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.................. Click here to comment!

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 -