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 26, 2009 00:54 AM Thursday; Rod Welch

Millie's letter to medical team reports meeting at Kaiser evaluate
response to radiation and hyperthermia completed at UCSF on 090317.

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 C9 0000. ref SDS C4 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
041308 -         ..
041309 -   22.  On 090313 0127 Millie letter to medical team, ref SDS C4 Q49L,
041310 -        reporting findings evaluating response to treatment from
041311 -        meeting at UCSF on 090312, ref SDS C2 TP9L; and, as listed
041312 -        above in the breast care clinic, ref SDS C9 FQ4N; and later the
041313 -        same day in the Radiation Oncology Department. ref SDS C9 M68F
041315 -         ..
041316 -   23.  On 090317 0915 Millie's final treatment with radiation and
041317 -        hyperthermia to recover from 6th relapse IBC. ref SDS C6 9L7K
041319 -         ..
041320 -   24.  On 090317 0915 Millie received orientation and medications for
041321 -        home care to treat severe radiation side effects. ref SDS C6
041322 -        M442
041324 -         ..
041325 -   25.  On 090317 1120 Kaiser orders another blood draw to correct
041326 -        failure to test for cancer marker CA 15-3 for the test on
041327 -        090309. ref SDS C7 3R7J  Millie went to Kaiser for make-up
041328 -        blood draw. ref SDS C7 PQ6R
041330 -         ..
041331 -   26.  On 090323 1352 Kaiser reports cancer marker CA 15-3 251,
041332 -        ref SDS C8 Y077, for Millie's blood test on 090317, ref SDS C7
041333 -        PQ6R, to correct omission in Millie's lab on 090309,
041334 -        ref SDS B5 PQTQ, which was cited during examination at UCSF on
041335 -        090312. ref SDS C2 337K, and prevented accurate assessment of
041336 -        response to treatment. ref SDS C2 YX5F
041338 -         ..
041339 -   27.  On 090324 0548 Millie's letter to medical team, ref SDS C9
041340 -        PR4Y, reports on meeting at UCSF on 090317 for final treatment
041341 -        with radiation and hyperthermia. ref SDS C6 9L7K
041342 -
041343 -        a.  Examination scheduled evaluate response to treatment
041344 -            scheduled at UCSF on 090423 1315. ref SDS C9 CT9R
041346 -             ..
041347 -        b.  Treatment for radiation side effects prescribed Silvadene
041348 -            Cream 1% and received instructions for home care.
041349 -            ref SDS C9 CT9W
041351 -             ..
041352 -        c.  Response to treatment cannot be fully assessed for a month
041353 -            or more, because radiation and hyperthermia treatments
041354 -            continue to have an effect for weeks and sometimes months
041355 -            after treatment ends. ref SDS C9 CT5Q
041357 -             ..
041358 -        d.  IBC needs timely treatment to maintain local control,
041359 -            ref SDS C9 CT6R, cited by Doctor Johnson during meeting at
041360 -            Kaiser on 090213. ref SDS A6 R75G
041362 -             ..
041363 -        e.  Agenda for meeting at Kaiser on 090325 includes schedule
041364 -            blood test to evaluate cancer marker CA 15-3, test INR for
041365 -            Coumadin to treat pulmnary embolism, and flush the Power
041366 -            Port. ref SDS C9 CT6U
041368 -             ..
041369 -        f.  Millie has been tired due to 4 weeks of radiation and
041370 -            hyperthermia treatments - continues strong efforts to
041371 -            maintain fitness - went hiking 4 days in a row this week,
041372 -            but only a single lap so far.  Will try going out again
041373 -            tomorrow.  I have not felt well physically nor emotionally
041374 -            for a month or so.  CA 15-3 report yesterday was a big
041375 -            help. ref SDS C9 CT6X
041376 -
041377 -
041378 -
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 C9 PR4Y, ref SDS C4 PR4Y.
250405 -
250406 - Millie met yesterday with the primary care physician at Kaiser on
250407 - 090325 0830 and to evaluate response to treatment, ref SDS D0 4W5I,
250408 - following up prior meeting at Kaiser on 090213 1140 ref SDS A6 4W5I,
250409 - explained in the letter to the medical team on 090218. ref SDS A7 TH6U
250410 - The meeting yesterday reviewed response to 4 weeks of radiation and
250411 - hyperthermia treatment at UCSF, which began on 090219, ref SDS A8
250412 - E57G, ended on 090317. ref SDS C6 9L7K
250414 -  ..
250415 - The following letter to the medical team reports results of meeting at
250416 - Kaiser on 090325,
250417 -
250418 -    1.  Subject: Meeting Kaiser on Recovery from IBC after Radiation Hyperthermia Treatment
250419 -        Date: Thu, 26 Mar 2009 00:00:01 -0800
250428 -         ..
250429 -    2.  I was encouraged by your examination today at Kaiser finding
250430 -        signs of recovery from my 6th relapse of IBC, following
250431 -        treatment on referral to UCSF with radiation and hyperthermia
250432 -        prescribed by Doctor Rugo in a letter to Kaiser on 090129.
250434 -         ..
250435 -    3.  As noted in the medical chart today, this work started on
250436 -        090219, ref SDS A8 E57G, and completed last week on 090317.
250437 -        ref SDS C6 9L7K  The radiation treatment plan dated 090209 was
250438 -        received from UCSF on 090226, ref SDS B4 D452, and submitted to
250439 -        you today during the meeting at Kaiser.
250441 -         ..
250442 -    4.  Scope and planning for hyperthermia dated 090209 and describing
250443 -        microwave and ultrasound technology was received from UCSF on
250444 -        090220. ref SDS B1 PR4Y  Thanks again to Chris for submitting
250445 -        documents to complete the record.
250447 -         ..
250448 -    5.  Your examination today at Kaiser finding progress toward
250449 -        improvement treating my IBC correlates with the UCSF report to
250450 -        you and prepared by Tara for Doctor Rugo during the meeting at
250451 -        UCSF on 090312. ref SDS C2 R45H  The report was submitted today
250452 -        during the meeting at Kaiser.
250454 -         ..
250455 -    6.  You asked today about follow up.
250457 -         ..
250458 -    7.  Tara will meet with Doctor Rugo and present results of
250459 -        examination on 090312, ref SDS C2 SS4F, along with cancer
250460 -        marker data showing Kaiser labs report CA 15-3 303 on 090116
250461 -        declined to 251 for the recent test on 090317, ref SDS C7 Y04R,
250462 -        [results reported in the record on 090323, ref SDS C8 Y077],
250463 -        the last day of treatment with radiation and hyperthermia.
250464 -        ref SDS C6 9L7K
250466 -         ..
250467 -    8.  Doctor Hsu scheduled examination on 090423 [1315, reported on
250468 -        090317, ref SDS C6 5Q42,
250470 -         ..
250471 -    9.  It would be great if Doctor Rugo can also make an examination
250472 -        at or near that same time to collaborate on follow on
250473 -        treatment.  April 23rd is a Thursday, which is my normal day to
250474 -        visit UCSF, so hopefully, that will fit Doctor Rugo's schedule.
250475 -        Tara indicated during the meeting on 090312 that discussions
250476 -        with Doctor Rugo have identified several treatment strategies
250477 -        to meet your objective for treating my IBC as a chronic
250478 -        disease. ref SDS C2 SS4F  Doctor Hsu and Chris also cited [on
250479 -        090312] possibilities of further hyperthermia combined with
250480 -        chemotherapy or biological therapies. ref SDS C2 F973
250482 -         ..
250483 -   10.  Research on 090204 identified a number of possible treatments
250484 -        that may help guide discussions. ref SDS 96 UK62
250486 -         ..
250487 -   11.  To facilitate Doctor Rugo's review, you scheduled a lab at
250488 -        Kaiser on 090413 3p, and a CT test later the same day at 0330p.
250489 -        This provides follow up on CA 15-3 to see if the cancer marker
250490 -        continues to drop, and to assess my suitability for further
250491 -        chemo.
250493 -         ..
250494 -   12.  Since we are getting a blood test at the same time, we don't
250495 -        need to schedule a separate port access for the CT test.
250497 -         ..
250498 -   13.  Research indicates hyperthermia can reduce IBC by 40%, 80%,
250499 -        sometimes close to 100% [reported on 090129. ref SDS 63 SQ6L]
250500 -        After the meeting at UCSF on 090425, I am hoping Doctor Hsu and
250501 -        Chris can submit a written report estimating results in my
250502 -        case, and how this is determined.  Will assessment use a
250503 -        special form of CT and/or CT/PET technology that shows where
250504 -        IBC still exists in my tissue?
250506 -         ..
250507 -   14.  After testing, examinations, and assessments, Doctor Rugo can
250508 -        submit recommendations to you for my treatment, like her letter
250509 -        on 090129 that prescribed hyperthermia.
250511 -         ..
250512 -   15.  You asked today about cream Doctor Hsu prescribed to treat side
250513 -        effects of radiation.  This is listed in the record on 090317.
250514 -        ref SDS C6 M442
250515 -
250516 -            Silvadene Cream 1%
250517 -            silver sulfadiazine
250518 -            Monarch Pharmaceuticals
250520 -         ..
250521 -   16.  You indicated during the meeting that another agent called
250522 -        something like "Domeboro" is used at Kaiser to treat radiation
250523 -        burns.
250525 -         ..
250526 -   17.  By copy ask Doctor Hsu if there is any conflict with Silvadene.
250527 -
250533 -
250534 -
250535 -
250536 -
250537 -
250538 -
250539 -
2506 -