CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 16 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie met with Doctor Wang in the Head and Neck Department on the 3rd
040902 - floor after getting Neupogen treatment on the 2nd floor in the
040903 - Infusion Clinic.  This implemented the schedule set by Doctor Daamen
040904 - in her letter this morning, ref SDS 17 4P4T, confirming the doctor's
040905 - letter the day before on 081023. ref SDS 14 667F
040907 -  ..
040908 - Doctor Wang explained that he called the Kaiser Lab to ask again about
040909 - doing another FNA biopsy to test for status change.  He related having
040910 - been told again by Kaiser's local lab in Walnut Creek that testing for
040911 - status change is done in San Francisco, and the lab in San Francisco
040912 - requires a core biopsy.  This aligns with Doctor Daamen's letter on
040913 - 081023, ref SDS 14 4Q5V, and clarified this morning citing reference
040914 - to a lab in San Francisco. ref SDS 17 EF4H
040916 -  ..
040917 - Doctor Wong further explained the staff in the Kaiser Lab related to
040918 - him that procedures and capabilites differ between labs.  It would not
040919 - be unusual for the UCSF lab to test for status change with FNA biopsy
040920 - specimen, and the Kaiser Lab to require tissue from a core biopsy,
040921 - based on differences in personnel, protocol, and technology between
040922 - labs.
040924 -  ..
040925 - Doctor Wong advised that a core biopsy is more invasive than FNA.
040926 - This aligns with Doctor Daamen's explanation on 081022, when she
040927 - presented Kaiser protocol to use the least invasive method, and would
040928 - use a core biopsy only if testing with FNA produces negative results.
040929 - ref SDS 12 HH99
040931 -         ..
040932 -        [On 081031 Millie's letter to Doctor Rugo and Doctor Johnson
040933 -        asks about doing FNA biopsy at UCSF, because this is less risky
040934 -        than core biopsy, and Kaiser cannot test for status change with
040935 -        FNA biopsy, must use core biopsy procedure. ref SDS 24 AJ6U
040937 -  ..
040938 - Millie recalled that on 040419 Doctor Riley-Paull performed a "punch"
040939 - biopsy on the left breast.  This was an add-on procedure following
040940 - surgery to implant a port catheter.  The biopsy evaluated severe
040941 - inflammation of the left breast observed during surgery. ref SDS 1
040942 - XU4S  The doctor reported on 040429 findings were positive for cancer,
040943 - but did not elaborate. ref SDS 2 F66N  On 040517 Kaiser submitted the
040944 - pathology that reported finding IBC. ref SDS 3 6T5G  On 040614 Kaiser
040945 - diagnosed Millie with IBC, ref SDS 4 6T5G, and changed from Stage II
040946 - to Stage IV cancer treatment protocols. ref SDS 4 6M9H
040948 -  ..
040949 - The punch biopsy on 040419 tested for status change, and findings were
040950 - negative, reported on 060711. ref SDS 8 ZR6J
040952 -  ..
040953 - Millie asked how core biopsy on the left supclavicular proposed to
040954 - test for status change today, compares with the punch biopsy procedure
040955 - on the left breast on 040419?
040957 -  ..
040958 - Doctor Wong seemed to indicate during the meeting that core biopsy is
040959 - more invasive than the punch biopsy Kaiser used on 040419.  More
040960 - invasive procedures are more complex, problematic, and so more costly.
040962 -  ..
040963 - The doctor cited core biopsy risks blood clots and infection problems.
040965 -  ..
040966 - He feels this can be problematic for Millie's history of cancer and
040967 - pulmonary embolism.
040968 -
040969 -            [On 081029 letter to UCSF discusses doing FNA biopsy
040970 -            for status check at UCSF instead of core biopsy at
040971 -            Kaiser. ref SDS 21 C49U
040973 -             ..
040974 -            [On 081031 letter to UCSF with copy to Kaiser asks about
040975 -            doing FNA biopsy at UCSF. ref SDS 22 NN5S
040977 -             ..
040978 -            [On 081031 Glenna called and advised that biopsy for status
040979 -            change is not a requirement for the sunitinib clinical
040980 -            trial, and so recommended contacting Doctor Rugo UCSF and
040981 -            Doctor Johnson at Kaiser. ref SDS 23 T27H
040983 -             ..
040984 -            [On 081031 Millie submits letter to medical team asking
040985 -            about doing the FNA biopsy to test status change at UCSF to
040986 -            reduce risks of core biopsy method. ref SDS 24 AJ6U
040988 -             ..
040989 -            [On 081101 Doctor Rugo says FNA biopsy to check for
040990 -            status change is not part of the sunitinib clinical
040991 -            study; requires Kaiser approval of payment which would
040992 -            be very cost effective since FNA biopsy at UCSF would
040993 -            cost much less than the more invasive and problematic
040994 -            core biopsy Kaiser has scheduled for Millie on 081113.
040995 -            ref SDS 25 5G5H
040997 -             ..
040998 -            [On 081102 Millie's letter to Doctor Rugo with copy to
040999 -            primary care physician at Kaiser asks how much the FNA
041000 -            biopsy to test for status change will cost at UCSF, and
041001 -            notes this should be less expensive than doing the core
041002 -            biopsy at Kaiser. ref SDS 26 AD3F
041004 -             ..
041005 -            [On 081106 Doctor Daamen calls from Kaiser Head and Neck,
041006 -            ref SDS 27 5F5H, and advances the schedule from 081117 to
041007 -            081107 and will perform a core biopsy to test Millie for
041008 -            status change. ref SDS 27 5F68
041010 -             ..
041011 -            [On 081106 letter to Kaiser confirms understandings on not
041012 -            having paused Coumadin in advance of doing core biopsy next
041013 -            day on 081107. ref SDS 28 WR9V
041015 -  ..
041016 - Doctor Wong reviewed Millie's blood test at UCSF on 081016 showing INR
041017 - 4.2 is elevated above the target range for patients being treated with
041018 - Coumadin for pulmonary embolism. ref SDS 11 K66J  The doctor commented
041019 - that this is not the best circumstance for core biopsy, due to risk of
041020 - bleeding.
041022 -  ..
041023 - Millie had recurrence of pulmonary embolism, reported on 061012,
041024 - ref SDS 10 294Q  Research on 060722 indicated 45% of patients die who
041025 - suffer recurrent pulmonary embolism. ref SDS 9 BI5J  Blood clots are a
041026 - major cause of pulmonary embolism, cited today by Doctor Wong as a
041027 - risk from core biopsy procedures.
041029 -  ..
041030 - Doctor Wong was pleased to hear today that the follow up blood test at
041031 - UCSF yesterday on 081023 shows INR 2.3 has returned to the target
041032 - range for pulmonary embolism. ref SDS 13 K66J  He feels this is good
041033 - for doing the core biopsy today, but feels Millie going on vacation
041034 - introduces additional factors that recommend doing the biopsy after
041035 - Millie returns from vaction on 081107.
041037 -  ..
041038 - The doctor explained that Millie vacationing on a cruise ship for 2
041039 - weeks increases risks of a core biopsy because of Millie's patient
041040 - history of pulmonary embolism, and potential for blood clots and
041041 - infection associated with core biopsy procedures.  He cited personal
041042 - experience of getting poor medical support onboard cruise ships.
041044 -  ..
041045 - Millie seems doubly at risk with the core biopsy procedure.  Coumadin
041046 - may cause excessive bleeding.  If the blood clots normally, would this
041047 - risk PE?
041048 -
041049 -            [On 081106 Doctor Daamen calls from Kaiser Head and Neck,
041050 -            ref SDS 27 5F5H, and advances the schedule from 081117 to
041051 -            081107 and will perform a core biopsy to test Millie for
041052 -            status change. ref SDS 27 5F68
041054 -             ..
041055 -            [On 081106 letter to Kaiser confirms understandings on not
041056 -            having paused Coumadin in advance of doing core biopsy next
041057 -            day on 081107. ref SDS 28 WR9V
041059 -  ..
041060 - Millie recalled that the punch biopsy on 040419 took over a year to
041061 - heal, reported initially by Doctor Parsley during treatment in the
041062 - Emergency Room on 041202. ref SDS 5 AH9H  Months later on 050312
041063 - Doctor Riley-Paull who performed the original punch biopsy on 040419,
041064 - reported the wound was beginning to heal. ref SDS 6 906K  Slow
041065 - recovery from the punch biopsy was attributed to cancer in the left
041066 - breast.
041068 -  ..
041069 - Since the biopsy performed by Doctor Daamen 2 days ago on 081022 was
041070 - reported the next day on 081023 positive for breast cancer,
041071 - ref SDS 14 W15N, this raises risks about doing another invasive
041072 - procedure with a core biopsy, explained by Doctor Wong. ref SDS 0 7M57
041074 -  ..
041075 - Doctor Wong noted that since UCSF has the report on the biopsy showing
041076 - progression of cancer, this permits working on tasks to begin Millie's
041077 - next treatment regimen.  The doctor recommended that Millie wait to
041078 - have the core biopsy after returning from vacation so that close
041079 - monitoring and follow up care is readily available in the event of
041080 - complications from a core biopsy.
041082 -  ..
041083 - Concern about complications of core biopsy may relate to Doctor
041084 - Daamen's letter to the medical team on 081023 asking if this risk is
041085 - necessary. ref SDS 14 4Q5V
041086 -
041087 -        [On 081031 Millie's letter to Doctor Rugo and Doctor Johnson
041088 -        asks about doing FNA biopsy at UCSF, because this is less risky
041089 -        than core biopsy, and Kaiser cannot test for status change with
041090 -        FNA biopsy, must use core biopsy procedure. ref SDS 24 AJ6U
041092 -  ..
041093 - Millie decided not to do the core biopsy today.
041095 -  ..
041096 - Doctor Wong took Millie into the administrative area.  An assistant
041097 - checked the Kaiser computer.  Millie asked if either Doctor Wang,
041098 - Doctor Daamen, or Doctor Laio could do the biopsy on 081107.
041100 -  ..
041101 - Doctor Wang said his schedule can accept Millie's core biopsy work.
041102 - The attendant scheduled the work for 081107 0930.  Millie had been
041103 - scheduled to get chemoterhapy treatment in the morning on 081107 at
041104 - UCSF.  Since this treatment was cancelled by Doctor Rugo in the UCSF
041105 - letter last night on 081023, ref SDS 15 D65G, Millie can come to Kaiser
041106 - for the biopsy at 0930 instead.
041107 -
041108 -            [On 081027 Karen called and said Doctor Wong has emergency
041109 -            surgery on 081107 and then goes on vacation; Karen
041110 -            re-scheduled Millie for the earliest anyone can perform the
041111 -            biopsy procedure is Doctor Wong at 081117 1130. ref SDS 18
041112 -            QK7F
041114 -             ..
041115 -            [On 081027 Millie notified UCSF that Kaiser delayed core
041116 -            biopsy again to 081117, ref SDS 19 G15K, and asks if this
041117 -            will delay getting treatment for cancer with the UCSF work
041118 -            plan for starting the sunitinib clinical study. ref SDS 19
041119 -            R79W
041121 -             ..
041122 -            [On 081027 Glenna called and planned to ask Doctor Rugo
041123 -            about requirements for biopsy to test status change in
041124 -            order for Millie to start the sunitinib clinical study.
041125 -            ref SDS 20 934O
041127 -             ..
041128 -            [On 081029 sunitinib work plan update proposes doing FNA
041129 -            biopsy at UCSF to check for status change. ref SDS 21 SF3P
041131 -             ..
041132 -            [On 081029 letter to UCSF discusses doing FNA biopsy for
041133 -            status check at UCSF instead of core biopsy at Kaiser.
041134 -            ref SDS 21 C49U
041136 -             ..
041137 -            [On 081031 letter to UCSF with copy to Kaiser asks about
041138 -            doing FNA biopsy at UCSF. ref SDS 22 NN5S
041140 -             ..
041141 -            [On 081031 Glenna called and advised that biopsy for status
041142 -            change is not a requirement for the sunitinib clinical
041143 -            trial, and so recommended contacting Doctor Rugo UCSF and
041144 -            Doctor Johnson at Kaiser. ref SDS 23 T27H
041146 -             ..
041147 -            [On 081031 Millie submits letter to medical team asking
041148 -            about doing the FNA biopsy to test status change at UCSF to
041149 -            reduce risks of core biopsy method. ref SDS 24 AJ6U
041151 -             ..
041152 -            [On 081101 Doctor Rugo says FNA biopsy to check for
041153 -            status change is not part of the sunitinib clinical
041154 -            study; requires Kaiser approval of payment which would
041155 -            be very cost effective since FNA biopsy at UCSF would
041156 -            cost much less than the more invasive and problematic
041157 -            core biopsy Kaiser has scheduled for Millie on 081113.
041158 -            ref SDS 25 5G5H
041160 -             ..
041161 -            [On 081102 Millie's letter to Doctor Rugo with copy to
041162 -            primary care physician at Kaiser asks how much the FNA
041163 -            biopsy to test for status change will cost at UCSF, and
041164 -            notes this should be less expensive than doing the core
041165 -            biopsy at Kaiser. ref SDS 26 AD3F
041166 -
041167 -
041168 -
041169 -
041170 -
041171 -
041172 -
041173 -
041174 -
0412 -