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 that the medical team sometimes feels that Millie has too
040962 - much support because reading through detailed patient history (like
040963 - this record) is very unusual compared to treating other patients, and
040964 - so feels overwhelming, when rushed by a hectic schedule that occurs
040965 - every day. Doctor Rugo further noted that Millie's survival with good
040966 - quality of life having stage 4 cancer over many years is also unusual.
040967 - Her "good fortune" validates extra effort that makes Millie a joy to
040968 - treat.
040970 - ..
040971 - Doctor Rugo's analysis today aligns with meeting Kaiser's Mental
040972 - Health professional last week on 080201 0845. ref SDS 43 SG8G
040974 - ..
040975 - Millie thanked Doctor Rugo, and said she is grateful for collaboration
040976 - at UCSF and Kaiser providing excellent care all these years.
040978 - ..
040979 - Blood tests at UCSF Infusion Clinic on 080131 seemed normal.
040980 - ref SDS 42 VJ8L Examination at Kaiser Minor Injury Department on
040981 - 080204 found no fractures or other serious injury requiring treatment.
040982 - Xrays were not taken. ref SDS 44 JQ8N
040983 -
040984 - [On 080212 Millie's right arm suffered further trauma from
040985 - multiple needle penetrations for CT test at Kaiser. ref SDS 47
040986 - FP6F
040988 - ..
040989 - Lab results for the test today show NEUTS 1.19. This is a substantial
040990 - decline from a week ago on 080131 when NEUTS were 1.67, which was
040991 - itself a big rise from a month earlier. The new doctor today
040992 - commented that erratic changes in blood counts may reflect effects of
040993 - extended treatment with cetuximab. Nominally, this treatment does not
040994 - effect blood counts. Millie has been treated weekly for nearly 60
040995 - weeks. This level of exposure may be accumulating very small impacts
040996 - on blood counts.
040998 - ..
040999 - The fall on 080125 curtailed Millie's activity the past few weeks.
041000 - Reduced exercise may be another factor in reduced blood counts.
041001 -
041002 - [On 080214 incremental lab ordered by the doctor shows NEUTS
041003 - 1.32, approximate 20% increase, but still well below target
041004 - levels for safe treatment. ref SDS 49 UL4N
041006 - ..
041007 - [On 080304 Millie suffers recurrence Cellulitis; also,
041008 - generally not feeling well past week or so, ref SDS 55 0P44;
041009 - UCSF recommmends immediate examination by physician.
041010 - ref SDS 55 5U8I
041012 - ..
041013 - [On 080304 Kaiser schedules meeting for examination of
041014 - Cellulitis the next day on 080305.
041016 - ..
041017 - Doctor Rugo discussed possible progression of disease based on
041018 - impressions observing IBC rash lightly sprinkled between the lower
041019 - stomach and the upper left chest area. Today, this seems like
041020 - possible spread of disease that signals requirement to add Carboplatin
041021 - to cetuximab for the treatment protocol. IBC rash and inflammation
041022 - seem possibly more intense today compared with examination on 080110.
041023 - ref SDS 38 JO6J
041024 -
041025 - [On 080219 Doctor Rugo confirms planning to add Carboplatin to
041026 - treatment plan as called out in clinical study protocol.
041027 - ref SDS 54 3J4I
041029 - ..
041030 - [On 080305 primary care physician at Kaiser concurs with
041031 - planning to add Carboplatin at this time to the treatment
041032 - protocol. ref SDS 56 N15N
041034 - ..
041035 - Decided to take pictures and compare with baseline pictures taken on
041036 - 070201. ref SDS 12 6T6M
041037 -
041038 - [On 080208 letter confirms understandings from meeting today.
041039 - ref SDS 45 6V5I
041041 - ..
041042 - [On 080214 Doctor Rugo orders emergency meeting to consider
041043 - increasing treatment by adding carboplatin to treat progression
041044 - of IBC disease. ref SDS 50 N94Y
041046 - ..
041047 - Jackie took pictures of conditions today. She tried to display the
041048 - pictures on the computer in the examination room, as requested in the
041049 - letter to Kaiser on 080109, ref SDS 37 4P8N, which also requested a
041050 - narrative of findings from the pictures. ref SDS 37 4P9K
041052 - ..
041053 - Jackie advised that UCSF lost pictures recording the baseline
041054 - condition taken on 070201, when Millie started treatment at UCSF.
041055 - ref SDS 12 6T6M Some kind of administrative mixup occurred. The
041056 - camera is shared with another business unit, or group. They deleted
041057 - pictures no longer needed for their work, and evidently deleted the
041058 - wrong pictures, which included those for Millie's case, beginning on
041059 - 070201. Jackie feels she has pictures from 070301, which starts the
041060 - 2nd cycle. That is close enough for a baseline to assess progression
041061 - of disease.
041062 -
041063 - [On 080208 requested copies of pictures for diagnostic evidence
041064 - showing progression of disease, so that there is a secure
041065 - record, and to facilitate assessment of treatment. ref SDS 45
041066 - OO8Y
041068 - ..
041069 - [On 080213 letter requests again pictures taken for evaluation
041070 - of IBC disease. ref SDS 48 7G9P
041072 - ..
041073 - [On 080214 Jackie reported the doctor is checking with clinical
041074 - trial management for permission to release photographic
041075 - diagnostics used to assess progression of disease. ref SDS 50
041076 - N94Q
041078 - ..
041079 - [On 080214 request copies of photographic evidence of disease
041080 - requested for distribution to primary care physician to
041081 - facilitate diagnosis. ref SDS 50 VX8Y
041083 - ..
041084 - Jackie plugged the cammera memory chip into the USB port on the
041085 - computer in the examination room. She was was unable to get the
041086 - immages to display fully. They look like jpg files, and so should
041087 - display with any number of Microsoft tools. Since the computer seems
041088 - to be using the Microsoft operating system, not clear why the picutres
041089 - would not display.
041091 - ..
041092 - Jackie was able to display very small preview images showing the
041093 - pictures on the camera's memory chip plugged into the USB port. This
041094 - small picture seemed to indicate there has not been much if any
041095 - progression of disease on the right breast, which has been a concern
041096 - lately.
041098 - ..
041099 - As a result of not being able to display pictures on the computer in
041100 - the examination room, Jackie, Doctor, Rugo, Brigid, and the new doctor
041101 - went to another office where Jackie was able to display the
041102 - photographic evidence. They did not report on findings. This may
041103 - mean the pictures did not display in the other room either.
041105 - ..
041106 - The doctor noted small rise of CA 15-3 from 48 to 51 from the prior
041107 - cycle, reported on 080110. ref SDS 39 A16M Review of change in cancer
041108 - marker for blood test today can be assessed when results are reported.
041109 -
041110 - [On 080214 CA 15-3 63 for the test today, increased 12 points;
041111 - Doctor Rugo schedules meeting on 080219. ref SDS 49 VR8N
041113 - ..
041114 - The doctor noted that the clinical trial management is anxious to see
041115 - results of Millie being treated with cetuximab and carboplatin.
041117 - ..
041118 - Millie is concerned that adding carboplatin will introduce a more
041119 - vigorous chemotherapy treatment that causes increased side effects of
041120 - lower energy, and feeling ill.
041122 - ..
041123 - The doctor indicated Millie's recent pattern of low blood counts with
041124 - weekly treatments using cetuximab alone, which has minimal affect on
041125 - blood counts, could be problematic by adding Carboplatin which is a
041126 - chemotherapy drug that causes low blood counts, and would be expected
041127 - to increase bad side effects, which Millie has no far avoided with
041128 - cetuximab alone. Even worse, low NEUTS will signal lower immunity
041129 - causing Millie to miss treatments, which increases risk of infectious
041130 - disease and compounds rise of cancer.
041132 - ..
041133 - Millie asked about trying another cycle of cetuximab without
041134 - carboplatin to see if cancer marker and IBC rash will subside again,
041135 - as exercise increases after a pause to recover from her fall a week or
041136 - so ago.
041138 - ..
041139 - There was further discussion of the record on 060810 reporting patient
041140 - history with nupigen treatment to increase recovery of blood counts so
041141 - that cancer treatments can be given on schedule. ref SDS 6 HV45
041143 - ..
041144 - Jackie commented that most patients tolerate carboplatin well when
041145 - added to cetuximab. She seemed further to indicate low blood counts
041146 - can be addressed in part by reducing the dose of carboplatin
041147 - chemotherapy.
041148 -
041149 - [On 080219 Millie letter to UCSF cites concern about low blood
041150 - counts with weekly chemotherapy treatments. ref SDS 53 1K4P
041152 - ..
041153 - [On 080219 Doctor decided to defer increasing treatment by
041154 - adding Carboplatin until starting the next cycle on 080306,
041155 - ref SDS 54 I35G; allows time to assess next blood test to see
041156 - if trauma of serious fall could have caused cancer marker to
041157 - rise, rather than signaling greater advance of IBC. ref SDS 54
041158 - CL4I
041160 - ..
041161 - [On 080305 meeting at Kaiser primary care physician Millie
041162 - coping with emotional stress from mounting medical issues,
041163 - ref SDS 56 KT4J, including difficulty maintaining blood counts
041164 - essential for safe chemotherapy to treat cancer. ref SDS 56
041165 - PC6M
041167 - ..
041168 - [On 080306 blood counts NEUTS 2.75 (ANC 2750) rise unexpectedly
041169 - to highest level in over a year provides safety for increasing
041170 - treatment by adding Carboplatin to treat expanding cancer
041171 - (IBC), and relieves anxiety, worry, and doubt. ref SDS 57 033B
041173 - ..
041174 - [On 080307 letter to primary care physician at Kaiser confirms
041175 - worry about blood counts; reports relief from sudden and
041176 - unexpected rise to highest level in over a year. ref SDS 58
041177 - HS6R
041179 - ..
041180 - [On 080313 first chemotherapy treatment with Carboplatin added
041181 - to cetuximab. ref SDS 59 TZ8I
041183 - ..
041184 - [On 030320 blood counts were too low for treatment with
041185 - Carboplatin, and so Millie received treatment only with
041186 - cetuximab. ref SDS 60 SE5R
041188 - ..
041189 - [On 080403 UCSF prescribes Neupogen to increase blood counts
041190 - for safe weekly treatments with Carboplatin chemotherapy added
041191 - to cetuximab. ref SDS 61 I33G
041193 - ..
041194 - Today, the doctor ordered expedited CT testing to follow up findings
041195 - from the test on 071210, ref SDS 33 IA5N, that revealed possible
041196 - rising adenopathy in the right axillary, but which had been omitted
041197 - from the prior tests, as reported during the meeting at UCSF on
041198 - 071213. ref SDS 34 SR5P
041199 -
041200 - [On 080208 Millie reports CT test ordered at Kaiser. ref SDS 45
041201 - OO8V
041203 - ..
041204 - [On 080212 Millie had CT test at Kaiser; technician did a good
041205 - job making only a few mistakes finding a vein to inject
041206 - contrast media. ref SDS 47 FP5H
041208 - ..
041209 - [On 080213 letter asks Kaiser to submit pathology report to
041210 - UCSF for CT test on 080212. ref SDS 48 7G4R
041212 - ..
041213 - [On 080214 doctor orders emergency meeting to evaluate
041214 - progression of cancer and changing treatment; cancer marker CA
041215 - 15-3 63 rises 12 points, 400% more than testing for prior
041216 - cycles. ref SDS 50 N94Y
041218 - ..
041219 - [On 080214 Millie asks UCSF about getting CT test report from
041220 - Kaiser to prepare for meeting with the doctor. ref SDS 50 C45U
041222 - ..
041223 - [On 080214 UCSF plans to get CT test report in time for meeting
041224 - with the doctor next week; not enough time to be prepared for a
041225 - productive meeting. ref SDS 50 I56N
041227 - ..
041228 - [On 080215 Millie notifies UCSF with copy to Kaiser that the
041229 - report from Kaiser is needed in time to prepare for meeting
041230 - with the doctor, rather, than during the meeting. ref SDS 51
041231 - ID5X
041233 - ..
041234 - [On 080215 Millie received from Kaiser the report for CT
041235 - test on 080212. ref SDS 52 XV9J
041237 - ..
041238 - [On 080219 doctor diagnoses IBC relapse requires increased
041239 - medication adding Carboplatin chemotherapy to cetuximab for
041240 - treating IBC, ref SDS 54 3J4I; CT testing shows rising
041241 - symptoms. ref SDS 54 3J49
041243 - ..
041244 - [On 080212 needle penetrations for more frequent CT testing
041245 - become more difficult and painful again requiring 3 attemps.
041246 - ref SDS 47 FP5H
041248 - ..
041249 - [On 080425 CT test required 4 needle penetrations and took
041250 - over 3 hours, very painful because of difficulty finding a
041251 - vein to inject contrast medium. ref SDS 62 FP6F
041253 - ..
041254 - Today, Doctor Rugo asked about status change possibilities. This was
041255 - previously discussed on 071009, ref SDS 20 4P6I, citing background on
041256 - 071007. ref SDS 19 S68T
041258 - ..
041259 - Millie was orginally tested and reported triple-negative status in the
041260 - record on 020321. ref SDS 1 6Q6J After inquiry, on 060711 Kaiser
041261 - reported that a follow up biopsy on 040419 tested status again, and
041262 - showed no change, ref SDS 4 SW7O, as further shown by the biopsy
041263 - report listed in the record on 060711. ref SDS 4 S45F
041265 - ..
041266 - Doctor Rugo requested a copy of the report from Kaiser for the biopsy
041267 - on 040419. After the meeting, a letter to Kaiser presented this
041268 - request.
041269 -
041270 - [On 080208 the record on status change was submitted to UCSF,
041271 - with copy to Kaiser requesting the original report. ref SDS 45
041272 - OO5W
041274 - ..
041275 - [On 080213 letter asks if UCSF has received the record from
041276 - Kaiser showing status change? ref SDS 48 7G9V
041278 - ..
041279 - [On 080214 no record of Kaiser submitting the report to UCSF
041280 - for the biopsy on 040419; follow up letter submitted.
041281 - ref SDS 49 VR4P
041283 - ..
041284 - [On 080214 letter to UCSF asks if data on status change has
041285 - been received from Kaiser. ref SDS 50 Y86G
041287 - ..
041288 - [On 080215 Millie asks again if UCSF has received the report
041289 - from Kaiser on status change. ref SDS 51 ID6Q
041291 - ..
041292 - [On 080219 UCSF receives report for biopsy on 040419 and
041293 - determines there is no change in Millie's triple negative
041294 - status, which would increase treatment options. ref SDS 54 VX6G
041296 - ..
041297 - [On 081016 letter to medical team confirms Doctor Rugo's
041298 - request for Kaiser to biopsy of lymph node in left
041299 - supraclavicular, and orders evaluation of triple negative to
041300 - investigate expanding options to treat Millie's 5th relapse of
041301 - IBC. ref SDS 63 J36R
041303 - ..
041304 - [On 081119 Kaiser submits summary of final pathology report,
041305 - ref SDS 65 5O8G, for the biopsy on 081107, ref SDS 64 496L, and
041306 - it shows status is unchanged, still triple negative.
041307 - ref SDS 65 UQ5P
041309 - ..
041310 - Millie feels stress from loss of control associated with the fast pace
041311 - of considerations today for changing her treatment, and worry about
041312 - the future.
041313 -
041314 - [On 080211 Millie met with Kaiser Mental Health; she feels slow
041315 - progress from this level of support justifies ending the
041316 - effort. ref SDS 46 SP4H
041317 -
041318 -
041319 -
041320 -
041321 -
041322 -
041323 -
041324 -
041325 -
0414 -