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 26, 2009 01:42 PM Thursday;
Rod Welch
Radiation plan for Millie's treatment received from UCSF.
1...Summary/Objective
2...Radiation Treatment Plan Complements Hyperthermia Recover IBC
........Radiation Oncology Course: 1
..............
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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 -