CONTACTS 

SUBJECTS
Consultation 2nd Opinion Chemotherapy Treatements IBC 6th Relapse Pr

2103 -
2103 -    ..
2104 - Summary/Objective
2105 -
210501 - Follow up ref SDS 63 0000. ref SDS 62 0000.
210502 -
210503 -
210504 -
210506 -  ..
2106 -
2107 -
2108 - Progress
2109 -
210901 - Background on working with Doctor Stritter is reported on 090106.
210902 - ref SDS 49 KI5I
210903 -
210904 -        1.  Millie met Doctor Stritter during
210905 -            seminar presentation at Wellness
210906 -            Community cancer support
210907 -            group.............................. 081018, ref SDS 28 PQ6X
210909 -             ..
210910 -        2.  Doctor Stritter asked for copies of
210911 -            correspondence with the medical team
210912 -            on Millie's response to sunitinib
210913 -            treatment for cancer that supports
210914 -            Doctor Stritter's research on
210915 -            advanced cancer
210916 -            treatments......................... 081018, ref SDS 28 1Y4G
210918 -             ..
210919 -        3.  Doctor Stritter was helpful finding
210920 -            referral for resolving payment issues
210921 -            with Kaiser for Millie's treatment
210922 -            on referral to UCSF................ 081114, ref SDS 32 638G
210924 -             ..
210925 -        4.  Millie was confused, worried, and
210926 -            emotional about plans to maintain
210927 -            strong recovery from cancer and reduce
210928 -            side effects by adjusting treatments
210929 -            to tolerable levels on 081226,
210930 -            presented during meeting at
210931 -            UCSF............................... 081218, ref SDS 40 QW48
210932 -            as set out in the letter confirming
210933 -            understandings to the medical
210934 -            team............................... 081218, ref SDS 41 GF4V
210935 -            Millie submitted a copy to Doctor
210936 -            Stritter of the letter on 081218 to
210937 -            the medical team reporting results of
210938 -            examination at
210939 -            UCSF............................... 081218. ref SDS 41 4P7F
210941 -             ..
210942 -        5.  Millie sent a copy to Doctor Stritter
210943 -            of another letter to the primary care
210944 -            physician at Kaiser on 081219, requesting
210945 -            assistance managing the work plan at
210946 -            UCSF for Millie's treatment with
210947 -            sunitinib.......................... 081219, ref SDS 43 KY8Q
210948 -            noting that case management is
210949 -            difficult due to limited time and emotional
210950 -            feelings that prevent thorough analysis
210951 -            during meetings with
210952 -            doctors............................ 081219, ref SDS 43 SU8X
210954 -             ..
210955 -        6.  Millie's letter to Doctor Stritter
210956 -            requested second opinion on Millie's
210957 -            treatment with sunitinib staying at
210958 -            full strength and reducing or ending
210959 -            treatment with cyclophosphamide
210960 -            to reduce side
210961 -            effects............................ 081220, ref SDS 45 I69Q
210963 -             ..
210964 -        7.  Millie received a letter from Doctor
210965 -            Stritter with terms and conditions for
210966 -            2nd opinion, and transmitting a pdf file
210967 -            requesting patient history in a
210968 -            questionnaire...................... 081223, ref SDS 46 8N9M
210970 -             ..
210971 -        8.  Questionnaire could not be filled out
210972 -            in pdf file because Adobe Acrobat
210973 -            could not be configured; information
210974 -            requested in the form was
210975 -            entered in the
210976 -            record............................. 081223, ref SDS 46 DQ6J
210978 -             ..
210979 -        9.  Patient history for Doctor Stritter's
210980 -            2nd opinion support was developed
210981 -            in the SDS record.................. 090106, ref SDS 49 IP6H
210983 -             ..
210984 -       10.  Millie sent letter to Doctor Stritter
210985 -            with payment of $300 for 2nd
210986 -            opinion services................... 090106, ref SDS 49 S34O
210987 -            and listing objectives for
210988 -            conslutation....................... 090106, ref SDS 49 6H3Q
210990 -             ..
210991 -       11.  Doctor Stritter notified Millie that
210992 -            she was attending a professional conference
210993 -            on integrative oncology conference in
210994 -            Florida, and would respond to
210995 -            Millie's letter on
210996 -            090114............................. 090107, ref SDS 51 PJ3I ,
210998 -             ..
210999 -       12.  Doctor Stritter called and advised she
211000 -            needs another $300 to provide a 2nd
211001 -            opinion on treatments for
211002 -            Millie............................. 090114, ref SDS 52 U290
211003 -            doctor requested support reviewing
211004 -            Millie's complex patient history
211005 -            for 2nd opinion
211006 -            work............................... 090114, ref SDS 52 U271
211008 -             ..
211009 -       13.  Millie sent a letter to Doctor Stritter,
211010 -            ref SDS 55 3C5O, following up the letter
211011 -            on 090106 setting out scope of assignment,
211012 -            ref SDS 49 S34O, confirming understandings
211013 -            from the call on 090114, and submitting
211014 -            additional information on pathology
211015 -            reports and CT tests requested
211016 -            by the doctor...................... 090119, ref SDS 52 U271
211018 -             ..
211019 -       14.  Called Doctor Stritter who asked for
211020 -            information in a questionaire she
211021 -            submitted with a letter to Millie on
211022 -            091223, ref SDS 46 DQ6J, the doctor
211023 -            wants another $300 to provide a list
211024 -            of treatments that can
211025 -            help Millie........................ 090120, ref SDS 56 CM66
211027 -             ..
211028 -       15.  Millie sent a letter to Stritter Medical
211029 -            Consulting transmitting information
211030 -            requested in the Questionnaire
211031 -            received in the record on
211032 -            081223............................. 090121, ref SDS 57 C57O
211034 -             ..
211035 -       16.  Regrettably, time has become a factor
211036 -            because the cancer marker jumped to
211037 -            CA 15-3 303 for the lab on 090116.
211038 -            ref SDS 53 PQTQ; Millie needs
211039 -            input as soon as
211040 -            possible........................... 090121, ref SDS 57 SC5T
211042 -             ..
211043 -       17.  Dislocated shoulder from fall treatment
211044 -            in Emergency Department on 090122, and
211045 -            notice that UCSF ended Millie's
211046 -            treatment with sunitinib due to 6th
211047 -            relapse of IBC, and rising side
211048 -            effects; copy of letter to
211049 -            medical team sent to Doctor
211050 -            Stritter........................... 090123, ref SDS 59 KR4P
211052 -             ..
211053 -       18.  Millie letter notified Doctor Stritter
211054 -            that UCSF ended treatment with sunitinib
211055 -            due progression of
211056 -            disease............................ 090126, ref SDS 62 Q59G
211057 -            Millie meeting with UCSF on 090129
211058 -            asks Doctor Stritter for
211059 -            treatment options.................. 090126, ref SDS 62 066T
211061 -             ..
211062 -       19.  Doctor Stritter requests additional
211063 -            payment $300, and schedules
211064 -            telephone conference
211065 -            090203 1600........................ 090127, ref SDS 63 L24J
211067 -             ..
211068 -       20.  Millie submits another $300 payment
211069 -            and agrees to telephone conference
211070 -            090203 1600........................ 090127, ref SDS 63 HO5W
211071 -
211072 -
211073 -
2111 -

SUBJECTS
Default Null Subject Account for Blank Record

2203 -
220401 -  ..
220402 - Cancer Treatments for Millie's Patient Profile Stritter Consultation
220403 - Consultation 2nd Opinion Cancer Treatments for Millie's Patient Profile
220404 -
220405 - Follow up ref SDS 64 7P9O.
220406 -
220407 - Yesterday, Millie received from Stritter Medical Consulting a report
220408 - listing possible chemotherapy treatments, ref SDS 64 RN9G, that fits
220409 - Millie's patient profile, including triple negative status.
220411 -  ..
220412 - Today, Gwen called to discuss her report.
220414 -  ..
220415 - Agenda...
220416 -
220417 -        1.  Patient history on 090106. ref SDS 49 IP6H
220418 -
220420 -             ..
220421 -        2.  Treatments
220422 -
220424 -             ..
220425 -        3.  Sources
220426 -
220428 -             ..
220429 -        4.  Contacts
220430 -
220432 -  ..
220433 - Gwen reviewed her letter on 090204, ref SDS 64 7P9O listing treatment
220434 - ideas, ref SDS 64 987F, as requested in the scope for the 2nd opinion,
220435 - which was submitted in the record on 090106. ref SDS 49 PQ6Q
220436 -
220437 -               [On 090206 Gwen notes that Millie's case is
220438 -               inspirational surviving a very aggressive cancer and
220439 -               complex case management for so many years. ref SDS 65
220440 -               7Q7J
220442 -                ..
220443 -               [On 090218 0828 received follow up letter from Gwen
220444 -               submitting article on Thermodox used with
220445 -               hyperthermia. ref SDS 66 7Q7J
220447 -  ..
220448 - Gwen indicated there may be a number of effective treatments in
220449 - clinical trials that will help Millie maintain recovery after
220450 - hyperthermia and lower dose radiation at UCSF.
220452 -  ..
220453 - The report addresses testing tissue sensitivity for response to
220454 - treatments, ref SDS 64 9K9W, as requested in scope on 090106.
220455 - ref SDS 49 E55M
220457 -  ..
220458 - For some reason, this is a very sketchy record.
220459 -
220460 -
220461 -
2205 -

SUBJECTS
Karnofsky Performance Scores for Chemotherapy Cancer Treatment or Me

2703 -
270401 -  ..
270402 - Karnofsky Performance Scores for Treatment v Hospice ECOG
270403 - ECOG Performance Scores for Treatment v Hospice Karnofsky
270404 - Treatment ECOG Performance Scores for Hospice Karnofsky
270405 - Hospice ECOG Performance Scores for Treatment Karnofsky
270406 -
270407 -
270408 - Karnofsky testing quality of life for ability to participate in
270409 - clinical trials, and other standard oncology therapies, e.g.,
270410 - chemotherapy.
270412 -  ..
270413 - Research on the Internet says...
270414 -
270415 -        The Karnofsky Performance Scale Index allows patients to be
270416 -        classified as to their functional impairment. This can be used
270417 -        to compare effectiveness of different therapies and to assess
270418 -        the prognosis in individual patients. The lower the Karnofsky
270419 -        score, the worse the survival for most serious illnesses.
270420 -
270421 -              http://www.hospicepatients.org/karnofsky.html
270423 -         ..
270424 -        KARNOFSKY PERFORMANCE STATUS SCALE DEFINITIONS RATING (%)
270425 -        CRITERIA
270427 -         ..
270428 -        Able to carry on normal activity and to work; no special care
270429 -        needed.
270430 -
270431 -             100 Normal no complaints; no evidence of disease.
270432 -
270433 -              90 Normal activity with effort; some signs or symptoms
270434 -                 of disease.
270436 -               ..
270437 -              80 Normal activity with effort; some signs or symptoms
270438 -                 of disease.
270440 -               ..
270441 -              70 Cares for self; unable to carry on normal activity or
270442 -                 to do active work.
270444 -         ..
270445 -        Unable to work; able to live at home and care for most
270446 -        personal needs; varying amount of assistance needed.
270447 -
270448 -              60 Requires occasional assistance, but is able to care
270449 -                 for most of his personal needs.
270450 -
270451 -              50 Requires considerable assistance and frequent medical
270452 -                 care.
270454 -         ..
270455 -        Unable to care for self; requires equivalent of institutional
270456 -        or hospital care; disease may be progressing rapidly.
270457 -
270458 -              40 Disabled; requires special care and assistance.
270459 -
270460 -              30 Severely disabled; hospital admission is indicated
270461 -                 although death not imminent.
270463 -               ..
270464 -              20 Very sick; hospital admission necessary; active
270465 -                 supportive treatment necessary.
270467 -               ..
270468 -              10 Moribund; fatal processes progressing rapidly.
270469 -
270470 -               0 Dead
270472 -  ..
270473 - Performance status is also discussed in Wikipedia.....
270474 -
270475 -        In medicine (oncology and other fields), performance status is
270476 -        an attempt to quantify cancer patients' general well-being.
270477 -        This measure is used to determine whether they can receive
270478 -        chemotherapy, whether dose adjustment is necessary, and as a
270479 -        measure for the required intensity of palliative care.  It is
270480 -        also used in oncological randomized controlled trials as a
270481 -        measure of quality of life.
270482 -
270483 -              http://en.wikipedia.org/wiki/Performance_status
270485 -  ..
270486 - Kaiser uses ECOG performance scale, shown in examination on 081219.
270487 - ref SDS 44 CS5G
270488 -
270489 -        ECOG/WHO/Zubrod score
270490 -
270491 -        The ECOG score (published by Oken et al. in 1982), also called
270492 -        the WHO or Zubrod score (after C.  Gordon Zubrod), runs from 0
270493 -        to 5, with 0 denoting perfect health and 5 death:[2]
270495 -             ..
270496 -        0 - Asymptomatic (Fully active, able to carry on all predisease
270497 -            activities without restriction)
270499 -             ..
270500 -        1 - Symptomatic but completely ambulatory (Restricted in
270501 -            physically strenuous activity but ambulatory and able to
270502 -            carry out work of a light or sedentary nature. For example,
270503 -            light housework, office work)
270505 -             ..
270506 -        2 - Symptomatic, <50% in bed during the day (Ambulatory
270507 -            and capable of all self care but unable to carry out any
270508 -            work activities. Up and about more than 50% of waking
270509 -            hours)
270511 -  ..
270512 - Additional research seems to indicate ECOG > 2 may limit
270513 - interventions, like chemotherapy, and qualify for Hospice services.
270514 -
270515 -               Medical College of Wisconsin
270516 -               EPERC
270517 -               End of Life Palliative Education Resources Center
270518 -
270519 -               # 090 Medicare Hospice Benefit Part III: Special
270520 -               Interventions, 2nd ed
270521 -
270522 -                    http://www.mcw.edu/fastFact/ff_90.htm
270524 -                ..
270525 -               Chemotherapy   Indication: symptoms from the cancer are
270526 -               causing distress; the likelihood of effectiveness is
270527 -               high (expected Response Rate greater than 25% - see
270528 -               Fast Facts #14, 99); patient will live long enough to
270529 -               benefit (> 4-8 weeks, ECOG 0-2); and benefits outweigh
270530 -               burdens.
270532 -             ..
270533 -        3 - Symptomatic, >50% in bed, but not bedbound
270534 -            (Capable of only limited self-care, confined to bed
270535 -            or chair 50% or more of waking hours)
270537 -             ..
270538 -        4 - Bedbound (Completely disabled. Cannot carry
270539 -            on any self-care. Totally confined to bed or
270540 -            chair)
270542 -             ..
270543 -        5 - Death
270545 -  ..
270546 - Patient access network:  866 316 7263
270547 -
270548 -       helps people who get large co-payment.
270550 -  ..
270551 - Millie's IBC may be easier to control than most patients.
270553 -  ..
270554 - Melatonin
270556 -  ..
270557 - Proactive stress management.
270558 -
270559 -
270560 -
270561 -
270562 -
270563 -
270564 -
270565 -
270566 -
270567 -
2706 -