THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: August 25, 2006 02:40 PM Friday;
Millie meeting at Kaiser evaluate treatment plan IBC relapse.
2...Agenda Develop Work Plan Stage IV Breast Cancer 8 Mos after Mastectomy
3...Vitals Show Stable Medical Condition
4...CA 15-3 Cancer Marker 71 No Test Current Period Since 060711
5...CA 15-3 73 Dramatic Drop in 4 Days Inidicates Response to Treatment
6...Esophagitis Not Compared in Current PET Test with Prior Report
7...Left Axillary No Evidence Lymphadenopathy
8...Lymphedema Left Arm Lump Under Arm Diagnosis Not Cancer
9...Post Operation Localized Edema Left Axillary Swelling Reduced
10...Right Axillary FDG SUV 2.5 Lump Discomfort Not Reported by Patient
11...Radiation Treatment Cancer Relapse Left Supraclavicular and IBC
12...Left Supraclavicular Examination PET Test Report Finding SUV 4.5
13...Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
14...Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
15...Red Rash Left Breast No Evident Increase Hopeful Response to Treatment
16...Examination Left Breast IBC Inflammation Red Rash Seems to Subside
17...IBC Inflammation Left Breast Red Rash Subsides Response to Treatment
18...Response to Treatment IBC Inflammation Left Breast Red Rash Subsides
19...Treatment Options Expand Pool of Drugs Biopsy Test for Status Change
20...Biopsy to Determine Biology of IBC and Guide Choice of Treatment
21...Status Change Did Not Occur Retest Biopsy 040419 Treatment Options
22...Treatment Options Limited Status Not Changed by Retest Biopsy 040419
23...PET CT Image Testing Distant Metastasis Deferred This Cycle
24...IBC Test Distant Metastasis Imaging Tests Deferred Until Next Cycle
25...Emotional Trauma Rising Falling Cancer Symptoms
26...Exercise Vigor Strength Engagement Ease Distress Living with Cancer
27...Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
28...Dizziness Mild Symptoms End No Evidence of Disease Head
29...Pool Chemotherapy Drugs Available to Treat IBC
30...Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
31...Strategy Treatment Options Scenarios Planning Patient Work Up Deferred
32...Blood Vessels Mastectomy Removed Expectations IBC Slow Recovery
33...Expectations Slow Recovery IBC Surgery Removed Blood Vessels
34...IBC Slow Recovery Expectations Low Mastectomy Removes Blood Vessels
35...Mastectomy Removes Blood Vessels Slows Rate Recovery IBC Relapse
36...Treatment Continue Taxotere and Capecitabine (Xeloda) for 3rd Cycle
37...3rd Cycle Taxotere and Capecitabine (Xeloda) Treatment Continue
38...Taxotere and Capecitabine (Xeloda) 3rd-Cycle Treatment Continue
39...Drug Trial - Doctor Checking with Rosalie Protocol Nurse
40...Schedule Treatment Continue Prescription Taxotere Capecitabine Xeloda
41...Millie High Risk Pulmonary Embolism Recurrence
42...Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
43...Pulmonary Emboli Genetic Cause Hypercoabullary Work Up Family History
44...Work Plan Received Communications Doctor/Patient Partnership
45...Communications Doctor Submits Work Plan Doctor/Patient Partnership
46...Doctor/Patient Partnership Communications Doctor Submits Work Plan
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Meeting Doctor Examination Prepare for 11th Cycle Treatment 3rd Rela
0403 - ..
0404 - Summary/Objective
040501 - Follow up ref SDS D8 0000. ref SDS C3 0000.
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
040521 - ..
0408 - Progress
040901 - Agenda Develop Work Plan Stage IV Breast Cancer 8 Mos after Mastectomy
040903 - Follow up ref SDS D8 SM6M, ref SDS C3 SM6M.
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...
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.
Vitals Pending Primary Care Physician Not Submitted with Doctor's Pr
060401 - ..
060402 - Vitals Show Stable Medical Condition
060404 - Follow up ref SDS D8 KB5L, ref SDS C3 KB5L.
060406 - ..
060407 - Date Bld Prssr Pulse Temp Weight SaO2
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
CA 15-3 73 and 34 Above 39 Big Drop fromn 87 Improvement Indicates R
160401 - ..
160402 - CA 15-3 Cancer Marker 71 No Test Current Period Since 060711
160404 - Follow up ref SDS D8 087J, ref SDS C3 087J.
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
160485 - ..
1607 - Analysis
160801 - CA 15-3 73 Dramatic Drop in 4 Days Inidicates Response to Treatment
160803 - Follow up ref SDS D8 GJ5M, ref SDS C3 GJ5M.
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
Esophagitis PET Scan Test Not Compared with Prior Report Symptoms Mi
200401 - ..
200402 - Esophagitis Not Compared in Current PET Test with Prior Report
200404 - Follow up ref SDS D8 JP6K, ref SDS C3 JP6K.
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
Left Auxillary Lymphadenopathy Patient No Complaint Swelling Discomf
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
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
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
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
Right Auxillary Lymphadenopathy Patient No Complaint Swelling Discom
340401 - ..
340402 - Right Axillary FDG SUV 2.5 Lump Discomfort Not Reported by Patient
340404 - Follow up ref SDS D8 3D6K, ref SDS C3 3D6K.
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
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
Left Neck Supraclavicular No Examination Benz 2nd Opinion Finds No E
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
420407 - Follow up ref SDS D8 8R6M, ref SDS C3 8R6M.
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
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
Examination IBC Red Rash Seems Unchanged from 060808 2 Scenarios Imp
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
560407 - Follow up ref SDS D8 025H, ref SDS C3 025H.
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
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.
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...
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.
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
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
Status Change Biopsy Tissue IBC Recurrence Update Biopsy 040419 for
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
610407 - Follow up ref SDS D8 KT7J, ref SDS C3 KT7J.
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...
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.
IBC Image Tests PET CT Scheduled Quarterly Diagnostics for Distant M
650401 - ..
650402 - PET CT Image Testing Distant Metastasis Deferred This Cycle
650403 - IBC Test Distant Metastasis Imaging Tests Deferred Until Next Cycle
650405 - Follow up ref SDS D8 EY5O, ref SDS C3 EY5O.
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.
Emotional Trauma Rises Abrupt Changes IBC Worsening then Improving P
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
700406 - Follow up ref SDS D8 Y642, ref SDS C3 Y642.
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.
Dizziness Mild Symptoms End No Evidence of Treatable Disease Patient
770401 - ..
770402 - Dizziness Mild Symptoms End No Evidence of Disease Head
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.
Strategy Treatment Plan IBC 3rd Relapse Scope Chemotherapy Drug Agen
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
A70406 - Follow up ref SDS E3 K36G, ref SDS D8 K36G.
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.
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
Mastectomy Removes Blood Vessels Slows Rate Recovery IBC Relapse Exp
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
AC0407 - Follow up ref SDS E3 NN3H, ref SDS C3 X54L.
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.
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
Treatment IBC 3rd Relapse Continue Chemotherapy Agents Taxotere Cape
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
AH0406 - Follow up ref SDS D8 PF3O, ref SDS C3 PF3O.
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.
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
Drug Trials Review 2nd Opinion Consultation UCSF 2 Drug Trials Milli
AL0401 - ..
AL0402 - Drug Trial - Doctor Checking with Rosalie Protocol Nurse
AL0404 - Follow up ref SDS D8 WB9K, ref SDS C3 WB9K.
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
Schedule Treatment 060908 Changing Back to Original Schedule Begin T
AN0401 - ..
AN0402 - Schedule Treatment Continue Prescription Taxotere Capecitabine Xeloda
AN0404 - Follow up ref SDS D8 N96O, ref SDS C3 N96O.
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.
Pulmonary Emboli Blood Clots Lungs Coumadin Warfarin Treatment Cance
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
AR0406 - Follow up ref SDS D8 CV5L, ref SDS D3 0001.
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
Work Plan Doctor Submits Doctor/Patient Partnership Communications I
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
AW0406 - Follow up ref SDS D8 FE4I, ref SDS C3 FE4I.
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
AW0429 - 1. 08/25/2006 02:40 PM
AW0431 - Wcr-ONnc2 > Main Campus
AW0434 - ..
AW0435 - 2. Your primary care clinician is listed as...