CONTACTS 

SUBJECTS
Return to Work Physician Approval Effective  00811 Disability Adjust

1903 -
1903 -    ..
1904 - Summary/Objective
1905 -
190501 - Follow up ref SDS 8 0000. ref SDS 7 0000.
190502 -
190503 -
190504 -
190505 -
190506 -
190507 -
190509 -  ..
1906 -
1907 -
1908 - Progress
1909 -
190901 - On 080725 after getting a favorable examination at UCSF, Millie
190902 - notified NP she plans to start work on 080811 after medical leave.
190903 - ref SDS 7 666I  Return to work implements guidance by primary care
190904 - physician for cancer patients to stay engaged on the job as a
190905 - component of health care to recover from cancer, reported on 030606.
190906 - ref SDS 1 LZ3L  On 041019 Doctor Guardino made a similar
190907 - recommendation during a meeting at Stanford Cancer Center. ref SDS 2
190908 - NN6N
190910 -  ..
190911 - Last week on 080729, Millie received a letter from N&P dated 080728,
190912 - and requesting a release from the doctor for Millie to return to work,
190913 - and setting out any restrictions. ref SDS 8 645J
190915 -  ..
190916 - Millie subsequently received on 080731 results of the cancer marker,
190917 - CA 15-3 71 for the blood test the week before on 080724. ref SDS 6
190918 - A16M   She has also had time to review results for the CT test on
190919 - 080718, which were received from Kaiser on 080723, due to a delay
190920 - reading the scans. ref SDS 4 R44O  The test is fairly complicated, due
190921 - in part to extravasation of contrast medium, and so took time to
190922 - review. ref SDS 4 EO8F
190924 -  ..
190925 - Today, Millie relates understandings from examination on 080724, and
190926 - testing that seems to indicated she can return to work, although there
190927 - is a new concern about interstitial lung disease set out in the CT
190928 - test. ref SDS 4 TS4J  There is also concern about side effects of
190929 - Neupogen treatments that cause bone pain and fatigue, and sometimes
190930 - headache.
190932 -  ..
190933 - Millie submitted ref DIT 1 0001 to Doctor Rugo with a copy to the
190934 - primary care physician at Kaiser, and a copy to Tim Blevins at NP,
190935 - saying...
190937 -         ..
190938 -    1.  My employer requests in a letter on 080728 a "release from
190939 -        physician" for me to return to work (see NP letter dated 080728
190940 -        received the next day on 080729, ref SDS 8 645J). ref DIT 1
190941 -        0001
190943 -         ..
190944 -    2.  This follows up my letter to NP last week on 080725 notifying
190945 -        that I have recovered enough to be productive working 3 days a
190946 -        week Monday - Wednesday, ref SDS 7 4P8H, as I was prior to
190947 -        disability leave last year in 2007. ref DIT 1 RW5N
190949 -  ..
190950 - Returning to work provides an important component of Millie's
190951 - recovery, cited in Millie's letter to NP on 080725, ref SDS 7 645J,
190952 - presented earlier in her letter to NP on 080401, ref SDS 3 5E9R,
190953 - reporting medical advice from Kaiser on 030606, ref SDS 1 LZ3L, and at
190954 - Stanford Medical Center on 041019. ref SDS 2 NN6N
190955 -
190956 -            [On 080807 UCSF responded and approved Millie for return to
190957 -            work. ref SDS 9 SX4O
190959 -             ..
190960 -            [On 080807 Millie thanks UCSF for timely response, and
190961 -            submitted to NP the UCSF letter with physician release for
190962 -            return to work from medical leave. ref SDS 10 AF5J
190964 -             ..
190965 -            [On 080808 Tim Blevins at NP requested signed copy of UCSF
190966 -            physician release from medical leave for Millie to return
190967 -            to work; and to delay starting work on 080811 so that NP
190968 -            has time to review recent changes to staffing. ref SDS 11
190969 -            F55H
190971 -         ..
190972 -    3.  Brigid's examination at UCSF this past Thursday on 080724 found
190973 -        continued stable to improved IBC.  The CT test on 080718 and
190974 -        received from Kaiser on 080723 seems to sustain the impression
190975 -        of stability. ref SDS 4 4K5H, compared with the prior two tests
190976 -        going back to February before starting the 2nd arm of treatment
190977 -        with Carboplatin. ref SDS 4 MJ9O  CA 15-3 71 test on 080724
190978 -        showed a reduction from the prior test on 080626, albeit
190979 -        slight.  This this was a big relief from 141 reported at Kaiser
190980 -        on 080708. ref SDS 6 TR4K, ref DIT 1 RW6J
190982 -         ..
190983 -    4.  The CT test on 080718 discusses Interstitial lung disease, and
190984 -        seems to indicate this is mostly stable [reviewed in the record
190985 -        on 080723]. ref SDS 4 TS4J, ref DIT 1 RW7O
190987 -         ..
190988 -    5.  The report that disease in the mid right lung is definitely
190989 -        less pronounced, hopefully reflects increased exercise and
190990 -        fitness.  Last week I hiked nearly 50 miles.  Bone pain and
190991 -        fatigue from Neupogen seems to be a 1 day event.  I was out of
190992 -        things yesterday, after 2 days of Neupogen treatments; but,
190993 -        today, I did 7+ miles hiking, and feel fine.  I'm thankful
190994 -        there seems to be fast recovery from Neupogen side effects.
190995 -        ref DIT 1 RW8L
190996 -
190997 -            [On 080821 meeting at UCSF with medical team, there was no
190998 -            discssion of CT test performed 080718 finding Interstitial
190999 -            lung disease, ref SDS 12 056G; none of the questions
191000 -            presented on 080723, ref SDS 4 6A4J, were addressed during
191001 -            the meeting at UCSF.
191003 -         ..
191004 -    6.  These trends beginning in February starting the 2nd arm of
191005 -        treatment in the clinical study on 080313, may support
191006 -        favorable long term prospects, for 6 months to a year, with
191007 -        understanding that the actual course of disease cannot be
191008 -        predicted. ref DIT 1 RW9K
191010 -         ..
191011 -    7.  The other major health issue is pulmonary embolism.  Gloria at
191012 -        Kaiser has been very effective stabilizing Coumadin treatments
191013 -        to maintain INR within the target rage for 2 years.  The most
191014 -        recent CT test has a lot more detail on lung conditions, but
191015 -        seems to say everything is stable or improved. ref SDS 4 RV78,
191016 -        ref DIT 1 RW9R
191018 -         ..
191019 -    8.  Can you please collaborate with Doctor Johnson at Kaiser and
191020 -        respond with a copy to Tim so that N&P has something in their
191021 -        files showing I am fit for work.  By copy to Doctor Johnson, I
191022 -        am alerting him to this issue as well. ref DIT 1 RW4U
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