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

SUBJECTS
Biopsy Determine Treatment Targeted to IBC Biology Status Change Rec
Status Change HER2/neu ER PR Retest Original Biopsy with More Recent

1204 -
1204 -    ..
1205 - Summary/Objective
1206 -
120601 - Follow up ref SDS 46 0000. ref SDS 45 0000.
120602 -
120603 -
120604 -
120605 -
120606 -
120608 -  ..
1207 -
1208 -
1209 - Background
121001 -  ..
121002 - On 060802 called for Doctor Grissom to discuss planning treatment of
121003 - Millie's IBC relapse, ref SDS 46 DT3J, as presented in a letter,
121004 - ref DIP 4 0001, submitted on 060727. ref SDS 43 QQ4N  Later in the
121005 - afternoon, on 060802 received ref DRP 1 0001 from Doctor Grissom
121006 - responding and saying in part...
121008 -         ..
121009 -        I would consider doing a punch biopsy of the rash area to see
121010 -        if there are any changes in the tumor which could direct the
121011 -        type of chemotherapy needed.
121013 -  ..
121014 - Biopsy was discussed on 060711, and Kaiser indicated this strategy
121015 - would not be cost effective at that time. ref SDS 37 KT7J
121017 -  ..
121018 - Later in the evening, submitted ref DIP 5 0001 to Doctor Grissom
121019 - responding to her letter. ref SDS 46 DT3J
121020 -
121022 -  ..
1211 -
1212 -
1213 - Called Doctor Grissom
1214 -
121401 - Talked to receptionist.  She transferred the call to Doctor Grissom's
121402 - voice mail.
121404 -  ..
121405 - Left a message explaining Millie's meeting tomorrow on changing
121406 - treatment, and asking about getting a biopsy, as shown in the letter
121407 - to Kaiser today on 060807. ref SDS 47 SL5T  Asked the doctor how hard
121408 - to push for this procedure?
121409 -
121411 -  ..
1215 -
1216 -
1217 - Progress
1218 -
121801 - Status Change Expand Treatment Options Biopsy
121802 -
121803 - Received ref DRT 1 0001 from Doctor Grissom saying...
121804 -
121805 -        I did receive your telephone call.  I don't know what to tell
121806 -        you about pushing for a biopsy.  I think that it would be a
121807 -        good idea to recheck the ER/PR and Her2/neu at least, but have
121808 -        to defer to your oncologist.  Also, it might not heal well
121809 -        (like last time).  Good luck.  I hope that they can come up
121810 -        with a plan that helps the situation.
121812 -  ..
121813 - This is helpful clarification of the doctor's letter on 060802,
121814 - ref SDS 46 IT7U, raising a proposal to test for status change,
121815 - discussed a year ago during the first meeting on 050912. ref SDS 26
121816 - YD4U  The doctor concurred with this idea at that time on 050912.
121817 - ref SDS 26 MX5N
121819 -  ..
121820 - Millie has tried to get status change biopsy test beginning the next
121821 - day meeting with the primary care physician on 050913, ref SDS 27
121822 - JP5H, then meeting with the surgeon on 060923, ref SDS 30 RX4I, again
121823 - with the primary care physician on 051007, ref SDS 32 ZR6J, and again,
121824 - and again, and...
121826 -  ..
121827 - Most recently on 060711 the primary care physician submitted a report
121828 - showing that the biopsy on 040419 had all along tested for status
121829 - change, and found none, but that everyone who had reviewed the report
121830 - overlooked this part of the test. ref SDS 37 SW7O  There appears to
121831 - have been a snafu of some kind in Kaiser's records.
121833 -  ..
121834 - Doctor Grissom may be pointing out today that the character of the
121835 - disease may have mutated, indicated by failed response to treatment
121836 - that previously was effective.  Since the disease has changed, there
121837 - might be a favorable change in status, which could increase treatments
121838 - availble for Millie.
121840 -  ..
121841 - This is a different perspective from initial impression that a
121842 - biological study of IBC cancer tissue could be used to test for
121843 - effective treatment agents, and results then guide prescribing a
121844 - chemotherapy drug targeted against the biology of the cancer, as
121845 - speculated on 060802. ref SDS 46 IT7U
121847 -  ..
121848 - Concern about the biopsy wound healing may represent an early sign of
121849 - treatment effectiveness.  When the wound did not heal previously, we
121850 - change the treatment.  This could be a similar "canary in the mine"
121851 - mechanism that facilitates treatment decisions.
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121853 -
121854 -
121855 -
121856 -
121857 -
121858 -
121859 -
1219 -