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 23, 2005 01:03 PM Tuesday; Rod Welch

Margaret notified Millie that UCSF recommends 2nd opinion by surgeron.

1...Summary/Objective
2...UCSF Proposes 2nd Opinion by Surgical Oncologist But Short Handed
3...Doctor Richards 2nd Opinion on Millie Having Surgery
4...Doctor Grissom 2nd Opinion on Millie Having Surgery
5...Doctor Bailey 2nd Opinion on Millie Having Surgery


..............
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CONTACTS 
0201 - University of California San Franci                                                                                                                                O-00000835 0406
020101 - Ms. Margaret Rubino                                                                                                                                              O-00000835 0406
020102 - New Patient Coordinator
020104 - Admissions                                                                                                                                                       O-00000835 0406

SUBJECTS
UCSF Proposes 2nd Opinion by Surgical Oncologist But Short Handed on

0903 -
0903 -    ..
0904 - Summary/Objective
0905 -
090501 - Follow up ref SDS 24 0000. ref SDS 22 0000.
090502 -
090503 - UCSF proposes Millie get a 2nd opinion from a surgical oncologist, and
090504 - reports that the UCSF staff is currently under strength for surgeons.
090505 - As a result, UCSF is not supporting 2nd opinion projects on surgery.
090506 - UCSF made three (3) referrals.  Responded to UCSF with gratitude for
090507 - referrals, ref SDS 0 QF7N, and note that referral to surgeon's may
090508 - imply that UCSF now supports possible role for surgery. ref SDS 0 7I5U
090509 - Further advised UCSF that Millie wants an opinion from an oncologist
090510 - to update the 1st 2nd opinion issued by Doctor Benz at UCSF last
090511 - October that stated there is no role for surgery in Millie's case,
090512 - and, also, to complement work in the Oncology Department at Kaiser,
090513 - which is now recommending surgery, contrary to UCSF's initial opinion
090514 - last year. ref SDS 0 7I5Y   Contacted referrals, and made progress
090515 - scheduling review of Millie's case for a 2nd opinion. ref SDS 0 P63I
090516 - Research indicates Doctor Grissom has solid credentials for the
090517 - project. ref SDS 0 PR4R  Subitted a letter to the doctor's office
090518 - explaining the scope of work, ref SDS 0 P68V, and subsequently
090519 - scheduled a meeting. ref SDS 0 P354  Research also shows Doctor Bailey
090520 - has a lot of experience treating breast cancer; sent the same letter
090521 - to the doctor, ref SDS 0 03A6, and the doctor's office responded that
090522 - she agreed to take the case. ref SDS 0 XX7F
090523 -
090524 -     [On 051108 notified Doctor Benz and UCSF of success following
090525 -     advice of referrals, which led to successful surgery and dramatic
090526 -     recovery from secondary IBC. ref SDS 33 SJ5H
090527 -
090528 -
090529 -
090530 -
090532 -  ..
0906 -
0907 -
0908 - Progress
0909 -
090901 - UCSF Proposes 2nd Opinion by Surgical Oncologist But Short Handed
090902 -
090903 - Received ref DRT 1 0001 a letter from Margaret responding to the
090904 - letter, ref DIP 5 0001, requesting a 2nd opinion from UCSF, and
090905 - submitted on 050819. ref SDS 22 AI8N  Margaret further follow up
090906 - discussions yesterday when she expedited review by UCSF. ref SDS 24
090907 - O46L
090909 -  ..
090910 - Margaret says....
090912 -         ..
090913 -    1.  I did hear back from the oncologist.  At this time they
090914 -        recommend a 2nd opinion with a surgeon.  Unfortunately, at this
090915 -        time we are not doing 2nd surgical opinions.  We are short two
090916 -        surgeons and can only see treatment patients. ref DRT 1 0001
090918 -         ..
090919 -    2.  I can refer you to CPMC for a 2nd opinion with Dr  Peter
090920 -        Richards (415-221-0735) or Dr Nima Grissom (415-292-8999), or
090921 -        Dr Lisa Bailey (510-883-1095) in Berkeley. ref DRT 1 RQ5N
090923 -  ..
090924 - Referrals seem to have been successful, per below. ref SDS 0 P63I
090926 -  ..
090927 - Write to UCSF with letter of appreciation on referrals.
090928 -
090929 -        [On 051108 notified Doctor Benz and UCSF of success following
090930 -        advice of referrals, which led to successful surgery and
090931 -        dramatic recovery from secondary IBC. ref SDS 33 SJ5H
090932 -
090933 -
090934 -
090936 -  ..
0910 -
0911 -
0912 - Analysis
0913 -
091301 - Referral to surgeons may imply that UCSF now feels there may be a role
091302 - for surgery in Millie's case, which addresses the issue in the letter
091303 - to UCSF on 050819 asking about this issue, ref SDS 22 PC5R, based on
091304 - the 2nd opinion received from UCSF on 041117. ref SDS 7 OU5P
091306 -  ..
091307 - There are many issues on which Millie needs support, besides criteria
091308 - for surgery, especially whether to have surgery, as set out in the
091309 - record on 050727. ref SDS 14 VL4O  If UCSF is saying to proceed with
091310 - surgery, it would help to get this clarified in relation to the 2nd
091311 - opinion that said there is no role for surgery.
091312 -
091313 -
091314 -
091316 -  ..
0914 -
0915 -
0916 - 1321
0917 -
091701 - Submitted ref DIT 1 0001 to Margaret at UCSF responding to her letter
091702 - earlier today, ref DRT 1 0001, per above, ref SDS 0 AI8N, and
091703 - following up the referral request to UCSF on 050819. ref SDS 22 AI8N
091705 -  ..
091706 - The letter says...
091707 -
091708 -    1.  Thanks very much for expediting review of Millie's case by the
091709 -        UCSF Oncology department, and for referrals on surgery.  Millie
091710 -        will follow up, as you suggest. ref DIT 1 0001
091711 -
091712 -            [On 051108 commend Doctor Benz and UCSF for excellent
091713 -            referrals, and report on results. ref SDS 33 F53N
091715 -         ..
091716 -    2.  This referral seems to imply that UCSF feels there may now be a
091717 -        role for surgery to treat Millie, which helps clarify things.
091718 -        ref DIT 1 FQ6I
091720 -         ..
091721 -    3.  Millie has not yet decided to have surgery.  She would like
091722 -        guidance from oncology on making this important decision, and
091723 -        on next steps, ref DIT 1 1W6M, if she decides against having
091724 -        surgery.  Doctor Benz wrote in his letter after seeing Millie
091725 -        on October 18, 2004 that he and a colleague, Doctor Rugo, can
091726 -        be contacted for support on continuing treatment, reported on
091727 -        041117. ref SDS 7 OV3T  Since UCSF's ideas were effective
091728 -        helping Millie the past few months, she has great respect and
091729 -        confidence in UCSF.  For example, on May 20 a few months ago,
091730 -        Millie asked the primary care physician at Kaiser about notice
091731 -        she received of a new treatment available at UCSF for breast
091732 -        cancer. ref SDS 13 L27G
091734 -         ..
091735 -    4.  We've had an action item pending to follow up, based on the 2nd
091736 -        opinion from Doctor Benz.
091738 -         ..
091739 -    5.  When time permits, please make further inquiry for Mil to meet
091740 -        with an oncologist on these issues.  In the meantime, we'll
091741 -        contact your referrals about discussing surgery issues.
091742 -
091743 -            [On 050912 Doctor Grissom, on referral from Oncology at
091744 -            UCSF, commented that Oncology should lead analysis of
091745 -            Millie's treatment options. ref SDS 30 1V8K
091747 -             ..
091748 -            [On 051108 notified Doctor Benz and UCSF of success
091749 -            following advice of referrals, which led to successful
091750 -            surgery and dramatic recovery from secondary IBC.
091751 -            ref SDS 33 SJ5H
091752 -
091753 -
091754 -
091755 -
091757 -  ..
0918 -
0919 -
0920 - 1349
0921 -
092101 - Called and left message for Margaret to follow up on pending issues,
092102 - as set out in the letter. ref SDS 0 QF7N
092103 -
092104 -
092106 -  ..
0922 -
0923 -
0924 - 1350
0925 -
092501 - Margaret did not call back.
092502 -
092503 -     [On 051108 notified Doctor Benz and UCSF of success following
092504 -     advice of referrals, which led to successful surgery and dramatic
092505 -     recovery from secondary IBC. ref SDS 33 SJ5H
092506 -
092507 -
092508 -
092509 -
092510 -
092511 -
0926 -

SUBJECTS
2nd Opinion #2 Surgical Oncologist on Criteria for Millie to Approve

1503 -
1504 - 1410
150501 -  ..
150502 - Doctor Richards 2nd Opinion on Millie Having Surgery
150503 -
150504 - Follow up Margaret's letter recommending doctors for 2nd opinion on
150505 - Millie having surgery, per above. ref SDS 0 R58U
150506 -
150507 - Called Doctor Peter Richards.        415-221-0735
150509 -  ..
150510 - Talked to Denise.
150512 -  ..
150513 - She said surgery oncology is a sub-speciality of Doctor Richards.
150515 -  ..
150516 - 2nd opinion will vary in cost from $75 to $200.
150518 -  ..
150519 - Denise's computer is down.  She will call back to schedule a meeting.
150521 -  ..
150522 - They are located downtown San Francisco on California Street.
150524 -  ..
150525 - It would be convenient for Millie to stop by.
150526 -
150527 -
150529 -  ..
1506 -
1507 -
1508 - 1739
1509 -
150901 - Doctor Richards called back.
150902 -
150903 - We reviewed Millie's case history as related in the letters earlier
150904 - today, shown below. ref SDS 0 P68V
150906 -  ..
150907 - The doctor asked questions about Millie's condition, mainly whether
150908 - inflammation has cleared from her breast.  He feels that if this has
150909 - occurred by visual examination, then she should be ready for an
150910 - operation.
150912 -  ..
150913 - The doctor further seemed to feel that an operation is appropriate for
150914 - a patient with IBC, and who has regional, but not distant, metastatic
150915 - disease.
150917 -  ..
150918 - The doctor confirmed that IBC is a rare disease.  He operates on
150919 - patients with IBC about once every 18 months.
150921 -  ..
150922 - The doctor asked about the number of lymph nodes found cancerous in
150923 - the left axilla.  This was reported as 4 out of 4, based on the report
150924 - by the primary care physician on 020321. ref SDS 2 5O5F
150926 -  ..
150927 - Doctor Richards indicated there is a technical issue to perform follow
150928 - on radiation treatments.  The radiaologist must determine if Millie is
150929 - able to have more radiation based on what has already been done.  This
150930 - aligns with Stanford's report received on 041209. ref SDS 8 O29W
150932 -  ..
150933 - The doctor said to call Denise tomorrow and schedule a meeting.
150934 -
150935 -     [On 050824 called Denise and scheduled meeting with Doctor
150936 -     Richards for 050915. ref SDS 25 GK4H
150937 -
150938 -     [On 050826 visited Kaiser and ordered medical records for 2nd
150939 -     opinion. ref SDS 27 H46J
150941 -      ..
150942 -     [On 050913 cancelled 2nd opinion consultation. ref SDS 31 0001
150943 -
150944 -
150945 -
1510 -

SUBJECTS
2nd Opinion #2 Surgical Oncologist 2nd Referral by UCSF on Criteria

2103 -
2104 - 1411
210501 -  ..
210502 - Doctor Grissom 2nd Opinion on Millie Having Surgery
210503 -
210504 - Follow up Margaret's letter recommending doctors for 2nd opinion on
210505 - Millie having surgery, per above. ref SDS 0 R58U
210506 -
210507 - Called Dr Nima Grissom                415-292-8999
210509 -              ..
210510 -             1700 California Street #550
210511 -             San Francisco, CA  94109
210512 -
210514 -  ..
210515 - Talked to Mary.
210517 -  ..
210518 - Doctor is on vacation until 050907.
210519 -
210520 -    scheduler1989@yahoo.com
210522 -  ..
210523 - 2nd opinion will vary in cost about $250.
210525 -  ..
210526 - Mary says to send the email to the doctor with a link to patient
210527 - history.
210529 -  ..
210530 - Quick research on Doctor Grissom found a diary of another patient,
210531 - that indicates the doctor is experienced, attentive, tactful, and
210532 - proactive helping the patient understand treatment options, and
210533 - decisions.  This particular patient indicates the doctor assisted her
210534 - in writing notes for a diary of the meeting.  Sounds like our kind of
210535 - doctor.  See particularly, the diary for Wednesday 030205, about 10%
210536 - through this page...
210537 -
210538 -        http://www.watsonhouse.net/~moya/breastlog/2003_02_02_archive.html
210539 -
210540 -
210541 -
210542 -
210544 -  ..
2106 -
2107 -
2108 - 1503
2109 -
210901 - Submitted ref DIT 2 0001 to Mary for review by the doctor, and
210902 - saying...
210903 -
210904 -    1.  Millie is a 69 year old patient at Kaiser in Walnut Creek.  She
210905 -        is seeking a 2nd opinion on whether to approve surgery on the
210906 -        left breast, originally treated with lumpectomy surgery on
210907 -        March 12, 2002; and then reexcission a few weeks later on March
210908 -        27. ref DIT 2 0001
210910 -         ..
210911 -    2.  After initial surgery in March 2002, Millie was given two (2)
210912 -        treatments of AC; her condition worsened, so she was switched
210913 -        and got two (2) treatments with Taxotere.  In July and August,
210914 -        2002, she had six (6) or so treatments with radiation, then
210915 -        four (4) more treatments of Taxotere, ending in December 2002.
210916 -        She received no treatment in 2003; testing, examinations, and
210917 -        the patient all reported during 2003 episodic activity under
210918 -        the left arm, and inflammation of the left breast.  On June 14,
210919 -        2004 she was diagnosed with IBC. ref DIT 2 PS63
210921 -         ..
210922 -    3.  Millie relapsed in February 2004.  She complained of lumps and
210923 -        stiffness on the left side of the neck. ref DIT 2 PS7H  A
210924 -        biopsy was positive.  On April 20, 2004 she began treatment
210925 -        with Avastin and Taxol on a trial.  There was favorable
210926 -        response to treatment, until November, when she was removed
210927 -        from the trial because pulmonary emboli was diagnosed in a CT
210928 -        test report on 041104. ref SDS 6 RZ4I  In January 2005 she
210929 -        began treatment with AC, and had 4 treatments, making a total
210930 -        of 6, including the original 2 in 2002.  Disease progressed, so
210931 -        on 050329, Mil was switched to Taxotere and capecitabine
210932 -        (Xeloda).  She responded well.  After 5 cycles, the primary
210933 -        care physician at Kaiser recommended surgery. ref SDS 16 BZ56
210934 -        On August 19, she began the 7th, and at this time final, cycle
210935 -        with Taxotere and capecitabine, and has been cleared for
210936 -        surgery at Kaiser.  Chemotherapy treatments have been paused
210937 -        while working through the surgery issue.  Side effects have
210938 -        been difficult the past few cycles, reported on 050808.
210939 -        ref SDS 18 0001  She is at work today as a secretary in San
210940 -        Francisco.
210942 -         ..
210943 -    4.  Millie wants a 2nd opinion on being ready for surgery, and on
210944 -        the scope of surgery based on inflammation that extended beyond
210945 -        the breast toward the neck in March, though at this time seems
210946 -        to have fully regressed. ref DIT 2 PS87
210948 -         ..
210949 -    5.  Millie also wants a 2nd opinion on whether surgery is a good
210950 -        choice for her overall. ref DIT 2 PS93
210952 -         ..
210953 -    6.  Chronology of patient history with links into test and
210954 -        pathology reports is shown in the record on 050812. ref SDS 20
210955 -        6L4M
210956 -
210957 -            [On 050920 records on patient history were cited in the 2nd
210958 -            opinion by Doctor Grissom. ref SDS 32 PR7H
210960 -         ..
210961 -    7.  You can scroll to the bottom to the most recent events,
210962 -        including scans and reports. ref DIT 2 PS43
210964 -         ..
210965 -    8.  Please call to discuss next steps.
210966 -
210967 -
210968 -
210969 -
210971 -  ..
2110 -
2111 -
2112 - 1528
2113 -
211301 - Called Mary.
211302 -
211303 - She received the letter, ref DIT 2 0001, sent earlier, per above.
211304 - ref SDS 0 P68V  We did an exercise to verify the doctor can access
211305 - patient history. ref SDS 0 Z24Q
211307 -  ..
211308 - Mary seemed comfortable with this exercise.
211309 -
211310 -
211312 -  ..
2114 -
2115 -
2116 - 1558
2117 -
211701 - Mary called back.
211702 -
211703 - Doctor Grissom has reviewed the referral letter, ref DIT 2 0001, per
211704 - above, ref SDS 0 P68V, and wants to support the 2nd opinion project.
211706 -  ..
211707 - Schedule meeting on 050912 1515 for Doctor Grissom to make an
211708 - examination.
211709 -
211710 -     [On 050825 letter advises planning for scope of medical records to
211711 -     request from Kaiser for 2nd opinion. ref SDS 26 XK8N
211712 -
211713 -     [On 050826 visited Kaiser and ordered medical records for 2nd
211714 -     opinion. ref SDS 27 H46J
211715 -
211716 -
211717 -
211718 -
211719 -
2118 -

SUBJECTS
2nd Opinion #2 Surgical Oncologist 3rd Referral by UCSF on Criteria

2703 -
2704 - 1411
270501 -  ..
270502 - Doctor Bailey 2nd Opinion on Millie Having Surgery
270503 -
270504 - Follow up Margaret's letter recommending doctors for 2nd opinion on
270505 - Millie having surgery, per above. ref SDS 0 R58U
270506 -
270507 - Called Dr Lisa Bailey                 510-883-1095
270508 -
270509 -        2500 Milvia Street #120
270510 -        Berkeley, CA 94704
270512 -  ..
270513 - Talked to Roberta.
270514 -
270517 -  ..
270518 - 2nd opinion will cost about $350.
270520 -  ..
270521 - Roberta says to send the email to the doctor with a link to patient
270522 - history.
270524 -  ..
270525 - Roberta said that Doctor Bailey is a surgical oncologist who
270526 - specializes in breast cancer.
270528 -  ..
270529 - Research on Doctor Bailey found that in 1997, the doctor served as
270530 - president of the American Cancer Society, California Division.  The
270531 - doctor's letter to the editor reflects personal experience and focus
270532 - on breast cancer treatment.  This particular letter pertains to the
270533 - efficacy and limitations of mammography, which Millie experienced
270534 - first hand on 020312. ref SDS 1 H66F
270535 -
270536 -        http://www.bcaction.org/Pages/SearchablePages/1997Newsletters/Newsletter042I.html
270538 -  ..
270539 - Doctor Bailey has written published articles, e.g.,
270540 -
270541 -    Rethinking Breast Cancer Risk and the Environment: The Case for
270542 -    the Precautionary Principle
270543 -
270544 -              http://ehp.niehs.nih.gov/docs/1998/106p523-529davis/abstract.html
270546 -  ..
270547 - This article does not bear directly on Millie's situation, but
270548 - indicates the doctor can write useful analysis.
270550 -  ..
270551 - Doctor Bailey was formerly an assistant professor at UCSF, which may
270552 - explain the referral from UCSF, and along with other extensive
270553 - credentials....
270554 -
270555 -              http://www.sanarus.com/patinfo/townhall.html
270556 -
270557 - ...which says in part...
270558 -
270559 -        Dr  Lisa Bailey, an assistant clinical professor at UCSF,
270560 -        breast cancer surgeon of Alta Bates Summit Medical Center and
270561 -        Co-Medical Director of Summit Cancer Care Center.
270562 -
270563 -
270565 -  ..
2706 -
2707 -
2708 - 1513
2709 -
270901 - Submitted ref DIT 3 0001 to Roberta at Doctor Baliely's office; this
270902 - is the same letter sent to Doctor Grissom, per above. ref SDS 0 P68V,
270903 - and so includes patient history on 050812, ref SDS 20 6L4M, also, per
270904 - above. ref SDS 0 Z24Q
270905 -
270906 -     [On 050909 Doctor Bailey found patient history by clicking a link
270907 -     in the letter. ref SDS 29 1G89
270908 -
270909 -
270910 -
270911 -
270913 -  ..
2710 -
2711 -
2712 - 1530
2713 -
271301 - Called Roberta.
271302 -
271303 - She is backed up, and will call back later to verify she has received
271304 - the letter on Millie.
271305 -
271306 -
271308 -  ..
2714 -
2715 -
2716 - 1637
2717 -
271701 - Roberta called back.
271702 -
271703 - Doctor Baily has received the letter explaining Millie's objectives
271704 - for a 2nd opinion, and the doctor wants to take the case.  Since it is
271705 - so late in the day, Roberta will call back tomorrow to schedule a
271706 - meeting.
271707 -
271708 -     [On 050824 Roberta called and advised the meeting with the doctor
271709 -     will be either 050909, or the following week on 050913.
271710 -     ref SDS 25 JF4I
271712 -      ..
271713 -     [On 050829 Roberta responded setting meeting with Millie and the
271714 -     doctor for 050909. ref SDS 28 EO6K
271716 -  ..
271717 - She evidently printed the letter summarizing the case, ref DIT 3 0001,
271718 - and submitted earlier today, per above, ref SDS 0 PS3T, and gave it to
271719 - the doctor; although she may have forwarded the email.  She may have
271720 - printed the full chronology listed on 050812, ref SDS 20 UF4J, because
271721 - Roberta said there is a lot there, and indicated that the doctor only
271722 - wants pathology reports.
271723 -
271724 -     [On 050829 Roberta clarified scope of medical records to
271725 -     supplement patient history. ref SDS 28 YJ6X
271727 -  ..
271728 - We reviewed history showing that doctors routinely request all
271729 - pathology reports, then wind up needing only very few.  We'll let the
271730 - doctor review the record, and then, if an original document is needed,
271731 - we can get it, and bring it to Kaiser.
271732 -
271733 -     [On 050825 letter advises planning for scope of medical records to
271734 -     request from Kaiser for 2nd opinion. ref SDS 26 XK8N
271736 -      ..
271737 -     [On 050826 visited Kaiser and ordered medical records for 2nd
271738 -     opinion. ref SDS 27 H46J
271739 -
271740 -
271741 -
271742 -
271743 -
271744 -
271745 -
271746 -
2718 -
Distribution. . . . See "CONTACTS"