CONTACTS 

SUBJECTS
Meeting Doctor Examine Red Rash Possibility IBC Relapse After Mastec

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 82 0000. ref SDS 72 0000.
040502 -
040503 - Red rash on left breast indicates likely IBC relapse, ref SDS 0 025H,
040504 - reconciles rising CA 15-3. ref SDS 0 GJ5M  Treatment of cancer
040505 - deferred to verify recovery from pneumonia. ref SDS 0 TV5G  Concurrent
040506 - treatment of red rash with Lamisil in case problem is not IBC.
040507 - ref SDS 0 FO5O  MRI on head ordered to evaluate continuing dizziness
040508 - symptoms. ref SDS 0 PT4K  Esophagitis not treated; symptoms still
040509 - mild. ref SDS 0 I36N
040510 -
040511 -
040512 -
040513 -
040514 -
040515 -
040517 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Agenda Develop Work Plan Stage IV Breast Cancer 8 Mos after Mastectomy
040902 -
040903 - Follow up ref SDS 82 SM6M, ref SDS 72 SM6M.
040904 -
040905 - Meeting scheduled for 1200 began at 1300 due to doctor's heavy
040906 - schedule.
040908 -  ..
040909 - Millie's daughter Pam attended the meeting today.
040911 -  ..
040912 - Prior to meeting with the doctor the nurse asked Millie to sign a
040913 - Kaiser form 90258 (REV 5-04) HIPPA Compliant Athorization for Use and
040914 - or Dislosure of Member/Patient Health Information.  She listed Rod and
040915 - Pam.
040917 -  ..
040918 - This is the 5th review meeting with primary care physician following
040919 - mastectomy surgery on 051021, ref SDS 64 0001, and following post op
040920 - examination by the surgeon on 051027 when Millie's status was reported
040921 - "no evidence of disease (NED)". ref SDS 5 M58G  Recently, on 060607
040922 - the doctor raised prospect of planning for treatment of relapse.
040923 - ref SDS 92 D56U
040925 -  ..
040926 - Millie submitted the agenda prior to the meeting so the doctor could
040927 - be prepare.  Prior to the meeting, Millie listed the agenda on the
040928 - marking board in the examination room to guide discussions...
040929 -
040930 -    1.  CA 15-3 cancer marker report............... ref SDS 0 GJ5M
040931 -    2.  PET test review............................ ref SDS 0 NL4N
040932 -    3.  CT contrast study with PET test............ ref SDS 0 II4L
040933 -    4.  Esophagitis................................ ref SDS 0 DH4O
040934 -    5.  Pneumonia recovered........................ ref SDS 0 TV5G
040935 -    6.  Lump under right arm....................... ref SDS 0 II4L
040936 -    7.  Lymphedema improving with treatment........ ref SDS 0 MW8J
040937 -    8.  Breast exam new IBC inflamation??.......... ref SDS 0 025H
040938 -    9.  Dizziness.................................. ref SDS 0 PT4K
040939 -   10.  Treatment plan............................. ref SDS 0 AW5G
040940 -   11.  Status change treatment options............ ref SDS 0 ZR6J
040942 -  ..
040943 - Scheduled next meeting in 2 weeks on July 11, 2006
040944 -
040945 -
040946 -
040947 -
040948 -
040949 -
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 82 KB5L, ref SDS 72 KB5L.
060406 -                           ..
060407 -                          Bld Prssr   Pulse   Temp   Weight  SaO2
060408 -     ..
060409 -    060623................. 141 87     71     98.0    147     99%
060410 -    060428................. 129 73     80     99.4    149     99%
060411 -    060217................. 153 81     61     98.6    150     99%
060412 -
060413 - ...per Doctor's report, shown below. ref SDS 0 JQ4J
060414 -
060415 -
060416 -
060417 -
060418 -
060419 -
0605 -

SUBJECTS
CA 15-3 63 and 24 Above 39 Signals Relapse IBC Growing Red Rash and

1603 -
160401 -  ..
160402 - CA 15-3 Cancer Marker 63 Rise from 44 Past 8 Weeks
160403 -
160404 - Follow up ref SDS 82 087J, ref SDS 72 087J.
160405 -
160406 - The most recent blood test on 060616 shows CA 15-3 now at 63 continues
160407 - rising; since dropping to 28 on 051202 there has been accelerated rise
160408 - until 060522, then slightly reduced rate of increase.  The test report
160409 - received today shows...
160411 -           ..
160412 -          Test Date                         Date Received
160413 -          060616......... 63 H............. 060623, ref SDS 0 UQ5Q
160414 -          060522......... 59 H............. 060605, ref SDS 91 UQ5Q
160415 -          060501......... 49 H............. 060522, ref SDS 88 MC4F
160416 -          060421......... 44 H............. 060428, ref SDS 82 087J
160417 -          060330......... 40 H............. 060428, ref SDS 82 087J
160418 -          060303......... 36............... 060428, ref SDS 82 087J
160419 -          060210......... 33............... 060217, ref SDS 10 087J
160420 -          060109......... 34............... 060126, ref SDS 9 KV59
160421 -          051223......... 34............... 060106, ref SDS 8 087J
160422 -          051202......... 28............... 060106, ref SDS 8 087J
160423 -          051116......... 31............... 051121, ref SDS 7 087J
160424 -          051109......... 30............... 051121, ref SDS 7 087J
160425 -          051102......... 34............... 051121, ref SDS 7 087J
160478 -
160479 -
160481 -  ..
1605 -
1606 -
1607 - Analysis
1608 -
160801 - CA 15-3 63 Cancer Marker Signals Relapse Rises Above Target Level 39
160802 -
160803 - Follow up ref SDS 82 GJ5M, ref SDS 72 GJ5M.
160804 -
160805 - Red rash on left breast at mastectomy incision may indicate IBC
160806 - relapse, per below. ref SDS 0 025H
160808 -  ..
160809 - The most recent CA 15-3 test on 060616 rose slightly from 59, and is
160810 - now 63, well above the cancer signal level of 39, and 19 points higher
160811 - than reported in the meeting on 060428. ref SDS 82 KV59
160813 -  ..
160814 - Examination shows evidence of IBC relapse left breast metastatic
160815 - disease, ref SDS 0 025H, consistent with rising CA 15-3. ref SDS 0
160816 - KV59  Image testing indicates no evidence of distant metastasis,
160817 - reported during the meeting on 060428, ref SDS 81 OW9N, and supported
160818 - by subsequent contrast CT test study, reported today, per below.
160819 - ref SDS 0 II4L
160820 -
160821 -
160822 -
160823 -
160824 -
160825 -
160826 -
160827 -
1609 -

SUBJECTS
Blood Tests on 060109 All Normal 1st Time 4 Years No Evidence Relaps

1803 -
180401 -  ..
180402 - Blood Tests Reports Pending from Kaiser Patient Requested on 060615
180403 -
180404 - Follow up ref SDS 82 SZ9L, ref SDS 72 SZ9L.
180405 -
180406 - There were no general blood tests this period.
180407 -
180408 -    The doctor's medical chart lists a blood test report that is not
180409 -    dated. ref SDS 0 128S  This may be from treatment in the ER for
180410 -    pneumonia on 060607. ref SDS 92 YS6O
180412 -     ..
180413 -    On 060615 Millie submitted a letter to the attending physician,
180414 -    requesting results of blood tests. ref SDS 94 6I3H  As of today,
180415 -    Kaiser has not submitted the reports.
180416 -
180417 -
180418 -
180419 -
180420 -
180421 -
180422 -
1805 -

SUBJECTS
PET Scan Test 040414 Doctor Reports No Evidence Distant Metastasis H

3403 -
340401 -  ..
340402 - PET Scan Test Findings FDG Right Axilla Left Supraclavicular
340403 -
340404 - Follow up ref SDS 82 NL4N, ref SDS 72 NL4N.
340405 -
340406 - On 060428 the doctor ordered a contrast CT test study, ref SDS 81
340407 - K64X, as recommended by the analyst for the PET scan test on 060414.
340408 - ref SDS 81 MU5M  On 060523 the CT test failed to compare with the PET
340409 - scan test, and so is still pending, ref SDS 88 006P, based on the
340410 - doctor's letter on 060607. ref SDS 92 4C6G
340411 -
340412 -
340413 -
340414 -
340415 -
3405 -

SUBJECTS
CT Test Mistakes Failure Perform Contrast Study Compare with PET Sca

3803 -
380401 -  ..
380402 - CT and PET Scan Testing Shows Patient No Evidence Metastatic Disease
380403 - NED CT Image Test Conflicts Examination Finding IBC Relapse
380404 - CT Contrast Study FDG Right Axillary Left Supraclavicular Pending
380405 -
380406 - Follow up ref SDS 82 II4L, ref SDS 72 II4L.
380407 -
380408 - Contrast CT test was performed on 060505, per above, ref SDS 0 NL4N,
380409 - and reviewed a few weeks ago on 060523. ref SDS 88 E355
380411 -  ..
380412 - On 060523 favorable CT test report findings NED, including the right
380413 - axillary, ref SDS 88 4O8P, aligns generally with PET scan test, per
380414 - above, ref SDS 81 A544, that previously supported deferring
380415 - considerations of treatment planning despite rising CA 15-3.
380416 - ref SDS 88 4R82  However, CT test results reviewed on 060523 conflict
380417 - with PET scan test a few weeks earlier which found progression of
380418 - swelled nodes in left supraclavicular. ref SDS 88 4R82  On 060607
380419 - doctor does not indicate progress on ordering study comparing CT test
380420 - with PET scan test on 060414. ref SDS 92 EB9J
380422 -         ..
380423 -        [...below, conflict between PET and CT tests further noted.
380424 -        ref SDS 0 TF6I
380426 -         ..
380427 -        [On 060929 Doctor Benz 2nd opinion notes that failure of CT
380428 -        test to report findings in left supraclavicular where PET test
380429 -        finds nodes progressing in size raises concerns. ref SDS 98
380430 -        WI4I
380432 -  ..
380433 - On 060607 the doctor indicated cancer may be forming in areas that
380434 - have not been tested, e.g., head. ref SDS 92 D45K  MRI ordered to test
380435 - head for cancer that reconciles rising CA 15-3 cancer marker, and
380436 - continued dizziness. ref SDS 0 PT4K
380438 -  ..
380439 - Can treatment planning be aided by further testing for cause of rising
380440 - CA 15-3, or might cancer be everywhere but too small for image
380441 - testing, per anlaysis on 060607? ref SDS 92 7O51
380443 -  ..
380444 - Today, comparing the CT test on 060505 with the PET scan test on
380445 - 060414, per planning on 060428, ref SDS 81 K64X, was dropped from the
380446 - work plan, because focus shifted to initial reports of IBC relapse
380447 - shown by slight rash on left breast area, where IBC was previously
380448 - treated, per below. ref SDS 0 025H
380449 -
380450 -
380451 -
380452 -
380453 -
380454 -
380455 -
3805 -

SUBJECTS
Esophagitis CT Scan Test Findings Nodes Within Right Paratracheal Re

6203 -
620401 -  ..
620402 - Esophagitis Not Compared in Current CT Test with Prior PET Test Report
620403 -
620404 - Follow up ref SDS 82 DH4O, ref SDS 72 DH4O.
620406 -  ..
620407 - Has Millie been diagnosed with esophagitis.  Did antibiotics treatment
620408 - for pneumonia on 060607 - 060609, discussed below, ref SDS 0 TV5G,
620409 - treat esophagitis; is further examination needed for assesment of
620410 - treatment plan for esophagitis?
620412 -  ..
620413 - Background...
620415 -  ..
620416 - On 060217 patient met with the doctor and received a report for a PET
620417 - scan test on 060120.  After meeting on 060217 the patient discovered
620418 - the PET scan test listed findings of esophagitis. ref SDS 72 DH4O  On
620419 - 060320 the patient submitted a letter reporting mild symptoms that
620420 - align with PET scan findings of esophagitis. ref SDS 75 X93U
620422 -  ..
620423 - During the meeting on 060428, the patient asked the doctor about
620424 - treatment for esophagitis, based on the letter submitted on 060320.
620425 - At that time on 060428, the doctor did not recall the letter dated on
620426 - 060320, nor findings of esophagitis in Kaiser's imaging test reports.
620427 - ref SDS 81 PR9J  The doctor tried to access the report for the PET
620428 - scan test on 060120 to review findings of esophagitis.
620430 -  ..
620431 - At that time, on 060428, there was difficulty manipulating Kaiser's
620432 - data base using the computer in the examination room. ref SDS 81 KC5K
620433 - The doctor was reluctant to look at the report listed in the record on
620434 - 060126. ref SDS 71 DH4O  The doctor then tried to open the actual
620435 - images for the PET scan test on 060120, and in order to make a spot
620436 - analysis for esophagitis.  There was further difficulty using the
620437 - computer that prevented access to the test imaging files.  As a
620438 - result, consideration of esophagitis was deferred.
620440 -  ..
620441 - On 060523 CT contrast study for PET scan test on 060414 shows findings
620442 - of less than 1 cm lymph nodes within the "right paratracheal" region,
620443 - which may relate to esophagitis, ref SDS 88 PA5G, reported in the PET
620444 - scan test on 060116. ref SDS 71 DH4O
620446 -  ..
620447 - The doctor did not recall reading this finding in the CT scan test,
620448 - and since it is not included in the summary impression, ref SDS 88
620449 - 014T, there has been no clinical correlation.
620451 -  ..
620452 - On 060607 Millie was treated in Kaiser's Emergency Room as a cancer
620453 - patient with an elevated temperature of 104.2.  At that time, xray
620454 - testing found pneumonia, ref SDS 92 PT7S  The attending physician
620455 - further disclosed that Kaiser's computer shows Millie has been
620456 - diagnosed with esophagitis, and the doctor asked how esophagitis is
620457 - being treated? ref SDS 92 K66E
620459 -  ..
620460 - Research on 060607 indicates possible correlation between esophagitis
620461 - and pneumonia. ref SDS 92 I24L
620463 -  ..
620464 - During the meeting today, the doctor again did not recall the issue of
620465 - esophagitis.  The patient reported symptoms are mild.  The doctor was
620466 - still unable to find Kaiser's computer files for either the CT test on
620467 - 060505, nor for the PET scan test on 060120 that report this issue, as
620468 - set out in the review on 060523. ref SDS 88 4O8P
620470 -  ..
620471 - Since the doctor was an hour behind schedule, ref SDS 0 SM6M, there
620472 - was reluctance to invest a few minutes to review analysts' reports on
620473 - the patient's computer, and to look up on Kaiser's computer reports on
620474 - Millie's treatment in the Emergency Room on 060607 that inquired about
620475 - esophagatis. ref SDS 92 K66E
620477 -  ..
620478 - There was brief discussion today about correlations between pneumonia
620479 - and esophagitis, cited by the ER physician on 060607. ref SDS 92 LN6M
620480 - Since the doctor could not access the tests nor the ER reports, this
620481 - issue was deferred in light of primary focus on findings of IBC
620482 - relapse, and planning to start treatment, discussed below. ref SDS 0
620483 - 025H
620485 -             ..
620486 -            [On 060711 primary care physician reports patient has not
620487 -            been diagnosed with esophagitis on the basis of imaging
620488 -            tests, since patient reports only mild, occassional
620489 -            symptoms. ref SDS 96 4R6K
620491 -             ..
620492 -            [On 061110 patient reports rising indigestion; symptoms
620493 -            still too infrequent to treat esophagatis. ref SDS A0 0R8J
620495 -  ..
620496 - The medical chart for today says...
620497 -
620498 -            Esophagitis on PET only, not symptomatic
620499 -            ref SDS 0 7M5H
620500 -
620501 - ...which may conflict with the report on 060523 for the CT test on
620502 - 060505 citing less than 1 cm nodes within the right paratrachael
620503 - region. ref SDS 88 4O8P
620504 -
620505 -
620506 -
620507 -
620508 -
6206 -

SUBJECTS
Cancer Treatment Delayed Pending Xray Verify Pneumonia Recovery Chem

6603 -
660401 -  ..
660402 - Cancer Treatment Delayed Pending Xray Verify Pneumonia Recovery
660403 - Penumonia Recovery Verified by Xray to Enable Start Cancer Treatment
660404 -
660405 - Follow up ref SDS 92 PT7S.
660406 -
660407 - Millie was treated in the ER on 060607 for temperature of 104+, and
660408 - diagnosis was pneumonia. ref SDS 92 PT7S
660410 -  ..
660411 - Her letter dated 060615 to the attending physician in the Respiratory
660412 - Department reported full recovery. ref SDS 94 TC4T
660414 -  ..
660415 - Today, the doctor examined the patient and concurred that pneumonia
660416 - seems fully cleared.
660418 -  ..
660419 - The doctor advised that pneumonia complicates starting chemotherapy
660420 - treatment for cancer relapse.  Chemotherapy reduces white blood cell
660421 - (WBC) count that maintains the immune system.  If WBC drops and
660422 - pneumonia is not yet fully cured, then pneumonia could quickly
660423 - escalate to life threatening disease.
660425 -  ..
660426 - The doctor ordered an xray to verify pneumonia is clear from the lungs
660427 - as a predicate to starting chemotherapy for IBC relapse, per above.
660428 - ref SDS 0 GJ5M
660429 -
660430 -    [On 060711 follow up xray shows pneumonia resolved, lungs clear.
660431 -    ref SDS 96 FF3K
660432 -
660433 -
660434 -
660435 -
660436 -
6605 -

SUBJECTS
Right Axillary Clinical Examination Finds No Lump Patient Complains

7103 -
710401 -  ..
710402 - Right Axillary FDG SUV 2.5 Rises from 1.9 Examination Finds No Lump
710403 -
710404 - Follow up ref SDS 82 CZ8L.
710405 -
710406 - PET test findings that FDG SUV increased from 1.9 to 2.5, ref SDS 82
710407 - OX68, aligns with rising CA 15-3. ref SDS 82 UC8L  CT test report of
710408 - no lymphadenopathy by size criteria, reported on 060523, ref SDS 88
710409 - E64I, and failure to perform contrast study, per above, ref SDS 0
710410 - II4L, presents a record with no evidence of cancer in the right
710411 - axillary at this time.
710412 -
710413 -     [On 061020 CT scan test for pulmonary embolism also examined the
710414 -     right axillary and reported finding no evidence of lymphadenopathy
710415 -     in the axilla. ref SDS 99 8T4S
710417 -  ..
710418 - Doctor made another clinical examination.  There is still no evidence
710419 - of lumpiness in the right axillary.  Patient has not complained of
710420 - discomfort under right arm, which occurred throughout the 4 years of
710421 - lymphadenopathy in left axilla, see study on 040517 citing complaint
710422 - on 020603, ref SDS 29 SU9W and further citing the record on 030109.
710423 - ref SDS 29 UF3L
710425 -  ..
710426 - Attention on completing contrast study reported on 060607, ref SDS 92
710427 - D443, diverted today by examination findings of red rash, which
710428 - indicates likely IBC relapse. ref SDS 0 025H
710429 -
710430 -
710431 -
710432 -
710433 -
710434 -
710435 -
710436 -
7105 -

SUBJECTS
Left Axillary Lump Under Arm No Discomfort Examination Finds Size of

8303 -
830401 -  ..
830402 - Lymphedema Left Arm Lump Under Arm Diagnosis Not Cancer
830403 - Post Operation Localized Edema Left Axillary Swelling Reduced
830404 - Dental Care Limitations for Lymphedema Check with Physical Therapist
830405 -
830406 - Follow up ref SDS 82 MW8J, ref SDS 72 MW8J.
830408 -  ..
830409 - Background on patient history of left axillary lymphadenopathy and
830410 - possible lymphedema is also reported on 060106. ref SDS 70 S164
830412 -  ..
830413 - The doctor's letter on 060607 cited swelled lymph nodes as possible
830414 - cause of rising CA 15-3. ref SDS 92 D45K
830416 -  ..
830417 - The patient reports no swelling or discomfort in the left axillary
830418 - region.  PET scan test report received on 060428 reports no evidence
830419 - of cancer in left axillary. ref SDS 82 OX68  CT test on 060505
830420 - reported no findings of swelled lymph nodes that signify possible
830421 - cancer, as reported in the record on 060523. ref SDS 88 Q95L  This
830422 - evidence indicates the left axillary, which that has long been a
830423 - problem area, shown by patient history reported on 040517, ref SDS 29
830424 - OW3I, currently seems clear of identifiable metastatis.
830425 -
830426 -        [...above, conflict between PET and CT tests also noted.
830427 -        ref SDS 0 II4L
830429 -         ..
830430 -        [On 060929 Doctor Benz 2nd opinion notes that failure of CT
830431 -        test to report findings in left supraclavicular where PET test
830432 -        finds nodes progressing in size raises concerns. ref SDS 98
830433 -        WI4I
830435 -         ..
830436 -        [On 061020 CT scan test for pulmonary embolism also examined
830437 -        the right axillary and reported finding no evidence of
830438 -        lymphadenopathy in the axilla. ref SDS 99 6Q6H
830440 -  ..
830441 - Lymphedema condition in left arm currently seems stable at near normal
830442 - level; the elblow still has swelling, reported in patient history
830443 - today. ref SDS 95 HO7F
830445 -  ..
830446 - On 060508 physical therapist indicated there is no risk for Millie to
830447 - have dental work performed. ref SDS 86 X59N
830448 -
830449 -
830450 -
830451 -
830452 -
830453 -
8305 -

SUBJECTS
Left Supraclavicular Neck CT Test Contrast Study on 060505 Finds No

9103 -
910401 -  ..
910402 - Radiation Treatment Cancer Relapse Left Supraclavicular and IBC
910403 - Left Supraclavicular Examination PET Test Report Finding SUV 4.5
910404 - Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
910405 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
910406 -
910407 - Follow up ref SDS 82 8R6M, ref SDS 72 8R6M.
910408 -
910409 - Patient history of left supraclavicular cancer activity is reported in
910410 - the record on 060127. ref SDS 10 YS4J
910412 -  ..
910413 - PET test report finding left supraclavicular rising to FDG SUV 4.5,
910414 - reported on 060428. ref SDS 82 OX68   CT scan ordered for contrast
910415 - study with PET scan test was performed on 060505.  The report received
910416 - on 060523 shows analyst failed to make the correct comparison,
910417 - ref SDS 88 006P, and further fails to present findings on left
910418 - supraclavicular region.  This presents possibility of cancer missed by
910419 - the CT scan analyst, or even by the scanning technology for the CT
910420 - test itself.
910422 -  ..
910423 - On 060607 correspondence with doctor on test comparison. ref SDS 92
910424 - D443
910425 -
910426 -        [On 060929 Doctor Benz 2nd opinion notes that failure of CT
910427 -        test to report findings in left supraclavicular where PET test
910428 -        finds nodes progressing in size raises concerns. ref SDS 98
910429 -        WI4I
910431 -         ..
910432 -        [On 061020 CT scan test for pulmonary embolism also examined
910433 -        axillary and other regions; reported finding no evidence of
910434 -        lymphadenopathy. ref SDS 99 LP5G
910436 -  ..
910437 - There will be an issue whether this area can be further radiated,
910438 - following treatment during 2002, based on planning reported on 020708.
910439 - ref SDS 11 ZO5N, as considered again recently on 060428. ref SDS 81
910440 - HT6H
910442 -  ..
910443 - Attention was diverted today by IBC relapse in the left breast,
910444 - reported below, ref SDS 0 025H, from consideration for radiation of
910445 - left supraclavicular post surgery considered by the Tumor Board on
910446 - 040416, shown in the record on 040517. ref SDS 29 F78G
910448 -  ..
910449 - As a result, there was no examination of the left supraclivucular
910450 - today.
910451 -
910452 -
910453 -
910454 -
910455 -
910456 -
910457 -
9105 -

SUBJECTS
Examination Inflammation Surgery Incision Wound Cancer Relapse IBC M

A203 -
A20401 -  ..
A20402 - Cancer Metastatic Disease Evident Inflammation Left Breast
A20403 - Diagnosis IBC Relapse Left Breast at Mastectomy Incision Wound
A20404 - Examination Left Breast IBC Inflammation Mastectomy Incision Wound
A20405 - IBC Inflammation Left Breast Incision for Mastectomy Surgery on 051021
A20406 -
A20407 - Follow up ref SDS 82 025H, ref SDS 72 025H.
A20408 -
A20409 - The incision for the left breast mastectomy performed on 051021 is
A20410 - beginning to show signs of IBC inflammation that requires treatment;
A20411 - reconciles rising CA 15-3 despite no evidence of disease in image
A20412 - testing, per above. ref SDS 0 QM5X  Inflammation previously
A20413 - demonstrated IBC symptoms, reported for example on 030109, ref SDS 18
A20414 - KW5F, and again on 040318. ref SDS 27 IM6J
A20416 -  ..
A20417 - The doctor observed a few sparse red dots lightly sprinkled along a
A20418 - thin line from the sternum on an angle above the incision line, and
A20419 - another below the incision line.  There is definite concentration near
A20420 - the sternum.  There is, as yet, no general inflammation.
A20421 -
A20422 -     [On 070130 similar light sprinkles of red dots observed during
A20423 -     examination at UCSF expanding toward abdomen and wrapping toward
A20424 -     the back. ref SDS A1 M68J
A20426 -  ..
A20427 - IBC relapse following mastectomy surgery was considered on 051007
A20428 - based on prospects that microscopic cancer cells remain. ref SDS 61
A20429 - I482
A20431 -  ..
A20432 - During the meeting on 060428 the doctor seemed to indicate that IBC
A20433 - relapse is the most likely scenario, ref SDS 81 K05F, in the event
A20434 - that rising CA 15-3 and FDG SUV 4.5 PET scan test findings for the
A20435 - left supraclavicular, ref SDS 82 OX68, turn out to presage metastatic
A20436 - disease.
A20438 -  ..
A20439 - Previously, on 060428 there was no examination of the left breast
A20440 - mastectomy incision to treat IBC on 051021, ref SDS 65 YG4R; the
A20441 - patient reported there had been no change in favorable recovery, and
A20442 - indicated the wound is still healing normally without complications,
A20443 - which extends findings on 060106. ref SDS 8 VN7I
A20445 -  ..
A20446 - Possibility "wide mastectomy" on 051021 was not wide enough to remove
A20447 - all infected IBC tissue. ref SDS 65 MM6M  Maybe it couldn't have been
A20448 - wide enough??
A20450 -  ..
A20451 - The doctor used a stethoscope to examine lung and heart function.  He
A20452 - seemed satisfied with these conditions, as shown below in the doctor's
A20453 - report. ref SDS 0 BU7I
A20455 -  ..
A20456 - The doctor changed patient status to consideration of IBC relapse.
A20457 - ref SDS 0 1248
A20459 -  ..
A20460 - Lamisil cream was prescribed today on the chance that rising CA 15-3
A20461 - and beginning red rash on left chest is not IBC. (see medical chart,
A20462 - ref SDS 0 125V)  On 040318 treatment for cancer was delayed to treat
A20463 - red rash on left breast for cellulitus. ref SDS 27 IM6J
A20465 -  ..
A20466 - Biopsy on 040419 identified IBC, reported on 040517. ref SDS 29 6T5G
A20468 -  ..
A20469 - Today, discussed taking another biopsy to help evaulate treatment
A20470 - options.  Does IBC have a variety of forms?  Can the current form be
A20471 - determined through laboratory testing to optimize chances of
A20472 - effective treatment by selecting drugs targeted against the biology
A20473 - of recurrent disease?
A20475 -  ..
A20476 - Patient not enthusiastic about another biopsy.
A20478 -  ..
A20479 - Today, the doctor decided to defer consideration of another biopsy
A20480 - until the next meeting in 2 weeks.
A20481 -
A20482 -            [On 060711 doctor decided biopsy would not be cost
A20483 -            effective because IBC disease is established by visible
A20484 -            observation.
A20486 -  ..
A20487 - Pneumonia reported on 060607 requires verification of recovery prior
A20488 - to starting chemoterapy to treat cancer relapse, per above.
A20489 - ref SDS 0 TV5G
A20491 -  ..
A20492 - Doctor scheduled follow up examination in 2 weeks after results of
A20493 - xray test are available to verify recovery from pneumonia, so that
A20494 - treatment for cancer relapse can begin, per medical chart plan.
A20495 - ref SDS 0 125V
A20496 -
A20497 -
A20498 -
A20499 -
A20500 -
A20501 -
A206 -

SUBJECTS
Emotional Trauma Eased by Engagement with Work Family and Exercise V

AC03 -
AC0401 -  ..
AC0402 - Emotional Trauma Eased by Engagement with Work Family and Exercise
AC0403 - Exercise Vigor Strength Engagement Ease Distress Living with Cancer
AC0404 - Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
AC0405 -
AC0406 - Follow up ref SDS 82 Y642, ref SDS 72 Y642.
AC0407 -
AC0408 - On 060524 Millie's letter to the doctor explains a big emotional lift,
AC0409 - ref SDS 89 KG5S, from favorable CT test report on 060523, ref SDS 88
AC0410 - 014T, which seems to confirm earlier favorable PET scan test received
AC0411 - on 060428 finding no evidence of disease. ref SDS 81 A544
AC0413 -  ..
AC0414 - Dramatic change of status today with rising spread of red rash
AC0415 - indicating IBC relapse presents traumatic event that requires
AC0416 - emotional support, illustrated by reluctance to discuss esophagitis,
AC0417 - ref SDS 0 463H, and reluctance to verify IBC recurrence with biopsy,
AC0418 - and to investigate expanding treatment options with status change.
AC0419 - ref SDS 0 6Z4N  Having Pam here today was very helpful.
AC0420 -
AC0421 -
AC0422 -
AC0423 -
AC0424 -
AC0425 -
AC05 -

SUBJECTS
MRI Head Evaluate Dizziness Cancer Distant Metastasis in Light of Ri

AG03 -
AG0401 -  ..
AG0402 - MRI Head Ordered Evaluate Caner in Light of Rising CA 15-3
AG0403 - Dizziness Occurs Occasionally Treatment Ordered by HEENT Cerumen Plug
AG0404 -
AG0405 - Follow up ref SDS 82 PT4K, ref SDS 72 PT4K.
AG0406 -
AG0407 - Patient reported continuing mild dizziness when waking up in the
AG0408 - morning, previously reported on 060428. ref SDS 81 PT4K
AG0410 -  ..
AG0411 - On 060428 contrast CT test was ordered; there was consideration to
AG0412 - include the head. ref SDS 81 245J  On 060504 the doctor limited the
AG0413 - test to not include the head. ref SDS 84 II4L
AG0415 -  ..
AG0416 - Prior tests listed on 060428 therefore omitted the head, ref SDS 81
AG0417 - OW9N,
AG0419 -  ..
AG0420 - Since dizziness symptoms persist, doctor ordered MRI of head to rule
AG0421 - out cancer that may be driving CA 15-3, though physical examination
AG0422 - showing possible IBC red rash seems more likely the cause of rising CA
AG0423 - 15-3, per above. ref SDS 0 025H
AG0424 -
AG0425 -
AG0426 -
AG0427 -
AG0428 -
AG0429 -
AG05 -

SUBJECTS
Treatment Deferred IBC Relapse Left Breast Verify Recovery from Pneu

BF03 -
BF0401 -  ..
BF0402 - Treatment Deferred to Verify Recovery from Pneumonia
BF0403 - Treatment Holiday Ends IBC Relapse Planning Treatment
BF0404 - Holiday Treatment Ends IBC Relapse Rising Red Rash  Test Ordered
BF0405 -
BF0406 - Follow up ref SDS 82 AW5G, ref SDS 72 AW5G.
BF0407 -
BF0408 - Treatment "holiday" has been in effect following last chemotherapy on
BF0409 - 050916, ref SDS 56 407N, and continues today in alignment with
BF0410 - examination showing patient status now questionable for NED, but not
BF0411 - sufficient evidence of relapse to require treatment, per above.
BF0412 - ref SDS 82 025H
BF0414 -  ..
BF0415 - On 060523 favorable CT test report findings NED, and aligned with
BF0416 - recent PET scan test report received on 060428, ref SDS 81 A544,
BF0417 - together defer considerations of treatment schedule despite rising CA
BF0418 - 15-3. ref SDS 88 014T
BF0420 -  ..
BF0421 - On 060607 the doctor discussed treatment planning to address rising CA
BF0422 - 15-3. ref SDS 92 D56U
BF0424 -  ..
BF0425 - Strength, stamina, vigor, and engagement has been significantly
BF0426 - restored, per report above. ref SDS 82 Y642
BF0428 -  ..
BF0429 - Lamisil cream was prescribed today on the chance the red rash is not
BF0430 - cancer. (see medical chart, ref SDS 0 125V)  On 040318 treatment for
BF0431 - cancer was delayed to treat red rash on left breast for cellulitus.
BF0432 - ref SDS 27 IM6J
BF0434 -  ..
BF0435 - Pneumonia recovery required before starting chemotherapy treatments;
BF0436 - doctor ordered xray to evaluate recovery, per above. ref SDS 0 6W9G
BF0437 -
BF0438 -
BF0440 -  ..
BF0441 - Treatment Options for Relapse Navelbine Capecitabine Taxotere
BF0442 - Navelbine Capecitabine Taxotere Treatment Options for Relapse
BF0443 -
BF0444 - Follow up ref SDS 82 K36G.
BF0445 -
BF0446 - Strategy and planning for treatment of IBC 3rd relapse can be aided by
BF0447 - Tumor Board to consider drug agents available, surgery options, and
BF0448 - additional radiation in the neck, discussed further below, ref SDS 0
BF0449 - Z26K, and previously in Millie's letter to Kaiser on 060512.
BF0450 - ref SDS 87 4T3S
BF0452 -  ..
BF0453 - The doctor asked about the scope for a Tumor Board hearing?
BF0454 -
BF0455 -        [On 060721 the doctor submitted a list of issues that require
BF0456 -        review to develop a new treatment plan for Millie's complex
BF0457 -        case. ref SDS 97 21A6
BF0459 -  ..
BF0460 - Surgery originally proposed to re-build left breast with skin grafts
BF0461 - may still be an option, based on planning with plastic surgeon on
BF0462 - 050928, ref SDS 60 253H, considering 2nd opinions from Doctor Grissom
BF0463 - on 050920, ref SDS 57 GT3M, and follow up telephone consultation on
BF0464 - 051010. ref SDS 62 GW4I  Doctor Baily's letter further discussed
BF0465 - reconstructive surgery to prevent relapse, reported on 050922.
BF0466 - ref SDS 58 XD8P
BF0468 -  ..
BF0469 - "Status change" required to fully evaluate treatment options, reviewed
BF0470 - during the meeting on 060428. ref SDS 82 ZR6J
BF0472 -  ..
BF0473 - Discussed treatment options from prior considerations on 060428,
BF0474 - ref SDS 81 K36G, and mentioned again in the doctor's letter on 060607
BF0475 - calling for discussion of next round of treatment. ref SDS 92 D56U
BF0477 -  ..
BF0478 - On 060428 the doctor proposed consideration of treatment with
BF0479 - Navelbine chemotherapy drugs to complement capecitabine (Xeloda) and
BF0480 - Taxotere, ref SDS 81 9H5I, that was effective last year, reported on
BF0481 - 050520, ref SDS 50 887S, and later on 051007. ref SDS 61 IE5R
BF0482 -
BF0484 -  ..
BF0485 - Radiation Treatment Left Supraclavicular Per Tumor Board
BF0486 -
BF0487 - Follow up ref SDS 82 Z26K.
BF0488 -
BF0489 - Radiation - as noted, on 040517 Kaiser's Tumor Board considered
BF0490 - further radiation of left supraclavicular in a hearing on 040416.
BF0491 - ref SDS 82 HT6H  Since left supraclavicular may present recurrance of
BF0492 - metastatic disease, indicated by PET test report today, ref SDS 82
BF0493 - OX68, should radiologist be consulted on radiating this area?
BF0495 -  ..
BF0496 - On 060512 Millie's letter to doctor asks about updating Tumor Board
BF0497 - considerations for radiation of left neck, ref SDS 87 4T3S, as part of
BF0498 - treatment strategy considered above. ref SDS 0 K36G
BF0500 -  ..
BF0501 - On 060523 favorable CT test report defers consideration of radiation
BF0502 - of left supraclavicular for treatment option. ref SDS 88 4T3S
BF0504 -  ..
BF0505 - The doctor was running behind schedule today, per above. ref SDS 0
BF0506 - SM6M  Decided to defer consideration of Tumor Board support until the
BF0507 - next meeting.
BF0508 -
BF0509 -
BF0510 -
BF0511 -
BF0512 -
BF0513 -
BF06 -

SUBJECTS
Port Catheter Flush Schedule at Kaiser Martinez to Maintain Chemo Tr

BH03 -
BH0401 -  ..
BH0402 - Port Catheter Flush Performed at Kaiser to Maintain Chemo Treatment
BH0403 -
BH0404 - Follow up ref SDS 82 SH5N, ref SDS 72 SH5N.
BH0406 -  ..
BH0407 - Millie had the port catheter flushed on 060501.
BH0409 -  ..
BH0410 - She was in the hospital on 060607 for treatment of pneumonia, and the
BH0411 - port catheter was used for antibiotics. ref SDS 92 K645
BH0413 -  ..
BH0414 - Port catheter flush not needed for 4 - 6 weeks OA 060715.
BH0415 -
BH0416 -
BH0417 -
BH0418 -
BH0419 -
BH0420 -
BH05 -

SUBJECTS
Status Test for Change More Urgent with Signs of Relapse ER PR HER2/

BK03 -
BK0401 -  ..
BK0402 - Status Change Retest Biopsy 040419 Treatment Options
BK0403 - Treatment Options Status Change Retest Biopsy 040419
BK0404 -
BK0405 - Follow up ref SDS 82 ZR6J, ref SDS 72 ZR6J.
BK0406 -
BK0407 - Background on status change is reported in the record of the meeting
BK0408 - on 060428. ref SDS 81 ZR6J
BK0410 -  ..
BK0411 - Since there is now strong evidence of IBC relapse, can a biopsy to
BK0412 - verify IBC also demonstrate whether there is a status change that
BK0413 - increases treatment options, per analysis of Doctor Shim on 050909
BK0414 - that proposed retest of the biopsy on 040419 that identified IBC?
BK0415 - ref SDS 54 P58N
BK0416 -
BK0417 -        [On 060711 computer access problem solved, primary care
BK0418 -        physician reports status change was reviewed with biopsy on
BK0419 -        040419 and was negative. ref SDS 96 SW7O
BK0420 -
BK0421 -
BK0422 -
BK0423 -
BK05 -

SUBJECTS
Disability Patient No Evidence of Disease Return to Work Meeting Doc

BO03 -
BO0401 -  ..
BO0402 - Disability Recovery from Cancer Millie Returning to Work
BO0403 -
BO0404 - Follow up ref SDS 82 J29L, ref SDS 72 J29L.
BO0405 -
BO0406 - On 060322 letter to the doctor asks about status of filing signed
BO0407 - disability entitlement form. ref SDS 4 LS6N
BO0409 -  ..
BO0410 - At this time the issue seems resolved?
BO0411 -
BO0412 -
BO0413 -
BO0414 -
BO0415 -
BO0416 -
BO05 -

SUBJECTS
Work Plan Doctor Submits Doctor/Patient Partnership Communications I

BT03 -
BT0401 -  ..
BT0402 - Work Plan Doctor Submits Doctor/Patient Partnership Communications
BT0403 - Communications Doctor Submits Work Plan Doctor/Patient Partnership
BT0404 - Doctor/Patient Partnership Communications Doctor Submits Work Plan
BT0405 -
BT0406 - Follow up ref SDS 82 FE4I, ref SDS 72 FE4I.
BT0407 -
BT0408 - Doctor patient communication improving.  Contemporaneous notes of work
BT0409 - in progress provided in printed media takes hours to render for
BT0410 - precision access and connection.  There remains resistance from
BT0411 - cultural latency to provide the record electronically (sometimes this
BT0412 - is done, and other times not) for efficient work up into medical
BT0413 - intelligence, e.g., on 060523. ref SDS 88 MC6M
BT0415 -  ..
BT0416 - Overall, progress continues toward good management using the doctor
BT0417 - patient partnership for timely review of medical chart, called out in
BT0418 - Kaiser's Healthwise Handbook, reviewed on 990625, ref SDS 3 TD5S, and
BT0419 - recently reported on 060106. ref SDS 8 FE4I
BT0420 -
BT0421 -    1.  6/23/06     12:00 PM
BT0422 -
BT0423 -            Wcr-ONnc2 > Main Campus
BT0426 -         ..
BT0427 -    2.  Your primary care clinician is listed as...
BT0428 -
BT0430 -
BT0677 -
BT0678 -
BT0679 -
BT0680 -
BT0681 -
BT0682 -
BT0683 -
BT07 -