CONTACTS 

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

1303 -
1303 -    ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS J8 0000. ref SDS I4 0000.
130502 -
130503 - Examination today shows stable IBC conditions, ref SDS 0 YW6M, and no
130504 - adenopathy, including left supraclavicular. ref SDS 0 4C6O  Aligns
130505 - with favorable CT test on 080911, ref SDS 0 4U6L, which found no
130506 - continuing Interstitional lung disease. ref SDS 0 NW6O  No evidence of
130507 - advancing cancer aligns with cancer marker CA 15-3 95 showing slight
130508 - decline over the past 4 weeks. ref SDS 0 VS9M  Rising blood counts
130509 - from increasing Neupogen, ref SDS 0 6Y5K, improved control of
130510 - neutropenia.  This prevented missing treatments for cycle 7,
130511 - ref SDS 0 KF4L, which in turn helped maintain response to treatment
130512 - even with lower dose of chemotherapy Carboplatin.  Stable cancer
130513 - conditions even with reduced treatment may reflect rising exercise
130514 - that increases immune system ability to resist cancer, ref SDS 0 2L5M;
130515 - and better fitness helps alot relieve to emotional stress. ref SDS 0
130516 - LT6I  Of courese, favorable examination and test findings today
130517 - greatly relieve emotional stress and anxiety. ref SDS 0 MM5N  Success
130518 - using Millie's Power Port for the CT test at Kaiser in Oakland,
130519 - further relieved fear and doubt about the future. ref SDS 0 SN8H  UCSF
130520 - expedited care today by coordinating examination with blood work and
130521 - chemotherapy treatment. ref SDS 0 GY3N  Communication for referral
130522 - coordination improved with medical team conducting meetings based on
130523 - agenda linked to patient history. ref SDS 0 QH4I
130524 -
130525 -
130526 -
130527 -
130528 -
130529 -
130530 -
130531 -
130532 -
130533 -
130534 -
130536 -  ..
1306 -
1307 -
1308 - Progress
1309 -
130901 - Agenda Progress Review Meeting
130902 -
130903 - Follow up ref SDS J8 YY3N.
130904 -
130905 - Millie submitted, ref DIP 4 0001 to UCSF yesterday on 080917 with an
130906 - agenda for the meeting this morning...
130907 -
130908 -        1.  Millie approved return to work thwarted
130909 -            UCSF approval enabled $20K severance
130910 -            pay-out; Millie retired, but looking
130911 -            for work - emotional roller
130912 -            coaster.................................. ref SDS 0 MM5N
130914 -             ..
130915 -        2.  Blood draw need vials and work order
130916 -            delivered to Infusion Clinic on
130917 -            5th floor................................ ref SDS 0 6Y5K
130919 -             ..
130920 -        3.  CT test on 080911 review results......... ref SDS 0 4U6L
130922 -             ..
130923 -        4.  Interstitional lung disease.............. ref SDS 0 056G
130925 -             ..
130926 -        5.  CT scan schedule next test at Kaiser
130927 -            Oakland................................... ref SDS 0 MF5L
130929 -             ..
130930 -        6.  Examination IBC seems continuing
130931 -            to improve............................... ref SDS 0 4C6K
130933 -             ..
130934 -        7.  Left supraclavicular lump................ ref SDS 0 4C6O
130935 -
130936 -            Neutropenia rising affects treatment
130937 -            options.................................. ref SDS 0 KF4L
130939 -             ..
130940 -            Progression Disease rising CA 15-3 96
130941 -            Kaiser approves follow on treatment
130942 -            at UCSF.................................. ref SDS 0 9W6H
130944 -             ..
130945 -        8.  Current medications...................... ref SDS 0 8A9G
130947 -  ..
130948 - The UCSF schedule received on 080904 lists the meeting today at 0900,
130949 - which is the same time as treatment in the Infusion Clinic, and then
130950 - seeing the doctor at 1130 today.  Millie got a call from UCSF
130951 - yesterday saying to meet the medical team at 0900, as scheduled.
130952 - Brigid explained during the meeting this morning that she changed the
130953 - schedule to meet with Millie this morning at 0830 after getting the
130954 - blood draw at 0800, and before treatment at 0900 in the Infusion
130955 - Clinic.  The meeting with the doctor scheduled for 1130 was cancelled
130956 - because Millie is doing well.
130957 -
130958 -            [...below, Brigid palpates no adenopathy in left
130959 -            supraclavicular, ref SDS 0 366L, and finds IBC rash sites
130960 -            stable to improving. ref SDS 0 YX3H
130962 -             ..
130963 -            [On 081016 examination indicates increased IBC intensity on
130964 -            left arm and small IBC nodules in the breast bone area,
130965 -            conflicting with stable cancer marker; other IBC rash sites
130966 -            seem stable to improved, consistent with stable cancer
130967 -            marker. ref SDS M2 J34U
130969 -  ..
130970 - Brigid reported today that she received a copy of the agenda Millie
130971 - submitted yesterday.  Jill also reported receiving Millie's letter
130972 - transmitting an agenda on 080917. ref SDS L5 4P7F  Jill commended
130973 - Millie's "organization" of the record noticed from the agenda.
130975 -  ..
130976 - This improved work last month on 080821, when Lynn did not get a copy
130977 - of the agenda submitted to UCSF for the meeting, ref SDS J8 YY3N,
130978 - repeating problems a few months earlier on 080529. ref SDS G1 4E69
130980 -  ..
130981 - Brigid introduced Megan today, who will be replacing Jill as the new
130982 - Clinical Research Coordinator for Millie's case.  Last month on
130983 - 080821, Jill replaced Jonathan, ref SDS J8 GY4M, who had replaced
130984 - Thomas the month before on 080724. ref SDS I4 YY63  Thomas had
130985 - replaced another "Megan" the month before on 080626, ref SDS H3 YY5U,
130986 - who had been assigned to replace Jackie on 080501. ref SDS F3 SR5M
130988 -  ..
130989 - Jill advised that the first Megan has moved on in her career either to
130990 - medical school, or other advanced training.
130991 -
130992 -
130993 -
130994 -
130995 -
1310 -

SUBJECTS
Default Null Subject Account for Blank Record

2103 -
210401 -  ..
210402 - CA 15-3 95 Cancer Marker May Indicate Response to Treatment
210403 -
210404 - Follow up ref SDS J8 GP3M, ref SDS B1 087J.
210405 -
210406 - Millie had a blood draw this morning in the Infusion Clinic at UCSF.
210407 - ref SDS L6 FW5N  Results for the cancer marker CA 15-3 95 were
210408 - reported a week later 080925. ref SDS L8 VK6H
210409 -
210410 -                               +- U=UCSF
210411 -                         +- K=Kaiser
210412 -         Test Date             |           Date Received
210413 -          080918......... 95 H U........... 080918, ref SDS L6 VK6H
210414 -          080821......... 96 H U........... 080821, ref SDS J9 VK6H
210415 -          080724......... 71 H U........... 080724, ref SDS I5 TR4K
210416 -          080708.........141 H K........... 080708, ref SDS H6 L74K
210417 -          080626......... 72 H U........... 080626, ref SDS H4 PW7I
210418 -          080529......... 66 H U........... 080529, ref SDS G2 IJ8L
210419 -          080501......... 59 H U........... 080501, ref SDS F4 U34O
210420 -          080403......... 66 H U........... 080403, ref SDS E6 A16M
210421 -          080313...cetuximab Carboplatin... 080313, ref SDS E2 TZ8I
210422 -          080306......... 59 H U........... 080306, ref SDS E0 A16M
210423 -          080207......... 63 H U........... 080207, ref SDS D4 A16M
210424 -          080110......... 51 H U........... 080110, ref SDS D1 A16M
210425 -          071213......... 48 H U........... 071213, ref SDS D0 A16M
210426 -          071115......... 43 H U........... 071115, ref SDS C9 A16M
210427 -          071018......... 75 H K........... 071018, ref SDS C8 5K6K
210428 -          070920......... 38 H U........... 070920, ref SDS C3 A16M
210429 -          070816......... 28 H U........... 070816, ref SDS C2 A16M
210430 -          070719...**.... ?? H U........... 070719, ref SDS C0 A16M
210431 -          070621......... 30 H U........... 070621, ref SDS B8 A16M
210432 -          070524......... 37 H U........... 070524, ref SDS B3 A16M
210433 -          070511......... 56 H K........... 070516, ref SDS A8 RH9H
210434 -          070426......... 29 ..U........... 070426, ref SDS A3 A16M
210435 -          070329......... 33 H U........... 070406, ref SDS 96 EQ6I
210436 -          070301......... 36 H U........... 070307, ref SDS 78 A16M
210437 -          070215......... 52 H K........... 070307, ref SDS 73 ER5O
210438 -          070208......... 55 H K........... 070307, ref SDS 73 ER5O
210439 -          070201.....cetuximab begins...... 070201, ref SDS 71 G68I
210440 -          070131......... 56 H K........... 070202, ref SDS 72 087J
210441 -          070123......... 52 H K........... 070202, ref SDS 72 087J
210442 -          070118......... 68 H K........... 070123, ref SDS 67 GK5B
210443 -          070104......... 56 H K........... 070110, ref SDS 63 087J
210444 -          061218......... 74 H K........... 061227, ref SDS 57 6P9F
210445 -          061214......... 63 H............. 061227, ref SDS 57 6P9F
210446 -          061201....Pause treatments..... . 061201, ref SDS 53 GJ5M
210447 -          061130......... 67 H............. 061201, ref SDS 53 087J
210448 -          061116......... 66 H............. 061201, ref SDS 53 087J
210449 -          061110......... 56 H............. 061201, ref SDS 53 087J
210450 -          061109......... 61 H............. 061110, ref SDS 52 087J
210451 -          061026......... 57 H............. 061110, ref SDS 52 087J
210452 -          061019......... 56 H............. 061020, ref SDS 50 087J
210453 -          060928......... 51 H............. 060929, ref SDS 47 087J
210454 -          060907......... 68 H............. 060929, ref SDS 47 087J
210455 -          060813......... 73 H............. 060817, ref SDS 44 U24M
210456 -          060809......... 87 H............. 060810, ref SDS 43 2N5J
210457 -          060721.begin capacitabine Taxotr. 060721, ref SDS 39 0001
210458 -          060708......... 71 H............. 060711, ref SDS 38 087J
210459 -          060616......... 63 H............. 060623, ref SDS 37 UQ5Q
210460 -          060522......... 59 H............. 060605, ref SDS 36 UQ5Q
210461 -          060501......... 49 H............. 060522, ref SDS 35 MC4F
210462 -          060421......... 44 H............. 060428, ref SDS 33 087J
210463 -          060330......... 40 H............. 060428, ref SDS 33 087J
210464 -          060303......... 36............... 060428, ref SDS 33 087J
210465 -          060210......... 33............... 060217, ref SDS 32 087J
210466 -          060109......... 34............... 060126, ref SDS 31 KV59
210467 -          051223......... 34............... 060106, ref SDS 30 087J
210468 -          051202....**... 28............... 060106, ref SDS 30 087J
210469 -          051116......... 31............... 051121, ref SDS 29 087J
210470 -          051109......... 30............... 051121, ref SDS 29 087J
210471 -          051102......... 34............... 051121, ref SDS 29 087J
210472 -          051021..Mastectomy surgery....... 051021, ref SDS 28 0001
210473 -          050916..End capecitabine Taxotere 050916, ref SDS 26 407N
210474 -          050909......... 45 H............. 051007, ref SDS 27 087J
210476 -  ..
210477 - Note:  CA 15-3 history prior to 2006 listed on 070426. ref SDS A2 CY4F
210478 -
210479 -
210481 -  ..
210482 - CA 15-3 95 Cancer Marker Stable Aligns Favorable CT and Examination
210483 -
210484 - Follow up ref SDS J8 VS9M, ref SDS A2 GJ5M.
210485 -
210486 - Patient history applying CA 15-3 cancer marker is shown in a case
210487 - study on 030710. ref SDS 7 IA7H
210489 -  ..
210490 - Millie had a blood test at Kaiser on 080708 for Power Port surgery.
210491 - ref SDS H6 MF4K  Results CA 15-3 141 were received on 080712, and
210492 - reported to UCSF at that time. ref SDS H7 K14R  This was a significant
210493 - increase from 72 reported at UCSF 2 weeks earlier on 080626.
210494 - ref SDS H4 PW7I  Kaiser's lab report on 080708 has a comment that the
210495 - blood sample was slightly hemolyzed.  Results may be affected.
210496 - ref SDS H6 05YW  At that time, on 080712 Millie asked about new drugs
210497 - to treat progression of disease. ref SDS H7 K15P
210499 -  ..
210500 - The test at UCSF a few weeks later on 080724 shows CA 15-3 71, which
210501 - seemed to indicate continuing response to treatment in the clinical
210502 - study. ref SDS I5 TR4K  Results at UCSF seemed further to indicate
210503 - that CA 15-3 141 at Kaiser on 080708 was actually corrupted, and so
210504 - did not show progerssion of disease.  Results 4 weeks later on 080821
210505 - CA 15-3 96 causes concern that testing at Kaiser on 080708 might have
210506 - been accurate indicating cancer is rising.
210508 -  ..
210509 - On 080829 primary care physician at Kaiser recommended Millie discuss
210510 - with UCSF options for changing chemotherapy drugs to prevent cancer
210511 - from spreading. ref SDS K7 RP9R
210513 -  ..
210514 - Results for the test today received a few days later, showing decline,
210515 - and essential stable cancer marker, CA 15-3 95, ref SDS 0 GP3M, seem
210516 - to align with the report on the CT test last week on 080911 also
210517 - showing stable condition, reviewed on 080912, ref SDS L2 4K5H, and
210518 - discussed with the medical team today, per below. ref SDS 0 MF9K
210519 - Stable cancer marker further aligns with examination today finding no
210520 - evidence of adenopathy in the left supraclavicular, ref SDS 0 4C6O,
210521 - and that IBC rash sites seem stable to improved. ref SDS 0 YW6M
210522 -
210523 -
210524 -
210525 -
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 J8 MM5N, ref SDS I4 W992.
310405 -
310406 - Brigid reported receiving Millie's letter yesterday on 080917
310407 - explaining increased energy, and also emotional relief as a result of
310408 - a successful CT test using the Power Port, correcting prior problems.
310409 - ref SDS L5 SH3R
310411 -  ..
310412 - She asked how Millie is feeling today, after concerns reviewed 4 weeks
310413 - ago on 080821? ref SDS J8 VN6M
310415 -  ..
310416 - Emotional issues this period include...
310417 -
310418 -    1.  Rise and fall of the cancer marker reported today makes the
310419 -        future more uncertain about changing treatment, per above.
310420 -        ref SDS 0 PP5G
310421 -
310422 -    2.  Improvement in blood counts enabling treatment today, relieves
310423 -        stress last month when treatment was missed due to neutropenia,
310424 -        reported below. ref SDS 0 7R5J
310426 -         ..
310427 -    3.  Continual mistakes in schedule for Neupogen treatments and
310428 -        repeated corrections increase worry about medical management,
310429 -        reported on 080823. ref SDS K1 WJ4O
310431 -         ..
310432 -    4.  CT testing at Kaiser using Power Port on 080911, ref SDS L1
310433 -        LK3R, significantly relieved worry, as reported in Millie's
310434 -        letter to the medical team yesterday on 080817. ref SDS L5 SG9T
310436 -         ..
310437 -    5.  CT test results showing stable conditions and no evident rise
310438 -        in cancer, which seems conflicting with cancer marker, per
310439 -        below, causes "roller coaster" of emotions.
310441 -  ..
310442 - Background on stress, anxiety, and worry from long term cancer is
310443 - reported on 080403. ref SDS E5 MK8F  Earlier on 070921 the doctor
310444 - ordered Atavin to relieve anxiety and worry about cancer relapse
310445 - compounded by difficulties with referral coordination and errors in
310446 - medical management. ref SDS C4 QY9V
310448 -  ..
310449 - Prozac was prescribed on 080305 ref SDS D8 KT4J, to cope with rising
310450 - emotional trauma, which continues today, listed above. ref SDS 0 H76K
310451 - Millie has not taken medication, and has relied on exercise to relieve
310452 - stress, reported on 080403. ref SDS E5 336H  Patient history on 080915
310453 - shows increased exercise that reflects better fitness. ref SDS L4 FN5K
310455 -  ..
310456 - Case study on emotional roller coaster was reported during examination
310457 - at Kaiser on 070105, ref SDS 62 Y642  Rising complexity of health
310458 - care, compare 33 medical issues on 061201, ref SDS 53 LU3J, with the
310459 - list of 45 issues on 070524, ref SDS B1 LU3J, compound communication
310460 - problems cited on 070301. ref SDS 77 O24J  Case study on 061020 shows
310461 - doctors describe Millie's complex patient history requires significant
310462 - effort to maintain order. ref SDS 50 T25H
310463 -
310464 -
310465 -
310466 -
310467 -
310468 -
3105 -

SUBJECTS
Default Null Subject Account for Blank Record

3203 -
320401 -  ..
320402 - Blood Counts Good NEUTS 2.07 Carboplatin Approved Today
320403 - Neutropenia Controled Chemotherapy Treatment Approved Today
320404 -
320405 - Follow up ref SDS J8 6Y5K.
320406 -
320407 - Millie went to the 5th floor at 0800 for a blood draw. ref SDS L6 LO4G
320409 -  ..
320410 - The work order was already prepared, ready for implementation by the
320411 - Infusion Clinic, as set out in the letter last night listing the
320412 - agenda for today. ref SDS L5 SG6T  This continued solving problems
320413 - communication, reported on 080821. ref SDS J8 XJ7M
320415 -  ..
320416 - Brigid checked the computer.  Results for the blood this morning test
320417 - were already posted by the lab on the 5th floor.
320419 -  ..
320420 - NEUTS 2.07 today is well above UCSF criteria for safe chemotherapy
320421 - shown in the blood test report performed in the Infusion Clinic this
320422 - morning. ref SDS L6 QY6H
320424 -  ..
320425 - Improved blood counts and getting treatment relieves emotional trauma
320426 - from disappointing results last month that prevented treatment,
320427 - discussed on 080821, ref SDS J8 4A4G, with consequent rise of cancer
320428 - marker, and discussed again today, per above. ref SDS 0 H76K
320430 -  ..
320431 - Brigid commended Millie for asking Kaiser to schedule Neupogen
320432 - treatments according to Doctor Rugo's guidance on 080821 that optimum
320433 - effects restoring blood counts occur when Neupogen is received at
320434 - least 24 hours after treatment with chemotherapy. ref SDS J8 4B4L
320435 - This was applied at Kaiser on 080823. ref SDS K1 JP5O  Schedule errors
320436 - on 080905, ref SDS K9 3D5F, were corrected by Kaiser on 080913.
320437 - ref SDS L3 WJ4O
320439 -  ..
320440 - Today, Brigid discussed the prescription for Neupogen.
320442 -  ..
320443 - Chemotherapy Orders for the past 6 cycles beginning on 080529 has
320444 - prescribed 2 Neupogen treatments for each week Millie gets
320445 - chemotherapy treatments with Carboplatin. ref SDS G2 PWSY  On 080609
320446 - Kaiser set up a schedule for Millie to get Neupogen treatments ordered
320447 - by UCSF. ref SDS G6 L16I  Neupogen stimulates bone marrow replenishing
320448 - the blood supply, which is reduced by chemotherapy, reported on
320449 - 030606. ref SDS 6 JP7G
320451 -  ..
320452 - Brigid noted advantages of minimizing Neupogen treatments.
320454 -  ..
320455 - Considered getting only 1 or no Neupogen today, because NEUTS 2.07 in
320456 - the blood test today is well above 1.50, the level required for safe
320457 - chemotherapy treatment today.  Millie recalled that 4 weeks ago
320458 - Carboplatin chemotherapy treatment was missed on 080821, ref SDS J8
320459 - MX7G, when Neupogen was skipped following the 4th week in the cycle,
320460 - when Millie does not get Carboplatin chemotherapy, reported on 080814.
320461 - ref SDS J7 UK3K
320462 -
320464 -  ..
320465 - Neutropenia Controlled with Neupogen No Missed Treatments This Cycle
320466 -
320467 - Case study indicates better control of neutropenia, reported in the
320468 - record today on getting chemotherapy treatment. ref SDS L6 OK67
320470 -  ..
320471 - Millie has not missed prescribed chemotherapy treatments due to low
320472 - blood counts, since 080821, ref SDS J8 4B84, following decision at
320473 - that time to treat low blood counts with Neupogen on all 4-weeks of
320474 - the cycle, even when Millie does not get chemotherapy. ref SDS J8 4B95
320475 - Last week is an example.  On 080911 Millie's blood counts NEUTS 1.43
320476 - were below the minimum, and Millie did not get chemotherapy because
320477 - the 4th week of the cycle is a bye week for chemotherapy. ref SDS L0
320478 - PU6K  This was similar to 080814, ref SDS J7 3L8Y, when Neupogen
320479 - treatment was avoided, because many patients recover blood counts
320480 - after missing chemotherapy for 2 weeks. ref SDS J7 UK3K
320482 -  ..
320483 - Since Millie has received cancer treatments for more than 7 years, and
320484 - since not many patients survive that long, reported on 080606,
320485 - ref SDS G5 0T6I, effects of chemotherapy accumulate.  Her body now
320486 - recovers blood counts to restore the immune system less quickly than
320487 - patients just starting chemotherapy.  As a result, missing Neupogen
320488 - following treatment for the 4th week of cycle 6 on 080814, caused
320489 - Millie to miss chemotherapy the following week on 080821. ref SDS J8
320490 - 4B84
320492 -  ..
320493 - The problem was avoided this past week by getting 2 Neupogen
320494 - treatments at Kaiser last week, reported on 080913, ref SDS L3 9W9I,
320495 - following treatment at UCSF for the 4th week of cycle 7 on 080911.
320496 - ref SDS L0 PU6K
320498 -  ..
320499 - Experience controlling neutropenia that allows getting prescribed
320500 - chemothearpy treatments supportes continuing with 2 Neupogen
320501 - treatments for the first 3 weeks when Millie gets both cetuximab and
320502 - Carboplatin, and to assess on the 4th week whether to get Neupogen
320503 - based on blood counts at that time.
320504 -
320505 -
320506 -
3206 -

SUBJECTS
Default Null Subject Account for Blank Record

3303 -
330401 -  ..
330402 - Chemotherapy Tolerance Remains Effective for High Level Exercise
330403 - Neupogen Side Effects Fatigue, Bone Pain, Headaches Minimal
330404 - Exercise Continues High Level of Effort Neupogen Side Effects Moderate
330405 -
330406 - Follow up ref SDS J8 LT6I.
330407 -
330408 - Brigid noted Millie's fitness keeping up regular exercise in the gym,
330409 - and hiking, related in Millie's letter yesterday submitting an agenda
330410 - for the meeting today. ref SDS L5 SH3R  Increased fitness helps cope
330411 - with emotional challenges of long term care recovering from cancer,
330412 - reported today, per above, ref SDS 0 MM5N and previously starting the
330413 - 7th cycle on 080821. ref SDS J8 MM5N  Emotional balance maintained
330414 - through exercise helps avoid reliance on drugs, e.g., Prozac, reported
330415 - to Kaiser on 080502, ref SDS F5 QU4M, and cited again during the
330416 - meeting today at UCSF. ref SDS 0 ZK5L
330418 -  ..
330419 - Millie thanked the doctor for guiding care the past 18 months that has
330420 - increased quality of life, cited in Millie's letter to UCSF on 080804,
330421 - reporting Millie has recovered vitality and strength to return to
330422 - work. ref SDS I8 GU5P
330424 -  ..
330425 - The report on chemotherapy and Neupogen side effects in the record for
330426 - treatment in the Infusion Clinic today, ref SDS L6 SB8I, aligns with
330427 - prior reporting on 080810 that shows good tolerance of both
330428 - chemotherapy and Neupogen, which has not reduced ability nor interest
330429 - in exercise. ref SDS J3 9W9I  The recent report on 080915 indicates
330430 - occassional side effects are difficult, but manageable, ref SDS L4
330431 - 9W9I, shown by continued heavy exercise. ref SDS L4 KO6F
330433 -  ..
330434 - Favorable findings from examination and testing today despite missing
330435 - treatments and reduced dose of chemotherapy Carboplatin may reflect
330436 - reduced side effects of cetuximab that enable increased exercise to
330437 - improve fitness that strengthens the immune system, discussed below.
330438 - ref SDS 0 YW6M  Vigorous exercise during treatment for cancer
330439 - illustrates reduced side effects of "targeted" treatment for cancer
330440 - with cetuximab.
330442 -         ..
330443 -        [On 081014 Millie's fitenss increases from increased exercise,
330444 -        that may be helping resist cancer. ref SDS L9 P49N
330446 -         ..
330447 -        [On 081018 report in seminar that recent research indicates
330448 -        exercise improves recovery from cancer and resists recurrence
330449 -        by 60%. ref SDS M3 IT68
330450 -
330451 -
330452 -
330453 -
3305 -

SUBJECTS
Default Null Subject Account for Blank Record

3403 -
340401 -  ..
340402 - Interstitional Lung Disease CT Test 080718 Heavy Chest Hiking Reduced
340403 -
340404 - Follow up ref SDS J8 056G, ref SDS I8 GU6P.
340405 -
340406 - The agenda for the meeting today reports favorable results for the CT
340407 - test on 080911, reviewed the next day on 080912. ref SDS L5 SG5Q  As
340408 - shown on 080912, the test makes no findings on Interstitial lung
340409 - disease, ref SDS L2 TS4J, which was reported in the prior CT test on
340410 - 080718, reviewed on 080723. ref SDS I3 TS4J
340412 -  ..
340413 - Background on Interstitional disease in Millie's patient history is
340414 - shown in a case study on 080723. ref SDS I3 7W6F  This presents 6
340415 - questions about risk of complications in Millie's case. ref SDS I3
340416 - 6A4J
340418 -  ..
340419 - The question arises from Millie's long treatment with cetuximab
340420 - beginning on 070201.  Interstitional lung disease is described in the
340421 - study consent documents as a serious side effect of cetuximab.
340422 - ref SDS 64 0256
340424 -  ..
340425 - During the meeting on 080724 UCSF could not consider findings of
340426 - Interstitional lung disease nor on risk of complications for Millie's
340427 - health care, because they did not get a copy of the CT test report
340428 - from Kaiser in time for the meeting. ref SDS I4 GG6J
340430 -  ..
340431 - A month later, Millie sent a letter with an agenda for meeeting with
340432 - UCSF on 080821.  She reported heaviness in her chest days earlier
340433 - while hiking, and this was less pronounced by the date of the meeting
340434 - on 080821. ref SDS J8 R37H  Scope and seriousness of Interstitional
340435 - lung disease as a rare side effect of cetuximab, which Millie has now
340436 - received for the past 85 weeks in a row, set out in the record meeting
340437 - on 080821, ref SDS J8 VB8J, including whether increased exercise helps
340438 - moderate the advance of this disease in Millie's case, was not
340439 - discussed with the medical team on 080821 due to limited time.
340440 - ref SDS J8 VB9I
340442 -  ..
340443 - There was no discussion of Interstitional lung disease during the
340444 - meeting today, perhaps because the more recent CT test on 080911 did
340445 - not report findings, as shown on 080912, ref SDS L2 TS4J, and as shown
340446 - below. ref SDS 0 MF6F
340447 -
340448 -
340449 -
340450 -
340451 -
3405 -

SUBJECTS
Default Null Subject Account for Blank Record

3503 -
350401 -  ..
350402 - CT Test 080911 Shows Stable Improving IBC Response to Treatment
350403 -
350404 - Follow up ref SDS J8 4U6L, ref SDS I4 TG96.
350405 -
350406 - Millie had a CT test on 080911, ref SDS L1 LK3R, required to evaluate
350407 - progress responding to treatment under the clinical study protocol.
350408 - Results were received the next day on 080912, ref SDS L2 6V5I, and
350409 - reviewed at that time. ref SDS L2 OO6M  Yesterday, on 080917 Millie
350410 - reported understandings from the CT test in a letter setting the
350411 - agenda for the meeting today, which described findings show everything
350412 - stable. ref SDS L5 SG5Q
350414 -  ..
350415 - Today, Brigid reviewed the CT test report findings and seemed to
350416 - conclude that swelled lymph nodes in the right axillary appear stable,
350417 - as shown in the record on 080912, ref SDS L2 4K5H   This aligns with
350418 - stable cancer marker, CA 15-3 95, reported a few days later for the
350419 - blood test today, per above, ref SDS 0 GP3M, further discussing
350420 - analysis and implications. ref SDS 0 RS3K
350421 -
350422 -        [...below, Brigid reported that palpation of right axilla
350423 -        cannot identify swelling, which aligns with the CT test
350424 -        reporting very small nodes. ref SDS 0 4C6K
350426 -  ..
350427 - Brigid noted that no findings of swelling in the left supraclavicular
350428 - aligns with examination today palpating no swelling in this area, per
350429 - below. ref SDS 0 4C6O
350431 -  ..
350432 - On 080827 Millie's letter to Kaiser and the medical team requested
350433 - that the CT test on 080912 focus on left side of the neck. ref SDS K3
350434 - 509V
350435 -
350436 -            [On 081022 Doctor Daamen takes biopsy of swelled lymph node
350437 -            in left supraclavicular, and reviews CT test on 080911, and
350438 -            says the scans did not include enough of the neck to
350439 -            evaluate the node in the left supraclavicular. ref SDS M4
350440 -            516F
350442 -  ..
350443 - Interstitional lung disease was not discussed today, per above.
350444 - ref SDS 0 NW6O, to follow up findings reviewed on 080723, ref SDS I3
350445 - TS4J, in the report on the CT test performed 080718, perhaps because
350446 - the report for the test last week on 080911 makes not findings of
350447 - Interstitional lung disease, reported the next day on 080912.
350448 - ref SDS L2 TS4J
350449 -
350450 -
350451 -
3505 -

SUBJECTS
Default Null Subject Account for Blank Record

3603 -
360401 -  ..
360402 - Schedule CT Test 081107 at Kaiser Walnut Creek After Treatment at UCSF
360403 -
360404 - Follow up ref SDS J8 MF5L.
360405 -
360406 - The letter yesterday to the medical team planning the meeting today
360407 - discusses scheduling the next CT test on 081113. ref SDS L5 SH5Q  The
360408 - next test is actually needed on 081107, which is 8 weeks after the
360409 - last test at Kaiser in Oakland on 080911. ref SDS L1 358L
360411 -  ..
360412 - During the meeting, Brigid concurred with doing the next CT test on
360413 - 081107, 8 weeks after the test last week.  This aligns with Doctor
360414 - Rugo's guidance on 080811 for doing CT tests on an 8 week schedule.
360415 - ref SDS J4 4T4N
360416 -
360417 -        [On 081016 work plan specifies CT test at Kaiser on 081107 for
360418 -        screening to participate in a new drug trial for sunitinib
360419 -        clinical study. ref SDS M2 J44X
360420 -
360421 -
360422 -
360423 -
360424 -
3605 -

SUBJECTS
Default Null Subject Account for Blank Record

3703 -
370401 -  ..
370402 - Examination Indicates Continuing Recovery 4th Relapse IBC
370403 - Axillary Sites Palpation Aligns CT Tests Minimal to No Swelling
370404 -
370405 - Follow up ref SDS J8 4C6K, ref SDS I4 FH7M.
370406 -
370407 - Brigid advised that palpation finds no evidence of swelling in the
370408 - left or right axillary.  This aligns with prior examinations, most
370409 - recently starting cycle 7 on 080821, ref SDS J8 4C6K, and starting the
370410 - prior cycle 6 on 080724. ref SDS I4 FH7M
370412 -  ..
370413 - This further aligns with the CT test on 080911.  As seen from
370414 - discussion today with the medical team, per above, ref SDS 0 MF9K,
370415 - Review the next day on 080912 seemed to indicate stable to improved
370416 - conditions on the right axilla where nodes are reported so small that
370417 - palpation is difficult, ref SDS L2 4K5H, and further the CT test found
370418 - no evidence of swelling in the left side. ref SDS L2 WM9L
370419 -
370420 -
370421 -
3705 -

SUBJECTS
Default Null Subject Account for Blank Record

3803 -
380401 -  ..
380402 - Lump Left Supraclavicular Area of Neck Palpation No Findings
380403 -
380404 - Follow up ref SDS J8 4C6O.
380405 -
380406 - The letter submitted to the team yesterday on 080917 for the agenda
380407 - today cites the letter on 080829 reporting Kaiser noticed swelling in
380408 - the left supraclavicular, and is willing to approve follow on
380409 - treatment if UCSF diagnoses progression of disease. ref SDS L5 SH5T
380411 -  ..
380412 - Today, Brigid could not find the slight lump in the area of the left
380413 - supraclavicular, which Lynn reported during examination 4 weeks ago on
380414 - 080821, ref SDS J8 4C6O, and which was reported again the following
380415 - week by Millie's primary care physician during examination at Kaiser,
380416 - cited in a letter to the medical team later that day. ref SDS K7 RP8T
380418 -  ..
380419 - This aligns with the CT test on 080911 that presents no findings in
380420 - the left supraclavicular, shown by review in the record the next day
380421 - on 080912. ref SDS L2 5O6N  Since Millie needs another CT in about 3
380422 - weeks on 081107, we can ask for review of the scans to pay close
380423 - attention to the left supraclavicular area.
380424 -
380425 -            [On 081016 doctor orders biopsy of left supraclavicular to
380426 -            evaluate progression of cancer. ref SDS M2 J36R
380428 -             ..
380429 -            [On 081022 Doctor Daamen takes biopsy of swelled lymph node
380430 -            in left supraclavicular, and reviews CT test on 080911, and
380431 -            says the scans did not include enough of the neck to
380432 -            evaluate the node in the left supraclavicular. ref SDS L2
380433 -            516F
380435 -             ..
380436 -            [On 081023 Kaiser reports pathology of biopsy positive for
380437 -            breast cancer. ref SDS M5 4Q9Q
380439 -  ..
380440 - The blood test today yielded results a week later showing the cancer
380441 - marker decreased over the past 4 weeks from 96 to CA 15-3 95 today.
380442 - ref SDS L6 VK6H  This stable condition aligns with examination today
380443 - and the CT test on 080911 that find swelling in the left
380444 - supraclavicular, which suggests there has been no growth of disease to
380445 - increase the cancer marker.
380447 -             ..
380448 -            [On 081016 cancer marker CA 15-3 95 continues stable
380449 -            consistent with continued response to treatment.
380450 -            ref SDS M1 VK6H
380452 -  ..
380453 - Millie has not complained of stiff neck the past 4 weeks, extending to
380454 - 8 weeks the period of not feeling symptoms of rising adenopathy in the
380455 - left supraclavicular, reported on 080821. ref SDS J8 E34I
380456 -
380457 -
380458 -
380459 -
380460 -
3805 -

SUBJECTS
Default Null Subject Account for Blank Record

3903 -
390401 -  ..
390402 - IBC Inflammation Rash Seem Stable and Possibly Subsiding
390403 -
390404 - Follow up ref SDS J8 YW6M.
390405 -
390406 - Millie's letter to UCSF yesterday comments on hopes that IBC rash
390407 - looks stable. ref SDS L5 SH4U
390409 -  ..
390410 - Today, Brigid looked carefully at all of the IBC sites and determined
390411 - that conditions seem improved to stable, continuing review last month
390412 - on 080821 by Lynn, who noted that IBC disease at all sites does not
390413 - give the impression of significant intensity compared with other
390414 - patients. ref SDS J8 YX49  At that time, on 080821 Doctor Rugo also
390415 - made examination and commented favorably on continuing improvement.
390416 - ref SDS J8 YX52
390418 -  ..
390419 - Examination today finding stable IBC rash seems to align with finding
390420 - no evident adenopathy in the right axilla, ref SDS 0 4C6K, nor the
390421 - left supraclavicular, ref SDS 0 366L, and further aligns with the
390422 - recent CT test on 080911, where review on 080912 indicates no
390423 - significant rise of adenopathy, ref SDS L2 OO6M; similarly, the cancer
390424 - marker has been stable for 2 months, per above, ref SDS 0 GP3M, after
390425 - having increased significantly the prior 2 months, reported on 080821.
390426 - ref SDS J9 VK6H
390428 -  ..
390429 - Favorable findings from examination and tests treating the 4th relapse
390430 - of IBC reflects improved control this cycle of neutropenia, cited
390431 - above, ref SDS 0 KF4L, which previously caused Millie to miss 20% of
390432 - prescribed chemotherapy treatments with Carboplatin, reported in case
390433 - study of patient history on getting treatment today in the Infusion
390434 - Clinic. ref SDS L6 OK67  Favorable findings today were achieved
390435 - despite error reported on reducing the dose of chemothapy treatment,
390436 - beginning on 080529. ref SDS G2 PVUQ
390438 -  ..
390439 - Continued response to treatment of IBC after 7 cycles of Carboplatin
390440 - where 20% of treatments were missed, and the dose was reduced, may be
390441 - aided by Millie's ability to improve fitness and thereby strengthen
390442 - the immune system through increased exercise, enabled by reduced side
390443 - effects of "targeted" treatment with cetuximab, discussed above.
390444 - ref SDS 0 LT6I  The primary care physician at Kaiser reported on
390445 - 030606 that exercise maintains the immune system that helps resist
390446 - advance of cancer. ref SDS 6 JP7G  Millie's experience from treatment
390447 - with the cetuximab and Carboplatin clinical study aligns with
390448 - published studies showing exercise aids the immune system, ref SDS 24
390449 - F88M, and improves quality of life with better strength and range of
390450 - motion, reviewed on 050609. ref SDS 24 F93X
390451 -
390452 -            [On 081014 Millie's fitenss increases from increased
390453 -            exercise, that may be helping resist cancer. ref SDS L9
390454 -            P49N
390456 -             ..
390457 -            [On 081016 cancer marker CA 15-3 95 continues stable
390458 -            consistent with continued response to treatment.
390459 -            ref SDS M1 VK6H
390461 -             ..
390462 -            [On 081016 examination indicates increased IBC intensity on
390463 -            left arm and small IBC nodules in the breast bone area,
390464 -            conflicting with stable cancer marker; other IBC rash sites
390465 -            seem stable to improved, consistent with stable cancer
390466 -            marker. ref SDS M2 J34U
390468 -             ..
390469 -            [On 081016 doctor orders biopsy of left supraclavicular to
390470 -            evaluate progression of cancer. ref SDS M2 J36R
390472 -             ..
390473 -            [On 081018 report in seminar that recent research indicates
390474 -            exercise improves recovery from cancer and resists
390475 -            recurrence by 60%. ref SDS M3 IT68
390477 -             ..
390478 -            [On 081022 Doctor Daamen takes biopsy of swelled lymph node
390479 -            in left supraclavicular, and reviews CT test on 080911, and
390480 -            says the scans did not include enough of the neck to
390481 -            evaluate the node in the left supraclavicular. ref SDS L2
390482 -            516F
390484 -             ..
390485 -            [On 081023 Kaiser reports pathology of biopsy positive for
390486 -            breast cancer. ref SDS M5 4Q9Q
390487 -
390488 -
3905 -

SUBJECTS
Default Null Subject Account for Blank Record

4003 -
400401 -  ..
400402 - Photographs Show IBC Disease Subsiding All Sites
400403 -
400404 - Follow up ref SDS J8 G74J, ref SDS E5 SA5J.
400405 -
400406 - Background on purpose of photographs and difficulties managing patient
400407 - medical history is reported in the record on 080331. ref SDS E3 GM5I
400409 -  ..
400410 - On 080821, 4-weeks ago, Jill took photographs to evaluate progression
400411 - of disease during examination by Lynn, and Doctor Rugo. ref SDS J8
400412 - G74J
400414 -  ..
400415 - UCSF has been taking pictures on an 8 week schedule, so no pictures
400416 - were taken today.
400417 -
400418 -
400419 -
4005 -

SUBJECTS
Default Null Subject Account for Blank Record

4103 -
410401 -  ..
410402 - Treatment Options Work Plan
410403 - Progression Disease Kaiser Approves UCSF for Continuing Treatment
410404 -
410405 - Millie's letter to the medical team on 080829 reported primary care
410406 - physician at Kaiser approved continuing treatment at UCSF after
410407 - progression of disease from current clinical trial, ref SDS K7 RP9R,
410408 - and cited in Millie's letter to the medical team yesterday, 080917 for
410409 - the agenda to guide the meeting today. ref SDS L5 SH5T
410411 -  ..
410412 - Today, there wasn't enough time for discussion of follow on treatments
410413 - approved by the primary care physician at Kaiser after examination on
410414 - 080829 showing possible progression of disease.  Favorable examination
410415 - and stable test results, ref SDS 0 YW6M, may have seemed like planning
410416 - for follow on treatment was unnecessary.
410417 -
410418 -            [On 081015 agenda for meeting with medical team at UCSF
410419 -            requests review of future treatments. ref SDS M0 K45V
410421 -             ..
410422 -            [On 081016 Doctor Rugo proposes follow on treatment with
410423 -            Sunitinib clinical study, ref SDS M2 J38U, which is
410424 -            another targeted chemotherapy; and additionally, Millie
410425 -            will qualify for participation in another clinical trial
410426 -            opening in about 4 months. ref SDS M2 J35X
410428 -             ..
410429 -            [On 081016 Doctor proposes FNA biopsy to check for
410430 -            status change ER PR HER2 neu, which could increase
410431 -            treatments for Millie. ref SDS M2 J36R
410433 -             ..
410434 -            [On 081018 Doctor Stritter speaking at a Wellness Community
410435 -            event related her research showing promising potential for
410436 -            Millie's treatment with Sunitinib. ref SDS M3 PQ6X
410438 -             ..
410439 -            [On 081022 Doctor Daamen takes biopsy of swelled lymph node
410440 -            in left supraclavicular, and reviews CT test on 080911, and
410441 -            says the scans did not include enough of the neck to
410442 -            evaluate the node in the left supraclavicular. ref SDS L2
410443 -            516F
410445 -             ..
410446 -            [On 081023 Kaiser reports pathology of biopsy positive for
410447 -            breast cancer. ref SDS M5 4Q9Q
410448 -
410449 -
410450 -
410451 -
4105 -

SUBJECTS
Default Null Subject Account for Blank Record

4203 -
420401 -  ..
420402 - Current Medications Submitted with Kaiser's Medical Chart
420403 -
420404 - Follow up ref SDS J8 8A9G, ref SDS I4 8A9G.
420405 -
420406 - Background on Millie's current medications listed at UCSF was reviewed
420407 - during the meeting last month starting cycle 6 on 080724, ref SDS I4
420408 - 8A9G, when Millie cited the list discussed for cycle 5 on 080626,
420409 - ref SDS H3 8A9G, which was presented at Kaiser on 080502. ref SDS F5
420410 - E43I  The list is summarized in Kaiser's medical chart on 080502.
420411 - ref SDS F5 7Y6F
420413 -  ..
420414 - Millie advised there has been no change in the list which previously
420415 - appeared on 080724 to be incomplete. ref SDS I4 PK7I
420417 -  ..
420418 - Brigid can update UCSF records on Millie's current medications using
420419 - the procedure applied this morning to update the UCSF medical chart
420420 - for Millie with results on prior blood tests.  She will similarly add
420421 - medications to the UCSF medical chart that are listed in Kaiser's
420422 - medical chart from meeting with the primary care physician on 080502,
420423 - ref SDS F5 7Y6F, and which was submitted in Millie's letter to UCSF on
420424 - 080821. ref DIP 3 YO5V
420425 -
420426 -
420427 -
420428 -
420429 -
420430 -
420431 -
420432 -
4205 -