CONTACTS 

SUBJECTS
Meeting Examination Doctor Review Strategy Work Plan 4th Cycle 1st T

1403 -
1403 -    ..
1404 - Summary/Objective
1405 -
140501 - Follow up ref SDS E1 0000. ref SDS D7 0000.
140502 -
140503 - Millie was approved to start the next cycle of treatment.  Clinical
140504 - examination today shows subsiding and stable IBC rash, and no new
140505 - sites, since treatment started on 070201 under a clinical study of
140506 - cetuximab alone. ref SDS 0 LB5L  A few days after meeting with the
140507 - medical team, getting treatment and blood tests in the Infusion Clinic
140508 - today, UCSF reported CA 15-3 has dropped to 29.  Favorable clinical
140509 - findings together with favorable cancer biomarker tests present strong
140510 - response to treatment, ref SDS 0 GJ5M, that supports starting cycle #4
140511 - in the drug trial today. ref SDS 0 PN9I  NEUTS (ANC) blood counts
140512 - falling unexpectedly below the level for safe treatment may be related
140513 - to annomolous cat bites rather than signalling difficulty recovering
140514 - from treatments. ref SDS 0 1R4H
140515 -
140516 -
140518 -  ..
1406 -
1407 -
1408 - Progress
1409 -
140901 - Agenda Develop Work Plan Stage IV Breast Cancer 15 Mos after Mastectomy
140902 -
140903 - Follow up ref SDS E1 SM6M, ref SDS D7 SM6M.
140905 -  ..
140906 - Millie met today with the medical team at UCSF starting the 4th cycle
140907 - and 13th treatment of IBC with cetuximab, as planned in the launch
140908 - meeting on 070130. ref SDS B1 WM7G  Last week Doctor Rugo made an
140909 - examination.  Results of the 15th physician meeting, which occurred on
140910 - 070419, support considerations today for starting a new cycle of
140911 - cetuximab chemotherapy. ref SDS E1 SM6M  Treatment at UCSF is on
140912 - referral from Kaiser for participation in a clinical study drug trial
140913 - ordered by the primary care physician on 070105. ref SDS A6 PK68  This
140914 - meeting starts the 11th chemotherapy cycle since treatments began on
140915 - 060711, ref SDS 83 SM6M, for the 3rd relapse of IBC. ref SDS 83 8Y8I
140917 -  ..
140918 - Complete list of treatments for IBC 3rd relapse is reported in the
140919 - record of treatment today in the Infusion Clinic. ref SDS E4 PR8Q
140921 -  ..
140922 - Agenda for meeting at UCSF on 070419 provides a structure for planning
140923 - the meeting today...
140924 -
140925 -    1.  Coordination plan.............................. ref SDS 0 2S4H
140926 -    2.  CA 15-3 29 improvement......................... ref SDS 0 GJ5M
140927 -    3.  Lymphedema restricts exercise.................. ref SDS 0 4Y93
140928 -    4.  Breast exam IBC stable subsides................ ref SDS 0 025H
140929 -    5.  Measurable disease declines.................... ref SDS 0 M652
140930 -    6.  Side effects minimal........................... ref SDS 0 TQ6L
140931 -    7.  Patient work up continue strategy.............. ref SDS 0 K36G
140932 -    8.  Treatment plan weekly clinical trial........... ref SDS 0 PF3O
140933 -    9.  Pulmonary emboli how serious r ventricle....... ref SDS 0 CV5L
140935 -  ..
140936 - Scheduled next meeting for Thursday 070524 0830, reported in the
140937 - record on 070315. ref SDS C7 159O
140939 -  ..
140940 - The doctor could not support the meeting today;  Millie met with two
140941 - (2) assistants...
140942 -
140943 -        1.  Brigid, Nurse Practitioner
140944 -        2.  Jackie, Clinical Research Coordinator, coordinating
140945 -
140946 -
140947 -
140948 -
1410 -

SUBJECTS
Complex Patient History 45 Issues Overwhelms Span of Attention Drive

2203 -
220401 -  ..
220402 - Complex Patient History Knowledge Management Dilemma Issues Grow 45
220403 -
220404 - Follow up ref SDS E1 LU3J, ref SDS D7 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 treatments fatigue accumulating
220454 -
220455 -
220456 -
220457 -
220458 -
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 E1 KB5L, ref SDS D7 KB5L.
280406 -                           ..
280407 -                          Bld Prssr   Pulse   Temp   Weight  SaO2
280408 -     ..
280409 -    070426 1130............ 119  70    57     36.3c            96
280410 -    070426 1030............ 141  73    67     36.4c            99
280411 -    070426 0900............ 130  78    52     36.5c            97
280412 -    070419 1230............ 133  79    57     36.3c            98
280413 -    070419 1130............ 141  78    56     37.6c **1        99
280414 -    070419 0930............ 153  80    53     36.1c   147     100
280415 -    070330 1540............ 136 92     52     99.4    150      98
280416 - *  070329 0900............ 141 76     60     36.6c            99
280417 - *  070301 1505............ 112 69     86     36.6c            98
280418 - *  070130 1300............ 140 83     87     98
280419 -    070105 1040............
280420 -    061208 1226............ 152 90     76     97.8    147     99%
280421 -    061201 1430............ 123 76     76     97.5
280422 -    061110................. 136 83     73     97.0    150     98%
280423 -    061020 1534............ 140 79     67     99.8    151     97
280424 -    060929 1452............ 141 78     66     98.3
280425 -    060908 1335............ 139 79     73     98.1
280426 -    060814 1610............ 139 80     59     98.2
280427 - *  060808.................
280428 -    060711................. 172 87     54     97.5    147
280429 -    060623................. 141 87     71     98.0    147     99%
280430 -    060428................. 129 73     80     99.4    149     99%
280431 -    060217................. 153 81     61     98.6    150     99%
280432 -
280433 - *  For some reason, vitals not submitted, use data from Infusion
280434 -    Clinic during treatment.
280436 -  ..
280437 - High blood pressure reflects pressure on patient about effectiveness
280438 - of new treatment and arrangements between UCSF and Kaiser for timely
280439 - care, discussed on 070130, ref SDS B1 Y642, and again on 070301.
280440 - ref SDS B9 Y642
280442 -  ..
280443 - Today, Millie's vitals are normal, indicating reduced emotional
280444 - strain, discussed with Brigid on 070315, ref SDS C7 6A7J, and reviewed
280445 - again during the meeting last week with the doctor on 070419,
280446 - ref SDS E1 Y642, citing improvement in patient status beginning a
280447 - month ago on 070329, ref SDS D4 Y642, and continuing today, per
280448 - below. ref SDS 0 Y642
280449 -
280450 -
280451 -
2805 -

SUBJECTS
Coordination Plan Communication UCSF Kaiser Collaboration Improve Di

5903 -
590401 -  ..
590402 - Coordination Plan Divided Responsibilities Kaiser UCSF Referral
590403 - Collaboration Primary Care at Kaiser with UCSF Clinical Study Cetuximab
590404 -
590405 - Follow up ref SDS E1 RM4G, ref SDS D7 RM4G.
590406 -
590407 - Background on coordination plan to manage divided responsibilities
590408 - between Kaiser and referral to UCSF is reported on 070301. ref SDS B9
590409 - RM4G  Case study on 070130 shows requirements for communication to
590410 - strengthen care. ref SDS B1 4T5N  Coordination requirements are listed
590411 - on 070222. ref SDS B7 KL5G
590413 -  ..
590414 - On 070418, Millie commended UCSF improved coordination, ref SDS E0
590415 - EQ6I, using email on 070406 for efficient notice of patient history
590416 - and accurate communication. ref SDS D8 EQ6I.  Last week on 070419
590417 - Brigid reported progress using explicit links in email for precision
590418 - access that saves time finding critical details. ref SDS E1 DI8J  At
590419 - that time, on 070419 Brigid provided feedback on requirements for
590420 - orientation and support transitioning to Knowledge Management
590421 - modalities. ref SDS E1 DI9F
590423 -  ..
590424 - This morning, Brigid demonstrated using a computer to access Internet
590425 - research for timely communication on research for side effects of
590426 - cetuximab treatments. ref SDS E1 D39M  This record suggests
590427 - opportunity to use the Internet for...
590428 -
590429 -        1.  Comprehensive review of side effects listed in the record
590430 -            getting treatment in the Infusion Clinic on 070419.
590431 -            ref SDS E2 QU8K
590433 -             ..
590434 -        2.  Agenda for meetings illustrated by work at Kaiser on 061020
590435 -            using the doctor/patient partnership model for
590436 -            comprehensive examinations during meetings. ref SDS 94 NO6O
590438 -             ..
590439 -        3.  Action item review pending issues.
590441 -  ..
590442 - On 070424 Millie coordinated scheduling blood tests prior to
590443 - examination and starting a new treatment cycle today. ref SDS E3 407N
590444 - Subsequently, the schedule was changed to perform blood tests after
590445 - examination to assess blood counts are safe for treatment. ref SDS E3
590446 - 1V3F  Test results showing questions about NEUTS (ANC) in connection
590447 - with safety of getting treatment today, ref SDS E4 P560, support
590448 - following standard of care for chemotherapy doing blood tests prior to
590449 - examinations and treatment, discussed further below in connection with
590450 - complex scenarios that create "wicked problems." ref SDS 0 1R4H
590451 -
590452 -
590453 -
590454 -
5905 -

SUBJECTS
CA 15-3 29 Trend Falls Cetuximab Clinical Study Drug Trial Cancer Ma

6603 -
660401 -  ..
660402 - CA 15-3 Cancer Marker 29 Showing Significant Improvement
660403 -
660404 - Follow up ref SDS E1 087J, ref SDS D7 087J.
660405 -
660406 - Millie had a blood draw this morning in the Infusion Clinic.  Results
660407 - of the blood test were reported a few days later 070501, and show
660408 - continuing decline from 33 to 29, reported in another record today.
660409 - ref SDS E4 A16M
660411 -           ..
660412 -         Test Date                         Date Received
660413 -          070426......... 29 .............. 070501, ref SDS E5 EQ6I
660414 -          070329......... 33 H............. 070406, ref SDS D8 EQ6I
660415 -          070301......... 36 H............. 070307, ref SDS C0 A16M
660416 -          070215......... 52 H............. 070307, ref SDS B5 ER5O
660417 -          070208......... 55 H............. 070307, ref SDS B5 ER5O
660418 -          070201.....cetuximab begins...... 070201, ref SDS B3 G68I
660419 -          070131......... 56 H............. 070202, ref SDS B4 087J
660420 -          070123......... 52 H............. 070202, ref SDS B4 087J
660421 -          070118......... 68 H............. 070123, ref SDS B0 GK5B
660422 -          070104......... 56 H............. 070110, ref SDS A7 087J
660423 -          061218......... 74 H............. 061227, ref SDS A1 6P9F
660424 -          061214......... 63 H............. 061227, ref SDS A1 6P9F
660425 -          061201....Pause treatments..... . 061201, ref SDS 97 GJ5M
660426 -          061130......... 67 H............. 061201, ref SDS 97 087J
660427 -          061116......... 66 H............. 061201, ref SDS 97 087J
660428 -          061110......... 56 H............. 061201, ref SDS 97 087J
660429 -          061109......... 61 H............. 061110, ref SDS 96 087J
660430 -          061026......... 57 H............. 061110, ref SDS 96 087J
660431 -          061019......... 56 H............. 061020, ref SDS 94 087J
660432 -          060928......... 51 H............. 060929, ref SDS 91 087J
660433 -          060907......... 68 H............. 060929, ref SDS 91 087J
660434 -          060813......... 73 H............. 060817, ref SDS 88 U24M
660435 -          060809......... 87 H............. 060810, ref SDS 87 2N5J
660436 -          060721..Taxotere capecitabine.... 060721, ref SDS 84 0001
660437 -          060708......... 71 H............. 060711, ref SDS 83 087J
660438 -          060616......... 63 H............. 060623, ref SDS 82 UQ5Q
660439 -          060522......... 59 H............. 060605, ref SDS 81 UQ5Q
660440 -          060501......... 49 H............. 060522, ref SDS 80 MC4F
660441 -          060421......... 44 H............. 060428, ref SDS 78 087J
660442 -          060330......... 40 H............. 060428, ref SDS 78 087J
660443 -          060303......... 36............... 060428, ref SDS 78 087J
660444 -          060210......... 33............... 060217, ref SDS 77 087J
660445 -          060109......... 34............... 060126, ref SDS 76 KV59
660446 -  ..
660447 -          051223......... 34............... 060106, ref SDS 75 087J
660448 -          051202......... 28............... 060106, ref SDS 75 087J
660449 -          051116......... 31............... 051121, ref SDS 74 087J
660450 -          051109......... 30............... 051121, ref SDS 74 087J
660451 -          051102......... 34............... 051121, ref SDS 74 087J
660452 -          051021..Mastectomy surgery....... 051021, ref SDS 73 0001
660453 -          050916...end treatment........... 050916, ref SDS 71 407N
660454 -          050909......... 45 H............. 051007, ref SDS 72 087J
660455 -          050826......... 45 H............. 050913, ref SDS 70 087J
660456 -          050819......... 45 H............. 050913, ref SDS 70 087J
660457 -          050812......... 39 .............. 050819, ref SDS 69 3K6L
660458 -          050729......... 45 H............. 050819, ref SDS 69 EA5G
660459 -          050708......... 46 H............. 050729, ref SDS 68 087J
660460 -          050701......... 37 .............. 050729, ref SDS 68 087J
660461 -          050617......... 45 H............. 050729, ref SDS 68 087J
660462 -          050527......... 56 H............. 050610, ref SDS 66 087J
660463 -          050512......... 67 H............. 050520, ref SDS 64 087J
660464 -          050506......... 80 H............. 050520, ref SDS 64 087J
660465 -  ..
660466 -          050415.........105 H............. 050422, ref SDS 63 087J
660467 -          050415..Taxoter capecitabie begin 050415, ref SDS 62 407N
660468 -          050325.........100 H............. 050329, ref SDS 61 087J
660469 -          050318.........101 H............. 050325, ref SDS 60 2N5J
660470 -          050304......... 88 H............. 050311, ref SDS 58 087J
660471 -          050225......... 95 H............. 050308, ref SDS 57 0001
660472 -          050211......... 78 H............. 050214, ref SDS 56 02BB
660473 -          050128......... 67 H............. 050204, ref SDS 54 087J
660474 -          050104...AC start treatment...... 050104, ref SDS 53 407N
660475 -          041228......... 56 H............. 041230, ref SDS 52 087J
660476 -          041204......... 43 H............. 041210, ref SDS 51 087J
660477 -          041021...Taxol bevczmb ends...... 041021, ref SDS 48 0001
660478 -          041007......... 39............... 041104, ref SDS 49 087J
660479 -          040923......... 49 H............. 041005, ref SDS 47 087J
660480 -          040908......... 44 H............. 040909, ref SDS 46 087J
660481 -          040825......... 47 H............. 040909, ref SDS 46 087J
660482 -          040811......... 42 H............. 040812, ref SDS 45 087J
660483 -          040728......... 43 H............. 040729, ref SDS 43 2N5J
660484 -          040712......... 47 H............. 040713, ref SDS 42 087J
660485 -          040614......... 55 H............. 040615, ref SDS 41 PX6X
660486 -          040517......... 78 H............. 040601, ref SDS 39 2N5J
660487 -          040420...Taxol bevczmb starts.... 040420, ref SDS 37 9Z5J
660488 -          040311......... 70 H............. 040318, ref SDS 32 SM6M
660489 -          040205......... 60 H............. 040211, ref SDS 29 SM6M
660490 -          031201......... 62 H............. 031205, ref SDS 28 SM6M
660491 -          030912......... 66 H............. 030915, ref SDS 27 SM6M
660492 -          030708......... 68 H............. 030710, ref SDS 26 SM6M
660493 -          030503......... 54 H............. 030508, ref SDS 24 SM6M
660494 -          030403......... 45 H............. 030508, ref SDS 24 SM6M
660495 -          030215......... 46 H............. 030220, ref SDS 23 5E6L
660496 -          030106......... 37 H............. 030109, ref SDS 22 SM6M
660497 -          021204..Adjuvant chemo ends...... 021204, ref SDS 21 SQ5I
660498 -          021202......... 41 H?............ 021204, ref SDS 21 SP5G
660499 -          021111......... 36 H?............ 021113, ref SDS 20 Y65I
660500 -          021023......... 33 H?............ 021023, ref SDS 19 SQ5I
660501 -          021002..Taxoter Phase II......... 021002, ref SDS 18 0001
660502 -          020930......... 33 H?..39........ 021002, ref SDS 18 SQ5I
660503 -          020917......... 36 H?............ 020924, ref SDS 17 SQ5I
660504 -          020723..Radiation begins......... 020723, ref SDS 14 0001
660505 -          020717......... 59 H?............ 020726, ref SDS 15 YN5K
660506 -          020629......... 75 H ............ 020705, ref SDS 13 UX6I
660507 -          020608........  67 H ............ 020614, ref SDS 12 0001
660508 -          020603........ 108 H ............ 020607, ref SDS 11 X67F
660509 -          020603..Taxotere change treatmnt. 020603, ref SDS 10 WO4O
660510 -          020511........ 117 H ............ 020603, ref SDS 10 4X5K
660511 -          020419......... 81 H ............ 020430, ref SDS 9 7N5H
660512 -          020419..AC chemo begins.......... 020430, ref SDS 9 7N5H
660513 -          020321......... 85 H ............ 020405, ref SDS 8 6T8K
660514 -
660515 -
660516 -
660517 -
660519 -  ..
6606 -
6607 -
6608 - Analysis
6609 -
660901 - CA 15-3 29 Cancer Marker Strong Response to Treatment Cetuximab
660902 -
660903 - Follow up ref SDS E1 GJ5M, ref SDS D7 GJ5M.
660905 -  ..
660906 - Patient history applying CA 15-3 is shown in a case study on 030710.
660907 - ref SDS 26 IA7H
660909 -  ..
660910 - CA 15-3 for the blood test today was not available in time for the
660911 - meeting, as shown in another record reporting treatment at 0840 in the
660912 - Infusion Clinic. ref SDS D5 2N5J  Subsequently, on 070501 Brigid
660913 - submitted a letter via email reporting CA 15-3 was 29 for the test
660914 - today.  This is the best result for Millie in 6 years of systemic
660915 - treatment, as shown above. ref SDS D4 087J  Previously, CA 15-3
660916 - dropped to 28 for only a few weeks after mastectomy surgery on 051021,
660917 - but immediately began climbing, resulting in recurrence diagnosed on
660918 - 060623.  In this case, CA 15-3 has been maintained at historic lows
660919 - for Millie's patient history for the past 2 months, giving hope for
660920 - sustained control of disease.
660921 -
660922 -    [On 070514 Millie requests CA 15-3 results from Kaiser for test on
660923 -    070511 cross-check. ref SDS E6 YQ6O
660925 -  ..
660926 - This record supports Doctor Rugo's assessment during the meeting last
660927 - week on 070419 noting IBC rash has substantially subsided.  Further
660928 - reduction of IBC intensity noted in examination today, per below,
660929 - ref SDS 0 025H, aligns with Doctor Rugo's findings. ref SDS E1 WU6J
660930 -
660931 -    [On 070516 Kaiser reports CA 15-3 56 significant increase in only 2
660932 -    weeks. ref SDS E7 RH9H
660934 -     ..
660935 -    [On 070516 Millie asks Kaiser to verify CA 15-3 56 test report, and
660936 -    notify UCSF for consideration of changing treatments. ref SDS E7
660937 -    ZJ9N
660939 -     ..
660940 -    [On 070517 Nurse's Notes at Kaiser report elevated CA 15-3; nurse
660941 -    practitioner orders retest; but, no blood test was actually
660942 -    performed. ref SDS E8 FG5N
660944 -     ..
660945 -    [On 070517 Kaiser advises that CA 15-3 calculation method different
660946 -    from UCSF so test results cannot be compared, like apples and
660947 -    oranges. ref SDS E9 NT3O
660949 -     ..
660950 -    [On 070517 Millie submits patient history on CA 15-3 to assist
660951 -    Kaiser evaluate response to treatment at UCSF on cetuxiab clinical
660952 -    study. ref SDS E9 KU4H
660954 -     ..
660955 -    [On 070517 Brigid discloses that coordinating divided
660956 -    responsibilities on referral projects is difficult; and that UCSF
660957 -    recommends limiting laboratory work rather than empowering labs to
660958 -    cross-check tests for accuracy. ref SDS E9 466H
660959 -
660960 -
660961 -
660962 -
660963 -
660964 -
660965 -
660966 -
660967 -
660968 -
6610 -

SUBJECTS
Lymphadenopathy Axillary No Findings Left Arm Patient No Complaint S

7403 -
740401 -  ..
740402 - Axillary Left Arm No Lymphadenopathy Lymphedema Prominent
740403 - Lymphadenopathy Axillary Left Arm No Evidence Local Edema
740404 -
740405 - Follow up ref SDS E1 MW8J, ref SDS D7 MW8J.
740406 -
740407 - Patient has a long history of IBC on the left breast and associated
740408 - lymphadenopathy symptoms in the left axillary, see case study on
740409 - 040517. ref SDS 38 OW3I
740411 -  ..
740412 - Brigid examined the left axilla.  Clinical palpation made no findings
740413 - of lumps or other indications of cancer, including swelled lymph nodes
740414 - that might indicate lymphadenopathy.  The patient made no complaint of
740415 - lumps or discomfort from swelling under the left arm.  This aligns
740416 - with CT test on 070326 showing no findings of lymphadenopathy,
740417 - reported on 070329, ref SDS D4 12GK, although, there is no express
740418 - finding that the analyst actually looked at the left and right
740419 - axillary.
740420 -
740421 -
740422 -
7405 -

SUBJECTS
Lymphedema Swelling Persistent Left Arm Upper Intensity Subsides Ras

9203 -
920401 -  ..
920402 - Lymphedema Cellulitis Complications Resolved Left Arm Swelling
920403 - Swelling Left Arm Lymphedema Cellulitis Complications Resolved
920404 - Left Arm Lymphedema Cellulitis Complications Resolved
920405 - Cellulitis Lymphedema Complications Resolved Left Arm Swelling
920406 -
920407 - Follow up ref SDS E1 4Y93, ref SDS D7 4Y93.
920408 -
920409 - Medical history of lymphedema in the left arm is reported in a case
920410 - study on 070130. ref SDS B1 VX6F
920412 -  ..
920413 - The left arm today has continued swelling from lymphedema.  Recent
920414 - measurement below the elbow was 11.00 inches, showing improvement, but
920415 - increased above previous norms reported in a study on 060509.
920416 - ref SDS 79 HO7F
920418 -  ..
920419 - There wasn't enough time again today for discussing correlations
920420 - between exercise to strengthen the immune system that resists cancer,
920421 - and helps dissipate emotional stress, reviewed at UCSF on 070315,
920422 - ref SDS C7 6A7J, but may compound lymphedema with increased swelling,
920423 - and complications of Cellulitis, discussed at UCSF on 070222.
920424 - ref SDS B7 GG4H  Lymphedema and Cellulitis in relation to side effects
920425 - on the cetuximab clinical study were considered on 070329. ref SDS D4
920426 - M84I
920428 -  ..
920429 - Brigid noted that the upper left arm shows no increased intensity, and
920430 - presents reduced inflammation of IBC rash.  This resolves issues
920431 - discussed last week with Doctor Rugo, ref SDS E1 115F, considering
920432 - Millie's letter on 070418, ref SDS E0 PZ3P, notifying UCSF that on
920433 - 070330 the primary care physician at Kaiser observed significantly
920434 - increased rash inflammation intensity on the upper left arm,
920435 - ref SDS D7 N19J, and new inflammation of high intensity above the
920436 - right breast and below the collar bone, per below. ref SDS E1 583G
920437 -
920438 -
920439 -
920440 -
9205 -

SUBJECTS
IBC Left Arm Examination Stable Subsides Rash Less Intense Responds

A603 -
A60401 -  ..
A60402 - IBC Left Arm Stable Subsiding Responds Treatment Cetuximab Drug Trial
A60403 - Left Arm IBC Stable Subsiding Responds Treatment Cetuximab Drug Trial
A60404 -
A60405 - Follow up ref SDS E1 527G, ref SDS D7 527G.
A60406 -
A60407 - Examination this moring shows reduced intensity of IBC rash on the
A60408 - upper left arm.
A60410 -  ..
A60411 - Examination further indicates the size of IBC rash on the upper left
A60412 - arm has been stable to subsiding, i.e., improving by responding to
A60413 - treatment, since the prior examination at UCSF on 070329. ref SDS D4
A60414 - 527G
A60416 -  ..
A60417 - Aligns with declining measurable disease cancer marker CA 15-3 29, per
A60418 - above. ref SDS 0 UZ8N
A60420 -  ..
A60421 - Since today starts a new treatment cycle, per above, ref SDS 0 SM6M,
A60422 - Jackie discussed taking photographs for measurable disease.   She
A60423 - explained photographs will be taken later under a new criteria rather
A60424 - than starting a new treatment cycle.
A60426 -  ..
A60427 - Brigid took measurements, and indicated the area of rash is about the
A60428 - same, as previously measured on 070329, ref SDS D4 2E9I, and discussed
A60429 - further below. ref SDS 0 M652
A60430 -
A60431 -
A60432 -
A60433 -
A60434 -
A605 -

SUBJECTS
Right Axillary Lymphadenopathy No Findings Right Arm Patient No Comp

AE03 -
AE0401 -  ..
AE0402 - Right Axillary Possible Involvement Red Rash Spreads Right Breast
AE0403 -
AE0404 - Follow up ref SDS E1 3D6K, ref SDS D7 3D6K.
AE0405 -
AE0406 - Background on patient history testing for lymphadenopathy in the right
AE0407 - axilla is reported in the record on 060929. ref SDS 91 3D6K
AE0409 -  ..
AE0410 - Examination of the right axillary yielded same negative results
AE0411 - finding no evidence of lymphadenopathy, as occurred examining the left
AE0412 - axilla, per above. ref SDS D4 VU6O  Also aligns with CT test on
AE0413 - 070326, reviewed on 070329. ref SDS D4 12GK
AE0414 -
AE0415 -
AE0416 -
AE0417 -
AE05 -

SUBJECTS
Right Arm Examination Rash Slight Blemishes No Evidence IBC No Findi

AL03 -
AL0401 -  ..
AL0402 - IBC Right Arm New Minimal Red Rash Not Diagnosed IBC or Cellulitis
AL0403 -
AL0404 - Follow up ref SDS E1 H15M, ref SDS D7 H15M.
AL0405 -
AL0406 - Background on slight red dots, rash or blemishes on the right arm is
AL0407 - reported on 070301. ref SDS B9 H15M  Examination at that time
AL0408 - concluded the rash is not IBC.  Further examination on 070315 reached
AL0409 - the same conclusion, ref SDS C7 FO6H, supported by another review on
AL0410 - 070322. ref SDS C8 LI4M
AL0412 -  ..
AL0413 - Examination today yielded no change in analysis that IBC has not
AL0414 - spread to the right arm, and Cellulitis has not occurred in the right
AL0415 - arm.  Similarly, there is no evidence of side effects in the right arm
AL0416 - from cetuximab treatment for IBC, reported on 070329. ref SDS D4 MF6I
AL0417 -
AL0418 -
AL0419 -
AL0420 -
AL0421 -
AL05 -

SUBJECTS
IBC Right Breast Examination Stable Subsides Rash Inflammation Less

AU03 -
AU0401 -  ..
AU0402 - Right Breast IBC Rash Intensity Subsides
AU0403 - Rash Right Breast Inflammation Intensity Subsides
AU0404 -
AU0405 - Follow up ref SDS E1 W58J, ref SDS D7 W58J.
AU0407 -  ..
AU0408 - On 061204 IBC inflammation spread from the left chest area infected
AU0409 - with IBC across the sternum and slightly onto the right breast.
AU0410 - ref SDS 99 AE5I  Since then, IBC has not spread farther.  It became
AU0411 - more intense through January, and then has continued to subside with
AU0412 - treatment.
AU0414 -  ..
AU0415 - Examination of right breast today shows reduced intensity of IBC rash,
AU0416 - and there is no spreading of the rash, suggesting favorable response
AU0417 - to treatment.  Declining CA 15-3 33 cancer marker reported today for
AU0418 - the blood test on 070329, per above, ref SDS E1 087J, aligns with
AU0419 - visual impression today of subsiding IBC.
AU0421 -  ..
AU0422 - Today starts a new cycle, so Brigid took measurements; Jackie did not
AU0423 - take photographs, per above, ref SDS 0 2E9I, and discussed further
AU0424 - below. ref SDS 0 M652
AU0425 -
AU0426 -
AU0427 -
AU0428 -
AU0429 -
AU0430 -
AU05 -

SUBJECTS
Rash Chest Right Side Above Breast Below Collar Bone Above Port Cath

B403 -
B40401 -  ..
B40402 - Right Chest Rash Not Visible Above Breast and Port Catheter
B40403 - Rash Above Port Catheter on Right Upper Chest Not Visible Today
B40404 -
B40405 - Follow up ref SDS E1 583G, ref SDS D7 583G.
B40406 -
B40407 - Background is reported in the record last week on 070419. ref SDS E1
B40408 - 583G  There has been no further report of inflammation at this
B40409 - location.
B40410 -
B40411 -
B40412 -
B405 -

SUBJECTS
Right Chest Blemish Port Catheter .75" Above Infection .5" Diameter

BH03 -
BH0401 -  ..
BH0402 - Port Catheter Infection Blemish Right Chest Blood Culture Investigate
BH0403 -
BH0404 - Follow up ref SDS E1 S640, ref SDS D4 BI5K.
BH0405 -
BH0406 - Today the entry to the port catheter shows mild inflammation that
BH0407 - appears like a skin blemish.  There has been no increased intensity of
BH0408 - this rash condition relative to examination by Doctor Rugo last week
BH0409 - on 070419. ref SDS E1 S640  Brigid advised that the blood culture
BH0410 - ordered last week and performed in the Infusion Clinic, ref SDS E2
BH0411 - R54J, to investigate this issue was negative.  There was no discussion
BH0412 - to biopsy this tissue to assess the problem, per below, ref SDS 0
BH0413 - KT7J, since the problem seems to be getting smaller without treatment.
BH0415 -  ..
BH0416 - The blemish above the port catheter observed last week on 070419,
BH0417 - ref SDS E1 Q564, has reduced to a slightly visible dot.
BH0418 -
BH0419 -
BH0420 -
BH0421 -
BH0422 -
BH05 -

SUBJECTS
Left Supraclavicular Examination Palpation Neck Lymphadenopathy No F

BP03 -
BP0401 -  ..
BP0402 - Left Supraclavicular Examination PET Test Report Finding SUV 4.5
BP0403 - Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
BP0404 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
BP0405 -
BP0406 - Follow up ref SDS E1 8R6M, ref SDS D7 8R6M.
BP0407 -
BP0408 - During examination on 070130, Doctor Rugo asked about history of
BP0409 - radiation to the neck, and sequence of finding recurrence from Doctor
BP0410 - Laio's biopsy reported on 040309. ref SDS 30 0001  Background of image
BP0411 - testing, and consideration for radiation treatment of left
BP0412 - supraclavicular is reported on 060623. ref SDS 82 8R6M
BP0414 -  ..
BP0415 - Like the left and right axillary locations, examination today for
BP0416 - cancer in left supraclavicular region found no evidence of lumps or
BP0417 - other indications of lymphadenopathy, as reported above. ref SDS E1
BP0418 - VU6O  CT test on 070326 shows no findings of lymphadenopathy, reported
BP0419 - during examination on 070329. ref SDS D4 12GK  There is no express
BP0420 - finding in the CT test report that the analyst actually looked at the
BP0421 - left and right supraclavicular.
BP0422 -
BP0423 -
BP0424 -
BP05 -

SUBJECTS
IBC Left Breast Examination 2 Scenarios End Stable Area No New Sites

C603 -
C60401 -  ..
C60402 - 2 Scenarios Conflict IBC Expanding Intensity Subsides
C60403 - IBC Rash Left Breast Stomach and Back Seems to Be Subsiding
C60404 - Examination IBC Rash Subsiding Responding to Treatment Cetuximab
C60405 - Cetuximab Effective Treatment IBC Subsiding Left Breast Stomach Back
C60406 -
C60407 - Follow up ref SDS E1 025H, ref SDS D7 025H.
C60408 -
C60409 - Background of IBC 3rd relapse on left breast beginning on 060623, and
C60410 - treatment with Taxotere and capecitabine ending on 061201, with
C60411 - subsequent progression of disease spreading to other areas is reported
C60412 - on 070301. ref SDS B9 025H
C60414 -  ..
C60415 - Case study on 070130 shows erratic changes in severity/intensity of
C60416 - IBC rash on left chest area, with referral to UCSF. ref SDS B1 5N6L
C60418 -  ..
C60419 - All case studies for Millie's patient history are listed on 061018.
C60420 - ref SDS 93 0001
C60422 -  ..
C60423 - Cetuximab treatment started at UCSF on 070201. ref SDS B3 G68I
C60425 -  ..
C60426 - Strategy for treating progression of disease was reviewed on 070301.
C60427 - ref SDS B9 1T4O
C60429 -  ..
C60430 - Examination today aligns with Doctor Rugo's examination last week on
C60431 - 070419, ref SDS E1 M68J, showing intensity of IBC rash continues to
C60432 - subside or remains stable, and there is no evident expansion of IBC
C60433 - rash areas, and further there are no new IBC rash sites, as listed on
C60434 - 070301. ref SDS B9 4140  The current condition today is...
C60435 -
C60436 -            left breast chest................. 060623, ref SDS 82 025H
C60437 -            right breast...................... 061204, ref SDS 99 AE5I
C60438 -            stomach........................... 070130, ref SDS B1 M68J
C60439 -            back.............................. 070130, ref SDS B1 M68J
C60440 -            left arm.......................... 070202, ref SDS B4 6Q5N
C60442 -  ..
C60443 - Examination today further shows that scattered sprinkles of rash
C60444 - diagnosed on 070130 as IBC on the stomach and back, ref SDS B1 M68J,
C60445 - have nearly disappeared after 3 cycles of treatment with cetuximab.
C60446 -
C60447 -
C60448 -
C60449 -
C605 -

SUBJECTS
Prognosis Stable Low Intensity IBC Rash Very Good Response Treatment

CD03 -
CD0401 -  ..
CD0402 - Prognosis Very Good IBC Stable Cetuximab Clinical Study
CD0403 - Stable Low Intensity IBC Rash Very Good Response to Treatment
CD0404 - Cetuximab Prognosis Good Chance IBC Rash 3rd Relapse Will Clear Up Again
CD0405 -
CD0406 - Follow up ref SDS E1 M645, ref SDS D7 M645.
CD0408 -  ..
CD0409 - IBC subsiding and no new disease sites, together with favorable CT
CD0410 - test reported on 070329, ref SDS D4 LV57, and falling cancer marker,
CD0411 - per above, ref SDS 0 GJ5M, indicate treatment with cetuximab alone
CD0412 - seems effective at this time, as predicted by Doctor Rugo on 070130.
CD0413 - ref SDS B1 M645
CD0414 -
CD0415 -
CD0416 -
CD05 -

SUBJECTS
Wicked Problem Blood Counts ANC 1.47 Falls Below Safe Level Treatmen

CY03 -
CY0401 -  ..
CY0402 - Wicked Problem Good Management Looks Like Unnecessary Overkill
CY0403 - ANC 1.47 Blood Counts Fall Below Safe Level for Treatment with Cetuximab
CY0404 -
CY0405 - Follow up ref SDS E1 VF5M, ref SDS D7 VF5M.
CY0406 -
CY0407 - Primary "wicked problem" in this case is making a mistake ignoring
CY0408 - life threatening complications from lung and heart disorders, blood
CY0409 - clots in the lungs, pulmonary embolism, enlarged right ventricls, Cor
CY0410 - Pulmonale for less serious side effects which patients must tolerate
CY0411 - in order to benefit from treating cancer with the cetuximab
CY0412 - carboplatin clincial study as set out in Consent documents received
CY0413 - from UCSF on 070116. ref SDS A8 I75I  Significant risk of errorneous
CY0414 - diagnosis and loss of life from failure to take timely action because
CY0415 - symptoms are mistaken for benign side effects was reviewed on 060722.
CY0416 - ref SDS 85 346F
CY0418 -  ..
CY0419 - On 070130 Doctor Rugo set a strategy to manage risks from cetuximab
CY0420 - causing complications of lung and heart disorders by vigorous CT
CY0421 - testing to assess progression of preconditions for pulmonary embolism
CY0422 - and enlarged right ventricle.
CY0424 -  ..
CY0425 - Millie had a blood test out of sequence last week on 070419 to
CY0426 - evaluate erratic inflammation and possible infection at the port
CY0427 - catheter on the right chest. ref SDS E1 L55J  The extra test aided
CY0428 - complex diagnosis of four (4) possible problems with similar
CY0429 - presentations. ref SDS E1 S57H
CY0431 -  ..
CY0432 - Subsiding inflammation on left arm, ref SDS 0 115F, and at the port
CY0433 - catheter site, ref SDS 0 S640, have resolved previous "wicked problem"
CY0434 - of diagnosis presented last week on 070419. ref SDS E1 S57H
CY0436 -  ..
CY0437 - Results of the test last week on 070419 showed blood counts for NEUTS
CY0438 - increased to 1.87 (ANC = 1870 by Kaiser criteria), ref SDS E2 P560,
CY0439 - which showed continuing resolution of prior "wicked problem" reported
CY0440 - on 070329, ref SDS D4 VF5M, and discussed at Kaiser the next day on
CY0441 - 070330. ref SDS D7 VF5M
CY0443 -  ..
CY0444 - Favorable blood counts resolving a "wicked problem" last week, created
CY0445 - fertile soil for a new "wicked problem" this week, because success
CY0446 - makes good management coordinating the work, per above, ref SDS 0
CY0447 - T15M, seem like unnecessary overkill.
CY0449 -  ..
CY0450 - Several days ago on 070424,procedures were changed for drawing blood
CY0451 - to test safety of receiving chemotherapy.  Since the test on 070419
CY0452 - showed blood counts (NEUTS - ANC) were safe and rising at that time,
CY0453 - the test today was scheduled after treatment, rather than before the
CY0454 - examination to approve treatment, ref SDS E3 1V3F, required for
CY0455 - standard of care cited in the Consent documents, reveiwed on 070116,
CY0456 - ref SDS A8 5U9U, and discussed with the medical team during the
CY0457 - meeting at UCSF on 070201. ref SDS B3 XR40
CY0459 -  ..
CY0460 - Blood tests were performed in the Infusion Clinic this morning after
CY0461 - examination in the Breast Care Center, and while getting treatment.
CY0462 - After Millie completed treatment, and while resting to recover and go
CY0463 - home, the nurse received results of the test from the Lab.
CY0465 -  ..
CY0466 - NEUTS (ANC) fell unexpectedly from 1.87 the week before, to 1.47
CY0467 - today, below the level of 1.80 for safe treatment. ref SDS E4 P560  No
CY0468 - adverse consequences occurring from relaxing test requirements today
CY0469 - aligns with Millie's patient history listed on 060810 showing she has
CY0470 - often been treated with blood counts below target levels with
CY0471 - authorization of the doctor. ref SDS 87 HV45  At that time, on 060810
CY0472 - the nurse was unable to obtain prior approval because Millie's doctor
CY0473 - was on vacation, ref SDS 87 5K4F  Since nobody else (e.g., substitute
CY0474 - doctor) had time to study the record and approve treatment,
CY0475 - chemotherapy was delayed a week, later changed to 4 days. ref SDS 87
CY0476 - I26F
CY0478 -  ..
CY0479 - Annoumolous test results for NEUTS (ANC) may be related to recent cat
CY0480 - bites reported last week on 070419. ref SDS E1 P67J   Patient history
CY0481 - shows low blood counts from a cat bite occurred on 050212. ref SDS E1
CY0482 - FA9K
CY0483 -
CY0484 -
CY0485 -
CY0486 -
CY0487 -
CY05 -

SUBJECTS
Measurable Disease IBC CA 15-3 29 Cancer Marker Improves Shows Respo

DC03 -
DC0401 -  ..
DC0402 - Measurable Disease IBC No New Sites No Expansion Intensity Declines
DC0403 - Photographs Record Measurable Disease IBC Tumor in Dermal Tissue
DC0404 - Measurable Disease IBC Observed with Tape Measure Photograph Pictures
DC0405 - CA 15-3 Diagnostic Measurable Disease IBC Not Measured by Image Testing
DC0406 -
DC0407 - Follow up ref SDS E1 M652, ref SDS D7 M652.
DC0408 -
DC0409 - Background on measurable disease for IBC using cancer biomarker CA
DC0410 - 15-3 and photographic records showing spread of cancer is reported in
DC0411 - a case study on 070101. ref SDS A4 4Q6K
DC0413 -  ..
DC0414 - CA 15-3 29 is the best cancer marker diagnostic Millie has achieved on
DC0415 - systemic chemotherapy over the 6 years of treatment for breast cancer.
DC0416 - ref SDS 0 087J  Consistent decline of the cancer marker the past 4
DC0417 - months, along with visual indications of IBC inflammation subsiding at
DC0418 - all sites measure strong response to treatment on the cetuximab
DC0419 - clinical study, per above. ref SDS 0 LB5L  Next month another CT test
DC0420 - will provide additional metrics on response to treatment.
DC0422 -  ..
DC0423 - Jackie advised that photographs with a camera are not needed today for
DC0424 - measurable disease starting cycle #4 of the clinical study protocol,
DC0425 - and showing that IBC disease has not expanded, and that intensity of
DC0426 - inflammation has subsided, since evaluation starting cycle #3 on
DC0427 - 070329, as reported above. ref SDS 0 M68J  The reason for changing
DC0428 - prior practice for the first three cycles, set out in the record on
DC0429 - 070329, ref SDS D4 BQ9J, was not presented.
DC0431 -  ..
DC0432 - Possibly, subsiding IBC inflammation with improving CA 15-3 cancer
DC0433 - marker makes the expense of pictures seem like unnecessary overkill.
DC0434 -
DC0435 -     [On 070524 pictures were taken to show measurable disease.
DC0436 -     ref SDS F0 M652
DC0438 -  ..
DC0439 - Brigid used a tape measure in several directions at each IBC site.
DC0440 - Measurements were entered in the Medical Chart reporting general
DC0441 - spread of inflammation, but do not convey subsiding intensity.  As
DC0442 - noted on 070329, photographs help make sense of measurements for IBC
DC0443 - inflammation that presents randomly with no consistent boundary.
DC0444 - ref SDS D4 EX8O
DC0445 -
DC0446 -
DC0447 -
DC05 -

SUBJECTS
Lung Cancer No Discussion Metastatic Disease Nodes Doctor's Progress

DN03 -
DN0401 -  ..
DN0402 - Lung Cancer Lymph Nodes Doctor's Progress Notes Medical Chart
DN0403 - Metastatic Cancer Lung Lymph Node Progress Notes Medical Chart
DN0404 -
DN0405 - Follow up ref SDS E1 G25K, ref SDS D7 G25K.
DN0406 -
DN0407 - Background is reported on 070130 in the record meeting with Doctor
DN0408 - Rugo at UCSF. ref SDS B1 G25K  Findings for the most recent CT test on
DN0409 - 070326 do not support concern about lung cancer shown in Kaiser's
DN0410 - Medical Chart on 061208, ref SDS A0 G25K, and, finding no
DN0411 - "interstitial disease" further indicates this side effect of cetuximab
DN0412 - treatment has not occurred in Millie's case so far, reported on
DN0413 - 070329. ref SDS D4 123I  Interstitial lung disease was listed in the
DN0414 - clincial study Consent documents received from UCSF on 070116.
DN0415 - ref SDS A8 0256
DN0417 -  ..
DN0418 - There was no discussion of this issue today, so that attention could
DN0419 - focus on assessing Millie's response to treatment for IBC.
DN0420 -
DN0421 -
DN0422 -
DN0423 -
DN05 -

SUBJECTS
Biopsy Left Right Breasts Left Arm Right Chest Erratic Changes Inten

DU03 -
DU0401 -  ..
DU0402 - Biopsy Erratic Changes Rash Intensity Verify IBC Left Arm
DU0403 -
DU0404 - Follow up ref SDS E1 KT7J, ref SDS D7 KT7J.
DU0405 -
DU0406 - Erratic inflammation at various sites considered by the doctor last
DU0407 - week, and which had subsided at that time have not recurred.  There
DU0408 - was no discussion to biopsy the port catheter site which still
DU0409 - presents slight inflammation, per above. ref SDS 0 S640
DU0411 -  ..
DU0412 - Since the blood culture ordered last week was negative, biopsy could
DU0413 - be considered to assess this issue.
DU0414 -
DU0415 -
DU0416 -
DU0417 -
DU05 -

SUBJECTS
Emotional Trauma Stress Moderate Pulse Normal Cancer Subsides Reliev

E603 -
E60401 -  ..
E60402 - Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
E60403 - Exercise Vigor Strength Engagement Ease Distress Living with Cancer
E60404 - Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
E60405 -
E60406 - Follow up ref SDS E1 Y642, ref SDS D7 Y642.
E60407 -
E60408 - Medical issues create an emotional roller coaster explained on 070105,
E60409 - ref SDS A6 Y642, and reviewed on 070301. ref SDS B9 Y642  Stress and
E60410 - trauma are compounded with rising complexity of case history, listed
E60411 - above. ref SDS E1 LU3J
E60413 -  ..
E60414 - Improved medical prognosis, ref SDS 0 M645, and better coordination,
E60415 - ref SDS 0 DI7I, relieve stress reflected in Millie's vitals that
E60416 - remain calm today, e.g., pulse below 60, ref SDS 0 KB5L, and reported
E60417 - in patient history for treatment after examination. ref SDS E4 AW4L
E60419 -  ..
E60420 - "Wicked problems" unexpected fall of blood counts discovered after
E60421 - getting treatment disrupts initiatives to save time by expediting, and
E60422 - so increases stress, per above. ref SDS 0 FZ5I
E60423 -
E60424 -
E60425 -
E60426 -
E605 -

SUBJECTS
Sleeping Difficulty subsides Worry Emotional Trauma Stress Prognosis

EI03 -
EI0401 -  ..
EI0402 - Sleeping Difficulty Subsides Health Issues Medical Management Improve
EI0403 -
EI0404 - Follow up ref SDS E1 MR99, ref SDS D7 MR99.
EI0405 -
EI0406 - Sleeping difficulties have subsided the past few weeks.
EI0407 -
EI0408 -
EI0409 -
EI05 -

SUBJECTS
Strategy Continue Planning on 070419 Distinguish IBC Progression fro

EN03 -
EN0401 -  ..
EN0402 - Planning Case Management from Patient Profile Work Up
EN0403 - Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
EN0404 - Strategy Cetuximab Continued with Low ANC Expanding IBC Disease
EN0405 -
EN0406 - Follow up ref SDS E1 K36G, ref SDS D7 K36G.
EN0407 -
EN0408 - Background is reported on 070301. ref SDS B9 K36G
EN0410 -  ..
EN0411 - Current strategy and planning is listed in the record last week on
EN0412 - 070419, ref SDS E1 883I, including coordination issues. ref SDS E1
EN0413 - RM4G
EN0414 -
EN0415 -
EN0416 -
EN05 -

SUBJECTS
Treatment IBC 11th Cycle 3rd Relapse 4th Cycle 1st Treatment Chemoth

ES03 -
ES0401 -  ..
ES0402 - Treatment IBC 3rd Relapse Start 4th Cycle Cetuximab Clinical Study
ES0403 - Cetuximab 4th Treatment Cycle IBC 3rd Relapse Clinical Study Drug Trial UCSF
ES0404 -
ES0405 - Follow up ref SDS E1 PF3O, ref SDS D7 PF3O.
ES0406 -
ES0407 - Patient history of cetuximab treatments is listed in the record on
ES0408 - 070426 working with the Infusion Clinic. ref SDS E4 7T3H
ES0410 -  ..
ES0411 - Examination today supported approval for Millie to start the 4th cycle
ES0412 - of treatment with cetuximab alone, in accordance with strategy
ES0413 - reviewed on 070329, ref SDS D4 1R9H, and considered again last week
ES0414 - reporting on meeting with Doctor Rugo. ref SDS E1 883I
ES0416 -  ..
ES0417 - Strategy for managing risks of cetuximab compounding lung and heart
ES0418 - disorders was also reviewed on 070419, ref SDS E1 RQ7K, and considered
ES0419 - today, below. ref SDS 0 4M5K
ES0421 -  ..
ES0422 - Treatment was approved this morning for Millie to begin the 4th cycle
ES0423 - of treatment on the cetuximab clinical study.  Approval was based on
ES0424 - tests last week performed during treatment on 070419 that showed NEUTS
ES0425 - blood counts increased to 1.87, which is a safe level for treatment
ES0426 - using UCSF criteria, ref SDS E2 P560, and in accordance with follow up
ES0427 - discussions on 070424, ref SDS E3 1V3F, reviewed also above.
ES0428 - ref SDS 0 1R4H
ES0430 -  ..
ES0431 - After the examination this morning, Millie had a blood draw while
ES0432 - getting treatment in the Infusion Clinic.  Results reported after
ES0433 - completing treatment showed NEUTS fell from 1.87 to 1.47 (ANC 1870 to
ES0434 - 1470), below the level of safety for receiving treatment. ref SDS E4
ES0435 - P560
ES0437 -  ..
ES0438 - Blood counts falling today reverses prior rising trend, reported in
ES0439 - the record receiving treatment today. ref SDS E4 WX8F  This issue is
ES0440 - discussed above on "wicked problems." ref SDS 0 FZ5I  As noted,
ES0441 - Millie's history shows treatment has often been approved with low
ES0442 - blood counts, reported on 060810. ref SDS 87 HV45  Sudden unexpected
ES0443 - fall of blood counts may be related to cat bites rather than effects
ES0444 - of treatment with cetuximab. ref SDS 0 TS4M
ES0445 -
ES0446 -
ES0447 -
ES0448 -
ES05 -

SUBJECTS
Side Effects Cetuximab Acne-like Rash Face Dry Skin Face Chest Arms

F403 -
F40401 -  ..
F40402 - Side Effects Cetuximab Similar Symptoms Pulmonary Embolism
F40403 - Energy Strength Rising Minimal Side Effects Cetuximab Treatment
F40404 - Facial Skin Dryness New Side Effect Cetuximab Curel Lotion Prescribed
F40405 - Curel Lotion Prescribed Facial Skin Dryness New Side Effect Cetuximab
F40406 -
F40407 - Follow up ref SDS E1 TQ6L, ref SDS D7 TQ6L.
F40408 -
F40409 - Side effects of treatment are listed in the record receiving treatment
F40410 - today in the Infusion Clinic. ref SDS E4 QU8K
F40412 -  ..
F40413 - Brigid and Jackie commented on continuing minimal acne-like rash on
F40414 - face, noted previously by Doctor Rugo last week on 070419, ref SDS E1
F40415 - 847H, and earlier by the primary care physician at Kaiser on 070330.
F40416 - ref SDS D7 N49K  This is reviewed further in the record on treatment
F40417 - in the Infusion Clinic later today. ref SDS E4 QU8K
F40419 -  ..
F40420 - Erratic changes with increased inflammation of IBC rash area on upper
F40421 - left arm, and other sites are also reviewed in the record today for
F40422 - treatment in the Infusion Clinic, ref SDS E4 SU6L, and considers
F40423 - possible side effects of cetuximab treatments. ref SDS E4 8B8Y
F40425 -  ..
F40426 - Millie continues to feel good, reported on 070419. ref SDS E1 8477
F40428 -  ..
F40429 - Fatigue shown by sleeping for several hours after getting home was
F40430 - reported last week, ref SDS E1 H59I, and continued today. ref SDS E4
F40431 - BB7G
F40432 -
F40433 -
F40434 -
F40435 -
F405 -

SUBJECTS
Cetuximab Clinical Study UCSF Drug Trial Clinical Examination IBC Su

FD03 -
FD0401 -  ..
FD0402 - Cetuximab UCSF Clinical Study Treatment Begins 070201
FD0403 - UCSF Clinical Study Treatment Cetuximab Drug Trial Begins 070201
FD0404 - Drug Trials UCSF Has Other Clinical Study Treatments May Help Millie
FD0405 -
FD0406 - Follow up ref SDS E1 ZJ9N, ref SDS D7 ZJ9N.
FD0407 -
FD0408 - Treatment with cetuximab alone on the clinical study at UCSF continues
FD0409 - to be effective, reported last week on 070419, ref SDS E1 TF9M, and
FD0410 - shown by declining CA 15-3 29 cancer biomarker, per above. ref SDS 0
FD0411 - 087J
FD0413 -  ..
FD0414 - Strategy to add carboplatin, and transition to an Avastin trial, as
FD0415 - needed, was most recently reviewed on 070419. ref SDS E1 838N
FD0416 -
FD0417 -
FD0418 -
FD0419 -
FD0420 -
FD05 -

SUBJECTS
Schedule Treatment Cetuximab 070426 Weekly Through 070524 Clinical S

FO03 -
FO0401 -  ..
FO0402 - Schedule Treatment Start Cetuximab Carboplatin 070201
FO0403 -
FO0404 - Follow up ref SDS E1 N96O, ref SDS D7 N96O.
FO0405 -
FO0406 - Scheduling has proven a continuing challenge, reported on 070419.
FO0407 - ref SDS D4 S63K
FO0409 -  ..
FO0410 - On 070315 Nola in the Infusion Clinic scheduled Millie for weekly
FO0411 - treatments through May 24th. ref SDS C7 159O
FO0413 -  ..
FO0414 - Meetings and treatments continue on Thursdays, so the next meeting at
FO0415 - UCSF will be on 070503 to get the 2nd treatment of cycle #4, and then
FO0416 - Millie will meet with the medical team the following week on 070510,
FO0417 - prior to getting the 3rd treatment, as shown on 070315. ref SDS C7
FO0418 - NM4M
FO0420 -  ..
FO0421 - On 070424 Millie notified Brigid about scheduling a blood draw this
FO0422 - morning at 0800 in the Infusion Clinic in order to be prepared for
FO0423 - meeting with the medical team to assess blood counts for approving
FO0424 - treatment. ref SDS E3 MF5Y
FO0426 -  ..
FO0427 - Millie called later on 070424 and asked about testing blood counts
FO0428 - after examination, and while getting treatment today.  This was
FO0429 - approved on the basis of favorable blood counts in a test the week
FO0430 - before on 070419. ref SDS E3 1V3F  Blood counts were reported today
FO0431 - unexpectedly low, below the level of safety for receiving treatments,
FO0432 - presenting a "wicked problem" that "good managment" that prevents
FO0433 - problems looks like "unnecessary overkill," per above. ref SDS 0 FZ5I
FO0434 -
FO0435 -
FO0436 -
FO05 -

SUBJECTS
Pulmonary Embolism Blood Clots Lung Disorder Enlarged Right Ventricl

G103 -
G10401 -  ..
G10402 - Tired Breathing Difficulty Routine Activity Signals Pulmonary Emboli
G10403 - Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
G10404 - Pulmonary Emboli Hypercoagulable Work Up PET Scan Test Compare History
G10405 -
G10406 - Follow up ref SDS E1 CV5L, ref SDS D7 CV5L.
G10407 -
G10408 - Background on pulmonary embolism and correlation with IBC treatment at
G10409 - UCSF is reported in the record meeting at UCSF on 070130. ref SDS B1
G10410 - CV5L  This was updated on 070329 when the CT test on 070326 failed to
G10411 - report findings on pulmonary embolism, ref SDS D4 LZ6H, noted as well
G10412 - the next day at Kaiser on 070330. ref SDS D7 NU55
G10414 -  ..
G10415 - Planning was reported last week on 070419 to order a thin slice CT
G10416 - test to assess side effects of cetuximab treatments that cause blood
G10417 - clot and heart disorders that compound Millie's diagnosis of pulmonary
G10418 - embolism and enlarged right ventricle. ref SDS E1 4M5K
G10419 -
G10421 -  ..
G10422 - INR 2.7 Blood Test Patient Stable for Coumadin Treatments Pulmonary Emboli
G10423 -
G10424 - Follow up ref SDS E1 FE9I, ref SDS D7 FE9I.
G10425 -
G10426 - On 070330 Millie's letter to Kaiser notified Gloria of INR stable
G10427 - blood tests for past 2 months; continuing current Coumadin regimen.
G10428 - ref SDS D6 ZH4H
G10430 -  ..
G10431 - The blood test this morning in the Infusion Clinic shows INR 2.7 and
G10432 - PT 29.4, and remains stable with the current treatment. ref SDS E4
G10433 - SE6N
G10434 -
G10435 -
G10436 -
G10437 -
G10438 -
G105 -

SUBJECTS
Examination Stethoscope No Findings Enlarged Right Ventricle Heart S

G903 -
G90401 -  ..
G90402 - Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
G90403 -
G90404 - Follow up ref SDS E1 Q35O, ref SDS D7 Q35O.
G90405 -
G90406 - Examination with a stethoscope today included multiple locations on
G90407 - Millie's back and chest.  There were no findings of cardio pulmonary
G90408 - issues from clinical examination.
G90410 -  ..
G90411 - After meeting with the medical team in the Breast Care Center, Millie
G90412 - was treated in the Infusion Clinic.  Vitals were taken twice.  The
G90413 - first test at 0900 reported Sa02 97%. ref SDS E4 AW4L
G90414 -
G90415 -
G90416 -
G90417 -
G905 -

SUBJECTS
Enlarged Right Ventricle Heart Disorder Cor Pulmonale Related Pulmon

GJ03 -
GJ0401 -  ..
GJ0402 - Cor Pulmonale Heart Disorder Enlarged Right Ventricle
GJ0403 - Heart Examination Not Ordered Investigate Enlarged Right Ventricle
GJ0404 - Enlarged Right Ventricle CT Test Aligns Patient Symptoms How Serious
GJ0405 -
GJ0406 - Follow up ref SDS E1 VJ4J, ref SDS D7 VJ4J.
GJ0407 -
GJ0408 - Background on heart disorder Cor Pulmonale from enlarged right
GJ0409 - ventricle, and plans for CT testing is reported on 070130. ref SDS B1
GJ0410 - VJ4J  Considerations on ordering the thin slice spiral CT test to
GJ0411 - evaluate enlarged right ventricle, along with pulmonary embolism and
GJ0412 - measureable metastatic disease for the cetuximab clinical study, were
GJ0413 - reported on 070419, ref SDS E1 CV5L, as further noted above.
GJ0414 - ref SDS 0 CV5L
GJ0415 -
GJ0416 -
GJ0417 -
GJ0418 -
GJ0419 -
GJ05 -