CONTACTS 

SUBJECTS
INR Falls to Target Range 3.3 Hemmoraging Risk Reduced Medication Mi

1403 -
1403 -    ..
1404 - Summary/Objective
1405 -
140501 - Follow up ref SDS 46 0000, ref SDS 44 0000.
140502 -
140503 - Millie reported evident rise of IBC rash, ref SDS 0 DY9T, and good
140504 - news that INR dropped into the normal range after ending treatment
140505 - with Diflucan, which conflicted with Coumadin prescribed for pulmonary
140506 - embolism. ref SDS 0 DY4P  Doctor reports further erratic CA 15-3
140507 - results, most recently rising to 74, and so reflecting worsening IBC
140508 - rash reported today. ref SDS 0 6P9F  Millie requested copies of
140509 - communication between Kaiser and UCSF on application for clinical drug
140510 - trials. ref SDS 0 KN5X  Brad in the Oncology Pharmacy commended for
140511 - helpful discussion on Navelbine pharmacology in relation to Millie's
140512 - patient profile, and advises Brad plans to submit written confirmation
140513 - of his findings. ref SDS 0 427M  Millie reports rising symptoms Cor
140514 - Pulmonale heart disorder from enlarged right ventricle, and plans to
140515 - further discuss scheduling examination by cardiologist. ref SDS 0 645I
140516 - Millie requests Tumor Board to support patient work up and strategy
140517 - for treatment plans, ref SDS 0 6L3F, and with a panel experienced with
140518 - secondary IBC. ref SDS 0 DY63  Millie responded to the doctor's letter
140519 - on 061218 saying Kaiser is looking for ways to improve care and
140520 - communication. ref SDS 0 JP74  She suggests Kaiser review list of
140521 - issues from Progress Notes in the Medical Chart for 061208,
140522 - ref SDS 0 Z89Y, and asks about lung cancer and lymph nodes shown in
140523 - Kaiser's medical records for 061208, since this is unsupported in the
140524 - record. ref SDS 0 Z84Y
140525 -
140526 -
140527 -
140528 -
140530 -  ..
1406 -
1407 -
1408 - Progress
1409 -
140901 - INR 3.3 Hemorraging Risk Reduced IBC Worsening Request CA 15-3
140902 -
140903 - Follow up ref SDS 44 8U5L, ref SDS 41 KW45.
140904 -
140905 - On 060218, Millie submitted ref DIP 1 0001 notifying the doctor about
140906 - INR rising to 6.4 because of conflict between Diflucan prescribed to
140907 - test a theory that rash on left, and now spreading to the right
140908 - breast, was a fungal infection, rather than IBC, and Coumadin to treat
140909 - pulmonary embolism, ref SDS 44 5M5Y; Millie also reported improved
140910 - rash condition, ref SDS 44 5M7Q, and asked about status of CA 15-3
140911 - test reports. ref SDS 44 5M8P
140913 -  ..
140914 - The doctor responded saying okay to stop taking Diflucan, and that lab
140915 - reports on CA 15-3 were not available. ref SDS 44 6P9F
140917 -  ..
140918 - Millie submitted ref DIT 1 0001 responding to the doctor's letter,
140919 - saying...
140920 -
140921 -    1.  Thank you for prompt response in your letter on December 18,
140922 -        ref SDS 44 6P9F, to my letter the same date reporting an
140923 -        evident conflict between Diflucan prescribed on 061208 to test
140924 -        and diagnose the rash spreading to my right breast.  At that
140925 -        time, you observed a "ring"-type infection. ref SDS 41 KW45  I
140926 -        followed your instructions and stopped taking Diflucan --
140927 -        actually, the 10 day treatment period expired on 061218.
140928 -        ref DIT 1 0001
140930 -         ..
140931 -    2.  Bad news - the rash seems to be worsening, though I admit my
140932 -        observations may not be clear headed.  Seems more intense and
140933 -        is spreading, thankfully slowly at this time. ref DIT 1 UM6H
140935 -  ..
140936 - Follows up report on 061218 that rash seemed improved, with history of
140937 - waxing and waining. ref SDS 44 5M7Q
140939 -  ..
140940 - On 061208 record of examination reports erratic changes (fluctuations)
140941 - in red rash. ref SDS 41 025H  Aligns with Bush 2nd opinion received on
140942 - 041117 reporting patient history IBC wax and wane. ref SDS 14 OS6W
140943 -
140944 -            [...below doctor report CA 15-3 cancer marker rises
140945 -            significantly after a small decline aligns with observation
140946 -            of rash getting a little better, then worse. ref SDS 0 UF3I
140948 -             ..
140949 -            [On 070112 Millie notified doctor that improvement in CA
140950 -            15-3 aligns with IBC rash intensity subsiding. ref SDS 51
140951 -            1G3K
140953 -  ..
140954 - Letter to primary care physician continues...
140955 -
140956 -    3.  Good news - INR has dropped into the target range following
140957 -        guidance from the Coagulation Treatment Clinic, and after
140958 -        ending Diflucan. ref DIT 1 YL6N
140960 -  ..
140961 - Reports blood test on 061218 dropped to 3.3. ref SDS 44 5M6W
140963 -  ..
140964 - Letter to primary care physician continues...
140965 -
140966 -    4.  Please submit results of CA 15-3 tests on 061214, and on
140967 -        061218. ref DIT 1 7M7I  Previously, lab reports had not been
140968 -        issued by the date your letter on 061218. ref SDS 44 XT4K
140969 -
140970 -
140971 -
140972 -
1410 -

SUBJECTS
CA 15-3 74 11 Point Rise Significant After Slight Fall Aligns with W

3403 -
3404 - 1231
340501 -  ..
340502 - IBC Progression Probably Represented CA 15-3 Rise Rash Worse
340503 - CA 15-3 74 Significant Rise After Small Decline Erratic
340504 -
340505 - Follow up ref SDS 44 6P9F, ref SDS 41 025H.
340506 -
340507 - Millie received ref DRT 1 0001 from the doctor responding to Millie's
340508 - letter, ref DIT 1 0001, this morning, per above. ref SDS 0 WU5G
340510 -  ..
340511 - Primary care physician says...
340512 -
340513 -    1.  The rash probably represent progression of the IBC and not a
340514 -        fungal rash.
340516 -         ..
340517 -    2.  CA 15-3
340518 -        DATE TIME
340519 -        A 12/18/06 06:40 | 74 H
340520 -        B 12/14/06 06:35 | 63 H
340522 -  ..
340523 - This is a significant change in patient diagnostics that aligns with
340524 - report on self-examination this morning of IBC rash worse, per above,
340525 - ref SDS 0 DY9T, after getting a little better, reported on 061218.
340526 - ref SDS 44 5M7Q  Fits review on 061208 that IBC rash has been erratic,
340527 - tracking rise and fall of CA 15-3. ref SDS 41 GJ5M
340528 -
340529 -        [On 070109 request report on CA 15-3 test on 070104.
340530 -        ref SDS 49 V86Q
340532 -         ..
340533 -        [On 070109 remind Kaiser submit results CA 15-3 test on 070104.
340534 -        ref SDS 49 4U6V
340536 -         ..
340537 -        [On 070110 CA 15-3 56 cancer marker drops dramatically
340538 -        significant improvement aligns with IBC rash intensity
340539 -        subsiding; continuing erratic changes. ref SDS 50 087J
340541 -         ..
340542 -        [On 070112 Millie notified doctor that improvement in CA 15-3
340543 -        aligns with IBC rash intensity subsiding. ref SDS 51 1G3K
340544 -
340545 -
340546 -
340547 -
340548 -
340549 -
3406 -

SUBJECTS
Drug Trials Kaiser Collaborating Due Diligence UCSF Proposals 2 Stud

4803 -
4804 - 0840
480501 -  ..
480502 - UCSF 2 Drug Trial Proposals Kaiser Collaborating to Help Millie
480503 - Drug Trials Kaiser Collaborating UCSF Consider Proposals Help Millie
480504 -
480505 - Follow up ref SDS 46 086H, ref SDS 44 086H.
480506 -
480507 - Millie submitted ref DIT 2 0001 to Kaiser saying...
480508 -
480509 -    1.  Thanks very much for your letter on December 20 advising of
480510 -        investigations with UCSF on drug trials, ref DIT 2 0001, that
480511 -        may help me, ref DRP 5 0001, as set out in the Benz 2nd opinion
480512 -        received on 060929, ref SDS 35 UI9K, and referenced in my
480513 -        letter to Kaiser on 061218. ref SDS 44 YV38
480515 -  ..
480516 - The doctor's letter on 061220 was received yesterday on 061226.
480517 - ref SDS 46 YE6N
480519 -  ..
480520 - Letter to primary care physician continues...
480521 -
480522 -    2.  ...Brad related discussions with you on collaborating with UCSF
480523 -        to consider drug trials, which might further expand treatments
480524 -        for my IBC. ref DIT 2 MT6L
480526 -         ..
480527 -    3.  Please submit correspondence between Kaiser and UCSF on
480528 -        my case, including email and printed documents.
480534 -  ..
480535 - We need the record of communications between Kaiser and UCSF in order
480536 - to support Knowledge Management on referral coordination that
480537 - maintains accuracy, alignment, order, structure, planning and
480538 - implementation.
480539 -
480540 -            [On 061228 Millie received communciations between Kaiser
480541 -            and UCSF on considerations for Millie to get treatment on
480542 -            referral to a clinical trial. ref SDS 47 086H
480544 -             ..
480545 -            [On 061230 Millie received communications between Kaiser
480546 -            and UCSF on arrangements for treatment on referral by
480547 -            clinical trial at UCSF. ref SDS 48 086H
480549 -             ..
480550 -            [On 070109 Kaiser reminded of procedures to submit the
480551 -            record on patient history of communications. ref SDS 49
480552 -            J35N
480554 -             ..
480555 -            [On 070610 Kaiser reports right channels are now open for
480556 -            effective communication to collaborate with UCSF on
480557 -            Millie's care. ref SDS 52 OG7F
480559 -             ..
480560 -            [On 080118 Kaiser reports new communication with UCSF on
480561 -            billings that need to be submitted for review by the
480562 -            patient. ref SDS 53 FT5H
480563 -
480564 -
480565 -
480566 -
480567 -
4806 -

SUBJECTS
Navelbine Vinorelbine Tartrate Side Effects Compatibility Protocol P

5603 -
560401 -  ..
560402 - Commend Kaiser Oncology Pharmacy Excellent Presentation Side Effects
560403 - Navelbine Compatibility Kaiser Submitting Review by Pharmacy
560404 -
560405 - Follow up ref SDS 44 EB6J.
560406 -
560407 - On 061218, Millie submitted ref DIP 3 0001 to the primary care
560408 - physician, on changing chemotherapy to Navelbine, ref SDS 44 427M, to
560409 - implement planning the day before on 061217, ref SDS 43 SU7H,
560410 - following up considerations with the doctor during the meeting on
560411 - 061208 to switch chemotherapy treatment from Taxotere and capecitabine
560412 - (Xeloda), to Navelbine. ref SDS 41 3B4N
560414 -  ..
560415 - The letter on 061218 asks Kaiser to perform due diligence by reviewing
560416 - compatibility of Navelbine with patient history, ref SDS 44 427M,
560417 - including the list of current issues that complicate Millie's patient
560418 - profile. ref SDS 41 LU3J
560420 -  ..
560421 - The doctor responded to Millie's letter on 061218, but did not report
560422 - progress on due diligence review of Navelbine. ref SDS 44 SF4K  As
560423 - well, the doctor's letter on 061220 received yesterday on 061226
560424 - commented on possibility of switching to a drug trial rather than to
560425 - Navelbine, but did not comment on due diligence compatibility review
560426 - of Navelbine. ref SDS 46 YE6N
560428 -  ..
560429 - Therefore....
560431 -  ..
560432 - Millie says to the primary care physician...
560433 -
560434 -    4.  Brad in the Pharmacy called on 061220 and gave an excellent
560435 -        verbal account of risks with Navelbine cited on 061208,
560436 -        ref SDS 41 CX9M, and relative to my elevated susceptability to
560437 -        infection, also, listed on 061208, ref SDS 41 LU3J, reported
560438 -        yesterday on 061226. ref SDS 46 EL4O  I don't remember details
560439 -        very well, so he plans to confirm understandings in a letter
560440 -        this week. ref DIT 2 0R5O
560442 -  ..
560443 - In the event, that clincial drug trial opportunities at UCSF are not
560444 - realized, we need review of Navelbine compared with Gemzar for follow
560445 - on treatment, including combinations with Taxotere or capecitabine, as
560446 - recommended by Doctor Benz in the 2nd opinion on 060929. ref SDS 35
560447 - WR3Y
560449 -  ..
560450 - Still need to clarify possible conflict also cited on 060929 in Benz
560451 - recommendations combining Gemzar and Naveline with either Taxotere or
560452 - capecitabine (Xeloda). ref SDS 35 LT30  This was reviewed on 061218,
560453 - when the doctor failed to comment on Benz 2nd opinion, ref SDS 44
560454 - SF4K, and citing case study showing Kaiser routinely prescribes
560455 - multi-agent chemotherapy treatments for Millie. ref SDS 44 EK6L
560457 -  ..
560458 - Also need recommendations on which to try first.  On 061208 the
560459 - primary care physician seemed to indicate the choice is even, and the
560460 - order is irrelevant. ref SDS 41 P09H  However, on 060711 the doctor
560461 - seemed to indicate that Gemzar is easier for Millie to tolerate.
560462 - ref SDS 27 576N
560463 -
560464 -
560465 -
560466 -
560467 -
560468 -
560469 -
5605 -

SUBJECTS
Enlarged Right Ventricle Cor Pulmonale Heart Disorder Doctor Does No

7003 -
700401 -  ..
700402 - Symptoms Cor Pulmonale Continue Fatigue Shortness Breath Heavy Chest
700403 - Cor Pulmonale Heart Disorder Request Examination Heart Specialist
700404 - Heart Examination Enlarged Right Ventricle Request Heart Specialist
700405 - Enlarged Right Ventricle Examination Heart Specialist Patient Request
700406 -
700407 - Follow up ref SDS 44 VC4M, ref SDS 41 VJ4J.
700408 -
700409 - On 061218 Millie submitted ref DIP 4 0001 a letter to the primary care
700410 - physician requesting a heart examination by a specialist, ref SDS 44
700411 - HX6V, that implements planning on 061217. ref SDS 43 0F9M  This
700412 - follows up the meeting with the doctor at Kaiser on 061208, when
700413 - Millie asked about scheduling an examination by a heart specialist.
700414 - ref SDS 41 J14I
700416 -  ..
700417 - The doctor responded later in the day on 061218 indicating that
700418 - diagnosis of enlarged right ventricle will not become life threatening
700419 - for years. ref SDS 44 WT6L
700421 -  ..
700422 - Yesterday, Millie mentioned that the doctor does not understand the
700423 - severity of symptoms for Cor Pulmonale with enlarged right ventricle,
700424 - and pulmonary emoblism with continuing shortness of breath, fatigue,
700425 - and heavy chest, reported during the meeting on 061208. ref SDS 41
700426 - CV5L  She feels frustrated not feeling well enough to resume working
700427 - out in the gym to restore physical and emotional fitness, and build
700428 - the immune system, also, reported on 061208. ref SDS 41 HZ39
700430 -  ..
700431 - Millie submitted ref DIT 3 0001 to Kaiser saying...
700432 -
700433 -    1.  Thanks very much for your letter on December 18 commenting on
700434 -        heart disorder reported in the CT test on 060930: enlarged
700435 -        right ventricle.  Your analysis that "most likely" there is
700436 -        nothing life threatening is encouraging.  I was asking in my
700437 -        letter on 061218 if Kaiser has a specialty, like a heart
700438 -        doctor, who can provide backup on our initial assessment.
700439 -        ref DIT 3 TG5M
700441 -         ..
700442 -    2.  I feel there is a larger problem because of continued shortness
700443 -        of breath, fatigue, heavy chest that occur now with routine
700444 -        effort, e.g., walking from parking my car into the BART
700445 -        station, walking from BART to my office; walking around the
700446 -        mall shopping.  I don't feel this is loss of fitness from
700447 -        chemo. ref DIT 3 GH6L
700449 -         ..
700450 -    3.  No need to respond; we can discuss during the meeting next week
700451 -        on 070105.  Hopefully, we will have the report for the PET/CT
700452 -        test being performed today. ref DIT 3 HH7J
700454 -         ..
700455 -    4.  Thanks again for support. ref DIT 3 OH7O
700456 -
700457 -
700458 -
700459 -
700460 -
7005 -

SUBJECTS
Strategy Treatment Plan 5 Year Case Review IBC 3rd Relapse Tumor Boa

8303 -
830401 -  ..
830402 - IBC Expert Panel Tumor Board Productive Review Millie's Complex Case
830403 - Tumor Board Review on Changing Treatment Expansion of Disease
830404 - Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
830405 - Strategy Treatment Options Scenarios Planning Patient Work Up Deferred
830406 -
830407 - Follow up ref SDS 44 T29I, ref SDS 41 K36G.
830408 -
830409 - Background on Tumor Board considerations are shown in a record on
830410 - 061218. ref SDS 45 FW9K  Case study shows difficulty applying Kaiser's
830411 - Tumor Board capabilities. ref SDS 45 6W3X  Planning to request a Tumor
830412 - Board hearing is reported on 061217. ref SDS 43 OA8O
830414 -  ..
830415 - Millie's letter, ref DIP 5 E46I, on 061218 requested a Tumor Board
830416 - hearing by a panel with IBC experience. ref SDS 44 MN9L  The hearing
830417 - can review diagnosis and treatment strategy for major change in
830418 - patient profile switching chemotherapy treatments, and recent
830419 - discovery of pulmonary embolism, with enlarged right ventricle,
830420 - reported on 061208 ref SDS 41 P69G
830422 -  ..
830423 - The doctor has not responded to the request for Tumor Board review.
830425 -  ..
830426 - Millie submitted ref DIT 4 0001 to the primary care physician, and
830427 - saying...
830428 -
830429 -    1.  Several requests for Tumor Board review to follow up the
830430 -        hearing on 040416.  You correctly urged patience in 2004 until
830431 -        completion of the Avastin trial, which ended on 041104.
830432 -        ref DIT 4 0001
830434 -  ..
830435 - On 040517 the doctor submitted a report on a Tumor Board hearing in
830436 - Millie's case on 040416. ref SDS 10 MB7G  At that time, on 040517 the
830437 - patient requested a re-hearing for the Tumor Board to consider new
830438 - findings of IBC from a biopsy on 040419, 3 days after the hearing on
830439 - 040416, and this was deferred until the next meeting. ref SDS 10 K48O
830440 - During the next meeting on 040614 the doctor recommended deferring
830441 - re-hearing by the Tumor Board to review major change from Stage II to
830442 - Stage IV cancer status until after experience with treatment under a
830443 - clinical drug trial. ref SDS 11 4R59  (see also Millie's patient
830444 - history with Tumor Boards on 061218. ref SDS 45 6W3X)
830446 -  ..
830447 - Letter to primary care physician continues...
830448 -
830449 -    2.  Major changes in patient status, like PE, IBC relapse, present
830450 -        opportunities to "ping the system" for ideas.  The Tumor Board
830451 -        seems like a good port of call for this support. ref DIT 4 RU5O
830453 -         ..
830454 -    3.  Research on 061218 indicates Tumor Boards help doctors solve
830455 -        complex, difficult cases, ref SDS 45 FW9K, and in turn educate
830456 -        the team to help other patients, ref SDS 45 6V5F, similar to
830457 -        case law in legal practice. ref DIT 4 JU6K
830459 -         ..
830460 -    4.  Research also indicates uneven results for Tumor Boards,
830461 -        ref SDS 45 NA6J, because doctors do not have time to prepare by
830462 -        reading up on patient history. ref SDS 45 6W3F  Another problem
830463 -        is getting someone to write up results for access when needed.
830464 -        ref DIT 4 UU7G
830466 -         ..
830467 -    5.  If you feel these problems cannot be overcome to make Tumor
830468 -        Board review effective, then I won't continue to ask about it.
830469 -        I would like Kaiser to assemble doctors with IBC experience,
830470 -        rather than just whoever happens to be handy. ref DIT 4 6V7M
830471 -
830472 -           [On 061228 doctor submits summary of patient history
830473 -           submitted to UCSF for participation in clincial drug trial
830474 -           as providing "5 year review" of complex patient history in
830475 -           place of Tumor Board support for analysis of diagnosis and
830476 -           treatment planning with fresh eyes and diversity of
830477 -           expertise and experience. ref SDS 47 NP8G
830478 -
830479 -
830480 -
830481 -
830482 -
830483 -
8305 -

SUBJECTS
Quarterly Review Patient History Precision Access to Case Studies Pi

AI03 -
AI0401 -  ..
AI0402 - Quarterly Review Patient History Access to Case Studies
AI0403 -
AI0404 - Follow up ref SDS 44 MF4I.
AI0406 -  ..
AI0407 - On 061218 Millie submitted ref DIP 6 0001 to the primary care
AI0408 - physician on reviewing the SDS record of patient history for feedback
AI0409 - on doctor patient partnership that implements planning from the day
AI0410 - before on 061217. ref SDS 43 PK4L
AI0412 -  ..
AI0413 - Millie asked about doing quarterly reviews of patient history,
AI0414 - ref SDS 44 VF65, and provided links to the SDS record on 061208 that
AI0415 - shows issues in the Medical Chart that require review, ref SDS 41
AI0416 - FE4I, and in her letter on 061218 requested comments. ref SDS 44 VF74
AI0418 -  ..
AI0419 - Later in the day on 061218, the doctor submitted a response,
AI0420 - ref DRP 4 0001, that said...
AI0421 -
AI0422 -            We always are looking for ways to improve care and
AI0423 -            communication. ref SDS 44 V28I
AI0425 -  ..
AI0426 - This does not address improvement constructively.
AI0428 -  ..
AI0429 - Millie submitted  ref DIT 5 0001 responding to the doctor's letter on
AI0430 - 061218 saying Kaiser is looking for ways to improve, ref SDS 44 V28I,
AI0431 - and nothing substantive on ideas in Millie's letter the same date.
AI0432 - ref SDS 44 RR5J
AI0434 -  ..
AI0435 - Letter to primary care physician says...
AI0436 -
AI0437 -    1.  Your letter on December 18 noted Kaiser is looking for ways to
AI0438 -        improve. ref SDS 44 TA9X  Who has time for "improvement"?
AI0439 -        ref DIT 5 0001
AI0441 -         ..
AI0442 -    2.  Doctors have a lot of expertise and limited time.  Patients
AI0443 -        have no expertise, and lots of time.  These assets can be
AI0444 -        leveraged through an effective doctor patient partnership.
AI0445 -        ref DIT 5 UJ5M
AI0447 -  ..
AI0448 - Physician Assistant role is another way to increase accuracy of
AI0449 - Medical Chart.
AI0451 -  ..
AI0452 - Sally's daughter, Katie talked about studying to become a Patient
AI0453 - Assistant during a call on 061225.
AI0455 -  ..
AI0456 - Millie had support from a physician assistant, Tammy, during recovery
AI0457 - in the hospital for a cat bite, reported on 050215. ref SDS 18 DL6J
AI0459 -  ..
AI0460 - Kaiser's Healthwise Handbook describes the physician assistant (PA)
AI0461 - role for facilitating communications, reviewed on 990625. ref SDS 1
AI0462 - 7H6J
AI0464 -  ..
AI0465 - Letter to primary care physician continues...
AI0466 -
AI0467 -    3.  Giving a doctor command and control of the record with
AI0468 -        precision access yields the power of knowledge from connecting
AI0469 -        "the dots" of cause and effect under the locality principle.
AI0470 -        ref DIT 5 RO6I  An example is the list of issues from the
AI0471 -        Medical Chart received for the meeting on 061208. ref SDS 41
AI0472 -        EN4K
AI0474 -         ..
AI0475 -    4.  Your note "Metastatic breast cancer (IBC) lung and lymph node;
AI0476 -        chest wall recurrence," listed in the Impression section seemed
AI0477 -        startling.  Periodic review of patient history might help
AI0478 -        clarify communications. ref DIT 5 PP7I
AI0480 -  ..
AI0481 - Citing new notation in Progress Notes for Medical Chart reporting on
AI0482 - meeting with doctor on 061208. ref SDS 41 G25K
AI0483 -
AI0484 -            [On 070112 Millie's letter to Kaiser asks doctor to explain
AI0485 -            support for notation of lung in Medical Chart. ref SDS 51
AI0486 -            NM6G
AI0487 -
AI0488 -
AI0489 -
AI0490 -
AI0491 -
AI0492 -
AI0493 -
AI05 -