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 23, 2009 02:37 AM Monday;
Rod Welch
Millie requests work plan for radiation that complements hyperthermia
treatment for recoverying from IBC.
1...Summary/Objective
2...Complexity IBC Involvement Requires Hyperthermia 4 Weeks
3...Treatment Strategy Hyperthermia and Lower Dose Radiation
ACTION ITEMS..................
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1...of the CT scans Doctor Hsu performed at UCSF on 090209 for
CONTACTS
020204 -
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS B0 0000. ref SDS A8 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - 1. On 090218 1205 Millie requests explanation of treatment plan.
040902 - Doctor Rugo's letter to Kaiser on 090129 discussed hyperthermia
040903 - with Doxil, reported on 090130. ref SDS 65 TZ6H Has the plan
040904 - changed to use "lower dose" radiation rather than Doxil. Will
040905 - both be used, or some other agent? At this time, the record is
040906 - confusing about scope. Please explain initial assessment, and
040907 - prognosis. If this has already been submitted to Doctor
040908 - Johnson and Doctor Rugo, send a copy to Millie. ref SDS A6 TH5W
040910 - ..
040911 - 2. On 090218 1205 Millie reports to medical team good meeting with
040912 - Doctor Johnson at Kaiser on 090213. He seemed optimistic that
040913 - Millie might have 3 - 6 months of recovery, but will need
040914 - treatment from Doctor Rugo for cancer as a "chronic disease." A
040915 - week or so ago on 090210, Lena called to scheduling meeting
040916 - with Doctor Rugo on 090312 0830, reflecting comprehensive
040917 - follow up ordered by Kaiser during the meeting on 090203.
040918 - ref SDS A6 TH6U
040920 - ..
040921 - 3. On 090218 1205 Millie asks UCSF about obtaining records from Mt
040922 - Diablo Medical Center of prior radiation in 2002, which Doctor
040923 - Hsu discussed doing during the meeting at UCSF on 090205.
040924 - ref SDS 99 PN8H, and which cites Doctor Benz 2nd opinion at
040925 - UCSF on 041018 saying Millie likely cannot tolerate more
040926 - radiation. ref SDS 99 YO9G Was that so long ago, there is risk
040927 - from additional radiation now? ref SDS A6 TH6X
040929 - ..
040930 - 4. On 090218 1205 Millie asks UCSF about responding, ref SDS A6
040931 - TH7V, to the letter a week ago on 090209 requesting explanation
040932 - of side effects from radiation and hyperthermia, ref SDS A2
040933 - 745R, following Doctor Hsu's comments during the meeting on
040934 - 090205. ref SDS 99 GM4N Does the treatment plan address this
040935 - prospectively, or as needed? For example, as noted in the
040936 - letter on 090209, research found that side effects of radiation
040937 - are sometimes treated with Vitamin E plus pentoxifylline
040938 - (Trental), ref SDS A2 745R, which can be problematic with
040939 - Coumadin, so Gloria in the Coagulation Control Clinic at Kaiser
040940 - will need input. ref SDS A6 TH7V
040942 - ..
040943 - 5. On 090218 1205 Millie looking forward to starting treatment on
040944 - 090219, and despite worry about delays that prevent treatment
040945 - from being effective. ref SDS A6 TH7Y Millie Thanks Doctor Hsu
040946 - for expediting care, reported on 090203, ref SDS 85 XX5I, and
040947 - to Doctor Rugo for guidance through troubled waters, shown by
040948 - UCSF letter on 090202 1722. ref SDS 80 Y15J
040950 - ..
040951 - 6. On 090220 Millie's letter to Doctor Hsu requests...
040952 -
040953 - a. Computer file of picture showing typical configuration
040954 - of hyperthermia treatment. ref SDS A8 XX5O
040955 -
040956 - b. Computer file of picture showing typical configuration
040957 - of radiation treatment. ref SDS A8 XX5O
040959 - ..
040960 - c. Summary/general explanatoin of radiation and
040961 - hyperthermia treatments. Radiation on 090219 took much
040962 - longer than radiation Millie had in 2002, so there seems
040963 - to be a qualitative difference in technology and
040964 - process. Initially assumed IBC in the skin is not
040965 - treated with radiation, and is directed instead to treat
040966 - lymphadenopathy. After today, seems like maybe UCSF is
040967 - treating IBC with both radiation and hyperthermia?? Can
040968 - you please clarify. ref SDS A8 EA4Q
040970 - ..
040971 - d. Hyperthermia is a sonar process of some kind.
040972 - ref SDS A8 EA4T
040974 - ..
040975 - e. Orders for Millie's radiation and hyperthermia
040976 - treatments, similar to "Chemotherapy Orders" received
040977 - for treatments in the Infusion Clinic the past 2 years.
040978 - If possible, UCSF should submit a computer file to
040979 - reduce the time and cost for adding the treatment plan
040980 - to patient history. ref SDS A8 EA4W
040982 - ..
040983 - f. Metrics for evaluating when treatment concludes.
040984 - ref SDS A8 EA5P
040986 - ..
040987 - When Millie was treated at Kaiser with capecitabine and
040988 - Taxotere from Apr - Sep 2005, IBC rash seemed totally
040989 - resolved by visual examination. There was then a
040990 - mastectomy in October 2005. Biopsy of removed tissue
040991 - affirmatively reported no findings of IBC. Yet, years
040992 - later Millie is being treated again for IBC. ref SDS A8
040993 - EA5T This raises two questions...
040995 - ..
040996 - 1. How comprehensively can the current treatment
040997 - resolve IBC, and how is this assessed, beyond simple
040998 - visual inspection, and drop in the cancer marker?
040999 - Is there an xray, PET scan, or other diagnostic that
041000 - shows where we are for planning follow on steps?
041001 - ref SDS A8 EA5T
041003 - ..
041004 - 2. Can hyperthermia treatment be done again, if IBC
041005 - pops up later, as obviously happened to me? Will
041006 - there be follow up at least for a month or so in
041007 - radiation oncology, in case IBC does recur in the
041008 - near term? ref SDS A8 WF5I
041010 - ..
041011 - 7. On 090220 0915 Millie radiation and hyperthermia treatment at
041012 - UCSF. ref SDS A9 0G5I Millie receivd a copy of notes Chris
041013 - prepared of a meeting on 090209 with the UCSF medical team on
041014 - planning Millie's treatment. ref SDS A9 4254
041016 - ..
041017 - 8. On 090220 1548 reviewed UCSF memo dated 090209 explaining
041018 - treatment plan using radiation and hyperthermia for Millie to
041019 - recover from IBC. ref SDS B0 PR4Y
041021 - ..
041022 - 9. On 090220 1548 reviewed BSD paper explaining hyperthermia
041023 - treatment for recovering from cancer, ref SDS B0 GK6F,
041024 - including hyperthermia alone...
041025 -
041026 - hyperthermia................. ref SDS B0 004P
041028 - ..
041029 - In combination with....
041030 -
041031 - radiation.................... ref SDS B0 TT6L
041032 - chemotherapy................. ref SDS B0 0129
041033 - biological vaccines.......... ref SDS B0 0164
041034 -
041035 -
041036 -
041037 -
041038 -
041039 -
0411 -
SUBJECTS
Spec Medical Physics Hyperthermia with Rdiation Strategy Treatment
1503 -
150401 - ..
150402 - Complexity IBC Involvement Requires Hyperthermia 4 Weeks
150403 - Treatment Strategy Hyperthermia and Lower Dose Radiation
150404 -
150405 - Follow up ref SDS B0 PR4Y, ref SDS A8 XX5O.
150406 -
150407 - Millie received a letter from Chris, per below, saying he did not a
150408 - copy of the letter to the medical team on 090220, ref SDS 0 AC5K,
150409 - reporting results of the meeting at UCSF on 090219, and requesting a
150410 - copy of the treatment plan for hyperthermia. ref SDS A8 EA4Q
150412 - ..
150413 - The letter to the medical team on 090220 used the email address,
150414 - ref SDS A8 278T, which was on the business card received from Chris on
150415 - 090219. ref SDS A7 X49J Review today shows the address in Chris'
150416 - email has a "c" that is missing from the email address on the business
150417 - card.
150419 - ..
150420 - Millie's letter this morning says...
150421 -
150422 - 1. Subject: Hyperthermia Radiation Treatment Plan Pending
150423 - Date: Mon, 23 Feb 2009 02:45:25 -0800
150433 - ..
150434 - 3. Thanks for feedback in your letter on 090220 [advising that you
150435 - did not receive a copy of the letter to the medical team on
150436 - 090220. ref SDS A8 278T] Somehow I got the wrong email address
150437 - from your business card. It omitted the "c" at the beginning
150438 - of the address. I may have received an old card with an
150439 - earlier address. Your letter on Friday provided a correction.
150440 - Sorry for the mix up.
150442 - ..
150443 - 4. Thanks, too, for the memo dated 090209 on the hyperthermia
150444 - treatment plan [received in the record on 090220, ref SDS B0
150445 - PR4Y, requested the day before on 090219, ref SDS A7 4254].
150447 - ..
150448 - 5. Is there comparable planning for my radiation treatments, for
150449 - example the use of molds or plates that guide radiation
150450 - therapy? How many total sites, the identification scheme, the
150451 - description of radiation. Somehow I have the impression that
150452 - all sites get radiation each treatment day, but only 1 site
150453 - gets hyperthermia per treatment day. Please clarify.
150454 -
150455 - [On 090223 1428 Chris coordinating with Doctor Hsu on
150456 - getting radiation treatment plan for patient review.
150457 - ref SDS B1 JI9G
150459 - ..
150460 - [On 090226 1342 Millie received radiation treatment plan
150461 - that complements hyperthermia plan for Millie to recover
150462 - from IBC. ref SDS B2 PR4Y
150464 - ..
150465 - 6. The CT test at Kaiser on 081107 reported multiple small nodes
150466 - in the right supraclavicular. This was the first time in my 8
150467 - year patient history that such findings occurred, reviewed on
150468 - 081113. ref SDS 25 OO6M
150469 -
150470 - [On 090226 1342 UCSF radiation plan shows treatment for
150471 - left supraclavicular; does not show treatment for right
150472 - supraclavicular nor right axillary. ref SDS B2 HK6H
150474 - ..
150475 - 7. The follow up test at Kaiser on 091230 showed the large node in
150476 - the left supraclavicular had fully subsided [reported on
150477 - 090107,
150478 - However, Doctor
150479 - Hsu palpated this node again at UCSF on 090205, and seemed to
150480 - indicate that the node on the left side of neck would get
150481 - radiation. ref SDS 99 OH88
150483 - ..
150484 - 8. Notice the link showing Doctor Johnson at Kaiser concurred on
150485 - 090213, also, finding that the node in the left supraclavicular
150486 - has increased again. ref SDS A5 4M5Y I have not seen results
150487 - of the CT scans Doctor Hsu performed at UCSF on 090209 for
150488 - planning my treatments. ref SDS A3 9R61 Was a narrative
150489 - produced on findings, as they do at Kaiser. Can I get a copy?
150490 - If it is difficult to submit, don't make an extra effort.
150492 - ..
150493 - 9. In any case, does UCSF plan to radiate both the left and right
150494 - supraclavicular, ref SDS 25 HW8M or just the left, or neither?
150495 - What about the right axillary, which has shown 3 fairly stable
150496 - nodes for the past year, possibly suggesting they are not
150497 - cancer? [reported in the CT test on 081107 and reviewed on
150498 - 081112. ref SDS 24 4K5H]
150499 -
150500 - [On 090226 1342 UCSF radiation plan shows treatment for
150501 - left supraclavicular; does not show treatment for right
150502 - supraclavicular nor right axillary. ref SDS B2 HK6H
150504 - ..
150505 - 10. Is there an explanation of radiation I am getting, similar to
150506 - the BSD paper you submitted that was published in 2002
150507 - explaining hyperthermia [received on 090220, ref SDS B0 GK6F, I
150508 - found that paper on the Internet, and that saved several hours
150509 - typing. If you have a link or a computer file, that would save
150510 - a lot more time.
150512 - ..
150513 - [On 090223 1428 Chris coordinating with Doctor Hsu on
150514 - getting radiation treatment plan for patient review.
150515 - ref SDS B1 JI9G
150517 - ..
150518 - [On 090226 1342 Millie received radiation treatment plan
150519 - that complements hyperthermia plan for recovering from IBC.
150520 - ref SDS B2 D44N
150522 - ..
150523 - 11. Please check my upper left arm in the morning. It now looks to
150524 - me more inflamed than before treatment started on 090219. Is
150525 - this a side effect reaction to radiation, to hyperthermia?
150526 - Hopefully IBC is not expanding? Are we within normally
150527 - expected conditions, or should treatment for side effects be
150528 - considered?
150529 -
150530 - [On 090312 0800 meeting at UCSF with Doctor Hsu and Chris
150531 - report examination shows response to treatment, and advised
150532 - that symptoms of IBC and side effects of radiation and
150533 - hyperthermia treatments are similar; experience treating
150534 - other patients with IBC yields a judgement that qualitative
150535 - differences in appearance of skin on upper left arm show
150536 - response to treatment. ref SDS B3 PU5N
150538 - ..
150539 - 12. Cellulitis is a risk. Heating the left arm may trigger
150540 - lymphedema, and Cellulitis which have landed me in the
150541 - emergency numerous times, when the left arm is stressed. The
150542 - surgeon at Kaiser reported on 080606 that lymphatics on the
150543 - left side have gradually become more robust since surgery in
150544 - October 2005, reducing risk of recurrence. ref SDS 19 4P6L
150546 - ..
150547 - 13. Should I be taking Keflex to resist Cellulitis recurrence, as
150548 - proactive risk management?
150550 - ..
150551 - 14. At this early time starting treatment after just 2 treatments,
150552 - there is no evident improvement in IBC on the chest wall.
150553 - Hoping we begin to see results at the end of this week.
150554 -
150555 - [On 090312 0800 meeting at UCSF in Breast Care Clinic, Tara
150556 - advises worsening inflamation and open sores on chest are
150557 - symptoms of response to treatment recovering from IBC.
150558 - ref SDS B3 9L7K Examination by Doctor Hsu and Chris in
150559 - radiation oncology department concurred that Millie's
150560 - condition shows response to treatment that will result in
150561 - recovering from IBC. ref SDS B3 F84U
150563 - ..
150564 - [On 090312 0800 meeting at UCSF with Doctor Hsu and Chris
150565 - report examination shows response to treatment, and advised
150566 - that symptoms of IBC and side effects of radiation and
150567 - hyperthermia treatments are similar; experience treating
150568 - other patients with IBC yields a judgement that qualitative
150569 - differences in appearance of skin on upper left arm show
150570 - response to treatment. ref SDS B3 PU5N
150572 - ..
150573 - 15. As we discussed, please submit computer files for the
150574 - photographs of the hyperthermia setup, which you took on
150575 - 090219. ref SDS A8 XX5O [and as requested in Millie's letter to
150576 - the medical team on 090220. ref SDS A8 XX5O]. Would also like
150577 - a picture of the radiation configuration, if possible. These
150578 - can be attached to an email for timely transmittal, and
150579 - incorporation into patient history.
150580 -
150581 - [...in another record later today on 090223 Chris submitted
150582 - the picture of Millie getting hyperthermia treatment at
150583 - UCSF. ref SDS B1 GZ4H
150585 - ..
150586 - 16. Look forward to seeing everyone in the morning.
150587 -
150593 -
150594 -
150595 - *****************************************
150597 - ..
150598 - Millie received the following from Chris this morning....
150600 - ..
150601 - February 20, 2009
150602 - Diederich, Chris wrote:
150603 - Subject: Hyperthermia Radiation Started Feb 19 Submission Treatment Plan Pending
150605 - ..
150606 - FYI: not sure why, but I did not receive this original email.
150607 -
150608 - [...above Millie responds and reports an error in the email
150609 - address caused the problem. ref SDS 0 PR4Y
150610 -
150612 - ..
150613 - Sent:* Friday, February 20, 2009 11:12 AM
150616 - Subject: Hyperthermia Radiation Started
150617 - Feb 19 Submission Treatment Plan Pending
150618 -
150620 - ..
150621 - This is Millie's letter to the medical team on 090220. ref SDS A8 278T
150622 -
150623 -
150624 -
150625 -
150626 -
150627 -
150628 -
150629 -
150630 -
1507 -