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FNA Biopsy Left Supraclavicular Neck Two Specimens Drawn Evaluate Ad

2203 -
2203 -    ..
2204 - Summary/Objective
2205 -
220501 - Follow up ref SDS 24 0000. ref SDS 22 0000.
220502 -
220503 -
220504 -
220505 -
220506 -
220508 -  ..
2206 -
2207 -
2208 - Progress
2209 -
220901 - FNA Biopsy Left Supraclavicular Two Specimens
220902 -
220903 - Follow up ref SDS 24 NZ5N, ref SDS 22 NZ5N.
220904 -
220905 - Millie had an FNA biopsy of a lump in the left supraclavicular
220906 - yesterday at Kaiser to evaluate progression of cancer that may qualify
220907 - Millie to participate in a new clinical study for sunitinib to treat
220908 - her IBC 5th relapse.  The biopsy was ordered by Doctor Rugo at UCSF
220909 - during a meeting on 081016, and shown in the UCSF work plan confirmed
220910 - in a letter to the medical team at that time. ref SDS 13 J36R  She
220911 - sent a letter to the doctor this morning on 081023, and shown in
220912 - another record, confirming understandings from the meeting, and
220913 - planning for follow up. ref SDS 24 0X5U
220915 -  ..
220916 - Doctor Daamen called this afternoon, and reported the pathology lab
220917 - reports the biopsy on the lump in the left supraclavicular is
220918 - positive, but they need to do a core biopsy to test for status change.
220919 - The doctor indicated the lab advised that FNA biopsy does not provide
220920 - enough tissue to test for status change.
220922 -  ..
220923 - This seems conflicting with the order prescribed by UCSF for an FNA
220924 - biopsy to check for status change, received on 081016. ref SDS 13 J36R
220926 -  ..
220927 - Asked the doctor to send a letter to the medical team with a
220928 - professional presentation, and request confirmation that a core biopsy
220929 - is required.
220930 -
220931 -            [...below, Doctor Daamen notifies medical team that core
220932 -            biopsy required to test for status change at Kaiser.
220933 -            ref SDS 0 4Q9Q
220934 -
220936 -  ..
2210 -
2211 -
2212 - 1511
2213 -
221301 - Submitted a letter to Doctor Daamen and the medical team confirming
221302 - work plan to determine whether a core biopsy is required.  This
221303 - provides email addresses to Doctor Daamen for the UCSF medical team.
221304 -
221305 -    1.  Subject: FNA Biopsy on 081022 Positive for Cancer; Need Core Biopsy to Test Status Change
221306 -        Date: Thu, 23 Oct 2008 15:13:57 -0700
221316 -         ..
221317 -    3.  Thanks for your call just now reporting initial results of FNA
221318 -        biopsy you performed yesterday at Kaiser in Walnut Creek.
221320 -         ..
221321 -    4.  You advised that pathology is positive for breast cancer;
221322 -        however, you were told by the lab that the specimen was too
221323 -        small to test for status change of ER PR HER2. ref SDS 0 W15N
221325 -         ..
221326 -    5.  You are notifying the primary care physician, Doctor Johnson,
221327 -        in Oncology at Kaiser in Walnut Creek, of initial findings.
221329 -         ..
221330 -    6.  You will also contact the UCSF medical team about doing the
221331 -        core biopsy to check for status change.
221332 -
221333 -            [...below, Doctor Daamen notifies medical team that core
221334 -            biopsy required to test for status change at Kaiser.
221335 -            ref SDS 0 4Q9Q
221337 -         ..
221338 -    7.  By copy I am alerting Doctor Rugo and Brigid Miralda of initial
221339 -        notice, and that you will submit further details.
221341 -         ..
221342 -    8.  I would like to get the follow up biopsy today or tomorrow if
221343 -        possible.
221344 -
221345 -            [...below, Doctor Daamen schedules follow up core biopsy
221346 -            tomorrow with Doctor Wong at 1130.
221347 -
221349 -         ..
221350 -    9.  Thanks for timely work.
221351 -
221358 -
221359 -
221361 -  ..
2214 -
2215 -
2216 - 1538
2217 -
221701 - Biopsy Positive Aspiration Millie Diagnosed 5th Relapse IBC
221702 - FNA Biopsy Test Status Changed Failed Required Core Biopsy Procedure
221703 - Core Biopsy Required Test for Status Change FNA Biopsy Inadequate
221704 -
221705 - Millie received a copy of Doctor Daamen's letter to the medical team
221706 - at Kaiser and UCSF reporting informally results of the biopsy, per
221707 - above. ref SDS 0 W15N
221708 -
221709 -    1.  Subject:  FNA Biopsy on 081022 Positive for Cancer; Need Core Biopsy to TestStatus Change
221710 -        Date: Thu, 23 Oct 2008 15:27:26 -0700
221718 -         ..
221719 -    2.  Hello-
221720 -
221721 -        I am writing to Dr. Rugo and Megan and Miralda about the FNA
221722 -        report of Millie's left supraclavicular neck mass. The FNA was
221723 -        positive for breast cancer metastasis.
221724 -
221725 -            [...in another record later today, on 081023 Millie
221726 -            notified medical team that Kaiser reported today the biopsy
221727 -            yesterday on 081022 was positive for breast cancer.
221728 -            ref SDS 25 JZ8X
221730 -             ..
221731 -            [...in another record later today, on 081023 Millie
221732 -            received a letter from UCSF advising that results reported
221733 -            today for the biopsy at Kaiser yesterday, require Millie to
221734 -            stop getting treatment with cetuximab and Carboplatin
221735 -            protocol. ref SDS 26 D65G
221737 -             ..
221738 -            [On 081120 pathology report for FNA biopsy on 081022, seems
221739 -            to support the work today based on finding progression of
221740 -            disease. ref SDS 40 LG45
221742 -         ..
221743 -    3.  However, the pathologist stated that he would need formalin
221744 -        fixed specimen [core biopsy] to perform the Her 2 Neu testing.
221745 -        Is it necessary to have this testing?
221746 -
221747 -            [On 081107 Doctor Kahn draws core biopys tissue at Kaiser,
221748 -            and places in a formalin specimen container for transport
221749 -            to the lab. ref SDS 38 494I
221751 -             ..
221752 -            [On 081119 Kaiser submitted a summary of results taken from
221753 -            the final pathology report for the biopsy on 081107, and it
221754 -            appears that status is unchanged, still triple negative.
221755 -            ref SDS 39 5O76
221757 -  ..
221758 - Asking whether testing is "necessary" raises a flag of caution about
221759 - the core biopsy procedure.  Nobody asked if testing for status change
221760 - was necessary, until the procedure changed from FNA to core biopsy.
221761 - What is really being asked is whether better care from results of the
221762 - biopsy justify increased risks of the more vigorous core procedure,
221763 - cited by Doctor Daamen yesterday on 081022 when performing the FNA
221764 - biopsy. ref SDS 22 HH99
221766 -  ..
221767 - Doctor Rugo has not expressly presented benefits to be derived from
221768 - the status change test.  This was reviewed on 081016 when UCSF issued
221769 - the order for FNA biopsy to test status change. ref SDS 13 PP9J  On
221770 - 050909 Doctor Shim at Kaiser in Oakland issued an opinion recommending
221771 - Kaiser test for status change because this would have a "huge" impact
221772 - on Millie's traetments. ref SDS 7 JX9P
221774 -  ..
221775 - "Huge impact" necesarily conveys justification to test within the
221776 - bounds of safety, such that core biopsy does not threaten greater harm
221777 - than benefits.  The solution is to do the FNA procedure ordered by
221778 - UCSF, which has not been cited for causing increased risks.
221779 -
221780 -            [On 081023 Brigid Miralda responds saying Doctor Rugo at
221781 -            UCSF recommends follow up biopsy with FNA, rather than a
221782 -            core biopsy. ref SDS 26 4P94
221784 -             ..
221785 -            [On 081024 Doctor Daamen clarifies that Kaiser's local lab
221786 -            explains a lab in San Francisco needs a core biopys sample
221787 -            to test for status change. ref SDS 27 008H
221789 -             ..
221790 -            [On 081024 1130 Millie met with Kaiser Head and Neck
221791 -            Department; decided to perform core biopsy to test for
221792 -            status change, because Kaiser Lab uses different procedures
221793 -            from the lab UCSF uses to check biopsy tissue for status
221794 -            change; Kaiser further decided to defer performing core
221795 -            biopsy work until 081107 after Millie returns from vacation
221796 -            to reduce risks of complications cascading out of control
221797 -            without ready access to Kaiser health care while traveling.
221798 -            ref SDS 28 G15K
221800 -             ..
221801 -            [On 081027 Kaiser delays core bipsy 3 times to 081117,
221802 -            providing more time to evaluate benefits justify risks to
221803 -            make core biopsy necessary. ref SDS 29 UE6N
221805 -             ..
221806 -            [On 081027 Millie notified UCSF that Kaiser delayed core
221807 -            biopsy again to 081117, ref SDS 30 G15K, and asks if this
221808 -            will delay getting treatment for cancer with the UCSF work
221809 -            plan for starting the sunitinib clinical study. ref SDS 30
221810 -            R79W
221812 -             ..
221813 -            [On 081029 sunitinib work plan update proposes doing FNA
221814 -            biopsy at UCSF to check for status change. ref SDS 31 SF3P
221816 -             ..
221817 -            [On 081029 letter to UCSF discusses doing FNA biopsy for
221818 -            status check at UCSF instead of core biopsy at Kaiser.
221819 -            ref SDS 31 C49U
221821 -             ..
221822 -            [On 081031 letter to UCSF with copy to Kaiser asks about
221823 -            doing FNA biopsy at UCSF. ref SDS 32 NN5S
221825 -             ..
221826 -            [On 081031 Glenna called and advised that biopsy for
221827 -            status change is not a requirement for the sunitinib
221828 -            clinical trial, and so recommended contacting Doctor
221829 -            Rugo UCSF and Doctor Johnson at Kaiser. ref SDS 33 T27H
221831 -             ..
221832 -            [On 081031 Millie submits letter to medical team asking
221833 -            about doing the FNA biopsy to test status change at
221834 -            UCSF to reduce risks of core biopsy method. ref SDS 34
221835 -            AJ6U
221837 -             ..
221838 -            [On 081101 Doctor Rugo says FNA biopsy to check for
221839 -            status change is not part of the sunitinib clinical
221840 -            study; requires Kaiser approval of payment which would
221841 -            be very cost effective since FNA biopsy at UCSF would
221842 -            cost much less than the more invasive and problematic
221843 -            core biopsy Kaiser has scheduled for Millie on 081113.
221844 -            ref SDS 35 5G5H
221846 -             ..
221847 -            [On 081102 Millie's letter to Doctor Rugo with copy to
221848 -            primary care physician at Kaiser asks how much the FNA
221849 -            biopsy to test for status change will cost at UCSF, and
221850 -            notes this should be less expensive than doing the core
221851 -            biopsy at Kaiser. ref SDS 36 AD3F
221853 -             ..
221854 -            [On 081103 primary care physician advises that Kaiser will
221855 -            perform the procedure. ref SDS 37 2M64
221857 -             ..
221858 -            [On 081107 Doctor Kahn draws core biopys tissue at Kaiser,
221859 -            and places in a formalin specimen container for transport
221860 -            to the lab. ref SDS 38 494I
221862 -         ..
221863 -    4.  We are going to set up Millie to have a core biopsy done (if
221864 -        possible) vs. an open biopsy of the mass by Dr  Louis Wong here
221865 -        at Walnut Creek Kaiser tomorrow if needed. (I am in the Antioch
221866 -        clinic tomorrow and will no be able to do the biopsy).
221868 -         ..
221869 -    5.  Please let me know as soon as possible if this is indeed
221870 -        needed.
221871 -
221872 -            [...below, Kaiser does not hear from UCSF, schedules Millie
221873 -            for core biopsy in Head and Neck Department on 081024 1130.
221874 -            ref SDS 0 667F
221876 -  ..
221877 - Below, Brigid plans to respond at the "end of clinic," which may put
221878 - Kaiser at unnecssary inconvenience waiting to the end of the day to
221879 - schedule work for tomorrow. ref SDS 0 FD6O
221880 -
221901 -
221903 -  ..
2220 -
2221 -
2222 - 1542
2223 -
222301 - Millie also received a letter from Brigid responding to Millie's first
222302 - letter, ref SDS 0 J96X, and evidently without having reviewed Doctor
222303 - Daamen's letter, just received, ref SDS 0 4Q9Q, since Brigid does not
222304 - respond to the medical team, and Doctor Daamen's letter, ref SDS 0
222305 - 4Q9Q, is listed in attachments...
222306 -
222307 -    1.  Subject:  FNA Biopsy on 081022 Positive for Cancer; Need Core Biopsy to Test Status Change
222308 -        From: "Miralda, Brigid"
222312 -         ..
222313 -    2.  Millie, let me talk to Dr.Rugo because I don't know if she
222314 -        would think you need a core biopsy.  I will talk with her at
222315 -        the end of clinic and call you
222317 -  ..
222318 - UCSF should try to repond directly to Kaiser, since Doctor Daamen says
222319 - that Kaiser is standing by to schedule work tomorrow based on UCSF
222320 - guidance on whether a core biopsy is needed. ref SDS 0 4Q61
222322 -  ..
222323 - Brigid's letter concludes...
222324 -
222325 -    3.  thanks
222326 -
222341 -
222343 -  ..
2224 -
2225 -
2226 - 1548
2227 -
222701 - Millie coordinated with the medical team to communicate directly on
222702 - planning medical procedures by having UCSF respond to Kaiser's request
222703 - for timely notice on whether to schedule core biopsy procedure
222704 - tomorrow. ref SDS 0 4Q61
222705 -
222706 -    1.  Subject: FNA Biopsy Positive for Cancer; Need Core Biopsy to Test Status Change
222707 -        Date: Thu, 23 Oct 2008 15:55:42 -0700
222718 -         ..
222719 -    3.  Thanks for coordinating with the medical team at Kaiser and
222720 -        UCSF on findings from the biopsy yesterday, as shown in your
222721 -        letter today. ref SDS 0 4Q9Q
222723 -         ..
222724 -    4.  Brigid responded separately, and plans to consult with Doctor
222725 -        Rugo on whether core biopsy is needed in this case. ref SDS 0
222726 -        FD6O  Note that Kaiser will schedule this work tomorrow if
222727 -        needed. ref SDS 0 4Q61
222729 -         ..
222730 -    5.  I had a question about doing a core biopsy the day after chemo
222731 -        treatment this morning at UCSF?
222733 -         ..
222734 -    6.  Brigid, please use this letter to respond with Doctor Rugo's
222735 -        determination, so it is associated with Doctor Daamen's report
222736 -        shown below.
222737 -
222738 -            [...in another record, Brigid responded to only Millie,
222739 -            saying that Doctor Rugo wants an FNA biopsy to check for
222740 -            status change. ref SDS 26 ZY6I
222742 -             ..
222743 -            [...in another record today, Doctor Rugo responded, saying
222744 -            an FNA biopsy should be sufficient to test for status
222745 -            change. ref SDS 26 D65G
222747 -         ..
222748 -    7.  Thanks to all for timely coordination.
222749 -
222757 -
222758 -
222760 -  ..
2228 -
2229 -
2230 - 1806
2231 -
223101 - UCSF did not respond, as requested in Millie's letter, ref SDS 0 VM3Q,
223102 - to Kaiser's notice scheduling core biopsy tomorrow, ref SDS 0 4Q61;
223103 - possibly Doctor Rugo was tied up and could not consult, as planned in
223104 - Brigid's letter earlier today. ref SDS 0 FD6O
223105 -
223106 -        [...in another record, actually UCSF did respond, but for some
223107 -        reason 5 UCSF letters were not received until later in the
223108 -        evening. ref SDS 26 NI7S
223109 -
223110 -
223112 -  ..
223113 - Kaiser Schedules Core Biopsy 081024 1130
223114 -
223115 - Millie received another letter from Doctor Daamen, with copies to the
223116 - medical team, and following up her earlier plan to schedule Millie for
223117 - a core biopsy tomorrow...
223118 -
223119 -    1.  Subject:  FNA Biopsy Positive for Cancer; Need Core Biopsy to Test Status Change
223120 -        Date: Thu, 23 Oct 2008 17:08:44 -0700
223128 -         ..
223129 -    2.  Millie-
223131 -         ..
223132 -        You are scheduled to be seen by Dr Wong here in Walnut Creek
223133 -        head and neck surgery at 11:30am for the core biopsy.
223135 -  ..
223136 - This responds to Millie's letter to the medical team, ref SDS 0 VM4P,
223137 - asking Brigid to respond to Doctor Daamen's letter planning to
223138 - schedule Millie for a core biopsy tomorrow. ref SDS 0 4Q61
223140 -  ..
223141 - Since UCSF did not have time to respond today, Kaiser has scheduled
223142 - the procedure for later tomorrow morning.  This will give UCSF time
223143 - to comment.
223145 -  ..
223146 - Doing the biopsy at 1130 tomorrow morning, conflicts with Millie
223147 - scheduled to see the primary care physician at 1140.
223149 -  ..
223150 - Kaiser's letter continues...
223151 -
223152 -        Please let me know if it is not needed and we can then cancel
223153 -        it.  Dr Wong will see if he can do the core or if an open
223154 -        biopsy may need to be done (small incision to remove some more
223155 -        of the tissue- sometimes safer for smaller lymph nodes).
223156 -
223157 -               [...in another record Millie responded to Doctor
223158 -               Daamen's letter saying she will meet with Doctor Wong
223159 -               tomorrow at 1130 to get the follow up biopsy.
223160 -               ref SDS 25 LX5H
223162 -                ..
223163 -               [...in another record Millie asks UCSF if biopsy on
223164 -               status change can be deferred. ref SDS 25 JZ8X
223166 -                ..
223167 -               [...in another record, Millie received 5 letters from
223168 -               UCSF, 3 from Brigid and 2 from Doctor Rugo, all
223169 -               indicating they want the biopsy to check for status
223170 -               change, but Brigid indicated this can be done with FNA,
223171 -               rather than core biopsy, ref SDS 26 NI7S; Doctor Rugo
223172 -               sent 2 letters saying the same thing. ref SDS 26 4Q52
223174 -                ..
223175 -               [On 081024 Doctor Daament confirms Millie schedule for
223176 -               core biopsy at 081024 1130. ref SDS 27 4P4T
223178 -                ..
223179 -               [On 081024 Millie met with Kaiser Head and Neck
223180 -               Department; decided to perform core biopsy to test for
223181 -               status change, because Kaiser Lab uses different
223182 -               procedures from the lab UCSF uses to check biopsy tissue
223183 -               for status change; Kaiser further decided to defer
223184 -               performing core biopsy work until 081107 after Millie
223185 -               returns from vacation to reduce risks of complications
223186 -               cascading out of control without ready access to Kaiser
223187 -               health care while traveling. ref SDS 28 G15K
223188 -
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