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
ACTION ITEMS..................
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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 -
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0412 -