THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: March 30, 2007 03:40 PM Friday;
Millie meeting at Kaiser review progress treatment for IBC at UCSF.
2...Agenda Develop Work Plan Stage IV Breast Cancer 15 Mos after Mastectomy
3...Complex Patient History Knowledge Management Dilemma Issues Grow 43
4...Vitals Show Stable Medical Condition with Slight Temp 99.4
5...Coordination Plan Divided Responsibilities Kaiser UCSF Referral
6...Collaboration Primary Care at Kaiser with UCSF Clinical Study Cetuximab
7...CA 15-3 Cancer Marker 36 Showing Significant Improvement
8...CA 15-3 33 Cancer Marker Strong Response to Treatment Cetuximab
9...Axillary Left Arm No Lymphadenopathy Lymphedema Prominent
10...Lymphadenopathy Axillary Left Arm No Evidence Local Edema
11...Lymphedema New Complications Elevated Rash Upper Left Arm
12...Swelling Rash Left Arm Lymphedema Complications Above Normal
13...Left Arm Lymphedema Cellulitis Complications Swelling Above Normal
14...Rash Lymphedema Complications Left Arm Swelling Above Normal
15...IBC Left Arm Stable Subsiding Responds Treatment Cetuximab Drug Trial
16...Left Arm IBC Stable Subsiding Responds Treatment Cetuximab Drug Trial
17...Right Axillary Possible Involvement Red Rash Spreads Right Breast
18...IBC Right Arm New Minimal Red Rash Not Diagnosed IBC or Cellulitis
19...Right Breast Red Rash Spreads Possible Involvement Right Axillary
20...Red Rash Right Breast Spreads Possible Involvement Right Axillary
21...Right Chest Rash Distinct Above Breast and Port Catheter
22...Rash Above Port Catheter on Right Upper Chest Very Distinct Today
23...Left Supraclavicular Examination PET Test Report Finding SUV 4.5
24...Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
25...Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
26...2 Scenarios Conflict IBC Expanding Intensity Subsides
27...IBC Rash Left Breast Stomach and Back Seems to Be Subsiding
28...Examination IBC Rash Subsiding Responding to Treatment Cetuximab
29...Cetuximab Effective Treatment IBC Subsiding Left Breast Stomach Back
30...Prognosis Very Good IBC Stable Cetuximab Clinical Study
31...Stable Low Intensity IBC Rash Very Good Response to Treatment
32...Cetuximab Prognosis Good Chance IBC Rash 3rd Relapse Will Clear Up Again
33...Distant Metastasis No Evidence Patient History Examinations Tests
34...Local IBC Infection No Record Distant Metastasis Improves Chances
35...Prognosis Favorable No Lymphadenopathy 2006 No Distant Metastasis 5 Years
36...Wicked Problem Resolved Disease Subsides ANC Rises to Safe Level
37...ANC 1.81 Blood Counts Rise Above Safe Level for Treatment with Cetuximab
38...Measurable Disease IBC No New Sites No Expansion Intensity Declines
39...Photographs Record Measurable Disease IBC Tumor in Dermal Tissue
40...Measurable Disease IBC Observed with Tape Measure Photograph Pictures
41...CA 15-3 Diagnostic Measurable Disease IBC Not Measured by Image Testing
42...Lung Cancer Lymph Nodes Doctor's Progress Notes Medical Chart
43...Metastatic Cancer Lung Lymph Node Progress Notes Medical Chart
44...Biopsy Erratic Changes Rash Intensity Verify IBC Left Arm
45...CT Test 070326 No Findings Metastatic Disease
....History Missing Context Pulmonary Embolism Enlarged Right Ventricle
....Comparison: 070131 061230 060930 Prior Related Tests Omitted
....CT Test Pending for Pulmonary Embolism Ordered by Doctor
46...Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
47...Exercise Vigor Strength Engagement Ease Distress Living with Cancer
48...Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
49...Sleeping Difficulty Worry Cancer Health Issues Medical Management
50...Planning Case Management from Patient Profile Work Up
51...Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
52...Strategy Cetuximab Continued with Low ANC Expanding IBC Disease
53...Treatment 3rd Cycle Cetuximab Carboplatin 070329 10th Cycle 3rd Relapse
54...10th Cycle Treatment IBC 3rd Relapse 3rd Cycle Cetuximab Clinical Study
55...Cetuximab 3rd Cycle 1st Treatment IBC 3rd Relapse Clinical Study Drug Trial
56...Keflex Treatment Cellulitis Defer UCSF Clinical Study Control
57...Side Effects Cetuximab Similar Symptoms Pulmonary Embolism
58...Energy Strength Rising Minimal Side Effects Cetuximab Treatment
59...Facial Skin Dryness New Side Effect Cetuximab Curel Lotion Prescribed
60...Curel Lotion Prescribed Facial Skin Dryness New Side Effect Cetuximab
61...Cetuximab UCSF Clinical Study Treatment Begins 070201
62...UCSF Clinical Study Treatment Cetuximab Drug Trial Begins 070201
63...Drug Trials UCSF Has Other Clinical Study Treatments May Help Millie
64...Schedule Treatment Start Cetuximab Carboplatin 070201
65...Tired Breathing Difficulty Routine Activity Signals Pulmonary Emboli
66...Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
67...Pulmonary Emboli Hypercoagulable Work Up PET Scan Test Compare History
68...INR 2.4 Blood Test Patient Stable for Coumadin Treatments Pulmonary Emboli
69...Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
70...Cor Pulmonale Heart Disorder Enlarged Right Ventricle
71...Heart Examination Not Ordered Investigate Enlarged Right Ventricle
72...Enlarged Right Ventricle CT Test Aligns Patient Symptoms How Serious
73...Work Plan Received Communications Doctor/Patient Partnership
74...Communications Doctor Submits Work Plan Doctor/Patient Partnership
75...Doctor/Patient Partnership Communications Doctor Submits Work Plan
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1...referral for examination by a heart specialist, nor to get a treadmill
Meeting Examination Doctor 14th Review Start Treatment #16 After Mas
1403 - ..
1404 - Summary/Objective
140501 - Follow up ref SDS D5 0000. ref SDS B9 0000.
140503 - CT scans, ref SDS 0 EY5O, and blood test diagnostics, ref SDS 0 087J,
140504 - indicate improvement treating IBC. Rash that spread during transition
140505 - for referral to UCSF has not increased, and intensity of all sites has
140506 - subsided, most notably the left chest area. Examination today
140507 - indicates Millie has responded well to treatment with cetuximab alone
140508 - on clinical study. ref SDS 0 025H Sudden increasing intensity of rash
140509 - on the upper left arm with IBC, ref SDS 0 T87G, and new rash on the
140510 - upper right chest occurred with elevated temperature, and following
140511 - increased exercise, suggesting complications of lymphedema rather than
140512 - rising IBC, especially in light of falling CA 15-3. ref SDS 0 7C8G
140513 - Keflex antibiotics were prescribed to treat Cellulitis in line with
140514 - patient history. In this case, the rash subsided substantially within
140515 - a few hours, so Keflex treatment was deferred pending consultation at
140516 - UCSF. ref SDS 0 N75M Kaiser failed to perform the thin slice spiral
140517 - CT test ordered by the doctor to evaluate pulmonary embolism and
140518 - enlarged right entricle. ref SDS 0 B74K Hectic schedule creates
140519 - stress that creates mistakes using conversation for communication of
140520 - critical details. Lack of feedback loops increases mistakes. Worry
140521 - about medical mistakes failing to perform procedures and tests ordered
140522 - by the doctor increases emotional stress. ref SDS 0 ZG6I Favorable CT
140523 - and blood test results bring relief from the stress of cancer.
140524 - ref SDS 0 Y642
140526 - [On 070426 examination at UCSF approve start 4th cycle clinical
140527 - study cetuximab alone. ref SDS E0 0001
140529 - ..
140530 - [On 070524 examination at UCSF approve start 5th cycle clinical
140531 - study cetuximab alone. ref SDS E1 0001
140533 - ..
140534 - [On 070607 recurrent cellulitis diagnosed during examination at
140535 - UCSF for treatment of IBC with cetuximab, ref SDS E3 8H3I;
140536 - condition worsened during treatment in the Infusion Clinic,
140537 - temperature over 102, ref SDS E3 8J37; UCSF treated Millie with
140538 - ceftriaxone antibiotics, ref SDS E3 8J9R, cellulitis seemed to
140539 - subside, and temperature dropped to 101.4, UCSF released Millie
140540 - to go home, ref SDS E3 8J5C; Kaiser prescribed outpatient
140541 - ceftriaxone antibiotics for 5 days. ref SDS E3 8L46
140546 - ..
1408 - Progress
140901 - Agenda Develop Work Plan Stage IV Breast Cancer 15 Mos after Mastectomy
140903 - Follow up ref SDS D5 SM6M, ref SDS B9 SM6M.
140905 - ..
140906 - This is the 14th physician meeting and follows starting the 10th
140907 - chemotherapy cycle since treatment began on 060711, ref SDS 80 SM6M,
140908 - for the 3rd relapse of IBC. ref SDS 80 8Y8I This is the 2nd meeting
140909 - with the primary care physician at Kaiser to review progress on
140910 - referral for treatment through clinical study that began 070201.
140911 - Millie met at UCSF yesterday to start the 3rd cycle of weekly
140912 - treatments with cetuximab. ref SDS D5 0001 Background on referral to
140913 - UCSF is reported in the record on 070105. ref SDS A5 PK68 The doctor
140914 - had a hectic schedule, and so the meeting scheduled to start at 1540
140915 - actually started at 1717, as shown in the Medical Chart. ref SDS 0
140916 - I49O The doctor seemed tired, ref SDS 0 V66M, and will get a much
140917 - needed vacation next week.
140919 - ..
140920 - Complete patient history of treatments for IBC 3rd relapse is reported
140921 - in the record of treatment following the meeting today. ref SDS D6
140922 - SG8I
140924 - ..
140925 - Agenda for meeting at Kaiser on 070202 provides a structure for
140926 - planning the meeting today...
140928 - 1. CA 15-3 33 improvement......................... ref SDS 0 GJ5M
140929 - 2. Lymphedema restricts exercise.................. ref SDS 0 4Y93
140930 - 3. Breast exam IBC stable subsides................ ref SDS 0 025H
140931 - 4. Side effects minimal........................... ref SDS 0 TQ6L
140932 - 5. CT no distant metastasis, no test for PE....... ref SDS 0 EY5O
140933 - 6. Patient work up continue strategy.............. ref SDS 0 K36G
140934 - 7. Treatment plan weekly clinical trial........... ref SDS 0 PF3O
140935 - 8. Pulmonary emboli how serious r ventricle....... ref SDS 0 CV5L
140937 - ..
140938 - Scheduled next meeting for Thursday 070524 1100, to review progress
140939 - treating IBC at UCSF on clinical study, and for general patient care,
140940 - as reported below. ref SDS 0 N96O
Complex Patient History 43 Issues Overwhelms Span of Attention Drive
220401 - ..
220402 - Complex Patient History Knowledge Management Dilemma Issues Grow 43
220404 - Follow up ref SDS D5 LU3J, ref SDS B9 LU3J.
220406 - Sampling of issues patient history diagnosis and treatment...
220408 - 1. CA 15-3 monitors advance of cancer response to treatment
220409 - 2. Lymphedema complicated by mastectomy surgery
220410 - 3. Broken finger from minor fall complicates lymphedema
220411 - 4. Esophagitis reflux digestion issues
220412 - 5. Immune system chemotherapy increases risk of infection
220413 - Chemotherapy increase risk of infection
220414 - 6. Cat bites increase risk of infection complicates lymphedema
220415 - 7. Pneumonia chemotherapy increases risk of infection
220416 - 8. Metastatic cancer increases risk pulmonary embolism
220417 - 9. Lymphadenopathy left axilla local regional metastasis
220418 - 10. Lymphadenopathy right axilla distant metastasis
220419 - 11. Lymphadenopathy left supraclavicular diagnose metastatic cancer
220420 - 12. Breast cancer secondary IBC 3rd relapse left breast
220421 - 13. Cancer mutates slow response chemotherapy treatment
220422 - 14. Mastectomy surgery impact on treatment IBC relapse
220423 - 15. Blood vessels removed mastectomy slow chemotherapy treatments
220424 - 16. Treatment options, strategy, planning, schedule
220425 - 17. Drug trials increase declining pool chemotherapy agents
220426 - 18. UCSF Doctor Benz 2nd opinion apply diagnosis and treatment
220427 - 19. Pulmonary embolism blood clots in lungs
220428 - 20. INR weekly adjustments Coumadin treatment blood clots
220429 - 21. Enlarged right ventricle heart problem Cor Pulmonale
220430 - 22. Dizziness symptom enlarged right ventricle Cor Pulmonale
220431 - 23. Fatigue shortness breath side effect chemotherapy loss fitness
220432 - 24. Fatigue shortness breath symptom pulmonary embolism
220433 - 25. Shortness breath fatigue dizzy symptoms pulmonary embolism
220434 - 26. Coagulapathy hypercoagulable state work up genetic risks
220435 - 27. Testing resolution of errors (see Benz 2nd opinion 060821)
220436 - 28. Testing distant metastatic disease
220437 - 29. Testing pulmonary embolism and heart disease
220438 - 30. Communication hectic schedule not enough time to manage details
220439 - 31. Emotional stress and well being
220440 - 32. Cellulitis inflammation temperature 102.6 on chemotherapy
220441 - 33. Urinary tract bladder infection
220442 - 34. IBC rash spreads to right breast
220443 - 35. Right breast rash may be "ring" infection, not cancer
220444 - 36. Lung cancer seems to be diagnosed in the Medical Chart
220445 - 37. IBC rash spreads to stomach and toward back
220446 - 38. IBC rash spreads to left arm
220447 - 39. Dry skin face chest arm
220448 - 40. Right arm evidence light red rash, may be IBC spreading
220449 - 41. Rash right upper right chest near port catheter
220450 - 42. Restless legs side effect Benadryl pre-treatment
220451 - 43. Sleeping difficulty side effect cetuximab
Vitals Blood Pressure Pulse Temperature 99.4 Slight Fever SaO2 Weigh
290401 - ..
290402 - Vitals Show Stable Medical Condition with Slight Temp 99.4
290404 - Follow up ref SDS D5 KB5L, ref SDS B9 KB5L.
290406 - Millie had a slight temperature today, 99.4, which may relate to
290407 - elevated rash, possibly Cellulitis, discussed below. ref SDS 0 4Y93
290408 - Lower than usual pulse at 52 was not discussed.
290410 - ..
290411 - Bld Prssr Pulse Temp Weight SaO2
290412 - ..
290413 - 070330 1540............ 136 92 52 99.4 150 98%
290414 - * 070329 0800............ [see treatment record, ref SDS D6 7T3H]
290415 - * 070301 1330............ [see treatment record, ref SDS C0 AW4L]
290416 - * 070130 1300............ 140 83 87 98
290417 - 070105 1040............
290418 - 061208 1226............ 152 90 76 97.8 147 99%
290419 - 061201 1430............ 123 76 76 97.5
290420 - 061110................. 136 83 73 97.0 150 98%
290421 - 061020 1534............ 140 79 67 99.8 151 97
290422 - 060929 1452............ 141 78 66 98.3
290423 - 060908 1335............ 139 79 73 98.1
290424 - 060814 1610............ 139 80 59 98.2
290425 - * 060808.................
290426 - 060711................. 172 87 54 97.5 147
290427 - 060623................. 141 87 71 98.0 147 99%
290428 - 060428................. 129 73 80 99.4 149 99%
290429 - 060217................. 153 81 61 98.6 150 99%
290431 - * For some reason, vitals not submitted.
290433 - ..
290434 - High blood pressure reflects pressure on patient worrying about
290435 - effectiveness of new treatment and arrangements between UCSF and
290436 - Kaiser for timely care, discussed on 070130, ref SDS A9 Y642, and
290437 - again last month on 070301. ref SDS B9 Y642
290439 - ..
290440 - Today, Millie's vitals are mostly normal, similar to yesterday during
290441 - treatment at UCSF, ref SDS D6 AW4L, indicating reduced emotional
290442 - strain at this time, as discussed at UCSF on 070315, ref SDS C8 6A7J,
290443 - and again during examination yesterday ref SDS D5 Y642
Coordination Plan Communication Collaboration UCSF Kaiser Referral K
800401 - ..
800402 - Coordination Plan Divided Responsibilities Kaiser UCSF Referral
800403 - Collaboration Primary Care at Kaiser with UCSF Clinical Study Cetuximab
800405 - Follow up ref SDS D5 RM4G, ref SDS B9 RM4G.
800407 - Coordination and teamwork between Kaiser and UCSF has been complex,
800408 - exposing risks to stakeholders, reported in the record meeting at UCSF
800409 - yesterday on 070329, ref SDS D5 RM4G, including case study,
800410 - ref SDS D5 S63K, that extends initial study on 070130. ref SDS B0 2X6L
800412 - ..
800413 - On 070215 the doctor advised that coordination is critical to satisfy
800414 - requirements of clinical study for treating IBC with cetuximab at
800415 - UCSF. ref SDS B5 HK5O Today, Kaiser prescribed treatment without
800416 - coordination, because there wasn't enough time to check the record due
800417 - a hectic schedule, per below. ref SDS 0 V66M
800419 - ..
800420 - Medical Chart for today fails to list lab results for blood test on
800421 - 070329, shown below, ref SDS 0 128S, illustrates impact of poor
800422 - coordination on referral cases.
800424 - ..
800425 - Kaiser's Medical Chart can display the CT test for 070326 on the
800426 - doctor's computer, but not for the doctor at UCSF. Similarly,
800427 - computers at UCSF display blood tests on 070329, but doctors at Kaiser
800428 - cannot find tests for Millie's blood work on their computers. Blood
800429 - tests and image tests are complementary; each supports the other.
800430 - This record indicates referral hospitals can access half of patient
800431 - diagnostics, and are missing the other half needed to make sense of
800432 - the half that is available. This reduces effectiveness of teamwork
800433 - for patient care on referral.
800435 - ..
800436 - Case management of Coumadin treatment for pulmonary embolism presents
800437 - similar teamwork problems coordinating blood test results from UCSF
800438 - for use in Kaiser's computer system by the Coagulation Control Clinic,
800439 - reported on 070307. ref SDS C4 UA3L This morning Millie submitted a
800440 - letter coordinating blood test work at UCSF with Kaiser's work
800441 - prescribing treatment to manage pulmonary embolism, below. ref SDS 0
800442 - 793M
800444 - ..
800445 - Kaiser's Team Care model suffers equally.
800447 - ..
800448 - Coordination between Kaiser Oncology and the Imaging department places
800449 - patients at risk. Failure to perform doctor's orders, reviewed below
800450 - in connection with CT tests, ref SDS 0 0136, prevents timely diagnosis
800451 - and treatment, and undermines communication essential for effective
800452 - care, called out in Kaiser's Healthwise Handbook, reviewed on 990625.
800453 - ref SDS 3 4185
800455 - ..
800456 - Poor communication reduces coordination, driving up the high cost of
800457 - medical mistakes, reported on 990912. ref SDS 4 0001
800459 - ..
800460 - Today, the doctor advised that he will be on vacation for the next few
800461 - weeks. Arlette assisted using the computer to schedule Millie's next
800462 - meeting at Kaiser, per below. ref SDS 0 UI8N A few weeks ago, she
800463 - reported on 070309 the doctor wanted Arlette to avoid coordinating
800464 - work with email on Millie's case, ref SDS C6 VP73, arising from issues
800465 - on 070307, ref SDS C4 9Z9N, to correct problems on 070301. ref SDS B9
800466 - MP58 Today, everything went smoothly with Arlette assisting doctor
800467 - and patient.
800469 - ..
800470 - The doctor further advised today that coordination with email can go
800471 - through Michele. This solves the problem reported on 070123, when
800472 - Millie tried to coordinate directly with the doctor, and was notified
800473 - that the doctor was not available, on vacation, out of the office,
800474 - etc. ref SDS A8 LP4L
800476 - [On 070418 Millie sent a copy to Michele for coordinating with
800477 - the doctor based on correspondence to UCSF explaining findings
800478 - today of new rash activity, and that the rash quickly subsided,
800479 - ref SDS D9 UP4F, so it was not necessary to take Keflex
800480 - prescribed today, per below. ref SDS 0 KZ6L
CA 15-3 33 Trend Falls through March Cetuximab Clinical Study Drug T
880401 - ..
880402 - CA 15-3 Cancer Marker 36 Showing Significant Improvement
880404 - Follow up ref SDS D5 087J, ref SDS B9 087J.
880406 - Millie had a blood test yesterday morning at UCSF; results reported a
880407 - few days later on 070403 show CA 15-3 33 continuing decline from 36,
880408 - set out in the record getting treatment on 070329. ref SDS D6 A16M
880409 - This is well below the Kaiser standard of 39, however, UCSF standard
880410 - is 31, so 33 is still a bit high by this standard...
880412 - ..
880413 - Test Date Date Received
880414 - 070329......... 33 H............. 070329, ref SDS D6 2N5J
880415 - 070301......... 36 H............. 070307, ref SDS C0 A16M
880416 - 070215......... 52 H............. 070307, ref SDS B4 ER5O
880417 - 070208......... 55 H...31........ 070307, ref SDS B4 ER5O
880418 - 070201.....cetuximab begins...... 070201, ref SDS B2 G68I
880419 - 070131......... 56 H............. 070202, ref SDS B3 087J
880420 - 070123......... 52 H............. 070202, ref SDS B3 087J
880421 - 070118......... 68 H............. 070123, ref SDS A8 GK5B
880422 - 070104......... 56 H............. 070110, ref SDS A6 087J
880423 - 061218......... 74 H............. 061227, ref SDS A0 6P9F
880424 - 061214......... 63 H............. 061227, ref SDS A0 6P9F
880425 - 061201....Pause treatments..... . 061201, ref SDS 96 GJ5M
880426 - 061130......... 67 H............. 061201, ref SDS 96 087J
880427 - 061116......... 66 H............. 061201, ref SDS 96 087J
880428 - 061110......... 56 H............. 061201, ref SDS 96 087J
880429 - 061109......... 61 H............. 061110, ref SDS 94 087J
880430 - 061026......... 57 H............. 061110, ref SDS 94 087J
880431 - 061019......... 56 H............. 061020, ref SDS 91 087J
880432 - 060928......... 51 H............. 060929, ref SDS 88 087J
880433 - 060907......... 68 H............. 060929, ref SDS 88 087J
880434 - 060813......... 73 H............. 060817, ref SDS 85 U24M
880435 - 060809......... 87 H............. 060810, ref SDS 84 2N5J
880436 - 060721..Taxotere capecitabine.... 060721, ref SDS 81 0001
880437 - 060708......... 71 H............. 060711, ref SDS 80 087J
880438 - 060616......... 63 H............. 060623, ref SDS 79 UQ5Q
880439 - 060522......... 59 H............. 060605, ref SDS 78 UQ5Q
880440 - 060501......... 49 H............. 060522, ref SDS 77 MC4F
880441 - 060421......... 44 H............. 060428, ref SDS 75 087J
880442 - 060330......... 40 H............. 060428, ref SDS 75 087J
880443 - 060303......... 36............... 060428, ref SDS 75 087J
880444 - 060210......... 33............... 060217, ref SDS 74 087J
880445 - 060109......... 34............... 060126, ref SDS 73 KV59
880446 - 051223......... 34............... 060106, ref SDS 72 087J
880447 - 051202......... 28............... 060106, ref SDS 72 087J
880448 - 051116......... 31............... 051121, ref SDS 71 087J
880449 - 051109......... 30............... 051121, ref SDS 71 087J
880450 - 051102......... 34............... 051121, ref SDS 71 087J
880451 - 051021..Mastectomy surgery....... 051021, ref SDS 70 0001
880452 - 050916...end treatment........... 050916, ref SDS 68 407N
880453 - 050909......... 45 H............. 051007, ref SDS 69 087J
880454 - 050826......... 45 H............. 050913, ref SDS 67 087J
880455 - 050819......... 45 H............. 050913, ref SDS 67 087J
880456 - 050812......... 39 .............. 050819, ref SDS 66 3K6L
880457 - 050729......... 45 H............. 050819, ref SDS 66 EA5G
880458 - 050708......... 46 H............. 050729, ref SDS 65 087J
880459 - 050701......... 37 .............. 050729, ref SDS 65 087J
880460 - 050617......... 45 H............. 050729, ref SDS 65 087J
880461 - 050527......... 56 H............. 050610, ref SDS 63 087J
880462 - 050512......... 67 H............. 050520, ref SDS 61 087J
880463 - 050506......... 80 H............. 050520, ref SDS 61 087J
880464 - ..
880465 - 050415.........105 H............. 050422, ref SDS 60 087J
880466 - 050415..Taxoter capecitabie begin 050415, ref SDS 59 407N
880467 - 050325.........100 H............. 050329, ref SDS 58 087J
880468 - 050318.........101 H............. 050325, ref SDS 57 2N5J
880469 - 050304......... 88 H............. 050311, ref SDS 55 087J
880470 - 050225......... 95 H............. 050308, ref SDS 54 0001
880471 - 050211......... 78 H............. 050214, ref SDS 53 02BB
880472 - 050128......... 67 H............. 050204, ref SDS 52 087J
880473 - 050104...AC start treatment...... 050104, ref SDS 51 407N
880474 - 041228......... 56 H............. 041230, ref SDS 50 087J
880475 - 041204......... 43 H............. 041210, ref SDS 49 087J
880476 - 041021...Taxol bevczmb ends...... 041021, ref SDS 46 0001
880477 - 041007......... 39............... 041104, ref SDS 47 087J
880478 - 040923......... 49 H............. 041005, ref SDS 45 087J
880479 - 040908......... 44 H............. 040909, ref SDS 44 087J
880480 - 040825......... 47 H............. 040909, ref SDS 44 087J
880481 - 040811......... 42 H............. 040812, ref SDS 43 087J
880482 - 040728......... 43 H............. 040729, ref SDS 41 2N5J
880483 - 040712......... 47 H............. 040713, ref SDS 40 087J
880484 - 040614......... 55 H............. 040615, ref SDS 39 PX6X
880485 - 040517......... 78 H............. 040601, ref SDS 37 2N5J
880486 - 040420...Taxol bevczmb starts.... 040420, ref SDS 35 9Z5J
880487 - 040311......... 70 H............. 040318, ref SDS 30 SM6M
880488 - 040205......... 60 H............. 040211, ref SDS 27 SM6M
880489 - 031201......... 62 H............. 031205, ref SDS 26 SM6M
880490 - 030912......... 66 H............. 030915, ref SDS 25 SM6M
880491 - 030708......... 68 H............. 030710, ref SDS 24 SM6M
880492 - 030503......... 54 H............. 030508, ref SDS 22 SM6M
880493 - 030403......... 45 H............. 030508, ref SDS 22 SM6M
880494 - 030215......... 46 H............. 030220, ref SDS 21 5E6L
880495 - 030106......... 37 H............. 030109, ref SDS 20 SM6M
880496 - 021204..Adjuvant chemo ends...... 021204, ref SDS 19 SQ5I
880497 - 021202......... 41 H?............ 021204, ref SDS 19 SP5G
880498 - 021111......... 36 H?............ 021113, ref SDS 18 Y65I
880499 - 021023......... 33 H?............ 021023, ref SDS 17 SQ5I
880500 - 020930......... 33 H?..39........ 021002, ref SDS 16 SQ5I
880501 - 020917......... 36 H?............ 020924, ref SDS 15 SQ5I
880502 - 020717......... 59 H?............ 020726, ref SDS 14 YN5K
880503 - 020629......... 75 H ............ 020705, ref SDS 13 UX6I
880504 - 020608........ 67 H ............ 020614, ref SDS 12 0001
880505 - 020603........ 108 H ............ 020607, ref SDS 11 X67F
880506 - 020511........ 117 H ............ 020603, ref SDS 10 PJ4J
880507 - 020419......... 81 H ............ 020430, ref SDS 9 7N5H
880508 - 020321......... 85 H ............ 020405, ref SDS 8 6T8K
880514 - ..
8808 - Analysis
880901 - CA 15-3 33 Cancer Marker Strong Response to Treatment Cetuximab
880903 - Follow up ref SDS D5 GJ5M, ref SDS B9 GJ5M.
880905 - Research and confidence in biomarkers to improve early detection, and
880906 - accurate assessment for response to treatment of cancer was reported
880907 - recently on 070328. ref SDS D4 0001
880909 - ..
880910 - Background on Millie's patient history applying CA 15-3 is shown in a
880911 - case study on 030710. ref SDS 24 IA7H
880913 - ..
880914 - On 070315, Millie reported blood test results showing CA 15-3 fell
880915 - significantly to 36. ref SDS C7 HR9G The doctor was very pleased by
880916 - favorable response to treatment with cetuximab on referral to UCSF.
880917 - ref SDS C7 E43H A few days after the meeting today, on 070403 CA 15-3
880918 - fell further during the past month to 33, which aligned with
880919 - examination yesterday at UCSF, ref SDS D5 Q48G, and again today at
880920 - Kaiser. ref SDS 0 Z85L This further aligned with rising ANC to levels
880921 - that support continuing treatments with cetuximab. ref SDS 0 VF5M
880923 - ..
880924 - [On 070406 Millie received a letter from UCSF confirming CA
880925 - 15-3 33 for the blood test on 070329. ref SDS D8 EQ6I
880927 - ..
880928 - Today, alignment was less certain, because there seemed to be elevated
880929 - intensity of rash on the left arm, ref SDS 0 527G, and there was a new
880930 - and prominent small rash on the right chest above the breast and below
880931 - the collar bone. ref SDS 0 583G Close correlation between patient
880932 - history of rising IBC rash and CA 15-3 cancer marker, listed on
880933 - 070130, ref SDS A9 SE9O, together with elevated temperature today,
880934 - yielded confidence that sudden new rash today is less likely rising
880935 - IBC than Cellulitis or side effects of cetuximab. ref SDS 0 7C8G
Lymphadenopathy Axillary No Findings Left Arm Patient No Complaint S
960401 - ..
960402 - Axillary Left Arm No Lymphadenopathy Lymphedema Prominent
960403 - Lymphadenopathy Axillary Left Arm No Evidence Local Edema
960405 - Follow up ref SDS D5 MW8J, ref SDS B9 MW8J.
960407 - Patient has a long history of IBC on the left breast and associated
960408 - lymphadenopathy in the left axillary, see case study on 040517.
960409 - ref SDS 36 OW3I
960411 - ..
960412 - Examination of the left axilla palpated no findings suggestive of
960413 - Lymphadenopathy, and aligns with examination at UCSF yesterday.
960414 - ref SDS D5 VU6O
960416 - ..
960417 - The CT test on 070326 makes no findings of lymphadenopathy, shown in
960418 - the record meeting at UCSF yesterday on 070329, ref SDS D5 12GK,
960419 - though no indication the analyst actually looked at the left and right
960420 - axillary, also, reported yesterday. ref SDS D5 VU6O
Lymphedema Left Arm Swelling Rash Upper Left Arm Increased Intensity
AA0401 - ..
AA0402 - Lymphedema New Complications Elevated Rash Upper Left Arm
AA0403 - Swelling Rash Left Arm Lymphedema Complications Above Normal
AA0404 - Left Arm Lymphedema Cellulitis Complications Swelling Above Normal
AA0405 - Rash Lymphedema Complications Left Arm Swelling Above Normal
AA0407 - Follow up ref SDS D5 4Y93, ref SDS B9 4Y93.
AA0409 - Medical history of lymphedema in the left arm is reported in a case
AA0410 - study on 070130. ref SDS A9 VX6F
AA0412 - ..
AA0413 - There wasn't enough time yesterday during the meeting at UCSF to
AA0414 - discuss correlations between exercise, ref SDS D5 RV8O, to strengthen
AA0415 - the immune system that resists cancer, and relieves stress, reviewed
AA0416 - at UCSF on 070315, ref SDS C8 6A7J, but may compound lymphedema with
AA0417 - increased swelling, and complications of Cellulitis, discussed at UCSF
AA0418 - on 070222. ref SDS B7 GG4H Similarly, there wasn't enough time for
AA0419 - coordination to distribute the list of side effects for comprehensive
AA0420 - review yesterday. ref SDS D5 M84I
AA0422 - ..
AA0423 - This morning, Millie worked out in the gym, doing exercises, lifting
AA0424 - weights, and riding the stationary bike. A few hours prior to meeting
AA0425 - with the doctor Millie hiked around the reservoir at Lafayette park,
AA0426 - about 2.5 miles.
AA0428 - ..
AA0429 - The left arm today has continued swelling from lymphedema, reported at
AA0430 - UCSF yesterday on 070329. ref SDS D5 4Y93 The doctor further observed
AA0431 - elevated intensity of rash on the upper left arm, and wrapping toward
AA0432 - the under arm at the same location reported on 070202. ref SDS B3 JP6F
AA0433 - A few weeks later on 070222, Brigid diagnosed this new rash location
AA0434 - on the upper arm as IBC. ref SDS B7 B64F Since that time, the rash
AA0435 - has gotten less intense, responding to treatment on the cetuximab
AA0436 - clinical study, reported yesterday at UCSF on 070329. ref SDS D5 527G
AA0438 - ..
AA0439 - Sudden elevated intensity of rash today, especially compared to
AA0440 - examination yesterday at UCSF reporting subsiding intensity,
AA0441 - ref SDS D5 527G, was therefore startling, and may present worsening
AA0442 - IBC conditions along with the new rash also seen today on the right
AA0443 - chest above the right breast, explained below. ref SDS 0 583G
AA0445 - ..
AA0446 - Rising intensity of IBC on the left arm seems conflicting with patient
AA0447 - history of declining CA 15-3, per above. ref SDS 0 UZ8N
AA0449 - ..
AA0450 - Increased rash intensity could also be a side effect of cetuximab
AA0451 - treatment for IBC, cited in product documentation reviewed on 070116,
AA0452 - ref SDS A7 MH4Q, complications of lymphedema causing Cellulitis, or
AA0453 - some combination, noted previously by the doctor in a letter on
AA0454 - 070315. ref SDS B5 HK5O
AA0456 - ..
AA0457 - The doctor noticed elevated temperature today, 99.4, per above.
AA0458 - ref SDS 0 KB5L Similar elevated temperature on 061027, ref SDS 92
AA0459 - 3N8K, and increased rash inflammation on the left arm, ref SDS 92
AA0460 - WO6N, like today, was treated for Cellulitis, ref SDS 92 V759, which
AA0461 - required treatment in the hospital for 5 days with discharge on
AA0462 - 061101. ref SDS 93 JR9N
AA0464 - ..
AA0465 - Millie has a long history of erratic changes in rash intensity and
AA0466 - spreading, which was mostly Cellulitis, shown in a case study on
AA0467 - 070130. ref SDS A9 SE9O
AA0469 - ..
AA0470 - The doctor further noticed patient history listed in the record
AA0471 - meeting with Doctor Rugo at UCSF on 070130, ref SDS A9 VX6F, which
AA0472 - shows Millie's left arm relapsed with Cellulitis on 061112,
AA0473 - ref SDS 95 HP52, and required treatment again at Kaiser. ref SDS 95
AA0474 - 029E A few weeks later on 061203 there was another flare-up of
AA0475 - Cellulitis on the left arm, ref SDS 97 MF9H, possibly associated with
AA0476 - over exertion in exercising, and reaction to a cat bite a week or so
AA0477 - earlier. ref SDS 97 T55X
AA0479 - ..
AA0480 - The doctor decided that extended exercise today, ref SDS 0 7C7F, in
AA0481 - relation to impaired lymphatics on the left side may have created
AA0482 - complications of lymphedema leading to Cellulitis recurrence, causing
AA0483 - elevated temperature.
AA0485 - ..
AA0486 - Biopsy was not ordered to evaluate change in patient condition today.
AA0488 - ..
AA0489 - The primary care physician feels that patient history, suggests, in
AA0490 - the absence of biopsy, that Millie may have recurrent Cellulitis on
AA0491 - the upper left arm that complicates IBC and lymphedema, leading to a
AA0492 - brightly intense rash, compared to observations yesterday at UCSF when
AA0493 - the rash seemed to be subsiding. ref SDS D5 527G
AA0495 - ..
AA0496 - [On 070607 recurrent cellulitis diagnosed during examination at
AA0497 - UCSF for treatment of IBC with cetuximab, ref SDS E3 8H3I;
AA0498 - condition worsened during treatment in the Infusion Clinic,
AA0499 - temperature over 102, ref SDS E3 8J37; UCSF treated Millie with
AA0500 - ceftriaxone antibiotics, ref SDS E3 8J9R, cellulitis seemed to
AA0501 - subside, and temperature dropped to 101.4, UCSF released Millie
AA0502 - to go home, ref SDS E3 8J5C; Kaiser prescribed outpatient
AA0503 - ceftriaxone antibiotics for 5 days. ref SDS E3 8L46
AA0505 - ..
AA0506 - [On 080409 Millie treated for Cellulitis recurrence at Kaiser
AA0507 - Emergency with tempeature of 101.9. ref SDS E5 0001
AA0509 - ..
AA0510 - [On 080411 increased rash on upper left arm, and on IBC
AA0511 - sites on the chest attributed to cetuximab side effects the
AA0512 - day after seeming full recovery from severe episode of
AA0513 - Cellulitis treated at the hospital Emergency on 080410.
AA0514 - ref SDS E6 V45J
AA0516 - ..
AA0517 - Previously, when rash on the upper left arm first appeared, Kaiser
AA0518 - deferred to UCSF for prescribing treatment, and in order to maintain
AA0519 - control for the cetuximab clinical study, noting in a letter on 070315
AA0520 - possibility of cetuximab side effects. ref SDS B5 HK5O
AA0522 - ..
AA0523 - Today, the doctor prescribed Keflex to treat Cellulitis recurrence,
AA0524 - per below. ref SDS 0 V66M
AA0526 - [On 070607 UCSF prescribed Keflex antibiotics to treat
AA0527 - recurrent cellulitis again. ref SDS E3 ZI37
AA0530 - ..
AA08 - 2022
AA0901 - Millie has Keflex left over from prior episodes of Cellulitis.
AA0903 - This evening at home, Millie prepared to start Keflex, prescribed
AA0904 - during the meeting at Kaiser. Millie noticed that elevated intensity
AA0905 - of the rash on the upper left arm, and the new rash on the upper
AA0906 - right chest, per below, ref SDS 0 583G, have both completely subsided.
AA0907 - The upper left arm now looks the same as yesterday on 070329 at UCSF,
AA0908 - when examination showed reduced IBC rash intensity, ref SDS D5 527G,
AA0909 - compared to examination several weeks earlier on 070315.
AA0911 - ..
AA0912 - As a result, Keflex treatment was not performed.
AA0914 - [On 070418 Kaiser notified that inflammation was resolved
AA0915 - without taking prescribed Keflex medication. ref SDS D9 PZ3P
AA0916 - and ref SDS D9 PZ7X
IBC Left Arm Examination Swelling Erratic Rash Inflammation Fever 99
AM0401 - ..
AM0402 - IBC Left Arm Stable Subsiding Responds Treatment Cetuximab Drug Trial
AM0403 - Left Arm IBC Stable Subsiding Responds Treatment Cetuximab Drug Trial
AM0405 - Follow up ref SDS D5 527G, ref SDS B9 527G.
AM0407 - See discussion of rising rash intensity on upper left arm, and
AM0408 - prospects that this is a reaction to cetuximab treatments for IBC,
AM0409 - and/or recurrent Cellulitis, rather than increased IBC, and in light
AM0410 - of falling CA 15-3 biomarker. ref SDS 0 T87G
Right Axillary Lymphadenopathy No Findings Right Arm Patient No Comp
AU0401 - ..
AU0402 - Right Axillary Possible Involvement Red Rash Spreads Right Breast
AU0404 - Follow up ref SDS D5 3D6K, ref SDS B9 3D6K.
AU0406 - Background on patient history testing for lymphadenopathy in the right
AU0407 - axilla is reported in the record on 060929. ref SDS 88 3D6K
AU0409 - ..
AU0410 - Examination of the right axillary yielded same negative results
AU0411 - finding no evidence of lymphadenopathy, as occurred examining the left
AU0412 - axilla, per above. ref SDS 0 I63O Aligns with CT test on 070326,
AU0413 - reviewed yesterday on 070329. ref SDS D5 12GK
Right Arm Examination Rash Slight Blemishes No Evidence IBC No Findi
B10401 - ..
B10402 - IBC Right Arm New Minimal Red Rash Not Diagnosed IBC or Cellulitis
B10404 - Follow up ref SDS D5 H15M, ref SDS B9 H15M.
B10406 - Background on slight red dots, rash or blemishes on the right arm is
B10407 - reported on 070301. ref SDS B9 H15M Examination at UCSF concluded the
B10408 - rash is not IBC. Further examination at UCSF on 070315 reached the
B10409 - same conclusion, ref SDS C8 FO6H, supported by another review on
B10410 - 070322. ref SDS C9 LI4M
B10412 - ..
B10413 - Review at UCSF yesterday on 070329 notes possibility this condition is
B10414 - very moderate IBC that is responding to treatment, as with IBC in
B10415 - other areas listed on 070301. ref SDS B9 4140
B10417 - ..
B10418 - The primary care physician looked at the right arm today, and
B10419 - concurred with analysis yesterday that IBC has not spread to the right
B10420 - arm, and Cellulitis has not occurred in the right arm.
B10422 - ..
B10423 - Discussion of side effects from cetuximab treatment for IBC is
B10424 - reported below. ref SDS D5 MF6I
IBC Right Breast Examination Stable Subsides Rash Less Intense Respo
B90401 - ..
B90402 - Right Breast Red Rash Spreads Possible Involvement Right Axillary
B90403 - Red Rash Right Breast Spreads Possible Involvement Right Axillary
B90405 - Follow up ref SDS D5 W58J, ref SDS B9 T99I.
B90407 - ..
B90408 - On 061204 IBC inflammation spread from the left chest area infected
B90409 - with IBC across the sternum and slightly onto the right breast.
B90410 - ref SDS 98 AE5I
B90412 - ..
B90413 - The doctor concurred with examination of the right breast yesterday at
B90414 - UCSF on 070329. ref SDS D5 613F
Rash Chest Right Side Above Breast Below Collar Bone Above Port Cath
IBC Right Breast Examination Stable Subsides Rash Less Intense Respo
BJ0501 - ..
BJ0502 - Right Chest Rash Distinct Above Breast and Port Catheter
BJ0503 - Rash Above Port Catheter on Right Upper Chest Very Distinct Today
BJ0505 - Follow up ref SDS D5 583G, ref SDS C9 KU3L.
BJ0507 - ..
BJ0508 - Today, the doctor observed distinct, solid, and intense rash area that
BJ0509 - formed an approximate oval 1" high, and 2" long, and located high
BJ0510 - above the right breast, and below the collar bone, above and slightly
BJ0511 - left of the port catheter. This rash has similar appearance and
BJ0512 - elevated intensity as the rash observed on the left arm today, per
BJ0513 - above. ref SDS 0 T87G
BJ0515 - [...below doctor's Progress Notes say "States rash on chest and
BJ0516 - LUE is present, evidently refers to this part of the examination.
BJ0517 - ref SDS 0 4S5I
BJ0519 - ..
BJ0520 - Like the left arm today, sudden appearance of an intense new rash was
BJ0521 - startling. ref SDS 0 N19J
BJ0523 - ..
BJ0524 - The doctor asked about background?
BJ0526 - ..
BJ0527 - Millie reviewed patient history listed yesterday on 070329 meeting at
BJ0528 - UCSF. ref SDS D5 583G Nurse's Notes for treatment at UCSF on 070315
BJ0529 - report a rash above the port catheter on the right side of the chest,
BJ0530 - ref SDS C8 KU3L, as seen today. There is no other history of a rash
BJ0531 - at this location, and it evidently quickly subsided at that time,
BJ0532 - since the patient never noticed it, until today. For example, a week
BJ0533 - later, on 070322 Nurse's Notes report no continuing rash at this
BJ0534 - location. ref SDS C9 KU3L
BJ0536 - ..
BJ0537 - Case study on 070130 shows erratic changes in severity/intensity of
BJ0538 - IBC rash on left chest area, which led to referral to UCSF.
BJ0539 - ref SDS A9 5N6L
BJ0541 - ..
BJ0542 - Previously, when rash on the upper left arm first appeared, Kaiser
BJ0543 - deferred to UCSF for prescribing treatment, and in order to maintain
BJ0544 - control for the cetuximab clinical study, noting in a letter on 070315
BJ0545 - possibility of cetuximab side effects. ref SDS B5 HK5O
BJ0547 - ..
BJ0548 - Today, the doctor decided to avoid biopsy, and treat for Cellulitis.
BJ0549 - Based on analysis for similar new condition on the left arm, as set
BJ0550 - out above, ref SDS 0 7C7G, the doctor prescribed treatment with Keflex
BJ0551 - antibiotic, per below. ref SDS 0 474O
BJ0554 - ..
BJ08 - 2020
BJ0901 - This evening at home, Millie prepared to start Keflex, prescribed
BJ0902 - during the meeting at Kaiser this afternoon. Millie noticed that rash
BJ0903 - on the upper right chest, and elevated rash intensity on the upper
BJ0904 - left arm, per above, ref SDS 0 T87G, have both completely subsided.
BJ0905 - The chest seems totally clear of any rash, similar to yesterday at
BJ0906 - UCSF, when previous reports of rash at this location in the Nurse's
BJ0907 - Notes could not be confirmed, per above. ref SDS 0 DH5H As a result,
BJ0908 - Keflex antibiotic medication was not taken, per below. ref SDS 0 KZ6L
BJ0910 - [On 070418 Kaiser notified that inflammation was resolved
BJ0911 - without taking prescribed Keflex medication. ref SDS D9 PZ3P
BJ0912 - and ref SDS D9 PZ7X
Left Supraclavicular Examination Palpation Neck Lymphadenopathy No F
BR0401 - ..
BR0402 - Left Supraclavicular Examination PET Test Report Finding SUV 4.5
BR0403 - Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
BR0404 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
BR0406 - Follow up ref SDS D5 8R6M, ref SDS B9 8R6M.
BR0408 - Background is reported on 070130 meeting with Doctor Rugo at UCSF.
BR0409 - ref SDS A9 8R6M
BR0411 - ..
BR0412 - Like the left and right axillary locations, examination today for
BR0413 - cancer in left supraclavicular region found no evidence of lumps or
BR0414 - other indications of lymphadenopathy, as reported above. ref SDS 0
BR0415 - I63O CT test on 070326 shows no findings of lymphadenopathy, reported
BR0416 - below. ref SDS D5 12GK There is no express finding that the analyst
BR0417 - actually looked at the left and right supraclavicular.
IBC Left Breast Examination 2 Scenarios End Stable Area No New Sites
C70401 - ..
C70402 - 2 Scenarios Conflict IBC Expanding Intensity Subsides
C70403 - IBC Rash Left Breast Stomach and Back Seems to Be Subsiding
C70404 - Examination IBC Rash Subsiding Responding to Treatment Cetuximab
C70405 - Cetuximab Effective Treatment IBC Subsiding Left Breast Stomach Back
C70407 - Follow up ref SDS D5 025H, ref SDS B9 025H.
C70409 - Left chest presents the primary IBC disease site. Recent patient
C70410 - history on this issue with case studies is presented in examination at
C70411 - UCSF yesterday on 070329. ref SDS D5 025H All case studies with
C70412 - lessons learned are listed on 061018. ref SDS 90 0001
C70414 - ..
C70415 - On 070315, Millie submitted a report to the primary care physician at
C70416 - Kaiser about progress getting treatment with cetuximab clinical study
C70417 - starting on 070201 at UCSF for the 3rd relapse of IBC. ref SDS C7 VP5N
C70419 - ..
C70420 - Examination today shows intensity and spread of IBC rash subsiding,
C70421 - confirming observations yesterday at UCSF. ref SDS D5 M68J Since new
C70422 - rash on the right chest, and increased rash on the left arm are
C70423 - initially diagnosed as Cellulitis, IBC condition remains stable
C70424 - today...
C70426 - left breast chest................. 060623, ref SDS 79 025H
C70427 - right breast...................... 061204, ref SDS 98 AE5I
C70428 - stomach........................... 070130, ref SDS A9 M68J
C70429 - back.............................. 070130, ref SDS A9 M68J
C70430 - left arm.......................... 070202, ref SDS B3 6Q5N
C70432 - ..
C70433 - The doctor feels that subsiding IBC rash intensity shown by
C70434 - examination today, and no additional disease sites, including findings
C70435 - of no distant metastasis in the CT test on 070326, as shown below,
C70436 - ref SDS 0 EY5O, indicates treatment with cetuximab alone seems
C70437 - effective, as reported at UCSF yesterday on 070329. ref SDS D5 ST4J
C70438 - This analysis is supported by declining CA 15-3 cancer biomarker, per
C70439 - above. ref SDS 0 UZ8N
C70441 - ..
C70442 - This is tempered by erratic changes in rash today initially diagnosed
C70443 - as Cellulitis, and adding to the case study on 070130. ref SDS A9 SE9O
Prognosis Stable Low Intensity IBC Rash Very Good Response Treatment
CE0401 - ..
CE0402 - Prognosis Very Good IBC Stable Cetuximab Clinical Study
CE0403 - Stable Low Intensity IBC Rash Very Good Response to Treatment
CE0404 - Cetuximab Prognosis Good Chance IBC Rash 3rd Relapse Will Clear Up Again
CE0406 - Follow up ref SDS D5 M645, ref SDS B9 M645.
CE0408 - At this time, the primary care physician concurs with favorable
CE0409 - prognosis presented during examination yesterday at UCSF. ref SDS D5
CE0410 - M645 The doctor defers to experience at UCSF with patients on the
CE0411 - cetuximab clinical study. Yesterday on 070329, Millie's condition of
CE0412 - stable to subsiding IBC rash was described as "very good," and another
CE0413 - patient was cited who has been treated with cetuximab for 10 months
CE0414 - without progression of cancer. ref SDS D5 WT9K
Distant Metastasis No Evidence 6 Years Patient History Examinations
CM0401 - ..
CM0402 - Distant Metastasis No Evidence Patient History Examinations Tests
CM0403 - Local IBC Infection No Record Distant Metastasis Improves Chances
CM0404 - Prognosis Favorable No Lymphadenopathy 2006 No Distant Metastasis 5 Years
CM0406 - Follow up ref SDS D5 FF4H, ref SDS B9 FF4H.
CM0408 - The doctor further concurred today with the record yesterday meeting
CM0409 - at UCSF on 070329, which reports no evidence of distant metastasis,
CM0410 - including the recent CT test on 070326, ref SDS D5 FF4H, and discussed
CM0411 - today, shown below. ref SDS 0 EY5O
Wicked Problem Resolved Disease Subsides Cetuximab Effective Treatme
D30401 - ..
D30402 - Wicked Problem Resolved Disease Subsides ANC Rises to Safe Level
D30403 - ANC 1.81 Blood Counts Rise Above Safe Level for Treatment with Cetuximab
D30405 - Follow up ref SDS D5 VF5M, ref SDS B9 VF5M.
D30407 - The doctor concurred with analysis yesterday at UCSF that rising ANC
D30408 - blood counts show Millie's immune system is strong enough to safely
D30409 - continue chemotherapy treatments with cetuximab, and further that
D30410 - falling CA 15-3 biomarker shows cancer treatments are effective.
D30411 - These favorable conditions have resolved the previous dilemma, as
D30412 - reported on 070329. ref SDS D5 VF5M
Measurable Disease IBC CA 15-3 33 Cancer Marker Improves Shows Respo
DH0401 - ..
DH0402 - Measurable Disease IBC No New Sites No Expansion Intensity Declines
DH0403 - Photographs Record Measurable Disease IBC Tumor in Dermal Tissue
DH0404 - Measurable Disease IBC Observed with Tape Measure Photograph Pictures
DH0405 - CA 15-3 Diagnostic Measurable Disease IBC Not Measured by Image Testing
DH0407 - Follow up ref SDS D5 M652, ref SDS B9 M652.
DH0409 - There was no discussion of measurable disease, since UCSF is
DH0410 - performing work to measure and photograph IBC rash for evaluating
DH0411 - response to treatment with cetuximab chemotherapy on referral through
DH0412 - clinical study, as reported yesterday on 070329. ref SDS D5 M652
DH0414 - ..
DH0415 - The doctor noted today improvement treating IBC shown by subsiding
DH0416 - rash, per above, ref SDS 0 M68J, and falling cancer biomarker, CA
DH0417 - 15-3, also per above. ref SDS 0 GJ5M
Lung Cancer No Discussion Metastatic Disease Nodes Doctor's Progress
DP0401 - ..
DP0402 - Lung Cancer Lymph Nodes Doctor's Progress Notes Medical Chart
DP0403 - Metastatic Cancer Lung Lymph Node Progress Notes Medical Chart
DP0405 - Follow up ref SDS D5 G25K, ref SDS B9 G25K.
DP0407 - Background is reported on 070130 in the record meeting with Doctor
DP0408 - Rugo at UCSF. ref SDS A9 G25K
DP0410 - ..
DP0411 - Review on 070329 of the CT test on 070326 shows findings that indicate
DP0412 - there is no evidence in patient history for lung cancer. ref SDS D5
DP0413 - 123I
DP0415 - ..
DP0416 - CT scan testing on 070326 further reported no findings of
DP0417 - "interstitial disease" in the lungs indicating this side effect of
DP0418 - cetuximab treatment has not occurred in Millie's case so far.
DP0419 - ref SDS D5 5S6L Interstitial lung disease was listed in the clincial
DP0420 - study Consent documents received from UCSF on 070116. ref SDS A7 0256
DP0421 - Interstitial disease is discussed further below in connection with
DP0422 - failure to perform thin slice spiral CT testing for pulmonary embolism
DP0423 - to assess cetuximab compounding risks of
DP0424 - blood clots in the lungs.
DP0426 - ..
DP0427 - There was no discussion of this issue today, so that attention could
DP0428 - focus on assessing Millie's response to treatment for IBC.
Biopsy Left Right Breasts Left Arm Right Chest Erratic Changes Inten
DW0401 - ..
DW0402 - Biopsy Erratic Changes Rash Intensity Verify IBC Left Arm
DW0404 - Follow up ref SDS D5 KT7J, ref SDS B9 KT7J.
DW0406 - Background avoiding biopsy to diagnose erratic rash on left and right
DW0407 - chest is reported in the record on 070130. ref SDS A9 KT7J
DW0409 - ..
DW0410 - Similarly, biopsy was avoided today for diagnosing rash on the left
DW0411 - arm showing sudden and significantly elevated intensity, compared to
DW0412 - just yesterday, per above. ref SDS 0 T87G. and to evaluate the new
DW0413 - rash on the upper right chest, per above, ref SDS 0 583G, and
DW0414 - following practice at UCSF analysing similar issues, including the
DW0415 - right arm, reported yesterday on 070329. ref SDS D5 PY4L
DW0417 - ..
DW0418 - Beginning in October 2006 there may have been concurrent IBC on the
DW0419 - upper left arm, and similarly IBC may be infecting the upper right
DW0420 - chest, and the right arm under the theory in the 2nd opinion received
DW0421 - from Doctor Benz on 041117 that IBC rash can "wax and wane," referring
DW0422 - to patient history of symptoms that occurred with the left breast in
DW0423 - 2003, ref SDS 48 OS6W, but was not diagnosed as IBC until biopsy was
DW0424 - performed a year later on 040419. ref SDS 34 789F A month later on
DW0425 - 040517 the doctor submitted a pathology report that presents IBC.
DW0426 - ref SDS 36 6T5G
DW0428 - ..
DW0429 - Research a few days ago on 070328 reported advances in biomarkers
DW0430 - aimed at early detection and treatment of cancer, ref SDS D4 PC6G,
DW0431 - indicated by Millie's patient history in 2003, listed in the study on
DW0432 - 050812. ref SDS 66 XX8G
CT Test Distant Metastasis No Findings Lymphadenopathy Cancer CT Sca
E10401 - ..
E10402 - CT Test 070326 No Findings Metastatic Disease
E10404 - Follow up ref SDS D5 EY5O, ref SDS B9 EY5O.
E10406 - The doctor noted good news finding no evidence of distant metastasis
E10407 - from the CT test at Kaiser on 070326, reported in the record meeting
E10408 - at UCSF yesterday on 070329. ref SDS D5 EY5O He feels that CT test
E10409 - results align with falling CA 15-3 testing, above, ref SDS 0 UZ8N, and
E10410 - with clinical examinations showing stable and improving IBC rash
E10411 - responding to treatment, also, per above. ref SDS 0 Z85L Testing at
E10412 - this time supports favorable prognosis, per above, ref SDS 0 M645
E10413 - Consistent success avoiding distant metastasis improves Millie's long
E10414 - term prognosis, also above. ref SDS 0 FF4H
CT Test 070326 History Identifies Breast Cancer Mistakes Testing Fai
EF0401 - ..
EF0402 - History Missing Context Pulmonary Embolism Enlarged Right Ventricle
EF0404 - Follow up ref SDS D5 GH5L, ref SDS B3 0Z6O.
EF0406 - ..
EF0407 - There was no discussion today of history showing persistent failure to
EF0408 - report relevant patient history for accurate understanding of context
EF0409 - presenting image test findings, reported in the record yesterday on
EF0410 - 070329. ref SDS D5 GH5L
EF0412 - ..
EF0413 - The primary care physician reports in the medical chart that the
EF0414 - patient has a history of pulmonary embolism, initially on 041104.
EF0415 - ref SDS 47 RZ4I The Medical Chart on 061020 further reports patient
EF0416 - history of recurrent pulmonary embolism, ref SDS 91 279I, which
EF0417 - reflects the CT test on 060930, reported in the record on 061012.
EF0418 - ref SDS 89 294Q The Medical Chart since that time failed to report
EF0419 - recurrent PE, per below, ref SDS 0 J59N, but consistently shows
EF0420 - history of PE as follows...
EF0422 - Hx of PE; on warfarin
EF0424 - ...in the Impression section, ref SDS 0 1248
EF0426 - ..
EF0427 - Cor Pulmonale heart disorder of enlarged right ventricle also
EF0428 - diagnosed in the CT test on 060930 as a complication of pulmonary
EF0429 - embolism, reviewed on 061012, ref SDS 89 7E5L, for some reason is not
EF0430 - shown in the Medical Chart, per below. ref SDS 0 J58L
EF0432 - ..
EF0433 - Failure to present accurate patient history may have contributed to
EF0434 - Imaging Department failing to perform thin slice spiral CT test
EF0435 - ordered by the doctor to update the status of pulmonary embolism and
EF0436 - enlarged right ventricle.
EF0438 - ..
EF0439 - Imaging Department may have changed procedures and now requires orders
EF0440 - to test for pulmonary embolism and enlarged right ventricle only from
EF0441 - lung and heart doctors, and so only reports history on cancer for
EF0442 - orders from the cancer department. This requirement did not prevent
EF0443 - Kaiser from performing thin slice spiral CT tests for pulmonary
EF0444 - embolism ordered by the doctor on...............
EF0446 - ..
EF0447 - 041103....................... 041104, ref SDS 47 RZ4I
EF0448 - 041218....................... 041230, ref SDS 50 PW3K
EF0449 - 060930....................... 061012, ref SDS 89 294Q
CT Test 070326 Comparison Failed Perform Context Management Missing
EV0401 - ..
EV0402 - Comparison: 070131 061230 060930 Prior Related Tests Omitted
EV0404 - Follow up ref SDS D5 0136, ref SDS B3 0136.
EV0406 - ..
EV0407 - The doctor noted failure to perform comparisons in the CT test on
EV0408 - 070326 with prior tests to assess changes in pulmonary embolism and
EV0409 - enlarged right ventricle, planned by the doctor on 070202, but missing
EV0410 - from the report received yesterday at UCSF on 070329. ref SDS D5 0136
EV0411 - The doctor advised that findings in the report, shown below, indicate
EV0412 - Kaiser did not perform the thin slice spiral CT test, which the doctor
EV0413 - was reminded to order on 070307, ref SDS C4 9Z9N, and was planned
EV0414 - during the meeting on 070202, ref SDS B3 T85K, as shown in the Medical
EV0415 - Chart at that time. ref SDS B3 125V
CT Test 070326 Findings Indicate Thin Slice Spiral CT Scan Doctor Or
F10401 - ..
F10402 - CT Test Pending for Pulmonary Embolism Ordered by Doctor
F10404 - Follow up ref SDS D5 B74K, ref SDS B3 013T.
F10406 - The doctor explained that findings in the CT test for 070326 indicate
F10407 - cancer has been contained to only local IBC sites, consistent with
F10408 - prior favorable tests listed in patient history. see above,
F10409 - ref SDS 0 EY5O
F10411 - ..
F10412 - Millie asked about the technician's report on 070326 that the work
F10413 - order did not specify a spiral CT scan needed to test for pulmonary
F10414 - embolism? ref SDS D1 SK8L Errors listing patient history, per above,
F10415 - ref SDS 0 GH5L, aligns with failure to test for pulmonary embolism and
F10416 - compare with the prior test on 060930 per above. ref SDS 0 0136
F10418 - ..
F10419 - The doctor advised that reference to "interstitial disease" in the
F10420 - report on the CT test, shown in the record receiving the report at
F10421 - UCSF yesterday on 070329, ref SDS D5 5S6L, does not relate to
F10422 - pulmonary embolism, nor to Cor Pulmonale (enlarged right ventricle).
F10423 - He said there is no indication that Kaiser performed the thin slice
F10424 - spiral CT scan ordered by the doctor on 070307 to test for pulmonary
F10425 - embolism and enlarged right ventricle. ref SDS C4 9Z9N
F10427 - ..
F10428 - This frustrates plans on 070202 for medical tests, ref SDS B3 P45O, to
F10429 - avoid "wicked problems" of compound symptoms for lung and heart
F10430 - disease that occur concurrent with side effects for cancer treatments.
F10431 - ref SDS B3 TN7J
F10433 - ..
F10434 - Difficulty coordinating between Oncology and Imaging at Kaiser is
F10435 - shown by the case study on 061012. ref SDS 89 A55J Coordination
F10436 - efforts are further shown by the study on 070307, ref SDS C4 G56L,
F10437 - listed in the larger study on 070130, ref SDS B0 ET4N, and discussed
F10438 - above under coordination. ref SDS 0 GH4G The high cost of medical
F10439 - mistakes was reported nationally on 990912, ref SDS 4 0001, and
F10440 - supported by study in this case on 040416. ref SDS 33 GN7J
Emotional Trauma Stress Moderate Pulse Normal Cancer Subsides Confid
FB0401 - ..
FB0402 - Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
FB0403 - Exercise Vigor Strength Engagement Ease Distress Living with Cancer
FB0404 - Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
FB0406 - Follow up ref SDS D5 Y642, ref SDS B9 Y642.
FB0408 - Medical issues create an emotional roller coaster explained on 070105,
FB0409 - ref SDS A5 Y642, and reviewed on 070301. ref SDS B9 Y642 Stress and
FB0410 - trauma are compounded with rising complexity of case history, listed
FB0411 - above. ref SDS 0 LU3J Millie's letter to Kaiser on 070315 illustrate
FB0412 - recent swings in emotional state from changes in prognosis.
FB0413 - ref SDS C7 VP5N
FB0415 - ..
FB0416 - Millie's vitals taken before the meeting are calmer today, e.g., pulse
FB0417 - below 60, per above, ref SDS 0 KB5L, similar to yesterday reported in
FB0418 - patient history for treatment at UCSF. ref SDS D6 AW4L
FB0420 - ..
FB0421 - During the meeting, the doctor discovered severely increased rash
FB0422 - intensity on the left arm, ref SDS 0 T87G, and new rash on the upper
FB0423 - right chest. ref SDS 0 583G These findings illustrate emotional
FB0424 - swings that occur with cancer, discussed at UCSF yesterday on 070329.
FB0425 - ref SDS D5 Q18K When the rash subsided, ref SDS 0 N75M, at both sites
FB0426 - later in the evening today, this brought significant relief from worry
FB0427 - about failed treatment. ref SDS 0 N95F
FB0429 - ..
FB0430 - Millie was worried on 070306 about coordination getting results of
FB0431 - blood tests at UCSF for prescribing Coumadin treatments at Kaiser. At
FB0432 - that time, she requested feedback from Kaiser verifying accuracy to
FB0433 - avoid mistakes treating pulmonary embolism managed by the Coagulation
FB0434 - Control Clinic. ref SDS C3 UI5H On 070307 Kaiser reported that
FB0435 - feedback with email to verify accuracy takes too much time; people
FB0436 - prefer to work by conversation. ref SDS C4 UH4M
FB0438 - ..
FB0439 - Discovery that doctor's orders are ignored, per above, ref SDS 0 B74K,
FB0440 - increases worry about communication coordinating the work for
FB0441 - effective treatment, per above, ref SDS 0 GH4G, and cited in the
FB0442 - meeting yesterday at UCSF on 070329. ref SDS D5 II7H At this time,
FB0443 - there is no evidence that previously observed defects for pulmonary
FB0444 - embolism and enlarged right ventricle have been repaired, and are not
FB0445 - getting worse. Increased energy and subsiding shortness of breath are
FB0446 - encouraging, reported below. ref SDS 0 E44L
Sleep Difficulty Worry Emotional Trauma Stress New Increasing Rash L
FM0401 - ..
FM0402 - Sleeping Difficulty Worry Cancer Health Issues Medical Management
FM0404 - Follow up ref SDS D5 MR99, ref SDS C9 NG3I.
FM0406 - Sleeping disorders were not discussed today, as presented during the
FM0407 - meeting yesterday at UCSF. ref SDS D5 MR99
FM0409 - ..
FM0410 - As noted, anxiety about rising symptoms, discussed above, ref SDS 0
FM0411 - O38H, contribute to difficulty sleeping. This is compounded by
FM0412 - failing to follow doctor's orders to test for recovery or progression
FM0413 - of disease. ref SDS 0 B74K
Strategy Continue Work Plan Weekly Treatments Cetuximab for IBC Cont
FR0401 - ..
FR0402 - Planning Case Management from Patient Profile Work Up
FR0403 - Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
FR0404 - Strategy Cetuximab Continued with Low ANC Expanding IBC Disease
FR0406 - Follow up ref SDS D5 K36G, ref SDS B9 K36G.
FR0408 - Background is reported on 070301. ref SDS B9 K36G Coordination issues
FR0409 - are presented above. ref SDS 0 RM4G
FR0411 - ..
FR0412 - Millie's letter on 070315 commends Kaiser for successful strategy,
FR0413 - ref SDS C7 HR9G, set by the primary care physician on 070105 to target
FR0414 - treatment of Millie's IBC disease with cetuximab on referral to UCSF.
FR0415 - ref SDS A5 PK7L
FR0417 - ..
FR0418 - CT testing shows no evidence of disease, per below, ref SDS 0 EY5O
FR0419 - Improved blood counts for CA 15-3 cancer marker, above, ref SDS 0
FR0420 - GJ5M, and ANC, ref SDS 0 VF5M, further indicate that the doctor's
FR0421 - strategy is yielding results treating IBC, also discussed at UCSF
FR0422 - yesterday. ref SDS D5 X68N
FR0424 - ..
FR0425 - Consideration of pulmonary embolism and Cor Pulmonale heart disorder
FR0426 - of enlarged right ventricle seem to require no change in treatment
FR0427 - strategy using Coumadin to control blood coagulation conditions,
FR0428 - reported in a letter today to the Coagulation Control Clinic at Kaiser
FR0429 - in Martinez, CA, ref SDS D7 ZH4H, and following up planning on 070307.
FR0430 - ref SDS C4 IY6I
Treatment IBC 3rd Relapse Prescribed UCSF 3rd Cycle 1st Treatment St
G60401 - ..
G60402 - Treatment 3rd Cycle Cetuximab Carboplatin 070329 10th Cycle 3rd Relapse
G60403 - 10th Cycle Treatment IBC 3rd Relapse 3rd Cycle Cetuximab Clinical Study
G60404 - Cetuximab 3rd Cycle 1st Treatment IBC 3rd Relapse Clinical Study Drug Trial
G60406 - Follow up ref SDS D5 PF3O, ref SDS B9 PF3O.
G60408 - Patient history of cetuximab treatments is listed in the record
G60409 - yesterday working with the Infusion Clinic. ref SDS D6 7T3H
G60411 - ..
G60412 - Millie had treatment with cetuximab for IBC yesterday starting cycle
G60413 - #3 at UCSF. ref SDS D6 1M6H
G60417 - ..
G60418 - Keflex Treatment Cellulitis Defer UCSF Clinical Study Control
G60420 - As noted, when rash on the upper left arm first appeared in February,
G60421 - Kaiser deferred to UCSF for prescribing treatment that maintains
G60422 - control of cetuximab side effects for clinical study, cited in a
G60423 - letter on 070215. ref SDS B5 HK5O
G60425 - ..
G60426 - Today, there wasn't enough time to check the record on 070215 due to a
G60427 - hectic schedule. ref SDS 0 SM6M The doctor prescribed Keflex to treat
G60428 - sudden increased intensity of rash on the left arm for Cellulitis
G60429 - diagnosed above. ref SDS 0 7C5F, and for similar erratic rash on the
G60430 - upper right chest, also, observed today, per above. ref SDS 0 DH6F
G60432 - ..
G60433 - Reporting on 990912 cited fatigue, limited time, hectic schedule cause
G60434 - medical mistakes. ref SDS 4 0285
G60436 - [...below Medical Chart shows Keflex prescribed in treatment
G60437 - plan. ref SDS 0 GF5O
G60439 - ..
G60440 - [On 070418 Millie notified UCSF of new rash activity, and that
G60441 - the rash quickly subsided, ref SDS D9 PZ3P, so it was not
G60442 - necessary to take Keflex prescribed today, per below.
G60443 - ref SDS 0 KZ6L
G60445 - ..
G60446 - The prescription was sent to the Kaiser pharmacy at the Park
G60447 - Shadelands clinic in Walnut Creek. Millie will pick up the medication
G60448 - tomorrow. Millie planned to begin taking Keflex antibiotic this
G60449 - evening using medication on hand from prior prescription ordered by
G60450 - the primary care physician at Kaiser on 070217,
G60451 - and approved by Brigid
G60452 - at UCSF on 070222. ref SDS B7 IS5K
G60454 - ..
G60455 - Keflex has been prescribed previously to treat Millie for Cellulitis,
G60456 - shown by case study on 061203. ref SDS 97 YT4M
G60459 - ..
G607 - 2020
G60801 - Millie prepared to take Keflex antibiotic medication prescribed to
G60802 - treat increased intensity of rash on the left arm, and new rash on the
G60803 - upper right chest for recurrent Cellulitis, per above. ref SDS 0 474O
G60805 - ..
G60806 - By this time, however, intensity of the rash on the left arm
G60807 - substantially subsided to the prior "improved" IBC condition observed
G60808 - yesterday at UCSF, per above. ref SDS 0 N75M As well, the rash above
G60809 - the right breast and below the collar bone, completely disappeared,
G60810 - also, per above. ref SDS 0 N95F As a result, Millie did not take
G60811 - Keflex antibiotic medication prescribed to treat for Cellulitis, per
G60812 - above. ref SDS 0 474O
G60814 - [On 070418 Millie sent a copy to Michele for coordinating with
G60815 - the doctor based on correspondence to UCSF explaining findings
G60816 - today of new rash activity, and that the rash quickly subsided,
G60817 - ref SDS D9 UP4F, so it was not necessary to take Keflex
G60818 - prescribed today, per below. ref SDS 0 KZ6L
G60820 - ..
G60821 - [On 080314 Millie considered increased inflammation on upper
G60822 - left arm might be recurrence of Cellulitis, ref SDS E4 JK50;
G60823 - she took a Keflex pill to start another round of treatment,
G60824 - ref SDS E4 JK6G, but then decided based on the prior record of
G60825 - similar false positive symptom to wait another day to continue
G60826 - treatment, and by that time inflammation subsided, and so
G60827 - treatment was not continued. ref SDS E4 JK6G
Side Effects Cetuximab Millie Looks Great Face Skin Cetuximab Possib
GL0401 - ..
GL0402 - Side Effects Cetuximab Similar Symptoms Pulmonary Embolism
GL0403 - Energy Strength Rising Minimal Side Effects Cetuximab Treatment
GL0404 - Facial Skin Dryness New Side Effect Cetuximab Curel Lotion Prescribed
GL0405 - Curel Lotion Prescribed Facial Skin Dryness New Side Effect Cetuximab
GL0407 - Follow up ref SDS D5 TQ6L, ref SDS B9 TQ6L.
GL0409 - On 070326 Millie submitted a list of side effects for discussion at
GL0410 - UCSF on 070329, ref SDS D0 627X, citing review on 070322, ref SDS C9
GL0411 - QU8K, and prepared under the doctor/patient partnership model, set out
GL0412 - in Kaiser's Healthwise Handbook, shown on 990625. ref SDS 3 4185
GL0414 - ..
GL0415 - The list was not reviewed during the meeting at UCSF on 070329. Work
GL0416 - was based on personal memory. ref SDS D5 TQ6L
GL0418 - ..
GL0419 - Millie reported today that her energy seems restored, indicating this
GL0420 - side effect of cetuximab has not been significant so far. ref SDS D5
GL0421 - QG4G
GL0423 - ..
GL0424 - Millie did not discuss difficulty sleeping. This was addressed
GL0425 - yesterday at UCSF. ref SDS D5 N49G
GL0427 - ..
GL0428 - The doctor commented on how well, fit, and healthy Millie looks,
GL0429 - echoing favorable assessment during the meeting at UCSF yesterday with
GL0430 - the medical team in the Breast Care Center, ref SDS D5 N49K; and
GL0431 - presented again in Nurse's Notes for treatment in the Infusion Clinic,
GL0432 - also, yesterday on 070329. ref SDS D6 QU8K
GL0434 - ..
GL0435 - Good health reflects renewed energy that enables returning to the gym
GL0436 - for regular exercise, reported on 070218, ref SDS B6 N05H, and cited
GL0437 - in case study on exercise issue. ref SDS B6 OB8H
GL0439 - [On 070418 Millie writes to UCSF with copy to Kaiser advising
GL0440 - she cannot remember feeling better. ref SDS D9 PY6W
GL0442 - ..
GL0443 - As noted, the doctor observed during examination today an intense rash
GL0444 - on the upper right chest, ref SDS 0 583G, originally reported by the
GL0445 - nurse in the Infusion Clinic on 070315, and cited in the list of side
GL0446 - effects on 070322. ref SDS C9 KU3L The doctor also noticed elevated
GL0447 - intensity of IBC rash area on the upper left arm. ref SDS 0 T87G
GL0448 - Whether these events are side effects of cetuximab, or rising IBC,
GL0449 - Cellulitis, or something else is not known. Initial analysis cites
GL0450 - elevated temperature, ref SDS 0 7C8G, and trauma that may complicate
GL0451 - lymphedema, perhaps from increased exercise, per above. ref SDS 0 7C7F
GL0453 - ..
GL0454 - The doctor concurred with review at UCSF yesterday, ref SDS D5 MF6I,
GL0455 - indicating no findings of IBC, nor any rash, or other indication of
GL0456 - side effects from cetuximab to the right arm, as discussed above.
GL0457 - ref SDS 0 H15M
GL0459 - ..
GL0460 - The doctor was pleased that "restless legs" was easily resolved
GL0461 - yesterday on 070329 by reducing the dose for pre-treatment Benadryl.
GL0462 - from 50 mg to 25 mg. ref SDS D5 WS3F
Cetuximab Clinical Study Kaiser Drug Trial Subsiding Stable IBC Meta
GR0401 - ..
GR0402 - Cetuximab UCSF Clinical Study Treatment Begins 070201
GR0403 - UCSF Clinical Study Treatment Cetuximab Drug Trial Begins 070201
GR0404 - Drug Trials UCSF Has Other Clinical Study Treatments May Help Millie
GR0406 - Follow up ref SDS D5 ZJ9N, ref SDS B9 ZJ9N.
GR0408 - Background on Kaiser referral to UCSF for treatment on clinical study
GR0409 - is reported on 070105. ref SDS A5 P256 Purpose of referral is to
GR0410 - improve patient care with new treatment. ref SDS A5 PK7L Case study
GR0411 - on Kaiser and UCSF collaborating to expedite treatment is listed on
GR0412 - 070130, ref SDS A9 4T5N, and reviewed again yesterday at UCSF on
GR0413 - 070329, ref SDS D5 RM4G, as further set out in the record for today,
GR0414 - per above. ref SDS 0 RM4G
GR0416 - ..
GR0417 - Results of referral have been very good, with IBC rash subsiding or at
GR0418 - worst stable on the upper left arm, and diagnostics all improving
GR0419 - shown by examination today, per above. ref SDS 0 M68J This was
GR0420 - reported to Kaiser in a letter on 070315. ref SDS C7 HR9G
GR0422 - ..
GR0423 - Moreover, Millie feels and looks better now, per above, ref SDS 0
GR0424 - N49K, than before starting treatment on 070201.
Schedule Treatment Cetuximab 070329 Weekly Through 070524 Clinical S
GY0401 - ..
GY0402 - Schedule Treatment Start Cetuximab Carboplatin 070201
GY0404 - Follow up ref SDS D5 N96O, ref SDS B9 N96O.
GY0406 - Scheduling and coordinating, per above, ref SDS 0 RM4G, have become a
GY0407 - continuing challenge, reviewed yesterday on 070329. ref SDS D5 S63K
GY0409 - ..
GY0410 - On 070315 Nola, the administrator for the Infusion Clinic at UCSF,
GY0411 - submitted a schedule for meetings with the medical team, and Millie's
GY0412 - treatments through 070524. ref SDS C8 QK6L
GY0414 - ..
GY0415 - During the meeting today, the doctor scheduled the next meeting in
GY0416 - eight (8) weeks on 070525 1100 to assess treatment for IBC with the
GY0417 - cetuximab clinical study on referral to UCSF, as reported on 070202.
GY0418 - ref SDS B3 LX4I
GY0420 - ..
GY0421 - When the meeting ended today, the doctor requested help from the
GY0422 - Medical Assistant. Arlette used the doctor's computer in the
GY0423 - examination room to demonstrate procedures using Kaiser's system to
GY0424 - schedule meetings according to the doctor's requirements. He asked
GY0425 - that status of pending on several matters be removed, which required
GY0426 - knowledge on manipulating the software program. Arlette executed the
GY0427 - commands to accomplish the doctor's objective.
Pulmonary Embolism Blood Clots Lungs Enlarged Right Ventricle Heart
HC0401 - ..
HC0402 - Tired Breathing Difficulty Routine Activity Signals Pulmonary Emboli
HC0403 - Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
HC0404 - Pulmonary Emboli Hypercoagulable Work Up PET Scan Test Compare History
HC0406 - Follow up ref SDS D5 CV5L, ref SDS B9 CV5L.
HC0408 - Background on pulmonary embolism and correlation with IBC treatment at
HC0409 - UCSF is reported in the record meeting at UCSF on 070130. ref SDS A9
HC0410 - CV5L Doctor Rugo planned to avoid overlooking symptoms of pulmonary
HC0411 - embolism that appear similar to side effects of chemotherapy
HC0412 - treatment. ref SDS A9 MO7K The plan called for a thin slice spiral CT
HC0413 - test to evaluate cancer and to also check for pulmonary embolism.
HC0414 - ref SDS A9 915J The test at Kaiser the next day on 070131, failed to
HC0415 - perform requirements for thin slice spiral CT testing, reported on
HC0416 - 070202. ref SDS B3 TN6N
HC0418 - ..
HC0419 - At that time, on 070202 the primary care physician at Kaiser planned
HC0420 - to correct the problem by ordering thin slice spiral CT scan that
HC0421 - tests for pulmonary embolism. ref SDS B3 P45O The doctor requested a
HC0422 - reminder to order the test for pulmonary embolism with Millie's next
HC0423 - CT test on the clinical study at UCSF. ref SDS B3 T85K
HC0425 - ..
HC0426 - On 070307 the doctor was reminded to order the test, as requested.
HC0427 - ref SDS C4 9Z9N
HC0429 - ..
HC0430 - Testing was performed on 070326. Review on 070329 shows no reference
HC0431 - to thin slice spiral CT, nor to findings on pulmonary embolism, as
HC0432 - commonly occurs when Kaiser tests this issue, shown by patient history
HC0433 - listed on 070202.
HC0435 - ..
HC0436 - Millie asked if references to "interstitial disease" in the report for
HC0437 - the CT test indicate Kaiser followed the doctor's order but described
HC0438 - the work with different terminology from prior tests that expressly
HC0439 - described pulmonary embolism, shown in patient study on 070202.
HC0440 - ref SDS B3 T85F
HC0442 - ..
HC0443 - The doctor noted there is no evidence in the report for the CT test on
HC0444 - 070326 that Kaiser used thin slice spiral CT technology that tests for
HC0445 - pulmonary embolism and enlarged right ventricle, as shown in the
HC0446 - record on 070329 reviewing Kaiser's test report. ref SDS D5 0136,
HC0448 - ..
HC0449 - At this time, status of pulmonary embolism remains unknown. Millie's
HC0450 - energy has improved, indicating reduced risk; however, affirmative
HC0451 - assessment with tests present better evidence than assumptions from
HC0452 - absence of clinical symptoms, especially for highly lethal conditions,
HC0453 - like pulmonary embolism, where rising symptoms can be hidden by side
HC0454 - effects and other benign maladies, reported on 060722. ref SDS 82 BI5J
HC0457 - ..
HC0458 - INR 2.4 Blood Test Patient Stable for Coumadin Treatments Pulmonary Emboli
HC0460 - Follow up ref SDS D5 FE9I, ref SDS B9 FE9I.
HC0462 - The doctor was pleased that INR has finally stabilized the past few
HC0463 - months, shown in the blood test at UCSF yesterday on 070329, reported
HC0464 - in the record getting treatment. ref SDS D6 SE6N INR was also
HC0465 - discussed with the medical team at UCSF on 070329. ref SDS D5 FE9I
HC0467 - ..
HC0468 - This morning Millie sent a letter to Gloria coordinating notice for
HC0469 - the Kaiser Coagulation Control Clinic in Martinez CA about results of
HC0470 - the blood test at UCSF on 070329, ref SDS D7 ZH4H, and which Gloria
HC0471 - requested to help manage Millie's Coumadin treatments for pulmonary
HC0472 - embolism, discussed in a telephone call on 070307. ref SDS C4 723G At
HC0473 - that time, Gloria explained that conversation makes reporting
HC0474 - fast-and-easy for Kaiser to get results on blood testing at UCSF,
HC0475 - ref SDS C4 UA3L, also discussed in connection with coordination,
HC0476 - above. ref SDS 0 LF5L
Examination Stethoscope No Findings Enlarged Right Ventricle Heart S
HK0401 - ..
HK0402 - Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
HK0404 - Follow up ref SDS D5 Q35O, ref SDS B9 Q35O.
HK0406 - Examination with a stethoscope today included multiple locations on
HK0407 - Millie's back and chest. The doctor reported no findings of cardio
HK0408 - pulmonary issues from clinical examination. This method aligns with
HK0409 - the practice reported on 061020, ref SDS 91 PC6H, citing research on
HK0410 - 061012 about monitoring heart disorder of enlarged right ventricle,
HK0411 - Cor Pulmonale. ref SDS 89 IR5T
HK0413 - ..
HK0414 - SaO2 diagnostic for oxygenated blood cited at Kaiser, on 061208,
HK0415 - ref SDS 99 1E5G, to indicate cardio-pulmonary functioning due to
HK0416 - pulmonary embolism, including enlarged right ventricle, was tested
HK0417 - three (3) times yesterday during treatment after examination, and was
HK0418 - consistently above 98%, demonstrating no immediate danger. ref SDS D6
HK0419 - AW4L Vitals today showing Sa02 98% demonstrate continuing strong
HK0420 - cardio-pulmonary system. ref SDS 0 KB5L
Enlarged Right Ventricle Heart Disorder Cor Pulmonale Related Pulmon
HU0401 - ..
HU0402 - Cor Pulmonale Heart Disorder Enlarged Right Ventricle
HU0403 - Heart Examination Not Ordered Investigate Enlarged Right Ventricle
HU0404 - Enlarged Right Ventricle CT Test Aligns Patient Symptoms How Serious
HU0406 - Follow up ref SDS D5 VJ4J, ref SDS B9 VJ4J.
HU0408 - Background on heart disorder Cor Pulmonale from enlarged right
HU0409 - ventricle, and plans for CT testing is reported on 070130. ref SDS A9
HU0410 - VJ4J Kaiser failed to perform the spiral CT test ordered by the
HU0411 - primary care physician to evaluate enlarged right ventricle, reported
HU0412 - above. ref SDS 0 B74K
HU0414 - ..
HU0415 - This issue is closely related to pulmonary embolism, reported by the
HU0416 - primary care physician on 061228. ref SDS A1 JU7L Continued subsiding
HU0417 - of symptoms for pulmonary embolism reported on 070301, ref SDS B9
HU0418 - SX6N, and again today signal Cor Pulmonale, also, seems under control,
HU0419 - however, the actual status is unknown, per above. ref SDS 0 E44L
HU0421 - ..
HU0422 - During the meeting today, the primary care physician did not make
HU0423 - referral for examination by a heart specialist, nor to get a treadmill
HU0424 - test, ref SDS B3 UN9F, discussed by Doctor Rugo during the meeting at
HU0425 - UCSF on 070130. ref SDS A9 RV3O
Work Plan Doctor Submits Doctor/Patient Partnership Communications I
IJ0401 - ..
IJ0402 - Work Plan Received Communications Doctor/Patient Partnership
IJ0403 - Communications Doctor Submits Work Plan Doctor/Patient Partnership
IJ0404 - Doctor/Patient Partnership Communications Doctor Submits Work Plan
IJ0406 - Follow up ref SDS B3 FE4I, ref SDS 97 FE4I.
IJ0412 - ..
IJ0413 - Issues from Kaiser's Progress Notes continue from prior review on
IJ0414 - 061110, ref SDS 84 EN4K, and listed again on 061208. ref SDS 89 EN4K
IJ0416 - ..
IJ0417 - New issues include...
IJ0419 - 1. Current medications do not show cetuximab begun on 070201,
IJ0420 - ref SDS 0 SE86, and cited in plan section. ref SDS 0 125V
IJ0422 - 2. New rash observed by doctor on upper left arm not cited in
IJ0423 - examination. ref SDS 0 ZL5W
IJ0425 - ..
IJ0426 - 3. Orders Placed during this visit for Keflex, ref SDS 0 1153, is
IJ0427 - not listed for Current Medications. ref SDS 0 SE86
IJ0429 - ..
IJ0430 - 4. Progress Notes represent IBC expanded after mastectomy surgery
IJ0431 - on 051021, when this was not reported until 060623. ref SDS 0
IJ0432 - J58L
IJ0434 - ..
IJ0435 - 5. Pulmonary embolism reported in Progress Notes diagnosed in
IJ0436 - 2004, ref SDS 0 J58L; but, Medical Chart fails to report
IJ0437 - recurrent PE diagnosed with CT test on 060930. ref SDS 0 J59N
IJ0439 - ..
IJ0440 - 6. Enlarged right ventricle heart disorder Cor Pulmonale
IJ0441 - complication pulmonary embolism has never been reported in the
IJ0442 - Medical Chart. ref SDS 0 LF5R
IJ0444 - ..
IJ0445 - 7. Progress Notes last sentence vague and incomplete evidently
IJ0446 - referring to new rash on the upper right chest below the collar
IJ0447 - bone, and separate from other IBC rash sites. Since the doctor
IJ0448 - observed new rash, presenting these conditions as mere patient
IJ0449 - statements is misleading and incomplete. ref SDS 0 J59N
IJ0451 - ..
IJ0452 - 8. Physical Examination report is incomplete and vague failing to
IJ0453 - present observation of new rash on the upper right chest; no
IJ0454 - context is explained diagnosing Cellulitis and treatment with
IJ0455 - Keflex. ref SDS 0 ZL5W
IJ0457 - ..
IJ0458 - 9. Lab section says only "at UCSF," which fails to report lab
IJ0459 - results for blood test on 070301 was submitted to Kaiser on
IJ0460 - 070315. ref SDS 0 128S Equally, blood test at UCSF yesterday
IJ0461 - on 070329 is not reported. ref SDS D6 A64L Medical Chart takes
IJ0462 - notice of small fraction of lab results at UCSF for INR,
IJ0463 - indicating critical details can be tracked with minimal effort.
IJ0464 - ref SDS 0 Y55K "at UCSF" is therefore vague, incomplete, and
IJ0465 - misleading in failing to convey the number of tests, the data,
IJ0466 - and implications for patient care interpreting other clinical
IJ0467 - and test diagnostics.
IJ0469 - ..
IJ0470 - 10. Failure to notice lab results essential for continuity of care
IJ0471 - indicates requirements for coordination plan. ref SDS 0 4T4L
IJ0473 - ..
IJ0474 - 11. CT test on 070326 is missing from list of Image Tests in the
IJ0475 - Medical Chart. ref SDS 0 129Y
IJ0477 - ..
IJ0478 - 12. Medical Chart does not report failure of Imaging Department to
IJ0479 - perform thin slice spiral CT test ordered by the doctor for the
IJ0480 - test on 070326. ref SDS 0 L14O
IJ0482 - ..
IJ0483 - 13. Medical Chart continues to omit 3 imaging tests between 060414
IJ0484 - and 060708, in addition to not reporting the most recent test
IJ0485 - on 070326. ref SDS 0 129Y
IJ0487 - ..
IJ0488 - 14. Imp section presents vague reference to "INR 2-3," which may
IJ0489 - reflect reliance on blood tests at UCSF on 070329, but are not
IJ0490 - listed in the Medical Chart. ref SDS 0 1248
IJ0492 - ..
IJ0493 - 15. Medical Chart saying "lymphedema; stable," conflicts with
IJ0494 - finding new rash on upper left arm, where similar findings have
IJ0495 - previously been diagnosed as Cellulitis, ref SDS B3 JP6F, and
IJ0496 - further conflicts with increased intensity of rash on the upper
IJ0497 - left arm, per above. ref SDS 0 F04H
IJ0500 - ..
IJ0501 - Progress continues toward good management using the doctor patient
IJ0502 - partnership for timely review of patient history, called out in
IJ0503 - Kaiser's Healthwise Handbook, reviewed on 990625, ref SDS 1 TD5S, and
IJ0504 - reported on 060106. ref SDS 58 FE4I
IJ0506 - 1. 3/30/2007 5:40 PM
IJ0508 - Wcr-ONnc2 > Main Campus
IJ0511 - ..
IJ0512 - 2. Your primary care clinician is listed as...