CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 78 0000. ref SDS 77 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 -    1.  Case study dilemma balancing sunitinib treatments to optimize
040902 -        recovery from 5th relapse IBC, and without increasing
040903 -        debilitating side effects that prevent exercise required to
040904 -        benefit from recovery. ref SDS 18 I87N
040906 -         ..
040907 -    2.  On 090108 examination at UCSF showed possible progression of
040908 -        IBC in breastbone area, as set out in Millie's letter to the
040909 -        medical team on 090109. ref SDS 20 UC4H  Millie reported severe
040910 -        side effects shown by wide range of blood counts falling.
040911 -        ref SDS 20 UF3Q  Medical team prescribed another cycle
040912 -        sunitinib treatment, with cyclophosphamide paused until blood
040913 -        counts increase to a safe level. ref SDS 20 UF3T
040915 -         ..
040916 -    3.  On 090109 Millie's letter reports rise of IBC with sunitinib
040917 -        seen at UCSF on 090108 occurred previously, cited in Millie's
040918 -        letter on 081125, ref SDS 12 XX4P; there was rise of IBC and
040919 -        then substantial recovery reported again on 081217, ref SDS 13
040920 -        YJ4V; on 081230 Millie's letter reported on 081224 and 081225
040921 -        rise of IBC, and then improvement on 081226, ref SDS 18 JV5M;
040922 -        most recently on 090106 Millie cited again advance of IBC on
040923 -        081224 and 081225, and now disease seems to be subsiding again.
040924 -        ref SDS 19 YO4V]
040926 -         ..
040927 -    4.  On 090115 Millie letter to Catherine and Diane in the Infusion
040928 -        Clinic at UCSF reported rising side effects of sunitinib
040929 -        protocol, ref SDS 23 5J9Y; she tried hiking a few times, but
040930 -        this hurts her feet (peripheral neuropathy) and legs are very
040931 -        weak, shown in patient history on daily treatments. ref SDS 22
040932 -        KL4J  Have been spending more time in the gym doing aerobics,
040933 -        which is a little more tolerable. ref SDS 22 3E4K
040935 -         ..
040936 -    5.  On 090116 Glenna called to ask about response to treatment and
040937 -        side effects, ref SDS 24 JY6L, and was advised that IBC in the
040938 -        breastbone area was stable to worse, and other sites are stable
040939 -        to improved with sunitinib protocol, citing the record of
040940 -        patient history the day before on 090115. ref SDS 22 124N
040942 -         ..
040943 -    6.  On 090116 during call from Glenna advised that Millie wants to
040944 -        reduce the dose of sunitinib in order to reduce debilitating
040945 -        side effects, and requested remedy to reduce side effects with
040946 -        full dose of sunitinib in order to optimize recovery.
040947 -        ref SDS 24 JY7J
040949 -         ..
040950 -    7.  On 090116 Millie received a letter from Glenna transmitting a
040951 -        copy of a letter Glenna wrote to the doctor reporting
040952 -        understandings from telecon in the morning on 090116,
040953 -        ref SDS 26 YN9H; Glenna's letter to the doctor described
040954 -        difficulty tolerating side effects of sunitinib, ref SDS 26
040955 -        4P5M, that Millie wants to reduce the dose to reduce side
040956 -        effects, but is afraid about losing benefits of recovering
040957 -        from IBC. ref SDS 26 HV3M
040959 -         ..
040960 -    8.  On 090116 Glenna's letter to the doctor asked about changing to
040961 -        another treatment. ref SDS 26 HV3O
040963 -         ..
040964 -    9.  On 090116 Glenna planned to meet with the doctor later in the
040965 -        day on 090116 to discuss changing Millie's treatment.
040966 -        ref SDS 26 HP4J
040968 -         ..
040969 -   10.  On 090116 Millie's letter to the medical team clarifies telecon
040970 -        on condition following examination at UCSF on 090108, reporting
040971 -        IBC in breastbone area looks stable to worse, and everywhere
040972 -        else looks improved to stable, indicating recovery has slowed
040973 -        ref SDS 27 IS6G, relative to findings on 081218, ref SDS 14
040974 -        VD4F, confirmed in Millie's letter later that day reporting
040975 -        significant recovery. ref SDS 15 GF8V
040977 -         ..
040978 -   11.  On 090118 Millie talks about wanting to end treatment with
040979 -        sunitinib that seems now less effective and has severe side
040980 -        effects after adding cycloposphamide. ref SDS 28 UC41
040982 -         ..
040983 -   12.  On 090121 Millie letter to primary care physician says very
040984 -        pleased to take this occasion on my birthday to say thanks for
040985 -        such great care the past 7 years.  You noted in our first
040986 -        meeting on 020321 that Oncology presents unique challenges.
040987 -        ref SDS 1 R94H  My case has been complicated by other maladies
040988 -        that strain resources of time, money, and emotion.  Having you
040989 -        at the helm with Arlette's assistance has been a blessing.
040990 -        ref SDS 31 F23Y
040992 -         ..
040993 -   13.  On 090121 Glenna calls and asks again about Millie's response
040994 -        to treatment, ref SDS 32 AJ3J, following up her call on 090116,
040995 -        ref SDS 24 JY6L, and per background above. ref SDS 32 JY5I
040997 -         ..
040998 -   14.  On 090121 during call from Glenna reported patient history,
040999 -        ref SDS 32 ZO4F, on 090120 shows IBC rash looks improved to
041000 -        stable, and nodules in the breastbone area seem worse,
041001 -        ref SDS 30 124N, relative to detailed review on 090110,
041002 -        ref SDS 21 124N, and after 11 days of treatment with only
041003 -        sunitinib, and 25 total treatments with sunitinib, since the
041004 -        pause on 081218 and resuming on 081226. ref SDS 29 6C4J
041006 -         ..
041007 -   15.  On 090121 during call from Glenna reported patient history
041008 -        reported IBC worsening in breastbone area has progressed onto
041009 -        the right breast and spread toward the left chest reflects
041010 -        rising cancer marker, ref SDS 32 N95K, Labs at Kaiser on 090116
041011 -        report CA 15-3 303. ref SDS 25 PQTQ  This record indicates
041012 -        Millie has suffered 6th relapse of IBC.
041014 -         ..
041015 -   16.  On 090121 Glenna asked for most severe side effects from
041016 -        continuing with sunitinib treatment. ref SDS 32 TW53
041018 -         ..
041019 -   17.  On 090121 Glenna asked for Millie's records on Doctor Rugo's
041020 -        plans for follow on treatments?  During the call developed
041021 -        background on UCSF planning for Millie's future treatment after
041022 -        sunitinib. ref SDS 32 Y67L
041024 -         ..
041025 -   18.  On 090121 Glenna reported during the call that she would send
041026 -        another letter to Doctor Rugo explaining Millie's slow response
041027 -        to treatment with sunitinib, and supplementing Glenna's letter
041028 -        to the doctor on 090116, ref SDS 43 SY5J; Glenna further advised
041029 -        during the call on 090121 that she would meet again with Doctor
041030 -        Rugo to discuss plans for changing Millie's treatment to
041031 -        recover from Millie's 6th IBC relapse. ref SDS 32 N976
041033 -         ..
041034 -   19.  On 090121 patient history summarized to faciliate Glenna's
041035 -        meeting with Doctor to figure out Millie's next treatment.
041036 -        ref SDS 32 NU5H
041038 -             ..
041039 -        a.  Laboratory blood tests listed for Millie to facilitate UCSF
041040 -            considering Millie's next treatment. ref SDS 32 6Y9K
041042 -             ..
041043 -        b.  Image test history of PET, CT, Xray, MRI listed for Glenna
041044 -            to discuss with Doctor Rugo discussing Millie's next
041045 -            treatment. ref SDS 32 216F
041047 -             ..
041048 -        c.  Treatment history listed for Glenna to discuss with Doctor
041049 -            Rugo discussing Millie's next treatment. ref SDS 32 H16M
041051 -             ..
041052 -        d.  Strategy considerations for selecting Millie's next
041053 -            treatment. ref SDS 32 558O
041055 -         ..
041056 -   20.  On 090122 telephone message from Glenna reported that the
041057 -        doctor ended treament with sunitinib protocol; Glenna met with
041058 -        Doctor Rugo to develop treatment plan for Millie, and UCSF
041059 -        scheduled Millie to start new treatment on 090129. ref SDS 36
041060 -        K96F
041062 -         ..
041063 -   21.  On 090123 primary care physician at Kaiser cited sudden relapse
041064 -        of IBC with nodules spreading in the breastbone area, and
041065 -        cancer marker elevated to CA 15-3 303 in the labs at Kaiser on
041066 -        090116, ref SDS 25 PQTQ, shows Millie needs immediate change of
041067 -        treatment to prevent cancer from cascading out of control, and
041068 -        that UCSF should prescribe treatment, ref SDS 41 RK6O, because
041069 -        Millie's 6th relapse of IBC shows cancer has mutated to cells
041070 -        that are now very resistant to treatments available at Kaiser,
041071 -        as discussed previously during the meeting at Kaiser on 080829,
041072 -        and cited in Millie's letter to the medical team. ref SDS 10
041073 -        RP9R
041075 -         ..
041076 -   22.  On 090123 Millie's letter to medical team reports progress at
041077 -        UCSF scheduling Millie to start on a new treatment. ref SDS 37
041078 -        KR4P
041080 -         ..
041081 -   23.  On 090123 Glenna called and thanked her for expediting Millie's
041082 -        new treatment to start on 090129 so that cancer does not
041083 -        cascade out of control, ref SDS 38 TR80; request documentation
041084 -        on new treatment in order to be prepared starting on 090129
041085 -        0830, as presented in Glenna's telephone message on 090122,
041086 -        ref SDS 36 AT6N
041088 -         ..
041089 -   24.  On 090123 Glenna advised during her call that there was not
041090 -        enough time to meet with Doctor Rugo on 090121; she received a
041091 -        letter from the doctor to coordinate with Kaiser on getting
041092 -        timely referral to start Millie's next treatment at UCSF on
041093 -        090129. ref SDS 38 118M
041095 -         ..
041096 -   25.  On 090123 Doctor Johnson, Millie's primary care physician at
041097 -        Kaiser, called and confirmed prior advice that Doctor Rugo can
041098 -        prescribe follow on treatment for Millie because her cancer has
041099 -        become resistant to drugs available at Kaiser. ref SDS 41 8K6K
041101 -         ..
041102 -   26.  On 090127 Millie letter to medical team reporting Doctor
041103 -        Johnson called on 090123 to advise of approval for Doctor Rugo
041104 -        to prescribe Millie's follow on treatment at UCSF to start
041105 -        immediately on 090129. ref SDS 43 TY5W
041107 -         ..
041108 -   27.  On 090127 Millie's letter to the medical team submitted patient
041109 -        history to facilitate prescribing new treatment for Millie's
041110 -        6th relapse of IBC. ref SDS 43 TY6S
041112 -         ..
041113 -   28.  On 090127 Millie's letter reported side effects of sunitinib
041114 -        have begun to subside after stopping treatment on 090122 in
041115 -        order to prepare to start new treatment on 090129. ref SDS 43
041116 -        TY8T
041118 -         ..
041119 -   29.  On 090128 Millie letter to primary care physician and the
041120 -        medical team reported IBC worsening, and taking Vicadin for
041121 -        pain. ref SDS 45 2S8X
041123 -         ..
041124 -   30.  On 090129 Doctor Rugo sent a letter to primary care physician
041125 -        at Kaiser requesting referral to UCSF for treatment with
041126 -        hyperthermia and Doxil, reported in Millie's letter to medical
041127 -        team on 090130. ref SDS 52 AY9Q
041129 -         ..
041130 -   31.  On 090130 Millie letter to primary care physician, ref SDS 52
041131 -        GV4M, reports examination at UCSF on 090129 found IBC
041132 -        progressing rapidly, ref SDS 52 4S8O, as Doctor Johnson noted
041133 -        earlier on 090123, ref SDS 41 8K6K;
041135 -         ..
041136 -   32.  On 090130 Millie letter to primary care physician advises UCSF
041137 -        reported communication delay prevented getting referral from
041138 -        Kaiser, which then delayed starting hyperthermia treatment on
041139 -        090129 in time to be effective. ref SDS 52 AY8Q
041141 -         ..
041142 -   33.  On 090130 Millie letter to medical team reports that on 090129
041143 -        coordinating timely referral from Kaiser was delayed because
041144 -        primary care physician was not in the office. ref SDS 52 AY9T
041146 -         ..
041147 -   34.  On 090130 Krshna called Millie to schedule hyperthermia
041148 -        treatment in the Radiation Oncology Department, and said that
041149 -        UCSF has not received referral authorization from Kaiser.
041150 -        ref SDS 50 NM5H
041152 -         ..
041153 -   35.  On 090130 called Arlette, ref SDS 51 RY4G, and she contacted
041154 -        Doctor Johnson off-site in a meeting, and he advised that the
041155 -        doctor would file authorization in the evening on 090130.
041156 -        ref SDS 51 PPYY
041158 -         ..
041159 -   36.  On 090131 Millie received letter from Doctor Johnson, primary
041160 -        care physician, that Kaiser authorization was issued on 090130,
041161 -        ref SDS 53 GV4M, for Millie to get treatment for 6th relapse of
041162 -        IBC with hyperthermia and Doxil, prescribed by Doctor Rugo on
041163 -        090129 (reported in Millie's letter on 090130. ref SDS 52 AY9Q
041165 -         ..
041166 -   37.  On 090201 Millie letter reports to medical team 6th relapse IBC
041167 -        getting worse by the hour requires immediate treatment to
041168 -        prevent cancer from getting out of control.  Pain from IBC
041169 -        makes sleeping difficult. ref SDS 54 KN9T
041171 -         ..
041172 -   38.  On 090201 Millie plans to go to UCSF for treatment tomorrow on
041173 -        090202 when convenient for Doctor Hsu to provide hypethermia
041174 -        treatment. ref SDS 54 KN9W
041176 -         ..
041177 -   39.  On 090201 Millie reports lymphedema recurrence caused by
041178 -        sling-immobilizer to treat dislocated shoulder on 090122;
041179 -        advises Cellulitis did not recur, as previously. ref SDS 54
041180 -        KN4S
041182 -         ..
041183 -   40.  On 090201 Millie reports good news energy recovering after side
041184 -        effects from stopping treatment on sunitinib clinical study
041185 -        ordered by Doctor Rugo on 090122. ref SDS 54 KN4Y
041187 -         ..
041188 -   41.  On 090201 UCSF letter notifies Millie that Doctor Rugo is
041189 -        communicating with Doctor Hsu using email to expedite Millie's
041190 -        treatment; recommends that Millie not come to UCSF on Monday
041191 -        090202 in order to assist the medical team start hyperthermia
041192 -        treatment in time to be effective. ref SDS 55 GV4M
041194 -         ..
041195 -   42.  On 090201 Millie letter assures medical team that the patient
041196 -        would not "camp out" in Doctor Hsu's office, but would stand-by
041197 -        in the cafeteria so that treatment can begin when convenient
041198 -        for UCSF, and without waiting for patient to travel through
041199 -        mid-day traffic, so that urgent treatment is not delayed beyond
041200 -        a point when treatment can no longer be effective. ref SDS 56
041201 -        GV4M
041203 -         ..
041204 -   43.  On 090201 Millie asks Doctor Rugo about coordinating to provide
041205 -        medical records on file in the doctor's office the past 2 years
041206 -        treating Millie at UCSF, ref SDS 56 5R4S, to use by Doctor Hsu,
041207 -        requested by Krshna in a call the day before on 090130.
041208 -        ref SDS 50 DL4J
041210 -         ..
041211 -   44.  On 090201 emotional trauma esclates from delays getting
041212 -        treatment for aggressive cancer that seems to be cascading out
041213 -        of control because of communication delays. ref SDS 56 5R4V
041215 -         ..
041216 -   45.  On 090202 Michelle at UCSF called in the morning, and said
041217 -        Kaiser has not submitted authorization for Millie's treatment
041218 -        by Doctor Hsu. ref SDS 58 9Y5I  Michelle asked the patient to
041219 -        coordinate with the primary care physician at Kaiser to file
041220 -        Authorization, ref SDS 58 9Y6Y, reported in Millie's letter to
041221 -        the medical team. ref SDS 60 GV4M
041223 -         ..
041224 -   46.  On 090202 Michelle was advised that Doctor Johnson reported in
041225 -        a letter on 090131 that Doctor Rugo at UCSF was notified on
041226 -        090130 that Kaiser issued authorization for Millie's treatment,
041227 -        ref SDS 53 GV4M, and further that Doctor Johnson would be out
041228 -        of town for several days, so he is not available on 090202 for
041229 -        coordinating requested by UCSF on 090202, ref SDS 57 Y35M, to
041230 -        file duplicate authorization, reported in Millie's letter to
041231 -        the medical team on 090202 1028. ref SDS 60 FR6P
041233 -         ..
041234 -   47.  On 090202 0940 numerous calls were made to coordinate.
041235 -        ref SDS 59 9Y5I  Florida in Kaiser Oncology Department, Walnut
041236 -        Creek CA advised that Pam in Kaiser Outside Referrals
041237 -        Department said the doctor did not enter a "code" in the
041238 -        Authorization form for hyperthermia treatment, so Pam is
041239 -        waiting to get the code when the doctor returns from traveling
041240 -        sometime in the next few days, ref SDS 59 1A5J, reported in
041241 -        Millie's letter to the medical team. ref SDS 60 FR7R
041243 -         ..
041244 -   48.  On 090202 1012 called Kaiser Outside Referrals and left a
041245 -        message that we need submission of authorization, so that
041246 -        Millie can get treatment in time to be effective. ref SDS 59
041247 -        W17K  Suggested Outside Referrals send written notice to
041248 -        Michelle Williams Jones at UCSF that authorization is on file
041249 -        at Kaiser, and will be submitted to UCSF, so that my treatment
041250 -        can be initiated concurrently. ref SDS 59 254F, reported in
041251 -        Millie's letter to the medical team. ref SDS 60 FR7U
041253 -         ..
041254 -   49.  On 090202 1047 Pam in Outside Referrals at Kaiser called and
041255 -        disclosed that the department needed to know the type of
041256 -        treatment Millie would get on referral to UCSF?  Advised
041257 -        treatment is "hyperthermia," in the Radiation Oncology
041258 -        department at UCSF.  Pam reported that Kaiser does not have a
041259 -        code for "hypethermia" nor for "Radiation Oncology."  Pam used
041260 -        a code for "Radiology."  Problem solved. ref SDS 61 QQ7N, and
041261 -        reported in Millie's letter to the medical team on 090202 1139.
041262 -        ref SDS 63 M88H
041264 -         ..
041265 -   50.  On 090202 1117 Pam called back and wanted to know if referral
041266 -        to UCSF is for in-patient or out-patient treatment?  Since
041267 -        radiation is often out-patient care, and initial discussions
041268 -        did not indicate Millie would require staying in the hospital,
041269 -        Pam coded the form for out-patient care, reported in the record
041270 -        on 090202 1047]. ref SDS 61 0256, and reported in Millie's
041271 -        letter to the medical team on 090202 1139. ref SDS 63 C94Y
041273 -         ..
041274 -   51.  On 090202 1118 Doctor Rugo notified the medical team that
041275 -        Doctor Hsu cannot see Millie on 090202; advises that Doctor Hsu
041276 -        is aware of Millie's situation. ref SDS 62 V47L
041278 -         ..
041279 -   52.  On 090202 1353 Doctor Hsu's assistant, Krshna reported that the
041280 -        doctor was not aware of urgency to treat Millie, cited in
041281 -        Doctor Rugo's letter on 090202 1118. ref SDS 62 V47L   Krshna
041282 -        proposes scheduling the work on 090219, ref SDS 64 XO7G, and
041283 -        does not feel comfortable asking Doctor Hsu to advance the date
041284 -        for treatment, because his schedule is already booked.
041285 -        ref SDS 64 SP8I, reported in Millie's letter to the medical
041286 -        team on 090202 1437. ref SDS 65 R23P
041288 -         ..
041289 -   53.  On 090202 1353 Krshna offers UCSF Radiation Oncology schedule
041290 -        hyperthermia treatment 3 weeks delay to 090219. ref SDS 64 XO7G
041292 -         ..
041293 -   54.  On 090202 1437 Millie notifies medical team that UCSF received
041294 -        Kaiser authorizations for treating the 6th relapse of IBC,
041295 -        ref SDS 65 JR4J, reported on 090202 1353. ref SDS 64 SP6H
041296 -        Millie thanks Doctor Rugo for expediting authorization with
041297 -        Doctor Johnson at Kaiser, citing Doctor Rugo's letter to Doctor
041298 -        Johnson on 090129, reported on 090130, ref SDS 52 TZ6H, Doctor
041299 -        Rugo's letter to medical team on 090202 1118, indicating Doctor
041300 -        Hsu is aware of Millie's situation. ref SDS 62 V47L
041302 -         ..
041303 -   55.  On 090202 1437 IBC disease has advanced significantly since
041304 -        examination at UCSF on 090129, and pain on chest is rising.
041305 -        Since Doctor Rugo has much more experience with IBC, if this
041306 -        just "looks bad," but delaying treatment to 090219 presents no
041307 -        risk of losing control, then I am fine with waiting until the
041308 -        19th. ref SDS 65 R23S
041310 -         ..
041311 -   56.  On 090202 1437 Millie notifies UCSF that Krshna indicated if
041312 -        Doctor Rugo feels earlier treatment is needed, she can notify
041313 -        Doctor Hsu directly. ref SDS 64 F65G, cited in Millie's letter
041314 -        to medical team on 090202 1437, ref SDS 65 R23V
041316 -         ..
041317 -   57.  On 090202 1437 Millie apologizes for adding to Doctor Rugo's
041318 -        work load.  Waiting to the 19th is a shock compared to what
041319 -        Millie sees on her chest.  Results for CA 15-3 from the lab
041320 -        last week on 090129 have not been published, but expect it will
041321 -        be 200+, since it was 303 at Kaiser on 090116. ref SDS 25 PQTQ
041322 -        Those are scary numbers in Millie's patient history.  Millie
041323 -        avers being a "sissy."  Doctor Rugo and others at UCSF and
041324 -        Kaiser are working hard to help Millie and many other patients,
041325 -        cited in Millie's letter to medical team on 090202 1437.
041326 -        ref SDS 65 R23Y
041328 -         ..
041329 -   58.  On 090202 1550 called VCI and asked about Millie getting
041330 -        hyperthermia treatment immediately, rather than wait to 090219
041331 -        offered by UCSF. ref SDS 66 YU8H
041333 -         ..
041334 -   59.  On 090202 1732 Doctor Rugo letter notifies medical team that
041335 -        Millie needs urgent treatment quickly to be effective.
041336 -        ref SDS 67 Y15J
041338 -         ..
041339 -   60.  On 090203 0939 call VCI and schedule call to discuss alternate
041340 -        source for Millie to get hyperthermia treatment in time to be
041341 -        effective recovering from 6th relapse of IBC. ref SDS 68 9Y5I
041343 -         ..
041344 -   61.  On 090203 1009 letter to VCI submits patient history for review
041345 -        to support telephone conference, ref SDS 68 IN94, on arranging
041346 -        for VCI to provide hyperthermia treatment in time for Millie to
041347 -        recover from 6th relapse of IBC. ref SDS 68 EP3S
041349 -         ..
041350 -   62.  On 090203 1024 called UCSF talked to Jennette in Radiation
041351 -        Oncology; she will discuss with Doctor Hsu advancing Millie
041352 -        getting hyperthermia treatment from 090219 to this week.
041353 -        ref SDS 69 XX5I
041355 -         ..
041356 -   63.  On 090203 1206 Doctor Al-Bussam called and reported well
041357 -        ordered record for Millie's patient history enabled expedited
041358 -        review of complex medical problems. ref SDS 70 8488  VCI
041359 -        offered to start work the next day on 090204 giving Millie
041360 -        hyperthermia treatment in time to be effective recoverying from
041361 -        6th relapse IBC. ref SDS 70 OE4F
041363 -         ..
041364 -   64.  On 090203 1417 Millie's letter to medical team reports VCI
041365 -        proposal to provide hyperthermia treatment in time to be
041366 -        effective starting tomorrow on 090204. ref SDS 71 IS3P
041368 -         ..
041369 -   65.  On 090203 1417 Millie advises medical team that if UCSF can
041370 -        juggle the schedule to start treatment in the next few days,
041371 -        Millie prefers working with Doctor Hsu locally, based on
041372 -        excellent results working with Doctor Rugo.  There is a lot of
041373 -        benefit to close practice collaboration at UCSF. ref SDS 71
041374 -        IS3Y
041376 -         ..
041377 -   66.  On 090203 1417 alternatively, Millie requests a medical opinion
041378 -        on risks of waiting to Feb 19th against advantages of doing the
041379 -        work tomorrow at VCI. ref SDS 71 IS4R
041381 -         ..
041382 -   67.  On 090203 1417 Millie ask whether treatment at UCSF can be
041383 -        advanced from 090219.  If not, is the medical condition urgent
041384 -        enough to require another provider, and, if so, is VCI a good
041385 -        choice under the circumstances?  Is there another way to get
041386 -        this work done in time to be effective? ref SDS 71 IS5V
041388 -         ..
041389 -   68.  On 090203 1438 Jennette with UCSF Radiation Oncology Department
041390 -        called back and advised that Doctor Hsu advanced Millie's
041391 -        hypertermia treatment to begin on 090205 in time to be
041392 -        effective recovering from 6th relapse of IBC, ref SDS 72 XX5I,
041393 -        rather than risk waiting until 090219, as proposed yesterday on
041394 -        090202 1357. ref SDS 64 XO7G
041396 -         ..
041397 -   69.  On 090203 1444 Millie's letter notified medical team,
041398 -        ref SDS 73 6Q3J, that Jennette in Doctor Hsu's office at UCSF
041399 -        called on 090203 1438, ref SDS 72 XX5I, following Millie's
041400 -        letter on 090203 1417 notifying medical team that VCI offered
041401 -        to perform hypethermia treatment tomorrow on 090204 in time to
041402 -        be effective for Millie to recover from 6th relapse IBC,
041403 -        ref SDS 71 IS3P, and Jennette said UCSF changed their proposal
041404 -        for Millie to start treatment on 090219, and instead Millie is
041405 -        scheduled to meet Doctor Hsu in Radiation Oncology at UCSF to
041406 -        start hyperthermia treatment on 090205, ref SDS 72 XX5I, shown
041407 -        in Millie's letter. ref SDS 73 YQ5W
041409 -         ..
041410 -   70.  On 090203 1444 Millie sent copy of letter for the medical team
041411 -        to VCI, ref SDS 73 YQ6P, thanking Nash and Doctor Al-Bussam for
041412 -        timely, professional support investigating my case, ref SDS 70
041413 -        JZ4F, and offering a backup solution [reported in record on
041414 -        090203 1206. ref SDS 70 OE4F
041416 -         ..
041417 -   71.  On 090203 1444 Millie's letter notifies the medical team that
041418 -        communication with Doctor Hsu's office at UCSF in Radiation
041419 -        Oncology has not been established, ref SDS 73 YQ6S, previously
041420 -        noted in Millie's letter to the medical team on 090202,
041421 -        ref SDS 63 C95U].  Millie routinely gets blood draws on
041422 -        Thursdays at 0800, and so asks if this is needed to support the
041423 -        meeting with Doctor Hsu on Thursday 090205, and if not need to
041424 -        cancel the meeting with the Infusion Clinic on Thursday.  By
041425 -        copy alerted Catherine and Diane in Infusion that blood draw
041426 -        may not be needed on 090205. ref SDS 73 YQ6S
041428 -         ..
041429 -   72.  On 090203 1444 Millie commended Doctor Johnson, the primary
041430 -        care physician at Kaiser Oncology, and Doctor Rugo, Millie's
041431 -        oncologist on referral to UCSF, for support moving forward with
041432 -        hyperthermia treatment to recover from 6th relapse of IBC.
041433 -        ref SDS 73 YQ6V  Noting this might not work; citing research
041434 -        [on 090129] indicates there is a good chance. ref SDS 49 OI6N
041435 -        and ref SDS 49 SQ6L
041437 -         ..
041438 -   73.  On 090203 1632 Doctor Johnson, Millie's primary care physician
041439 -        at Kaiser advised that Millie does not need blood draw at UCSF
041440 -        on Thursday 090205 to support starting hyperthermia treatment
041441 -        meeting Doctor Hsu in the UCSF Radiation Oncology Department,
041442 -        ref SDS 74 3X6H, responding to Millie's letter to the medical
041443 -        team on 090203 1444 asking about labs. ref SDS 73 YQ6S
041445 -         ..
041446 -   74.  On 090203 2257 Doctor Rugo letter to medical team commends Dr
041447 -        Hsu on advancing the schedule by 2 weeks of Millie to getting
041448 -        hyperthermia treatment, ref SDS 76 WX8M, responding to Millie's
041449 -        letter earlier today on 090203 1444 notifying that Radiation
041450 -        Oncology changed the schedule from 090219 to 090205 in order to
041451 -        provide urgent treatment quickly enough to be effective, which
041452 -        was requested in Doctor Rugo's letter to the medical team on
041453 -        090202 1732. ref SDS 67 Y15J]
041455 -         ..
041456 -   75.  On 090203 2257 Doctor Rugo notifies medical team that Millie
041457 -        cannot get treatment at UCSF without authorization.  Millie
041458 -        does not have any regular blood draws, and the doctor
041459 -        recommends checking for authorization before Millie does
041460 -        anything at UCSF.  This includes clinic visits.  Infusion
041461 -        Clinic was notified Millie's meetings should be cancelled.
041462 -        ref SDS 76 L35Q  This responds to Millie's letter on 090203
041463 -        1444 asking about getting a blood draw before visiting Doctor
041464 -        Hsu in Radiation Oncology on 090205. ref SDS 73 YQ6S
041466 -         ..
041467 -   76.  On 090203 2257 Doctor Rugo is hopeful Millie can move on to
041468 -        another trial after the hyperthermia, that will continue a high
041469 -        quality of life experienced the past 2 years at UCSF.
041470 -        ref SDS 76 L36S
041472 -         ..
041473 -   77.  On 090203 2247 Doctor Rugo letter to Millie advises against
041474 -        getting hyperthermia treatment at VCI, ref SDS 77 DY4K,
041475 -        responding to Millie's letter earlier on 090203 1417 asking for
041476 -        medical opinion about getting hyperthermia treatment at VCI
041477 -        today on 090204, compared to waiting 3 weeks until 090219
041478 -        proposed for treatment by UCSF. ref SDS 71 IS4R
041480 -         ..
041481 -   78.  On 090204 0117 Millie's letter thanks Doctor Rugo for help
041482 -        advancing the schedule in Radiation Oncology for hyperthermia
041483 -        treatment 3 weeks, ref SDS 78 DY4K, with a letter to the
041484 -        medical team on 090202 1932 advising that Millie needs urgent
041485 -        treatment quickly enough to be effective. ref SDS 67 Y15J, and
041486 -        the doctor's letter on 090129 expedited referral from Kaiser
041487 -        authorizing hyperthermia treatment, reported in Millie's letter
041488 -        to the medical team on 090130. ref SDS 52 TZ6H
041490 -         ..
041491 -   79.  On 090204 0117 Millie notes in a letter to UCSF that VCI said
041492 -        they had treated patients on referral from UCSF, reported on
041493 -        090202. ref SDS 66 P67F  Did UCSF have a bad experience sending
041494 -        a patient to VCI?  Patients can make mistakes when rushed to
041495 -        find a solution, a la "clutching at straws," ref SDS 78 EL4U,
041496 -        which seemed to occur on 090202 when UCSF had earlier advised
041497 -        on 090122 that Millie should stop treatment to be prepared for
041498 -        starting new treatment on 090129, ref SDS 36 J47F, and on
041499 -        090129 UCSF advised there was a communication mixup that
041500 -        prevented getting treatment, reported on 090130, ref SDS 52
041501 -        AY8Q, and then writes a letter on 090202 saying Millie needs
041502 -        urgent treatment quickly in time to be effective, ref SDS 67
041503 -        Y15J, and UCSF schedules the work 3 weeks later on 090219.
041504 -        ref SDS 64 XO7G
041505 -
041506 -
0416 -

SUBJECTS
Default Null Subject Account for Blank Record

0503 -
0504 - Progress
050501 -  ..
050502 - Treatment Strategy Scenarios Proactive Management afer Hyperthermia
050503 -
050504 - Millie sent a letter to the medical team responding to Doctor Rugo's
050505 - letter on 090203 2257 saying Millie needs payment authorization from
050506 - Kaiser for continuing Doctor Rugo's support, including blood draws,
050507 - ref SDS 76 L35Q, and the doctor saying she is hopeful Millie can get
050508 - further systemic treatment after hyperthermia in another clinical
050509 - trial. ref SDS 76 L36S
050510 -
050511 -    1.  Subject: Oncology Strategy UCSF Case Management
050512 -        Date: Wed, 04 Feb 2009 02:27:26 -0800
050524 -         ..
050525 -    3.  Thanks for commenting on case management in your letter this
050526 -        evening [on 090203 2257, ref SDS 76 L35Q], responding to my
050527 -        letter asking about labs, and notifying the Infusion Clinic to
050528 -        cancel my blood draws [090203 1444, ref SDS 73 YQ6S].  Doctor
050529 -        Johnson noted earlier in the day that I do not need a blood
050530 -        draw on Thursday [Kaiser letter 090203 1533, ref SDS 74 3X6H],
050531 -        so everyone seems to be on the same page.
050532 -
050533 -
050534 -
0506 -

SUBJECTS
Default Null Subject Account for Blank Record

0603 -
060401 -  ..
060402 - UCSF Commended for Critical Care Millie's Cancer Past 2 Years
060403 - Innovation Required Effective Case Management Cancer Disease
060404 -
060405 -
060406 -    4.  I am very comfortable with primary case management reverting to
060407 -        Doctor Johnson.  He has been at the helm all along directing
060408 -        the work on my behalf at UCSF.  I am aware that you and your
060409 -        team, Brigid, and more recently Tara, with Jackie and Glenna
060410 -        coordinating, have been critical to my success so far.  I am
060411 -        hopeful for a good response with Doctor Hsu's hyperthermia, but
060412 -        recognize that patient history indicates more innovation will
060413 -        be needed sooner or later.
060414 -
060415 -
0605 -

SUBJECTS
Default Null Subject Account for Blank Record

0703 -
070401 -  ..
070402 - Teamwork Synergy Essential Effective Treatment Cancer Chronic Disease
070403 - Synergy Medical Practice Collaboration Essential Chronic Cancer Care
070404 - Effective Care Requires Synergy Medical Practice Doctor Rugo Involved
070405 -
070406 -
070407 -    5.  I feel teamwork between your office and Doctor Johnson at
070408 -        Kaiser has been effective, and would like to know how much it
070409 -        would cost to continue getting your invaluable input once a
070410 -        month, every 6 weeks, 8 weeks, some interval that keeps you in
070411 -        the loop that leverages practice synergy with Doctor Hsu.
070412 -
070413 -            [On 090204 1914 UCSF defers teamwork for practice synergy
070414 -            and proactive management to plan for alternate scenarios
070415 -            that optimize coprehensive care is prevented because
070416 -            Millie's case is very complicated. ref SDS 81 063I
070418 -             ..
070419 -            [On 090204 1930 Millie letter to medical team advises that
070420 -            breaking up a winning team risks losing effective and
070421 -            comprehensive care that has provided a "security blanket"
070422 -            treating cancer as a chronic disease. ref SDS 82 W84Q
070424 -             ..
070425 -            [On 090303 2053 applied advantage of leveraging practice
070426 -            synergy attempting to continue continuity working with
070427 -            Olsen Dental Offices that offers integrated services.
070428 -            ref SDS 87 O13H
070429 -
070430 -
070431 -
070432 -
0705 -

SUBJECTS
Default Null Subject Account for Blank Record

0803 -
080401 -  ..
080402 - Request Opinion Proactive Case Management Prepare for Next Treatment
080403 - Opinion Oncology Likely Cancer Scenarios and Available Treatments
080404 - Treatment Strategy Scenarios Proactive Management afer Hyperthermia
080405 - Proactive Case Management Cancer Chronic Disease Treatment Strategies
080406 -
080407 -
080408 -    6.  Specifically, I would like an opinion within a week or so on
080409 -        the most likely scenarios that could result in the next few
080410 -        months, and what treatments are available to meet them [as
080411 -        discussed previously with Glenna for presentation to Doctor
080412 -        Rugo on 090121 1017. ref SDS 32 EV53].  That's how I came to
080413 -        you.
080415 -  ..
080416 - This implements instructions from primary care physician, Doctor
080417 - Johnson, at Kaiser on 090123 1322, who advised that Millie's cancer has
080418 - mutated to resist treatments available at Kaiser, and so Kaiser
080419 - authorizes treatment at UCSF. ref SDS 41 RK6O
080421 -  ..
080422 - This was discussed previously on 081219, ref SDS 16 KU6F, following up
080423 - prior instructions on 081024, ref SDS 11 BO9F, and citing planning
080424 - reported in the medical chart for the meeting at Kaiser on 080829,
080425 - ref SDS 9 PX5V, as reported in Millie's letter to the medical team.
080426 - ref SDS 10 RP9R
080428 -             ..
080429 -            [On 090204 0257 Millie's letter discusses requirements for
080430 -            strategic planning to treat cancer as chronic disease after
080431 -            hyperthermia treatment at UCSF achieves local control.
080432 -            ref SDS 79 FP6X
080434 -             ..
080435 -            [On 090204 1914 Doctor Rugo notifies medical team that
080436 -            Millie's patient profile is very compex, and so researching
080437 -            options for treating Millie's cancer as a chronic disease
080438 -            takes a lot of time and hard work; therefore, UCSF defers
080439 -            teamwork for practice synergy and proactive management to
080440 -            plan for alternate scenarios that optimize coprehensive
080441 -            care is prevented because Millie's case is very
080442 -            complicated. ref SDS 81 063I
080444 -             ..
080445 -            [On 090204 1747 Millie received list of 10 additional
080446 -            treatments targeted for Millie's patient profile, so there
080447 -            is a list of drugs to treat Millie's cancer as a chronic
080448 -            disease, as recommended by Doctor Johnson. ref SDS 80 4R3S
080450 -             ..
080451 -            [On 090213 1140 Doctor Johnson authorizes Kaiser support
080452 -            for proactive planning at UCSF to treat Millie's next
080453 -            relapse of IBC as a chronic disease, ref SDS 85 GD3I,
080454 -            and approved meeting with Doctor Rugo at UCSF to start
080455 -            research so that treatment can begin in time to be
080456 -            effective. ref SDS 85 WZ6K
080458 -             ..
080459 -            [On 090218 1205 Millie's letter notifies medical team that
080460 -            Doctor Johnson has ordered Millie's continued care at UCSF,
080461 -            citing prior instructions on 080829, 081026, 081219, and on
080462 -            090123, all authorizing UCSF to begin planning for Millie's
080463 -            next treatment, so that past delays are avoided, because
080464 -            Millie's cancer has mutated through multiple relapses
080465 -            (total of 7 so far) into a very aggressive disease which
080466 -            requires treatment quickly in order to be effective.
080467 -            ref SDS 86 TH6U
080469 -         ..
080470 -    7.  Years ago and on several occasions, Doctor Benz set out
080471 -        strategies [see UCSF opinion on 041018 received on 041117,
080472 -        ref SDS 2 OU5V, and another opinion on 060821 and received on
080473 -        060929. ref SDS 5 UI9K, which were [both] later implemented by
080474 -        Doctor Johnson in an orderly manner and in time to be effective
080475 -        [reported on 050329, ref SDS 3 FP57, and later on 070105 making
080476 -        referral to UCSF, ref SDS 6 PK68]. What can we do to be
080477 -        prepared for the next transition without putting everybody
080478 -        under pressure scrambling at the last minute [as occurred in
080479 -        this case shown by case study today, per above. ref SDS 0 GV4H]
080480 -
080481 -            [On 090204 1914 UCSF defers teamwork for practice synergy
080482 -            and proactive management to plan for alternate scenarios
080483 -            that optimize coprehensive care is prevented because
080484 -            Millie's case is very complicated. ref SDS 81 063I
080486 -         ..
080487 -    8.  Thankfully, we don't have to figure it all out right now.  Your
080488 -        excellent hyperthemia prescription buys weeks, possibly months.
080489 -        We're just looking for collaboration.  So, take a break from me
080490 -        and all those darn letters.  Let me know your thoughts when
080491 -        time permits.
080492 -
080493 -            [On 090204 0257 Millie's letter discusses requirements for
080494 -            strategic planning to treat cancer as chronic disease after
080495 -            hyperthermia treatment at UCSF achieves local control.
080496 -            ref SDS 79 FP6X
080498 -             ..
080499 -            [On 090213 1140 Doctor Johnson authorizes Kaiser support
080500 -            for proactive planning at UCSF to treat Millie's next
080501 -            relapse of IBC as a chronic disease, ref SDS 85 GD3I,
080502 -            and approved meeting with Doctor Rugo at UCSF to start
080503 -            research so that treatment can begin in time to be
080504 -            effective. ref SDS 85 WZ6K
080506 -         ..
080507 -    9.  Great work this past week [shown in case study above.
080508 -        ref SDS 0 LQ3O]
080509 -
080516 -
080517 -
080518 -
080519 -
080520 -
080521 -
080522 -
0806 -