CONTACTS 
020204 -

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 96 0000. ref SDS 94 0000.
040502 -
040503 -
040504 -
040506 -  ..
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 28 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 30 UC4H  Millie reported severe
040910 -        side effects shown by wide range of blood counts falling.
040911 -        ref SDS 30 UF3Q  Medical team prescribed another cycle
040912 -        sunitinib treatment, with cyclophosphamide paused until blood
040913 -        counts increase to a safe level. ref SDS 30 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 23 XX4P; there was rise of IBC and
040919 -        then substantial recovery reported again on 081217, ref SDS 24
040920 -        YJ4V; on 081230 Millie's letter reported on 081224 and 081225
040921 -        rise of IBC, and then improvement on 081226, ref SDS 28 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 29 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 33 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 32
040932 -        KL4J  Have been spending more time in the gym doing aerobics,
040933 -        which is a little more tolerable. ref SDS 32 3E4K
040935 -         ..
040936 -    5.  On 090116 Glenna called to ask about response to treatment and
040937 -        side effects, ref SDS 34 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 32 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 34 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 36 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 36 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 36 HV3M
040959 -         ..
040960 -    8.  On 090116 Glenna's letter to the doctor asked about changing to
040961 -        another treatment. ref SDS 36 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 36 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 37 IS6G, relative to findings on 081218, ref SDS 25
040974 -        VD4F, confirmed in Millie's letter later that day reporting
040975 -        significant recovery. ref SDS 26 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 38 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 2 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 41 F23Y
040992 -         ..
040993 -   13.  On 090121 Glenna calls and asks again about Millie's response
040994 -        to treatment, ref SDS 42 AJ3J, following up her call on 090116,
040995 -        ref SDS 34 JY6L, and per background above. ref SDS 42 JY5I
040997 -         ..
040998 -   14.  On 090121 during call from Glenna reported patient history,
040999 -        ref SDS 42 ZO4F, on 090120 shows IBC rash looks improved to
041000 -        stable, and nodules in the breastbone area seem worse,
041001 -        ref SDS 40 124N, relative to detailed review on 090110,
041002 -        ref SDS 31 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 39 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 42 N95K, Labs at Kaiser on 090116
041011 -        report CA 15-3 303. ref SDS 35 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 42 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 42 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 53 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 42 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 42 NU5H
041038 -             ..
041039 -        a.  Laboratory blood tests listed for Millie to facilitate UCSF
041040 -            considering Millie's next treatment. ref SDS 42 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 42 216F
041047 -             ..
041048 -        c.  Treatment history listed for Glenna to discuss with Doctor
041049 -            Rugo discussing Millie's next treatment. ref SDS 42 H16M
041051 -             ..
041052 -        d.  Strategy considerations for selecting Millie's next
041053 -            treatment. ref SDS 42 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 46
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 35 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 51 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 20
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 47
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 48 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 46 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 48 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 51 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 53 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 53 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 53
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 55 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 62
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 62 AY9Q
041130 -         ..
041131 -   31.  On 090130 Millie letter to primary care physician, ref SDS 62
041132 -        GV4M, reports examination at UCSF on 090129 found rising vitals
041133 -        signal Millie suffering rising pain, ref SDS 62 AY7T, because
041134 -        IBC progressing rapidly, ref SDS 62 4S8O, as Doctor Johnson
041135 -        noted earlier on 090123, ref SDS 51 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 62 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 62 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 60 NM5H
041154 -         ..
041155 -   35.  On 090130 called Arlette, ref SDS 61 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 61 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 63 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 62 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 64 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 64 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 64
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 64 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 65 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 66
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 66 5R4S, to use by Doctor Hsu,
041210 -        requested by Krshna in a call the day before on 090130.
041211 -        ref SDS 60 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 66 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 68 9Y5I  Michelle asked the patient to
041222 -        coordinate with the primary care physician at Kaiser to file
041223 -        Authorization, ref SDS 68 9Y6Y, reported in Millie's letter to
041224 -        the medical team. ref SDS 70 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 63 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 67 Y35M, to
041233 -        file duplicate authorization, reported in Millie's letter to
041234 -        the medical team on 090202 1028. ref SDS 70 FR6P
041236 -         ..
041237 -   47.  On 090202 0940 numerous calls were made to coordinate.
041238 -        ref SDS 69 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 69 1A5J, reported in
041244 -        Millie's letter to the medical team. ref SDS 70 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 69
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 69 254F, reported in
041254 -        Millie's letter to the medical team. ref SDS 70 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 71 QQ7N, and
041264 -        reported in Millie's letter to the medical team on 090202 1139.
041265 -        ref SDS 73 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 71 0256, and reported in Millie's
041274 -        letter to the medical team on 090202 1139. ref SDS 73 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 72 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 72 V47L   Krshna
041285 -        proposes scheduling the work on 090219, ref SDS 74 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 74 SP8I, reported in Millie's letter to the medical
041289 -        team on 090202 1437. ref SDS 75 R23P
041291 -         ..
041292 -   53.  On 090202 1353 Krshna offers UCSF Radiation Oncology schedule
041293 -        hyperthermia treatment 3 weeks delay to 090219. ref SDS 74 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 75 JR4J, reported on 090202 1353. ref SDS 74 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 62 TZ6H, Doctor
041302 -        Rugo's letter to medical team on 090202 1118, indicating Doctor
041303 -        Hsu is aware of Millie's situation. ref SDS 72 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 75 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 74 F65G, cited in Millie's letter
041317 -        to medical team on 090202 1437, ref SDS 75 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 35 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 75 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 76 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 77 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 78 9Y5I
041346 -         ..
041347 -   61.  On 090203 1009 letter to VCI submits patient history for review
041348 -        to support telephone conference, ref SDS 78 IN94, on arranging
041349 -        for VCI to provide hyperthermia treatment in time for Millie to
041350 -        recover from 6th relapse of IBC. ref SDS 78 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 79 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 80 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 80 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 81 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 81
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 81 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 81 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 82 XX5I,
041396 -        rather than risk waiting until 090219, as proposed yesterday on
041397 -        090202 1357. ref SDS 74 XO7G
041399 -         ..
041400 -   69.  On 090203 1444 Millie's letter notified medical team,
041401 -        ref SDS 83 6Q3J, that Jennette in Doctor Hsu's office at UCSF
041402 -        called on 090203 1438, ref SDS 82 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 81 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 82 XX5I, shown
041410 -        in Millie's letter. ref SDS 83 YQ5W
041412 -         ..
041413 -   70.  On 090203 1444 Millie sent copy of letter for the medical team
041414 -        to VCI, ref SDS 83 YQ6P, thanking Nash and Doctor Al-Bussam for
041415 -        timely, professional support investigating my case, ref SDS 80
041416 -        JZ4F, and offering a backup solution [reported in record on
041417 -        090203 1206. ref SDS 80 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 83 YQ6S, previously
041423 -        noted in Millie's letter to the medical team on 090202,
041424 -        ref SDS 73 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 83 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 83 YQ6V  Noting this might not work; citing research
041437 -        [on 090129] indicates there is a good chance. ref SDS 59 OI6N
041438 -        and ref SDS 59 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 84 3X6H, responding to Millie's letter to the medical
041446 -        team on 090203 1444 asking about labs. ref SDS 83 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 86 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 77 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 86 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 83 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 86 L36S
041475 -         ..
041476 -   77.  On 090203 2247 Doctor Rugo letter to Millie advises against
041477 -        getting hyperthermia treatment at VCI, ref SDS 87 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 81 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 88 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 77 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 62 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 76 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 88 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 46 J47F, and on
041502 -        090129 UCSF advised there was a communication mixup that
041503 -        prevented getting treatment, reported on 090130, ref SDS 62
041504 -        AY8Q, and then writes a letter on 090202 saying Millie needs
041505 -        urgent treatment quickly in time to be effective, ref SDS 77
041506 -        Y15J, and UCSF schedules the work 3 weeks later on 090219.
041507 -        ref SDS 74 XO7G
041509 -         ..
041510 -   80.  On 090204 0219 Millie thanks Doctor Rugo for guidance on case
041511 -        management, ref SDS 89 135F, and notes innovation will be
041512 -        needed for continuing care after hyperthermia treatment at
041513 -        UCSF. ref SDS 89 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 89 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 89 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 93 MN5I
041529 -         ..
041530 -   82.  On 090204 1528 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 91
041533 -        135F, and responding to Millie's letter reporting rising pain
041534 -        on 090203 1417, ref SDS 81 IS6U; following up request the
041535 -        before for pain relief, on 090202 1437. ref SDS 75 R23S, and
041536 -        further cited 2 days ago on 090201 1852, ref SDS 64 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 85 KE5I
041541 -         ..
041542 -   83.  On 090204 1528 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 85 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 62 AY7T], but with everything going on
041548 -        lately, 53 case management tasks since 090129, per above,
041549 -        ref SDS 94 LQ3O, the patient got mixed up and forgot.
041550 -        ref SDS 91 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 91 D64T
041557 -         ..
041558 -   85.  On 090204 1914 Doctor Rugo advised that UCSF has to wait for
041559 -        results of hyperthermia to arrange for comprehensive cancer
041560 -        care from teamwork practice synergy collaborating with Doctor
041561 -        Hsu applying Doctor Rugo's experience treating Millie weekly
041562 -        for 2 years, as requested in Millie's letter to UCSF on 090204
041563 -        0219, ref SDS 89 278Q, and further Millie's request for Doctor
041564 -        Rugo to plan strategy for treatment after hyperthermia, also in
041565 -        Millie's letter to UCSF on 090204 0217, ref SDS 89 278Q.  Since
041566 -        Millie's case is very complex, proactive planning to be
041567 -        prepared for alternate scenarios, which was successful applying
041568 -        2nd opinions from Doctor Benz in 2005 and 2007, won't work in
041569 -        2009, because UCSF proposes scheduling is not a simple
041570 -        prescription like when you first saw Doctor a consultation
041571 -        after hyperthermia to talk about the options. ref SDS 93 278T
041573 -         ..
041574 -   86.  On 090204 1914 the cost to collaborate with Doctor Hsu for
041575 -        practice synergy and proactive planning for treating cancer as
041576 -        a chronic disease requires talking with the clinic manager or
041577 -        patient services to determine the scope of services covered by
041578 -        the Kaiser referral for hyperthermia treatment. ref SDS 93 T43Y
041580 -         ..
041581 -   87.  On 090204 1930 Millie thanks the medical team for explaining
041582 -        strategy to defer planning treatment of cancer as a chronic
041583 -        disease for Millie's 7th relapse in 8 years, until after
041584 -        results of hyperthermia, because Millie's case is too complex
041585 -        for proactive management to plan for alternate scenarios.
041586 -        ref SDS 94 278T
041588 -         ..
041589 -   88.  On 090204 1930 Millie notifies medical team of risks failing to
041590 -        apply collaboration synergy of a winning team demonstrated over
041591 -        the past 26 months. ref SDS 94 W84Q  Continuity of care from
041592 -        doctors experienced with the case provides the best security
041593 -        for effectiveness, as requested in Millie's letter to UCSF and
041594 -        Kaiser on 090204 0219 for Doctor Rugo to collaborate on
041595 -        continuing care based on 2 years of weekly treatments.
041596 -        ref SDS 89 278Q
041598 -         ..
041599 -   89.  On 090204 1930 Millie's letter to medical team asks if Doxil
041600 -        will be given in the Infusion Clinic, since this is a
041601 -        chemotherapy drip treatment, ref SDS 94 W84T, which Doctor Rugo
041602 -        prescribed in the recommendation for Millie's treatment
041603 -        submitted to Kaiser on 090129, reported on 090130, ref SDS 62
041604 -        HK3V, and UCSF stated in a letter on 090203 2257 that Millie
041605 -        would no longer be treated in the Infusion Clinic. ref SDS 86
041606 -        L35Q and ref SDS 86 L35Y
041608 -         ..
041609 -   90.  On 090204 1930 Millie reports side effects of sunitinib and
041610 -        cyclophosphamide seem mostly gone.  Still have pain from IBC
041611 -        and mostly my shoulder (actually the arm). ref SDS 94 W84W
041612 -        Doctor Johnson has prescribed treatment that is working tody,
041613 -        reported in the record earlier on 090204 1528. ref SDS 91 D64T
041615 -         ..
041616 -   91.  On 090205 1318 primary care physician at Kaiser, Doctor
041617 -        Johnson, asks Millie to start using Kaiser's "closed" email
041618 -        system that is part of Kaiser's "Health[Connect" Knowledge
041619 -        Management system rather than public domain email, because
041620 -        checking multiple email systems complicates and so delays
041621 -        communication.  Since the doctor checks Health Connect
041622 -        regularly, correspondence sent through public domain email
041623 -        increases risks that Millie will "fall through the cracks," at
041624 -        a time when Millie is reporting rising symptoms of pain.
041625 -        ref SDS 96 278T
041627 -         ..
041628 -   92.  On 090205 1318 review shows most of Millie's care is now
041629 -        performed at UCSF which requires coordination with Kaiser.
041630 -        Since Kaiser's Health Connect system has limitations that
041631 -        prevent communication with UCSF, using the public domain email
041632 -        for efficient, uniform distribution of correspondence among
041633 -        Millie's large medical team increases chances to prevent urgent
041634 -        care from falling through the cracks. ref SDS 96 YU4L
041635 -
041636 -
041637 -
0417 -

SUBJECTS
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0503 -
0504 - Progress
050501 -  ..
050502 - Feedback Meeting UCSF 090205 Assess Hyperthermia Treatment for IBC
050503 -
050504 - Follow up ref SDS 96 278T, ref SDS 94 278T.
050505 -
050506 - Millie's letter submits the record meeting at UCSF on 090205,
050507 - ref SDS 95 O47G, to start planning for hyperthermia treatment...
050508 -
050509 -    1.  Subject: Meeting UCSF Feb 5th Work Plan Hyperthermia Lower Dose Radiation
050510 -        Date: Mon, 09 Feb 2009 00:27:49 -0800
050522 -         ..
050523 -    2.  Thanks very much for seeing me on short notice last week on
050524 -        090205. ref SDS 95 0001  I enjoyed working with your colleague
050525 -        Doctor Linda Chang, who facilitated a productive meeting.
050526 -        ref SDS 95 O47G
050527 -
050528 -
050529 -
0506 -

SUBJECTS
Default Null Subject Account for Blank Record

0603 -
060401 -  ..
060402 - INR 2.5 Notified Kaiser Coagulation Control Clinic PE Coumadin
060403 -
060404 -
060405 -    3.  During the meeting you asked about my PE. ref SDS 95 P33M
060406 -        Gloria Closson at Kaiser has done excellent work managing
060407 -        Coumadin treatments for 5 years.  By copy to Gloria, confirming
060408 -        understandings in the letter to the medical team on 090130,
060409 -        ref SDS 62 AY6R [and answering Gloria's letter on 090207 asking
060410 -        about blood tests, ref SDS 98 7C5L] advising that INR 2.5 was
060411 -        reported in the lab at UCSF on 090129, showing counts have
060412 -        normalized, ref SDS 57 K66J, since ending treatment on
060413 -        sunitinib study, ordered by Doctor Rugo on 090122. ref SDS 46
060414 -        AT6N
060416 -         ..
060417 -    4.  On 090203 Doctor Johnson, primary care physician at Kaiser,
060418 -        advised that I do not need blood draws to support your work.
060419 -        ref SDS 84 3X6H  As well, Doctor Rugo notified that I am off
060420 -        study, ref SDS 86 L35Q, so the UCSF team in the Infusion
060421 -        Clinic, who has been drawing blood every week for 2 years,
060422 -        cannot flush the Power Port, which is required every 4 - 6
060423 -        weeks, when not being used regularly.  Florida called last
060424 -        Friday on 090130, and canceled pending Neupogen treatments in
060425 -        the Infusion Clinic at Kaiser, since blood counts have
060426 -        recovered after ending the sunitinib study on 090122.
060427 -        ref SDS 46 AT6N  Gloria will likely want a blood draw for INR
060428 -        case management within a few weeks.
060429 -
060430 -
0605 -

SUBJECTS
Default Null Subject Account for Blank Record

0703 -
070401 -  ..
070402 - Schedule INR Blood Test for Coumadin Manage PE and Flush Power Port
070403 - Pulmonary Embolism INR Blood Test at Kaiser for Coumadin Treatment
070404 - Power Port Flush with Blood Draw in Kaiser Infusion Clinic Test INR
070405 -
070406 -
070407 -    5.  If a blood draw for PE case management can be scheduled for the
070408 -        Chemo Infusion Clinic at Kaiser to use the Power Port, then it
070409 -        will accomplish port flush requirements.  Possibly, Arlette can
070410 -        make needed arrangements at Kaiser.
070411 -
070412 -
070413 -
0705 -

SUBJECTS
Default Null Subject Account for Blank Record

0803 -
080401 -  ..
080402 - Meeting 090205 Submit Record Confirm Understandings Hyperthermia Plan
080403 -
080404 -
080405 -    6.  There is a "summary" of understandings from meeting with you
080406 -        last Thursday, which takes about 30 seconds to read through for
080407 -        feedback on accuracy. ref SDS 95 0001
080409 -         ..
080410 -    7.  The summary is supported by details, which can [be] reviewed as
080411 -        needed.
080413 -         ..
080414 -    8.  Please let me know if anything jumps out that should be
080415 -        corrected.  I know things were hurried, so its easy for me to
080416 -        get confused.
080417 -
080418 -
0805 -

SUBJECTS
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0903 -
090401 -  ..
090402 - Lymphedempa Left Arm At Risk Because Right Arm Injured 090122
090403 -
090404 -
090405 -    9.  Lymphedema, which flared up during the meeting with you on
090406 -        Thursday, subsided after I got home and put the sleeve on.  I
090407 -        didn't wear it to the meeting, because it is hard to take on
090408 -        and off, and everyone was in a hurry that day.  Yesterday,
090409 -        there was another flare up, when I overexerted the left arm
090410 -        because I cannot use the right arm.  That too has subsided.
090411 -
090412 -
090413 -
0905 -

SUBJECTS
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1003 -
100401 -  ..
100402 - Trental Pentoxifyline and Vitamin E for Side Effects Radiation
100403 - Vitamin E Pentoxifyline Treat Side Effects Hyperthermia Radiation
100404 - Radiation Hyperthermia Side Effects Managed Vitamin E Pentoxifyline
100405 -
100406 -
100407 -   10.  Research [received on 090206, ref SDS 97 SJ6R] found that side
100408 -        effects of radiation are sometimes treated with Vitamin E plus
100409 -        pentoxifylline (Trental).  Will this or something else help
100410 -        moderate side effects you described [during the meeting on
100411 -        090205, ref SDS 95 GM4N]?
100412 -
100413 -            [On 090218 1205 Millie asks medical team for feedback on
100414 -            treatment for side effects, and whether Vitamin E plus
100415 -            pentoxifylline is a solution, since this will require
100416 -            coordination with Gloria to adjust Coumadin treatments for
100417 -            Millie's pulmonary embolism. ref SDS A0 TH7V
100419 -             ..
100420 -            [On 090312 0800 Doctor Hsu discloses that severe side
100421 -            effects from radiation and hyperthermia, which were
100422 -            reported on 090310 to look worse than IBC, ref SDS A1 O56X,
100423 -            will be treated beginning on 090317 after ending treatment
100424 -            with cream, ref SDS A2 F860; the doctor did not discuss
100425 -            Vitamin E plus pentoxifylline (Trental), ref SDS A2 6P8K,
100426 -            but proposed providing "cream" to treat radiation side
100427 -            effects. ref SDS A2 F852
100429 -             ..
100430 -            [On 090317 Millie receives Silvadene Cream 1% from Doctor
100431 -            Hsu, ref SDS A3 M442, and also received instructions from
100432 -            Miranda for application, including an orientation for
100433 -            bandaging to recover from expanding sores caused by
100434 -            radiation and hyperthermia treatments. ref SDS A3 ET46
100435 -
100436 -
100437 -
100438 -
1005 -

SUBJECTS
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1103 -
110401 -  ..
110402 - Energy Recovers After Sunitinib Hiking Lafayette Reservoir
110403 - Sunitinib Side Effects Energy Recovering Hiking Lafayette Reservoir
110404 - Hiking Lafayette Reservoir Energy Recovering After Ending Sunitinib
110405 -
110406 -
110407 -   11.  Went hiking on Saturday; did the usual 3 miles at Lafayette
110408 -        reservoir for the first time in a month or so.  My legs felt
110409 -        strong, and there was no pain my feet, reflecting ending
110410 -        treatment with sunitinib on 090122.  Tried again today, but had
110411 -        to turn back, mostly due to emotional trauma of recent days.
110412 -
110413 -
1105 -

SUBJECTS
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1203 -
120401 -  ..
120402 - Hyperthermia Treatment Needed Tomorrow 4 Times Per Week for 4 Weeks
120403 -
120404 -
120405 -   12.  Thanks again for very thorough examination last Thursday.
120406 -        Hoping we can get started with treatment tomorrow or Wednesday.
120407 -        IBC seems to be accelerating, reflecting your treatment plan
120408 -        for 4 - 5 treatments per week for 4 - 6 weeks, and changing
120409 -        from Doxil to low dose radiation, assuming I have that correct.
120410 -
120416 -
120417 -
120418 -
120419 -
120420 -
120421 -
120422 -
120423 -
120424 -
120425 -
120426 -
120427 -
120428 -
120429 -
1205 -