CONTACTS
SUBJECTS
Meeting Doctor Examine Recovery from Mastectomy Surgery Response to
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 70 0000. ref SDS 68 0000.
040502 -
040503 - Steady rise of CA 15-3 from a low of 28 several months ago, to now 44,
040504 - about 5 points above the cancer signal of 39, ref SDS 0 GJ5M, deserves
040505 - attention, along with PET scan report finding FDG activity in right
040506 - axilla, and left supraclavicular. ref SDS 0 GV6K Patient general good
040507 - health, and no express findings of disease at this time support
040508 - continuing treatment "holiday." ref SDS 0 AW5G Treatment options can
040509 - be developed during the holiday, including role for radiation,
040510 - ref SDS 0 K36G, and investigate status change to increase treatment
040511 - options. ref SDS 0 ZR6J Contrast CT study, ref SDS 0 II4L, and
040512 - continued CA 15-3 monitoring present current treatment plan.
040513 - ref SDS 0 BB9M Esophagitis diagnosed in PET test on 060120, was not
040514 - compared and so requires follow up review for progress or resolution
040515 - in recent PET test on 060414. ref SDS 0 DH4O Lymphedema has improved
040516 - and stabilized with treatment of left arm. ref SDS 0 MW8J Mild
040517 - dizziness not yet resolved; decided to allow more time for treatment
040518 - in March to become effective, before further investigation and
040519 - treatment. ref SDS 0 PT4K
040520 -
040521 - [On 060505 CT study performed, moved ahead in the schedule from
040522 - 060609. ref SDS 83 II4L
040524 - ..
040525 - [On 060512 Millie requests report from the doctor on results of
040526 - the test. ref SDS 85 4S5T
040528 - ..
040529 - [On 060523 favorable CT test report findings NED, defer
040530 - considerations of treatment planning despite rising CA 15-3.
040531 - ref SDS 86 4R82
040533 - ..
040534 - [On 060524 Millie's letter to the doctor asks for comparing CT
040535 - test on 060505 with recent PET scan test on 060414, in light of
040536 - rising CA 15-3. ref SDS 87 KG4W
040538 - ..
040539 - [On 060526 the doctor asks for clarification of date format.
040540 - ref SDS 88 6T8L Millie clarifies date format, and explains
040541 - advantage of comparing recent tests to supplement comparing tests
040542 - 1 year apart. ref SDS 88 JD5K
040544 - ..
040545 - [On 060605 CA 15-3 test on 060522 shows another big rise to 59.
040546 - ref SDS 89 DB3J
040548 - ..
040549 - [On 060607 test comparison seems difficult to achieve; doctor
040550 - discusses planning for treatment of cancer relapse based on
040551 - rapidly rising CA 15-3. ref SDS 90 D45K
040553 - ..
040554 - [On 060607 Millie temperature 104+, hospitalized with pneumonia.
040555 - ref SDS 90 PR5R
040557 - ..
040558 - [On 060623 examination shows rising left breast inflammation
040559 - indicating IBC relapse; reconciles rising CA 15-3 cancer marker
040560 - with no evidence of disease reported in image tests, because IBC
040561 - occurs in the skin (dermal lymphatics), which is hard to recognize
040562 - in image testing. ref SDS 91 025H
040564 - ..
040565 - [On 060711 doctor diagnosis IBC relapse based on image testing
040566 - today in combination with rising IBC rash, and rising cancer
040567 - marker. ref SDS 92 025H
040568 -
040569 -
040570 -
040571 -
040572 -
040573 -
040575 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Agenda Develop Work Plan Stage IV Breast Cancer 6 Mos after Mastectomy
040902 -
040903 - Follow up ref SDS 70 SM6M, ref SDS 68 SM6M.
040905 - ..
040906 - This is the 4th review meeting with primary care physician following
040907 - mastectomy surgery on 051021, ref SDS 61 0001, and following post op
040908 - examination by the surgeon on 051027 when Millie's status was reported
040909 - "no evidence of disease (NED)". ref SDS 6 M58G
040911 - ..
040912 - Millie submitted the agenda prior to the meeting so the doctor could
040913 - be prepare. Prior to the meeting, Millie listed the agenda on the
040914 - marking board in the examination room to guide discussions...
040915 -
040916 - 1. CA 15-3 cancer marker report............... ref SDS 0 GJ5M
040917 - 2. Cholesterol test LIPOD Panel............... ref SDS 0 TE5N
040918 - 3. Port flush................................. ref SDS 0 SH5N
040919 - 4. PET test review............................ ref SDS 0 NL4N
040920 - 5. Esophagitis................................ ref SDS 0 DH4O
040921 - 6. CT contrast study to supplement PET........ ref SDS 0 II4L
040922 - 7. Lymphedema work up review by surgeon....... ref SDS 0 MW8J
040923 - 8. Dental work and lymphedema................. ref SDS 0 E67G
040924 - 9. Lump under right arm....................... ref SDS 0 II4L
040925 - 10. Breast exam recovering IBC................. ref SDS 0 025H
040926 - 11. Emotional support.......................... ref SDS 0 Y642
040927 - 12. Dizziness.................................. ref SDS 0 PT4K
040928 - 13. Surgeon's pre-op patient history........... ref SDS 0 355G
040929 - 14. Treatment plan............................. ref SDS 0 AW5G
040930 - 15. Status change treatment options............ ref SDS 0 ZR6J
040932 - ..
040933 - Scheduled next meeting in 8 weeks on June 23, 2006
040934 -
040935 - Note: Mil leaves for vacation in Arizona on 060629, so the
040936 - meeting with the doctor will have to be the week prior or the week
040937 - after.
040938 -
040939 -
040940 -
040941 -
0410 -
SUBJECTS
Vitals Show Stable Medical Condition Meeting Primary Care Physician
0603 -
060401 - ..
060402 - Vitals Show Stable Medical Condition
060403 -
060404 - Follow up ref SDS 70 KB5L.
060405 -
060406 - The admitting attendant now enters this data into the doctor's
060407 - computer prior to each meeting...
060409 - ..
060410 - Bld Prssr Pulse Temp Weight SaO2
060411 - ..
060412 - 060428................. 129 73 80 99.4 149 99%
060413 - 060217................. 153 81 61 98.6 150 99%
060414 -
060415 - ...per Doctor's report, shown below. ref SDS 0 JQ4J
060416 -
060417 -
060418 -
060419 -
060420 -
060421 -
0605 -
SUBJECTS
CA 15-3 44 and 5 Points Above Normal 39 and 11 Point Rise from 33 ab
1603 -
160401 - ..
160402 - CA 15-3 Cancer Marker 44 Rise from 33 the Past 8 Weeks
160403 -
160404 - Follow up ref SDS 70 087J, ref SDS 68 087J.
160405 -
160406 - The most recent blood test on 060421 shows that CA 15-3 rose again
160407 - this time to 44; since dropping to 33 on 060210, CA 15-3 rose to 36 on
160408 - 060303, and then to 40 on 060330. The test report received today
160409 - shows...
160411 - ..
160412 - Test Date Date Received
160413 - 060421......... 44 H............. 060428, ref SDS 0 087J
160414 - 060330......... 40 H............. 060428, ref SDS 0 087J
160415 - 060303......... 36............... 060428, ref SDS 0 087J
160416 - 060210......... 33............... 060217, ref SDS 11 087J
160417 - 060109......... 34............... 060126, ref SDS 10 KV59
160418 - 051223......... 34............... 060106, ref SDS 9 087J
160419 - 051202......... 28............... 060106, ref SDS 9 087J
160420 - 051116......... 31............... 051121, ref SDS 8 087J
160421 - 051109......... 30............... 051121, ref SDS 8 087J
160422 - 051102......... 34............... 051121, ref SDS 8 087J
160475 -
160476 -
160478 - ..
1605 -
1606 -
1607 - Analysis
1608 -
160801 - CA 15-3 44 Cancer Marker Rises Slightly Above Target Level 39
160802 -
160803 - Follow up ref SDS 70 GJ5M, ref SDS 68 GJ5M.
160804 -
160805 - Could ductal carcinoma insitu (DCIS) in the right breast be causing
160806 - elevated CA 15-3 and activity in right axilla and left
160807 - supraclavicular, in like manner that was discovered for the left
160808 - breast on 051027? ref SDS 7 615K After removal of the left breast, CA
160809 - 15-3 dropped from 45 to 34, reported on 051127. ref SDS 8 GJ5M Right
160810 - breast mastectomy, or other form of treatment for DCIS may resolve
160811 - rising CA 15-3, per below. ref SDS 0 K36G
160813 - ..
160814 - The most recent CA 15-3 test on 060421 rose slightly from 40, and is
160815 - now 44, 5 points above the cancer signal level of 39, and 11 points
160816 - higher than reported in the meeting on 060217. ref SDS 0 KV59
160818 - ..
160819 - Status may remain NED, however, patient history showing strong
160820 - correlation between relapse and rising CA 15-3 and in conjunction with
160821 - PET scan test finding FDG SUB 4.5 in left supraclavicular, ref SDS 0
160822 - OX68, supports careful attention, reported by the doctor on 030606.
160823 - ref SDS 22 VY7G
160824 -
160825 - [On 060523 favorable CT test report findings NED, defer
160826 - considerations of treatment planning despite CA 15-3 continuing
160827 - steady rise to 49. ref SDS 86 4R82
160829 - ..
160830 - [On 060605 CA 15-3 test on 060522 shows another big rise from 49 to
160831 - 59. ref SDS 89 DB3J
160833 - ..
160834 - [On 060607 test comparison seems difficult to achieve; doctor
160835 - discusses planning for treatment of cancer relapse based on rapidly
160836 - rising CA 15-3. ref SDS 90 D45K
160838 - ..
160839 - [On 060623 examination shows rising left breast inflammation
160840 - indicating IBC relapse, which reconciles rising CA 15-3 cancer
160841 - marker with no evidence of disease reported in image tests, because
160842 - IBC occurs in the skin (dermal lymphatics), which generally are not
160843 - recognizable in image testing. ref SDS 91 025H
160845 - ..
160846 - [On 060711 doctor diagnosis IBC relapse based on image testing
160847 - today in combination with rising IBC rash, and rising cancer
160848 - marker. ref SDS 92 025H
160849 -
160850 -
160851 -
160852 -
160853 -
1609 -
SUBJECTS
Blood Tests on 060109 All Normal 1st Time 4 Years No Evidence Relaps
1803 -
180401 - ..
180402 - Blood Tests All Normal 1st Time 4 Years Supports Diagnosis NED
180403 -
180404 - Follow up ref SDS 70 SZ9L, ref SDS 68 SZ9L.
180405 -
180406 - There were no general blood tests this period.
180407 -
180408 -
180409 -
180410 -
180411 -
1805 -
SUBJECTS
Cholesterol Blood Test on 060303 Lipid Profile Slightly High No Chan
2103 -
210401 - ..
210402 - Cholesterol Blood Test Scheduled Preventive Medicine
210403 -
210404 - Follow up ref SDS 70 TE5N.
210405 -
210406 - During the meeting on 060217 the doctor ordered LIPID test for
210407 - cholesterol, ref SDS 11 HG6M, following up Kaiser's notice that this
210408 - preventive medicine test is due before April.
210410 - ..
210411 - Patient Provider Category View FR Date To Date
210415 - Procedure Results Reference Range
210416 - ..
210418 - ** TPMG Regional Laboratory, MWS **
210420 - ..
210421 - LIPID
210422 -
210423 - Cholesterol H 268 mg/dL { =< 239 }
210424 - Triglycerides 97 mg/dL { =< 199 }
210425 - HDL Cholesterol 58 mg/dL {> 45 - }
210426 - LDL Cholesterol H 191 mg/dL { =< 129 }
210427 -
210429 - ..
210430 - The doctor advised this patent profile is slightly above recommended
210431 - targets. He said there is no reason for Millie to change diet, and
210432 - the continued exercise will maintain the level of health intended by
210433 - test parameters.
210434 -
210435 -
210436 -
210437 -
210438 -
210439 -
210440 -
2105 -
SUBJECTS
Patients Medical Test Reports Do Not Request Nor Receive for Review
4903 -
490401 - ..
490402 - Patients Do Not Get Medical Test Reports to Prepare for Meetings
490403 - Medical Reports Not Distributed to Patients to Prepare for Meetings
490404 - Test Reports Not Requested by Patients To Be Prepared for Meetings
490405 -
490406 - Follow up ref SDS 70 NL4N, ref SDS 68 NL4N.
490407 -
490408 - During the meeting on 060217 the doctor scheduled a PET scan test,
490409 - ref SDS 11 OR6M, to follow up the test on 060120, which was partially
490410 - received on 060126, ref SDS 10 E53H, and later, during a meeting on
490411 - 060217, the doctor submitted the full report on printed paper,
490412 - ref SDS 11 DU9O This was used to manually type the report over again
490413 - to get a workable copy for the record. ref SDS 10 697N
490415 - ..
490416 - A few days ago on 060424, Millie requested an electronic transmission
490417 - of the full report for the PET scan test performed on 060414,
490418 - ref SDS 8 V15I, and to correct prior practice of partial submission
490419 - on 060126. ref SDS 10 E538 Based on this request, later that day on
490420 - 060424, the doctor submitted the full report, ref SDS 8 N95H
490422 - ..
490423 - Millie thanked the doctor for timely response on 060424. Expediting
490424 - the work getting an accurate record saves a lot of time and expense,
490425 - as reported on 060217. ref SDS 11 DU7K, to be prepared by reviewing
490426 - test findings, which makes meetings productive, further reported on
490427 - 960205. ref SDS 2 5902 As a result, the problem of overlooking test
490428 - findings of medical diagnosis, reported on 060217, was avoided today.
490429 - ref SDS 11 DH4O
490431 - ..
490432 - Doctor Johnson commented that Millie is the only patient in the
490433 - Oncology Department who has ever requested a pathology report on CT,
490434 - PET and other image tests, on blood tests, and other patient history
490435 - in the medical chart, including doctor's progress notes, and in order
490436 - to facilitate meetings, and strengthen analysis, diagnosis and
490437 - treatment planning, as called out in Kaiser's Healthwise Handbook,
490438 - reviewed on 990625. ref SDS 3 3960 Change to a new way of working
490439 - takes time for cultural adjustment. This aligns with....
490440 -
490441 - [...below on 060428 1520 Doctor Johnson begins using email
490442 - to efficiently transmit to the patient Progress Notes in
490443 - Kaiser's electronic medical records (EMR) that leverage
490444 - doctor/patient partnership for optimizing patient care.
490445 - ref SDS 0 FE4I
490446 -
490447 - 1. Study shows people waste 70% of day
490448 - in unproductive meetings because
490449 - nobody cares about being
490450 - prepared.............................. 960205, ref SDS 2 5222
490452 - ..
490453 - 2. People frustrated when asked to
490454 - use good management practices for
490455 - accurate understandings............... 041130, ref SDS 40 YR8F
490457 - ..
490458 - 3. Organizations have only weak
490459 - ability to capture organizational
490460 - memory - daily work experience........ 041130, ref SDS 4 IE4M
490462 - ..
490463 - 4. Drucker reported people have given
490464 - up on communications, because good
490465 - management is too complex............. 931130, ref SDS 1 3851
490467 - ..
490468 - 5. Standards, regulations, policies,
490469 - and urging of experts on using good
490470 - management are all ignored............ POIMS, ref OF 3 PG9M
490472 - ..
490473 - 6. ISO, FAR, Kaiser's Healthwise
490474 - Handbook, Covey, Drucker, Grove
490475 - are all ignored....................... POIMS, ref OF 7 QT5L
490476 - shown by 20 year study................ 020504, ref SDS 7 NS6F
490477 -
490478 -
490479 -
490480 -
490481 -
4905 -
SUBJECTS
PET Scan Test 040414 Doctor Reports No Evidence Distant Metastasis H
6503 -
650401 - ..
650402 - PET Scan Test Findings FDG Right Axilla Left Supraclavicular
650403 -
650404 - Background on ordering PET scan test reported above, discussing
650405 - practices on distribution of medical reports. ref SDS 0 NL4N
650406 -
650407 - [On 070202 followed up. ref SDS 94 WX3F
650409 - ..
650410 - Test History No Evidence Distant Metastasis
650411 -
650412 - Type Date Received Source
650413 - PET 060414 reported on 060428........... ref SDS 0 WJ6G
650414 - PET 060120 reported on 060126........... ref SDS 69 WJ6G
650415 - PET 051005 reported on 051007........... ref SDS 60 WJ6G
650416 - CT 050530 reported on 050610........... ref SDS 53 G75L
650417 - CT 050325 reported on 050422........... ref SDS 49 G75L
650418 - CT 041217 reported on 041230........... ref SDS 42 G75L
650419 - CT 041103 reported on 041104........... ref SDS 38 NL4N
650420 - CT 040921 reported on 041005........... ref SDS 37 NL4N
650421 - CT 040710 reported on 040811........... ref SDS 34 DU9I
650422 - CT 040410 reported on 040416........... ref SDS 29 HX4K
650423 - CT 040307 reported on 040318........... ref SDS 28 LK5L
650424 - CT 031031 reported on 031205........... ref SDS 25 IG9K
650425 - CT 030626 reported on 030710........... ref SDS 23 AL6N
650426 - CT 030428 reported on 030508........... ref SDS 21 LK5L
650427 - PET 021218 reported on 030109........... ref SDS 19 LK5L
650428 - PET 020529 reported on 020603........... ref SDS 8 0001
650429 -
650430 -
650432 - ..
650433 - PET scan test report was reviewed, as follows...
650434 -
650435 - BODY PET SCAN (Digital)
650440 - ..
650441 - Patient
650449 - ..
650450 - Body PET Scan (Digital)
650451 -
650456 - ..
650457 - ** HISTORY **:
650458 -
650459 - 70 year old female with history of left breast carcinoma
650460 - diagnosed in 3/02, left cervical metastatic disease in 2004,
650461 - S/P left mastectomy 10/05. She was referred for PET scan for
650462 - interval re-evaluation of disease status.
650464 - ..
650465 - What does "S/P left mastectomy 10/05" mean?
650467 - ..
650468 - Maybe the analyst is commenting that in October 2005, and specifically
650469 - on 051021 the patient had left breast mastectomy surgery.
650471 - ..
650472 - Previously, on 040517 requirements for clear, concise, complete
650473 - communication were reviewed to avoid errors in diagnosis and
650474 - treatment. ref SDS 30 RZ5O
650476 - ..
650477 - PET test report continues...
650478 -
650479 - PROCEDURE:
650480 -
650481 - Blood sugar was 80 mg/dl prior to injection of radioisotope.
650483 - ..
650484 - Radiopharmaceutical used: 16.2 mCi 18-F Fluorodeoxyglucose IV
650486 - ..
650487 - Time of tracer injection: 07:18
650489 - ..
650490 - Time of emission scan: 08:03
650492 - ..
650493 - Following intravenous injection of radioisotope, the uptake
650494 - period and voiding, the patient was positioned on the full ring
650495 - dedicated PET scanner. Emission (5 min per bed position) and
650496 - transmission (2 min per bed position) scans from the base of the
650497 - skull through mid-thigh were acquired in 6 bed positions. The
650498 - transmission scans were acquired using two Ge-68 rod sources.
650499 - Images were corrected for signal attenuation and reviewed in the
650500 - coronal, sagittal and transaxial planes.
650502 - ..
650503 - This scope seems to include the neck, but not the head, i.e., from the
650504 - base of the skill, which is needed for follow up contrast CT test.
650506 - ..
650507 - PET test report continues...
650508 -
650509 - CORRELATION: None
650511 - ..
650512 - COMPARISON: Body PET study dated 1/20/06
650514 - ..
650515 - Findings fail to compare prior study on 060126 that diagnosed
650516 - esophagitis. ref SDS 69 DH4O
650517 -
650518 - [On 061024 case study medical practice computer access
650519 - limited even with everything on the computer, people can't
650520 - find details stored in parts of the computer (software
650521 - modules) that are not frequently used. ref SDS 93 JD9L
650523 - ..
650524 - PET scan test report continues...
650525 -
650526 - FINDINGS:
650527 -
650528 - When compared with previous PET study from 1/06, a small focus
650529 - with mildly increased FDG activity (standardized uptake value,
650530 - SUV, 2.6, compared with previous SUV of 1.9) is again
650531 - identified in the right axillary region, with no significant
650532 - change. This may represent local inflammatory response or
650533 - metastatic disease.
650535 - ..
650536 - Interval development of an additional hypermetabolic focus in
650537 - the left supraclavicular region (#635) with moderately
650538 - increased FDG uptake (SUV 4.5), which may also represent
650539 - metastatic disease or physiological vascular activity. A
650540 - contrast CT study would be helpful to correlate with the above
650541 - findings.
650542 -
650543 - [On 060505 CT study performed, moved ahead in the schedule
650544 - from 060609. ref SDS 83 II4L
650546 - ..
650547 - [On 060523 CT study findings no lymphadenopathy in the
650548 - neck. ref SDS 86 IM9M
650550 - ..
650551 - [On 060524 Millie's letter to the doctor asks for comparing
650552 - CT test on 060505 with PET scan test on 060414. ref SDS 87
650553 - KG4W
650555 - ..
650556 - [On 060526 the doctor asks for clarification of the date
650557 - format. ref SDS 88 6T8L Millie responds with
650558 - clarification, and explains advantage of comparing recent
650559 - tests to supplement comparing tests 1 year apart.
650560 - ref SDS 88 JD5K
650562 - ..
650563 - [On 060711 doctor diagnosis IBC relapse based on image
650564 - testing today in combination with rising IBC rash, and
650565 - rising cancer marker. ref SDS 92 025H
650567 - ..
650568 - Could PET findings of FDG uptake SUV 4.5 in supraclavicular relate to
650569 - prior findings of esophagitis, per issue below? ref SDS 0 DH4O
650571 - ..
650572 - Left supraclavicular findings in this PET scan test on 060414, per
650573 - above, ref SDS 0 MU5M, compares with prior PET scan test on 060120
650574 - that made no findings in this region. ref SDS 69 XF41 and summarized
650575 - as "unremarkable" on 060126. ref SDS 69 DH53
650577 - ..
650578 - During the meeting today, the doctor seemed to feel this is a very
650579 - remote possibility. He indicated that if there is metastasis in the
650580 - neck area, it most likely suggests IBC relapse. The contrast CT study
650581 - ordered today will clarify this matter. ref SDS 0 K64X
650582 -
650583 - [On 060711 doctor diagnosis IBC relapse based on image
650584 - testing today in combination with rising IBC rash, and
650585 - rising cancer marker. ref SDS 92 025H
650587 - ..
650588 - How do findings of "FDG" and "SUV" 1.9, and 4.5, ref SDS 0 OX68,
650589 - relate to CT test reports of lymph nodes being 1.0 cm, shown in the
650590 - report for the test on 050530, and received on 050610 in the right
650591 - axilla? Are the 1.9 and 2.6 centimeters, or some other unit of
650592 - measure. ref SDS 53 TH9N
650594 - ..
650595 - Research on the Internet indicates clinical trials in 2000 - 2004
650596 - report low prognostic value of FDG SUV diagnostics. More recent
650597 - trials may demonstrate stronger predictive value of FDG SUV?
650598 -
650599 - [On 060523 CT study findings no lymphadenopathy in the
650600 - neck. ref SDS 86 WW97
650602 - ..
650603 - Several studies seem to give SUV 9 as a point of interest, and suggest
650604 - this can point to an area that should be tested with biopsy,
650605 - illustrated by following study...
650606 -
650607 - http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15611393&dopt=Abstract
650609 - ..
650610 - FDG = fluoro-d-glucose
650612 - ..
650613 - SUV = standard uptake value
650615 - ..
650616 - HNSCC = head and neck squamous cell carcinoma
650618 - ..
650619 - Primary tumor standardized uptake value (SUV) of greater than 9.0
650620 - predicted inferior local recurrence-free survival (P = .02) and
650621 - disease-free survival (P = .03).
650623 - ..
650624 - Nodal SUV dichotomized according to the cohort median of 6.1 did
650625 - not predict for either disease outcome (P = .71 and P = .98,
650626 - respectively).
650628 - ..
650629 - On proportional hazards analysis, local recurrence and disease
650630 - event hazard ratios for a primary tumor SUV of 9.0 or greater
650631 - remained significant or at borderline significance when adjusted
650632 - for nodal SUV or other clinical covariates.
650634 - ..
650635 - CONCLUSIONS: Our findings support an association between baseline
650636 - primary tumor FDG SUV and HNSCC outcomes. In contrast, nodal FDG
650637 - SUV was not predictive.
650639 - ..
650640 - Primary tumor FDG SUV is a promising prognostic factor and may
650641 - establish the need for intensified locoregional therapy in
650642 - individual patients. Multi-institutional imaging trials and
650643 - further characterization of the biology responsible for elevated
650644 - FDG uptake in HNSCC will be necessary to confirm the prognostic
650645 - utility of FDG-labeled PET.
650647 - ..
650648 - Another article indicates that FDG uptake in supraclavicular can
650649 - occur without indicating cancer....
650650 -
650651 - http://jnm.snmjournals.org/cgi/content/abstract/44/2/170
650652 -
650653 - The supraclavicular region is a common site for lymph node
650654 - metastases. A commonly reported type of nonmalignant 18F-FDG
650655 - uptake on PET imaging in the supraclavicular region is "muscle
650656 - uptake" purportedly due to muscle contraction in tense patients
650657 - during the 18F-FDG uptake phase.
650658 -
650659 - [On 060523 CT study findings no lymphadenopathy in the neck
650660 - in seeming conflict with PET scan FDG findings, and rising
650661 - CA 15-3. ref SDS 86 WW97
650663 - ..
650664 - [On 060623 examination shows rising left breast
650665 - inflammation indicating IBC relapse, which reconciles
650666 - rising CA 15-3 cancer marker with no evidence of disease
650667 - reported in image tests, because IBC occurs in the skin
650668 - (dermal lymphatics), which generally are not recognizable
650669 - in image testing. ref SDS 91 025H
650671 - ..
650672 - Conclusion: So-called muscle uptake in the supraclavicular region
650673 - may be caused in a significant proportion of cases by an unrelated
650674 - process we call the USA-fat finding, with 18F-FDG uptake in tissues
650675 - of low-Hounsfield (fat) density. This finding most likely reflects
650676 - an underlying nonpathologic process that we hypothesize to be in
650677 - foci of brown fat. This intense supraclavicular uptake should be
650678 - recognized and should not be misinterpreted as a malignant
650679 - metastatic process or as muscle uptake.
650681 - ..
650682 - Another article reports that FDG above 4, is "high", and this presents
650683 - requirement for examination in Millie's case, showing 4.5, per above.
650684 - ref SDS 0 OX68
650686 - ..
650687 - Examination of left supraclavicular - seem significant and accelerated
650688 - increase, per below. ref SDS 0 8R6M
650690 - ..
650691 - How do these findings relate to prior enlarged right axillary lymph
650692 - node in the CT test on 050530, and received from the doctor on 050610,
650693 - ref SDS 53 WA52, which was cited for possible cause of rising CA 15-3,
650694 - per the report today. ref SDS 0 087J
650696 - ..
650697 - Findings continue...
650698 -
650699 - Physiological tracer activity is seen in the myocardium,
650700 - bilateral kidneys and urinary bladder.
650702 - ..
650703 - No evidence for abnormal hypermetabolic focus in the hepatic or
650704 - pulmonary parenchyma.
650706 - ..
650707 - IMPRESSION **:
650708 -
650709 - Stable appearance of the right axillary focus with mildly
650710 - increased FDG activity with interval development of a
650711 - moderately hypermetabolic left supraclavicular focus. While
650712 - these may represent reactive process and vascular activity,
650713 - metastatic disease cannot be excluded. Correlations with a
650714 - contrast CT study would be helpful.
650715 -
650716 - [On 060505 CT study performed, moved ahead in the schedule
650717 - from 060609. ref SDS 83 II4L
650719 - ..
650720 - [On 060523 CT test impression generally aligns with report
650721 - on PET scan test showing no evidence of disease. ref SDS 86
650722 - 014T
650724 - ..
650725 - [On 060623 examination shows rising left breast inflammation
650726 - indicating IBC relapse, which reconciles rising CA 15-3
650727 - cancer marker with no evidence of disease reported in image
650728 - tests, because IBC occurs in the skin (dermal lymphatics),
650729 - which generally are not recognizable in image testing.
650730 - ref SDS 91 025H
650732 - ..
650733 - What does "moderately hypermetabolic" mean? How does this relate to
650734 - prior findings of swelled lymph nodes in centimeters. Is the PET
650735 - test measuring differently?
650737 - ..
650738 - Generally, this PET scan report supports continuing status of no
650739 - evidence of disease (NED), and appears conflicting with rising CA 15-3
650740 - cancer marker the past 4 months, per above. ref SDS 0 UC8L
650741 -
650753 -
650754 -
650755 -
650756 -
650757 -
650758 -
650759 -
6508 -
SUBJECTS
Esophagitis PET Scan Test Not Compared with Prior Report Symptoms Mi
9303 -
930401 - ..
930402 - Esophagitis Not Compared Current PET Test with Prior PET Test Report
930403 -
930404 - Follow up ref SDS 70 DH4O, ref SDS 69 DH4O.
930405 -
930406 - PET scan test report today does not mention resolution nor worsening
930407 - of prior finding of esophagitis from test on 060120 received in the
930408 - record on 060126. ref SDS 69 DH4O
930410 - ..
930411 - Diagnostic research on esophagitis was developed in the record on
930412 - 060126. ref SDS 10 WA8L
930414 - ..
930415 - Ordinarily prior findings should be cited in reporting on follow up
930416 - tests for comparison. ref SDS 0 OX65 See test history on 040416.
930417 - ref SDS 29 GN7J
930418 -
930419 - [On 060607 Millie admitted to emergency room for temperature of
930420 - 104.2; xray shows pneumonia, ref SDS 90 PT7S, doctor reports
930421 - Kaiser's computer says Millie has been diagnosed with esophagitis,
930422 - and asks how esophagitis is being treated. ref SDS 90 LO3H
930423 - Research indicates possible correlation between esophagitis and
930424 - pneumonia. ref SDS 90 I24L
930426 - ..
930427 - Since there is no mention of prior findings, this may have been
930428 - overlooked by the analyst reviewing the PET scan test on 040414, after
930429 - discovering possible cancer in right axillary and left
930430 - supraclavicular. ref SDS 0 OX68
930432 - ..
930433 - Today, the doctor did not recall Millie's letter, ref DRP 6 0H6F, on
930434 - 060320 asking about findings of esophagitis, ref SDS 73 XE3M, and
930435 - reporting patient history of symptoms. ref SDS 73 X94Q The doctor
930436 - also did not remember reading the analysts's findings of "likely
930437 - esophagitis" for the PET scan test on 060120, as shown in the review
930438 - on 060126. ref SDS 69 DH4O
930439 -
930440 - [On 060428 read medical test findings - case study doctors
930441 - limited time prevents reading findings to correlate
930442 - clinically for discovering symptomatic trends that enable
930443 - proactive case management; there is only enough time to
930444 - read summaries that present the gist of findings.
930445 - ref SDS 80 VG5L
930447 - ..
930448 - [On 060523 CT contrast study for PET scan test on 060414
930449 - reports findings of less than 1 cm lymph nodes within the
930450 - "right paratracheal region" may relate to esophagitis,
930451 - ref SDS 86 PA5G, reported in the PET scan test on 060116, per
930452 - above. ref SDS 69 DH4O
930454 - ..
930455 - [On 060623 medical chart says esophagitis not symptomatic,
930456 - ref SDS 91 X75J; there is no record of receiving the letter
930457 - submitted today, 060320, listing symptoms, per above.
930458 - ref SDS 73 X94Q
930460 - ..
930461 - During the meeting today, the doctor tried to access the report for
930462 - the PET scan test on 060120. There was difficulty manipulating
930463 - Kaiser's data base using the computer in the examination room. The
930464 - doctor was reluctant to look at the report listed in the record on
930465 - 060126. ref SDS 69 DH4O The doctor then tried to open the actual
930466 - images for the PET scan test on 060120, and in order to make a spot
930467 - analysis for esophagitis. There was further difficulty using the
930468 - computer that prevented access to the test image files today during
930469 - the meeting.
930470 -
930471 - [...see below same problem prevented examining current PET scan
930472 - test online during the examination. ref SDS 0 L66H
930474 - ..
930475 - [On 060623 doctor unable to access computer again to review
930476 - test findings on esophagitis. ref SDS 91 463H
930478 - ..
930479 - [On 060711 computer access corrected prior problems finding
930480 - status change report for biopsy on 040419. ref SDS 92 ZR6J
930482 - ..
930483 - As a result, the doctor could not discuss findings of esophagitis in
930484 - relation to new findings, ref SDS 0 OX68, and impressions today, per
930485 - above. ref SDS 0 A544 The doctor plans to make this review later when
930486 - there is more time to reconcile the gap in test reports.
930488 - ..
930489 - During the meeting today, Millie indicated that esophagitis symptoms
930490 - have been mild and infrequent, as reported previously in the letter to
930491 - Kaiser on 060320. ref SDS 73 X94Q
930492 -
930493 - [On 060623 medical chart says esophagitis not symptomatic,
930494 - ref SDS 91 X75J; there is no record of receiving the letter
930495 - submitted today, 060320, listing symptoms, per above.
930496 - ref SDS 73 X94Q
930498 - ..
930499 - The doctor seemed to indicate that IBC relapse is the most likely
930500 - scenario in the event that rising CA 15-3 and FDG SUV 4.5 PET scan
930501 - test findings for the left supraclavicular, ref SDS 0 OX68, turn out
930502 - to presage metastatic disease. There was discussion that prior
930503 - findings of esophagitis that is regionally near the left
930504 - supraclavicular, ref SDS 0 K05F, would not likely cause FDG SUV 4.5
930505 - reported in the PET scan test on 060414, per above. ref SDS 0 OX68 As
930506 - a result, no treatment was prescribed for esophagitis.
930508 - ..
930509 - [On 060607 Millie admitted to emergency room with temperature of
930510 - 104.2; xray shows pneumonia, ref SDS 90 PT7S, doctor reports
930511 - Kaiser's computer says Millie has been diagnosed with esophagitis,
930512 - and asks how esophagitis is being treated. ref SDS 90 K66E
930513 - Research indicates possible correlation between esophagitis and
930514 - pneumonia. ref SDS 90 I24L
930515 -
930516 -
930517 -
930518 -
930519 -
9306 -
SUBJECTS
CT Contrast Study Test Scheduled 060609 Evaluate Left Supraclavicula
9603 -
960401 - ..
960402 - CT Contrast Study FDG Right Axillary Left Supraclavicular Scheduled
960403 - FDG Right Axillary Left Supraclavicular Schedule Contrast CT Study
960404 - Schedule CT Contrast Study Left Supraclavicular FDG Right Axillary
960405 -
960406 - Follow up ref SDS 70 II4L, ref SDS 69 XF41.
960407 -
960408 - During the meeting on 060217 Millie asked about the analysts
960409 - "Impression" in the PET scan test report that calls for a contrast CT
960410 - study of right axillary, shown on 060126. ref SDS 10 MW6K
960412 - ..
960413 - At that time on 060217, the doctor proposed that, based on blood work
960414 - showing everything normal for the first time in four (4) years,
960415 - including a slight drop in CA 15-3, which was well below the danger
960416 - target level of 39, that a contrast CT study should be deferred until
960417 - after the next PET scan test in April.
960419 - ..
960420 - Today, the analyst again calls for a contrast CT study, in the report
960421 - for the PET scan test on 060414, per above, ref SDS 0 A544,
960423 - ..
960424 - The doctor used the computer to order a contrast CT study to compare
960425 - with PET scan findings on 060414. This will be performed in 4 to 6
960426 - weeks on 060609, and in time for review during the next meeting with
960427 - the doctor scheduled for late June, per above. ref SDS 0 4Y9N
960429 - ..
960430 - [On 060505 CT study performed, moved ahead in the schedule from
960431 - 060609. ref SDS 83 II4L
960433 - ..
960434 - [On 060512 Millie requests report from the doctor on results of
960435 - the test. ref SDS 85 4S5T
960437 - ..
960438 - [On 060523 favorable CT test report findings NED, defer
960439 - considerations of treatment planning despite rising CA 15-3.
960440 - ref SDS 86 4R82
960442 - ..
960443 - [On 060523 CT test on 060505 does not expressly present a contrast
960444 - study comparing with the PET scan test on 060414. ref SDS 86 006P
960446 - ..
960447 - [On 060523 letter asks doctor to obtain supplemental analysis
960448 - comparing the test on 060505 with the test on 060414. ref SDS 87
960449 - 4C6G
960451 - ..
960452 - [On 060524 Millie's letter to the doctor asks for comparing
960453 - CT test on 060505 with PET scan test on 060414. ref SDS 87
960454 - KG4W
960456 - ..
960457 - [On 060526 the doctor asks for clarification of the date
960458 - format. ref SDS 88 6T8L Millie responds with
960459 - clarification, and explains advantage of comparing recent
960460 - tests to supplement comparing tests 1 year apart.
960461 - ref SDS 88 JD5K
960463 - ..
960464 - [On 060605 patient notes CA 15-3 rising above cancer signal;
960465 - requests comparison study to prepare for the next meeting.
960466 - ref SDS 89 UQ5X
960468 - ..
960469 - [On 060607 doctor does not indicate progress on ordering study
960470 - comparing CT test with PET scan test on 060414. ref SDS 90 EB9J
960472 - ..
960473 - After entering the order for the CT test in the computer, the doctor
960474 - commented that the test should include the neck in order to address
960475 - the PET test findings today that cite FDG uptake SUV 4.5 in the left
960476 - supraclavicular. ref SDS 0 OX68
960478 - ..
960479 - We also discussed including the head as further consideration of
960480 - rising CA 15-3.
960481 -
960482 - [On 060623 MRI on head ordered to evaluate continuing dizziness.
960483 - ref SDS 91 PT4K
960485 - ..
960486 - Time limitations and a computer snafu during the meeting prevented the
960487 - doctor from modifying the order for the test. The doctor requested an
960488 - email notice to remind him to clarify the scope of the test at a
960489 - convenient time, so that when the patient arrives the technicians
960490 - will include the head and neck in the contrast CT test ordered today.
960491 -
960492 - [On 060503 Millie sent a letter to the doctor reminding about
960493 - updating the scope of the CT test. ref SDS 81 OT7N
960495 - ..
960496 - [On 060504 letter from doctor advises that scope of the CT test
960497 - was modified to include the neck. ref SDS 82 YN8G
960499 - ..
960500 - [On 060505 CT study performed, moved ahead in the schedule from
960501 - 060609. ref SDS 83 II4L
960503 - ..
960504 - [On 060523 favorable CT test report findings NED, defer
960505 - considerations of treatment planning despite rising CA 15-3.
960506 - ref SDS 86 4R82
960507 -
960508 -
960509 -
960510 -
9606 -
SUBJECTS
Right Axillary FDG SUV 2.5 Rises from 1.9 PET Scan Test Indicates Ri
A203 -
A20401 - ..
A20402 - Right Axillary FDG SUV 2.5 Rises from 1.9 Examination Finds No Lump
A20403 -
A20404 - PET test findings that FDG SUV increased from 1.9 to 2.5, ref SDS 0
A20405 - OX68, aligns with rising CA 15-3. ref SDS 0 UC8L
A20407 - ..
A20408 - Doctor made clinical examination. There was no evidence of lumpiness
A20409 - in the right axillary. Patient has not complained of discomfort
A20410 - under right arm, which occurred throughout the 4 years of
A20411 - lymphadenopathy in left axilla, see study on 040517 citing complaint
A20412 - on 020603, ref SDS 30 SU9W and further citing the record on 030109.
A20413 - ref SDS 30 UF3L
A20415 - ..
A20416 - There was discussion of DCIS causing rising CA 15-3 and FDG SUV
A20417 - findings in the PET scan test on 060414, per above. ref SDS 0 GJ5M
A20419 - ..
A20420 - Doctor ordered contrast CT study scheduled today for 060609 to
A20421 - evaluate for distant metastatic disease. ref SDS 0 244O
A20423 - ..
A20424 - Previously, imaging tests were not effective identifying DCIS,
A20425 - reported on 051027. ref SDS 7 HC3L
A20427 - ..
A20428 - Research on 051027 indicates that biopsy can detect DCIS. ref SDS 7
A20429 - AE8N
A20430 -
A20431 -
A20432 -
A20433 -
A20434 -
A20435 -
A20436 -
A205 -
SUBJECTS
Left Axillary Lump Under Arm Examination Finds Size of Lump Still Re
AM03 -
AM0401 - ..
AM0402 - Left Axillary No Findings Lymphadenopathy PET Scat Test
AM0403 - Lymphedema Left Arm Lump Under Arm Diagnosis Not Cancer
AM0404 - Post Operation Localized Edema Left Axillary Swelling Reduced
AM0405 - Dental Care Limitations for Lymphedema Check with Physical Therapist
AM0406 -
AM0407 - Follow up ref SDS 70 MW8J, ref SDS 68 MW8J.
AM0409 - ..
AM0410 - Background on patient history of left axillary lymphadenopathy and
AM0411 - possible lymphedema is also reported on 060106. ref SDS 9 S164
AM0413 - ..
AM0414 - PET scan test report received today reports no evidence of cancer in
AM0415 - left axillary, ref SDS 0 OX68, which has long been a problem area,
AM0416 - shown by patient history reported on 040517. ref SDS 30 OW3I Since
AM0417 - the test report does not mention the left axillary, this hopefully
AM0418 - means it was examined and there was nothing to report. If so, that
AM0419 - should be stated in light of patient history, and in order to
AM0420 - eliminate the possibility that the analyst did not examine this
AM0421 - region due to overlight, limited time,
AM0423 - ..
AM0424 - On 060320 Millie submitted a letter to the doctor requesting review by
AM0425 - the surgeon of recent symptoms for lymphedema. ref SDS 2 VR6M
AM0427 - ..
AM0428 - Research reported on 060106 indicates that a work up on lymphedema,
AM0429 - ref SDS 9 S28I, and timely treatment helps prevent disease from
AM0430 - cascading out of control. ref SDS 9 PG5J
AM0432 - ..
AM0433 - Condition currently seems stable following support by Kaiser physical
AM0434 - therapy clinic prescribed by the doctor on 060217. ref SDS 11 VY3F
AM0435 - There has been some improvement, reported today in another record.
AM0436 - ref SDS 9 HO7F
AM0438 - ..
AM0439 - Dental work prophylactic antibiotics - Millie's research on 060417
AM0440 - says to consult primary care physician. ref SDS 7 L24K
AM0442 - ..
AM0443 - The doctor said the physical therapist should be contacted about
AM0444 - Kaiser protocol for precautions during dental treatment for lymphedema
AM0445 - patients.
AM0446 -
AM0447 - [On 060508 physical therapist indicated there is no risk for
AM0448 - Millie to have dental work performed. ref SDS 84 X59N
AM0449 -
AM0450 -
AM0451 -
AM0453 - ..
AM0454 - Lesson Learned Mastectomy Patients Exercise Increases Lymphedema
AM0455 -
AM0456 - Follow up ref SDS 30 PW8F.
AM0457 -
AM0458 - Analysis on 060306 indicates that improved health and vigor recovering
AM0459 - from IBC after treatment with capecitabine and Taxotere, and
AM0460 - mastectomy, then enabled increased exercise that has accelerated
AM0461 - symptoms of lymphedema. ref SDS 0 5Q7H
AM0463 - ..
AM0464 - Lesson learned...
AM0465 -
AM0466 - Doctors should notify mastectomy patients of increased risk
AM0467 - from removal of additional lymph drainage system, and remedial
AM0468 - precautions to reduce impact of exercising that causes
AM0469 - increased lymphedema symptoms, per above, ref SDS 0 MW8J, cited
AM0470 - in patient's letter on 060320. ref SDS 2 X95Y
AM0471 -
AM0472 -
AM0473 -
AM0474 -
AM0475 -
AM05 -
SUBJECTS
Left Supraclavicular Neck PET Test Report Finding FDG SUV 4.5 Examin
BL03 -
BL0401 - ..
BL0402 - Left Supraclavicular Examination PET Test Report Finding SUV 4.5
BL0403 - Prognosis Stage IV Metastatic Disease Currently in Remission
BL0404 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
BL0405 -
BL0406 - Follow up ref SDS 70 8R6M, ref SDS 68 8R6M.
BL0407 -
BL0408 - Background on history of left supraclavicular cancer activity is
BL0409 - reported in the record on 060127. ref SDS 11 YS4J
BL0411 - ..
BL0412 - PET test report finding left supraclavicular FDG SUV 4.5, per above.
BL0413 - ref SDS 0 OX68
BL0415 - ..
BL0416 - Doctor examined the neck and found no evidence of lumps in the area of
BL0417 - the left supraclavicular. This contrasts with experience on 040211
BL0418 - when the patient reported lumps, and doctor examination concurred,
BL0419 - ref SDS 26 WP7L, leading to biopsy that identified cancer on 040309.
BL0420 - ref SDS 27 0001
BL0422 - ..
BL0423 - The doctor indicated IBC relapse is the most likely in the event that
BL0424 - current findings of FDG in left supraclaviular turn out to be
BL0425 - metastatic disease, and so there is likely no relationship with prior
BL0426 - findings of likely esophagitis, per above. ref SDS 0 GF5J
BL0428 - ..
BL0429 - The doctor tried to open the image files for the PET scan test on
BL0430 - 060414 to directly examine the left supraclavicular area to review the
BL0431 - analyst's report, per above. ref SDS 0 OX68 Diffculty using the
BL0432 - computer prevented this direct examination, as also occurred trying to
BL0433 - investigate test images on esophagatitis from the prior PET scan test.
BL0434 - Per above, the doctor will make this examination later when there is
BL0435 - more time. ref SDS 0 KC5K
BL0436 -
BL0437 - [On 060607 doctor asked several times about results comparing the
BL0438 - CT test on 060505 with the PET scan test on 060414, as recommended
BL0439 - by PET scan test analyst; there has been difficulty getting this
BL0440 - done. ref SDS 90 D443
BL0442 - ..
BL0443 - Doctor ordered contrast CT test, recommended in PET test. ref SDS 0
BL0444 - A544 Test scheduled for 060609. ref SDS 0 244O
BL0446 - ..
BL0447 - Radiation of left supraclavicular post surgery was considered by the
BL0448 - Tumor Board on 040416, shown in the record on 040517. ref SDS 30 F78G
BL0450 - ..
BL0451 - There will be an issue whether this area can be further radiated,
BL0452 - following treatment during 2002, based on planning reported on 020708.
BL0453 - ref SDS 12 ZO5N
BL0454 -
BL0455 - [...see below considering radiation as part of treatment
BL0456 - planning. ref SDS 0 NY59
BL0458 - ..
BL0459 - [On 060512 Millie's letter to doctor asks about updating Tumor
BL0460 - Board considerations for radiation of left neck. ref SDS 85 4T3S
BL0461 -
BL0462 -
BL0463 -
BL0464 -
BL0465 -
BL0466 -
BL0467 -
BL05 -
SUBJECTS
Examination Finds No Evidence of Disease NED But PET Scan Test and C
BV03 -
BV0401 - ..
BV0402 - Evidence of Disease Patient Recovering Mastectomy Surgery
BV0403 - Examination Left Breast Surgical Wound Mastectomy Incision Healing
BV0404 - Healing Surgical Wound Mastectomy Incision Examination Left Breast
BV0405 -
BV0406 - Follow up ref SDS 70 025H, ref SDS 68 025H.
BV0407 -
BV0408 - The doctor did not examine the incision wound from mastectomy surgery
BV0409 - on 051021. ref SDS 62 YG4R The patient reported there has been no
BV0410 - change in favorable recovery, and indicated the wound is still healing
BV0411 - normally without complications, which extends findings on 060106.
BV0412 - ref SDS 9 VN7I
BV0414 - ..
BV0415 - In particular, there is no inflammation that previously demonstrated
BV0416 - IBC symptoms, reported for example on 030109, ref SDS 19 KW5F, and
BV0417 - again on 040318. ref SDS 28 IM6J
BV0419 - ..
BV0420 - The doctor seemed to indicate that IBC relapse is the most likely
BV0421 - scenario in the event that rising CA 15-3 and FDG SUV 4.5 PET scan
BV0422 - test findings for the left supraclavicular, ref SDS 0 OX68, turn out
BV0423 - to presage metastatic disease. There was discussion that prior
BV0424 - findings of esophagitis, located regionally near the left
BV0425 - supraclavicular would not likely cause FDG SUV 4.5, per discussion
BV0426 - above. ref SDS 0 DH4O
BV0428 - ..
BV0429 - Possibility "wide mastectomy" on 051021 was not wide enough to remove
BV0430 - all infected IBC tissue. ref SDS 62 MM6M
BV0432 - ..
BV0433 - The doctor did not report on Kaiser finding the surgeon's pre-op
BV0434 - patient history, which was missing from the record prior to surgery on
BV0435 - 051021, ref SDS 62 DG6J, and then discussed with the surgeon a week
BV0436 - later on 051027. ref SDS 7 PO5J
BV0438 - ..
BV0439 - Prior mild and periodic, general discomfort all along the left side,
BV0440 - including ear ache was not experienced since the meeting on 060106.
BV0441 - ref SDS 9 5P7I
BV0443 - ..
BV0444 - The doctor used a stethoscope to examine lung and heart function. He
BV0445 - seemed satisfied with these conditions, as shown below in the doctor's
BV0446 - report. ref SDS 11 BU7I
BV0448 - ..
BV0449 - The doctor did not expressly change patient status, today, previously
BV0450 - described as NED and stable, based on history and analysis reported on
BV0451 - 051121, ref SDS 8 GV6K, and continuing through examination on 060217.
BV0452 - ref SDS 11 GV6K
BV0454 - ..
BV0455 - Diagnostics reviewed today seem to change the perspective, if not the
BV0456 - actual status. PET scan test results of rising FDG SUV 2.6 in right
BV0457 - axilla, and 4.5 in left supraclavicular, ref SDS 0 OX68, together with
BV0458 - rising CA 15-3, now 5 points above the danger level, ref SDS 0 GJ5M,
BV0459 - all raise concerns about cancer relapse.
BV0461 - ..
BV0462 - Contrast CT test was scheduled for 060609, per above, ref SDS 0 244O,
BV0463 - to further evaluate status, along with continued CA 15-3 blood
BV0464 - testing.
BV0466 - ..
BV0467 - Began discussion of treatment options. ref SDS 0 K36G
BV0469 - ..
BV0470 - Doctor scheduled follow up examination the end of June, after results
BV0471 - of the CT test are available, and per above. ref SDS 0 4Y9N
BV0472 -
BV0473 -
BV0474 -
BV0475 -
BV0476 -
BV0477 -
BV0478 -
BV0479 -
BV05 -
SUBJECTS
Emotional Trauma Eased by Engagement with Work Family and Exercise V
C603 -
C60401 - ..
C60402 - Lesson Learned Engagement Work Exercise Help Relieve Emotional Trauma
C60403 - Emotional Trauma Eased by Engagement with Work Family and Exercise
C60404 - Exercise Vigor Strength Engagement Ease Distress Living with Cancer
C60405 - Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
C60406 -
C60407 - Follow up ref SDS 70 Y642.
C60408 -
C60409 - Exercising 3 - 4 times per week at health club, and hiking 3 - 7
C60410 - miles reflects general good health, high energy, and positive outlook
C60411 - reported on 060217. ref SDS 11 Y642
C60413 - ..
C60414 - Millie was awarded a bonus at work for superior work, based on annual
C60415 - review showing excellent performance, and a report that N&P management
C60416 - wants to "clone" her attitude, reported on 060323. ref SDS 6 YN6F
C60418 - ..
C60419 - Planning to continue employment working 3 days per week, rather than
C60420 - retire in July. Vacation scheduled for Alaska cruise at end of May,
C60421 - vacation to work-out facility in Arizona in July, and possible trip to
C60422 - Greece in October, all demonstrate forward perspective that aids
C60423 - recovery from emotional concerns discussed on 060217. ref SDS 11 Y64H
C60424 -
C60425 - [On 060524 Millie's letter to the doctor explains that
C60426 - recent favorable CT test report was a big emotional lift.
C60427 - ref SDS 87 KG5S
C60429 - ..
C60430 - Improvement in mental and emotional outlook reflects the doctor's
C60431 - recommendations on 060217. ref SDS 11 Y74K
C60433 - ..
C60434 - Lesson learned....
C60435 -
C60436 - Engagement, work, and exercise are strong aids for emotional
C60437 - trauma, reported today, ref SDS 0 Y642, and recommended by the
C60438 - doctor on 060217. ref SDS 11 Y74K
C60440 - ..
C60441 - The doctor asked about helpfulness relieving emotional distress from
C60442 - meeting with behavioral medical specialist (BMS) prescribed during
C60443 - the visit on 060217? ref SDS 11 JL5G
C60445 - ..
C60446 - Millie asked if the doctor received her letter, submitted to Kaiser on
C60447 - 060320, ref SDS 73 RE4Y, which stated in part...
C60448 -
C60449 - ...referral to BMS was not helpful; however, continued exercise
C60450 - and engagement in family and work are getting me back in the swim
C60451 - of things. ref DRP 6 WT8H,
C60453 - ..
C60454 - The doctor did not recall this letter. Millie related that the
C60455 - meeting with Kaiser's BMS counselor left an impression that she should
C60456 - not have been referred for support, because emotional trauma stemming
C60457 - from cancer the past 5 years, shown in the record on 050812,
C60458 - ref SDS 55 UF4J, was too mild to justify treatment.
C60459 -
C60460 - [On 060524 Millie's letter to the doctor explains that recent
C60461 - favorable CT test report was a big emotional lift. ref SDS 87
C60462 - KG5S
C60464 - ..
C60465 - [On 070921 doctor makes referral to mental health again to cope
C60466 - with emotional stress from poor handling of billings by Kaiser
C60467 - and UCSF. ref SDS 95 QY54
C60469 - ..
C60470 - [On 080118 doctor recommends again Millie consult with Mental
C60471 - Health therapyst. ref SDS 96 X14J
C60473 - ..
C60474 - [On 080201 mental health therapyst advised that prior
C60475 - consultation dismissing Millie's need for assistance was
C60476 - improper. ref SDS 97 SG7K
C60477 -
C60478 -
C60479 -
C60480 -
C605 -
SUBJECTS
Dizziness Occurs Occasionally Treatment on 060308 by HEENT Cerumen P
CA03 -
CA0401 - ..
CA0402 - Dizziness Occurs Occasionally Treatment Ordered by HEENT Cerumen Plug
CA0403 -
CA0404 - Follow up ref SDS 70 PT4K.
CA0405 -
CA0406 - Mild dizziness 5 - 10 seconds at the time of getting up from bed each
CA0407 - morning, recently reported to the doctor. Symptoms continue following
CA0408 - treatment prescribed on 060217, ref SDS 11 GB3F, as reported on
CA0409 - 060308. ref SDS 1 TO9G Failure to improve dizziness problem with
CA0410 - treatment may indicate the scope is different from original problem
CA0411 - reported on 030710, ref SDS 23 WS47, which was relieved with
CA0412 - treatment, reported a few months later on 030915. ref SDS 24 WS47
CA0414 - ..
CA0415 - The doctor used an instrument to examine the ears again, following
CA0416 - practice used during the examination on 060217. ref SDS 11 W54K
CA0417 - Nothing was observed that accounts for dizziness.
CA0419 - ..
CA0420 - Since the symptoms are mild, and of very short duration, the doctor
CA0421 - decided to defer further tests and treatment until the next visit in
CA0422 - about 60 days. This will give more time for the prior treatment to
CA0423 - further relieve symptoms.
CA0424 -
CA0425 -
CA0426 -
CA0427 -
CA0428 -
CA05 -
SUBJECTS
Treatment Plan Contrast CT Test for Relapse Patient Demonstrating So
CR03 -
CR0401 - ..
CR0402 - Treatment Plan Holiday Continue CT Test Evidence Cancer Relapse
CR0403 - Holiday Treatment Patient Minor Evidence Relapse CT Test Ordered
CR0404 -
CR0405 - Follow up ref SDS 70 AW5G, ref SDS 68 AW5G.
CR0406 -
CR0407 - Treatment "holiday" has been in effect following last chemotherapy on
CR0408 - 050916, ref SDS 59 407N, and continues in alignment with examination
CR0409 - showing patient status now questionable for NED, but not sufficient
CR0410 - evidence of relapse to require treatment, per above. ref SDS 0 025H
CR0411 -
CR0412 - [On 060512 Millie's letter notifies about vacation schedule for
CR0413 - effect on treatment plans. ref SDS 85 4T3S
CR0415 - ..
CR0416 - Strength, stamina, vigor, and engagement has been significantly
CR0417 - restored, per report above. ref SDS 0 Y642
CR0419 - ..
CR0420 - Testing continues for relapse based on prognosis of metastatic cancer,
CR0421 - most recently on 051121, ref SDS 8 8R6M, as "treatment" approach at
CR0422 - this time. Implementation with CA 15-3, reported on 060106, and
CR0423 - reviewed today, above, ref SDS 0 GJ5M, and, also, with PET scan test
CR0424 - findings, reported today, ref SDS 0 OX68, suggest growing evidence of
CR0425 - advancing disease, possibly in the right axilla, and left
CR0426 - supraclavicular. ref SDS 0 025H
CR0428 - ..
CR0429 - Since there is no express diagnosis of cancer in the testing, as
CR0430 - occurred for example in previous test reports...
CR0431 -
CR0432 - Type Date Received Link
CR0433 -
CR0434 - PET 020529 reported on 020603........... ref SDS 8 0001
CR0435 - CT 050325 reported on 050422........... ref SDS 49 WJ8J
CR0436 -
CR0437 - ...and further since the doctor feels that FDG SUV 4.5 in the left
CR0438 - supraclavicular would, if cancerous, relate to IBC relapse, and since
CR0439 - there is no evident coloration of the chest area, as the primary
CR0440 - symptom of IBC, ref SDS 0 025H, then the doctor decided to extend the
CR0441 - treatment holiday for the current period.
CR0443 - ..
CR0444 - Current plan is for contrast CT test per recommendations on PET scan
CR0445 - test report 060414, received today. ref SDS 0 A544
CR0446 -
CR0447 - [On 060523 favorable CT test report findings NED, defer
CR0448 - considerations of treatment planning despite rising CA 15-3.
CR0449 - ref SDS 86 4R82
CR0451 - ..
CR0452 - [On 060607 test comparison seems difficult to achieve; doctor
CR0453 - discusses planning for treatment of cancer relapse. ref SDS 90
CR0454 - D45K
CR0455 -
CR0456 -
CR0458 - ..
CR0459 - Treatment Options for Relapse Navelbine Capecitabine Taxotere
CR0460 - Navelbine Capecitabine Taxotere Treatment Options for Relapse
CR0461 -
CR0462 - "Status change" required to fully evaluate treatment options, reviewed
CR0463 - below. ref SDS 0 ZR6J
CR0465 - ..
CR0466 - Treatment consider patient history of ductal carcinoma insitu (DCIS)
CR0467 - discovered with left breast mastectomy; CA 15-3 dropped dramatically.
CR0468 - DCIS may occur in right breast and not be detected by image testing,
CR0469 - as occurred previously, per above. ref SDS 0 GJ5M This record
CR0470 - suggests right breast surgery of some form may resolve rising CA 15-3.
CR0472 - ..
CR0473 - The doctor proposed consideration of treatment for recurrence with
CR0474 - Navelbine chemotherapy drugs.
CR0476 - ..
CR0477 - Millie asked about resuming treatment with Taxotere and capecitabine
CR0478 - (Xeloda) which was successful last year treating IBC in the left
CR0479 - breast, reducing the CA 15-3 cancer marker, eliminating all signs of
CR0480 - red rash, and reducing lymphadenopathy below signs detectable by
CR0481 - testing, as reported on 050520, ref SDS 52 887S, further when meeting
CR0482 - with the surgeon on 050727, ref SDS 54 YY7F, and later on 051007.
CR0483 - ref SDS 60 IE5R
CR0485 - ..
CR0486 - The doctor indicated that this record supports beginning treatment of
CR0487 - relapse with Taxoeter and Xeloda, and that Navelbine along with other
CR0488 - chemotherapy agents for breast cancer, listed on 041130, ref SDS 40
CR0489 - 9V63, will complement the initial treatment effort.
CR0491 - ..
CR0492 - [On 060512 Millie letter notifies about vacation schedule for
CR0493 - effect on treatment plans. ref SDS 85 4T3S
CR0495 - ..
CR0496 - [On 060523 favorable CT test report findings NED, defer
CR0497 - considerations of treatment planning despite rising CA 15-3.
CR0498 - ref SDS 86 4R82
CR0500 - ..
CR0501 - Navelbine may be a newer drug. It was not on the list submitted by
CR0502 - the doctor during the meeting on 041130, as drugs available for
CR0503 - Millie. ref SDS 40 9V91 Navelbine is not in listed in the Kaiser
CR0504 - pamphlet for treating breast cancer, also, reviewed on 041130.
CR0505 - ref SDS 40 2F6K
CR0507 - ..
CR0508 - Research on the Internet shows Navelbine (vinorelbine tartrate) is
CR0509 - an older drug, and has been successful treating lung cancer...
CR0510 -
CR0511 - http://www.oncologychannel.com/lungcancer/chemotherapy.shtml
CR0513 - ..
CR0514 - Another location...
CR0515 -
CR0516 - http://www.pslgroup.com/dg/9086.htm
CR0517 -
CR0518 - The Doctor's Guide
CR0519 -
CR0520 - ...says in part...
CR0521 -
CR0522 - Navelbine effective and well tolerated for breast cancer.
CR0523 -
CR0524 - [On 060711 primary care physician seems to indicate that
CR0525 - side effects of Navelbine are severe. ref SDS 92 PF4M
CR0527 - ..
CR0528 - Navelbine introduced in 1996, costs one quarter the price of
CR0529 - newer medications. Navelbine costs about $550 for a 21-day
CR0530 - cycle. The same cycle of therapy costs more than $2,000 for
CR0531 - other chemotherapies to treat advanced breast cancer.
CR0533 - ..
CR0534 - Navelbine is indicated for patients who have failed standard
CR0535 - first-line chemotherapy or who have relapsed within six months
CR0536 - of anthracycline-based adjuvant therapy.
CR0538 - ..
CR0539 - Clinical trial in 1995 showed 32% showed complete or partial
CR0540 - response. Survival duration was 62 weeks.
CR0541 -
CR0543 - ..
CR0544 - Radiation Treatment Left Supraclavicular Per Tumor Board
CR0545 -
CR0546 - Radiation - as noted, on 040517 Kaiser's Tumor Board considered
CR0547 - further radiation of left supraclavicular in a hearing on 040416.
CR0548 - ref SDS 0 HT6H Since left supraclavicular may present recurrance of
CR0549 - metastatic disease, indicated by PET test report today, ref SDS 0
CR0550 - OX68, should radiologist be consulted on radiating this area?
CR0551 -
CR0552 - [On 060512 Millie's letter to doctor asks about updating Tumor
CR0553 - Board considerations for radiation of left neck. ref SDS 85 4T3S
CR0555 - ..
CR0556 - [On 060523 favorable CT test report defers consideration of
CR0557 - radiation of left supraclavicular for treatment option.
CR0558 - ref SDS 86 4T3S
CR0559 -
CR0560 -
CR0561 -
CR0562 -
CR0563 -
CR06 -
SUBJECTS
Port Catheter Flush Schedule at Kaiser Martinez to Maintain Chemo Tr
CT03 -
CT0401 - ..
CT0402 - Port Catheter Flush Performed at Kaiser to Maintain Chemo Treatment
CT0403 -
CT0404 - Follow up ref SDS 70 SH5N, ref SDS 68 SH5N.
CT0405 -
CT0406 - Millie understands that Kaiser will no longer support port flush
CT0407 - operations at the Walnut Creek facility. This may require separate
CT0408 - trip to Kaiser in Martinez to get the port catheter flushed.
CT0410 - ..
CT0411 - There was an approximate 30 minute wait to see the doctor, and the
CT0412 - meeting lasted about 40 minutes. Port flush takes about 30 seconds.
CT0413 - Cost benefits of expending another 40 minutes traveling to Martinez,
CT0414 - and engaging administrative and nursing staff to perform a 30 second
CT0415 - task that can be performed concurrently during a 70 minute visit has
CT0416 - not been presented. Previously, while waiting to see the doctor,
CT0417 - Laura, Barbara, or someone get Millie, and they flush the port.
CT0419 - ..
CT0420 - Millie plans to get the port catheter flushed on 060501.
CT0422 - ..
CT0423 - Need to schedule follow up in 4 - 6 weeks.
CT0424 -
CT0425 -
CT0426 -
CT0427 -
CT0428 -
CT0429 -
CT05 -
SUBJECTS
Status Test for Change More Urgent with Signs of Relapse ER PR HER2/
CW03 -
CW0401 - ..
CW0402 - Status Change Retest Biopsy 040419 Treatment Options
CW0403 - Treatment Options Status Change Retest Biopsy 040419
CW0404 -
CW0405 - Follow up ref SDS 70 ZR6J, ref SDS 68 ZR6J.
CW0406 -
CW0407 - On 060106 the record was not clarified whether favorable results for
CW0408 - status change, ref SDS 68 ZR6J, were reported in a call from the
CW0409 - doctor on 051123, ref SDS 66 OT5H, following up inquiries presented on
CW0410 - 051121. ref SDS 65 ZP5F
CW0412 - ..
CW0413 - There was no action on this today. Requirements to determine options
CW0414 - for treatment has gained priority and urgency, ref SDS 0 K36G, with
CW0415 - consideration of relapse, per above. ref SDS 0 GV6K
CW0417 - ..
CW0418 - Since the patient has been NED, can the status test be effective
CW0419 - performed again in the event of relapse? For example, if metastasis
CW0420 - occurs in the left supraclavicular and/or the right axilla, can a
CW0421 - biopsy be performed for status change, in the manner that initial
CW0422 - status was evaluated on 020321, ref SDS 5 6Q6J, and for the purpose of
CW0423 - expanding treatment options, discussed by Doctor Shim in a letter on
CW0424 - on 050907, ref SDS 56 AE6P, and clarified two (2) days later on
CW0425 - 050909? ref SDS 57 P58N This issue was earlier noted by Doctor Benz
CW0426 - at UCSF in a 2nd opinion received on 041117. ref SDS 39 OU6W
CW0427 -
CW0428 - [On 060512 Millie's letter asks about progress considering status
CW0429 - change issue. ref SDS 85 4T4T
CW0431 - ..
CW0432 - [On 060523 as a result of favorable CT test report, consideration
CW0433 - of status change can be deferred. ref SDS 86 X54M
CW0435 - ..
CW0436 - [On 060711 primary care physician found status change report
CW0437 - for the biopsy on 040419 was in Kaiser's computer in a location
CW0438 - that required training and experience to access, and showed no
CW0439 - change in status. ref SDS 92 SW7O
CW0440 -
CW0441 -
CW0442 -
CW0443 -
CW05 -
SUBJECTS
Disability Patient No Evidence of Disease Return to Work Meeting Doc
D003 -
D00401 - ..
D00402 - Disability Recovery from Cancer Millie Returning to Work
D00403 -
D00404 - Follow up ref SDS 70 J29L, ref SDS 68 J29L.
D00405 -
D00406 - On 060322 letter to the doctor asks about status of filing signed
D00407 - disability entitlement form. ref SDS 5 LS6N
D00409 - ..
D00410 - At this time the issue seems resolved?
D00411 -
D00412 -
D00413 -
D00414 -
D00415 -
D00416 -
D005 -
SUBJECTS
Work Plan Doctor Submits Doctor/Patient Partnership Communications I
DP03 -
DP0401 - ..
DP0402 - Work Plan Doctor Submits Doctor/Patient Partnership Communications
DP0403 - Communications Doctor Submits Work Plan Doctor/Patient Partnership
DP0404 - Doctor/Patient Partnership Communications Doctor Submits Work Plan
DP0405 -
DP0406 - Follow up ref SDS 70 FE4I, ref SDS 68 FE4I.
DP0407 -
DP0408 - During the meeting today, the doctor prepared a contemporaneous
DP0409 - electronic medical record (Progress Notes) in his computer reporting
DP0410 - examination findings, diagnosis, and work plans, and implementing new
DP0411 - capabilities first reported on 050520. ref SDS 51 HX6J
DP0413 - ..
DP0414 - At the end of the meeting, the doctor proposed printing this record,
DP0415 - as was done for the meeting on 060217. ref SDS 70 PG9I There was
DP0416 - discussion that submitting the record by electronic transmission using
DP0417 - email, as done for the PET scan test report on 060424, ref SDS 8 N95H,
DP0418 - would significantly increase productivity, shown by the meeting today,
DP0419 - reported above. ref SDS 0 YU3H
DP0421 - ..
DP0422 - The doctor requested a reminder using Kaiser's electronic mailing
DP0423 - system, first reported on 051121. ref SDS 65 FE4I He indicated that
DP0424 - upon receipt of a reminder, the doctor's report (i.e., Progress Notes)
DP0425 - on the meeting today would be transmitted electronically, similar to
DP0426 - the reminder requested for modifying the scope of the order of the CT
DP0427 - contrast study test, per above. ref SDS 0 886J
DP0428 -
DP0429 - [On 060503 submitted reminder for doctor to submit the record to
DP0430 - the patient showing understandings in the Medical Chart on the
DP0431 - meeting today. ref SDS 81 GV6H
DP0433 - ..
DP0434 - [On 060504 doctor does not submit the record of patient
DP0435 - history from the meeting on 060428. ref SDS 82 FE4I
DP0437 - ..
DP0438 - [On 060512 resubmit request for doctor's notes; can pick up a
DP0439 - printed document at Kaiser, if email system is down. ref SDS 85
DP0440 - WZ6L
DP0442 - ..
DP0443 - [On 060523 doctor resists submitting patient history to the
DP0444 - patient. ref SDS 86 MC6M
DP0446 - ..
DP0447 - This continues progress toward good management using the doctor
DP0448 - patient partnership for timely review of medical chart, called out in
DP0449 - Kaiser's Healthwise Handbook, reviewed on 990625, ref SDS 3 TD5S, and
DP0450 - recently reported on 060106. ref SDS 9 FE4I
DP0451 -
DP0452 - 1. 4/28/06 03:20 PM
DP0453 -
DP0454 - Wcr-ONnc2 > Main Campus
DP0457 - ..
DP0458 - 2. Your primary care clinician is listed as...
DP0459 -
DP0461 -
DP0584 -
DP0585 -
DP0586 -
DP0587 -
DP0588 -
DP0589 -
DP0590 -
DP06 -