CONTACTS 

SUBJECTS
2nd Opinion Retainer $300 Scope of Work  Rceived Support Medical Tea

1803 -
1803 -    ..
1804 - Summary/Objective
1805 -
180501 - Follow up ref SDS 64 0000. ref SDS 62 0000.
180502 -
180503 -
180504 -
180505 -
180507 -  ..
1806 -
1807 -
1808 - Progress
1809 -
180901 - Background on working with Doctor Stritter is reported on 090106.
180902 - ref SDS 48 KI5I
180903 -
180904 -        1.  Millie met Doctor Stritter during
180905 -            seminar presentation at Wellness
180906 -            Community cancer support
180907 -            group.............................. 081018, ref SDS 28 PQ6X
180909 -             ..
180910 -        2.  Doctor Stritter asked for copies of
180911 -            correspondence with the medical team
180912 -            on Millie's response to sunitinib
180913 -            treatment for cancer that supports
180914 -            Doctor Stritter's research on
180915 -            advanced cancer
180916 -            treatments......................... 081018, ref SDS 28 1Y4G
180918 -             ..
180919 -        3.  Doctor Stritter was helpful finding
180920 -            referral for resolving payment issues
180921 -            with Kaiser for Millie's treatment
180922 -            on referral to UCSF................ 081114, ref SDS 32 638G
180924 -             ..
180925 -        4.  Millie was confused, worried, and
180926 -            emotional about plans to maintain
180927 -            strong recovery from cancer and reduce
180928 -            side effects by adjusting treatments
180929 -            to tolerable levels on 081226,
180930 -            presented during meeting at
180931 -            UCSF............................... 081218, ref SDS 40 QW48
180932 -            as set out in the letter confirming
180933 -            understandings to the medical
180934 -            team............................... 081218, ref SDS 41 GF4V
180935 -            Millie submitted a copy to Doctor
180936 -            Stritter of the letter on 081218 to
180937 -            the medical team reporting results of
180938 -            examination at
180939 -            UCSF............................... 081218. ref SDS 41 4P7F
180941 -             ..
180942 -        5.  Millie sent a copy to Doctor Stritter
180943 -            of another letter to the primary care
180944 -            physician at Kaiser on 081219, requesting
180945 -            assistance managing the work plan at
180946 -            UCSF for Millie's treatment with
180947 -            sunitinib.......................... 081219, ref SDS 43 KY8Q
180948 -            noting that case management is
180949 -            difficult due to limited time and emotional
180950 -            feelings that prevent thorough analysis
180951 -            during meetings with
180952 -            doctors............................ 081219, ref SDS 43 SU8X
180954 -             ..
180955 -        6.  Millie's letter to Doctor Stritter
180956 -            requested second opinion on Millie's
180957 -            treatment with sunitinib staying at
180958 -            full strength and reducing or ending
180959 -            treatment with cyclophosphamide
180960 -            to reduce side
180961 -            effects............................ 081220, ref SDS 44 I69Q
180963 -             ..
180964 -        7.  Millie received a letter from Doctor
180965 -            Stritter with terms and conditions for
180966 -            2nd opinion, and transmitting a pdf file
180967 -            requesting patient history in a
180968 -            questionnaire...................... 081223, ref SDS 45 8N9M
180970 -             ..
180971 -        8.  Questionnaire could not be filled out
180972 -            in pdf file because Adobe Acrobat
180973 -            could not be configured; information
180974 -            requested in the form was
180975 -            entered in the
180976 -            record............................. 081223, ref SDS 45 DQ6J
180978 -             ..
180979 -        9.  Patient history for Doctor Stritter's
180980 -            2nd opinion support was developed
180981 -            in the SDS record.................. 090106, ref SDS 48 IP6H
180983 -             ..
180984 -       10.  Millie sent letter to Doctor Stritter
180985 -            with payment of $300 for 2nd
180986 -            opinion services................... 090106, ref SDS 48 S34O
180987 -            and listing objectives for
180988 -            conslutation....................... 090106, ref SDS 48 6H3Q
180990 -             ..
180991 -       11.  Doctor Stritter notified Millie that
180992 -            she was attending a professional conference
180993 -            on integrative oncology conference in
180994 -            Florida, and would respond to
180995 -            Millie's letter on
180996 -            090114............................. 090107, ref SDS 50 PJ3I ,
180998 -             ..
180999 -       12.  Doctor Stritter called and advised she
181000 -            needs another $300 to provide a 2nd
181001 -            opinion on treatments for
181002 -            Millie............................. 090114, ref SDS 51 U290
181003 -            doctor requested support reviewing
181004 -            Millie's complex patient history
181005 -            for 2nd opinion
181006 -            work............................... 090114, ref SDS 51 U271
181008 -             ..
181009 -       13.  Millie sent a letter to Doctor Stritter,
181010 -            ref SDS 54 3C5O, following up the letter
181011 -            on 090106 setting out scope of assignment,
181012 -            ref SDS 48 S34O, confirming understandings
181013 -            from the call on 090114, and submitting
181014 -            additional information on pathology
181015 -            reports and CT tests requested
181016 -            by the doctor...................... 090119, ref SDS 51 U271
181018 -             ..
181019 -       14.  Called Doctor Stritter who asked for
181020 -            information in a questionaire she
181021 -            submitted with a letter to Millie on
181022 -            091223, ref SDS 45 DQ6J, the doctor
181023 -            wants another $300 to provide a list
181024 -            of treatments that can
181025 -            help Millie........................ 090120, ref SDS 55 CM66
181027 -             ..
181028 -       15.  Millie sent a letter to Stritter Medical
181029 -            Consulting transmitting information
181030 -            requested in the Questionnaire
181031 -            received in the record on
181032 -            081223............................. 090121, ref SDS 56 C57O
181034 -             ..
181035 -       16.  Regrettably, time has become a factor
181036 -            because the cancer marker jumped to
181037 -            CA 15-3 303 for the lab on 090116.
181038 -            ref SDS 52 PQTQ; Millie needs
181039 -            input as soon as
181040 -            possible........................... 090121, ref SDS 56 SC5T
181042 -             ..
181043 -       17.  Dislocated shoulder from fall treatment
181044 -            in Emergency Department on 090122, and
181045 -            notice that UCSF ended Millie's
181046 -            treatment with sunitinib due to 6th
181047 -            relapse of IBC, and rising side
181048 -            effects; copy of letter to
181049 -            medical team sent to Doctor
181050 -            Stritter........................... 090123, ref SDS 58 KR4P
181052 -             ..
181053 -       18.  Millie letter notified Doctor Stritter
181054 -            that UCSF ended treatment with sunitinib
181055 -            due progression of
181056 -            disease............................ 090126, ref SDS 61 Q59G
181057 -            Millie meeting with UCSF on 090129
181058 -            asks Doctor Stritter for
181059 -            treatment options.................. 090126, ref SDS 61 066T
181061 -             ..
181062 -       19.  Doctor Stritter letter proposes teleon
181063 -            2nd opinion on 090203 or on 090205 at
181064 -            1600, and needs payment of another
181065 -            $300 paymnet in advance of
181066 -            consultation....................... 090127, ref SDS 62 L24J
181068 -             ..
181069 -       20.  Millie submitted payment of $300 and
181070 -            requests consultation on 090203,
181071 -            requests receipt................... 090127, ref SDS 62 HO5W
181073 -             ..
181074 -       21.  Doctor Stritter receives payment;
181075 -            says cannot have telecon on 090203;
181076 -            asks about having consultation
181077 -            on 090205 1600..................... 090130, ref SDS 64 4W6L
181079 -  ..
181080 - Millie notifies Doctor Stritter of difficulties getting follow on
181081 - treatment set up; requests urgent 2nd opinions...
181082 -
181083 -    1.  Subject: 2nd Opinion Needed Urgtently
181084 -        Date: Sat, 31 Jan 2009 11:37:57 -0800
181091 -         ..
181092 -    2.  Responding to your letter yesterday on January 30 (seems like
181093 -        ages ago now), ref SDS 64 4W6L, my cancer is progressing [see
181094 -        Millie's letter to medical team on 090130, ref SDS 65 AY7X, and
181095 -        lining up treatment options has been difficult, as shown in the
181096 -        letter to the medical team yesterday, with a copy to you.
181097 -        ref SDS 65 W858
181099 -         ..
181100 -    3.  While I understand that your practice includes talking to the
181101 -        patient, I am primarily interested in your research and written
181102 -        opinion listing treatments and sources for my patient profile.
181103 -        For example, I had never heard of hyperthermia.  Yesterday,
181104 -        Tara, the Nurse Practitioner, who does most of the patient
181105 -        examination work, and Doctor Rugo had glowing reports of
181106 -        success treating IBC.  I had asked for notice of what was to be
181107 -        presented in order to be prepared for a productive meeting, and
181108 -        Glenna, the coordinator said they didn't have time.  I'm sure
181109 -        she felt political pressure not to ask Doctor Rugo, because of
181110 -        a hectic schedule.
181112 -         ..
181113 -    4.  So, we show up, nobody is prepared.  Doctor Rugo said she told
181114 -        Glenna a week ago to get authorization from Kaiser so I could
181115 -        get treatment Thursday.  This wasn't done, so no treatment.
181116 -        Instead folks are scrambling trying write a coherent letter
181117 -        under stress during a meeting; nobody can find the address.  It
181118 -        is a mess. ref SDS 65 AY9Q  By the time this all gets done, the
181119 -        guy who has to issue the authorization at Kaiser had left,
181120 -        because on Friday he works in the afternoon at another Kaiser
181121 -        facility [reported on 090129. ref SDS 63 3P7J]
181123 -         ..
181124 -        Medical Case Management Health Care Complex Communications
181125 -
181126 -    5.  I'm sure this is nobody's fault.  Doctor Rugo probably told
181127 -        Glenna in the hallway to do 3 or 4 things, and other assistants
181128 -        were told to do 2 or 3 things, and all of this could be
181129 -        interpreted in multiple ways, causing endless bumbling with
181130 -        everyone working hard by conversation.
181132 -         ..
181133 -    6.  Had a real battle to get Doctor Rugo to send a letter to Kaiser
181134 -        recommending my next treatment.  This took 10 minutes, but
181135 -        required 30 minutes to be done correctly.  However, the doctor
181136 -        is under great pressure to spend that 10 minutes talking to the
181137 -        next patient.  It's a Knowledge Management dilemma.
181139 -         ..
181140 -    7.  The obvious question is are there other treatment that can help
181141 -        me?
181143 -         ..
181144 -    8.  We can have the telecon you propose on Thursday, or any time at
181145 -        your convenience.  I would like an agenda a day or so before
181146 -        with a partial list of possible treatments, so I can be
181147 -        prepared with focused questions.
181148 -
181149 -            [On 090202 Gwen submitted preliminary report on proposed
181150 -            follow on treatments for Millie, which enables review to be
181151 -            prepared for telecon consultation on 090205. ref SDS 67
181152 -            EF9M
181154 -             ..
181155 -            [On 090203 2327 Millie receives Gwen's preliminary report
181156 -            with possible treatments to maintain Millie's quality of
181157 -            life, and which can guide telecon consultation scheduled
181158 -            for 090205 1600. ref SDS 68 CF7J
181160 -         ..
181161 -    9.  Hopefully, the authorization for treatment at UCSF will come
181162 -        through and this will relieve pressure on finding another
181163 -        solution immediately, especially if the treatment is effective.
181164 -
181165 -            [On 090202 Kaiser authorizes hyperthermia treatment for
181166 -            Millie on referral at UCSF. ref SDS 66 SP6H
181168 -         ..
181169 -   10.  Thanks for hanging in there with me.
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