CONTACTS 

SUBJECTS
Meeting Doctor Examination Prepare for 11th Cycle Treatment 3rd Rela

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS D8 0000. ref SDS C3 0000.
040502 -
040503 - Doctor very pleased with sudden reversal of CA 15-3 cancer marker
040504 - falling significanlty after 8 month rise and 2 cycles of treatment.
040505 - ref SDS 0 GJ5M  Examination shows minimal improvement in red rash on
040506 - left breast area; condition seems stable, may some slight improvement
040507 - since examination on 060808. ref SDS 0 025H  Since cancer marker has
040508 - improved, and clinical examination shows no worsening of disease, the
040509 - doctor decided to defer imaging tests at this time. ref SDS 0 EY5O
040510 - Current treatment was approved for another cycle, ref SDS 0 PF3O, and
040511 - the schedule was switched back to Friday. ref SDS 0 N96O  Reviewed 2nd
040512 - opinion consultation at UCSF, and consideration that Millie qualifies
040513 - for 2 trials. ref SDS 0 WB9K  Reported Kaiser's new policy to type up
040514 - doctor's progress notes was helpful for 2nd opinion consultations.
040515 - ref SDS 0 FE4I
040516 -
040517 -
040518 -
040519 -
040521 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Agenda Develop Work Plan Stage IV Breast Cancer 8 Mos after Mastectomy
040902 -
040903 - Follow up ref SDS D8 SM6M, ref SDS C3 SM6M.
040904 -
040905 - This is the 3rd review meeting following start of treatments on 060711
040906 - for 3rd relapse of IBC. ref SDS C3 SM6M  It is the 2nd meeting with
040907 - the primary care physician, and the 1st since he returned from
040908 - vacation.  The 2nd review was an emergency meeting when IBC progressed
040909 - during treatment, and was handled by a backup physician on 060808,
040910 - because the primary care physician is on vacation. ref SDS D8 SM6M
040912 -  ..
040913 - Today, the doctor was delayed by other matters, and started the
040914 - meeting at 1545, about 65 minutes late.  There was initial discussion
040915 - on strengthening coordination to reduce lost time.  Kaiser could
040916 - notify customers when delays occur and estimate the amount of delay.
040917 - This has been done with great effect previously.  The doctor indicated
040918 - today that estimating delays presents a big challenge for medical
040919 - practice, because each meeting has unique dynamics that are hard to
040920 - estimate.
040922 -  ..
040923 - This morning Millie submitted an agenda so the doctor could prepare
040924 - for the meeting, similar to meeting a few weeks ago with the
040925 - substitute doctor.  Prior to starting the meeting, Millie listed the
040926 - agenda on the marking board in the examination room to guide
040927 - discussions...
040928 -
040929 -    1.  CA 15-3 review seems favorable............. ref SDS 0 GJ5M
040930 -    2.  Lymphedema stable.......................... ref SDS 0 MW8J
040931 -    3.  PET CT Exam defer.......................... ref SDS 0 EY5O
040932 -    4.  Breast exam IBC relapse diagnosis.......... ref SDS 0 025H
040933 -    5.  Treatment plan strategy.................... ref SDS 0 K36G
040934 -    6.  Trials 2nd Opinion Doctor Benz............. ref SDS 0 WB9K
040935 -    7.  Dizziness gone............................. ref SDS 0 PT4K
040937 -  ..
040938 - Scheduled next meeting in about 5 weeks after 13 cycle of treatment.
040939 - on September 29, 2006 1430.
040940 -
040941 -
040942 -
040943 -
040944 -
040945 -
0410 -

SUBJECTS
Vitals Pending Primary Care Physician Not Submitted with Doctor's Pr

0603 -
060401 -  ..
060402 - Vitals Show Stable Medical Condition
060403 -
060404 - Follow up ref SDS D8 KB5L, ref SDS C3 KB5L.
060406 -     ..
060407 -    Date                  Bld Prssr   Pulse   Temp   Weight  SaO2
060408 -
060409 - *  060825.................
060410 -    060808.................
060411 -    060711................. 172 87     54     97.5    147
060412 -    060623................. 141 87     71     98.0    147     99%
060413 -    060428................. 129 73     80     99.4    149     99%
060414 -    060217................. 153 81     61     98.6    150     99%
060416 -      ..
060417 -  •  Per Doctor's report, shown below, vitals were not reported again
060418 -     for some reason. ref SDS 0 JQ4J
060419 -
060420 -
060421 -
060422 -
060423 -
0605 -

SUBJECTS
CA 15-3 73 and 34 Above 39 Big Drop fromn 87 Improvement Indicates R

1603 -
160401 -  ..
160402 - CA 15-3 Cancer Marker 71 No Test Current Period Since 060711
160403 -
160404 - Follow up ref SDS D8 087J, ref SDS C3 087J.
160405 -
160406 - There have been 2 tests since the meeting with the backup doctor on
160407 - 060808. ref SDS D8 087J  One jumped significantly higher over a 30 day
160408 - period; but, the most recent test showed an almost equal drop in only
160409 - 4 days.
160411 -           ..
160412 -          Test Date                         Date Received
160413 -          060813......... 73 H............. 060817, ref SDS E2 U24M
160414 -          060809......... 87 H............. 060810, ref SDS E0 5T9J
160415 -          060708......... 71 H............. 060711, ref SDS C3 087J
160416 -          060616......... 63 H............. 060623, ref SDS C1 UQ5Q
160417 -          060522......... 59 H............. 060605, ref SDS B6 UQ5Q
160418 -          060501......... 49 H............. 060522, ref SDS B3 MC4F
160419 -          060421......... 44 H............. 060428, ref SDS A6 087J
160420 -          060330......... 40 H............. 060428, ref SDS A6 087J
160421 -          060303......... 36............... 060428, ref SDS A6 087J
160422 -          060210......... 33............... 060217, ref SDS 96 087J
160423 -          060109......... 34............... 060126, ref SDS 95 KV59
160424 -          051223......... 34............... 060106, ref SDS 94 087J
160425 -          051202......... 28............... 060106, ref SDS 94 087J
160426 -          051116......... 31............... 051121, ref SDS 92 087J
160427 -          051109......... 30............... 051121, ref SDS 92 087J
160428 -          051102......... 34............... 051121, ref SDS 92 087J
160429 -          050909......... 45 H............. 051007, ref SDS 85 087J
160430 -          050826......... 45 H............. 050913, ref SDS 78 087J
160431 -          050819......... 45 H............. 050913, ref SDS 78 087J
160432 -          050812......... 39 .............. 050819, ref SDS 71 3K6L
160433 -          050729......... 45 H............. 050819, ref SDS 71 EA5G
160434 -          050708......... 46 H............. 050729, ref SDS 70 087J
160435 -          050701......... 37 .............. 050729, ref SDS 70 087J
160436 -          050617......... 45 H............. 050729, ref SDS 70 087J
160437 -          050527......... 56 H............. 050610, ref SDS 67 087J
160438 -          050512......... 67 H............. 050520, ref SDS 64 087J
160439 -          050506......... 80 H............. 050520, ref SDS 64 087J
160440 -  ..
160441 -          050415.........105 H............. 050422, ref SDS 60 087J
160442 -          050325.........100 H............. 050329, ref SDS 58 087J
160443 -          050318.........101 H............. 050325, ref SDS 57 2N5J
160444 -          050304......... 88 H............. 050311, ref SDS 55 087J
160445 -          050225......... 95 H............. 050308, ref SDS 54 0001
160446 -          050211......... 78 H............. 050214, ref SDS 53 02BB
160447 -          050128......... 67 H............. 050204, ref SDS 52 087J
160448 -          041228......... 56 H............. 041230, ref SDS 51 087J
160449 -          041204......... 43 H............. 041210, ref SDS 50 087J
160450 -          041007......... 39............... 041104, ref SDS 46 087J
160451 -          040923......... 49 H............. 041005, ref SDS 44 087J
160452 -          040908......... 44 H............. 040909, ref SDS 43 087J
160453 -          040825......... 47 H............. 040909, ref SDS 43 087J
160454 -          040811......... 42 H............. 040812, ref SDS 42 087J
160455 -          040728......... 43 H............. 040729, ref SDS 40 2N5J
160456 -          040712......... 47 H............. 040713, ref SDS 39 087J
160457 -          040614......... 55 H............. 040615, ref SDS 38 PX6X
160458 -          040517......... 78 H............. 040601, ref SDS 36 2N5J
160459 -          040311......... 70 H............. 040318, ref SDS 30 SM6M
160460 -          040205......... 60 H............. 040211, ref SDS 27 SM6M
160461 -          031201......... 62 H............. 031205, ref SDS 26 SM6M
160462 -          030912......... 66 H............. 030915, ref SDS 25 SM6M
160463 -          030708......... 68 H............. 030710, ref SDS 24 SM6M
160464 -          030503......... 54 H............. 030508, ref SDS 22 SM6M
160465 -          030403......... 45 H............. 030508, ref SDS 22 SM6M
160466 -          030215......... 46 H............. 030220, ref SDS 21 5E6L
160467 -          030106......... 37 H............. 030109, ref SDS 20 SM6M
160468 -          021202......... 41 H?............ 021204, ref SDS 19 SP5G
160469 -          021111......... 36 H?............ 021113, ref SDS 18 Y65I
160470 -          021023......... 33 H?............ 021023, ref SDS 17 SQ5I
160471 -          020930......... 33 H?..39........ 021002, ref SDS 16 SQ5I
160472 -          020917......... 36 H?............ 020924, ref SDS 15 SQ5I
160473 -          020717......... 59 H?............ 020726, ref SDS 14 YN5K
160474 -          020629......... 75 H ............ 020705, ref SDS 12 UX6I
160475 -          020608........  67 H ............ 020614, ref SDS 10 0001
160476 -          020603........ 108 H ............ 020607, ref SDS 9 X67F
160477 -          020511........ 117 H ............ 020603, ref SDS 8 PJ4J
160478 -          020419......... 81 H ............ 020430, ref SDS 6 7N5H
160479 -          020321......... 85 H ............ 020405, ref SDS 5 6T8K
160480 -
160481 -
160482 -
160483 -
160485 -  ..
1605 -
1606 -
1607 - Analysis
1608 -
160801 - CA 15-3 73 Dramatic Drop in 4 Days Inidicates Response to Treatment
160802 -
160803 - Follow up ref SDS D8 GJ5M, ref SDS C3 GJ5M.
160804 -
160805 - The doctor was pleased with sudden reversal of CA 15-3 cancer marker
160806 - dropping to 73 from 87 in just 4 days, shown above, ref SDS 0 087J,
160807 - and reported on 060817. ref SDS E2 U24M  He indicated this is evidence
160808 - of response to treatment, in line with examination, shown below,
160809 - ref SDS 0 025H, and supports continuing the current prescribed
160810 - treatment. ref SDS 0 PF3O
160811 -
160812 -
160813 -
160814 -
160815 -
1609 -

SUBJECTS
Esophagitis PET Scan Test Not Compared with Prior Report Symptoms Mi

2003 -
200401 -  ..
200402 - Esophagitis Not Compared in Current PET Test with Prior Report
200403 -
200404 - Follow up ref SDS D8 JP6K, ref SDS C3 JP6K.
200405 -
200406 - Background on diagnosis of "likely esophagitis" reported in PET scan
200407 - test performed on 060120, and received on 060126, ref SDS 95 DH4O,
200408 - were most recently reviewed on 060623. ref SDS C1 DH4O  A contrast CT
200409 - study performed on 060505 showed findings of nodes within the right
200410 - paratracheal that might relate to the earlier findings, as reported on
200411 - 060523. ref SDS B3 4O8P  Attending physicians who treated Millie for
200412 - pneumonia in the Emergency Room on 060607 reported Kaiser diagnosed
200413 - Millie with esophagitis. ref SDS B7 K66E  Research indicates possible
200414 - correlations with pneumonia. ref SDS B7 HX7L
200416 -  ..
200417 - About a week prior to examination on 060711, Millie had a strong
200418 - episode of reflux, sometimes associated with esophagitis. ref SDS C3
200419 - KH7N
200421 -  ..
200422 - At that time, on 060711 the primary care physician advised that
200423 - doctors in the Emergency Room on 060607 were mistaken interpreting PET
200424 - and CT scan reports in Kaiser's computer system as diagnosing
200425 - esophagitis. ref SDS C3 AN6L  As a result, the doctor deferred action
200426 - on this issue pending rise of clinical symptoms. ref SDS C3 J28H
200428 -  ..
200429 - Doctor Benz did not have time to address this issue during the meeting
200430 - on 060821 for 2nd opinion review. ref SDS E3 JP6K
200432 -  ..
200433 - There was no discussion today of esophagitis, shown by the doctor's
200434 - record. ref SDS 0 1248
200435 -
200436 -
200437 -
200438 -
200439 -
200440 -
2005 -

SUBJECTS
Left Auxillary Lymphadenopathy Patient No Complaint Swelling Discomf

2903 -
290401 -  ..
290402 - Left Axillary No Evidence Lymphadenopathy
290403 - Lymphedema Left Arm Lump Under Arm Diagnosis Not Cancer
290404 - Post Operation Localized Edema Left Axillary Swelling Reduced
290405 -
290406 - Follow up ref SDS D8 MW8J, ref SDS C3 MW8J.
290408 -  ..
290409 - Patient history of left axillary lymphadenopathy and lymphedema is
290410 - reported on 060106. ref SDS 94 S164
290412 -  ..
290413 - On 060710 physical therapist found significant improvement; decided to
290414 - end physical therapy, since patient making good progress with
290415 - self-care, ref SDS C2 Q05H, further reported during examination on
290416 - 060711. ref SDS C3 U433
290417 -
290418 -        [On 060914 Millie fell at the BART station as a result of
290419 -        fatigue, and injured her middle index finger on her left hand;
290420 -        since this was the side of mastectomy surger on 051021,
290421 -        lymphedema increased rapidly causing the left arm to swell
290422 -        significantly. ref SDS E4 ZQ5I
290424 -         ..
290425 -        [On 061016 Millie had her finger examined at Kaiser to assess
290426 -        slow healing from fall on 060914; xrays showed the finger is
290427 -        broken, requiring a cast for a week to
290428 -        facilitate healing.
290430 -  ..
290431 - Patient reports stable, and mild swelling from lymphedema condition
290432 - left arm with continued home treatment.  Measurement today 10.75
290433 - slightly above normal 10.5 listed in case study on 060509. ref SDS B1
290434 - HO7F
290436 -  ..
290437 - Patient reports no discomfort under left arm which has signaled rise
290438 - of lymphadenopathy, e.g., 030508, as shown in patient history in the
290439 - record on 050812. ref SDS 71 QSPT  Compare with follow up report on
290440 - 030606. ref SDS 71 E49H
290442 -  ..
290443 - Doctor Benz recently examined Millie on 060821 at UCSF for a 2nd
290444 - opinion, and indicated finding no evidence palpitating lymphadenopathy
290445 - in the left axillary. ref SDS E3 UH72
290446 -
290447 -        [On 060929 Benz 2nd opinion notes finding no evidence of
290448 -        lymphadenopathy in left axilla, stating on the left there is
290449 -        sensation of a 1.5 to 2 cm node present high in the axilla;
290450 -        however, I cannot be completely certain about this; for some
290451 -        reason, UCSF does not cite history of image testing to
290452 -        correlate impressions, nor the record of lymphedema.
290453 -        ref SDS E7 WQ4Q
290455 -  ..
290456 - Continuing lack of symptoms left axilla aligns with PET and CT test
290457 - reports reviewed during meeting on 060623, indicating no findings of
290458 - lymphadenopathy, ref SDS C1 MW8J, suggesting cancer relapse seems
290459 - primarily local.
290461 -  ..
290462 - There was no discussion today of left axilla, shown by the doctor's
290463 - record. ref SDS 0 ZL5W
290464 -
290465 -
290466 -
290467 -
290468 -
290469 -
2905 -

SUBJECTS
Right Auxillary Lymphadenopathy Patient No Complaint Swelling Discom

3403 -
340401 -  ..
340402 - Right Axillary FDG SUV 2.5 Lump Discomfort Not Reported by Patient
340403 -
340404 - Follow up ref SDS D8 3D6K, ref SDS C3 3D6K.
340405 -
340406 - Patient history of rising FDG SUV activity by PET testing, reported on
340407 - 060428, ref SDS A5 CZ8L, and no adenopathy found in contrast CT test
340408 - on 060505, as reported on 060523, ref SDS B3 4O8P, which further
340409 - failed to perform contrast study with prior PET test findings,
340410 - ref SDS B2 WT6M, was reviewed during a meeting with the doctor on
340411 - 060623. ref SDS C1 CZ8L
340413 -  ..
340414 - Like the left axillary, the patient made no complaint of swelling or
340415 - discomfort in the right axilla, consistent with image testing reported
340416 - on 060623. ref SDS C1 CZ8L
340418 -  ..
340419 - Primary focus today was assessing response to treatment of IBC red
340420 - rash on left chest.
340422 -  ..
340423 - Doctor Benz recently examined Millie on 060821 at UCSF for a 2nd
340424 - opinion, and indicated finding no evidence palpitating lymphadenopathy
340425 - in the right axillary. ref SDS E3 C44G
340426 -
340427 -        [On 060929 Benz 2nd opinion notes finding no evidence of
340428 -        lymphadenopathy in right axilla. ref SDS E7 WQ9W
340430 -  ..
340431 - There was no discussion today of right axilla, shown by the doctor's
340432 - record. ref SDS 0 ZL5W
340433 -
340434 -
340435 -
340436 -
340437 -
3405 -

SUBJECTS
Left Neck Supraclavicular No Examination Benz 2nd Opinion Finds No E

4203 -
420401 -  ..
420402 - Radiation Treatment Cancer Relapse Left Supraclavicular and IBC
420403 - Left Supraclavicular Examination PET Test Report Finding SUV 4.5
420404 - Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
420405 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
420406 -
420407 - Follow up ref SDS D8 8R6M, ref SDS C3 8R6M.
420408 -
420409 - Background of image testing, and consideration for radiation treatment
420410 - of left supraclivicular is reported on 060623. ref SDS C1 8R6M
420412 -  ..
420413 - Like the left and right axillary, the patient made no complaint of
420414 - swelling or discomfort in the left supraclavicular, consistent with
420415 - image testing reported on 060623. ref SDS C1 CZ8L
420417 -  ..
420418 - There was no examination of left supraclavicular due to focus on IBC
420419 - relapse in left breast, shown by the doctor's record. ref SDS 0 ZL5W
420421 -  ..
420422 - Doctor Benz recently examined Millie on 060821 at UCSF for a 2nd
420423 - opinion, and indicated finding no evidence palpitating lymphadenopathy
420424 - in the left supraclavicular, including no difference from the right
420425 - side. ref SDS E3 LH5M
420426 -
420427 -        [On 060929 Benz 2nd opinion notes finding supraclavicular
420428 -        fossae show vague sensation of fullness on the left side, which
420429 -        was present during previous examination on 041018, and thus,
420430 -        represents no clinical change. ref SDS E7 WQ8Q
420431 -
420432 -
420433 -
4205 -

SUBJECTS
Examination IBC Red Rash Seems Unchanged from 060808 2 Scenarios Imp

5603 -
560401 -  ..
560402 - Red Rash Left Breast No Evident Increase Hopeful Response to Treatment
560403 - Examination Left Breast IBC Inflammation Red Rash Seems to Subside
560404 - IBC Inflammation Left Breast Red Rash Subsides Response to Treatment
560405 - Response to Treatment IBC Inflammation Left Breast Red Rash Subsides
560406 -
560407 - Follow up ref SDS D8 025H, ref SDS C3 025H.
560408 -
560409 - Background on prior relapse examinations is listed on 060711.
560410 - ref SDS C3 8Y7O
560412 -  ..
560413 - The doctor examined Millie today and seemed to indicate uncertainty
560414 - about improvement in the IBC red rash on the left breast after 2
560415 - cycles of treatment with Taxotere and capecitabine (Xeloda).  He feels
560416 - there has been no increase in the rash following examination on
560417 - 060711, and characterized this condition as "stable."
560419 -  ..
560420 - Since the meeting was an hour late, ref SDS 0 2T58, the doctor did not
560421 - take time to discuss rapid expansion of IBC rash reported in the
560422 - patient's letter to Kaiser on 060807, ref SDS D6 423C, and subsequent
560423 - improvement reported in an emergency meeting at Kaiser on 060808,
560424 - ref SDS D8 VO6G, and thus, continuing improvement gives the illusion
560425 - of "stable," for an observer returning from vacation, and not having
560426 - enough time to review the record of patient history.  This perspective
560427 - was also reflected in pathology for the CT test on 060505, as reviewed
560428 - on 060523, where the analyst failed to make comparisons requested by
560429 - the doctor. ref SDS B3 4O8P
560431 -  ..
560432 - Big changes in IBC rash activity have tracked sudden steep climb in CA
560433 - 15-3 reported on 060810, and equally dramatic drop in the cancer
560434 - marker on 060817. ref SDS 0 087J
560436 -  ..
560437 - There was not enough time to review significant disparity cited in the
560438 - meeting on 060808 between rapid improvement under the current
560439 - treatment protocol in 2005, ref SDS D8 MM4I, compared to slow
560440 - improvement further noted by the doctor today, and presented for 2nd
560441 - opinion consultation with Doctor Benz at UCSF on 060821. ref SDS E3
560442 - KR6I
560443 -
560444 -    [On 060922 case study analysis indicates improvement may be more
560445 -    rapid during the current treatment than occurred in 2005.
560446 -    ref SDS E5 0D4T
560448 -  ..
560449 - The doctor commented that specific patient conditions, in this case
560450 - severity and degree of IBC inflammation, are hard to remember from the
560451 - last time he examined the patient on 060711 before going on vacation.
560452 - The doctor's record of examination on 060711 shows there was not
560453 - enough time to write down details that can be assessed in relation to
560454 - observations today. ref SDS C3 BU7I  Patient's record showing
560455 - conditions found by the doctor on 060711, ref SDS C3 8Z8G, and
560456 - prepared under Kaiser requirements for patient diary, to complement
560457 - the doctor patient partnership, reviewed on 990625, ref SDS 2 TD6Q,
560458 - were not reviewed today.
560460 -             ..
560461 -            [On 060929 Benz 2nd opinion finds red rash is not
560462 -            established as cancer, not IBC; requires explanation of
560463 -            rising CA 15-3 cancer marker; doctor indicates there may be
560464 -            wide spread distant metastasis too small for recognition by
560465 -            image testing and currently being treated systemcially with
560466 -            chemotherapy. ref SDS E7 WQ8V
560468 -  ..
560469 - The doctor feels the examination today can be reported in Progress
560470 - Notes to provide a new baseline for future examinations to evaluate
560471 - response to treatment, along with the cancer marker, CA 15-3, and
560472 - image tests.
560473 -
560474 -            [...below, doctor's progress notes report expanding
560475 -            lesions, ref SDS 0 U65J, but, physicial examination says
560476 -            lesions are decreasing. ref SDS 0 ZL5W
560478 -  ..
560479 - Observation of patient condition today shows...
560480 -
560481 -    1.  Previously, the patient reported to the backup doctor on 060808
560482 -        that red rash near the sternum may have expanded, but was less
560483 -        intense, and so breaking up, compared to conditions observed on
560484 -        060711. ref SDS D8 FQ9N  Additionally this area of greatest
560485 -        concern for IBC relapse seemed smaller than a few days earlier
560486 -        when the rash seemed to be expanding. ref SDS D8 FQ45  The
560487 -        patient further reported on 060808 that both thin lines of rash
560488 -        above and below the incision line had likewise expanded in
560489 -        area, but seemed less intense, indicating tumor is breaking up.
560490 -        ref SDS D8 J36J
560492 -         ..
560493 -    2.  Today, the largest area of rash near the sternum may have
560494 -        further expanded, though somewhat less intense than on 060808.
560495 -        The trails of IBC rash above and below the mastectomy incision
560496 -        line and eminating from the area near the sternum might also be
560497 -        slightly expanded, and remain lightly and clearly colored
560498 -        compared to surrounding skin.
560500 -         ..
560501 -        This condition today seems more similar than better or worse
560502 -        than observed on 060808, reflecting the short period between
560503 -        observations.
560504 -
560505 -            [On 060922 slow response to treatment for 3rd IBC relapse
560506 -            reported in a letter to the doctor, ref SDS E5 LE48; study
560507 -            of patient history may indicate recovery compares favorably
560508 -            to treatment in 2005 for 2nd IBC relapse. ref SDS E5 9F35
560510 -  ..
560511 - Millie was again relieved that the doctor is not alarmed by
560512 - observations today, similar to examination by the backup doctor on
560513 - 060808. ref SDS D8 J364
560515 -  ..
560516 - Two (2) scenarios considered on 060808 were not discussed today due to
560517 - limited time.  Hopefully, the patient is experiencing an actual
560518 - response to treatment. ref SDS D8 J16O
560520 -  ..
560521 - Alternatively, disease is growing while inflammation is temporarily
560522 - waning, and so requires timely change for effective treatment, also,
560523 - reviewed on 060808. ref SDS D8 HT5K
560525 -  ..
560526 - The favorable scenario seems supported by Kaiser's report on 060817
560527 - that CA 15-3 cancer marker dropped from 87 to 73, per above.
560528 - ref SDS 0 GJ5M  Analysis at that time on 060817 shows a rationale for
560529 - patient response to treatment. ref SDS E2 TS5O  Patient history in a
560530 - letter to Kaiser on 060808 cites further evidence of delayed response
560531 - to treatment. ref SDS D9 DT5V
560533 -  ..
560534 - Doctor Benz recently examined Millie on 060821 at UCSF for a 2nd
560535 - opinion, and found red rash symptoms of IBC. ref SDS E3 025H
560536 -
560537 -            [On 060922 slow response to treatment reported in a letter
560538 -            to the doctor citing rate of decline CA 15-3 from 73 to
560539 -            only 68, ref SDS E5 MG6F; study of patient history may
560540 -            indicate recovery compares favorably to treatment in 2005
560541 -            for 2nd IBC relapse. ref SDS E5 9F35
560543 -             ..
560544 -            [On 060929 Benz 2nd opinion finds red rash is not
560545 -            established as cancer, not IBC; requires explanation of
560546 -            rising CA 15-3 cancer marker; doctor indicates there may be
560547 -            wide spread distant metastasis too small for recognition by
560548 -            image testing and currently being treated systemcially with
560549 -            chemotherapy. ref SDS E7 WQ8V
560550 -
560551 -
560552 -
560553 -
560554 -
5606 -

SUBJECTS
Status Change Biopsy Tissue IBC Recurrence Update Biopsy 040419 for

6103 -
610401 -  ..
610402 - Treatment Options Expand Pool of Drugs Biopsy Test for Status Change
610403 - Biopsy to Determine Biology of IBC and Guide Choice of Treatment
610404 - Status Change Did Not Occur Retest Biopsy 040419 Treatment Options
610405 - Treatment Options Limited Status Not Changed by Retest Biopsy 040419
610406 -
610407 - Follow up ref SDS D8 KT7J, ref SDS C3 KT7J.
610408 -
610409 - Reviewed understandings from meeting with Doctor Benz on 060821
610410 - consulting on 2nd opinion support for Kaiser. ref SDS E3 0001
610412 -  ..
610413 - Doctor Benz asked about a biopsy to establish red rash on left breast
610414 - is IBC, and to establish measureable IBC disease in the left breast,
610415 - ref SDS E3 KT7J, which was discussed at Kaiser during the meeting on
610416 - 060711 to develop patient work up for a strategy and treatment plan,
610417 - discussed on 060711, ref SDS C3 K36G, following initial consideration
610418 - on 060623 of performing a biopsy to verify diagnosis of IBC relapse,
610419 - and help guide selection of treatment targeted to IBC recurrence.
610420 - ref SDS C1 6Z4N
610422 -  ..
610423 - On 060802 a 2nd opinion from Doctor Grissom proposed biopsy to help
610424 - guide choice of chemotherapy treatment. ref SDS D4 GM5M
610426 -  ..
610427 - There are three (3) purposes of biopsy...
610428 -
610429 -        1.  Expand treatment options by updating status change of
610430 -            HER2/Neu, ER, PR, from original biopsy reported on 020321
610431 -            and later biopsy performed on 040419, and reported several
610432 -            years later on 060711. ref SDS C3 ZR6J
610434 -             ..
610435 -        2.  Verify IBC in left breast; Doctor Benz seems unconvinced by
610436 -            examination on 060821. ref SDS E3 KT7J
610438 -             ..
610439 -        3.  Establish measurable disease to qualify Millie for drug
610440 -            trials at UCSF, discussed on 060821, ref SDS E3 KT7J,
610441 -            discussed further below. ref SDS E3 6Q6O
610443 -  ..
610444 - There was no discussion today of Millie's letter to Kaiser on 060806
610445 - reporting progression of disease following treatment with Taxotere and
610446 - capecitabine, ref SDS D5 7Q95, as giving rise to consideration for
610447 - switching treatments.  Background on changing treatment in Millie's
610448 - patient history was discussed with the backup doctor on 060808.
610449 - ref SDS D8 UO6J
610451 -  ..
610452 - Possible improvement in red rash subsiding on 060808, ref SDS D8 VO6G,
610453 - and subsequent dramatic rise of CA 15-3 cancer marker to 87, and then
610454 - even more dramatic drop back to 73, as reported today, per above,
610455 - ref SDS 0 GJ5M, have diverted attention from taking a biopsy to verify
610456 - IBC has actually relapsed.
610458 -  ..
610459 - Alternate theories that explain changes in patient status listed in
610460 - the record of the meeting on 060808, ref SDS D8 J16O, were not
610461 - reviewed today.
610462 -
610463 -
610464 -
610465 -
610466 -
610467 -
610468 -
610469 -
610470 -
610471 -
6105 -

SUBJECTS
IBC Image Tests PET CT Scheduled Quarterly Diagnostics for Distant M

6503 -
650401 -  ..
650402 - PET CT Image Testing Distant Metastasis Deferred This Cycle
650403 - IBC Test Distant Metastasis Imaging Tests Deferred Until Next Cycle
650404 -
650405 - Follow up ref SDS D8 EY5O, ref SDS C3 EY5O.
650406 -
650407 - Patient history of imaging tests after surgery on 051021 has not
650408 - identified cancer, as reported in the CT test reviewed with the doctor
650409 - on 060623. ref SDS C1 II4L  In fact, PET scan and CT imaging tests
650410 - listed on 060711, ref SDS C3 FE8F, have never reported distant
650411 - metastasis.
650413 -  ..
650414 - Following mastectomy surgery on 051021, the primary care physician
650415 - planned to assess patient NED status with CA 15-3 blood tests every 2
650416 - weeks complemented by imaging tests every 3 months, reported on
650417 - 051121. ref SDS 92 NL4N  Recently, on 060802 a 2nd opinion by Doctor
650418 - Grissom, who helped guide Millie's surgery on 051021, proposed another
650419 - PET scan test for distant metastasis in light of rising IBC symptoms,
650420 - including CA 15-3 rising for the past 6 months. ref SDS D4 IT8U  The
650421 - last PET scan test was on 060414.  Quarterly testing calls for a test
650422 - in July.  Since a contrast CT test was done on 060505 (received on
650423 - 060523, ref SDS B3 E355), adjusting for this date would make August an
650424 - appropriate time for another image test within the diagnostic plan
650425 - schedule.
650427 -  ..
650428 - Primary care physician did not comment today on the backup doctor
650429 - explaining during the meeting on 060808 a practice of limiting image
650430 - testing to limit exposure to medical radiation, and seemed further at
650431 - that time on 060808 to strongly discourage diagnostics with quarterly
650432 - tests planned in the meeting on 051121. ref SDS 92 NL4N  The backup
650433 - doctor compared PET scan and CT testing to risking cancer from
650434 - excessive dental xrays, ref SDS D8 3T7L, and submitted an article to
650435 - support his analysis. ref SDS D8 LS9F
650437 -  ..
650438 - The doctor decided today to defer imaging tests with CT or PET scan to
650439 - evaluate progression of disease, because CA 15-3 cancer marker has
650440 - reversed direction and fallen dramatically.  Reversal of cancer marker
650441 - aligns with evident IBC inflamation subsiding, reported on 060808,
650442 - during the meeting with the backup doctor. ref SDS D8 FQ6G
650443 - Additionally, the patient has not experienced discomfort from swelled
650444 - lymph nodes.  Examination today found no evidence of lymphadenopathy.
650445 - As a result, there is no evident reason at this time to order an
650446 - imaging test for cancer.
650447 -
650448 -
650449 -
650450 -
650451 -
650452 -
6505 -

SUBJECTS
Emotional Trauma Rises Abrupt Changes IBC Worsening then Improving P

7003 -
700401 -  ..
700402 - Emotional Trauma Rising Falling Cancer Symptoms
700403 - Exercise Vigor Strength Engagement Ease Distress Living with Cancer
700404 - Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
700405 -
700406 - Follow up ref SDS D8 Y642, ref SDS C3 Y642.
700407 -
700408 - Slow improvement treating IBC rash on the left breast compared to
700409 - prior rapid improvement reported in 2005, big swings in an unfavorable
700410 - direction, followed by swings back to more favorable in IBC rash, and
700411 - in the CA 15-3 cancer marker, all per above, ref SDS 0 025H, plus
700412 - treatment options and criteria, and questions about hypercoagulable
700413 - state from family history of pulmonary emboli, and genetic risk
700414 - factors, esophagitis, test issues all create an emotional blur.
700415 -
700416 -
700417 -
700418 -
700419 -
700420 -
700421 -
7005 -

SUBJECTS
Dizziness Mild Symptoms End No Evidence of Treatable Disease Patient

7703 -
770401 -  ..
770402 - Dizziness Mild Symptoms End No Evidence of Disease Head
770403 -
770404 - Follow up ref SDS D8 PT4K, ref SDS C3 PT4K.
770406 -  ..
770407 - Confirm understandings from the meeting on 060808 that mild dizziness
770408 - symptoms seem to have ended.
770409 -
770410 -
770411 -
770412 -
770413 -
7705 -

SUBJECTS
Strategy Treatment Plan IBC 3rd Relapse Scope Chemotherapy Drug Agen

A703 -
A70401 -  ..
A70402 - Pool Chemotherapy Drugs Available to Treat IBC
A70403 - Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
A70404 - Strategy Treatment Options Scenarios Planning Patient Work Up Deferred
A70405 -
A70406 - Follow up ref SDS E3 K36G, ref SDS D8 K36G.
A70407 -
A70408 - During a meeting at Kaiser on 060711, the patient requested a work up
A70409 - with Tumor Board support on the 3rd relapse of IBC to include strategy
A70410 - for the order applying treatment options, consideration of radiation
A70411 - and surgery, and, also, a complete list of chemotherapy drugs
A70412 - available for IBC treatment in this case. ref SDS C3 FP9H  The patient
A70413 - requested an update and formal presentation on an informal, rough
A70414 - draft list of chemotherapy agents scribbled on examination table
A70415 - tissue paper by the primary care physician on 041130. ref SDS 48 9V63
A70417 -  ..
A70418 - Millie's letter on 060720 requested Tumor Board review to help devise
A70419 - treatment strategy for a complex case. ref SDS C5 5S8F  On 060721 the
A70420 - doctor wrote a reply indicating Kaiser will not provide Tumor Board
A70421 - assistance in this case. ref SDS C7 IP9L
A70423 -  ..
A70424 - On 060725 the patient's letter to UCSF requested a price for a 2nd
A70425 - opinion on these issues. ref SDS D2 QR6Y  On 060821 the patient met
A70426 - with Doctor Benz.  Most of the meeting was spent constructing another
A70427 - chronology by verbally recalling events from memory, rather than rely
A70428 - on the record of patient history provided to UCSF. ref SDS E3 FP8N
A70429 - The remainder of the meeting was a physical examination, which was
A70430 - performed with great care and professionalism. ref SDS E3 025H  When
A70431 - asked for the list of chemotherapy drugs available to treat Millie,
A70432 - Doctor Benz made a vague reference to his letter for the first opinion
A70433 - received on 041117, ref SDS E3 8F75, and said there wasn't enough time
A70434 - to address questions presented to UCSF in Millie's letter on 060725,
A70435 - because he was late for another meeting. ref SDS E3 WG5F
A70437 -  ..
A70438 - Since the doctor today was an hour late, ref SDS 0 2T58, there wasn't
A70439 - enough time to develop a work up on patient profile, list the drugs,
A70440 - and treatment options, nor develop a strategy on deploying treatments,
A70441 - and plan for implementation.
A70443 -  ..
A70444 - So far, professionals at the primary and secondary levels do not have
A70445 - time for professional work.
A70446 -
A70447 -     [On 070105 getting referral for proactive examination of heart
A70448 -     disorder Cor Pulmonale was deferred in order to spend all the time
A70449 -     on referral to UCSF for cancer treatment, and because enlarged
A70450 -     right ventricle diagnosed in CT test on 060930 may take years to
A70451 -     become life threatening. ref SDS E9 FG7J
A70453 -      ..
A70454 -     [On 070130 case study coordination of referral showed requirements
A70455 -     for a plan to manage coordination between Kaiser and UCSF.
A70456 -     ref SDS F0 RM4G
A70458 -      ..
A70459 -     [On 070222 clincial research coordinator at UCSF calls for plan to
A70460 -     coordinate divided responsibilities between Kaiser and UCSF to
A70461 -     manage patient care on referral, ref SDS F1 VK5N; scope of plan
A70462 -     for coordination was also developed. ref SDS F1 KL5G
A70464 -      ..
A70465 -     [On 070301 planning to manage coordination between Kaiser and UCSF
A70466 -     was strongly resisted; practioners prefer frail, emotionally
A70467 -     traumatized patients to perform complex, stressful coordination,
A70468 -     rather than rely on medical professionals, ref SDS F2 RM4G,
A70469 -     because coordinatin health caretakes a lot of time and diligence
A70470 -     to get things done and avoid mistakes. ref SDS F2 O67N
A70472 -      ..
A70473 -     [On 070301 medical professionals avoid coordinating patient care
A70474 -     because accurate communication essential for effective medical
A70475 -     practice is highly stressful. ref SDS F2 O24J
A70477 -      ..
A70478 -     [On 070315 UCSF asks about patient coping with emotional stress
A70479 -     with major swings in prognosis and treatment planning, ref SDS F3
A70480 -     6A7J; not enough time to relieve stress on patient of complex
A70481 -     communications coordinating health care. ref SDS F3 OR5K
A70483 -      ..
A70484 -     [On 070329 UCSF reports timely electronic distribution of
A70485 -     communications to coordinate the work was resisted, ref SDS F4
A70486 -     945F; practioners ignored written presentation of issues to
A70487 -     prepare for a productive meeting, and relied on momentary,
A70488 -     emotional memory of patient during conversation. ref SDS F4 W25L
A70489 -
A70490 -
A70491 -
A70492 -
A70493 -
A705 -

SUBJECTS
Mastectomy Removes Blood Vessels Slows Rate Recovery IBC Relapse Exp

AC03 -
AC0401 -  ..
AC0402 - Blood Vessels Mastectomy Removed Expectations IBC Slow Recovery
AC0403 - Expectations Slow Recovery IBC Surgery Removed Blood Vessels
AC0404 - IBC Slow Recovery Expectations Low Mastectomy Removes Blood Vessels
AC0405 - Mastectomy Removes Blood Vessels Slows Rate Recovery IBC Relapse
AC0406 -
AC0407 - Follow up ref SDS E3 NN3H, ref SDS C3 X54L.
AC0408 -
AC0409 - Treatment response expectations in this case for Taxotere and
AC0410 - capecitabine are informed by rapid improvement during 2005,
AC0411 - illustrated by the record on 050502 after 1 cycle, ref SDS 61 EO5J,
AC0412 - and further reported in a meeting at Kaiser on 050520 after 2 cycles
AC0413 - of cheotherapy. ref SDS 65 025H  So far, the rate of recovery with the
AC0414 - same treatment seems much slower, shown by examination today after 2
AC0415 - cycles treating IBC relapse. ref SDS 0 025H
AC0417 -  ..
AC0418 - Case study of Millie's patient history considering mastectomy surgery
AC0419 - is presented in the record on 041210. ref SDS 50 657F  Second opinion
AC0420 - review on 060821, ref SDS E3 657F, considered expectations on response
AC0421 - to treatment tempered by breast mastectomy that removed blood vessels
AC0422 - and capillaries which normally deliver chemotherapy treatment and
AC0423 - nutrients from the immune system to infected tissue, as noted by
AC0424 - Doctor Bailey in 2nd opinion consulation reported on 051011?
AC0425 - ref SDS 86 G65S
AC0427 -  ..
AC0428 - Earlier, on 050923 Doctor Bailey discussed breast reconstruction to
AC0429 - improve chances of successful mastectomy surgery. ref SDS 81 6Z3M  As
AC0430 - well, Doctor Grissom recommended similarly in an opinion received on
AC0431 - 050920. ref SDS 80 XL8U  During a meeting at Kaiser on 050928,  Doctor
AC0432 - Smith reviewed these recommendations for the Surgery Department, and
AC0433 - on referral within Kaiser's Team Care practice. ref SDS 84 J24M  Her
AC0434 - opinion letter received during a meeting at Kaiser on 051007
AC0435 - recommended postponing breast reconstruction until after initial
AC0436 - mastectomy surgery can be evaluated. ref SDS 85 KO58
AC0438 -  ..
AC0439 - Surgery to increase effectiveness of chemotherapy by replacing tissue
AC0440 - with defective blood vessels with breast reconstruction to increase
AC0441 - blood flow was considered on 060711, as part of strategy to start
AC0442 - treatments for Millie's 3rd IBC relapse. ref SDS C3 X54L  UCSF was
AC0443 - asked about this issue in Millie's letter on 060725. ref SDS D2 QS7R
AC0444 - There was not enough time for Doctor Benz to comment during the 2nd
AC0445 - opinion consultation at UCSF on 060821. ref SDS E3 X54L
AC0447 -  ..
AC0448 - Since the doctor was behind schedule today, ref SDS 0 2T58, this issue
AC0449 - was not reviewed.
AC0450 -
AC0451 -    [On 060922 letter to the doctor cites slower recovery from IBC with
AC0452 -    same treatment used in 2005. ref SDS E5 MG6F
AC0454 -     ..
AC0455 -    [On 060922 analysis of impact from mastectomy surgery that removed
AC0456 -    blood vessels with removal of left breast reduces ability of blood
AC0457 -    system to deliver treatment and natural nutrients to the area
AC0458 -    infected with IBC. ref SDS E5 ML3I
AC0460 -     ..
AC0461 -    [On 060929 expections for recovery tempered by disparity between
AC0462 -    rapid drop in CA 15-3 cancer marker, and slow recovery of IBC rash.
AC0463 -    ref SDS E6 EH3F
AC0465 -     ..
AC0466 -    [On 061110 doctor reports IBC rash on left breast area is
AC0467 -    "stable," ref SDS E8 ZL5W, indicating recovery is very slow,
AC0468 -    because on 051021 blood vessels were removed from the treatment
AC0469 -    area by mastectomy surgery, per analysis of expectations on
AC0470 -    060929. ref SDS E6 EH3F
AC0471 -
AC0472 -
AC0473 -
AC05 -

SUBJECTS
Treatment IBC 3rd Relapse Continue Chemotherapy Agents Taxotere Cape

AH03 -
AH0401 -  ..
AH0402 - Treatment Continue Taxotere and Capecitabine (Xeloda) for 3rd Cycle
AH0403 - 3rd Cycle Taxotere and Capecitabine (Xeloda) Treatment Continue
AH0404 - Taxotere and Capecitabine (Xeloda) 3rd-Cycle Treatment Continue
AH0405 -
AH0406 - Follow up ref SDS D8 PF3O, ref SDS C3 PF3O.
AH0407 -
AH0408 - On 060821 Doctor Benz 2nd opinion consultation recommended continuing
AH0409 - current treatment with Taxotere and capecitabine. ref SDS E3 PF3O
AH0411 -  ..
AH0412 - Today, the primary care physician concurred and, also, recommended for
AH0413 - reasons cited in examination today, ref SDS 0 025H, including patient
AH0414 - history presented on 060821, ref SDS E3 KR6I, continuing the current
AH0415 - treatment plan for another cycle.
AH0416 -
AH0417 -        [On 060929 Benz 2nd opinion #2 recommends continuing with
AH0418 -        current treatment plan until there is measurable progression of
AH0419 -        disease. ref SDS E7 WQ6Y
AH0420 -
AH0421 -
AH0422 -
AH0423 -
AH0424 -
AH05 -

SUBJECTS
Drug Trials Review 2nd Opinion Consultation UCSF 2 Drug Trials Milli

AL03 -
AL0401 -  ..
AL0402 - Drug Trial - Doctor Checking with Rosalie Protocol Nurse
AL0403 -
AL0404 - Follow up ref SDS D8 WB9K, ref SDS C3 WB9K.
AL0405 -
AL0406 - On 060711 the doctor planned to review with the protocol nurse drug
AL0407 - trials to treat Millie's cancer.  Limitations qualifying for drug
AL0408 - trials is cited on 060711. ref SDS C3 WB9K
AL0410 -  ..
AL0411 - Background on drug trials mentioned by Doctor Benz, and by Doctor
AL0412 - Bailey in connection with work at UCSF is listed in the record on
AL0413 - 060711. ref SDS C3 ED50
AL0415 -  ..
AL0416 - Reviewed understandings from meeting with Doctor Benz on 060821
AL0417 - indicating UCSF may have 2 trials of new drugs for treating Millie
AL0418 - based on her patient history. ref SDS E3 W66J   Noted discussion of
AL0419 - requirement for biopsy in connection with establishing measurable
AL0420 - disease to participate in UCSF drug trials, per above. ref SDS 0 KT7J
AL0422 -            ..
AL0423 -           [On 060929 2nd opinion received from Doctor Benz proposes
AL0424 -           several drug trials are available for Millie at UCSF.
AL0425 -           ref SDS E7 WQ6Y
AL0426 -
AL0427 -
AL0428 -
AL0429 -
AL0430 -
AL05 -

SUBJECTS
Schedule Treatment 060908 Changing Back to Original Schedule Begin T

AN03 -
AN0401 -  ..
AN0402 - Schedule Treatment Continue Prescription Taxotere Capecitabine Xeloda
AN0403 -
AN0404 - Follow up ref SDS D8 N96O, ref SDS C3 N96O.
AN0405 -
AN0406 - The doctor noted that examination today found no strong evidence of
AN0407 - increased IBC red rash, ref SDS 0 025H, and the CA 15-3 cancer marker
AN0408 - made a dramatic reversal and fell significantly over just 4 days,
AN0409 - after 6 months of continuous rise, also, reported above. ref SDS 0
AN0410 - GJ5M  The doctor recommended that these conditions support continuing
AN0411 - treatment with a third cycle of Taxotere and capacitabine (Xeloda).
AN0413 -  ..
AN0414 - The doctor asked Millie to agree to change the schedule from Monday
AN0415 - back to the original scheme of treatments on Friday.  He wants to meet
AN0416 - for examination before starting each new treatment cycle, and Fridays
AN0417 - are more convenient for his schedule than Mondays.
AN0419 -  ..
AN0420 - Millie said that changing back will help her recover from debilitating
AN0421 - effects of chemotherapy treatments on Friday during the following
AN0422 - Saturday - Monday, and in time to start work on Tuesdays, as discussed
AN0423 - with the nurse on 060814. ref SDS E1 QK6L
AN0425 -  ..
AN0426 - The doctor used a handheld computer of some kind to schedule the next
AN0427 - treatment on 060908.  This will extend the period between treatments
AN0428 - by about 4 days.  The doctor indicated that examination today, and
AN0429 - favorable CA 15-3 cancer marker test together, per above, ref SDS 0
AN0430 - N96O, offer sufficient conditions to permit this change without undue
AN0431 - risk of relapse, contrary to the situation on 060810 when Kaiser
AN0432 - proposed a 7 day delay at a time when the cancer marker increased
AN0433 - substantially. ref SDS E0 I25J
AN0435 -  ..
AN0436 - The doctor asked Millie to tell the schedule attendant that he wants
AN0437 - treatments on Friday, and that the next examination should be 2 hours
AN0438 - ahead of treatment on 060908 to allow for normal delays seeing the
AN0439 - patient as occurred today of 65 minutes.
AN0441 -  ..
AN0442 - Millie reviewed the record showing that Kaiser's team care practice of
AN0443 - doctor patient partnership does not support coordination for efficient
AN0444 - scheduling.  The only control in Kaiser's system is through the
AN0445 - doctor.  Millie explained that the doctor can assist Kaiser's staff by
AN0446 - directing the work.
AN0448 -  ..
AN0449 - The doctor left the examination room.  He returned about 20 minutes
AN0450 - later and said that he personally visited the Chemotherapy Infusion
AN0451 - Clinic and assisted the staff in changing treatments back to Friday,
AN0452 - and set the next treatment on 060908 at 1330.
AN0454 -  ..
AN0455 - The doctor said that he also scheduled an examination 2 hours earlier
AN0456 - on 060908 at 1100.  He wrote this out on paper and handed it to Millie
AN0457 - to give to the scheduling clerk.
AN0458 -
AN0459 -
AN0460 -
AN0461 -
AN0462 -
AN05 -

SUBJECTS
Pulmonary Emboli Blood Clots Lungs Coumadin Warfarin Treatment Cance

AR03 -
AR0401 -  ..
AR0402 - Millie High Risk Pulmonary Embolism Recurrence
AR0403 - Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
AR0404 - Pulmonary Emboli Genetic Cause Hypercoabullary Work Up Family History
AR0405 -
AR0406 - Follow up ref SDS D8 CV5L, ref SDS D3 0001.
AR0407 -
AR0408 - On 060711 chemotherapy treatment was reviewed in connection with
AR0409 - patient history of blood clots, ref SDS C3 S33L, first reported in a
AR0410 - CT test received on 041104, while being treated with Avastin
AR0411 - chemotherapy drugs. ref SDS 46 RZ4I  Millie was treated with Coumadin
AR0412 - until 051121; at that time, she was removed from Coumadin treatment,
AR0413 - ref SDS 92 RZ4I, because she was no longer being treated with Avastin,
AR0414 - as presented earlier on 051007. ref SDS 85 XN7K
AR0416 -  ..
AR0417 - Also, on 051121, the doctor explained hypercoagulable state work up
AR0418 - recommended in Doctor Bailey's 2nd opinion is not required because
AR0419 - pulmonary emboli was thought to be caused in this patient solely by
AR0420 - prior participation in the Avastin trial. ref SDS 92 GW7G
AR0422 -  ..
AR0423 - On 060724 Kaiser was notified about new information on blood clot
AR0424 - problems that came to light on 060722, ref SDS C9 3D9T, citing
AR0425 - findings of genetic cause for family history of pulmonary emboli,
AR0426 - ref SDS D1 NL5Q, and reviewing patient history showing high risk for
AR0427 - pulmonary embolims. ref SDS C9 6G6O
AR0429 -  ..
AR0430 - Prescribing Coumadin (Warfarin) to treat family genetic disposition
AR0431 - for pulmonary emboli was not discussed by the backup doctor on 060808.
AR0432 - The doctor mentioned having access to Progress Notes prepared by
AR0433 - primary care physician. ref SDS D8 FQ6G
AR0435 -  ..
AR0436 - Primary care physician was an hour behind schedule today.  The doctor
AR0437 - did not mention having reviewed the letter on 060724, ref SDS D1 NL5Q,
AR0438 - and there was not enough time to discuss doing a CT test for pulmonary
AR0439 - emboli based on Millie's risk factors, listed on 060722. ref SDS C9
AR0440 - 6G6O
AR0442 -  ..
AR0443 - This issue was presented in the agenda for meeting at UCSF on 060821
AR0444 - on 2nd opinion consultation, ref SDS E3 CV5L, since the record
AR0445 - indicates that Doctor Benz contributed to discovering pulmonary emboli
AR0446 - from the original examination on 041018, ref SDS 45 LX96, and the
AR0447 - doctor's written opinion received on 041117 noting symptoms were being
AR0448 - investigated. ref SDS 47 OT5Q  However, on 060821 there wasn't enough
AR0449 - time for UCSF to address the issue, ref SDS E3 H53K, and may have been
AR0450 - influenced by Kaiser's records showing patient is being treated with
AR0451 - warfarin (Coumadin). ref SDS E3 H46F
AR0452 -
AR0453 -
AR0454 -
AR0455 -
AR0456 -
AR0457 -
AR05 -

SUBJECTS
Work Plan Doctor Submits Doctor/Patient Partnership Communications I

AW03 -
AW0401 -  ..
AW0402 - Work Plan Received Communications Doctor/Patient Partnership
AW0403 - Communications Doctor Submits Work Plan Doctor/Patient Partnership
AW0404 - Doctor/Patient Partnership Communications Doctor Submits Work Plan
AW0405 -
AW0406 - Follow up ref SDS D8 FE4I, ref SDS C3 FE4I.
AW0407 -
AW0408 - Doctor's Progress Note on the meeting today was received via email
AW0409 - later this evening.  This facilitates Communication Metrics, Knowledge
AW0410 - Management, and Intelligence support under Kaiser's practice of
AW0411 - patient care based on effective communication.
AW0413 -  ..
AW0414 - During the meeting on 060821 UCSF made use of Kaiser's new practice to
AW0415 - type progress notes for a legible record of doctor patient
AW0416 - consultations. ref SDS E3 FE4I
AW0418 -  ..
AW0419 - For some reason, the doctor did not submit data details on vitals,
AW0420 - labs, treatment history, etc, which is a critical part of the medical
AW0421 - chart that supplements Progress Note.
AW0423 -  ..
AW0424 - Progress continues toward good management using the doctor patient
AW0425 - partnership for timely review of patient history, called out in
AW0426 - Kaiser's Healthwise Handbook, reviewed on 990625, ref SDS 2 TD5S, and
AW0427 - recently reported on 060106. ref SDS 94 FE4I
AW0428 -
AW0429 -    1.  08/25/2006     02:40 PM
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AW0431 -            Wcr-ONnc2 > Main Campus
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AW0435 -    2.  Your primary care clinician is listed as...
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