CONTACTS
SUBJECTS
Excellent Productive Meeting Surgeon Well Prepared Read Patient Hist
3803 -
3803 - ..
3804 - Summary/Objective
3805 -
380501 - Follow up ref SDS 25 0000, ref SDS 22 0000.
380502 -
380503 -
380504 -
380505 -
380507 - ..
3806 -
3807 -
3808 - Progress
3809 -
380901 - Productive Meeting Effective Coordination Doctor Well Prepared
380902 -
380903 - Follow up ref SDS 25 634V, ref SDS 22 MG6F.
380904 -
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
380911 -
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
380915 -
380916 -
380917 -
3810 -
SUBJECTS
Still Alive Life Terminal Disease Accelerated by Cancer Survival Opt
7203 -
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
720406 -
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.
720423 -
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
720469 -
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
720499 -
720500 - http://www.imaginis.com/breasthealth/staging3.asp#survival
720501 -
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...
720514 -
720515 - Survivor
720516 - Breast Cancer Stage IV
720517 -
720518 - http://www.cancer-survivor.org/index3.shtml
720520 - ..
720521 - Stage IV... 5 year survival rate = 18%; 7 year survival rate =
720522 - 11%.
720523 -
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...
720529 -
720530 - Yahoo Answers
720531 -
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
720559 -
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
720579 -
720580 -
720581 -
720582 -
7206 -
SUBJECTS
Fitness Healthy Looks Great Requires Exercise Increases Risks Lymphe
9903 -
990401 - ..
990402 - Exercise Increases Risks Lymphedema Cellulitis from Loss of Lymphatics
990403 -
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
990413 -
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
990431 -
990433 - ..
990434 - Lymphatics Reduced by Surgery Become More Robust with Exercise
990435 - Cellulitis May Decline as Lymphatic System Gets Robust with Exercise
990436 -
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
990472 -
990473 -
990474 -
990475 -
990476 -
9905 -
SUBJECTS
Power Port Surgery Risks Minimal Replace Port Catheter Examination F
AJ03 -
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
AJ0405 -
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
AJ0417 -
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
AJ0420 -
AJ0422 - ..
AJ0423 - Replace Port Catheter Right Side Cannot Implant on Primary Cancer Site
AJ0424 -
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.
AJ0433 -
AJ0434 -
AJ0436 - ..
AJ0437 - Schedule Power Port Surgery by mid-July in Time for Next CT Test
AJ0438 -
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.
AJ0452 -
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.
AJ0469 -
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
AJ0508 -
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
AJ0538 -
AJ0578 -
AJ0579 -
AJ0580 -
AJ0581 -
AJ0582 -
AJ0583 -
AJ0584 -
AJ0585 -
AJ0586 -
AJ0587 -
AJ06 -