CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 8 0000, ref SDS 4 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie submitted an agenda to Glenna for the meeting tomorrow at UCSF
040902 - to review progress recovering from the 5th relapse of IBC, and to get
040903 - a blood draw.  This follows up the agenda for the previous meeting on
040904 - 081126, submitted on 081125. ref SDS 4 QW9N
040905 -
040906 -    1.  Subject: Meeting Agenda UCSF Dec 18th
040907 -        Date: Wed, 17 Dec 2008 14:37:15 -0800
040915 -         ..
040916 -    2.  As noted in the letter to Kaiser on 081211, the next CT test at
040917 -        Kaiser is scheduled on 081230 1020, to comply with your UCSF
040918 -        letter on 081203 requesting scans for review at the meeting on
040919 -        090108.
040921 -         ..
040922 -    3.  Please order the blood test for tomorrow at 0800 in the
040923 -        Infusion Clinic at UCSF to include CA 15-3 and INR.
040924 -
040925 -            [On 081218 agenda submitted today guided the meeting at
040926 -            UCSF with the medical team. ref SDS 12 5G5H
040928 -         ..
040929 -    4.  Results of the lab at Kaiser on 081210 were previously
040930 -        submitted showing NEUTS 1.085. ref SDS 6 S65I
040932 -         ..
040933 -    5.  Cancer marker CA 15-3 197 increased significantly. ref SDS 6
040934 -        PQTQ
040936 -         ..
040937 -    6.  Follow up labs at Kaiser on 081212 showed NEUTS 1.054.
040938 -        ref SDS 7 PQTQ
040940 -         ..
040941 -    7.  As a result, Kaiser withheld Neupogen treatment on 081212  and
040942 -        081213, ref SDS 7 KQ5T, pending review of labs tomorrow at
040943 -        UCSF, when we will need updated guidance on Neupogen scheduled
040944 -        at Kaiser for 081219 and 081220.
040946 -         ..
040947 -    8.  Arlette indicated in conversation that Doctor Johnson leaves to
040948 -        UCSF review of blood test diagnostics, ref SDS 7 KQ66,
040949 -        generally all below or above targets, including platelets 64,
040950 -        about 60% below the target 140.
040951 -
040952 -            [On 081218 labs at UCSF for examination starting 2nd cycle
040953 -            of sunitinib protocol show CBC blood counts again very low,
040954 -            ref SDS 11 075H, with platelets 67, ref SDS 11 7Z6N,
040955 -            attributed for causing new sunitinib side effect of
040956 -            nosebleed, ref SDS 14 GF4S, and NEUTS 0.74 have again
040957 -            fallen substantially, ref SDS 11 QY6H; as a result
040958 -            treatment regimen changed; all treatment was paused for 7
040959 -            days until 081226; Methotrexate ended entirely;
040960 -            consideration will be made to reduce dose for sunitinib.
040961 -            ref SDS 14 GF4V
040963 -             ..
040964 -            [On 081219 1140 primary care physician concurs with UCSF
040965 -            order to pause treatments, ref SDS 15 JK7H; diagnoses
040966 -            cytopenia, including pancytopenia from expanded low blood
040967 -            counts that risks fatal infection, and cause chronic
040968 -            fatigue, muscle weakness, and loss of vitality and vigor
040969 -            associated with chemotherapy. ref SDS 15 LS6K
040971 -             ..
040972 -            [On 090122 0925 Millie suffers fall during aerobics
040973 -            exercise at the gym due to fatigue and muscle weankess
040974 -            caused by low blood counts, ref SDS 17 CW6J; suffered
040975 -            severe pain, ref SDS 17 WS7T, and treated for dislocated
040976 -            shoulder at Emergency Room Department, ref SDS 17 W05P
040977 -                                                                        M
040978 -             ..
040979 -            [On 090213 1140 Doctor Johnson explains risks of cytopenia
040980 -            and pancytopenia that reduce energy, fitness, and muscle
040981 -            strength contribute to Millie's fall and dislocated
040982 -            shoulder. ref SDS 18 PQTX
040984 -         ..
040985 -    9.  Self-examination today indicates further substantial reduction
040986 -        of IBC rash at all locations, as explained in the record,
040987 -        including emotional doubts and worries, which have subsided
040988 -        today along with IBC rash reduction. ref SDS 8 F65G
040990 -  ..
040991 - This confirms the letter on 081202 reporting good response after 14
040992 - days of treatment with sunitinib alone, and starting the 1st full
040993 - cycle of the sunitinib protocol, ref SDS 5 AS6X, and commending the
040994 - medical team for outstanding work achieving good results on a
040995 - difficult challenge of continuing recovery for a 5th relapse of
040996 - cancer. ref SDS 5 AT6X
040997 -
040998 -            [On 081218 UCSF finds substantial recovery from 5th relapse
040999 -            of IBC, including significant reduction of cancer at all
041000 -            sites, and upper left arm that has been most prominent.
041001 -            ref SDS 14 GF8V
041003 -  ..
041004 - Millie's letter to medical team continues...
041005 -
041006 -   10.  Hopefully, the sudden rise of the cancer marker is reconciled
041007 -        by previously unreported adenopathy in the right
041008 -        supraclavicular which was presented in the 2nd report on the
041009 -        neck only for the CT test on 081107, ref SDS 2 OO6M, and which
041010 -        was not received from Kaiser in time for review during the
041011 -        meeting with the medical team on 081113. ref SDS 1 VL5L
041013 -  ..
041014 - Millie's letter to UCSF on 081113 asked if Kaiser submitted the 2nd
041015 - report on the neck for the CT test on 081107. ref SDS 3 4E4Q
041016 -
041017 -            [On 081218 Tara advised that Kaiser did not submit to UCSF
041018 -            the 2nd report on the neck for the CT test on 081107, and
041019 -            asked Millie to submit the report to UCSF. ref SDS 12 LM4I
041021 -             ..
041022 -            [On 081218 Millie submitted to UCSF the 2nd report on the
041023 -            neck for the CT test on 081107, which was requested during
041024 -            the meeting today on 081118. ref SDS 13 4B7N
041026 -             ..
041027 -            [On 081219 the primary care physician explained that rapid
041028 -            recovery with treatment killing many cancer cells can cause
041029 -            release of CA 15-3 protien which in turn creates a
041030 -            short-term rise of cancer marker that conveys false
041031 -            impression of rising cancer, when patient is actually
041032 -            recovering rapidly, ref SDS 15 YK4I, reported in Millie's
041033 -            case in the letter on 081217, ref SDS 9 YJ4V, and later
041034 -            observed during examination at UCSF on 081218, ref SDS 12
041035 -            VD4F, and with similar findings reported again at Kaiser
041036 -            the next day on 081219. ref SDS 15 3L9L
041038 -             ..
041039 -            [On 081230 Jennifer, CT Technologist at Kaiser CT
041040 -            Department in Walnut Creek CA added comments to the work
041041 -            order for the CT test to consolidate findings in a single
041042 -            report, ref SDS 16 FF8M, and to correct the test last month
041043 -            on 081107 by comparing with the previous test on 080911,
041044 -            rather than with the test on 080718. ref SDS 16 F34K
041046 -         ..
041047 -   11.  My personal feeling is that IBC nodes in the breastbone area,
041048 -        which had seemed in the past few weeks to be increasing in
041049 -        number and size, now seem less prominent.
041050 -
041051 -            [On 081218 UCSF finds IBC nodules in the breastbone area
041052 -            have reduced in size and color. ref SDS 14 GF8Y
041054 -         ..
041055 -   12.  We will get another read on the cancer marker tomorrow, and the
041056 -        CT test on 081230 will provide further guidance.
041058 -         ..
041059 -   13.  While I am very pleased with reduction of IBC rash, energy and
041060 -        vitality are significantly drained, shown in the record today
041061 -        (reporting side effects, ref SDS 8 E38H, and further] tracking
041062 -        reduction of physical exercise to near zero. ref SDS 8 X64F
041063 -
041064 -            [On 081218 0700 Millie's record of daily treatments with
041065 -            sunitinib protocol explains greater detail on debilitating
041066 -            side effects that make tolerating treatments very
041067 -            difficult. ref SDS 10 6E7G
041069 -             ..
041070 -            [On 081218 0700 case study patient history shows side
041071 -            effects sunitinib chemotherapy protocol has increased
041072 -            fatigue and muscle weakness that reduces exercise to zero.
041073 -            ref SDS 10 X64F
041075 -             ..
041076 -            [On 081218 1000 during meeting with UCSF medical team Tara
041077 -            was very thorough discussing severe side effects reported
041078 -            in Millie's letter today. ref SDS 12 QW7H
041080 -         ..
041081 -   14.  Low energy may correlate with low blood counts. [implements
041082 -        Doctor Johnson's request conveyed by Arlette at Kaiser on
041083 -        081212 for UCSF to address problem of low blood counts.
041084 -        ref SDS 7 KQ66]
041085 -
041086 -            [On 081218 labs at UCSF for examination starting 2nd cycle
041087 -            of sunitinib protocol show CBC blood counts again very low,
041088 -            ref SDS 11 075H, with platelets 64, ref SDS 11 7Z6N,
041089 -            attributed for causing new sunitinib side effect of
041090 -            nosebleed, ref SDS 14 GF4S, and NEUTS 0.74 have again
041091 -            fallen substantially, ref SDS 11 QY6H; as a result
041092 -            treatment regimen was changed; all treatment was paused for
041093 -            7 days until 081226, ref SDS 12 QW48; Methotrexate ended
041094 -            entirely; consideration will be made to reduce dose for
041095 -            sunitinib, confirmed in Millie's letter to the medical team
041096 -            on 081218. ref SDS 14 GF4V
041098 -             ..
041099 -            [On 081219 1140 primary care physician concurs with UCSF
041100 -            order to pause treatments, ref SDS 15 JK7H; diagnoses
041101 -            cytopenia, including pancytopenia from expanded low blood
041102 -            counts that risks fatal infection, and cause chronic
041103 -            fatigue, muscle weakness, and loss of vitality and vigor
041104 -            associated with chemotherapy. ref SDS 15 LS6K
041106 -             ..
041107 -            [On 090122 0925 Millie suffers fall during aerobics
041108 -            exercise at the gym due to fatigue and muscle weankess
041109 -            caused by low blood counts, ref SDS 17 CW6J; suffered
041110 -            severe pain, ref SDS 17 WS7T, and treated for dislocated
041111 -            shoulder at Emergency Room Department, ref SDS 17 W05P
041113 -             ..
041114 -            [On 090213 1140 Doctor Johnson explains risks of cytopenia
041115 -            and pancytopenia that reduce energy, fitness, and muscle
041116 -            strength contribute to Millie's fall and dislocated
041117 -            shoulder. ref SDS 18 PQTX
041119 -         ..
041120 -   15.  Fortunately, side effects other than fatigue seem mild.  I had
041121 -        some heartburn.  Prilosec prescribed by Tara on 081126 was
041122 -        taken beginning on 081208 and solved the problem.  Recently,
041123 -        joint pain has begun.  You can see the report on side effects
041124 -        including rising joint pain in the record of patient history
041125 -        today. ref SDS 8 6E7G
041127 -         ..
041128 -   16.  Looking forward to the meeting.
041129 -
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0412 -