THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com


S U M M A R Y


DIARY: January 21, 2009 10:17 AM Wednesday; Rod Welch

Glenna called about Millie's response to sunitinib treatment.

1...Summary/Objective
2...Medical Team Requests Support Doctor Patient Partnership
3...Treatment Strategy UCSF Planning Millie's Care After Sunitinib
4...Treatment Planning List UCSF Proposals for Millie's Future Treatments
5...Treating Millie's Cancer as Chronic Disease UCSF Drugs Proposed
6...Patient history...
........1...Summary
........2...Laboratory Blood Tests...
........3...Image tests show no evidence distant metastasis in 7 years,
........4...Treatment history...
7...Treatment Strategy Considerations...


..............
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CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0403 -    ..
0404 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040501 - Follow up ref SDS 56 0000. ref SDS 54 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040506 -  ..
0406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0408 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040901 - Background...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040902 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040903 -    1.  On 090108 examination at UCSF showed possible progression of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040904 -        IBC in breastbone area.  Millie reported severe side effects.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040905 -        Medical team prescribed another cycle sunitinib treatment, with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040906 -        paused until blood counts to a safe level.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040908 -         ..
040909 -    2.  On 090108 Millie received a letter from Glenna summarizing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040910 -        understandings for the work plan presented during the meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040911 -        earlier at UCSF on 090108. ref SDS 49 LX7O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040913 -         ..
040914 -    3.  On 090109, Millie submitted a letter to the medical team                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040915 -        presenting findings from the examination and transmitting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040916 -        Glenna's work plan summary. ref SDS 50 UC4H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040918 -         ..
040919 -    4.  On 090116 Glenna called about Millie's response to sunitinib                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040920 -        treatments. during 3rd cycle of sunitinib. ref SDS 56 JY6L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040921 -        Reviewed record on 090115 reporting IBC rash looks improved to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040922 -        stable, and nodules in the breastbone area seem stable to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040923 -        worse, ref SDS 54 124N, relative to detailed review on 090110,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040924 -        ref SDS 51 124N, and after 7 days of treatment with only                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040925 -        sunitinib, and 21 total treatments with sunitinib since the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040926 -        pause on 081218 and resuming on 081226, ref SDS 54 6C4J,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040928 -         ..
040929 -    5.  Millie talked on 090116 in the morning about reducing the dose                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040930 -        of sunitinib in order to reduce side effects. ref SDS 56 JY7J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040931 -        She seems at this point still committed to trying the current                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040932 -        higher dose in order to optimize recovery, planned in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040933 -        meeting with the medical team on 090108, noted in Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040934 -        letter on 090109. ref SDS 50 UF3T                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040936 -         ..
040937 -    6.  Asked Glenna about remedy to relieve side effects, mainly of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040938 -        sore toes that prevent exercise that maintains immune system                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040939 -        for recoverying from cancer. ref SDS 56 PPUQ                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040941 -         ..
040942 -    7.  On 090116 Millie received Glenna's letter planning a meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040943 -        with Doctor Rugo to discuss a treatment plan for progression of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040944 -        cancer, ref SDS 58 YN9H, and which attached a letter Glenna                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040945 -        sent to the doctor describing IBC in the breastbone area has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040946 -        worsened. ref SDS 58 FW3J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040948 -         ..
040949 -    8.  On 090116 Millie's letter to Glenna clarifies breastbone area                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040950 -        looks stable to worse; everything else looks improved to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040951 -        stable. ref SDS 59 IS6G  Millie further reports rising side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040952 -        effects of treatment, and requests remedy. ref SDS 59 IT4V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040954 -         ..
040955 -    9.  On 090118 Millie talks about wanting to end treatment with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040956 -        sunitinib that seems now less effective and has severe side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040957 -        effects after adding cycloposphamide. ref SDS 60 UC41                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040959 -  ..
040960 - Glenna asks again today about Millie's response to treatment following                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040961 - up her call on 090116, ref SDS 56 JY6L, and per background above.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040962 - ref SDS 0 JY5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040964 -  ..
040965 - Reviewed the record of patient history on 090120 reporting IBC rash                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040966 - looks stable to worse, and nodules in the breastbone area seem worse,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040967 - ref SDS 62 124N, relative to detailed review on 090110, ref SDS 51                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040968 - 124N, and after 11 days of treatment with only sunitinib, and 25 total                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040969 - treatments with sunitinib, since the pause on 081218 and resuming on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040970 - 081226, shown below. ref SDS 61 6C4J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040972 -  ..
040973 - Worsening IBC in breastbone area that has progressed onto the right                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040974 - breast and spread toward the left chest reflects rising cancer marker;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040975 - Labs at Kaiser on 090116 report CA 15-3 303. ref SDS 57 PQTQ                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040977 -  ..
040978 - This record indicates Millie has suffered progression, which is the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040979 - 6th relapse of IBC.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040980 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040981 -            [On 090122 2321 telephone message from Glenna says Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040982 -            Rugo diagnoses 7th relapse, ends treatment on sunitinib;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040983 -            plans meeting to prescribe next treatment. ref SDS 67 J47F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040985 -             ..
040986 -            [On 090122 2321 case study shows Millie suffers 7th relapse                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040987 -            of cancer. ref SDS 67 J34U                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040989 -  ..
040990 - Glenna asked for the 5 most severe side effects of Sunitinib?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040992 -  ..
040993 - Patient history on 090120 shows continuing fatigue, ref SDS 62 KL4J,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040994 - cited on 090116, ref SDS 55 KL4J, pain in feet and mostly toes,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040995 - ref SDS 61 HY8M, and muscle weakness in the legs, reported on 090111.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040996 - ref SDS 52 3E4K  Millie's legs tire quickly, ref SDS 61 3E4K, cited                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040997 - previously on 090102. ref SDS 45 6E7G  Joint pain, discomfort, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040998 - total ill feeling, commonly associated with chemotherapy, reported on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040999 - 081218, ref SDS 37 E38H, and discussed with the medical team at UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041000 - also on 081218, ref SDS 38 QW7H, has now returned after just 3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041001 - chemotherapy treatments with cyclophosphamide, shown in patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041002 - history. ref SDS 62 E38H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041003 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041004 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041006 -  ..
041007 - Medical Team Requests Support Doctor Patient Partnership                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041008 - Treatment Strategy UCSF Planning Millie's Care After Sunitinib                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041009 - 
041010 - Glenna advised that she met with Doctor Rugo today.  The doctor asked                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041011 - her to call the [patient assistant - Rod] for help finding treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041012 - to aid UCSF planning for Millie to continue recovery from cancer.  The                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041013 - doctor wants Millie to check the SDS record for treatments UCSF has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041014 - identified to treat Millie's cancer as a "chronic disease."  Glenna                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041015 - explained that Millie's patient profile requires "targeted" treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041016 - lined up to maintain local control.  This implements Doctor Johnson's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041017 - instructions the past few months, and recently during the meeting at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041018 - Kaiser on 081219 1140, for UCSF to identify future treatments for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041019 - timely care of additional relapses. ref SDS 40 V93O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041021 -  ..
041022 - We reviewed the record on 081016, when Doctor Rugo advised that UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041023 - has targeted drugs lined up for providing care of future relapses in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041024 - time to be effective controlling Millie's cancer. ref SDS 30 NW6M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041026 -  ..
041027 - Glenna explained that UCSF has lost the list of therapies which Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041028 - Rugo planned for treating Millie's cancer as a chronic disease.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041030 -  ..
041031 - Glenna recalled that Brigid attended the meeting on 081016, and she                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041032 - left UCSF for military duty.  Megan may have been involved, but she                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041033 - transferred out of the Department.  As a result, nobody can find what                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041034 - Doctor Rugo was planning for Millie.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041036 -                ..
041037 -               [On 090123 1326 Millie's primary care physician at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041038 -               Kaiser, Doctor Johnson, called and advised again that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041039 -               Millie's cancer has mutated to resist treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041040 -               available at Kaiser, and so Millie should notify Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041041 -               Rugo that Kaiser authorizes treatment at UCSF, which                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041042 -               must be planned to start quickly in time to be effectve                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041043 -               for Millie's patient profile. ref SDS 69 8K6K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041045 -  ..
041046 - Glenna said that finding details to assemble UCSF's treatment plans                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041047 - for Millie is hard work that takes a lot of time.  Since Millie has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041048 - survived cancer for a long time, her medical records expanding into                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041049 - 8-years of treatment are very complex, noted previously by doctors on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041050 - Millie's medical team in case study on 061020. ref SDS 21 T25H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041051 - Information gets mixed up and misplaced due to rising confusion and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041052 - limited time, explained in NWO on advantages of a "well ordered                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041053 - record." ref OF 12 RX4K  This aligns with Doctor Rugo frustration from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041054 - difficulty finding information in Millie's medical chart at UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041055 - during the meeting on 080219. ref SDS 26 L18L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041057 -                ..
041058 -               [On 090123 1326 Doctor Johnson complimented Doctor Rugo                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041059 -               for proactive case management getting a list for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041060 -               treating Millie's cancer as a chronic disease.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041061 -               ref SDS 69 VK6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041063 -                ..
041064 -               [On 090202 1011 Doctor Rugo advises medical team that a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041065 -               simple prescription is inadequate, ref SDS 76 278T, for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041066 -               comprehensive care required to treat Millie's complex                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041067 -               patient profile, later listed on 090213, during meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041068 -               with Doctor Johnson at Kaiser. ref SDS 79 ES7I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041070 -                ..
041071 -               [On 100301 0005 medical team has still not analyzed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041072 -               trade-offs on alternative cancer treatments because this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041073 -               takes "yeoman's work." ref SDS 94 OO9P                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041075 -  ..
041076 - Millie faced similar problems at her firm, Nixon Peabody on 960406.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041077 - She was asked to help people in another department find information on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041078 - a major case which had been misfiled by an attorney. ref SDS 1 5922                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041079 - Research at that time showed finding critical details is a problem for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041080 - everybody. ref SDS 1 4249  Later on 031211, Millie's boss stored                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041081 - information "behind the cupboard" because the filing cabinet was full.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041082 - Remembering where information was stored in that case demonstrated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041083 - superior intelligence. ref SDS 9 5B96                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041085 -  ..
041086 - Glenna said today that Doctor Rugo is concerned that Millie needs to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041087 - change treatments very soon in order to continue controlling her                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041088 - cancer.  The doctor feels experience the past 2 years shows the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041089 - patient has a well ordered record of medical history that helps find                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041090 - critical details for planning Millie's next treatment.  Glenna cited                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041091 - the "work plan" on 081016 for starting sunitinib treatment shows                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041092 - complex work in progress can be organized and managed effectively.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041093 - SDS provides a well ordered record of patient history that enables                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041094 - finding details in time to be effective. ref SDS 30 J36R  As a result,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041095 - Doctor Rugo asked Glenna to ask Millie for help this morning to find                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041096 - the various treatments which UCSF has planned for Millie's next                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041097 - relapse.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041099 -                ..
041100 -               [On 090203 Doctor Al-Bussam said Millie's paitient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041101 -               history is very complicated, and SDS record is well                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041102 -               organized that helped his review to prescribe treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041103 -               in time to be effective. ref SDS 73 JZ4F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041105 -                ..
041106 -               [On 090206 Doctor Stritter cited patient longevity                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041107 -               surprising for IBC, and credits good case management.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041108 -               ref SDS 78 7Q7J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041110 -                ..
041111 -               [On 090514 0830 during a meeting at UCSF, Doctor Rugo                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041112 -               asked for help again on Millie's patient history, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041113 -               noted that Millie's records cited in communication with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041114 -               the medical team are very detailed. ref SDS 86 LS5M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041116 -  ..
041117 - Requesting patient support today aligns with Doctor Rugo's request on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041118 - 080403 for assistance coordinating with Kaiser on referral case                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041119 - management. ref SDS 28 4U9O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041120 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041122 -  ..
041123 - Treatment Planning List UCSF Proposals for Millie's Future Treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041124 - Treating Millie's Cancer as Chronic Disease UCSF Drugs Proposed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041125 - 
041126 - As requested by Doctor Rugo, per above, ref SDS 0 Y67L, during the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041127 - call today we reviewed background in the SDS record on UCSF planning                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041128 - for Millie's next treatment after sunitinib.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041129 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041130 -        1.  On 041117 Doctor Rugo's colleague, Doctor Benz, submitted a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041131 -            2nd opinion to Kaiser listing treatments for Millie...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041133 -                 ..
041134 -            a.  Bevacizumab (Avastin) and Taxol....... ref SDS 13 OU5P                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041135 -            b.  Bevacizumab (Avastin) and Tarceva..... ref SDS 13 OV3T                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041136 -            c.  Capecitabine.......................... ref SDS 13 OU5V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041137 -            d.  Capecitabine with Taxotere............ ref SDS 13 OU6S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041138 -    **      e.  liposomal anthracycline                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041139 -                known as Doxil........................ ref SDS 13 OU5V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041140 -            e.  Gemzar with Taxotere.................. ref SDS 13 OU6S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041141 -            f.  small molecule kinase inhibitors                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041142 -                as part of a protocol would certainly                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041143 -                be warranted.......................... ref SDS 13 OU6W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041145 -             ..
041146 -            ** Note:  on 090129 Doctor Rugo proposed Doxil with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041147 -            hyperthermia in a letter to Kaiser, reported the next day                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041148 -            on 090130. ref SDS 71 HK3V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041150 -             ..
041151 -        2.  On 060929 Doctor Rugo's colleague, Doctor Benz, submitted                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041152 -            another 2nd opinion to Kaiser listing possible treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041153 -            for Millie...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041154 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041155 -    **      a.  Cetuximab with carboplatin............ ref SDS 20 UI9K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041156 -            g.  Abraxane with lapatinib............... ref SDS 20 UI9K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041157 -            h.  Navelbine............................. ref SDS 20 WR3Y                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041158 -            i.  Navelbine with capecitbine............ ref SDS 20 WR3Y                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041159 -            j.  Gemzar................................ ref SDS 20 WR3Y                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041160 -            k.  Gemzar with capecitabine.............. ref SDS 20 WR3Y                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041162 -             ..
041163 -            ** Note: Millie was successfully treated with cetuximab                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041164 -            and carboplatin for 2 years, beginning on 070201.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041166 -             ..
041167 -            Note:  Doctor Benz appears to amend the first 2nd opinion                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041168 -            received on 041117, saying in the follow up opinion...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041169 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041170 -                In my opinion, it is less likely she would receive much                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041171 -                benefit from newer formulations of anthracyclines or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041172 -                taxanes which she has already received, such as Doxil                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041173 -                or Abraxane.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041174 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041175 -                   [On 090129 Doctor Rugo proposed Doxil with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041176 -                   hyperthermia in a letter to Kaier, reported the next                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041177 -                   day on 090130. ref SDS 71 HK3V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041179 -             ..
041180 -        3.  On 061230 Doctor Rugo proposed in a letter to Kaiser that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041181 -            Millie might benefit from treatment at UCSF with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041182 -            bevacizumab and abraxane. ref SDS 23 JP5V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041184 -             ..
041185 -        4.  On 070130 Doctor Rugo seemed to indicate Millie qualifies                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041186 -            for treatment with other drugs in clinical study at UCSF,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041187 -            ref SDS 24 TG5G, noted previously by Doctor Benz in a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041188 -            letter dated 060821, and reviewed at Kaiser on 060929.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041189 -            ref SDS 20 UI9K  This was discussed again at Kaiser on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041190 -            061208, ref SDS 22 P256, leading to Kaiser's referral for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041191 -            Millie's treatment at UCSF on 061230. ref SDS 23 PN5X                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041193 -             ..
041194 -        5.  On 070130 during a meeting at UCSF Doctor Rugo discussed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041195 -            again treatment for Millie with bevacizumab and Abraxane,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041196 -            and seemed to indicate that diagnosis of pulmonary embolism                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041197 -            may not have been caused by bevacizumab. ref SDS 24 LD6Y                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041199 -             ..
041200 -        6.  On 081016 the doctor seemed to say that a new study would                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041201 -            be starting in about 4 months that can help Millie, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041202 -            proposed interim treatment with sunitinib, and further                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041203 -            indicated that UCSF has other treatments targeted to help                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041204 -            Millie recover from IBC. ref SDS 30 J35X                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041205 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041206 -               [On on 090130 Millie's letter to the medical team                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041207 -               reports that on 090129 Doctor Rugo prescribed treating                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041208 -               Millie with hyperthermia in the Radiation Oncology                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041209 -               Department at UCSF, and in order to establish local                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041210 -               control of expanding IBC, following relapse during                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041211 -               treatment with sunitinib study. ref SDS 71 AY9Q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041213 -             ..
041214 -        7.  On 090108 the doctor again indicated other treatments and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041215 -            studies are avilable at UCSF, cited in Millie's letter to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041216 -            the medical team on 090109. ref SDS 50 UC4H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041218 -  ..
041219 - During the call today, Glenna explained that she prepared another                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041220 - letter to Doctor Rugo presenting patient status, per above,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041221 - ref SDS 0 AJ3J, Glenna said that she will meet with the doctor later                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041222 - today about follow on treatments for Millie to recover from her 6th                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041223 - relapse of IBC, per above, ref SDS 0 Y67L, as planned in Glenna's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041224 - letter on 090116. ref SDS 58 YN9H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041226 -         ..
041227 -        [On 090122 called Glenna from Kaiser Emergency Department to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041228 -        report Millie's shoulder injury; left message asking about                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041229 -        results of Glenna's meeting with Doctor Rugo. ref SDS 66 YT7J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041231 -         ..
041232 -        [On 090122 telephone message from Glenna reporting she met with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041233 -        Doctor Rugo to develop treatment plan for Millie, and schedules                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041234 -        Millie to start new treatment on 090129. ref SDS 67 K96F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041236 -         ..
041237 -        [On 090123 Millie's letter to medical team reports progress at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041238 -        UCSF scheduling Millie to start on a new treatment. ref SDS 68                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041239 -        KR4P                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041241 -         ..
041242 -        [On 090123 1326 Doctor Johnson called was pleased that UCSF is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041243 -        implementing his many requests for UCSF to prescribe Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041244 -        next treatment (e.g., see on 081219 1140, ref SDS 40 KU6F,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041245 -        because after multiple relapses Millie' cancer has mutated into                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041246 -        a very aggressive disease that requires immediate treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041247 -        ref SDS 69 RK6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041249 -         ..
041250 -        [On 090127 Millie's letter notified medical team that primary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041251 -        care physician approves UCSF prescribing treatment for Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041252 -        6th relapse from IBC, because recent rise of cancer marker CA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041253 -        15-3 303 for the labs at Kaiser on 090116 indicated Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041254 -        cancer has mutated to cells that now resist treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041255 -        available at Kaiser. ref SDS 70 TY5W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041257 -         ..
041258 -        [On 090127 1344 Millie's letter to medical team submitted list                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041259 -        of prospective treatments previously presented by UCSF,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041260 -        ref SDS 70 TY6S, and requested by Glenna for review with Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041261 -        Rugo on 090121 (today, per above. ref SDS 0 Y67L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041263 -         ..
041264 -        [On 090127 Millie's letter to medical team reported side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041265 -        effects of sunitinib treatment begin to subside 5 days after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041266 -        UCSF ended treatment with the sunitinib protocol. ref SDS 70                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041267 -        TY8T                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041269 -         ..
041270 -        [On 090129 0800 Doctor Rugo wrote a letter to Kaiser explaining                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041271 -        next treatment with hyperthermia and Doxil for Millie to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041272 -        recover from 6th relapse of IBC, cited in Millie's letter to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041273 -        the medical team on 090130.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041275 -         ..
041276 -        [On 090204 0219 Millie requests planning from Doctor Rugo at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041277 -        UCSF showing strategy and drug options for treating Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041278 -        cancer as a chronic disease, ordered by Doctor Johnson at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041279 -        Kaiser. ref SDS 74 278T                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041281 -         ..
041282 -        [On 090204 1747 Millie received list of 10 additional                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041283 -        treatments targeted for Millie's patient profile, so there is a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041284 -        list of drugs to treat Millie's cancer as a chronic disease, as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041285 -        recommended by Doctor Johnson. ref SDS 75 4R3S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041287 -         ..
041288 -        [On 090205 0830 Doctor Hsu changed Millie's treatment to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041289 -        radiation with hyperthermia because delaying treatment caused                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041290 -        Millie's cancer to become too severe to recover with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041291 -        hyperthermia and Doxil. ref SDS 77 EY5F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041293 -         ..
041294 -        [On 090218 0828 received follow up letter from Gwen submitting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041295 -        article on Thermodox used with hyperthermia. ref SDS 80 7Q7J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041297 -         ..
041298 -        [On 090220 1548 paper received from UCSF on hyperthermia                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041299 -        explains options combining with chemotherapy, ref SDS 82 0129,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041300 -        and biological vaccines. ref SDS 82 0164                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041302 -         ..
041303 -        [On 090312 0830 meeting with Tara says Doctor Rugo planning                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041304 -        treatments for Millie after radiation and hyperthermia.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041305 -        ref SDS 83 SS4F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041307 -         ..
041308 -        [On 090312 0830 Doctor Hsu advises UCSF Radiology Oncology                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041309 -        Department has more treatments that can help Millie recover                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041310 -        from IBC, ref SDS 83 F973; this includes combining hyperthermia                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041311 -        with a new form of Doxil, ref SDS 83 T95N, and also the use of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041312 -        vaccines with hyperthermia. ref SDS 83 F991                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041314 -         ..
041315 -        [On 090514 0830 Doctor Rugo explained a number of treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041316 -        becoming available at UCSF targeted to Millie's patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041317 -        profile, including triple negative, and which can treat                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041318 -        Millie's cancer as a chronic disease, as ordered by Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041319 -        Johnson at Kaiser. ref SDS 86 YW48                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041321 -         ..
041322 -        [On 090514 0830 Doctor Rugo prescribed MPA as the first new                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041323 -        treatment targeted to treat Millie's triple negative status.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041324 -        ref SDS 86 D647                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041326 -         ..
041327 -        [On 090528 1238 Millie re-submitted comprehensive list of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041328 -        treatments cited by the medical team targeted to Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041329 -        patient profile for treating her cancer as a chronic disease,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041330 -        ref SDS 87 4N5U, as shown in the record on 090121, ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041331 -        EV53, and including clinical trials researched on 090204 1523,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041332 -        ref SDS 75 4R3S, and submitted to the medical team on 090326                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041333 -        0054, at the request of Doctor Johnson, the primary care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041334 -        physician at Kaiser. ref SDS 85 DW5S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041336 -         ..
041337 -        [On 090616 0830 Doctor says everybody at Kaiser and UCSF is on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041338 -        board for treating Millie's cancer as a chronic disease, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041339 -        says the medical team plans on Millie's next treatment in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041340 -        September will apply PARP technology. ref SDS 88 KD6L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041342 -         ..
041343 -        [On 090701 1652 Doctor Hsu reports he has another treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041344 -        for Millie's symptoms of tightness on her left side.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041345 -        ref SDS 89 4P51                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041346 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041347 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041349 -  ..
041350 - Patient history...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041351 - 
041352 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041353 -        1.  Summary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041354 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041355 -            Millie is being treated at UCSF on referral from Kaiser for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041356 -            5th relapse of secondary IBC.  She was diagnosed with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041357 -            breast cancer on 020321 from biopsy performed 020304.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041358 -            ref SDS 3 MA5K  IBC symptoms were reported in PET scan test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041359 -            10 months later on 021218, reviewed at Kaiser on 030109.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041360 -            ref SDS 8 L66M  Symptoms were diagnosed and treated as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041361 -            Cellulitis. ref SDS 8 KW5F  This persisted through 2003.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041362 -            During that period, Millie received no treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041363 -            Secondary IBC was diagonsed with biopsy on 040419, shown in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041364 -            pathology report received from Kaiser on 040517.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041365 -            ref SDS 11 7D6F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041366 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041367 -               [On 090203 Millie's patient history submitted to VCI for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041368 -               review to expedite planning of hyperthermia treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041369 -               needed in time to be effective for recovering from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041370 -               Millie's 6th relapse of IBC. ref SDS 72 EO5Q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041372 -                ..
041373 -               [On 090206 Doctor Stritter cited patient longevity                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041374 -               surprising for IBC credits case management. ref SDS 78                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041375 -               7Q7J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041377 -                ..
041378 -               [On 090127 1344 Millie's letter submitted with link to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041379 -               this record patient history for planning follow up                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041380 -               treatment. ref SDS 70 TY6X                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041382 -             ..
041383 -            In 7 years of treatment Millie has not been diagnosed with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041384 -            distant metastasis other than axillary and supraclavicular                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041385 -            lymph nodes, which are symptoms of IBC. (see patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041386 -            history of image tests listed on 081112, ref SDS 32 GM3N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041387 -            In effect, she only has IBC.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041389 -             ..
041390 -            Pulmonary embolism was diagnosed with CT test on 041103,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041391 -            reported at Kaiser the next day on 041104.  Millie was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041392 -            removed from treatment on clinical study with bevacizumab                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041393 -            and Taxol. ref SDS 12 RZ4I  Kaiser delayed treatment of IBC                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041394 -            for 3 months while searching for another clinical trial to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041395 -            treat Millie.  Millie was treated again with another 4                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041396 -            cycles of AC beginning on 050104. ref SDS 14 407N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041398 -             ..
041399 -            Triple negative status (ER, PR, HER2 neu all negative)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041400 -            originally diagnosed on 020321 citing core biopsy on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041401 -            020304. ref SDS 3 6Q6J  This was recently confirmed as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041402 -            unchanged with follow up core biopsy ordered by Doctor Rugo                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041403 -            and performed at Kaiser on 081107; results reported triple                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041404 -            negative on 081119. ref SDS 34 5O8G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041407 -             ..
041408 -        2.  Laboratory Blood Tests...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041410 -            Millie has extensive blood testing, currently every 3 weeks                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041411 -            at UCSF, but weekly for the past 2 years.  Occassionally,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041412 -            there are backup labs at Kaiser.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041414 -             ..
041415 -            On 090108 labs at UCSF start 3rd cycle sunitinib protocol.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041416 -            ref SDS 47 075H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041418 -             ..
041419 -            On 090116 labs at Kaiser show WBC 5.2 rising for first                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041420 -            time, ref SDS 57 OT8J, but cancer marker CA 15-3 303                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041421 -            indicates Millie suffering 6th relapse of IBC. ref SDS 57                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041422 -            PQTQ                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041423 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041424 -               [On 090122 partial lab CBC without Diff at Kaiser in ER                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041425 -               for treatment dislocated shoulder. ref SDS 66 S65I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041426 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041428 -             ..
041429 -        3.  Image tests show no evidence distant metastasis in 7 years,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041430 -            listed on 081112... ref SDS 32 GM3N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041431 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041432 -            Millie had a CT test on 081230; results received on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041433 -            090107 show no significant change. ref SDS 46 GM3N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041434 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041436 -             ..
041437 -        4.  Treatment history...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041438 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041439 -            Left breast sentinel node procedure                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041440 -            and left axilary disection and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041441 -            left breast lumpectomy........... 020312, ref SDS 2 Q78M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041443 -             ..
041444 -            AC 2 cycles...................... 020423, ref SDS 4 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041445 -            Taxotere 2....................... 020610, ref SDS 5 MR5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041446 -            Radiation........................ 020924, ref SDS 6 0J7H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041447 -            Taxotere 2 (total 4)............. 021204, ref SDS 7 F5Z5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041449 -             ..
041450 -            Bevacizumab Taxol 7.............. 040420, ref SDS 10 9Z5J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041451 -            AC 4 (total 6)................... 050104, ref SDS 14 407N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041453 -             ..
041454 -            Capacitabine and Taxotere 8...... 050329, ref SDS 15 T58M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041455 -              completed...................... 050916, ref SDS 16 407N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041457 -             ..
041458 -            Mastectomy left breast........... 051021, ref SDS 17 EG5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041460 -             ..
041461 -            Relapse cancer...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041462 -            Capacitabine and Taxotere 7                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041463 -            (total 15)....................... 060721, ref SDS 19 407N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041465 -             ..
041466 -            Cetuximab (total 90)............. 070201, ref SDS 25 G68I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041467 -            Carboplatin and cetuximab 21..... 080313, ref SDS 27 4E9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041469 -             ..
041470 -            Sunitinib (daily)................ 081114, ref SDS 33 506F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041471 -            Cyclophosphamide Methotrexate.... 081128, ref SDS 36 PA8Y                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041472 -            Sunitinib Cyclophosphamide                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041473 -            paused........................... 081219, ref SDS 39 716I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041474 -            Methotrexate ended............... 081219, ref SDS 39 716I
041475 -             ..
041476 -            Sunitinib Cyclophosphamide                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041477 -            resumed.......................... 081226, ref SDS 43 505G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041478 -            Sunitinib only                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041479 -            Cyclophosmphamide paused                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041480 -            1 week........................... 090109, ref SDS 50 UF3Q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041482 -             ..
041483 -            Sunitinib treatment ended due                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041484 -            to rising symptoms of 6th                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041485 -            relapse IBC...................... 090122, ref SDS 67 K96F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041487 -             ..
041488 -            Radiation and hyperthermia for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041489 -            6th relapse IBC started getting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041490 -            4 treatments per week............ 090219, ref SDS 81 E57G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041491 -            Treatment ended after 4                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041492 -            weeks............................ 090317, ref SDS 84 9L7K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041494 -             ..
041495 -            MPA clinical trial at UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041496 -            begins........................... 090616, ref SDS 88 D647                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041498 -             ..
041499 -            MPA ends due to concerns about                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041500 -            effectiveness, and possibility of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041501 -            causing another pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041502 -            embolism which could                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041503 -            be fatal......................... 090716, ref SDS 91 YG8Y                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041505 -             ..
041506 -            Gemzar treatment started at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041507 -            Kaiser........................... 090728, ref SDS 92 W65H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041509 -             ..
041510 -            Navelbine started at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041511 -            Kaiser........................... 091118, ref SDS 93 625I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041513 -             ..
041514 -            Abraxane started at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041515 -            Kaiser........................... 100303, ref SDS 95 625I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041516 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041518 -  ..
041519 - Treatment Strategy Considerations...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041520 - 
041521 - After 5 relapses, Millie's cancer has mutated to resist single-agent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041522 - chemotherapy drugs, noted by primary care physician on 080829, cited                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041523 - in the letter to the medical team at that time. ref SDS 29 RP9R  This                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041524 - issue was presented with 2nd opinion research on 060721. ref SDS 18                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041525 - RQ5N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041527 -             ..
041528 -            [On 090122 telephone message from Glenna reporting she met                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041529 -            with Doctor Rugo to develop treatment plan for Millie, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041530 -            schedules Millie to start new treatment on 090129.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041531 -            ref SDS 67 K96F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041533 -             ..
041534 -            [On 090123 primary care physician advised that Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041535 -            cancer has mutated to cells that are resistant to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041536 -            treatments available at Kaiser, and indicated UCSF has the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041537 -            best chance of helping Millie. ref SDS 69 RK6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041539 -             ..
041540 -            [On 090123 Millie's letter to medical team reports progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041541 -            at UCSF scheduling Millie to start on a new treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041542 -            ref SDS 68 KR4P                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041544 -             ..
041545 -            [On 090127 Millie's letter notified medical team that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041546 -            primary care physician approves UCSF prescribing treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041547 -            for Millie's 6th relapse from IBC, because recent rise of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041548 -            cancer marker CA 15-3 303 for the labs at Kaiser on 090116                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041549 -            indicated Millie's cancer has mutated to cells that now                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041550 -            resist treatments available at Kaiser. ref SDS 70 TY5W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041552 -             ..
041553 -            [On 090127 1344 Millie's letter submitted with link to this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041554 -            record patient history for planning follow up treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041555 -            ref SDS 70 TY6X                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041556 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041557 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041558 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041559 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041560 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041561 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041562 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041563 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041564 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0416 -