CONTACTS 

SUBJECTS
Cellulitis Treatment Antibiotic Keflex Millie Begins Taking Medicati

1703 -
1703 -    ..
1704 - Summary/Objective
1705 -
170501 - Follow up ref SDS 39 0000.
170502 -
170503 -
170504 -
170505 -
170507 -  ..
1706 -
1707 -
1708 - Progress
1709 -
170901 - About noon today, Millie played tennis again for the second day in a
170902 - row.  This is the first time Mil has played tennis in about 10 years.
170903 - Millie went to exercise class this morning, following up exercise
170904 - class for two days a week ago. ref SDS 39 HF5H
170905 -
170906 -     [On 070222 Brigid investigated effects of tennis on lymphedema and
170907 -     cellulitis in left arm, and determined that playing right handed
170908 -     makes this a manageable risk for restoring fitness to strengthen
170909 -     the immune system. ref SDS 41 457F
170911 -  ..
170912 - Former shortness of breath and continual weakness seems less, and
170913 - energy seems higher.  May signal side effects of chemotherapy with
170914 - Taxotere and capecitabine (Xeloda) that ended on 061201, ref SDS 32
170915 - 0001, have brought greater vigor that enables exercise to regain
170916 - fitness, cited by the doctor on 050729, ref SDS 19 XX7G, and which in
170917 - turn strengthens the immune system that helps resist cancer, and side
170918 - effects of chemotherapy, discussed by the doctor on 030606.
170919 - ref SDS 3 JP7G
170921 -  ..
170922 - Today, Millie wore a watch that, also, monitors her heart beat.  While
170923 - playing and chasing balls, the monitor sounded several alerts that
170924 - Millie's pulse exceeded 138.  The high was about 164, which startled
170925 - Millie.
170927 -  ..
170928 - We hit balls for about 45 minutes, and did not play a match.
170930 -  ..
170931 - Millie commented that tennis today seemed significantly more
170932 - strenuous than aerobics class at the gym.  Her face was flushed, and
170933 - she breathed heavily.
170935 -  ..
170936 - During a meeting at Kaiser on 070105, Millie asked about referral to a
170937 - heart specialist for review of CT test on 060930 that reported
170938 - findings of enlarged right ventricle. ref SDS 36 CV5L  Research on
170939 - 061012 described a heart disorder Cor Pulmonale. ref SDS 29 IM5J
170940 - Millie therefore asked for clearance on 070105 to resume exercising in
170941 - order to restore fitness that strengthens the immune system.
170942 - ref SDS 36 MA9K  At that time, the doctor said Millie can resume
170943 - working out, and to be careful. ref SDS 36 G35K
170945 -  ..
170946 - After playing tennis, Millie noticed her left arm still seems swollen
170947 - and slightly inflammed, cited by the primary care physician during
170948 - examination on 070202. ref SDS 38 JP6F
170949 -
170950 -        [On 070222 Brigid verified that Millie plays tennis right
170951 -        handed; which avoids trauma to left arm that is sensitive to
170952 -        activity resulting in complications of cellulitis from
170953 -        lymphedema. ref SDS 41 IS5K
170955 -  ..
170956 - Therefore, Millie began taking Keflix pills for cellulitis, which she
170957 - picked up from the Kaiser Pharmacy, reported in her letter to Kaiser
170958 - on 070217. ref SDS 40 9C6J
170959 -
170960 -        [On 070222 examination at UCSF indicates rash on upper left arm
170961 -        likely expanding IBC. ref SDS 41 B64F
170963 -         ..
170964 -        [On 070330 Cellulitis diagnosed during meeting at Kaiser,
170965 -        ref SDS 43 7C7F, but subsided quickly, and so no medication was
170966 -        taken. ref SDS 43 N75M
170968 -         ..
170969 -        [On 070607 recurrent cellulitis diagnosed during examination at
170970 -        UCSF for treatment of IBC with cetuximab, ref SDS 45 8H3I;
170971 -        condition worsened during treatment in the Infusion Clinic,
170972 -        temperature over 102, ref SDS 45 8J37; UCSF treated Millie with
170973 -        ceftriaxone antibiotics, ref SDS 45 8J9R, cellulitis seemed to
170974 -        subside, and temperature dropped to 101.4, UCSF released Millie
170975 -        to go home, ref SDS 45 8J5C; Kaiser prescribed outpatient
170976 -        ceftriaxone antibiotics for 5 days. ref SDS 45 8L46
170977 -
170978 -
170979 -
1710 -

SUBJECTS
Case Study Exercise Strengthens Immune System Resists Cancer Increas

2803 -
280401 -  ..
280402 -  ..
280403 - Case Study Exercise Strengthens Immune System Risks Heart Disorder
280404 -
280405 - Follow up ref SDS 35 JU9L.
280406 -
280407 - On 070105 Millie asked about referral for meeting with heart
280408 - specialist to get clearance to resume exercise.  This presents an
280409 - issue to balance fitness to strengthen immune system that helps resist
280410 - cancer, and accomodate aggressive chemotherapy treatment, against
280411 - risks of heart disorder that may cause an immediate terminal event.
280412 -
280413 -    1.  Millie had a left breast lumpectomy and
280414 -        lymph node removal left axilla on 020312,
280415 -        ref SDS 1 0001, with reexcision on 020329,
280416 -        ref SDS 2 0001, she she then had 2 treatments
280417 -        with AC and was switched to Taxotere for
280418 -        6 treatments, ending in December 2002.
280419 -        She had no treatment during 2003; cancer
280420 -        marker continued to rise in 2003 and lumps
280421 -        under left axilla raised concerns.  Millie
280422 -        met every few months with the doctor during
280423 -        2003, and asked about resuming treatment.
280425 -         ..
280426 -    2.  Exercise for fitness important for
280427 -        maintaining immune system that resists
280428 -        cancer and side effects of chemotherapy
280429 -        which can prevent treatment of
280430 -        cancer................................ 030606, ref SDS 3 JP7G
280432 -         ..
280433 -    3.  Chemotherapy side effects of fatigue,
280434 -        weakness, reduction of immune system,
280435 -        feeling lousy that reduce exercise
280436 -        causing loss of fitness that further
280437 -        weakens immune system, and causes
280438 -        shortness of breath, heavy
280439 -        chest................................. 030606, ref SDS 3 O44J
280441 -         ..
280442 -    4.  Millie has fitness level of a 50 year
280443 -        old and so can accomodate aggressive
280444 -        chemotherapy treatment................ 030606, ref SDS 3 NE57
280446 -         ..
280447 -    5.  Doctor cites Millie's fitness aids
280448 -        treatment prospects................... 030710, ref SDS 4 FZ4N
280450 -         ..
280451 -    6.  Patient's habits of regular exercise
280452 -        and diet maintain health and fitness
280453 -        help avoid advance of
280454 -        disease............................... 031205, ref SDS 5 GW8F
280456 -         ..
280457 -    7.  Treatment begins cancer recurrence
280458 -        diagnosed IBC; patient placed in drug
280459 -        trial Taxol and bevacizumab
280460 -        (Avastin)............................. 040420, ref SDS 6 W55O
280462 -         ..
280463 -    8.  Fatigue, shortness of breath, heavy
280464 -        chest, cough side effects chemotherapy
280465 -        clinical study Taxol bevacizumab
280466 -        (Avastin) drug
280467 -        trial................................. 040517, ref SDS 7 RZ4I
280469 -         ..
280470 -    9.  Fatigue, shortness of breath, heavy
280471 -        chest, chronic cough side effects
280472 -        increase, cough medicine
280473 -        prescribed............................ 040614, ref SDS 8 RZ4I
280475 -         ..
280476 -   10.  Patient's good health, strength, lifestyle
280477 -        of exercise help recover from cancer
280478 -        treatments giving doctor flexibility
280479 -        allowing chemotherpay when blood
280480 -        counts do not meet standing
280481 -        guidelines............................ 040614, ref SDS 8 6T7F
280483 -         ..
280484 -   11.  Fatigue, shortness of breath, heavy
280485 -        chest, chronic cough increase; Genentec,
280486 -        manufacturer of Avastin makes public
280487 -        announcement increased risk for pulminary
280488 -        embolism (blood clots); Millie reports
280489 -        family history of blood clot issues,
280490 -        and asks about rising symptoms of
280491 -        coughing, difficult breathing, heaviness
280492 -        in chest; doctor advises increased risk
280493 -        on Avastin trial related to personal
280494 -        history of blood clots, rather than
280495 -        family history; no change in treatment
280496 -        prescribed............................ 040812, ref SDS 10 RZ4I
280498 -         ..
280499 -   12.  Fatigue, shortness of breath, heavy
280500 -        chest increase; cough medicine redeuces
280501 -        sore throat from chronic cough; doctor
280502 -        advises CT tests do not show cause
280503 -        of problems........................... 040909, ref SDS 11 RZ4I
280505 -         ..
280506 -   13.  2nd opinion on rising fatigue, shortness
280507 -        of breath, heavy chest, chronic cough
280508 -        Doctor Benz at UCSF suggests Kaiser
280509 -        investigate lung
280510 -        cancer................................ 041018, ref SDS 12 LX96
280512 -         ..
280513 -   14.  Fatigue, shortness of breath, heavy
280514 -        chest increase; pulmonary embolism side
280515 -        effect bevacizumab (Avastin) diagnosed
280516 -        CT test; Millie removed clinical study
280517 -        Taxol and bevacizumab (Avastin); begins
280518 -        treatment for pulmonary
280519 -        embolims with Coumadin
280520 -        (warfarin)............................ 041104, ref SDS 13 RZ4I
280522 -         ..
280523 -   15.  Energy restored, cough ends after ending
280524 -        treatment with bevacizumab (Avastin), and
280525 -        getting treatment for pulmonary embolism
280526 -        CT test reports no visualization
280527 -        of former pulmonary embolism after
280528 -        treatment with Coumadin
280529 -        (warfarin)............................ 041230, ref SDS 14 RZ4I
280531 -         ..
280532 -   16.  Chemotherapy begins AC................ 050104, ref SDS 15 0001
280534 -         ..
280535 -   17.  Chemotherapy switched to Taxotere
280536 -        and capecitabine
280537 -        (Xeloda).............................. 050415, ref SDS 16 407N
280539 -         ..
280540 -   18.  Chemotherapy side effects difficult to
280541 -        tolerate, patient would rather be dead
280542 -        than continue; dose
280543 -        reduced............................... 050516, ref SDS 17 AQ6G
280545 -         ..
280546 -   19.  Article reports study found exercise
280547 -        repairs some of the cumulative damage
280548 -        chemotherapy causes to the immune
280549 -        system; this prolongs effectiveness of
280550 -        chemotherapy treatment to aid
280551 -        recovery from breast
280552 -        cancer................................ 050609, ref SDS 18 F88M
280554 -         ..
280555 -   20.  Quality of life from strength and range
280556 -        of motion are obvious benefits of
280557 -        exercise.............................. 050609, ref SDS 18 F93X
280559 -         ..
280560 -   21.  Side effects escalate, very difficult
280561 -        to tolerate even with 25% reduced dose,
280562 -        doctor maintains strength of capecitabine
280563 -        (Xeldoa) for two (2) more treatments
280564 -        to guard against another
280565 -        relapse............................... 050729, ref SDS 19 VP4N
280567 -         ..
280568 -   22.  Fatigue, weakness, shortness of
280569 -        breath, heavy chest, cough symptoms
280570 -        of pulmonary embolism, attributed
280571 -        to loss of fitness from low energy
280572 -        caused by chemotherapy
280573 -        treatments............................ 050729, ref SDS 19 JP9J
280575 -         ..
280576 -   23.  Chemotherapy Taxotere capecitabine
280577 -        (Xeloda) treatment ends prior to
280578 -        mastectomy surgery.................... 050916, ref SDS 20 407N
280580 -         ..
280581 -   24.  Coumadin treatment for pulmonary
280582 -        embolism ended........................ 051007, ref SDS 21 RZ4I
280584 -         ..
280585 -   25.  Mastectomy surgery.................... 051021, ref SDS 22 0001
280587 -         ..
280588 -   26.  Lymphedema diagnosed.................. 060106, ref SDS 23 MW8J
280590 -         ..
280591 -   27.  Rising energy after ending chemotherapy
280592 -        enabled vigorous exercise to restore
280593 -        fitness that strengthens immune system
280594 -        to resist cancer recurrence, caused
280595 -        lymphedema in left arm to increase
280596 -        significantly......................... 060320, ref SDS 24 X95Y
280598 -         ..
280599 -   28.  Lessons learned exercise to increase
280600 -        fitness and strengthen immune system
280601 -        to resist cancer, conflicts with
280602 -        mastectomy to reduce risks of cancer
280603 -        recurrence because very wide
280604 -        breast surgery increases
280605 -        lymphedema............................ 060428, ref SDS 25 M89K
280607 -         ..
280608 -   29.  IBC recurrence diagnosed, patient
280609 -        begins treatment with Taxotere and
280610 -        capecitabine (Xeloda)................. 060721, ref SDS 26 0001
280612 -         ..
280613 -   30.  Millie increasing fatigue, low energy,
280614 -        shortness of breath, falls at
280615 -        BART station.......................... 060914, ref SDS 27 ZQ5I
280617 -         ..
280618 -   31.  Kaiser orders CT test for pulmonary
280619 -        embolism; test on 060930 discovers
280620 -        pulmonary embolism recurrence;
280621 -        patient resumes
280622 -        treatment............................. 061002, ref SDS 28 MI5I
280624 -         ..
280625 -   32.  Enlarged right ventricle heart disorder
280626 -        Cor Pulmonale reported in pathology
280627 -        findings for CT test on
280628 -        060930................................ 061012, ref SDS 29 7E5L
280630 -         ..
280631 -   33.  Millie asks when she can return to gym
280632 -        to resume exercise in order to regain
280633 -        fitness to resist
280634 -        cancer................................ 061020, ref SDS 30 VJ4J
280636 -         ..
280637 -   34.  Pulmonary embolism symptoms increase
280638 -        fatigue, shortness of breath weakness,
280639 -        Kaiser prescribes procrit
280640 -        for anemia............................ 061110, ref SDS 31 CV5L,
280642 -         ..
280643 -   35.  Patient ends treatment with Taxotere
280644 -        and capecitabine; planning to start
280645 -        new treatment......................... 061201, ref SDS 32 0001
280647 -         ..
280648 -   36.  Case study Cellulitis and lymphedema
280649 -        indicates risks increase with exercise
280650 -        after surgery removes lymph
280651 -        nodes................................. 061203, ref SDS 33 YT4M
280653 -         ..
280654 -   37.  Doctor orders CT test to compare with
280655 -        test on 060930 to evaluate whether
280656 -        pulmoanry embolism no longer visualized
280657 -        as reported on prior diagnosis,
280658 -        reported on 041230.................... 061208, ref SDS 34 Q93H
280660 -         ..
280661 -   38.  Case study Millie requests examination
280662 -        heart specialist for heart disorder
280663 -        Cor Pulmonale......................... 061228, ref SDS 35 JU9L
280665 -         ..
280666 -   39.  CT test failed to make comparison
280667 -        says nothing about pulmonary embolism;
280668 -        doctor advises Millie may have
280669 -        permanent lung
280670 -        damage................................ 070105, ref SDS 36 XX8H
280672 -         ..
280673 -   40.  Doctor advised Millie can resume
280674 -        exercise and to be
280675 -        careful............................... 070105, ref SDS 36 G35K
280677 -         ..
280678 -   41.  Cellulitis and lymphedema case study
280679 -        traces all causation in Millie's
280680 -        patient history....................... 070130, ref SDS 37 VX6F
280682 -         ..
280683 -   42.  Millie exercising in the gym twice
280684 -        on consecutive days, 1st time in 6
280685 -        months; and following treatment with
280686 -        cetuximab on clinical study at
280687 -        UCSF on 070201........................ 070204, ref SDS 39 JJ7O
280689 -         ..
280690 -   43.  Energy increases, shortness of breath,
280691 -        fatigue, weakness subside 10 weeks
280692 -        after ending treatment for 3rd relapse
280693 -        of IBC with Taxotere and cacecitabine;
280694 -        Millie is exercising in the gym again,
280695 -        playing tennis 2 days 1st time in
280696 -        many years, her pulse
280697 -        reached 144........................... 070218, ref SDS 0 N05H
280699 -         ..
280700 -   44.  Healthy medical team at UCSF comments
280701 -        how well, fit, and strong Millie looks
280702 -        after 2 cycles treatment with cetuximab,
280703 -        and higher energy enabling
280704 -        regular exercise...................... 070329, ref SDS 42 N49K
280706 -         ..
280707 -   45.  Healthy primary care physician at Kaiser
280708 -        comments how well, fit, and strong Millie
280709 -        looks after 2 cycles treatment with
280710 -        cetuximab, and higher energy enabling
280711 -        regular exercise...................... 070330, ref SDS 43 N49K
280713 -         ..
280714 -   46.  Millie cannot remember feeling better
280715 -        after starting exercise possible
280716 -        with cetuximab
280717 -        treatments............................ 070418, ref SDS 44 PY6W
280719 -         ..
280720 -   47.  Cellulitis lymphedema recurrence during
280721 -        treatment for cancer at UCSF; evident
280722 -        cause increased exercise to stimulate
280723 -        bone marrow that produces new blood that
280724 -        maintains immune system essential for
280725 -        chemotherapy treatments; exercise further
280726 -        maintains physicial fitness essential
280727 -        for aggressive chemotherapy
280728 -        treatments to recover from
280729 -        cancer................................ 070607, ref SDS 45 ZH6I
280731 -         ..
280732 -   48.  Lymphedema and Cellulitis risk declines
280733 -        gradually after surgery remove cancerous
280734 -        lymph nodes; lymphatic system gradually
280735 -        becomes more robust because remaining
280736 -        lymph nodes increase capacity so that
280737 -        exercise can continue to maintain fitness
280738 -        essential for aggressive chemotherapy
280739 -        treatment to recover from cancer
280740 -        reported by surgeon at
280741 -        Kaiser................................ 080606, ref SDS 46 4P7L
280742 -
280743 -
280744 -
280745 -
280746 -
280747 -
280748 -
280749 -
280750 -
2808 -