THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: November 13, 2008 02:53 PM Thursday; Rod Welch

Millie letter to medical team on meeting at UCSF approving start sunitinib treatment.

1...Summary/Objective


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SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 5 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie met with the medical team this morning at UCSF.  Doctor Rugo's
040902 - team reviewed reports on medical tests received from Kaiser, which
040903 - were requested in Millie's letter to Kaiser on 081111. ref SDS 4 2E5P
040904 - Millie was approved to start treatment tomorrow with sunitinib
040905 - metronomic protocol.
040907 -  ..
040908 - Millie submitted a letter to the primary care physician at Kaiser with
040909 - copies to full medical team, confirming understandings on follow
040910 - up...
040911 -
040912 -    1.  Subject: Sunitinib Treatment Begins at UCSF
040913 -        Date: Thu, 13 Nov 2008 15:05:54 -0800
040923 -         ..
040924 -    2.  I met with Doctor rugo and the medical team at UCSF this
040925 -        morning, including nurse practitioner Tara Lacey.
040927 -         ..
040928 -    3.  Doctor Rugo reviewed medical tests [received from Kaiser, but
040929 -        not the biopsy report on status change, as requested in
040930 -        Millie's letter on 081111, ref SDS 4 2E5P, with a reminder sent
040931 -        yesterday on 081112, ref SDS 5 4T5J], and cleared me to start
040932 -        treatment with sunitinib alone tomorrow. ref SDS 8 OG5H  As set
040933 -        out in Consent documents, which we reviewed in your office on
040934 -        081024, ref SDS 3 XZ8W], my next meeting is in 2 weeks on
040935 -        081126.  At that time, I start with supplemental chemotherapy
040936 -        drugs.
040937 -
040938 -            [On 081113 Kaiser submitted a second report for the CT test
040939 -            on 081107, which turned out to be for only the neck, and
040940 -            complementing the first report received the day before on
040941 -            081112 for everything below the neck. ref SDS 10 6V5I
040943 -             ..
040944 -            [On 081113 Millie sent a supplemental letter to Kaiser
040945 -            notifying Doctor Daamen that during the meeting at UCSF
040946 -            today, Doctor Rugo asked about results of the biopsy on
040947 -            081107 testing for status change, ref SDS 11 IV4S, cited in
040948 -            the letter to the medical team, including Doctor Daamen on
040949 -            081111. ref SDS 4 2E5P
040951 -             ..
040952 -            [On 081113 Millie received from Doctor Daamen at Kaiser
040953 -            partial results of the biopsy performed today. ref SDS 12
040954 -            QY5I
040956 -             ..
040957 -            [On 081202 letter to medical team reports findings from
040958 -            examination on 081126 of recovery from IBC; and days later
040959 -            there was significant increased recovery. ref SDS 13 AS6U
040961 -         ..
040962 -    4.  Thanks very much for extra effort at Kaiser getting everything
040963 -        done so that work commenced today on schedule.
040965 -         ..
040966 -    5.  Doctor Rugo requested corrections to the CT test on 081107 by
040967 -        adding comparison with the test on 080911.[reviewed on 081112
040968 -        shows Kaiser compared the test on 081107 with the test on
040969 -        080718, rather than the most recent test on 080911, ref SDS 7
040970 -        RV49, which was requested by Millie's letter to Kaiser
040971 -        yesterday. ref SDS 6 WJ4Q
040972 -
040973 -            [On 081113 Kaiser submitted a second report for the CT test
040974 -            on 081107, which turned out to be for only the neck, but
040975 -            included overlapping and conflicting findings on the
040976 -            axillary and supraclavicular regions, and further
040977 -            purporting to complement the first report received the day
040978 -            before on 081112 for everything below the neck. ref SDS 10
040979 -            6V5I
040981 -  ..
040982 - These multiple and conflicting reports for the same test on 081107
040983 - caused confusion and error applying findings.
040985 -  ..
040986 - Earlier today, the primary care physician at Kaiser replied to
040987 - Millie's letter requesting corrections to the report for the CT test
040988 - on 081107 saying that Doctor Rugo's view on need for correcting test
040989 - report mistakes is important. ref SDS 9 ML8N
040990 -
040991 -            [On 081230 Jennifer, CT Technologist at Kaiser CT
040992 -            Department in Walnut Creek CA added comments to the work
040993 -            order for the CT test to consolidate findings in a single
040994 -            report, ref SDS 14 FF8M, and to correct the test last month
040995 -            on 081107 by comparing with the previous test on 080911,
040996 -            rather than with the test on 080718. ref SDS 14 F34K
040998 -             ..
040999 -            [On 090409 2018 Doctor Davidson letter advises Kaiser made
041000 -            a mistake publishing multiple reports for each CT test that
041001 -            causes confusion and error presenting patient medical
041002 -            condition, ref SDS 15 L14I; advises future tests will
041003 -            consolidate findings into single report for each test that
041004 -            maintains a well ordered record for efficient case
041005 -            management essential to save lives, time, and money.
041006 -            ref SDS 15 XZ6U
041008 -  ..
041009 - Millie's letter to the medical team continues...
041010 -
041011 -    6.  There was also request [in Millie's letter to Kaiser on 081112]
041012 -        for clarification of finding nodes in the right
041013 -        supraclavicular, ref SDS 6 WJ4W, since cancer has been on my
041014 -        left side, and you found a swelled node on the left neck during
041015 -        the meeting on 080829, ref SDS 1 RP8T, and Doctor Rugo
041016 -        concurred at UCSF on 081016. ref SDS 2 J34X
041018 -         ..
041019 -    7.  Your letter today submitted a 2nd CT test limited only to the
041020 -        neck.  This aligns with the record on 081107 when the CT
041021 -        technician did 2 test runs.
041022 -
041023 -            [On 081230 Jennifer, CT Technologist at Kaiser CT
041024 -            Department in Walnut Creek CA added comments to the work
041025 -            order for the CT test to consolidate findings in a single
041026 -            report, ref SDS 14 FF8M, and to correct the test last month
041027 -            on 081107 by comparing with the previous test on 080911,
041028 -            rather than with the test on 080718. ref SDS 14 F34K
041030 -         ..
041031 -    8.  By copy to Doctor Rugo and Glenna request any additions or
041032 -        corrections to these understandings, including whether the 2nd
041033 -        CT test on the neck clarifies questions today about no mention
041034 -        of nodes in the left supraclavicular, and new reports of nodes
041035 -        in the right supraclavicular?
041036 -
041044 -
041045 -
041046 -
041047 -
041048 -
041049 -
0411 -