THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: April 26, 2007 08:00 AM Thursday;
Millie meeting at UCSF 4th cycle 1st treatment cetuximab for IBC.
2...Agenda Develop Work Plan Stage IV Breast Cancer 15 Mos after Mastectomy
3...Complex Patient History Knowledge Management Dilemma Issues Grow 45
4...Vitals Show Stable Medical Condition
5...Coordination Plan Divided Responsibilities Kaiser UCSF Referral
6...Collaboration Primary Care at Kaiser with UCSF Clinical Study Cetuximab
7...CA 15-3 Cancer Marker 29 Showing Significant Improvement
8...CA 15-3 29 Cancer Marker Strong Response to Treatment Cetuximab
9...Axillary Left Arm No Lymphadenopathy Lymphedema Prominent
10...Lymphadenopathy Axillary Left Arm No Evidence Local Edema
11...Lymphedema Cellulitis Complications Resolved Left Arm Swelling
12...Swelling Left Arm Lymphedema Cellulitis Complications Resolved
13...Left Arm Lymphedema Cellulitis Complications Resolved
14...Cellulitis Lymphedema Complications Resolved Left Arm Swelling
15...IBC Left Arm Stable Subsiding Responds Treatment Cetuximab Drug Trial
16...Left Arm IBC Stable Subsiding Responds Treatment Cetuximab Drug Trial
17...Right Axillary Possible Involvement Red Rash Spreads Right Breast
18...IBC Right Arm New Minimal Red Rash Not Diagnosed IBC or Cellulitis
19...Right Breast IBC Rash Intensity Subsides
20...Rash Right Breast Inflammation Intensity Subsides
21...Right Chest Rash Not Visible Above Breast and Port Catheter
22...Rash Above Port Catheter on Right Upper Chest Not Visible Today
23...Port Catheter Infection Blemish Right Chest Blood Culture Investigate
24...Left Supraclavicular Examination PET Test Report Finding SUV 4.5
25...Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
26...Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
27...2 Scenarios Conflict IBC Expanding Intensity Subsides
28...IBC Rash Left Breast Stomach and Back Seems to Be Subsiding
29...Examination IBC Rash Subsiding Responding to Treatment Cetuximab
30...Cetuximab Effective Treatment IBC Subsiding Left Breast Stomach Back
31...Prognosis Very Good IBC Stable Cetuximab Clinical Study
32...Stable Low Intensity IBC Rash Very Good Response to Treatment
33...Cetuximab Prognosis Good Chance IBC Rash 3rd Relapse Will Clear Up Again
34...Wicked Problem Good Management Looks Like Unnecessary Overkill
35...ANC 1.47 Blood Counts Fall Below Safe Level for Treatment with Cetuximab
36...Measurable Disease IBC No New Sites No Expansion Intensity Declines
37...Photographs Record Measurable Disease IBC Tumor in Dermal Tissue
38...Measurable Disease IBC Observed with Tape Measure Photograph Pictures
39...CA 15-3 Diagnostic Measurable Disease IBC Not Measured by Image Testing
40...Lung Cancer Lymph Nodes Doctor's Progress Notes Medical Chart
41...Metastatic Cancer Lung Lymph Node Progress Notes Medical Chart
42...Biopsy Erratic Changes Rash Intensity Verify IBC Left Arm
43...Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
44...Exercise Vigor Strength Engagement Ease Distress Living with Cancer
45...Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
46...Sleeping Difficulty Subsides Health Issues Medical Management Improve
47...Planning Case Management from Patient Profile Work Up
48...Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
49...Strategy Cetuximab Continued with Low ANC Expanding IBC Disease
50...Treatment IBC 3rd Relapse Start 4th Cycle Cetuximab Clinical Study
51...Cetuximab 4th Treatment Cycle IBC 3rd Relapse Clinical Study Drug Trial UCSF
52...Side Effects Cetuximab Similar Symptoms Pulmonary Embolism
53...Energy Strength Rising Minimal Side Effects Cetuximab Treatment
54...Facial Skin Dryness New Side Effect Cetuximab Curel Lotion Prescribed
55...Curel Lotion Prescribed Facial Skin Dryness New Side Effect Cetuximab
56...Cetuximab UCSF Clinical Study Treatment Begins 070201
57...UCSF Clinical Study Treatment Cetuximab Drug Trial Begins 070201
58...Drug Trials UCSF Has Other Clinical Study Treatments May Help Millie
59...Schedule Treatment Start Cetuximab Carboplatin 070201
60...Tired Breathing Difficulty Routine Activity Signals Pulmonary Emboli
61...Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
62...Pulmonary Emboli Hypercoagulable Work Up PET Scan Test Compare History
63...INR 2.7 Blood Test Patient Stable for Coumadin Treatments Pulmonary Emboli
64...Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
65...Cor Pulmonale Heart Disorder Enlarged Right Ventricle
66...Heart Examination Not Ordered Investigate Enlarged Right Ventricle
67...Enlarged Right Ventricle CT Test Aligns Patient Symptoms How Serious
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Meeting Examination Doctor Review Strategy Work Plan 4th Cycle 1st T
1403 - ..
1404 - Summary/Objective
140501 - Follow up ref SDS E1 0000. ref SDS D7 0000.
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
140518 - ..
1408 - Progress
140901 - Agenda Develop Work Plan Stage IV Breast Cancer 15 Mos after Mastectomy
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...
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...
140943 - 1. Brigid, Nurse Practitioner
140944 - 2. Jackie, Clinical Research Coordinator, coordinating
Complex Patient History 45 Issues Overwhelms Span of Attention Drive
220401 - ..
220402 - Complex Patient History Knowledge Management Dilemma Issues Grow 45
220404 - Follow up ref SDS E1 LU3J, ref SDS D7 LU3J.
220406 - Sampling of issues patient history diagnosis and treatment...
220408 - 1. CA 15-3 monitors advance of cancer response to treatment
220409 - 2. Lymphedema complicated by mastectomy surgery
220410 - 3. Broken finger from minor fall complicates lymphedema
220411 - 4. Esophagitis reflux digestion issues
220412 - 5. Immune system chemotherapy increases risk of infection
220413 - Chemotherapy increase risk of infection
220414 - 6. Cat bites increase risk of infection complicates lymphedema
220415 - 7. Pneumonia chemotherapy increases risk of infection
220416 - 8. Metastatic cancer increases risk pulmonary embolism
220417 - 9. Lymphadenopathy left axilla local regional metastasis
220418 - 10. Lymphadenopathy right axilla distant metastasis
220419 - 11. Lymphadenopathy left supraclavicular diagnose metastatic cancer
220420 - 12. Breast cancer secondary IBC 3rd relapse left breast
220421 - 13. Cancer mutates slow response chemotherapy treatment
220422 - 14. Mastectomy surgery impact on treatment IBC relapse
220423 - 15. Blood vessels removed mastectomy slow chemotherapy treatments
220424 - 16. Treatment options, strategy, planning, schedule
220425 - 17. Drug trials increase declining pool chemotherapy agents
220426 - 18. UCSF Doctor Benz 2nd opinion apply diagnosis and treatment
220427 - 19. Pulmonary embolism blood clots in lungs
220428 - 20. INR weekly adjustments Coumadin treatment blood clots
220429 - 21. Enlarged right ventricle heart problem 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
Vitals Submitted by Doctor UCSF Blood Pressure Pulse Normal Low Anxi
280401 - ..
280402 - Vitals Show Stable Medical Condition
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%
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
Coordination Plan Communication UCSF Kaiser Collaboration Improve Di
590401 - ..
590402 - Coordination Plan Divided Responsibilities Kaiser UCSF Referral
590403 - Collaboration Primary Care at Kaiser with UCSF Clinical Study Cetuximab
590405 - Follow up ref SDS E1 RM4G, ref SDS D7 RM4G.
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...
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
CA 15-3 29 Trend Falls Cetuximab Clinical Study Drug Trial Cancer Ma
660401 - ..
660402 - CA 15-3 Cancer Marker 29 Showing Significant Improvement
660404 - Follow up ref SDS E1 087J, ref SDS D7 087J.
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
660519 - ..
6608 - Analysis
660901 - CA 15-3 29 Cancer Marker Strong Response to Treatment Cetuximab
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.
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
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
Lymphadenopathy Axillary No Findings Left Arm Patient No Complaint S
740401 - ..
740402 - Axillary Left Arm No Lymphadenopathy Lymphedema Prominent
740403 - Lymphadenopathy Axillary Left Arm No Evidence Local Edema
740405 - Follow up ref SDS E1 MW8J, ref SDS D7 MW8J.
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.
Lymphedema Swelling Persistent Left Arm Upper Intensity Subsides Ras
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
920407 - Follow up ref SDS E1 4Y93, ref SDS D7 4Y93.
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
IBC Left Arm Examination Stable Subsides Rash Less Intense Responds
A60401 - ..
A60402 - IBC Left Arm Stable Subsiding Responds Treatment Cetuximab Drug Trial
A60403 - Left Arm IBC Stable Subsiding Responds Treatment Cetuximab Drug Trial
A60405 - Follow up ref SDS E1 527G, ref SDS D7 527G.
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
Right Axillary Lymphadenopathy No Findings Right Arm Patient No Comp
AE0401 - ..
AE0402 - Right Axillary Possible Involvement Red Rash Spreads Right Breast
AE0404 - Follow up ref SDS E1 3D6K, ref SDS D7 3D6K.
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
Right Arm Examination Rash Slight Blemishes No Evidence IBC No Findi
AL0401 - ..
AL0402 - IBC Right Arm New Minimal Red Rash Not Diagnosed IBC or Cellulitis
AL0404 - Follow up ref SDS E1 H15M, ref SDS D7 H15M.
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
IBC Right Breast Examination Stable Subsides Rash Inflammation Less
AU0401 - ..
AU0402 - Right Breast IBC Rash Intensity Subsides
AU0403 - Rash Right Breast Inflammation Intensity Subsides
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
Rash Chest Right Side Above Breast Below Collar Bone Above Port Cath
B40401 - ..
B40402 - Right Chest Rash Not Visible Above Breast and Port Catheter
B40403 - Rash Above Port Catheter on Right Upper Chest Not Visible Today
B40405 - Follow up ref SDS E1 583G, ref SDS D7 583G.
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.
Right Chest Blemish Port Catheter .75" Above Infection .5" Diameter
BH0401 - ..
BH0402 - Port Catheter Infection Blemish Right Chest Blood Culture Investigate
BH0404 - Follow up ref SDS E1 S640, ref SDS D4 BI5K.
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.
Left Supraclavicular Examination Palpation Neck Lymphadenopathy No F
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
BP0406 - Follow up ref SDS E1 8R6M, ref SDS D7 8R6M.
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.
IBC Left Breast Examination 2 Scenarios End Stable Area No New Sites
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
C60407 - Follow up ref SDS E1 025H, ref SDS D7 025H.
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...
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.
Prognosis Stable Low Intensity IBC Rash Very Good Response Treatment
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
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
Wicked Problem Blood Counts ANC 1.47 Falls Below Safe Level Treatmen
CY0401 - ..
CY0402 - Wicked Problem Good Management Looks Like Unnecessary Overkill
CY0403 - ANC 1.47 Blood Counts Fall Below Safe Level for Treatment with Cetuximab
CY0405 - Follow up ref SDS E1 VF5M, ref SDS D7 VF5M.
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
Measurable Disease IBC CA 15-3 29 Cancer Marker Improves Shows Respo
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
DC0407 - Follow up ref SDS E1 M652, ref SDS D7 M652.
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.
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
Lung Cancer No Discussion Metastatic Disease Nodes Doctor's Progress
DN0401 - ..
DN0402 - Lung Cancer Lymph Nodes Doctor's Progress Notes Medical Chart
DN0403 - Metastatic Cancer Lung Lymph Node Progress Notes Medical Chart
DN0405 - Follow up ref SDS E1 G25K, ref SDS D7 G25K.
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.
Biopsy Left Right Breasts Left Arm Right Chest Erratic Changes Inten
DU0401 - ..
DU0402 - Biopsy Erratic Changes Rash Intensity Verify IBC Left Arm
DU0404 - Follow up ref SDS E1 KT7J, ref SDS D7 KT7J.
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.
Emotional Trauma Stress Moderate Pulse Normal Cancer Subsides Reliev
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
E60406 - Follow up ref SDS E1 Y642, ref SDS D7 Y642.
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
Sleeping Difficulty subsides Worry Emotional Trauma Stress Prognosis
EI0401 - ..
EI0402 - Sleeping Difficulty Subsides Health Issues Medical Management Improve
EI0404 - Follow up ref SDS E1 MR99, ref SDS D7 MR99.
EI0406 - Sleeping difficulties have subsided the past few weeks.
Strategy Continue Planning on 070419 Distinguish IBC Progression fro
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
EN0406 - Follow up ref SDS E1 K36G, ref SDS D7 K36G.
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
Treatment IBC 11th Cycle 3rd Relapse 4th Cycle 1st Treatment Chemoth
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
ES0405 - Follow up ref SDS E1 PF3O, ref SDS D7 PF3O.
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
Side Effects Cetuximab Acne-like Rash Face Dry Skin Face Chest Arms
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
F40407 - Follow up ref SDS E1 TQ6L, ref SDS D7 TQ6L.
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
Cetuximab Clinical Study UCSF Drug Trial Clinical Examination IBC Su
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
FD0406 - Follow up ref SDS E1 ZJ9N, ref SDS D7 ZJ9N.
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
Schedule Treatment Cetuximab 070426 Weekly Through 070524 Clinical S
FO0401 - ..
FO0402 - Schedule Treatment Start Cetuximab Carboplatin 070201
FO0404 - Follow up ref SDS E1 N96O, ref SDS D7 N96O.
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
Pulmonary Embolism Blood Clots Lung Disorder Enlarged Right Ventricl
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
G10406 - Follow up ref SDS E1 CV5L, ref SDS D7 CV5L.
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
G10421 - ..
G10422 - INR 2.7 Blood Test Patient Stable for Coumadin Treatments Pulmonary Emboli
G10424 - Follow up ref SDS E1 FE9I, ref SDS D7 FE9I.
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
Examination Stethoscope No Findings Enlarged Right Ventricle Heart S
G90401 - ..
G90402 - Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
G90404 - Follow up ref SDS E1 Q35O, ref SDS D7 Q35O.
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
Enlarged Right Ventricle Heart Disorder Cor Pulmonale Related Pulmon
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
GJ0406 - Follow up ref SDS E1 VJ4J, ref SDS D7 VJ4J.
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