THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: February 8, 2008 04:44 PM Friday; Rod Welch

Letter to UCSF on meeting yesterday to evaluate Millie's treatment.

1...Summary/Objective

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1...By copy will alert Kaiser that communication with UCSF should

CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 10 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Yesterday, the doctor discussed factors to assess progression of
040902 - disease. ref SDS 10 GH5H  Submitted a letter confirming
040903 - understandings...
040904 -
040905 -    1.  Subject:  Meeting UCSF 080207 Evaluate Adding Carboplatin; Status Change
040906 -        Date:  Fri, 08 Feb 2008 16:51:14 -0800
040911 -         ..
040912 -    2.  Jackie,
040914 -         ..
040915 -    3.  Great meeting yesterday.  Doctor Amy Lin made initial
040916 -        examination, and assisted you taking pictures before Doctor
040917 -        Rugo and Brigid made their examination.
040919 -         ..
040920 -    4.  Kaiser has scheduled a CT test for Millie next Tuesday, 080212
040921 -        1400.  Thanks for timely coordination.  Expedited testing was
040922 -        requested by Doctor Rugo yesterday to assess requirements for
040923 -        adding carboplatin to the treatment regimen. ref SDS 10 GH5M
040924 -
040925 -            [On 080212 Millie had a CT test at Kaiser; technician did a
040926 -            good job making only a few mistakes finding a vein to
040927 -            inject contrast media. ref SDS 11 FP5H
040929 -             ..
040930 -            [On 080213 letter asks Kaiser to submit pathology report to
040931 -            UCSF for CT test on 080212. ref SDS 12 7G4R
040933 -             ..
040934 -            [On 080214 Jackie notifies Millie the doctor wants an
040935 -            emergency meeting to evaluate progression of cancer and
040936 -            changing treatment; cancer marker CA 15-3 63 rises 12
040937 -            points, 400% more than testing for prior cycles.
040938 -            ref SDS 13 N94Y
040940 -             ..
040941 -            [On 080214 Millie asks UCSF about getting CT test report
040942 -            from Kaiser to prepare for meeting with the doctor.
040943 -            ref SDS 13 C45U
040945 -             ..
040946 -            [On 080214 UCSF plans to get CT test report in time for
040947 -            meeting with the doctor next week; not enough time to be
040948 -            prepared for a productive meeting. ref SDS 13 I56N
040950 -             ..
040951 -            [On 080215 Millie notifies UCSF with copy to Kaiser that
040952 -            the report from Kaiser is needed in time to prepare for
040953 -            meeting with the doctor, rather, than during the meeting.
040954 -            ref SDS 14 ID5X
040956 -             ..
040957 -            [On 080215 Millie received from Kaiser the report for CT
040958 -            test on 080212. ref SDS 15 XV9J
040959 -
040961 -         ..
040962 -    5.  Please submit the pictures you have from March of last year,
040963 -        and the pictures taken yesterday so Millie can assess
040964 -        progression of disease, ref SDS 10 GH61, along with CA 15-3
040965 -        which should be available next week, and CT test results that
040966 -        will be available by the end of next week.
040968 -  ..
040969 - On 080901 Millie submitted a letter to UCSF requesting photographs of
040970 - IBC taken over the past year, at least for the baseline condition on
040971 - 070201 to compare with recent conditions on 080207, ref SDS 8 4P8N,
040972 - and, also, requested a narrative of findings from the pictures.
040973 - ref SDS 8 4P9K
040974 -
040975 -            [On 080213 letter requests again pictures taken for
040976 -            evaluation of IBC disease. ref SDS 12 7G9P
040978 -             ..
040979 -            [On 080214 Jackie reported the doctor is checking with
040980 -            clinical trial management for permission to release
040981 -            photographic diagnostics used to assess progression of
040982 -            disease. ref SDS 13 N94Q
040984 -             ..
040985 -            [On 080214 submitted follow up letter reminding UCSF to
040986 -            submit data to assess patient status, diagnosis.
040987 -            ref SDS 13 VX8V
040989 -             ..
040990 -            [On 080219 the doctor proposes releasing pictures to the
040991 -            patient after making the decision on progression of disease
040992 -            and changing treatment to add Carboplatin. ref SDS 16 KH5M
040994 -         ..
040995 -    6.  Doctor Rugo seemed to indicate that Millie getting good results
040996 -        from treatment on cetuximab alone for such a long time may
040997 -        present issues for the clinical trial managers who want to see
040998 -        effects of adding Carboplatin. ref SDS 10 GI5N
041000 -         ..
041001 -    7.  Another matter noted by Doctor Lin yesterday is possibility
041002 -        that long exposure to cetuximab may be impacting blood counts,
041003 -        which were down again, NEUTS 1.19 (ANC 1190) after rising a
041004 -        week earlier to 1.67 (taken to assess effects of fall).  This
041005 -        seems anomalous for cetuximab, except not many patients have
041006 -        had 52+ treatments.
041008 -         ..
041009 -    8.  Doctor Rugo noted yesterday that persistent low blood counts
041010 -        may be compounded by adding chemotherapy with Carboplatin, and
041011 -        so require treatment.  Previously Kaiser has occasionally
041012 -        prescribed Nupigen, see case study on 060810. ref SDS 3 HV45
041014 -         ..
041015 -    9.  Impression yesterday was that IBC disease is progressing very
041016 -        slowly.  See as well Kaiser's medical chart on 080118.
041017 -        ref SDS 9 DR4L
041019 -         ..
041020 -   10.  During the meeting, the doctor asked about patient
041021 -        impressions...
041023 -         ..
041024 -   11.  The larger spot on the lower stomach seems a little bigger not
041025 -        from last month, but remembering back a year ago.  It also
041026 -        seems, as Doctor Rugo noted, like there are more isolated
041027 -        blotches of small red dots between the larger dot on the lower
041028 -        stomach and the upper chest, which itself seems stable.  As
041029 -        well, it seemed that the area of IBC on the right breast has
041030 -        increased from a year ago.  However, when you displayed
041031 -        pictures on the computer in the examination room from March of
041032 -        last year, the area on the right breast actually seems stable.
041033 -        Accordingly, it is easy to make mistakes relying on impressions
041034 -        from memory.
041036 -         ..
041037 -   12.  Review of photographic evidence, the cancer marker, and CT test
041038 -        results available next week will help assess progression of
041039 -        disease.
041041 -         ..
041042 -   13.  During the meeting Doctor Rugo asked about status change.  She
041043 -        requested the pathology report from Kaiser for the biopsy on
041044 -        040419. ref SDS 10 6S6G
041046 -         ..
041047 -   14.  By copy request Doctor Johnson to submit the pathology report
041048 -        on the biopsy taken 040419.  This was partly received from
041049 -        Kaiser on 040517. ref SDS 1 736K
041050 -
041051 -            [On 080213 letter asks if UCSF has received the record from
041052 -            Kaiser showing status change? ref SDS 12 7G9V
041054 -         ..
041055 -   15.  Several years later on 060711 Kaiser submitted the rest of the
041056 -        report.  The 2nd part of the report for the biopsy on 040419
041057 -        shows triple negative status did not change, ref SDS 2 S45F,
041058 -        established by link to original biopsy received on 020321.
041059 -        More recently, there was discussion about whether criteria for
041060 -        status change has been modified, reported on 071007.
041061 -        ref SDS 5 S68T
041063 -         ..
041064 -   16.  It might therefore be helpful to review the actual diagnostic
041065 -        numbers that support positive or negative status.  Doctor Rugo
041066 -        seemed to resolve this issue by noting on 071009 that criteria
041067 -        for status has not been revised from 2002 when Millie was first
041068 -        evaluated. ref SDS 6 4P6I
041070 -         ..
041071 -   17.  In any case, if it's not too much trouble, it would be helpful
041072 -        to see the actual numbers determined by the biopsy on 040419
041073 -        that supports conclusionary opinion of status.  By copy,
041074 -        hopefully Kaiser can accommodate analysis of status, and
041075 -        participate in evaluation on progression of disease with
041076 -        respect to adding carboplatin.
041077 -
041078 -            [On 080213 letter reminds Kaiser to submit diagnostics that
041079 -            establish Millie's status. ref SDS 12 7G9Y
041081 -             ..
041082 -            [On 080214 letter to UCSF with copy to Kaiser asks if
041083 -            Kaiser has submitted the report to UCSF. ref SDS 13 X86K
041085 -             ..
041086 -            [On 080215 Millie asks again if UCSF has received the
041087 -            report from Kaiser. ref SDS 14 ID6Q
041089 -             ..
041090 -            [On 080219 UCSF receives report for biopsy on 040419 and
041091 -            determines there is no change in Millie's triple negative
041092 -            status, which would increase treatment options. ref SDS 16
041093 -            VX6G
041095 -             ..
041096 -            [On 081016 letter to medical team confirms Doctor Rugo's
041097 -            request for Kaiser to biopsy of lymph node in left
041098 -            supraclavicular, and orders evaluation of triple negative
041099 -            to investigate expanding options to treat Millie's 5th
041100 -            relapse of IBC. ref SDS 17 J36R
041102 -         ..
041103 -   18.  Seeing the entire team working together constructively is a
041104 -        great relief to Millie who has suffered rising emotional
041105 -        stress.  Support prescribed by Kaiser for mental health
041106 -        consultations has been helpful.  She was very pleased to hear
041107 -        during a recent meeting at Kaiser on 080118 that Doctor Johnson
041108 -        and Doctor Rugo have been communicating by email. ref SDS 9
041109 -        WP5M
041111 -         ..
041112 -   19.  By copy will alert Kaiser that communication with UCSF should
041113 -        be submitted to complete the record on patient history, noted
041114 -        in Millie's letter dated 061227 on referral coordination
041115 -        planning. ref SDS 4 KN5X
041117 -         ..
041118 -   20.  Thanks again for outstanding work.
041120 -         ..
041121 -   21.  Sincerely,
041123 -         ..
041124 -   22.  Rod
041125 -
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041128 -
041129 -
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0412 -