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CONTACTS
SUBJECTS
Meeting Examination Doctor 15th Review Start Treatment #19 After Mas
1403 -
1403 - ..
1404 - Summary/Objective
1405 -
140501 - Follow up ref SDS D6 0000. ref SDS D3 0000.
140502 -
140503 - Clinical examination today was out of sequence on the 4th treatment in
140504 - the cycle. ref SDS 0 SM6M Shows subsiding and stable IBC rash, with
140505 - no new sites since treatment started 070201 on the cetuximab clinical
140506 - study. ref SDS 0 LB5L Recent redness and inflammation on the upper
140507 - left arm, and on the right chest below the collar bone may be side
140508 - effects of cetuximab, and not progression of IBC disease. ref SDS 0
140509 - 116J Doctor Rugo noticed a large blemish above the port catheter on
140510 - the right chest. She ordered a culture with a blood test. ref SDS 0
140511 - S640 This could be an infection caused by cetuximab. ref SDS 0 EZ8K
140512 - Cat bites have previously caused fever, inflammation and swelling of
140513 - skin, and Millie recently suffered this problem again. ref SDS 0 P67J
140514 - Results of blood tests were negative on the culture, and showed blood
140515 - counts NEUTS 1.87 (ANC 1870), continuing to strengthen the immune
140516 - system that helps resist cancer. ref SDS 0 VF5M
140517 -
140518 -
140519 -
140521 - ..
1406 -
1407 -
1408 - Progress
1409 -
140901 - Agenda Develop Work Plan Stage IV Breast Cancer 15 Mos after Mastectomy
140902 -
140903 - Follow up ref SDS D6 SM6M, ref SDS D3 SM6M.
140904 -
140905 - The meeting today was scheduled last week on 070412 to occur out of
140906 - sequence for the treatment protocol. ref SDS D8 FO6H
140908 - ..
140909 - This is the 15th physician meeting to treat the 3rd relapse of IBC
140910 - shown on 060711. ref SDS 82 8Y8I Normally meetings with Doctor Rugo
140911 - occur starting a new cycle, which will be next week. The doctor will
140912 - not be available next week, and so meets with Millie today, as planned
140913 - on 070412. ref SDS D8 FO6H Examination today evaluates patient status
140914 - starting the 19th treatment during the 10th chemotherapy cycle since
140915 - treatments began on 060721 for recurrent disease after mastectomy
140916 - surgery on 051021. ref SDS 72 E74F This is the 4th meeting scheduled
140917 - with Doctor Rugo, and occurs during the 3rd cycle and 12th treatment
140918 - with cetuximab, ref SDS E0 PR8Q, on a clinical study drug trial
140919 - ordered by the primary care physician on 070105. ref SDS A5 PK68
140921 - ..
140922 - Complete list of treatments for IBC 3rd relapse is reported in the
140923 - record of treatment following the meeting today. ref SDS E0 7T3H
140925 - ..
140926 - Agenda for meeting at UCSF on 070329 provides a structure for planning
140927 - the meeting today...
140928 -
140929 - 1. Coordination plan.............................. ref SDS 0 RM4G
140930 - 2. CA 15-3 33 improvement......................... ref SDS 0 GJ5M
140931 - 3. Lymphedema restricts exercise.................. ref SDS 0 4Y93
140932 - 4. Breast exam IBC stable subsides................ ref SDS 0 025H
140933 - 5. Measurable disease declines.................... ref SDS 0 M652
140934 - 6. Side effects minimal........................... ref SDS 0 TQ6L
140935 - 7. CT no distant metastasis, no test for PE....... ref SDS 0 EY5O
140936 - 8. Patient work up continue strategy.............. ref SDS 0 K36G
140937 - 9. Treatment plan weekly clinical trial........... ref SDS 0 PF3O
140938 - 10. Pulmonary emboli how serious r ventricle....... ref SDS 0 CV5L
140940 - ..
140941 - Scheduled next meeting for Thursday 070426 0800, reported in the
140942 - record on 070315. ref SDS C6 159O
140944 - ..
140945 - The doctor was assisted by (2) aides...
140946 -
140947 - 1. Brigid, Nurse Practitioner
140948 - 2. Jackie, Clinical Research Coordinator, coordinating
140949 -
140950 -
140951 -
140952 -
1410 -
SUBJECTS
Complex Patient History 44 Issues Overwhelms Span of Attention Drive
2203 -
220401 - ..
220402 - Complex Patient History Knowledge Management Dilemma Issues Grow 45
220403 -
220404 - Follow up ref SDS D6 LU3J, ref SDS D3 LU3J.
220405 -
220406 - Sampling of issues patient history diagnosis and treatment...
220407 -
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 core 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
220452 - 44. Rash intense .5" round rash about .75" above port catheter
220453 - 45. Sleep nap after cetuximab treatment fatigue accumulating
220454 -
220455 -
220456 -
220457 -
2205 -
SUBJECTS
Vitals Submitted by Doctor UCSF Blood Pressure Pulse Normal Low Anxi
2803 -
280401 - ..
280402 - Vitals Show Stable Medical Condition
280403 -
280404 - Follow up ref SDS D6 KB5L, ref SDS D3 KB5L.
280406 - ..
280407 - Bld Prssr Pulse Temp Weight SaO2
280408 - ..
280409 - 070419 1230............ 133 79 57 36.3c 98
280410 - 070419 1130............ 141 78 56 37.6c **1 99
280411 - 070419 0930............ 153 80 53 36.1c 147 100
280412 - 070330 1540............ 136 92 52 99.4 150 98
280413 - * 070329 0900............ 141 76 60 36.6c 99
280414 - * 070301 1505............ 112 69 86 36.6c 98
280415 - * 070130 1300............ 140 83 87 98
280416 - 070105 1040............
280417 - 061208 1226............ 152 90 76 97.8 147 99%
280418 - 061201 1430............ 123 76 76 97.5
280419 - 061110................. 136 83 73 97.0 150 98%
280420 - 061020 1534............ 140 79 67 99.8 151 97
280421 - 060929 1452............ 141 78 66 98.3
280422 - 060908 1335............ 139 79 73 98.1
280423 - 060814 1610............ 139 80 59 98.2
280424 - * 060808.................
280425 - 060711................. 172 87 54 97.5 147
280426 - 060623................. 141 87 71 98.0 147 99%
280427 - 060428................. 129 73 80 99.4 149 99%
280428 - 060217................. 153 81 61 98.6 150 99%
280429 -
280430 - * For some reason, vitals not submitted, use data from Infusion
280431 - Clinic during treatment.
280433 - ..
280434 - High blood pressure reflects pressure on patient about effectiveness
280435 - of new treatment and arrangements between UCSF and Kaiser for timely
280436 - care, discussed on 070130, ref SDS B0 Y642, and again on 070301.
280437 - ref SDS B8 Y642
280439 - ..
280440 - Today, Millie's vitals are normal, indicating reduced emotional strain
280441 - at this time, as discussed with Brigid on 070315, ref SDS C6 6A7J, and
280442 - reviewed again during the meeting today, per below, ref SDS 0 Y642,
280443 - reflecting changes in patient status reported on 070329. ref SDS D3
280444 - Y642
280445 -
280446 -
280447 -
280448 -
2805 -
SUBJECTS
Coordination Plan Communication UCSF Kaiser Collaboration Improve Di
6803 -
680401 - ..
680402 - Coordination Plan Divided Responsibilities Kaiser UCSF Referral
680403 - Collaboration Primary Care at Kaiser with UCSF Clinical Study Cetuximab
680404 -
680405 - Follow up ref SDS D6 RM4G, ref SDS D3 RM4G.
680406 -
680407 - Background on coordination plan to manage divided responsibilities
680408 - between Kaiser and referral to UCSF is reported on 070301. ref SDS B8
680409 - RM4G Case study on 070130 shows requirements for communication to
680410 - strengthen care. ref SDS B0 4T5N Coordination requirements are listed
680411 - on 070222. ref SDS B6 KL5G
680413 - ..
680414 - Coordination improved on 070406, when Brigid submitted CA 15-3 results
680415 - via email, ref SDS D7 EQ6I, for the blood test at UCSF on 070329.
680416 - ref SDS D4 2N5J
680418 - ..
680419 - On 070418, Millie reported appreciation to UCSF for improved
680420 - coordination. ref SDS D9 EQ6I
680422 - ..
680423 - At that time, on 070418 efforts to coordinate efficiently by sending
680424 - information quickly and accurately using email with links for
680425 - precision access that enables comprehensive review was tried again.
680426 - Millie submitted notice of new rash issues, ref SDS D9 PZ3P, observed
680427 - by the primary care physician during examination at Kaiser on 070330.
680428 - ref SDS D6 474O
680430 - ..
680431 - This morning Brigid was aware of new rash issues, and that Kaiser had
680432 - prescribed Keflex, but the rash subsided within a few hours, and so
680433 - medication was not taken, pending review by UCSF today, as set out in
680434 - Millie's letter on 070418. ref SDS D9 PZ3P This shows progress toward
680435 - strengthening coordination using email with precision access to
680436 - patient history. This aligns with using the computer in the
680437 - examination room for research on the Internet to verify cetuximab side
680438 - effects, discussed below. ref SDS 0 D39M
680440 - ..
680441 - Brigid also seemed to report during the meeting today being confused
680442 - following some of the links. This illustrates concerns Jackie cited
680443 - on 070329 that people may need orientation and initial assistance
680444 - using links for precision access. ref SDS D3 L55G On 000327, Doug
680445 - Engelbart reported similar experience. Introducing new systems at SRI
680446 - required persistant exposure and support. ref SDS 6 1530 Stuart
680447 - Harrow's work at DCMA on 020905 illustrates benefits of support
680448 - helping people transform to a new way of "working intelligently,"
680449 - ref SDS 15 DAPW, as defined in POIMS. ref OF 1 1X6G
680451 - ..
680452 - Feedback is a critical aspect of transformation, explained in POIMS,
680453 - ref OF 4 6M4K, and showing possible progress on strengthening
680454 - coordination at this time.
680456 - ..
680457 - Also, on 070418 Millie provided a link to side effects, ref SDS D9
680458 - PZ4W, listed in the record on 070329. ref SDS D4 QU8K There wasn't
680459 - enough time this morning for the medical team to access the list using
680460 - the computer in the examination room for comprehensive review of side
680461 - effects.
680462 -
680463 -
680464 -
6805 -
SUBJECTS
CA 15-3 33 Trend Falls Cetuximab Clinical Study Drug Trial Cancer Ma
7503 -
750401 - ..
750402 - CA 15-3 Cancer Marker 33 Showing Significant Improvement
750403 -
750404 - Follow up ref SDS D6 087J, ref SDS D3 087J.
750405 -
750406 - There was no blood draw today, because the meeting today is out of
750407 - sequence, reported above, ref SDS 0 SM6M, and citing work on 070412.
750408 - ref SDS D8 FO6H CA 15-3 will be tested next week on 070426, which is
750409 - the normal schedule starting a new cycle. The most recent test for
750410 - the breast cancer biomarker was on 070329, and results of CA 15-3 33
750411 - were received in a letter from UCSF a week later on 070406.
750412 - ref SDS D7 EQ6I
750414 - ..
750415 - Test Date Date Received
750416 - 070329......... 33 H............. 070406, ref SDS D7 EQ6I
750417 - 070301......... 36 H............. 070307, ref SDS B9 A16M
750418 - 070215......... 52 H............. 070307, ref SDS B4 ER5O
750419 - 070208......... 55 H............. 070307, ref SDS B4 ER5O
750420 - 070201.....cetuximab begins...... 070201, ref SDS B2 G68I
750421 - 070131......... 56 H............. 070202, ref SDS B3 087J
750422 - 070123......... 52 H............. 070202, ref SDS B3 087J
750423 - 070118......... 68 H............. 070123, ref SDS A9 GK5B
750424 - 070104......... 56 H............. 070110, ref SDS A6 087J
750425 - 061218......... 74 H............. 061227, ref SDS A0 6P9F
750426 - 061214......... 63 H............. 061227, ref SDS A0 6P9F
750427 - 061201....Pause treatments..... . 061201, ref SDS 96 GJ5M
750428 - 061130......... 67 H............. 061201, ref SDS 96 087J
750429 - 061116......... 66 H............. 061201, ref SDS 96 087J
750430 - 061110......... 56 H............. 061201, ref SDS 96 087J
750431 - 061109......... 61 H............. 061110, ref SDS 95 087J
750432 - 061026......... 57 H............. 061110, ref SDS 95 087J
750433 - 061019......... 56 H............. 061020, ref SDS 93 087J
750434 - 060928......... 51 H............. 060929, ref SDS 90 087J
750435 - 060907......... 68 H............. 060929, ref SDS 90 087J
750436 - 060813......... 73 H............. 060817, ref SDS 87 U24M
750437 - 060809......... 87 H............. 060810, ref SDS 86 2N5J
750438 - 060721..Taxotere capecitabine.... 060721, ref SDS 83 0001
750439 - 060708......... 71 H............. 060711, ref SDS 82 087J
750440 - 060616......... 63 H............. 060623, ref SDS 81 UQ5Q
750441 - 060522......... 59 H............. 060605, ref SDS 80 UQ5Q
750442 - 060501......... 49 H............. 060522, ref SDS 79 MC4F
750443 - 060421......... 44 H............. 060428, ref SDS 77 087J
750444 - 060330......... 40 H............. 060428, ref SDS 77 087J
750445 - 060303......... 36............... 060428, ref SDS 77 087J
750446 - 060210......... 33............... 060217, ref SDS 76 087J
750447 - 060109......... 34............... 060126, ref SDS 75 KV59
750448 - 051223......... 34............... 060106, ref SDS 74 087J
750449 - 051202......... 28............... 060106, ref SDS 74 087J
750450 - 051116......... 31............... 051121, ref SDS 73 087J
750451 - 051109......... 30............... 051121, ref SDS 73 087J
750452 - 051102......... 34............... 051121, ref SDS 73 087J
750453 - 051021..Mastectomy surgery....... 051021, ref SDS 72 0001
750454 - 050916...end treatment........... 050916, ref SDS 70 407N
750455 - 050909......... 45 H............. 051007, ref SDS 71 087J
750456 - 050826......... 45 H............. 050913, ref SDS 69 087J
750457 - 050819......... 45 H............. 050913, ref SDS 69 087J
750458 - 050812......... 39 .............. 050819, ref SDS 68 3K6L
750459 - 050729......... 45 H............. 050819, ref SDS 68 EA5G
750460 - 050708......... 46 H............. 050729, ref SDS 67 087J
750461 - 050701......... 37 .............. 050729, ref SDS 67 087J
750462 - 050617......... 45 H............. 050729, ref SDS 67 087J
750463 - 050527......... 56 H............. 050610, ref SDS 65 087J
750464 - 050512......... 67 H............. 050520, ref SDS 63 087J
750465 - 050506......... 80 H............. 050520, ref SDS 63 087J
750466 - ..
750467 - 050415.........105 H............. 050422, ref SDS 62 087J
750468 - 050415..Taxoter capecitabie begin 050415, ref SDS 61 407N
750469 - 050325.........100 H............. 050329, ref SDS 60 087J
750470 - 050318.........101 H............. 050325, ref SDS 59 2N5J
750471 - 050304......... 88 H............. 050311, ref SDS 57 087J
750472 - 050225......... 95 H............. 050308, ref SDS 56 0001
750473 - 050211......... 78 H............. 050214, ref SDS 55 02BB
750474 - 050128......... 67 H............. 050204, ref SDS 53 087J
750475 - 050104...AC start treatment...... 050104, ref SDS 52 407N
750476 - 041228......... 56 H............. 041230, ref SDS 51 087J
750477 - 041204......... 43 H............. 041210, ref SDS 50 087J
750478 - 041021...Taxol bevczmb ends...... 041021, ref SDS 47 0001
750479 - 041007......... 39............... 041104, ref SDS 48 087J
750480 - 040923......... 49 H............. 041005, ref SDS 46 087J
750481 - 040908......... 44 H............. 040909, ref SDS 45 087J
750482 - 040825......... 47 H............. 040909, ref SDS 45 087J
750483 - 040811......... 42 H............. 040812, ref SDS 44 087J
750484 - 040728......... 43 H............. 040729, ref SDS 42 2N5J
750485 - 040712......... 47 H............. 040713, ref SDS 41 087J
750486 - 040614......... 55 H............. 040615, ref SDS 40 PX6X
750487 - 040517......... 78 H............. 040601, ref SDS 38 2N5J
750488 - 040420...Taxol bevczmb starts.... 040420, ref SDS 36 9Z5J
750489 - 040311......... 70 H............. 040318, ref SDS 31 SM6M
750490 - 040205......... 60 H............. 040211, ref SDS 28 SM6M
750491 - 031201......... 62 H............. 031205, ref SDS 27 SM6M
750492 - 030912......... 66 H............. 030915, ref SDS 26 SM6M
750493 - 030708......... 68 H............. 030710, ref SDS 25 SM6M
750494 - 030503......... 54 H............. 030508, ref SDS 23 SM6M
750495 - 030403......... 45 H............. 030508, ref SDS 23 SM6M
750496 - 030215......... 46 H............. 030220, ref SDS 22 5E6L
750497 - 030106......... 37 H............. 030109, ref SDS 21 SM6M
750498 - 021204..Adjuvant chemo ends...... 021204, ref SDS 20 SQ5I
750499 - 021202......... 41 H?............ 021204, ref SDS 20 SP5G
750500 - 021111......... 36 H?............ 021113, ref SDS 19 Y65I
750501 - 021023......... 33 H?............ 021023, ref SDS 18 SQ5I
750502 - 020930......... 33 H?..39........ 021002, ref SDS 17 SQ5I
750503 - 020917......... 36 H?............ 020924, ref SDS 16 SQ5I
750504 - 020717......... 59 H?............ 020726, ref SDS 14 YN5K
750505 - 020629......... 75 H ............ 020705, ref SDS 13 UX6I
750506 - 020608........ 67 H ............ 020614, ref SDS 12 0001
750507 - 020603........ 108 H ............ 020607, ref SDS 11 X67F
750508 - 020511........ 117 H ............ 020603, ref SDS 10 PJ4J
750509 - 020419......... 81 H ............ 020430, ref SDS 9 7N5H
750510 - 020321......... 85 H ............ 020405, ref SDS 8 6T8K
750511 -
750512 -
750513 -
750514 -
750516 - ..
7506 -
7507 -
7508 - Analysis
7509 -
750901 - CA 15-3 33 Cancer Marker Strong Response to Treatment Cetuximab
750902 -
750903 - Follow up ref SDS D6 GJ5M, ref SDS D3 GJ5M.
750905 - ..
750906 - Patient history applying CA 15-3 is shown in a case study on 030710.
750907 - ref SDS 25 IA7H
750909 - ..
750910 - Doctor Rugo was pleased by dramatic decline in CA 15-3 33, per above,
750911 - ref SDS 0 087J, since examination on 070301, when IBC rash was
750912 - expanding, and elevated cancer marker diagnostics seemed to indicate
750913 - failed treatment. ref SDS B8 464O Examination today showing IBC rash
750914 - continues to subside, ref SDS 0 M68J, will be cross-checked with the
750915 - cancer marker for the blood test next week to start cycle 4.
750916 -
750917 - [On 070426 CA 15-3 29 continues decline to lowest level of
750918 - sustained indications for recovery, and aligns with continued
750919 - decline of IBC rash intensity. ref SDS E1 GJ5M
750920 -
750921 -
750922 -
750923 -
750924 -
7510 -
SUBJECTS
Lymphadenopathy Axillary No Findings Left Arm Patient No Complaint S
8303 -
830401 - ..
830402 - Axillary Left Arm No Lymphadenopathy Lymphedema Prominent
830403 - Lymphadenopathy Axillary Left Arm No Evidence Local Edema
830404 -
830405 - Follow up ref SDS D6 MW8J, ref SDS D3 MW8J.
830406 -
830407 - Patient has a long history of IBC on the left breast and associated
830408 - lymphadenopathy symptoms in the left axillary, see case study on
830409 - 040517. ref SDS 37 OW3I
830411 - ..
830412 - Brigid examined the left axilla. Clinical palpation made no findings
830413 - of lumps or other indications of cancer, including swelled lymph nodes
830414 - that might indicate lymphadenopathy. The patient made no complaint of
830415 - lumps or discomfort from swelling under the left arm. This aligns
830416 - with CT test on 070326 showing no findings of lymphadenopathy,
830417 - reported on 070329, ref SDS D3 12GK, although, there is no express
830418 - finding that the analyst actually looked at the left and right
830419 - axillary.
830420 -
830421 -
830422 -
8305 -
SUBJECTS
Lymphedema Swelling Persistent Left Arm Upper Erratic Intensity Rash
A103 -
A10401 - ..
A10402 - Lymphedema Cellulitis Complications Left Arm Swelling
A10403 - Swelling Left Arm Lymphedema Cellulitis Complications
A10404 - Left Arm Lymphedema Cellulitis Complications Swelling Above Normal
A10405 - Cellulitis Lymphedema Complications Left Arm Swelling Above Normal
A10406 -
A10407 - Follow up ref SDS D6 4Y93, ref SDS D3 4Y93.
A10408 -
A10409 - Medical history of lymphedema in the left arm is reported in a case
A10410 - study on 070130. ref SDS B0 VX6F
A10412 - ..
A10413 - The left arm today has continued swelling from lymphedema. Recent
A10414 - measurement below the elbow was 11.25 inches, down slightly, but
A10415 - increased above previous norms reported in a study on 060509.
A10416 - ref SDS 78 HO7F
A10418 - ..
A10419 - There wasn't enough time again today for discussing correlations
A10420 - between exercise to strengthen the immune system that resists cancer,
A10421 - and helps dissipate emotional stress, reviewed at UCSF on 070315,
A10422 - ref SDS C6 6A7J, but may compound lymphedema with increased swelling,
A10423 - and complications of Cellulitis, discussed at UCSF on 070222.
A10424 - ref SDS B6 GG4H Lymphedema and Cellulitis in relation to side effects
A10425 - on the cetuximab clinical study are shown below. ref SDS D3 M84I
A10427 - ..
A10428 - Brigid had reviewed Millie's letter on 070418, ref SDS D9 PZ3P,
A10429 - discussed, also, in connection with improved coordination, above,
A10430 - ref SDS 0 DI7M, and notifying UCSF that on 070330 the primary care
A10431 - physician at Kaiser observed significantly increased rash inflammation
A10432 - intensity on the upper left arm, ref SDS D6 N19J, and new inflammation
A10433 - of high intensity above the right breast and below the colar bone, per
A10434 - below. ref SDS 0 583G Brigid was aware that at that time Millie had a
A10435 - slight fever of 99.4, ref SDS D6 7C8G, and that Kaiser prescribed
A10436 - Keflex medication to treat for Cellulitis, ref SDS D6 474O, but the
A10437 - rash subsided within a few hours after examination, and so Keflex
A10438 - medication was not taken. ref SDS D6 KZ6L
A10439 -
A10440 - [On 070426 examination shows reduced IBC rash and no signs of
A10441 - inflammation due to cetuximab side effects nor Cellulitis, cat
A10442 - bite, etc. ref SDS E1 115F
A10444 - ..
A10445 - Brigid examined the upper left arm today, and found intensity of
A10446 - inflammation has continued to subside, indicating response to
A10447 - treatment for IBC, which extends progress reported during examination
A10448 - on 070329, ref SDS D3 527G, as discussed below. ref SDS 0 527G Doctor
A10449 - Rugo later made examination, and concurred that no change in treatment
A10450 - is required.
A10452 - ..
A10453 - Millie asked about possibility that erratic inflammation on the left
A10454 - arm and upper right chest observed at Kaiser, and then subsided within
A10455 - a few hours, and not seen at UCSF today, might be side effects of
A10456 - cetuximab treatment for IBC, cited in the record meeting at UCSF on
A10457 - 070329? ref SDS D3 M84I Jackie recalled that UCSF submitted a list of
A10458 - side effects from cetuximab treatments in a letter to Millie on
A10459 - 070116, as part of the clinical study consent documentation.
A10460 - ref SDS A7 RT7K
A10462 - ..
A10463 - Review of cetuximab drug trial Consent showed...
A10464 -
A10465 - Cetuximab causes skin reactions such as an acne-like rash,
A10466 - drying, cracking, inflammation and infections. ref SDS A7
A10467 - MH4Q
A10469 - ..
A10470 - Millie sent a letter to UCSF the next day on 070117 requesting
A10471 - comments on issues presented by consent documents, ref SDS A8 HT3Q,
A10472 - and listed in the review on 070116. One issue was cetuximab side
A10473 - effects in relation to Inflammatory Breast Cancer IBC. ref SDS A7 MH4Q
A10474 - On 070130 discussion at UCSF seemed to indicate that rash side effects
A10475 - from cetuximab only occur on the face. ref SDS B0 RN8O
A10477 - ..
A10478 - Possibly inflammation and infection side effects of cetuximab could
A10479 - compound or otherwise intensify inflammation that occurs in skin
A10480 - infected with IBC?
A10481 -
A10482 - [On 070426 examination shows reduced IBC rash and no signs of
A10483 - inflammation due to cetuximab side effects nor Cellulitis, cat
A10484 - bite, etc. ref SDS E1 115F
A10486 - ..
A10487 - Brigid noted that research on the Internet, per below, ref SDS 0 D39M,
A10488 - indicates skin rash side effects of cetuximab only occur on the face,
A10489 - as discussed on 070130, and so cannot intensify IBC rash inflammation
A10490 - on the upper left arm, nor otherwise cause inflammation rash on the
A10491 - upper right chest observed at Kaiser on 070330, per above. ref SDS 0
A10492 - 115F
A10493 -
A10495 - ..
A10496 - Redness Swelling Inflammation Side Effects Cetuximab
A10497 -
A10498 - Additional research on the Internet shows...
A10499 -
A10500 - About Drug Finder
A10501 - Cetuximab
A10502 - Patient Education
A10503 -
A10504 - http://gsm.about.com/compact/showtext.asp?cpnum=2710&monotype=full&gname=Cetuximab&r=6078
A10506 - ..
A10507 - Cetuximab commonly causes skin reactions including a rash that
A10508 - looks like acne, skin dryness and cracking, redness, swelling
A10509 - and other signs of inflammation that can result in skin
A10510 - infections. These reactions may require treatment with
A10511 - antibiotics.
A10513 - ..
A10514 - This seems very close to language in the cetuximab Consent documents,
A10515 - per above, ref SDS 0 F57K, and could be interpretted to indicate that,
A10516 - besides acne-like rash on the face, in some cases cetuximab causes
A10517 - "redness, swelling, and other signs of inflammation," at locations
A10518 - other than the face, including observations at Kaiser on 070330 during
A10519 - examination of the upper left arm, ref SDS D6 N19J, and on the upper
A10520 - right chest, ref SDS D6 583G, as reported to UCSF on 070418, per
A10521 - above. ref SDS 0 115F
A10523 - ..
A10524 - For example, on 070329 Millie reported cetuximab side effects of dry
A10525 - skin on the face, and also on the chest, arms, and back, which has
A10526 - been relieved with treatment prescribed by UCSF. ref SDS D4 JS6M
A10528 - ..
A10529 - This record suggests that erratic rash observed at Kaiser could be a
A10530 - side effect of cetuximab treatment, but is unknown. At this time, the
A10531 - rash has subsided, as occurred previously reported in Nurses Notes on
A10532 - 070315. ref SDS C6 KU3L
A10534 - ..
A10535 - There was no discussion today of taking a biopsy to diagnose issues
A10536 - arrising from this rash, per below. ref SDS 0 KT7J
A10537 -
A10538 -
A10539 -
A10540 -
A10541 -
A106 -
SUBJECTS
Computer Examination Room Intelligence Support UCSF Internet Researc
AB03 -
AB0401 - ..
AB0402 - Intelligence Support Computer Examination Room UCSF Internet Research
AB0403 - Computer Examination Room Intelligence Support UCSF Internet Research
AB0404 - UCSF Internet Research Computer Examination Room Intelligence Support
AB0405 -
AB0406 - During the meeting today, Brigid used the computer in the examination
AB0407 - room to check the Internet for cetuximab side effects.
AB0409 - ..
AB0410 - Skills using computers to access Internet sources facilitate working
AB0411 - intelligently with precision access that strengthens coordination,
AB0412 - case management, and collaboration within the doctor/patient
AB0413 - partnership model, per above. ref SDS 0 DI9F
AB0414 -
AB0415 -
AB0416 -
AB0417 -
AB05 -
SUBJECTS
Cat Bite Symptoms Cancer Chemotherapy Case Study Fever Low Blood Cou
B503 -
B50401 - ..
B50402 - Cat Bite Erratic Inflammation Fever Low Blood Counts
B50403 -
B50404 - Ruling out side effects of cetuximab, ref SDS 0 D39M, and also that
B50405 - rising inflammation is not rising IBC rash, per below, ref SDS 0 527G,
B50406 - may point to other trauma which has historically caused erratic rash
B50407 - and inflammation reactions, as occurred on Millie's upper left arm,
B50408 - along with slight fever found during examination at Kaiser on 070330,
B50409 - per above. ref SDS 0 115F
B50411 - ..
B50412 - An example is cat bites.
B50414 - ..
B50415 - Millie had a cat bite 3 - 4 weeks ago. She had another cat bite a few
B50416 - days prior to examination at UCSF when no rash was observed, but was
B50417 - seen the next day at Kaiser on 070330. Millie also suffered a
B50418 - household accident cutting herself with a small knife preparing dinner
B50419 - during this period. At least one of these incidents took a matter of
B50420 - hours to stop bleeding, though the rate was very mild, and so medical
B50421 - assitance was not requested. Prolonged bleeding may reflect treatment
B50422 - for pulmonary embolism with Coumadin.
B50423 -
B50424 - [On 070426 examination shows reduced IBC rash and no signs of
B50425 - inflammation due to cetuximab side effects nor Cellulitis, cat
B50426 - bite, etc. ref SDS E1 115F
B50428 - ..
B50429 - [On 070612 Millie suffered another cat bite while recovering from
B50430 - Cellulitis and fever. ref SDS E4 6G7N
B50432 - ..
B50433 - Patient history shows cat bites while getting chemotherapy have caused
B50434 - delayed Cellulitis-like symptoms of temperature, inflammation,
B50435 - swelling, low blood counts, and pain, including hospitalization...
B50436 -
B50437 - 1. Cellulitis treated Emergency Room
B50438 - rash spreads above left brast toward
B50439 - neck, elevated temperature diagnosed
B50440 - side effect of medication prescribed
B50441 - to treat wound from punch biopsy
B50442 - on 040419 to diagnose IBC, and had
B50443 - gotten worse with rise of IBC
B50444 - after ending treatment on
B50445 - 041104............................. 041202, ref SDS 49 0001
B50447 - ..
B50448 - 2. Cat bite right hand, emergency
B50449 - treatment, hospitalized 4 days
B50450 - temperature, swelling,
B50451 - pain in arm........................ 050212, ref SDS 54 0001
B50453 - ..
B50454 - Inflammation, low blood counts,
B50455 - fever.............................. 050212, ref SDS 54 I34W
B50457 - ..
B50458 - 3. Broken finger left hand on 060914
B50459 - diagnosed in emergency room as
B50460 - causing Cellulitis 6 weeks later
B50461 - with elevated temperature, and
B50462 - severe swelling and inflammation
B50463 - entire left
B50464 - arm................................ 061027, ref SDS 94 0001,
B50466 - ..
B50467 - 4. Cellulitis relapse following cat
B50468 - bite 2 weeks earlier............... 061203, ref SDS 97 MF9H
B50469 - left arm swollen, inflammation,
B50470 - fatigue, slight
B50471 - temperature........................ 061203, ref SDS 97 5X3N
B50473 - ..
B50474 - 5. Cat bite inflammation upper left
B50475 - arm IBC rash upper right chest
B50476 - below collar bone infection above
B50477 - port catheter upper right
B50478 - chest.............................. 061203, ref SDS 0 P67J
B50480 - ..
B50481 - 6. Cat bites in March may cause erratic
B50482 - inflammation and fever compounding
B50483 - side effects of cetuximab
B50484 - treatments at UCSF................. 070419, ref SDS 0 P67J
B50486 - ..
B50487 - 7. Cat bites in March and April may have
B50488 - caused delayed reaction sudden reversal
B50489 - and falling blood counts below the
B50490 - level of safety for receiving
B50491 - treatments......................... 070426, ref SDS E1 G23M
B50493 - ..
B50494 - As a precaution, more related to investigating a new blemish on the
B50495 - right side of the chest above the port catheter, the doctor ordered an
B50496 - interim blood test today, mostly to perform a culture study on the
B50497 - port catheter, discussed further below. ref SDS 0 583G
B50498 -
B50499 -
B50500 -
B50501 -
B50502 -
B50503 -
B506 -
SUBJECTS
IBC Left Arm Examination Stable Subsides Rash Less Intense Responds
BJ03 -
BJ0401 - ..
BJ0402 - IBC Left Arm Stable Subsiding Responds Treatment Cetuximab Drug Trial
BJ0403 - Left Arm IBC Stable Subsiding Responds Treatment Cetuximab Drug Trial
BJ0404 -
BJ0405 - Follow up ref SDS D6 527G, ref SDS D3 527G.
BJ0406 -
BJ0407 - There was no evidence today of increased rash intensity on the upper
BJ0408 - left arm, as observed at Kaiser on 070330, and diagnosed at that time
BJ0409 - as Cellulitis, per above. ref SDS 0 115F Research today indicating
BJ0410 - redness and inflammation are, also, side effects of cetuximab, which
BJ0411 - may cause short term compounding appearance of rash on the upper left
BJ0412 - arm, without progression of IBC, per above. ref SDS 0 RA5F As well,
BJ0413 - Millie suffered a cat bite within the past month or so. Patient
BJ0414 - history shows erratic changes in inflammation, and temperature due to
BJ0415 - infection, that may compound appearance of IBC rash. ref SDS 0 P67J
BJ0416 - Falling CA 15-3 cancer marker, and appearance of subsiding IBC rash
BJ0417 - today, support conclusion other factors caused short-term increase of
BJ0418 - intensity on 070330 for IBC rash on upper left arm observed at Kaiser.
BJ0419 - Doctor Rugo and the medical team at Kaiser have done an excellent job
BJ0420 - addressing "wicked problems" presented by multiple diagnosis issues,
BJ0421 - discussed further below. ref SDS 0 VF5M
BJ0423 - ..
BJ0424 - Examination today indicates the size of IBC rash on the upper left arm
BJ0425 - has been stable, and intensity stable to subsiding, i.e., improving by
BJ0426 - responding to treatment, since the prior examination at UCSF on
BJ0427 - 070329. ref SDS D3 527G
BJ0429 - ..
BJ0430 - Aligns with declining measurable disease cancer marker CA 15-3, per
BJ0431 - above. ref SDS 0 UZ8N
BJ0433 - ..
BJ0434 - Since today does not start a new treatment cycle, per above,
BJ0435 - ref SDS 0 SM6M, Jackie did not take photographs for measurable
BJ0436 - disease. She explained photographs will be taken next week to begin
BJ0437 - cycle 4.
BJ0438 -
BJ0439 -
BJ0440 -
BJ05 -
SUBJECTS
Right Axillary Lymphadenopathy No Findings Right Arm Patient No Comp
BR03 -
BR0401 - ..
BR0402 - Right Axillary Possible Involvement Red Rash Spreads Right Breast
BR0403 -
BR0404 - Follow up ref SDS D6 3D6K, ref SDS D3 3D6K.
BR0405 -
BR0406 - Background on patient history testing for lymphadenopathy in the right
BR0407 - axilla is reported in the record on 060929. ref SDS 90 3D6K
BR0409 - ..
BR0410 - Examination of the right axillary yielded same negative results
BR0411 - finding no evidence of lymphadenopathy, as occurred examining the left
BR0412 - axilla, per above. ref SDS D3 VU6O Also aligns with CT test on
BR0413 - 070326, reviewed on 070329. ref SDS D3 12GK
BR0414 -
BR0415 -
BR0416 -
BR0417 -
BR05 -
SUBJECTS
Right Arm Examination Rash Slight Blemishes No Evidence IBC No Findi
BY03 -
BY0401 - ..
BY0402 - IBC Right Arm New Minimal Red Rash Not Diagnosed IBC or Cellulitis
BY0403 -
BY0404 - Follow up ref SDS D6 H15M, ref SDS D3 H15M.
BY0405 -
BY0406 - Background on slight red dots, rash or blemishes on the right arm is
BY0407 - reported on 070301. ref SDS B8 H15M Examination at that time
BY0408 - concluded the rash is not IBC. Further examination on 070315 reached
BY0409 - the same conclusion, ref SDS C6 FO6H, supported by another review on
BY0410 - 070322. ref SDS C7 LI4M
BY0412 - ..
BY0413 - Examination today yielded no change in analysis that IBC has not
BY0414 - spread to the right arm, and Cellulitis has not occurred in the right
BY0415 - arm. Similarly, there is no evidence of side effects in the right arm
BY0416 - from cetuximab treatment for IBC, reported on 070329. ref SDS D3 MF6I
BY0417 -
BY0418 -
BY0419 -
BY0420 -
BY0421 -
BY05 -
SUBJECTS
IBC Right Breast Examination Stable Subsides Rash Less Intense Respo
C703 -
C70401 - ..
C70402 - Right Breast Red Rash Spreads Possible Involvement Right Axillary
C70403 - Red Rash Right Breast Spreads Possible Involvement Right Axillary
C70404 -
C70405 - Follow up ref SDS D6 W58J, ref SDS D3 T99I.
C70407 - ..
C70408 - On 061204 IBC inflammation spread from the left chest area infected
C70409 - with IBC across the sternum and slightly onto the right breast.
C70410 - ref SDS 98 AE5I Since that time, IBC rash has spread no further. It
C70411 - became more intense through January, and then intensity of the rash
C70412 - has continued to subside with treatment.
C70414 - ..
C70415 - Examination of right breast today shows reduced intensity of IBC rash,
C70416 - and there is no spreading of the rash, suggesting favorable response
C70417 - to treatment. Declining CA 15-3 33 cancer marker reported today for
C70418 - the blood test on 070329, per above, ref SDS 0 087J, aligns with
C70419 - visual impression today of subsiding IBC.
C70421 - ..
C70422 - Since today does not start a new treatment cycle, per above,
C70423 - ref SDS 0 SM6M, Jackie did not take photographs for measurable
C70424 - disease. She explained photographs will be taken next week to begin
C70425 - cycle 4.
C70426 -
C70427 -
C70428 -
C70429 -
C70430 -
C705 -
SUBJECTS
Rash Chest Right Side Above Breast Below Collar Bone Above Port Cath
CH03 -
CH0401 - ..
CH0402 - Right Chest Rash Not Visible Above Breast and Port Catheter
CH0403 - Rash Above Port Catheter on Right Upper Chest Not Visible Today
CH0404 -
CH0405 - Follow up ref SDS D6 583G, ref SDS D3 583G.
CH0406 -
CH0407 - Nurse's Notes for treatment on 070315 in the Infusion Clinic report
CH0408 - rash above the port catheter on the right side of the chest, and well
CH0409 - above the right breast, just below the collar bone. This condition
CH0410 - was not previously reported at Kaiser nor UCSF. Following review of
CH0411 - Nurse's Notes, there was no evident rash observed by the patient.
CH0412 - ref SDS C6 KU3L A week later, on 070322 Nurse's Notes for treatment
CH0413 - report no continuing inflammation at this location. ref SDS C7 KU3L
CH0415 - ..
CH0416 - Case study on 070130 shows erratic changes in severity/intensity of
CH0417 - IBC rash on the left chest area, which led to referral to UCSF.
CH0418 - ref SDS B0 5N6L Possible correlation with cat bites with rash and
CH0419 - fever are listed in a case study, above. ref SDS 0 P67J
CH0421 - ..
CH0422 - This morning, Brigid had reviewed Millie's letter on 070418,
CH0423 - ref SDS D9 PZ3P, and was prepared to discuss the approximate 2" x 1"
CH0424 - oval red rash on the right chest and just below the collar bone that
CH0425 - was observed during examination at Kaiser on 070330, along with
CH0426 - increased intensity of inflammation on the left arm, and which had
CH0427 - fully subsided, i.e., was no longer visible on the right chest, within
CH0428 - a few hours, per above. ref SDS 0 115F
CH0430 - ..
CH0431 - Like examination of the left arm finding no increased rash intensity,
CH0432 - also, per above, ref SDS 0 116J, examination today observed no
CH0433 - identifiable rash or inflammation above the port catheter area and
CH0434 - below the collar bone on the right chest. Skin coloration and texture
CH0435 - appear normal today in all respects, similar to the left arm that now
CH0436 - appears "normal" for mild IBC rash that was diagnosed on 070222, and
CH0437 - observed again this morning to have subsiding intensity, per above.
CH0438 - ref SDS 0 116J
CH0440 - ..
CH0441 - Erratic rash on the upper right chest, first observed by the nurse on
CH0442 - 070315, and then again 2 weeks later at Kaiser on 070330, and quickly
CH0443 - subsided presents possibility that cetuximab side effects of redness
CH0444 - and inflammation were factors, as discussed above, ref SDS 0 F57K,
CH0445 - including research on the Internet that Brigid did during the meeting
CH0446 - today, ref SDS 0 D39M, along with post-meeting supplemental research,
CH0447 - also, listed above. ref SDS 0 RA5F
CH0449 - ..
CH0450 - Cetuximab side effects are further discussed below. ref SDS 0 TQ6L
CH0452 - ..
CH0453 - There was no discussion today of taking a biopsy to diagnose issues
CH0454 - arrising from this rash, per below. ref SDS 0 KT7J
CH0455 -
CH0456 -
CH0457 -
CH0458 -
CH0459 -
CH05 -
SUBJECTS
Right Chest Blemish Port Catheter .75" Above Infection .5" Diameter
CU03 -
CU0401 - ..
CU0402 - Port Catheter Infection Blemish Right Chest Blood Culture Investigate
CU0403 -
CU0404 - Follow up ref SDS D3 BI5K.
CU0405 -
CU0406 - Today the entry to the port catheter shows mild inflammation that
CU0407 - appears like a skin blemish, but seems more prominent today than
CU0408 - usual.
CU0409 -
CU0410 - [On 070426 Nurse's Notes for treatment in the Infusion Clinic note
CU0411 - redness at the port site. ref SDS E2 LX7H
CU0413 - ..
CU0414 - The doctor further noticed during the examination an approximate .5"
CU0415 - diameter blemish, rash or inflammation of the skin centered about .75"
CU0416 - directly above the port catheter, and perhaps .75" to the right of the
CU0417 - inflammation below the collar bone discussed above. ref SDS 0 FE5O
CU0419 - ..
CU0420 - Observations today align with examination on 070329. At that time,
CU0421 - Brigid reported a few blemishes on the right chest with reddish
CU0422 - coloration. ref SDS D3 BI5K
CU0424 - ..
CU0425 - Considerations of cetuximab side effects that cause infection,
CU0426 - redness, and inflammation were not discussed, per above discussing
CU0427 - previous observations of inflammation on left arm, ref SDS 0 F57K,
CU0428 - similar to not discussing erratic rash to skin area left of this
CU0429 - blemish, per above. ref SDS 0 583G
CU0431 - ..
CU0432 - Cetuximab side effects are further discussed below. ref SDS 0 TQ6L
CU0434 - ..
CU0435 - There was no discussion today of taking a biopsy to diagnose issues
CU0436 - arrising from this rash/inflammation/infection, per below. ref SDS 0
CU0437 - KT7J
CU0439 - ..
CU0440 - The port was installed at Kaiser on 040419 to start treatments with
CU0441 - bevacizumab on the Avastin clinical drug trial. ref SDS 35 0001
CU0443 - ..
CU0444 - Since the port is accessed once a week, prolonged use and frequency
CU0445 - may be causing slight irritation or infection that presents mild and
CU0446 - small areas of redness and inflammation. The doctor noted that the
CU0447 - other, now, .5" blemish above the port has no evident explanation.
CU0449 - ..
CU0450 - FDA reports side effects of cetuximab include skin inflammation and
CU0451 - infection, per below. ref SDS 0 WR4O
CU0453 - ..
CU0454 - Consideration might be given to notifying the surgeon, who installed
CU0455 - the port, for comments and examination.
CU0457 - ..
CU0458 - Millie asked if the blemish above the port catheter could be part of
CU0459 - the port catheter that runs beneath the skin toward the neck, and for
CU0460 - some reason shows irritation only at this isolated location? The tube
CU0461 - from the port catheter is evident to the touch that connects the
CU0462 - entery point to the blemish .75" above. Might this other blemish that
CU0463 - this week has increased slightly with inflammation be another
CU0464 - manifestation of cetuximab side effects that cause skin redness and
CU0465 - inflammation, per research above? ref SDS 0 RA5F
CU0467 - ..
CU0468 - Doctor Rugo ordered a "culture" to investigate this issue.
CU0470 - ..
CU0471 - Brigid prepared an order for a blood test, which Millie hand carried
CU0472 - to the Infusion Clinic after the examination, reported in another
CU0473 - record. Results of the blood test did not diagnose a medical problem
CU0474 - that requires treatment. Millies blood counts show continued
CU0475 - improvement with NEUTS rising to 1.87 (ANC - 1870), per below.
CU0476 - ref SDS 0 VF5M
CU0477 -
CU0478 - [On 070426 no evident inflammation at this location; problem
CU0479 - resolved itself without treatment; UCSF reported results of blood
CU0480 - culture were negative. ref SDS E2 UJ4M
CU0482 - ..
CU0483 - Later in the day, the .5" diameter rash above the port subsided to
CU0484 - more of a small blemish, or large "dot." Over the next day this nearly
CU0485 - disappeared, similar to the rash below the collar bone that appeared
CU0486 - on 070330 and then completely disappeared within a few hours, per
CU0487 - above. ref SDS 0 FE5O
CU0488 -
CU0489 -
CU0490 -
CU0491 -
CU0492 -
CU05 -
SUBJECTS
Left Supraclavicular Examination Palpation Neck Lymphadenopathy No F
D203 -
D20401 - ..
D20402 - Left Supraclavicular Examination PET Test Report Finding SUV 4.5
D20403 - Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
D20404 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
D20405 -
D20406 - Follow up ref SDS D6 8R6M, ref SDS D3 8R6M.
D20407 -
D20408 - During examination on 070130, Doctor Rugo asked about history of
D20409 - radiation to the neck, and sequence of finding recurrence from Doctor
D20410 - Laio's biopsy reported on 040309. ref SDS 29 0001 Background of image
D20411 - testing, and consideration for radiation treatment of left
D20412 - supraclavicular is reported on 060623. ref SDS 81 8R6M
D20414 - ..
D20415 - Like the left and right axillary locations, examination today for
D20416 - cancer in left supraclavicular region found no evidence of lumps or
D20417 - other indications of lymphadenopathy, as reported above. ref SDS 0
D20418 - VU6O CT test on 070326 shows no findings of lymphadenopathy, reported
D20419 - during examination on 070329. ref SDS D3 12GK There is no express
D20420 - finding in the CT test report that the analyst actually looked at the
D20421 - left and right supraclavicular.
D20422 -
D20423 -
D20424 -
D205 -
SUBJECTS
IBC Left Breast Examination 2 Scenarios End Stable Area No New Sites
DJ03 -
DJ0401 - ..
DJ0402 - 2 Scenarios Conflict IBC Expanding Intensity Subsides
DJ0403 - IBC Rash Left Breast Stomach and Back Seems to Be Subsiding
DJ0404 - Examination IBC Rash Subsiding Responding to Treatment Cetuximab
DJ0405 - Cetuximab Effective Treatment IBC Subsiding Left Breast Stomach Back
DJ0406 -
DJ0407 - Follow up ref SDS D6 025H, ref SDS D3 025H.
DJ0408 -
DJ0409 - Background of IBC 3rd relapse on left breast beginning on 060623, and
DJ0410 - treatment with Taxotere and capecitabine ending on 061201, with
DJ0411 - subsequent progression of disease spreading to other areas is reported
DJ0412 - on 070301. ref SDS B8 025H
DJ0414 - ..
DJ0415 - Case study on 070130 shows erratic changes in severity/intensity of
DJ0416 - IBC rash on left chest area, with referral to UCSF. ref SDS B0 5N6L
DJ0418 - ..
DJ0419 - All case studies for Millie's patient history are listed on 061018.
DJ0420 - ref SDS 92 0001
DJ0422 - ..
DJ0423 - Cetuximab treatment started at UCSF on 070201. ref SDS B2 G68I
DJ0425 - ..
DJ0426 - Strategy for treating progression of disease was reviewed on 070301.
DJ0427 - ref SDS B8 1T4O
DJ0429 - ..
DJ0430 - Examination today shows intensity of IBC rash continues to subside or
DJ0431 - remains stable, and there is no evident expansion of IBC rash areas,
DJ0432 - and further there are no new IBC rash sites, as listed on 070301.
DJ0433 - ref SDS B8 4140 The current condition today is...
DJ0434 -
DJ0435 - left breast chest................. 060623, ref SDS 81 025H
DJ0436 - right breast...................... 061204, ref SDS 98 AE5I
DJ0437 - stomach........................... 070130, ref SDS B0 M68J
DJ0438 - back.............................. 070130, ref SDS B0 M68J
DJ0439 - left arm.......................... 070202, ref SDS B3 6Q5N
DJ0441 - ..
DJ0442 - Examination today further shows that scattered sprinkles of rash
DJ0443 - diagnosed on 070130 as IBC on the stomach and back, ref SDS B0 M68J,
DJ0444 - have nearly disappeared after 3 cycles of treatment with cetuximab.
DJ0446 - ..
DJ0447 - The doctor feels that erratic increase of inflammation intensity on
DJ0448 - the upper left arm infected with IBC rash does not represent
DJ0449 - progression of disease, per above, ref SDS 0 527G,
DJ0451 - ..
DJ0452 - On 070330 primary care physician at Kaiser comments on how well Millie
DJ0453 - looks, ref SDS D6 N49K, reflecting similar report at UCSF the previous
DJ0454 - day on 070329.
DJ0456 - ..
DJ0457 - On 070418 Millie notified UCSF with copy to Kaiser that she cannot
DJ0458 - remember feeling better. ref SDS D9 PY6W
DJ0459 -
DJ0460 -
DJ0461 -
DJ0462 -
DJ05 -
SUBJECTS
Prognosis Stable Low Intensity IBC Rash Very Good Response Treatment
DQ03 -
DQ0401 - ..
DQ0402 - Prognosis Very Good IBC Stable Cetuximab Clinical Study
DQ0403 - Stable Low Intensity IBC Rash Very Good Response to Treatment
DQ0404 - Cetuximab Prognosis Good Chance IBC Rash 3rd Relapse Will Clear Up Again
DQ0405 -
DQ0406 - Follow up ref SDS D6 M645, ref SDS D3 M645.
DQ0408 - ..
DQ0409 - IBC conditions of subsiding intensity and no new disease sites,
DQ0410 - together with favorable CT test reported on 070329, ref SDS D3 LV57,
DQ0411 - and falling cancer marker, per above, ref SDS 0 WU6J, indicate that
DQ0412 - treatment with cetuximab alone seems effective at this time, as
DQ0413 - predicted by Doctor Rugo on 070130. ref SDS B0 M645
DQ0414 -
DQ0415 -
DQ0416 -
DQ0417 -
DQ0418 -
DQ05 -
SUBJECTS
Distant Metastasis No Evidence 6 Years Patient History Examinations
DY03 -
DY0401 - ..
DY0402 - Distant Metastasis No Evidence Patient History Examinations Tests
DY0403 - Local IBC Infection No Record Distant Metastasis Improves Chances
DY0404 - Prognosis Favorable No Lymphadenopathy 2006 No Distant Metastasis 5 Years
DY0405 -
DY0406 - Follow up ref SDS D6 FF4H, ref SDS D3 FF4H.
DY0407 -
DY0408 - The doctor concurred today with assessment at Kaiser during the
DY0409 - meeting on 070330, ref SDS D6 FF4H, citing CT test on 070326 showing
DY0410 - no evidence of distant metastasis, reviewed on 070329. ref SDS D3 LV57
DY0411 - Further alignment with patient history showing no reports of distant
DY0412 - metastasis in all image tests for over 5 years. ref SDS D3 DA8O
DY0413 -
DY0414 -
DY0415 -
DY0416 -
DY05 -
SUBJECTS
Wicked Problem Erratic Inflammation Rash Left Arm Right Chest Could
EL03 -
EL0401 - ..
EL0402 - Wicked Problem Resolved Disease Subsides ANC Rises to Safe Level
EL0403 - ANC 1.87 Blood Counts Rise Above Safe Level for Treatment with Cetuximab
EL0404 -
EL0405 - Follow up ref SDS D6 VF5M, ref SDS D3 VF5M.
EL0406 -
EL0407 - Millie had a blood test this morning during treatment at 0830 in the
EL0408 - Infusion Clinic, ordered by the doctor to evaluate blemish and
EL0409 - possible infection inflammation both at and above the port catheter on
EL0410 - the right chest, per above. ref SDS 0 L55J
EL0412 - ..
EL0413 - Test results show blood counts for NEUTS rising to 1.87 (ANC = 1870 by
EL0414 - Kaiser criteria), which demonstrates further resolution of prior
EL0415 - "wicked problem," as reported on 070329, ref SDS D3 VF5M, and
EL0416 - discussed at Kaiser the next day on 070330. ref SDS D6 VF5M
EL0418 - ..
EL0419 - Erratic inflammation and rash on upper left arm presents a "wicked
EL0420 - problem" of diagnosis, explained on 060722. ref SDS 84 346F UCSF has
EL0421 - used integrated strategy of CT tests, and CA 15-3 cancer marker trend
EL0422 - analysis in combination with clinical examinations and photographic
EL0423 - measurement to distinguish multiple causes of common symptoms...
EL0424 -
EL0425 - 1. IBC progression of disease..................... ref SDS 0 527G
EL0426 - 2. Cellulitis complications lymphedema............ ref SDS 0 4Y93
EL0427 - 3. Cetuximab side effects inflammation redness.... ref SDS 0 F57K
EL0428 - 4. Cat bite....................................... ref SDS 0 P67J
EL0429 -
EL0430 -
EL0431 -
EL0432 -
EL0433 -
EL0434 -
EL05 -
SUBJECTS
Measurable Disease IBC CA 15-3 33 Cancer Marker Improves Shows Respo
EZ03 -
EZ0401 - ..
EZ0402 - Measurable Disease IBC No New Sites No Expansion Intensity Declines
EZ0403 - Photographs Record Measurable Disease IBC Tumor in Dermal Tissue
EZ0404 - Measurable Disease IBC Observed with Tape Measure Photograph Pictures
EZ0405 - CA 15-3 Diagnostic Measurable Disease IBC Not Measured by Image Testing
EZ0406 -
EZ0407 - Follow up ref SDS D6 M652, ref SDS D3 M652.
EZ0408 -
EZ0409 - Measurements and pictures will be taken next week to start the next
EZ0410 - cycle, per planning last week on 070412. ref SDS D8 FO6H
EZ0411 -
EZ0412 -
EZ0413 -
EZ0414 -
EZ05 -
SUBJECTS
Lung Cancer No Discussion Metastatic Disease Nodes Doctor's Progress
FA03 -
FA0401 - ..
FA0402 - Lung Cancer Lymph Nodes Doctor's Progress Notes Medical Chart
FA0403 - Metastatic Cancer Lung Lymph Node Progress Notes Medical Chart
FA0404 -
FA0405 - Follow up ref SDS D6 G25K, ref SDS D3 G25K.
FA0406 -
FA0407 - Background is reported on 070130 in the record meeting with Doctor
FA0408 - Rugo at UCSF. ref SDS B0 G25K Findings for the most recent CT test on
FA0409 - 070326 do not support concern about lung cancer shown in Kaiser's
FA0410 - Medical Chart on 061208, ref SDS 99 G25K, and, finding no
FA0411 - "interstitial disease" further indicates this side effect of cetuximab
FA0412 - treatment has not occurred in Millie's case so far, reported on
FA0413 - 070329. ref SDS D3 123I Interstitial lung disease was listed in the
FA0414 - clincial study Consent documents received from UCSF on 070116.
FA0415 - ref SDS A7 0256
FA0417 - ..
FA0418 - There was no discussion of this issue today, so that attention could
FA0419 - focus on assessing Millie's response to treatment for IBC.
FA0420 -
FA0421 -
FA0422 -
FA0423 -
FA05 -
SUBJECTS
Biopsy Left Right Breasts Left Arm Right Chest Erratic Changes Inten
FH03 -
FH0401 - ..
FH0402 - Biopsy Erratic Changes Rash Intensity Verify IBC Left Arm
FH0403 -
FH0404 - Follow up ref SDS D6 KT7J, ref SDS D3 KT7J.
FH0405 -
FH0406 - Background on biopsy to diagnose erratic rash on left and right chest
FH0407 - is reported in the record on 070130. ref SDS B0 KT7J On 070202 a new
FH0408 - rash was observed on the upper left arm, ref SDS B3 JP6F, which has
FH0409 - since been considered expanding IBC, reported on 070222. ref SDS B6
FH0410 - B643 This new rash on the left arm has not been verified by biopsy,
FH0411 - as reported on 070202. ref SDS B3 JP6L More recently consideration of
FH0412 - possible rash on right arm is reported on 070301. ref SDS B8 KT7J
FH0414 - ..
FH0415 - There was no discussion today of taking biopsies to verify diagnosis
FH0416 - of rash on the left arm, discussed on 070301, ref SDS B8 527G, and
FH0417 - reported to present increased intensity during examination at Kaiser
FH0418 - on 070330, per above. ref SDS 0 115F At that time on 070330 diagnosis
FH0419 - of Cellulitis was made and treatment prescribed without biopsy.
FH0420 - ref SDS D6 Z23K Similarly, there was no discussion of taking a biopsy
FH0421 - to test the 2" x 1" oval area of rash reported in Nurses Notes for
FH0422 - treatment on 070315, and observed again at Kaiser on 070330,
FH0423 - ref SDS D6 DH6F, also, per above. ref SDS 0 583G
FH0425 - ..
FH0426 - The doctor ordered a blood culture to assess the blemish above the
FH0427 - port catheter, per above, ref SDS 0 Q57J, and findings were negative,
FH0428 - so this method did not identify the cause of this new issue.
FH0430 - ..
FH0431 - Previously, on 040419 biospy was successful in this case identifying
FH0432 - unknown rash on the left breast, that had stumped investigators for
FH0433 - over a year, reported 040517. ref SDS 37 6T5G Doctor Benz noted in a
FH0434 - second opinon consultation at UCSF on 060815 that biopsy is effective
FH0435 - for diagnosing medical problems. ref SDS 88 KT7J
FH0436 -
FH0437 -
FH0438 -
FH0439 -
FH05 -
SUBJECTS
Emotional Trauma Stress Moderate Pulse Normal Cancer Subsides Confid
FT03 -
FT0401 - ..
FT0402 - Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
FT0403 - Exercise Vigor Strength Engagement Ease Distress Living with Cancer
FT0404 - Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
FT0405 -
FT0406 - Follow up ref SDS D6 Y642, ref SDS D3 Y642.
FT0407 -
FT0408 - Medical issues create an emotional roller coaster explained on 070105,
FT0409 - ref SDS A5 Y642, and reviewed on 070301. ref SDS B8 Y642 Stress and
FT0410 - trauma are compounded with rising complexity of case history, listed
FT0411 - above. ref SDS 0 LU3J
FT0413 - ..
FT0414 - Improved medical prognosis, ref SDS 0 M645, and better coordination,
FT0415 - ref SDS 0 CQ6J, relieve stress reflected in Millie's vitals that are
FT0416 - calmer today, e.g., pulse below 60, ref SDS 0 KB5L, and reported in
FT0417 - patient history for treatment after examination. ref SDS E0 AW4L
FT0418 -
FT0419 -
FT0420 -
FT0421 -
FT0422 -
FT0423 -
FT05 -
SUBJECTS
Sleeping Difficulty subsides Worry Emotional Trauma Stress Prognosis
G503 -
G50401 - ..
G50402 - Sleeping Difficulty Subsides Health Issues Medical Management Improve
G50403 -
G50404 - Follow up ref SDS D6 MR99, ref SDS D3 NG3I.
G50405 -
G50406 - Sleeping difficulties have subsided the past few weeks.
G50407 -
G50408 -
G50409 -
G505 -
SUBJECTS
Strategy 3 Issues Resolved Sucessfully Work Plan Continue Weekly Tre
GA03 -
GA0401 - ..
GA0402 - Planning Case Management from Patient Profile Work Up
GA0403 - Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
GA0404 - Strategy Cetuximab Continued with Low ANC Expanding IBC Disease
GA0405 -
GA0406 - Follow up ref SDS D6 K36G, ref SDS D3 K36G.
GA0407 -
GA0408 - Background is reported on 070301. ref SDS B8 K36G Coordination issues
GA0409 - are presented above. ref SDS 0 RM4G
GA0411 - ..
GA0412 - There are three (3) strategy issues...
GA0413 -
GA0414 - 1. Find new treatments as disease progresses.
GA0415 - 2. Aggressive treatment IBC distinguish from other issues.
GA0416 - 3. Aggressive treatment by monitoring side effects of
GA0417 - lung and heart disease.
GA0419 - ..
GA0420 - Millie is fortunate the doctor can plan on adding carboplatin to
GA0421 - strengthen current treatment, if disease progresses with only
GA0422 - cetuximab, per above. ref SDS 0 Q65N On 070130 the doctor plans to
GA0423 - consider another treatment with Avastin, if needed later after the
GA0424 - clinical study for cetuximab and carboplatin. ref SDS B0 LD64
GA0426 - ..
GA0427 - Doctor Rugo developed a strategy on 070130 to reduce risks of blood
GA0428 - clots and heart attacks presented by cetuximab treatments, reported on
GA0429 - 070116 in Clinical Study Consent documents for participating in the
GA0430 - drug trial at UCSF. ref SDS A7 I75I Millie's patient history of
GA0431 - recurrent pulmonary embolism, and heart disorders (Cor Pulmonale)
GA0432 - diagnosed in CT test on 060930, and reviewed on 061012, ref SDS 91
GA0433 - 294Q, requires effective strategy to manage life threatening risks
GA0434 - compounded by cetuximab treatments. At that time on 070130, the
GA0435 - doctor cited Millie's family history as an additional risk factor.
GA0436 - ref SDS B0 LD6Y The doctor's strategy on 070130 called for thin slice
GA0437 - spiral CT testing to assess progression of lung and heart disease with
GA0438 - cetuximab treatments. ref SDS B0 R16N
GA0440 - ..
GA0441 - On 070330 the primary care physician noted that the CT scan on 070326
GA0442 - did not implement the UCSF strategy to test for blood clots and heart
GA0443 - disorder, ref SDS D6 XW5N, discussed further below. ref SDS 0 CV5L
GA0445 - ..
GA0446 - UCSF strategy to assess progression of IBC disease with CT tests, CA
GA0447 - 15-3 cancer marker, and clinical examination has been effective
GA0448 - resolving "wicked problem" distinguishing multiple forms of rash and
GA0449 - inflammation observed today, per above. ref SDS 0 S57H
GA0450 -
GA0451 -
GA0452 -
GA0453 -
GA0454 -
GA0455 -
GA0456 -
GA05 -
SUBJECTS
Treatment IBC 10th Cycle 3rd Relapse 3rd Cycle 4th Treatment Chemoth
GF03 -
GF0401 - ..
GF0402 - Treatment 3rd Cycle Cetuximab Carboplatin 070329 10th Cycle 3rd Relapse
GF0403 - 10th Cycle Treatment IBC 3rd Relapse 3rd Cycle Cetuximab Clinical Study
GF0404 - Cetuximab 3rd Cycle 1st Treatment IBC 3rd Relapse Clinical Study Drug Trial
GF0405 -
GF0406 - Follow up ref SDS D6 PF3O, ref SDS D3 PF3O.
GF0407 -
GF0408 - Patient history of cetuximab treatments is listed in the record on
GF0409 - 070419 working with the Infusion Clinic. ref SDS E0 7T3H
GF0411 - ..
GF0412 - Following examination in the Breast Care Center, Millie received
GF0413 - treatment at 0930 with pre-treatment Benadryl, ref SDS E0 DC7J, and at
GF0414 - 1000 with cetuximab on clincial study, reported in another record.
GF0415 - ref SDS E0 4N5M
GF0417 - ..
GF0418 - Jackie advised that patients can no longer be treated with cetuximab
GF0419 - alone, per above. ref SDS 0 Q65N
GF0421 - ..
GF0422 - Treatment of blemishes on the port catheter will be assessed after
GF0423 - results of the culture from the blood test are reported later today,
GF0424 - per above. ref SDS 0 S640
GF0426 - ..
GF0427 - Since increased intensity of IBC rash on the upper left arm, and on
GF0428 - the right chest below the collar bone subsided after meeting with the
GF0429 - doctor on 070330, and have not further appeared, per above,
GF0430 - ref SDS 0 115F, no treatment was prescribed today.
GF0431 -
GF0432 -
GF0433 -
GF0434 -
GF0435 -
GF05 -
SUBJECTS
Side Effects Cetuximab Acne-like Rash Face Dry Skin Face Chest Arms
GT03 -
GT0401 - ..
GT0402 - Side Effects Cetuximab Similar Symptoms Pulmonary Embolism
GT0403 - Energy Strength Rising Minimal Side Effects Cetuximab Treatment
GT0404 - Facial Skin Dryness New Side Effect Cetuximab Curel Lotion Prescribed
GT0405 - Curel Lotion Prescribed Facial Skin Dryness New Side Effect Cetuximab
GT0406 -
GT0407 - Follow up ref SDS D6 TQ6L, ref SDS D3 TQ6L.
GT0408 -
GT0409 - Yesterday, on 070418 Millie submitted the list of side effects,
GT0410 - ref SDS D9 PZ4W, shown in the record on 070329, ref SDS D4 QU8K, and
GT0411 - to facilite review this morning during the examination. This morning,
GT0412 - after using the computer in the examination room to check side effects
GT0413 - of cetuximab, per above, ref SDS 0 D39M, there wasn't enough time for
GT0414 - the medical team to display the list on the computer screen for
GT0415 - comprehensive review.
GT0417 - ..
GT0418 - On 070418 Millie also notified UCSF and Kaiser that she cannot
GT0419 - remember feeling better. ref SDS D9 PY6W So far, previous low energy
GT0420 - has been significantly increased. as discussed with the medical team
GT0421 - on 070329. ref SDS D6 QG4G This record indicates that loss of energy
GT0422 - listed as a side effect of cetuximab in the clinical trial Consent
GT0423 - documents received from UCSF on 070116, ref SDS A7 O64M, has been very
GT0424 - limited until recently.
GT0426 - ..
GT0427 - There is a one hour rest after cetuximab treatments to help recover
GT0428 - from drowsiness associated with Benadryl pre-treatment, reported on
GT0429 - 060721, ref SDS 83 6L5F, and from fatigue caused by cetuximab. This
GT0430 - hour provides opportunity to monitor for severe effects of treatment,
GT0431 - which have not occurred. Vitals are taken to verify patients are
GT0432 - alert, reported later today. ref SDS E0 AW4L Millie continues to
GT0433 - recover well enough treatments to drive home from San Francisco to
GT0434 - Concord, about 25 miles, a 40 minute drive in heavy traffic.
GT0436 - ..
GT0437 - Within the past 3 weeks, beginning on 070329, Millie has been taking a
GT0438 - nap (sleeping) for several hours after getting home from treatments,
GT0439 - reported on 070412. ref SDS D8 D48I This change from prior practice
GT0440 - may reflect accumulating fatigue from cetuximab.
GT0442 - ..
GT0443 - Millie's vitals show evident decline in blood pressure since starting
GT0444 - treatment with cetuximab, particularly pulse, as shown in the record
GT0445 - today on treatment. ref SDS E0 AW4L This change may reflect improved
GT0446 - fitness, which has been a goal Millie works hard to achieve, as a
GT0447 - component of quality of life, and to resist cancer, noted by the
GT0448 - primary care physician during the meeting at Kaiser on 070105.
GT0449 - ref SDS A5 MA9K
GT0451 - ..
GT0452 - Low blood pressure is also a side effect of cetuximab, shown on the
GT0453 - Internet...
GT0455 - ..
GT0456 - FDA
GT0457 - Patient Information Sheet
GT0458 - Cetuximab (marketed as Erbitux)
GT0459 -
GT0460 - http://www.fda.gov/cder/drug/InfoSheets/patient/cetuximabPIS.htm
GT0462 - ..
GT0463 - The doctor commented on very minimal acne-like rash, and was pleased
GT0464 - Millie looks well while continuing weekly treatments for stage IV
GT0465 - cancer, showing little signs of cetuximab side effects. On 070330
GT0466 - primary care physician commented similarly during examination at
GT0467 - Kaiser on how well and fit Millie looks, ref SDS D6 N49K, which aligns
GT0468 - with the report the day before at UCSF that Millie has avoided
GT0469 - significant acne-like facial rash. ref SDS D3 N49K
GT0471 - ..
GT0472 - Skin blemishes, redness, inflammation and infection are also listed as
GT0473 - side effects of cetuximab, see again FDA, per above. ref SDS 0 WR4O
GT0474 - This issue was carefully reviewed during examination this morning in
GT0475 - connection with...
GT0476 -
GT0477 - 1. Left arm (upper) erratic change intensity of rash currently
GT0478 - diagnosed with IBC, and possibly compounded by Cellulitis,
GT0479 - and/or side effects of cetuximab, per above. ref SDS 0
GT0480 - F57K, and cat bite. ref SDS 0 P67J
GT0482 - ..
GT0483 - 2. Chest Right below collar bone rash reported Nurses Notes on
GT0484 - 070315, and observed at Kaiser on 070330, also possible
GT0485 - side effect of cetuximab, cat bite, IBC, per above.
GT0486 - ref SDS 0 583G
GT0488 - ..
GT0489 - 3. Chest Right above port catheter erratic skin blemish,
GT0490 - possible infection, inflammation side effect of cetuximab,
GT0491 - noted by Doctor Rugo, per above. ref SDS 0 S640
GT0492 -
GT0493 -
GT0494 -
GT0495 -
GT0496 -
GT0497 -
GT05 -
SUBJECTS
Cetuximab Clinical Study UCSF Drug Trial Clinical Examination IBC Su
H203 -
H20401 - ..
H20402 - Cetuximab UCSF Clinical Study Treatment Begins 070201
H20403 - UCSF Clinical Study Treatment Cetuximab Drug Trial Begins 070201
H20404 - Drug Trials UCSF Has Other Clinical Study Treatments May Help Millie
H20405 -
H20406 - Follow up ref SDS D6 ZJ9N, ref SDS D3 ZJ9N.
H20407 -
H20408 - Background on Kaiser referral to UCSF for treatment on clinical study
H20409 - is reported on 070105. ref SDS A5 P256 Purpose of referral is to
H20410 - improve patient care with new treatment. ref SDS A5 PK7L Case study
H20411 - on Kaiser and UCSF collaborating to expedite treatment is listed on
H20412 - 070130, ref SDS B0 4T5N, and reviewed again today, per above.
H20413 - ref SDS D3 RM4G
H20415 - ..
H20416 - Jackie will coordinate to schedule blood draw for seven (7) vials on
H20417 - 070426 required to start the next cycle on the cetuximab study. This
H20418 - was successful on 070329 with blood drawn in the Infusion Clinic.
H20419 - ref SDS D4 Q659
H20421 - ..
H20422 - Millie has been fortunate to respond well to treatment for IBC with
H20423 - cetuximab alone, and no carboplatin...
H20424 -
H20425 - 1. Clinical examination shows IBC inflammation subsiding.
H20426 - ref SDS 0 M68J,
H20427 -
H20428 - 2. CA 15-3 testing shows evidence of cancer falling.
H20429 - ref SDS 0 087J
H20431 - ..
H20432 - 3. CT test 070326 finds no evidence of metastatic disease,
H20433 - reviewed on 070329. ref SDS D3 LV57
H20435 - ..
H20436 - Jackie advised that new patients accepted for the clincial study are
H20437 - no longer being treated with cetuximab alone. Study data revealed not
H20438 - enough patients get favorable results with only cetuximab. Therefore,
H20439 - new patients accepted for treatment in the clincial study are treated
H20440 - with both cetuximab and carboplatin.
H20441 -
H20442 - [On 070607 Millie must sign a waiver to continue treatment with
H20443 - cetuximab alone, as a result of the change in the clinical study
H20444 - protocol. ref SDS E3 AT8L
H20446 - ..
H20447 - Millie had fortunate timing coming along before this change to the
H20448 - study protocol, with the result that the doctor's planning options are
H20449 - significantly expanded, per below. ref SDS 0 K36G
H20451 - ..
H20452 - On 070202 the primary care physician at Kaiser explained advantage for
H20453 - Millie getting treatment with cetuximab alone for as long as there is
H20454 - favorable response, ref SDS B3 QO6O, also, discussed at UCSF on
H20455 - 070130, ref SDS B0 PF3O, and again on 070201. ref SDS B2 XR3M
H20457 - ..
H20458 - On 070301 Doctor Rugo noted that adding carboplatin to Millie's
H20459 - treatment would risk ability to maintain effective dose levels,
H20460 - because Millie had low blood counts without carboplatin. Since adding
H20461 - carboplatin increases pressure lowering blood counts below a level
H20462 - save for treatment, ref SDS B8 VF6O, Millie might not be able to get
H20463 - treatments on the study, which has proven beneficial with cetuximab
H20464 - alone, as reported today. ref SDS 0 ST4J
H20465 -
H20466 -
H20467 -
H20468 -
H205 -
SUBJECTS
Schedule Treatment Cetuximab 070419 Weekly Through 070524 Clinical S
HA03 -
HA0401 - ..
HA0402 - Schedule Treatment Start Cetuximab Carboplatin 070201
HA0403 -
HA0404 - Follow up ref SDS D6 N96O, ref SDS D3 N96O.
HA0405 -
HA0406 - Scheduling has proven a continuing challenge, listed above.
HA0407 - ref SDS D3 S63K
HA0409 - ..
HA0410 - On 070315 Nola in the Infusion Clinic scheduled Millie for weekly
HA0411 - treatments through May 24th. ref SDS C6 159O This continues to align
HA0412 - with examination today showing current protocol has been effective,
HA0413 - per above. ref SDS 0 M68J and further fits the strategy. ref SDS 0
HA0414 - K36G
HA0416 - ..
HA0417 - Meetings and treatments continue on Thursdays, so the next meeting at
HA0418 - UCSF will be on 070426 to start the next cycle of treatment.
HA0419 -
HA0420 -
HA0421 -
HA0422 -
HA0423 -
HA05 -
SUBJECTS
Pulmonary Embolism Blood Clots Lung Disorder Enlarged Right Ventricl
HN03 -
HN0401 - ..
HN0402 - Tired Breathing Difficulty Routine Activity Signals Pulmonary Emboli
HN0403 - Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
HN0404 - Pulmonary Emboli Hypercoagulable Work Up PET Scan Test Compare History
HN0405 -
HN0406 - Follow up ref SDS D6 CV5L, ref SDS D3 CV5L.
HN0407 -
HN0408 - Background on pulmonary embolism and correlation with IBC treatment at
HN0409 - UCSF is reported in the record meeting at UCSF on 070130. ref SDS B0
HN0410 - CV5L This was updated on 070329 when the CT test on 070326 failed to
HN0411 - report findings on pulmonary embolism, ref SDS D3 LZ6H, noted as well
HN0412 - the next day at Kaiser on 070330. ref SDS D6 NU55
HN0414 - ..
HN0415 - Since cetuximab can cause blood clots, reported on 070116 reviewing
HN0416 - clinical study Consent documents, ref SDS A7 I75I, and since Millie's
HN0417 - patient history shows recurrent pulmonary embolism, reported on
HN0418 - 061012, ref SDS 91 294Q, and since family history of mother and son
HN0419 - shows blood clot problems, reviewed at Kaiser on 060722, ref SDS 84
HN0420 - 3D9T, Doctor Rugo planned to assess Millie's risk of cetuximab causing
HN0421 - interstitial lung disease, per above, ref SDS 0 G25K, and compounding
HN0422 - pulmonary embolism by investigating for progression of blood clotting
HN0423 - disease in the lungs with thin slice spiral CT testing. ref SDS B0
HN0424 - R16N Evaluating progression of disease requires comparing current
HN0425 - conditions with findings in the test on 060930 that diagnosed
HN0426 - recurrent pulmonary embolism, and, also, enlarged right ventricle, as
HN0427 - discussed at Kaiser on 070202. ref SDS B3 T85F This comparison was
HN0428 - performed by Kaiser in a test on 041217 that reported pulmonary
HN0429 - embolism found with an earlier test on 041103 was no longer
HN0430 - visualized, reported on 041230. ref SDS 51 PW3K
HN0432 - ..
HN0433 - On 070330 the primary care physician reported that Kaiser has not
HN0434 - performed the required test. ref SDS D6 NU66 At this time, status of
HN0435 - pulmonary embolism remains unknown, and needs to be investigated for
HN0436 - risk analysis.
HN0438 - ..
HN0439 - Millie's energy has improved, indicating reduced risk. She continues
HN0440 - increased exercise at the gym, and vigorous hiking.
HN0442 - ..
HN0443 - Affirmative test evidence with a thin slice spiral CT scan supports
HN0444 - assumptions from absence of clinical symptoms, e.g., hear attack
HN0445 - caused by highly lethal conditions like pulmonary embolism, reported
HN0446 - on 060722. ref SDS 84 BI5J Activities like tennis that spikes the
HN0447 - heart rate reported on 070218, ref SDS B5 N06R, must performed with a
HN0448 - level of care that reduces benefits.
HN0449 -
HN0451 - ..
HN0452 - INR 2.4 Blood Test Patient Stable for Coumadin Treatments Pulmonary Emboli
HN0453 -
HN0454 - Follow up ref SDS D6 FE9I, ref SDS D3 FE9I.
HN0455 -
HN0456 - On 070330 Millie's letter to Kaiser notified Gloria of INR stable
HN0457 - blood tests for past 2 months; continuing current Coumadin regimen.
HN0458 - ref SDS D5 ZH4H
HN0460 - ..
HN0461 - INR will be tested next week.
HN0462 -
HN0463 -
HN0464 -
HN05 -
SUBJECTS
Examination Stethoscope No Findings Enlarged Right Ventricle Heart S
HV03 -
HV0401 - ..
HV0402 - Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
HV0403 -
HV0404 - Follow up ref SDS D6 Q35O, ref SDS D3 Q35O.
HV0405 -
HV0406 - Examination with a stethoscope today included multiple locations on
HV0407 - Millie's back and chest. There were no findings of cardio pulmonary
HV0408 - issues from clinical examination.
HV0410 - ..
HV0411 - After meeting with Doctor Rugo in the Oncology Clinic, Millie was
HV0412 - treated in the Infusion Clinic. Vitals were taken twice. The first
HV0413 - test at 0930 reported Sa02 100%. ref SDS E0 AW4L
HV0414 -
HV0415 -
HV0416 -
HV0417 -
HV05 -
SUBJECTS
Enlarged Right Ventricle Heart Disorder Cor Pulmonale Related Pulmon
I503 -
I50401 - ..
I50402 - Cor Pulmonale Heart Disorder Enlarged Right Ventricle
I50403 - Heart Examination Not Ordered Investigate Enlarged Right Ventricle
I50404 - Enlarged Right Ventricle CT Test Aligns Patient Symptoms How Serious
I50405 -
I50406 - Follow up ref SDS D6 VJ4J, ref SDS D3 VJ4J.
I50407 -
I50408 - Background on heart disorder Cor Pulmonale from enlarged right
I50409 - ventricle, and plans for CT testing is reported on 070130. ref SDS B0
I50410 - VJ4J Kaiser failed to perform the spiral CT test ordered by the
I50411 - primary care physician to evaluate enlarged right ventricle, reported
I50412 - above. ref SDS 0 CV5L
I50414 - ..
I50415 - This issue is closely related to pulmonary embolism, reported by the
I50416 - primary care physician on 061228. ref SDS A1 JU7L Continued subsiding
I50417 - of symptoms for pulmonary embolism reported on 070301, ref SDS B8
I50418 - SX6N, and again today signal Cor Pulmonale, also, seems under control,
I50419 - however, the actual status is unknown, per above. ref SDS 0 E44L
I50421 - ..
I50422 - During the meeting at Kaiser on 070330, the primary care physician did
I50423 - not make referral for examination by a heart specialist, nor on
I50424 - getting a treadmill test, ref SDS D6 SY5N, discussed by Doctor Rugo
I50425 - during the meeting at UCSF on 070130. ref SDS B0 RV3O
I50427 - ..
I50428 - Since cetuximab has a documented history of causing heart attacks, use
I50429 - of this drug requires monitoring patients with heart disorders.
I50430 - Millie's history of enlarged right ventricle reported in the CT test
I50431 - on 060930, shown by review on 061012, ref SDS 91 7E5L, should be
I50432 - investigated to evaluate compounding effects of cetuximab treatments.
I50433 -
I50434 -
I50435 -
I50436 -
I50437 -
I50438 -
I50439 -
I505 -