CONTACTS 

SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 7 0000, ref SDS 4 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie submitted a letter to UCSF with a copy to Kaiser on planning
040902 - an agenda for a meeting today at UCSF, which says...
040903 -
040904 -    1.  Subject: Treatment Considerations CT Test, Biopsy
040905 -        Date: Tue, 19 Feb 2008 08:07:06 -0800
040914 -         ..
040915 -    2.  Dear Jackie,
040917 -         ..
040918 -    3.  This past Friday afternoon, I received the report from Doctor
040919 -        Johnson for the CT test on 080212. ref SDS 6 FP5H  Thanks to
040920 -        all for expediting things, and especially to Doctor Johnson
040921 -        (and Arlette).
040923 -  ..
040924 - This follows up Millie's letter to UCSF on 080214 asking if UCSF had
040925 - received the report on the CT test. ref SDS 8 C45U
040927 -  ..
040928 - Letter to UCSF continues...
040929 -
040930 -    4.  The CT test report I received does not show control criteria,
040931 -        header, name of the analyst, etc.  Hopefully I can get this
040932 -        today when we meet with Doctor Rugo.
040934 -         ..
040935 -    5.  The test on 080212 says in part...
040936 -
040937 -        "A node in the right axilla 12.7 x 11.3 cm versus 11.6 x 11.3
040938 -        cm on the prior study. Slightly superior to this node there
040939 -        appears to be a second enlarged node measuring approximately
040940 -        1.9 x 0.9 cm. This was present on the prior exam and is
040941 -        unchanged. In the inferior right axilla (image 16) there is a 1
040942 -        cm lymph node which appears larger than on the prior exam."
040944 -  ..
040945 - Nodes measuring 12.7 x 11.3 cm are 10 times larger than 12.7 x 11.3
040946 - mm, reported on 071213. ref SDS 2 SR5P
040948 -  ..
040949 - Millie's letter to UCSF continues...
040950 -
040951 -    6.  This report seems conflicting with the prior test on 071210
040952 -        (Dec 10) which reports only a single node measuring 11 x 11.
040953 -        CT testing continues to ignore patient history of PE, enlarged
040954 -        right ventricle, and most recently enlarged heart, reported in
040955 -        the test on 071210, received on 071213. ref SDS 2 SR5P
040957 -         ..
040958 -    7.  In any case, there now seems to be three (3) nodes in the right
040959 -        axilla, where none were reported during the prior 12 months.
040960 -        This may account for steady rise in the cancer marker the past
040961 -        5 months, and recent sudden increase from 51 on 080110,
040962 -        ref SDS 3 A16M, to 63 on 080207. ref SDS 5 A16M
040964 -         ..
040965 -    8.  I was encouraged over the weekend by examination showing
040966 -        substantial subsidence of IBC rash on all areas, and so would
040967 -        be prepared to continue with the current treatment using
040968 -        cetuximab alone.  However, this morning the rash seems again
040969 -        more intense. Accordingly, the CT test and rising cancer marker
040970 -        may support considerations for increasing treatment by adding
040971 -        carboplatin, if Doctor Rugo and Doctor Johnson reach that
040972 -        conclusion at this time.
040974 -         ..
040975 -    9.  Hopefully, this will clear the IBC rash as occurred with
040976 -        capecitabine, and will not cause excessive loss of energy and
040977 -        vitality, which was a big problem with capecitabine.
040979 -  ..
040980 - Debilitating loss of energy and vitality from side effects of
040981 - chemotherapy are reported in a case study on 050422. ref SDS 1 NT3I
040982 -
040983 -            [On 080306 worry during meeting to start next cycle of
040984 -            treatment which was scheduled to add chemotherapy
040985 -            Carboplatin to cetuximab in the clinical trial was reduced
040986 -            by Jackie's report that patients tolerate Carboplatin well.
040987 -            ref SDS 12 7V6M
040989 -             ..
040990 -            [On 080312 Millie's letter reports to UCSF that energy has
040991 -            begun to recover after traumatic experience of a serious
040992 -            fall on 080125. ref SDS 14 RT5X
040994 -             ..
040995 -            [On 080313 first chemotherapy treatment with Carboplatin
040996 -            added to cetuximab. ref SDS 15 TZ8I
040998 -             ..
040999 -            [On 080312 Millie's letter to UCSF reports further
041000 -            improvement in IBC rash subsiding prior to getting first
041001 -            treatment with Carboplatin chemotherapy added to cetuximab.
041002 -            ref SDS 14 RU4U
041004 -             ..
041005 -            [On 080320 Millie reports definite loss of energy from
041006 -            treatment adding chemotherapy Carboplatin to cetuximab in
041007 -            the clinical trial. ref SDS 16 1S9L
041009 -             ..
041010 -            [On 080402 Millie reported a burst of energy increasing
041011 -            exercise more than any time in the past 4 years.
041012 -            ref SDS 18 Q25V [On 080409 Millie reports to Kaiser being
041013 -            thrilled by improvement recovering from IBC disease, and
041014 -            that energy and exercise have increased despite adding
041015 -            Carboplatin chemotherapy to cetuximab for the clinical
041016 -            trial regimen; causing reduced emotional trauma from
041017 -            stress, anxeity, doubt, and worry about the future.
041018 -            ref SDS 21 W14P
041020 -         ..
041021 -   10.  Another concern is blood counts being consistently low the past
041022 -        3 or 4 months.  Doctor Rugo discussed this on 080207,
041023 -        ref SDS 4 E14H, so today we may hear treatment ideas on this
041024 -        issue.  There is not a lot of time to recover from one week to
041025 -        the next.
041026 -
041027 -            [On 080219 Doctor decided to defer increasing treatment by
041028 -            adding Carboplatin until starting the next cycle on 080306,
041029 -            ref SDS 9 I35G; allows time to assess next blood test to
041030 -            see if trauma of serious fall on 080125 could have caused
041031 -            cancer marker to rise in test on 080207, rather than
041032 -            signaling greater advance of IBC. ref SDS 9 CL4I
041034 -             ..
041035 -            [On 080305 Millie coping with emotional stress and
041036 -            depression from mounting medical issues, ref SDS 11 KT4J,
041037 -            including difficulty maintaining blood counts essential for
041038 -            safe chemotherapy to treat cancer. ref SDS 11 PC6M
041040 -             ..
041041 -            [On 080306 blood counts NEUTS 2.75 (ANC 2750) rise
041042 -            unexpectedly to highest level in over a year provides
041043 -            safety for increasing treatment by adding Carboplatin to
041044 -            treat expanding cancer (IBC), and relieves anxiety, worry,
041045 -            and doubt. ref SDS 12 033B
041047 -             ..
041048 -            [On 080307 letter to primary care physician at Kaiser
041049 -            confirms worry about blood counts; reports relief from
041050 -            sudden and unexpected rise to highest level in over a year.
041051 -            ref SDS 13 HS6R
041053 -             ..
041054 -            [On 080313 first chemotherapy treatment with Carboplatin
041055 -            added to cetuximab. ref SDS 15 TZ8I
041057 -             ..
041058 -            [On 030320 blood counts were too low for treatment with
041059 -            Carboplatin, and so Millie received treatment only with
041060 -            cetuximab. ref SDS 17 SE5R
041062 -             ..
041063 -            [On 080403 blood counts fall NEUTS 1.34, ref SDS 20 QY6H,
041064 -            Neupogen prescribed to increase blood counts.
041066 -             ..
041067 -            [On 080403 UCSF prescribes Neupogen to increase blood
041068 -            counts for safe weekly treatments with Carboplatin
041069 -            chemotherapy added to cetuximab. ref SDS 19 I33G
041071 -             ..
041072 -            [On 080410 NEUTS 6.85 rise to highest ever after treatment
041073 -            with Neupogen, and suffering Cellulitis and lymphedema
041074 -            recurrence, treated in Emergency Room clinic at Kaiser on
041075 -            080409. ref SDS 22 EH5K
041077 -             ..
041078 -            [On 080417 NEUTS 0.95 lowest ever blood counts reflects
041079 -            concern today about holding blood counts. ref SDS 23 PU6K
041081 -             ..
041082 -            [On 080417 Millie notifies medical team that concern today
041083 -            about maintaining blood counts for weekly chemotherapy
041084 -            treatments, ref SDS 24 P45J, correctly anticipated
041085 -            problems that have occurred consistently. ref SDS 24 4W8X
041087 -             ..
041088 -            [On 080418 Brigid says Neupogen treatment not needed this
041089 -            week, because not Carboplatin chemothearpy next week for
041090 -            4th treatment in the cycle; discusses new treatment plan
041091 -            lowering dose of Carboplatin to achieve consistent
041092 -            treatments. ref SDS 25 MR3L
041094 -         ..
041095 -   11.  On 080207, Doctor Rugo asked about status change reported for
041096 -        the biopsy taken at Kaiser on 040419.  Has UCSF received the
041097 -        report from Kaiser?  What are the actual numbers reported that
041098 -        set status?
041099 -
041100 -            [On 080226 another patient reported status change occurred
041101 -            in her case. ref SDS 10 M36R
041103 -         ..
041104 -   12.  Also, I need the name of the doctor who made the initial
041105 -        examination during the meeting on 080207 (Feb 7).
041107 -         ..
041108 -   13.  Thanks very much for expediting review by advancing the meeting
041109 -        from Thursday to today, and for good teamwork between Kaiser
041110 -        and UCSF.
041112 -         ..
041113 -   14.  See you at 1100.
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