CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS B2 0000. ref SDS B1 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
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
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 B1 T47U
041041 -                 ..
041042 -            b.  Requests work plan for radiation treatments.
041043 -                ref SDS B1 3N9J and ref SDS B1 T49U, similar to work
041044 -                plan for hyperthermia.
041046 -                 ..
041047 -            c.  Notes clinical findings that swelled lymph node in left
041048 -                supraclavicular occurred again, ref SDS B1 T48S, and
041049 -                asks if this will be radiated, and what other areas
041050 -                will be radiated. ref SDS B1 T49R
041052 -                 ..
041053 -            d.  Reports upper left arm looks worse than before
041054 -                treatment started, asks if this is expected side
041055 -                effects of radiation and hyperthermia treatment.
041056 -                ref SDS B1 T49Y
041058 -                 ..
041059 -            e.  Reports Cellulitis and lymphadema have been continuing
041060 -                problems on left arm, ref SDS B1 T44R, asks if Keflex
041061 -                should be started to prevent recurrence caused by
041062 -                treatment for IBC? ref SDS B1 T44W
041064 -                 ..
041065 -            f.  Requests picture of Millie getting hyperthermia
041066 -                treatment showing configuration of work process.
041067 -                ref SDS B1 T45S
041069 -         ..
041070 -   11.  On 090223 1428 Millie received a letter from Chris advising
041071 -        that UCSF is looking for the radiation treatment plan, and that
041072 -        he is checking with Doctor Hsu. ref SDS B2 PR4Y
041074 -         ..
041075 -   12.  On 090223 1428 Millie received the picture taken at UCSF on
041076 -        090219 showing Millie getting hyperthermia treatment.
041077 -        ref SDS B2 GZ4H
041078 -
041079 -
041080 -
041081 -
041082 -
0411 -

SUBJECTS
Spec Medical Physics Hyperthermia with  Rdiation Strategy Treatment

1503 -
150401 -  ..
150402 - Radiation Treatment Plan Complements Hyperthermia Recover IBC
150403 -
150404 - Follow up ref SDS B2 PR4Y, ref SDS B1 PR4Y.
150405 -
150406 - On 090205 Doctor Hsu met with Millie for examination to plan
150407 - treatments with radiation and hyperthermia required for Millie to
150408 - recover from IBC. ref SDS 99 R29M  At that time, the doctor seemed to
150409 - indicate Millie would require 4 - 6 weeks of treatment. ref SDS 99
150410 - PR8J
150412 -  ..
150413 - After treatment today at UCSF, Chris submitted UCSF's work plan for
150414 - Millie's radiation treatment, ref SDS 0 D452, as requested in Millie's
150415 - letter to the medical team on 090218. ref SDS A6 TH5W  This was
150416 - requested again during a meeting at UCSF on 090219 when Millie started
150417 - the 1st day of treatment. ref SDS A7 4254  On 090220 0157 Millie's
150418 - letter to the medical team confirmed request for explanation of the
150419 - treatment plan, including the doctor's orders for radiation and
150420 - hyperthermia treatments, similar to Chemotherapy Orders Millie
150421 - received for care in the Infusion Clinic. ref SDS A8 EA4Q  On 090220
150422 - 0915 UCSF submitted a memo dated 090209 which has notes of a meeting
150423 - at UCSF on general planning for Millie's radiation and hyperthermia
150424 - treatments at UCSF; additionally Chirs submitted a paper published in
150425 - 2002 by BSD Medical that explains theory and practice using
150426 - hyperthermia treatment for cancer. ref SDS A9 4254  The paper was
150427 - reviewed later that day on 090220 explaining use of hyperthermia with
150428 - radiation. ref SDS B0 GK6F
150430 -  ..
150431 - On 090223 0237 Millie requests similar paper on radiation treatments
150432 - given with hyperthermia. ref SDS B1 T49U   Chris submitted a letter
150433 - reporting he would ask Doctor Hsu to look for the radiation plan.
150434 - ref SDS B2 PR4Y
150436 -  ..
150437 - Today, at the end of treatment, Millie received a copy of the
150438 - radiation plan.  The document received from UCSF today says...
150439 -
150440 -        Diagnosis and Interventions
150442 -        Level Order Set
150443 -        DX Female Breast NOS (Excludes skin of Breast T-173.5)
150444 -        Adenocarcinoma NOS
150445 -        Date:  February 9, 2009 (Start)
150447 -         ..
150448 -        Radiation Oncology Course:  1
150450 -         ..
150451 -        Rad Rx:  R breast - Tangentials - 18MV/6MV Dose: 4256 cGy @ 266 cGy x  1   A 2/12/2009 | H
150452 -        Rad Rx:  L arm - AP/PA        -   6MV PHOT Dose: 4256 cGy @ 266 cGy x 16   A 2/12/2009 | H
150453 -        Rad Rx:  L CW upper EN FACE   -     9 E    Dose: 3200 cGy @ 400 cGy x  8   A 2/12/2009 | H
150454 -        Rad Rx:  L CW lower EN FACE   -     9 E    Dose: 3200 cGy @ 400 cGy x  8   A 2/12/2009 | H
150455 -        Rad Rx:  L CW lateral EN FACE -     9 E    Dose: 3200 cGy @ 400 cGy x  8   A 2/12/2009 | H
150456 -        Rad Rx:  L NECK       EN FACE -    12 E    Dose: 3200 cGy @ 400 cGy x  8   A 2/12/2009 | H
150458 -  ..
150459 - This listing received from UCSF today does not clearly correlate with
150460 - a specific treatment schedule in relation to original planning in the
150461 - meeting on 090205 that discussed 4 - 6 weeks of treatment. ref SDS 99
150462 - R29M
150464 -  ..
150465 - Looks like treatment zones are...
150466 -
150467 -            1.  Left arm upper near shoulder
150468 -            2.  Left supraclavicular neck
150469 -            3.  Right breast
150470 -            4.  Left chest wall (CW) upper
150471 -            5.  Left chest wall (CW) lower
150472 -            6.  Left chest wall (CW) lateral (wrapping toward back)
150474 -  ..
150475 - Seems to indicate no treatment for right axillary nodes cited in the
150476 - report for the CT test on 081107, reviewed on 081112, ref SDS 24 4K5H;
150477 - nor, for the right supraclavicular also cited in the report on 081107,
150478 - but reviewed the next day on 081113. ref SDS 25 OO6M  This answers the
150479 - question on scope of radiation, asked in Millie's letter to the
150480 - medical team on 090213. ref SDS B1 T49R
150482 -  ..
150483 - Omitting treatment for right axillary may reflect belief that nodes
150484 - are not cancer, based on patient history showing these nodes have been
150485 - stable for a year, reported on 081112. ref SDS 24 RM6I
150487 -  ..
150488 - Omitting treatment of right supraclavicular similarly aligns with
150489 - analysis on 081113. ref SDS 25 SE9H
150490 -
150491 -             [On 090310 0351 Millie's letter to the medical team thanks
150492 -             UCSF for submitting the radiation treatment plan.
150493 -             ref SDS B3 O56P
150495 -              ..
150496 -             [On 090312 0800 during meeting at UCSF with Tara in the
150497 -             Breast Care Clinic, Millie submitted a copy of the
150498 -             radiation treatment plan received from UCSF today, and
150499 -             Tara entered notes in Millie's medical chart for
150500 -             collaboration with radiation oncology to support
150501 -             comprehensive care. ref SDS B4 8V60
150503 -              ..
150504 -             [On 090312 0800 during meeting at UCSF to evaluate
150505 -             response to treatment, the doctor reviewed the "Radiation
150506 -             Oncology Course:  1" on the computer and advised that the
150507 -             UCSF plan is for 4 weeks of treatment because that is all
150508 -             of the radiation Millie can tolerate due to prior
150509 -             radiation treatments in 2002, and the UCSF plan calls for
150510 -             using radiation with hyperthermia because that provides
150511 -             the strongest treatment for IBC, and therefore since
150512 -             Millie can only tolerate 4 weeks of treatment 4 days per
150513 -             week, her last treatment will be on 090317. ref SDS B4
150514 -             NV66
150516 -              ..
150517 -             [On 090317 Millie gets last day of treatment with
150518 -             radiation and hyperthermia. ref SDS B5 9L7K
150520 -              ..
150521 -             [On 090326 0054 Millie's letter reports that radiation
150522 -             treatment plan was submitted to primary care physician at
150523 -             Kaiser. ref SDS B7 6A5R
150525 -              ..
150526 -             [On 090415 1642 report for CT test on 090413 reported
150527 -             progression of nodules in the lungs, ref SDS B8 RV78;
150528 -             after completing 4 weeks of intense radiation 090317;
150529 -             research indicates "ground glass opacities" are early
150530 -             stages of lung cancer; and, lung cancer can be safely
150531 -             excised without lobectomy surgery. ref SDS B8 LG9L
150532 -
150533 -
150534 -
150535 -
150536 -
150537 -
150538 -
150539 -
1506 -