CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 16 0000, ref SDS 14 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Agenda
040902 -
040903 - The record for the meeting on 081016 has not yet been posted, so the
040904 - agenda can reflect the record for the meeting on 080918. ref SDS 7
040905 - YY3N
040907 -             ..
040908 -            CT test review
040910 -             ..
040911 -            Examination
040913 -             ..
040914 -            Neutropenia need for Neupogen
040916 -             ..
040917 -            Cost of care at UCSF?
040919 -             ..
040920 -            Cost of drugs?
040922 -  ..
040923 - With assistance of Tara, nurse practitioner, and Glenna, the doctor's
040924 - research coordinator, Doctor Rugo reviewed Millie's medical tests
040925 - performed at Kaiser last week.
040927 -  ..
040928 - Examination showed significant increase of IBC disease in area and
040929 - intensity of rash inflammation, compared with the last examination on
040930 - 081016. ref SDS 9 J34U  The right breast shows slight spread and
040931 - higher intensity.  The area around the breastbone has more and larger
040932 - cancer nodules than were evident on 081016.  The area from above the
040933 - breast bone and across the left chest now shows near solid IBC rash
040934 - vertially to the abdomen and wrapping toward the back.  This condition
040935 - seems more severe than when Millie started treatment with cetuximab,
040936 - shown by examination on 070130. ref SDS 3 M68J  Nearly the entire
040937 - upper left arm shows solid, very intense IBC rash.  The doctor
040938 - characterized intensity of IBC on the upper left arm as reflecting
040939 - internal bleeding beneath the skin, and explained this can occur from
040940 - scratching.  Millie reported not having done this.  The doctor
040941 - explained sometimes paients will scratch irritated skin during sleep.
040943 -  ..
040944 - The overall condition reflects the highest continuous CA 15-3 cancer
040945 - marker in patient history.  For some reason, this was not included
040946 - with the labs today, reported in another record. ref SDS 20 WV62  The
040947 - test on 081016 shows CA 15-3 95 for about 3 months. ref SDS 8 VK6H
040949 -  ..
040950 - The doctor asked about results of status change biopsy performed at
040951 - Kaiser on 081107? ref SDS 18 496L  The doctor recalled Millie's letter
040952 - to Kaiser on 081111, ref SDS 19 WP8G, asking for submission to UCSF of
040953 - reports on medical tests. ref SDS 19 2E5P  The doctor explained that
040954 - since UCSF has received everything except the report on status change,
040955 - sunitinib treatment will not be delayed by delay getting the report on
040956 - status change.  She asked Millie to follow up with Kaiser to complete
040957 - the record.
040958 -
040959 -        [...in another record after the meeting at UCSF today, on
040960 -        081113, Millie notified Kaiser again to submit the report on
040961 -        testing for status change. ref SDS 22 IV8K
040963 -         ..
040964 -        [...in another record after the meeting at UCSF today, on
040965 -        081113 Millie received from Doctor Daamen at Kaiser partial
040966 -        results of the biopsy performed today. ref SDS 23 QY5I
040968 -         ..
040969 -        [On 081119 Kaiser submitted summary of final pathology report,
040970 -        ref SDS 24 5O8G, for the biopsy today on 081107, ref SDS 18
040971 -        496L, and it appears status is unchanged, still ER PR Her2neu
040972 -        triple negative. ref SDS 24 UQ5P
040974 -  ..
040975 - The doctor determined that examination today and review of test
040976 - results show Millie is a good candidate for treatment at UCSF with the
040977 - sunitinib metronomic protocol, as set out in the treatment consent
040978 - form entered in the record on 081017, ref SDS 10 YX9N, and approved by
040979 - the primary care physician, Doctor Johnson, during the meeting at
040980 - Kaiser on 081024. ref SDS 13 XZ8W
040982 -  ..
040983 - Doctor Rugo indicated that starting treatment tomorrow will have a
040984 - good chance of reducing Millie's IBC disease.
040985 -
040986 -        [On 081219 1140 primary care physician concurs with UCSF order
040987 -        to pause treatments, ref SDS 29 JK7H; diagnoses cytopenia,
040988 -        including pancytopenia from expanded low blood counts that
040989 -        risks fatal infection, and cause chronic fatigue, muscle
040990 -        weakness, and loss of vitality and vigor associated with
040991 -        chemotherapy. ref SDS 29 LS6K
040993 -         ..
040994 -        [On 090122 0925 Millie suffers fall during aerobics
040995 -        exercise at the gym due to fatigue and muscle weankess
040996 -        caused by low blood counts, ref SDS 31 CW6J; suffered
040997 -        severe pain, ref SDS 31 WS7T, and treated for dislocated
040998 -        shoulder at Emergency Room Department, ref SDS 31 W05P
041000 -         ..
041001 -        [On 090213 1140 Doctor Johnson explains risks of cytopenia and
041002 -        pancytopenia that reduce energy, fitness, and muscle strength
041003 -        contribute to Millie's fall and dislocated shoulder.
041004 -        ref SDS 32 PQTX
041006 -  ..
041007 - Doctor Rugo noticed that the doctor's analysis of Millie's CT test at
041008 - Kaiser in Walnut Creek last week on 081107 was compared with the prior
041009 - test at Kaiser in Walnut Creek on 080718, rather than with the more
041010 - recent test at Kaiser in Oakland on 080911.
041012 -  ..
041013 - The doctor further asked why the analyst described adenopathy in the
041014 - right supraclavicular and makes no mention of findings in the left
041015 - supraclavicular despite recent patient history on 081023 when Doctor
041016 - Daamen at Kaiser reported a biopsy of a large lump in the left
041017 - supraclavicular is positive for cancer. ref SDS 12 4Q9Q  The doctor
041018 - further noted there is no patient history of CT tests reporting
041019 - adenopathy in the right supraclavicular, and no findings from
041020 - palpation in this location during examinations for the past 7 years.
041021 -
041022 -            [On 071212 1711 report of similar issues at Stanford
041023 -            Medical Center getting accurate analysis of radiology
041024 -            tests. ref SDS 4 DT9K
041026 -  ..
041027 - The doctor asked Millie to coordinate with Kaiser for clarification of
041028 - these problems in the report for the CT test on 081107, which help
041029 - establish Millie's baseline condition required to evaluate response
041030 - from starting a new treatment,
041031 -
041032 -        [...in another record today, on 081113 the primary care
041033 -        physician submitted to the medical team a report on a 2nd CT
041034 -        test covering only the neck, ref SDS 21 YO7M, and it describes
041035 -        the node in the left supraclavicular. ref SDS 21 OO6M
041037 -         ..
041038 -        [On 081217 Millie's letter to UCSF cited the 2nd report on the
041039 -        neck issued for the CT test on 081107. ref SDS 26 YJ5Q
041041 -         ..
041042 -        [On 081218 Tara advised that Kaiser did not submit to UCSF the
041043 -        2nd report on the neck for the CT test on 081107, and asked
041044 -        Millie to submit the report to UCSF. ref SDS 27 LM4I
041046 -         ..
041047 -        [On 081218 Millie submitted to UCSF the 2nd report on the neck
041048 -        for the CT test on 081107, which was requested during the
041049 -        meeting today on 081118. ref SDS 28 4B7N
041051 -         ..
041052 -        [On 081218 Millie's letter to Kaiser requests consolidated
041053 -        report for the CT test on 081230 in order to avoid confusion
041054 -        caused by Kaiser publishing multiple reports for the CT test on
041055 -        081107. ref SDS 28 UY3T
041057 -         ..
041058 -        [On 081219 Millie met with primary care physician at Kaiser and
041059 -        requested clarifications of work order to consolidate findings
041060 -        into a single report for the CT test on 081230. ref SDS 29 PI5M
041062 -         ..
041063 -        [On 081230 Jennifer, CT Technologist at Kaiser CT Department in
041064 -        Walnut Creek CA added comments to the work order for the CT
041065 -        test to consolidate findings in a single report, ref SDS 30
041066 -        FF8M, and to correct the test last month on 081107 by comparing
041067 -        with the previous test on 080911, rather than with the test on
041068 -        080718. ref SDS 30 F34K
041069 -
041071 -  ..
041072 - Millie received two bottles of pills with different doses of
041073 - sunitinib.  The prescription calls for taking both pills together
041074 - each day at the same time,
041076 -  ..
041077 - There is no restriction on taking pills with food, and restriction on
041078 - diet.
041080 -  ..
041081 - Millie received enough sunitinib pills today to last for 2 weeks,
041082 - exactly 14 days.  Since in 2 weeks on Thursday will be a holiday for
041083 - Thanksgiving, Glenna and Tara scheduled Millie to see Tara the day
041084 - before on Wednesday.  During the meeting Tara advised she can only see
041085 - Millie in the afternoon on Wednesday.  After the meeting, Glenna
041086 - investigated further and arranged the meeting for the regular time.
041087 -
041088 -            [On 081202 letter to medical team reports findings from
041089 -            examination on 081126 of recovery from IBC; and days later
041090 -            there was significant increased recovery. ref SDS 25 AS6U
041092 -  ..
041093 - Therefore, Millie's next meeting is on 081126 0830 with the Glenna and
041094 - Tara to review response to treatment, evaluate side effects, and
041095 - prescribe supplemental chemotherapy drugs.
041097 -  ..
041098 - Prior to meeting with the medical team on the 2nd floor, Millie will
041099 - meet with Catherine in the Infusion Clinic on the 5th floor for a
041100 - blood draw at 0800.
041102 -  ..
041103 - Millie's letter to the medical team on 081111 requested review of
041104 - requirements for Neupogen treatment. ref SDS 19 2E6Y  Today, there was
041105 - not enough time during the meeting for professional comment.  This
041106 - may reflect that sunitinib is similar to cetuximab that had minimal
041107 - effect on blood counts.
041109 -  ..
041110 - During work in the Infusion Clinic this morning, Catherine advised
041111 - she will be in the Clinic on 081126 for Millie's blood draw at 0800.
041113 -  ..
041114 - After meeting with the medical team, and getting the pescription for
041115 - chemotherapy drugs that will supplement treatment wtih sunitinib,
041116 - Millie will go to the Infusion Clinic for a blood draw.
041117 -
041118 -
041119 -
041120 -
041121 -
041122 -
041123 -
041124 -
041125 -
041126 -
041127 -
0412 -