CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 44 0000. ref SDS 43 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
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
041120 -         ..
041121 -   29.  On 090128 Millie letter to primary care physician and the
041122 -        medical team reported IBC worsening, and taking Vicadin for
041123 -        pain. ref SDS 37 2S8X
041125 -         ..
041126 -   30.  On 090129 Doctor Rugo sent a letter to primary care physician
041127 -        at Kaiser requesting referral to UCSF for treatment with
041128 -        hyperthermia and Doxil, reported in Millie's letter to medical
041129 -        team on 090130. ref SDS 43 AY9Q
041131 -         ..
041132 -   31.  On 090130 Millie letter to primary care physician, ref SDS 43
041133 -        GV4M, reports examination at UCSF on 090129 found IBC
041134 -        progressing rapidly, ref SDS 43 4S8O, as Doctor Johnson noted
041135 -        earlier on 090123, ref SDS 33 8K6K;
041137 -         ..
041138 -   32.  On 090130 Millie letter to primary care physician advises UCSF
041139 -        reported communication delay prevented getting referral from
041140 -        Kaiser, which then delayed starting hyperthermia treatment on
041141 -        090129 in time to be effective. ref SDS 43 AY8Q
041143 -         ..
041144 -   33.  On 090130 Millie letter to medical team reports that on 090129
041145 -        coordinating timely referral from Kaiser was delayed because
041146 -        primary care physician was not in the office. ref SDS 43 AY9T
041148 -         ..
041149 -   34.  On 090130 Krshna called Millie to schedule hyperthermia
041150 -        treatment in the Radiation Oncology Department, and said that
041151 -        UCSF has not received referral authorization from Kaiser.
041152 -        ref SDS 41 NM5H
041154 -         ..
041155 -   35.  On 090130 called Arlette, ref SDS 42 RY4G, and she contacted
041156 -        Doctor Johnson off-site in a meeting, and he advised that the
041157 -        doctor would file authorization in the evening on 090130.
041158 -        ref SDS 42 PPYY
041160 -         ..
041161 -   36.  On 090131 Millie received letter from Doctor Johnson, primary
041162 -        care physician, that Kaiser authorization was issued on 090130,
041163 -        ref SDS 44 GV4M, for Millie to get treatment for 6th relapse of
041164 -        IBC with hyperthermia and Doxil, prescribed by Doctor Rugo on
041165 -        090129 (reported in Millie's letter on 090130. ref SDS 43 AY9Q
041167 -  ..
041168 - Millie sent a letter to the medical team advising that Kaiser has
041169 - issued authorization for Millie's treatment at UCSF with hyperthermia
041170 - and Doxil, and requests timely implementation to prevent cancer from
041171 - cascading out of control...
041172 -
041173 -    1.  Subject: UCSF Treatment Plan Hyperthermia Doxil
041174 -        Date: Sun, 01 Feb 2009 19:03:34 -0800
041183 -         ..
041184 -    2.  Thanks very much for your letter last night advising that
041185 -        Kaiser authorization was submitted on 090130, ref SDS 44 GV4M,
041186 -        for me to have hyperthermia treatment at UCSF prescribed by
041187 -        Doctor Rugo in her letter to you on 090129. ref SDS 43 TZ6H
041189 -         ..
041190 -    3.  I am very grateful.  Thanks to Krshna at UCSF [reported on
041191 -        090130, ref SDS 41 NM5H], and to Arlette in your office for
041192 -        timely coordination [also reported on 090130, ref SDS 42 PPYY].
041193 -
041194 -           [On 090202 Michelle at UCSF called and reported Kaiser has
041195 -           not submitted authorization for Millie's treatment on
041196 -           referral, and so UCSF cannot schedule urgent treatment.
041197 -           ref SDS 48 9Y5I
041199 -            ..
041200 -           [On 090202 1028 Millie sent a letter to the medical team
041201 -           advising prior notice that Kaiser sent authorrization for
041202 -           Millie's treatment was changed, ref SDS 50 GV4M, and
041203 -           Michelle indicates she would call and tell Doctor Rugo that
041204 -           Kaiser has to send authorization to Michelle as well as
041205 -           Krshna in Doctor Hsu's office at radiation oncology.
041206 -           ref SDS 50 FR6S
041208 -            ..
041209 -           [On 090202 Kaiser reports doctor's authorization for
041210 -           Millie's urgent treatment on referral to UCSF has been
041211 -           witheld until the doctor, who is out of town, returns to the
041212 -           office and can provide a code to complete the referral form.
041213 -           ref SDS 49 J15F
041214 -
041216 -  ..
041217 - Pain Worsening Needs Medication
041218 - IBC Worsening Needs Immediate Treatment to Prevent Losing Control
041219 - Hyperthermia Doxil Treatment Schedule 090202 at UCSF Radiation Oncology
041220 -
041221 -
041222 -    4.  IBC seems to be getting worse by the hour.  I'm afraid to look
041223 -        at my chest.  As noted in my letter to the medical team on
041224 -        090130, I am taking Tylenol and Vicadin for pain relief
041225 -        prescribed for my shoulder.  This is becoming less effective
041226 -        for pain from IBC on my chest [noted by Tara during examination
041227 -        at UCSF citing rising vitals signal rising pain, ref SDS 43
041228 -        AY7T, further shown by Doctor Rugo report of rising pain in a
041229 -        letter to primary care physician requesting referral for
041230 -        treatment with hyperthermia and Doxil, ref SDS 43 TZ6H - and
041231 -        following up Millie's letter to medical team on 090128
041232 -        reporting rising pain from IBC. ref SDS 37 2S8X]  Should I
041233 -        increase the dose above prescribed levels?  On a scale of 1 -
041234 -        10 pain is 2 or 3; so it is not severe like the dislocated
041235 -        shoulder last week (that was a "15").  IBC hurts most when the
041236 -        skin squeezes slightly, as in reaching across my chest, or
041237 -        rolling over in bed.
041238 -
041239 -           [On 090201 Millie emotinoal trauma relieved medical team
041240 -           plans for treatment in time to be effective relieving
041241 -           severe symptoms of 6th relapse IBC. ref SDS 46 5R3T
041243 -            ..
041244 -           [On 090201 Doctor Johnson sent a leter advising Millie that
041245 -           he is out of town and cannot respond until 090303.
041246 -           ref SDS 47 Y35M
041248 -            ..
041249 -           [On 090202 1437 Millie reports to medical team IBC disease
041250 -           progressed significantly with rising pain, since meeting at
041251 -           UCSF on 090129, ref SDS 51 R23S, when hyperthermia
041252 -           treatment was prescribed to achieve local control in time
041253 -           to be effective because communication mishaps delayed
041254 -           treatment a week, reported on 090130 1722. ref SDS 43 AY8Q
041256 -            ..
041257 -           [On 090203 Millie experiences rising pain that interrupts
041258 -           sleep at night. ref SDS 53 KE5I
041260 -            ..
041261 -           [On 090203 1417 Millie reports pain control with Tylenol
041262 -           and Vicadin using increased dose above prescribed levels;
041263 -           asks for confirmation. ref SDS 52 IS6U
041265 -            ..
041266 -           [On 090204 1622 Millie's letter to medical team reported
041267 -           having called Kaiser on 090203 for pain relief interrupting
041268 -           sleep from worsening IBC and recovering from shoulder
041269 -           injury, as reported in the record on 090203 2217,
041270 -           ref SDS 53 KE5I; Millie advised on 090204 1622 implementing
041271 -           Kaiser instructions, ref SDS 54 135F, to double the dose
041272 -           prescribed for pain medication and the doctor will
041273 -           prescribe low-dose morphine, ref SDS 54 D64W, resolving
041274 -           fears of over medicating by taking only 30% of prescribed
041275 -           dose levels, also reported on 090203 2217. ref SDS 53 L74H
041276 -
041278 -  ..
041279 - Top Priority Expedite Treatment Tomorrow at UCSF Recover IBC
041280 - Hyperthermia Treatment 6th Relapse IBC Start Tomorrow 090202 at UCSF
041281 -
041282 -
041283 -    5.  For Doctor Rugo, can I come in to UCSF tomorrow morning to
041284 -        expedite hyperthermia treatment?  I don't mind standing by in
041285 -        the cafeteria until Doctor Hsu can fit me in.  (sending copy to
041286 -        Glenna because she has coordinated when Doctor Rugo is out of
041287 -        the office, and at this time another coordinator has not been
041288 -        assigned.)
041290 -         ..
041291 -    6.  Krshna, in Doctor Hsu's office  indicated last Friday [on
041292 -        090130] that, if she had authorization [from Kaiser], I could
041293 -        get treatment tomorrow on Monday. ref SDS 41 NM5H  I called and
041294 -        left a message late Friday afternoon that Arlette reported
041295 -        authorization was approved, ref SDS 41 PPYR, but I did not hear
041296 -        back from Krshna.  So, things may already be set up for Monday.
041297 -
041298 -            [On 090201 Doctor reports communicating with Doctor Hsu
041299 -            using email notifying Doctor Hsu Millie's report of IBC
041300 -            increasing in severity and pain, and telling Millie not to
041301 -            come to UCSF tomorrow on 090202, and that Doctor Hsu is
041302 -            working to scheduling Millie for treatment in time to be
041303 -            effective. ref SDS 45 GV4M
041305 -             ..
041306 -            [On 090201 Millie emotinoal trauma relieved medical team
041307 -            plans for treatment in time to be effective relieving
041308 -            severe symptoms of 6th relapse IBC. ref SDS 46 5R3T
041310 -             ..
041311 -            [On 090201 Doctor Johnson sent a leter advising Millie that
041312 -            he is out of town and cannot respond until 090303.
041313 -            ref SDS 47 Y35M
041314 -
041315 -
041317 -  ..
041318 - Lymphedema Increses Forced Remove Immobilizer to Prevent Cellulitis
041319 -
041320 -
041321 -    7.  Today, I had to remove the immobilizer on the right arm [see
041322 -        Kaiser prescription on 090129, ref SDS 40 YU8W], because
041323 -        pressure on my chest (this is a complex harness) caused my left
041324 -        arm to start swelling from lymphedema.  I found an alternate
041325 -        sling here at the house used for another injury a few years
041326 -        ago.  It does not wrap around my waist, and so relieves
041327 -        pressure on lymphatics.
041328 -
041329 -            [On 090201 Doctor Johnson sent a leter advising Millie that
041330 -            he is out of town and cannot respond until 090303.
041331 -            ref SDS 47 Y35M
041333 -             ..
041334 -            [On 090203 lymphedema mostly subsided 2 days after removing
041335 -            the harness-sling. ref SDS 53 RN68
041337 -             ..
041338 -            [On 090205 lymphedema recurrence from overuse of left arm
041339 -            because right arm healing from dislocated shoulder.
041340 -            ref SDS 55 9Y5I
041342 -         ..
041343 -    8.  Temperature is 97.4, and no evidence of Cellulitis, which has
041344 -        often occurred with lymphedema.  I assume Keflex is only needed
041345 -        if Cellulitis and temperature occur.
041346 -
041348 -  ..
041349 - Energy Recovers Sunitinib Side Effects Subside Feet Better
041350 - Side Effects Sunitinib Clinical Study Subsiding Millie Recovering Energy
041351 -
041352 -
041353 -    9.  Good news... my feet are better today.  I went hiking and did
041354 -        the 3 mile flat course.  Energy is getting back to normal.
041356 -         ..
041357 -   10.  I put the lymphedema sleeve on the left arm and will elevate,
041358 -        per prior guidance.
041359 -
041361 -  ..
041362 - Start Treatment Top Priority Prevent Cancer Cascade Out of Control
041363 -
041364 -
041365 -   11.  Priority is to start treatment on IBC to prevent cancer from
041366 -        cascading out of control.  That's my big worry now.
041367 -
041374 -
041375 -
041376 -
041377 -
041378 -
041379 -
041380 -
041381 -
041382 -
041383 -
041384 -
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041389 -
0414 -