THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: September 9, 2005 09:00 AM Friday;
Doctor Bailey meeting with Millie for 2nd opinion on surgery.
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0201 - Medical Offices Lisa Bailey O-00000850 0605
020101 - Ms. Roberta Bennett O-00000850 0605
020103 - Administration Department O-00000850 0605
2nd Opinion #2 Meeting 3rd Referral from UCSF Perform Due Diligence
1203 - ..
1204 - Summary/Objective
120501 - Follow up ref SDS 34 0000, ref SDS 31 0000.
120503 - Doctor made a thorough examination. She feels there is coloration in
120504 - the left breast that might be remnants of IBC, rather than reaction to
120505 - radiation. ref SDS 0 1G4N The doctor recommends continuing systemic
120506 - treatment with chemotherapy, ref SDS 0 1G4X, further recommends
120507 - against mastectomy surgery at this time. ref SDS 0 1G4Q She proposes
120508 - testing to verify that IBC has fully regressed. ref SDS 0 1G75 The
120509 - doctor also indicates that Doctor Parks at UCSF may have a drug trial
120510 - that can help Millie. ref SDS 0 AL3N
120512 - [On 050913 impressions of Doctor Bailey's 2nd opinion presented to
120513 - primary care physician. ref SDS 36 VO44
120515 - ..
120516 - [On 050918 received doctor's 2nd opinion 1st draft, ref SDS 37
120517 - LW3O; comments submitted. ref SDS 37 YP7U
120519 - ..
120520 - [On 050922 Doctor Bailey's 2nd opinion final draft received.
120521 - ref SDS 39 WO4O
120527 - ..
1208 - Progress
120901 - We walked about half a mile from the Downtown Berkeley BART station on
120902 - Shattuck to the doctor's office on Dwight.
120904 - ..
120905 - Millie paid $350 for Doctor Bailey to provide a 2nd opinion. Roberta
120906 - gave Millie a form to enter patient identification. Prior to the
120907 - examination, the doctor asked about long term patient and family
120908 - medical history. This was written by hand on a form.
120910 - ..
120911 - Doctor examined the patient with great care and attention, similar to
120912 - the examination on 050826, ref SDS 29 AY5N, and initialy indicated
120913 - finding that inflammation has regressed. She commented that a single
120914 - examination does not provide sufficient data to determine causal
120915 - factors.
120917 - ..
120918 - The doctor commented further that observation of the patient laying
120919 - down presents a different view from standing and sitting up, showing
120920 - some slight coloration or flushness in the lower right area of the
120921 - left breast, tracking findings of skin thickening. These findings
120922 - align with comments on 050826 when Doctor Shim examined Millie in
120923 - Kaiser's Oakland office. ref SDS 29 G28J
120925 - [On 050913 patient observed and seemed to present similar slight
120926 - coloration, inflammation, flushness in left breast cited in
120927 - examination today, ref SDS 36 025H, but subsequent examination by
120928 - doctor minutes later also seemed to show coloration was restored
120929 - to normal. ref SDS 36 M56N
120931 - ..
120932 - [On 051021 mastectomy surgery performed left breast based on
120933 - reports for biopsy tests performed on 051012, which found no
120934 - evidence of IBC, and inflammation consistant with minimal to mild
120935 - radiation effect. ref SDS 40 7B4O
120937 - ..
120938 - Millie explained this area of lingering symptoms seems from memory to
120939 - fit alignment of radiation treatments in July and August of 2002. At
120940 - that time in 2002, there was significant coloration and skin
120941 - thickening after conclusion of radiation treatment. The area was much
120942 - larger and more severe than observed today, and centered on the
120943 - location noted by the doctor. On 020912 the primary care physician
120944 - described these symptoms as normal reaction to radiation treatments.
120945 - Reaction to radiation was cited from time to time over the next
120946 - several years to explain similar symptoms, e.g., the meeting on
120947 - 040402, ref SDS 2 IM6J, which worsened and then were diagnosed as
120948 - IBC, reported on 040517. ref SDS 3 6T5G
120950 - ..
120951 - The doctor seemed to indicate that observations today could present
120952 - lingering mild reaction to radiation treatments, and that another
120953 - explanation is that IBC has very nearly, but not yet fully regressed.
120955 - ..
120956 - After the examination, we met in the doctor's office to discuss the
120957 - scope of the 2nd opinion.
120959 - ..
120960 - The doctor has performed many mastectomy surgeries on patients with
120961 - IBC. She cited a number of factors that influence this surgical
120962 - procedure on an IBC patient that do not arise with patients who have
120963 - not been diagnosed and treated for IBC.
120965 - ..
120966 - Doctor Bailey related that she found a reference to Doctor Benz in
120967 - patient history cited in the letter to her on 050823. ref SDS 26 PS3T
120968 - She asked how to access the 2nd opinion received from Doctor Benz at
120969 - UCSF on 041117, ref SDS 8 6L9O, that is listed in the chronology on
120970 - 050812? ref SDS 21 6F9I
120972 - ..
120973 - This was demonstrated and explained during the meeting using the
120974 - computer on Doctor Bailey's desk. The doctor successfully applied
120975 - instructions to open the case study on patient history listed in the
120976 - record on 050812. ref SDS 21 6L4M The doctor scrolled to the date in
120977 - the chronology that lists receipt of the 2nd opinion prepared by
120978 - Doctor Benz. ref SDS 21 6F9I
120980 - [On 060809 Margaret learned to use patient history on the computer
120981 - to save time and money organizing the record to prepare Doctor
120982 - Benz for another meeting to prepare another 2nd opinion following
120983 - relapse. ref SDS 42 I73H
120985 - ..
120986 - During the meeting Doctor Bailey learned to click a link in the
120987 - summary of case history to open the record on 041117 that reviews the
120988 - 2nd opinion prepared by Doctor Benz. ref SDS 8 OS6W The doctor
120989 - further learned that analysis of the Benz 2nd opinion in the record on
120990 - 041117 shows corrections to factual errors with links into the
120991 - original report for verification. The doctor bookmarked the case
120992 - study on 050812 that lists patient history, so she can retrieve an
120993 - accurate record with a single click. There was brief discussion that
120994 - Millie has a long, complex history that is easy to cause confusion and
120995 - error, and that the doctor can call for assistance to find key details
120996 - needed for writing medical history to ground the opinion.
120998 - [On 050922 Doctor Bailey's 2nd opinion aligns with the Benz report
120999 - on patient history. ref SDS 39 WO4O
121001 - ..
121002 - [On 060821 Margaret reports Doctors are more comfortable working
121003 - with printed documents rather than improve speed and accuracy
121004 - using the computer. ref SDS 43 B76N
121006 - ..
121007 - The doctor recommends against surgery at this time because the
121008 - examination today presents uncertainty about full recovery from IBC.
121009 - The doctor seemed to indicate that if IBC has not fully regressed,
121010 - then mastectomy surgery can worsen patient prospects from recovery,
121011 - longevity, and quality of life.
121013 - ..
121014 - The doctor recommends a testing regimine to assess patient status that
121015 - includes an MRI breast exam, a mammogram, and PET scan testing.
121017 - [On 050913 impressions of Doctor Bailey's 2nd opinion presented to
121018 - primary care physician. ref SDS 36 VO44
121020 - ..
121021 - The doctor supports retesting of skin biopsy on the left breast to
121022 - update status of the patient, proposed by Doctor Shim in the draft 2nd
121023 - opinion on 050907. ref SDS 33 F49H
121025 - [On 050913 presented status retest proposal to primary care
121026 - physician. ref SDS 36 X561
121028 - ..
121029 - [On 050922 Doctor Bailey's 2nd opinion recommends retesting
121030 - status. ref SDS 39 XD4S
121032 - ..
121033 - The doctor proposes continuing the current systemic treatment regimen
121034 - for locoregional and distant control of disease with Taxotere and
121035 - capecitabine (Xeloda), which means doing at least an 8th and possibly
121036 - a 9th cycle, while testing is evaluated to assess actual status of
121037 - IBC.
121039 - ..
121040 - Doctor Bailey cited the importance of experience performing surgery on
121041 - IBC patients, and noted that not many doctors have this experience,
121042 - because IBC is a rare disease. Lack of experience makes mastectomy
121043 - surgery high risk for mistakes, and so not a good option, given that
121044 - chemotherapy seems to be providing local control. The doctor
121045 - indicated that cutting into previously infected skin with mastectomy
121046 - surgery for Millie's patient history of IBC diagnosed on relapse on
121047 - 040517, and later relapsing again on 041230, could worsen chances for
121048 - survival and reduce quality of life, rather than increase local
121049 - control proposed by Kaiser on 050729. ref SDS 17 5B9K
121051 - [On 050913 Doctor Bailey's 2nd opinion that mastectomy surgery
121052 - could worsen local control was reported to Kaiser. ref SDS 35 MA5F
121054 - ..
121055 - Doctor Bailey explained that, if mastectomy surgery is attempted, then
121056 - carefull pre-op planning will be required to lay out a very large area
121057 - beyond the breast itself in order to remove skin previously infected
121058 - with IBC. She feels the risk of cutting through infected skin would
121059 - prevent healing the surgical wound, as occurred previously with the
121060 - punch biopsy taken on 040419, yet not healed as late as 050107.
121062 - ..
121063 - The doctor emphasized the importance of further testing to verify that
121064 - IBC has subsided, and there is still no detectable distant metastasis,
121065 - before surgery is considered. If either of these conditions are found
121066 - by testing, then chemotherapy treatment should continue, and surgery
121067 - is not a viable option.
121069 - [On 050922 Doctor Bailey's 2nd opinion says that mastectomy
121070 - could be considered only if cancer still exists in left
121071 - breast, clarifying understandings today. ref SDS 39 XD8P
121073 - ..
121074 - There was not enough time during the meeting to consider the basis for
121075 - laying out the size and boundaries of surgery, cited as problematic by
121076 - the surgeon at Kaiser in a meeting on 050727. ref SDS 15 JV5F
121077 - Possibly, this will be presented in the 2nd opinion.
121079 - ..
121080 - The doctor will write a letter today to summarize recommendations for
121081 - a testing regimine and continuing treatment while investigating
121082 - surgery options. This initial letter today will provide talking
121083 - points that support meeting with the primary care physician next week
121084 - on 050913. Additionally, the doctor will call the Primary Care
121085 - Physician to indicate a 2nd opinion is in the works that will reflect
121086 - the meeting today.
121088 - ..
121089 - Doctor Bailey indicated that Millie might qualify for a new drug trial
121090 - sponsored by Doctor Parks at UCSF. She will call Doctor Parks to
121091 - discuss Millie's case. We considered today the possibility of Millie
121092 - participating in the trial with treatment through Kaiser in Walnut
121093 - Creek. This would greatly reduce the travel burden. The doctor
121094 - commented that receiving drip treatment of chemotherapy drugs might be
121095 - done at Kaiser in Walnut Creek, however, there is part of this
121096 - treatment that involves some form of heat application. Doctor Bailey
121097 - feels this might require Millie to visit UCSF.
121099 - [On 050913 Doctor Bailey's suggestion of a new trial reported in
121100 - record of meeting with the primary care physician. ref SDS 36 L27G
121102 - ..
121103 - [On 060711 Millie relapses; primary care physician
121104 - coordinating with protocol nurse to find drug trials that
121105 - may arrest progression of disease. ref SDS 41 ED4K
121107 - ..
121108 - On 050520 Millie asked the primary care physician at Kaiser about a
121109 - new drug trial at UCSF. ref SDS 14 L27G At that time, there was no
121110 - mention of heat being part of the treatment, as Doctor Bailey mentions
121111 - today, so this may a different trial.
121113 - [On 050921 ask Doctor Bailey about contacting UCSF for Millie to
121114 - participate in the trial. ref SDS 38 UE4U
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