CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 6 0000, ref SDS 5 NZ5N.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie received a call from Doctor Daamen at Kaiser earlier today
040902 - saying the FNA biopsy yesterday is positive for breast cancer.
040903 - ref SDS 6 NZ5N  The doctor further reported the Kaiser lab requests
040904 - Millie have a core biopsy to check for status change, ref SDS 6 W15N,
040905 - requested by UCSF in the work plan on 081016. ref SDS 4 J36R
040907 -  ..
040908 - Doctor Daamen wrote a letter at 1527 to the medical team, including
040909 - the primary care physician, and to Doctor Rugo, Brigid, and Megan at
040910 - UCSF, explaining results, and the request by the Kaiser Lab that
040911 - Millie get a core biopsy to test for status change. ref SDS 6 VE5J
040913 -  ..
040914 - Millie recieved 5 letters from UCSF all at once, from 1850 to 1936,
040915 - indicating they may have been held up at the UCSF server, or by heavy
040916 - Internet traffic.
040918 -  ..
040919 - Brigid's first letter went to the medical team at Kaiser, with copies
040920 - to Doctor Rugo, Megan, and Millie...
040921 -
040922 -    1.  Subject:  FNA Biopsy on 081022 Positive for Cancer; Need Core Biopsy to TestStatus Change
040923 -        Date: Thu, 23 Oct 2008 18:50:31 -0700
040930 -         ..
040931 -    2.  I discussed this with Dr.Rugo and we feel that maybe a
040932 -        follow-up FNA might be reasonable to avoid a core vs. open
040933 -        biopsy?? We will defer to Dr.Johnson as her primary oncologist.
040935 -  ..
040936 - Brigid responds to Doctor Daamen at Kaiser, her letter to the medical
040937 - team at 1527, reported in another record today. ref SDS 6 4Q9Q
040939 -  ..
040940 - Brigid's letter from UCSF concludes...
040941 -
040942 -    3.  thanks
040944 -         ..
040962 -
040964 -  ..
040965 - Brigid's second letter went only to Millie, responding to Millie's
040966 - letter to the medical team today 081023 1555, ref SDS 6 PR9X, and
040967 - specifically responding to Millie's request for Brigid to respond to
040968 - Doctor Daamen's letter at Kaiser, ref SDS 6 VM4P, which Brigid did,
040969 - per above. ref SDS 0 1Y7N
040970 -
040971 -    1.  Subject:  FNA Biopsy Positive for Cancer; Need Core Biopsy to Test Status Change
040972 -        Date: Thu, 23 Oct 2008 18:55:24 -0700
040976 -         ..
040977 -    2.  Hi Millie,
040978 -
040979 -        Dr.Rugo feels that another FNA might be reasonable to obtain
040980 -        enough tissue to obtain markers but will defer to Dr.Johnson as
040981 -        which procedure would be best at Kaiser to obtain the markers.
040983 -  ..
040984 - Brigid responded to Millie alone saying the same thing that was in the
040985 - letter to the medical team, including Kaiser, per above. ref SDS 0
040986 - 1Y7N  Since Millie got a copy of the letter to the medical team, and
040987 - since it says the same thing, this second letter increases confusion
040988 - and reduces understanding by allocating time to make sure the letters
040989 - are identical.
040991 -  ..
040992 - UCSF letter to Millie concludes...
040993 -
040994 -    3.  thanks
040995 -
041011 -
041013 -  ..
041014 - Brigid wrote another letter to only Millie explaining that UCSF sent a
041015 - letter saying the same thing to Kaiser (the primary care physician).
041016 -
041017 -    1.  Subject:  FNA Biopsy Positive for Cancer; Need Core Biopsy to Test Status Change
041018 -        Date: Thu, 23 Oct 2008 18:56:46 -0700
041022 -         ..
041023 -    2.  We also sent same email to Dr.Johnson
041025 -  ..
041026 - This second letter to Millie is very thoughtful of Brigid, saying they
041027 - sent the content of the letter to Millie at 1855, ref SDS 0 ZY6I, to
041028 - the primary care physician at Kaiser.  Brigid may have forgotten that
041029 - she copied Millie with her letter to Kaiser at 1850, per above.
041030 - ref SDS 0 1Y7N
041032 -  ..
041033 - This makes it appear that the 2 letters to Millie are redundant, and
041034 - reflect difficulty keeping track of complex details with limited time.
041035 - Three lettes saying the same thing increases difficulty for busy
041036 - people to make sense of complex work. explained in NWO, ref OF 12
041037 - AY9L, and in POIMS. ref OF 4 05A9
041039 -  ..
041040 - UCSF letter to Millie concludes...
041041 -
041042 -    3.  thanks
041043 -
041044 -        Brigid S. Miralda FNP
041045 -        UCSF Breast Care Center
041046 -        415-353-7070
041047 -        fax 415-353-9898
041049 -         ..
041050 -        CONFIDENTIALITY NOTICE: This email is for the sole use of the intended
041051 -        recipient and may contain information that is confidential and
041052 -        privileged under state and federal privacy laws. If you receive this
041053 -        email in error, be aware that any unauthorized use, disclosure, copying,
041054 -        or distribution is strictly prohibited. Please contact the sender
041055 -        immediately and delete and/or destroy all copies of this message.
041056 -
041057 -
041059 -  ..
041060 - UCSF Uses FNA to Test Status Change But Core May Work at Kaiser
041061 -
041062 - Doctor Rugo's first letter went to the medical team at Kaiser,
041063 - including Doctor Daamen, Doctor Johnson, and to Millie, and to Brigid
041064 - and Megan at UCSF, and it responds to Millie's letter to Kasier today
041065 - 081023 1932, and the medical team confirming Doctor Daamen's schedule
041066 - for Millie to get a core biopsy at Kaiser tomorrow at 1130.
041067 - ref SDS 7 LX5H
041068 -
041069 -    1.  Subject: RE: Core Biopsy at Kaiser Friday 1130 Is It Needed?
041070 -        Date: Thu, 23 Oct 2008 19:34:55 -0700
041075 -         ..
041076 -    2.  We usually get HER2 status from FNAs and  avoid core biopsies
041077 -        or excisions.  Depends on what works for Dr.  Johnson and
041078 -        Kaiser!
041080 -  ..
041081 - This responds to Millie's letter today 081023 1932 addressed to Doctor
041082 - Daamen at Kaiser Head and Neck in Walnut Creek, but a copy was sent to
041083 - UCSF asking Doctor Rugo to comment on Kaiser's proposal to retest for
041084 - status change with a core biopsy, rather than an FNA biopsy ordered by
041085 - UCSF. ref SDS 7 JZ8X
041086 -
041094 -
041096 -  ..
041097 - Biopsy Positive Aspiration Cancer Neck Cetuximab Clinical Study
041098 - UCSF Ends Millie's Chemo with Cetuximab Carboplatin Clinical Study
041099 - Sunitinib Drug Trial Doctor Rugo Meeting at UCSF Plan Millie's Treatment
041100 -
041101 - Doctor Rugo's second letter responded to an earlier letter from Millie
041102 - today 081023 1555, ref SDS 6 PR9X, which cited Doctor Daamen's letter
041103 - from Kaiser also on 081023 1527, which was submitted independently by
041104 - Kaiser and directly to UCSF, ref SDS 6 4Q9Q, and reported the biopsy
041105 - yesterday 081022 was positive for breast cancer. ref SDS 6 VE5J
041106 -
041107 -    1.  Subject: RE: FNA Biopsy Positive for Cancer; Need Core Biopsy to Test Status Change
041108 -        Date: Thu, 23 Oct 2008 19:36:25 -0700
041115 -         ..
041116 -    2.  You had chemo this morning?  AT this point, with the positive
041117 -        needle aspiration, you should stop chemotherapy here at UCSF
041118 -        until we decide what to do.
041120 -  ..
041121 - Progression of cancer determined by biopsy today reflects lowering
041122 - dose of Carboplatin chemotherapy on 080501, ref SDS 1 PVUQ, which was
041123 - described as an error in the record on 080529, ref SDS 2 PVUQ, and
041124 - indicated by cancer marker CA 15-3 142 rising to highest level in 7
041125 - years of patient history, reported on 080716. ref SDS 3 IT77
041126 -
041127 -            [On 081113 CT test neck finds swelled lymph node in left
041128 -            supraclavicular. ref SDS 13 5O6N
041130 -  ..
041131 - Doctor Rugo received a copy of Doctor Daamen's letter from Kaiser
041132 - earlier today, reporting that the biopsy yesterday on 081022 was
041133 - positive for cancer. ref SDS 6 VE5J
041134 -
041135 -            [On 081024 primary care phsyician prescribes treatment for
041136 -            Millie at UCSF with sunitinib metronomic and multi-agent
041137 -            protocol, ref SDS 10 XZ8W, because Millie's advancing
041138 -            cancer has become resistant to chemotherapy and so requires
041139 -            double agent drugs, and Kaiser only has single agent
041140 -            treatments which will be ineffective to treat Millie's 5th
041141 -            relapse of IBC, and further, becauser Kaiser's experience
041142 -            with sunitinib indicates this can be effective for Millie.
041143 -            ref SDS 10 ER4I
041145 -             ..
041146 -            [On 081120 pathology report for FNA biopsy on 081022, seems
041147 -            to support UCSF decision today on 081023 that Millie has
041148 -            suffered progression of cancer, and so must end treatment
041149 -            with cetuximab, because this chemotherapy is no longer
041150 -            effective, ref SDS 0 D65G, and Millie needs immediate
041151 -            treatment with another chemotherapy drug. ref SDS 15 LG45
041153 -  ..
041154 - This seems unclear in the record.  It may be that positive aspiration
041155 - from the biopsy is required for Millie to start treatment with the
041156 - sunitinib clinical study.  Why though does finding adenopathy require
041157 - ending otherwise effective treatment with cetuximab and Carboplatin?
041158 -
041159 -            [On 081024 since Doctor Rugo seems to cancel Millie's
041160 -            treatment for cancer at UCSF on 081107, Kaiser scheduled
041161 -            Millie for core biopsy to prepare for starting new cancer
041162 -            treatment on the sinitinib clinical study. ref SDS 9 W159
041164 -             ..
041165 -            [On 081113 UCSF prescribes new treatment with sunitinib .
041166 -            ref SDS 12 Q79M
041168 -             ..
041169 -            [On 081114 Millie begins treatment with sunitinib
041170 -            metronomic protocol. ref SDS 14 505G
041172 -  ..
041173 - Adenopathy was reported in the right axillary, beginning with the CT
041174 - test on 070211.
041176 -  ..
041177 - UCSF letter continuess...
041178 -
041179 -    3.  Megan, lets discuss tomorrow.
041181 -  ..
041182 - Doctor Rugo developed a work plan last week on 081016 during the
041183 - meeting with the medical team at 0830. ref SDS 4 J36R  At that time,
041184 - the doctor proposed treating Millie in the sunitinib clinical trial.
041185 - ref SDS 4 J38U
041187 -  ..
041188 - UCSF letter continuess...
041189 -
041190 -    4.  We get markers from needle aspirations, hopefully this can be
041191 -        done rather than the core?
041193 -  ..
041194 - The UCSF work plan shows an FNA biopsy was ordered to check for status
041195 - change. ref SDS 4 J36R
041197 -  ..
041198 - This responds to Doctor Daamen's letter earlier today sent to the
041199 - medical team saying that testing for status change requires core
041200 - biopsy rather than an FNA biopsy ordered by UCSF. ref SDS 6 4Q5V
041201 -
041202 -            [On 081024 Doctor Daamen responded to the medical team
041203 -            saying the Kaiser Lab reports checking for status change
041204 -            requires core biopsy. ref SDS 8 4P4L
041206 -             ..
041207 -            [On 081024 Doctor Wong confirms Kaiser cannot check for
041208 -            status change with core biopsy, ref SDS 9 KE6J; and relates
041209 -            that core biopsy is higher risk for Millie's patient
041210 -            profile than using less invasive FNA biopsy possible at
041211 -            UCSF. ref SDS 9 W183
041213 -             ..
041214 -            [On 081029 sunitinib work plan update proposes doing FNA
041215 -            biopsy at UCSF to check for status change. ref SDS 11 SF3P
041216 -
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041225 -
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