THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: June 6, 2008 04:00 PM Friday;
Millie meeting with Surgeon at Kaiser to upgrade port catheter.
2...Productive Meeting Effective Coordination Doctor Well Prepared
3...We Are Not Getting Out of Life Alive
4...Life is a Terminal Disease Accelerated by Cancer
5...Still Alive Doctor Surprised Stage IV Cancer Patient Doing Well
6...Patient Looks Well Living with Cancer and Treatments for 7 Years
7...Exercise Increases Risks Lymphedema Cellulitis from Loss of Lymphatics
8...Lymphatics Reduced by Surgery Become More Robust with Exercise
9...Cellulitis May Decline as Lymphatic System Gets Robust with Exercise
10...Port Catheter Beginning to Fail Requires Replacement
11...Surgery Risks Minimal Upgrade Port Catheter to Power Port
12...Power Port Kaiser Switched Replacements Upgrading Routine Surgery
13...Replace Port Catheter Right Side Cannot Implant on Primary Cancer Site
14...Schedule Power Port Surgery by mid-July in Time for Next CT Test
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Excellent Productive Meeting Surgeon Well Prepared Read Patient Hist
3803 - ..
3804 - Summary/Objective
380501 - Follow up ref SDS 25 0000, ref SDS 22 0000.
380507 - ..
3808 - Progress
380901 - Productive Meeting Effective Coordination Doctor Well Prepared
380903 - Follow up ref SDS 25 634V, ref SDS 22 MG6F.
380905 - The doctor was well prepared from the detailed referral submitted by
380906 - the primary care physician, noted in the letter to the medical team
380907 - yesterday on 080605, ref SDS 25 635W, citing the doctor's eConsult
380908 - referral to surgery that provided patient history explaining
380909 - background, objectives, requirements, and commitments, reported on
380910 - 080523. ref SDS 22 MG6F
380912 - [On 080801 report that record on CT test performed 080718
380913 - was distributed to support training and technology transfer
380914 - on using Power Ports for CT tests. ref SDS 39 SK4K
Still Alive Life Terminal Disease Accelerated by Cancer Survival Opt
720401 - ..
720402 - We Are Not Getting Out of Life Alive
720403 - Life is a Terminal Disease Accelerated by Cancer
720404 - Still Alive Doctor Surprised Stage IV Cancer Patient Doing Well
720405 - Patient Looks Well Living with Cancer and Treatments for 7 Years
720407 - On entering the examination room, the Doctor Riley-Paull looked
720408 - stunned seeing Millie, and joked saying... "I'm surprised you're still
720409 - alive." The doctor hugged Millie, and said "Gosh! Welcome back."
720411 - ..
720412 - The doctor further commented that Millie looks very well for a stage
720413 - IV cancer patient, reported on 040614, ref SDS 7 6M9H, following
720414 - diagnosis of cancer 7 years ago on 020321, ref SDS 2 6Q4U, and now
720415 - today 3 years after the doctor performed mastectomy surgery on 051021.
720416 - ref SDS 8 EG5L
720418 - ..
720419 - She feels Millie's long survival with such an aggressive disease
720420 - encourages health care professionals and patients alike not to give up
720421 - on working hard to maintain good care and comprehensive case
720422 - management that yield resutls evident today.
720424 - [On 080611 0732 Laura, another IBC patient getting
720425 - treatment at UCSF, reports Millie inspires other patients
720426 - and providers to work for a healthy life-style surviving
720427 - cancer. ref SDS 29 K44H
720429 - ..
720430 - [On 080708 0700 Doctor Riley-Paull reports that good
720431 - management to avoid mistakes in order to make health care
720432 - effective is annoying. ref SDS 34 7Y6I
720434 - ..
720435 - Doctor Riley-Paull added that "Life is a terminal disease accelerated
720436 - by cancer," explaining the doctor's surprise on entering the
720437 - examination room and seeing Millie, since longevity for IBC disease
720438 - diagnosed by the doctor on 040429 1445. ref SDS 5 F66N, is about 2
720439 - years, reported on 040517 1200. ref SDS 6 EE7I
720441 - ..
720442 - Obviously, we are not getting out of life alive, evident in the 2nd
720443 - law of thermodynamics, reviewed on 040312, ref SDS 3 566F, and applied
720444 - in management theory recognizing all systems fail from rising entropy,
720445 - reported on 970707 0652. ref SDS 1 0108 There is joy in the struggle
720446 - to learn and be productive advancing and improving family, community,
720447 - and civilization with courage, dignity, integrity, and hope.
720449 - ..
720450 - [On 080719 Sharee and Julie were stunned welcoming Millie
720451 - back to the Kaiser Infusion Clinic. ref SDS 37 SR3J
720453 - ..
720454 - [On 090213 1140 primary care physician surprised Millie has
720455 - survived 7 years with stage IV IBC, much longer than
720456 - expected, ref SDS 45 NY7L
720458 - ..
720459 - Some patients achieve remission; their cancer is no longer active for
720460 - months and years, e.g., Lance Armstrong, Jack Park.
720462 - ..
720463 - Millie has been treated continuously for 7 years; living daily with
720464 - complex medical maladies, listed on 070524. ref SDS 15 LU3J
720465 - Constantly one step away from "crossing the river" requires support to
720466 - cope with emotional stress that enables people to be productive and
720467 - enjoy quality of life, discussed recently with the primary care
720468 - physician at Kaiser on 080502. ref SDS 19 KT4J
720470 - [On 090213 case study patient advised to get affairs in
720471 - order for life ending in months. ref SDS 45 L19H
720473 - ..
720474 - After the meeting, research shows the American Cancer Society
720475 - indicates stage IV patients have a 20% survival for 5 years, and 10%
720476 - for 7 years.
720478 - ..
720479 - Millie is now in a very select group of people.
720481 - ..
720482 - [On 080725 Millie notifies NP experience on 2nd arm of
720483 - clinical study demonstrates sufficient recovery from cancer
720484 - relapse in February for Millie to return to work, as
720485 - recommended by her doctor for increasing recovery.
720486 - ref SDS 38 645J
720488 - ..
720489 - [On 080807 UCSF approved Millie for return to work.
720490 - ref SDS 40 SX4O
720492 - ..
720493 - Imaginis
720494 - The Women's Health Resource
720495 - Staging and Survival Rate by Stage
720497 - ..
720498 - Breast Cancer Survival Rate by Stage
720500 - http://www.imaginis.com/breasthealth/staging3.asp#survival
720502 - 5-year Relative
720503 - Stage Survival Rate
720504 - 0 100%
720505 - 1 100%
720506 - 2A 92%
720507 - 2B 81%
720508 - 3A 67%
720509 - 3B 54%
720510 - 4 20%
720512 - ..
720513 - Another source says...
720515 - Survivor
720516 - Breast Cancer Stage IV
720518 - http://www.cancer-survivor.org/index3.shtml
720520 - ..
720521 - Stage IV... 5 year survival rate = 18%; 7 year survival rate =
720522 - 11%.
720524 - [On 090213 case study patient advised to get affairs in
720525 - order for life ending in months. ref SDS 45 L19H
720527 - ..
720528 - Third source says...
720530 - Yahoo Answers
720532 - http://answers.yahoo.com/question/index?qid=20061107185755AARhlN4
720534 - ..
720535 - Is three years a long time to live with Stage 4 breast cancer?
720537 - ..
720538 - Yes, it is. ...all the new advanced drug therapies have
720539 - recorded average survival rates of fewer than 24 months-so your
720540 - mom sure had a passion for life!
720542 - ..
720543 - Today, Doctor Riley-Paull indicated that Millie gives people hope that
720544 - longevity with quality of life can be optimized through courage,
720545 - planning, and diligence getting good care in time to be effective.
720547 - ..
720548 - Millie credited team care at Kaiser and UCSF for relative good health
720549 - at this time. An example of fitness and vigor, while undergoing
720550 - chemotehrapy the past 24 months since the doctor performed surgery on
720551 - 051021, was today Millie walked home from the Pleasant Hill BART
720552 - station, 4+ miles away on Treat boulevard.
720554 - ..
720555 - The doctor's comments today align with Millie's letter to the medical
720556 - team yesterday on 080605 commending advantages of strong referral
720557 - coordination between Kaiser and UCSF collaborating on Millie's care.
720558 - ref SDS 25 635W
720560 - [On 081024 1200 Doctor Johnson indicated that despite
720561 - possible mistakes and mixups in communication and changes
720562 - in chemotherapy dose levels that may have reduced Millie's
720563 - recovery from IBC, he feels treatment with cetuximab and
720564 - Carboplatin has been a stunning success for 23 months.
720565 - ref SDS 43 K65M Millie's extremely favorable response
720566 - makes the doctor's referral on 070105 for treatment at UCSF
720567 - a very good medical decision. ref SDS 12 PK68 Doctor Rugo
720568 - commented similarly, when Carboplatin was added to
720569 - cetuximab on 080306. ref SDS 16 5V4O Aligns with Doctor
720570 - Riley-Paull being surprised today that Millie is still
720571 - alive, ref SDS 0 0T6I, and research indicating 90% of stage
720572 - IV cancer patients do not survive for 7 years. ref SDS 0
720573 - SG4M
720575 - ..
720576 - [On 090213 1140 Doctor Johnson advised that giving up on
720577 - treatment and going into Hospice for a comfortable death is
720578 - always an option for everyone. ref SDS 45 M59F
Fitness Healthy Looks Great Requires Exercise Increases Risks Lymphe
990401 - ..
990402 - Exercise Increases Risks Lymphedema Cellulitis from Loss of Lymphatics
990404 - On 080501 Millie reported to the medical team increased exercise in
990405 - the gym, and hiking at Lafayette Reservoir, resulting from good
990406 - tolerance of chemotherapy in the clinical study at UCSF. ref SDS 18
990407 - FW5J Increased exercise was discussed again the next day on 080502
990408 - with the primary care physician at Kaiser. Exercise helps recovery
990409 - from cancer by increasing blood counts that enable aggressive
990410 - chemotherapy. ref SDS 19 ZD9O Millie's letter to the medical team on
990411 - 080520 reported increased energy and exercise. ref SDS 20 TV6U The
990412 - letter on 080528 reported further increased exercise. ref SDS 23 IK5V
990414 - [On 080616 Millie hiked Mt Diablo trail to Deer Flat about 7
990415 - miles, and very vigorous, steep climb. ref SDS 30 7L6O
990417 - ..
990418 - Millie asked the doctor today about increased Cellulitis and
990419 - lymphedema, shown in the case study on 061203. ref SDS 11 YT4M Another
990420 - study on 070130 tracks causation of Cellulitis and lymphedema
990421 - recurrence. ref SDS 13 VX6F A third case study on 070218 shows
990422 - exercise can cause lymphedema and Cellulitis when lymph nodes are
990423 - removed during surgery. ref SDS 14 3M3J
990425 - ..
990426 - Recently, Millie was treated in the Emergency Room department at
990427 - Kaiser on 080409. ref SDS 17 0001 After treatment, there was another
990428 - recurrence on 080520. ref SDS 21 OU5J Millie asked UCSF on 080501 how
990429 - to reduce recurrence of Cellulitis and lymphedema. UCSF could not
990430 - support this issue. ref SDS 18 9U5M
990433 - ..
990434 - Lymphatics Reduced by Surgery Become More Robust with Exercise
990435 - Cellulitis May Decline as Lymphatic System Gets Robust with Exercise
990437 - Today, the doctor seemed to indicate that recurrence of Cellulitis and
990438 - lymphedema may decline, because surgery on 020312, and more recently
990439 - mastectomy surgery on 051021 that did not remove axillary lymph nodes,
990440 - but had to remove lymph nodes surrounding the breast, ref SDS 8 QU5I,
990441 - may eventually self-repair. The doctor explained that remaining lymph
990442 - nodes sometimes adjust with continued exercise to become more robust
990443 - over time, and so can then handle increased exercise and minor trauma,
990444 - e.g., a cut finger, lifting heavy stuff, a fall), which have all been
990445 - causing Millie's left arm to swell up with Cellulitis, requiring
990446 - emergency care due to high temperature.
990448 - ..
990449 - On 060417 Millie's physical therapyst explained that removal of lymph
990450 - nodes during surgery on 051021 may have triggered increased symptoms
990451 - of lymphedema, ref SDS 9 2Z9M, which can in turn cause recurrence of
990452 - Cellulitis with increased exercise, as Millie has experienced the past
990453 - few months, per above. ref SDS 0 U14O The doctor seemed to suggest
990454 - today that, as the remaining lymphatic system grows more robust,
990455 - pressures from increased exercise that cause lymphedema and Cellulitis
990456 - subside naturally without any additonal treatment. Hopefully, this
990457 - will avoid more trips to the emergency room.
990459 - ..
990460 - [On 080829 Millie has had no further recurrence of lymphedema
990461 - and Cellulitis since 080520. ref SDS 41 U54H
990463 - ..
990464 - [On 080908 Millie increases exercise in hot weather; no
990465 - recurrence of Cellulitis and lymphedema. ref SDS 42 KO6F
990467 - ..
990468 - [On 081125 Millie continues vigorous exercise that previously
990469 - caused Cellulitis and lymphedema that required emergency
990470 - treatment, but continues to show no signs of recurrence.
990471 - ref SDS 44 PZ4M
Power Port Surgery Risks Minimal Replace Port Catheter Examination F
AJ0401 - ..
AJ0402 - Port Catheter Beginning to Fail Requires Replacement
AJ0403 - Surgery Risks Minimal Upgrade Port Catheter to Power Port
AJ0404 - Power Port Kaiser Switched Replacements Upgrading Routine Surgery
AJ0406 - The doctor examined the site of the current port catheter implanted on
AJ0407 - 040419, and commented the equipment is beginning to "protrude," and so
AJ0408 - needs replacement. She indicated that Kaiser has switched to use only
AJ0409 - Power Ports, similar to UCSF, reported by Brigid on 080501.
AJ0410 - ref SDS 18 TQ6F Doctor Riley-Paul further advised she has done
AJ0411 - upgrade/replacement surgeries for Power Ports. Based on this
AJ0412 - experience and Millie's evident good health the doctor indicated that
AJ0413 - upgrading the port catheter to a Power Port should be "routine" with
AJ0414 - minimal risks, no greater than the original port surgery on 040419.
AJ0415 - This analysis addresses concerns presented at UCSF on 080501.
AJ0416 - ref SDS 18 TQ8P
AJ0418 - [On 080708 port catheter removed and replaced with Power Port even
AJ0419 - with the skin to solve problem reported today. ref SDS 36 WD49
AJ0422 - ..
AJ0423 - Replace Port Catheter Right Side Cannot Implant on Primary Cancer Site
AJ0425 - The doctor discussed installing the new port on the left side, and
AJ0426 - leaving the current port in place. Understandings were presented that
AJ0427 - the port should be on the opposite side from the primary site of
AJ0428 - cancer, related during the meeting at UCSF on 080501. ref SDS 18 N77H
AJ0429 - The doctor therefore plans to remove and replace the existing port on
AJ0430 - the right side. There was also discussion that the new port may be
AJ0431 - offset slightly (.5") from the current location. Please comment on
AJ0432 - this matter if necessary.
AJ0436 - ..
AJ0437 - Schedule Power Port Surgery by mid-July in Time for Next CT Test
AJ0439 - There is a slight scheduling issue.
AJ0441 - ..
AJ0442 - Millie explained she gets weekly infusion treatments using the port on
AJ0443 - Thursdays. The next CT test will be due on or about July 18th, based
AJ0444 - on a 12-week test interval, reviewed during the recent meeting at UCSF
AJ0445 - on 080529. ref SDS 24 3F9O
AJ0447 - ..
AJ0448 - The doctor is going on vacation for 3 weeks beginning next week.
AJ0449 - Another surgeon could be assigned, however, Millie prefers Doctor
AJ0450 - Riley-Paul, based on patient history of having done all four (4) prior
AJ0451 - surgeries.
AJ0453 - [On 080617 Power Port surgery scheduled on 080708.
AJ0454 - ref SDS 31 3C7N; CT test using Power Port scheduled 10 days
AJ0455 - later on 080718 1100, ref SDS 31 DF55; access Power Port
AJ0456 - with Huber needle scheduled in Infusion Clinis 080718 1030
AJ0457 - half hour prior to test. ref SDS 31 OQ61
AJ0459 - ..
AJ0460 - [On 080708 Millie gets surgery for Power Port. ref SDS 36
AJ0461 - IT77
AJ0463 - ..
AJ0464 - The doctor indicated today during the meeting that the port can be
AJ0465 - used normally beginning 4 days after surgery. If the new port needs
AJ0466 - to be used sooner, then the doctor will insert a Huber needle, and rig
AJ0467 - it to be in place for use either the next chemotherapy infusion,
AJ0468 - and/or the CT test.
AJ0470 - [On 080619 Millie coordinates with UCSF scheduling the next
AJ0471 - CT test on 080718 or advancing the date to the day after
AJ0472 - the surgery on 080708 and the surgeon will implant a Huber
AJ0473 - needle to faciliate port access for the CT test the next
AJ0474 - day. ref SDS 32 YV7T
AJ0476 - ..
AJ0477 - [On 080626 UCSF nurse in Infusion Clinic requested copy of
AJ0478 - certificate showing new Power Port was successfully tested
AJ0479 - on 080708 for use at UCSF on 080710. ref SDS 33 MZ40
AJ0480 - ..
AJ0481 - The doctor performed initial surgery prep today, and Millie signed
AJ0482 - consent documents.
AJ0484 - ..
AJ0485 - The Kaiser scheduling department will call Millie to advise the date
AJ0486 - for surgery, expected to occur the first 2 weeks in July, after the
AJ0487 - doctor returns from vacation. Mid-July is about the time needed for
AJ0488 - the next CT test on or about 080718 as discussed with UCSF last week
AJ0489 - on 080529. ref SDS 24 3F9O There may be some flexibility to push the
AJ0490 - test date allowing a little more time if needed to accomodate the
AJ0491 - surgeon's vacation and schedule to perform the surgery upgrading the
AJ0492 - port.
AJ0494 - ..
AJ0495 - The doctor advised that Millie will have to pause her Coumadin
AJ0496 - treatments for Pulmonary Embolism 5 days before surgery. The computer
AJ0497 - in the scheduling department will automatically notify the Coagulation
AJ0498 - Control Department so that Millie's case manager for pulmonary
AJ0499 - embolism can plan when Millie should pause taking Coumadin, and then
AJ0500 - when treatment should resume after surgery.
AJ0502 - ..
AJ0503 - Millie asked what should be done if she does not hear from the
AJ0504 - Coagulation Department due a computer glitch or something, like the
AJ0505 - case studies on 061024? ref SDS 10 9W4O The doctor recalled computer
AJ0506 - problems discussed on 040419 that prevented surgery follow up
AJ0507 - examinations. ref SDS 4 XU75
AJ0509 - [On 080608 Millie sent a letter to the doctor confirming
AJ0510 - request to coordinate date of surgery with next CT test
AJ0511 - planned for mid-July. ref SDS 27 IT8V
AJ0513 - ..
AJ0514 - [On 080609 Millie received a letter from the surgeon
AJ0515 - advising that coordination concerns for surgery prior to
AJ0516 - the next CT test in mid-July were submitted to the surgery
AJ0517 - scheduling department. ref SDS 28 MG5I
AJ0519 - ..
AJ0520 - [On 080617 Power Port surgery scheduled on 080708.
AJ0521 - ref SDS 31 3C7N; CT test using Power Port scheduled 10 days
AJ0522 - later on 080718 1100. ref SDS 31 DF55
AJ0524 - ..
AJ0525 - [On 080707 Millie was not notified by Coagulation Control
AJ0526 - Clinic when to pause Coumadin for surgery on 080708; she
AJ0527 - paused treatment on 080703, and notified Kaiser on 080707
AJ0528 - of plans to resume Coumadin the day after surgery on
AJ0529 - 080709. ref SDS 35 JP7W
AJ0531 - ..
AJ0532 - [On 080708 surgery blood test shows INR 1.1 well below
AJ0533 - target range INR 2.0 - 3.0 for pulmonary embolism case
AJ0534 - management; doctor describes INR 1.1 adequate and normal
AJ0535 - for patients not suffering pulmonary embolism, and within
AJ0536 - expected range when Coumadin is paused 5 days prior to
AJ0537 - surgery. ref SDS 36 MF4K