CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 11 0000, ref SDS 10 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie notified Doctor Rugo about progress today scheduling tests
040902 - required to start treatment with the sinitinib clinical study at UCSF.
040903 -
040904 -    1.  Subject: Sunitinib Tests Scheduled Nov 7th
040905 -        Date: Fri, 24 Oct 2008 14:07:52 -0700
040916 -         ..
040917 -    3.  I got Neupogen this morning at 1115.
040919 -         ..
040920 -    4.  I met with Doctor Wong at 1130a in Kaiser Head and Neck.
040922 -         ..
040923 -    5.  He called the Kaiser Lab again, and was told again to use a
040924 -        core biopsy to extract enough tissue to test for status change
040925 -        on HER2 neu.  Doctor Wong recommended doing this after I return
040926 -        from vacation to avoid risks of blood clots, he mentioned my
040927 -        INR 4.2 last week.  The test yesterday showed normal INR 2.3.
040928 -        In any case, he scheduled a core biopsy on Nov 7 at 0900 to
040929 -        test for status change.
040931 -         ..
040932 -    6.  At 1150, I saw Doctor Johnson, my primary care physician.
040933 -        ref SDS 11 C45H  He examined my IBC and concurs with UCSF
040934 -        assessment. ref SDS 11 WK82  The doctor entered into my medical
040935 -        chart approval, ref SDS 11 OZ5F, for treatment to continue on
040936 -        clinical trial at UCSF with the sunitinib study [as discussed
040937 -        that day. ref SDS 11 K67J
040939 -  ..
040940 - During the meeting today at 1150, the doctor discussed Millie's letter
040941 - to Kaiser on 081019 citing Doctor Stritter's favorable comments about
040942 - the UCSF sunitinib metronomic and multi-agent treatment protocol,
040943 - which were presented during a seminar on 081018. ref SDS 5 D13Q  The
040944 - primary care physician further reviewed the Consent document for the
040945 - sunitinib treatment, ref SDS 11 K64L, which was submitted to Kaiser
040946 - with Millie s letter on 081021. ref SDS 6 W83I
040948 -  ..
040949 - The doctor feels that Doctor Rugo's letter last night on 081023 ending
040950 - treatment with cetuximab, ref SDS 9 D65G, aligns with pathology on the
040951 - biopsy of the swelled node in the left supraclavicular, which was
040952 - performed at Kaiser on 081022, and which Doctor Daamen reported to the
040953 - medical team earlier yesterday, and found positive for cancer,
040954 - demonstrating progression of disease. ref SDS 8 4Q9Q
040956 -  ..
040957 - The doctor prescribed treatment today for progression of disease with
040958 - the sunitinib metronomic and multi-agent protocol at UCSF. ref SDS 11
040959 - K67J  This aligns with the meeting at Kaiser on 080829, when the
040960 - doctor palpated a swelled lymph node in the left supraclavicular, and
040961 - diagnosed likely advancing cancer, ref SDS 1 RP8T   At that time on
040962 - 080829, the doctor asked Millie to notify UCSF to investigate
040963 - progression of disease that signals a 5th relapse of IBC, and further
040964 - advised that relapse requires changing treatment using double agent
040965 - "trargeted" drugs, because Millie's 5th relapse of IBC has become
040966 - resistant to single agent treatments.  Since Kaiser only has single
040967 - agent "old technology" drugs for treating Millie's advanced cancer
040968 - condition, the doctor plans to approve payment for Millie's treatment
040969 - at UCSF with the sunitinib metronomic and multi-agent protocol.
040970 - ref SDS 1 RP9W
040972 -  ..
040973 - Today, the doctor explained that the UCSF sunitinib multi-agent
040974 - protocol offers the best treatment for Millie to recover from a 5th
040975 - relapse of IBC.  The doctor cited experience at Kaiser with sunitinib.
040976 - ref SDS 11 MH3K
040978 -             ..
040979 -            [On 081031 Glenna reported conversation with Millie's
040980 -            primary care physician stating authorization of Kaiser to
040981 -            pay for Millie's treatment in the sunitinib clinical study
040982 -            at UCSF would be submitted on 081031; Glenna is following
040983 -            up wtih the doctor to secure authorization in time for
040984 -            treatment to begin on 081107 signing Consent documents.
040985 -            ref SDS 17 5C7J
040987 -             ..
040988 -            [On 081031 UCSF letter to Millie, Glenna notes Doctor
040989 -            Johnson submitted authorization for Millie's treatment in
040990 -            sunitinib clinical study. ref SDS 18 458L
040992 -             ..
040993 -            [On 081219 1140 Doctor Johnson finds favorable response to
040994 -            treatment with sunitinib, ref SDS 25 3L9L; the doctor cites
040995 -            urgency of timely treatment increases when Millie suffers
040996 -            relapse; delay increases risk of losing control for cancer
040997 -            that mutates into more aggressive disease. ref SDS 25 KU6F
040999 -             ..
041000 -            [Doctor Johnson asked Millie to notify Doctor Rugo about
041001 -            planning treatment for the 6th relapse to ensure treatment
041002 -            starts in time to be effective, ref SDS 25 V93O, and asked
041003 -            for a letter from UCSF to facilitate the next referral,
041004 -            ref SDS 25 SU8G; because the 6th relapse will be very
041005 -            serious, ref SDS 25 NS8H; further emphasized need for
041006 -            letter from UCSF recommending treatment on referral from
041007 -            Kaiser. ref SDS 25 E84J
041009 -  ..
041010 - Millie's letter to medical team continues...
041011 -
041012 -    7.  CT was scheduled Nov 7 in the afternoon.  He specified the test
041013 -        to include the neck to track the node you found last week.
041014 -        ref SDS 11 454L
041016 -  ..
041017 - During the meeting today, the doctor ordered Barium Sulfate suspension
041018 - for oral contrast medium, ref SDS 11 QL7G, on the way home Millie
041019 - stopped at Kaiser in
041020 -
041021 -            [On 081025 Millie went to Kaiser pharmacy in Park
041022 -            Shadelands and purchased Barium Sulfate suspension to take
041023 -            on 081107 for the CT test scheduled today. ref SDS 12 FT5H
041025 -             ..
041026 -            [On 081031 brain MRI scheduled 081108 to not concflict with
041027 -            CT test on 081107. ref SDS 16 UJ68
041029 -  ..
041030 - On 080918 examination did not find the node reported the month before
041031 - on 080821, so planning to check the next CT scan carefully on 081107.
041032 - ref SDS 2 N65G
041034 -  ..
041035 - On 081022 Doctor Daamen in Head and Neck Department at Kaiser reported
041036 - that the CT scan on 080911 did not include enough of the neck to
041037 - evaluate adenopathy of the left supraclavicular. ref SDS 7 516F
041038 -
041039 -            [On 081028 Millie letter to Dennis at Kaiser CT Department
041040 -            to coordinate test using Power Port. ref SDS 14 PE6L
041042 -  ..
041043 - Millie's letter to UCSF continues...
041044 -
041045 -    8.  Echocardiogram was scheduled on Nov 10th 0930. ref SDS 11 R45N
041047 -  ..
041048 - This is a screening test for participation in the sunitinib clinical
041049 - study shown by requirements in the Consent documents for the sunitinib
041050 - clinical study. ref SDS 4 LH53
041051 -
041052 -           [On 081029 echocardiogram added to work plan for sunitinib
041053 -           clinical study shows. ref SDS 15 SE4N
041055 -            ..
041056 -           [On 081105 called and talked to Katie in Nuclear Medicine at
041057 -           Kaiser in Walnut Creek; Katie advised that on 081103 the
041058 -           primary care physician ordered a Muga test for Millie which
041059 -           is performed in the Nuclear Medicine Department. ref SDS 19
041060 -           WO6O
041062 -            ..
041063 -           [On 081106 primary care physician at Kaiser responds asking
041064 -           if an echocardiogram was ordered instead of a Mega test.
041065 -           ref SDS 21 1693
041067 -            ..
041068 -           [On 081106 Millie responds to the medical team confirming
041069 -           that an echocardiogram is scheduled for 081110 0930,
041070 -           ref SDS 22 WH9N, and asks if this duplicates the Muga test,
041071 -           then can the Muga test be cancelled? ref SDS 22 T66S
041073 -            ..
041074 -           [On 081106 1521 primary care physician asks patient to
041075 -           cancel Muga test scheduled on 081111 0930. ref SDS 23 2J9M
041077 -            ..
041078 -           [On 081110 echocardiogram test of heart; initial indications
041079 -           Millie has strong heart that permits low blood pressure, no
041080 -           evident signs of enlarged right ventricle, nor enlarged
041081 -           heart. ref SDS 24 WL63
041083 -         ..
041084 -    9.  The doctor cited experience at Kaiser with sunitinib shows some
041085 -        patients have skin problems [...the work plan on 081016 lists
041086 -        side effects of sunitinib for careful review. ref SDS 3 N94W].
041087 -        He noticed your study calls for low dose, and suggested asking
041088 -        you about what to expect. ref SDS 11 MH3K  Will I be able to
041089 -        continue hiking?
041091 -         ..
041092 -   10.  The manufacturer pays for sunitinib.  Will I get supplemental
041093 -        drugs from UCSF or from Kasier.  What is the ballpark cost per
041094 -        cycle?
041095 -
041096 -            [On 081027 asked Glenna, the study coordinator, about costs
041097 -            to the patient participating in the study. ref SDS 13 724H
041099 -             ..
041100 -            [On 081029 letter to Glenna submits revised work plan that
041101 -            asks for cost of care to the patient for the sunitinib case
041102 -            study. ref SDS 15 SS7L
041104 -         ..
041105 -   11.  I leave for 2 weeks on Sunday, and return Nov 6th.  Hoping I
041106 -        can resume treatment quickly.  We can coordinate by mail on
041107 -        next steps.
041108 -
041109 -            [On 081029 work plan submitted to medical team for Millie
041110 -            to start treatment on 081113. ref SDS 15 0U8N
041112 -             ..
041113 -            [On 081031 Glenna called and reported UCSF has scheduled
041114 -            Millie to begin treatment in the sunitinib clinical study
041115 -            on 081113, starting with meeting Doctor Rugo at UCSF at
041116 -            0830. ref SDS 17 L57F
041118 -             ..
041119 -            [On 081031 UCSF letter confirms Millie scheduled to start
041120 -            treatment in sunitinib clinical study on 081113.
041121 -            ref SDS 18 SJ3W
041122 -
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