CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 27 0000. ref SDS 23 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 13
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 - Tara asked today about Millie's letter yesterday on 081217 submitting
040924 - an agenda for the meeting today, and citing a 2nd report on the neck,
040925 - ref SDS 24 TP8L, for the CT test at Kaiser in Walnut Creek on 081107,
040926 - ref SDS 34 YJ5Q, and noting Kaiser's report clarifying evident errors
040927 - in the report for the CT test on 081107, which was requested by Doctor
040928 - Rugo during the meeting at UCSF on 081113. ref SDS 23 VL5L
040930 -  ..
040931 - The report for the CT test on the neck identifies new and increasing
040932 - adenopathy, shown in the record on 081113, ref SDS 24 OO6M, which may
040933 - reconcile rising cancer marker CA 15-3 197 from Kaiser's blood test on
040934 - 081210, ref SDS 31 PQTQ, that shows significant rise of cancer at a
040935 - time when examination today shows substantial recovery from cancer,
040936 - ref SDS 34 YJ4V, cited in Millie's letter yesterday on 081217 to
040937 - enable the medical team to be prepared for the meeting today by
040938 - reconciling conflicting evidence. ref SDS 34 YJ5Q
040940 -  ..
040941 - Tara advised that Kaiser did not submit the 2nd report on the neck to
040942 - UCSF, and so requested that Millie submit the report to complete
040943 - UCSF's record in the medical chart on patient care for the CT test at
040944 - Kaiser on 081107.
040945 -
040946 -        [On 081218 Millie submitted to UCSF the 2nd report on the neck
040947 -        for the CT test on 081107, which was requested during the
040948 -        meeting today on 081118. ref SDS 37 4B7N
040950 -         ..
040951 -        [On 081218 Millie's letter to Kaiser requests consolidated
040952 -        report for the CT test on 081230 in order to avoid confusion
040953 -        caused by Kaiser publishing multiple reports for the CT test on
040954 -        081107. ref SDS 37 UY3T
040956 -         ..
040957 -        [On 081219 Millie met with primary care physician at Kaiser and
040958 -        requested clarifications of work order to consolidate findings
040959 -        into a single report for the CT test on 081230. ref SDS 40 PI5M
040961 -         ..
040962 -        [On 081230 Jennifer, CT Technologist at Kaiser CT
040963 -        Department in Walnut Creek CA added comments to the work
040964 -        order for the CT test to consolidate findings in a single
040965 -        report, ref SDS 45 FF8M, and to correct the test last month
040966 -        on 081107 by comparing with the previous test on 080911,
040967 -        rather than with the test on 080718. ref SDS 45 F34K
040969 -         ..
040970 -        [On 090106 Chris in Radiology Department reported that the
040971 -        referral by the primary care physician ordered consolidated
040972 -        report for Millie's CT test on 081230. ref SDS 46 OO82
040974 -         ..
040975 -        [On 090107 Kaiser issued multiple reports again for
040976 -        Millie's CT test on 081230. ref SDS 48 J85F
040978 -         ..
040979 -        [On 090409 2018 Doctor Davidson, Director fo Radiology of
040980 -        Kaiser Mt Diablo Service Area, advised that Kaiser CT
040981 -        Department Walnut Creek made a mistake issuing multiple reports
040982 -        for the CT test on 090413, ref SDS 53 WB6G, and advised that
040983 -        findings for future CT tests will consolidate findings into a
040984 -        single report for each test. ref SDS 53 XZ6U
040986 -         ..
040987 -        [On 090409 2347 letter thanks Doctor Davidson for correcting
040988 -        problems with CT test reporting, and explains problems for
040989 -        doctors caused by multiple reports on Kaiser CT tests.
040990 -        ref SDS 54 4R4K
040992 -  ..
040993 - Tara advised that UCSF received Millie's letter yesterday on 081217
040994 - submitting an agenda for the meeting today, and reporting progress
040995 - recovering from IBC, ref SDS 34 YJ4V, citing the record of Millie's
040996 - daily treatments with sunitinib. ref SDS 33 M66N
040998 -  ..
040999 - Examination today shows IBC rash has further subsided substantially
041000 - from 3 weeks ago on 081126.  At that time on 081126, Tara observed
041001 - good response to the 14-day test phase to evaluate effectiveness and
041002 - tolerance of side effects with sunitinib alone, ref SDS 27 VD4F, later
041003 - reported in a letter to the medical team on 081202, ref SDS 30 YJ3G,
041004 - which also noted continued improvement until 081202, ref SDS 30 AS6X,
041005 - and then possible slowing of improvement. ref SDS 30 AT4Q
041006 -
041007 -        [...in another record today on 081218 Millie's letter to the
041008 -        medical team confirms findings during the meeting today at UCSF
041009 -        substantial recovery from 5th relapse of IBC. ref SDS 38 4P7F
041011 -         ..
041012 -        [On 081219 1140 examination at Kaiser aligns with findings
041013 -        today of significantly reduced IBC rash all sites. ref SDS 40
041014 -        3L9L
041016 -         ..
041017 -        [On 090109 0027 examination finds significant relapse of IBC
041018 -        worsening. ref SDS 49 UE6R
041020 -         ..
041021 -        [On 090715 0224 Millie had similar experience with MPA
041022 -        protocol recovering from 7th relapse of cancer; IBC got
041023 -        much worse after starting treatment on 090616, and 3-weeks
041024 -        later began to improve, but still looked worse after
041025 -        4-weeks of treatment, than when treatment started on
041026 -        090616. ref SDS 55 0I4Y
041028 -         ..
041029 -        [On 100111 1120 Millie had similar experience where
041030 -        shingles symptoms began to improve after 5 days of
041031 -        treatment, but after 2 days of recovery, still looked worse
041032 -        than when treatment began; this record indicates Millie
041033 -        should have full recovery in another 7 days. ref SDS 56 ML7H
041035 -  ..
041036 - Tara advised that examination today continues strong response to
041037 - sunitinib treatment, finding dramatic recovery from the 5th relapse of
041038 - IBC.  On 081113 intense IBC was spreading from the edge of the right
041039 - breast, enveloping the entire left side of the chest and abdomen,
041040 - wrapping toward the back.  The entire upper left arm was a solid
041041 - deeply intense inflammatory breast cancer.  This was the worst
041042 - condition Millie has suffered in 7 years fighting cancer. ref SDS 23
041043 - OG52  After just 14 days of treatment with sunitinib alone,
041044 - examination on 081126 found significant recovery from cancer.
041045 -
041046 -        [...below in the record today on 081218, Doctor Rugo made an
041047 -        examination and concurred there has been good response to
041048 -        treatment. ref SDS 0 QX44
041050 -  ..
041051 - Examination today shows IBC barely visible at all locations, except
041052 - the upper left arm continues with some patchy areas of intense
041053 - infection with IBC, marked improvement from previous solid and
041054 - continuous cancer.
041056 -  ..
041057 - CA 15-3 95 for the blood test today at UCSF, ref SDS 36 A16M, shows
041058 - significant decline from CA 15-3 197 from lab at Kaiser on 081210.
041059 - ref SDS 31 PQTQ  These tests are not directly correlated, but results
041060 - align with findings today of substantial improvement recovering from
041061 - 5th relapse of IBC.
041062 -
041063 -        [On 081219 the primary care physician explained that rapid
041064 -        recovery with treatment killing many cancer cells can cause
041065 -        release of CA 15-3 protien which in turn creates a short-term
041066 -        rise of cancer marker that conveys false impression of rising
041067 -        cancer, when patient is actually recovering rapidly,
041068 -        ref SDS 40 YK4I, reported in Millie's case in the letter on
041069 -        081217, ref SDS 34 YJ4V, and later observed during examination
041070 -        at UCSF on 081218, ref SDS 0 VD4F, and with similar findings
041071 -        reported again at Kaiser the next day on 081219. ref SDS 40
041072 -        3L9L
041074 -  ..
041075 - The lump in the left supraclavicular, which first indicated
041076 - progression of disease on 080821, ref SDS 12 4C6O, and observed again
041077 - on 081016, ref SDS 15 J34X, today palpates significant reduction in
041078 - size.
041079 -
041080 -        [On 081219 1140 examination at Kaiser aligns with findings
041081 -        today of reduced lymph node in left suprclavicular. ref SDS 40
041082 -        3L9L
041084 -  ..
041085 - Tara was very thorough today discussing severe side effects reported
041086 - in Millie's letter to the medical team yesterday on 081217,
041087 - ref SDS 34 YJ6R, and presented in patient history today on 081218,
041088 - reporting difficulties tolerating daily treatments. ref SDS 35 6E7G
041090 -  ..
041091 - Chronic fatigue and loss of vitality have reduced exercise to zero,
041092 - reported in Millie's letter yesterday, ref SDS 34 YJ6R, and evident
041093 - from case study on patient history today, ref SDS 35 X64F  Tara
041094 - recalled the medical team was pleased during examination on 081126
041095 - when Millie reported the day before on 081125 that side effects were
041096 - zero after 2 weeks of daily treatments with sunitinib alone,
041097 - ref SDS 26 XX3W, shown by daily exercise in the gym and hiking 5 - 8
041098 - miles a day, reported on 081127. ref SDS 28 X64F  After added
041099 - cyclophosphamide and Methotrexate to daily treatments on 081127,
041100 - fatigue started rising on 081130. ref SDS 29 RE9K  A few days later on
041101 - 081202, Millie requested relief from rising side effects to restore
041102 - energy and vitality. ref SDS 30 AT5W
041103 -
041104 -            [...in another record today on 081218 1734 Millie's letter
041105 -            to the medical team confirm firms findings of chronic low
041106 -            blood counts and difficult side effects from chemotherapy.
041107 -            ref SDS 38 GF9X
041109 -             ..
041110 -            [On 081219 1038 Millie's second letter to Kaiser clarifies
041111 -            agenda for meeting with primary care physician to discuss
041112 -            alternatives for changing the treatment plan to reduce side
041113 -            effects, including recent chronic low blood counts.
041114 -            ref SDS 39 SU9Q
041116 -             ..
041117 -            [On 081219 1140 primary care physician concurs UCSF order
041118 -            to pause treatments, ref SDS 40 JK7H; diagnoses cytopenia,
041119 -            including pancytopenia from expanded low blood counts that
041120 -            risks fatal infection, and cause chronic fatigue, muscle
041121 -            weakness, and loss of vitality and vigor associated with
041122 -            chemotherapy. ref SDS 40 LS6K
041124 -             ..
041125 -            [On 090122 0925 Millie suffers fall during aerobics
041126 -            exercise at the gym due to fatigue and muscle weankess
041127 -            caused by low blood counts, ref SDS 50 CW6J; suffered
041128 -            severe pain, ref SDS 50 WS7T, and treated for dislocated
041129 -            shoulder at Emergency Room Department, ref SDS 50 W05P
041131 -             ..
041132 -            [On 090213 1140 Doctor Johnson explains risks of cytopenia
041133 -            and pancytopenia that reduce energy, fitness, and muscle
041134 -            strength that contribute to Millie's fall and dislocated
041135 -            shoulder. ref SDS 51 PQTX
041137 -  ..
041138 - Tara explained that severe loss of energy reducing exercise to zero,
041139 - reported in Millie's letter yesterday on 081217, ref SDS 34 YJ6R, is
041140 - caused by low blood counts, and aligns with patient history showing
041141 - exercise has declined dramatically the past 3 weeks, since adding
041142 - cyclophosphamide and Methotresate on 081114. ref SDS 35 X64F  UCSF
041143 - labs today on 081218, ref SDS 36 075H, show adding cyclophosphamide,
041144 - and Methotrexate to daily treatments has reduced blood counts below
041145 - safe levels, reported in Millie's letter to UCSF yesterday.
041146 - ref SDS 34 YJ6W
041148 -  ..
041149 - Tara feels the medical team can adjust Millie's daily treatment to
041150 - reduce fatigue, and closely monitored Neupogen will increase blood
041151 - counts.
041152 -
041153 -            [...below, in the record today on 081218 the doctor
041154 -            proposes new treatment plans. ref SDS 0 R65H
041156 -  ..
041157 - Nosebleed presented today on 081218 in patient history on side effects
041158 - of sunitinib, ref SDS 35 ZF5F, was attributed during the meeting to
041159 - low platelets 67, reported for labs at Kaiser on 081210, ref SDS 31
041160 - DM6J, cited in Millie's letter to the medical team on 081211,
041161 - ref SDS 32 S28P, continued in follow up labs at Kaiser on 081212,
041162 - cited in the letter on 081217, ref SDS 34 YJ4S, submitting the agenda
041163 - for meeting today, and reported again with the lab at UCSF this
041164 - morning on 081218 showing platelets 67. ref SDS 36 7Z6N
041165 -
041166 -            [...in another record today on 081218 1734 Millie's letter
041167 -            to the medical team confirm firms findings of chronic low
041168 -            blood counts and difficult side effects from chemotherapy.
041169 -            ref SDS 38 GF9X
041171 -             ..
041172 -            [On 081219 1038 Millie's second letter to Kaiser clarifies
041173 -            agenda for meeting with primary care physician to discuss
041174 -            alternatives for changing the treatment plan to reduce side
041175 -            effects, including recent chronic low blood counts.
041176 -            ref SDS 39 SU9Q
041178 -             ..
041179 -            [On 081219 1140 primary care physician concurs UCSF order
041180 -            to pause treatments, ref SDS 40 JK7H, due to rising
041181 -            cytopenia, including pancytopenia from expanded low blood
041182 -            counts that risks fatal infection. ref SDS 40 LS6K
041184 -  ..
041185 - Tara made a careful examination of Millie's feet observing lesions and
041186 - blisters causing discomfort that reduces ability to walk, reported in
041187 - patient history on side effects of treatment with the sunitinib
041188 - protocol, reported in patient history earlier today. ref SDS 35 AS4O
041190 -  ..
041191 - Labs today at UCSF show NEUTS 0.74, and platelets very low at 0.67.
041192 - The doctor ordered Neupogen treatment tomorrow and Saturday,
041193 - previously scheduled.
041195 -  ..
041196 - Tara feels Millie's constant fitigue and ill feeling is shown by
041197 - chronic low blood counts.
041199 -  ..
041200 - Glenna left the meeting to consult with Doctor Rugo.
041202 -  ..
041203 - Tara explained that evaluating cancer marker CA 15-3 197 at Kaiser for
041204 - the blood test on 081210 presents difficulties, because UCSF practice
041205 - emphasizes comparing uniform test labs.  Tara feels CA 15-3 197 at
041206 - Kaiser deserves review, and advised that the blood test today at UCSF
041207 - will enable accurate analysis comparing patient history for the cancer
041208 - marker test the past 2 years at UCSF.  As a result, discussion of CA
041209 - 15-3 197 was deferred until results of the lab at UCSF are published
041210 - for the cancer marker next week.
041212 -  ..
041213 - Glenna returned and advised that the doctor ordered...
041214 -
041215 -        1.  Neupogen at Kaiser tomorrow and Saturday to increase blood
041216 -            counts.
041217 -
041218 -        2.  Cancer treatments paused for 1 week starting tomorrow, and
041219 -            resume with sunitinib alone on 081226, continuing the
041220 -            successful regimen during the first 14 days of treatment,
041221 -            reported on 081126, ref SDS 27 VD4F, and cited in Millie's
041222 -            letter to the medical team on 081202. ref SDS 30 YJ3G
041224 -             ..
041225 -        3.  Chemotherapy treatments ended permenantly with
041226 -            cyclophosphmaide and Methotrexate.
041228 -  ..
041229 - Tara prepared written instructions to facilitate implementation of
041230 - guidance for treatment decisions today.
041232 -  ..
041233 - This includes using an over-the-counter spray to maintain moisture in
041234 - the nasal passage, which helps control and avoid nosebleed, reported
041235 - today, per above, ref SDS 0 WS8O, and which can be a rare side effect
041236 - of sunitinib, related in part to low platelets.
041238 -  ..
041239 - Tara explained that energy and vitality should increase with pausing
041240 - treatments for 1 week, and that recovery from cancer will continue
041241 - with sunitinib alone when daily treatments resume on 081226.  Tara
041242 - feels Millie's reduced IBC symptoms during the 2-week protocol
041243 - evaluation period, reported during the meeting at UCSF on 081126.
041244 - ref SDS 27 VD4F, and cited in the letter to the medical team on
041245 - 081202, ref SDS 30 YJ3G, shows Millie's cancer can be treated
041246 - effectively with sunitinib alone.  Tara further advised that ending
041247 - chemotherapy treatments with cyclophosphamide and Methotrexate should
041248 - significantly reduce debilitating side effects, per above, ref SDS 0
041249 - WS8N, because sunitinib is a "targeted" drug that only destroys cancer
041250 - cells, rather than healthy cells the body needs.
041252 -  ..
041253 - Millie was grateful for prognosis of continuing recovery from cancer
041254 - with reduced side effects.  Life can become liveable again enabling
041255 - exercise that builds the immune system to fight cancer and other
041256 - infirmities, called out by Kaiser on 030606, ref SDS 1 JP7G, and cited
041257 - in a recent health care seminar on 081018. ref SDS 17 IT68
041259 -  ..
041260 - Tara and Glenna both left the examination room to consult again with
041261 - Doctor Rugo.
041263 -  ..
041264 - They returned about 5 minutes later and advised that the doctor will
041265 - visit with Millie briefly during the meeting today.
041267 -  ..
041268 - Tara advised that the doctor revised the initial treatment plan to end
041269 - cyclophosphamide, and decided instead stop all treatments beginning
041270 - tomorrow on 081219, and...
041271 -
041272 -        1.  Resume sunitinib on 081226 for 14 days (after pausing for 7
041273 -            days) at a reduced dose of 25 mg per day, rather than 37.5
041274 -            mg per day that was successful during the first 14 days of
041275 -            treatment, reported at UCSF on 081126, and shows continuing
041276 -            recovery in findings from examination today, per above.
041277 -            ref SDS 0 VD4F
041279 -             ..
041280 -        2.  Chemotherapy treatments with cyclophosphmaide continue on
041281 -            081226 for 14-days at the original dose 50 mg per day along
041282 -            with the reduced dose of sunitinib under point 1.
041284 -             ..
041285 -        3.  Methotrexate treatment ended.
041287 -  ..
041288 - Tara prepared a revised written order to confirm verbal explanation of
041289 - the new treatment plan.
041290 -
041291 -            [On 081218 labs at UCSF for examination starting 2nd cycle
041292 -            of sunitinib protocol show CBC blood counts again very low,
041293 -            ref SDS 36 075H, with platelets 64, ref SDS 36 7Z6N,
041294 -            attributed for causing new sunitinib side effect of
041295 -            nosebleed, ref SDS 38 GF4S, and NEUTS 0.74 have again
041296 -            fallen substantially, ref SDS 36 QY6H; as a result
041297 -            treatment regimen was changed; all treatment was paused for
041298 -            7 days until 081226, ref SDS 0 QW48; Methotrexate ended
041299 -            entirely; consideration will be made to reduce dose for
041300 -            sunitinib, confirmed in Millie's letter to the medical team
041301 -            on 081218. ref SDS 38 GF4V
041303 -             ..
041304 -            [On 081219 1140 primary care physician concurs UCSF order
041305 -            to pause treatments, ref SDS 40 JK7H, due to rising
041306 -            cytopenia, including pancytopenia from expanded low blood
041307 -            counts that risks fatal infection. ref SDS 40 LS6K
041309 -             ..
041310 -            [On 081223 Millie's letter to medical team commends Doctor
041311 -            Rugo for engineering recovery from 5th relapse of
041312 -            Inflammatory Breast Cancer (IBC) with sunitinib,
041313 -            ref SDS 41 BV4T; Millie cited discussion with Doctor
041314 -            Johnson at Kaiser today on 081219 explaining competing
041315 -            values of patient health and getting test data, ref SDS 41
041316 -            BV6R; Millie advised the medical team of willingness to
041317 -            optimize recovery by maintaining sunitinib dose amount that
041318 -            has been effective, and to reduce dose or eliminate
041319 -            treatment with cyclophosphamide that may not be effective,
041320 -            and which may be causing severe adverse chemotherapy side
041321 -            effects that prevent Millie from getting sufficient
041322 -            treatment with sunitinib to continue recovery for cancer.
041323 -            ref SDS 41 BW3V
041325 -  ..
041326 - The doctor joined the meeting in the examination room.  After looking
041327 - at Millie's IBC, the doctor asked for the report on that last CT scan
041328 - on 081107.  Tara explained Kaiser evidently issued 2 reports for the
041329 - CT test on 081107, and that Kaiser has not submitted the 2nd report to
041330 - UCSF, per Tara's initial discussion, shown above. ref SDS 0 LM4I
041332 -  ..
041333 - Doctor Rugo read the first report on scans from the neck down, and
041334 - indicated they indicate reduced adenopathy.  She asked why findings on
041335 - scans for neck were published separately; and, why UCSF did not get
041336 - the 2nd report?  The doctor noted that multiple reports for a single
041337 - test significantly complicates evaluating findings.
041339 -  ..
041340 - Millie explained the meeting scheduled with the primary care physician
041341 - at Kaiser tomorrow will request consolidated findings.
041342 -
041343 -            [On 081218 Millie's letter to Kaiser requests consolidated
041344 -            report for the CT test on 081230 in order to avoid
041345 -            confusion caused by Kaiser publishing multiple reports for
041346 -            the CT test on 081107. ref SDS 37 UY3T
041348 -             ..
041349 -            [On 081219 Millie met with primary care physician at Kaiser
041350 -            and requested clarifications of work order to consolidate
041351 -            findings into a single report for the CT test on 081230.
041352 -            ref SDS 40 PI5M
041354 -             ..
041355 -            [On 081230 Jennifer, CT Technologist at Kaiser CT
041356 -            Department in Walnut Creek CA added comments to the work
041357 -            order for the CT test to consolidate findings in a single
041358 -            report, ref SDS 45 FF8M, and to correct the test last month
041359 -            on 081107 by comparing with the previous test on 080911,
041360 -            rather than with the test on 080718. ref SDS 45 F34K
041362 -             ..
041363 -            [On 090106 Chris in Radiology Department reported that the
041364 -            referral by the primary care physician ordered consolidated
041365 -            report for Millie's CT test on 081230. ref SDS 46 OO82
041367 -             ..
041368 -            [On 090107 Kaiser issued multiple reports again for
041369 -            Millie's CT test on 081230. ref SDS 48 J85F
041370 -
041372 -  ..
041373 - the doctor concurred that examination today shows significant
041374 - improvement recovering from cancer, per Tara's review above.
041375 - ref SDS 0 VD4F
041376 -
041377 -            [On 081219 1140 examination at Kaiser aligns with findings
041378 -            today of significantly reduced IBC rash all sites.
041379 -            ref SDS 40 3L9L
041381 -             ..
041382 -            [On 081219 the primary care physician explained that rapid
041383 -            recovery with treatment killing many cancer cells can cause
041384 -            release of CA 15-3 protien which in turn creates a
041385 -            short-term rise of cancer marker that conveys false
041386 -            impression of cancer rising, when patient is actually
041387 -            recovering rapidly, ref SDS 40 YK4I, reported in Millie's
041388 -            case in the letter on 081217, ref SDS 34 YJ4V, and later
041389 -            observed during examination at UCSF on 081218, ref SDS 0
041390 -            VD4F, and with similar findings reported again at Kaiser
041391 -            the next day on 081219. ref SDS 40 3L9L
041393 -  ..
041394 - Before leaving the meeting, the doctor considered the treatment plan
041395 - with respect to reducing Sunitinib from 37.5 down to 25 mg per day.
041397 -  ..
041398 - The doctor noticed findings from examination today showing significant
041399 - recovery from the 5th relapse of IBC.  The doctor recalled similar
041400 - findings of significant improvement with the prior treatment after
041401 - adding Carboplatin to cetuximab, reported on 080501. ref SDS 9 NW3N  A
041402 - month later on 080529, treatment with Carboplatin was reduced in order
041403 - to reduce side effects of chronic low blood counts, ref SDS 10 PVUQ, as
041404 - proposed today. ref SDS 0 QW48  In that case, IBC disease got worse,
041405 - reported on 080821. ref SDS 12 4C6O
041407 -  ..
041408 - Patient history shows similar poor results after reducing treatment
041409 - for the 3rd relapse of IBC in 2006.  Earlier, in 2005, full dose of
041410 - capecitabine yielded miraculous recovery from the 2nd relapse of IBC,
041411 - reported in findings by the primary care physician on 050520.
041412 - ref SDS 2 025H, and later by the surgeon in another meeting at Kaiser
041413 - on 050724. ref SDS 3 YY7F  A year later after IBC disease relapsed for
041414 - the 3rd time, Kaiser considered good results starting treatment with a
041415 - full dose in 2005. ref SDS 4 RH9L  Treatment was resumed with reduced
041416 - dose of capecitabine, reported on 060711, ref SDS 4 PF3O, and failed,
041417 - reported beginning with the first cycle on 060806. ref SDS 5 7Q95
041419 -  ..
041420 - Today, the doctor decided to evaluate whether to reduce sunitinib to
041421 - 25 mg per day, which has proven to be effective treatment at the full
041422 - dose of 37.5 mg per day for the 5th relapse of IBC.  The doctor
041423 - ordered another blood test on 081226 next Friday at Kaiser.  If blood
041424 - counts are high, NEUTS above 1.250, then sunitinib will be continued
041425 - at the full dose 37.5 mg per day with the current dose of
041426 - cyclophosphamide 50 mg per day.
041427 -
041428 -            [On 081218 Millie's letter to medical team confirms work
041429 -            plan to evaluate treatments based on blood test at Kaiser
041430 -            on 081226. ref SDS 38 GF5X
041432 -             ..
041433 -            [On 081219 primary care physician at Kaiser orders blood
041434 -            test on 081226 to implement UCSF work plan. ref SDS 40 3L6L
041436 -             ..
041437 -            [On 081223 Glenna called and advised that the medical team
041438 -            orders Neupogen treatment for Millie when blood counts fall
041439 -            below NEUTS 1.000 (ANC 1000). ref SDS 42 4P4K
041441 -             ..
041442 -            [On 081226 NEUTS 1.71 (ANC 1710) for blood test at Kaiser.
041443 -            ref SDS 43 DM6M
041445 -             ..
041446 -            [On 081230 case study dilemma cancer treatmnets cause low
041447 -            blood counts, which prevents getting treatment; not getting
041448 -            treatment incerases cancer; UCSF paused treatment for a
041449 -            week and prescribed Neupogen to increase blood counts.
041450 -            ref SDS 44 I87N
041452 -  ..
041453 - There was no further discussion today about reducing or eliminating
041454 - cyclophosphamide to reduce side effects, rather than reduce the dose
041455 - of sunitinib.  Since Millie has had 6 previous high does treatments
041456 - with cyclophosphamide beginning in 2002, and continuing in 2005,
041457 - cancer cells may be resistant.  Ending this chemotherapy could enable
041458 - maintaining the full dose of sunitinib, which might optimize recovery
041459 - and bring greater relief of side effects, rather than reduce sunitinib
041460 - which has proven effective treating Millie's cancer.
041462 -             ..
041463 -            [On 081223 Millie's letter to medical team reports patient
041464 -            willing to maintain dose of sunitinib and reduce or end
041465 -            treatment with chemotherapy cyclophosphamide in order to
041466 -            maintain progress recovering from IBC and to reduce side
041467 -            effects of chemotherpay. ref SDS 41 BW3V
041469 -             ..
041470 -            [On 090106 Millie's letter to medical team submitting
041471 -            agenda for meeting on 090106 discusses reducing
041472 -            cyclophosphamide in order to maintain treatment with
041473 -            sunitinib. ref SDS 47 YO4Y
041475 -             ..
041476 -            [On 090109 Millie letter to medical team reports blood
041477 -            counts very low again, NEUTS 0.87, confirms UCSF treatment
041478 -            plan on 090108 continues sunitinib at full strenth, and
041479 -            pauses cyclophosphamice until blood counts rise to NEUTS
041480 -            1.00, and further reduces cyclophosphamide from 7 to 5 days
041481 -            per week. ref SDS 49 UF3Q
041483 -  ..
041484 - Another concern is low blood counts for platelets.
041486 -  ..
041487 - The doctor wants to be notified on 081226 in the event the blood test
041488 - on 081226 shows results of platelets blow 75.
041489 -
041490 -            [...in another record today on 081218, Millie's letter to
041491 -            the medical team confirms instructions to notify Doctor
041492 -            Rugo if the lab at Kaiser on 081226 reports platelets below
041493 -            75. ref SDS 38 GF6T,
041495 -             ..
041496 -            [On 081219 1140 primary care physician concurs UCSF order
041497 -            to pause treatments, ref SDS 40 JK7H, due to rising
041498 -            cytopenia, including pancytopenia from expanded low blood
041499 -            counts that risks fatal infection. ref SDS 40 LS6K
041501 -             ..
041502 -            [On 081226 platelets 187 for blood test at Kaiser.
041503 -            ref SDS 43 DM6M
041505 -             ..
041506 -            [On 090310 1500 platelets 245 again well within normal
041507 -            range. ref SDS 52 8T6M
041509 -  ..
041510 - After meeting on the 2nd floor in Breast Care Clinic with the medical
041511 - team, Glenna met with Millie on the 5th floor in the Infusion Clinic.
041512 - Millie had to return so that Catherine could remove the Huber needle,
041513 - which was left in place after the blood draw at 0800, because
041514 - Catherine thought the medical team might order IV treatment to restore
041515 - blood counts.  Since the doctor decided
041516 -
041517 -
041518 -
041519 -
041520 -
041521 -
041522 -
041523 -
041524 -
0416 -