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: December 18, 2008 06:22 PM Thursday;
Rod Welch
Millie letter to medical team on understandings from meeting today at UCSF.
1...Summary/Objective
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 13 0000, ref SDS 10 0000.
040502 -
040503 -
040504 -
040506 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie met this morning on 081218 with the medical team at UCSF to
040902 - review progress, ref SDS 13 5G5H, based on the agenda submitted the
040903 - day before on 081217. ref SDS 10 VZ5I
040905 - ..
040906 - This afternoon, Millie submitted a letter confirming understandings on
040907 - changes in treatment, and planning for evaluation further adjustments
040908 - based on results of testing. Copies went to primary care physician at
040909 - Kaiser, the Coumadin Treatment case manager at Kaiser, and to Doctor
040910 - Stritter who asked on 081018 to be notified of Millie's progress as
040911 - part of the doctor's research on cutting edge treatments. ref SDS 4
040912 - 1Y4G
040914 - ..
040915 - [On 081219 Millie sent another letter to Kaiser only that
040916 - complements the letter today in order to clarify planning
040917 - options for adjusting treatments to maintain recovery, with
040918 - less side effects. ref SDS 16 SU8R
040920 - ..
040921 - Millie's letter says...
040922 -
040923 - 1. Subject: Meeting UCSF Dec 18th Agenda Meeting at Kaiser Dec 19th
040924 - Date: Thu, 18 Dec 2008 18:36:07 -0800
040937 - ..
040938 - 2. This confirms understandings from meeting with the medical team
040939 - at UCSF this morning at 1000. ref SDS 13 0001
040941 - ..
040942 - 3. Tara made findings of substantial improvement recovering from
040943 - the 5th relapse of IBC [as reported in Millie's letter to the
040944 - medical team on 081217 for preparing to meet, ref SDS 10 YJ4V].
040945 - Rash intensity has subsided, including the upper left arm that
040946 - has been a major problem in recent months.
040948 - ..
040949 - 4. Nodules in the breastbone area have reduced in size and color
040950 - [as reported in Millie's letter to the medical team on 081217
040951 - for preparing to meet, ref SDS 10 YJ5V].
040953 - ..
040954 - 5. Tara palpated reduced size of the node in the left
040955 - supraclavicular, and could identify no nodes in the right
040956 - supraclavicular consistent with examinations the past 7 years.
040958 - ..
040959 - 6. Doctor Rugo visited with the team and concurred examination
040960 - findings show significant improvement.
040961 -
040962 - [On 081219 the primary care physician explained that rapid
040963 - recovery with treatment killing many cancer cells can cause
040964 - release of CA 15-3 protien which in turn creates a
040965 - short-term rise of cancer marker that conveys false
040966 - impression of rising cancer, when patient is actually
040967 - recovering rapidly, ref SDS 17 YK4I, reported in Millie's
040968 - case in the letter on 081217, ref SDS 10 YJ4V, and later
040969 - observed during examination at UCSF on 081218, ref SDS 13
040970 - VD4F, and with similar findings reported again at Kaiser
040971 - the next day on 081219. ref SDS 17 3L9L
040973 - ..
040974 - [On 081230 0109 Millie's letter to medical team reports IBC
040975 - seemed to significantly increase on 081224 and 081225, then
040976 - seemed to improve somewhat. ref SDS 21 JV5M
040978 - ..
040979 - [On 090109 0027 examination finds significant relapse of
040980 - IBC worsening. ref SDS 22 UE6R
040982 - ..
040983 - 7. CBC Blood counts in the test today at UCSF continue to suffer
040984 - substandard levels, e.g., NEUTS 0.74 and platelets 67. Most
040985 - all CBC counts are below targets. ref SDS 12 YN8O
040987 - ..
040988 - 8. By copy notifying Gloria at Kaiser's Coagulation Treatment
040989 - Clinic that INR 2.8. ref SDS 12 PU7Y
040990 -
040991 - [On 081219 Millie received letter from Gloria presenting
040992 - prescription for Coumadin. ref SDS 18 Z68L
040994 - ..
040995 - 9. Also reported nosebleed today [during meeting at UCSF,
040996 - ref SDS 13 WS8O, and presented in patient history on side
040997 - effects of sunitinib, ref SDS 11 ZF5F], attributed during the
040998 - meeting to low platelets [67 reported for labs at Kaiser on
040999 - 081210, ref SDS 8 DM6J, cited in Millie's letter to the medical
041000 - team on 081211, ref SDS 9 S28P, reported in follow up labs at
041001 - Kaiser on 081212 cited in the letter on 081217, ref SDS 10
041002 - YJ4S, submitting the agenda for meeting yesterday, and again in
041003 - the lab at UCSF yesterday on 081218 showing platelets 67,
041004 - ref SDS 12 7Z6N], along with low energy i.e., rising chronic
041005 - fatigue under the current treatment regimen [discussed with the
041006 - medical team at UCSF yesterday on 081218, ref SDS 13 QW7H,
041007 - review issues presented in Millie's letter yesterday on 081217
041008 - submitted for the medical team to prepare for the meeting,
041009 - ref SDS 10 YJ6R].
041011 - ..
041012 - 10. Doctor Rugo addressed these conditions by pausing all treatment
041013 - for 1 week until 081226. ref SDS 13 QW49 This provides time
041014 - for bone marrow to replenish blood counts [explained previously
041015 - at Kaiser on 030606. ref SDS 1 TT3G, reviewed again at Kaiser
041016 - on 040614, ref SDS 2 6T7F, and discussed at UCSF on 070301,
041017 - ref SDS 3 D24M]
041019 - ..
041020 - Changing treatment to reduce side effects so that treating cancer can
041021 - be tolerated responds to Millie's letter to the medical team on
041022 - 081202, ref SDS 7 AT6U, and to the more recent letter sent yesterday
041023 - on 081217 to prepare for the meeting today. ref SDS 10 YJ6R
041024 -
041025 - [On 081219 1038 Millie's second letter to Kaiser clarifies
041026 - agenda for meeting with primary care physician to discuss
041027 - alternatives for changing the treatment plan to reduce side
041028 - effects, including recent chronic low blood counts.
041029 - ref SDS 16 SU9Q
041031 - ..
041032 - [On 081219 1140 primary care physician concurs UCSF order
041033 - to pause treatments, ref SDS 17 JK7H, due to rising
041034 - cytopenia, including pancytopenia from expanded low blood
041035 - counts that risks fatal infection. ref SDS 17 LS6K
041037 - ..
041038 - Millie's letter to the medical team continues...
041039 -
041040 - 11. Treatment was ended entirely with Methotrexate. [Millie feels
041041 - this will be a big help reducing side effects of ill feelings
041042 - reported the past few weeks, including today. ref SDS 11 E38H
041043 -
041044 - [On 081219 Millie sent another letter to Kaiser only that
041045 - complements the letter today in order to clarify planning
041046 - options for adjusting treatments to maintain recovery, with
041047 - less side effects. ref SDS 16 SU8R
041049 - ..
041050 - 12. There was consideration to end treatment with cyclophosphamide
041051 - and to reduce sunitinib from 37.5 mg to 25 mg per day. Upon
041052 - discussion, treatment with cyclophosphamide was continued at
041053 - prescribed strength, 50 mg per day, beginning next week on
041054 - 081226.
041055 -
041056 - [On 081223 Millie's letter to medical team commends Doctor
041057 - Rugo for engineering recovery from 5th relapse of
041058 - Inflammatory Breast Cancer (IBC) with sunitinib,
041059 - ref SDS 19 BV4T; Millie cited discussion with Doctor
041060 - Johnson at Kaiser today on 081219 explaining competing
041061 - values of patient health and getting test data, ref SDS 19
041062 - BV6R; Millie advised the medical team of willingness to
041063 - optimize recovery by maintaining sunitinib dose amount that
041064 - has been effective, and to reduce dose or eliminate
041065 - treatment with cyclophosphamide that may not be effective,
041066 - and which may be causing severe adverse chemotherapy side
041067 - effects that prevent Millie from getting sufficient
041068 - treatment with sunitinib to continue recovery for cancer.
041069 - ref SDS 19 BW3V
041071 - ..
041072 - 13. I currently have some cyclophosphamide on hand, and the
041073 - prescription permits several refills, so I can get additional
041074 - drugs at Kaiser without additional prescription.
041076 - ..
041077 - 14. Another blood test is needed at Kaiser next week in the morning
041078 - on 081226. ref SDS 13 BQ8F
041079 -
041080 - [On 081219 primary care physician at Kaiser orders blood
041081 - test on 081226 to implement UCSF work plan. ref SDS 17 3L9L
041083 - ..
041084 - 15. If NEUTS are below 1.250, then sunitinib can be reduced to 25
041085 - mg per day. Otherwise, sunitinib will continue at the original
041086 - dose of 37.5 mg. There will be further consideration of
041087 - Neupogen at that time on 081226. ref SDS 13 BQ8F
041088 -
041089 - [On 081219 Millie sent another letter to Kaiser only that
041090 - complements the letter today in order to clarify planning
041091 - options for adjusting treatments to maintain recovery, with
041092 - less side effects. ref SDS 16 SU8R
041094 - ..
041095 - [On 081223 Millie's letter to medical team commends Doctor
041096 - Rugo for engineering recovery from 5th relapse of
041097 - Inflammatory Breast Cancer (IBC) with sunitinib,
041098 - ref SDS 19 BV4T; Millie cited discussion with Doctor
041099 - Johnson at Kaiser today on 081219 explaining competing
041100 - values of patient health and getting test data, ref SDS 19
041101 - BV6R; Millie advised the medical team of willingness to
041102 - optimize recovery by maintaining sunitinib dose amount that
041103 - has been effective, and to reduce dose or eliminate
041104 - treatment with cyclophosphamide that may not be effective,
041105 - and which may be causing severe adverse chemotherapy side
041106 - effects. that prevent Millie from getting sufficient
041107 - treatment with sunitinib to continue recovery. ref SDS 19
041108 - BW3V
041110 - ..
041111 - [On 081226 NEUTS 1.71 (ANC 1710) for blood test at Kaiser.
041112 - ref SDS 20 DM6M
041114 - ..
041115 - [On 090109 Millie letter to medical team reports blood
041116 - counts very low again, NEUTS 0.87, confirms UCSF treatment
041117 - plan on 090108 continues sunitinib at full strenth, and
041118 - pauses cyclophosphamice until blood counts rise to NEUTS
041119 - 1.00. ref SDS 22 UF3Q
041121 - ..
041122 - 16. Additionally, if platelets are greater than 75, treatment with
041123 - sunitinib at the full dose of 37.5 mg will continue. If
041124 - platelets in the blood test on 081226 are less than 75, then I
041125 - will notify Doctor Rugo with another letter for additional
041126 - guidance.
041127 -
041128 - [On 081226 platelets 187 for blood test at Kaiser.
041129 - ref SDS 20 DM6M
041131 - ..
041132 - [On 090310 1500 platelets 245 again well within normal
041133 - range. ref SDS 23 8T6M
041135 - ..
041136 - 17. By copy request Kaiser schedule the blood test in the morning
041137 - on 081226, and advise that determination of Neupogen treatment
041138 - on 081226 and 081227 will be made based on results of the test,
041139 - and consultation with Doctor Johnson and Doctor Rugo.
041141 - ..
041142 - 18. Responding to the blood test today showing NEUTS 0.74, Doctor
041143 - Rugo prescribed Neupogen for tomorrow 081219 and 081220, as
041144 - already scheduled. I talked to Bella today in Kaiser's
041145 - Infusion Clinic, and talked again to Deseriee to coordinate
041146 - Neupogen tomorrow with meeting Doctor Johnson scheduled at
041147 - 1140. ref SDS 14 RW5H
041149 - ..
041150 - 19. Very grateful for adjustments in treatment today will enable
041151 - continued recovery from IBC symptoms, and bring increased
041152 - energy so that exercise and vitality are restored.
041154 - ..
041155 - 20. In a separate letter earlier today submitted to UCSF the 2nd
041156 - report for the CT test on the neck performed Nov 7th, [see
041157 - another record today 081218, ref SDS 15 BE9J], which
041158 - supplements the report sent to UCSF by Kaiser for below the
041159 - neck [received on 081112, ref SDS 5 6V5I, and discussed with
041160 - UCSF the next day on 081113, ref SDS 6 VL5L; at that time, the
041161 - doctor requested clarification of evident errors in the report
041162 - for the CT test on 081107, ref SDS 6 9C9M,
041164 - ..
041165 - 21. Looking forward to meeting Doctor Johnson tomorrow.
041167 - ..
041168 - 22. Best wishes and happy holidays to all.
041169 -
041176 -
041177 -
041178 -
041179 -
041180 -
041181 -
041182 -
041183 -
041184 -
041185 -
041186 -
041187 -
0412 -