CONTACTS 

SUBJECTS
CT Scan Test Performed Kaiser Health Center Pleasenton CA Scope Supp

0703 -
0703 -    ..
0704 - Summary/Objective
0705 -
070501 - Follow up ref SDS 9 EY5O, ref SDS 8 JM4J.
070502 -
070503 -
070504 -
070505 -
070507 -  ..
0706 -
0707 -
0708 - Progress
0709 -
070901 - Millie received ref DRT 1 0001 from Jackie at UCSF responding to the
070902 - letter, ref DIP 1 0001, submitted earlier this morning (in another
070903 - record), and transmitting the record of the meeting yesterday, and
070904 - asking for the location and time of the CT test today. ref SDS 10 FT4X
070906 -  ..
070907 - Jackie at UCSF says to Millie...
070908 -
070909 -    1.  Your scan is today at 10:30 in Pleasanton.  We are going to
070910 -        start treatment tomorrow.  You have an 8am appt in clinic,
070911 -        followed by the infusion.  Also, I will contact you later today
070912 -        once I know your randomization! ref DRT 1 0001
070913 -
070915 -  ..
0710 -
0711 -
0712 - 0946
0713 -
071301 - Millie drove to Kaiser in Pleasenton, about 30 miles South of Concord
071302 - on highway 680, per Jackie's letter this morning, shown above.
071303 - ref SDS 0 K95I
071304 -
071305 -     [On 070202 CT test on 070131 entered in record of meeting with
071306 -     primary care physician. ref SDS 12 1Y8G
071308 -      ..
071309 -     [On 070208 Millie requests report for CT test on 070131.
071310 -     ref SDS 13 LX5O
071312 -      ..
071313 -     [On 070213 Millie submitted follow up request to get the report
071314 -     for the CT test on 070131. ref SDS 14 SS6P
071316 -  ..
071317 - Millie got the CT test coordinated by UCSF so that she can get
071318 - treatment tomorrow at UCSF under the care of Doctor Rugo, as planned
071319 - during the meeting yesterday. ref SDS 9 M882
071321 -  ..
071322 - Millie was charged $50 for the test today.
071324 -  ..
071325 - Millie was told there is an additional $60 charge to send the CT test
071326 - files on a CD to UCSF in order for Millie to get treatment tomorrow.
071327 - Another attendant overheard this conversation, and said there is no
071328 - charge for sending test files to UCSF.  This seems a very loose
071329 - procedure for customers to avoid being overcharged, similar to
071330 - experience checking out of the hospital at Kaiser on 061101.
071331 - ref SDS 5 LL38
071333 -  ..
071334 - During the test, which takes about 30 - 40 minutes or so including
071335 - patient preparation and equipment setup, Millie asked about performing
071336 - the CT CT test described by the primary care physician on 060120 that
071337 - evaluates pulmonary embolism and enlarged right ventricle. ref SDS 4
071338 - S56G  The technician advised that they do this special form of CT test
071339 - when ordered by the doctor.  Millie gathered from technician comments
071340 - that CT testing for pulmonary embolism requires changing test
071341 - equipment configuration.
071343 -  ..
071344 - This report appears to conflict with understandings from Jackie at
071345 - UCSF who worked very hard to advance Millie's treatment from tomorrow
071346 - to today, so that Millie can get treatment tomorrow with Doctor
071347 - supervising the work, as discussed during the meeting at UCSF
071348 - yesterday on 070130. ref SDS 9 M84R
071349 -
071350 -
071352 -  ..
0714 -
0715 -
0716 - 1210
0717 -
071701 - Millie submitted ref DIT 1 0001 to the primary care physician at
071702 - Kaiser to explain resolution of prior conflict in schedule to meet on
071703 - Friday, and saying...
071704 -
071705 -    1.  I just got back from Kaiser in Pleasenton.  The technician told
071706 -        me they do the special CT test you described in our meeting on
071707 -        061020 that evaluates pulmonary embolism, ref SDS 4 S56G, so
071708 -        hopefully we'll get an update. ref DIT 1 0001
071710 -         ..
071711 -    2.  They also told me I had to pay $60 to put the files on a CD and
071712 -        courrier to UCSF, but another person who overheard the
071713 -        disucssion said there is no charge for UCSF, so I saved some
071714 -        money.  They should be able to send files electronically,
071715 -        rather go to the time and expense of making a CD. ref DIT 1
071716 -        G46F
071718 -         ..
071719 -    3.  I guess you heard UCSF moved everything ahead, so treatment is
071720 -        tomorrow [scheduled during meeting at UCSF on 070130,
071721 -        ref SDS 9 N96O], and I can meet with you at the scheduled time
071722 -        on Friday 2:20p. ref DIT 1 I46M
071724 -         ..
071725 -    4.  Bad news.  Rash has spread toward my stomach and wrapping
071726 -        toward the back.  Good news.  The main area of rash seems much
071727 -        less intense. ref SDS 9 M68J  Doctor Rugo concurred with your
071728 -        analysis that new treatment will clear it up. ref SDS 9 M645
071729 -        Keeping my fingers crossed. ref DIT 1 W47H
071730 -
071731 -           [On 070202 doctor's examination at Kaiser, and progress
071732 -           notes report cancer spreading toward the stomach, and around
071733 -           toward the back. ref SDS 12 368I
071735 -         ..
071736 -    5.  If possible, can I get the lastest blood test with CA 15-3.
071737 -
071738 -
071739 -
071740 -
071741 -
0718 -

SUBJECTS
Treatment Ready to Start Cetuximab Carboplatin Clinical Study Drug T

1803 -
1804 - 1325
180501 -  ..
180502 - Treatment Tomorrow Ready CT Test Done Blood Tests???
180503 - Blood Work Retest Laboratory for Chemotherapy Tomorrow
180504 - UCSF Notified CT Test Performed Ask About Blood Work
180505 - CT Test Kaiser Pleasenton Supports CT for Pulmonary Embolism
180506 -
180507 - Follow up ref SDS 9 MP4H, ref SDS 6 AS6M.
180508 -
180509 - Millie submitted ref DIT 2 0001 to Jackie at UCSF saying...
180510 -
180511 -    1.  Got the CT test done this morning at Kaiser in Pleasenton.  I
180512 -        asked the technician if he can do the special CT test for
180513 -        pulmonary embolism, and he said they do them when ordered; all
180514 -        he does is change the setting on the machine.  Sounds simple
180515 -        enough.
180517 -  ..
180518 - Millie reports getting CT done, per above. ref SDS 0 ZL9M, and advises
180519 - that scope can test for pulmonary embolism with equipment at Kaiser in
180520 - Pleasenton, per above, ref SDS 0 KM7L,
180522 -  ..
180523 - Millie's letter to Jackie at UCSF continues...
180524 -
180525 -    2.  They told me I had to pay $60 for Kaiser to put the scan files
180526 -        on a CD and mail it to UCSF.  Someone who overheard the
180527 -        discussion said there is no charge for UCSF, so I save the $60.
180528 -        Not sure why anyone would put a computer file on a CD and mail
180529 -        it when transmitting the file electronically takes less time
180530 -        and money.
180532 -         ..
180533 -    3.  Just checking that you have all the blood tests UCSF needs.  Do
180534 -        you get this in a computer file that you can manage, or does
180535 -        Kaiser submit a printed document?  If you get the computer file
180536 -        I would like a copy, otherwise I will ask Arlette.
180538 -  ..
180539 - This follows up the meeting yesterday, when many issues were
180540 - discussed, but the blood test somehow got overlooked. ref SDS 9 MP4H
180541 -
180543 -  ..
1806 -
1807 -
1808 - 1510
1809 -
180901 - Jackie called Millie responding to the letter submitted earlier this
180902 - afternoon, per above. ref SDS 0 RS3P
180904 -  ..
180905 - UCSF requires another blood test today in order to meet requirements
180906 - for starting the cetuximab carboplatin clinical study drug trial
180907 - tomorrow.  Jackie indicated the test on 070123, ref SDS 6 AS6M, cannot
180908 - be used now to assess Millie's condition for starting treatment
180909 - tomorrow.  Per above, this subject was not expressly discussed in the
180910 - project launch meeting at UCSF yesterday. ref SDS 9 MP4H
180911 -
180912 -
180914 -  ..
1810 -
1811 -
1812 - 1523
1813 -
181301 - Millie drove to Kaiser in Walnut Creek.  She had blood drawn in the
181302 - Laboratory, rather than the Infusion Clinic.
181304 -  ..
181305 - CA 15-3 was requested again to monitor trends for decision support.
181306 -
181307 -        [On 070131 Millie randomized for treatment with Cetuximab;
181308 -        since CA 15-3 seems moderate, if the test today tracks evident
181309 -        improvement in IBC rash subsiding, then Millie is better served
181310 -        by having opportunity to add Carboplatin to the clinical study
181311 -        treatment later, if IBC surges in severity again at a later
181312 -        time. ref SDS 11 XR3M
181314 -  ..
181315 - After blood was drawn, the technician told Millie to keep her arm
181316 - elevated for about 5 minutes to minimize internal bleeding from the
181317 - needle that drew blood.  Since Millie is on Coumadin (warfarin) she
181318 - has increased risk of bleeding.
181319 -
181320 -        [...Jackie's letter later today explains Doctor Rugo and UCSF
181321 -        surgeon are cautious about Millie having biopsies for the
181322 -        clinical study, because this could present increased risk of
181323 -        bleeding with Millie on Coumadin for pulmonary embolism.
181324 -        ref SDS 0 IE8K
181326 -         ..
181327 -        [On 070201 blood draws for clinical study needed only every 4
181328 -        weeks; blood draws can be done using the port catheter that
181329 -        avoids needle penetrations, and on same day of treatment and at
181330 -        UCSF. ref SDS 11 6U5J
181331 -
181332 -
181334 -  ..
1814 -
1815 -
1816 - 1703
1817 -
181701 - Millie submitted ref DIT 3 0001 responding to Jackie's call earlier
181702 - today, ref SDS 0 8U4P, and saying...
181703 -
181704 -    1.  Just back from Kaiser in Walnut Creek.  They did the blood test
181705 -        UCSF ordered today per your call OA 1510.  I asked for an INR
181706 -        to evaluate pulmonary embolism so I don't have to go back next
181707 -        week.  CA 15-3 was also performed to get a sense of trends.
181708 -
181709 -            [On 070201 Millie had a little trouble with 10 vials of
181710 -            blood for the cetuximab clincial study. ref SDS 11 C76G
181712 -         ..
181713 -    2.  See you at 0800.  We plan to arrive before 0600 to beat the
181714 -        traffic and will hang out in the cafeteria.  If we can get
181715 -        started earlier than 0800 just let me know.
181717 -         ..
181718 -    3.  Thanks for all your expediting!!
181719 -
181720 -
181722 -  ..
1818 -
1819 -
1820 - 2235
1821 -
182101 - Biopsy Not Performed While Millie on Coumadin
182102 -
182103 - Millie received ref DIT 2 0001 from Jackie responding to the letter
182104 - submitted earlier, ref DIT 3 0001, per above. ref SDS 0 L96G
182106 -  ..
182107 - Jackie at UCSF says to Millie...
182108 -
182109 -    1.  Thanks for getting the bloods done.  I will Kaiser and make
182110 -        sure we receive a copy. ref DRT 2 0001
182112 -         ..
182113 -    2.  I also wanted to let you know that Dr.  Rugo and one of the
182114 -        surgeons spoke and decided not to do the biopsy since you are
182115 -        on coumadin.  From what I understand (not a medical opinion)
182116 -        that it would not be worth the small risk to do a procedure
182117 -        that is not medically indicated.  We do thank you for your
182118 -        willingness to particpate in the research! ref DRT 2 WE5N
182120 -  ..
182121 - This revises planning on 070130 for Millie to get biopsies to assess
182122 - IBC rash, and check for status change. ref SDS 9 M840
182124 -  ..
182125 - Concern about bleeding, aligns with report at Kaiser today that needle
182126 - penetration for blood draws needs to be minimized in order to reduce
182127 - risk of internal bleeding, per above. ref SDS 0 E87I
182129 -  ..
182130 - Millie's patient history shows that risks of hemoraging from biopsy
182131 - procedures were managed effectively on 051012 when Kaiser took 4 test
182132 - biopsies to evaluate prospects for mastectomy surgery, and to help
182133 - determine the boundaries of breast removal. ref SDS 2 DG6J  Gloria in
182134 - Kaiser's Coagluation Treatment Clinic called earlier on 051006 and
182135 - instructed Millie to pause Coumadin treatments for 5 days prior to the
182136 - biopsies, and then to resume after the procedure, and on the same day.
182137 - ref SDS 1 5E6O
182139 -  ..
182140 - Millie's patient history since starting Coumadin treatments on 061002,
182141 - ref SDS 3 JK7J, shows she has not suffered excessive nor even mild
182142 - bleeding from occassional cuts and abrasions that occur in daily life.
182143 - This raises prospects that biopsies for the clinical study on
182144 - Cetuximab could yield diagnosic and pathology on diagnosis to further
182145 - guide treatment, as set out in the record meeting with Doctor Rugo on
182146 - 070130. ref SDS 9 KT7J
182147 -
182148 -            [On 070201 Jackie explains that biopsy diagnostics and
182149 -            pathology are not reported to the doctor for patient
182150 -            diagnosis and treatment; therefore, even though Millie has
182151 -            experienced minimal bleeding while on Coumadin the past few
182152 -            months, there is no benefit to balance risk to the patient
182153 -            for performing biopsies that only support research.
182154 -            ref SDS 11 IH6H
182155 -
182157 -  ..
182158 - Jackie at UCSF says to Millie continues...
182159 -
182160 -    3.  We will definitely start by 8am - I am not sure if the NP would
182161 -        be ready earlier. ref DRT 2 WE6L
182163 -         ..
182164 -    4.  See you tomorrow.  I am so glad we are finally ready to start!
182165 -        ref DRT 2 3B6O
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182168 -
182169 -
182170 -
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182172 -
182173 -
182174 -
182175 -
182176 -
182177 -
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182179 -
1822 -