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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 35 0000. ref SDS 29 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Background...
040902 -
040903 -    1.  Case study dilemma balancing sunitinib treatments to optimize
040904 -        recovery from 5th relapse IBC, and without increasing
040905 -        debilitating side effects that prevent exercise required to
040906 -        benefit from recovery. ref SDS 10 I87N
040908 -         ..
040909 -    2.  On 090108 examination at UCSF showed possible progression of
040910 -        IBC in breastbone area, as set out in Millie's letter to the
040911 -        medical team on 090109. ref SDS 12 UC4H  Millie reported severe
040912 -        side effects shown by wide range of blood counts falling.
040913 -        ref SDS 12 UF3Q  Medical team prescribed another cycle
040914 -        sunitinib treatment, with cyclophosphamide paused until blood
040915 -        counts increase to a safe level. ref SDS 12 UF3T
040917 -         ..
040918 -    3.  On 090109 Millie's letter reports rise of IBC with sunitinib
040919 -        seen at UCSF on 090108 occurred previously, cited in Millie's
040920 -        letter on 081125, ref SDS 5 XX4P; there was rise of IBC and
040921 -        then substantial recovery reported again on 081217, ref SDS 6
040922 -        YJ4V; on 081230 Millie's letter reported on 081224 and 081225
040923 -        rise of IBC, and then improvement on 081226, ref SDS 10 JV5M;
040924 -        most recently on 090106 Millie cited again advance of IBC on
040925 -        081224 and 081225, and now disease seems to be subsiding again.
040926 -        ref SDS 11 YO4V]
040928 -         ..
040929 -    4.  On 090115 Millie letter to Catherine and Diane in the Infusion
040930 -        Clinic at UCSF reported rising side effects of sunitinib
040931 -        protocol, ref SDS 15 5J9Y; she tried hiking a few times, but
040932 -        this hurts her feet (peripheral neuropathy) and legs are very
040933 -        weak, shown in patient history on daily treatments. ref SDS 14
040934 -        KL4J  Have been spending more time in the gym doing aerobics,
040935 -        which is a little more tolerable. ref SDS 14 3E4K
040937 -         ..
040938 -    5.  On 090116 Glenna called to ask about response to treatment and
040939 -        side effects, ref SDS 16 JY6L, and was advised that IBC in the
040940 -        breastbone area was stable to worse, and other sites are stable
040941 -        to improved with sunitinib protocol, citing the record of
040942 -        patient history the day before on 090115. ref SDS 14 124N
040944 -         ..
040945 -    6.  On 090116 during call from Glenna advised that Millie wants to
040946 -        reduce the dose of sunitinib in order to reduce debilitating
040947 -        side effects, and requested remedy to reduce side effects with
040948 -        full dose of sunitinib in order to optimize recovery.
040949 -        ref SDS 16 JY7J
040951 -         ..
040952 -    7.  On 090116 Millie received a letter from Glenna transmitting a
040953 -        copy of a letter Glenna wrote to the doctor reporting
040954 -        understandings from telecon in the morning on 090116,
040955 -        ref SDS 18 YN9H; Glenna's letter to the doctor described
040956 -        difficulty tolerating side effects of sunitinib, ref SDS 18
040957 -        4P5M, that Millie wants to reduce the dose to reduce side
040958 -        effects, but is afraid about losing benefits of recovering
040959 -        from IBC. ref SDS 18 HV3M
040961 -         ..
040962 -    8.  On 090116 Glenna's letter to the doctor asked about changing to
040963 -        another treatment. ref SDS 18 HV3O
040965 -         ..
040966 -    9.  On 090116 Glenna planned to meet with the doctor later in the
040967 -        day on 090116 to discuss changing Millie's treatment.
040968 -        ref SDS 18 HP4J
040970 -         ..
040971 -   10.  On 090116 Millie's letter to the medical team clarifies telecon
040972 -        on condition following examination at UCSF on 090108, reporting
040973 -        IBC in breastbone area looks stable to worse, and everywhere
040974 -        else looks improved to stable, indicating recovery has slowed
040975 -        ref SDS 19 IS6G, relative to findings on 081218, ref SDS 7
040976 -        VD4F, confirmed in Millie's letter later that day reporting
040977 -        significant recovery. ref SDS 8 GF8V
040979 -         ..
040980 -   11.  On 090118 Millie talks about wanting to end treatment with
040981 -        sunitinib that seems now less effective and has severe side
040982 -        effects after adding cycloposphamide. ref SDS 20 UC41
040984 -         ..
040985 -   12.  On 090121 Millie letter to primary care physician says very
040986 -        pleased to take this occasion on my birthday to say thanks for
040987 -        such great care the past 7 years.  You noted in our first
040988 -        meeting on 020321 that Oncology presents unique challenges.
040989 -        ref SDS 1 R94H  My case has been complicated by other maladies
040990 -        that strain resources of time, money, and emotion.  Having you
040991 -        at the helm with Arlette's assistance has been a blessing.
040992 -        ref SDS 23 F23Y
040994 -         ..
040995 -   13.  On 090121 Glenna calls and asks again about Millie's response
040996 -        to treatment, ref SDS 24 AJ3J, following up her call on 090116,
040997 -        ref SDS 16 JY6L, and per background above. ref SDS 24 JY5I
040999 -         ..
041000 -   14.  On 090121 during call from Glenna reported patient history,
041001 -        ref SDS 24 ZO4F, on 090120 shows IBC rash looks improved to
041002 -        stable, and nodules in the breastbone area seem worse,
041003 -        ref SDS 22 124N, relative to detailed review on 090110,
041004 -        ref SDS 13 124N, and after 11 days of treatment with only
041005 -        sunitinib, and 25 total treatments with sunitinib, since the
041006 -        pause on 081218 and resuming on 081226. ref SDS 21 6C4J
041008 -         ..
041009 -   15.  On 090121 during call from Glenna reported patient history
041010 -        reported IBC worsening in breastbone area has progressed onto
041011 -        the right breast and spread toward the left chest reflects
041012 -        rising cancer marker, ref SDS 24 N95K, Labs at Kaiser on 090116
041013 -        report CA 15-3 303. ref SDS 17 PQTQ  This record indicates
041014 -        Millie has suffered 6th relapse of IBC.
041016 -         ..
041017 -   16.  On 090121 Glenna asked for most severe side effects from
041018 -        continuing with sunitinib treatment. ref SDS 24 TW53
041020 -         ..
041021 -   17.  On 090121 Glenna asked for Millie's records on Doctor Rugo's
041022 -        plans for follow on treatments?  During the call developed
041023 -        background on UCSF planning for Millie's future treatment after
041024 -        sunitinib. ref SDS 24 Y67L
041026 -         ..
041027 -   18.  On 090121 Glenna reported during the call that she would send
041028 -        another letter to Doctor Rugo explaining Millie's slow response
041029 -        to treatment with sunitinib, and supplementing Glenna's letter
041030 -        to the doctor on 090116, ref SDS 35 SY5J; Glenna further advised
041031 -        during the call on 090121 that she would meet again with Doctor
041032 -        Rugo to discuss plans for changing Millie's treatment to
041033 -        recover from Millie's 6th IBC relapse. ref SDS 24 N976
041035 -         ..
041036 -   19.  On 090121 patient history summarized to faciliate Glenna's
041037 -        meeting with Doctor to figure out Millie's next treatment.
041038 -        ref SDS 24 NU5H
041040 -             ..
041041 -        a.  Laboratory blood tests listed for Millie to facilitate UCSF
041042 -            considering Millie's next treatment. ref SDS 24 6Y9K
041044 -             ..
041045 -        b.  Image test history of PET, CT, Xray, MRI listed for Glenna
041046 -            to discuss with Doctor Rugo discussing Millie's next
041047 -            treatment. ref SDS 24 216F
041049 -             ..
041050 -        c.  Treatment history listed for Glenna to discuss with Doctor
041051 -            Rugo discussing Millie's next treatment. ref SDS 24 H16M
041053 -             ..
041054 -        d.  Strategy considerations for selecting Millie's next
041055 -            treatment. ref SDS 24 558O
041057 -         ..
041058 -   20.  On 090122 telephone message from Glenna reported that the
041059 -        doctor ended treament with sunitinib protocol; Glenna met with
041060 -        Doctor Rugo to develop treatment plan for Millie, and UCSF
041061 -        scheduled Millie to start new treatment on 090129. ref SDS 28
041062 -        K96F
041064 -         ..
041065 -   21.  On 090123 primary care physician at Kaiser cited sudden relapse
041066 -        of IBC with nodules spreading in the breastbone area, and
041067 -        cancer marker elevated to CA 15-3 303 in the labs at Kaiser on
041068 -        090116, ref SDS 17 PQTQ, shows Millie needs immediate change of
041069 -        treatment to prevent cancer from cascading out of control, and
041070 -        that UCSF should prescribe treatment, ref SDS 33 RK6O, because
041071 -        Millie's 6th relapse of IBC shows cancer has mutated to cells
041072 -        that are now very resistant to treatments available at Kaiser,
041073 -        as discussed previously during the meeting at Kaiser on 080829,
041074 -        and cited in Millie's letter to the medical team. ref SDS 4
041075 -        RP9R
041077 -         ..
041078 -   22.  On 090123 Millie's letter to medical team reports progress at
041079 -        UCSF scheduling Millie to start on a new treatment. ref SDS 29
041080 -        KR4P
041082 -         ..
041083 -   23.  On 090123 Glenna called and thanked her for expediting Millie's
041084 -        new treatment to start on 090129 so that cancer does not
041085 -        cascade out of control, ref SDS 30 TR80; request documentation
041086 -        on new treatment in order to be prepared starting on 090129
041087 -        0830, as presented in Glenna's telephone message on 090122,
041088 -        ref SDS 28 AT6N
041090 -         ..
041091 -   24.  On 090123 Glenna advised during her call that there was not
041092 -        enough time to meet with Doctor Rugo on 090121; she received a
041093 -        letter from the doctor to coordinate with Kaiser on getting
041094 -        timely referral to start Millie's next treatment at UCSF on
041095 -        090129. ref SDS 30 118M
041097 -         ..
041098 -   25.  On 090123 Doctor Johnson, Millie's primary care physician at
041099 -        Kaiser, called and confirmed prior advice that Doctor Rugo can
041100 -        prescribe follow on treatment for Millie because her cancer has
041101 -        become resistant to drugs available at Kaiser. ref SDS 33 8K6K
041103 -         ..
041104 -   26.  On 090127 Millie letter to medical team reporting Doctor
041105 -        Johnson called on 090123 to advise of approval for Doctor Rugo
041106 -        to prescribe Millie's follow on treatment at UCSF to start
041107 -        immediately on 090129. ref SDS 35 TY5W
041109 -         ..
041110 -   27.  On 090127 Millie's letter to the medical team submitted patient
041111 -        history to facilitate prescribing new treatment for Millie's
041112 -        6th relapse of IBC. ref SDS 35 TY6S
041114 -         ..
041115 -   28.  On 090127 Millie's letter reported side effects of sunitinib
041116 -        have begun to subside after stopping treatment on 090122 in
041117 -        order to prepare to start new treatment on 090129. ref SDS 35
041118 -        TY8T
041119 -
041121 -  ..
041122 - Severe Bruising Dislocated Shoulder Request Medical Advice
041123 -
041124 - Millie sent a letter to the primary care physician with copy to the
041125 - medical team on recovering from dislocated shoulder treated at Kaiser
041126 - Emergency Department on 090122, and explaining also reported on issues
041127 - related to starting new treatment to recover from 6th relapse of
041128 - IBC...
041129 -
041130 -    1.  Subject: Bruising on Right Arm Advancing Stitches Remove from Right Eye
041131 -        Date: Wed, 28 Jan 2009 09:53:21 -0800
041144 -         ..
041145 -    2.  Severe bruising seems to be spreading on my right inner arm
041146 -        from the arm pit to well below the elbow.  This morning there
041147 -        is also bruising on the right side above my right breast.  I
041148 -        assume this is partly due to Coumadin, and elevated INR 3.7
041149 -        reported in the ER lab last Thursday on 090122. ref SDS 26 PU7Y
041151 -         ..
041152 -    3.  Should Coumadin be adjusted in advance of getting an INR test
041153 -        tomorrow at UCSF?
041154 -
041155 -            [On 090128 Doctor Johnson, primary care physician responds
041156 -            and does not prescribe treatment for bruising. ref SDS 37
041157 -            OR4F
041159 -             ..
041160 -            [On 090203 Millie suffers bruising spreading to lower right
041161 -            side above the hip. ref SDS 42 4K5I
041163 -         ..
041164 -    4.  ER special instructions received on 090122 from the Emergency
041165 -        Department called for removal of stitches in 5 days, which
041166 -        would have been yesterday. ref SDS 26 4Y5K
041168 -         ..
041169 -    5.  Previously, on 080710 Catherine in the Infusion Clinic at UCSF
041170 -        removed stitches for the Huber needle, ref SDS 3 I274,
041171 -        implanted at Kaiser during surgery on 080708.  I will be in the
041172 -        Infusion Clinic at UCSF in the morning at 0800.  Should the
041173 -        stitches be removed then?
041175 -         ..
041176 -    6.  I am scheduled to meet with the Orthopedics Department at
041177 -        Kaiser tomorrow afternoon at 1:30p, after I get back from UCSF.
041178 -        This visit follows up treatment for the shoulder injury on
041179 -        090122. Can stitches be removed during this visit?
041181 -         ..
041182 -    7.  Alternatively, should I come in today for review of expanding
041183 -        bruising and to get stitches removed?
041185 -         ..
041186 -    8.  My arm seems to be doing better.  Swelling has been controlled
041187 -        with ice as prescribed in Special Instructions, and is
041188 -        relatively pain free.
041190 -         ..
041191 -    9.  Please advise work plan to address bruising and stitches
041192 -        issues.
041193 -
041195 -  ..
041196 - Pain IBC on Chest Relieved with Vicadin
041197 - IBC Shoulder Better Breastbone Worse Taking Vicadin to Relieve Pain
041198 -
041199 -
041200 -   10.  Good news, IBC on left shoulder looks better.  The breastbone
041201 -        area still seems worse, but not so intense today.  Last night I
041202 -        took a Vicadin to relieve discomfort from IBC in the breastbone
041203 -        area.
041205 -             ..
041206 -            [On 090130 Millie reported increased IBC, and rising pain
041207 -            from IBC; that she has held off taking prescribed drugs in
041208 -            order to avoid over medicating, but that UCSF prescribed
041209 -            taking the medication because Millie's vitals are elevated
041210 -            in response to rising pain. ref SDS 38 AY7T
041212 -             ..
041213 -            [On 090130 Doctor Rugo reported rising pain from IBC heat
041214 -            in her letter to Kaiser requesting referral for
041215 -            hyperthermia treatment of 6th relapse IBC. ref SDS 38 BF3J
041217 -             ..
041218 -            [On 090201 Millie reports IBC getting worse by the hour;
041219 -            asks for advice to treat rising pain, ref SDS 39 KN9T,
041220 -            further requests getting treatment the next day at UCSF on
041221 -            090202. ref SDS 39 KN9W
041223 -             ..
041224 -            [On 090202 1437 Millie reports to medical team IBC disease
041225 -            progressed significantly with rising pain, since meeting at
041226 -            UCSF on 090129, ref SDS 40 R23S, when hyperthermia
041227 -            treatment was prescribed to achieve local control in time
041228 -            to be effective because communication mishaps delayed
041229 -            treatment a week, reported on 090130 1722. ref SDS 38 AY8Q
041231 -             ..
041232 -            [On 090203 1417 Millie reports pain control with Tylenol
041233 -            and Vicodin using increased dose above prescribed levels;
041234 -            asks for confirmation. ref SDS 41 IS6U
041236 -             ..
041237 -            [On 090204 1622 Millie's letter to medical team reported
041238 -            having called Kaiser on 090203 for pain relief interrupting
041239 -            sleep from worsening IBC and recovering from shoulder
041240 -            injury, as reported in the record on 090203 2217,
041241 -            ref SDS 42 KE5I; Millie advised on 090204 1622 implementing
041242 -            Kaiser instructions, ref SDS 43 135F, to double the dose
041243 -            prescribed for pain medication and the doctor will
041244 -            prescribe low-dose morphine, ref SDS 43 D64W, resolving
041245 -            fears of over medicating by taking only 30% of prescribed
041246 -            dose levels, also reported on 090203 2217. ref SDS 42 L74H
041248 -         ..
041249 -   11.  Physically, I'm feeling stronger.
041250 -
041257 -
041258 -
041259 -
041260 -
041261 -
041262 -
041263 -
041264 -
041265 -
041266 -
0413 -