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 4, 2009 04:22 PM Wednesday;
Rod Welch
Millie letter requests guidance on pain control IBC and injured shoulder.
1...Summary/Objective
2...Pain Control Guidance Vicadin for IBC and Dislocated Shoulder
3...Cell Phone Request for Backup Use Main Number for Routine Calls
..............
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 76 0000. ref SDS 75 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
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 15 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 17 UC4H Millie reported severe
040910 - side effects shown by wide range of blood counts falling.
040911 - ref SDS 17 UF3Q Medical team prescribed another cycle
040912 - sunitinib treatment, with cyclophosphamide paused until blood
040913 - counts increase to a safe level. ref SDS 17 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 10 XX4P; there was rise of IBC and
040919 - then substantial recovery reported again on 081217, ref SDS 11
040920 - YJ4V; on 081230 Millie's letter reported on 081224 and 081225
040921 - rise of IBC, and then improvement on 081226, ref SDS 15 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 16 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 20 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 19
040932 - KL4J Have been spending more time in the gym doing aerobics,
040933 - which is a little more tolerable. ref SDS 19 3E4K
040935 - ..
040936 - 5. On 090116 Glenna called to ask about response to treatment and
040937 - side effects, ref SDS 21 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 19 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 21 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 23 YN9H; Glenna's letter to the doctor described
040954 - difficulty tolerating side effects of sunitinib, ref SDS 23
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 23 HV3M
040959 - ..
040960 - 8. On 090116 Glenna's letter to the doctor asked about changing to
040961 - another treatment. ref SDS 23 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 23 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 24 IS6G, relative to findings on 081218, ref SDS 12
040974 - VD4F, confirmed in Millie's letter later that day reporting
040975 - significant recovery. ref SDS 13 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 25 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 28 F23Y
040992 - ..
040993 - 13. On 090121 Glenna calls and asks again about Millie's response
040994 - to treatment, ref SDS 29 AJ3J, following up her call on 090116,
040995 - ref SDS 21 JY6L, and per background above. ref SDS 29 JY5I
040997 - ..
040998 - 14. On 090121 during call from Glenna reported patient history,
040999 - ref SDS 29 ZO4F, on 090120 shows IBC rash looks improved to
041000 - stable, and nodules in the breastbone area seem worse,
041001 - ref SDS 27 124N, relative to detailed review on 090110,
041002 - ref SDS 18 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 26 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 29 N95K, Labs at Kaiser on 090116
041011 - report CA 15-3 303. ref SDS 22 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 29 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 29 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 40 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 29 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 29 NU5H
041038 - ..
041039 - a. Laboratory blood tests listed for Millie to facilitate UCSF
041040 - considering Millie's next treatment. ref SDS 29 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 29 216F
041047 - ..
041048 - c. Treatment history listed for Glenna to discuss with Doctor
041049 - Rugo discussing Millie's next treatment. ref SDS 29 H16M
041051 - ..
041052 - d. Strategy considerations for selecting Millie's next
041053 - treatment. ref SDS 29 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 33
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 22 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 38 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 9
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 34
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 35 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 33 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 35 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 38 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 40 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 40 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 40
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 42 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 49 AY9Q
041129 - ..
041130 - 31. On 090130 Millie letter to primary care physician, ref SDS 49
041131 - GV4M, reports examination at UCSF on 090129 found IBC
041132 - progressing rapidly, ref SDS 49 4S8O, as Doctor Johnson noted
041133 - earlier on 090123, ref SDS 38 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 49 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 49 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 47 NM5H
041152 - ..
041153 - 35. On 090130 called Arlette, ref SDS 48 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 48 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 50 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 49 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 51 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 51 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 51
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 51 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 52 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 53
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 53 5R4S, to use by Doctor Hsu,
041207 - requested by Krshna in a call the day before on 090130.
041208 - ref SDS 47 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 53 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 55 9Y5I Michelle asked the patient to
041219 - coordinate with the primary care physician at Kaiser to file
041220 - Authorization, ref SDS 55 9Y6Y, reported in Millie's letter to
041221 - the medical team. ref SDS 57 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 50 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 54 Y35M, to
041230 - file duplicate authorization, reported in Millie's letter to
041231 - the medical team on 090202 1028. ref SDS 57 FR6P
041233 - ..
041234 - 47. On 090202 0940 numerous calls were made to coordinate.
041235 - ref SDS 56 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 56 1A5J, reported in
041241 - Millie's letter to the medical team. ref SDS 57 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 56
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 56 254F, reported in
041251 - Millie's letter to the medical team. ref SDS 57 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 58 QQ7N, and
041261 - reported in Millie's letter to the medical team on 090202 1139.
041262 - ref SDS 60 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 58 0256, and reported in Millie's
041271 - letter to the medical team on 090202 1139. ref SDS 60 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 59 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 59 V47L Krshna
041282 - proposes scheduling the work on 090219, ref SDS 61 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 61 SP8I, reported in Millie's letter to the medical
041286 - team on 090202 1437. ref SDS 62 R23P
041288 - ..
041289 - 53. On 090202 1353 Krshna offers UCSF Radiation Oncology schedule
041290 - hyperthermia treatment 3 weeks delay to 090219. ref SDS 61 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 62 JR4J, reported on 090202 1353. ref SDS 61 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 49 TZ6H, Doctor
041299 - Rugo's letter to medical team on 090202 1118, indicating Doctor
041300 - Hsu is aware of Millie's situation. ref SDS 59 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 62 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 61 F65G, cited in Millie's letter
041314 - to medical team on 090202 1437, ref SDS 62 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 22 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 62 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 63 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 64 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 65 9Y5I
041343 - ..
041344 - 61. On 090203 1009 letter to VCI submits patient history for review
041345 - to support telephone conference, ref SDS 65 IN94, on arranging
041346 - for VCI to provide hyperthermia treatment in time for Millie to
041347 - recover from 6th relapse of IBC. ref SDS 65 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 66 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 67 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 67 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 68 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 68
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 68 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 68 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 69 XX5I,
041393 - rather than risk waiting until 090219, as proposed yesterday on
041394 - 090202 1357. ref SDS 61 XO7G
041396 - ..
041397 - 69. On 090203 1444 Millie's letter notified medical team,
041398 - ref SDS 70 6Q3J, that Jennette in Doctor Hsu's office at UCSF
041399 - called on 090203 1438, ref SDS 69 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 68 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 69 XX5I, shown
041407 - in Millie's letter. ref SDS 70 YQ5W
041409 - ..
041410 - 70. On 090203 1444 Millie sent copy of letter for the medical team
041411 - to VCI, ref SDS 70 YQ6P, thanking Nash and Doctor Al-Bussam for
041412 - timely, professional support investigating my case, ref SDS 67
041413 - JZ4F, and offering a backup solution [reported in record on
041414 - 090203 1206. ref SDS 67 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 70 YQ6S, previously
041420 - noted in Millie's letter to the medical team on 090202,
041421 - ref SDS 60 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 70 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 70 YQ6V Noting this might not work; citing research
041434 - [on 090129] indicates there is a good chance. ref SDS 46 OI6N
041435 - and ref SDS 46 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 71 3X6H, responding to Millie's letter to the medical
041443 - team on 090203 1444 asking about labs. ref SDS 70 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 73 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 64 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 73 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 70 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 73 L36S
041472 - ..
041473 - 77. On 090203 2247 Doctor Rugo letter to Millie advises against
041474 - getting hyperthermia treatment at VCI, ref SDS 74 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 68 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 75 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 64 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 49 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 63 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 75 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 33 J47F, and on
041499 - 090129 UCSF advised there was a communication mixup that
041500 - prevented getting treatment, reported on 090130, ref SDS 49
041501 - AY8Q, and then writes a letter on 090202 saying Millie needs
041502 - urgent treatment quickly in time to be effective, ref SDS 64
041503 - Y15J, and UCSF schedules the work 3 weeks later on 090219.
041504 - ref SDS 61 XO7G
041506 - ..
041507 - 80. On 090204 0219 Millie thanks Doctor Rugo for guidance on case
041508 - management, ref SDS 76 135F, and notes innovation will be
041509 - needed for continuing care after hyperthermia treatment at
041510 - UCSF. ref SDS 76 277X Millie requests Doctor Rugo at UCSF
041511 - continue teamwork from past 2 years with Doctor Johnson at
041512 - Kaiser, and maintain internal practice synergy with Doctor Hsu
041513 - at UCSF to collaborate on designing effective treatment.
041514 - ref SDS 76 278Q
041516 - ..
041517 - 81. On 090204 0219 Millie asks Doctor Rugo to submit an opinion on
041518 - likely scenarios and possible treatment options so that
041519 - proactive management will avoid scrambling at the last minute
041520 - to get things done for the next treatment, ref SDS 76 278T,
041521 - that were required for the current hyperthermia treatment
041522 - scheduled to begin tomorrow on 090205. ref SDS 0 GV4H
041523 -
041524 -
041525 -
041526 -
0416 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
0504 - Progress
050501 - ..
050502 - Pain Control Guidance Vicadin for IBC and Dislocated Shoulder
050503 -
050504 - Follow up ref SDS 76 135F.
050505 -
050506 - 1. Subject: Pain Control Guidance Effective
050507 - Date: Wed, 04 Feb 2009 15:37:01 -0800
050515 - ..
050516 - 3. I called Arlette this morning, returning her message on my cell
050517 - phone yesterday with instructions on pain medication, and
050518 - responding to my letter yesterday afternoon reporting rising
050519 - pain [on 090203 1417, ref SDS 68 IS6U; followed up request the
050520 - before for pain relief, on 090202 1437. ref SDS 62 R23S, and
050521 - further cited 2 days ago on 090201 1852, ref SDS 51 KN9T].
050522 - Thanks for timely follow up. I had a pretty bad flare up last
050523 - night, but got through it by taking more Vicodin. ref SDS 72
050524 - KE5I
050526 - ..
050527 - 4. As shown in the record on 090203 2217, I was taking about 30%
050528 - of prescribed pain medicine. ref SDS 72 L74H Tara mentioned
050529 - last week at UCSF [on 090129] I should take more medication
050530 - [reported to medical team on 090130 1722, ref SDS 49 AY7T], but
050531 - with everything going on lately I guess I forgot.
050533 - ..
050534 - 5. Today, following Arlette's instructions I am taking more
050535 - medication and things seem better. So thanks very much for
050536 - clarifying the protocol...
050538 - ..
050539 - 6. I gathered from the call I should take a double dose of
050540 - Vicodin, and if that doesn't work then low-dose morphine will
050541 - be prescribed??
050542 -
050543 -
0506 -
SUBJECTS
Default Null Subject Account for Blank Record
0603 -
060401 - ..
060402 - Cell Phone Request for Backup Use Main Number for Routine Calls
060403 -
060404 -
060405 - 7. For Arlette, please use *** *** ****, and use the cell number
060406 - *** *** **** for backup on urgent issues. I see the flashing
060407 - light on the house phone to get messages. Often I don't get
060408 - messages on the cell for a day or so. Email works better, so I
060409 - get things written down, but calling is fast and easy; and of
060410 - course I luuuuuve talking to you.
060411 -
060412 - [On 090204 1817 Arlette reports Kaiser medical records
060413 - listed Millie's primary number as her cell phone; Arlette
060414 - corrected the record listing the home phone as primary, and
060415 - cell as backup; solved the problem reported today.
060416 - ref SDS 78 D65P
060417 -
060424 -
060425 -
060426 -
060427 -
060428 -
060429 -
060430 -
060431 -
0605 -