CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 69 0000. ref SDS 60 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie met today with the medical team following up meeting with the
040902 - primary care physician yesterday at Kaiser. ref SDS 71 QY5I
040903 -
040904 -
040905 -
0410 -

SUBJECTS
Backup Teamwork Accuracy Verify Authenticate Quality Care Referral C

3103 -
310401 -  ..
310402 - Referral Coordination Plan UCSF Relies Kaiser Backup Examinations
310403 -
310404 - Brigid commented today that Doctor Rugo feels support has been very
310405 - effective by Doctor Johnson, Millie's primary care physician at
310406 - Kaiser.  Timely 2nd opinion backup helps avoid mistakes for Millie's
310407 - comprehensive care at UCSF Medical Center.  Two months ago on 080118,
310408 - Doctor Johnson reported good communication with Doctor Rugo on
310409 - Millie's care. ref SDS 56 FT5H  Collaboration through 2nd opinions
310410 - have significantly aided Millie's care the past 7 years.
310411 -
310412 -     [On 080307 notified primary care physician at Kaiser that UCSF
310413 -     draws 2nd opinion backup support from Kaiser examinations and
310414 -     reviews of Millie's care on referral at UCSF. ref SDS 74 HT3U
310416 -      ..
310417 -     [On 080312 primary care physician at Kaiser concurrs Kaiser
310418 -     and UCSF functioning as a team for Millie's treatment on
310419 -     referral deserves support. ref SDS 75 HT3U
310421 -      ..
310422 -     [On 080418 Millie coordinates referral tasks on Neupogen
310423 -     prescriptions at UCSF and Pharmacy orders at Kaiser. ref SDS 87
310424 -     GR7U
310426 -      ..
310427 -     [On 090213 1140 case study 2nd opinions implemented by Kaiser have
310428 -     expanded experience and expertise for Millie's health care to
310429 -     significantly extend quality of life. ref SDS 93 J58K
310431 -      ..
310432 -     [On 090213 1140 Doctor Johnson explains Millie's good results
310433 -     surviving stage IV cancer 3 times longer than other patients show
310434 -     benefits of synergy between Kaiser's knowledge of patient history,
310435 -     and UCSF research have been optimized through communication that
310436 -     integrates Kaiser's team care model of case management with the
310437 -     UCSF practice of comprehensive care. ref SDS 93 685I
310439 -  ..
310440 - Collaboration between UCSF and Kaiser is a powerful part of referral
310441 - coordination planning discussed at UCSF on 070222. ref SDS 26 KL5G
310442 - This can be more than mere "lip service" that occurs in Tumor Board
310443 - conversations, illustrated by the record on 040517, ref SDS 10 MB7F,
310444 - and prior proposals for Doctor Moini at Mount Diablo Hospital
310445 - performing Radiation treatment on referral to "backup" the primary
310446 - care physician on analysis of patient status, including response to
310447 - treatment, reported on 020726, ref SDS 6 YO6K, which resulted in no
310448 - discernable work product in the record.
310449 -
310450 -     [On 080307 UCSF blood test report distributed to primary care
310451 -     physician at Kaiser implements referral coordination plan that
310452 -     enables accurate, comprehensive assessment by Kaiser for backup to
310453 -     support comprehensive cancer care for Millie at UCSF. ref SDS 74
310454 -     UF9F
310456 -  ..
310457 - Yesterday, the primary care physician commented that new
310458 - correspondence procedures at UCSF for secure email prevent timely,
310459 - efficient distribution of the record.  He could not figure out what
310460 - buttons to press in order to accomplish anything.  Very frustrating,
310461 - which discourages busy people from communicating. ref SDS 71 US6I
310463 -  ..
310464 - Similarly, the record on 080304, notifying the medical team that
310465 - Millie suffered recurrence, reports that Brigid's response letter
310466 - prepared using UCSF's new policy to protect patient privacy, could not
310467 - be accessed for communication to treat the patient due to conflicts in
310468 - password policies. ref SDS 70 0T8F
310469 -
310470 -
310471 -
3105 -

SUBJECTS
Default Null Subject Account for Blank Record

4903 -
490401 -  ..
490402 - Communication Security Email Complications Compromise Patient Health
490403 -
490404 - Follow up ref SDS 71 US6I, ref SDS 70 0T8F.
490405 -
490406 - Millie asked during the meeting today about recent correspondence
490407 - received from UCSF which was difficult to use, and which Millie's
490408 - primary care physician at Kaiser was unable to access yesterday,
490409 - causing delays and extra expense providing Millie's health care,
490410 - reported on 080305 1200. ref SDS 71 US6I
490412 -  ..
490413 - Brigid explained this morning that UCSF management performed an audit
490414 - of work practices in the breast care clinic.  This resulted in
490415 - ordering the medical team to use a UCSF proprietary email system with
490416 - increased security for protecting patient privacy, compared to the
490417 - current system that relies on public domain email.  There was no audit
490418 - to balance privacy with accuracy and speed required for efficient
490419 - coordination and collaboration that saves lives, time, and money.
490421 -  ..
490422 - This change in procedure adding more steps to communicate with
490423 - intended objectives of better security has unintended consequences of
490424 - compromising accuracy and efficiency essential for patient health,
490425 - reported by primary care physician at Kaiser yesterday, ref SDS 71
490426 - US6I, and cited above, ref SDS 0 RZ4O,
490427 -
490428 -        [On 080403 UCSF asks patient to perform referral coordination
490429 -        because coordinating takes too much for the doctor. ref SDS 83
490430 -        6Y9K
490432 -         ..
490433 -        [On 081103 Millie received "secure email" correspondence from
490434 -        Kaiser, ref SDS 91 XO8J, alleged to be sent by the primary care
490435 -        physician, but which could not be accessed, and which the
490436 -        doctor indicated not having actually sent the letters.
490437 -        ref SDS 91 E59N
490439 -         ..
490440 -        [On 090205 Kaiser asked the patient to use Kaiser's
490441 -        proprietary, closed email system to increase efficiency of the
490442 -        doctor compared to using public domain email that is faster and
490443 -        easier for collaboration among Millie's medical team that
490444 -        includes doctors from Kaise and UCSF. ref SDS 92 278T
490445 -
490446 -
490447 -
490448 -
490449 -
4905 -

SUBJECTS
Default Null Subject Account for Blank Record

5003 -
500401 -  ..
500402 - Coordination Clinical Trial Research and Infusion Clinic
500403 - Blood Draw Delayed Communication Problems Submitting Prescription
500404 -
500405 - Millie had a blood draw in the Infusion Clinic this morning at 0800.
500406 - ref SDS 73 439L  She explained Stephanie's dilemma of seeing
500407 - instructions in the medical chart blood tests on a 6-week cycle, and
500408 - so did only a minimal scope until instructions can be clarified by the
500409 - medical team.
500411 -  ..
500412 - Jackie feels instructions in the medical chart prepared by the
500413 - Infusion Clinic for blood tests on a 6-week schedule reported by
500414 - Stephanie this morning, ref SDS 73 NK5Q, since all instructions for
500415 - the past year have specified a 4-week schedule that aligns with the
500416 - protocol for the cetuximab clinical study protocol, noted in the
500417 - record on 070201. ref SDS 25 5594
500419 -  ..
500420 - Jackie reported that she received the letter on 080304 reminding UCSF
500421 - to order blood tests for Millie's treatment today. ref SDS 70 TN8W
500422 - She prepared the prescription, including blood vials, but was out of
500423 - the office yesterday.  Jackie asked staff to take the order and the
500424 - vials for Millie's blood draw to the Infusion Clinic on the 5th floor.
500425 - Jackie feels this morning that mixup on the 5th floor today occurred
500426 - because the order was delivered to the Lab on the 1st floor.  Perhaps
500427 - her instructions were misunderstood, or by the time the work was
500428 - actually done a day or so later, the precise instruction was
500429 - forgotten, and so people relied on standard procedure and familiar
500430 - practice delivering prescriptions for blood draws to the Lab on the
500431 - 1st floor.  The person who got Jackie's instructions may not have done
500432 - the work, but asked someone else to deliver the order for Millie's
500433 - blood draw, and either forgot and explained incorrectly, or was
500434 - imprecise, and the person who got the instructions misunderstood.
500435 - There are a great many ways for communication mistakes to occur, noted
500436 - by Drucker, reviewed on 931130, saying people have given up because
500437 - communication is very complex process. ref SDS 2 3851  Andy Grove at
500438 - Intel notes the human mind is awfully forgiving of ambiguity, reported
500439 - on 980307. ref SDS 3 3668  Jeremy Campbell notes in his book "The
500440 - Improbable Machine" that people pay a price for relying on assumption
500441 - from personal memory of experience to fill in the gaps of ambiguity in
500442 - routine conversation, reviewed 900303. ref SDS 1 F999
500443 -
500444 -        [On 080402 coordination starting next cycle of treatment in the
500445 -        clinical trial reminds medical team to send the order for blood
500446 -        tests to the Infusion Clinic on the 5th floor, rather than the
500447 -        Lab on the 1st floor. ref SDS 82 Q24T
500449 -  ..
500450 - Jackie left the meeting, to look for the order on Millie's labs.  She
500451 - returned about 15 mintuest later.  Turned out the order was taken to
500452 - the Lab on the 1st floor.  The price today was very small for mistakes
500453 - in communication, and so will be quickly forgotten, as people deal
500454 - with continuing crises.
500455 -
500456 -        [On 080404 people forget how fast and easy mistakes occur using
500457 -        verbal communication that is a lot faster and easier than
500458 -        writing a prescription. ref SDS 84 O76G
500460 -  ..
500461 - Jackie prepared a new order to supplement work Stephanie did earlier
500462 - this morning.
500464 -  ..
500465 - The Breast Care Clinic was very busy today.  Brigid was about 20
500466 - minutes late for the meeting.  Jackie used that time to retrieve the
500467 - blood draw order per above, and correct the problem of incomplete
500468 - initial testing due to erroneous instructions in the medical chart.
500470 -  ..
500471 - During the meeting 080207 Doctor Rugo observed spreading IBC disease,
500472 - ref SDS 60 GH5H, including photograhic evidence. ref SDS 60 GH57  As a
500473 - result, at that time on 080207 the doctor ordered CT testing to be
500474 - expedited to assess evident progression of disease found in the right
500475 - axilla, but not reported in prior tests, ref SDS 60 GH5M  On 080213
500476 - UCSF reported CA 15-3 63, ref SDS 65 VR8N, for labs performed on
500477 - 080207. ref SDS 61 A16M  CT test at Kaiser on 080212, ref SDS 64 FP5H,
500478 - indicates progression of disease based on finding increased adenopathy
500479 - in the right axilla, reviewed on 080215. ref SDS 67 EO8F
500481 -  ..
500482 - Millie's letter to UCSF this morning sets the agenda. ref SDS 68 1K9T
500484 -  ..
500485 - Brigid, RN NP, did the initial examination.
500486 -
500487 -
500488 -
5005 -

SUBJECTS
Default Null Subject Account for Blank Record

5103 -
510401 -  ..
510402 - Brigid and Jackie were pleased to see brusing has substantially
510403 - subsided on the upper right arm, caused by the fall on 080125.
510404 - ref SDS 57 N65K
510405 -
510406 -
510407 -
5105 -

SUBJECTS
Default Null Subject Account for Blank Record

5203 -
520401 -  ..
520402 - Cellulitis rash and swelling from lymphedema on the left are now
520403 - barely visible, much improved from the report on 080304, ref SDS 70
520404 - V45J, and continuing improvement reported at Kaiser yesterday on
520405 - 080305. ref SDS 71 RM6J
520406 -
520407 -     [On 080313 Millie completed 10-day treatment with Keflex for
520408 -     Cellulitis; no visible inflammation or swelling that signal
520409 -     Cellulitis and lymphedema. ref SDS 77 MQ4I
520411 -      ..
520412 -     [On 080314 possible Cellulitis relapse; difficult to
520413 -     distinguish from normal inflammation caused by cetuximab
520414 -     treatments for cancer; Millie begins another 10 day treatment.
520415 -     ref SDS 79 XS82
520416 -
520417 -
5205 -

SUBJECTS
Default Null Subject Account for Blank Record

5303 -
530401 -  ..
530402 - IBC rash seems significantly less intense, with no appreciable spread,
530403 - although there was no discussion of measurements recorded today
530404 - compared to last month on 080207.
530405 -
530406 -
5305 -

SUBJECTS
Default Null Subject Account for Blank Record

5403 -
540401 -  ..
540402 - Photographs Establish Baseline Evaluate Response to Treatment
540403 -
540404 - Jackie took photographs to evaluate response to treatment.   This will
540405 - be the new baseline to assess adding Carboplatin, based on
540406 - determination today that IBC has relapsed into progression of disease.
540407 -
540408 -     [On 080403 examination seems to indicate response to treatment;
540409 -     for some reason clinical trial practice to take photographs for
540410 -     evaluating response to treatment based on measurable disease was
540411 -     not performed. ref SDS 83 SA5J
540412 -
540413 -
5405 -

SUBJECTS
Default Null Subject Account for Blank Record

5503 -
550401 -  ..
550402 - Millie reported examination at Kaiser yesterday.  The primary care
550403 - physician...
550404 -
550405 -    1.  Xray ordered to asses continuing pain in the right arm.
550406 -        ref SDS 71 5M39  Xray was performed after the meeting with the
550407 -        doctor at Kaiser; results will be submitted to UCSF.
550408 -        ref SDS 71 P14M
550409 -
550410 -            [On 080307 xray results negative reported by letter from
550411 -            primary care physician. ref SDS 74 IT8N
550412 -
550413 -
550414 -
5505 -

SUBJECTS
Default Null Subject Account for Blank Record

5603 -
560401 -         ..
560402 -    2.  Prozac prescribed to treat depression from emotional stress,
560403 -        ref SDS 71 5L5M, which evidently replaces Ativan prescribed for
560404 -        panic attacks, reported on 070921. ref SDS 33 N98J
560406 -         ..
560407 -        (side effects - see research. ref SDS 71 GG7M)
560409 -  ..
560410 - Brigid commented that UCSF prescribes Prozac for depression.  Millie
560411 - asked about comment from Kaiser Pharmacy yesterday that Prozac takes 6
560412 - weeks of daily treatments before the patient experiences effects,
560413 - i.e., benefits. ref SDS 71 GG5I
560415 -  ..
560416 - Brigid seemed to indicate UCSF experience that most patients begin
560417 - feeling better with less depression after 2 weeks, and that 6 weeks is
560418 - the longest period some patients take to feel better.
560419 -
560420 -            [On 080312 Millie reported starting Prozac treatments,
560421 -            ref SDS 75 RT8Y; she felt strange after taking the first 2
560422 -            pills (treatments), ref SDS 75 RT4S; improved prospects
560423 -            from rising blood counts, along with increased exercise,
560424 -            ref SDS 75 RT5X, have relieved a lot of emotional stress
560425 -            and depression, so she stopped taking Prozac after the 2
560426 -            treatments, and does not plan to resume at this time.
560427 -            ref SDS 75 RT4W
560429 -  ..
560430 - UCSF gave no explanation today of side effects caused by Prozac, which
560431 - aligns with practice at Kaiser reflecting limited time for customer
560432 - support. ref SDS 71 NE4O
560434 -  ..
560435 - Research reported on 080305 seems to indicate significant risks of
560436 - increasing depression, rather than effective treatment. ref SDS 71
560437 - CY8I
560438 -
560439 -            [On 080312 Millie reported to the medical team feeling
560440 -            badly after taking 2 pills of Prozac; this reaction
560441 -            together with research showing bad side effects led to
560442 -            ending Prozac treatment, ref SDS 75 RT9U; subsequently
560443 -            professional care by the primary care physician and Doctor
560444 -            Rugo at UCSF, and increased exersice have helped relieve
560445 -            former depression. ref SDS 75 RT9U
560447 -             ..
560448 -            [On 080313 Millie reported to Kaiser further research with
560449 -            Wellness Community cancer support group revealed favorable
560450 -            results taking Prozac with minimal side effects.
560451 -            ref SDS 77 TA4U
560453 -             ..
560454 -            [On 080313 primary care physician requests confirmation on
560455 -            whether Millie is taking Prozac. ref SDS 77 UE5N
560457 -             ..
560458 -            [On 080403 meeting at UCSF Millie confirms she is not
560459 -            taking Prozac; emotional trauma subsides with improving
560460 -            health, better medical management and coordination,
560461 -            increased exercise. ref SDS 83 336H
560463 -             ..
560464 -            [On 080502 meeting at Kaiser Millie notified the doctor
560465 -            that she is not taking Prozac because issues causing former
560466 -            emotional stress have subsided, and exercise helps relieve
560467 -            routine stress. ref SDS 88 HH4I
560468 -
560469 -
560470 -
560471 -
5605 -

SUBJECTS
Default Null Subject Account for Blank Record

5703 -
570401 -  ..
570402 - Millie's report on meeting yesterday at Kaiser continues...
570403 -
570404 -    3.  Prescribed Keflex so the patient has inventory to treat future
570405 -        recurrence of Cellulitis. ref SDS 71 RM6J
570407 -         ..
570408 -    4.  IBC concurs with UCSF planning to add Carboplatin. ref SDS 71
570409 -        N15G
570410 -
570411 -
570412 -
5705 -

SUBJECTS
Default Null Subject Account for Blank Record

5803 -
5804 - 0910
580501 -  ..
580502 - Labs Blood Counts NEUTS 2.75 (ANC 2750) Rises Unexpectedly
580503 -
580504 - Brigid was able to get a preliminary report on the blood test this
580505 - morning, per above. ref SDS 0 EX4I
580507 -  ..
580508 - Very favorable, in fact the best, finding for NEUTS 2.75 in the blood
580509 - test report, ref SDS 73 QY6H, which Millie has ever recorded during
580510 - treatments at UCSF spanning more than 13 months.
580511 -
580512 -            [On 080307 letter to primary care physician reports
580513 -            corrections to current medications in medical chart at
580514 -            Kaiser so that primary care physician can provide effective
580515 -            medical opinion to backup care at UCSF. ref SDS 74 JY5K
580517 -             ..
580518 -            [On 080307 worry blood counts too low for safe weekly
580519 -            chemotherapy treatment adding Carboplatin to cetuximab,
580520 -            reported in letter to Kaiser. ref SDS 74 HS6R
580522 -  ..
580523 - There was slight panic by some in the meeting when the screen suddenly
580524 - showed something like 1.3; Brigid explained 2.75 is correct, she had
580525 - simply changed the screen to compare with last month.
580527 -  ..
580528 - NEUTS rising this week well above level of safety for aggressive
580529 - chemotherapy treatment suggests strengthening immune system, which
580530 - makes starting Carboplatin treatment possible today.  Seems to resolve
580531 - issue discussed yesterday on 080305 at Kaiser about emotional stress
580532 - and depression, ref SDS 71 PC6M, and that starting Carboplatin may be
580533 - delayed from further recovery from Cellulitis. ref SDS 71 N15N
580535 -  ..
580536 - There may have been discussion today that sudden, anomolous rise of
580537 - blood counts may relate to the body warding off Cellulitis, rather
580538 - than underlying improvement that will sustain chemotherapy treatment
580539 - with Carboplatin going forward.
580540 -
580541 -
580542 -
580543 -
5806 -

SUBJECTS
Disability Status Benefits Entitlement Documentation Requested Patie

6503 -
650401 -  ..
650402 - Disability Documentation Employer and Insurance Requirements
650403 -
650404 - Millie reported receiving a letter dated 080225 from her employer,
650405 - N&P, and also a request dated 080305 from First Unum Insurance
650406 - Company, both requesting documentation from the doctor showing medical
650407 - status that relates to employment disability and benefits entitlement.
650409 -  ..
650410 - Jackie explained that UCSF has a department that processes disability
650411 - documentation, and prepares a report for the doctor to approve.  She
650412 - asked Millie to submit all of the documents to the attendant at the
650413 - front desk.  Jackie will follow up to expedite processing.
650414 -
650416 -  ..
6505 -
6506 -
6507 - 0943
6508 -
650801 - After the meeting, Millie stopped at the front desk and gave the
650802 - disability documentation to the attendant.  The clerk put the
650803 - documents in a folder, and prepared a sticker with Millie's patient
650804 - identification to manage processing.  She said it usually takes a few
650805 - weeks because of a backlog, but sometimes reports are issued sooner.
650806 -
650807 -        [On 080403 meeting at UCSF Millie reports inquiry from employer
650808 -        and insurance company asking about UCSF progress processing
650809 -        documentation on medical disability entitlement. ref SDS 83
650810 -        I33H
650812 -         ..
650813 -        [On 080409 Millie submitted letter to UCSF asking about
650814 -        progress preparing documentation requested by N&P and Unum
650815 -        Insurance company on Millie's entitlement to medical disability
650816 -        benefits. ref SDS 85 OX3S
650817 -
650818 -
650819 -
650820 -
6509 -

SUBJECTS
Default Null Subject Account for Blank Record

6603 -
6604 - 0922
660501 -  ..
660502 - IBC 4th Relapse Patient Scheduled Treatment Cetuximab and Carboplatin
660503 - Clinical Study 2nd Arm Add Carboplatin Approved to Treat IBC Relapse
660504 - Progression Disease IBC Doctor Approves Start 2nd Arm Clinical Study
660505 - 2nd Arm Clinical Study Add Carboplatin Approved Treat IBC Progression
660506 -
660507 - Doctor Rugo arrived in the examination room.  A brief examination
660508 - concurred with Brigid's earlier review, per above. ref SDS 0 NV4M  The
660509 - doctor indicated confidence in recent findings of CT testing reviewed
660510 - on 080215 shows no evidence of distant metastasis, but does indicate
660511 - progression of IBC disease, ref SDS 67 RX6J, that requires expanding
660512 - chemotherapy treatment for cancer by adding Carboplatin to supplement
660513 - cetuximab treatments the past year, as reported during interim
660514 - examination on 080219, ref SDS 69 3J4I, even without results of CA
660515 - 15-3 from blood tests today.  The cancer marker test increased from 51
660516 - on 080110 by adding 12 points for CA 15-3 63 on 080207 ref SDS 61 A16M
660517 - On 080219 this was described as not significant. ref SDS 69 L18L
660519 -  ..
660520 - Primary care physician at Kaiser noted yesterday on 080305 that Millie
660521 - is ready for adding Carboplatin to cetuximab for treating progression
660522 - of disease on clinical trial, ref SDS 71 N15G, and per report above.
660523 - ref SDS 0 NV56
660524 -
660525 -        [On 080312 letter to UCSF with copy to Kaiser reports IBC rash
660526 -        seems to subside before starting new treatment with Carboplatin
660527 -        added to existing treatment with cetuximab. ref SDS 75 RU4U
660529 -  ..
660530 - Doctor Rugo said that Millie can start getting Carbolatin today, or
660531 - this could wait until next week on 080313.  Approval for starting the
660532 - next phase of IBC treatment by adding Carboplatin chemotherapy to
660533 - cetuximab aligns with strong recovery of blood counts showing NEUTS
660534 - unexpectedly rising today well above the level of safety for
660535 - chemotherapy treatments, per above. ref SDS 0 033B  The primary care
660536 - physician at Kaiser discussed yesterday possibly waiting another week
660537 - for further recovery from Cellulitis. ref SDS 71 N163
660539 -  ..
660540 - Millie wants to start next week on 080313.
660542 -  ..
660543 - Doctor Rugo approved starting Carboplatin next week on 080313.
660545 -  ..
660546 - Progression of Cancer 5th Relapse and 4th Relapse of IBC
660547 -
660548 - Follow up ref SDS 20 H54F, ref SDS 16 8Y8I.
660549 -
660550 - This is the 4th relapse of IBC Millie has suffered, and the 5th
660551 - relapse of her cancer overall.  Original diagnosis of IBC occurred on
660552 - 040517. ref SDS 10 YN3L  However, the doctor diagnosed a general
660553 - initial relapse of breast cancer on 040318, as seen in the following
660554 - case study of patient history...
660555 -
660556 -        1.  Lymph node biopsy positive start
660557 -            bevacizumab Taxotere.............. 040318, ref SDS 9 8R6M
660558 -        2.  Cancer marker IBC increase end
660559 -            bevacizumab Taxotere due to
660560 -            pulmonary embolism................ 041210, ref SDS 11 025H
660561 -        3.  Cancer marker IBC recurs 9 months
660562 -            months after mastectomy........... 060711, ref SDS 16 025H
660563 -        4.  Cancer marker IBC worsens end
660564 -            capeticabine Taxotere............. 061201, ref SDS 20 RU6J
660565 -        5.  IBC progression with increased
660566 -            lymph nodes in axilla add
660567 -            Carboplatin to cetuximab.......... 080306, ref SDS 0 NW3N
660569 -               ..
660570 -              [On 081016 2342 Millie suffers 5th relapse of IBC; ends
660571 -              treatment on cetuximab and Carboplatin clinical study.
660572 -              ref SDS 89 8V5O
660574 -  ..
660575 - The doctor congratulated Millie on being treated for 13 months with
660576 - cetuximab alone, since beginning on 070201. ref SDS 25 G68I  This is 3
660577 - times longer than any previous patient getting cetuximab alone, and
660578 - exceeds the longest period any patient has been treated with both
660579 - cetuximab and Carboplatin.  On 070315 Brigid reported the longest
660580 - period of treatment with both cetuximab and Carboplatin was 10 months.
660581 - ref SDS 28 6A40  The doctor feels that since most patients do better
660582 - with both cetuximab and Carboplatin, there is a good chance Millie can
660583 - continue for another 8 - 12 months, hopefully longer, without
660584 - suffering progression of cancer.  That would more than double the
660585 - longest period of treatment for patients in the study.
660586 -
660587 -        [On 081024 1150 Doctor Johnnson concurred that Kaiser
660588 -        prescribing cetuximab and Carboplatin treatment at UCSF for
660589 -        Millie on 070105 was a stunning success. ref SDS 90 K65M
660591 -  ..
660592 - Millie said her fingers are crossed hoping blood counts hold up for
660593 - weekly chemotherapy treatments with Carboplatin added to cetuximab.
660594 - Problems maintaining blood counts for monthly chemotherapy treatments,
660595 - reported in the study on 060810, ref SDS 18 HV45, cause worry and
660596 - doubt about ability to withstand weekly treatments.  Doctor Rugo
660597 - recalled discussing low blood counts a few weeks ago at UCSF on
660598 - 080219, ref SDS 69 I35G, citing the meeting 2 weeks earlier on 080207.
660599 - ref SDS 60 E14H  Millie's letter to the medical team in the morning on
660600 - 080219 requested ideas to maintain blood counts in order to get the
660601 - full dose of Carboplatin. ref SDS 68 1K4P
660603 -  ..
660604 - Millie asked again today if blood counts can be maintained without
660605 - reducing dose levels of Carboplatin, as Jackie discussed on 080207?,
660606 - ref SDS 60 GI65  Doctor Johnson at Kaiser has talked about synergy
660607 - between exercise that strengthens the natural immune system to augment
660608 - cancer treatments, e.g., discussed on 030606. ref SDS 7 CN3N  The
660609 - past year Millie has been able to get both full strength cetuximab
660610 - while keeping up vigrous daily exercise.  Can these results be
660611 - maintained adding Carboplatin?
660613 -  ..
660614 - Doctor Rugo feels Neupogen treatments can be added to help maintain
660615 - blood counts in order to give Carboplatin an optimal chance on the 2nd
660616 - arm of the study.
660618 -  ..
660619 - Brigid prepared the order to change treatment for IBC by adding
660620 - Carboplatin beginning next week on 080313.  This will complement
660621 - treatment with cetuximab alone that began on 070201, and implements
660622 - the clinical study protocol to evaluate cetuximab with Carboplatin,
660623 - shown in the record on 070116. ref SDS 22 0Q7I
660625 -  ..
660626 - There was brief discussion of side effects from Carboplatin
660627 - chemotherapy drugs.  Experience the past 6 years with AC, Taxol,
660628 - Taxotere, bevacizumab, and capecitabine have demonstrated debilitating
660629 - side effects, illustrated by case study on 050422. ref SDS 12 NT3I
660630 - Worry about side effects was cited in Millie's letter to UCSF on
660631 - 080219, ref SDS 68 1K9W, based on experiencing debilitating loss of
660632 - energy and vitality from side effects of chemotherapy reported in a
660633 - case study on 050422. ref SDS 12 NT3I
660635 -  ..
660636 - Jackie said that most patients seem to tolerate Carboplatin well.
660637 -
660638 -        [On 080313 first chemotherapy treatment with Carboplatin added
660639 -        to cetuximab. ref SDS 76 TZ8I
660640 -
660641 -        [On 080314 Millie reports energetic day after 1st treatment
660642 -        with Carboplatin chemotherapy. ref SDS 78 4W3H
660644 -         ..
660645 -        [On 080320 Millie reports definite loss of energy from
660646 -        treatment adding chemotherapy Carboplatin to cetuximab in the
660647 -        clinical trial. ref SDS 80 1S9L
660649 -         ..
660650 -        [On 030320 blood counts were too low for treatment with
660651 -        Carboplatin, and so Millie received treatment only with
660652 -        cetuximab. ref SDS 81 SE5R
660654 -         ..
660655 -        [On 080402 Millie reported a burst of energy increasing
660656 -        exercise more than any time in the past 4 years.
660657 -        ref SDS 82 Q25V
660659 -         ..
660660 -        [On 080409 Millie reports to Kaiser being thrilled by
660661 -        improvement recovering from IBC disease, and that energy and
660662 -        exercise have increased despite adding Carboplatin chemotherapy
660663 -        to cetuximab for the clinical trial regimen; causing reduced
660664 -        emotional trauma from stress, anxeity, doubt, and worry about
660665 -        the future. ref SDS 86 W14P
660666 -
660667 -
660668 -
660669 -
660670 -
6607 -

SUBJECTS
Default Null Subject Account for Blank Record

6703 -
670401 -  ..
670402 - Jackie discussed continuing for now the current regimen to visit with
670403 - the medical team once a month instituted on 070802. ref SDS 29 0001
670404 - rather than go back to the original schedule of 2 meetings each month.
670405 -
670406 -
670407 -
6705 -

SUBJECTS
Default Null Subject Account for Blank Record

6803 -
680401 -  ..
680402 - Brigid wrote a prescription for drugs to treat nausea that can be a
680403 - side effect of Carboplatin chemotherapy...
680404 -
680405 -        1.  Compazine 10 mg tablets
680406 -
680407 -            T PO -- Q 6 hrs per nausea
680408 -
680409 -                    # 30  refill = 3
680411 -             ..
680412 -        2.  Zofran  5 mb tablets
680413 -
680414 -            T PO -- Q 8 hrs per nausea
680415 -
680416 -                    # 12  refill = 3
680418 -  ..
680419 - Legiblity of handwriting is problematic.  This is a common cause of
680420 - medical mistakes, reported on 990912. ref SDS 4 0900
680422 -  ..
680423 - Brigid asked Millie to coordinate with the primary care physician to
680424 - place the order for these new medications at the Kaiser pharmacy.
680425 -
680426 -            [On 080307 Millie notifies primary care physician at Kaiser
680427 -            to order new medications prescribed the UCSF for Millie's
680428 -            treatment beginning next week. ref SDS 74 RW5V
680430 -             ..
680431 -            [On 080307 Millie commends referral coordination by primary
680432 -            care physician placing timely order for medications at
680433 -            Kaiser prescribed for Millie by UCSF ref SDS 74 GZ4H
680435 -  ..
680436 - There was discussion about cost that was not clear.  Something to the
680437 - effect that one of the drugs is expensive, and the pharmacy and or
680438 - insurance allows only small orders to evaluate effectiveness before
680439 - allowing production level orders.
680440 -
680441 -
680442 -
6805 -

SUBJECTS
Default Null Subject Account for Blank Record

6903 -
690401 -  ..
690402 - These new medications, including Carboplatin need to be added to the
690403 - list at Kaiser reported during the meeting yesterday, ref SDS 71 7Y6F
690404 - for evaluating conflicts, including with Coumadin.
690405 -
690406 -            [On 080307 letter to Kaiser coagulation control clinic in
690407 -            Martinez CA advises of medication changes to correlate
690408 -            Coumadin treatment for pulmonary embolism. ref SDS 74 RW3T
690410 -             ..
690411 -            [On 080307 letter to primary care physician reports
690412 -            corrections to current medications in medical chart at
690413 -            Kaiser so that primary care physician can provide effective
690414 -            medical opinion to backup care at UCSF. ref SDS 74 RW3T
690415 -
690416 -
690417 -
690418 -
690419 -
690420 -
690421 -
690422 -
690423 -
690424 -
6905 -