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1...Need written coordination plan on file at UCSF and Kaiser, including
2...Who will make analysis on treating cellulitis, how will a prescription
CONTACTS
SUBJECTS
Meeting Doctor Examination 11th Review Prepare Changing Protocols St
0503 -
0503 - ..
0504 - Summary/Objective
0505 -
050501 - Follow up ref SDS A6 0000, ref SDS 97 0000.
050502 -
050503 - Millie met with the primary care physician at Kaiser following start
050504 - of treatment for IBC at UCSF on referral for participating in a
050505 - clinical study of cetuximab and carboplatin. CA 15-3 continues
050506 - erratic changes up and down, ref SDS 0 GJ5M, which aligns with IBC
050507 - rash spreading from left to right breast, seeming less intense, but
050508 - further spreading toward the stomach and back, ref SDS 0 368I, and new
050509 - rash on the left arm today, which could be cellulitis or IBC.
050510 - ref SDS 0 JP6F New treatment with cetuximab started only yesterday
050511 - and so has not had time to affect recovery. ref SDS 0 PF3O CT test on
050512 - 070131 still shows no evidence of distant metastasis. ref SDS 0 GB8J
050513 - The doctor plans to order CT test specification that evaluates
050514 - recovery from pulmonary embolism and enlarged right ventricle.
050515 - ref SDS 0 T85K Need coordination plan for Millie getting medication
050516 - prescriptions and Emergency treatment from Kaiser. ref SDS 0 RM4G
050517 -
050518 -
050519 -
050520 -
050521 -
050522 -
050524 - ..
0506 -
0507 -
0508 - Progress
0509 -
050901 - Agenda Develop Work Plan Stage IV Breast Cancer 14 Mos after Mastectomy
050902 -
050903 - Follow up ref SDS A6 SM6M, ref SDS 97 SM6M.
050904 -
050905 - This is the 11th review meeting for the 8th chemotherapy cycle since
050906 - starting treatment on 060711, ref SDS 68 SM6M, for the 3rd relapse of
050907 - IBC. ref SDS 68 8Y8I Millie met with Doctor Rugo at UCSF on 070130,
050908 - ref SDS A6 SM6M, and then again with Nurse Practitioner Brigid on
050909 - 070201, ref SDS A8 407N, which makes today the 3rd meeting to start
050910 - the 1st cycle and 1st treatment with cetuximab at UCSF on 070201 on a
050911 - clinical study drug trial. The doctor was on schedule today, starting
050912 - the meeting 1420.
050914 - ..
050915 - Millie did not submit a letter this morning with an agenda for the
050916 - meeting today; the agenda for the meeting on 070105 provides
050917 - guidance for discussion today...
050918 -
050919 - 1. CA 15-3 dropped dramatically................... ref SDS 0 GJ5M
050920 - 2. Lymphedema/Cellulitis controlled............... ref SDS 0 MW8J
050921 - 3. Breast exam IBC less intense................... ref SDS 0 025H
050922 - 4. IBC spread right breast........................ ref SDS 0 AX6G
050923 - 5. CT test 070131 need results.................... ref SDS 0 EY5O
050924 - 6. Treatment plan continue cetuximab.............. ref SDS 0 K36G
050925 - 7. Drug trials UCSF started 070201................ ref SDS 0 WI3J
050926 - 8. Pulmonary emboli how serious r ventricle....... ref SDS 0 CV5L
050927 - 9. Symptoms fatigue, weakness shortness breath.... ref SDS 0 CV5L
050928 - 10. Cor Pulmonale enlarged r ventricle heart doctor ref SDS 0 VJ4J
050929 - 11. Esophagitis, heart burn PET test check......... ref SDS 0 JP6K
050931 - ..
050932 - The doctor's Progress Notes in the Medical Chart do not list an
050933 - agenda. ref SDS 0 684G
050935 - ..
050936 - Scheduled next meeting in 8 weeks on 070406 1420, to review effect of
050937 - new treatments. ref SDS 0 N96O
050938 -
050939 -
050940 -
050941 -
050942 -
0510 -
SUBJECTS
Complex Patient History 38 Issues Situational Awareness Overwhelms S
0703 -
070401 - ..
070402 - Complex Patient History Knowledge Management Dilemma Issues Grow 38
070403 -
070404 - Follow up ref SDS A6 LU3J, ref SDS 97 LU3J.
070405 -
070406 - Complexity overwhelms span of attention, compounding Knowledge
070407 - Management dilemma presented on 070105, ref SDS 97 EM5N, from
070408 - expanding issues of diagnosis and treatment...
070409 -
070410 - 1. CA 15-3 monitors advance of cancer response to treatment
070411 - 2. Lymphedema complicated by mastectomy surgery
070412 - 3. Broken finger from minor fall complicates lymphedema
070413 - 4. Esophagitis reflux digestion issues
070414 - 5. Immune system chemotherapy increases risk of infection
070415 - 6. Chemotherapy increase risk of infection
070416 - 7. Cat bites increase risk of infection complicates lymphedema
070417 - 8. Pneumonia chemotherapy increases risk of infection
070418 - 9. Metastatic cancer increases risk pulmonary embolism
070419 - 10. Lymphadenopathy left axilla local regional metastasis
070420 - 11. Lymphadenopathy right axilla distant metastasis
070421 - 12. Lymphadenopathy left supraclavicular diagnose metastatic cancer
070422 - 13. Breast cancer secondary IBC 3rd relapse left breast
070423 - 14. Cancer mutates slow response chemotherapy treatment
070424 - 15. Mastectomy surgery impact on treatment IBC relapse
070425 - 16. Blood vessels removed mastectomy slow chemotherapy treatments
070426 - 17. Treatment options, strategy, planning, schedule
070427 - 18. Drug trials increase declining pool chemotherapy agents
070428 - 19. UCSF Doctor Benz 2nd opinion apply diagnosis and treatment
070429 - 20. Pulmonary embolism blood clots in lungs
070430 - 21. INR weekly adjustments Coumadin treatment blood clots
070431 - 22. Enlarged right ventricle heart problem cor pulmonale
070432 - 23. Dizziness symptom enlarged right ventricle cor pulmonale
070433 - 24. Fatigue shortness breath side effect chemotherapy loss fitness
070434 - 25. Fatigue shortness breath symptom pulmonary embolism
070435 - 26. Shortness breath fatigue dizzy symptoms pulmonary embolism
070436 - 27. Coagulapathy hypercoagulable state work up genetic risks
070437 - 28. Testing resolution of errors (see Benz 2nd opinion 060821)
070438 - 29. Testing distant metastatic disease
070439 - 30. Testing pulmonary embolism and heart disease
070440 - 31. Communication hectic schedule not enough time to manage details
070441 - 32. Emotional stress and well being
070442 - 33. Cellulitis inflammation temperature 102.6 on chemotherapy
070443 - 34. Urinary tract bladder infection
070444 - 35. IBC rash spreads to right breast
070445 - 36. Right breast rash may be "ring" infection, not cancer
070446 - 37. Lung cancer seems to be diagnosed in the Medical Chart
070447 - 38. Kaiser authorize treatment UCSF cetuximab clinical study
070448 - 39. IBC rash spreads to stomach and toward back
070449 - 40. IBC rash spreads to left arm or cellulitis
070450 -
070451 -
070452 -
0705 -
SUBJECTS
Vitals Not Submitted Doctor Progress Note Medical Chart Meeting Doct
0903 -
090401 - ..
090402 - Vitals Show Stable Medical Condition
090403 -
090404 - Follow up ref SDS A6 KB5L, ref SDS 97 KB5L.
090406 - ..
090407 - Bld Prssr Pulse Temp Weight SaO2
090408 - ..
090409 - * 070202 1420............
090410 - * 070201 0800............
090411 - * 070130 1420............
090412 - * 070105 1040............
090413 - 061208 1226............ 152 90 76 97.8 147 99%
090414 - 061201 1430............ 123 76 76 97.5
090415 - 061110................. 136 83 73 97.0 150 98%
090416 - 061020 1534............ 140 79 67 99.8 151 97
090417 - 060929 1452............ 141 78 66 98.3
090418 - 060908 1335............ 139 79 73 98.1
090419 - 060814 1610............ 139 80 59 98.2
090420 - * 060808.................
090421 - 060711................. 172 87 54 97.5 147
090422 - 060623................. 141 87 71 98.0 147 99%
090423 - 060428................. 129 73 80 99.4 149 99%
090424 - 060217................. 153 81 61 98.6 150 99%
090425 -
090426 - ...per the doctor's report in the Medical Chart shown below.
090427 - ref SDS 0 JQ4J
090428 -
090429 - * For some reason, vitals not submitted.
090430 -
090431 -
090432 -
090433 -
0905 -
SUBJECTS
Collaborate Kaiser UCSF Clinical Study Drug Trial Complex Communicat
1903 -
190401 - ..
190402 - Collaboration Primary Care at Kaiser with UCSF Standard of Care
190403 -
190404 - Follow up ref SDS A6 RM4G.
190405 -
190406 - Review of case study on collaboration during December and January
190407 - between Kaiser and UCSF, and presented in the record for the meeting
190408 - at UCSF on 070130 shows evident critical requirement for coordination
190409 - procedures between UCSF and Kaiser. ref SDS A6 RM4G
190411 - ..
190412 - Yesterday, on 070201 Jackie asked the patient to call a number at UCSF
190413 - for emergencies. ref SDS A8 407N
190415 - ..
190416 - Need written coordination plan on file at UCSF and Kaiser, including
190417 - instructions to the patient on handling prescriptions and emergency
190418 - treatment, so this work occurs routinely, and without depending on
190419 - availability of particular individuals who have been taking exigent
190420 - action, because they have personal knowledge of the case.
190421 -
190422 - [On 070216 Jackie confirms patient should call UCSF for
190423 - emergencies. ref SDS B6 AM4N
190425 - ..
190426 - [On 070217 Millie requests clarification of coordination
190427 - planning on emergency treatment; notes that patient history
190428 - shows treatment at Kaiser Emergency does not require
190429 - calling a number, just show up; notes that driving to San
190430 - Francisco for emergency treatment at UCSF might enocunter
190431 - fatal traffic delays. ref SDS B7 4Q8O
190433 - ..
190434 - [On 070218 letter to Kaiser illustrates confusion about handling
190435 - coordination between Kaiser and UCSF with respect to mediciation
190436 - prescriptions and emergencies. ref SDS B5 VW6U
190438 - ..
190439 - [On 070222 Jackie proposed UCSF and Kaiser develop coordination
190440 - plan to facilitate collaboration on care for Millie's complex
190441 - patient history. ref SDS B9 VK5N
190443 - ..
190444 - [On 070228 letter to UCSF requests draft of coordination
190445 - plan for review during meeting on 070301. ref SDS C0 LQ6R
190446 -
190447 -
190448 -
190449 -
1905 -
SUBJECTS
CA 15-3 56 Cancer Marker Trending Down Aligns with IBC Rash Subsidin
3103 -
310401 - ..
310402 - CA 15-3 Cancer Marker 56 Erratic Past 4 Months Trending Down
310403 -
310404 - Follow up ref SDS A6 087J, ref SDS 97 087J.
310405 -
310406 - Millie has had four (4) tests for CA 15-3 since the last meeting on
310407 - 070105 when CA 15-3 was 74 for the test on 061218. Results continue
310408 - to go up and down, but the general trend now seems down.
310410 - ..
310411 - Test Date Date Received
310412 - 070131......... 56 H............. 070202, ref SDS 0 087J
310413 - 070123......... 52 H............. 070202, ref SDS 0 087J
310414 - 070118......... 68 H............. 070123, ref SDS A4 GK5B
310415 - 070104......... 56 H............. 070110, ref SDS 99 087J
310416 - 061218......... 74 H............. 061227, ref SDS 92 6P9F
310417 - 061214......... 63 H............. 061227, ref SDS 92 6P9F
310418 - 061130......... 67 H............. 061201, ref SDS 86 087J
310419 - 061116......... 66 H............. 061201, ref SDS 86 087J
310420 - 061110......... 56 H............. 061201, ref SDS 86 087J
310421 - 061109......... 61 H............. 061110, ref SDS 84 087J
310422 - 061026......... 57 H............. 061110, ref SDS 84 087J
310423 - 061019......... 56 H............. 061020, ref SDS 82 087J
310424 - 060928......... 51 H............. 060929, ref SDS 78 087J
310425 - 060907......... 68 H............. 060929, ref SDS 78 087J
310426 - 060813......... 73 H............. 060817, ref SDS 74 U24M
310427 - 060809......... 87 H............. 060810, ref SDS 73 2N5J
310428 - 060708......... 71 H............. 060711, ref SDS 68 087J
310429 - 060616......... 63 H............. 060623, ref SDS 67 UQ5Q
310430 - 060522......... 59 H............. 060605, ref SDS 65 UQ5Q
310431 - 060501......... 49 H............. 060522, ref SDS 64 MC4F
310432 - 060421......... 44 H............. 060428, ref SDS 61 087J
310433 - 060330......... 40 H............. 060428, ref SDS 61 087J
310434 - 060303......... 36............... 060428, ref SDS 61 087J
310435 - 060210......... 33............... 060217, ref SDS 60 087J
310436 - 060109......... 34............... 060126, ref SDS 59 KV59
310437 - 051223......... 34............... 060106, ref SDS 58 087J
310438 - 051202......... 28............... 060106, ref SDS 58 087J
310439 - 051116......... 31............... 051121, ref SDS 57 087J
310440 - 051109......... 30............... 051121, ref SDS 57 087J
310441 - 051102......... 34............... 051121, ref SDS 57 087J
310442 - 050909......... 45 H............. 051007, ref SDS 55 087J
310443 - 050826......... 45 H............. 050913, ref SDS 54 087J
310444 - 050819......... 45 H............. 050913, ref SDS 54 087J
310445 - 050812......... 39 .............. 050819, ref SDS 53 3K6L
310446 - 050729......... 45 H............. 050819, ref SDS 53 EA5G
310447 - 050708......... 46 H............. 050729, ref SDS 52 087J
310448 - 050701......... 37 .............. 050729, ref SDS 52 087J
310449 - 050617......... 45 H............. 050729, ref SDS 52 087J
310450 - 050527......... 56 H............. 050610, ref SDS 51 087J
310451 - 050512......... 67 H............. 050520, ref SDS 50 087J
310452 - 050506......... 80 H............. 050520, ref SDS 50 087J
310453 - ..
310454 - 050415.........105 H............. 050422, ref SDS 49 087J
310455 - 050325.........100 H............. 050329, ref SDS 48 087J
310456 - 050318.........101 H............. 050325, ref SDS 47 2N5J
310457 - 050304......... 88 H............. 050311, ref SDS 46 087J
310458 - 050225......... 95 H............. 050308, ref SDS 45 0001
310459 - 050211......... 78 H............. 050214, ref SDS 44 02BB
310460 - 050128......... 67 H............. 050204, ref SDS 43 087J
310461 - 041228......... 56 H............. 041230, ref SDS 41 087J
310462 - 041204......... 43 H............. 041210, ref SDS 40 087J
310463 - 041007......... 39............... 041104, ref SDS 38 087J
310464 - 040923......... 49 H............. 041005, ref SDS 37 087J
310465 - 040908......... 44 H............. 040909, ref SDS 36 087J
310466 - 040825......... 47 H............. 040909, ref SDS 36 087J
310467 - 040811......... 42 H............. 040812, ref SDS 35 087J
310468 - 040728......... 43 H............. 040729, ref SDS 33 2N5J
310469 - 040712......... 47 H............. 040713, ref SDS 32 087J
310470 - 040614......... 55 H............. 040615, ref SDS 31 PX6X
310471 - 040517......... 78 H............. 040601, ref SDS 30 2N5J
310472 - 040311......... 70 H............. 040318, ref SDS 26 SM6M
310473 - 040205......... 60 H............. 040211, ref SDS 25 SM6M
310474 - 031201......... 62 H............. 031205, ref SDS 24 SM6M
310475 - 030912......... 66 H............. 030915, ref SDS 23 SM6M
310476 - 030708......... 68 H............. 030710, ref SDS 22 SM6M
310477 - 030503......... 54 H............. 030508, ref SDS 20 SM6M
310478 - 030403......... 45 H............. 030508, ref SDS 20 SM6M
310479 - 030215......... 46 H............. 030220, ref SDS 19 5E6L
310480 - 030106......... 37 H............. 030109, ref SDS 18 SM6M
310481 - 021202......... 41 H?............ 021204, ref SDS 17 SP5G
310482 - 021111......... 36 H?............ 021113, ref SDS 16 Y65I
310483 - 021023......... 33 H?............ 021023, ref SDS 15 SQ5I
310484 - 020930......... 33 H?..39........ 021002, ref SDS 14 SQ5I
310485 - 020917......... 36 H?............ 020924, ref SDS 13 SQ5I
310486 - 020717......... 59 H?............ 020726, ref SDS 12 YN5K
310487 - 020629......... 75 H ............ 020705, ref SDS 11 UX6I
310488 - 020608........ 67 H ............ 020614, ref SDS 10 0001
310489 - 020603........ 108 H ............ 020607, ref SDS 9 X67F
310490 - 020511........ 117 H ............ 020603, ref SDS 8 PJ4J
310491 - 020419......... 81 H ............ 020430, ref SDS 6 7N5H
310492 - 020321......... 85 H ............ 020405, ref SDS 5 6T8K
310493 -
310494 -
310495 -
310496 -
310498 - ..
3105 -
3106 -
3107 - Analysis
3108 -
310801 - CA 15-3 56 Cancer Marker Decline May Aligns IBC Rash Subsides
310802 -
310803 - Follow up ref SDS A6 GJ5M, ref SDS 97 GJ5M.
310804 -
310805 - Erratic changes in cancer marker, CA 15-3, over the past 4 months,
310806 - shown above, ref SDS 0 087J, may signal conflicting forces.
310807 - Examinations on 070130 at UCSF, and again today, see below, report
310808 - dramatic spread of disease in the skin, while at the same time
310809 - intensity may be subsiding, which indicates response to treatment.
310810 - ref SDS 0 025H As well, new rash observed on left arm may be IBC or
310811 - cellulitis. ref SDS 0 JP6F
310813 - ..
310814 - Millie started new treatments with cetuximab at UCSF, yesterday on
310815 - 070201, ref SDS A8 0001, so today is too soon for evaluation. Changes
310816 - up until today are therefore attributed to prior treatment which ended
310817 - on 061201 with Taxotere and capecitabine. ref SDS 85 0001
310818 -
310819 -
310820 -
310821 -
310822 -
3109 -
SUBJECTS
Digestion Problems GERD PET Scan Test on 061227 Failed Perform Analy
3503 -
350401 - ..
350402 - Digestion Problems Increasing Relatively Infrequent Mild
350403 - Esophagitis Not Compared in Current PET Test with Prior Report
350404 -
350405 - Follow up ref SDS A6 JP6K, ref SDS 97 JP6K.
350406 -
350407 - Background is reported in the meeting on 070105. ref SDS 97 JP6K
350408 -
350409 - There were no complaints and no discussion on this issue.
350410 -
350411 -
350412 -
350413 -
3505 -
SUBJECTS
Left Axillary Lymphadenopathy Patient No Complaint Swelling Discomfo
4503 -
450401 - ..
450402 - Cellulitis Complications Lymphedema Recovering Improved
450403 - Left Axillary No Evidence Lymphadenopathy Lymphedema Improving
450404 - Red Rash Upper Left Arm Could Be Cellulitis IBC or Other Malady y
450405 - Lymphadenopathy Left Axillary No Evidence Lymphedema Improving Cellulitus Recovered
450406 -
450407 - Follow up ref SDS A6 MW8J, ref SDS 97 MW8J.
450409 - ..
450410 - Patient history of left axillary lymphadenopathy and lymphedema is
450411 - reported on 060106. ref SDS 58 S164
450413 - ..
450414 - There was no examination today for cancer in left axilla. The patient
450415 - has made no complaint of lumps or discomfort from swelling under the
450416 - left arm for the past 6 months, reported on 070105. ref SDS 97 MW8J
450418 - ..
450419 - CT test on 070131 shows no evidence lymphedema left axillar, reported
450420 - below. ref SDS 0 013T
450422 - ..
450423 - Background on lymphedema and complications of Cellulitis are reported
450424 - on 070105. ref SDS 97 5Y5F
450426 - ..
450427 - Over the past month, lymphedema has significantly subsided. Millie's
450428 - left hand and lower arm are near normal. The upper left arm still
450429 - seems somewhat swelled. There was no measurement today. On 070130
450430 - measurement below the left elbow was 10.75" reported in case study on
450431 - 060509. ref SDS 63 HO7F
450433 - ..
450434 - The doctor noticed today spotty red inflammation in the upper left
450435 - arm, which is a symptom of cellulitus. On 061027, lymphedema flared
450436 - into cellulitis on the entire left arm, ref SDS 83 WO6N, and fine red
450437 - lines were observed extending from the IBC rash on the left breast
450438 - area to the top of the left shoulder which then was totally inflamed
450439 - in red rash. ref SDS 83 V79M
450440 -
450441 - [...see Medical Chart reporting lymphedema stable, and no mention
450442 - of new rash on left arm. ref SDS 0 1248
450444 - ..
450445 - [On 070214 Millie notifies primary care physician rash continues
450446 - on left arm, requests refill prescription antibiotic treatment for
450447 - cellulitus, Keflex. ref SDS B4 R66P
450449 - ..
450450 - [On 070218 Millie played tennis; left arm seemed more swollen; she
450451 - began taking Keflex antibiotic to treat cellulitis. ref SDS B8
450453 - ..
450454 - [On 070222 examination at UCSF indicates rash on upper left arm
450455 - more likely expanding IBC. ref SDS B9 B64F
450457 - ..
450458 - The doctor commented today that fine red lines observed on 061027,
450459 - ref SDS 83 V79M, were likely inflamed from loss of lymphatics, leading
450460 - to lympedema with complications of cellulitis.
450462 - ..
450463 - The rash on the left arm looks similar to sprinkled red dots observed
450464 - during examination by Doctor Rugo at UCSF on 070130, and which seemed
450465 - like possible expansion of IBC from the left breast. ref SDS A6 M68J
450467 - ..
450468 - Since cellulitis has occurred several times on the left arm, beginning
450469 - on 061027, this may be another recurrence.
450471 - ..
450472 - There is, also, concern that this rash might be IBC spreading to the
450473 - left arm; or, that cellulitis might present a compound problem on the
450474 - left chest area, and on the stomach, and wrapping toward the back.
450475 - which the doctor observed today, reported below on examining the left
450476 - breast. ref SDS 0 368I This presents a context of "wicked problems,"
450477 - reviewed on 060722. ref SDS 69 346F Previously, on 040419 biopsy was
450478 - performed which established IBC involvement on the left breast,
450479 - reported on 040517. Biopsy was not ordered to day, reported below.
450480 - ref SDS 0 BR7M
450481 -
450482 - [On 070214 Millie asks about treatment for new rash on left arm.
450483 - ref SDS B4 R66P
450485 - ..
450486 - [On 070215 primary care physician at Kaiser refers matter to UCSF
450487 - for care under clinical study. ref SDS B5 HK5O
450489 - ..
450490 - [On 070215 Millie notifies UCSF about rash problem and doctor's
450491 - referral for consideration of treatment. ref SDS B5 LK8H
450493 - ..
450494 - [On 070215 UCSF prescribes treatment for cellulitis and
450495 - coordinates ordering prescription by primary care physician at
450496 - Kaiser. ref SDS B5 VE3K
450498 - ..
450499 - [On 070216 UCSF schedules meeting to examine report new rash on
450500 - left arm; proactive management may be spread of IBC. ref SDS B6
450501 - VE3K
450503 - ..
450504 - [On 070222 examination at UCSF indicates new rash likely
450505 - progression of IBC. ref SDS B9 B64F
450507 - ..
450508 - [On 070301 IBC progression to left arm, evident rise CA 15-3
450509 - cancer marker presents prognosis of failed response to treatment,
450510 - requiring increasing prescription from cetuximab alone to add
450511 - carboplatin. ref SDS C1 OL5M
450513 - ..
450514 - On 061204 the doctor prescribed Keflex antibiotics to treat recurrence
450515 - of cellulitis on the left arm, ref SDS 88 ZS5N, similar to
450516 - observations today.
450517 -
450518 - [On 070218 Millie began Keflex treatment for red rash on left
450519 - arm. ref SDS B8 N069
450520 -
450521 -
450522 -
450523 -
450524 -
4506 -
SUBJECTS
Right Auxillary Lymphadenopathy Patient No Complaint Swelling Discom
5103 -
510401 - ..
510402 - Right Axillary No Evidence Cancer Red Rash Spreads Right Breast
510403 - Right Breast Red Rash Spreads No Evidence Disease Right Axillary
510404 - Red Rash Right Breast Spreads No Evidence Cancer Right Axillary
510405 -
510406 - Follow up ref SDS A6 3D6K, ref SDS 97 3D6K.
510407 -
510408 - Background on patient history of testing for lymphadenopathy in the
510409 - right axilla is reported in the record on 060929. ref SDS 78 3D6K On
510410 - 061204 patient notified Kaiser that inflammation spread from the left
510411 - chest area infected with IBC across the sternum and slightly onto the
510412 - right breast. ref SDS 88 AE5I This was observed by the doctor during
510413 - examination on 061208. ref SDS 89 LG9I On 070105 the doctor reported
510414 - in the Medical Chart spread of IBC to the right breast. ref SDS 97
510415 - 925L
510417 - ..
510418 - There was no examination today for cancer in the right axilla. The
510419 - patient made no complaint of lumps or discomfort from swelling under
510420 - the right arm. This work aligns with CT test on 061227.
510422 - ..
510423 - Examination of the right breast shows no advance of IBC rash since the
510424 - meeting on 070105. ref SDS 97 925L
510426 - ..
510427 - CT test on 070131 shows no evidence lymphedema left axillar, reported
510428 - below. ref SDS 0 013T
510429 -
510430 -
510431 -
510432 -
5105 -
SUBJECTS
Left Supraclavicular Neck Lymphadenopathy Patient No Complaint Swell
5903 -
590401 - ..
590402 - Left Supraclavicular Examination PET Test Report Finding SUV 4.5
590403 - Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
590404 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
590405 -
590406 - Follow up ref SDS A6 8R6M, ref SDS 97 8R6M.
590407 -
590408 - Background of image testing, and consideration for radiation treatment
590409 - of left supraclavicular is reported on 060623. ref SDS 67 8R6M
590411 - ..
590412 - Like the left and right axillary locations, there was no examination
590413 - in left the supraclavicular region, per above. ref SDS 0 6Z4I The
590414 - patient made no complaint of lumps or discomfort from swelling under
590415 - the right arm. These results align with CT test on 070131, reported
590416 - in the record today, per below. ref SDS 0 013T
590417 -
590418 -
590419 -
590420 -
590421 -
590422 -
5905 -
SUBJECTS
Examination IBC Red Rash Left Breast Spreads to Left Arm Right Breas
6603 -
660401 - ..
660402 - Pockets of Resistance to Treatment of IBC Red Rash Left Breast
660403 - IBC Red Rash Left Breast Extends Slightly onto the Right Breast
660404 - Examination Left Breast IBC Inflammation Spreads to Right Breast
660405 - Measurable Disease IBC Inflammation Spreading to Right Breast
660406 -
660407 - Follow up ref SDS A6 025H, ref SDS 97 025H.
660408 -
660409 - Background on prior relapse examinations is listed on 060711.
660410 - ref SDS 68 8Y7O
660412 - ..
660413 - On 061204 Millie notified the doctor that IBC spread from the left
660414 - chest area to the right breast. ref SDS 88 I93X This was observed by
660415 - the doctor during examination on 061208. ref SDS 89 RU6J The rash
660416 - and CA 15-3 cancer marker have fluctuated shown by case study on
660417 - 070130. ref SDS A6 5N6L The primary care physician advised on 061227
660418 - that changes in clinical conditions and test data may represent
660419 - progression of metastatic disease (cancer). ref SDS 92 6P9F Patient
660420 - history on this issue was reviewed during examination at Kaiser on
660421 - 070105, ref SDS 97 555O At that time, the doctor found IBC worsening
660422 - on the left chest and expanding to the right breast, ref SDS 97 J44H,
660423 - leading to referral for changing treatment to cetuximab at UCSF on a
660424 - clinical study. ref SDS 97 PK7L
660426 - ..
660427 - On 070131 Millie notified Kaiser in a letter to the primary care
660428 - physician that IBC rash now seems less severe and intense on the left
660429 - breast area, but has spread toward the stomach area and is wrapping
660430 - toward the back. ref SDS A7 6K6V, citing examination at UCSF on
660431 - 070130. ref SDS A6 M68J
660433 - ..
660434 - Today, the doctor examined the IBC rash, and observed infection and
660435 - disease spreading since the last treatment at Kaiser on 061201.
660436 - ref SDS 85 0001 The doctor seemed less sure about intensity. Like
660437 - slight inflammation on the left arm, observed above, ref SDS 0 JP6F,
660438 - redness spreading out from the left breast area to the stomach and
660439 - toward the back could be IBC or cellulitis, discussed above.
660440 - ref SDS 0 JP6F This could explain rapid changes in rash intensity,
660441 - reported in a case study during the meeting at UCSF on 070130,
660442 - ref SDS A6 SE9O, which may be more common to cellulitis than to IBC.
660444 - ..
660445 - On 040419 biopsy distinguished IBC from cellulitis, and from reaction
660446 - to radiation treatment. ref SDS 28 789F
660448 - ..
660449 - Previously, cellulitis has been treated with antibiotics, most
660450 - recently prescribed on 061204. ref SDS 88 ZS5N
660452 - ..
660453 - Who will make analysis on treating cellulitis, how will a prescription
660454 - occur?
660456 - ..
660457 - The doctor's Progress Notes in the Medical Chart today describe "Chest
660458 - wall: increased erythema on lower left chest wall and now extending to
660459 - the right breast and around her back." ref SDS 0 ZL5W
660461 - ..
660462 - This record supports the doctor's efforts on 070105 to expedite
660463 - treatment of advancing disease so that cancer does not cascade out of
660464 - control. ref SDS 97 Y46N Expanding disease may reflect extended pause
660465 - in treatment from 061201 when chemotherapy with Taxotere and
660466 - capecitabine ended, ref SDS 85 0001, until 070201 when treatment with
660467 - cetuximab was started. ref SDS A8 G68I There was a comparable
660468 - expansion of disease when treatment was ended on 041021 due to
660469 - pulmonary embolism, until treatment began on 050104. ref SDS 42 407N
660470 - Review on 060922 shows at that time in 2005, disease continued to
660471 - spread for several more months, until treatment was switched to
660472 - Taxotere and capecitabine. ref SDS 77 GG6H
660473 -
660474 -
660475 -
660476 -
660477 -
660478 -
660479 -
6605 -
SUBJECTS
Lung Cancer No Discussion Metastatic Disease Lymph Nodes Doctor's Pr
7003 -
700401 - ..
700402 - Lung Cancer Lymph Nodes Doctor's Progress Notes Medical Chart
700403 - Metastatic Cancer Lung Lymph Node Progress Notes Medical Chart
700404 -
700405 - Follow up ref SDS A6 G25K, ref SDS 97 G25K.
700406 -
700407 - The doctor's Progress Notes in the Medical Chart for 061208 present an
700408 - impression that Millie suffers lung cancer. This was repeated for the
700409 - meeting on 070105, ref SDS 97 G25K, and is further presented in
700410 - doctor's progress notes for today. ref SDS 0 1248
700412 - ..
700413 - On 070112 Millie's letter asks the doctor to explain references to
700414 - lung cancer in Medical Chart, since this has not been presented in
700415 - discussion during meetings over the past 5 years, nor by any other
700416 - communication from Kaiser. ref SDS A0 NM6G
700418 - ..
700419 - On 070117 primary care physician cited several CT tests over past few
700420 - years report pulmonary nodules involving the right lung, which are
700421 - smaller than 5 mm, and so do not appear in PET scan tests. ref SDS A2
700422 - TS8G This explanation of lung cancer seems vague. Case study on
700423 - patient history confirms that CT tests beginning in 2002 report
700424 - nodules in the lungs; none are identified as cancer, and none show
700425 - growth that support a determination of lung cancer. ref SDS A2 4Q46
700427 - ..
700428 - The doctor advised on 070105 that Millie may have suffered permanent
700429 - lung damage from pulmonary embolism, ref SDS 97 MA9K This seems like
700430 - a different issue from lung cancer.
700432 - ..
700433 - There was no discussion of lung cancer today, in the context of the
700434 - doctor's practice presented on 070105 to focus on treatment for breast
700435 - cancer. ref SDS 97 MA8O
700436 -
700437 -
700438 -
700439 -
700440 -
7005 -
SUBJECTS
Biopsy Clinical Study Cetuximab Drug Trial Research UCSF Decided Not
8203 -
820401 - ..
820402 - Treatment Options Expand Pool of Drugs Biopsy Test for Status Change
820403 - Biopsy to Determine Biology of IBC and Guide Choice of Treatment
820404 - Status Change Did Not Occur Retest Biopsy 040419 Treatment Options
820405 -
820406 - Follow up ref SDS A6 KT7J, ref SDS 97 KT7J.
820407 -
820408 - Biopsy was discussed on 060711 for patient work up to develop strategy
820409 - and treatment plan, ref SDS 68 KT7J, and later on 061020? ref SDS 82
820410 - KH6H Review on 061110 set objectives and rationale to assess IBC red
820411 - rash on the left breast. ref SDS 84 448F On 061208 biopsy was again
820412 - deferred for evaluating spread of disease to the right breast.
820413 - ref SDS 89 AX6G Patient history shows IBC was originally diagnosed
820414 - with a biopsy on 040419. ref SDS 28 789F On 060821 Doctor Benz
820415 - discussed during a 2nd opinion consultation doing a biopsy to verify
820416 - IBC recurrence. ref SDS 75 6Q6O This was confirmed in the doctor's
820417 - written opinion received on 060929. ref SDS 79 WY79
820419 - ..
820420 - Patient history using biopsy on 040419, ref SDS 28 1572, to diagnose
820421 - IBC on the left breast on 040517, ref SDS 29 6T5G, was not applied
820422 - today for evaluating new rash on the upper left arm, per above.
820423 - ref SDS 0 JP6F
820425 - ..
820426 - On 070116 consent documents for cetuximab carboplatin clinical study
820427 - drug trial call for biopsy of cancer tumor. ref SDS A1 5U7S
820428 - Additional tumor biopsies are also part of the, drug trial, but are
820429 - optional based on patient history. ref SDS A1 0348 During the meeting
820430 - on 070130 Millie consented to performing optional biopsies to support
820431 - the clinical study. ref SDS A6 M840
820433 - ..
820434 - On 070131 UCSF reported that Millie's treatment with Coumadin for
820435 - pulmonary embolism presented elevated risk of bleeding (hemoraging),
820436 - and so decided against performing the study biopsies. ref SDS A7 6E3J
820438 - ..
820439 - On 070201 Jackie, UCSF Clinical Research explains that biopsy results
820440 - for the study are not reported to the doctor for patient diagnosis and
820441 - treatment; therefore, even though Millie has experienced minimal
820442 - bleeding while on Coumadin the past few months, there is no benefit to
820443 - balance risk to the patient for performing biopsies that only support
820444 - research. ref SDS A8 IH6H
820446 - ..
820447 - Therefore, IBC relapse diagnosed on 060711, ref SDS 68 025H, has never
820448 - been verified by biopsy. The last biopsy on Millie was performed with
820449 - the surgery on 051021, and the pathology on 051027 reported finding no
820450 - evidence of disease. ref SDS 56 616P
820451 -
820452 -
820453 -
820454 -
820455 -
8205 -
SUBJECTS
CT Test 070131 Did Not Perform Pulmonary Embolism Evaluation Kaiser
8703 -
870401 - ..
870402 - CT Test 070131 Results Not Submitted Pending Evaluation PE Cor Pulmonale
870403 -
870404 - Follow up ref SDS A6 EY5O, ref SDS 97 EY5O.
870405 -
870406 - PET/CT test on 061227 received on 070102. ref SDS 96 9X6O Another CT
870407 - was performed on 070131 for baseline status to evaluate new treatment
870408 - with cetuximab on clinical study at UCSF. ref SDS A7 ZL9M Results of
870409 - that test are reported below. ref SDS 0 1Y8G
870411 - ..
870412 - The test on 061227 did not perform comparisons ordered by the doctor,
870413 - including to evaluate pulmonary embolism and enlarged right ventricle,
870414 - as shown in the record reviewing pathology on 070102. ref SDS 96 AK9H
870415 - UCSF coordinated with Kaiser on 070130 for the CT test on 070131 to
870416 - correct past omissions. ref SDS A6 M882
870418 - ..
870419 - The doctor explained today that the test the next day on 070131 at
870420 - Kaiser in Pleasanton did not test for pulmonary embolism and enlarged
870421 - right ventricle, as shown below, ref SDS 0 013T, because the equipment
870422 - was not designed for that task. The doctor further advised that
870423 - Kaiser's CT scan equipment at the Walunt Creek hospital can test for
870424 - pulmonary embolism.
870426 - ..
870427 - During the meeting at UCSF on 070130 Doctor Rugo carefully reviewed
870428 - Millie's symptoms of pulmonary embolism, and Cor Pulmonale, which
870429 - overlap side effects of treatment with cetuximab on clinical study.
870430 - ref SDS A6 MO7K
870432 - ..
870433 - Analysis at that time indicated risks diagnosing symptoms as side
870434 - effects of chemotherapy, which are uncomfortable, but not fatal, must
870435 - be distinguished from rising pulmonary embolism, which can quickly
870436 - escalate to a terminal event, reported on 060722. ref SDS 69 346F
870437 -
870438 - [On 070204 Kaiser and UCSF notified no initial side effects of 1st
870439 - treatment with cetuximab; energy has increased, Millie worked out
870440 - in the gym 2 days in a row, and for the first time in 6 months;
870441 - planning for CT test to evaluate pulmonary embolism. ref SDS B0
870442 - JJ7O
870444 - ..
870445 - Recognizing pulmonary embolism can be managed with "thin slice"
870446 - spiral CT tests specified to evaluate this disease, as performed on...
870447 -
870448 - 041103 reviewed on 041104.................. ref SDS 38 QP6S
870449 - 041217 reviewed on 041230.................. ref SDS 41 PW3K
870450 - 060930 reviewed on 061012.................. ref SDS 81 M36G
870452 - ..
870453 - On 061020 the doctor explained that pulmonary embolism requires a
870454 - special order from the doctor for equipment at the Kaiser Walnut Creek
870455 - location to be configured and applied to use thin slice spiral CT
870456 - testing for pulmonary embolism. ref SDS 82 S56G
870458 - ..
870459 - Today, the doctor requested 30 day notice from UCSF for the next CT
870460 - test required by the cetuximab clinical study. This will provide time
870461 - to schedule the "thin slice" spiral CT scan methods to generate 1 mm
870462 - scans for comparison with findings in similar scans from the test on
870463 - 060930 that diagnised recurrent pulmonary embolism, and, also,
870464 - enlarged right ventricle, as reported on 061012. ref SDS 81 294Q
870465 - Evaluating progression of disease compares current conditions with
870466 - findings in the test on 060930, similiar to Kaiser's CT test on 041217
870467 - that reported pulmonary embolism found in a prior test on 041103 was
870468 - no longer visualized, reported on 041230. ref SDS 41 PW3K
870469 -
870470 - [...below Medical Chart shows plan for thin slice CT test.
870471 - ref SDS 0 125V
870473 - ..
870474 - There is no record of previous tests for pulmonary embolism requiring
870475 - 30 day advance notice, per above. ref SDS 0 T85F
870476 -
870477 - [...see below on pulmonary embolism. ref SDS 0 CV5L
870478 -
870479 - [On 070204 Millie sent a letter notifying Kaiser and UCSF of
870480 - understandings to facilitate communications between Kaiser and
870481 - UCSF on scheduling the next CT test for the clinical study to
870482 - also perform a follow up test on pulmonary embolism and
870483 - enlarged right ventricle. ref SDS B0 4L5Q
870485 - ..
870486 - [On 070208 Jackie received notice on 070204 that Kaiser needs
870487 - about a 1 month notice to order the CT test that checks both
870488 - response to treatment for IBC under the clinical study, and,
870489 - also, for pulmonary embolism. ref SDS B1 PR5L
870491 - ..
870492 - [On 070301 Jackie reminded that Kaiser needs a months notice to
870493 - order the CT test for the next cycle in Millie's treatment, and
870494 - to include an order to evaluate pulmonary embolism. ref SDS C1
870495 - 5Z6L Brigid advised that UCSF relies on patients to coordinate
870496 - scheduling CT tests on referrals. ref SDS C1 CI9L
870498 - ..
870499 - [On 070307 doctor reminded to order CT test. ref SDS C4 9Z9N
870501 - ..
870502 - [On 070326 CT test performed; Millie understands Kaiser had
870503 - another problem carrying out the doctor's order for
870504 - comparison testing. ref SDS C5 2H8H
870506 - ..
870507 - [On 070329 CT test reports no comparison to evaluate pulmonary
870508 - embolism and enlarged right ventricle. ref SDS C6 0136
870510 - ..
870511 - [On 070330 primary care physician notes that Kaiser did not
870512 - perform spiral CT test to compare progression of disease for
870513 - pulmonary embolims and enlarged right ventricle (Cor Pulmonale
870514 - heart disorder). ref SDS C7 0136
870515 -
870516 -
870517 -
870518 -
870519 -
870520 -
870521 -
8706 -
SUBJECTS
Distant Metastasis No Findings Lymphadenopathy Cancer CT Test 070131
9103 -
910401 - ..
910402 - CT Scan Results for Test on 070131
910403 -
910404 - Millie received from Arlette via FAX the following report...
910405 -
910406 - Test History No Evidence Distant Metastasis
910407 - Distant Metastasis No Evidence 5 Years Imaging Tests
910408 -
910409 - Follow up ref SDS 96 1Y8G, ref SDS 81 1Y8G
910410 -
910411 - Type Date Received Source
910412 - CT 070131 reported on 070202........... ref SDS 0 1Y8G
910413 - PET/CT 061227 reported on 070102........... ref SDS 96 1Y8G
910414 - CT 060930 reported on 061012........... ref SDS 81 284J
910415 - MRI 060708 reported on 060711........... ref SDS 68 PT4K
910416 - Xray 060623 reported on 060711........... ref SDS 68 WJ6G
910417 - CT 060505 reported on 060523........... ref SDS 64 E355
910418 - PET 060414 reported on 060428........... ref SDS 61 WJ6G
910419 - PET 060120 reported on 060126........... ref SDS 59 WJ6G
910420 - PET/CT 051005 reported on 051007........... ref SDS 55 WJ6G
910421 - CT 050530 reported on 050610........... ref SDS 51 G75L
910422 - CT 050325 reported on 050422........... ref SDS 49 G75L
910423 - CT 041217 reported on 041230........... ref SDS 41 G75L
910424 - CT 041103 reported on 041104........... ref SDS 38 WV7H
910425 - CT 040921 reported on 041005........... ref SDS 37 NL4N
910426 - CT 040710 reported on 040811........... ref SDS 34 H85S
910427 - CT 040410 reported on 040416........... ref SDS 27 HX4K
910428 - CT 040307 reported on 040318........... ref SDS 26 LK5L
910429 - CT 031031 reported on 031205........... ref SDS 24 IG9K
910430 - CT 030626 reported on 030710........... ref SDS 22 AL6N
910431 - CT 030428 reported on 030508........... ref SDS 20 LK5L
910432 - PET 021218 reported on 030109........... ref SDS 18 LK5L
910433 - PET 020529 reported on 020603........... ref SDS 8 0001
910434 -
910436 - ..
910437 - Patient Personal Physician 71/F Radiology Report
910441 - ..
910442 - CT Scan Chest, Abdomen and Pelvis (Digital)
910445 - ..
910446 - Ordered 01/31/2007 1056 at WCR Outpatient
910447 - Performed in: PLS - Read By: Jun Wu, MD
910448 -
910449 - [On 070208 Millie requests report for CT test on 070131.
910450 - ref SDS A1 LX5O
910451 -
910452 - [On 070213 Millie submitted follow up request to get the
910453 - report for the CT test on 070131. ref SDS B3 SS6P
910455 - ..
910456 - The doctor submitted the report and it is entered in this record
910457 - for context, since Kaiser already had the report, but there was a
910458 - delay making distribution to the customer.
910459 -
910460 -
910461 -
910462 -
9105 -
SUBJECTS
CT Test 070131 History Identifies Breast Cancer Fails Present Contex
9903 -
990401 - ..
990402 - History Missing Context Pulmonary Embolism Enlarged Right Ventricle
990403 -
990404 -
990405 - Breast cancer. Follow-up
990407 - ..
990408 - Why isn't context of patient history on pulmonary embolism and
990409 - enlarged right ventricle part of "history" listed in the CT test along
990410 - with breast cancer?
990411 -
990412 - [On 070329 context on patient history was omitted from the
990413 - next CT test on 070326. ref SDS C6 5B6M
990415 - ..
990416 - On 070105 the primary care physician explained the importance of
990417 - context. ref SDS 97 MA8O Context was cited on 001019 as critical for
990418 - understanding to make sense of complexity. ref SDS 3 TF5H Context is
990419 - further presented in POIMS. ref OF 4 8555
990420 -
990421 -
990422 -
990423 -
9905 -
SUBJECTS
CT Test 070131 Failed Perform Context Management Missing Comparison
A203 -
A20401 - ..
A20402 - Comparison: 5/5/06 Missing Context Prior Related Tests
A20403 -
A20404 - Follow up ref SDS 96 AK9H, ref SDS 81 2935.
A20405 -
A20406 - Comparison is a critical dimension of context that complements patient
A20407 - history, reviewed above. ref SDS 0 0Z6O
A20409 - ..
A20410 - Comparing tests on 070131 only with a single prior test on 060505 is
A20411 - incomplete and misleading by omitting consideration of 4 other tests,
A20412 - reviewed previously on 070102, ref SDS 96 AK9H, and further omits
A20413 - comparison to evaluate progression of lung and heart disease diagnosed
A20414 - by the CT test on 060930, ref SDS 81 294Q, as discussed above.
A20415 - ref SDS 0 EY5O
A20416 -
A20417 - [On 070214 letter to primary care physician at Kaiser notes odd
A20418 - comparing current test with test 8 months agon, and not
A20419 - comparing with three subsequent tests. ref SDS B4 Q54G
A20421 - ..
A20422 - Comparison with the test on 060505 appears incomplete because the
A20423 - prior test reported findings of nodes in the right paratrachael,
A20424 - reviewed on 060523. ref SDS 64 4O8P The report today fails to resolve
A20425 - prior findings, perhaps because the scope was different...
A20426 -
A20427 - [On 070214 letter to primary care physician requests Kaiser
A20428 - to complete comparison in test on 060505. ref SDS B4 R65I
A20430 - ..
A20431 - Technique:
A20432 -
A20433 - Routine CT scan of chest, abdomen and pelvis with IV and p.o.
A20434 - contrast.
A20436 - ..
A20437 - Appears that the scope of the test today is different from the scope
A20438 - for the comparison test on 060505, which stated in part...
A20439 -
A20440 - Following administration of oral and intravenous contrast,
A20441 - 5 mm images were obtained through the chest, abdomen and
A20442 - pelvis. Following this, 5 mm images were obtained from the
A20443 - skull base to the vertex. Delayed imaging through the
A20444 - kidneys was obtained as well. ref SDS 64 4O60
A20445 -
A20446 -
A20447 -
A20448 -
A205 -
SUBJECTS
CT Test 070131 Findings No Cancer Lymphadenopathy No Evidence Metast
A403 -
A40401 - ..
A40402 - Cancer No Findings Lymphadenopathy No Evidence Metastatic Disease
A40403 -
A40404 - Follow up ref SDS 96 RG4J.
A40405 -
A40406 - Findings
A40407 -
A40408 - No significant interval change. Mild radiculopathy at the left
A40409 - apex, likely post radiation change. Small thyroid lesion is
A40410 - unchanged. Left mastectomy. No axillary, mediastinal or hilar
A40411 - lymphadenopathy. There are several tiny lung nodules
A40412 - unchanged. They include 2 mm nodule in the right upper lobe
A40413 - (image #22), 4 mm nodule in the right middle lobe (image #38),
A40414 - 2 mm nodule in the right middle lobe (image #38), and 3 mm
A40415 - nodule in the left lower lobe (image #51). No pleural
A40416 - effusion.
A40418 - ..
A40419 - Liver cyst unchanged. 2 mm hypervascular focus seen in the
A40420 - left lobe of the liver (image #62) in the early arterial phase
A40421 - which is not seen on the portal venous phase, probably
A40422 - perfusion anomaly. Old granulomatous disease in the spleen.
A40423 - Hiatal hernia. Pancreas, gallbladder, adrenals and kindneys
A40424 - are unremarkable. No retroperitoneal lymphadenopathy. Small
A40425 - bowell and large bowel are unremarkable. No ascites.
A40426 - Degenerative disease in the lumbar spine.
A40428 - ..
A40429 - Impression
A40430 -
A40431 - No significant interval change.
A40433 - ..
A40434 - See comments on "Comparison," and citing scope issues. ref SDS 0 0136
A40435 -
A40440 - ..
A40441 - DD: 02/02/2007 DT: 02/03/2007 SFD
A40442 -
A40443 -
A40444 -
A40445 -
A405 -
SUBJECTS
Emotional Trauma Increases Stress Pulse 87 Complex Medical Profile 3
A903 -
A90401 - ..
A90402 - Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
A90403 - Exercise Vigor Strength Engagement Ease Distress Living with Cancer
A90404 - Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
A90405 -
A90406 - Follow up ref SDS A6 Y642, ref SDS 97 Y642.
A90407 -
A90408 - Medical issues create an emotional roller coaster that increase
A90409 - patient stress and trauma listed in the record on 061020. ref SDS 82
A90410 - Y642
A90412 - ..
A90413 - Rising symptoms the past few weeks and delay starting treatment at
A90414 - UCSF, reported on 070130, ref SDS A6 4T5N, increased tension and
A90415 - emotional trauma, reported during the meeting on 070105, ref SDS 97
A90416 - Y642, shown by high blood pressure also reported on 070130.
A90417 - ref SDS A6 Y642 Now that treatment is underway, and symptoms seem
A90418 - improved, there is less anxiety.
A90420 - ..
A90421 - Differentiating symptoms between IBC, lymphedema, and complications of
A90422 - cellulitus, discussed above, ref SDS 0 YK8O, and differentiating
A90423 - symptoms of pulmonary embolism from side effects of cancer treatments,
A90424 - also, discussed above, ref SDS 0 TN7J, create doubt about treatment,
A90425 - effectiveness, and prognosis. Increased energy the past week in
A90426 - particular, brings significant relief from stress.
A90427 -
A90428 - [On 070204 Kaiser and UCSF notified no initial side effects of 1st
A90429 - treatment with cetuximab; energy has increased, Millie worked out
A90430 - in the gym 2 days in a row, and for the first time in 6 months;
A90431 - planning for CT test to evaluate pulmonary embolism. ref SDS B0
A90432 - JJ7O
A90434 - ..
A90435 - [On 070307 CA 15-3 36 dramatic improvement after concern that IBC
A90436 - 3rd relapse expanded during December and January, another emotional
A90437 - roller coaster. ref SDS C4 046S
A90438 -
A90439 -
A90440 -
A90441 -
A905 -
SUBJECTS
Strategy Treatment Plan IBC 3rd Relapse Referral UCSF Clinical Study
AD03 -
AD0401 - ..
AD0402 - Strategy Treatment Options Scenarios Planning Patient Work Up Deferred
AD0403 - Work Up Patient History Kaiser Summary Avoids Treatment Strategy Options
AD0404 - Tumor Board Review on Changing Treatment Expansion of Disease
AD0405 -
AD0406 - Follow up ref SDS A6 K36G, ref SDS 97 K36G.
AD0407 -
AD0408 - Background on requirements and resistance to planning and proactive
AD0409 - management in time for action to be effective is reported on 060825.
AD0410 - ref SDS 76 K36G
AD0412 - ..
AD0413 - Discussing "context" to avoid "irrelevant" issues illustrates forces
AD0414 - that drive crisis management and resist proactive medical practice to
AD0415 - prepare patient work up, including history, strategy, treatmennt
AD0416 - options, and work plan, reported on 070105. ref SDS 97 MA8O
AD0418 - ..
AD0419 - Review of strategy issues was reported on 061208, ref SDS 89 5Q5I,
AD0420 - including consideration of Tumor Board support to address slow
AD0421 - response to treatment, ref SDS 89 P69G, and erratic changes in CA 15-3
AD0422 - cancer marker, severity of IBC rash, and major changes in patient
AD0423 - profile, e.g., pulmonary embolism, enlarged right ventricle, lung
AD0424 - cancer, and permanent damage to lungs. ref SDS 89 ZZ9H
AD0426 - ..
AD0427 - On 061218 Millie's letter to Kaiser confirmed request for Tumor Board
AD0428 - with panel that has experience treating secondary IBC relapse, post
AD0429 - mastectomy surgery. ref SDS 90 OT5I On 061228 Millie submitted a
AD0430 - follow up letter to Kaiser on this issue. ref SDS 92 6L3F On 061228
AD0431 - the doctor submitted a copy of a letter sent to UCSF summarizing
AD0432 - patient history to qualify Millie for participation in a clinical drug
AD0433 - trial. The doctor advised that this summary provided a "5 year
AD0434 - review" of complex patient history in place of Tumor Board support for
AD0435 - analysis of diagnosis and treatment planning. ref SDS 93 086H
AD0437 - ..
AD0438 - There was no discussion today of Tumor Board review to develop
AD0439 - strategy with fresh eyes and diversity of experience and expertise
AD0440 - that complements analysis by primary care physician, also, cited on
AD0441 - 061228. ref SDS 93 NP8G
AD0443 - ..
AD0444 - On 070105, the doctor commented that his research on the clinical
AD0445 - study at UCSF for the drug trial on cetuximab and carboplatin offers a
AD0446 - better solution for Millie because these drugs are targeted to breast
AD0447 - cancer, rather than general chemotherapy that attacks all body cells
AD0448 - attempting to also attack cancer cells. ref SDS 97 VQ5K
AD0450 - ..
AD0451 - The doctor further noted today that Millie benefits from being
AD0452 - randomized yesterday to start treatment on the clinical study with
AD0453 - cetuximab, rather than carboplatin, because this provides another line
AD0454 - of treatment in the event disease progresses, also, discussed at UCSF
AD0455 - on 070130, ref SDS A6 PF3O, and again yesterday on 070201. ref SDS A8
AD0456 - XR3M
AD0458 - ..
AD0459 - [On 070329 strategy continues to add carboplatin if disease
AD0460 - progresses, ref SDS C6 1R9H, patient responding well to
AD0461 - cetuximab alone, ref SDS C6 M68J, after initial concern on
AD0462 - 070301 that IBC was cascading out of control. ref SDS C1 1T4O
AD0464 - ..
AD0465 - [On 070419 IBC subsiding; Millie fortunate responding to
AD0466 - treatment with cetuximab alone, clinical study changes protocol
AD0467 - eliminating this option because not enough patients getting
AD0468 - favorable response with cetuximab alone. ref SDS C8 Q665
AD0469 -
AD0470 -
AD0471 -
AD0472 -
AD0473 -
AD05 -
SUBJECTS
Treatment IBC 8th Cycle 3rd Relapse 1st Cycle 1st Treatment Chemothe
AH03 -
AH0401 - ..
AH0402 - Treatment 8th Cycle IBC 3rd Relapse 1st Cycle 1st Treatment Cetuximab
AH0403 - Randomized Cetuximab Clinical Trial 1st Cycle 1st Treatment UCSF
AH0404 - 8th Cycle IBC 3rd Relapse 1st Cycle 1st Treatment Cetuximab Erbitux
AH0405 - Cetuximab Erbitux Clinical Study Drug Trial UCSF 1st Cycle 1st Treatment
AH0406 -
AH0407 - Follow up ref SDS A6 PF3O, ref SDS 97 PF3O.
AH0408 -
AH0409 - Kaiser's effort beginning on 061208 to expedite referral for treatment
AH0410 - at UCSF, reported on 070130, ref SDS A6 4T5N, led to starting
AH0411 - treatment on 070201. ref SDS A8 0001 Examination today indicates that
AH0412 - IBC may have spread since the last treatment on 061201, ref SDS 85
AH0413 - 407N, to infect skin in stomach area, and wrapping toward the back.
AH0414 - ref SDS 0 368I Disease may also have begun spreading to upper left
AH0415 - arm. ref SDS 0 JP6F
AH0417 - ..
AH0418 - On 070201 Millie was randomized to start treatments on the clinical
AH0419 - study with only cetuximab. ref SDS A8 XR3M As noted, the doctor feels
AH0420 - this is the best strategy for treating Millie by providing another
AH0421 - level of treatment, per above. ref SDS 0 QO6O
AH0422 -
AH0423 - [...doctor progress notes in the medical chart describe
AH0424 - cetuximab as Erbitux. ref SDS 0 125V
AH0426 - ..
AH0427 - Weekly treatments with cetuximab are now scheduled for Thursdays at
AH0428 - 0800.
AH0429 -
AH0430 -
AH0431 -
AH0432 -
AH0433 -
AH0434 -
AH05 -
SUBJECTS
Cetuximab UCSF Clinical Study Treatment Drug Trial Starts 070201 Mil
AN03 -
AN0401 - ..
AN0402 - Cetuximab UCSF Clinical Study Treatment Begins 070201
AN0403 - UCSF Clinical Study Treatment Cetuximab Drug Trial Begins 070201
AN0404 - Drug Trials UCSF Has Other Clinical Study Treatments May Help Millie
AN0405 -
AN0406 - Follow up ref SDS A6 ZJ9N, ref SDS 97 P256.
AN0407 -
AN0408 - Background on Kaiser referral to UCSF for treatment on clincial study
AN0409 - is reported on 070105. ref SDS 97 P256
AN0411 - ..
AN0412 - Purpose of referral was presented at that time on 070105 for improving
AN0413 - care with new treatment. ref SDS 97 PK7L
AN0415 - ..
AN0416 - On 070105 Kaiser considered contacting UCSF about expediting treatment
AN0417 - for expanding disease. ref SDS 97 Y47J
AN0419 - ..
AN0420 - Case study on Kaiser and UCSF collaborating to expedite treatment in
AN0421 - the clincial study drug trial is listed in the record meeting with
AN0422 - UCSF on 070130. ref SDS A6 4T5N
AN0424 - ..
AN0425 - On 070130 Millie met with Doctor Rugo at UCSF to plan starting
AN0426 - treatment. ref SDS A6 0001
AN0428 - ..
AN0429 - Doctor Rugo advised during the meeting on 070130 that UCSF has other
AN0430 - drug trials for treating Millie, ref SDS A6 LD64, which supplements
AN0431 - prior notice by Doctor Benz, reviewed with Kaiser on 061208.
AN0432 - ref SDS 89 P256
AN0434 - ..
AN0435 - On 070201 Millie was randomized to get only Cetuximab, ref SDS A8
AN0436 - XR3M, and started treatment. ref SDS A8 G68I Analysis of starting
AN0437 - treatment with only cetuximab indicates this gives Millie another
AN0438 - level of treatment if disease progresses, per above. ref SDS 0 QO6O
AN0439 -
AN0440 -
AN0441 -
AN0442 -
AN0443 -
AN05 -
SUBJECTS
Schedule Weekly Treatment Cetuximab 070201 Start Clinical Study Drug
AR03 -
AR0401 - ..
AR0402 - Schedule Treatment Pending Start Clinical Study Cetuximab at UCSF
AR0403 - Chemotherapy Holiday Treatment Delayed Pending Start Drug Trial at UCSF
AR0404 -
AR0405 - Follow up ref SDS A6 N96O, ref SDS 97 N96O.
AR0406 -
AR0407 - As noted, weekly treatments with cetuximab at UCSF are now scheduled
AR0408 - for Thursdays at 0800. Cycles occur every 4 weeks, however, since
AR0409 - Millie is not treated with carboplatin, the only effect of study
AR0410 - cycles is for scheduling CT evaluation tests. Millie also meets with
AR0411 - Doctor Rugo to start each new cycle. Interim examinations to start
AR0412 - weekly treatments is performed by Brigid, nurse practitioner with
AR0413 - Jackie, Clinical Study Coordinator assisting.
AR0415 - ..
AR0416 - During the meeting today, the doctor scheduled the next meeting in
AR0417 - eight (8) weeks on 070330 1540 to assess treatment at UCSF for IBC
AR0418 - with a clinical study, as reported above. ref SDS 0 LX4I
AR0420 - ..
AR0421 - The doctor further requested 1 month (30 days) notice to schedule the
AR0422 - next clinical study CT test so that Kaiser can order the type of test
AR0423 - that also evaluates pulmonary embolism and enlarged right ventricle,
AR0424 - per planning above. ref SDS 0 T85K
AR0425 -
AR0426 -
AR0427 -
AR0428 -
AR0429 -
AR0430 -
AR05 -
SUBJECTS
Pulmonary Emboli Blood Clots Lungs Enlarged Right Ventricle Heart Di
AW03 -
AW0401 - ..
AW0402 - Energy Recovering May Signal Pulmonary Embolism Recovery
AW0403 - Pulmonary Emboli CT Test Schedule Next Evaluation Clinical Study
AW0404 - Immune System Cancer Recovery Exercise Prevented Permanent Lung Damage
AW0405 -
AW0406 - Follow up ref SDS A6 CV5L, ref SDS 97 CV5L.
AW0407 -
AW0408 - Background on pulmonary embolism is reported in the record meeting at
AW0409 - Kaiser on 070105. ref SDS 97 CV5L At that time, the doctor diagnosed
AW0410 - possible permanent lung damage that reduces capacity to exercise,
AW0411 - which affects immune system resisting cancer and enables patients to
AW0412 - get aggressive treatment. ref SDS 97 WR4J Review a few days ago in
AW0413 - the record meeting at UCSF on 070130 presents continuing symptoms,
AW0414 - ref SDS A6 CV5L, and determination to perform CT test to distinguish
AW0415 - symptoms of pulmonary embolism from side effects of chemotherapy.
AW0416 - ref SDS A6 RT6I
AW0418 - ..
AW0419 - Recently, patient energy has increased, possibly signaling recovery
AW0420 - from pulmonary embolism, and enlarged right ventricle diagnosed in the
AW0421 - CT test on 060920, reported on 061012. ref SDS 81 294Q
AW0422 -
AW0423 - [On 070204 Kaiser and UCSF notified no initial side effects of 1st
AW0424 - treatment with cetuximab; energy has increased, Millie worked out
AW0425 - in the gym 2 days in a row, and for the first time in 6 months;
AW0426 - planning for CT test to evaluate pulmonary embolism. ref SDS B0
AW0427 - JJ7O
AW0429 - ..
AW0430 - [On 070218 Millie experienced further increase in energy, playing
AW0431 - tennis for several days, and for the first time in 5 years.
AW0432 - ref SDS B8 N05H
AW0434 - ..
AW0435 - Delays performing a CT test to evaluate recovery from pulmonary
AW0436 - embolism and enlarged right ventricle are reported above. ref SDS 0
AW0437 - EY5O Purpose for test is getting a report like the test on 041217,
AW0438 - which reported no pulmonary embolism visualized, received on 041230.
AW0439 - ref SDS 41 PW3K
AW0441 - ..
AW0442 - Today, the doctor planned to include with the order for the next CT
AW0443 - test to evaluate treatment with the cetuximab clinical trial, another
AW0444 - request for the test to, also, evaluate pulmonary embolism and
AW0445 - enlarged right ventricle for the purpose of distinguishing symptoms of
AW0446 - pulmonary embolism from side effects from chemotherapy treatment with
AW0447 - Cetuximab, as discussed with Doctor Rugo at UCSF on 070130.
AW0448 - ref SDS A6 R16N
AW0450 - ..
AW0451 - The doctor further requested today 30 days notice on when the test
AW0452 - should be scheduled, so that the Kaiser Imaging Department can
AW0453 - schedule the spiral "thin slice" CT test equipment needed to test for
AW0454 - both cancer and pulmonary embolism, also, noted above. ref SDS 0 T85F
AW0455 -
AW0456 - [...below Medical Chart shows plan for thin slice CT test.
AW0457 - ref SDS 0 125V
AW0459 - ..
AW0460 - [On 070204 Millie sent a letter notifying Kaiser and UCSF of
AW0461 - understandings to facilitate communications between Kaiser and
AW0462 - UCSF on scheduling the next CT test for the clinical study to also
AW0463 - perform a follow up test on pulmonary embolism and enlarged right
AW0464 - ventricle. ref SDS B0 4L5Q
AW0466 - ..
AW0467 - [On 070208 UCSF received notice that Kaiser needs about a 1
AW0468 - month notice to order the CT test that checks both response
AW0469 - to treatment for IBC under the clinical study, and, also,
AW0470 - for pulmonary embolism. ref SDS B1 PR5L
AW0472 - ..
AW0473 - [On 070301 Jackie discussed Kaiser requirements for 1 month
AW0474 - notice to order a CT test to evaluate patient progress on
AW0475 - the clinical study, and that this would allow time to
AW0476 - specify that the test also evaluate pulmonary embolism,
AW0477 - ref SDS C1 5Z6L; the doctor advised the next test for the
AW0478 - study will be needed to start the 3rd cycle of treatment on
AW0479 - 070329; Brigid prepared a radiology request to get the CT
AW0480 - test before 070328, and asked the patient to coordinate
AW0481 - communications with Kaiser rather than rely on medical
AW0482 - professionals. ref SDS C1 UR9J
AW0484 - ..
AW0485 - [On 070302 Millie submitted a letter to Kaiser presenting
AW0486 - results of the meeting today, and conveying UCSF request
AW0487 - for CT test before 070328, and specifying testing for
AW0488 - pulmonary embolism. ref SDS C2 EZ6T
AW0490 - ..
AW0491 - [On 070306 follow up letter to Kaiser reminding to order CT
AW0492 - test in time for starting next cycle on 070329, and to
AW0493 - order test for pulmonary embolism. ref SDS C3 HS3X
AW0495 - ..
AW0496 - [On 070307 doctor reminded to order CT test for pulmonary embolism
AW0497 - and enlarged right ventricle. ref SDS C4 9Z9N
AW0499 - ..
AW0500 - [On 070329 CT test report did not include comparisons with prior
AW0501 - findings of pulmonary embolism and enlarged right ventricle,
AW0502 - ref SDS C6 0136, and reported no findings to update the prior test
AW0503 - report. ref SDS C6 B74K
AW0504 -
AW0505 -
AW0506 -
AW06 -
SUBJECTS
Examination Stethoscope No Findings Enlarged Right Ventricle Heart S
B303 -
B30401 - ..
B30402 - Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
B30403 -
B30404 - Follow up ref SDS A6 Q35O, ref SDS 97 Q35O.
B30405 -
B30406 - The doctor examined Millie with a stethoscope again today. This
B30407 - included multiple locations on her her back, and on her chest. He
B30408 - reported no evidence of cardio pulmonary issues. The doctor's
B30409 - Progress Notes in the Medical Chart Lung: Clear to A & P. ref SDS 0
B30410 - ZL5W
B30412 - ..
B30413 - There again was no report on Sa02 today. The test on 061208 was 99%,
B30414 - ref SDS 89 KB5L, indicating Millie was not suffering at that time from
B30415 - loss of cardio-pulmonary functioning due to pulmonary embolism,
B30416 - including enlarged right ventricle.
B30417 -
B30418 -
B30419 -
B30420 -
B30421 -
B305 -
SUBJECTS
Enlarged Right Ventricle Heart Disorder Cor Pulmonale CT Test Schedu
BB03 -
BB0401 - ..
BB0402 - Cor Pulmonale Heart Disorder Enlarged Right Ventricle
BB0403 - Heart Examination Not Ordered Investigate Enlarged Right Ventricle
BB0404 - Enlarged Right Ventricle CT Test Aligns Patient Symptoms How Serious
BB0405 -
BB0406 - Follow up ref SDS A6 VJ4J, ref SDS 97 VJ4J.
BB0407 -
BB0408 - Background on 070105 presents request for referral to heart specialist
BB0409 - to review the record on heart disorder Cor Pulmonale enlarged right
BB0410 - ventricle. ref SDS 97 HZ39 The doctor's plan to order a spiral CT
BB0411 - test to evaluate pulmonary embolism, will also test for severity or
BB0412 - resolution of enlarged right ventricle, per above. ref SDS 0 P45O
BB0414 - ..
BB0415 - During the meeting at UCSF a few days ago on 070130 Doctor Rugo
BB0416 - carefully reviewed patient history to assess correlations of symptoms
BB0417 - from enlarged right ventricle, with side effects for cetuximab
BB0418 - treatment. At that time, the doctor seemed to recommend examination
BB0419 - by a heart specialist, and a treadmill test to verify patient profile
BB0420 - that avoids errors in diagnosis and timely treatment for Cor
BB0421 - Pulmonale. ref SDS A6 RV3O
BB0423 - ..
BB0424 - Today, the doctor did not report receiving recommendations from UCSF
BB0425 - on this issue.
BB0427 - ..
BB0428 - Increased energy may signal recovery noted above. ref SDS 0 NI6L
BB0429 -
BB0430 - [On 070204 Kaiser and UCSF notified no initial side effects of 1st
BB0431 - treatment with cetuximab; energy has increased, Millie worked out
BB0432 - in the gym 2 days in a row, and for the first time in 6 months;
BB0433 - planning for CT test to evaluate pulmonary embolism. ref SDS B0
BB0434 - JJ7O
BB0436 - ..
BB0437 - [On 070218 Millie experienced further increase in energy, playing
BB0438 - tennis for several days, and for the first time in 5 years.
BB0439 - ref SDS B8 N05H
BB0440 -
BB0441 -
BB0442 -
BB0443 -
BB0444 -
BB05 -
SUBJECTS
Work Plan Doctor Submits Doctor/Patient Partnership Communications I
C203 -
C20401 - ..
C20402 - Work Plan Received Communications Doctor/Patient Partnership
C20403 - Communications Doctor Submits Work Plan Doctor/Patient Partnership
C20404 - Doctor/Patient Partnership Communications Doctor Submits Work Plan
C20405 -
C20406 - Follow up ref SDS A6 FE4I, ref SDS 97 FE4I.
C20412 - ..
C20413 - Issues from Kaiser's Progress Notes continue from prior review on
C20414 - 061110, ref SDS 84 EN4K, and listed again on 061208. ref SDS 89 EN4K
C20416 - ..
C20417 - New issues inclued...
C20418 -
C20419 - 1. Current medications do not show cetuximab begun on 070201,
C20420 - ref SDS 0 SE86, and cited in plan section. ref SDS 0 125V
C20421 -
C20422 - 2. New rash observed by doctor on upper left arm not cited in
C20423 - examination. ref SDS 0 ZL5W
C20425 - ..
C20426 - Progress continues toward good management using the doctor patient
C20427 - partnership for timely review of patient history, called out in
C20428 - Kaiser's Healthwise Handbook, reviewed on 990625, ref SDS 1 TD5S, and
C20429 - reported on 060106. ref SDS 58 FE4I
C20430 -
C20431 - 1. 2/2/2007 2:39 PM
C20432 -
C20433 - Wcr-ONnc2 > Main Campus
C20436 - ..
C20437 - 2. Your primary care clinician is listed as...
C20438 -
C20440 -
C20730 -
C20731 -
C20732 -
C20733 -
C20734 -
C20735 -
C20736 -
C208 -