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 02:28 PM Monday; Rod Welch

Chris investigating submission of radiation plan for Millie's treatment
at UCSF to recovery from IBC.

1...Summary/Objective
2...Radiation Treatment UCSF Investigates to Locate Plan
3...Treatment Strategy Hyperthermia and Lower Dose Radiation
4...Picture Configuration Hyperthermia Treatment Recover from IBC at UCSF


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

CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS B0 0000. ref SDS A9 0000.
040502 -
040503 -
040504 -
040506 -  ..
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 64 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 A5 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 A5 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 98 PN8H, and which cites Doctor Benz 2nd opinion at
040925 -        UCSF on 041018 saying Millie likely cannot tolerate more
040926 -        radiation. ref SDS 98 YO9G  Was that so long ago, there is risk
040927 -        from additional radiation now? ref SDS A5 TH6X
040929 -         ..
040930 -    4.  On 090218 1205 Millie asks UCSF about responding, ref SDS A5
040931 -        TH7V, to the letter a week ago on 090209 requesting explanation
040932 -        of side effects from radiation and hyperthermia, ref SDS A1
040933 -        745R, following Doctor Hsu's comments during the meeting on
040934 -        090205. ref SDS 98 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 A1 745R, which can be problematic with
040939 -        Coumadin, so Gloria in the Coagulation Control Clinic at Kaiser
040940 -        will need input. ref SDS A5 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 A5 TH7Y  Millie Thanks Doctor Hsu
040946 -        for expediting care, reported on 090203, ref SDS 84 XX5I, and
040947 -        to Doctor Rugo for guidance through troubled waters, shown by
040948 -        UCSF letter on 090202 1722. ref SDS 79 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 A7 XX5O
040955 -
040956 -           b.  Computer file of picture showing typical configuration
040957 -               of radiation treatment. ref SDS A7 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 A7 EA4Q
040970 -                ..
040971 -           d.  Hyperthermia is a sonar process of some kind.
040972 -               ref SDS A7 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 A7 EA4W
040982 -                ..
040983 -           f.  Metrics for evaluating when treatment concludes.
040984 -               ref SDS A7 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 A7
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 A7 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 A7 WF5I
041010 -         ..
041011 -    7.  On 090220 0915 Millie radiation and hyperthermia treatment at
041012 -        UCSF. ref SDS A8 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 A8 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 A9 PR4Y
041021 -         ..
041022 -    9.  On 090220 1548 reviewed BSD paper explaining hyperthermia
041023 -        treatment for recovering from cancer, ref SDS A9 GK6F,
041024 -        including hyperthermia alone...
041025 -
041026 -               hyperthermia................. ref SDS A9 004P
041028 -         ..
041029 -        In combination with....
041030 -
041031 -               radiation.................... ref SDS A9 TT6L
041032 -               chemotherapy................. ref SDS A9 0129
041033 -               biological vaccines.......... ref SDS A9 0164
041035 -         ..
041036 -   10.  On 090223 0237 Millie's letter to medical team....
041037 -
041038 -            a.  Thanks UCSF for submitting memo dated 090209 on
041039 -                planning hyperthermia treatments. ref SDS B0 T47U
041041 -                 ..
041042 -            b.  Requests work plan for radiation treatments.
041043 -                ref SDS B0 3N9J and ref SDS B0 T49U, similar to work
041044 -                plan for hyperthermia.
041045 -
041046 -                    [...below, Chris reports investigating to get the
041047 -                    work plan for radiation. ref SDS 0 PR4Y
041049 -                 ..
041050 -            c.  Notes clinical findings that swelled lymph node in left
041051 -                supraclavicular occurred again, ref SDS B0 T48S, and
041052 -                asks if this will be radiated, and what other areas
041053 -                will be radiated. ref SDS B0 T49R
041055 -                 ..
041056 -            d.  Reports upper left arm looks worse than before
041057 -                treatment started, asks if this is expected side
041058 -                effects of radiation and hyperthermia treatment.
041059 -                ref SDS B0 T49Y
041061 -                 ..
041062 -            e.  Reports Cellulitis and lymphadema have been continuing
041063 -                problems on left arm, ref SDS B0 T44R, asks if Keflex
041064 -                should be started to prevent recurrence caused by
041065 -                treatment for IBC? ref SDS B0 T44W
041067 -                 ..
041068 -            f.  Requests picture of Millie getting hyperthermia
041069 -                treatment showing configuration of work process.
041070 -                ref SDS B0 T45S
041071 -
041072 -                    [...below, Chris sumbits the picture. ref SDS 0
041073 -                    GZ4H
041074 -
041075 -
041076 -
041077 -
041078 -
0411 -

SUBJECTS
Spec Medical Physics Hyperthermia with  Rdiation Strategy Treatment

1503 -
150401 -  ..
150402 - Radiation Treatment UCSF Investigates to Locate Plan
150403 - Treatment Strategy Hyperthermia and Lower Dose Radiation
150404 -
150405 - Follow up ref SDS B0 PR4Y, ref SDS A9 PR4Y.
150406 -
150407 - Millie received a letter from Chris sent today responding to Millie's
150408 - letter sent earlier this morning, ref SDS B0 3H7H,
150409 -
150410 -    1.  Subject:  Hyperthermia Radiation Treatment Plan Pending
150411 -        Date: Mon, 23 Feb 2009 08:18:16 -0800
150418 -
150419 -        [...responding to your letter this morning 090223, ref SDS B0
150420 -        3H7H]
150422 -         ..
150423 -        I do not have access to print out the radiation plan [requested
150424 -        in Millie's letter this morning on 090223 0237, ref SDS B0
150425 -        3N9J, I will look into this and also ask Dr.  Hsu to do so when
150426 -        he gets a chance.
150427 -
150428 -           [On 090226 1342 Millie received radiation treatment plan
150429 -           that complements hyperthermia plan for Millie to recover
150430 -           from IBC. ref SDS B1 PR4Y
150431 -
150432 -
150437 -
150439 -  ..
150440 - Picture Configuration Hyperthermia Treatment Recover from IBC at UCSF
150441 -
150442 - Later in the afternoon, received a second letter from Chris that has
150443 - the picture of the configuration for getting hyperthernmia treatment
150444 - at UCSF...
150445 -
150446 -                 
150447 -
150448 -
150449 -
150450 -
150451 -
150452 -
150453 -
150454 -
1505 -