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 20, 2009 01:57 AM Friday;
Rod Welch
Millie requests treatment plan and explanation hyperthermia with
radiation treatment at UCSF to recover from 6th relapse IBC.
1...Summary/Objective
2...Treatment Delay Risks Losing Opportunity for Effective Care
3...Emotional Trauma Delayed Treatment Relieved UCSF Excellent Care
4...Anxiety Fears Treatment Delays Relieved Starting Treatment IBC
5...Radiation Hyperthermia Start Treatment Relieves Anxiety Fears
6...Schedule Treatments Start 0800 - 0900 Optimize Work Time
7...Treatment Plan Scope Prescribed Doxil Now Using Lower Dose Radiation
8...Emotional Trauma Delaying Treatment Required Urgently Recover IBC
9...Hope Hyperthermia Treatment Starting in Time to be Effective
10...Commend Doctor Hsu and Doctor Rugo Expediting Treatment 6th Relapse IBC
..............
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CONTACTS
020204 -
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS A4 0000. ref SDS A0 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
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 30 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 32 UC4H Millie reported severe
040910 - side effects shown by wide range of blood counts falling.
040911 - ref SDS 32 UF3Q Medical team prescribed another cycle
040912 - sunitinib treatment, with cyclophosphamide paused until blood
040913 - counts increase to a safe level. ref SDS 32 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 25 XX4P; there was rise of IBC and
040919 - then substantial recovery reported again on 081217, ref SDS 26
040920 - YJ4V; on 081230 Millie's letter reported on 081224 and 081225
040921 - rise of IBC, and then improvement on 081226, ref SDS 30 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 31 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 35 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 34
040932 - KL4J Have been spending more time in the gym doing aerobics,
040933 - which is a little more tolerable. ref SDS 34 3E4K
040935 - ..
040936 - 5. On 090116 Glenna called to ask about response to treatment and
040937 - side effects, ref SDS 36 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 34 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 36 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 38 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 38 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 38 HV3M
040959 - ..
040960 - 8. On 090116 Glenna's letter to the doctor asked about changing to
040961 - another treatment. ref SDS 38 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 38 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 39 IS6G, relative to findings on 081218, ref SDS 27
040974 - VD4F, confirmed in Millie's letter later that day reporting
040975 - significant recovery. ref SDS 28 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 40 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 43 F23Y
040992 - ..
040993 - 13. On 090121 Glenna calls and asks again about Millie's response
040994 - to treatment, ref SDS 44 AJ3J, following up her call on 090116,
040995 - ref SDS 36 JY6L, and per background above. ref SDS 44 JY5I
040997 - ..
040998 - 14. On 090121 during call from Glenna reported patient history,
040999 - ref SDS 44 ZO4F, on 090120 shows IBC rash looks improved to
041000 - stable, and nodules in the breastbone area seem worse,
041001 - ref SDS 42 124N, relative to detailed review on 090110,
041002 - ref SDS 33 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 41 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 44 N95K, Labs at Kaiser on 090116
041011 - report CA 15-3 303. ref SDS 37 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 44 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 44 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 55 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 44 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 44 NU5H
041038 - ..
041039 - a. Laboratory blood tests listed for Millie to facilitate UCSF
041040 - considering Millie's next treatment. ref SDS 44 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 44 216F
041047 - ..
041048 - c. Treatment history listed for Glenna to discuss with Doctor
041049 - Rugo discussing Millie's next treatment. ref SDS 44 H16M
041051 - ..
041052 - d. Strategy considerations for selecting Millie's next
041053 - treatment. ref SDS 44 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 48
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 37 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 53 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 22
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 49
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 50 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 48 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 50 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 53 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 55 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 55 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 55
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 57 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 64
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 64 AY9Q
041130 - ..
041131 - 31. On 090130 Millie letter to primary care physician, ref SDS 64
041132 - GV4M, reports examination at UCSF on 090129 found rising vitals
041133 - signal Millie suffering rising pain, ref SDS 64 AY7T, because
041134 - IBC progressing rapidly, ref SDS 64 4S8O, as Doctor Johnson
041135 - noted earlier on 090123, ref SDS 53 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 64 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 64 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 62 NM5H
041154 - ..
041155 - 35. On 090130 called Arlette, ref SDS 63 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 63 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 65 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 64 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 66 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 66 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 66
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 66 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 67 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 68
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 68 5R4S, to use by Doctor Hsu,
041210 - requested by Krshna in a call the day before on 090130.
041211 - ref SDS 62 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 68 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 70 9Y5I Michelle asked the patient to
041222 - coordinate with the primary care physician at Kaiser to file
041223 - Authorization, ref SDS 70 9Y6Y, reported in Millie's letter to
041224 - the medical team. ref SDS 72 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 65 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 69 Y35M, to
041233 - file duplicate authorization, reported in Millie's letter to
041234 - the medical team on 090202 1028. ref SDS 72 FR6P
041236 - ..
041237 - 47. On 090202 0940 numerous calls were made to coordinate.
041238 - ref SDS 71 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 71 1A5J, reported in
041244 - Millie's letter to the medical team. ref SDS 72 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 71
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 71 254F, reported in
041254 - Millie's letter to the medical team. ref SDS 72 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 73 QQ7N, and
041264 - reported in Millie's letter to the medical team on 090202 1139.
041265 - ref SDS 75 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 73 0256, and reported in Millie's
041274 - letter to the medical team on 090202 1139. ref SDS 75 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 74 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 74 V47L Krshna
041285 - proposes scheduling the work on 090219, ref SDS 76 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 76 SP8I, reported in Millie's letter to the medical
041289 - team on 090202 1437. ref SDS 77 R23P
041291 - ..
041292 - 53. On 090202 1353 Krshna offers UCSF Radiation Oncology schedule
041293 - hyperthermia treatment 3 weeks delay to 090219. ref SDS 76 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 77 JR4J, reported on 090202 1353. ref SDS 76 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 64 TZ6H, Doctor
041302 - Rugo's letter to medical team on 090202 1118, indicating Doctor
041303 - Hsu is aware of Millie's situation. ref SDS 74 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 77 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 76 F65G, cited in Millie's letter
041317 - to medical team on 090202 1437, ref SDS 77 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 37 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 77 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 78 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 79 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 80 9Y5I
041346 - ..
041347 - 61. On 090203 1009 letter to VCI submits patient history for review
041348 - to support telephone conference, ref SDS 80 IN94, on arranging
041349 - for VCI to provide hyperthermia treatment in time for Millie to
041350 - recover from 6th relapse of IBC. ref SDS 80 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 81 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 82 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 82 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 83 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 83
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 83 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 83 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 84 XX5I,
041396 - rather than risk waiting until 090219, as proposed yesterday on
041397 - 090202 1357. ref SDS 76 XO7G
041399 - ..
041400 - 69. On 090203 1444 Millie's letter notified medical team,
041401 - ref SDS 85 6Q3J, that Jennette in Doctor Hsu's office at UCSF
041402 - called on 090203 1438, ref SDS 84 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 83 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 84 XX5I, shown
041410 - in Millie's letter. ref SDS 85 YQ5W
041412 - ..
041413 - 70. On 090203 1444 Millie sent copy of letter for the medical team
041414 - to VCI, ref SDS 85 YQ6P, thanking Nash and Doctor Al-Bussam for
041415 - timely, professional support investigating my case, ref SDS 82
041416 - JZ4F, and offering a backup solution [reported in record on
041417 - 090203 1206. ref SDS 82 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 85 YQ6S, previously
041423 - noted in Millie's letter to the medical team on 090202,
041424 - ref SDS 75 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 85 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 85 YQ6V Noting this might not work; citing research
041437 - [on 090129] indicates there is a good chance. ref SDS 61 OI6N
041438 - and ref SDS 61 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 86 3X6H, responding to Millie's letter to the medical
041446 - team on 090203 1444 asking about labs. ref SDS 85 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 88 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 79 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 88 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 85 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 88 L36S
041475 - ..
041476 - 77. On 090203 2247 Doctor Rugo letter to Millie advises against
041477 - getting hyperthermia treatment at VCI, ref SDS 89 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 83 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 90 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 79 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 64 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 78 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 90 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 48 J47F, and on
041502 - 090129 UCSF advised there was a communication mixup that
041503 - prevented getting treatment, reported on 090130, ref SDS 64
041504 - AY8Q, and then writes a letter on 090202 saying Millie needs
041505 - urgent treatment quickly in time to be effective, ref SDS 79
041506 - Y15J, and UCSF schedules the work 3 weeks later on 090219.
041507 - ref SDS 76 XO7G
041509 - ..
041510 - 80. On 090204 0219 Millie thanks Doctor Rugo for guidance on case
041511 - management, ref SDS 91 135F, and notes innovation will be
041512 - needed for continuing care after hyperthermia treatment at
041513 - UCSF. ref SDS 91 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 91 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 91 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 95 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 93
041533 - 135F, and responding to Millie's letter reporting rising pain
041534 - on 090203 1417, ref SDS 83 IS6U; following up request the
041535 - before for pain relief, on 090202 1437. ref SDS 77 R23S, and
041536 - further cited 2 days ago on 090201 1852, ref SDS 66 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 87 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 87 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 64 AY7T], but with everything going on
041548 - lately, 53 case management tasks since 090129, per above,
041549 - ref SDS 96 LQ3O, the patient got mixed up and forgot.
041550 - ref SDS 93 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 93 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 91 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 91 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 Benz, and so UCSF
041571 - now proposes getting a scan to support consultation after
041572 - hyperthermia to talk about the options. ref SDS 95 278T
041574 - ..
041575 - 86. On 090204 1914 the cost to collaborate with Doctor Hsu for
041576 - practice synergy and proactive planning for treating cancer as
041577 - a chronic disease requires talking with the clinic manager or
041578 - patient services to determine the scope of services covered by
041579 - the Kaiser referral for hyperthermia treatment. ref SDS 95 T43Y
041581 - ..
041582 - 87. On 090204 1930 Millie thanks the medical team for explaining
041583 - strategy to defer planning treatment of cancer as a chronic
041584 - disease for Millie's 7th relapse in 8 years, until after
041585 - results of hyperthermia, because Millie's case is too complex
041586 - for proactive management to plan for alternate scenarios.
041587 - ref SDS 96 278T
041589 - ..
041590 - 88. On 090204 1930 Millie notifies medical team of risks failing to
041591 - apply collaboration synergy of a winning team demonstrated over
041592 - the past 26 months. ref SDS 96 W84Q Continuity of care from
041593 - doctors experienced with the case provides the best security
041594 - for effectiveness, as requested in Millie's letter to UCSF and
041595 - Kaiser on 090204 0219 for Doctor Rugo to collaborate on
041596 - continuing care based on 2 years of weekly treatments.
041597 - ref SDS 91 278Q
041599 - ..
041600 - 89. On 090204 1930 Millie's letter to medical team asks if Doxil
041601 - will be given in the Infusion Clinic, since this is a
041602 - chemotherapy drip treatment, ref SDS 96 W84T, which Doctor Rugo
041603 - prescribed in the recommendation for Millie's treatment
041604 - submitted to Kaiser on 090129, reported on 090130, ref SDS 64
041605 - HK3V, and UCSF stated in a letter on 090203 2257 that Millie
041606 - would no longer be treated in the Infusion Clinic. ref SDS 88
041607 - L35Q and ref SDS 88 L35Y
041609 - ..
041610 - 90. On 090204 1930 Millie reports side effects of sunitinib and
041611 - cyclophosphamide seem mostly gone. Still have pain from IBC
041612 - and mostly the shoulder (actually the arm). ref SDS 96 W84W
041613 - Doctor Johnson has prescribed treatment that is working tody,
041614 - reported in the record earlier on 090204 1528. ref SDS 93 D64T
041616 - ..
041617 - 91. On 090205 1318 primary care physician at Kaiser, Doctor
041618 - Johnson, asks Millie to start using Kaiser's "closed" email
041619 - system that is part of Kaiser's "Health[Connect" Knowledge
041620 - Management system rather than public domain email, because
041621 - checking multiple email systems complicates and so delays
041622 - communication. Since the doctor checks Health Connect
041623 - regularly, correspondence sent through public domain email
041624 - increases risks that Millie will "fall through the cracks," at
041625 - a time when Millie is reporting rising symptoms of pain.
041626 - ref SDS 98 278T
041628 - ..
041629 - 92. On 090205 1318 review shows most of Millie's care is now
041630 - performed at UCSF which requires coordination with Kaiser.
041631 - Since Kaiser's Health Connect system has limitations that
041632 - prevent communication with UCSF, using the public domain email
041633 - for efficient, uniform distribution of correspondence among
041634 - Millie's large medical team increases chances to prevent urgent
041635 - care from falling through the cracks. ref SDS 98 YU4L
041637 - ..
041638 - 93. On 090209 0018 Millie submits the record of meeting on 090205
041639 - with Doctor Hsu, ref SDS A0 278T, launching the hyperthermia
041640 - treatment project at UCSF, ref SDS 97 0001, for Millie to
041641 - recover from the 6th relapse of IBC. Doctor Linda Chang
041642 - facilitated a productive meeting. ref SDS 97 O47G Millie
041643 - requests feedback to verify accuracy of patient history for
041644 - effective care. ref SDS A0 744V
041646 - ..
041647 - 94. On 090209 0018 Millie requests starting treatment 090210 or
041648 - 090211. IBC accelerating, reflects UCSF treatment plan for 4 -
041649 - 5 treatments per week for 4 - 6 weeks, and changing from Doxil
041650 - to low dose radiation. ref SDS A0 745X
041652 - ..
041653 - 95. On 090213 1140 Millie meeting with primary care physician at
041654 - Kaiser to review plans for expediting treatment at UCSF in time
041655 - to be effective, reports emotional trauma performing a maze of
041656 - tasks overcoming treatment delays. ref SDS A3 NY8H Kaiser
041657 - reports everything has been done that can be done to provide
041658 - timely treatment for Millie. ref SDS A3 GC9G
041660 - ..
041661 - 96. On 090218 1205 Millie requests scheduling treatments at UCSF
041662 - starting OA 0800. Starting radiation and hyperthermia early
041663 - optimizes work by avoiding traffic delays going in and out of
041664 - the City. If UCSF's schedule requires doing the work in the
041665 - afternoon, Millie will work to that requirement. ref SDS A4
041666 - TH5T
041668 - ..
041669 - 97. On 090218 1205 Millie requests explanation of treatment plan.
041670 - Doctor Rugo's letter to Kaiser on 090129 discussed hyperthermia
041671 - with Doxil, reported on 090130. ref SDS 64 TZ6H Has the plan
041672 - changed to use "lower dose" radiation rather than Doxil. Will
041673 - both be used, or some other agent? At this time, the record is
041674 - confusing about scope. Please explain initial assessment, and
041675 - prognosis. If this has already been submitted to Doctor
041676 - Johnson and Doctor Rugo, send a copy to Millie. ref SDS A4 TH5W
041678 - ..
041679 - 98. On 090218 1205 Millie reports to medical team good meeting with
041680 - Doctor Johnson at Kaiser on 090213. He seemed optimistic that
041681 - Millie might have 3 - 6 months of recovery, but will need
041682 - treatment from Doctor Rugo for cancer as a "chronic disease." A
041683 - week or so ago on 090210, Lena called to scheduling meeting
041684 - with Doctor Rugo on 090312 0830, reflecting comprehensive
041685 - follow up ordered by Kaiser during the meeting on 090203.
041686 - ref SDS A4 TH6U
041688 - ..
041689 - 99. On 090218 1205 Millie asks UCSF about obtaining records from Mt
041690 - Diablo Medical Center of prior radiation in 2002, which Doctor
041691 - Hsu discussed doing during the meeting at UCSF on 090205.
041692 - ref SDS 97 PN8H, and which cites Doctor Benz 2nd opinion at
041693 - UCSF on 041018 saying Millie likely cannot tolerate more
041694 - radiation. ref SDS 97 YO9G Was that so long ago, there is risk
041695 - from additional radiation now? ref SDS A4 TH6X
041697 - ..
041698 - 100. On 090218 1205 Millie asks UCSF about responding, ref SDS A4
041699 - TH7V, to the letter a week ago on 090209 requesting explanation
041700 - of side effects from radiation and hyperthermia, ref SDS A0
041701 - 745R, following Doctor Hsu's comments during the meeting on
041702 - 090205. ref SDS 97 GM4N Does the treatment plan address this
041703 - prospectively, or as needed? For example, as noted in the
041704 - letter on 090209, research found that side effects of radiation
041705 - are sometimes treated with Vitamin E plus pentoxifylline
041706 - (Trental), ref SDS A0 745R, which can be problematic with
041707 - Coumadin, so Gloria in the Coagulation Control Clinic at Kaiser
041708 - will need input. ref SDS A4 TH7V
041710 - ..
041711 - 101. On 090218 1205 Millie looking forward to starting treatment on
041712 - 090219, and despite worry about delays that prevent treatment
041713 - from being effective. ref SDS A4 TH7Y Millie Thanks Doctor Hsu
041714 - for expediting care, reported on 090203, ref SDS 84 XX5I, and
041715 - to Doctor Rugo for guidance through troubled waters, shown by
041716 - UCSF letter on 090202 1722. ref SDS 79 Y15J
041718 - ..
041719 - 102. On 090219 1315 Millie begins treatment for 6th relapse of IBC
041720 - with radiation and hyperthermia, ref SDS A5 E57G, ordered by
041721 - Doctor Rugo on 090129, reported on 090130, ref SDS 64 4S8O, and
041722 - 4 weeks after ending prior treatment for the 5th relapse of IBC
041723 - on 090122. ref SDS 48 AT6N
041725 - ..
041726 - 103. On 090220 0157 Millie requests treatment plan again from UCSF
041727 - to recover from 6th relapse of IBC. ref SDS 0 XX5O
041729 - ..
041730 - 104. On 090220 0915 Chris requested an email address for submitting
041731 - copies of the photograph showing configuration for hyperthermia
041732 - treatments. ref SDS A6 MJ9J
041734 - ..
041735 - 105. On 090223 0237 Millie asks again for the file of the picture
041736 - showing hyperthermia treatment. ref SDS A8 T45S
041738 - ..
041739 - 106. On 090223 1438 Chris submitted the picture of Millie getting
041740 - hyperthermia treatment at UCSF. ref SDS A9 GZ4H
041742 - ..
041743 - 107. On 090220 0915 UCSF submitted Notes memorandum dated 090209 and
041744 - which explains general planning for Millie's radiation and
041745 - hyperthermia treatments at UCSF; additionally Chirs submitted a
041746 - paper published in 2002 by BSD Medical that explains theory and
041747 - practice using hyperthermia treatment for cancer. ref SDS A6
041748 - 4254
041750 - ..
041751 - 108. On 090220 1548 reviewed UCSF notes for Radiation Oncology
041752 - department planning Millie;s radiation and hyperthermia
041753 - treatments to recover from 6th relapse of IBC. ref SDS A7 PR4Y
041755 - ..
041756 - 109. On 090220 1548 reviewed BSD paper received from UCSF explaining
041757 - application of hyperthermia for treating IBC, ref SDS A7 GK6F,
041758 - and setting out prospects for treating future relapse combining
041759 - hyperthermia with other modalities. ref SDS A7 0129
041761 - ..
041762 - 110. On 090223 0237 Millie requests work plan for radiation
041763 - treatments that complements work plan for hyperthermia received
041764 - on 090220. ref SDS A8 3N9J
041766 - ..
041767 - 111. On 090223 1428 Chris coordinating with Doctor Hsu on getting
041768 - radiation treatment plan for patient review. ref SDS A9 JI9G
041770 - ..
041771 - 112. On 090226 1342 Millie received radiation treatment plan that
041772 - complements hyperthermia plan for Millie to recover from IBC.
041773 - ref SDS B0 D452
041774 -
041775 -
041776 -
041777 -
041778 -
0418 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
0504 - Progress
050501 - ..
050502 - Treatment Delay Risks Losing Opportunity for Effective Care
050503 - Emotional Trauma Delayed Treatment Relieved UCSF Excellent Care
050504 - Anxiety Fears Treatment Delays Relieved Starting Treatment IBC
050505 - Radiation Hyperthermia Start Treatment Relieves Anxiety Fears
050506 -
050507 - Follow up ref SDS A4 278T, ref SDS A0 278T.
050508 -
050509 - Millie's letter to the medical team confirms understandings from the
050510 - first day of radiation and hyperthermia treatment on 090219,
050511 - ref SDS A5 428F, and continues requests for scope of care, and
050512 - explanation of treatments. Used email address for Chris from the
050513 - business card received during the meeting yesterday. ref SDS A5 X49J
050514 -
050515 - 1. Subject: Hyperthermia Radiation Started Feb 19 Submission Treatment Plan Pending
050516 - Date: Fri, 20 Feb 2009 02:05:57 -0800
050527 - ..
050528 - 2. I feel much better today, after experiencing your excellent
050529 - care at UCSF yesterday afternoon. Leading up to getting
050530 - started I had a lot of anxiety and tears about delays and
050531 - efficacy of the process. Now things seem back on track.
050532 -
050533 - [On 090223 Millie received letter from Chris advising that
050534 - he did not get a copy of this letter sent to the medical
050535 - team today. The email address in Chris' letter correctes a
050536 - mistake in the address on Chris' businss card that omits
050537 - "c". ref SDS A8 PR4Y
050539 - ..
050540 - [On 090223 0237 Millie's letter notifies Chris that the
050541 - email address on his business card is incorrect.
050542 - ref SDS A8 T47R
050543 -
050544 -
050545 -
050546 -
050547 -
050548 -
0506 -
SUBJECTS
Default Null Subject Account for Blank Record
0603 -
060401 - ..
060402 - Schedule Treatments Start 0800 - 0900 Optimize Work Time
060403 -
060404 - Follow up ref SDS A4 TH5T.
060406 - ..
060407 - 3. Thanks very much for adjusting my treatment schedule to start
060408 - in the mornings, as requested in the letter yesterday [on
060409 - 090218]. ref SDS A4 TH5T
060410 -
060411 -
060412 -
060413 -
0605 -
SUBJECTS
Default Null Subject Account for Blank Record
0703 -
070401 - ..
070402 - Treatment Plan Scope Prescribed Doxil Now Using Lower Dose Radiation
070403 -
070404 - Follow up ref SDS A4 TH5W.
070406 - ..
070407 - 4. As you discussed with Rod and Chris [during the meeting at UCSF
070408 - on 090219, ref SDS A5 PB49, I would like a computer file, if
070409 - possible, of the picture Chris took showing the typical
070410 - configuration of my hyperthermia treatment, ref SDS A5 PB53,
070411 - and also a picture file (e.g., jpg) of the radiation setup.
070412 -
070413 - [On 090220 0915 Chris requested an email address for
070414 - submitting copies of the photograph showing configuration
070415 - for hyperthermia treatments. ref SDS A6 MJ9J
070417 - ..
070418 - [On 090223 0237 Millie asks again for the file of the
070419 - picture showing hyperthermia treatment. ref SDS A8 T45S
070421 - ..
070422 - [On 090223 1438 Chris submitted the picture of Millie
070423 - getting hyperthermia treatment at UCSF. ref SDS A9 GZ4H
070425 - ..
070426 - 5. I am striving for a summary/general understanding of treatments
070427 - I am getting [as requested in a letter to the medical team on
070428 - 090218, ref SDS A4 TH5W]. Radiation today took much longer
070429 - than radiation I had in 2002, so there seems to be a
070430 - qualitative difference in technology and process. Initially, I
070431 - thought IBC per se, which is in my skin was not being treated
070432 - with radiation, rather you were going after lymphadenopathy.
070433 - After today, I am not sure. Seems like maybe you are treating
070434 - IBC with both radiation and hyperthermia?? Can you please
070435 - clarify.
070437 - ..
070438 - [On 090220 0915 UCSF submitted Notes memorandum dated
070439 - 090209 and which explains general planning for Millie's
070440 - radiation and hyperthermia treatments at UCSF; additionally
070441 - Chirs submitted a paper published in 2002 by BSD Medical
070442 - that explains theory and practice using hyperthermia
070443 - treatment for cancer. ref SDS A6 4254
070445 - ..
070446 - [On 090220 1548 reviewed UCSF notes for Radiation Oncology
070447 - department planning Millie;s radiation and hyperthermia
070448 - treatments to recover from 6th relapse of IBC. ref SDS A7
070449 - PR4Y
070451 - ..
070452 - 6. Abby or Chris seemed to say that hyperthermia is a sonar
070453 - process of some kind.
070454 -
070455 - [On 090220 0915 UCSF submitted Notes memorandum dated
070456 - 090209 and which describes ultrasound treatments.
070457 - ref SDS A6 4254
070459 - ..
070460 - 7. I appreciate very much your submitting the orders for my
070461 - treatments [requested in Millie's letter to the team on 090218,
070462 - ref SDS A5 4254, similar to "Chemotherapy Orders" I received
070463 - for treatments in the Infusion Clinic the past 2 years. If
070464 - possible, I would like to get a computer file, so I don't have
070465 - to type it up for incorporation into patient history. If you
070466 - use a printed form, like Doctor Rugo does for the Chemo Orders,
070467 - then I can get it from Chris in the morning, as you discussed
070468 - with Rod and Chris. If it is a computer file, then just attach
070469 - to an email, and that will reduce my work.
070470 -
070471 - [On 090220 0915 UCSF submitted Notes memorandum dated
070472 - 090209 and which explains general planning for Millie's
070473 - radiation and hyperthermia treatments at UCSF; additionally
070474 - Chris submitted a paper published in 2002 by BSD Medical
070475 - that explains theory and practice using hyperthermia
070476 - treatment for cancer. ref SDS A6 4254
070478 - ..
070479 - [On 090220 0915 not clear that Millie has received medical
070480 - "orders" for radiation and hyperthermia, unless the Notes
070481 - on planning treatment substitute for the doctor's order,
070482 - which seems unlikely. ref SDS A6 MJ4L
070484 - ..
070485 - [On 090223 0237 Millie's letter to the medical team thanks
070486 - Chris for submitting the UCSF memo on 090209 that seems to
070487 - explain the treatment plan for hyperthermia. ref SDS A8
070488 - T47U Millie requests similar plan for radiation treatment
070489 - that complements hyperthermia. ref SDS A8 3N9J
070491 - ..
070492 - 8. Finally, can you explain metrics for evaluating when treatment
070493 - concludes. When I was treated at Kaiser with capecitabine and
070494 - Taxotere from Apr - Sep 2005, IBC rash seemed totally resolved
070495 - by visual examination [reported on 050724. ref SDS 9 YY7F;
070496 - earlier on 030109, visual examination diagnosed IBC as reaction
070497 - to radiation, ref SDS 3 KW5F, and also Cellulitis, ref SDS 3
070498 - 0T6N]. There was then a mastectomy in October 2005. Biopsy of
070499 - removed tissue affirmatively reported no findings of IBC.
070501 - ..
070502 - This question reflects research on 090129 indicating a patient was
070503 - treated with hyperthermia until all evidence of IBC was resovled.
070504 - ref SDS 61 OI9X
070506 - ..
070507 - Enhanced MRI technology seems to enable directly calculating amount of
070508 - recovery from IBC following hyperthermia, reported on 090129.
070509 - ref SDS 61 SQ6L
070510 -
070511 - [On 090312 0800 examination at UCSF radiation oncology
070512 - department does not discuss using enhanced MRI for metric
070513 - evaluating recovery from IBC after treatment with radiation
070514 - and hyperthermia. ref SDS B1 BY8L
070516 - ..
070517 - [On 090312 0800 meeting with Doctor Hsu and Chris seemed to
070518 - indicate that visual examination by experienced doctors,
070519 - and the cancer marker are the only "metrics" for evaluating
070520 - recovery from IBC with radiation hyperthermia treatment,
070521 - ref SDS B1 F893; Millie was given the maximum radiation she
070522 - could tolerate based on prior treatments in 2002, and
070523 - hyperthermia treatments were given for the same duration,
070524 - with expectation this will have the optimum possible
070525 - recovery from IBC. ref SDS B1 NV66
070527 - ..
070528 - [On 090330 1200 Doctor Hsu indicated that weakness of
070529 - visual examiantion for evaluating response to radiation and
070530 - hyperthermia treatment recovering from IBC has will work
070531 - better than enhanced MRI in Millie's case. ref SDS B2 LO5N
070533 - ..
070534 - 9. Yet, here I am today, being treated for the same darn thing.
070535 - This raises two questions...
070536 -
070537 - 1. How comprehensively can the current treatment resolve IBC,
070538 - and how is this assessed, beyond simple visual inspection,
070539 - and drop in the cancer marker? Is there an xray, PET scan,
070540 - or other diagnostic that shows where we are for planning
070541 - follow on steps [for example, research on 090129 described
070542 - enhanced MRI can directly calculate the amount of remaining
070543 - IBC to evaluate response to treatment. ref SDS 61 JU4H
070544 -
070545 - [On 090312 1200 Doctor Hsu discussed metrics for
070546 - evaluating Millie's response to treatment. ref SDS B1
070547 - 1R5I
070549 - ..
070550 - [On 090330 1200 Doctor Hsu indicated that weakness of
070551 - visual examiantion for evaluating response to radiation
070552 - and hyperthermia treatment recovering from IBC has will
070553 - work better than enhanced MRI in Millie's case.
070554 - ref SDS B2 LO5N
070556 - ..
070557 - 2. Can hyperthermia treatment be done again, if IBC pops up
070558 - later, as obviously happened to me? Will there be follow
070559 - up at least for a month or so in radiation oncology, in
070560 - case IBC does recur in the near term?
070561 -
070562 - [On 090312 Doctor Hus and Chris seemed to indicate
070563 - patients can get hyperthermia more than just once,
070564 - unlike radiation which is a one-time treatment.
070565 - ref SDS B1 F973
070566 -
070567 -
070568 -
0706 -
SUBJECTS
Default Null Subject Account for Blank Record
0803 -
080401 - ..
080402 - Emotional Trauma Delaying Treatment Required Urgently Recover IBC
080403 - Hope Hyperthermia Treatment Starting in Time to be Effective
080404 - Commend Doctor Hsu and Doctor Rugo Expediting Treatment 6th Relapse IBC
080405 -
080406 - Follow up ref SDS A4 TH7Y.
080408 - ..
080409 - 10. I always felt I was in good hands in the Infusion Clinic for
080410 - the past 2 years. Experience working with your team makes me
080411 - feel very confident about being in the hands of "experts," as
080412 - Doctor Rogo noted in her letter to Kaiser on 090129.
080413 -
080421 -
080422 -
080423 -
080424 -
080425 -
080426 -
080427 -
080428 -
0805 -