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 23, 2009 01:52 PM Monday; Rod Welch

Called Kaiser to get report CA 15-3 251 shows response to treatment for
blood test on 090317 corrects mistake from labs on 090309.

1...Summary/Objective


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

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS B9 0000. ref SDS B7 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 -    1.  On 090213 the doctor ordered labs for Millie at Kaiser on
040902 -        090309 to evaluate progress with treatments at UCSF for cancer.
040903 -        ref SDS B0 IW68
040905 -         ..
040906 -    2.  On 090309 Millie went to Kaiser and blood was drawn for the
040907 -        lab. ref SDS B2 6Z4F
040909 -         ..
040910 -    3.  On 090310 Millie's letter to the medical team requested report
040911 -        for blood test on 090309 to support the meeting at UCSF need CA
040912 -        15-3 as only objective metric on progress responding to
040913 -        treatment. ref SDS B3 O63T
040915 -         ..
040916 -    4.  On 090311 Millie went to Kaiser and received a copy of the
040917 -        report for the blood test on 090309. ref SDS B4 CV83  The report
040918 -        received from Kaiser on 090311 did not include CA 15-3.
040919 -        ref SDS B4 CV9M
040921 -         ..
040922 -    5.  On 090312 Millie met with the medical team at UCSF and
040923 -        submitted the report for the blood test on 090309. ref SDS B2
040924 -        S65I  Tara entered this in the UCSF medical chart. ref SDS B5
040925 -        337K  She said that evaluation of resonse to treatment is
040926 -        difficult without CA 15-3, because IBC symptoms are similar to
040927 -        side effects of radiation and hyperthermia treatments.
040928 -        ref SDS B5 YX5F
040930 -         ..
040931 -    6.  On 090312 called Kaiser and learned mistake ordering blood
040932 -        tests computer shows CA 15-3 was not included in order for labs
040933 -        on 090309. ref SDS B6 SV8M
040935 -         ..
040936 -    7.  On 090313 called Arlette.  She planned to ask Doctor Johnson
040937 -        about CA 15-3, ref SDS B7 3R7J, results for the blood test at
040938 -        Kasier on 090309. ref SDS B2 S65I
040940 -         ..
040941 -    8.  On 090317 1120 called Kaiser and talked to Arlette; hectic
040942 -        schedule on 090313 prevented following up on plans to discuss
040943 -        CA 15-3 results for blood test on 090309. ref SDS B9 Y077
040945 -         ..
040946 -    9.  On 090317 1120 Arlette ordered make up blood draw to test CA
040947 -        15-3. ref SDS B9 YP6S
040949 -         ..
040950 -   10.  On 090317 1120 Millie went to Kaiser on the way home from
040951 -        treatment at UCSF and got another blood draw to test CA 15-3.
040952 -        ref SDS B9 PQ6R
040953 -
040954 -
040955 -
0410 -

SUBJECTS
Default Null Subject Account for Blank Record

0503 -
050401 -  ..
050402 - Connie called with results of Millie's blood test on 090317 for the
050403 - cancer marker CA 15-3 251, ref SDS B9 PQ6R, to correct omission in
050404 - Millie's lab on 090309, ref SDS B2 PQTQ, which was cited during
050405 - examination at UCSF on 090312. ref SDS B5 337K, and prevented accurate
050406 - assessment of response to treatment. ref SDS B5 YX5F
050408 -  ..
050409 - Connie noted with great delight that Millie has a significant 50 point
050410 - drop in the cancer marker for the prior lab at Kaiser that tested CA
050411 - 15-3 303 for the blood draw on 090116. ref SDS A6 A16M
050413 -  ..
050414 - Millie's letter to medical team on 090310 considered scenarios of
050415 - rising, stable, and declining cancer marker for evaluating response to
050416 - treatment. ref SDS B3 O64T
050418 -  ..
050419 - Net decline of 54 points (305 - 251) in the cancer marker today seems
050420 - to support examination in the Breast Care Clinic at UCSF on 090312
050421 - finding response to treatement. ref SDS B5 337K  Similar favorable
050422 - assessment in the Radiation Oncology Department also on 090312,
050423 - ref SDS B5 H68O, also supported by declining cancer marker reported
050424 - today, and effective on 090317, the day Millie's treatments ended at
050425 - UCSF.
050427 -  ..
050428 - Decline of 54 points from CA 15-3 305 on 090116 at Kaiser labs likely
050429 - represents a much larger improvement, because Millie's IBC was rising
050430 - rapidly during the 3 weeks after treatment with sunitinib was ended on
050431 - 090122. illustrated by sudden increase of 14 points after months of
050432 - stability in cancer marker calculated by the UCSF labs, and during 3
050433 - weeks from 090108 to 090129. (see study below, ref SDS 0 J13O)
050434 -
050435 -        [On 090325 0830 Doctor Johnson seems to concur with analysis
050436 -        today that cancer marker declined much more significantly based
050437 -        on rising trajectory from 090116 until the start of Millie's
050438 -        treatment on 090219. ref SDS C0 WU5O
050440 -  ..
050441 - If the cancer burden as measured by Kaiser labs continued to rise at
050442 - the same rate during the period from 090116 until the start of
050443 - treatment 5 weeks later with radiation and hyperthermia on 090219, as
050444 - occurred during the 3 weeks between 081226 and 090116 that would be
050445 - approximately...
050446 -
050447 -                     090116 - 091226 = 21 days
050449 -                 ..
050450 -                305 - 202 = 103 / 21 = 5 points rise per day.
050451 -
050452 -                     090219 - 090116 = 34 days
050453 -
050454 -                         5 x 34 days = 170
050456 -                            ..
050457 -                           305 + 170 = 475
050459 -                            ..
050460 -                           475 - 251 = 224 calculated minimal improvement
050462 -  ..
050463 - It seems likely that the cancer marker was accelerating rather than
050464 - increasing at a steady rate during the 4 weeks Millie did not get
050465 - treatment, so CA 15-3 diagnostic could have climbed to 500 or even
050466 - above 1000, until treatment started on 090219, based on Doctor Rugo's
050467 - letter on 090202 notifying the medical team that Millie needs urgent
050468 - treatment quickly to stop the spread of IBC disease. ref SDS A9 Y15J
050470 -  ..
050471 - The critical factor will be the next test to assess continued recovery
050472 - toward cancer marker targets (39 at Kaiser), and based on Doctor Hsu's
050473 - explanation at UCSF on 090312 that patients continue to get theraputic
050474 - benefits recovering from cancer for weeks and even months after
050475 - radiation and hyperthermia ends. ref SDS B5 VL4O
050477 -  ..
050478 - Patient history on CA 15-3 and treatments....
050479 -
050480 -                  Kaiser = K---|
050481 -                    UCSF = U---|
050482 -        Test Date                            Date Received
050483 -          100622........1116 H K.............. 100622, ref SDS D6 L54I
050484 -          100529........ 606 H K.............. 100606, ref SDS D5 8H5I
050485 -          100511........ 520 H K.............. 100511, ref SDS D4 L54I
050486 -          100426........ 424 H K.............. 100428, ref SDS D3 QX4O
050487 -          100413........ 367 H K.............. 100414, ref SDS D2 683K
050488 -          100329........ 384 H K.............. 100331, ref SDS D1 GE5F
050489 -          100316........ 369 H K.............. 100319, ref SDS D0 1T3Y
050490 -          100303....Abraxane begins........... 100303, ref SDS C9 625I
050491 -          100301........ 426 H K.............. 100301,
050492 -          100216........ 328 H K.............. 100217,
050493 -          100202........ 275 H K.............. 100202,
050494 -          100112....treatment paused 3 weeks.. 100112,
050495 -          100111........ 212 H K.............. 100111,
050496 -          091222........ 248 H K.............. 091222,
050497 -          091215........ 211 H K.............. 091215,
050498 -          091124........ 262 H K.............. 091215,
050499 -          091116....Navelbine begins.......... 091118, ref SDS C8 625I
050500 -          091103........ 299 H K..............
050501 -          091020........ 299 H K..............
050502 -          091006........ 343 H K..............
050503 -          090929........ 297 H K..............
050504 -          090921........ 302 H K..............
050505 -          090908........ 346 H K.............. 090908,
050506 -          090825........ 335 H K.............. 090825,
050507 -          090810........ 350 H K..............
050508 -          090728....Gemzar begins............. 090728, ref SDS C7 W65H
050509 -          090727........ 389 H K...........
050510 -          090716....MPA ends.................. 090716, ref SDS C6 YG8P
050511 -          090716........ 193 H U.............. 090716, ref SDS C5 A16M
050512 -          090616....MPA begin................. 090616, ref SDS C4 YO4J
050513 -          090602........ 289 H K.............. 090602, ref SDS C3 PQTQ
050514 -          090512........ 320 H K.............. 090512, ref SDS C2 PQTQ
050515 -          090413........ 271 H K.............. 090413, ref SDS C1 PQTQ
050516 -          090317........ 251 H K.............. 090323, ref SDS 0 Y077
050517 -          090317...rad hyprthmia end.......... 090317, ref SDS B8 9L7K
050518 -          090219...rad hyprthmia begin........ 090219, ref SDS B1 E57G
050519 -          090129........ 113 H U.............. 090129, ref SDS A8 A16M
050520 -          090122...sunitinib end.............. 090122, ref SDS A7 AT6N
050521 -          090116........ 303 H K.............. 090116, ref SDS A6 A16M
050522 -          090108......... 99 H U.............. 090108, ref SDS A5 A16M
050523 -          081218......... 95 H U.............. 081218, ref SDS A3 A16M
050524 -          081226........ 202 H K.............. 081226, ref SDS A4 A16M
050525 -          081210........ 197 H K.............. 081210, ref SDS A2 A16M
050526 -          081126........ 105 H U.............. 081126, ref SDS A1 A16M
050527 -          081114...sunitinib begin............ 081114, ref SDS A0 505G
050528 -          081023...cetuximab Carbo ends....... 081023, ref SDS 99 D65G
050529 -          081016........  95 H U.............. 081016, ref SDS 98 A16M
050530 -          080918........  95 H U.............. 080918, ref SDS 97 A16M
050531 -          080821........  96 H U.............. 080821, ref SDS 96 A16M
050532 -          080918......... 95 H U.............. 080918, ref SDS 97 VK6H
050533 -          080821......... 96 H U.............. 080821, ref SDS 96 VK6H
050534 -          080724......... 71 H U.............. 080724, ref SDS 95 TR4K
050535 -          080708.........141 H K.............. 080708, ref SDS 94 L74K
050536 -          080626......... 72 H U.............. 080626, ref SDS 93 PW7I
050537 -          080529......... 66 H U.............. 080529, ref SDS 92 IJ8L
050538 -          080501......... 59 H U.............. 080501, ref SDS 91 U34O
050539 -          080403......... 66 H U.............. 080403, ref SDS 90 A16M
050540 -          080313...cetuximab Carboplatin...... 080313, ref SDS 89 TZ8I
050541 -          080306......... 59 H U.............. 080306, ref SDS 88 A16M
050542 -          080207......... 63 H U.............. 080207, ref SDS 87 A16M
050543 -          080110......... 51 H U.............. 080110, ref SDS 86 A16M
050544 -          071213......... 48 H U.............. 071213, ref SDS 85 A16M
050545 -          071115......... 43 H U.............. 071115, ref SDS 84 A16M
050546 -          071018......... 75 H K.............. 071018, ref SDS 83 5K6K
050547 -          070920......... 38 H U.............. 070920, ref SDS 82 A16M
050548 -          070816......... 28 H U.............. 070816, ref SDS 81 A16M
050549 -          070719...**.... ?? H U.............. 070719, ref SDS 80 A16M
050550 -          070621......... 30 H U.............. 070621, ref SDS 79 A16M
050551 -          070524......... 37 H U.............. 070524, ref SDS 78 A16M
050552 -          070511......... 56 H K.............. 070516, ref SDS 77 RH9H
050553 -          070426......... 29 ..U.............. 070426, ref SDS 76 A16M
050554 -          070329......... 33 H U.............. 070406, ref SDS 75 EQ6I
050555 -          070301......... 36 H U.............. 070307, ref SDS 74 A16M
050556 -          070215......... 52 H K.............. 070307, ref SDS 73 ER5O
050557 -          070208......... 55 H K.............. 070307, ref SDS 73 ER5O
050558 -          070201...cetuximab begin............ 070201, ref SDS 71 G68I
050559 -          070131......... 56 H K.............. 070202, ref SDS 72 087J
050560 -          070123......... 52 H K.............. 070202, ref SDS 72 087J
050561 -          070118......... 68 H K.............. 070123, ref SDS 70 GK5B
050562 -          070104......... 56 H K.............. 070110, ref SDS 69 087J
050563 -          061218......... 74 H K.............. 061227, ref SDS 68 6P9F
050564 -          061214......... 63 H................ 061227, ref SDS 68 6P9F
050565 -          061130....capecitabine Taxotere.end. 061201, ref SDS 67 ZZ9N
050566 -          061130......... 67 H................ 061201, ref SDS 67 087J
050567 -          061116......... 66 H................ 061201, ref SDS 67 087J
050568 -          061110......... 56 H................ 061201, ref SDS 67 087J
050569 -          061109......... 61 H................ 061110, ref SDS 66 087J
050570 -          061026......... 57 H................ 061110, ref SDS 66 087J
050571 -          061019......... 56 H................ 061020, ref SDS 65 087J
050572 -          060928......... 51 H................ 060929, ref SDS 64 087J
050573 -          060907......... 68 H................ 060929, ref SDS 64 087J
050574 -          060813......... 73 H................ 060817, ref SDS 63 U24M
050575 -          060809......... 87 H................ 060810, ref SDS 62 2N5J
050576 -          060721....capecitabine Taxotere..... 060721, ref SDS 61 0001
050577 -          060708......... 71 H................ 060711, ref SDS 60 087J
050578 -          060616......... 63 H................ 060623, ref SDS 59 UQ5Q
050579 -          060522......... 59 H................ 060605, ref SDS 58 UQ5Q
050580 -          060501......... 49 H................ 060522, ref SDS 57 MC4F
050581 -          060421......... 44 H................ 060428, ref SDS 56 087J
050582 -          060330......... 40 H................ 060428, ref SDS 56 087J
050583 -          060303......... 36.................. 060428, ref SDS 56 087J
050584 -          060210......... 33.................. 060217, ref SDS 55 087J
050585 -          060109......... 34.................. 060126, ref SDS 54 KV59
050586 -          051223......... 34.................. 060106, ref SDS 53 087J
050587 -          051202....**... 28.................. 060106, ref SDS 53 087J
050588 -          051116......... 31.................. 051121, ref SDS 52 087J
050589 -          051109......... 30.................. 051121, ref SDS 52 087J
050590 -          051102......... 34.................. 051121, ref SDS 52 087J
050591 -          051021....Mastectomy surgery........ 051021, ref SDS 51 0001
050592 -          050916....capecitabine Taxotere end. 050916, ref SDS 49 407N
050593 -          050909......... 45 H................ 051007, ref SDS 50 087J
050594 -          050826......... 45 H................ 050913, ref SDS 48 087J
050595 -          050819......... 45 H................ 050913, ref SDS 48 087J
050596 -          050812......... 39 ................. 050819, ref SDS 47 3K6L
050597 -          050729......... 45 H................ 050819, ref SDS 47 EA5G
050598 -          050708......... 46 H................ 050729, ref SDS 46 087J
050599 -          050701......... 37 ................. 050708, ref SDS 45 2N5J
050600 -          050617......... 45 H................ 050729, ref SDS 46 087J
050601 -          050527......... 56 H................ 050610, ref SDS 44 087J
050602 -          050512......... 67 H................ 050520, ref SDS 43 087J
050603 -          050506......... 80 H................ 050520, ref SDS 43 087J
050604 -    050415.........105 H................ 050422, ref SDS 42 087J
050605 -          050415....capecitabine Taxotere..... 050329, ref SDS 41 AW5G
050606 -          050329....AC ends................... 050329, ref SDS 41 AW5G
050607 -          050325.........100 H................ 050329, ref SDS 41 087J
050608 -          050318.........101 H................ 050325, ref SDS 40 2N5J
050609 -          050304......... 88 H................ 050311, ref SDS 39 087J
050610 -          050225......... 95 H................ 050308, ref SDS 38 0001
050611 -          050211......... 78 H................ 050214, ref SDS 37 02BB
050612 -          050128......... 67 H................ 050204, ref SDS 36 087J
050613 -          050104....AC resume 3rd cycle....... 050104, ref SDS 35 407N
050614 -          041228......... 56 H................ 041230, ref SDS 34 087J
050615 -          041204......... 43 H................ 041210, ref SDS 33 087J
050616 -          041104....bevacizumab Taxol ends.... 041104, ref SDS 32 RZ4I
050617 -          041007......... 39.................. 041104, ref SDS 32 087J
050618 -          040923......... 49 H................ 041005, ref SDS 31 087J
050619 -          040908......... 44 H................ 040909, ref SDS 30 087J
050620 -          040825......... 47 H................ 040812, ref SDS 30 087J
050621 -          040811......... 42 H................ 040812, ref SDS 29 087J
050622 -          040728......... 43 H................ 040729, ref SDS 28 2N5J
050623 -          040712......... 47 H................ 040713, ref SDS 27 087J
050624 -          040614......... 55 H................ 040615, ref SDS 26 PX6X
050625 -          040517......... 78 H................ 040601, ref SDS 35 2N5J
050626 -          040420....bevacizumab Taxol begin... 040420, ref SDS 34 9Z5J
050627 -          040311......... 70 H................ 040318, ref SDS 33 SM6M
050628 -          040205......... 60 H................ 040211, ref SDS 32 SM6M
050629 -          031201......... 62 H................ 031205, ref SDS 31 SM6M
050630 -          030912......... 66 H................ 030915, ref SDS 30 SM6M
050631 -          030708......... 68 H................ 030710, ref SDS 29 SM6M
050632 -          030503......... 54 H................ 030508, ref SDS 28 SM6M
050633 -          030403......... 45 H................ 030508, ref SDS 28 SM6M
050634 -          030215......... 46 H................ 030220, ref SDS 27 5E6L
050635 -          030106......... 37 H................ 030109, ref SDS 26 SM6M
050636 -          021204....Taxotere phase II ends.... 021204, ref SDS 15 F5Z5
050637 -          021202......... 41 H?............... 021204, ref SDS 35 SP5G
050638 -          021111......... 36 H?............... 021113, ref SDS 34 Y65I
050639 -          021023......... 33 H?............... 021023, ref SDS 33 SQ5I
050640 -          021002....Taxotere phase II begin... 021002, ref SDS 12 XA5N
050641 -          020930......... 33 H?..29........... 021002, ref SDS 12 SQ5I
050642 -          020917......... 36 H?............... 020924, ref SDS 11 SQ5I
050643 -          020910....Radiation ends............ 020924, ref SDS 11 0J7H
050644 -          020723....Radiation begins.......... 020723, ref SDS 9 0001
050645 -          020717......... 59 H?............... 020726, ref SDS 10 YN5K
050646 -          020629......... 75 H ............... 020705, ref SDS 8 UX6I
050647 -          020610....Taxotere 2 cycles begin... 020610, ref SDS 6 MR5I
050648 -          020608........  67 H ............... 020614, ref SDS 7 0001
050649 -          020603....AC end after 2 cycles..... 020603, ref SDS 4 WO4O
050650 -          020603........ 108 H ............... 020607, ref SDS 5 X67F
050651 -          020511........ 117 H ............... 020603, ref SDS 4 PJ4J
050652 -          020423....AC adjuvant begin......... 020405, ref SDS 2 6SWS
050653 -          020419......... 81 H ............... 020430, ref SDS 3 7N5H
050654 -          020321......... 85 H ............... 020405, ref SDS 2 6T8K
050655 -          020312....lumpectemy................ 020312, ref SDS 1 Q78M
050656 -
050657 -
050658 -
050659 -
050660 -
050661 -
050662 -
050663 -
050664 -
050665 -
0507 -