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 07:14 PM Wednesday;
Rod Welch
Doctor Rugo proposes defer UCSF oncology strategy cancer chronic disease
until after hyperthermia then case management recover 6th relapse IBC.
1...Summary/Objective
2...UCSF Defers Proactive Case Management to Prepare for Next Treatment
3...Complex Case Management Prevents Proactive Strategy Treatment Planning
4...Treatment Strategy Scenarios Proactive Management afer Hyperthermia
5...Proactive Case Management Cancer Chronic Disease Treatment Strategies
..............
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 84 0000. ref SDS 82 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 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 13 XX4P; there was rise of IBC and
040919 - then substantial recovery reported again on 081217, ref SDS 14
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, and IBC on
040955 - breastbone area looks worse, ref SDS 26 4P5M, that Millie wants
040956 - to reduce the dose to reduce side effects, but is afraid about
040957 - losing benefits of recovering 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 15
040974 - VD4F, confirmed in Millie's letter later that day reporting
040975 - significant recovery. ref SDS 16 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 12
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 Vicodin for
041121 - pain. ref SDS 45 2S8X
041123 - ..
041124 - 30. On 090129 Doctor Rugo sent a letter to primary care physician
041125 - at Kaiser reporting rising pain from worsening IBC, ref SDS 52
041126 - TZ6H; and, requesting referral to UCSF for treatment with
041127 - hyperthermia and Doxil, reported in Millie's letter to medical
041128 - team on 090130. ref SDS 52 AY9Q
041130 - ..
041131 - 31. On 090130 Millie letter to primary care physician, ref SDS 52
041132 - GV4M, reports examination at UCSF on 090129 found rising vitals
041133 - signal Millie suffering rising pain, ref SDS 52 AY7T, because
041134 - IBC progressing rapidly, ref SDS 52 4S8O, as Doctor Johnson
041135 - noted earlier on 090123, ref SDS 41 8K6K;
041137 - ..
041138 - 32. On 090130 Millie letter to primary care physician advises UCSF
041139 - reported communication delay prevented getting referral from
041140 - Kaiser, which then delayed starting hyperthermia treatment on
041141 - 090129 in time to be effective. ref SDS 52 AY8Q
041143 - ..
041144 - 33. On 090130 Millie letter to medical team reports that on 090129
041145 - coordinating timely referral from Kaiser was delayed because
041146 - primary care physician was not in the office. ref SDS 52 AY9T
041148 - ..
041149 - 34. On 090130 Krshna called Millie to schedule hyperthermia
041150 - treatment in the Radiation Oncology Department, and said that
041151 - UCSF has not received referral authorization from Kaiser.
041152 - ref SDS 50 NM5H
041154 - ..
041155 - 35. On 090130 called Arlette, ref SDS 51 RY4G, and she contacted
041156 - Doctor Johnson off-site in a meeting, and he advised that the
041157 - doctor would file authorization in the evening on 090130.
041158 - ref SDS 51 PPYY
041160 - ..
041161 - 36. On 090131 2318 Millie received letter from Doctor Johnson,
041162 - primary care physician, that Kaiser authorization was issued on
041163 - 090130, ref SDS 53 GV4M, for Millie to get treatment for 6th
041164 - relapse of IBC with hyperthermia and Doxil, prescribed by
041165 - Doctor Rugo on 090129 (reported in Millie's letter on 090130.
041166 - ref SDS 52 AY9Q
041168 - ..
041169 - 37. On 090201 Millie letter reports to medical team 6th relapse IBC
041170 - getting worse by the hour requires immediate treatment to
041171 - prevent cancer from getting out of control. Rising pain from
041172 - IBC makes sleeping difficult. ref SDS 54 KN9T
041174 - ..
041175 - 38. On 090201 Millie plans to go to UCSF for treatment tomorrow on
041176 - 090202 when convenient for Doctor Hsu to provide hypethermia
041177 - treatment. ref SDS 54 KN9W
041179 - ..
041180 - 39. On 090201 Millie reports lymphedema recurrence caused by
041181 - sling-immobilizer to treat dislocated shoulder on 090122;
041182 - advises Cellulitis did not recur, as previously. ref SDS 54
041183 - KN4S
041185 - ..
041186 - 40. On 090201 Millie reports good news energy recovering after side
041187 - effects from stopping treatment on sunitinib clinical study
041188 - ordered by Doctor Rugo on 090122. ref SDS 54 KN4Y
041190 - ..
041191 - 41. On 090201 UCSF letter notifies Millie that Doctor Rugo is
041192 - communicating with Doctor Hsu using email to expedite Millie's
041193 - treatment; recommends that Millie not come to UCSF on Monday
041194 - 090202 in order to assist the medical team start hyperthermia
041195 - treatment in time to be effective. ref SDS 55 GV4M
041197 - ..
041198 - 42. On 090201 Millie letter assures medical team that the patient
041199 - would not "camp out" in Doctor Hsu's office, but would stand-by
041200 - in the cafeteria so that treatment can begin when convenient
041201 - for UCSF, and without waiting for patient to travel through
041202 - mid-day traffic, so that urgent treatment is not delayed beyond
041203 - a point when treatment can no longer be effective. ref SDS 56
041204 - GV4M
041206 - ..
041207 - 43. On 090201 Millie asks Doctor Rugo about coordinating to provide
041208 - medical records on file in the doctor's office the past 2 years
041209 - treating Millie at UCSF, ref SDS 56 5R4S, to use by Doctor Hsu,
041210 - requested by Krshna in a call the day before on 090130.
041211 - ref SDS 50 DL4J
041213 - ..
041214 - 44. On 090201 emotional trauma esclates from delays getting
041215 - treatment for aggressive cancer that seems to be cascading out
041216 - of control because of communication delays. ref SDS 56 5R4V
041218 - ..
041219 - 45. On 090202 Michelle at UCSF called in the morning, and said
041220 - Kaiser has not submitted authorization for Millie's treatment
041221 - by Doctor Hsu. ref SDS 58 9Y5I Michelle asked the patient to
041222 - coordinate with the primary care physician at Kaiser to file
041223 - Authorization, ref SDS 58 9Y6Y, reported in Millie's letter to
041224 - the medical team. ref SDS 60 GV4M
041226 - ..
041227 - 46. On 090202 Michelle was advised that Doctor Johnson reported in
041228 - a letter on 090131 that Doctor Rugo at UCSF was notified on
041229 - 090130 that Kaiser issued authorization for Millie's treatment,
041230 - ref SDS 53 GV4M, and further that Doctor Johnson would be out
041231 - of town for several days, so he is not available on 090202 for
041232 - coordinating requested by UCSF on 090202, ref SDS 57 Y35M, to
041233 - file duplicate authorization, reported in Millie's letter to
041234 - the medical team on 090202 1028. ref SDS 60 FR6P
041236 - ..
041237 - 47. On 090202 0940 numerous calls were made to coordinate.
041238 - ref SDS 59 9Y5I Florida in Kaiser Oncology Department, Walnut
041239 - Creek CA advised that Pam in Kaiser Outside Referrals
041240 - Department said the doctor did not enter a "code" in the
041241 - Authorization form for hyperthermia treatment, so Pam is
041242 - waiting to get the code when the doctor returns from traveling
041243 - sometime in the next few days, ref SDS 59 1A5J, reported in
041244 - Millie's letter to the medical team. ref SDS 60 FR7R
041246 - ..
041247 - 48. On 090202 1012 called Kaiser Outside Referrals and left a
041248 - message that we need submission of authorization, so that
041249 - Millie can get treatment in time to be effective. ref SDS 59
041250 - W17K Suggested Outside Referrals send written notice to
041251 - Michelle Williams Jones at UCSF that authorization is on file
041252 - at Kaiser, and will be submitted to UCSF, so that my treatment
041253 - can be initiated concurrently. ref SDS 59 254F, reported in
041254 - Millie's letter to the medical team. ref SDS 60 FR7U
041256 - ..
041257 - 49. On 090202 1047 Pam in Outside Referrals at Kaiser called and
041258 - disclosed that the department needed to know the type of
041259 - treatment Millie would get on referral to UCSF? Advised
041260 - treatment is "hyperthermia," in the Radiation Oncology
041261 - department at UCSF. Pam reported that Kaiser does not have a
041262 - code for "hypethermia" nor for "Radiation Oncology." Pam used
041263 - a code for "Radiology." Problem solved. ref SDS 61 QQ7N, and
041264 - reported in Millie's letter to the medical team on 090202 1139.
041265 - ref SDS 63 M88H
041267 - ..
041268 - 50. On 090202 1117 Pam called back and wanted to know if referral
041269 - to UCSF is for in-patient or out-patient treatment? Since
041270 - radiation is often out-patient care, and initial discussions
041271 - did not indicate Millie would require staying in the hospital,
041272 - Pam coded the form for out-patient care, reported in the record
041273 - on 090202 1047]. ref SDS 61 0256, and reported in Millie's
041274 - letter to the medical team on 090202 1139. ref SDS 63 C94Y
041276 - ..
041277 - 51. On 090202 1118 Doctor Rugo notified the medical team that
041278 - Doctor Hsu cannot see Millie on 090202; advises that Doctor Hsu
041279 - is aware of Millie's situation. ref SDS 62 V47L
041281 - ..
041282 - 52. On 090202 1353 Doctor Hsu's assistant, Krshna reported that the
041283 - doctor was not aware of urgency to treat Millie, cited in
041284 - Doctor Rugo's letter on 090202 1118. ref SDS 62 V47L Krshna
041285 - proposes scheduling the work on 090219, ref SDS 64 XO7G, and
041286 - does not feel comfortable asking Doctor Hsu to advance the date
041287 - for treatment, because his schedule is already booked.
041288 - ref SDS 64 SP8I, reported in Millie's letter to the medical
041289 - team on 090202 1437. ref SDS 65 R23P
041291 - ..
041292 - 53. On 090202 1353 Krshna offers UCSF Radiation Oncology schedule
041293 - hyperthermia treatment 3 weeks delay to 090219. ref SDS 64 XO7G
041295 - ..
041296 - 54. On 090202 1437 Millie notifies medical team that UCSF received
041297 - Kaiser authorizations for treating the 6th relapse of IBC,
041298 - ref SDS 65 JR4J, reported on 090202 1353. ref SDS 64 SP6H
041299 - Millie thanks Doctor Rugo for expediting authorization with
041300 - Doctor Johnson at Kaiser, citing Doctor Rugo's letter to Doctor
041301 - Johnson on 090129, reported on 090130, ref SDS 52 TZ6H, Doctor
041302 - Rugo's letter to medical team on 090202 1118, indicating Doctor
041303 - Hsu is aware of Millie's situation. ref SDS 62 V47L
041305 - ..
041306 - 55. On 090202 1437 IBC disease has advanced significantly since
041307 - examination at UCSF on 090129, and pain on chest is rising.
041308 - Since Doctor Rugo has much more experience with IBC, if this
041309 - just "looks bad," but delaying treatment to 090219 presents no
041310 - risk of losing control, then I am fine with waiting until the
041311 - 19th. ref SDS 65 R23S
041313 - ..
041314 - 56. On 090202 1437 Millie notifies UCSF that Krshna indicated if
041315 - Doctor Rugo feels earlier treatment is needed, she can notify
041316 - Doctor Hsu directly. ref SDS 64 F65G, cited in Millie's letter
041317 - to medical team on 090202 1437, ref SDS 65 R23V
041319 - ..
041320 - 57. On 090202 1437 Millie apologizes for adding to Doctor Rugo's
041321 - work load. Waiting to the 19th is a shock compared to what
041322 - Millie sees on her chest. Results for CA 15-3 from the lab
041323 - last week on 090129 have not been published, but expect it will
041324 - be 200+, since it was 303 at Kaiser on 090116. ref SDS 25 PQTQ
041325 - Those are scary numbers in Millie's patient history. Millie
041326 - avers being a "sissy." Doctor Rugo and others at UCSF and
041327 - Kaiser are working hard to help Millie and many other patients,
041328 - cited in Millie's letter to medical team on 090202 1437.
041329 - ref SDS 65 R23Y
041331 - ..
041332 - 58. On 090202 1550 called VCI and asked about Millie getting
041333 - hyperthermia treatment immediately, rather than wait to 090219
041334 - offered by UCSF. ref SDS 66 YU8H
041336 - ..
041337 - 59. On 090202 1732 Doctor Rugo letter notifies medical team that
041338 - Millie needs urgent treatment quickly to be effective.
041339 - ref SDS 67 Y15J
041341 - ..
041342 - 60. On 090203 0939 call VCI and schedule call to discuss alternate
041343 - source for Millie to get hyperthermia treatment in time to be
041344 - effective recovering from 6th relapse of IBC. ref SDS 68 9Y5I
041346 - ..
041347 - 61. On 090203 1009 letter to VCI submits patient history for review
041348 - to support telephone conference, ref SDS 68 IN94, on arranging
041349 - for VCI to provide hyperthermia treatment in time for Millie to
041350 - recover from 6th relapse of IBC. ref SDS 68 EP3S
041352 - ..
041353 - 62. On 090203 1024 called UCSF talked to Jennette in Radiation
041354 - Oncology; she will discuss with Doctor Hsu advancing Millie
041355 - getting hyperthermia treatment from 090219 to this week.
041356 - ref SDS 69 XX5I
041358 - ..
041359 - 63. On 090203 1206 Doctor Al-Bussam called and reported well
041360 - ordered record for Millie's patient history enabled expedited
041361 - review of complex medical problems. ref SDS 70 8488 VCI
041362 - offered to start work the next day on 090204 giving Millie
041363 - hyperthermia treatment in time to be effective recoverying from
041364 - 6th relapse IBC. ref SDS 70 OE4F
041366 - ..
041367 - 64. On 090203 1417 Millie's letter to medical team reports VCI
041368 - proposal to provide hyperthermia treatment in time to be
041369 - effective starting tomorrow on 090204. ref SDS 71 IS3P
041371 - ..
041372 - 65. On 090203 1417 Millie advises medical team that if UCSF can
041373 - juggle the schedule to start treatment in the next few days,
041374 - Millie prefers working with Doctor Hsu locally, based on
041375 - excellent results working with Doctor Rugo. There is a lot of
041376 - benefit to close practice collaboration at UCSF. ref SDS 71
041377 - IS3Y
041379 - ..
041380 - 66. On 090203 1417 alternatively, Millie requests a medical opinion
041381 - on risks of waiting to Feb 19th against advantages of doing the
041382 - work tomorrow at VCI. ref SDS 71 IS4R
041384 - ..
041385 - 67. On 090203 1417 Millie ask whether treatment at UCSF can be
041386 - advanced from 090219. If not, is the medical condition urgent
041387 - enough to require another provider, and, if so, is VCI a good
041388 - choice under the circumstances? Is there another way to get
041389 - this work done in time to be effective? ref SDS 71 IS5V
041391 - ..
041392 - 68. On 090203 1438 Jennette with UCSF Radiation Oncology Department
041393 - called back and advised that Doctor Hsu advanced Millie's
041394 - hypertermia treatment to begin on 090205 in time to be
041395 - effective recovering from 6th relapse of IBC, ref SDS 72 XX5I,
041396 - rather than risk waiting until 090219, as proposed yesterday on
041397 - 090202 1357. ref SDS 64 XO7G
041399 - ..
041400 - 69. On 090203 1444 Millie's letter notified medical team,
041401 - ref SDS 73 6Q3J, that Jennette in Doctor Hsu's office at UCSF
041402 - called on 090203 1438, ref SDS 72 XX5I, following Millie's
041403 - letter on 090203 1417 notifying medical team that VCI offered
041404 - to perform hypethermia treatment tomorrow on 090204 in time to
041405 - be effective for Millie to recover from 6th relapse IBC,
041406 - ref SDS 71 IS3P, and Jennette said UCSF changed their proposal
041407 - for Millie to start treatment on 090219, and instead Millie is
041408 - scheduled to meet Doctor Hsu in Radiation Oncology at UCSF to
041409 - start hyperthermia treatment on 090205, ref SDS 72 XX5I, shown
041410 - in Millie's letter. ref SDS 73 YQ5W
041412 - ..
041413 - 70. On 090203 1444 Millie sent copy of letter for the medical team
041414 - to VCI, ref SDS 73 YQ6P, thanking Nash and Doctor Al-Bussam for
041415 - timely, professional support investigating my case, ref SDS 70
041416 - JZ4F, and offering a backup solution [reported in record on
041417 - 090203 1206. ref SDS 70 OE4F
041419 - ..
041420 - 71. On 090203 1444 Millie's letter notifies the medical team that
041421 - communication with Doctor Hsu's office at UCSF in Radiation
041422 - Oncology has not been established, ref SDS 73 YQ6S, previously
041423 - noted in Millie's letter to the medical team on 090202,
041424 - ref SDS 63 C95U]. Millie routinely gets blood draws on
041425 - Thursdays at 0800, and so asks if this is needed to support the
041426 - meeting with Doctor Hsu on Thursday 090205, and if not need to
041427 - cancel the meeting with the Infusion Clinic on Thursday. By
041428 - copy alerted Catherine and Diane in Infusion that blood draw
041429 - may not be needed on 090205. ref SDS 73 YQ6S
041431 - ..
041432 - 72. On 090203 1444 Millie commended Doctor Johnson, the primary
041433 - care physician at Kaiser Oncology, and Doctor Rugo, Millie's
041434 - oncologist on referral to UCSF, for support moving forward with
041435 - hyperthermia treatment to recover from 6th relapse of IBC.
041436 - ref SDS 73 YQ6V Noting this might not work; citing research
041437 - [on 090129] indicates there is a good chance. ref SDS 49 OI6N
041438 - and ref SDS 49 SQ6L
041440 - ..
041441 - 73. On 090203 1632 Doctor Johnson, Millie's primary care physician
041442 - at Kaiser advised that Millie does not need blood draw at UCSF
041443 - on Thursday 090205 to support starting hyperthermia treatment
041444 - meeting Doctor Hsu in the UCSF Radiation Oncology Department,
041445 - ref SDS 74 3X6H, responding to Millie's letter to the medical
041446 - team on 090203 1444 asking about labs. ref SDS 73 YQ6S
041448 - ..
041449 - 74. On 090203 2257 Doctor Rugo letter to medical team commends Dr
041450 - Hsu on advancing the schedule by 2 weeks of Millie to getting
041451 - hyperthermia treatment, ref SDS 76 WX8M, responding to Millie's
041452 - letter earlier today on 090203 1444 notifying that Radiation
041453 - Oncology changed the schedule from 090219 to 090205 in order to
041454 - provide urgent treatment quickly enough to be effective, which
041455 - was requested in Doctor Rugo's letter to the medical team on
041456 - 090202 1732. ref SDS 67 Y15J]
041458 - ..
041459 - 75. On 090203 2257 Doctor Rugo notifies medical team that Millie
041460 - cannot get treatment at UCSF without authorization. Millie
041461 - does not have any regular blood draws, and the doctor
041462 - recommends checking for authorization before Millie does
041463 - anything at UCSF. This includes clinic visits. Infusion
041464 - Clinic was notified Millie's meetings should be cancelled.
041465 - ref SDS 76 L35Q This responds to Millie's letter on 090203
041466 - 1444 asking about getting a blood draw before visiting Doctor
041467 - Hsu in Radiation Oncology on 090205. ref SDS 73 YQ6S
041469 - ..
041470 - 76. On 090203 2257 Doctor Rugo is hopeful Millie can move on to
041471 - another trial after the hyperthermia, that will continue a high
041472 - quality of life experienced the past 2 years at UCSF.
041473 - ref SDS 76 L36S
041475 - ..
041476 - 77. On 090203 2247 Doctor Rugo letter to Millie advises against
041477 - getting hyperthermia treatment at VCI, ref SDS 77 DY4K,
041478 - responding to Millie's letter earlier on 090203 1417 asking for
041479 - medical opinion about getting hyperthermia treatment at VCI
041480 - today on 090204, compared to waiting 3 weeks until 090219
041481 - proposed for treatment by UCSF. ref SDS 71 IS4R
041483 - ..
041484 - 78. On 090204 0117 Millie's letter thanks Doctor Rugo for help
041485 - advancing the schedule in Radiation Oncology for hyperthermia
041486 - treatment 3 weeks, ref SDS 78 DY4K, with a letter to the
041487 - medical team on 090202 1932 advising that Millie needs urgent
041488 - treatment quickly enough to be effective. ref SDS 67 Y15J, and
041489 - the doctor's letter on 090129 expedited referral from Kaiser
041490 - authorizing hyperthermia treatment, reported in Millie's letter
041491 - to the medical team on 090130. ref SDS 52 TZ6H
041493 - ..
041494 - 79. On 090204 0117 Millie notes in a letter to UCSF that VCI said
041495 - they had treated patients on referral from UCSF, reported on
041496 - 090202. ref SDS 66 P67F Did UCSF have a bad experience sending
041497 - a patient to VCI? Patients can make mistakes when rushed to
041498 - find a solution, a la "clutching at straws," ref SDS 78 EL4U,
041499 - which seemed to occur on 090202 when UCSF had earlier advised
041500 - on 090122 that Millie should stop treatment to be prepared for
041501 - starting new treatment on 090129, ref SDS 36 J47F, and on
041502 - 090129 UCSF advised there was a communication mixup that
041503 - prevented getting treatment, reported on 090130, ref SDS 52
041504 - AY8Q, and then writes a letter on 090202 saying Millie needs
041505 - urgent treatment quickly in time to be effective, ref SDS 67
041506 - Y15J, and UCSF schedules the work 3 weeks later on 090219.
041507 - ref SDS 64 XO7G
041509 - ..
041510 - 80. On 090204 0219 Millie thanks Doctor Rugo for guidance on case
041511 - management, ref SDS 79 135F, and notes innovation will be
041512 - needed for continuing care after hyperthermia treatment at
041513 - UCSF. ref SDS 79 277X Millie requests Doctor Rugo at UCSF
041514 - continue teamwork from past 2 years with Doctor Johnson at
041515 - Kaiser, and maintain internal practice synergy with Doctor Hsu
041516 - at UCSF to collaborate on designing effective treatment.
041517 - ref SDS 79 278Q
041519 - ..
041520 - 81. On 090204 0219 Millie asks Doctor Rugo to submit an opinion on
041521 - likely scenarios and possible treatment options so that
041522 - proactive management will avoid scrambling at the last minute
041523 - to get things done for the next treatment, ref SDS 79 278T,
041524 - that were required for the current hyperthermia treatment
041525 - scheduled to begin tomorrow on 090205, and shown by case study
041526 - in this record listing chronology of delays, per above.
041527 - ref SDS 0 MN5I
041529 - ..
041530 - 82. On 090204 1622 Millie letter to medical team reports calling
041531 - Arlette returning her message on Millie's cell phone yesterday
041532 - on 090203 with instructions on pain medication, ref SDS 82
041533 - 135F, and responding to Millie's letter reporting rising pain
041534 - on 090203 1417, ref SDS 71 IS6U; following up request the
041535 - before for pain relief, on 090202 1437. ref SDS 65 R23S, and
041536 - further cited 2 days ago on 090201 1852, ref SDS 54 KN9T.
041537 - Millie reported a bad flare up of pain the previous night on
041538 - 090203 2217, and got through it by taking more Vicodin.
041539 - ref SDS 75 KE5I
041541 - ..
041542 - 83. On 090204 1622 Millie cited the record on 090203 2217 showing
041543 - only 30% of prescribed pain medicine was being taken in order
041544 - to avoid over-medicating, ref SDS 75 L74H, ignoring
041545 - instructions during examination at UCSF a week earlier on
041546 - 090129 to take more medication reported to medical team on
041547 - 090130 1722, ref SDS 52 AY7T], but with everything going on
041548 - lately, 53 case management tasks since 090129, per above,
041549 - ref SDS 84 LQ3O, the patient got mixed up and forgot.
041550 - ref SDS 82 D64P
041552 - ..
041553 - 84. On 090204 1528 following Arlette's instructions pain relieved
041554 - Millie taking a double dose of Vicodin, and if that doesn't
041555 - work then low-dose morphine will be prescribed. ref SDS 81 D64T
041556 -
041557 -
041558 -
041559 -
0416 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - UCSF Defers Proactive Case Management to Prepare for Next Treatment
050403 - Complex Case Management Prevents Proactive Strategy Treatment Planning
050404 - Treatment Strategy Scenarios Proactive Management afer Hyperthermia
050405 - Proactive Case Management Cancer Chronic Disease Treatment Strategies
050406 -
050407 - Follow up ref SDS 79 135F.
050408 -
050409 - 1. Subject: Oncology Strategy UCSF Case Management
050410 - Date: Wed, 4 Feb 2009 18:45:34 -0800
050422 - ..
050423 - 2. We have to wait for the hyperthermia and see how you do [to
050424 - arrange for Millie to benefit from comprehensive cancer care
050425 - from teamwork with Doctor Rugo collaborating with Doctor Hsu
050426 - that yields local practice synergy based on Doctor Rugo being a
050427 - colleague and having treated Millie weekly for 2 years, while
050428 - Doctor Hsu has never met Millie, as requested in Millie's
050429 - letter to UCSF on 090204 0219, ref SDS 79 278Q, and further
050430 - Millie's request for Doctor Rugo to plan strategy for treatment
050431 - after hyperthermia, also requested in Millie's letter to UCSF
050432 - on 090204 0217, ref SDS 79 278Q].
050434 - ..
050435 - 3. It is not a simple prescription like when you first saw Doctor
050436 - Benz. we can schedule a consultation when you are done with
050437 - hyperthermia and have a followup scan, then we can talk about
050438 - the options ahead of you.
050440 - ..
050441 - Experience in Millie's case history shows that waiting to talk about
050442 - treatment options has not been effective strategy, compared to
050443 - proactive planning that positions people to be effective at the time
050444 - action is required, noted in Millie's letter to UCSF on 090204 0219.
050445 - ref SDS 79 278W
050447 - ..
050448 - [On 090204 1747 Millie received list of 10 additional
050449 - treatments targeted for Millie's patient profile, so
050450 - there is a list of drugs to treat Millie's cancer as a
050451 - chronic disease, as recommended by Doctor Johnson.
050452 - ref SDS 83 4R3S
050454 - ..
050455 - [On 090204 1930 Millie letter to medical team advises
050456 - that breaking up a winning team risks losing effective
050457 - and comprehensive care that has provided a "security
050458 - blanket" treating cancer as a chronic disease.
050459 - ref SDS 85 W84Q
050461 - ..
050462 - [On 090210 Lena called to schedule meeting with Doctor
050463 - Rugo on 090212 0830. ref SDS 87 XU5N
050465 - ..
050466 - [On 090213 1140 Doctor Johnson authorizes Kaiser support
050467 - for proactive planning at UCSF to treat Millie's next
050468 - relapse of IBC as a chronic disease, ref SDS 88 GD3I,
050469 - and approved meeting with Doctor Rugo at UCSF to start
050470 - research so that treatment can begin in time to be
050471 - effective. ref SDS 88 WZ6K
050473 - ..
050474 - Millie's case has been "complex" for a long time, even when Doctor
050475 - Benz supported the work in a 2nd opinion consultation on 041018.
050476 - ref SDS 2 QU6F On 060821 Doctor Benz examined Millie again noting
050477 - this is a very complex case. ref SDS 6 TQ7I
050479 - ..
050480 - Case study on 061020 shows many doctors have described complexity of
050481 - Millie's case. ref SDS 8 T25H
050483 - ..
050484 - Doctor Rugo's letter to Millie continues...
050485 -
050486 - 4. I hope that sounds okay for you. For the cost of the visit, it
050487 - would be best to talk with the clinic manager or patient
050488 - services, as I don't bill for anything myself!
050490 - ..
050491 - Why should Doctor Rugo's time and support require additional payment
050492 - authorization from Kaiser, since Doctor Hsu requires practice synergy
050493 - from Doctor Rugo's experience treating Millie for 2 years, and Doctor
050494 - Rugo made the referral for hyperthermia, and further since Kaiser has
050495 - authorized payment for all reasonable and necessary expense to
050496 - provide hyperthermia treatment.
050498 - ..
050499 - Doctor Rugo's letter to Millie continues...
050500 -
050501 - 5. Good luck with the hyperthermia, and then we will plan a bit
050502 - more.
050503 -
050504 - [On 090206 Lena called to schedule meeting with Doctor
050505 - Rugo on 090212 0830. ref SDS 87 XU5N
050506 -
050515 -
050516 -
050517 -
050518 -
050519 -
050520 -
050521 -
050522 -
050523 -
050524 -
050525 -
050526 -
050527 -
050528 -
050529 -
0506 -