CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 8 0000. ref SDS 6 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On 081218 UCSF set work plan to pause treatment until 081226, and then
040902 - to do a blood that evaluates whether to reduce sunitinib dosage, and
040903 - to continue the doce of cyclophosphamide, and end Methotrexate.
040904 - ref SDS 5 QW48
040906 -  ..
040907 - In the evening, on 081218, Millie sent a letter to the medical team
040908 - confirming these understandings. ref SDS 6 GF4V
040910 -  ..
040911 - The next day on 081219 Millie sent a letter to the primary care
040912 - physician presenting a decision scenario on the treatment plan.
040913 - ref SDS 7 SU9T
040915 -  ..
040916 - Later in the morning on 081219, Millie met with the primary care
040917 - physician at Kaiser.  The doctor explained that UCSF may be restrained
040918 - by a study protocol to reduce sunitinib, a "targeted" cancer drug,
040919 - which has been helping Millie recover from cancer and has minimal side
040920 - effects, and to maintain cyclophosphamide, which causes severe side
040921 - effects, and may not be helping Millie.
040923 -  ..
040924 - Millie's letter to the medical team says...
040925 -
040926 -    1.  Subject: Happy Holidays - Side Effects Subside
040927 -        Date: Tue, 23 Dec 2008 23:29:42 -0800
040941 -         ..
040942 -    2.  Happy holidays to the medical team.  I'm always asked at the
040943 -        Wellness Community my "secret" for looking good after 7 years
040944 -        of treatment?  I credit luck having a "dream" team of medical
040945 -        professionals who innovate and manage the levers of care with
040946 -        consumate skill and sensitivity.
040947 -
040948 -            [On 081224 Tara sent a letter wishing Millie Merry
040949 -            Christmas, and noting Millie's recovery of energy after
040950 -            pausing treatment for a week. ref SDS 11 3X4H
040952 -         ..
040953 -    3.  Congratulations engineering another recovery from the 5th IBC
040954 -        relapse, reported by Tara during the examination, ref SDS 5
040955 -        VD4F, and which you observed as well on 081218. ref SDS 5 QX44
040956 -        Doctor Johnson was very pleased seeing response to treatment
040957 -        with your sunitinib study, observed the next day at Kaiser on
040958 -        081219. ref SDS 8 3L9L
040960 -  ..
040961 - On 081219 Doctor Johnson further asked the medical team to begin
040962 - planning treatments for Millie's next relapse so that treatment can
040963 - begin in time to recover from cancer that has mutated into more
040964 - aggressive disease. ref SDS 8 V93O
040965 -
040966 -           [On 081224 0700 IBC appears to increase suddenly,
040967 -           ref SDS 10 1Y4I, after pausing sunitinib treatments on
040968 -           081219, ordered at UCSF on 081218. ref SDS 5 WS8N
040970 -            ..
040971 -           [On 090106 1136 Millie's letter to medical team submits
040972 -           agenda for meeting on 090108 to evaluate progress and
040973 -           reported again IBC increased then seemed to get better
040974 -           after resuming treatment on 081226. ref SDS 14 YO4V
040976 -            ..
040977 -           [On 090109 Millie's letter to medical team reports
040978 -           examination on 090108 finding IBC relapse increasing mostly
040979 -           in the breastbone area after pausing treatment for 1 week
040980 -           ordered during the meeting at UCSF on 081218, and further
040981 -           treatment was adjusted and continued to evaluate possibility
040982 -           of another recovery from consistent treatment with
040983 -           sunitinib. ref SDS 16 UE6R
040985 -  ..
040986 - Millie's letter to medical team contiues...
040987 -
040988 -    4.  Best wishes to Doctor Johnson for speedy recovery from his cold
040989 -        [reported at Kaiser on 081219, ref SDS 8 QW5J].
040991 -         ..
040992 -    5.  On Friday [081219], Doctor Johnson scheduled the blood test at
040993 -        Kaiser, ref SDS 8 3L7J, which you ordered for 081126 to
040994 -        evaluate the treatment plan.
040995 -
040996 -           [On 081223 Glenna called and advised that the medical team
040997 -           orders Neupogen treatment for Millie when blood counts fall
040998 -           below NEUTS 1.000 (ANC 1000), ref SDS 9 4P4K; Millie sent a
040999 -           letter confirming UCSF guidance on Neupogen. ref SDS 9 CV5K
041001 -         ..
041002 -    6.  Doctor Johnson also clarified on the computer the order for the
041003 -        CT test scheduled for 081230 to include the neck, and he
041004 -        requested a consolidated report, ref SDS 8 WP30, in order to
041005 -        avoid confusion getting two (2) separate reports on different
041006 -        days, which happened for the prior CT test on 081107 [reported
041007 -        on 081113, ref SDS 2 TP8L].
041009 -         ..
041010 -    7.  Good news.  After 4 days of worsening side effects staying
041011 -        mostly in bed (could barely walk), today I felt better, and
041012 -        went to the gym.  Tomorrow will try hiking again.  It's another
041013 -        miracle!!
041014 -
041015 -            [On 081224 Tara sent a letter wishing Millie Merry
041016 -            Christmas, and noting Millie's recovery of energy after
041017 -            pausing treatment for a week. ref SDS 11 3X4H
041019 -             ..
041020 -            [On 081224 Glenna sent a letter to Millie responding to
041021 -            notice of Millie recovering energy and planning to go
041022 -            hiking. ref SDS 12 4Q3N
041024 -         ..
041025 -    8.  The gift of energy starting a new year is a wonderful Christmas
041026 -        present.
041028 -         ..
041029 -    9.  Doctor Johnson noted on Friday at Kaiser, that on 081126 Tara
041030 -        found substantial recovery from IBC after the initial 14 days
041031 -        of treatment with sunitinib alone, ref SDS 3 VD4F, cited in a
041032 -        letter to the medical team on 081202. ref SDS 4 YJ3G
041034 -         ..
041035 -   10.  Doctor Johnson further recalled prescribing 6 treatments with
041036 -        AC that included cyclophosphamide chemotherapy, ref SDS 8 JM6K,
041037 -        ending on 050329. ref SDS 1 E87M
041039 -         ..
041040 -   11.  He indicated possibility of cancer cells resisting treatment
041041 -        after progression of disease with cyclophosphamide chemotherapy
041042 -        [considered in the record on 081218 on changing the treatment
041043 -        plan to maintain recovery, and reduce side effects. ref SDS 5
041044 -        EL6I]
041046 -         ..
041047 -   12.  Now that I seem to be regaining strength, to maintain this
041048 -        recovery, I would be willing to reduce chemotherapy with
041049 -        cyclophosphamide on Friday, or later as needed, in order to
041050 -        tolerate currently prescribed dose of sunitinib, which seems to
041051 -        be yielding good results.  Hopefully, under your study of
041052 -        metronomic "targeted" drug treatments the higher dose of
041053 -        sunitinib will maintain progress reducing symptoms of IBC,
041054 -        while avoiding side effects often associated with chemotherapy.
041055 -
041056 -            [On 081230 case study dilemma cancer treatmnets cause low
041057 -            blood counts, which prevents getting treatment; not getting
041058 -            treatment incerases cancer; UCSF paused treatment for a
041059 -            week and prescribed Neupogen to increase blood counts.
041060 -            ref SDS 13 I87N
041062 -             ..
041063 -            [On 090106 Millie's letter to medical team submitting
041064 -            agenda for meeting on 090106 discusses reducing
041065 -            cyclophosphamide in order to maintain treatment with
041066 -            sunitinib. ref SDS 14 YO4Y
041068 -             ..
041069 -            [On 090108 patient history reports medical team at UCSF
041070 -            maintained sunitinib at full dose to optimize recovery
041071 -            from IBC, and paused cyclophosmphamide until blood
041072 -            counts rise above NEUTS 1.00, and in that case dose of
041073 -            cyclophasphamide will be reduced to treatment 5 days per
041074 -            week from 7 days. ref SDS 15 9V4I
041076 -             ..
041077 -            [On 090109 Millie letter to medical team reports blood
041078 -            counts very low again, NEUTS 0.87, confirms UCSF treatment
041079 -            plan on 090108 continues sunitinib at full strenth, and
041080 -            pauses cyclophosphamice until blood counts rise to NEUTS
041081 -            1.00. ref SDS 16 UF3Q
041083 -         ..
041084 -   13.  I realize this is all an experiment, and that you are the boss;
041085 -        so, whatever you say I will do.  Just wanted you to know I am
041086 -        open to innovation within the framework of study protocol and
041087 -        your good judgment.
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0412 -