CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS B4 0000. ref SDS B3 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 66 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 A8 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 A8 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 A0 PN8H, and which cites Doctor Benz 2nd opinion at
040925 -        UCSF on 041018 saying Millie likely cannot tolerate more
040926 -        radiation. ref SDS A0 YO9G  Was that so long ago, there is risk
040927 -        from additional radiation now? ref SDS A8 TH6X
040929 -         ..
040930 -    4.  On 090218 1205 Millie asks UCSF about responding, ref SDS A8
040931 -        TH7V, to the letter a week ago on 090209 requesting explanation
040932 -        of side effects from radiation and hyperthermia, ref SDS A3
040933 -        745R, following Doctor Hsu's comments during the meeting on
040934 -        090205. ref SDS A0 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 A3 745R, which can be problematic with
040939 -        Coumadin, so Gloria in the Coagulation Control Clinic at Kaiser
040940 -        will need input. ref SDS A8 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 A8 TH7Y  Millie Thanks Doctor Hsu
040946 -        for expediting care, reported on 090203, ref SDS 86 XX5I, and
040947 -        to Doctor Rugo for guidance through troubled waters, shown by
040948 -        UCSF letter on 090202 1722. ref SDS 81 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 B0 XX5O
040955 -
040956 -           b.  Computer file of picture showing typical configuration
040957 -               of radiation treatment. ref SDS B0 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 B0 EA4Q
040970 -                ..
040971 -           d.  Hyperthermia is a sonar process of some kind.
040972 -               ref SDS B0 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 B0 EA4W
040982 -                ..
040983 -           f.  Metrics for evaluating when treatment concludes.
040984 -               ref SDS B0 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 B0
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 B0 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 B0 WF5I
041010 -         ..
041011 -    7.  On 090220 0915 Millie radiation and hyperthermia treatment at
041012 -        UCSF. ref SDS B1 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 B1 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 B2 PR4Y
041021 -         ..
041022 -    9.  On 090220 1548 reviewed BSD paper explaining hyperthermia
041023 -        treatment for recovering from cancer, ref SDS B2 GK6F,
041024 -        including hyperthermia alone...
041025 -
041026 -               hyperthermia................. ref SDS B2 004P
041028 -         ..
041029 -        In combination with....
041030 -
041031 -               radiation.................... ref SDS B2 TT6L
041032 -               chemotherapy................. ref SDS B2 0129
041033 -               biological vaccines.......... ref SDS B2 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 B3 T47U
041041 -                 ..
041042 -            b.  Requests work plan for radiation treatments.
041043 -                ref SDS B3 3N9J and ref SDS B3 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 B3 T48S, and
041049 -                asks if this will be radiated, and what other areas
041050 -                will be radiated. ref SDS B3 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 B3 T49Y
041058 -                 ..
041059 -            e.  Reports Cellulitis and lymphadema have been continuing
041060 -                problems on left arm, ref SDS B3 T44R, asks if Keflex
041061 -                should be started to prevent recurrence caused by
041062 -                treatment for IBC? ref SDS B3 T44W
041064 -                 ..
041065 -            f.  Requests picture of Millie getting hyperthermia
041066 -                treatment showing configuration of work process.
041067 -                ref SDS B3 T45S
041069 -         ..
041070 -   11.  On 090223 1428 Millie receives letter from Chris saying UCSF
041071 -        looking for radiation treatment plan. ref SDS B4 PR4Y
041073 -         ..
041074 -   12.  On 090223 1428 Millie receives file of picture showing scope of
041075 -        hyperthermia treatments at UCSF for recovering from IBC.
041076 -        ref SDS B4 GZ4H
041078 -         ..
041079 -   13.  On 090309 Millie had blood draw at Kaiser for test to support
041080 -        examination at UCSF on 090312 to evaluate response to
041081 -        treatment. ref SDS B6 S65I  Included INR test required once a
041082 -        month to verify dose of Coumadin treatments of pulmonary
041083 -        embolism. ref SDS B6 PU7Y  Blood draw flushes port catheter,
041084 -        also, required at least within 5 weeks, when patient not
041085 -        getting chemotherapy treatments, as planned during meeting at
041086 -        Kaiser on 090213. ref SDS A6 6P3F
041087 -
041088 -
041089 -
041090 -
041091 -
0411 -

SUBJECTS
Agenda Meeting Scheduled 090312 UCSF Breast Care Clinic and Radiatio

2503 -
250401 -  ..
250402 - Agenda Meeting UCSF March 12 Progress Review Recover IBC
250403 -
250404 - Follow up ref SDS B4 PR4Y, ref SDS B3 PR4Y.
250405 -
250406 -    1.  Subject: IBC Progress Review March 12, 2009 0800 UCSF
250407 -        Date: Tue, 10 Mar 2009 04:02:43 -0800
250421 -         ..
250422 -    2.  I am meeting with Doctor Rugo's colleague in the Breast Care
250423 -        Clinic, Tara Lacy, NP, on Thursday at 0800 [scheduled by Lena
250424 -        on 090210. ref SDS A5 XU5N  Doctor Rugo attends when time
250425 -        permits, to provide strategic analysis, e.g., on 090129 she got
250426 -        the ball rolling at Kaiser by writing a letter [listed in the
250427 -        record on 090130] reporting my condition to Doctor Johnson at
250428 -        Kaiser, and requirements for your support in radiation oncology
250429 -        for achieving local control. ref SDS 66 TZ6H
250430 -
250431 -            [On 090310 1935 Millie received letter from Tara at UCSF
250432 -            saying Doctor Rugo cannot meet on 090312, and suggesting
250433 -            Millie reschedule the meeting to another date no specified
250434 -            when Doctor Rugo can attend. ref SDS B8 PR4Y
250436 -             ..
250437 -            [On 090311 1431 Millie's letter to UCSF responds to Tara's
250438 -            letter on 090310 1935 proposing to defer meeting on 090312,
250439 -            and Millie requests date to reschedule meeting with Doctor
250440 -            Rugo for planning treatment of Millie's IBC as a chronic
250441 -            disease. ref SDS B9 O15X
250443 -             ..
250444 -            [On 090312 Tara clarified that she has very limited
250445 -            experience caring for patients with IBC who have been
250446 -            treated with radiation and hyperthermia in the UCSF
250447 -            Radication Oncology Department, ref SDS C1 SP8J; Doctor Hsu
250448 -            cited extensive experience treating IBC patients with
250449 -            radiation and hyperthermia, and advised that examination
250450 -            shows rising IBC symptoms are actually evidence of side
250451 -            effects from treatment with radiation and hyperthremia, and
250452 -            this worsening condition will get worse, but eventually
250453 -            recover, and further signals expected recovery from IBC.
250454 -            ref SDS C1 F84U
250455 -
250456 -
250458 -  ..
250459 - Doctor Meet Breast Care Clinic Collaborate Comprehensive Care
250460 - IBC Recover Evaluate Response Treatment Plan Treatments Required
250461 - Evaluate Response Treatment Plan Treatments Required Recover from IBC
250462 -
250463 -
250464 -    3.  Hopefully, your schedule will permit stopping by for
250465 -        collaboration to assess my current condition and plans for the
250466 -        period ahead.  We originally discussed [on 090205] 4 - 6 weeks
250467 -        of treatment may be needed. ref SDS A0 PR8J  We have now done 3
250468 -        weeks; so, another week seems optimistic to achieve local
250469 -        control.  Will another 3 weeks be enough, or does it now seem
250470 -        like this will be extended?
250471 -
250472 -            [On 090310 1935 Millie received a letter to Tara at UCSF
250473 -            saying Doctor Rugo cannot meet on 090312, and suggesting
250474 -            Millie reschedule the meeting to another date no specified
250475 -            when Doctor Rugo can attend. ref SDS B8 PR4Y
250477 -             ..
250478 -            [On 090312 0800 UCSF advised the work plan calls for only 4
250479 -            weeks of treatment regardless of whether this is enough for
250480 -            Millie to recover, because Millie's patient history can
250481 -            only tolerate radiation treatment for 4 days a week for 4
250482 -            weeks. ref SDS C1 F96V
250484 -             ..
250485 -            [On 090312 0800 meeting with Tara in Breast Care Clinic
250486 -            examination indicates Millie shows strong recovery from IBC
250487 -            with current treatment plan. ref SDS C1 9L7K  Lack of blood
250488 -            test for CA 15-3 cancer marker makes evaluation more
250489 -            difficult without definitive metrics of trends. ref SDS C1
250490 -            YX5F  Meeting with Doctor Hsu in Radiation Oncology
250491 -            concurred that examination shows strong response to
250492 -            treatment. ref SDS C1 H68O
250494 -         ..
250495 -    4.  Thanks Doctor Hsu for documentation listing the radiation sites
250496 -        [received from UCSF on 090226. ref SDS B5 D452]
250497 -
250498 -            [On 090312 the doctor used the listing of radiation
250499 -            treatments received on 090226 to disclose that the work
250500 -            plan for Millie requires 4 weeks of treatments 4 days per
250501 -            week, and the last day of Millie's treatment with radiation
250502 -            and hyperthermia will be 090317. ref SDS C1 GY5G
250504 -         ..
250505 -    5.  Thanks, also, to Chris for documentation on scope of
250506 -        hyperthermia in the UCSF submission on 090220.  The work plan
250507 -        dated 090209 clarifies scope. ref SDS B2 PR4Y  The paper
250508 -        explaining hyperthermia is very helpful, ref SDS B2 GK6F,
250509 -        including application with radiation which we have been doing,
250510 -        ref SDS B2 TT6L, and also indicates strong potential for Doctor
250511 -        Rugo's plan to add chemotherapy. ref SDS B2 3T6K
250513 -         ..
250514 -    6.  At this time, I am disappointed about slow recovery, but not
250515 -        discouraged.  The breastbone area looks worse, but that may be
250516 -        normal reaction to radiation, rather than advancing disease.
250517 -        Some of the IBC nodules have bled, which is new.  However, they
250518 -        feel smaller.  I told Chris yesterday that I have given up on
250519 -        looking at my chest until there is an environmental impact
250520 -        study saying it is safe for inexperienced eyes (just joking).
250522 -             ..
250523 -            [On 090312 0800 examination in Breast Care Clinic finds
250524 -            worsening symptoms signal recovery from IBC because strong
250525 -            reaction to radiation indicates IBC receiving significant
250526 -            treatment. ref SDS C1 9L7K  Tara clarified that she has
250527 -            very limited experience caring for patients with IBC who
250528 -            have been treated with radiation and hyperthermia in the
250529 -            UCSF Radication Oncology Department, ref SDS C1 SP8J;
250530 -            Doctor Hsu cited extensive experience treating IBC patients
250531 -            with radiation and hyperthermia, and advised that
250532 -            examination shows rising IBC symptoms are actually evidence
250533 -            of side effects from treatment with radiation and
250534 -            hyperthremia, and this worsening condition will get worse,
250535 -            but eventually recover, and further signals expected
250536 -            recovery from IBC. ref SDS C1 F84U
250538 -             ..
250539 -            [On 090317 Millie receives Silvadene Cream 1% from Doctor
250540 -            Hsu, ref SDS C4 M442, and also received instructions from
250541 -            Miranda for application, including an orientation for
250542 -            bandaging to recover from expanding sores caused by
250543 -            radiation and hyperthermia treatments. ref SDS C4 ET46
250545 -             ..
250546 -            [On 090401 0121 Doctor Rugo notifies Millie and the medical
250547 -            team that treatment of IBC recurrence on the lower left arm
250548 -            diagnosed by Doctor Hsu, reported on 090401 0032,
250549 -            ref SDS C8 R24X, must be delayed until Millie's wound heals
250550 -            in breastbone area diagnosed as reaction to radiation in
250551 -            the meeting on 090330 1200, ref SDS C7 MN6F, and so defers
250552 -            meeting scheduled on 090402 0800; expects recovery from IBC
250553 -            in areas treated with radiation and hyperthermia to be very
250554 -            effective. ref SDS C9 K56O
250556 -             ..
250557 -            [On 090607 2253 Millie notified medical team that wound in
250558 -            the breastbone area diagnosed as reaction to readiation
250559 -            treatment was worse; requested additional treatment planned
250560 -            by UCSF. ref SDS C0 KS62
250562 -             ..
250563 -            [On 090609 Doctor Hsu advises that the wound in Millie's
250564 -            breastbone area is not caused by reaction to radiation
250565 -            treatments; the bleeding wound was caused by a mistake
250566 -            performing radiation in February and March at UCSF that
250567 -            missed treating IBC in the breastbone area and this
250568 -            untreated IBC tumor has caused cancer to spread, and causes
250569 -            problems in Millie's lungs that prevent breathing.
250570 -            ref SDS C1 TP9L
250572 -         ..
250573 -    7.  For Doctor Johnson (copy to Arlette), can you please ask Bella
250574 -        or Cisi, Forida, Sherree, anyone in the Chemotherapy Infusion
250575 -        Clinic to print the report with ANC calculated and in the usual
250576 -        format with a log #, date, etc, for the blood test on 090309,
250577 -        ref SDS B6 S65I, and ordered by you at Kaiser on 090213.
250578 -        ref SDS A6 WY5M  I will stop by Kaiser on the way home from
250579 -        treatment this afternoon and enter it in the record, so we have
250580 -        a published version that enables everyone to work from a common
250581 -        data set in time for the meeting Thursday morning [that helps
250582 -        solve the problem presented during the meeting at Kaiser also
250583 -        on 090213 of everyone needing fast, easy access to a common set
250584 -        of medical records on patient history, ref SDS A6 4Y8F].
250585 -
250586 -               [...in another record later today on 090310 1142 called
250587 -               Kaiser, and talked to Florida; made plans for Millie to
250588 -               get the report tomorrow for the blood test yesterday in
250589 -               order to be prepared for the meeting in 2 days at UCSF
250590 -               on 090312. ref SDS B7 JH4H
250592 -                ..
250593 -               [On 090311 1517 Lupe in the Oncology Chemotherapy
250594 -               Infusion Clinic will fax a copy to Tara at UCSF for the
250595 -               meeting on 090312 0800; concerned about problems with
250596 -               the fax machine. ref SDS C0 A63N
250598 -                ..
250599 -               [On 090311 1517 after meeting at the Wellness Community
250600 -               in Pleasant Hill, Millie drove to Kaiser in Walnut Creek
250601 -               and picked up a copy of the report for the blood test on
250602 -               090309. ref SDS C0 6Z4F
250604 -                ..
250605 -               [On 090312 0800 UCSF did not receive fax from Kaiser for
250606 -               blood test report. ref SDS C1 XE3K  Tara used the copy
250607 -               that Lupe printed for Millie and was picked up from
250608 -               Kaiser in the afternoon by driving to and from Kaiser on
250609 -               090311 1517. ref SDS C0 524N
250611 -         ..
250612 -    8.  CA 15-3 results may not be available until Wednesday, since the
250613 -        blood draw was yesterday.  It would help if this can be
250614 -        expedited with the outside lab.  Since we did not do a scan
250615 -        this cycle, other than visual examination, CA 15-3 is our only
250616 -        metric.  As we discussed on 090213 there is a huge difference
250617 -        in presentation of these markers. ref SDS A6 A46O  UCSF CA 15-3
250618 -        113 was reported on 090129. ref SDS 61 A16M
250620 -  ..
250621 - On 090129 research found enhanced MRI technology shows the extent of
250622 - IBC in the skin, which typically not evident using CT and PET scan
250623 - technology. ref SDS 63 SQ6L
250625 -  ..
250626 - Millie's letter on 090220 asked the medical team to explain metrics
250627 - for evaluating response to treatment beyond visual examination, which
250628 - has been problematic in patient history. ref SDS B0 EA5P
250629 -
250630 -               [On 090311 1517 report for the blood test on 090309 did
250631 -               not include the cancer marker. ref SDS C0 1U7J
250633 -                ..
250634 -               [On 090312 0800 examination at UCSF indicates evaluating
250635 -               response to treatment is complicated because CA 15-3
250636 -               cancer marker diagnostic was missing from Kaiser's
250637 -               report on the blood test on 090309. ref SDS C1 YX5F
250639 -                ..
250640 -               [On 090312 0800 examination at UCSF radiation oncology
250641 -               department does not discuss using enhanced MRI for
250642 -               metric evaluating recovery from IBC after treatment with
250643 -               radiation and hyperthermia. ref SDS C1 BY8L
250645 -                ..
250646 -               [On 090312 1437 called Kaiser talked to Cisi; she
250647 -               reported that CA 15-3 was not ordered for blood test on
250648 -               090309, and recommended Millie contact the doctor to
250649 -               order the test. ref SDS C2 SV90
250651 -                ..
250652 -               [On 090313 0943 called Arlette to ask Doctor Johnson
250653 -               about getting CA 15-3 results for the blood test on
250654 -               090309 to support the record of examination at UCSF on
250655 -               090312. ref SDS C3 Y077
250657 -                ..
250658 -               [On 090317 1120 Millie went to Kaiser for make-up blood
250659 -               test to correct mistake that omitted CA 15-3 from the
250660 -               test on 090309. ref SDS C5 PQ6R
250662 -                ..
250663 -               [On 090323 1352 cancer marker for delayed blood test on
250664 -               090317 shows CA 15-4 251, reversing a year of rising
250665 -               cancer marker, suggesting possible favorable response to
250666 -               treatment. ref SDS C6 8T3I
250668 -                ..
250669 -               [On 090330 1200 Doctor Hsu indicated that weakness of
250670 -               visual examiantion for evaluating response to radiation
250671 -               and hyperthermia treatment recovering from IBC has will
250672 -               work better than enhanced MRI in Millie's case.
250673 -               ref SDS C7 LO5N
250675 -         ..
250676 -    9.  The rise of 14 points from CA 15-3 99 at UCSF just 3 weeks
250677 -        earlier, seems modest compared to the 100 point rise in
250678 -        Kaiser's testing on 081226 CA 15-3 212, and 2 weeks later on
250679 -        090116 CA 15-3 303. ref SDS 39 PQTQ
250681 -         ..
250682 -   10.  Seems like if the cancer marker for the test at Kaiser
250683 -        yesterday on 090309 has held steady or dropped, we may be okay.
250684 -        Another big jump could be problematic.  On 081219 there was
250685 -        discussion at Kaiser indicating the big jump in the cancer
250686 -        marker [CA 15-3 197 on 081210, ref SDS 26 A16M] can occur from
250687 -        sudden destruction of cancer cells.  This correlated with
250688 -        examinations at UCSF and Kaiser that found significant
250689 -        reduction of IBC rash at that time. ref SDS 30 3L8H
250690 -
250691 -               [On 090323 1352 cancer marker for delayed blood test on
250692 -               090317 shows CA 15-4 251, reversing a year of rising
250693 -               cancer marker, suggesting possible favorable response to
250694 -               treatment. ref SDS C6 8T3I
250696 -         ..
250697 -   11.  So, we have a complex picture.  It would help to get an interim
250698 -        analysis from Rad-Onc updating the treatment plan.  Are any
250699 -        adjustments needed?  Doctor Rugo discussed [on 090129 and
250700 -        reported on 090130] using Doxil with Hyperthermia. ref SDS 66
250701 -        HK3V  Will this or another agent work with radiation and
250702 -        hyperthermia?  Would this be difficult to tolerate?
250704 -  ..
250705 - On 090213 Doctor Johnson at Kaiser indicated that we need to get the
250706 - next treatment at UCSF lined up to treat Millie's cancer as a "chronic
250707 - disease," because after 6 relapses, she has less time for delays.
250708 - ref SDS A6 GD3I  This was reported to the medical team in Millie's
250709 - letter on 090218. ref SDS A8 TH6U
250710 -
250711 -            [On 090311 1431 Millie's letter to UCSF responds to Tara's
250712 -            letter on 090310 1935 proposing to defer meeting on 090312,
250713 -            and Millie requests date to reschedule meeting with Doctor
250714 -            Rugo for planning treatment of Millie's IBC as a chronic
250715 -            disease. ref SDS B9 O15X
250717 -  ..
250718 - Earlier on 090204, Millie received a list of possible follow on
250719 - treatments, ref SDS 96 4R3S, for her patient profile listed on 090121.
250720 - ref SDS 46 NU5H
250722 -  ..
250723 - More recently, on 090218 reviewed report of new treatment being tested
250724 - in clincial studies combining hyperthermia with Thermodox. ref SDS A7
250725 - P734
250726 -
250727 -            [On 090310 1935 Millie received a letter to Tara at UCSF
250728 -            saying Doctor Rugo cannot meet on 090312, and suggesting
250729 -            Millie reschedule the meeting to another date no specified
250730 -            when Doctor Rugo can attend. ref SDS B8 PR4Y
250732 -             ..
250733 -            [On 090311 1517 report for the blood test on 090309 did
250734 -            not include the cancer marker. ref SDS C0 1U7J
250736 -             ..
250737 -            [On 090312 complexity compounded evaluating Millie's
250738 -            response to treatment for prescribing care after radiation
250739 -            and hyperthermia, because interim analysis shows worsening
250740 -            symptoms signal recovery from strong reaction to radiation
250741 -            that indicates IBC receiving significant treatment.
250742 -            ref SDS C1 9L7K  Without cancer marker CA 15-3 results for
250743 -            the blood test on 090309, the only metric of recovery is
250744 -            visual observation based on experience. ref SDS C1 YX5F
250745 -            Tara clarified that she has very limited experience caring
250746 -            for patients with IBC who have been treated with radiation
250747 -            and hyperthermia in the UCSF Radication Oncology
250748 -            Department, ref SDS C1 SP8J; Doctor Hsu cited extensive
250749 -            experience treating IBC patients with radiation and
250750 -            hyperthermia, and advised that examination shows symptoms
250751 -            do not signal rising IBC, but are actually evidence of side
250752 -            effects from treatment with radiation and hyperthremia, and
250753 -            this worsening condition will get worse, but eventually
250754 -            recover, and further signals expected recovery from IBC,
250755 -            ref SDS C1 F84U, and therefore no adjustments are required
250756 -            to the treatment plan, answering the question in the letter
250757 -            to the medical team on 090310. ref SDS 0 O64Y
250759 -         ..
250760 -   12.  Preliminary results of the blood test at Kaiser [yesterday on
250761 -        090309] indicate ANC (NEUTS at UCSF) has recovered with WBC 4.0
250762 -        and neutrophils 51, Bands 2, so the calculation should be above
250763 -        1.5. ref SDS B6 QY6H  Looks like most of the counts have
250764 -        recovered from chronic lows since ending sunitinib on 090122.
250765 -        So, nominally, I may be able to handle complementary chemo, if
250766 -        this is needed to achieve local control, and prevent spread
250767 -        internally.
250769 -         ..
250770 -   13.  My energy has not been the best.  Hiked Lafayette on Saturday,
250771 -        just 1 lap about 3 miles, and then did the Safeway trail in
250772 -        Clayton, also 3 miles but flat, the next day on Sunday.  This
250773 -        is my first double in maybe 3 months, so I am getting stronger,
250774 -        but my sense is that continual radiation takes a toll.  Not
250775 -        sure how I can hold up adding chemo, but if it is necessary, we
250776 -        can try.
250777 -
250778 -               [On 090324 Millie hiked 4 days in a row, may indicate
250779 -               energy recovering.
250781 -         ..
250782 -   14.  For Doctor Boulris in Kaiser's Orthopedic Department, my
250783 -        shoulder range of motion is increasing with physical therapy,
250784 -        and home exercises.  Planning to get support at the gym for
250785 -        building strength with range of motion.  This has been
250786 -        difficult getting hyperthermia and radiation, rolling onto the
250787 -        shoulder.  The UCSF team in Radiation Oncology has been very
250788 -        considerate assisting me to prevent further injury.
250790 -         ..
250791 -   15.  For Gloria in Kaiser's Coagulation Control Department, [INR 2.2
250792 -        for the labs on 090309 is well within the target range],
250793 -        ref SDS B6 PU7Y  May reflect standing down on all chemo drugs
250794 -        the past cycle.  My sense would be to continue current dose for
250795 -        another cycle, and then adjust if elevated INR continues.
250797 -         ..
250798 -   16.  Looking forward to seeing the radiation team in the morning,
250799 -        along with Chris and Abby, and then meeting with Tara, Doctor
250800 -        Rugo and Doctor Hsu (if available) on Thursday.
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