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 10:57 PM Tuesday;
Rod Welch
Doctor Rugo notifies medical team Millie needs authorization for medical
care at UCSF after hyperthermia treatments by Doctor Hsu.
1...Summary/Objective
2...UCSF Requires Authorization from Kaiser for Millie's Care
3...Cancer Chronic Disease Treatment Strategy after Hyperthermia
..............
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 66 0000. ref SDS 64 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 -
040902 - 1. Case study dilemma balancing sunitinib treatments to optimize
040903 - recovery from 5th relapse IBC, and without increasing
040904 - debilitating side effects that prevent exercise required to
040905 - benefit from recovery. ref SDS 11 I87N
040907 - ..
040908 - 2. On 090108 examination at UCSF showed possible progression of
040909 - IBC in breastbone area, as set out in Millie's letter to the
040910 - medical team on 090109. ref SDS 13 UC4H Millie reported severe
040911 - side effects shown by wide range of blood counts falling.
040912 - ref SDS 13 UF3Q Medical team prescribed another cycle
040913 - sunitinib treatment, with cyclophosphamide paused until blood
040914 - counts increase to a safe level. ref SDS 13 UF3T
040916 - ..
040917 - 3. On 090109 Millie's letter reports rise of IBC with sunitinib
040918 - seen at UCSF on 090108 occurred previously, cited in Millie's
040919 - letter on 081125, ref SDS 6 XX4P; there was rise of IBC and
040920 - then substantial recovery reported again on 081217, ref SDS 7
040921 - YJ4V; on 081230 Millie's letter reported on 081224 and 081225
040922 - rise of IBC, and then improvement on 081226, ref SDS 11 JV5M;
040923 - most recently on 090106 Millie cited again advance of IBC on
040924 - 081224 and 081225, and now disease seems to be subsiding again.
040925 - ref SDS 12 YO4V]
040927 - ..
040928 - 4. On 090115 Millie letter to Catherine and Diane in the Infusion
040929 - Clinic at UCSF reported rising side effects of sunitinib
040930 - protocol, ref SDS 16 5J9Y; she tried hiking a few times, but
040931 - this hurts her feet (peripheral neuropathy) and legs are very
040932 - weak, shown in patient history on daily treatments. ref SDS 15
040933 - KL4J Have been spending more time in the gym doing aerobics,
040934 - which is a little more tolerable. ref SDS 15 3E4K
040936 - ..
040937 - 5. On 090116 Glenna called to ask about response to treatment and
040938 - side effects, ref SDS 17 JY6L, and was advised that IBC in the
040939 - breastbone area was stable to worse, and other sites are stable
040940 - to improved with sunitinib protocol, citing the record of
040941 - patient history the day before on 090115. ref SDS 15 124N
040943 - ..
040944 - 6. On 090116 during call from Glenna advised that Millie wants to
040945 - reduce the dose of sunitinib in order to reduce debilitating
040946 - side effects, and requested remedy to reduce side effects with
040947 - full dose of sunitinib in order to optimize recovery.
040948 - ref SDS 17 JY7J
040950 - ..
040951 - 7. On 090116 Millie received a letter from Glenna transmitting a
040952 - copy of a letter Glenna wrote to the doctor reporting
040953 - understandings from telecon in the morning on 090116,
040954 - ref SDS 19 YN9H; Glenna's letter to the doctor described
040955 - difficulty tolerating side effects of sunitinib, ref SDS 19
040956 - 4P5M, that Millie wants to reduce the dose to reduce side
040957 - effects, but is afraid about losing benefits of recovering
040958 - from IBC. ref SDS 19 HV3M
040960 - ..
040961 - 8. On 090116 Glenna's letter to the doctor asked about changing to
040962 - another treatment. ref SDS 19 HV3O
040964 - ..
040965 - 9. On 090116 Glenna planned to meet with the doctor later in the
040966 - day on 090116 to discuss changing Millie's treatment.
040967 - ref SDS 19 HP4J
040969 - ..
040970 - 10. On 090116 Millie's letter to the medical team clarifies telecon
040971 - on condition following examination at UCSF on 090108, reporting
040972 - IBC in breastbone area looks stable to worse, and everywhere
040973 - else looks improved to stable, indicating recovery has slowed
040974 - ref SDS 20 IS6G, relative to findings on 081218, ref SDS 8
040975 - VD4F, confirmed in Millie's letter later that day reporting
040976 - significant recovery. ref SDS 9 GF8V
040978 - ..
040979 - 11. On 090118 Millie talks about wanting to end treatment with
040980 - sunitinib that seems now less effective and has severe side
040981 - effects after adding cycloposphamide. ref SDS 21 UC41
040983 - ..
040984 - 12. On 090121 Millie letter to primary care physician says very
040985 - pleased to take this occasion on my birthday to say thanks for
040986 - such great care the past 7 years. You noted in our first
040987 - meeting on 020321 that Oncology presents unique challenges.
040988 - ref SDS 1 R94H My case has been complicated by other maladies
040989 - that strain resources of time, money, and emotion. Having you
040990 - at the helm with Arlette's assistance has been a blessing.
040991 - ref SDS 24 F23Y
040993 - ..
040994 - 13. On 090121 Glenna calls and asks again about Millie's response
040995 - to treatment, ref SDS 25 AJ3J, following up her call on 090116,
040996 - ref SDS 17 JY6L, and per background above. ref SDS 25 JY5I
040998 - ..
040999 - 14. On 090121 during call from Glenna reported patient history,
041000 - ref SDS 25 ZO4F, on 090120 shows IBC rash looks improved to
041001 - stable, and nodules in the breastbone area seem worse,
041002 - ref SDS 23 124N, relative to detailed review on 090110,
041003 - ref SDS 14 124N, and after 11 days of treatment with only
041004 - sunitinib, and 25 total treatments with sunitinib, since the
041005 - pause on 081218 and resuming on 081226. ref SDS 22 6C4J
041007 - ..
041008 - 15. On 090121 during call from Glenna reported patient history
041009 - reported IBC worsening in breastbone area has progressed onto
041010 - the right breast and spread toward the left chest reflects
041011 - rising cancer marker, ref SDS 25 N95K, Labs at Kaiser on 090116
041012 - report CA 15-3 303. ref SDS 18 PQTQ This record indicates
041013 - Millie has suffered 6th relapse of IBC.
041015 - ..
041016 - 16. On 090121 Glenna asked for most severe side effects from
041017 - continuing with sunitinib treatment. ref SDS 25 TW53
041019 - ..
041020 - 17. On 090121 Glenna asked for Millie's records on Doctor Rugo's
041021 - plans for follow on treatments? During the call developed
041022 - background on UCSF planning for Millie's future treatment after
041023 - sunitinib. ref SDS 25 Y67L
041025 - ..
041026 - 18. On 090121 Glenna reported during the call that she would send
041027 - another letter to Doctor Rugo explaining Millie's slow response
041028 - to treatment with sunitinib, and supplementing Glenna's letter
041029 - to the doctor on 090116, ref SDS 36 SY5J; Glenna further advised
041030 - during the call on 090121 that she would meet again with Doctor
041031 - Rugo to discuss plans for changing Millie's treatment to
041032 - recover from Millie's 6th IBC relapse. ref SDS 25 N976
041034 - ..
041035 - 19. On 090121 patient history summarized to faciliate Glenna's
041036 - meeting with Doctor to figure out Millie's next treatment.
041037 - ref SDS 25 NU5H
041039 - ..
041040 - a. Laboratory blood tests listed for Millie to facilitate UCSF
041041 - considering Millie's next treatment. ref SDS 25 6Y9K
041043 - ..
041044 - b. Image test history of PET, CT, Xray, MRI listed for Glenna
041045 - to discuss with Doctor Rugo discussing Millie's next
041046 - treatment. ref SDS 25 216F
041048 - ..
041049 - c. Treatment history listed for Glenna to discuss with Doctor
041050 - Rugo discussing Millie's next treatment. ref SDS 25 H16M
041052 - ..
041053 - d. Strategy considerations for selecting Millie's next
041054 - treatment. ref SDS 25 558O
041056 - ..
041057 - 20. On 090122 telephone message from Glenna reported that the
041058 - doctor ended treament with sunitinib protocol; Glenna met with
041059 - Doctor Rugo to develop treatment plan for Millie, and UCSF
041060 - scheduled Millie to start new treatment on 090129. ref SDS 29
041061 - K96F
041063 - ..
041064 - 21. On 090123 primary care physician at Kaiser cited sudden relapse
041065 - of IBC with nodules spreading in the breastbone area, and
041066 - cancer marker elevated to CA 15-3 303 in the labs at Kaiser on
041067 - 090116, ref SDS 18 PQTQ, shows Millie needs immediate change of
041068 - treatment to prevent cancer from cascading out of control, and
041069 - that UCSF should prescribe treatment, ref SDS 34 RK6O, because
041070 - Millie's 6th relapse of IBC shows cancer has mutated to cells
041071 - that are now very resistant to treatments available at Kaiser,
041072 - as discussed previously during the meeting at Kaiser on 080829,
041073 - and cited in Millie's letter to the medical team. ref SDS 5
041074 - RP9R
041076 - ..
041077 - 22. On 090123 Millie's letter to medical team reports progress at
041078 - UCSF scheduling Millie to start on a new treatment. ref SDS 30
041079 - KR4P
041081 - ..
041082 - 23. On 090123 Glenna called and thanked her for expediting Millie's
041083 - new treatment to start on 090129 so that cancer does not
041084 - cascade out of control, ref SDS 31 TR80; request documentation
041085 - on new treatment in order to be prepared starting on 090129
041086 - 0830, as presented in Glenna's telephone message on 090122,
041087 - ref SDS 29 AT6N
041089 - ..
041090 - 24. On 090123 Glenna advised during her call that there was not
041091 - enough time to meet with Doctor Rugo on 090121; she received a
041092 - letter from the doctor to coordinate with Kaiser on getting
041093 - timely referral to start Millie's next treatment at UCSF on
041094 - 090129. ref SDS 31 118M
041096 - ..
041097 - 25. On 090123 Doctor Johnson, Millie's primary care physician at
041098 - Kaiser, called and confirmed prior advice that Doctor Rugo can
041099 - prescribe follow on treatment for Millie because her cancer has
041100 - become resistant to drugs available at Kaiser. ref SDS 34 8K6K
041102 - ..
041103 - 26. On 090127 Millie letter to medical team reporting Doctor
041104 - Johnson called on 090123 to advise of approval for Doctor Rugo
041105 - to prescribe Millie's follow on treatment at UCSF to start
041106 - immediately on 090129. ref SDS 36 TY5W
041108 - ..
041109 - 27. On 090127 Millie's letter to the medical team submitted patient
041110 - history to facilitate prescribing new treatment for Millie's
041111 - 6th relapse of IBC. ref SDS 36 TY6S
041113 - ..
041114 - 28. On 090127 Millie's letter reported side effects of sunitinib
041115 - have begun to subside after stopping treatment on 090122 in
041116 - order to prepare to start new treatment on 090129. ref SDS 36
041117 - TY8T
041119 - ..
041120 - 29. On 090128 Millie letter to primary care physician and the
041121 - medical team reported IBC worsening, and taking Vicadin for
041122 - pain. ref SDS 38 2S8X
041124 - ..
041125 - 30. On 090129 Doctor Rugo sent a letter to primary care physician
041126 - at Kaiser requesting referral to UCSF for treatment with
041127 - hyperthermia and Doxil, reported in Millie's letter to medical
041128 - team on 090130. ref SDS 45 AY9Q
041130 - ..
041131 - 31. On 090130 Millie letter to primary care physician, ref SDS 45
041132 - GV4M, reports examination at UCSF on 090129 found IBC
041133 - progressing rapidly, ref SDS 45 4S8O, as Doctor Johnson noted
041134 - earlier on 090123, ref SDS 34 8K6K;
041136 - ..
041137 - 32. On 090130 Millie letter to primary care physician advises UCSF
041138 - reported communication delay prevented getting referral from
041139 - Kaiser, which then delayed starting hyperthermia treatment on
041140 - 090129 in time to be effective. ref SDS 45 AY8Q
041142 - ..
041143 - 33. On 090130 Millie letter to medical team reports that on 090129
041144 - coordinating timely referral from Kaiser was delayed because
041145 - primary care physician was not in the office. ref SDS 45 AY9T
041147 - ..
041148 - 34. On 090130 Krshna called Millie to schedule hyperthermia
041149 - treatment in the Radiation Oncology Department, and said that
041150 - UCSF has not received referral authorization from Kaiser.
041151 - ref SDS 43 NM5H
041153 - ..
041154 - 35. On 090130 called Arlette, ref SDS 44 RY4G, and she contacted
041155 - Doctor Johnson off-site in a meeting, and he advised that the
041156 - doctor would file authorization in the evening on 090130.
041157 - ref SDS 44 PPYY
041159 - ..
041160 - 36. On 090131 Millie received letter from Doctor Johnson, primary
041161 - care physician, that Kaiser authorization was issued on 090130,
041162 - ref SDS 46 GV4M, for Millie to get treatment for 6th relapse of
041163 - IBC with hyperthermia and Doxil, prescribed by Doctor Rugo on
041164 - 090129 (reported in Millie's letter on 090130. ref SDS 45 AY9Q
041166 - ..
041167 - 37. On 090201 Millie letter reports to medical team 6th relapse IBC
041168 - getting worse by the hour requires immediate treatment to
041169 - prevent cancer from getting out of control. Pain from IBC
041170 - makes sleeping difficult. ref SDS 47 KN9T
041172 - ..
041173 - 38. On 090201 Millie plans to go to UCSF for treatment tomorrow on
041174 - 090202 when convenient for Doctor Hsu to provide hypethermia
041175 - treatment. ref SDS 47 KN9W
041177 - ..
041178 - 39. On 090201 Millie reports lymphedema recurrence caused by
041179 - sling-immobilizer to treat dislocated shoulder on 090122;
041180 - advises Cellulitis did not recur, as previously. ref SDS 47
041181 - KN4S
041183 - ..
041184 - 40. On 090201 Millie reports good news energy recovering after side
041185 - effects from stopping treatment on sunitinib clinical study
041186 - ordered by Doctor Rugo on 090122. ref SDS 47 KN4Y
041188 - ..
041189 - 41. On 090201 UCSF letter notifies Millie that Doctor Rugo is
041190 - communicating with Doctor Hsu using email to expedite Millie's
041191 - treatment; recommends that Millie not come to UCSF on Monday
041192 - 090202 in order to assist the medical team start hyperthermia
041193 - treatment in time to be effective. ref SDS 48 GV4M
041195 - ..
041196 - 42. On 090201 Millie letter assures medical team that the patient
041197 - would not "camp out" in Doctor Hsu's office, but would stand-by
041198 - in the cafeteria so that treatment can begin when convenient
041199 - for UCSF, and without waiting for patient to travel through
041200 - mid-day traffic, so that urgent treatment is not delayed beyond
041201 - a point when treatment can no longer be effective. ref SDS 49
041202 - GV4M
041204 - ..
041205 - 43. On 090201 Millie asks Doctor Rugo about coordinating to provide
041206 - medical records on file in the doctor's office the past 2 years
041207 - treating Millie at UCSF, ref SDS 49 5R4S, to use by Doctor Hsu,
041208 - requested by Krshna in a call the day before on 090130.
041209 - ref SDS 43 DL4J
041211 - ..
041212 - 44. On 090201 emotional trauma esclates from delays getting
041213 - treatment for aggressive cancer that seems to be cascading out
041214 - of control because of communication delays. ref SDS 49 5R4V
041216 - ..
041217 - 45. On 090202 Michelle at UCSF called in the morning, and said
041218 - Kaiser has not submitted authorization for Millie's treatment
041219 - by Doctor Hsu. ref SDS 51 9Y5I Michelle asked the patient to
041220 - coordinate with the primary care physician at Kaiser to file
041221 - Authorization, ref SDS 51 9Y6Y, reported in Millie's letter to
041222 - the medical team. ref SDS 53 GV4M
041224 - ..
041225 - 46. On 090202 Michelle was advised that Doctor Johnson reported in
041226 - a letter on 090131 that Doctor Rugo at UCSF was notified on
041227 - 090130 that Kaiser issued authorization for Millie's treatment,
041228 - ref SDS 46 GV4M, and further that Doctor Johnson would be out
041229 - of town for several days, so he is not available on 090202 for
041230 - coordinating requested by UCSF on 090202, ref SDS 50 Y35M, to
041231 - file duplicate authorization, reported in Millie's letter to
041232 - the medical team on 090202 1028. ref SDS 53 FR6P
041234 - ..
041235 - 47. On 090202 0940 numerous calls were made to coordinate.
041236 - ref SDS 52 9Y5I Florida in Kaiser Oncology Department, Walnut
041237 - Creek CA advised that Pam in Kaiser Outside Referrals
041238 - Department said the doctor did not enter a "code" in the
041239 - Authorization form for hyperthermia treatment, so Pam is
041240 - waiting to get the code when the doctor returns from traveling
041241 - sometime in the next few days, ref SDS 52 1A5J, reported in
041242 - Millie's letter to the medical team. ref SDS 53 FR7R
041244 - ..
041245 - 48. On 090202 1012 called Kaiser Outside Referrals and left a
041246 - message that we need submission of authorization, so that
041247 - Millie can get treatment in time to be effective. ref SDS 52
041248 - W17K Suggested Outside Referrals send written notice to
041249 - Michelle Williams Jones at UCSF that authorization is on file
041250 - at Kaiser, and will be submitted to UCSF, so that my treatment
041251 - can be initiated concurrently. ref SDS 52 254F, reported in
041252 - Millie's letter to the medical team. ref SDS 53 FR7U
041254 - ..
041255 - 49. On 090202 1047 Pam in Outside Referrals at Kaiser called and
041256 - disclosed that the department needed to know the type of
041257 - treatment Millie would get on referral to UCSF? Advised
041258 - treatment is "hyperthermia," in the Radiation Oncology
041259 - department at UCSF. Pam reported that Kaiser does not have a
041260 - code for "hypethermia" nor for "Radiation Oncology." Pam used
041261 - a code for "Radiology." Problem solved. ref SDS 54 QQ7N, and
041262 - reported in Millie's letter to the medical team on 090202 1139.
041263 - ref SDS 56 M88H
041265 - ..
041266 - 50. On 090202 1117 Pam called back and wanted to know if referral
041267 - to UCSF is for in-patient or out-patient treatment? Since
041268 - radiation is often out-patient care, and initial discussions
041269 - did not indicate Millie would require staying in the hospital,
041270 - Pam coded the form for out-patient care, reported in the record
041271 - on 090202 1047]. ref SDS 54 0256, and reported in Millie's
041272 - letter to the medical team on 090202 1139. ref SDS 56 C94Y
041274 - ..
041275 - 51. On 090202 1118 Doctor Rugo notified the medical team that
041276 - Doctor Hsu cannot see Millie on 090202; advises that Doctor Hsu
041277 - is aware of Millie's situation. ref SDS 55 V47L
041279 - ..
041280 - 52. On 090202 1353 Doctor Hsu's assistant, Krshna reported that the
041281 - doctor was not aware of urgency to treat Millie, cited in
041282 - Doctor Rugo's letter on 090202 1118. ref SDS 55 V47L Krshna
041283 - proposes scheduling the work on 090219, ref SDS 57 XO7G, and
041284 - does not feel comfortable asking Doctor Hsu to advance the date
041285 - for treatment, because his schedule is already booked.
041286 - ref SDS 57 SP8I, reported in Millie's letter to the medical
041287 - team on 090202 1437. ref SDS 58 R23P
041289 - ..
041290 - 53. On 090202 1353 Krshna offers UCSF Radiation Oncology schedule
041291 - hyperthermia treatment 3 weeks delay to 090219. ref SDS 57 XO7G
041293 - ..
041294 - 54. On 090202 1437 Millie notifies medical team that UCSF received
041295 - Kaiser authorizations for treating the 6th relapse of IBC,
041296 - ref SDS 58 JR4J, reported on 090202 1353. ref SDS 57 SP6H
041297 - Millie thanks Doctor Rugo for expediting authorization with
041298 - Doctor Johnson at Kaiser, citing Doctor Rugo's letter to Doctor
041299 - Johnson on 090129, reported on 090130, ref SDS 45 TZ6H, Doctor
041300 - Rugo's letter to medical team on 090202 1118, indicating Doctor
041301 - Hsu is aware of Millie's situation. ref SDS 55 V47L
041303 - ..
041304 - 55. On 090202 1437 IBC disease has advanced significantly since
041305 - examination at UCSF on 090129, and pain on chest is rising.
041306 - Since Doctor Rugo has much more experience with IBC, if this
041307 - just "looks bad," but delaying treatment to 090219 presents no
041308 - risk of losing control, then I am fine with waiting until the
041309 - 19th. ref SDS 58 R23S
041311 - ..
041312 - 56. On 090202 1437 Millie notifies UCSF that Krshna indicated if
041313 - Doctor Rugo feels earlier treatment is needed, she can notify
041314 - Doctor Hsu directly. ref SDS 57 F65G, cited in Millie's letter
041315 - to medical team on 090202 1437, ref SDS 58 R23V
041317 - ..
041318 - 57. On 090202 1437 Millie apologizes for adding to Doctor Rugo's
041319 - work load. Waiting to the 19th is a shock compared to what
041320 - Millie sees on her chest. Results for CA 15-3 from the lab
041321 - last week on 090129 have not been published, but expect it will
041322 - be 200+, since it was 303 at Kaiser on 090116. ref SDS 18 PQTQ
041323 - Those are scary numbers in Millie's patient history. Millie
041324 - avers being a "sissy." Doctor Rugo and others at UCSF and
041325 - Kaiser are working hard to help Millie and many other patients,
041326 - cited in Millie's letter to medical team on 090202 1437.
041327 - ref SDS 58 R23Y
041329 - ..
041330 - 58. On 090202 1550 called VCI and asked about Millie getting
041331 - hyperthermia treatment immediately, rather than wait to 090219
041332 - offered by UCSF. ref SDS 59 YU8H
041334 - ..
041335 - 59. On 090202 1732 Doctor Rugo letter notifies medical team that
041336 - Millie needs urgent treatment quickly to be effective.
041337 - ref SDS 60 Y15J
041339 - ..
041340 - 60. On 090203 0939 call VCI and schedule call to discuss alternate
041341 - source for Millie to get hyperthermia treatment in time to be
041342 - effective recovering from 6th relapse of IBC. ref SDS 61 9Y5I
041344 - ..
041345 - 61. On 090203 1009 letter to VCI submits patient history for review
041346 - to support telephone conference, ref SDS 61 IN94, on arranging
041347 - for VCI to provide hyperthermia treatment in time for Millie to
041348 - recover from 6th relapse of IBC. ref SDS 61 EP3S
041350 - ..
041351 - 62. On 090203 1024 called UCSF talked to Jennette in Radiation
041352 - Oncology; she will discuss with Doctor Hsu advancing Millie
041353 - getting hyperthermia treatment from 090219 to this week.
041354 - ref SDS 62 XX5I
041356 - ..
041357 - 63. On 090203 1206 Doctor Al-Bussam called and reported well
041358 - ordered record for Millie's patient history enabled expedited
041359 - review of complex medical problems. ref SDS 63 8488 VCI
041360 - offered to start work the next day on 090204 giving Millie
041361 - hyperthermia treatment in time to be effective recoverying from
041362 - 6th relapse IBC. ref SDS 63 OE4F
041364 - ..
041365 - 64. On 090203 1417 Millie's letter to medical team reports VCI
041366 - proposal to provide hyperthermia treatment in time to be
041367 - effective starting tomorrow on 090204. ref SDS 64 IS3P
041369 - ..
041370 - 65. On 090203 1417 Millie advises medical team that if UCSF can
041371 - juggle the schedule to start treatment in the next few days,
041372 - Millie prefers working with Doctor Hsu locally, based on
041373 - excellent results working with Doctor Rugo. There is a lot of
041374 - benefit to close practice collaboration at UCSF. ref SDS 64
041375 - IS3Y
041377 - ..
041378 - 66. On 090203 1417 alternatively, Millie requests a medical opinion
041379 - on risks of waiting to Feb 19th against advantages of doing the
041380 - work tomorrow at VCI. ref SDS 64 IS4R
041382 - ..
041383 - 67. On 090203 1417 Millie ask whether treatment at UCSF can be
041384 - advanced from 090219. If not, is the medical condition urgent
041385 - enough to require another provider, and, if so, is VCI a good
041386 - choice under the circumstances? Is there another way to get
041387 - this work done in time to be effective? ref SDS 64 IS5V
041389 - ..
041390 - 68. On 090203 1438 Jennette with UCSF Radiation Oncology Department
041391 - called back and advised that Doctor Hsu advanced Millie's
041392 - hypertermia treatment to begin on 090205 in time to be
041393 - effective recovering from 6th relapse of IBC, ref SDS 65 XX5I,
041394 - rather than risk waiting until 090219, as proposed yesterday on
041395 - 090202 1357. ref SDS 57 XO7G
041397 - ..
041398 - 69. On 090203 1444 Millie's letter notified medical team,
041399 - ref SDS 66 6Q3J, that Jennette in Doctor Hsu's office at UCSF
041400 - called on 090203 1438, ref SDS 65 XX5I, following Millie's
041401 - letter on 090203 1417 notifying medical team that VCI offered
041402 - to perform hypethermia treatment tomorrow on 090204 in time to
041403 - be effective for Millie to recover from 6th relapse IBC,
041404 - ref SDS 64 IS3P, and Jennette said UCSF changed their proposal
041405 - for Millie to start treatment on 090219, and instead Millie is
041406 - scheduled to meet Doctor Hsu in Radiation Oncology at UCSF to
041407 - start hyperthermia treatment on 090205, ref SDS 65 XX5I, shown
041408 - in Millie's letter. ref SDS 66 YQ5W
041410 - ..
041411 - 70. On 090203 1444 Millie sent copy of letter for the medical team
041412 - to VCI, ref SDS 66 YQ6P, thanking Nash and Doctor Al-Bussam for
041413 - timely, professional support investigating my case, ref SDS 63
041414 - JZ4F, and offering a backup solution [reported in record on
041415 - 090203 1206. ref SDS 63 OE4F
041417 - ..
041418 - 71. On 090203 1444 Millie's letter notifies the medical team that
041419 - communication with Doctor Hsu's office at UCSF in Radiation
041420 - Oncology has not been established, ref SDS 66 YQ6S, previously
041421 - noted in Millie's letter to the medical team on 090202,
041422 - ref SDS 56 C95U]. Millie routinely gets blood draws on
041423 - Thursdays at 0800, and so asks if this is needed to support the
041424 - meeting with Doctor Hsu on Thursday 090205, and if not need to
041425 - cancel the meeting with the Infusion Clinic on Thursday. By
041426 - copy alerted Catherine and Diane in Infusion that blood draw
041427 - may not be needed on 090205.
041429 - ..
041430 - 72. On 090203 1444 Millie commended Doctor Johnson, the primary
041431 - care physician at Kaiser Oncology, and Doctor Rugo, Millie's
041432 - oncologist on referral to UCSF, for support moving forward with
041433 - hyperthermia treatment to recover from 6th relapse of IBC.
041434 - ref SDS 66 YQ6V Noting this might not work; citing research
041435 - [on 090129] indicates there is a good chance. ref SDS 42 OI6N
041436 - and ref SDS 42 SQ6L
041438 - ..
041439 - 73. On 090203 1632 Doctor Johnson, Millie's primary care physician
041440 - at Kaiser advised that Millie does not need blood draw at UCSF
041441 - on Thursday 090205 to support starting hyperthermia treatment
041442 - meeting Doctor Hsu in the UCSF Radiation Oncology Department.
041443 - ref SDS 67 3X6H
041444 -
041445 -
041447 - ..
0415 -
0416 -
0417 - Progress
0418 -
041801 - Millie received a letter from Doctor Rugo responding to Millie's
041802 - letter submitted earlier in the day on 090203 1444 and notifying the
041803 - medical team good news that UCSF Radiation Oncology advanced treatment
041804 - to recover from the 6th relapse of IBC, ref SDS 66 YQ5W, and further
041805 - asking about getting a blood draw on 090205. ref SDS 66 YQ6S
041806 -
041807 - 1. Subject: Problem Solved Meet Doctor Hsu at UCSF Feb 5 0830
041808 - Date: Tue, 3 Feb 2009 22:31:34 -0800
041817 - ..
041818 - 2. Yes, Dr Hsu rearranged his schedule to fit you in for which I
041819 - am very appreciative. [Doctor refers to notice in Millie's
041820 - letter earlier today on 090203 1444 that Radiation Oncology
041821 - advanced Millie's schedule from 090219 to 090205 in order
041822 - provide urgent treatment quickly enough to be effective, which
041823 - was requested in Doctor Rugo's letter to the medical team on
041824 - 090202 1732. ref SDS 60 Y15J]
041825 -
041826 -
041827 -
0419 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - UCSF Requires Authorization from Kaiser for Millie's Care
050403 -
050404 -
050405 - 3. Millie, now that you are no longer on a study, you are not
050406 - covered to have anything done at UCSF without authorization.
050407 - Treatment, labs, etc done on study can be billed through your
050408 - medicare ONLY if you are on a study. Otherwise you will be
050409 - billed. So you do not have any regular blood draws, and I
050410 - recommend checking for authorization before you do anything at
050411 - UCSF. This includes clinic visits. [Doctor Rugo responds to
050412 - Millie's letter this afternoon 090203 1444 asking if she should
050413 - get a blood draw in the Infusion Clinic prior to meeting with
050414 - Doctor Hsu in Radiation Oncology on 090205 0900. ref SDS 66
050415 - YQ6S]
050417 - ..
050418 - This aligns with pattern and practice the past two (2) years with
050419 - Millie getting weekly treatment authorized by Kaiser, reported on
050420 - 070105, ref SDS 2 PK68, and continuing with the recent authorization
050421 - for hyperthermia treatment on 090202. ref SDS 57 SP6H
050422 -
050423 - [On 090204 0219 Millie asks Doctor Rugo for continued
050424 - support based on practice synergy with Doctor Hsu
050425 - providing hyperthermia treatment on referral from Doctor
050426 - Rugo, who has extensive experience providing weekly
050427 - treatments for Millie the past 2 years. ref SDS 69 278Q
050429 - ..
050430 - [On 090204 0219 Millie asks Doctor Rugo to submit a work
050431 - plan with strategy for treating Millie's cancer as chronic
050432 - disease after hyperthermia in time to be effective.
050433 - ref SDS 69 278T, and similar to treatment proposals
050434 - submitted by Doctor Benz that brought Millie to UCSF.
050435 - ref SDS 69 278W
050437 - ..
050438 - [On 090204 1914 Doctor Rugo notifies Millie that strategic
050439 - planning to be prepared for treating cancer as a chronic
050440 - disease in time to be effective should be deferred until
050441 - after hypetthermia treatment, because the case is more
050442 - complicated than when Doctor Benz suggested treatments in
050443 - 2004 that were effective in 2005, and later suggested
050444 - treatments in 2006 that were very effective in 2007.
050445 - ref SDS 70 278T
050447 - ..
050448 - [On 090206 Lena called to schedule meeting with Doctor
050449 - Rugo on 090212 0830. ref SDS 72 XU5N
050451 - ..
050452 - Doctor Rugo's letter concludes...
050453 -
050454 - 4. Catherine please make note that Millie ***** appointments
050455 - should be cancelled.
050457 - ..
050458 - This seems conflicting with UCSF letter to Kaiser on 090129
050459 - recommending treatment with hyperthermia in radiation oncology, and
050460 - with Doxil, which sounds like a chemotherapy drip treatment that is
050461 - provided in the Infusion Clinic, reported on 090130. ref SDS 45 HK3V
050462 -
050463 -
050464 -
050465 -
050466 -
050467 -
050468 -
0505 -
SUBJECTS
Default Null Subject Account for Blank Record
0603 -
060401 - ..
060402 - Cancer Chronic Disease Treatment Strategy after Hyperthermia
060403 -
060404 -
060405 - 5. I am of course hopeful that we will be able to move on to
060406 - another trial after the hyperthermia, but we will see!
060408 - ..
060409 - Does this mean the only treatment Doctor Rugo can prescribe is through
060410 - a clinical trial? What about prescribing treatment with chemotherapy
060411 - drugs that proved successful in previous clinical studies?
060412 -
060413 - [On 090204 Millie asks Doctor Rugo to submit medical
060414 - opinion on likely scenarios and strategies for treating
060415 - cancer as a chronic disease, so that the medical team is
060416 - prepared to continue work in an orderly manner without
060417 - scrambling at the last minute. ref SDS 69 278T
060419 - ..
060420 - [On 090210 Lena called to schedule meeting with Doctor
060421 - Rugo on 090212 0830. ref SDS 72 XU5N
060423 - ..
060424 - [On 090218 1205 letter to the medical team confirms Doctor
060425 - Rugo's staff scheduled meeting on 090312 0800 to review
060426 - progress. ref SDS 73 TH6U
060428 - ..
060429 - [On 090312 0800 Millie met with Tara for examination in
060430 - the Breast Care Clinic, ref SDS 74 9L7K, and later at 0930
060431 - she met with Doctor Hsu and Chris to evaluate radiation
060432 - and hyperthermia treatment. ref SDS 74 02AC
060433 -
060434 -
060444 -
060445 -
060446 -
060447 -
060448 -
060449 -
060450 -
060451 -
060452 -
060453 -
060454 -
060455 -
060456 -
060457 -
060458 -
060459 -
0605 -