CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 8 0000. ref SDS 7 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Met Missy at the front desk of the Radiation Oncology Department in
040902 - the basement at UCSF on Divisadero Street in San Francisco.
040904 -  ..
040905 - Missy said everything is ready for Millie's meeting.  She took Millie
040906 - to dress for treatment at 1415, implementing Doctor Hsu's work plan
040907 - presented in the meeting on 090205 0830. ref SDS 7 LT6K
040908 -
040910 -  ..
0410 -
0411 -
0412 - 1403
0413 -
041301 - Rannier, the technologist, came into the lobby, and said they are
041302 - ready for Millie, reflecting Millie's letter to Doctor Hsu advising
041303 - plans to arrive early this afternoon in order to expedite the work.
041305 -  ..
041306 - Millie went to dress for the CT test.  Rannier will come back to the
041307 - lobby for patient assistance support prior to starting the work.
041308 -
041309 -
041311 -  ..
0414 -
0415 -
0416 - 1420
0417 -
041701 - Rannier comes into the waiting room lobby, and says that he and
041702 - Doctor Hsu are still configuring the CT test equipment to begin
041703 - laying out the treatment plan for Millie to get lower dose radiation,
041704 - and hyperthermia.
041705 -
041706 -            [On 090220 reviewed UCSF notes for Radiation Oncology
041707 -            department planning Millie's hyperthermia treatments to
041708 -            recover from 6th relapse of IBC, ref SDS 14 PR4Y; describes
041709 -            Millie meeting on 090209 with Doctor Hsu, Chris and Abby,
041710 -            and that this team explained the plan for radiation and
041711 -            hyperthermia treatments. ref SDS 14 VU54  Millie met with
041712 -            the team on 090209 and there is no record of submitting the
041713 -            treatment plan. ref SDS 9 PP8R
041714 -
041715 -
041717 -  ..
0418 -
0419 -
0420 - 1445
0421 -
042101 - Rainer Ilejay was still working with Doctor Hsu.
042102 -
042103 - Left the lobby to get an overcoat from the car, because the computer
042104 - was getting too hot for work on knees.
042105 -
042107 -  ..
0422 -
0423 -
0424 - 1513
0425 -
042501 - Returned to waiting room lobby for Radiation Oncology.
042502 -
042503 - Rainer had come and gone.
042505 -  ..
042506 - Missy called the office.  Rainer came to the lobby and provided
042507 - escort to the CT test room.
042509 -  ..
042510 - He explained the layout was already completed, and the next step is a
042511 - CT test.
042513 -  ..
042514 - Rainer explained that layout was done by marking areas of IBC for
042515 - treatment.
042517 -  ..
042518 - We went into the CT test room.  Millie was laying on the table.  There
042519 - was a standard hospital gown drapped around the shoulders.  Markings
042520 - were visible running from the chest to the neck.
042522 -  ..
042523 - Millie was in very good spirits.  She said treatment will start on
042524 - Thursday on 090212.  This allows time for the medical team to "plan"
042525 - the direction of treatment using computers to align radiation and
042526 - hyperthermia.
042528 -  ..
042529 - Doctor Hsu was supported by 3 - 5 doctors and staff.
042531 -  ..
042532 - The doctor marked IBC sites on Millie's chest and abdomen for
042533 - treatment to recover from IBC.
042534 -
042535 -            [On 090220 1548 received UCSF memo from Chris dated 090209
042536 -            that describes scope of work, some treatment planning, and
042537 -            references discussions with Millie. ref SDS 14 DH3H
042539 -             ..
042540 -            [On 090220 reviewed UCSF notes for Radiation Oncology
042541 -            department planning Millie's hyperthermia treatments to
042542 -            recover from 6th relapse of IBC, ref SDS 14 PR4Y; describes
042543 -            Millie meeting on 090209 with Doctor Hsu, Chris and Abby,
042544 -            and that this team explained the plan for radiation and
042545 -            hyperthermia treatments. ref SDS 14 VU54  Millie met with
042546 -            the team on 090209 and there is no record of submitting the
042547 -            treatment plan. ref SDS 9 PP8R
042549 -  ..
042550 - Pictures were taken to preserve the layout for hyperthermia.
042552 -  ..
042553 - Millie was asked to preserve the layout by not allowing water to run
042554 - on her chest during showering until the day of treatment.
042556 -  ..
042557 - Xrays were taken.
042559 -  ..
042560 - Doctor Hsu needed to lift Millie's right arm to xray under the arm and
042561 - the right side of the right breast to layout radiation treatment for
042562 - IBC.
042564 -  ..
042565 - Millie reminded the team that the right shoulder was dislocated on
042566 - 090122.  During the meeting at Kaiser on 090129, the Orthopedic
042567 - Physician's Assistant advised Millie not to move her right shoulder
042568 - until the examination this week on 090212.  Kaiser provided an
042569 - immobilizer to prevent moving the right arm 24-7, including during
042570 - sleep. ref SDS 1 YU8W  Millie had to remove the immobilizer, because
042571 - pressure around the waist caused lymphedema on 090201. ref SDS 3 KN4S
042572 - She continued not moving the right arm, called out by Kaiser, as
042573 - essential for recovery from the shoulder injury.
042574 -
042575 -        [On 090212 0017 Millie's letter to medical team notifies Doctor
042576 -        Boulris that on 090209 UCSF carefully manipulated Millie's
042577 -        right arm that was injured in a fall and treated at Kaiser for
042578 -        separated shoulder on 090122; Kaiser's prescription for
042579 -        immobolizing the right arm was ignored on 090209 for the
042580 -        purpose of designing Millie's next cancer treatment.
042581 -        ref SDS 10 0W6Y
042583 -  ..
042584 - Doctor Hsu said he had forgotten the right shoulder is healing from a
042585 - dislocation injury on 090122, reported during the meeting at UCSF on
042586 - 090205. ref SDS 7 V65O  As a result, he did not include orthopedic
042587 - expertise for the meeting today to position Millie's arm.  Doctor Hsu
042588 - requested deference to physician discretion for medical necessity
042589 - carefully moving Millie's arm in order to treat her bigger problem in
042590 - time to be effective surviving a 6th relapse of cancer.  Last week on
042591 - 090203 Doctor Rugo notified the medical team that Millie needs urgent
042592 - treatment quickly. ref SDS 5 Y15J
042594 -  ..
042595 - Millie agreed to expedite the doctor's work today by allowing the
042596 - doctor to lift the arm vertically above her head to a point where pain
042597 - was severe.  Doctor Hsue indicated this was sufficient for the team to
042598 - generate enough data to plan Millie's treatment.
042599 -
042600 -        [On 090212 1420 Millie meeting with Kaiser Orthopedics
042601 -        Department advised that manipulating righ shoulder so soon
042602 -        after suffering severe dislocation could cause recurrence of
042603 -        the same injury. ref SDS 11 6X9H
042605 -  ..
042606 - After the team did the layout and took xrays, another technician
042607 - performed a CT test.
042608 -
042609 -        [On 090223 0237 Millie's letter to medical team requests copy
042610 -        of report on CT test performed today. ref SDS 15 T48X
042612 -  ..
042613 - The technician clarified that treatment will not start this Thursday
042614 - on 090212, as Millie seemed to say initially, ref SDS 0 E634, but
042615 - rather treatment is delayed another 10 days until...
042616 -
042617 -                           090219 1315
042619 -  ..
042620 - This seems devestating, increasing risk of losing local control, and
042621 - conflicting with Doctor Rugo's diagnosis that Millie needs urgent
042622 - treatment that must be performed quickly, reported on 090202,
042623 - ref SDS 5 Y15J, because she had not been treated since 090122, and at
042624 - that time her condition was rapidly worsening, also noted in Doctor
042625 - Rugo's letter to Kaiser on 090129, reported in the record for 090130
042626 - 1722. ref SDS 2 TZ6H
042627 -
042628 -        [On 090212 0017 Millie's letter to the medical team reports IBC
042629 -        is getting worse "waiting for the water to boil" while UCSF
042630 -        makes radiation molds; asks about expediting treatment to
042631 -        prevent cancer from spiraling out of control. ref SDS 10 1N3X
042633 -         ..
042634 -        [On 090218 1205 Millie's letter to medical team requests
042635 -        confirmation of date and time starting hyperthermia treatment
042636 -        at UCSF. ref SDS 13 TH5P
042638 -  ..
042639 - Doctor Hsu explained that the team has to wait to perform treatment
042640 - until molds are manufactured to accurately guide radiation.  He and
042641 - Chris, the physicist technician, will layout treatment zones on the
042642 - computer from xrays, CT scans, and pictures taken today.  He indicated
042643 - delay starting treatment has caused Millie's cancer to spread.  This
042644 - presents a very complex problem defining treatment zones, reported
042645 - previously by Doctor Hsu on 090205, ref SDS 7 R29M  Planning and
042646 - layout therefore take longer to perform, and manufacturing molds also
042647 - takes more time.  Doctor Hsu feels that extra time for planning,
042648 - layout, and building the molds correctly is needed to avoid mistakes,
042649 - so that treatment is effective.
042651 -         ..
042652 -        [On 090212 0017 Millie's letter to the medical team reports IBC
042653 -        is getting more severe, ref SDS 10 1N3X, asks for advice on
042654 -        home care patient can initiate to slow progression of disease,
042655 -        and requests starting treatment with hyperthermia in a few days
042656 -        rather than wait until molds are designed and built for
042657 -        radiation. ref SDS 10 1N4Q
042659 -         ..
042660 -        [On 090213 1140 Doctor Johnson at Kaiser concurs that even
042661 -        though Millie's cancer is getting worse, the best strategy is
042662 -        to take enough time for doing radiation and hyperthermia
042663 -        correctly in order for Millie to recover from the 7th relapse
042664 -        of cancer. ref SDS 12 GW6H
042666 -         ..
042667 -        [On 090312 0800 Millie got more radiation to recover from
042668 -        severe cancer that progressed during delay starting treatment;
042669 -        theraputic effects of radiation and hyperthermia will last for
042670 -        monhs after ending treatment, and recovery from radiation
042671 -        blisters may take longer because more radiation was needed.
042672 -        ref SDS 16 F860
042674 -  ..
042675 - The record today indicates that if UCSF had not expedited Millie's
042676 - care respoinding to Doctor Rugo's letter on 090202 ordering urgent
042677 - treatment quickly, then Millie may not have started treatment until
042678 - mid-March or even April, according to the initial schedule proposed by
042679 - Krshna on 090202 1353. ref SDS 4 XO7G
042680 -
042681 -
042682 -
042683 -
042684 -
042685 -
042686 -
042687 -
042688 -
042689 -
042690 -
0427 -