CONTACTS 
0201 - Medical Offices Nima Grissom                                                                                                                                       O-00000849 0101
020101 - Ms. Nima Grissom, MD                                                                                                                                             O-00000849 0101
020103 - Executive Office                                                                                                                                                 O-00000849 0101

SUBJECTS
2nd Opinion #3 Proposes Biopsy to Determine Treatment Targeted to IB

1303 -
1303 -    ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS 43 0000. ref SDS 41 0000.
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130504 -
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130506 -
130508 -  ..
1306 -
1307 -
1308 - Background
1309 -
130901 - Called for Doctor Grissom to follow up the letter, ref DIP 4 0001,
130902 - submitted on 060727. ref SDS 41 QQ4N
130904 -  ..
130905 - On 060801 Talked to Mary.  Doctor Grissom will be in the office in the
130906 - afternoon.  Mary will ask if she has seen the letter yet. ref SDS 43
130907 - YK6N
130909 -  ..
130910 - Received ref DRT 1 0001 from Doctor Grissom responding to the letter
130911 - ref DIP 4 0001 submitted a few days ago on 060727. ref SDS 41 QQ4N
130913 -  ..
130914 - Doctor Grissom says...
130915 -
130916 -    1.  I am sorry to hear that Millie's tumor has recurred in the skin
130917 -        in the breast area.  This does happen more commonly with IBC
130918 -        because of involvement of the dermal lymphatics with cancer
130919 -        cells.  I think that at this point, surgery is not an
130920 -        appropriate option as sometimes it can make the problem worse.
130922 -         ..
130923 -    2.  I would consider doing a punch biopsy of the rash area to see
130924 -        if there are any changes in the tumor which could direct the
130925 -        type of chemotherapy needed.
130927 -  ..
130928 - Biopsy was discussed on 060711, and Kaiser indicated this strategy
130929 - would not be cost effective at that time. ref SDS 35 KT7J
130930 -
130931 -            [On 060807 biopsy was presented again so that Kaiser can
130932 -            prepare for a meeting on 060808. ref SDS 44 SL5T
130933 -
130934 -            [On 060807 Doctor Grissom clarifies that the biopsy test is
130935 -            for status change, which was previously considered.
130936 -            ref SDS 45 S554
130938 -  ..
130939 - Doctor Grissom's letter continues...
130940 -
130941 -    3.  I am not an expert on types of chemotherapy which would be
130942 -        appropriate in Millie's complex case and would recommend that
130943 -        you consult with Doctor Benz again for his current
130944 -        recommendations.
130946 -  ..
130947 - On 051007 surgery department at Kaiser described Millie's compelx
130948 - case.
130949 -
130950 -            [On 060809 schedule meeting with Doctor Benz at UCSF on
130951 -            060821. ref SDS 46 YK6N
130953 -             ..
130954 -            [On 060809 patient coordinator at UCSF worried about level
130955 -            of effort to organize a large complex record on patient
130956 -            history in Millie's case; feels patient work to arrange the
130957 -            record into a simple chronology based on context that is
130958 -            accessible on the computer will save time and avoid
130959 -            mistakes. ref SDS 46 0S7G
130961 -             ..
130962 -            [On 061020 primary care physician feels patient profile has
130963 -            too many issues for a 5-year medical case of secondary
130964 -            inflammatory breast cancer (IBC), cellulitus, lymphedema,
130965 -            pulmonary embolism, broken finger. ref SDS 47 MO4K
130967 -         ..
130968 -    4.  A repeat PET scan might be in order as well if the tumor
130969 -        markers are going up.
130971 -         ..
130972 -    5.  Please pass along my sympathy to Millie.
130973 -
130974 -
130976 -  ..
1310 -
1311 -
1312 - 0920
1313 -
131301 - Submitted ref DIT 1 0001 to Doctor Grissom responding to her letter
131302 - shown above. ref SDS 0 DT3J
131303 -
131304 -    1.  Thanks very much for timely follow up in your letter yesterday
131305 -        considering IBC recurrence, ref DRT 1 0001, in Millie's case.
131306 -        ref DIT 1 0001
131308 -         ..
131309 -    2.  During the meeting on July 11, a biopsy was discussed to study
131310 -        the biological make up disease in order to guide the choice of
131311 -        treatment, as proposed in your letter today. ref DIT 1 XM6F  At
131312 -        that time, on July 11th, Kaiser indicated this would not be
131313 -        cost effective. ref SDS 35 KT7J
131315 -         ..
131316 -    3.  As well, Millie was not enthusiastic about another punch biopsy
131317 -        because the last time it took 18 months to heal. ref DIT 1 6N6N
131319 -         ..
131320 -    4.  Right now we are concerned that disease is progressing at the
131321 -        end of the 1st cycle using the prior treatment.  This makes
131322 -        timeliness critical. ref DIT 1 EN7H
131324 -         ..
131325 -    5.  Today, you suggest a way to possibly target treatment against
131326 -        Millie's recurrent disease.  We submitted a letter to UCSF Med
131327 -        Center on 060725 asking for support by Doctor Benz on selection
131328 -        of chemo drugs. ref SDS 39 ST9O  By copy will let them know of
131329 -        your referral today.  Mil is also considering getting input
131330 -        from Doctor Guardino at Stanford on treatment options, so will
131331 -        copy Rochelle to give them a chance to comment on this idea, if
131332 -        Millie decides to get a 2nd opinion. ref DIT 1 RN7M
131334 -  ..
131335 - A call to UCSF yesterday on 060801 resulted in a new patient
131336 - coordinator working to schedule a meeting. ref SDS 42 IH5I
131337 -
131338 -            [On 060809 schedule meeting with Doctor Benz at UCSF on
131339 -            060821. ref SDS 46 YK6N
131341 -  ..
131342 - Letter to Doctor Grissom concludes...
131343 -
131344 -    6.  By copy letting Millie know of your good wishes. ref DIT 1 00W2
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