THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: August 29, 2008 10:56 PM Friday;
Millie notified medical team about meeting with the doctor at Kaiser today.
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Meeting Examination Kaiser Backup Doctor Review Strategy Work Plan 3
1303 - ..
1304 - Summary/Objective
130501 - Follow up ref SDS C8 0000. ref SDS B0 0000.
130511 - ..
1308 - Progress
130901 - Millie submitted results of the meeting today with the primary care
130902 - physician, to the medical team at UCSF....
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.
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
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...
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.
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
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
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
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...
131235 - 14. I feel much better today getting ideas and support for evolving
131236 - conditions.