CONTACTS 
0202 - University of California San Franci                                                                                                                                O-00000835 0406
020201 - Ms. Margaret Rubino                                                                                                                                              O-00000835 0406
020202 - New Patient Coordinator
020204 - Admissions                                                                                                                                                       O-00000835 0406

SUBJECTS
2nd Opinion Doctor Benz Meeting 060821 0930 Comment on Changes Patie

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 44 0000. ref SDS 43 0000.
060502 -
060503 - Confirmed meeting with Doctor Benz on 060821, and notified of
060504 - significant changes in patient condition, along with new issues so
060505 - that the doctor can be prepared for an effective meeting.
060506 -
060507 -
060509 -  ..
0606 -
0607 -
0608 - Background
0609 -
060901 - On 060809 Margaret scheduled a meeting with Doctor Benz on 060821
060902 - 0930.  At that time, on 060809, ref SDS 44 6U3L, Margaret found
060903 - Millie's letter, ref DIP 2 0001, to UCSF on 060725, ref SDS 39 ST9O,
060904 - which lists issues to be addressed in a 2nd opinion. ref DIP 2 AC4L
060906 -  ..
060907 - Since that time, new information in patient history, and additional
060908 - issues need to be addressed.
060910 -  ..
060911 - Submitted ref DIT 1 0001 to Doctor Benz through Margaret, and
060912 - saying...
060913 -
060914 -    1.  This confirms our discussion on August 9th.  Millie will meet
060915 -        with Doctor Benz at UCSF on Monday, August 21 at 0930.
060916 -        ref DIT 1 0001 ....... ref SDS 44 YK6N
060918 -         ..
060919 -    2.  Mil's letter to UCSF on July 25th sets out a summary of patient
060920 -        history, ref DIP 2 3Z8F, and issues to be addressed in a 2nd
060921 -        opinion. ref DIP 2 AC4L  When we talked on the 9th, you seemed
060922 -        comfortable accessing patient history, ref DIP 2 ZD6I, online,
060923 -        and planned to support Doctor Benz as needed in order to avoid
060924 -        handling a lot of printed documents. ref DIT 1 XQ6H
060926 -         ..
060927 -    3.  This letter draws attention to recent changes in Millie's
060928 -        condition. ref SDS 38 5G3H  She started treatment again with
060929 -        Taxotere and capecitabine on July 21.  Her condition worsened
060930 -        in that the red rash of IBC spread and intensified.  We
060931 -        requested an emergency meeting to consider changing treatments.
060932 -        The next day on August 8th, we met with a backup doctor
060933 -        (primary was on vacation), there seemed to be a sudden
060934 -        lessening of IBC rash.  The doctor decided to continue the
060935 -        prescribed protocol.  Two days later regularly scheduled
060936 -        treatment was delayed due to low blood counts, but CA 15-3
060937 -        spiked from 71 to 87 over a 4 week period.  Since then, Millie
060938 -        had another treatment on August 14th, and got another CA 15-3
060939 -        test the next day.  Yesterday, we learned this cancer marker
060940 -        has now dropped to 73 in just a six day period, which aligns
060941 -        with continued improvement in red rash subsiding.  All good
060942 -        news. ref DIT 1 TA6N
060944 -         ..
060945 -    4.  At this time, there seems to have been a delayed response to
060946 -        treatment, which is very favorable.  Millie may be on the mend
060947 -        again. ref DIT 1 TA9G
060949 -         ..
060950 -    5.  Objectives for UCSF 2nd opinion are to consider future
060951 -        scenarios for treatment strategy, ref DIP 2 AC4L, as listed in
060952 -        the prior letter on July 27th, and deemed helpful by Doctor
060953 -        Benz.  Previously, treatment completely cleared inflammation.
060954 -        Kaiser recommended a mastectomy, which was done on October 21,
060955 -        2005.  If current treatment clears the rash, CA 15-3 drops back
060956 -        into the 30s, can treatment end until progression?  Are there
060957 -        proactive steps to prevent or extend the time to progression?
060958 -        ref DIT 1 TA8U
060960 -         ..
060961 -    6.  On September 9, 2005 Doctor Bailey mentioned that Doctor Parks
060962 -        at UCSF may have a drug trial underway, ref DIT 1 PPWV, which
060963 -        might help Millie. ref SDS 23 AL3N
060965 -         ..
060966 -    7.  Doctor Bailey also discussed a work-up for hypercoagulable
060967 -        state, ref SDS 25 XD9X based on pulmonary emboli diagnosed on
060968 -        November 4, 2004, at that time attributable to the Avastin
060969 -        trial.  Subsequent family history involving treatment for
060970 -        relapse of her oldest son, and possible findings of genetic
060971 -        factors reported on July 22nd, ref SDS 37 3D9T, update Doctor
060972 -        Bailey's earlier review. ref DIT 1 T353
060974 -         ..
060975 -    8.  We look forward to visiting wtih Doctor Benz again, and will
060976 -        bring some of Kaiser's printed documents, in case Doctor Benz
060977 -        needs verification. ref DIT 1 TA6I
060979 -  ..
060980 - Later today, organized documents from Kaiser. ref SDS 0 LK4M
060982 -  ..
060983 - Letter to UCSF on 2nd Opinion concludes...
060984 -
060985 -    9.  By copy I am updating Doctor Bailey, and Doctor Grissom, both
060986 -        recommended by USCF last year, and who were exceptional in
060987 -        assisting Millie and Kaiser consider surgery. ref DIT 1 00W2
060988 -
060989 -
060990 -
060991 -
0610 -
0611 -
0612 -
061201 -
0613 -

SUBJECTS
Organize Kaiser's Medical Records On Patient History Facilitate Revi

1003 -
1004 - 1932
100501 -  ..
100502 - Organized Kaiser's Medical Records to Facilitate Review by Doctor Benz
100503 -
100504 - Went through the packet of documents received from Arlette on 060814.
100505 - ref SDS 45 407N
100507 -  ..
100508 - Since we are submitting records only from the date of Mastectomy
100509 - surgery, which is less than 1 year, and further since films and biopsy
100510 - slides are not being supplied, as was done for 2nd opinions #1 and #2,
100511 - this packet of documents is a lot smaller than for previous 2nd
100512 - opinion studies on 041014, ref SDS 5 PF7I, and a year later on 050907.
100513 - ref SDS 22 FA7O
100515 -  ..
100516 - Configured in chronological order based on following criteria...
100517 -
100518 -        a.  Image and biopsy analyst reports.
100520 -             ..
100521 -        b.  Blood tests with summary of CA 15-3 history on top.
100523 -             ..
100524 -        c.  Doctors Progress Notes from meetings with the patient.
100526 -  ..
100527 - Kaiser prints documents from a data base, documents in each category
100528 - separated by a header that is difficult to distinguish when a new
100529 - event occurs.
100531 -  ..
100532 - Underlined the date in red ink so each new event is easy to recognize
100533 - from glancing through the documents.
100535 -  ..
100536 - Removed duplications.
100538 -  ..
100539 - For some reason, Kaiser did not include the PET scan on 060109, which
100540 - was received on 060126, ref SDS 31 AH8V, and reviewed with the doctor
100541 - on 060217. ref SDS 32 II4L
100542 -
100543 -
100544 -
100545 -
1006 -