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: March 13, 2009 01:27 AM Friday; Rod Welch

Millie's letter to Kaiser reports UCSF finds recovery from IBC responding
to treatment with radiation and hyperthermia examination on March 12th.

1...Summary/Objective
2...IBC Recovering Radiation Hyperthermia Finding Examination UCSF


..............
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CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS C0 0000. ref SDS B9 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 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 A7 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 A7 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 A7 TH6X
040929 -         ..
040930 -    4.  On 090218 1205 Millie asks UCSF about responding, ref SDS A7
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 A7 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 A7 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 A9 XX5O
040955 -
040956 -           b.  Computer file of picture showing typical configuration
040957 -               of radiation treatment. ref SDS A9 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 A9 EA4Q
040970 -                ..
040971 -           d.  Hyperthermia is a sonar process of some kind.
040972 -               ref SDS A9 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 A9 EA4W
040982 -                ..
040983 -           f.  Metrics for evaluating when treatment concludes.
040984 -               ref SDS A9 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 A9
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 A9 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 A9 WF5I
041010 -         ..
041011 -    7.  On 090220 0915 Millie radiation and hyperthermia treatment at
041012 -        UCSF. ref SDS B0 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 B0 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 B1 PR4Y
041021 -         ..
041022 -    9.  On 090220 1548 reviewed BSD paper explaining hyperthermia
041023 -        treatment for recovering from cancer, ref SDS B1 GK6F,
041024 -        including hyperthermia alone...
041025 -
041026 -               hyperthermia................. ref SDS B1 004P
041028 -         ..
041029 -        In combination with....
041030 -
041031 -               radiation.................... ref SDS B1 TT6L
041032 -               chemotherapy................. ref SDS B1 0129
041033 -               biological vaccines.......... ref SDS B1 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 B2 T47U
041041 -                 ..
041042 -            b.  Requests work plan for radiation treatments.
041043 -                ref SDS B2 3N9J and ref SDS B2 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 B2 T48S, and
041049 -                asks if this will be radiated, and what other areas
041050 -                will be radiated. ref SDS B2 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 B2 T49Y
041058 -                 ..
041059 -            e.  Reports Cellulitis and lymphadema have been continuing
041060 -                problems on left arm, ref SDS B2 T44R, asks if Keflex
041061 -                should be started to prevent recurrence caused by
041062 -                treatment for IBC? ref SDS B2 T44W
041064 -                 ..
041065 -            f.  Requests picture of Millie getting hyperthermia
041066 -                treatment showing configuration of work process.
041067 -                ref SDS B2 T45S
041069 -         ..
041070 -   11.  On 090223 1428 Millie receives letter from Chris saying UCSF
041071 -        looking for radiation treatment plan. ref SDS B3 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 B3 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 B5 S65I  Included INR test required once a
041082 -        month to verify dose of Coumadin treatments of pulmonary
041083 -        embolism. ref SDS B5 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
041088 -         ..
041089 -   14.  On 090310 0351 Millie letter to medical team submits agenda for
041090 -        meeting at UCSF on 090312 0800, ref SDS B6 PR4Y, scheduled by
041091 -        Doctor Rugo on 090210 to evaluate response to treatment with
041092 -        hyperthermia and Doxil to establish local control of IBC,
041093 -        ref SDS A5 XU5N, and begin planning follow on care to treat
041094 -        cancer as chronic disease, ordered by Doctor Johnson at Kaiser
041095 -        on 090213. ref SDS A6 GD3I
041096 -
041097 -        a.  Treatment plan - Millie's invites Doctor Hsu to attend
041098 -            meeting with Breats Care Clinic on 090312 to collaborate on
041099 -            clarifying work plan for Millie to recover from IBC based
041100 -            on evaluation of response to treatment in relatino to
041101 -            original plan for 4 - 6 weeks of radiation treatment.
041102 -            ref SDS B6 O55W
041104 -             ..
041105 -        b.  Slow recovery disappointing becasue breastbone area looks
041106 -            much worse. ref SDS B6 O56X
041108 -             ..
041109 -        c.  Blood test report of labs at Kaiser on 090309 requested for
041110 -            submision to UCSF to support meeting on 090312 that
041111 -            evaluates response to treatment. ref SDS B6 O63Q
041113 -             ..
041114 -        d.  CA 15-3 blood test cancer marker diagnostic only objective
041115 -            metric on response to treatment. ref SDS B6 O63T
041116 -            Significant rise of cancer marker at Kaiser in recent
041117 -            months, and extreme differences with cancer marker at UCSF
041118 -            present challenges evaluating response to treatment.
041119 -            ref SDS B6 O63Y
041121 -             ..
041122 -        e.  Complicated diagnostic status increases requirements for
041123 -            interim assessment of response to teratment. ref SDS B6
041124 -            O64Y
041126 -             ..
041127 -        f.  Anemia seems to be recovering evidenced by labs at Kaiser
041128 -            on 090309 indicating effects of ending treatment on 090122
041129 -            with sunitinib protocol. ref SDS B6 O65R
041131 -             ..
041132 -        g.  Energy still low, but recovering shown by increased hiking
041133 -            at Lafayette reservoir.  May be able to tolerate adding
041134 -            chemotherapy with hyperthermia if needed to recover from
041135 -            IBC. ref SDS B6 O65V
041137 -             ..
041138 -        h.  Shoulder injury recovering with increased range of motion
041139 -            will be demonstrated during examination at Kaiser on 090312
041140 -            1300 in Orthopedics Department. ref SDS B6 O65Y
041142 -             ..
041143 -        i.  INR 2.2 within target range shows eliminating sunitinib
041144 -            chemotherapy treatment on 090122 has caused blood counts to
041145 -            fall back to normal continuing Coumadin treatment for
041146 -            pulminary embolism. ref SDS B6 O66R
041148 -         ..
041149 -   15.  On 090310 1142 called Kaiser to get the report for the blood
041150 -        test on 090309 in time for distribution to the medical team for
041151 -        being prepared to meet at UCSF on 090312. ref SDS B7 JH4H
041152 -        Florida checked the computer and found that CA 15-3 has not yet
041153 -        been posted to the report; she said to call back the next day
041154 -        on 090311 just before noon to arrange for getting the full
041155 -        report. ref SDS B7 QP6H
041157 -         ..
041158 -   16.  On 090310 1735 Millie received a letter from Tara suggesting
041159 -        the meeting tomorrow on 090312 0800 at UCSF be deferred because
041160 -        Doctor Rugo cannot attend, ref SDS B8 PR4Y, which was known on
041161 -        090210 when UCSF called and scheduled the meeting. ref SDS A5
041162 -        XU5N
041164 -         ..
041165 -   17.  On 090311 1047 Millie letter to primary care physician at
041166 -        Kaiser coordinates getting report for blood test on 090309 for
041167 -        meeting at Kaiser on 090312. ref SDS B9 S84F
041169 -             ..
041170 -        a.  Requests advice from primary care physician at Kaiser on
041171 -            meeting with Tara at UCSF for evaluating response to
041172 -            treatment, ref SDS B9 TE3Y, for interim assessment after 3
041173 -            weeks of treatment to assess adjusting the course of
041174 -            action. ref SDS B9 TE4R
041176 -             ..
041177 -        b.  Begin planning treatment for next relapse. ref SDS B9 TE4U
041179 -             ..
041180 -        c.  Requests analysis of UCSF letter on 090310 asking about
041181 -            deferring meeting, ref SDS B9 TE4X, and notes advantages of
041182 -            examination based on Tara's experience treating Millie,
041183 -            expertise performing examinations, and experience caring
041184 -            for patients being treated for IBC with hyperthremia.
041185 -            ref SDS B9 TE5Q
041187 -             ..
041188 -        d.  Expresses preference to have the meeting in order to
041189 -            prevent new issues from delaying treatment. ref SDS B9 TE5T
041191 -         ..
041192 -   18.  On 090311 1431 Millie letter to UCSF with copy to Kaiser...
041193 -
041194 -        a.  Thanks Doctor Johnson and Arlette for expediting blood test
041195 -            report, ref SDS C0 5Z9K, needed for meeting at UCSF to
041196 -            evaluate response to treatment, which was scheduled by UCSF
041197 -            on 090210 for tomorrow on 090312 0800 with Tara.
041198 -            ref SDS A5 XU5N
041200 -             ..
041201 -        b.  Asks Tara to submit a date and time for rescheduling the
041202 -            meeting to evaluate response to treatment, ref SDS C0 O15X,
041203 -            if she feels the meeting should be deferred until Doctor
041204 -            Rugo is available, as set out in Tara's letter the day
041205 -            before on 090311 1935. ref SDS B8 PR4Y  Doctor Hsu and
041206 -            Chris have been terrific in Radiation Oncology; Millie
041207 -            requests Tara's assessment of recovery, ref SDS C0 O16S,
041208 -            based on the meeting in January when Tara discussed
041209 -            experience caring for IBC patients treated with
041210 -            hyperthermia [reported in a letter to the medical team on
041211 -            090130. ref SDS 66 4S8O].
041213 -             ..
041214 -        c.  Millie will stop by the Breast Care Clinic in the morning
041215 -            on 090312 0800, since treatment does not start until 0915
041216 -            in the Radiation Oncology Department, so that Tara can
041217 -            evaluate response to treatment, if she feels this can be a
041218 -            productive meeting. ref SDS C0 O16V
041220 -         ..
041221 -   19.  On 090311 1517 called Kaiser to get the report with CA 15-3 for
041222 -        the blood test at Kaiser on 090309, and as planned in telecon
041223 -        with Florida the day before on 090310.  Problems contacting
041224 -        someone at Kaiser to implement Kaiser's instructions required
041225 -        being on hold for an hour. ref SDS C1 6Z4F  In the afternoon,
041226 -        Millie received blood test report from Kaiser without CA 15-3
041227 -        diagnostic for evaluating response to treatment at UCSF on
041228 -        090312. ref SDS C1 1U7J
041230 -         ..
041231 -   20.  On 090312 0800 Millie meeting in Breast Care Clinic;
041232 -        receptionist said Tara would meet with Millie. ref SDS C2 TP9L
041233 -
041234 -        a.  Lab report for blood test on 090309 at Kaiser, ref SDS B5
041235 -            075H, submitted to UCSF, and without CA 15-3 diagnostics.
041236 -            ref SDS C2 337K
041238 -             ..
041239 -        b.  Radiation treatment plan which also controls the schedule
041240 -            for Millie's hyperthermia treatments, and which was
041241 -            received from Doctor Hsu on 090226, ref SDS B4 D452, was
041242 -            submitted to Tara for Millie's record in the Breast Care
041243 -            Clinic. ref SDS C2 8V60
041245 -             ..
041246 -        c.  Examination shows many open, oozing sores in the breastbone
041247 -            area, ref SDS C2 9L7K, where IBC was most acute during
041248 -            prior examintion on 090129, ref SDS 66 4S8O, and IBC
041249 -            appears worse, reported to the medical team on 090130 that
041250 -            Millie is disappointed by evident slow recovery from IBC.
041251 -            ref SDS B6 O56X  Tara diagnosed this condition as reaction
041252 -            to radiation and concluded Millie shows a strong response
041253 -            to treatment. ref SDS C2 YX9F
041255 -             ..
041256 -        d.  Doctor Rugo has a number of treatment ideas for helping
041257 -            Millie continue recovering from IBC, ref SDS C2 QQ9L, after
041258 -            radiation and hyperthermia by treating Millie's IBC as a
041259 -            chronic disease, requested by Doctor Johnson at Kaiser
041260 -            during the meeting on 090213. ref SDS A6 GD3I
041262 -         ..
041263 -   21.  On 090312 0800 Millie meeting in Radiation Oncology at 0930
041264 -        with Doctor Hsu, ref SDS C2 02AC, and Chris joined the meeting
041265 -        at 0952. ref SDS C2 F935
041266 -
041267 -        a.  Doctor Hsu advises review on 090312 was timely to assess
041268 -            Millie's progress responding to radiation and hyperthermia
041269 -            treatments; examination shows strong recovery from IBC
041270 -            compared with severe disease found during examination 5
041271 -            weeks earlier on 090205. ref SDS C2 F88K
041273 -             ..
041274 -        b.  Asked about UCSF metrics to evaluate recovery from IBC
041275 -            after treatment with radiation and hyperthermia; research
041276 -            on 090129 indicates enhanced MRI technology can show
041277 -            severity of IBC in the skin after treatment, ref SDS 63
041278 -            SQ6L; Doctor Hsu advised that severe blistering and open
041279 -            sores on Millie's chest are a positive result of treatment
041280 -            that shows maximum recovery from IBC and do not signal
041281 -            worsening IBC. ref SDS C2 1R5I
041283 -             ..
041284 -        c.  Radiation and hyperthermia treatments will be completed on
041285 -            090317 calculated from the UCSF work plan submitted to
041286 -            Millie on 090226. ref SDS C2 8P7G
041288 -             ..
041289 -        d.  Recovery from radiation and hyperthermia will continue for
041290 -            weeks and possibly months after treatment ends on 090317.
041291 -            ref SDS C2 VL4O, and so will take weeks and months to fully
041292 -            assess recovery after side effects from treatment of severe
041293 -            inflammation subside. ref SDS C2 F89Y
041295 -             ..
041296 -        e.  Cream will be supplied to treat side effects of radiation
041297 -            and hyperthermia. ref SDS C2 F852
041299 -             ..
041300 -        f.  Hyperthermia works best in multimodel combinations using
041301 -            radiation, chemotherapy, and biological vaccine therapies.
041302 -            ref SDS C2 E65L  Hyperthermia and radiation provide the
041303 -            strongest treatment for IBC, ref SDS C2 F97T; Millie's
041304 -            treatment was changed from hyperthermia and chemotherapy to
041305 -            hyperthermia and radiation, because examination on 090205
041306 -            showed IBC was more severe than expected. ref SDS C2 F96V
041307 -
041308 -
041309 -
041310 -
0414 -

SUBJECTS
Agenda Meeting Scheduled 090312 UCSF Breast Care Clinic and Radiatio

2503 -
250401 -  ..
250402 - IBC Recovering Radiation Hyperthermia Finding Examination UCSF
250403 -
250404 - Follow up ref SDS C0 PR4Y, ref SDS B9 PR4Y.
250405 -
250406 - On 090204 Doctor Rugo planned to meet after hyperthermia treatment and
250407 - evaluate next steps, following up the doctor's letter the day before
250408 - on 090203 saying she hopes to continue treating Millie after
250409 - hyperthermia. ref SDS 90 L36S
250411 -  ..
250412 - On 090210 Doctor Rugo's assistant called and scheduled a meeting on
250413 - 090312 0800 with Tara, because the doctor will be traveling at that
250414 - time. ref SDS A5 XU5N
250416 -  ..
250417 - On 090309 blood test at Kaiser was performed, ref SDS B5 S65I,
250418 - previously scheduled on 090213, ref SDS A6 WY5M, to support meeting at
250419 - UCSF on 090312.
250421 -  ..
250422 - On 090310 0351 Millie submitted a letter with an agenda for meeting at
250423 - UCSF on 090912 0800 to evaluate response to treatment and consider
250424 - adjustments in order for Millie recover from IBC. ref SDS B6 O64Y
250426 -  ..
250427 - On 090310 1735 Millie received a letter from Tara responding to the
250428 - agenda on a meeting scheduled by UCSF for tomorrow on 090312
250429 - evaluating response to treaement, and which was submitted to the
250430 - medical team in a letter earlier on 090312 0351. ref SDS B6 PR4Y  Tara
250431 - asks whether the meeting should scheduled for a month to occur on
250432 - 090312 should be be deferred until Doctor Rugo can attend. ref SDS B8
250433 - PR4Y
250435 -  ..
250436 - On 090311 Millie asked Tara submit a revised schedule for meeting with
250437 - Doctor Rugo; advised will stop by Breast Care Clinis at currently
250438 - scheduled time of 0800 to meet for examination if Tara has enough
250439 - time. ref SDS C0 O15X
250441 -  ..
250442 - On 090312 0800 Millie went to the Breast Care Clinic.  Tara was able
250443 - to meet and made an examination. ref SDS C2 TP9L  Later on 090312 at
250444 - 0930 in the Radiation Oncology Department, Doctor Hsu and Chris also
250445 - had time to meet with Millie. ref SDS C2 02AC
250447 -  ..
250448 - This morning, Millie sent a letter to the medical team explaining
250449 - results of meetings at UCSF yesterday...
250450 -
250451 -    1.  Subject: IBC Responding to Treatment Meeting at UCSF
250452 -        Date: Fri, 13 Mar 2009 01:32:59 -0800
250464 -         ..
250465 -    2.  Productive meetings yesterday morning at UCSF with Tara in the
250466 -        Breast Care Clinic, ref SDS C2 TP9L, and with Doctor Hsu, and
250467 -        Chris in Radiation Oncology. ref SDS C2 02AC
250469 -         ..
250470 -    3.  Tara noted that rapid advance of IBC during treatment with
250471 -        sunitinib immediately following rapid recovery reflects
250472 -        mutation  of my cancer into a more aggressive disease.
250473 -        ref SDS C2 XJ43  This seems to align with your analysis at
250474 -        Kaiser on 090213. ref SDS A6 GC6N
250476 -         ..
250477 -    4.  Tara explained that IBC and reaction to radiation are difficult
250478 -        to distinguish, ref SDS C2 YX40 (noted later by Doctor Hsu,
250479 -        ref SDS C2 F893); she feels IBC is at least stable, and likely
250480 -        much improved.  Nodules in the breastbone area are now much
250481 -        smaller and less "angry." ref SDS C2 ME3N
250483 -         ..
250484 -    5.  Tara indicated that open sores on my chest are likely not
250485 -        advancing IBC, but "reaction to radiation" that signal maximum
250486 -        treatment delivered to diseased tissue. ref SDS C2 YX9F
250488 -         ..
250489 -    6.  Tara wrote an Outpatient Progress Note on findings, ref SDS C2
250490 -        R45H, which I will submit for your files.  It says...
250491 -
250505 -         ..
250506 -    7.  Tara explained that Doctor Rugo is following patient progress
250507 -        via email, while traveling this week. ref SDS C2 SS4F
250509 -         ..
250510 -    8.  Tara has discussed my case with Doctor Rugo, and plans to
250511 -        provide more detailed update on examination today during
250512 -        regular patient reviews.  This will supplement Doctor Hsu's
250513 -        assessments (discussed below, ref SDS 0 MY7J).  Tara seemed to
250514 -        indicate Doctor Rugo has several follow on treatments in mind
250515 -        for my care, ref SDS C2 QQ9L, per your planning in the meeting
250516 -        at Kaiser on Feb 13th. ref SDS A6 GD3I
250518 -         ..
250519 -    9.  Doctor Hsu indicated that my hyperthermia treatments were
250520 -        calculated based on the amount of additional radiation I can
250521 -        tolerate after previous treatments in 2002. ref SDS C2 F866
250522 -        Ending treatment in a week or so, will not be based on
250523 -        assessment of having fully recovered from IBC, but will be
250524 -        required to prevent exceeding my tolerance for radiation.
250526 -         ..
250527 -   10.  Expectation is that the combination of radiation with
250528 -        hyperthermia has significantly reduced IBC toward local
250529 -        control. ref SDS C2 AH6L  I can get more hyperthermia later, if
250530 -        needed, but my skin will have to recover from reaction to
250531 -        radiation. ref SDS C2 F973  [...metrics requested in Millie's
250532 -        letter to the medical team on 090220, ref SDS A9 EA5P, were not
250533 -        discussed during the meeting yesterday, ref SDS C2 BY8L,
250534 -        considering research on 090129 that indicates enhanced MRI
250535 -        technology can directly measure IBC that requires treatment.
250536 -        ref SDS 63 JU4H...].
250537 -
250538 -            [On 090324 0548 Millie reports to medical team being
250539 -            encouraged, ref SDS C7 CT4U, after completing treatments at
250540 -            UCSF with radiation and hyperthermia on 090317, and getting
250541 -            favorable prognosis from Doctor Hsu during the meeting on
250542 -            090312. ref SDS C2 AH6L
250544 -             ..
250545 -            [On 090330 1200 Doctor Hsu indicated that weakness of
250546 -            visual examiantion for evaluating response to radiation and
250547 -            hyperthermia treatment recovering from IBC has will work
250548 -            better than enhanced MRI in Millie's case. ref SDS D0 LO5N
250550 -         ..
250551 -   11.  Doctor Hsu said that after radiation and hyperthermia are
250552 -        stopped, I will continue to recover from IBC for weeks,
250553 -        possibly months. ref SDS C2 VL4O  Additionally, my skin will
250554 -        also suffer more severe reaction to radiation, but will
250555 -        eventually heal. ref SDS C2 F860  He will provide a cream
250556 -        treatment to aid healing.  After the skin heals, a better
250557 -        assessment of local control can be made, I understood in 4 - 6
250558 -        weeks.  Evidently, my skin will look normal, but may have a
250559 -        different texture. ref SDS C2 F852
250560 -
250561 -            [On 090328 0909 Millie notifies medical team pain and
250562 -            suffering rising from radiation side effects 2 weeks after
250563 -            ending treatments at UCSF on 090317; side effects have been
250564 -            tolerated in order to benefit from treating IBC; Millie
250565 -            considering adding zink and Domeboro to increase relief
250566 -            from radiation "burn" side effects. ref SDS C0 4S4P
250568 -             ..
250569 -            [On 090604 1021 Millie's cancer marker drops 30 points in 2
250570 -            weeks after rising 70 points in 6 weeks, demonstrates
250571 -            continuing recovery from radiation treatments that ended on
250572 -            090317. ref SDS D2 07AD
250574 -         ..
250575 -   12.  I can have more hyperthermia, but not with radiation.
250576 -        ref SDS C2 F973  The doctor indicated best results occur
250577 -        combining hyperthermia with other modalities.  Chemotherapy
250578 -        would be an option. ref SDS C2 F984  Another would be
250579 -        biological therapy cited in UCSF documentation received on
250580 -        090220. ref SDS B1 0164
250582 -         ..
250583 -   13.  Doctor Hsu emphasized today that biological therapies are just
250584 -        coming on stream, and so have less of a track record.
250585 -        ref SDS C2 F991
250587 -         ..
250588 -   14.  Notice as well that the paper supports your discussion [at
250589 -        Kaiser on 090213, ref SDS A6 GD3I] of hyperthermia applied for
250590 -        "palliation." ref SDS B1 01G6  The meeting today gives hope
250591 -        that this consideration can be addressed effectively in the
250592 -        future.
250594 -         ..
250595 -   15.  CA 15-3 is another metric for assessment.  Since CA 15-3 was
250596 -        not listed on the report from Kaiser for the blood test last
250597 -        Monday on 090310 [noted during the meeting at UCSF on 090312
250598 -        0800, ref SDS C2 6I9L], I called [in the afternoon] after
250599 -        getting back from UCSF.  I was on hold so long I heard "Hound
250600 -        Dog" twice. ref SDS C3 6Z4F  Finally, Cisi came on the line
250601 -        after an hour, and said they have no record of CA 15-3 having
250602 -        been ordered.  Cisi indicated your department has had a re-org
250603 -        with new procedures, so things are hectic.  She suggested I
250604 -        contact you for CA 15-3 results. ref SDS C3 EM9K
250605 -
250606 -            [...in another record later today on 090313 0943 Arlette
250607 -            investigating to get results for CA 15-3 diagnostic for
250608 -            blood test on 090309. ref SDS C4 3R7J
250610 -             ..
250611 -            [On 090317 1120 Arlette ordered make up blood draw to
250612 -            test CA 15-3. ref SDS C5 YP6S
250614 -             ..
250615 -            [On 090317 1120 Millie went to Kaiser on the way home
250616 -            from treatment at UCSF and got another blood draw to test
250617 -            CA 15-3. ref SDS C5 PQ6R
250619 -             ..
250620 -            [On 090323 1352 CA 15-3 251 cancer marker declined for
250621 -            blood test at Kaiser on 090317 on the last day of
250622 -            Millie's treatment with radiation and hyperthermia at
250623 -            UCSF, ref SDS C6 NR4H; net improvement dropping 54 points
250624 -            from prior test at Kaiser on 090116, may represent much
250625 -            greater decline based on trend lines where Millie's
250626 -            cancer was rising rapidly during 4 weeks without
250627 -            treatment. ref SDS C6 NR4O
250629 -             ..
250630 -            [On 090325 0830 primary care physician disappointed by
250631 -            continual delays submittng data to UCSF, and notes conflict
250632 -            with requirements to streamline delivery of care in order
250633 -            to treat Millie's cancer at this time as a chronic disease.
250634 -            ref SDS C8 RB3G
250636 -             ..
250637 -            [On 090420 1451 Doctor Mason reported that other patients have
250638 -            not reported problems having labs performed at Kaiser and
250639 -            submitted to UCSF for referral treatment. ref SDS D1 2H8J
250641 -         ..
250642 -   16.  Overall, recovery seems to be on track, as much as possible for
250643 -        a 6th relapse.  I feel much better understanding what lies
250644 -        ahead, including options for evolving scenarios. ref SDS C2
250645 -        F973
250647 -         ..
250648 -   17.  Thanks to the medical team at UCSF for progress review today.
250649 -
250656 -
250657 -
250658 -
250659 -
250660 -
250661 -
250662 -
250663 -
250664 -
2507 -