CONTACTS 

SUBJECTS
Meeting Examination Kaiser Backup Doctor Review Strategy Work Plan 3

1303 -
1303 -    ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS C8 0000. ref SDS B0 0000.
130502 -
130503 -
130504 -
130505 -
130506 -
130507 -
130508 -
130509 -
130511 -  ..
1306 -
1307 -
1308 - Progress
1309 -
130901 - Millie submitted results of the meeting today with the primary care
130902 - physician, to the medical team at UCSF....
130903 -
130904 -    1.  Subject:  Examination at Kaiser CT Test Re-scheduled for Oakland
130905 -        Date: Fri, 29 Aug 2008 23:11:20 -0700
130910 -         ..
130911 -    2.  Dear Doctor Rugo,
130913 -         ..
130914 -    3.  I met with Doctor Johnson at Kaiser in Walnut Creek today.
130916 -         ..
130917 -    4.  The doctor concurred with your examination a week earlier that
130918 -        IBC rash appears stable. [reported in the record on 080821,
130919 -        ref SDS C1 YX52,
130921 -         ..
130922 -    5.  Doctor Johnson used Kaiser's Knowledge Management system to
130923 -        investigate why Kaiser in Oakland sent the order for my next CT
130924 -        test back to the Walnut Creek office [reported by Kaiser on
130925 -        080826, ref SDS C5 VU64].  I also saw Paula briefly, and she
130926 -        commented strongly that problems on my last test have not been
130927 -        solved, so the CT Department in Walnut Creek is still not ready
130928 -        to perform tests with my Power Port for injecting contrast
130929 -        medium.  Doctor Johnson recalled common practice for Kaiser
130930 -        business units to collaborate on patient care.  For example, on
130931 -        070131, he sent me to Pleasant Hill when you needed a CT test,
130932 -        ref SDS 26 ZL9M, in order for me to start treatment at UCSF the
130933 -        next day on 070201.
130935 -  ..
130936 - Paula indicated today understanding from reading government
130937 - regulations that connecting CT test equipment to a Power Port with a
130938 - Huber needle that accesses a central venous artery is required by law
130939 - to be performed by a doctor or other specially trained radiology
130940 - expert.  She said on 080829 that the CT department in Walnut Creek
130941 - cannot legally perform Millie's CT test using her Power Port, because
130942 - they have no one assigned from Interventional Radiology who qualifies
130943 - to connect the CT test equipment to the Power Port.
130944 -
130945 -            [On 080905 Paula discussing Millie's case with Kaiser
130946 -            management in Radiology about upgrading CT test service to
130947 -            support injecting contrast mediume with Power Port
130948 -            technology, ref SDS D2 6S7H; Paula indicated the law
130949 -            requires the CT Department to assign a qualified nurse from
130950 -            Interventional Radiology for connecting CT test equipment
130951 -            to Millie's Power Port. ref SDS D2 AX8N
130953 -             ..
130954 -            [On 081017 Paula reports further discussion with Kaiser
130955 -            management making progress on arrangements for Millie's
130956 -            next CT test on 081113 at Kaiser in Walunt Creek using
130957 -            procedures for injecting contrast medium with Power Port
130958 -            technology that was done successfully at Oakland.
130959 -            ref SDS D8 707L
130961 -         ..
130962 -    6.  Today, the doctor found a section of the computer program to
130963 -        enter the "reason" he is sending me to Oakland.  He feels that
130964 -        I am now scheduled again to get the CT test at Oakland on
130965 -        080911, which is a week before I see you to start the next
130966 -        cycle. Hopefully, the scan will be read and submitted in time
130967 -        for review.  Confirming guidance today, if I don't hear from
130968 -        the Kaiser CT Department in Oakland by Tuesday of next week, I
130969 -        will call to schedule a time for the test on 080911 after my
130970 -        treatment at UCSF.
130972 -  ..
130973 - Millie's letter on 080827 discussed using the Huber needle access to
130974 - Power Port for chemotherapy treatment at UCSF use at Kaiser in Oakland
130975 - for the CT test. ref SDS C6 513T  This implemented planning in
130976 - Millie's letter on 080811, ref SDS C0 P43Y, based on recommendations
130977 - at Kaiser during the prior CT test on 080718. ref SDS B7 FL75
130978 -
130979 -           [On 080903 discuss with Kaiser CT Department in Oakland
130980 -           leaving Huber needle access Power Port for chemotherapy
130981 -           treatment at UCSF so the needle can be used again for CT
130982 -           test at Oakland; schedule attendant asks Millie to notify
130983 -           primary care p[hysician at Kaiser to request procedure.
130984 -           ref SDS D1 S289
130986 -            ..
130987 -           [On 080903 Valerie reported that Millie's CT has not been
130988 -           scheduled in Oakland; the order is still in the queue at the
130989 -           CT Department at Kaiser in Oakland. ref SDS D1 IO4U
130991 -            ..
130992 -           [On 080905 Paula discussed Millie notifying Member Services
130993 -           about difficulty getting CT tests in Oakland, and that
130994 -           assigning a nurse to CT Department would provide better
130995 -           health care services. ref SDS D2 MK5J
130997 -  ..
130998 - Millie's letter to medical team continues...
130999 -
131000 -    7.  The doctor further suggested I am "good to go" for a vacation.
131001 -        (...  Millie cancelled the trip on 080827 due to concerns about
131002 -        progression of cancer, ref SDS C7 I56M].  After the meeting, I
131003 -        re-scheduled this to leave on Monday October 27, and return Nov
131004 -        6. ref SDS C9 EN74  This enables getting 2 Neupogen treatments
131005 -        before leaving.  I will miss treatment at UCSF on Oct 30.
131006 -        Returning on Nov 6 is a Thursday, so we need to re-schedule
131007 -        treatment at UCSF to the next day Friday Nov 7th.  By copy to
131008 -        Jill, requesting confirmation on schedule changes at UCSF.
131009 -
131010 -           [On 081105 Kaiser schedules Millie for Muga test on 081106
131011 -           1030; computer mistake conflicts with work plan for starting
131012 -           medical tasks on 081107. ref SDS E6 WO72
131014 -         ..
131015 -    8.  Doctor Johnson confirmed there seems to be a slight lump
131016 -        forming in the left supraclavicular area [reported in medical
131017 -        chart today, ref SDS C8 1Z6O], which Lynn mentioned during the
131018 -        meeting at UCSF on 080821. ref SDS C1 4C6O
131019 -
131020 -           [On 080912 report on CT test 080911 presents no findings in
131021 -           left supraclavicular. ref SDS D3 5O6N
131023 -            ..
131024 -           [On 080918 Brigid finds no swelling in left supraclavicular
131025 -           using palpation. ref SDS D5 4C6O
131027 -            ..
131028 -           [On 081016 Brigid and Doctor Rugo palpate lump left
131029 -           supraclavicular, ref SDS D7 J34X; Doctor Rugo orders biopsy.
131030 -           ref SDS D7 J36R
131032 -            ..
131033 -           [On 081022 Doctor Daamen takes biopsy of swelled lymph node
131034 -           in left supraclavicular, and reviews CT test on 080911, and
131035 -           says the scans did not include enough of the neck to
131036 -           evaluate the node in the left supraclavicular. ref SDS E0
131037 -           516F
131039 -            ..
131040 -           [On 081023 Doctor Daamen reports pathology on swelled lymph
131041 -           node in left supraclavicular positive for breast cancer.
131042 -           ref SDS E1 4Q9Q
131044 -         ..
131045 -    9.  The doctor recalled cancer was identified at this location with
131046 -        biopsy reported on 040309. ref SDS 6 0001  This patient
131047 -        history along with rise of the cancer marker from 71 to CA 15-3
131048 -        96 for the labs on 080821, ref SDS C2 VK6H, may present
131049 -        progression.
131051 -         ..
131052 -   10.  Doctor Johnson explained today advantages of targeted
131053 -        chemotherapy agents, like cetuximab, used in double agent
131054 -        treatments.  The doctor suggested getting your ideas for follow
131055 -        on treatment, if my condition worsens [into 5th relapse of IBC
131056 -        that now has mutated to resist conventional chemotherapy] [as
131057 -        shown in the doctor's medical chart earlier today. ref SDS C8
131058 -        PX5V  Evidently, at this time Kaiser has only single agent
131059 -        treatments for my patient profile.  He mentioned Gemzar and
131060 -        Navelbine again today, discussed at Kaiser on 061208,
131061 -        ref SDS 19 XU3O, prior to referral to UCSF on 070105.
131062 -        ref SDS 21 PK68
131063 -
131064 -            [On 081016 Doctor Rugo proposes follow on treatment with
131065 -            Sunitinib clinical study, ref SDS D7 J34R, which is
131066 -            another targeted chemotherapy; and additionally, Millie
131067 -            will qualify for participation in another clinical trial
131068 -            opening in about 4 months. ref SDS D7 J35X
131070 -             ..
131071 -            [On 081024 1150 Millie met with Doctor Johnson at Kaiser
131072 -            and explained Doctor Rugo reported on 081016 that UCSF
131073 -            has more treatments lined up for future relapses; he
131074 -            wants to get the list so the details do not slip through
131075 -            the cracks. followed up, ref SDS E3 PU4L
131077 -             ..
131078 -            [On 081219 1140 Doctor Johnson explained again that
131079 -            Millie's cancer has mutated after 7 years of treatments
131080 -            into disease that resists chemotherapy drugs approved for
131081 -            use at Kaiser. ref SDS E8 EL5J
131083 -         ..
131084 -   11.  Today, Doctor Johnson indicated willingness to approve changing
131085 -        treatment and continuing at UCSF under your care.  During the
131086 -        meeting on 070130 you mentioned that UCSF has other drugs to
131087 -        help me, including bevacizumab (Avastin) with Abraxane.
131088 -        ref SDS 25 TG5G
131090 -  ..
131091 - The doctor explained today that ending cetuximab treatment at UCSF due
131092 - to progression of disease, per above, ref SDS 0 RP8T, requires
131093 - treatment with double agent "trargeted" drugs, because Millie's
131094 - advanced cancer condition suffering a 5th relapse of IBC, has become
131095 - through succeeding mutations resistant to single agent treatments.
131096 - Doctor Johnson indicated that Millie has been treated with all of the
131097 - drugs approved for use at Kaiser.  He asked Millie to notify UCSF that
131098 - Kaiser will approve payment for Millie's continued treatment at UCSF
131099 - with new technology, as set out in the medical chart. ref SDS C8 PX5V
131101 -             ..
131102 -            [On 080917 agenda for meeting with medical team proposes
131103 -            presentation of follow on treatments. ref SDS D4 SH5T
131105 -             ..
131106 -            [On 080918 there was not enough time to review follow on
131107 -            treatments for progression of cancer. ref SDS D5 9W6H
131109 -             ..
131110 -            [On 081015 agenda for meeting with medical team at UCSF
131111 -            requests review of future treatments. ref SDS D6 K45V
131113 -             ..
131114 -            [On 081016 Doctor Rugo proposes follow on treatment with
131115 -            Sunitinib clinical study, ref SDS D7 J38U, which is another
131116 -            targeted chemotherapy; and additionally, Millie will
131117 -            qualify for participation in another clinical trial opening
131118 -            in about 4 months. ref SDS D7 J35X
131120 -             ..
131121 -            [On 081016 Doctor proposes FNA biopsy to check for
131122 -            status change ER PR HER2 neu, which could increase
131123 -            treatments for Millie. ref SDS D7 J36R
131125 -             ..
131126 -            [On 081018 Doctor Stritter seminar presenation describes
131127 -            sunitinib as "targeted" treatment for cancer, ref SDS D9
131128 -            IT8V, which may help overcome resistance from cancer
131129 -            mutating with Millie's 5th relapse of IBC. ref SDS D9 GI4K
131131 -             ..
131132 -            [On 081022 FNA biopsy performed at Kaiser; pathology
131133 -            report expected within a few days to a week,
131134 -            ref SDS E0 NZ5N; if pathology negative for cancer,
131135 -            Kaiser proposes retest with core biopsy, a more
131136 -            rigorous procedure. ref SDS E0 HH99
131138 -             ..
131139 -            [On 081023 Doctor Rugo stopped Millie's treatment with
131140 -            cetuximab due to biopsy findings that confirm progression
131141 -            of disease. ref SDS E2 D65G
131143 -             ..
131144 -            [On 081024 1150 Millie met with Doctor Johnson at Kaiser
131145 -            and explained Doctor Rugo reported on 081016 that UCSF
131146 -            has more treatments lined up for future relapses; he
131147 -            wants to get the list so the details do not slip through
131148 -            the cracks. followed up, ref SDS E3 PU4L
131150 -             ..
131151 -            [On 081024 1150 Millie met with Doctor Johnson at
131152 -            Kaiser, ref SDS E3 C45H; examination concurred with UCSF
131153 -            assessment on 081016 finding progression of IBC.
131154 -            ref SDS E3 WK82  The doctor authorized payment for
131155 -            Millie continuing treatment on clinical study at UCSF,
131156 -            ref SDS E3 K67J; explained requirements for treatment to
131157 -            start in time to be effective because Millie's cancer
131158 -            has mutated into a more aggressive disease; the doctor
131159 -            entered into Kaiser's medical chart approval for
131160 -            treatment at UCSF with the sunitinib study. ref SDS E3
131161 -            OZ5F
131163 -             ..
131164 -            [On 081024 Millie's letter notifies medical team that
131165 -            during meeting at Kaiser with primary care physician the
131166 -            doctor confirmed authorization for Millie's treatment in
131167 -            the sunitinib clinical study, because Millie needs a
131168 -            double agent "targeted" treatment, and Kaiser does not
131169 -            have treatments that can help recover from the 5th
131170 -            relapse of IBC. ref SDS E4 XZ8W
131172 -             ..
131173 -            [On 081031 Glenna Clinical Study Coordinator for the
131174 -            sunitinib drug trial progran advised that the primary care
131175 -            physician for Millie at Kaiser reported authorization would
131176 -            be signed for Kaiser to pay for Millie's treatment.
131177 -            ref SDS E5 YK4F
131179 -             ..
131180 -            [On 081219 1140 Doctor Johnson finds favorable response to
131181 -            treatment with sunitinib, ref SDS E8 3L9L; the doctor cites
131182 -            urgency of timely treatment increases when Millie suffers
131183 -            relapse; delay increases risk of losing control for cancer
131184 -            that mutates into more aggressive disease. ref SDS E8 KU6F
131185 -            Doctor Johnson asked Millie to notify Doctor Rugo about
131186 -            planning treatment for the 6th relapse to ensure treatment
131187 -            starts in time to be effective, ref SDS E8 V93O, and asked
131188 -            for a letter from UCSF to facilitate the next referral,
131189 -            ref SDS E8 SU8G; because the 6th relapse will be very
131190 -            serious, ref SDS E8 NS8H; further emphasized need for
131191 -            letter from UCSF recommending treatment on referral from
131192 -            Kaiser. ref SDS E8 E84J
131194 -             ..
131195 -            [On 090123 1326 Doctor Johnson calls and concurs Millie has
131196 -            suffered IBC relapse with cancer marker CA 15-3 303 in
131197 -            blood test on 090116 at Kaiser; confirms Millie's cancer
131198 -            has mutated to resist treatments available at Kaiser,
131199 -            authorizes UCSF to prescribe next treatment. ref SDS E0
131200 -            RK6O
131202 -             ..
131203 -            [On 090204 0219 Millie's letter asks Doctor Rugo to submit
131204 -            proactive planning for follow on treatment after
131205 -            hyperthermia and Doxil for Millie's 6th relapse of IBC.
131206 -            ref SDS F0 278T
131208 -         ..
131209 -   12.  Doctor Johnson recommends review of patient history on 041018
131210 -        when Doctor Benz identified PE may have occurred from treatment
131211 -        at Kaiser with bevacizumab and Taxotere. ref SDS 11 LX96
131213 -         ..
131214 -   13.  During the meeting at Kaiser today, the doctor opened the file
131215 -        for the CT test on 080718 and displayed scans on the computer
131216 -        screen in the examination room.  He seemed to indicate that
131217 -        Interstitional lung disease found in the CT test reviewed on
131218 -        080723, ref SDS B8 TS4J, appears very mild in the scan films,
131219 -        so as not to indicate side effects of cetuximab cited in the
131220 -        consent documents reviewed on 070116. ref SDS 22 0256
131222 -  ..
131223 - Review of the CT test sans by the primary care pysician at Kaiser
131224 - supported work at UCSF on 080821 when there wasn't enough time to
131225 - consider correlations, implications, and nuance from disclosure in the
131226 - CT test finding Interstitional lung disease. ref SDS C1 056G
131227 -
131228 -            [On 081112 CT test on 0811107 finds Interstitional disease
131229 -            at higher levels than shown by CT test on 080718.
131230 -            ref SDS E7 TS4J
131232 -  ..
131233 - Millie's letter to medical team continues...
131234 -
131235 -   14.  I feel much better today getting ideas and support for evolving
131236 -        conditions.
131237 -
131243 -
131244 -
131245 -
1313 -