CONTACTS 

SUBJECTS
Examination IBC Red Rash Left Breast Spreads to Right Breast Stable

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 5 0000, ref SDS 4 0000.
040502 -
040503 - Examination this morning seems to show some improvement; aligns with
040504 - history on 2 scenarios. ref SDS 0 QT5K  Planning correspondence with
040505 - Kaiser on pending issues. ref SDS 0 5S84
040506 -
040507 -
040508 -
040509 -
040511 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - 2 Scenarios IBC Rash Wax Wane Infection May Respond Treatment
040902 -
040903 - Examination of rash on the left chest region, and slightly spread onto
040904 - the right breast shows stable to decreasing condition compared to
040905 - recent examination at Kaiser on 061208. ref SDS 4 025H
040907 -  ..
040908 - The rash has not spread, and seems less intense this morning, as
040909 - though infection is drying up, similar to prior reports on...
040910 -
040911 -            Examination by backup
040912 -            doctor............................. 060808, ref SDS 1 8Z8G
040914 -             ..
040915 -            Report of reduced severity on
040916 -            left and right breast
040917 -            regions............................ 061204, ref SDS 3 2P8U
040919 -  ..
040920 - Today, the condition seems again less severe than perhaps Friday a
040921 - week ago during the meeting with the doctor, when patient history
040922 - reported "stable to worsening" rash, ref SDS 4 RU6J, possibly
040923 - suggesting some response to treatment by antibiotic Diflucan
040924 - prescribed at that time on 061208. ref SDS 4 KW45
040925 -
040926 -        [On 061227 CA 15-3 74 significant rise aligns with rash
040927 -        getting worse, after small decline when rash improved
040928 -        slightly. ref SDS 7 UF3I
040930 -         ..
040931 -        [On 070110 CA 15-3 56 cancer marker drops dramatically
040932 -        significant improvement aligns with IBC rash intensity
040933 -        subsiding; continuing erratic changes. ref SDS 8 087J
040935 -  ..
040936 - This record seems to align with 2-scenario analysis on 060808, where
040937 - IBC rash has compound infections that respond to treatment with
040938 - antibiotics; while IBC rash presents pockets that resist treatment
040939 - because mastectomy surgery removed blood vessels needed to deliver
040940 - drugs to infected tissue. ref SDS 1 HT5K
040941 -
040942 -
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040945 -
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040948 -
0410 -

SUBJECTS
Kaiser Planning Issues Notify 5 Year Case Review

0603 -
060401 -  ..
060402 - Scope Letter to Kaiser on Progress Review Diagnosis Treatment
060403 -
060404 - Transitioning to a new treatment protocol marks a major event in
060405 - patient history, since typically succeeding treatments become less
060406 - effective due to mutation of cancer.
060407 -
060408 -              [On 061218 issues letters implementing plans today.
060409 -              ref SDS 6 5S84
060411 -  ..
060412 - Several issues might be addressed on transition to a new phase in
060413 - patient history by the primary care physician...
060414 -
060415 -        1.  Doctor requested a letter on drug
060416 -            trial opportunities offered to
060417 -            Millie at UCSF..................... 061208, ref SDS 4 D58F
060418 -
060419 -                [On 061218 letter notifies Kaiser about where to find
060420 -                drug trials UCSF offered to Millie in the 2nd opinion.
060421 -                ref SDS 6 YV3K
060423 -             ..
060424 -        2.  INR 6.4 Diflucan (fluconazole)
060425 -            treatment prescribed on 061208
060426 -            for rash spreading from left
060427 -            to right breast, conflicts
060428 -            with Coumadin...................... 061214, ref SDS 5 4O5H
060429 -
060430 -                [On 061218 letter notifies Kaiser about conflict
060431 -                between Diflucan and Coumadin. ref SDS 6 5M5Y
060433 -             ..
060434 -        3.  Rash on left breast and slightly
060435 -            on right breast appears slightly
060436 -            improved to stable; seems less
060437 -            intense, and has not
060438 -            spread............................. 061217, ref SDS 0 QT5K
060439 -
060440 -                [On 061218 letter notifies Kaiser about slow response
060441 -                to treatment with Diflucan combined with chemotherapy.
060442 -                ref SDS 6 5M7Q
060444 -             ..
060445 -        4.  Review conflicts Navelbine increased
060446 -            risk infection with Millie's recent
060447 -            history of sensitivity to infection
060448 -            and in relation to difficulties
060449 -            with medication conflicts from
060450 -            Coumadin and Diflucan, and earlier
060451 -            between bevacizumab causing
060452 -            pulmonary embolism................. 061208, ref SDS 4 CX9M
060453 -
060454 -                [On 061218 Millie's letter asks about Navelbine
060455 -                compatibility with patient history, and about combining
060456 -                Navelbine with other agents. ref SDS 6 6M7K
060458 -             ..
060459 -        5.  Medical chart progress notes
060460 -            review feedback to refine
060461 -            accuracy........................... 061110, ref SDS 2 FE4I
060462 -            additional issues.................. 061208, ref SDS 4 C55J
060464 -             ..
060465 -        6.  Commend primary care physician for
060466 -            5 years through 3rd relapse highly
060467 -            aggressive IBC metastatic disease
060468 -            with 36 pending issues requiring
060469 -            continual review................... 061208, ref SDS 4 LU3J
060471 -             ..
060472 -        7.  Major change in patient profile
060473 -            escalating complexity.............. 061208, ref SDS 4 LU3J
060474 -            benefit from Tumor Board review;
060475 -            can a panel be assembled with
060476 -            experience treating IBC from
060477 -            oncology and
060478 -            surgery............................ 061208, ref SDS 4 P69G
060479 -
060480 -                [On 061218 Millie's letter requests Tumor Board hearing
060481 -                and a panel with IBC experience. ref SDS 6 OP5H
060483 -             ..
060484 -        8.  Heart disorder Cor Pulmonale
060485 -            enlarged right ventricle
060486 -            examination by heart specialist
060487 -            backup primary care physician
060488 -            examination under
060489 -            Kaiser's Team Care
060490 -            practice........................... 061208, ref SDS 4 VJ4J
060491 -
060492 -               [On 061218 Millie requests examination by heart
060493 -               specialist. ref SDS 6 HX6V
060495 -             ..
060496 -        9.  Quarterly review of patient history
060497 -            under Kaiser's "ping pong" policy
060498 -            to refine accuracy of communication
060499 -            with feedback...................... 061208, ref SDS 4 FE4I
060501 -             ..
060502 -            Need comment on how best to support
060503 -            doctor/patient partnership to assist
060504 -            care, review and improve medical
060505 -            practice and team care with feedback
060506 -            loops, provide case study for training
060507 -            doctors, and educating patients on
060508 -            participating effectively in team
060509 -            care by strengthening accuracy of
060510 -            patient history.
060511 -
060512 -                [On 061218 Millie asks about doctor/patient partnership
060513 -                providing feedback to support accuracy, and notes
060514 -                doctor indiating clarifications to correct errors and
060515 -                omissions cannot be entered in the Medical Chart.
060516 -                ref SDS 6 6V5M
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060519 -
060520 -
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060526 -
0606 -