THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: February 3, 2009 02:17 PM Tuesday;
Rod Welch
Millie notifies medical team VCI can provide hyperthemia tomorrow in time
to be effective recoverying from IBC 6th relapse.
1...Summary/Objective
..............
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 59 0000. ref SDS 57 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
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 44 AY9Q
041131 - ..
041132 - 31. On 090130 Millie letter to primary care physician, ref SDS 44
041133 - GV4M, reports examination at UCSF on 090129 found IBC
041134 - progressing rapidly, ref SDS 44 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 44 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 44 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 42 NM5H
041154 - ..
041155 - 35. On 090130 called Arlette, ref SDS 43 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 43 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 45 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 44 AY9Q
041167 - ..
041168 - 37. On 090201 Millie letter reports to medical team 6th relapse IBC
041169 - getting worse by the hour requires immediate treatment to
041170 - prevent cancer from getting out of control. Pain from IBC
041171 - makes sleeping difficult. ref SDS 46 KN9T
041173 - ..
041174 - 38. On 090201 Millie plans to go to UCSF for treatment tomorrow on
041175 - 090202 when convenient for Doctor Hsu to provide hypethermia
041176 - treatment. ref SDS 46 KN9W
041178 - ..
041179 - 39. On 090201 Millie reports lymphedema recurrence caused by
041180 - sling-immobilizer to treat dislocated shoulder on 090122;
041181 - advises Cellulitis did not recur, as previously. ref SDS 46
041182 - KN4S
041184 - ..
041185 - 40. On 090201 Millie reports good news energy recovering after side
041186 - effects from stopping treatment on sunitinib clinical study
041187 - ordered by Doctor Rugo on 090122. ref SDS 46 KN4Y
041189 - ..
041190 - 41. On 090201 UCSF letter notifies Millie that Doctor Rugo is
041191 - communicating with Doctor Hsu using email to expedite Millie's
041192 - treatment; recommends that Millie not come to UCSF on Monday
041193 - 090202 in order to assist the medical team start hyperthermia
041194 - treatment in time to be effective. ref SDS 47 GV4M
041196 - ..
041197 - 42. On 090201 Millie letter assures medical team that the patient
041198 - would not "camp out" in Doctor Hsu's office, but would stand-by
041199 - in the cafeteria so that treatment can begin when convenient
041200 - for UCSF, and without waiting for patient to travel through
041201 - mid-day traffic, so that urgent treatment is not delayed beyond
041202 - a point when treatment can no longer be effective. ref SDS 48
041203 - GV4M
041205 - ..
041206 - 43. On 090201 Millie asks Doctor Rugo about coordinating to provide
041207 - medical records on file in the doctor's office the past 2 years
041208 - treating Millie at UCSF, ref SDS 48 5R4S, to use by Doctor Hsu,
041209 - requested by Krshna in a call the day before on 090130.
041210 - ref SDS 42 DL4J
041212 - ..
041213 - 44. On 090201 emotional trauma esclates from delays getting
041214 - treatment for aggressive cancer that seems to be cascading out
041215 - of control because of communication delays. ref SDS 48 5R4V
041217 - ..
041218 - 45. On 090202 Michelle at UCSF called in the morning, and said
041219 - Kaiser has not submitted authorization for Millie's treatment
041220 - by Doctor Hsu. ref SDS 50 9Y5I Michelle asked the patient to
041221 - coordinate with the primary care physician at Kaiser to file
041222 - Authorization, ref SDS 50 9Y6Y, reported in Millie's letter to
041223 - the medical team. ref SDS 52 GV4M
041225 - ..
041226 - 46. On 090202 Michelle was advised that Doctor Johnson reported in
041227 - a letter on 090131 that Doctor Rugo at UCSF was notified on
041228 - 090130 that Kaiser issued authorization for Millie's treatment,
041229 - ref SDS 45 GV4M, and further that Doctor Johnson would be out
041230 - of town for several days, so he is not available on 090202 for
041231 - coordinating requested by UCSF on 090202, ref SDS 49 Y35M, to
041232 - file duplicate authorization, reported in Millie's letter to
041233 - the medical team on 090202 1028. ref SDS 52 FR6P
041235 - ..
041236 - 47. On 090202 0940 numerous calls were made to coordinate.
041237 - ref SDS 51 9Y5I Florida in Kaiser Oncology Department, Walnut
041238 - Creek CA advised that Pam in Kaiser Outside Referrals
041239 - Department said the doctor did not enter a "code" in the
041240 - Authorization form for hyperthermia treatment, so Pam is
041241 - waiting to get the code when the doctor returns from traveling
041242 - sometime in the next few days, ref SDS 51 1A5J, reported in
041243 - Millie's letter to the medical team. ref SDS 52 FR7R
041245 - ..
041246 - 48. On 090202 1012 called Kaiser Outside Referrals and left a
041247 - message that we need submission of authorization, so that
041248 - Millie can get treatment in time to be effective. ref SDS 51
041249 - W17K Suggested Outside Referrals send written notice to
041250 - Michelle Williams Jones at UCSF that authorization is on file
041251 - at Kaiser, and will be submitted to UCSF, so that my treatment
041252 - can be initiated concurrently. ref SDS 51 254F, reported in
041253 - Millie's letter to the medical team. ref SDS 52 FR7U
041255 - ..
041256 - 49. On 090202 1047 Pam in Outside Referrals at Kaiser called and
041257 - disclosed that the department needed to know the type of
041258 - treatment Millie would get on referral to UCSF? Advised
041259 - treatment is "hyperthermia," in the Radiation Oncology
041260 - department at UCSF. Pam reported that Kaiser does not have a
041261 - code for "hypethermia" nor for "Radiation Oncology." Pam used
041262 - a code for "Radiology." Problem solved. ref SDS 53 QQ7N, and
041263 - reported in Millie's letter to the medical team on 090202 1139.
041264 - ref SDS 55 M88H
041266 - ..
041267 - 50. On 090202 1117 Pam called back and wanted to know if referral
041268 - to UCSF is for in-patient or out-patient treatment? Since
041269 - radiation is often out-patient care, and initial discussions
041270 - did not indicate Millie would require staying in the hospital,
041271 - Pam coded the form for out-patient care, reported in the record
041272 - on 090202 1047]. ref SDS 53 0256, and reported in Millie's
041273 - letter to the medical team on 090202 1139. ref SDS 55 C94Y
041275 - ..
041276 - 51. On 090202 1118 Doctor Rugo notified the medical team that
041277 - Doctor Hsu cannot see Millie on 090202; advises that Doctor Hsu
041278 - is aware of Millie's situation. ref SDS 54 V47L
041280 - ..
041281 - 52. On 090202 1353 Doctor Hsu's assistant, Krshna reported that the
041282 - doctor was not aware of urgency to treat Millie, cited in
041283 - Doctor Rugo's letter on 090202 1118. ref SDS 54 V47L Krshna
041284 - proposes scheduling the work on 090219, ref SDS 56 XO7G, and
041285 - does not feel comfortable asking Doctor Hsu to advance the date
041286 - for treatment, because his schedule is already booked.
041287 - ref SDS 56 SP8I, reported in Millie's letter to the medical
041288 - team on 090202 1437. ref SDS 57 R23P
041290 - ..
041291 - 53. On 090202 1357 Krshna offers UCSF Radiation Oncology schedule
041292 - hyperthermia treatment 3 weeks delay to 090219. ref SDS 56 XO7G
041294 - ..
041295 - 54. On 090202 1437 Millie notifies medical team that UCSF received
041296 - Kaiser authorizations for treating the 6th relapse of IBC,
041297 - ref SDS 57 JR4J, reported on 090202 1353. ref SDS 56 SP6H
041298 - Millie thanks Doctor Rugo for expediting authorization with
041299 - Doctor Johnson at Kaiser, citing Doctor Rugo's letter to Doctor
041300 - Johnson on 090129, reported on 090130, ref SDS 44 TZ6H, Doctor
041301 - Rugo's letter to medical team on 090202 1118, indicating Doctor
041302 - Hsu is aware of Millie's situation. ref SDS 54 V47L
041304 - ..
041305 - 55. On 090202 1437 IBC disease has advanced significantly since
041306 - examination at UCSF on 090129, and pain on chest is rising.
041307 - Since Doctor Rugo has much more experience with IBC, if this
041308 - just "looks bad," but delaying treatment to 090219 presents no
041309 - risk of losing control, then I am fine with waiting until the
041310 - 19th. ref SDS 57 R23S
041312 - ..
041313 - 56. On 090202 1437 Millie notifies UCSF that Krshna indicated if
041314 - Doctor Rugo feels earlier treatment is needed, she can notify
041315 - Doctor Hsu directly. ref SDS 56 F65G, cited in Millie's letter
041316 - to medical team on 090202 1437, ref SDS 57 R23V
041318 - ..
041319 - 57. On 090202 1437 Millie apologizes for adding to Doctor Rugo's
041320 - work load. Waiting to the 19th is a shock compared to what
041321 - Millie sees on her chest. Results for CA 15-3 from the lab
041322 - last week on 090129 have not been published, but expect it will
041323 - be 200+, since it was 303 at Kaiser on 090116. ref SDS 17 PQTQ
041324 - Those are scary numbers in Millie's patient history. Millie
041325 - avers being a "sissy." Doctor Rugo and others at UCSF and
041326 - Kaiser are working hard to help Millie and many other patients,
041327 - cited in Millie's letter to medical team on 090202 1437.
041328 - ref SDS 57 R23Y
041330 - ..
041331 - 58. On 090202 1550 called VCI and asked about Millie getting
041332 - hyperthermia treatment immediately, rather than wait to 090219
041333 - offered by UCSF. ref SDS 58 YU8H
041335 - ..
041336 - 59. On 090202 1732 letter notifies medical team that Millie needs
041337 - urgent treatment quickly in time to be effective. ref SDS 59
041338 - Y15J
041340 - ..
041341 - 60. On 090203 0939 call VCI and schedule call to discuss alternate
041342 - source for Millie to get hyperthermia treatment in time to be
041343 - effective recovering from 6th relapse of IBC. ref SDS 60 9Y5I
041345 - ..
041346 - 61. On 090203 1009 letter to VCI submits patient history for review
041347 - to support telephone conference, ref SDS 60 IN94, on arranging
041348 - for VCI to provide hyperthermia treatment in time for Millie to
041349 - recover from 6th relapse of IBC. ref SDS 60 EP3S
041351 - ..
041352 - 62. On 090203 1024 called UCSF talked to Jennette in Radiation
041353 - Oncology; she will discuss with Doctor Hsu advancing Millie
041354 - getting hyperthermia treatment from 090219 to this week.
041355 - ref SDS 61 XX5I
041357 - ..
041358 - 63. On 090203 1206 Doctor Al-Bussam called and reported well
041359 - ordered record for Millie's patient history enabled expedited
041360 - review of complex medical problems. ref SDS 62 8488, VCI
041361 - offered to start work the next day on 090204 giving Millie
041362 - hyperthermia treatment in time to be effective recoverying from
041363 - 6th relapse IBC. ref SDS 62 OE4F
041364 -
041366 - ..
041367 - Millie sent a letter to the medical team explaining VCI offer to
041368 - provide hyperthermia treatment tomorrow on 090204, in time to be
041369 - effective, and asks for medical opinion comparing this offer with UCSF
041370 - proposal delaying treatment 3 weeks to 090219...
041371 -
041372 - 1. Subject: IBC Patient History Requires Immediate Hyperthermia
041373 - Date: Tue, 03 Feb 2009 14:23:34 -0800
041382 - ..
041383 - 2. As you know, UCSF has scheduled my treatment with hyperthermia
041384 - and Doxil on 090219 1000 [reported on 090202 1353, ref SDS 56
041385 - XO7G, presented in Millie's letter to the medical team on
041386 - 090202 1437, ref SDS 57 R23P]. I [reported disease advanced
041387 - significantly since examination on 090129, and asked Doctor
041388 - Rugo for an opinion on whether delaying treatment 3 weeks would
041389 - be okay [Millie's letter to medical team on 090202 1437.
041390 - ref SDS 57 R23S
041392 - ..
041393 - 3. Doctor [Rugo] wrote a letter to the medical team with a copy to
041394 - you and to Radiation Oncology at UCSF that I need urgent
041395 - treatment, and that this should be done quickly. ref SDS 59
041396 - Y15J
041398 - ..
041399 - 4. This morning during a call to UCSF, Jennette in Radiation
041400 - Oncology said she would talk to Doctor Hsu about advancing my
041401 - treatment to today, tomorrow, sometime this week, per Doctor
041402 - Rugo's letter, and would call back to advise. ref SDS 61 XX5I
041404 - ..
041405 - 5. Research on hyperthermia treatment [on 090129 after disclosure
041406 - at UCSF that this was proposed to treat Millie's 6th relapse of
041407 - IBC, ref SDS 41 QS5H, led to discussion with Valley Cancer
041408 - Institute (VCI) in Los Angeles [on 090202 1550. ref SDS 58
041409 - YU8H]
041411 - ..
041412 - 6. In a call a few mintues ago, Doctor Al-Bussam says that VCI can
041413 - start treatment tomorrow on Wednesday, or Thursday, or Friday.
041414 - ref SDS 62 OE4F
041415 -
041416 - [On 090203 1438 Jennette with UCSF Radiation Oncology
041417 - Department called back and advised that Doctor Hsu will
041418 - begin hypertermia treatment on 090205 so that Millie can
041419 - recover from 6th relapse of IBC, rather than risk waiting
041420 - until 090219, as proposed yesterday. ref SDS 63 XX5I
041422 - ..
041423 - [On 090203 1444 Millie notifies medical team problem
041424 - solved; UCSF changed schedule for Millie's hyperthermia
041425 - treatment to 090205 from prior proposal to start on
041426 - 090219. ref SDS 64 YQ5T
041428 - ..
041429 - 7. VCI hyperthermia is performed over an approximate 2 week period
041430 - on an out-patient protocol, so I would have to stay there for 2
041431 - weeks. I need a PET/CT scan to identify IBC fields that get
041432 - treatment. This can be done at Kaiser or at VCI. Assume the
041433 - same for UCSF. So, if we do the work at UCSF, should Kaiser
041434 - schedule a PET/CT scan as well?
041436 - ..
041437 - 8. Doctor Al-Bussam says VCI will combine hyperthermia with low
041438 - dose radiation to treat IBC, and they can combine Doxil as
041439 - Doctor Rugo prescribes. Cost is about $40K.
041441 - ..
041442 - 9. If UCSF can juggle the schedule to start treatment in the next
041443 - few days, I would prefer working with Doctor Hsu locally, based
041444 - on excellent results working with Doctor Rugo. There is a lot
041445 - of benefit to close practice collaboration at UCSF.
041446 -
041447 - [On 090202 1438 Jennette with UCSF Radiation Oncology
041448 - Department called back and advised that Doctor Hsu will
041449 - begin hypertermia treatment on 090205 so that Millie can
041450 - recover from 6th relapse of IBC, rather than risk waiting
041451 - until 090219, as proposed yesterday. ref SDS 63 XX5I
041453 - ..
041454 - 10. Alternatively, a medical opinion should be issued on risks of
041455 - waiting to Feb 19th against advantages of doing the work
041456 - tomorrow at VCI. Here is some research on the VIC hyperthermia
041457 - program [listed on 090129. ref SDS 41 QS5H]
041458 -
041459 - [On 090203 Doctor Rugo would not choose VCI for
041460 - hyperthermia treatment. ref SDS 66 DY4K
041462 - ..
041463 - 11. VCI can be reached at: 310-398-0013
041465 - ..
041466 - 12. Ask for Nash; she is familiar with Millie's case. There is not
041467 - a long wait, no hassle making contact.
041469 - ..
041470 - 13. VCI indicates they have treated patients with hyperthermia on
041471 - referral from UCSF.
041473 - ..
041474 - 14. The question is whether treatment at UCSF can be advanced. If
041475 - not, is my condition urgent enough to require another provider,
041476 - and, if so, is VCI a good choice under the circumstances? Is
041477 - there another way to get this work done in time to be
041478 - effective?
041480 - ..
041481 - 15. Good news -- lymphedema swelling on left arm reported on 090201
041482 - has now subsided.
041484 - ..
041485 - 16. Bruising has sprung up along my lower right side above the hip.
041486 -
041487 - [On 090203 2217 in another record today later at night,
041488 - Millie complains of rising pain in right shoulder and arm,
041489 - ref SDS 65 KE5I, and further observes expanding and
041490 - worsening bruising. ref SDS 65 RN6J
041492 - ..
041493 - 17. Vicadin and Tylenol with increased dose from the prescription
041494 - on 090122 are controlling pain from IBC on my chest [reported
041495 - in Millie's letter yesterday on 090202 1437, ref SDS 57 R23S,
041496 - and also the day before on 090201 presenting mild pain on scale
041497 - 1 - 10 only 3. ref SDS 46 KN9T]. Hope that's okay. My
041498 - shoulder seems to be recovering fine. No pain, no more
041499 - swelling.
041500 -
041501 - [On 090204 1528 Millie reported calling Kaiser on 090203
041502 - for pain relief from interrupting sleep caused by worsening
041503 - IBC and shoulder injury, as reported in the record on
041504 - 090203 2217, ref SDS 65 KE5I; Millie advised on 090204 1528
041505 - implementing Kaiser instructions, ref SDS 67 135F, to
041506 - double the dose for pain medication, and if pain persists,
041507 - the doctor will prescribe low-dose morphine, ref SDS 67
041508 - D64W, resolving fears of over medicating by taking only 30%
041509 - of prescribed dose levels, also reported on 090203 2217.
041510 - ref SDS 65 L74H
041512 - ..
041513 - 18. Please advise on scheduling hyperthermia treatment. Do we need
041514 - to accelerate the schedule?
041515 -
041522 -
041523 -
041524 -
041525 -
041526 -
041527 -
041528 -
041529 -
041530 -
041531 -
0416 -