THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: August 12, 2005 10:25 AM Friday;
Rod Welch
Case study meetings communication due diligence medical healthcare.
1...Summary/Objective
2...Cancer Discovery Lumps Left Breast Left Axilla Biopsy 020208
3...Surgery Lumpectomy 3/3 Lymph Nodes Positive 020312
4...Treatment Plan Stage IIA 4 Treatments AC Radition Taxotere
5...Chemotherapy Treatment Begins with AC 020423
6...CA 15-3 Rises PET Scan Shows Poor Response So Switch to Taxotere
7...Radiation Treatments Begin at Mt Diablo CA 15-3 Drops 020723
8...Radiation Completed Phase II Chemotherapy with Taxotere 020924
9...Patient Cleared for Return to Work
10...PET Test CA 15-3 Falls Rises IBC Symptoms Begin to Appear 030109
11...Red Rash Observed on Left Breast Treated for Cellulitus
12...IBC Symptoms Rise and Fall through 2003 No Treatment 030508
13...CT Test Reports 2 Lymph Nodes Left Axilla Not Previously Observed
14...CT Test Reports Breast Cancer Symptoms Correlate Clinically 030710
15...CA 15-3 Continues Rising to 68 Neck Stiffness Reported
16...Relapse Neck Biopsy Positive Diagnosed Metastatic Cancer 040211
17...CT Test Reports Symptoms of IBC CA 15-3 Continues Rising
18...Red Rash Observed on Left Breast Treated for Cellulitus
19...Avastin Taxol Treatment Breast Cancer Delayed to Treat Cellulitus
20...Treatments Begin with Avastin Taxol Drug Trial 040420
21...IBC Diagnosed Biopsy Left Breast Consistent with Regional Symptoms
22...Cough Chest Breathing Heavy Nose Bleed Side Effects Avastin 040517
23...IBC Diagnosed Stage IV Treatment Priority Assigned
24...CT Tests Shows Favorable Response Treatment with Avastin Trial 040811
25...2nd Opinion Evaluate Surgery Option When IBC Regresses Sufficiently
26...CT Test Shows No Distant Metastasis Reports Pulmonary Emboli 041104
27...Pulmonary Emboli Report on CT Test Patient Removed from Avastin Trial
28...Treatment Paused to Change Protocol due to Finding Pulmonary Emboli
29...Treatment Resumes with AC Implement Stanford 2nd Opinion 041230
30...Relapse IBC Treatment with AC Begins Patient Condition Worsens
31...CT Test Reports No Change in Adenopathy No Finding Distant Metastasis
32...Symptoms Rise Surgery Discussed for Mastectomy Continue AC 050311
33...Surgery Examination to Assess Criteria for Treatment with Mastectomy
34...IBC Symptoms Rise CA 15-3 100 Treatment Changed Taxotere Xeloda 050329
35...Taxotere Capecitabien (Xeloda) Treatment Switched Patient Improves
36...Patient Improves Inflammation Regresses CA 15-3 Falls to 67 050520
37...IBC Symptoms Fall Treatment with Taxotere and Capecitiabine (Xeloda)
38...CT Test Shows No Signs Distant Metastasis Adenopathy Almost Resolved
39...Surgery Window of Opportunity Examination for Mastectomy 050610
40...CA 15-3 Falls to Lowest in 4 years IBC Symptoms Appear Resolved
41...Due Diligence Assess Treatment Options Planning Mastectomy
42...2nd Opinion #2 Planning Due Diligence on Mastectomy Option 050811
43...Treatment Paused after 7 Cycles for Surgery Analysis and Operation
44...Mastectomy Surgery Planning to Obtain 2nd Opinions for Due Diligence
........PET scan shows complete response to treatment
..............
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CONTACTS
SUBJECTS
Medical Management Case Study History Organizational Memory Meetings
2703 -
2703 - ..
2704 - Summary/Objective
2705 -
270501 - Follow up ref SDS 86 0000, ref SDS 84 0000.
270502 -
270503 - This study presents a chronology with the first event at the top, and
270504 - most recent at the bottom; so, for example, the first event is problem
270505 - discovery, ref SDS 0 UF4J, and the last event demonstrates progress
270506 - toward a solution. ref SDS 0 XQ7H Only major meetings and events are
270507 - shown, and are linked for instant access to give command and control
270508 - of communications, based on situational awareness, as explained in
270509 - POIMS. ref OF 1 1113
270510 -
270511 - [On 060722 case study continues to obtain 2nd opinion on
270512 - options to treat IBC relapse following surgery. ref SDS C1 XQ7H
270514 - ..
270515 - The study sounds in health care for managing cancer; process mechanics
270516 - illustrate general "intelligence" support, defined in NWO. ref OF 2
270517 - A56M The overall study of patient history presents several studies on
270518 - aspects of care, e.g., discovery of IBC, purpose and scope of surgery.
270520 - ..
270521 - Documentation of tests and diagnsotics is presented in context with
270522 - links to original sources. e.g., PET, CT test reports. For example,
270523 - where "CT test" is mentioned, click on the link to get the pathology
270524 - report, along with related analysis, decisions, and follow up on
270525 - results.
270527 - ..
270528 - "Precision access" opens links to relevant context, as defined in NWO.
270529 - ref OF 2 5H4J This means click a link, e.g., ref SDS 0 KP68, to read
270530 - a few sentences or paragraphs, then click...
270531 -
270532 - Back
270533 -
270534 - ...in the top left corner of the browser to continue following work
270535 - history in this case study.
270537 - ..
270538 - Chronology, context, and connection enable navigation for command and
270539 - control of complex history. see POIMS, ref OF 1 8555 Links open
270540 - original sources on points of interest, with further connections
270541 - within a contextual frame going forward and backward in time showing
270542 - the sequence of implementation for understanding causation, as
270543 - explained in POIMS. ref OF 1 1113
270544 -
270545 -
270546 -
270547 -
270549 - ..
2706 -
2707 -
2708 - Progress
2709 -
270901 - On 050811 work began on 2nd opinion for treatment plan, ref SDS 86
270902 - 0001, including surgery. This case study summarizes patient history
270903 - on meetings at Kaiser, integrating dialog and documents on symptoms,
270904 - tests, analysis, reasoning, diagnosis, planning, and treatment...
270905 -
270906 - [On 060722 case study continues from date of mastectomy surgery
270907 - on 051021 to obtain 2nd opinion on treating IBC relapse.
270908 - ref SDS C1 XQ7H
270909 -
270911 - ..
270912 - Cancer Discovery Lumps Left Breast Left Axilla Biopsy 020208
270913 -
270914 -
270915 - 1. Meeting with doctor; lump
270916 - reported on left breast, and
270917 - under left arm; mamogram and
270918 - biopsy ordered to diagnose
270919 - lump under left arm and on
270920 - left breast.......................... 020208, ref SDS 1 0001
270922 - ..
270923 - 2. Mamogram test........................ 020211, ref SDS 2 0001
270924 -
270925 - [...results negative. ref SDS 0 884G
270927 - ..
270928 - 3. Biopsy scheduled on left
270929 - breast for 020304.................... 020214, ref SDS 3 SI5K
270931 - ..
270932 - 4. Biopsy on left breast performed...... 020304, ref SDS 4 0001
270934 - ..
270935 - 5. Biopsy report received during
270936 - meeting with surgeon; diagnosis
270937 - tumor infiltrating carcinoma
270938 - in the left breast; patient
270939 - scheduled for surgery to perform
270940 - lumpectomy........................... 020306, ref SDS 5 IW6N
270941 -
270942 - [On 040517 report on biopsy taken
270943 - 040419 diagnoses IBC. ref SDS 0 MD5W
270944 -
270945 -
270947 - ..
270948 - Surgery Lumpectomy 3/3 Lymph Nodes Positive 020312
270949 - Treatment Plan Stage IIA 4 Treatments AC Radition Taxotere
270950 -
270951 -
270952 - 6. Surgery on left breast at
270953 - Kaiser hospital in Walnut Creek...... 020312, ref SDS 6 0001
270955 - ..
270956 - Lumpectomy operation performed
270957 - and biopsy of removed tissue;
270958 - post-op report by surgeon on
270959 - discovery of cancerous left
270960 - axillary lymph nodes found
270961 - out of capsule....................... 020312, ref SDS 6 Q78M
270963 - ..
270964 - Mamography test report received
270965 - in mail after returning from
270966 - surgery for breast cancer, says
270967 - the mamogram test found no
270968 - evidence of breast cancer............ 020312, ref SDS 6 YV3O
270970 - ..
270971 - 7. Meeting in Oncology Department
270972 - to plan treatment for breast
270973 - cancer............................... 020321, ref SDS 7 0001
270975 - ..
270976 - Primary care physician assigned;
270977 - collaboration with surgery
270978 - pending on Team Care practice........ 020321, ref SDS 7 MA3F
270980 - ..
270981 - Pathology reports on two (2)
270982 - biopsies received from operation
270983 - on left breast: metastatic
270984 - carcinoma tumor infiltrating
270985 - through the capsule into
270986 - the peri-nodal fatty tissue,
270987 - left breast sentinel lymph node;
270988 - 3 out of 3 lymph nodes positive
270989 - for metastatic disease, tumor
270990 - involves the capsule, but does
270991 - not extend into the perinodal
270992 - fatty tissue, left axillary
270993 - tissue; estrogen receptor
270994 - negative; progesteron receptor
270995 - negative; Her2/neu negative;
270996 - DNA index 1.6; MIB1 16%
270997 - borderline........................... 020321, ref SDS 7 YE5N
270999 - ..
271000 - AJCC staging criteria
271001 - presented, patient classified
271002 - stage IIA; regional lymph nodes
271003 - involved, distant metastasis not
271004 - identified at this time.............. 020321, ref SDS 7 6Q4U
271005 -
271006 - [On 040614 patient changed to
271007 - stage IV after IBC diagnosed.
271008 - ref SDS 0 MD5W
271010 - ..
271011 - Tests ordered CT, bone scan,
271012 - blood................................ 020321, ref SDS 7 4Z59
271014 - ..
271015 - Treatment plan chemotherapy begin
271016 - phase 1 with 4 cycles of Adriamycin
271017 - Cytoxan (AC) over 4 months; then
271018 - 4 weeks of radiation; conclude
271019 - with phase 2 chemotherapy
271020 - Taxotere............................. 020321, ref SDS 7 6SWS
271022 - ..
271023 - 8. Surgery reexcision left breast
271024 - to achieve clear margins............. 020327, ref SDS 8 0001
271026 - ..
271027 - 9. Meeting doctor in Oncology;
271028 - schedule chemotherapy treatments
271029 - to begin on 020421; pathology
271030 - reports clear margins achieved
271031 - reexcision surgery left breast
271032 - on 020327............................ 020405, ref SDS 9 0001
271034 - ..
271035 - 10. Surgeon examins patient for
271036 - recovery from operation.............. 020408, ref SDS 10 0001
271037 -
271038 -
271040 - ..
271041 - Chemotherapy Treatment Begins with AC 020423
271042 - CA 15-3 Rises PET Scan Shows Poor Response So Switch to Taxotere
271043 -
271044 -
271045 - 11. Chemotherapy treatments begin
271046 - at Kaiser in Walnut Creek............ 020423, ref SDS 11 0001
271048 - ..
271049 - 12. CA 15-3 above 80 after surgery;
271050 - conflicts with normal pattern of
271051 - rapid decline toward normal after
271052 - surgery; doctor orders PET scan
271053 - test................................. 020430, ref SDS 12 PD7J
271055 - ..
271056 - 13. PET scan test on 020529; pathology
271057 - report discussed during meeting
271058 - with doctor, and shows regional
271059 - metastasis under left axillary;
271060 - no finding of distant
271061 - metastasis........................... 020603, ref SDS 13 0001
271063 - ..
271064 - CA 15-3 elevates to 117.............. 020603, ref SDS 13 4X5K
271066 - ..
271067 - Treatment changed from AC to
271068 - Taxotere............................. 020603, ref SDS 13 WO4O
271070 - ..
271071 - 14. 3rd Chemotherapy treatment starts
271072 - first treatment with Taxotere after
271073 - doctor switched on 020603 from
271074 - AC................................... 020610, ref SDS 14 MR5I
271076 - ..
271077 - 15. Meeting with doctor reports brain
271078 - MRI test shows no distant
271079 - metastasis........................... 020628, ref SDS 15 5S5M
271081 - ..
271082 - Bone scan test on 020613
271083 - results submitted no problems........ 020628, ref SDS 15 QA6L
271085 - ..
271086 - CA 15-3 67 shows substantial drop
271087 - from 117 after changing chemotherapy
271088 - drug agent treatment from AC
271089 - to Taxotere.......................... 020628, ref SDS 15 QB22
271091 - ..
271092 - 16. Chemotherapy phase 1 complete
271093 - afer 2 treatments with AC and
271094 - final 2 with Taxotere; treatment
271095 - proceeds with concern that white
271096 - blood cell count is very
271097 - low.................................. 020701, ref SDS 16 0001
271098 -
271099 -
271101 - ..
271102 - Radiation Treatments Begin at Mt Diablo CA 15-3 Drops 020723
271103 -
271104 -
271105 - 17. Radition orientation meeting at
271106 - Mt Diablo to plan treatments
271107 - scheduled for 4 cycles............... 020708, ref SDS 17 0001
271109 - ..
271110 - 18. Radiation treatment begins
271111 - at Mt Diablo hospital in Concord..... 020723, ref SDS 18 0001
271113 - ..
271114 - 19. Meeting primary care physician
271115 - CA 15-3 cancer marker drops to
271116 - lowest level; doctor concerned
271117 - about erratic changes in CA 15-3;
271118 - Millie's case submitted to Kaiser
271119 - Tumor Board, results not submitted
271120 - to patient........................... 020726, ref SDS 19 0001
271122 - ..
271123 - 20. Rash reaction to radiation on left
271124 - breast not evident from
271125 - examination.......................... 020726, ref SDS 19 2F5J
271127 - ..
271128 - Doctor consulting the radiologist
271129 - for backup 2nd opinion on
271130 - diagnosis and treatment
271131 - ideas................................ 020726, ref SDS 19 YO6K
271132 -
271133 -
271135 - ..
271136 - Radiation Completed Phase II Chemotherapy with Taxotere 020924
271137 - Patient Cleared for Return to Work
271138 -
271139 -
271140 - 21. Meeting with doctor to schedule
271141 - phase II chemotherapy treatment
271142 - with Taxotere........................ 020924, ref SDS 20 0001
271144 - ..
271145 - CA 15-3 cancer marker dropped into
271146 - the 30s; doctor gives clearance for
271147 - returning to work during 3rd phase
271148 - of treatment beginning following
271149 - week................................. 020924, ref SDS 20 TE3J
271151 - ..
271152 - 22. Taxotere 1st cycle phase II
271153 - adjuvant chemotherapy treatment
271154 - begins............................... 021002, ref SDS 21 0001
271156 - ..
271157 - 23. Taxotere 4th cycle phase II
271158 - chemotherapy treatment, and 6th cycle
271159 - overall of Taxotere, including 2
271160 - cycles that replaced phase I AC
271161 - treatments on 020603, concludes
271162 - adjuvant breast cancer
271163 - treatment............................ 021204, ref SDS 22 0001
271165 - ..
271166 - 24. Meeting with doctor on completing
271167 - phase 2 of chemotherapy.............. 021206, ref SDS 24 0001
271169 - ..
271170 - CA 15-3 continues rising over
271171 - period of Taxotere treatment;
271172 - doctor explains a trend has
271173 - not yet been established............. 021206, ref SDS 23 5E6L
271175 - ..
271176 - Patient reports mild, occassional
271177 - discomfort from swelling under
271178 - left arm; diagnosed as drainage
271179 - from surgery 9 months earlier when
271180 - lymph nodes were removed on 020312,
271181 - and condition was diagnosed as
271182 - "out of capsule"..................... 021206, ref SDS 24 KW5F
271184 - ..
271185 - Firm, stiff skin on left breast
271186 - diagnosed as reaction to radiation
271187 - treatment............................ 021206, ref SDS 23 SG7J
271189 - ..
271190 - PET scan test schedule advanced
271191 - from January to December for
271192 - evaluating rising CA 15-3............ 021206, ref SDS 23 LK5L
271193 -
271195 - ..
271196 - PET Test CA 15-3 Falls Rises IBC Symptoms Begin to Appear 030109
271197 - Red Rash Observed on Left Breast Treated for Cellulitus
271198 -
271199 -
271200 - 25. Meeting with doctor to review
271201 - recent diagnostics for assessing
271202 - relapse; good news CA 15-3 finally
271203 - falls................................ 030109, ref SDS 25 0001
271205 - ..
271206 - PET test on 021218 reports new
271207 - mild diffuse increased uptakes
271208 - at region of left supraclavicular,
271209 - left upper chest, and, also, left
271210 - axilla; may align with increased
271211 - discomfort under left arm, and
271212 - previous report on 021206 of new
271213 - mild discomfort from new
271214 - swelling under left arm.............. 030109, ref SDS 25 L66M
271215 -
271216 - [On 040517 pathology report on
271217 - breast biopsy reports IBC,
271218 - ref SDS 0 FS6K; research found
271219 - regional metastatic disease
271220 - involving same side breast,
271221 - axilla, supraclavicular
271222 - symptomatic of IBC.
271223 - ref SDS 0 RV8H
271225 - ..
271226 - [On 041104 analyst called to
271227 - alert doctor of severe condition
271228 - pulmonary emboli findings in
271229 - CT test report. ref SDS 0 4V5G
271231 - ..
271232 - PET scan report for test on 021218
271233 - evaluated as showing no finding of
271234 - distant metastasis................... 030109, ref SDS 25 GK61
271236 - ..
271237 - Patient reports increased
271238 - discomfort under left arm,
271239 - along left side; clinical
271240 - examination under left
271241 - arm found no scar
271242 - tissue............................... 030109, ref SDS 25 KW5F
271244 - ..
271245 - Doctor observes red rash
271246 - coloration and firmness of
271247 - left breast.......................... 030109, ref SDS 25 KW5F
271248 - Diagnosis cellulitis................. 030109, ref SDS 25 0T6N
271249 - Treatment antibiotics................ 030109, ref SDS 25 GK7T
271251 - ..
271252 - Neck stiffness examined; diagnosed
271253 - side effects of surgery and
271254 - radiation treatments................. 030109, ref SDS 25 II34
271256 - ..
271257 - 26. Doctor observes red rash
271258 - reduced indicating effective
271259 - treatment with antibiotics........... 030220, ref SDS 26 0T6N
271261 - ..
271262 - CA 15-3 25% rise discussed
271263 - with doctor for treatment
271264 - of relapse........................... 030220, ref SDS 26 GJ5M
271266 - ..
271267 - Research CA 15-3 cancer marker....... 030220, ref SDS 26 PQ7T
271269 - ..
271270 - CT test report shows no
271271 - evidence of cancer................... 030220, ref SDS 26 GK51
271272 -
271273 -
271275 - ..
271276 - IBC Symptoms Rise and Fall through 2003 No Treatment 030508
271277 - CT Test Reports 2 Lymph Nodes Left Axilla Not Previously Observed
271278 -
271279 -
271280 - 27. Meeting with doctor reveals
271281 - rising symptoms; discuss plans
271282 - for proactive care to avoid
271283 - and minimize relapse................. 030508, ref SDS 27 0001
271285 - ..
271286 - Patient reports lump under left
271287 - arm where surgery was performed
271288 - to remove infected lymph nodes
271289 - and cancer was found out of
271290 - capsule; doctor cannot detect
271291 - lump, diagnosis scar tissue
271292 - from surgery and reaction to
271293 - radiation............................ 030508, ref SDS 27 7C84
271295 - ..
271296 - CA 15-3 54 - 20% rise discuss
271297 - implications for relapse based
271298 - on ASCO guidance..................... 030508, ref SDS 27 GJ5M
271300 - ..
271301 - CT test report finds 2 lymph
271302 - nodes less than 1 CM in
271303 - left axilla that were not
271304 - present in prior exam................ 030508, ref SDS 27 VM8N
271306 - ..
271307 - Biopsy discussed to investigate
271308 - new swelled lymph nodes; decide
271309 - to wait for next CT test............. 030508, ref SDS 27 7C98
271311 - ..
271312 - 28. Meeting requested by patient ahead
271313 - of scheduled examination in July,
271314 - because of rising symptoms in left
271315 - axilla and red rash on left
271316 - breast............................... 030606, ref SDS 28 0001
271318 - ..
271319 - Growing lump under left arm and
271320 - discomfort during exercise; doctor
271321 - found lump now feels larger;
271322 - commented that 2 1 CM swelled
271323 - lymph nodes reported in CT test
271324 - on 030508 are deeper in the body
271325 - than lumps indicated by clinical
271326 - examination; diagnosis of
271327 - patient discomfort from lump
271328 - under the arm was scar tissue........ 030606, ref SDS 28 Y45M
271330 - ..
271331 - Doctor observes severe redness,
271332 - reported a week earlier, had
271333 - subsided on the day of examination,
271334 - so no treatment prescribed; doctor
271335 - notices thickening of skin on
271336 - left breast attributed to side
271337 - effects of radiation................. 030606, ref SDS 28 7C6W
271339 - ..
271340 - Relapse symptoms of breast cancer
271341 - rise; has doctors attention;
271342 - examination determines that test,
271343 - and clinical symptoms do not yet
271344 - require treatment for
271345 - relpase.............................. 030606, ref SDS 28 NE7L
271347 - ..
271348 - Biopsy and PET scan testing
271349 - discussed and deferred to
271350 - following month for assessing
271351 - rising symptoms and treatment
271352 - to mitigate relapse.................. 030606, ref SDS 28 P97J
271353 -
271354 -
271356 - ..
271357 - CT Test Reports Breast Cancer Symptoms Correlate Clinically 030710
271358 - CA 15-3 Continues Rising to 68 Neck Stiffness Reported
271359 -
271360 -
271361 - 29. CT scan test on 030626 reports
271362 - findings of persistant dermal
271363 - (skin) thickening left breast;
271364 - notes that invasion of the dermal
271365 - lymphatics from known breast
271366 - cancer can present similarly;
271367 - left axillary adenopathy nodes
271368 - measuring 1.5 cm, a 50% increase
271369 - from prior study; findings
271370 - attributed to radiation treatment
271371 - a year earlier; recommends to
271372 - correlate clinically................. 030710, ref SDS 29 VM7I
271373 -
271374 - [On 040517 pathology report on
271375 - breast biopsy uses similar
271376 - language for symptoms of IBC.
271377 - ref SDS 0 296L
271379 - ..
271380 - [On 040517 research found regional
271381 - metastatic disease involving same
271382 - side breast, axilla, supraclavicular
271383 - symptomatic of IBC. ref SDS 0 RV8H
271385 - ..
271386 - [On 041104 analyst called to
271387 - alert doctor of severe condition
271388 - pulmonary emboli findings in
271389 - CT test report. ref SDS 0 4V5G
271391 - ..
271392 - CA 15-3 68 - 30% rise and
271393 - clinical correlation of CT
271394 - test findings with examination
271395 - attributes patient symptoms to
271396 - reaction from prior radiation
271397 - treatment a year
271398 - earlier.............................. 030710, ref SDS 29 7C6W
271400 - ..
271401 - 30. PET scan testing discussed to
271402 - assess emerging problems for
271403 - proactive treatment.................. 030915, ref SDS 30 7C6W
271405 - ..
271406 - CA 15-3 66 - stable test report
271407 - showing prior steady rise has
271408 - paused indicates patient may
271409 - have stabalized; doctor plans
271410 - to order another CT test in
271411 - 2 months............................. 030915, ref SDS 30 7C6W
271413 - ..
271414 - Neck stiffness periodic and
271415 - persisting past 9 months; doctor
271416 - orders xray.......................... 030915, ref SDS 30 GB3M
271418 - ..
271419 - 31. CT test on 031031 relatively stable
271420 - since 030626 with slight decrease
271421 - in size of a few left axillary lymph
271422 - nodes; appears conflicting with
271423 - prior reports of 2 1.5 CM lymph
271424 - nodes in left axilla increasing
271425 - by 50%............................... 031205, ref SDS 31 GJ69
271427 - ..
271428 - CA 15-3 62 - drops from 66
271429 - indicating patient stable;
271430 - doctor reports "great"............... 031205, ref SDS 31 7C6W
271431 -
271432 -
271434 - ..
271435 - Relapse Neck Biopsy Positive Diagnosed Metastatic Cancer 040211
271436 - CT Test Reports Symptoms of IBC CA 15-3 Continues Rising
271437 - Red Rash Observed on Left Breast Treated for Cellulitus
271438 - Avastin Taxol Treatment Breast Cancer Delayed to Treat Cellulitus
271439 -
271440 -
271441 - 32. Lymph nodes swelled in neck
271442 - supraclavicular region
271443 - near collarbone, led to
271444 - request for meeting with
271445 - doctor............................... 040211, ref SDS 32 WP7L
271446 - Diagnosis infection.................. 040211, ref SDS 32 S15G
271447 - Treatment antibiotics................ 040211, ref SDS 32 6S6N
271449 - ..
271450 - 33. Lymph nodes supraclavicular
271451 - swelling persists in the
271452 - neck, biopsy ordered................. 040227, ref SDS 33 0001
271454 - ..
271455 - 34. Biopsy performed on swelled
271456 - lymph nodes left side of
271457 - neck; planning for surgery
271458 - to removed suspect lymph
271459 - nodes................................ 040303, ref SDS 34 Y171
271461 - ..
271462 - 35. Meeting with doctor to assess
271463 - pathology report on lumps in the
271464 - neck, and red rash on left breast
271465 - that flarred up again................ 040318, ref SDS 35 0001
271467 - ..
271468 - Biopsy pathology report
271469 - found swelled lymph nodes
271470 - in the supraclavicular area
271471 - of the neck are cancer............... 040318, ref SDS 35 8R6M
271473 - ..
271474 - Relapse diagnosed metastatic
271475 - cancer due to disease in the
271476 - neck................................. 040318, ref SDS 35 WA4H
271478 - ..
271479 - Treatment chemotherapy prescribed
271480 - bevacizumab (Avastin) Taxol
271481 - trial protocol....................... 040318, ref SDS 35 PU6M
271483 - ..
271484 - CT test on 040307 reports 11 x 7 mm
271485 - node in the left posterior
271486 - cervical triangle. There is
271487 - 11 x 9 mm node in the high
271488 - left supraclavicular region
271489 - A few subcentimeter nodes are
271490 - seen along the jugular chains
271491 - bilateralerly. There is no
271492 - express finding of cancer nor
271493 - mention of adenopathy................ 040318, ref SDS 35 WB8Q
271495 - ..
271496 - CA 15-3 70 - rise signals reaction
271497 - to biopsy, does not indicate
271498 - distant metastasis................... 040318, ref SDS 35 GJ5M
271500 - ..
271501 - Doctor observes severe redness
271502 - redness in left breast that led
271503 - request for early meeting............ 040318, ref SDS 35 IM6J
271504 - Diagnosis cellulitus................. 040318, ref SDS 35 PY4N
271505 - Treatment antibiotics delays
271506 - start of chemotherapy until
271507 - after antibiotics clear
271508 - cellulitus........................... 040318, ref SDS 35 PY5H
271510 - ..
271511 - PET test rejected to assess
271512 - scope of metastasis because
271513 - CT tests show problem limited
271514 - to the neck.......................... 040318, ref SDS 35 HC5G
271516 - ..
271517 - 2nd opinion discussed to support
271518 - Kaiser Team Care; primary care
271519 - physician commends cancer programs
271520 - at UCSF and Stanford................. 040318, ref SDS 35 AW6M
271522 - ..
271523 - 36. Red rash left breast persists
271524 - observed by doctor................... 040402, ref SDS 36 IM6J
271525 - Diagnosis changed from cellulitus
271526 - to reaction from radiation
271527 - treatments given in August 2002...... 040402, ref SDS 36 8T5O
271528 - Treatment steroid and cleared
271529 - to commence chemotherapy with
271530 - taxol and bevacizumab (Avastin)...... 040402, ref SDS 36 SY6J
271532 - ..
271533 - 37. 2nd opinion Kaiser explains
271534 - support by the Tumor Board to
271535 - assist Team Care practice............ 040409, ref SDS 37 7K4G
271537 - ..
271538 - 38. Tumor Board scheduled to hear
271539 - Millie's case on 040416.............. 040414, ref SDS 38 HS3O
271541 - ..
271542 - 39. Meeting with doctor to begin 1st
271543 - cycle of chemotherapy trial using
271544 - Taxol and bevacizumab (Avastin);
271545 - doctor advises that Tumor Board
271546 - met earlier in the day and heard
271547 - Millie's case; but published
271548 - findings not yet
271549 - available............................ 040416, ref SDS 39 AW6M
271551 - ..
271552 - Doctor examined left breast
271553 - and found red inflammation
271554 - had reduced slightly, and
271555 - new CT test report today
271556 - shows no cancer in the left
271557 - breast, so treatment with
271558 - steriods was ended................... 040416, ref SDS 39 IM6J
271560 - ..
271561 - CT test on 040410 marked "not
271562 - finalized" describes post operative
271563 - multiple axillary lymph nodes,
271564 - the largest on the right
271565 - measuring 15 x 9 mm and
271566 - the largest on the left
271567 - measuring 14 x 10 mm.
271568 - Post operative changes are
271569 - again noted within the left
271570 - axillary region and the breast.
271571 - No significant mediastinal or
271572 - hilar lymphadenopathy is
271573 - appreciated.......................... 040416, ref SDS 39 7V3R
271575 - ..
271576 - Case study Communication Metrics
271577 - requirements for accuracy to
271578 - spearate "signal from noise"
271579 - wicked problem illustrated by
271580 - variance in language and lack of
271581 - prompts to alert doctors and
271582 - expand situational awareness of
271583 - critical findings; doctors do
271584 - not invest time for study and
271585 - analysis (cognitive overhead) to
271586 - correlate clinically critical
271587 - findings with related patient
271588 - history for accurate assessment
271589 - of diagnosis and
271590 - treatment............................ 040416, ref SDS 39 PTSX
271591 -
271592 -
271594 - ..
271595 - Treatments Begin with Avastin Taxol Drug Trial 040420
271596 - IBC Diagnosed Biopsy Left Breast Consistent with Regional Symptoms
271597 -
271598 -
271599 - 40. Surgeon takes punch biopsy on
271600 - left breast to assess severe
271601 - red rash at request of patient
271602 - after minor operation to install
271603 - port catheter for getting
271604 - chemotherapy treatments.............. 040419, ref SDS 40 789F
271605 -
271606 - [On 040517 patient receives
271607 - pathology report. ref SDS 0 FS6K
271609 - ..
271610 - [On 040614 patient diagnosed with
271611 - IBC. ref SDS 0 MD5J
271613 - ..
271614 - 41. Treatments begin with Taxol and
271615 - trial protocol using bevacizumab
271616 - (Avastin)............................ 040420, ref SDS 41 9Z5J
271618 - ..
271619 - 42. Surgeon reports pathology on
271620 - biopsy of left breast taken on
271621 - 040419 found cancer; requires
271622 - mastectomy after 4 - 6 cycles
271623 - of chemotherapy to clear up
271624 - red rash; no disclosure of
271625 - IBC.................................. 040429, ref SDS 42 J757
271627 - ..
271628 - 43. Doctor visits patient in
271629 - Chemotherapy Clinic during
271630 - treatment, explains normally
271631 - biopsy is ordered when breast
271632 - redness observed, invariably
271633 - results are negative, so biopsy
271634 - was not ordered, and IBC was
271635 - overlooked. No change in
271636 - treatment; there was no
271637 - disclosure to patient of
271638 - IBC.................................. 040504, ref SDS 43 WI8F
271640 - ..
271641 - 44. Meeting with doctor for examination
271642 - to begin 2nd cycle of Taxol and
271643 - bevacizumab (Avastin) chemotherapy
271644 - trial treatment...................... 040517, ref SDS 44 0001
271646 - ..
271647 - Tumor Board findings from hearing
271648 - on 040416 to assist Team Care
271649 - practice submitted to patient,
271650 - shows no consideration of report
271651 - on biopsy taken 040419 that later
271652 - reveals diagnosis of IBC............. 040517, ref SDS 44 4R59
271654 - ..
271655 - During the meeting, doctor handed
271656 - patient a pathology report for
271657 - breast biopsy taken on 040419,
271658 - ref SDS 0 525U, report was not
271659 - reviewed nor discussed; IBC was
271660 - not explained during the
271661 - meeting.............................. 040517, ref SDS 44 6T5G
271663 - ..
271664 - Biopsy reviewed after meeting doctor;
271665 - pathology report shows diagnosis of
271666 - metastatic carcinoma involving dermal
271667 - lymphmatics consistent with
271668 - inflammatory carcinoma of the
271669 - breast (IBC), similar to language
271670 - received last year on 030710,
271671 - ref SDS 0 UF77, in a CT scan
271672 - test report.......................... 040517, ref SDS 44 7D6F
271673 -
271674 - [On 051027 biopsy of mastectomy
271675 - tissue following systemic
271676 - treatment finds no evidence of
271677 - IBC. ref SDS 0 XO9J
271679 - ..
271680 - Research on biopsy report shows
271681 - regional symptoms inflammatory
271682 - breast cancer (IBC) red rash,
271683 - thickening of skin and swelled
271684 - lymph nodes in neck and under
271685 - the arm; first reported on 021206,
271686 - ref SDS 44 2F4G; cited in PET scan
271687 - test report on 021218, received
271688 - by patient 030109, ref SDS 0 P66P,
271689 - and later in a CT scan report on
271690 - 030626 received 030710, ref SDS 0
271691 - UF77, IBC rare, aggressive
271692 - metastatic disease with average
271693 - longevity 18 months, afflicts
271694 - less than 1% of breast cancer
271695 - cases; requires immediate
271696 - aggressive and tailored
271697 - treatment............................ 040517, ref SDS 44 6M9H
271699 - ..
271700 - Case study regional metastasis
271701 - axillary lymphadenopathy summary
271702 - of history on lumps under left
271703 - arm.................................. 040517, ref SDS 44 OW3I
271705 - ..
271706 - Case study red rash inflammation
271707 - of left breast....................... 040517, ref SDS 44 S66O
271709 - ..
271710 - Work plan for aggressive treatment
271711 - IBC.................................. 040517, ref SDS 44 5Q5L
271713 - ..
271714 - Lessons learned patient case
271715 - history.............................. 040517, ref SDS 44 PW8F
271716 -
271717 -
271719 - ..
271720 - Cough Chest Breathing Heavy Nose Bleed Side Effects Avastin 040517
271721 - IBC Diagnosed Stage IV Treatment Priority Assigned
271722 -
271723 -
271724 - Coughing, breathing difficult,
271725 - heavy chest new problem reported;
271726 - may correlate with side effects
271727 - of bevacizumab (Avastin) for
271728 - pulmonary emboli due to blood
271729 - clots................................ 040517, ref SDS 44 RZ4I
271731 - ..
271732 - 45. Letter to doctor asking about
271733 - biopsy report, diagnosis of IBC
271734 - and work plan to prepare for
271735 - next meeting on 040614............... 040610, ref SDS 45 0001
271737 - ..
271738 - 46. Meeting with doctor for examination
271739 - to begin 3rd cycle of Taxol and
271740 - bevacizumab (Avastin) chemotherapy
271741 - trial treatment...................... 040614, ref SDS 46 0001
271743 - ..
271744 - CA 15-3 78 - rise aligns with new
271745 - diagnosis IBC most severe form
271746 - breast cancer........................ 040614, ref SDS 46 GJ5M
271748 - ..
271749 - IBC - inflammatory breast cancer
271750 - patient notified of diagnosis
271751 - in this case......................... 040614, ref SDS 46 6T5G
271753 - ..
271754 - Stage IV most severe cancer
271755 - condition assigned to patient
271756 - elevated from orignial stage
271757 - IIA, ref SDS 0 OR56, treatment
271758 - protocol............................. 040614, ref SDS 46 6M9H
271760 - ..
271761 - Tumor Board did not review IBC
271762 - symptoms, doctor recommends
271763 - against re-hearing based on
271764 - pathology report for biopsy taken
271765 - on 040419 which diagnosed IBC
271766 - 3 days after the hearing
271767 - on 040416............................ 040614, ref SDS 46 4R59
271769 - ..
271770 - Cough and heavy chest continue;
271771 - difficulty breathing subsides,
271772 - except when climbing stairs,
271773 - hiking, etc; cough medicine
271774 - prescribed........................... 040614, ref SDS 46 RZ4I
271776 - ..
271777 - Dilemma - doctor advises patient
271778 - will have to make a choice on
271779 - having surgery orginally set
271780 - in the treatment plan, or continue
271781 - with Avastin trial; requires
271782 - 2nd opinion.......................... 040614, ref SDS 46 JK8L
271784 - ..
271785 - 47. Meeting with doctor to start 4th
271786 - cycle of Taxol and bevacizumab
271787 - (Avastin) chemotherapy trial
271788 - yields reduced symptoms of
271789 - cancer............................... 040713, ref SDS 47 0001
271791 - ..
271792 - CA 15-3 47 - falls 1st time in 7
271793 - months; indicates favorable
271794 - response to treatment................ 040713, ref SDS 47 GJ5M
271796 - ..
271797 - Bone scan shows no evidence
271798 - metastatic cancer.................... 040713, ref SDS 47 L34N
271800 - ..
271801 - Metastatic cancer diagnosed
271802 - based solely on lumps in neck
271803 - which are symptoms of IBC............ 040713, ref SDS 47 8R6M
271804 -
271805 -
271807 - ..
271808 - CT Tests Shows Favorable Response Treatment with Avastin Trial 040811
271809 - 2nd Opinion Evaluate Surgery Option When IBC Regresses Sufficiently
271810 -
271811 -
271812 - 48. CT test on 040710 shows no
271813 - findings of cancer; lumps in
271814 - neck, under arm significantly
271815 - decreased indicating favorable
271816 - response to treatment................ 040811, ref SDS 48 WV66
271818 - ..
271819 - 49. Meeting with doctor to start 5th
271820 - cycle of Taxol and bevacizumab
271821 - (Avastin) chemotherapy trial;
271822 - clinical examination shows strong
271823 - recovery under Avastin trial......... 040812, ref SDS 49 0001
271825 - ..
271826 - CA 15-3 78 - rise aligns with new
271827 - diagnosis IBC most severe form
271828 - breast cancer........................ 040812, ref SDS 46 GJ5M
271830 - ..
271831 - Patient advised that surgery not
271832 - necessarily recommended treatment
271833 - for IBC; discuss criteria for
271834 - evaluating sufficient recovery
271835 - to pause treatments in order to
271836 - recover from side effects............ 040812, ref SDS 49 T75L
271838 - ..
271839 - Conflicts in medical tests not
271840 - resolved with precision of
271841 - engineering.......................... 040812, ref SDS 49 T761
271843 - ..
271844 - Coughing, bleeding nose, heavy
271845 - chest, difficult breathing
271846 - continue; patient asks about
271847 - public reports by Genentec
271848 - that Avastin causes blood clots
271849 - in some patients who died;
271850 - related family history of
271851 - blood clots.......................... 040812, ref SDS 49 RZ4I
271852 -
271853 - [On 050922 2nd opinion recommends
271854 - hypercoagulable state work up for
271855 - family history blood clot issues.
271856 - ref SDS 0 5Z3N
271858 - ..
271859 - [On 051007 patient removed from
271860 - treatment for pulmonary emboli after
271861 - report of high risks for surgery
271862 - complications due to patient history
271863 - of pulmonary emboli. ref SDS 0 MI45
271865 - ..
271866 - [On 060722 evident family genetic
271867 - cause pulmonary emboli.
271868 - ref SDS C0 3D9T
271870 - ..
271871 - 50. Meeting with doctor to start 6th
271872 - cycle of Taxol and bevacizumab
271873 - (Avastin) chemotherapy trial;
271874 - clinical examination shows
271875 - recovery under Avastin trial......... 040909, ref SDS 50 0001
271877 - ..
271878 - Side effects worsen, coughing
271879 - same, but heaviness in chest
271880 - and breathing more difficult;
271881 - doctor reviews CT tests showing
271882 - no evidence of cancer................ 040909, ref SDS 50 RZ4I
271884 - ..
271885 - 2nd opinion plans to implement
271886 - doctor's recommendation and resolve
271887 - dilemma presented by doctor on
271888 - 040614 and 040812 whether treat
271889 - IBC with surgery after recovery
271890 - with Taxol bevacizumab (Avastin)
271891 - trial, or avoid surgery and
271892 - continue with Avastin until
271893 - progression.......................... 040909, ref SDS 50 AW6M
271895 - ..
271896 - 51. 2nd opinion investigate sources
271897 - and submit requests to cancer
271898 - centers.............................. 041002, ref SDS 51 0001
271900 - ..
271901 - 52. Meeting with doctor to start 7th
271902 - cycle of Taxol and bevacizumab
271903 - (Avastin) chemotherapy trial;
271904 - clinical examination shows
271905 - recovery under Avastin trial......... 041005, ref SDS 52 0001
271907 - ..
271908 - CA 15-3 49 unexpectedly rising
271909 - in seeming conflict with improved
271910 - clinical condition, and CT tests
271911 - showing recovery from IBC............ 041005, ref SDS 52 GJ5M
271913 - ..
271914 - CT test on 040921 shows
271915 - significant progress
271916 - toward recovery, no signs of
271917 - cancer............................... 041005, ref SDS 52 NL4N
271919 - ..
271920 - Side effects from chemotherapy
271921 - worsen for cough, heavy chest,
271922 - nose bleed, and breathing
271923 - difficulty........................... 041005, ref SDS 52 RZ4I
271925 - ..
271926 - 2nd opinion doctor facilitates
271927 - assembly and transfer of patient
271928 - medical history, including test
271929 - reports and imaging.................. 041005, ref SDS 52 AW6M
271931 - ..
271932 - 53. CA 15-3 39 falls to normal for
271933 - first time in 3 years reverses
271934 - 3 month rise to 49................... 041014, ref SDS 54 2N5J
271936 - ..
271937 - 54. Documents patient history received
271938 - from Kaiser for transfer to Cancer
271939 - Centers in support of 2nd opinions;
271940 - organized record, corrected errors
271941 - and omissions, prepared summary
271942 - index of chronology to facilitate
271943 - review by doctors.................... 041014, ref SDS 53 0001
271945 - ..
271946 - 55. Meeting at UCSF Doctor Benz for
271947 - 2nd opinion; examination found
271948 - slight inflammation in left breast;
271949 - recommend continue Avastin trial;
271950 - sees no role for
271951 - surgery.............................. 041018, ref SDS 55 0001
271952 -
271953 - [...see below receive 2nd opinion
271954 - from Doctor Benz. ref SDS 0 6F9I
271956 - ..
271957 - 56. Meeting at Stanford Doctor Guardino
271958 - 2nd opinion; examination found
271959 - slight inflammation left breast;
271960 - recommend continue Avastin trial;
271961 - sees possible role for surgery
271962 - after regression of
271963 - inflammation......................... 041019, ref SDS 56 0001
271964 -
271965 - [...see below receive 2nd opinion
271966 - from Doctor Guardino. ref SDS 0
271967 - OO8F
271968 -
271970 - ..
271971 - CT Test Shows No Distant Metastasis Reports Pulmonary Emboli 041104
271972 - Pulmonary Emboli Report on CT Test Patient Removed from Avastin Trial
271973 - Treatment Paused to Change Protocol due to Finding Pulmonary Emboli
271974 -
271976 - ..
271977 - 57. 7th treatment on Avastin Taxol
271978 - Trial................................ 041021, ref SDS 57 0001
271979 -
271981 - ..
271982 - 58. Meeting at Kaiser with doctor
271983 - to start 8th cycle of Taxol
271984 - and bevacizumab (Avastin) trial;
271985 - clinical examination shows
271986 - continued recovery; dramatic
271987 - change in patient profile with
271988 - all treatment paused
271989 - for 2 weeks.......................... 041104, ref SDS 58 0001
271991 - ..
271992 - CT test on 041103 reports pulmonary
271993 - emboli blood clots; analyst calls
271994 - doctor to warn about severe
271995 - conditions........................... 041104, ref SDS 58 QP6S
271996 -
271997 - [...see above, previously,
271998 - doctor not warned on 030109
271999 - of regional symptoms for IBC
272000 - reported in PET scan test,
272001 - ref SDS 0 P66P; nor for CT
272002 - scan test report 6 months
272003 - later on 030710. ref SDS 0 UF77
272005 - ..
272006 - Patient removed from Avastin trial
272007 - to resolve side effects cough,
272008 - bleeding nose, heavy chest,
272009 - difficult breathing.................. 041104, ref SDS 58 RZ4I
272011 - ..
272012 - Coumadin treatment dose increased,
272013 - extended for life based on one CT
272014 - test report.......................... 041104, ref SDS 58 4Y9G
272016 - ..
272017 - Examination found slight
272018 - inflammation of left breast
272019 - requiring continued
272020 - treatment............................ 041104, ref SDS 58 6T5G
272022 - ..
272023 - Substitute doctor explains dilemma
272024 - of whether to continue treatment
272025 - with Taxol or Taxotere which have
272026 - proven effective, or pause
272027 - treatments, and allow disease to
272028 - regain momentum; doctor schedules
272029 - meeting with primary care
272030 - physician and recommends
272031 - immediate treatment to maintain
272032 - progress recovering from
272033 - IBC.................................. 041104, ref SDS 58 Q59K
272035 - ..
272036 - 59. 2nd opinion report received from
272037 - Doctor Benz for examination at
272038 - UCSF on 041018, ref SDS 0 4Y3F,
272039 - excellent review of patient
272040 - history despite difficulty
272041 - accessing documentation
272042 - online............................... 041117, ref SDS 59 OS6W
272044 - ..
272045 - Mastectomy surgery not recommended
272046 - for Millie's patient profile......... 041117, ref SDS 59 OU5P
272047 -
272048 - [On 050729 Kaiser recommends
272049 - mastectomy. ref SDS 0 T35I
272050 -
272051 - [On 050819 UCSF asked for 2nd
272052 - opinion on surgery. ref SDS 0 3H5F
272054 - ..
272055 - Taxotere capecitabine and other
272056 - treatment options suggested after
272057 - disease progresses under Avastin
272058 - trial................................ 041117, ref SDS 59 OU5V
272059 -
272060 - [On 041130 primary care physician
272061 - plans treatment with trial protocol
272062 - based on 2nd opinion from Doctor
272063 - Benz. ref SDS 0 VY5M
272065 - ..
272066 - [On 041210 treatment trial protocol
272067 - using capecitabine scheduled to
272068 - implement. ref SDS 0 VA4F
272070 - ..
272071 - [On 041230 could not implement trial
272072 - protocol; tried AC recommended by
272073 - Doctor Guardino at Stanford.
272074 - ref SDS 0 RW7I
272076 - ..
272077 - [On 050329 treatment switched to
272078 - implement Doctor Benz 2nd opinion.
272079 - ref SDS 0 8O8J
272081 - ..
272082 - 60. Meeting with doctor to schedule
272083 - treatment after patient removed
272084 - from Avastin trial................... 041130, ref SDS 60 0001
272086 - ..
272087 - CA 15-3 39 sudden drop to normal
272088 - reported on 041014 cited by
272089 - doctor to indicate patient made
272090 - favorale response to treatment on
272091 - Avastin trial, ref SDS 0 YE4U,
272092 - and goal is to maintain
272093 - recovery............................. 041130, ref SDS 60 GJ5M
272095 - ..
272096 - Side effects cough, heavy chest,
272097 - nose bleed, breathing difficult
272098 - continue since ending treatment on
272099 - Avastin trial, and increasing
272100 - dosage of Coumadin; doctor expects
272101 - side effects to subside without
272102 - additional treatment................. 041130, ref SDS 60 RZ4I
272104 - ..
272105 - Wound from biopsy on left breast
272106 - performed on 040419, ref SDS 0 525U,
272107 - has suddenly worsened, tissue
272108 - sample taken antibioitc based on
272109 - penicillin prescribed to treat
272110 - cellulitus........................... 041130, ref SDS 60 6T5G
272112 - ..
272113 - IBC red rash observed on left
272114 - breast; discuss taking "holiday"
272115 - from treatment, extending period
272116 - since last treatment 5 weeks
272117 - earlier on 041021.................... 041130, ref SDS 60 025H
272119 - ..
272120 - 2nd opinion from UCSF reviewed;
272121 - primary care physician explans
272122 - practice to synthesize ideas;
272123 - proposes implement recommendation
272124 - by Doctor Benz to treat Millie
272125 - with Taxotere and capecitabine
272126 - (Xeloda)............................. 041130, ref SDS 60 5X4J
272127 -
272128 - [On 041230 primary care physician
272129 - synthesizes 2nd opinions by
272130 - prescribing AC proposed by Stanford
272131 - in order to qualify patient for
272132 - drug trial with capecitabine
272133 - proposed by UCSF. ref SDS 0 RW7I
272135 - ..
272136 - [On 050329 AC was not effective
272137 - treatment switched to Taxotere and
272138 - capecitabine recommended in 2nd
272139 - opinion from Doctor Benz at UCSF.
272140 - ref SDS 0 8O8J
272142 - ..
272143 - [On 050913 primary care physician
272144 - objects to performing Time Out due
272145 - diligence on grounds that 2nd opinions
272146 - delay impementation of Kaiser's opinion
272147 - for mastectomy surgery to treat stage IV
272148 - secondary IBC and pulmonary emboli,
272149 - currently NED by CT testing.
272150 - ref SDS 0 265F
272152 - ..
272153 - Treatment needs to resume in order
272154 - to avoid relapse by maintaining
272155 - continuity of drug levels in the
272156 - body, recommended in 2nd opinions
272157 - from UCSF and Stanford............... 041130, ref SDS 60 Y66F
272159 - ..
272160 - Treatment deferred while protocol
272161 - nurse searches for new drug trial
272162 - using capecitiabine recommended
272163 - by Doctor Benz at
272164 - UCSF................................. 041130, ref SDS 60 028N
272166 - ..
272167 - Work planning requirements
272168 - and further review by Tumor
272169 - Board discussed...................... 041130, ref SDS 60 YR8F
272171 - ..
272172 - Chemotherapy drugs available for
272173 - treatment options to extend
272174 - quality of life...................... 041130, ref SDS 60 FY5F
272175 -
272176 - [On 041230 treatment plan
272177 - developed based on 2nd opinions
272178 - from UCSF and Stanford.
272179 - ref SDS 0 WZ42
272181 - ..
272182 - 61. Emergency room hospital treatment
272183 - IBC symptoms suddenly increase;
272184 - temperature, inflammation rise;
272185 - resolved as reaction to antibiotic
272186 - treatment of persistant biopsy
272187 - wound for cellulitus................. 041202, ref SDS 61 0001
272189 - ..
272190 - 62. 2nd opinion received from Doctor
272191 - Guardino for examination at Stanford
272192 - on 041019, ref SDS 0 4Y36, delayed
272193 - submission and communication
272194 - issues hamper use of Stanford's
272195 - report............................... 041209, ref SDS 62 LO5L
272196 - Excellent review with few
272197 - mistakes on patient history
272198 - despite inability to access
272199 - documentation online................. 041209, ref SDS 62 OW4T
272200 -
272201 - [On 050819 prior problems with
272202 - delays and communication prevent
272203 - asking Stanford for follow up
272204 - 2nd opinion on surgery........... 050819, ref SDS 0 QP6G
272206 - ..
272207 - Recommendation to continue on
272208 - Avastin trial........................ 041209, ref SDS 62 XS4I
272209 -
272210 - [On 041104 recommendation failed
272211 - due to new finding of pulmonary
272212 - emboli. ref SDS 0 GX5K
272214 - ..
272215 - Patient has room for for 2 more
272216 - doses of AC chemotherapy............. 041209, ref SDS 62 SN88
272217 -
272218 - [On 041230 Kaiser prescribes 4
272219 - more treatments with AC to
272220 - qualify patient for drug trial
272221 - with capecitabine recommended
272222 - by UCSF. ref SDS 0 RW7I
272224 - ..
272225 - Surgery possibility for patient
272226 - after regression of inflammatory
272227 - component of disease................. 041209, ref SDS 62 SN97
272228 -
272229 - [On 050729 Kaiser recommends
272230 - mastectomy surgery. ref SDS 0 T35I
272232 - ..
272233 - [On 050819 prior problems with
272234 - delays and communication prevent
272235 - asking Stanford for follow up
272236 - 2nd opinion on surgery........... 050819, ref SDS 0 QP6G
272238 - ..
272239 - 63. Meeting with doctor to schedule
272240 - treatment after patient removed
272241 - from Avastin trial................... 041210, ref SDS 63 0001
272243 - ..
272244 - CA 15-3 43 slight rise offers no
272245 - signal of concern after 7 weeks
272246 - without treatment.................... 041210, ref SDS 63 GJ5M
272248 - ..
272249 - Side effects cough, heavy chest,
272250 - nose bleed, breathing difficult
272251 - now seem improved since ending
272252 - treatment on Avastin trial,
272253 - and increasing dosage of
272254 - Coumadin............................. 041210, ref SDS 63 RZ4I
272256 - ..
272257 - Wound from biopsy on left breast
272258 - performed on 040419, ref SDS 0 525U,
272259 - recovery slow; prescription with
272260 - antibiotics penicillin to treat
272261 - cellulitus continued................. 041210, ref SDS 63 6T5G
272263 - ..
272264 - IBC red rash on left breast worsening
272265 - after removing patient from treatment
272266 - due to side effects of pulmonary embolism
272267 - and 2 months delay starting new
272268 - treatment while searching for
272269 - clinical trial....................... 041210, ref SDS 63 025H
272271 - ..
272272 - Case study mastectomy surgery
272273 - considerations; primary care
272274 - physician requests feedback
272275 - from surgeon......................... 041210, ref SDS 63 ZV5J
272277 - ..
272278 - Rising symptoms relapse doctor
272279 - reports immediate treatment
272280 - needed to maintain control of
272281 - disease.............................. 041210, ref SDS 63 028N
272283 - ..
272284 - Treatment trial protocal proposed
272285 - Novel Epothilones BMS-247550 plus
272286 - capecitabine, implementing ideas
272287 - in 2nd opinion received from
272288 - Doctor Benz at UCSF.................. 041210, ref SDS 63 CF9F
272289 -
272290 - [...see above, Doctor Benz
272291 - suggested trying capecitabine
272292 - in combination with other
272293 - drugs. ref SDS 0 DJ4F
272295 - ..
272296 - [...see below, discovered
272297 - patient does not qualify.
272298 - ref SDS 0 RW7I
272300 - ..
272301 - Treatment rarely cures cancer;
272302 - oncology case management controls
272303 - progression of disease to extend
272304 - quality of life...................... 041210, ref SDS 63 NQ9J
272305 -
272307 - ..
272308 - Treatment Resumes with AC Implement Stanford 2nd Opinion 041230
272309 - Relapse IBC Treatment with AC Begins Patient Condition Worsens
272310 - CT Test Reports No Change in Adenopathy No Finding Distant Metastasis
272311 -
272312 -
272313 - 64. Meeting with doctor to determine
272314 - new treatment plan after relapse
272315 - of IBC............................... 041230, ref SDS 64 0001
272317 - ..
272318 - CA 15-3 56 25% rise signals relapse
272319 - along with other findings after
272320 - 10 weeks without treatment........... 041230, ref SDS 64 GJ5M
272322 - ..
272323 - CT test on 041217 reports no
272324 - change in adenopathy, no finding
272325 - of distant metastasis from prior
272326 - report............................... 041230, ref SDS 64 NL4N
272328 - ..
272329 - Case study longevity and quality of
272330 - life, not cure, are purpose of
272331 - treatment for stage IV cancer patient
272332 - prevent disease from cascading
272333 - out of control....................... 041230, ref SDS 64 P19O
272335 - ..
272336 - Pulmonary emboli blood clot
272337 - problem reported in prior
272338 - report resolved...................... 041230, ref SDS 64 PW3K
272340 - ..
272341 - Side effects cough, heavy chest,
272342 - nose bleed, breathing difficult
272343 - now seem resolved since ending
272344 - treatment on Avastin trial,
272345 - and increasing dosage of
272346 - Coumadin............................. 041230, ref SDS 64 RZ4I
272348 - ..
272349 - Wound from biopsy on left breast
272350 - performed on 040419, ref SDS 0 525U,
272351 - has worsened; prescription
272352 - antibiotics penicillin to treat
272353 - cellulitus ended; treatment plan
272354 - developed for IBC with chemotherapy
272355 - and surgery.......................... 041230, ref SDS 64 6T5G
272357 - ..
272358 - Surgery examination scheduled for
272359 - 050107 now part of treatment plan
272360 - and cited in 2nd opinion by Doctor
272361 - Guardino at Stanford................. 041230, ref SDS 64 CW6J
272363 - ..
272364 - IBC red rash on left breast much worse
272365 - after nearly 3 months off treatment
272366 - searching for clinical
272367 - trial................................ 041230, ref SDS 64 025H
272369 - ..
272370 - Trial protocal capecitabine and
272371 - Novel Epothilones BMS-247550,
272372 - doctor reports patient does not
272373 - yet qualify needs 2 more
272374 - treatments with AC................... 041230, ref SDS 64 028N
272376 - ..
272377 - Adriamacyn Cytoxan (AC) proposed
272378 - to implemnet 2nd opinion by Doctor
272379 - Guardino at Stanford and qualify
272380 - for trial with capecitabine to
272381 - implement 2nd opinion by Doctor
272382 - Bunz at UCSF......................... 041230, ref SDS 64 XQ41
272384 - ..
272385 - Treatment scheduled to begin ASAP
272386 - on 050104............................ 041230, ref SDS 64 8945
272388 - ..
272389 - Treatment plan for IBC relapse
272390 - chemotherapy options, possible
272391 - drug trial, testing and
272392 - surgery.............................. 041230, ref SDS 64 475F
272394 - ..
272395 - 65. Treatment resumes since 041021
272396 - with Adriamacyn Cytoxan (AC)
272397 - begin 2 cycles to qualify for
272398 - drug trial with capecitabine......... 050104, ref SDS 65 0001
272399 -
272400 - [...see last treatment on 041021.
272401 - ref SDS 0 WJ3J
272403 - ..
272404 - 66. Surgery mastectomy impossible; IBC red
272405 - rash inflammation spreads beyond breast
272406 - toward neck; biopsy wound very messy
272407 - discuss criteria required for surgery
272408 - proposed by primary care
272409 - physician............................ 050107, ref SDS 66 IS5N
272411 - ..
272412 - 67. Meeting with doctor to assess progress
272413 - and adjust treatment for
272414 - IBC relapse.......................... 050204, ref SDS 67 0001
272416 - ..
272417 - CA 15-3 67 20% rise signals relapse
272418 - worsening along with other findings
272419 - after 2 cycles treatment with
272420 - AC; extend treatment for 2 more
272421 - cycles............................... 050204, ref SDS 67 GJ5M
272423 - ..
272424 - Wound from biopsy on left breast
272425 - performed on 040419, ref SDS 0 525U,
272426 - improves with chemotherapy
272427 - treatment AC; discuss meeting with
272428 - surgeon on 050107.................... 050204, ref SDS 67 6T5G
272430 - ..
272431 - IBC on left breast inflammation
272432 - may show both regression in some
272433 - places, and might be worse;
272434 - progress indeterminate............... 050204, ref SDS 67 025H
272436 - ..
272437 - Trial protocal capecitabine and
272438 - Novel Epothilones BMS-247550
272439 - doctor reports patient cannot
272440 - qualify afterall by getting
272441 - more treatments with AC.............. 050204, ref SDS 67 028N
272443 - ..
272444 - Treatment AC extended 2 more
272445 - cycles for a total of 6; MUGA
272446 - test proposed to check for
272447 - heart damage......................... 050204, ref SDS 67 XQ41
272449 - ..
272450 - 68. Emergency room treatment for cat
272451 - bite; temperature rises, infection
272452 - spreads on right hand; hospitalized
272453 - 4 days in fairly dangerous
272454 - condition............................ 050212, ref SDS 68 0001
272456 - ..
272457 - 69. Chemotherapy treatment deferred
272458 - a week by primary care physician
272459 - visiting Millie in hospital;
272461 - ..
272462 - CA 15-3 78 another major jump
272463 - after 2 treatments with AC;
272464 - doctor plans to switch to
272465 - capecitabine if progresss does not
272466 - improve.............................. 050214, ref SDS 69 D177
272468 - ..
272469 - 70. Chemotherapy 3rd treatment (5th
272470 - overall) under relapse regimine
272471 - and implementing plans on 050204,
272472 - performed today...................... 050225, ref SDS 70 407N
272473 -
272474 -
272476 - ..
272477 - Symptoms Rise Surgery Discussed for Mastectomy Continue AC 050311
272478 - Surgery Examination to Assess Criteria for Treatment with Mastectomy
272479 -
272480 -
272481 - 71. Meeting with doctor to assess
272482 - progress and adjust treatment for
272483 - IBC relapse condition worsens........ 050311, ref SDS 71 0001
272485 - ..
272486 - CA 15-3 95 20% rise then falls
272487 - to 88, may signal beginning of
272488 - favorable response to AC............. 050311, ref SDS 71 GJ5M
272490 - ..
272491 - Wound from biopsy on left breast
272492 - performed on 040419, ref SDS 0 525U,
272493 - shows slight improvement with AC
272494 - treatments........................... 050311, ref SDS 71 6T5G
272496 - ..
272497 - IBC on left breast inflammation now
272498 - spreading, and cancer blisters
272499 - suddently occur, signal rising IBC
272500 - activity............................. 050311, ref SDS 71 025H
272502 - ..
272503 - Doctor calls surgeon requests
272504 - another examination to assess
272505 - pockets of resistance to
272506 - chemotherapy, and determine
272507 - criteria for mastectomy.............. 050311, ref SDS 71 XQ41
272509 - ..
272510 - Treatment with AC continued and
272511 - MUGA test scheduled to assess
272512 - heart damage......................... 050311, ref SDS 71 J53N
272514 - ..
272515 - 72. Surgery examination for evaluation
272516 - of criteria to perform mastectomy;
272517 - surgeon found condition worse
272518 - than prior exam...................... 050324, ref SDS 72 0001
272520 - ..
272521 - Inflammation left breast advances
272522 - above breast toward neck; cancer
272523 - sores visible on surface of breast
272524 - continuing problem observed by
272525 - primary care physician............... 050324, ref SDS 72 YY7F
272527 - ..
272528 - Surgery criteria discussed for
272529 - diagnostics on conditions,
272530 - scope, and practitioner for
272531 - performing mastectomy on IBC
272532 - patient with regional
272533 - disease.............................. 050324, ref SDS 72 OV5H
272535 - ..
272536 - Surgery criteria reviewed
272537 - for patient to approve surgical
272538 - solution............................. 050324, ref SDS 72 VL4O
272540 - ..
272541 - Research found some background
272542 - indicating IBC with regional
272543 - metastatic disease is not always
272544 - inoperable........................... 050324, ref SDS 72 TN76
272545 -
272547 - ..
272548 - IBC Symptoms Rise CA 15-3 100 Treatment Changed Taxotere Xeloda 050329
272549 - Taxotere Capecitabien (Xeloda) Treatment Switched Patient Improves
272550 -
272551 -
272552 - 73. Meeting with doctor to assess
272553 - progress and adjust treatment for
272554 - IBC relapse condition worsens........ 050329, ref SDS 73 0001
272556 - ..
272557 - CA 15-3 100 20% rise signals
272558 - worsening condition under treatment
272559 - with AC, and where treatments
272560 - deferred due to low WBC.............. 050329, ref SDS 73 GJ5M
272562 - ..
272563 - Wound from biopsy on left breast
272564 - performed on 040419, ref SDS 0 525U,
272565 - making slow recovery with
272566 - AC................................... 050329, ref SDS 73 6T5G
272568 - ..
272569 - IBC on left breast inflammation
272570 - still spreading; may be less
272571 - intense in some spots; cancer
272572 - blisters continue, and CA 15-3
272573 - rising to 100 signal worsening
272574 - IBC, or at best slow
272575 - recovery............................. 050329, ref SDS 73 025H
272577 - ..
272578 - Treatment plan revised; switch
272579 - from AC to combination of
272580 - Taxotere and capecitatine (Xeloda)
272581 - recommended in 2nd opinion by
272582 - Doctor Benz at UCSF.................. 050329, ref SDS 73 AW5G
272583 -
272584 - [On 050502 after 2 weeks, IBC
272585 - substantially subsides.
272586 - ref SDS 0 9H6F
272588 - ..
272589 - [On 051007 PET scan test indicates
272590 - complete response to treatment.
272591 - ref SDS 0 MI3Y
272593 - ..
272594 - 74. Treatment begins Taxotere and
272595 - capecitabine (Xeloda)................ 050415, ref SDS 74 407N
272596 -
272597 - [On 050502 after 2 weeks, IBC
272598 - substantially subsides.
272599 - ref SDS 0 9H6F
272601 - ..
272602 - Neupogin prescribed to build
272603 - immune system and recover from
272604 - low blood counts..................... 050415, ref SDS 74 SQ4H
272606 - ..
272607 - Side effects reviewed by
272608 - pharmacist........................... 050415, ref SDS 74 PS6X
272610 - ..
272611 - Coumadin dose adjusted to fit
272612 - prescription for Taxotere and
272613 - capecitabine (Xeloda)................ 050415, ref SDS 74 BV42
272615 - ..
272616 - Diary of side effects supports
272617 - adjusting dose of drugs.............. 050415, ref SDS 74 XT5F
272619 - ..
272620 - 75. Meeting with doctor to assess
272621 - progress with new treatment plan
272622 - for IBC relapse; conditions
272623 - worsen............................... 050422, ref SDS 75 0001
272625 - ..
272626 - CA 15-3 105 highest level ever
272627 - but moderating rise from prior
272628 - period; may indicate positive
272629 - results after starting 1st
272630 - treatment with Taxotere and
272631 - capecitabine (Xeloda) just a
272632 - week earlier......................... 050422, ref SDS 75 GJ5M
272634 - ..
272635 - CT test on 040325 reports
272636 - no finding of distant
272637 - metastasis........................... 050422, ref SDS 75 NL4N
272639 - ..
272640 - 100% growth right axillary
272641 - lymphadenopathy may signal
272642 - advancing disease.................... 050422, ref SDS 75 B58M
272644 - ..
272645 - MUGA test showed no hear damage
272646 - from getting 6 treatments
272647 - with AC.............................. 050422, ref SDS 75 IL7F
272649 - ..
272650 - IBC on left breast inflammation
272651 - not spreading; some cancer sores
272652 - may be drying up; too soon to
272653 - assess response...................... 050422, ref SDS 75 025H
272655 - ..
272656 - Side effects diary summarized
272657 - for decision support................. 050422, ref SDS 75 JY3N
272659 - ..
272660 - Work week reduced to 3 days to
272661 - cope with rising side
272662 - effects.............................. 050422, ref SDS 75 8X8L
272664 - ..
272665 - 76. IBC subsides substantially after 2
272666 - weeks treatment with Taxotere and
272667 - capecitabine (Xeloda)................ 050502, ref SDS 76 EO5J
272669 - ..
272670 - 77. Side effects compound beyond
272671 - patient tolerance; treatment
272672 - with capecitabine (Xeloda)
272673 - paused............................... 050514, ref SDS 77 AQ6G
272674 -
272675 -
272677 - ..
272678 - Patient Improves Inflammation Regresses CA 15-3 Falls to 67 050520
272679 - IBC Symptoms Fall Treatment with Taxotere and Capecitiabine (Xeloda)
272680 - CT Test Shows No Signs Distant Metastasis Adenopathy Almost Resolved
272681 -
272682 -
272683 - 78. Meeting with doctor shows big
272684 - improvement treating IBC relapse
272685 - after 2 cycles Taxoter and
272686 - capecitatine (Xeloda) recommended
272687 - by Doctor Benz at UCSF in a
272688 - 2nd opinion.......................... 050520, ref SDS 78 0001
272690 - ..
272691 - CA 15-3 67 significant fall from
272692 - 105 signals positive response
272693 - to treatment......................... 050520, ref SDS 78 GJ5M
272695 - ..
272696 - IBC on left breast inflammation
272697 - dramatic regression 1st time
272698 - since 041104; cancer sores seem
272699 - fully "dried up"; miraculous
272700 - recovery and improvement............. 050520, ref SDS 78 025H
272702 - ..
272703 - Side effects doctor examined
272704 - patient and discussed diary of
272705 - medical history on 050514,
272706 - ref SDS 0 1Z5M, showing tolerance
272707 - for side effects was
272708 - exceeded............................. 050520, ref SDS 78 NT3I
272710 - ..
272711 - Treatment plan continue full
272712 - dose Taxotere and reduce dose
272713 - for captecitabine (Xeloda) by
272714 - 25%.................................. 050520, ref SDS 78 V43H
272716 - ..
272717 - Urinary tract bladder infection
272718 - treated with antibiotics prescribed
272719 - Keflex............................... 050520, ref SDS 78 VT3O
272721 - ..
272722 - Dental cleaning examination for
272723 - infection approved................... 050520, ref SDS 78 YU8N
272725 - ..
272726 - 79. Meeting with doctor shows
272727 - continued strong improvement
272728 - treating IBC relapse after 3
272729 - cycles Taxoter and capecitatine
272730 - (Xeloda) with dose reduced by
272731 - 25%.................................. 050610, ref SDS 79 0001
272733 - ..
272734 - CA 15-3 56 continues falling
272735 - signals positive response
272736 - to treatment......................... 050610, ref SDS 79 GJ5M
272738 - ..
272739 - CT test on 050530 reports no
272740 - finding of distant
272741 - metastasis........................... 050610, ref SDS 79 NL4N
272743 - ..
272744 - Adenopathy lymph nodes on prior
272745 - test almost totally resolved......... 050610, ref SDS 79 B58M
272747 - ..
272748 - IBC on left breast inflammation
272749 - and skin thickening regression
272750 - continues, texture returning
272751 - to normal............................ 050610, ref SDS 79 025H
272752 -
272753 -
272755 - ..
272756 - Surgery Window of Opportunity Examination for Mastectomy 050610
272757 - CA 15-3 Falls to Lowest in 4 years IBC Symptoms Appear Resolved
272758 -
272759 -
272760 - Surgery window of opportunity
272761 - doctor calls surgeon requests
272762 - follow up examination................ 050610, ref SDS 79 XQ41
272763 -
272764 - [...patient responds to treatment
272765 - proposed by Doctor Benz 2nd
272766 - opinion implemented on 050329.
272767 - ref SDS 0 8O8J
272769 - ..
272770 - Treatment plan maintain current
272771 - dose; side effects subside........... 050610, ref SDS 79 NC6I
272773 - ..
272774 - Urinary tract bladder infection
272775 - treated successfully with
272776 - Keflex............................... 050610, ref SDS 79 VT3O
272778 - ..
272779 - 80. Side effects - 2 hikes of 3 miles
272780 - within several days at end of
272781 - 3rd cycle; side effects tolerable
272782 - with dose capecitabine
272783 - reduced 25%.......................... 050617, ref SDS 80 0001
272785 - ..
272786 - 81. CA 15-3 37 - falls to lowest level
272787 - in 4 years, aligns with other
272788 - diagnostics and examinations......... 050708, ref SDS 81 2N5J
272790 - ..
272791 - 82. Side effects become more severe
272792 - tolerance very difficult after
272793 - 5th cycle even with dose of
272794 - capecitabine reduced by 25%.......... 050712, ref SDS 82 0001
272796 - ..
272797 - 83. Surgery examination shows patient
272798 - seems ready for mastectomy; Kaiser
272799 - Team Care investigating
272800 - options.............................. 050727, ref SDS 83 0001
272802 - ..
272803 - Inflammation left breast full
272804 - regression; nipple distortion
272805 - fully recovered to normal; skin
272806 - texture near normal.................. 050727, ref SDS 83 YY7F
272808 - ..
272809 - Criteria for surgery discussed
272810 - on performing mastectomy on IBC
272811 - patient with regional
272812 - disease.............................. 050727, ref SDS 83 OV5H
272814 - ..
272815 - CA 15-3 46 bounces back from
272816 - low of 37 reported during
272817 - treatment on 050708.................. 050727, ref SDS 83 YK6K
272819 - ..
272820 - Surgeon will investigate for
272821 - practitioners who have performed
272822 - mastectomy on patients with
272823 - IBC.................................. 050727, ref SDS 83 O85O
272825 - ..
272826 - Surgeon discusses criteria for
272827 - patient to consider in approving
272828 - a mastectomy in this case............ 050727, ref SDS 83 VL4O
272830 - ..
272831 - 84. Meeting with doctor no clinical
272832 - examinations; focus on scheduling
272833 - surgery for mastectomy of left
272834 - breast............................... 050729, ref SDS 84 0001
272836 - ..
272837 - CA 15-3 46 sudden reversal of 4
272838 - month trend with 25% rise signals
272839 - possible continuing cancer
272840 - activity; doctor orders 2 more
272841 - cycles Taxotere and capecitabine
272842 - (Xeloda)............................. 050729, ref SDS 84 GJ5M
272844 - ..
272845 - Surgery - doctor asks date when
272846 - mastectomy is scheduled to be
272847 - performed; patient presents plans
272848 - for due diligence to assess
272849 - surgery.............................. 050729, ref SDS 84 BZ56
272851 - ..
272852 - Surgeon in Kaiser's Oakland office
272853 - called today on referall from
272854 - Kaiser's Walnut Creek office and
272855 - discussed general planning for
272856 - surgery in mid-Septemeber............ 050729, ref SDS 84 U265
272858 - ..
272859 - Treatment plan after 5 cycles of
272860 - Taxotere and capecitabine (Xeloda)
272861 - doctor schedules 2 more cycles
272862 - to address rising CA 15-3, and
272863 - to maintain window of opportunity
272864 - for surgery; 7th and final cycle
272865 - to begin on 050819, then pause
272866 - for "chemotherapy holiday" and
272867 - possible surgery in
272868 - mid-September........................ 050729, ref SDS 84 AW5G
272870 - ..
272871 - Side effects becoming harder to
272872 - tolerate; decide to maintain dose
272873 - for 2 more cycles.................... 050729, ref SDS 84 DS5J
272875 - ..
272876 - 85. Side effects increase following
272877 - 6th cycle Taxotere capecitabine
272878 - (Xeloda)............................. 050809, ref SDS 85 0001
272879 -
272880 -
272882 - ..
272883 - Due Diligence Assess Treatment Options Planning Mastectomy
272884 - 2nd Opinion #2 Planning Due Diligence on Mastectomy Option 050811
272885 - Treatment Paused after 7 Cycles for Surgery Analysis and Operation
272886 - Mastectomy Surgery Planning to Obtain 2nd Opinions for Due Diligence
272887 -
272888 -
272889 - 86. 2nd opinion planning to assess
272890 - surgery for mastectomy, and
272891 - follow up treatment.................. 050811, ref SDS 86 0001
272893 - ..
272894 - Entitlement and necessity for
272895 - due diligence performance of
272896 - 2nd opinion.......................... 050811, ref SDS 86 AY86
272898 - ..
272899 - 87. Patient history assembled with
272900 - comprehensive case study to support
272901 - 2nd opinion due diligence............ 050812, ref SDS 0 6L4M
272903 - ..
272904 - 88. 7th cycle begin with treatment
272905 - Taxotere and capecitabine (Xeloda);
272906 - dose maintained...................... 050819, ref SDS 88 0001
272908 - ..
272909 - CA 15-3 39 reverses again and
272910 - drops from 46 after 6th cycle
272911 - Taxotere and capecitabine
272912 - (Xeloda)............................. 050819, ref SDS 88 3K6L
272914 - ..
272915 - Side effects discussed with
272916 - Kaiser's pharmacist in Walnut
272917 - Creek Chemotherapy Clinic; Millie
272918 - at low end of severity suffered
272919 - by most patients..................... 050819, ref SDS 88 NY4F
272921 - ..
272922 - 89. UCSF Medical Center was asked for
272923 - 2nd opinion on advisability and
272924 - scope of surgery proposed by Kaiser;
272925 - Doctor Benz could update 2nd opinion
272926 - received on 041117 stating there
272927 - is no role for surgery in Millie's
272928 - case, and offering follow up
272929 - advice............................... 050819, ref SDS 87 PB4O
272930 -
272931 - [...see prior opinion on 041117.
272932 - ref SDS 0 NO4K
272934 - ..
272935 - Stanford Medical Center was not
272936 - asked for 2nd opinion because of
272937 - timing and communication
272938 - issues............................... 050819, ref SDS 87 AI8N
272939 -
272940 - [...see prior opinion received
272941 - on 041209. ref SDS 0 OO8F
272943 - ..
272944 - 90. UCSF Medical Center refused comment;
272945 - makes referral to surgeons for
272946 - 2nd opinions......................... 050823, ref SDS 89 AI8N
272947 - Requested again UCSF support first
272948 - 2nd opinion in November 2004 that
272949 - there is no role for surgery to
272950 - treat Millie's patient profile of
272951 - secondary IBC........................ 050823, ref SDS 89 QF7N
272953 - ..
272954 - 91. 2nd opinion #2 internal referral
272955 - at Kaiser; meeting with surgeon
272956 - in Oakland office.................... 050826, ref SDS 90 0001
272958 - ..
272959 - Examination finds IBC inflammation
272960 - regressed; recommends patient
272961 - ready for mastectomy surgery on
272962 - left breast.......................... 050826, ref SDS 90 AY5N
272964 - ..
272965 - Patient profile metastatic cancer
272966 - limited to regional disease which
272967 - presents stage III curative
272968 - treatment model...................... 050826, ref SDS 90 F49H
272970 - ..
272971 - 92. Medical records received from
272972 - Kaiser for 2nd opinions.............. 050907, ref SDS 92 11D8
272974 - ..
272975 - Business Office failed to notify
272976 - Pathology Department so biopsy
272977 - slides were not ready for
272978 - distribution......................... 050907, ref SDS 92 FA93
272980 - ..
272981 - Nuclear Medicine cannot find PET
272982 - scan test films ordered last
272983 - week................................. 050907, ref SDS 92 FA57
272985 - ..
272986 - Kaiser gave out medical records
272987 - for the wrong patient in envelope
272988 - for Millie; called and arranged
272989 - to return and obtain Millie's
272990 - medical records for 2nd
272991 - opinions............................. 050907, ref SDS 92 028E
272993 - ..
272994 - 93. 2nd opinion draft received from
272995 - Kaiser internal referal; confirms
272996 - findings from meeting on 050826
272997 - recommends surgery, and sets
272998 - goal for curative treatment
272999 - model................................ 050907, ref SDS 91 0001
273001 - ..
273002 - Distant metastasis study patient
273003 - history shows no evidence by
273004 - image testing and biopsy; patient
273005 - diagnosed local-regional breast
273006 - cancer............................... 050907, ref SDS 91 555G
273008 - ..
273009 - Retesting for change in original
273010 - status recommended to assess
273011 - expanding treatment options
273012 - proposed in Kaiser internal
273013 - referral............................. 050907, ref SDS 91 AE6P
273015 - ..
273016 - Patient history too complicated
273017 - not enough time for doctor to
273018 - review the record.................... 050907, ref SDS 91 AE5P
273020 - ..
273021 - Corrections submitted to doctor
273022 - on accurate patient
273023 - history.............................. 050908, ref SDS 93 08GF
273025 - ..
273026 - 94. 2nd opinion consultation Doctor
273027 - Bailey examination recommends
273028 - against mastectomy for Millie's
273029 - patient profile, and suggests
273030 - PET scan, mammogram, and breast
273031 - MRI testing to assess response
273032 - to treatment......................... 050909, ref SDS 94 1G4Q
273033 - proposes systemic treatment for
273034 - local control........................ 050909, ref SDS 94 1G4X
273036 - ..
273037 - 95. 2nd opinion consultation Doctor
273038 - Grissom recommends continuing
273039 - systemic chemotherapy treatment
273040 - with PET scan tests plus a series
273041 - of sliver skin biopsies to assess
273042 - response to treatment................ 050912, ref SDS 95 MW5M
273044 - ..
273045 - Very wide mastectomy and immediate
273046 - resonstruction best chance for
273047 - disease-free survival without
273048 - continuing systemic treatment........ 050912, ref SDS 95 MW67
273049 -
273050 - [...Doctor Bailey concurs on 050922. ref SDS 0 SY81
273052 - ..
273053 - 96. Primary care physician reviews
273054 - progress on due diligence for
273055 - patient to decide course of
273056 - action............................... 050913, ref SDS 96 T46F
273057 - doctor objects that Kaiser's
273058 - requirements for Time Out to
273059 - perform due diligence delays
273060 - surgery needed for local
273061 - control to save patient's
273062 - life................................. 050913, ref SDS 96 5T4J
273063 -
273064 - [Previously, on 041130 primary
273065 - care physician presented practice
273066 - to synthesize ideas from 2nd
273067 - opinions. ref SDS 0 SZ4L
273069 - ..
273070 - [On 041230 primary care physician
273071 - implemented 2nd opinion from
273072 - Stanford in order to qualify patient
273073 - for participating in trial that
273074 - implements 2nd opinion from UCSF.
273075 - ref SDS 0 RW7I
273077 - ..
273078 - [On 050329 treatment switched to
273079 - Taxotere and capecitabine proposed
273080 - in 2nd opinion from UCSF.
273081 - ref SDS 0 8O8J
273083 - ..
273084 - [On 050610 patient recovers with
273085 - treatment recommended in 2nd opinion
273086 - by Doctor Benz. ref SDS 0 W44L
273088 - ..
273089 - PET scan test and chemotherapy
273090 - requested by patient to implement
273091 - due diligence........................ 050913, ref SDS 96 G46F
273093 - ..
273094 - Doctor called surgeon and requested
273095 - that mastectomy be scheduled......... 050913, ref SDS 96 T646
273097 - ..
273098 - 97. Chemotherapy 8th cycle............... 050916, ref SDS 97 407N
273100 - ..
273101 - 98. Mammogram test....................... 050922, ref SDS 99 0001
273103 - ..
273104 - 99. 2nd opinion consultation Doctor
273105 - Bailey recommends against mastectomy
273106 - surgery.............................. 050922, ref SDS 98 XD6U
273108 - ..
273109 - Mastectomy if performed should
273110 - follow Grissom plan on 050912,
273111 - ref SDS 0 364I, for very wide
273112 - surgery.............................. 050922, ref SDS 98 XD8P
273114 - ..
273115 - 2nd opinion Doctor Bailey recommends
273116 - hypercoagulable state work up for
273117 - family history (reported on 040812,
273118 - ref SDS 0 QN3G) blood clot
273119 - issues............................... 050922, ref SDS 98 XD9X
273120 -
273121 - [On 060722 evident family genetic
273122 - cause pulmonary emboli.
273123 - ref SDS C0 3D9T
273125 - ..
273126 - 100. Surgeon consultation reviews
273127 - 2nd opinions received from
273128 - doctors Bailey, Grissom and
273129 - Shim................................. 050923, ref SDS A0 Z46K
273131 - ..
273132 - Team care communication has not
273133 - been effective for collaboration
273134 - performing due diligence............. 050923, ref SDS A0 N45O
273136 - ..
273137 - Surgeon orders retesting biopsy
273138 - on 040419 for status change to
273139 - investigate increasing treatment
273140 - options.............................. 050923, ref SDS A0 RX4I
273142 - ..
273143 - Thin skin biopies ordered to
273144 - compliment PET test, and establish
273145 - scope for very wide mastectomy to
273146 - remove skin previously infected
273147 - with IBC in order to reduce the
273148 - risk of relapse, as proposed in
273149 - 2nd opinions......................... 050923, ref SDS A0 SZ6M
273151 - ..
273152 - Due diligence check list reviewed
273153 - for Kaiser's Time Out surgery
273154 - requirements......................... 050923, ref SDS A0 HF7M
273156 - ..
273157 - Surgeon explains risks of
273158 - mastectomy surgery for Millie's
273159 - patient profile metastatic
273160 - cancer secondary IBC, multiple
273161 - relapses, pulmonary emboli,
273162 - microscopic cancer cells
273163 - will cause relapse................... 050923, ref SDS A0 KF6I
273165 - ..
273166 - 101. Plastic surgeon presents risks
273167 - of immediate reconstruction.......... 050928, ref SDS A1 UZ7K
273168 - recommends standard closure for
273169 - very wide mastectomy................. 050928, ref SDS A1 245N
273171 - ..
273172 - 102. Primary care physician submits
273173 - notes prepared by plastic surgeon
273174 - for meeting with patient on
273175 - 050928 that describe mastectomy
273176 - surgery for palliation............... 051007, ref SDS A2 MW6M
273178 - ..
273179 - 103. Plastic surgeon's consultation
273180 - notes say patient profile extremely
273181 - high risk for mastectomy surgical
273182 - complications from secondary
273183 - IBC, history of
273184 - relapse.............................. 051007, ref SDS A2 KO64
273185 - loss of blood vessels reduces
273186 - ability to deliver treatment
273187 - and nutrients to breast skin
273188 - in the case of relapse, and
273189 - pulmonary emboli..................... 051007, ref SDS A2 KO49
273191 - ..
273192 - Doctor asks patient to consent to
273193 - mastectomy surgery for palliation
273194 - strategy............................. 051007, ref SDS A2 MW6O
273195 - in the event of future relapse
273196 - caused by microscopic cancer
273197 - cells not detected by
273198 - testing.............................. 051007, ref SDS A2 IV4G
273200 - ..
273201 - Case study purpose of surgery for
273202 - local control........................ 051007, ref SDS A2 MW5O
273204 - ..
273205 - PET scan shows complete response to treatment
273206 - local control, and no evidence
273207 - of distant metastasis................ 051007, ref SDS A2 L66M
273208 -
273209 - [...patient responds to treatment
273210 - proposed by Doctor Benz 2nd
273211 - opinion implemented on 050329.
273212 - ref SDS 0 8O8J
273214 - ..
273215 - Pulmonary emboli treatment ended
273216 - one year after ending treatment
273217 - with Avastin that has blood clot
273218 - side effects; Kaiser policy waived
273219 - treat cancer patients diagnosed
273220 - with pulmonary emboli for life,
273221 - removes concern high risk for
273222 - surgical, postoperative complications
273223 - allowing palliative surgery
273224 - ordered by Oncology Department to
273225 - proceed; hypercoagulable state work
273226 - up recommended in 2nd opinion for
273227 - patient with family history of
273228 - blood clot problems was not
273229 - performed............................ 051007, ref SDS A2 RZ4I
273230 -
273231 - [On 060722 evident family genetic cause
273232 - pulmonary emboli reported. ref SDS C0 3D9T
273234 - ..
273235 - 104. Cure purpose very wide mastectomy
273236 - with immediate reconstruction to
273237 - remove skin previously infected with
273238 - IBC; pallication not required when
273239 - no evidence of disease; consultation
273240 - Doctor Grissom....................... 051010, ref SDS A3 GW4I
273242 - ..
273243 - 105. Doctor's notes for meeting on 051007
273244 - state in part that the patient
273245 - "...was seen by the plastic surgery
273246 - and the decision was that
273247 - reconstruction would add no value
273248 - to our current palliative
273249 - strategy."........................... 051011, ref SDS A5 SM6M
273251 - ..
273252 - 106. Reduce risk relapse purpose of
273253 - mastectomy surgery by removing
273254 - microscopic cancer cells in skin
273255 - previously infected with IBC;
273256 - palliation not required for disease-
273257 - free status; consultation Doctor
273258 - Bailey............................... 051011, ref SDS A4 X93F
273260 - ..
273261 - 107. Mastectomy surgery reduces palliation
273262 - prospects and benefits, and also
273263 - reduces ability to treat patient
273264 - for IBC relapse; surgery removes
273265 - blood vessels and capillaries in
273266 - breast tissue, which prevents
273267 - delivery of chemotherapy drug
273268 - treatment and immune system
273269 - nutrients 2nd opinion consultation
273270 - Doctor Bailey........................ 051011, ref SDS A4 G65S
273272 - ..
273273 - 108. Biopsies taken to assess response
273274 - to treatment, and determine scope
273275 - of surgery........................... 051012, ref SDS A6 DG6J
273277 - ..
273278 - 109. Letter prepared for patient to
273279 - support Kaiser's performance of
273280 - Time Out requirements for
273281 - due diligence........................ 051012, ref SDS A6 6Q9N
273283 - ..
273284 - 110. Due diligence analysis requirements
273285 - for "Time Out" to evaluate need
273286 - for surgery, scope, schedule,
273287 - tasks, and risks were not performed
273288 - by medical team...................... 051019, ref SDS A7 O95W
273289 -
273290 - [On 051021 Millie has left breast mastectomy surgery.
273291 - ref SDS A8 0001
273293 - ..
273294 - [On 060722 case study continues to obtain 2nd opinion on
273295 - options to treat IBC relapse following surgery. ref SDS C1
273296 - XQ7H
273297 -
273298 -
273299 -
273300 -
273301 -
273302 -
273303 -
273304 -
2734 -