CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 11 0000, ref SDS 9 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Karen called this morning from the Head and Neck Department for
040902 - Kaiser in Walnut Creek.
040904 -  ..
040905 - Karen explained that after the doctor met with Millie on 081024 at
040906 - 1130 and scheduled Millie to get a core biopsy on 081107 1130,
040907 - ref SDS 11 W15J, he had to schedule an emergency surgery on 081107.
040908 - He then goes on vacation.  Karen said the earliest anyone can do the
040909 - biopsy procedure at Kaiser is on 081117 at 1130.
040910 -
040911 -        [On 081106 Doctor Daamen called and changed the schedule again,
040912 -        ref SDS 20 5F5H, for the core biopsy back to 081107 1600.
040913 -        ref SDS 20 5F68
040915 -  ..
040916 - Karen noticed from patient history that Doctor Laio performed an FNA
040917 - biopsy on 040303, ref SDS 1 Y171, and Doctor Daamen recently did an
040918 - FNA biopsy on 081022. ref SDS 5 NZ5N  Karen said during the call today
040919 - that neither Doctor Laio nor Doctor Daamen is available sooner than
040920 - Doctor Wong on 081117.
040922 -  ..
040923 - This record presents a caution.
040925 -  ..
040926 - This is the third time Kaiser has delayed doing the core biopsy for
040927 - Millie, to replace the FNA biopsy ordered by UCSF on 081016.
040928 - ref SDS 4 J36R  Giving a reason for delay that a doctor has an
040929 - emergency procedure 2 weeks ahead in time, presents a red flag caution
040930 - that people are reluctant to perform the core biopsy for Millie's
040931 - patient profile of compound maladies that include cancer and pulmonary
040932 - embolism, noted by Doctor Wong during the meeting at Kaiser on 081024.
040933 - ref SDS 11 W19G  Reporting today that two people who have done FNA
040934 - biopsies for Millie in the left supraclavicular are "not available" to
040935 - perform the core biopsy in this location is another caution that
040936 - people familiar with Millie's care won't do the core biopsy.  Doctor
040937 - Daamen's letter on 081023 reporting that Kaiser can only test for
040938 - status change with a core biopsy, and asking if this is necessary,
040939 - ref SDS 7 4Q5V, shows further reluctance to do a core biopsy on
040940 - Millie's neck at a location identified by the FNA biopsy on 081022 to
040941 - be infected with cancer, noted by Doctor Wong during the meeting at
040942 - Kaiser last Friday on 081024. ref SDS 11 O54N
040944 -  ..
040945 - Karen advised that Doctor Daamen and Doctor Wong seemed to indicate
040946 - today that the purpose of testing for status change ordered by UCSF on
040947 - 081016, ref SDS 4 J36R, is to expand Millie's treatments, which are
040948 - currently limited by triple negative status.
040950 -  ..
040951 - Karen did not say so during the call, but the Head and Neck Department
040952 - at Kaiser in Walnut Creek may have reviewed Doctor Shim's letter on
040953 - 050909 with 2nd opinion from the Surgery Department at Kaiser in
040954 - Oakland that recommended repeat ER, PR, and HER-2 status check that
040955 - can have a "huge impact" on treatment options. this needs ref SDS 2
040956 - JX9P
040958 -  ..
040959 - Karen indicated today that Kaiser in Walnut Creek feels delaying core
040960 - biopsy for status change tests may not delay starting Millie's
040961 - treatment a UCSF in the sunitinib clnical study.
040963 -  ..
040964 - Karen said the earliest Kaiser can schedule the work now for
040965 - performing a core biopsy to check for status change is on 081117 1130.
040967 -  ..
040968 - Went ahead and set this up.
040969 -
040970 -        [...in another record today, Millie notifies UCSF that Kaiser
040971 -        delays biopsy to check for status change until 081117.
040972 -        ref SDS 12 G15K
040974 -         ..
040975 -        [...in another record today, Glenna coordinates tasks for
040976 -        Millie to start treatment in the sunitinid clinical study, and
040977 -        does not mention anything about Kaiser delaying the core biopsy
040978 -        to check for status change another 2 weeks. ref SDS 13 TU5I
040980 -         ..
040981 -        [On 081106 Doctor Daamen called and changed the schedule again,
040982 -        ref SDS 20 5F5H, for the core biopsy back to 081107 1600.
040983 -        ref SDS 20 5F68
040985 -  ..
040986 - Kaiser delaying the work 3 times, per Karen's call today above,
040987 - ref SDS 0 G15K, indicates significant reluctance to perform core
040988 - biopsy for reasons cited by Doctor Wong on 081024. ref SDS 11 W183
040989 - Additionally, Doctor Daamen's letter to the medical team on 081024
040990 - asked if a core biopsy to check status change is "necessary" in the
040991 - face of a doctor's signed order dated 081016 for an FNA biopsy to
040992 - check for status change, ref SDS 4 J36R, implies people should pause
040993 - to weigh risks and benefits of a core biopsy procedure, ref SDS 7
040994 - 4Q5V, and consider how to get the work done with less risky FNA
040995 - procedure ordered by the doctor, and in order to get "huge" potential
040996 - benefits for patient care cited by Doctor Shim in a letter from Kaiser
040997 - on 050909. ref SDS 2 JX9P
040999 -         ..
041000 -        [On 081029 sunitinib work plan update proposes doing FNA
041001 -        biopsy at UCSF to check for status change. ref SDS 14 SF3P
041003 -         ..
041004 -        [On 081031 letter to UCSF with copy to Kaiser asks about doing
041005 -        FNA biopsy at UCSF. ref SDS 15 NN5S
041007 -         ..
041008 -        [On 081031 Glenna advised that biopsy for status change is not
041009 -        a requirement for the sunitinib clinical trial, and so
041010 -        recommended contacting Doctor Rugo and Doctor Johnson.
041011 -        ref SDS 15 T27H
041013 -         ..
041014 -        [On 081031 Millie submits letter to medical team asking about
041015 -        doing the FNA biopsy to test status change at UCSF to reduce
041016 -        risks of core biopsy method. ref SDS 16 AJ6U
041018 -         ..
041019 -        [On 081101 Doctor Rugo says FNA biopsy to check for status
041020 -        change is not part of sunitinib clinical study; requires Kaiser
041021 -        approval of payment which would be very cost effective since
041022 -        FNA biopsy at UCSF would cost much less than the more invasive
041023 -        and problematic core biopsy Kaiser has scheduled for Millie on
041024 -        081113. ref SDS 17 5G5H
041026 -         ..
041027 -        [On 081102 Millie's letter to Doctor Rugo with copy to primary
041028 -        care physician at Kaiser asks how much the FNA biopsy to test
041029 -        for status change will cost at UCSF, and notes this should be
041030 -        less expensive than doing the core biopsy at Kaiser.
041031 -        ref SDS 18 AD3F
041033 -         ..
041034 -        [On 081103 primary care physician advises that Kaiser will
041035 -        perform the procedure. ref SDS 19 2M64
041037 -         ..
041038 -        [On 081106 Doctor Daamen called and changed the schedule again,
041039 -        ref SDS 20 5F5H, for the core biopsy back to 081107 1600.
041040 -        ref SDS 20 5F68
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0411 -