CONTACTS 

SUBJECTS
Meeting Examination Doctor Review Strategy  Wrk Plan 7th Cycle 1st T

1303 -
1303 -    ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS I2 0000. ref SDS H1 0000.
130502 -
130503 - Oncology health care presents an emotional roller coaster. ref SDS 0
130504 - MM5N  Low blood counts prevented getting chemotherapy treatment today.
130505 - ref SDS 0 4B7L  The doctor prescribed Neupogen to increase blood
130506 - counts so that Millie can get chemotherapy next Thursday. ref SDS 0
130507 - RV93  The medical team did not have time to discuss results of the CT
130508 - test at Kaiser on 080718.  This may indicate concurrance with review
130509 - showing favorable response to treatment. ref SDS 0 MF9K  The doctor
130510 - approved Millie for getting the next CT test at Kaiser in Oakland on
130511 - 080911, after getting treatment the same day in the clinical study at
130512 - UCSF. ref SDS 0 MF5L  Examination revealed new swelling in the left
130513 - supraclavicular area, which has not been previously noted in CT tests,
130514 - nor examinations since 2004. ref SDS 0 4C6O  Other findings from
130515 - examination today, ref SDS 0 4C6K, indicate subsiding IBC disease.
130516 - ref SDS 0 YW6M  The next CT test in a few weeks together with results
130517 - of CA 15-3 cancer marker next week will clarify evaluation today.
130518 - ref SDS 0 JT5O
130519 -
130520 -        [On 080827 Millie submitted the record for the meeting today to
130521 -        the medical team. ref SDS K0 0001
130522 -
130523 -
130524 -
130525 -
130527 -  ..
1306 -
1307 -
1308 - Progress
1309 -
130901 - Agenda Progress Review Meeting
130902 -
130903 - Millie submitted ref DIT 1 0001 to UCSF with an agenda for the meeting
130904 - this morning...
130905 -
130906 -        1.  Millie approved return to work
130907 -            great emotional lift; no work
130908 -            available - emotional roller
130909 -            coaster.................................. ref SDS 0 MM5N
130911 -             ..
130912 -        2.  Blood draw need vials and work order
130913 -            delivered to Infusion Clinic on
130914 -            5th floor................................ ref SDS 0 6Y5K
130916 -             ..
130917 -        3.  CT test on 080718 review results......... ref SDS 0 4U6L
130919 -             ..
130920 -        4.  Interstitional lung disease.............. ref SDS 0 056G
130922 -             ..
130923 -        5.  CT scan schedule next test at Kaiser
130924 -            Oakland................................... ref SDS 0 MF5L
130926 -             ..
130927 -        6.  Huber needle inserted at UCSF for
130928 -            chemotherapy cancer treatment
130929 -            reuse at Kaiser for CT
130930 -            test??.................................... ref SDS 0 MF6N
130932 -             ..
130933 -        7.  Bard manufacturer's review failed
130934 -            Power Port device medical
130935 -            protocol................................. ref SDS 0 ZZ6H
130937 -             ..
130938 -        8.  Examination IBC seems continuing
130939 -            to improve............................... ref SDS 0 4C6K
130941 -             ..
130942 -        9.  Current medications...................... ref SDS 0 8A9G
130944 -             ..
130945 -       10.  Schedule meetings medical team
130946 -            after treatment in September
130947 -            and October.............................. ref SDS 0 HT6N
130949 -  ..
130950 - Brigid is tied up with other customers this morning, so Lynn did the
130951 - examination.  Millie remembered Lynn doing a great job filling in for
130952 - Brigid during the meeting on 080529. ref SDS G0 4E65
130954 -  ..
130955 - As occurred on 080529, ref SDS G0 4E69, Lynn did not get a copy of the
130956 - agenda submitted to UCSF for the meeting today, per above. ref SDS 0
130957 - YY3N   Lynn did not have time today to make inquires from the medical
130958 - team for the meeting agenda, as was done on 080529. ref SDS G0 UE4L
130960 -  ..
130961 - Lynn introduced Jill as the new Clinical Research Coordinator taking
130962 - over for Jonathan from last month on 080724. ref SDS I2 YY63  Jonathon
130963 - had replaced Megan the month before on 080626. ref SDS H1 YY5U
130965 -  ..
130966 - Jill seemed to say she received a copy of Millie's letter to UCSF,
130967 - ref DIT 1 0001, with the agenda for the meeting today.  There was not
130968 - enough time for review with Lynn to guide a productive meeting today.
130969 -
130970 -
1310 -

SUBJECTS
Default Null Subject Account for Blank Record

2103 -
210401 -  ..
210402 - CA 15-3 Cancer Marker 96 May Indicate Progression of Disease
210403 -
210404 - Follow up ref SDS B0 087J, ref SDS A1 087J.
210405 -
210406 - Millie had a blood draw this morning in the Infusion Clinic at UCSF.
210407 - ref SDS J6 FW5N  Results for the cancer marker CA 15-3 96 were
210408 - reported a week later 080828. ref SDS K3 3T4O
210409 -
210410 -                               +- U=UCSF
210411 -                         +- K=Kaiser
210412 -         Test Date             |           Date Received
210413 -          080821......... 96 H U........... 080821, ref SDS J6 VK6H
210414 -          080724......... 71 H U........... 080724, ref SDS I3 TR4K
210415 -          080708.........141 H K........... 080708, ref SDS H4 L74K
210416 -          080626......... 72 H U........... 080626, ref SDS H2 PW7I
210417 -          080529......... 66 H U........... 080529, ref SDS G1 IJ8L
210418 -          080501......... 59 H U........... 080501, ref SDS F3 U34O
210419 -          080403......... 66 H U........... 080403, ref SDS E5 A16M
210420 -          080313...cetuximab Carboplatin... 080313, ref SDS E1 TZ8I
210421 -          080306......... 59 H U........... 080306, ref SDS D9 A16M
210422 -          080207......... 63 H U........... 080207, ref SDS D3 A16M
210423 -          080110......... 51 H U........... 080110, ref SDS D0 A16M
210424 -          071213......... 48 H U........... 071213, ref SDS C9 A16M
210425 -          071115......... 43 H U........... 071115, ref SDS C8 A16M
210426 -          071018......... 75 H K........... 071018, ref SDS C7 5K6K
210427 -          070920......... 38 H U........... 070920, ref SDS C2 A16M
210428 -          070816......... 28 H U........... 070816, ref SDS C1 A16M
210429 -          070719...**.... ?? H U........... 070719, ref SDS B9 A16M
210430 -          070621......... 30 H U........... 070621, ref SDS B7 A16M
210431 -          070524......... 37 H U........... 070524, ref SDS B2 A16M
210432 -          070511......... 56 H K........... 070516, ref SDS A7 RH9H
210433 -          070426......... 29 ..U........... 070426, ref SDS A2 A16M
210434 -          070329......... 33 H U........... 070406, ref SDS 95 EQ6I
210435 -          070301......... 36 H U........... 070307, ref SDS 77 A16M
210436 -          070215......... 52 H K........... 070307, ref SDS 72 ER5O
210437 -          070208......... 55 H K........... 070307, ref SDS 72 ER5O
210438 -          070201.....cetuximab begins...... 070201, ref SDS 70 G68I
210439 -          070131......... 56 H K........... 070202, ref SDS 71 087J
210440 -          070123......... 52 H K........... 070202, ref SDS 71 087J
210441 -          070118......... 68 H K........... 070123, ref SDS 66 GK5B
210442 -          070104......... 56 H K........... 070110, ref SDS 62 087J
210443 -          061218......... 74 H K........... 061227, ref SDS 56 6P9F
210444 -          061214......... 63 H............. 061227, ref SDS 56 6P9F
210445 -          061201....Pause treatments..... . 061201, ref SDS 52 GJ5M
210446 -          061130......... 67 H............. 061201, ref SDS 52 087J
210447 -          061116......... 66 H............. 061201, ref SDS 52 087J
210448 -          061110......... 56 H............. 061201, ref SDS 52 087J
210449 -          061109......... 61 H............. 061110, ref SDS 51 087J
210450 -          061026......... 57 H............. 061110, ref SDS 51 087J
210451 -          061019......... 56 H............. 061020, ref SDS 49 087J
210452 -          060928......... 51 H............. 060929, ref SDS 46 087J
210453 -          060907......... 68 H............. 060929, ref SDS 46 087J
210454 -          060813......... 73 H............. 060817, ref SDS 43 U24M
210455 -          060809......... 87 H............. 060810, ref SDS 42 2N5J
210456 -          060721.begin capacitabine Taxotr. 060721, ref SDS 38 0001
210457 -          060708......... 71 H............. 060711, ref SDS 37 087J
210458 -          060616......... 63 H............. 060623, ref SDS 36 UQ5Q
210459 -          060522......... 59 H............. 060605, ref SDS 35 UQ5Q
210460 -          060501......... 49 H............. 060522, ref SDS 34 MC4F
210461 -          060421......... 44 H............. 060428, ref SDS 32 087J
210462 -          060330......... 40 H............. 060428, ref SDS 32 087J
210463 -          060303......... 36............... 060428, ref SDS 32 087J
210464 -          060210......... 33............... 060217, ref SDS 31 087J
210465 -          060109......... 34............... 060126, ref SDS 30 KV59
210466 -          051223......... 34............... 060106, ref SDS 29 087J
210467 -          051202....**... 28............... 060106, ref SDS 29 087J
210468 -          051116......... 31............... 051121, ref SDS 28 087J
210469 -          051109......... 30............... 051121, ref SDS 28 087J
210470 -          051102......... 34............... 051121, ref SDS 28 087J
210471 -          051021..Mastectomy surgery....... 051021, ref SDS 27 0001
210472 -          050916..End capecitabine Taxotere 050916, ref SDS 25 407N
210473 -          050909......... 45 H............. 051007, ref SDS 26 087J
210475 -  ..
210476 - Note:  CA 15-3 history prior to 2006 listed on 070426. ref SDS A1 CY4F
210477 -
210478 -
210480 -  ..
210481 - CA 15-3 37 Cancer Marker Rising Conflicts Favorable CT and Examination
210482 -
210483 - Follow up ref SDS A1 GJ5M, ref SDS 98 GJ5M.
210484 -
210485 - Patient history applying CA 15-3 cancer marker is shown in a case
210486 - study on 030710. ref SDS 7 IA7H
210488 -  ..
210489 - Millie had a blood test at Kaiser on 080708 for Power Port surgery.
210490 - ref SDS H4 MF4K  Results CA 15-3 141 were received on 080712, and
210491 - reported to UCSF at that time. ref SDS H5 K14R  Kaiser's lab report on
210492 - 080708 has a comment that the blood sample was slightly hemolyzed.
210493 - Results may be affected. ref SDS H4 05YW  At that time, on 080712
210494 - Millie asked about new drugs to treat progression of disease.
210495 - ref SDS H5 K15P
210497 -  ..
210498 - The test at UCSF a few weeks later on 080724
210499 - shows CA 15-3 71,
210500 -
210501 -
210502 -
210503 -
2106 -

SUBJECTS
Meeting Examination Doctor Review Strategy  Wrk Plan 7th Cycle 1st T

3103 -
310401 -  ..
310402 - Emotional Roller Coaster Stress Anxiety Wellness Support Group
310403 -
310404 - Follow up ref SDS I2 W992.
310405 -
310406 - Lynn asked Millie how she is feeling today?
310408 -  ..
310409 - Case study on emotional roller coaster was reported during examination
310410 - at Kaiser on 070105, ref SDS 61 Y642  Rising complexity of health
310411 - care, compare 33 medical issues on 061201, ref SDS 52 LU3J, with the
310412 - list of 45 issues on 070524, ref SDS B0 LU3J, compound communication
310413 - problems cited on 070301. ref SDS 76 O24J  Case study on 061020 shows
310414 - doctors describe Millie's complex patient history requires significant
310415 - effort to maintain order. ref SDS 49 T25H
310417 -  ..
310418 - Recent background on stress, anxiety, and worry from long term cancer
310419 - care is reported on 080403. ref SDS E4 MK8F  Prozac was prescribed to
310420 - cope with emotional trauma on 080305. ref SDS D7 KT4J  Earlier on
310421 - 070921 the doctor ordered Atavin to relieve mounting anxiety and worry
310422 - about health care prospects compounded by difficulties with referral
310423 - coordination and errors in medical management. ref SDS C3 QY9V
310425 -  ..
310426 - Current issues that drive and help resolve anxiety....
310428 -         ..
310429 -    1.  Stress relieved, Millie was encouraged by Doctor Rugo's
310430 -        approval for returning to work, reported on 080807, ref SDS I8
310431 -        AF5J, based on Millie's letter to UCSF on 080804. ref SDS I6
310432 -        GU5P  The doctor's approval was submitted to NP a few days
310433 -        later on 080808 with anticipation of getting back to work,
310434 -        ref SDS I9 F55H, implementing medical advice at Kaiser on
310435 -        030606, ref SDS 6 TF5M, and later from Doctor Guardino at
310436 -        Stanford Cancer Center on 041019, ref SDS 20 NN6N, noting that
310437 -        working can be a component of recovery from cancer by helping
310438 -        maintain a positive additude and distracting from worry and
310439 -        doubt about the course of disease, delays, and problems that
310440 -        occur in case management, as set out in Millie's letter to NP
310441 -        on 080401, ref SDS E3 5E9R,
310443 -         ..
310444 -    2.  Spirits lifted hearing that co-workers and colleagues have been
310445 -        coming by the personnel office saying how wonderful that Millie
310446 -        is returning to work, as set out in Millie's letter to UCSF
310447 -        this morning. ref DIT 1 YO6M
310449 -         ..
310450 -    3.  Disappointment increased learning that attorney layoffs have
310451 -        reduced requirements, so there is no work for Millie at this
310452 -        time, reported in Millie's letter to NP on 080814. ref SDS J4
310453 -        R24W
310455 -         ..
310456 -    4.  Dissapointment and stress increase attending Wellness Community
310457 -        cancer support group meetings.  Discussion all negative without
310458 -        considering solutions and presenting prospects for progress or
310459 -        anything positive to give people hope.  Reluctance to comment
310460 -        in the meetings, because she is doing relatively well, and this
310461 -        seems to make people upset, noted in her letter to the medical
310462 -        team today. ref DIT 1 YO7K
310464 -         ..
310465 -        Lynn was not familiar with support groups that offer positive
310466 -        solutions and focus on progress.
310468 -         ..
310469 -    5.  Stress, anxiety, and doubt increased when Kaiser failed with
310470 -        multiple attempts doing the CT test on 080718 using Millie's
310471 -        Power Port with Huber needle technology, causing extravisation
310472 -        and bleeding that required emergency measures, turning a 20
310473 -        minute procedure into a 3 hour ordeal. ref SDS H7 LK3R  At that
310474 -        time, Kaiser CT staff noted that Millie suffered significantly,
310475 -        ref SDS H7 FM74, discussed with Brigid on 080724. ref SDS I2
310476 -        W992
310478 -         ..
310479 -    6.  Stress and worry relieved Kaiser reported on 080811 finding
310480 -        personnel trained and experienced using Huber needle with Power
310481 -        Port technology in the Oakland office to perform Millie's next
310482 -        CT test in a few weeks. ref SDS J2 L45M  Stress was further
310483 -        relieved on 080811, when Doctor Rugo approved Millie getting
310484 -        the next CT test at Oakland on an 8-week schedule. ref SDS J2
310485 -        4T4N  Now today, the doctor further approved Millie can have
310486 -        the CT test at Kaiser in Oakland on the same day as treatment
310487 -        for cancer at UCSF on 080911, per below. ref SDS 0 MF5L
310488 -
310489 -               [On 080825 Kaiser cancelled Millie's test at Oakland CT
310490 -               Department where personnel are experienced using Power
310491 -               Port and Huber needle technology required for Millie's
310492 -               test, and referred the case back to the CT Department in
310493 -               Walnut Creek where personnel are not trained nor
310494 -               experienced to do this work, ref SDS J9 XF64, and where
310495 -               attempts on 080718 to do the CT test failed. ref SDS H7
310496 -               LK3R
310498 -         ..
310499 -    7.  Stress, doubt, worry, and disappointment increase today about
310500 -        rising neutropenia, when blood counts were too low for getting
310501 -        treatment, discussed below, ref SDS 0 7R5J, after consideration
310502 -        on 080814 resulted in not getting Neupogen treatment to
310503 -        increase blood counts, ref SDS J5 UK3K, following report of low
310504 -        blood counts at that time. ref SDS J5 LD3H  Stress and worry
310505 -        today compounded concerns about errors in Chemotherapy Orders
310506 -        received months after the fact that reduced the dose of
310507 -        Carboplatin, reported on 080529, ref SDS G1 PVUQ, and which
310508 -        conflicted with Millie's letter to the medical team on 080423
310509 -        asking to maintain a full dose of chemotherapy in order to
310510 -        continue recovery from cancer. ref SDS E8 TY6Y
310512 -         ..
310513 -        Millie's spirits were significantly raised by results of the CT test
310514 -        on 080718 shown in the record on 080723, ref SDS I1 EO8F; she was
310515 -        disappointed that referral coordination delayed Kaiser submitting the
310516 -        report to UCSF in time to cooborate understandings during the meeting
310517 -        on 080724. ref SDS I2 VE8O
310519 -         ..
310520 -        Emotions were further boosted today by examination indicating recovery
310521 -        from IBC disease, shown below, ref SDS 0 FH7M, including comments by
310522 -        Doctor Rugo noting conditions seem better than when she saw Millie six
310523 -        months ago on 080219. ref SDS D6 3J4I
310525 -  ..
310526 - This record presents a roller coaster of stress, trauma, and anxiety
310527 - that has been managed well by Kaiser, UCSF, and by the patient with
310528 - increased exercise from a very fortunate ability to tolerate cancer
310529 - treatments with cetuximab and Carboplatin, and more recently with
310530 - Neupogen, discussed further below. ref SDS 0 LT6I
310531 -
310532 -
310533 -
310534 -
3106 -

SUBJECTS
Default Null Subject Account for Blank Record

3203 -
320401 -  ..
320402 - Blood Counts Very Low NEUTS 0.99 Carboplatin Skipped Today
320403 - Neutropenia Prevents Chemotherapy Treatments Increases Rising Cancer
320404 -
320405 - Millie went to the 5th floor at 0800 for a blood draw. ref SDS J6 LO4G
320407 -  ..
320408 - The work order was already prepared, ready for implementation by the
320409 - Infusion Clinic, as set out in the letter last night listing the
320410 - agenda for today. ref DIT 1 0001  This corrected prior communication
320411 - problems the past few months, reported on 080724. ref SDS I2 O95I and
320412 - the month before on 080626, ref SDS H1 YY4X, citing problems on
320413 - 080529. ref SDS G0 4E5J
320415 -  ..
320416 - During the meeting with the medical team in the Breast Care Clinic on
320417 - the 2nd floor an attendant knocked on the door and brought into the
320418 - examination room a form with results for the blood test.
320420 -  ..
320421 - Lynn checked the computer.  Results for the blood test were already
320422 - posted by the lab on the 5th floor.  This improved performance last
320423 - month on 080724, when results from the Infusion Clinic lab on the 5th
320424 - floor were not available in time for review during the meeting with
320425 - the medical team on the 2nd floor. ref SDS I2 YY7U
320427 -  ..
320428 - As she did on 080529, Lynn asked to pause the meeting for a few
320429 - minutes, ref SDS G0 L255, while she updated Millie's medical chart at
320430 - UCSF with results of prior blood tests, which had not yet been
320431 - entered.  She scrolled back through various screens on the computer to
320432 - get data for the prior tests data and entered this in handwriting on
320433 - the UCSF medical chart form maintained in Millie's case management
320434 - folder.
320436 -  ..
320437 - NEUTS 0.99 is nearly 50% below UCSF criteria for safe chemotherapy
320438 - reported in the blood test performed in the Infusion Clinic this
320439 - morning. ref SDS J6 QY6H
320440 -
320441 -     [On 080918 followed up. ref SDS L0 237K
320443 -  ..
320444 - Emotional trauma from disappointing results today, discussed above,
320445 - ref SDS 0 4A4G, reflect efforts last week.  On 080814 blood counts
320446 - were too low. ref SDS J3 PU6K  Millie asked about prescribing Neupogen
320447 - to increase blood counts for treatment today. ref SDS J5 3L8Y  The
320448 - medical team decided to take a chance that blood counts would rise
320449 - without Neupogen, since this often occurs for other patients who do
320450 - not get chemotherapy on the bye week of the treatment cycle.
320451 - ref SDS J5 UK3K  At that time on 080814, there wasn't enough time to
320452 - review patient history for alignment with other patients. ref SDS J6
320453 - K55N Limited time presents a constant challenge evaluating context of
320454 - each patient's evolving medical history to apply fixed policies and
320455 - procedures.
320457 -  ..
320458 - Lynn explained that blood counts so low below the level for safe
320459 - treatment may prevent Millie from getting Carboplatin, essential to
320460 - maintain recovery from IBC.  She indicated that Doctor Rugo should
320461 - make the decision, and the doctor is in a meeting.
320463 -  ..
320464 - Lynn used the computer in the examination room to send a message to
320465 - the doctor with the UCSF electronic mail system, and asking about
320466 - Millie gettting Carboplatin chemotherapy with blood counts NEUTS 0.99.
320467 - Patient history in the case study on 060810 shows Millie has been
320468 - treated often when blood counts are below published guidance for safe
320469 - chemotherapy. ref SDS 42 HV45
320471 -  ..
320472 - Near the end of the meeting, Doctor Rugo visited Millie and the
320473 - medical team briefly in the examination room.  She complimented Millie
320474 - on the color and design of her blouse.
320476 -  ..
320477 - Doctor Rugo confirmed that Carboplatin should be skipped today
320478 - starting the 1st treatment of the 7th cycle, due to low blood counts
320479 - with NEUTS 0.99. ref SDS J6 QY6H
320481 -  ..
320482 - Millie has been worried about rising neutropenia that prevents getting
320483 - chemotherapy treatment for cancer (see research in the record on
320484 - 070301, ref SDS 76 O59H, and case study on missing treatments listed
320485 - in the record on 060810. ref SDS 42 HV45
320487 -  ..
320488 - Last week on 080814 blood counts showed NEUTS 1.37 for the bye week
320489 - getting Carboplatin chemotherapy.  Millie asked about getting Neupogen
320490 - treatments on 080815, and 080816 at Kaiser, ref SDS J5 3L8Y, which
320491 - were previously scheduled by Donna on 080809? ref SDS J0 NQ4O  At that
320492 - time decided to skip Neupogen, ref SDS J5 UK3K, and then make
320493 - adjustments if necessary. ref SDS J5 UK4P
320495 -  ..
320496 - Today, the doctor related again UCSF policy and procedure in Brigid's
320497 - letter on 080814 that Neupogen is not prescribed when, like today,
320498 - patients do not get chemotherapy treatment. ref SDS J5 UK3K  There was
320499 - discussion about risk management in relation to experience today
320500 - applying the policy in this case.  The doctor approved Neupogen
320501 - treatent today and tomorrow, because blood counts are much lower today
320502 - rather than higher, as expected last week.
320504 -  ..
320505 - Doctor Rugo further clarified that Neupogen has optimum effects
320506 - restoring blood counts when received after 24 hours from treatment
320507 - with chemotherapy.
320508 -
320509 -        [On 080918 case study shows 2 Neupogen treatments on each of
320510 -        all 4-weeks in the chemotherapy cycle avoids missing
320511 -        chemotherapy treatments. ref SDS L1 OK67
320513 -  ..
320514 - Millie thanked the doctor for critical guidance today.  Seems to align
320515 - with research on neutropenia reported 070301, ref SDS 76 R15F
320516 - following discussion with the doctor about problems of low blood
320517 - counts. ref SDS 76 D24M
320518 -
320519 -        [On 080823 Millie applied the doctor's guidance scheduling
320520 -        Neupogen treatments for September. ref SDS J8 JP5O
320522 -         ..
320523 -        [On 080905 updated schedule from Kaiser shows Neupogen
320524 -        treatments at 0830 and 0900 on Fridays, ref SDS K7 6E4G, which
320525 -        is about 23 and 22 hours after Millie completes Carboplatin
320526 -        chemotherapy treatments shown by the schedule from UCSF
320527 -        received on 080904. ref SDS K6 HG57
320529 -         ..
320530 -        [On 080913 Kaiser changed the schedule for Neupogen treatments
320531 -        to the afternoons on Fridays. ref SDS K9 WJ4O
320533 -         ..
320534 -        [On 081003 Neupogen scheduled at 0830 on Friday 081128, because
320535 -        the day before is Thanksgiving, and so chemotherapy treatment
320536 -        at UCSF will be 2 days earlier on 081126. ref SDS L2 PQ6X
320538 -  ..
320539 - Lynn prepared the Chemotherapy Order for cetuximab.
320541 -  ..
320542 - Lynn decided not to prepare an order today for Carboplatin to start
320543 - next week, rather than today.  Lynn feels that comprehensive risk
320544 - management requires waiting until labs next week show Millie's blood
320545 - counts have increased to the level safe for getting chemotherapy.
320546 - UCSF will then prepare a Chemotherapy Order for Millie to get
320547 - Carboplatin.  The importance of increasing blood counts this week in
320548 - order to get chemotherapy next Thursday supports Doctor Rugo's
320549 - approval for Neupogen treatments.
320550 -
320551 -        [On 080827 Millie notified UCSF to prepare Chemotherapy Order
320552 -        for Carboplatin treatment tomorrow. ref SDS K1 KU5J
320554 -         ..
320555 -        [On 080828 Chemotherapy Order for Carboplatin was submitted to
320556 -        the Infusion Clinic, ref SDS K3 N54I, and the order for labs
320557 -        was ready for Millie's treatment. ref SDS K3 FW5N
320559 -  ..
320560 - To implement the doctor's approval for Neupogen treatments this week,
320561 - ref SDS 0 4B95, Lynn added a handwritten comment on the Chemotherapy
320562 - Order for cetuximab that prescribes Neupogen treatments beginning
320563 - tomorrow at Kaiser, shown in the record getting treatment today in the
320564 - Infusion Clinic. ref SDS J6 RU7O
320565 -
320566 -
320568 -  ..
320569 - Chemotherapy Tolerance Remains Effective for High Level Exercise
320570 - Neupogen Side Effects Fatigue, Bone Pain, Headaches Minimal
320571 - Exercise Continues High Level of Effort Neupogen Side Effects Moderate
320572 -
320573 - The doctor was pleased with Millie's fitness keeping up regular
320574 - exercise in the gym, and hiking, related in Millie's letter submitting
320575 - an agenda for the meeting today. ref DIT 1 YO9Q  Increased fitness
320576 - helps cope with emotional challenges of long term care recovering from
320577 - cancer, per above. ref SDS 0 MM5N  Emotional balance maintained
320578 - through exercise helps avoid reliance on drugs, reported to Kaiser on
320579 - 080502. ref SDS F4 QU4M
320581 -  ..
320582 - Millie thanked the doctor for guiding care the past 18 months that has
320583 - increased quality of life, cited in Millie's letter to UCSF on 080804,
320584 - reporting Millie has recovered vitality and strength to return to
320585 - work. ref SDS I6 GU5P
320587 -  ..
320588 - The recent report on chemotherapy and Neupogen side effects in the
320589 - record for 080810 indicates good tolerance of both chemotherapy and
320590 - Neupogen, which has not reduced ability nor interest in exercise.
320591 - ref SDS J1 9W9I
320592 -
320593 -
320595 -  ..
320596 - Interstitional Lung Disease CT Test 080718 Heavy Chest Hiking Reduced
320597 -
320598 - Follow up ref SDS I6 GU6P, ref SDS I1 TS4J.
320599 -
320600 - The agenda for the meeting today lists "Interstitial lung disease" for
320601 - discussion today, ref DIT 1 YO9J, based on findings in the CT test on
320602 - 080718 reviewed in the record on 080723. ref SDS I1 TS4J
320604 -  ..
320605 - Millie reported in her letter to the doctor this morning, heaviness in
320606 - her chest while hiking the past few weeks.  This seems less pronounced
320607 - lately.  Yesterday (Wednesday) she hiked 6 miles, and did not notice
320608 - out of the ordinary breathing while hiking the hills.  Pulse seems
320609 - strong and steady. ref DIT 1 YO9Q
320611 -  ..
320612 - Background on Interstitional disease in Millie's patient history is
320613 - shown in a case study on 080723. ref SDS I1 7W6F
320615 -  ..
320616 - Institial lung disease is listed as a side effect that occurs in less
320617 - than 1% of patients treated with cetuximab, which Millie has been
320618 - getting in the clinical study at UCSF, reported on 070116. ref SDS 63
320619 - 0256  Millie's treatment today, listed in another record, shows she
320620 - will have received 81 treatments with cetuximab since 070201.
320621 - ref SDS J6 5B6J  Since this is a great deal more cetuximab than other
320622 - patients get, could Millie be suffering from an accumulation?
320624 -  ..
320625 - Does increased exercise help moderate the advance, and even reverse
320626 - the course of this disease in Millie's case?
320628 -  ..
320629 - Today, the medical team did not have time to comment on these among 6
320630 - questions about new findings of Interstitial lung disease listed on
320631 - 080723. ref SDS I1 6A4J
320632 -
320633 -        [On 080829 the primary care physician looked at the scans for
320634 -        the CT test on 080718 that reported Interstitional lung
320635 -        disease, and determined the problem is very minimal.
320636 -        ref SDS K5 RP4X
320637 -
320638 -
320640 -  ..
320641 - CT Test 080718 Shows Stable Improving IBC Response to Treatment
320642 -
320643 - Follow up ref SDS I2 TG96.
320644 -
320645 - Millie had a CT test on 080718 required to evaluate progress
320646 - responding to treatment under the clinical study protocol.  Testing
320647 - was timed for evaluation to start the prior cycle on 080724.  During
320648 - the meeting at UCSF on 080724, Brigid advised that the report on CT
320649 - test performed at Kaiser on 080718 was missing from the UCSF medical
320650 - chart, and so discussion of findings could not occur at that time.
320651 - ref SDS I2 TG96
320653 -  ..
320654 - Patient review the day before on 080723 seemed to indicate stable to
320655 - improved IBC. ref SDS I1 YH41  This was discussed with the medical
320656 - team at UCSF during the meeting on 080724. ref SDS I2 4D4K  Brigid
320657 - feels these results indicate favorable response to treatment in the
320658 - clinical trial.  She cited UCSF practice protocols require medical
320659 - review to substantiate conclusions for case management. ref SDS I2
320660 - 2X7I  After the meeting on 080724, Millie submitted a letter to UCSF
320661 - on 080804 evaluating recovery from cancer that justifies ending
320662 - medical leave and going back to work.  The letter on 080804 cited
320663 - results from the CT test on 080718 based on patient review in the
320664 - record on 080723. ref SDS I6 GU5P  Brigid's letter a few days later on
320665 - 080807 submitted UCSF approval, and so may indicate UCSF concurs with
320666 - the record on 080723 reporting favorable conclusions on patient health
320667 - from the CT test on 080718. ref SDS I7 LM3L
320669 -  ..
320670 - UCSF indicated the CT test was important to evaluate patient health
320671 - and progress recovering from cancer.  On 080619 UCSF notified Millie
320672 - to advance the test scheduled at Kaiser for 080718 by 4 weeks.
320673 - ref SDS G8 DR5N  A week later on 080625, UCSF requested doing the CT
320674 - test at Kaiser as soon as possible. ref SDS H0 IU5X  The next day on
320675 - 080626 Brigid confirmed the importance of expediting the next CT test
320676 - as much as possible. ref SDS H1 4F5S
320678 -  ..
320679 - The agenda for the meeting today planned discussion of UCSF findings
320680 - from independent review of the CT test on 080718, which was planned on
320681 - 080724, ref DIT 1 YO8K, and centering on two issues...
320682 -
320683 -        1.  Right axillary................... 080723, ref SDS I1 4K5H
320684 -        2.  Interstitial lung disease........ 080723, ref SDS I1 TS4J
320686 -  ..
320687 - Today, Lynn and the doctor did not present UCSF analysis on the CT
320688 - test of any kind.  This may indicate UCSF concurs with review comments
320689 - in the record on 080723, ref SDS I1 EO8F, as further summarized in the
320690 - letter to UCSF on 080804. ref SDS I6 GU5P
320691 -
320692 -
320694 -  ..
320695 - Schedule CT Test 080911 at Kaiser in Oakland After Treatment at UCSF
320696 -
320697 - During the meeting today, the doctor advised there is no medical
320698 - restriction or conflict that prevents Millie from getting the next CT
320699 - test on the same day and after getting treatment in the clinical study
320700 - with cetuximab at UCSF.
320702 -  ..
320703 - This responds to Millie's letter to the medical team on 080811 about
320704 - coordinating the schedule for the CT test on 080911 at Kaiser in
320705 - Oakland where the CT Department has experience performing CT tests
320706 - using Power Ports and Huber needles, reported on 080811 crediting
320707 - Paula's research, ref SDS J2 P95U, and which is on the way home from
320708 - Millie getting treatment in the clinical study at UCSF. ref SDS J2
320709 - P96Q
320711 -             ..
320712 -            [On 080822 Arlette reported the Kaiser computer does not
320713 -            show Millie scheduled for the CT test at Kaiser Oakland,
320714 -            ref SDS J7 034E; Arlette called later and advised the test
320715 -            has now been scheduled for 080911. ref SDS J7 N66E
320717 -             ..
320718 -            [On 080826 the schedule branch of the CT Department for
320719 -            Kaiser in Walnut Creek reported that the Oakland office
320720 -            refused to perform; the Kaiser Walnut Creek CT Department
320721 -            that is not yet trained is trying to make arrangements for
320722 -            Millie's CT test using the Power Port. ref SDS J9 XF64
320724 -             ..
320725 -            [On 080827 Millie sent a letter asking Kaiser to present
320726 -            work plans for the next CT test on 080912. ref SDS K0 506P
320727 -
320728 -
320730 -  ..
320731 - Huber Needle Inserted for Treatment UCSF Use for CT Test at Kaiser
320732 -
320733 - Millie's letter to UCSF on 080811 asked about leaving the Huber needle
320734 - in the Power Port used for treatment at UCSF, so that the needle can
320735 - be used again an hour or so later at Kaiser in Oakland for the CT
320736 - test. ref SDS J2 P43Y  This was originally proposed on 080716 to
320737 - Kaiser in Walnut Creek for the CT test on 080718. ref SDS H6 K14N  At
320738 - that time on 080716, Kaiser rejected the proposal.  Two days later on
320739 - 080718, Kaiser had difficulty accessing the port with a Huber needle.
320740 - ref SDS H7 LK41  Kaiser's analysis at that time, indicated that
320741 - leaving the Huber needle in place inserted by UCSF for Millie's cancer
320742 - treatment, would have helped avoid problems at Kaiser. ref SDS H7 VX4F
320744 -  ..
320745 - Doctor Rugo did not discuss this issue today.  It is primarily a
320746 - Kaiser matter.
320748 -  ..
320749 - This can be reviewed with Kaiser in Oakland a week or so before the
320750 - test.
320751 -
320753 -  ..
320754 - Manufacturer Report Correcting CT Test Problems Power Port Huber Needle
320755 -
320756 - Follow up ref SDS J2 P44W, ref SDS I5 4R40.
320757 -
320758 - On 080804 Bard reported having a manufacturer's protocol to
320759 - investigate failed CT tests for verifying the Power Port has no
320760 - manufacturing defects. ref SDS I5 4R40  This was cited in a letter
320761 - asking the medical team about follow up on failed CT test on 080718,
320762 - as shown on 080811. ref SDS J2 P44W
320764 -  ..
320765 - On 080529 UCSF presented high priority to protect patient privacy by
320766 - confiscating customer property and disrupting work for several hours.
320767 - ref SDS G0 LD7L  Does patient safety justify similar effort?
320769 -  ..
320770 - Today, there was not enough time to consider industry practice
320771 - investigating failed medical procedures and new technology devices for
320772 - suitability to attempt the same procedure.
320773 -
320774 -
320776 -  ..
320777 - Examination Indicates Continuing Recovery 4th Relapse IBC
320778 - Axillary Sites Palpation Aligns CT Tests Minimal to No Swelling
320779 -
320780 - Follow up ref SDS I2 FH7M.
320781 -
320782 - Lynn advised that palpation finds no evidence of swelling in the left
320783 - or right axillary.  This aligns with prior examinations, most recently
320784 - on 080724. ref SDS I2 FH7M  This further aligns with the CT test on
320785 - 080718 when subsequent review on 080723 seemed to indicate stable to
320786 - improved conditions on the right axilla, ref SDS I1 4K5H, and found no
320787 - evidence of swelling in the left side. ref SDS I1 WM9L
320789 -  ..
320790 - Lynn pressed harder on the right axillary for evidence of swelling,
320791 - since CT testing has indentified swelling since February.  Today, she
320792 - was unable to feel any evidence of swelling.  This aligns with prior
320793 - examinations since February, which have never recognized swelling in
320794 - the right axilla, reported on 080724. ref SDS I2 FH7M
320795 -
320797 -  ..
320798 - Lump Left Supraclavicular Area of Neck New Condition Today
320799 -
320800 - Lynn reported palpation seems to indicate a slight lump in the left
320801 - supraclavicular area.
320803 -  ..
320804 - She seemed uncertain about location vertically along the neck.
320805 -
320806 -        [On 080827 letter to Kaiser and the medical team requested that
320807 -        the CT test on 080912 focus on left side of the neck.
320808 -        ref SDS K0 509V
320809 -
320810 -        [On 080829 1200 Kaiser medical chart reports primary care
320811 -        physician palpates lump left supraclavicular. ref SDS K4 VC6I
320813 -         ..
320814 -        [On 080829 2256 Millie's letter to medical team reports that
320815 -        primary care physician at Kaiser palpates lump left
320816 -        supraclavicular, ref SDS K5 RP8T, aligns with findings at UCSF
320817 -        on 080821. ref SDS 0 4C6O
320819 -         ..
320820 -        [On 080912 report on CT test 080911 presents no findings in
320821 -        left supraclavicular. ref SDS K8 5O6N
320823 -         ..
320824 -        [On 080918 Brigid could not find swelling in the left
320825 -        supraclavicular, which may align with the CT test not reporting
320826 -        findings in this area. ref SDS L0 N65G
320828 -         ..
320829 -        [On 081016 Brigid and Doctor Rugo palpate lump left
320830 -        supraclavicular, ref SDS L3 J34X; Doctor Rugo orders biopsy.
320831 -        ref SDS L3 J36R
320833 -         ..
320834 -        [On 081022 Doctor Daamen takes biopsy of swelled lymph node in
320835 -        left supraclavicular, and reviews CT test on 080911, and says
320836 -        the scans did not include enough of the neck to evaluate the
320837 -        node in the left supraclavicular. ref SDS L4 516F
320839 -         ..
320840 -        [On 081023 Doctor Daamen reports pathology on swelled lymph
320841 -        node in left supraclavicular positive for breast cancer.
320842 -        ref SDS L5 4Q9Q
320844 -  ..
320845 - The blood test today yielded results a week later showing the cancer
320846 - marker increased over the past 4 weeks from 71 to CA 15-3 96 today.
320847 - ref SDS J6 VK6H
320849 -  ..
320850 - The PET scan test on 021208 reported findings in this area reviewed at
320851 - Kaiser on 030109. ref SDS 4 L66M  On 040211 Millie reported stiffness
320852 - in the neck, and asked the doctor to examin a possible lump in the
320853 - left supraclavicular region. ref SDS 9 WP7L
320855 -  ..
320856 - At that time on 040211, the doctor at Kaiser confirmed finding a
320857 - slight lump, as Lynn indicates today at UCSF, and explained that lymph
320858 - nodes flare up periodically due to benign infections from small
320859 - variations in health.  Millie's extended treatment in the clinical
320860 - study at UCSF the past 18 months has been very effective extending
320861 - quality of life.  Weekly treatments for cancer also create pressure on
320862 - blood counts that diminishes the immune system, disucssed above.
320863 - ref SDS 0 6Y5K  On 040211, the primary care physician at Kaiser noted
320864 - that flare ups of lymph nodes can recede on their own. ref SDS 9 S159
320866 -  ..
320867 - Kaiser prescribed pennicilen antibiotic to treat the new lump found
320868 - from examination of the left supraclavicular on 040211. ref SDS 9 6S6N
320870 -  ..
320871 - Examination on 040227 showned the lump persisted.  Kaiser ordered a
320872 - biopsy. ref SDS 10 0001, which reported cancer on 040309. ref SDS 11
320873 - 0001  The patient requested further review of rash on the left breast
320874 - diagnosed and treated as Cellulitis.  Biopsy of the left breast
320875 - performed on 040419, ref SDS 15 1572, was received at Kaiser on
320876 - 040517; reveiw after the meeting showed biopsy findings of IBC.
320877 - ref SDS 16 7D6F  Research then indicated lumps in the supraclavicular
320878 - area, along with lumps in the axilla and breast rash are symptoms of
320879 - IBC, ref SDS 16 6M9H, which had been identified in the PET scan test
320880 - on 021218, reviewed at Kaiser on 030109. ref SDS 4 L66M
320882 -  ..
320883 - In the present case, Millie has not complained of stiff neck nor
320884 - feeling a lump.  The CT test on 080718 did not report swelled lymph
320885 - nodes in the left supraclavicular region, nor the left axillary,
320886 - reviewed on 080723. ref SDS I1 4K5H  Cancer marker rising from 71 to
320887 - CA 15-3 96, seems to align with Lynn's findings of a new lump, and
320888 - relates to Millie's letter on 080423 requesting treatment with a full
320889 - dose of chemotherapy with hopes of stretching out recovery,
320890 - ref SDS E8 TY6Y, since eventually all treatments will fail.
320892 -  ..
320893 - Case study today of rising neutropenia shows Millie has missed 20% of
320894 - prescribed treatments due to low blood counts. ref SDS J6 EP7N  UCSF
320895 - indicated on 080423 that the doce cannot be increased, ref SDS E8
320896 - I49N, may suggest that if Carboplatin treatments can be regularized
320897 - with Neupogen then the current regimen can slow or reverse possible
320898 - progression of disease.
320900 -             ..
320901 -            [On 080827 Millie sets agenda for follow up examination by
320902 -            primary care physician on 080829, and focus of next CT test
320903 -            on 080912. ref SDS K0 509S
320905 -             ..
320906 -            [On 080827 Millie cancels vacation plans due to concern
320907 -            about new lump signaling progression of disease, with
320908 -            requirements to change treatments. ref SDS K2 K377
320909 -
320911 -  ..
320912 - IBC Inflammation Rash Seem Stable and Possibly Subsiding
320913 -
320914 - Millie's letter to UCSF earlier today reports self-examination seems
320915 - to show continued recovery from IBC, ref DIT 1 YO5O, extending
320916 - Brigid's favorable report on 080724. ref SDS I2 XN5L
320918 -  ..
320919 - Lynn advised that Bigid does not have time for a 5 minute examination
320920 - to compare IBC conditions today with last month on 080724, when Brigid
320921 - noted intensity of IBC disease at all locations, e.g., left arm, left
320922 - chest, right breast, lower left abdomen, and the left lower rib area,
320923 - have all continued to subside from prior examination starting the 5th
320924 - cycle on 080626, ref SDS H1 FH8P, and extending favorable findings
320925 - from examination for the 3rd cycle on 080501. ref SDS F2 JJ3N
320927 -  ..
320928 - Lynn feels today that her examination starting the 4th cycle on 080529
320929 - was too long ago to remember for reliable comparison with Millie's
320930 - condition today starting the 7th cycle.  She looked through the
320931 - medical chart.  There wasn't enough time to find her report on 080529,
320932 - or possibly there was not enough time to prepare findings, or by the
320933 - time there was enough time, everybody forgot to prepare findings with
320934 - enough detail on 080529 to make a comparison with conditions today.
320935 - Doctor Rugo had similar experience during examination on 080219.
320936 - ref SDS D6 L18L
320938 -  ..
320939 - Lynn noted that IBC disease at all sites does not give the impression
320940 - of significant intensity today compared with other patients she sees
320941 - more regularly than Millie.
320943 -  ..
320944 - Near the end of the meeting Doctor Rugo visited for about 10 minutes.
320945 - Millie had already dressed.  The doctor did another examination.
320946 - Doctor Rugo feels IBC disease today shows significant improvement with
320947 - subsiding inflammation compared to remembering her last examination on
320948 - 080219. ref SDS D6 3J4I  She seemed to indicate that the condition of
320949 - IBC observed today does not present evidence of worsening, spread, nor
320950 - rising intensity that suggests progession of cancer.
320952 -  ..
320953 - There was no discussion with Doctor Rugo of the new lump on the left
320954 - side of the neck noticed during Lynn's initial examination this
320955 - morning, per above. ref SDS 0 4C6O
320957 -  ..
320958 - Examinations by Lynn and the doctor today seem to align with the
320959 - recent CT test on 080718, based on report reviewed on 080723,
320960 - ref SDS I1 YH41, even though there was not enough time for discussion
320961 - today, per above. ref SDS 0 MF9K  This evidence indicates the slight
320962 - lump in the left supraclavicular may be benign, as concluded for
320963 - previous similar findings on 040211, per above. ref SDS 0 I18H
320964 -
320965 -        [On 080821 cancer marker CA 15-3 increased over 4 weeks from 71
320966 -        to 96, reported a week later on 080828. ref SDS J6 VK6H
320968 -  ..
320969 - Since Millie has another CT scheduled in about 3 weeks, we can ask for
320970 - review of the scans to pay close attention to the left supraclavicular
320971 - area.  Results of CA 15-3 tested today will be available next week to
320972 - provide further data on changing conditions.
320973 -
320974 -        [On 080827 letter to Kaiser and the medical team requested that
320975 -        the CT test on 080912 focus on left side of the neck.
320976 -        ref SDS K0 509V
320977 -
320978 -
320980 -  ..
320981 - Photographs Show IBC Disease Subsiding All Sites
320982 -
320983 - Follow up ref SDS E4 SA5J, ref SDS D8 814N.
320984 -
320985 - Background on purpose of photographs and difficulties managing patient
320986 - medical history is reported in the record on 080331. ref SDS E2 GM5I
320988 -  ..
320989 - After Lynn's examination, Jill took photographs to evaluate
320990 - progression of disease.
320992 -  ..
320993 - The most recent date taking photographs seems to have been 080306.
320994 - ref SDS D8 814N   The following cycle on 080403, there is a note that
320995 - pictures were not taken. ref SDS E4 I26H
320997 -  ..
320998 - There is vague memory pictures may have been taken 2 months ago on
320999 - 080626, but there is no record this occurred. ref SDS H1 YY3N
321001 -  ..
321002 - Should check with UCSF on their records taking pictures in this case.
321003 -
321004 -
321005 -
321007 -  ..
321008 - Current Medications Submitted with Kaiser's Medical Chart
321009 -
321010 - Follow up ref SDS I2 8A9G.
321011 -
321012 - Background on Millie's current medications listed at UCSF was reviewed
321013 - during the meeting last month starting cycle 6 on 080724, ref SDS I2
321014 - 8A9G, when Millie cited the list discussed for cycle 5 on 080626,
321015 - ref SDS H1 8A9G, which was presented at Kaiser on 080502. ref SDS F4
321016 - E43I  The list is summarized in Kaiser's medical chart on 080502.
321017 - ref SDS F4 7Y6F
321019 -  ..
321020 - Millie advised there has been no change in the list which previously
321021 - appeared on 080724 to be incomplete. ref SDS I2 PK7I
321023 -  ..
321024 - Lynn can update UCSF records on Millie's current medications using the
321025 - procedure applied this morning to update the UCSF medical chart for
321026 - Millie with results on prior blood tests.  She will similarly add
321027 - medications to the UCSF medical chart that are listed in Kaiser's
321028 - medical chart from meeting with the primary care physician on 080502,
321029 - ref SDS F4 7Y6F, and which was submitted in Millie's letter to UCSF
321030 - this morning. ref DIT 1 YO5V
321031 -
321032 -
321033 -
321035 -  ..
321036 - Schedule Meetings with Medical Team
321037 -
321038 - Follow up ref SDS I2 HT6N.
321039 -
321040 - Last month during the meeting on 080724, Brigid ordered meetings with
321041 - the medical team through December.  The schedule UCSF submitted seems
321042 - to have some gaps that require coordination. ref SDS I3 SO8F
321044 -  ..
321045 - Millie's letter to UCSF on 080811 requested clarification of the
321046 - schedule. ref SDS J2 P96Y  Doctor Rugo replied in a letter that timing
321047 - can be worked out later. ref SDS J2 4T4N
321049 -  ..
321050 - During the meeting today neither Lynn nor the doctor took time to
321051 - clarify the time of meetings scheduled on 080918, and the following
321052 - month on 081016, cited in Millie's letter to UCSF on 080811.
321053 - ref SDS J2 P96Y  At this time, the schedule received from UCSF on
321054 - 080724 appears to stand. ref SDS I7 U15Y
321055 -
321056 -
321057 -
321058 -
321059 -
321060 -
321061 -
321062 -
321063 -
321064 -
321065 -
3211 -