CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 38 0000. ref SDS 34 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie had a blood draw on the 5th floor in Infusion Clinic this
040902 - morning at 0800, ref SDS 39 546N, to evaluate readiness for the next
040903 - treatment cycle.
040905 - ..
040906 - Now at 0900 in the Breast Care Clinic on the 2nd floor a new doctor,
040907 - Amy Lin, MD, made examination for approving Millie to start another
040908 - cycle on the clinical trial with cetuximab later today in the Infusion
040909 - Clinic.
040911 - ..
040912 - Doctor Lin was shocked by severity of brusing on Millie's face, with
040913 - 80% of right arm and right side showing very dark bruising, reported
040914 - in meeting at Kaiser Minor Injury Clinic a few days ago on 080204
040915 - 1045. ref SDS 44 JQ8N
040917 - ..
040918 - Doctor Rugo normally does not arrive until the last 15 minutes of
040919 - these meetings. Today she came with Doctor Lin, and Jackie, the
040920 - clinical trial coordinator, and so was present during initial
040921 - examination.
040923 - ..
040924 - Doctor Rugo asked about circumstances of Millie's severe bruising?
040925 - She noted that internal bleeding seen as "bruising" is increased by
040926 - Coumadin treatment for PE, but severity of Millie's injury is
040927 - shocking.
040929 - ..
040930 - Millie explained falling and not having a good memory of how it
040931 - happened on 080125. ref SDS 41 N65K Millie reported care at Kaiser
040932 - Minor Injury Clinic found no actual intenral injuries, shown in the
040933 - record a few days ago on 080204 1045. ref SDS 44 546N At that time,
040934 - Doctor Malone explained poor memory often occurs from minor head
040935 - injuries, shown in Kaiser documentation received from the Minor Injury
040936 - Clinic on 080204. ref SDS 44 U85F
040938 - ..
040939 - Doctor Rugo said she is required (under domestic abuse regulations) to
040940 - report severe injuries, like today. She ask if Millie wants to see a
040941 - social worker or other authorities on the cause of her injuries, and
040942 - for protection? She asked if anyone or anything caused this?
040944 - ..
040945 - Millie smiled and said there is no need to say anything more on her
040946 - fall, and she does not want assistance nor involvement with other
040947 - professionals. Don't worry - Rod didn't knock me down because I
040948 - wouldn't read the SDS record. I fell - it was a dumb mistake
040949 - (reported on 080125 1629. ref SDS 41 N65K). That's it - part of the
040950 - emotional roller coaster from cancer - I had a bad day, but am fine
040951 - now.
040953 - ..
040954 - [On 080219 examination at UCSF shows slowing recovery from
040955 - severe bruising caused by fall on 080125. ref SDS 54 OS4N
040957 - ..
040958 - Doctor Rugo smiled in return and said that she and Doctor Johnson (at
040959 - Kaiser) have discussed Millie's good fortunate getting through
040960 - continual physical and emotional trauma cancer patients suffer. The
040961 - doctor noted they sometimes feel Millie has too much support because
040962 - reading through such detailed patient history (like this record) is
040963 - very unusual compared to treating other patients, and so feels
040964 - overwhelming, when rushed by a hectic schedule that occurs every day.
040965 - Doctor Rugo further noted that Millie's survival with good quality of
040966 - life having stage 4 cancer over many years is also unusual. Her "good
040967 - fortune" validates extra effort that makes Millie a joy to treat.
040969 - ..
040970 - Doctor Rugo's analysis today aligns with meeting Kaiser's Mental
040971 - Health professional last week on 080201 0845. ref SDS 43 SG8G
040973 - ..
040974 - Millie thanked Doctor Rugo, and said she is grateful for collaboration
040975 - at UCSF and Kaiser providing excellent care all these years.
040977 - ..
040978 - Blood tests at UCSF Infusion Clinic on 080131 seemed normal.
040979 - ref SDS 42 VJ8L Examination at Kaiser Minor Injury Department on
040980 - 080204 found no fractures or other serious injury requiring treatment.
040981 - Xrays were not taken. ref SDS 44 JQ8N
040982 -
040983 - [On 080212 Millie's right arm suffered further trauma from
040984 - multiple needle penetrations for CT test at Kaiser. ref SDS 47
040985 - FP6F
040987 - ..
040988 - Lab results for the test today show NEUTS 1.19. This is a substantial
040989 - decline from a week ago on 080131 when NEUTS were 1.67, which was
040990 - itself a big rise from a month earlier. The new doctor today
040991 - commented that erratic changes in blood counts may reflect effects of
040992 - extended treatment with cetuximab. Nominally, this treatment does not
040993 - effect blood counts. Millie has been treated weekly for nearly 60
040994 - weeks. This level of exposure may be accumulating to impact blood
040995 - counts.
040997 - ..
040998 - The fall on 080125 curtailed Millie's activity the past few weeks.
040999 - Reduced exercise may be a factor in reduced blood counts.
041000 -
041001 - [On 080214 incremental lab ordered by the doctor shows NEUTS
041002 - 1.32, approximate 20% increase, but still well below target
041003 - levels for safe treatment. ref SDS 49 UL4N
041005 - ..
041006 - [On 080304 Millie suffers recurrence Cellulitis; also,
041007 - generally not feeling well past week or so, ref SDS 55 0P44;
041008 - UCSF recommmends immediate examination by physician.
041009 - ref SDS 55 5U8I
041011 - ..
041012 - [On 080304 Kaiser schedules meeting for examination of
041013 - Cellulitis the next day on 080305.
041015 - ..
041016 - Doctor Rugo discussed possible progression of disease based on
041017 - impressions observing IBC rash lightly sprinkled between the lower
041018 - stomach and the upper left chest area. Today, this seems like
041019 - possible spread of disease that signals requirement to add Carboplatin
041020 - to cetuximab for the treatment protocol. IBC rash and inflammation
041021 - seem possibly more intense today compared with examination on 080110.
041022 - ref SDS 38 JO6J
041023 -
041024 - [On 080219 Doctor Rugo confirms planning to add Carboplatin to
041025 - treatment plan as called out in clinical study protocol.
041026 - ref SDS 54 3J4I
041028 - ..
041029 - [On 080305 primary care physician at Kaiser concurs with
041030 - planning to add Carboplatin at this time to the treatment
041031 - protocol. ref SDS 56 N15N
041033 - ..
041034 - Decided to take pictures and compare with baseline pictures taken on
041035 - 070201. ref SDS 12 6T6M
041036 -
041037 - [On 080208 letter confirms understandings from meeting today.
041038 - ref SDS 45 6V5I
041040 - ..
041041 - [On 080214 Doctor Rugo orders emergency meeting to consider
041042 - increasing treatment by adding carboplatin to treat progression
041043 - of IBC disease. ref SDS 50 N94Y
041045 - ..
041046 - Jackie took pictures of conditions today. She tried to display the
041047 - pictures on the computer in the examination room, as requested in the
041048 - letter to Kaiser on 080109, ref SDS 37 4P8N, which also requested a
041049 - narrative of findings from the pictures. ref SDS 37 4P9K
041051 - ..
041052 - Jackie advised that UCSF lost pictures recording the baseline
041053 - condition taken on 070201, when Millie started treatment at UCSF.
041054 - ref SDS 12 6T6M Some kind of administrative mixup occurred. The
041055 - camera is shared with another business unit, or group. They deleted
041056 - pictures no longer needed for their work, and evidently deleted the
041057 - wrong pictures, which included those for Millie's case, beginning on
041058 - 070201. Jackie feels she has pictures from 070301, which starts the
041059 - 2nd cycle. That is close enough for a baseline to assess progression
041060 - of disease.
041061 -
041062 - [On 080208 requested copies of pictures for diagnostic evidence
041063 - showing progression of disease, so that there is a secure
041064 - record, and to facilitate assessment of treatment. ref SDS 45
041065 - OO8Y
041067 - ..
041068 - [On 080213 letter requests again pictures taken for evaluation
041069 - of IBC disease. ref SDS 48 7G9P
041071 - ..
041072 - [On 080214 Jackie reported the doctor is checking with clinical
041073 - trial management for permission to release photographic
041074 - diagnostics used to assess progression of disease. ref SDS 50
041075 - N94Q
041077 - ..
041078 - [On 080214 request copies of photographic evidence of disease
041079 - requested for distribution to primary care physician to
041080 - facilitate diagnosis. ref SDS 50 VX8Y
041082 - ..
041083 - Jackie plugged the cammera memory into the USB port on the computer in
041084 - the examination room. She was was unable to get the immages to
041085 - display fully. They look like jpg files, and so should display with
041086 - any number of Microsoft tools. Since the computer seems to be using
041087 - the Microsoft operating system, not clear why the picutres would not
041088 - display.
041090 - ..
041091 - Jackie was able to display very small preview images showing the
041092 - pictures on the camera's memory chip plugged into the USB port. This
041093 - small picture seemed to indicate there has not been much if any
041094 - progression of disease on the right breast, which has been a concern
041095 - lately.
041097 - ..
041098 - As a result of not being able to display pictures on the computer in
041099 - the examination room, Jackie, Doctor, Rugo, Brigid, and the new doctor
041100 - went to another office where Jackie was able to display the
041101 - photographic evidence. They did not report on findings. This may
041102 - mean the pictures did not display in the other room either.
041104 - ..
041105 - The doctor noted small rise of CA 15-3 from 48 to 51 from the prior
041106 - cycle, reported on 080110. ref SDS 39 A16M Review of change in cancer
041107 - marker for blood test today can be assessed when results are reported.
041108 -
041109 - [On 080214 CA 15-3 63 for the test today, increased 12 points;
041110 - Doctor Rugo schedules meeting on 080219. ref SDS 49 VR8N
041112 - ..
041113 - The doctor noted that the clinical trial management is anxious to see
041114 - results of Millie being treated with cetuximab and carboplatin.
041116 - ..
041117 - Millie is concerned that adding carboplatin will introduce a more
041118 - vigorous chemotherapy treatment that causes increased side effects of
041119 - lower energy, and feeling ill.
041121 - ..
041122 - The doctor indicated Millie's recent pattern of low blood counts with
041123 - weekly treatments using cetuximab alone, which has minimal affect on
041124 - blood counts, could be problematic by adding Carboplatin which is a
041125 - chemotherapy drug that causes low blood counts, and would be expected
041126 - to increase bad side effects, which Millie has no far avoided with
041127 - carboplatin alone. Even worse, low NEUTS will signal lower immunity
041128 - causing Millie to miss treatments, which increases risk of infectious
041129 - disease and compounds rise of cancer.
041131 - ..
041132 - Millie asked about trying another cycle of cetuximab without
041133 - carboplatin to see if cancer marker and IBC rash will subside again,
041134 - as exercise increases after a pause to recover from her fall a week or
041135 - so ago.
041137 - ..
041138 - There was further discussion of the record on 060810 reporting patient
041139 - history with nupigen treatment to increase recovery of blood counts so
041140 - that cancer treatments can be given on schedule. ref SDS 6 HV45
041142 - ..
041143 - Jackie commented that most patients tolerate carboplatin well when
041144 - added to cetuximab. She seemed further to indicate low blood counts
041145 - can be addressed in part by reducing the dose of carboplatin
041146 - chemotherapy.
041147 -
041148 - [On 080219 Millie letter to UCSF cites concern about low blood
041149 - counts with weekly chemotherapy treatments. ref SDS 53 1K4P
041151 - ..
041152 - [On 080219 Doctor decided to defer increasing treatment by
041153 - adding Carboplatin until starting the next cycle on 080306,
041154 - ref SDS 54 I35G; allows time to assess next blood test to see
041155 - if trauma of serious fall could have caused cancer marker to
041156 - rise, rather than signaling greater advance of IBC. ref SDS 54
041157 - CL4I
041159 - ..
041160 - [On 080305 meeting at Kaiser primary care physician Millie
041161 - coping with emotional stress from mounting medical issues,
041162 - ref SDS 56 KT4J, including difficulty maintaining blood counts
041163 - essential for safe chemotherapy to treat cancer. ref SDS 56
041164 - PC6M
041166 - ..
041167 - [On 080306 blood counts NEUTS 2.75 (ANC 2750) rise unexpectedly
041168 - to highest level in over a year provides safety for increasing
041169 - treatment by adding Carboplatin to treat expanding cancer
041170 - (IBC), and relieves anxiety, worry, and doubt. ref SDS 57 033B
041172 - ..
041173 - [On 080307 letter to primary care physician at Kaiser confirms
041174 - worry about blood counts; reports relief from sudden and
041175 - unexpected rise to highest level in over a year. ref SDS 58
041176 - HS6R
041178 - ..
041179 - [On 080313 first chemotherapy treatment with Carboplatin added
041180 - to cetuximab. ref SDS 59 TZ8I
041182 - ..
041183 - [On 030320 blood counts were too low for treatment with
041184 - Carboplatin, and so Millie received treatment only with
041185 - cetuximab. ref SDS 60 SE5R
041187 - ..
041188 - [On 080403 UCSF prescribes Neupogen to increase blood counts
041189 - for safe weekly treatments with Carboplatin chemotherapy added
041190 - to cetuximab. ref SDS 61 I33G
041192 - ..
041193 - Today, the doctor ordered expedited CT testing to follow up findings
041194 - from the test on 071210, ref SDS 33 IA5N, that revealed possible
041195 - rising adenopathy in the right axillary, but which had been omitted
041196 - from the prior tests, as reported during the meeting at UCSF on
041197 - 071213. ref SDS 34 SR5P
041198 -
041199 - [On 080208 Millie reports CT test ordered at Kaiser. ref SDS 45
041200 - OO8V
041202 - ..
041203 - [On 080212 Millie had CT test at Kaiser; technician did a good
041204 - job making only a few mistakes finding a vein to inject
041205 - contrast media. ref SDS 47 FP5H
041207 - ..
041208 - [On 080213 letter asks Kaiser to submit pathology report to
041209 - UCSF for CT test on 080212. ref SDS 48 7G4R
041211 - ..
041212 - [On 080214 doctor orders emergency meeting to evaluate
041213 - progression of cancer and changing treatment; cancer marker CA
041214 - 15-3 63 rises 12 points, 400% more than testing for prior
041215 - cycles. ref SDS 50 N94Y
041217 - ..
041218 - [On 080214 Millie asks UCSF about getting CT test report from
041219 - Kaiser to prepare for meeting with the doctor. ref SDS 50 C45U
041221 - ..
041222 - [On 080214 UCSF plans to get CT test report in time for meeting
041223 - with the doctor next week; not enough time to be prepared for a
041224 - productive meeting. ref SDS 50 I56N
041226 - ..
041227 - [On 080215 Millie notifies UCSF with copy to Kaiser that the
041228 - report from Kaiser is needed in time to prepare for meeting
041229 - with the doctor, rather, than during the meeting. ref SDS 51
041230 - ID5X
041232 - ..
041233 - [On 080215 Millie received from Kaiser the report for CT
041234 - test on 080212. ref SDS 52 XV9J
041236 - ..
041237 - [On 080219 doctor diagnoses IBC relapse requires increased
041238 - medication adding Carboplatin chemotherapy to cetuximab for
041239 - treating IBC, ref SDS 54 3J4I; CT testing shows rising
041240 - symptoms. ref SDS 54 3J49
041242 - ..
041243 - [On 080212 needle penetrations for more frequent CT testing
041244 - become more difficult and painful again requiring 3 attemps.
041245 - ref SDS 47 FP5H
041247 - ..
041248 - [On 080425 CT test required 4 needle penetrations and took
041249 - over 3 hours, very painful because of difficulty finding a
041250 - vein to inject contrast medium. ref SDS 62 FP6F
041252 - ..
041253 - Today, Doctor Rugo asked about status change possibilities. This was
041254 - previously discussed on 071009, ref SDS 20 4P6I, citing background on
041255 - 071007. ref SDS 19 S68T
041257 - ..
041258 - Millie was orginally tested and reported triple-negative status in the
041259 - record on 020321. ref SDS 1 6Q6J After inquiry, on 060711 Kaiser
041260 - reported that a follow up biopsy on 040419 tested status again, and
041261 - showed no change, ref SDS 4 SW7O, as further shown by the biopsy
041262 - report listed in the record on 060711. ref SDS 4 S45F
041264 - ..
041265 - Doctor Rugo requested a copy of the report from Kaiser for the biopsy
041266 - on 040419. After the meeting, a letter to Kaiser presented this
041267 - request.
041268 -
041269 - [On 080208 the record on status change was submitted to UCSF,
041270 - with copy to Kaiser requesting the original report. ref SDS 45
041271 - OO5W
041273 - ..
041274 - [On 080213 letter asks if UCSF has received the record from
041275 - Kaiser showing status change? ref SDS 48 7G9V
041277 - ..
041278 - [On 080214 no record of Kaiser submitting the report to UCSF
041279 - for the biopsy on 040419; follow up letter submitted.
041280 - ref SDS 49 VR4P
041282 - ..
041283 - [On 080214 letter to UCSF asks if data on status change has
041284 - been received from Kaiser. ref SDS 50 Y86G
041286 - ..
041287 - [On 080215 Millie asks again if UCSF has received the report
041288 - from Kaiser on status change. ref SDS 51 ID6Q
041290 - ..
041291 - [On 080219 UCSF receives report for biopsy on 040419 and
041292 - determines there is no change in Millie's triple negative
041293 - status, which would increase treatment options. ref SDS 54 VX6G
041295 - ..
041296 - [On 081016 letter to medical team confirms Doctor Rugo's
041297 - request for Kaiser to biopsy of lymph node in left
041298 - supraclavicular, and orders evaluation of triple negative to
041299 - investigate expanding options to treat Millie's 5th relapse of
041300 - IBC. ref SDS 63 J36R
041302 - ..
041303 - [On 081119 Kaiser submits summary of final pathology report,
041304 - ref SDS 65 5O8G, for the biopsy on 081107, ref SDS 64 496L, and
041305 - it shows status is unchanged, still triple negative.
041306 - ref SDS 65 UQ5P
041308 - ..
041309 - Millie feels stress from loss of control associated with the fast pace
041310 - of considerations today for changing her treatment, and worry about
041311 - the future.
041312 -
041313 - [On 080211 Millie met with Kaiser Mental Health; she feels slow
041314 - progress from this level of support justifies ending the
041315 - effort. ref SDS 46 SP4H
041316 -
041317 -
041318 -
041319 -
041320 -
041321 -
041322 -
041323 -
041324 -
0414 -