040903 - Follow up ref SDS 42 SM6M, ref SDS 38 SM6M.
040904 -
040905 - The meeting today was originally scheduled on 041230 to occur last
040906 - week on 050128. ref SDS 42 YO6G  Since it turned out that 050128 was
040907 - the date of the 2nd treatment with Adriamycin Cytoxan (AC), the doctor
040908 - deferred the meeting. ref SDS 45 407N  This change permits a better
040909 - assessment on effectiveness of two (2) treatments with AC chemotherapy
040910 - to qualify for changing to a new drug trial under the work plan
040911 - developed on 041230. ref SDS 42 XQ41
040913 -  ..
040914 - Millie created an agenda on the marking board...
040915 -
040916 -        CA 15-3 dramatic rise...................... ref SDS 0 GJ5M
040917 -        Coumadin treatments after pulmonary
040918 -        emboli symptoms end........................ ref SDS 0 RZ4I
040919 -        Lumps under arm more severe................ ref SDS 0 MW8J
040920 -        Lumps in neck disappeared.................. ref SDS 0 8R6M
040921 -        Wound punch biopsy better.................. ref SDS 0 6T5G
040922 -        Breast redness worse....................... ref SDS 0 IM5H
040923 -        Trial protocol............................. ref SDS 0 028N
040924 -
040925 -
040926 -
040927 -
040928 -
040929 -
040930 -
040931 -
040932 -
0410 -

SUBJECTS
CA 15-3 Cancer Marker 67 Rises from 56 Signaling Active IBC Wound No

1203 -
120401 -  ..
120402 - CA 15-3 Cancer Marker 67 Rises Dramatically Again
120403 -
120404 - Follow up ref SDS 42 087J, ref SDS 38 087J,
120405 -
120406 - Blood test on 050128 shows CA 15-3 rising again to 67 from 56 just 2
120407 - weeks ago....
120409 -           ..
120410 -          050128......... 67 H............. 050204, ref SDS 0 087J
120411 -          041228......... 56 H............. 041230, ref SDS 42 087J
120412 -          041204......... 43 H............. 041210, ref SDS 39 087J
120413 -          041007......... 39............... 041104, ref SDS 33 087J
120414 -          040923......... 49 H............. 041005, ref SDS 31 087J
120415 -          040908......... 44 H............. 040909, ref SDS 30 087J
120416 -          040825......... 47 H............. 040812, ref SDS 30 087J
120417 -          040811......... 42 H............. 040812, ref SDS 29 087J
120418 -          040728......... 43 H............. 040729, ref SDS 28 2N5J
120419 -          040712......... 47 H............. 040713, ref SDS 27 087J
120420 -          040614......... 55 H............. 040615, ref SDS 26 PX6X
120421 -          040517......... 78 H............. 040601, ref SDS 25 2N5J
120422 -          040311......... 70 H............. 040318, ref SDS 22 SM6M
120423 -          040205......... 60 H............. 040211, ref SDS 21 SM6M
120424 -          031201......... 62 H............. 031205, ref SDS 20 SM6M
120425 -          030912......... 66 H............. 030915, ref SDS 19 SM6M
120426 -          030708......... 68 H............. 030710, ref SDS 18 SM6M
120427 -          030503......... 54 H............. 030508, ref SDS 17 SM6M
120428 -          030403......... 45 H............. 030508, ref SDS 17 SM6M
120429 -          030215......... 46 H............. 030220, ref SDS 16 5E6L
120430 -          030106......... 37 H............. 030109, ref SDS 15 SM6M
120431 -          021202......... 41 H?............ 021204, ref SDS 14 SP5G
120432 -          021111......... 36 H?............ 021113, ref SDS 13 Y65I
120433 -          021023......... 33 H?............ 021023, ref SDS 12 SQ5I
120434 -          020930......... 33 H?..29........ 021002, ref SDS 11 SQ5I
120435 -          020917......... 36 H?............ 020924, ref SDS 10 SQ5I
120436 -          020717......... 59 H?............ 020726, ref SDS 9 YN5K
120437 -          020629......... 75 H ............ 020705, ref SDS 8 UX6I
120438 -          020608........  67 H ............ 020614, ref SDS 7 0001
120439 -          020603........ 108 H ............ 020607, ref SDS 6 X67F
120440 -          020511........ 117 H ............ 020603, ref SDS 5 PJ4J
120441 -          020419......... 81 H ............ 020430, ref SDS 4 7N5H
120442 -          020321......... 85 H ............ 020405, ref SDS 3 6T8K
120443 -
120444 -
120446 -  ..
1205 -
1206 -
1207 - Analysis
1208 -
120801 - CA 15-3 67 Cancer Marker Rises Again Signaling Active IBC
120802 - IBC Progressing Clinical Symptoms Rise Aligns with Rising CA 15-3
120803 -
120804 - Follow up ref SDS 42 GJ5M. ref SDS 39 GJ5M.
120805 -
120806 - There was concern today about continuing rise in the cancer marker
120807 - after two (2) treatments with AC, beginning on 050104. ref SDS 43 0001
120808 - Clinical examination found improvement in the biopsy wound, but likely
120809 - some spread of inflammation in the upper half of the breast, per
120810 - below. ref SDS 0 025H
120812 -  ..
120813 - The doctor recalled planning on 041230 that showed treatment was
120814 - previously changed on 020603 after two (2) cycles with AC, because of
120815 - a dramatic rise in CA 15-3 cancer marker, ref SDS 42 437N, similar to
120816 - the rise reported today. ref SDS 0 087J  Since the meeting on 041230
120817 - further showed that CA 15-3 was not rising on the prior occassion when
120818 - treatment was switched on 020603, but rather was falling, ref SDS 42
120819 - XQ88, the doctor feels on this occassion, the prescription will be
120820 - continued for two (2) more treatments with AC, rather than switched,
120821 - as discussed further below.
120823 -         ..
120824 -        [On 050308 CA 15-3 rose to 95. ref SDS 46 0001
120826 -         ..
120827 -        [On 050311 CA 15-3 dropped to 88. ref SDS 47 087J
120828 -
120829 -
120830 -
120831 -
120832 -
120833 -
1209 -

SUBJECTS
CT Test No Discussion Prior Pathology Reports No New CT Testing Sche

1303 -
130401 -  ..
130402 - CT Scan Testing No New Pathology Reporting
130403 -
130404 - Follow up ref SDS 42 NL4N, ref SDS 39 NL4N.
130405 -
130406 - There was no discussion on CT test, and there was no schedule set for
130407 - the next test.
130408 -
130409 -
130410 -
130411 -
1305 -

SUBJECTS
Pulmonary Emoboli Symptoms End Treatment with Coumadin Continue Kais

2103 -
210401 -  ..
210402 - Pulmonary Emoboli Symptoms End Treatment with Coumadin Continue
210403 - Coumadin Treatment Continues for Pulmonary Emoboli after Symptoms End
210404 -
210405 - Follow up ref SDS 42 RZ4I, ref SDS 39 RZ4I.
210406 -
210407 - Millie advised that improvement reported on 041230 has continued with
210408 - no further symptoms of pulmonary emboli since 041211, nearly 2 months
210409 - ago.
210411 -  ..
210412 - The doctor feels that despite symptoms subsiding and CT testing on
210413 - 041230 showing no visiualization, ref SDS 42 RZ4I, treatment of
210414 - pulomnary emboli with coumadin should continue, because cancer
210415 - patients with a history of pulmonary emboli are highly susceptible to
210416 - cascading symptoms.  Cautionary treatment should therefore continue
210417 - for the period ahead with coumadin under Kaiser's policy to treat
210418 - cancer patients diagnosed with pulmonary emboli for life, reported on
210419 - 041104. ref SDS 32 4Y9G
210421 -  ..
210422 - Millie explained problems from Coumadin treatments that require
210423 - getting shots which cause trauma to her arm.  The doctor examined this
210424 - problem on 040318, and ordered a port cathether.  This technology
210425 - reduces trauma from chemotherapy drip treatments, but not for testing
210426 - pulmonary emboli performed in the Martinez hospital, where the staff
210427 - is not trained to use the port. ref SDS 22 CO3G
210428 -
210429 -     [On 051021 Millie explained to a nurse in the surgery department
210430 -     of Kaiser's Martinez Clinic how to use the port catheter to
210431 -     connect an IV preparing for mastectomy surgery. ref SDS 53 QV6K
210433 -  ..
210434 - Further consideration can be given in a few months time to ending
210435 - treatment for pulmonary emboli, which in this case is a single reading
210436 - in a single CT test received on 041104. ref SDS 32 RZ4I
210437 -
210438 -     [On 050422 no symptoms, and new CT test shows no visualiztion of
210439 -     pulmonary emboli; Coumadin treatments continued to avoid high risk
210440 -     of relapse when cancer patients suffer recurrence of pulmonary
210441 -     emboli. ref SDS 51 D64K
210442 -
210443 -
210444 -
210445 -
210446 -
210447 -
2105 -

SUBJECTS
Arm Lumps Lymph Nodes Swelled Under Left Side No Examination Patient

2403 -
240401 -  ..
240402 - Lumps Under Arm Seems Like Increase in Lumpiness
240403 -
240404 - Follow up ref SDS 42 MW8J, ref SDS 39 MW8J.
240405 -
240406 - There was no examination of the left axilla today.  Millie reported
240407 - feeling there is no improvement from discomfort and lumpiness under
240408 - the left arm reported on 041230. ref SDS 42 MW8J
240410 -  ..
240411 - The doctor expects treatmens with AC to resolve this condition, along
240412 - with IBC in the left breast.
240413 -
240414 -
240415 -
240416 -
2405 -

SUBJECTS
Neck Lumps Lymph Nodes Left Side No Examination Patient Reports Favo

3003 -
300401 -  ..
300402 - Lumps in Neck No Evidence of Swelling Indicating Cancer Receded
300403 -
300404 - Follow up ref SDS 42 8R6M, ref SDS 39 8R6M.
300405 -
300406 - No examination of the neck, because of favorable examinations and
300407 - testing the past few months, illustrated by the report on 041104.
300408 - ref SDS 33 8R6M
300409 -
300410 -
300411 -
300412 -
3005 -

SUBJECTS
Find Surgeon's Report Doctor Cannot Find in Medical Chart with Reaso
Wound Punch Biopsy Left Breast Healing Improves after 2 Treatments w

5004 -
500501 -  ..
500502 - Wound Biopsy Beginning to Heal Treatment with Adriamycin Cytoxan AC
500503 -
500504 - Follow up ref SDS 42 6T5G, ref SDS 39 6T5G.
500505 -
500506 - The doctor examined the left breast and was pleased to see signs of
500507 - improvement beginning to appear in healing the punch biopsy wound
500508 - after two (2) treatments with AC beginning on 050104. ref SDS 43 0001
500509 - This has been a concern since the meeting on 041210, when the wound
500510 - got suddenly worse, ref SDS 38 6T5G, and reported again on 041230.
500511 - ref SDS 42 6T5G
500513 -  ..
500514 - Millie asked if the doctor has received a report or talked to the
500515 - surgeon on results examining the biopsy sore relative to planning for
500516 - surgery, discussed by the doctor on 041230? ref SDS 42 CW6J
500518 -  ..
500519 - The doctor indicated he has not seen a report from the surgeon; they
500520 - have left several telephone messages for each other the past few weeks
500521 - trying to collaborate on criteria for surgery, as planned in the
500522 - meeting on 041230. ref SDS 42 UJ5M  The doctor asked patient
500523 - impressions from meeting with the surgeon on 050107. ref SDS 44 IS5N
500524 - This aligns with the meeting on 020321 when the doctor asked about
500525 - the surgeon's findings after the initial operation.
500527 -  ..
500528 - Millie recalled the surgeon was disappointed to see the biopsy wound
500529 - still not healed after eight (8) months since the procedure was
500530 - performed last April. ref SDS 44 UM6I  The surgeon further indicated
500531 - chemotherapy must reverse worsening IBC to clear cancer from the
500532 - breast before surgery for a masectomy can be considered, based on
500533 - reasoning presented in the meeting on 040429. ref SDS 23 SD7F
500535 -  ..
500536 - The doctor looked through the medical chart, and could not find the
500537 - surgeon's report for the meeting on 040429.  Millie mentioned that the
500538 - doctor discussed the surgon's findings when he met with Millie in the
500539 - Chemotherapy Clinic on 040504. ref SDS 24 WI8F
500540 -
500541 -     [On 050311 the doctor has not seen the report from the surgeon,
500542 -     ref SDS 47 UH3O; doctor calls surgeon asks for another examination
500543 -     to report on performing surger to remove pockets of resistance to
500544 -     chemotherapy. ref SDS 47 XQ41
500546 -  ..
500547 - The doctor could not find a record of the meeting o 040504.  He feels
500548 - that seeing the biopsy wound starting to heal today is a good sign for
500549 - meeting requirements in the surgery department to consider a masectomy
500550 - on the left breast, discussed on 041230. ref SDS 42 CW6J
500551 -
500552 -
500553 -
500554 -
500555 -
5006 -

SUBJECTS
IBC Symptoms Show Some Improvement and Some Worsening Redness IBC In

5203 -
520401 -  ..
520402 - IBC Symptoms Show Some Improvement and Some Worsening
520403 - Redness IBC Indicates Some Improvement with AC Treatments
520404 -
520405 - Follow up ref SDS 42 025H, ref SDS 39 025H.
520406 -
520407 - The doctor feels there is improvement reducing redness in the lower
520408 - half of the breast, which reflects healing of the biopsy wound, per
520409 - above. ref SDS 0 6T5G  The upper half of the breast seems the same or
520410 - possibly a little worse, reflecting rising CA 15-3 after two (2)
520411 - treatments with AC, per above. ref SDS 0 GJ5M
520412 -
520413 -     [On 050311 examination shows cancer progresses with new sores on
520414 -     left breast; presents concerns about continuing treatment with
520415 -     Adriamycin Cytoxen (AC). ref SDS 47 025H
520417 -      ..
520418 -     [On 050520 dramatic improvement after 2 cycles of treatment with
520419 -     Taxotere and Xeloda. ref SDS 52 R19I
520420 -
520421 -
520422 -
520423 -
520424 -
5205 -

SUBJECTS
Trial Qualify Failed Novel Epothilones BMS-247550 Plus Capecitabine
Treatment Trial Novel Epothilones BMS-247550 Plus Capecitabine Appro

5804 -
580501 -  ..
580502 - Trial Qualify for Novel Epothilones BMS-247550 Plus Capecitabine
580503 - Qualify for Trial Novel Epothilones BMS-247550 Plus Capecitabine
580504 -
580505 - Follow up ref SDS 42 028N, ref SDS 39 028N.
580506 -
580507 - The doctor asked if Rosalie, the Protocol Nurse who directs clinical
580508 - trials has scheduled Millie to start treatments on the new drug trial
580509 - now that Millie has completed two (2) more chemotherapy treatments
580510 - with Adriamycin Cytoxan (AC), as of 050128, ref SDS 45 0001, and in
580511 - accordance with planning during the meeting on 041230? ref SDS 42 XQ41
580513 -  ..
580514 - Millie related conversation with Rosalie in the chemotherapy clinic on
580515 - 050104.  Rosalie indicated Millie could not qualify for the new trial
580516 - by getting more AC treatments, and that she would notify the doctor
580517 - after doing more research to confirm protocol requirements, so that
580518 - the work plan could be adjusted in the event it turns out that Millie
580519 - cannot participate in the trial. ref SDS 43 NT5G
580521 -  ..
580522 - Later, on 050128 Rosalie visited with Millie briefly to say hello in
580523 - the waiting area for the Chemotherapy Clinic.  She did not explain
580524 - results of her research on the drug trial protocol, ref SDS 45 BH5M,
580525 - so possibly the matter was resolved favorably.  Millie asked if the
580526 - doctor has discussed this with Rosalie?
580528 -  ..
580529 - The doctor said Rosalie has not mentioned Millie's case, since the
580530 - meeting on 041230.
580532 -  ..
580533 - The doctor left the examination room to consult with Rosalie, and
580534 - returned in about 15 minutes.
580536 -  ..
580537 - He related understandings that Rosalie believes Millie cannot qualify
580538 - for the chemotherapy drug trial because treatment history receiving AC
580539 - while classified with stage II cancer, completed on 020603, as
580540 - reported during the meeting on 041230, ref SDS 42 XQ88, and then
580541 - getting Avastin, while classified with stage IV cancer, and now
580542 - completing another two cycles of AC, conflicts with the trial protocol
580543 - that calls for stage IV patients to have received initially four (4)
580544 - consecutive treatments of AC.
580545 -
580546 -     [...see below, the doctor schedules Millie to get two (2) more
580547 -     treatments with AC, which may meet trial protocol requirements for
580548 -     four (2) consequtive AC cycles while classified with stage IV
580549 -     cancer. ref SDS 0 WY5F
580551 -  ..
580552 - There was no documentation presented on this requirement, and no offer
580553 - for Kaiser to investigate and analyse the protocol to explore and
580554 - formulate options to accomplish a favorable interpretation on behalf
580555 - of Millie's requirements for effective treatment.
580557 -  ..
580558 - The doctor advised that Rosalie indicated Millie's complex patient
580559 - history and triple negative status, make finding clinical trials for
580560 - new drugs hard to find for treating Millie.  Rosalie is continuing to
580561 - search for drug trials that can help Millie by supplementing the
580562 - declining pool of drugs for her condition, as discussed on 041130,
580563 - ref SDS 34 028N, and citing Kaiser's rationale that drug trials are an
580564 - essential part of patient care for oncology practice. ref SDS 22 DG4X
580565 -
580566 -
580567 -
580568 -
5806 -

SUBJECTS
Adriamycin Cytoxan AC 2 Cycles Doctor Prescribes Additional Cycles a

6303 -
630401 -  ..
630402 - Heart Test for Damage from More than 4 Cycles of AC
630403 - Adriamycin Cytoxan AC 6 Cycles Prescribed and MUGA Test to Check Heart
630404 - MUGA Test Cumulative Heart Damage from Exceeding 4 AC Treatments
630405 -
630406 - Follow up ref SDS 42 XQ41.
630407 -
630408 - The doctor was disappointed learning today that Millie cannot
630409 - participate in the drug trial per above. ref SDS 0 JF4M
630411 -  ..
630412 - Millie asks if this means treatments can switch to Taxol, or to
630413 - Taxotere and capecitabine, planned on 041230, ref SDS 42 XQ41, since
630414 - examination today indicates that AC does not seem very effective, per
630415 - above? ref SDS 0 025H
630417 -  ..
630418 - On 050104 treatments began with Adriamycin Cytoxan (AC) prescribed on
630419 - 041230 in order for Millie to qualify for a clinical study.  At that
630420 - time on 041230 only 2 treatments were prescribed, making a total of 4
630421 - with AC, ref SDS 43 DB65, which complies with guidance on 041230 that
630422 - limits cumulative damage to the heart. ref SDS 42 XQ84
630424 -  ..
630425 - On 050104 the nurse in the Infusion Clinic discovered that the
630426 - Chemotherapy Order prescribed 4 additional treatments, ref SDS 43
630427 - DB6G, making a total of 6, which is 50% greater than guidance to avoid
630428 - cumulative damage to the heart, discussed by the doctor on 041230.
630429 - ref SDS 42 XQ84
630431 -  ..
630432 - Millie has now received a total of four (4) treatments with AC, adding
630433 - the first two completed on 020603, ref SDS 5 WO4O, and the two
630434 - completed on 050128. ref SDS 45 0001  There are 2 more treatments
630435 - under the current Chemotherapy Order reported on 050104. ref SDS 43
630436 - DB6G  The doctor explained today that the additional treatments makig
630437 - a total of 6 prescribed with AC might meet requirements for having
630438 - four (4) consequtive cycles of AC to qualify for the drug trial,
630439 - discussed above. ref SDS 0 JF4M
630440 -
630441 -        [On 050329 AC not yielding good response, doctor changed
630442 -        treatment to capecitabine and Taxotere. ref SDS 50 T58M
630444 -  ..
630445 - Today, the doctor further proposed adding two (2) more treatments with
630446 - AC, making a total of 8, based on the prior history indicating there
630447 - may have been delayed improvement in diagnostics and clinical
630448 - observations, previously discussed on 041230. ref SDS 42 XQ88
630450 -  ..
630451 - Millie asked about concerns cited by the doctor on 041230 that more
630452 - than 4 treatments with AC increases risk of heart damage. ref SDS 42
630453 - XQ84
630455 -  ..
630456 - The doctor scheduled a MUGA test for impact on the heart from
630457 - extending AC beyond four (4) treatments, cited on 041230 as the point
630458 - of potiential risk to patients. ref SDS 42 XQ84
630459 -
630460 -     [On 050328 Millie at Kaiser for MUGA test. ref SDS 49 0Y6I
630461 -
630462 -     [On 050329 Kaiser changed prescription to treat 1st relapse of
630463 -     IBC from AC to capecitabine and Taxotere. ref SDS 50 T58M
630464 -
630465 -
630466 -
630467 -
630468 -
630469 -
630470 -
630471 -
630472 -
630473 -
630474 -
630475 -
6305 -