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 31, 2009 08:47 PM Tuesday; Rod Welch

Millie temperature 99.4 new IBC rash on lower left arm 7th relapse.

1...Summary/Objective
2...Temperature Rises 99.4 Feeling Chills
3...Shortness Breath Hiking 3 Miles Good Time Slow Recovery
4...IBC Rash Lightly Sprinkled on Lower Left Arm 7th Relapse
5...IBC 7th Relapse 8th Relapse Cancer Evident Lower Left Arm


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CONTACTS 

SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS B0 0000. ref SDS A9 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - The letter today follows up patient history...
040902 -
040903 -        1.  Examination at Kaiser found significant
040904 -            recovery with sunitinib protocol
040905 -            at UCSF........................... 081219, ref SDS 43 QW5J
040907 -             ..
040908 -        2.  Primary care physician calls about
040909 -            Millie's fall and treatment in ER for
040910 -            separated shoulder the day before on
040911 -            090122; advises review of patient history
040912 -            requested in ER release instructions
040913 -            shows Millie does not need
040914 -            treatment for high
040915 -            blood pressure.................... 090123, ref SDS 53 ZI5I
040917 -             ..
040918 -        3.  Doctor Johnson indicated during call
040919 -            that Millie's patient history of CT
040920 -            tests over the past 7 years shows no
040921 -            evidence of distant metastasis, except
040922 -            in the axilla and supraclavicular
040923 -            regions, which are symptoms of IBC;
040924 -            at this time, shows IBC is
040925 -            only problem to
040926 -            solve............................. 090123, ref SDS 53 8K6K
040928 -             ..
040929 -        4.  Primary care physician cites Millie's
040930 -            blood test on 090116 shows cancer marker
040931 -            CA 15-3 303 rising to historic highs
040932 -            signals severe relapse of IBC for
040933 -            6th time; Millie needs immediate
040934 -            treatment at UCSF for her
040935 -            cancer as chronic
040936 -            disease........................... 090123, ref SDS 53 RK6O
040938 -             ..
040939 -        5.  Sudden reversal with severe relapse
040940 -            of IBC that requires immediate
040941 -            change of treatment reported
040942 -            from examination at
040943 -            UCSF.............................. 090130, ref SDS 56 4S8O
040945 -             ..
040946 -        6.  Doctor Rugo prescribes immediate
040947 -            treatment at UCSF in radiation
040948 -            oncology department for
040949 -            7th relapse....................... 090130, ref SDS 56 TZ6H
040951 -             ..
040952 -        7.  Urgent treatment was delayed a week
040953 -            due to communication problems
040954 -            at UCSF........................... 090130, ref SDS 56 AY8Q
040956 -             ..
040957 -        8.  Approval for Kaiser referral to UCSF
040958 -            was delayed by documentation
040959 -            errors............................ 090202, ref SDS 58 SP6H
040961 -             ..
040962 -        9.  Kaiser expedites referral authorization
040963 -            in order for UCSF to provide urgent
040964 -            treatment quickly enough for
040965 -            Millie to recover................. 090202, ref SDS 57 LC7H
040967 -             ..
040968 -       10.  UCSF proposes 3-week delay to begin
040969 -            planning Millie's treatment for
040970 -            recovering from 6th relapse of
040971 -            of IBC............................ 090202, ref SDS 58 SP7M
040973 -             ..
040974 -       11.  Doctor Rugo notifies medical team
040975 -            Millie needs urgent treatment quickly
040976 -            in time to be effective recovering
040977 -            from 6th relapse of
040978 -            IBC............................... 090202, ref SDS 59 Y15J
040980 -             ..
040981 -       12.  Millie's letter to UCSF implements Doctor
040982 -            Johnson's requests for UCSF strategy
040983 -            to treat Millie's cancer as a
040984 -            chronic disease................... 090203, ref SDS 60 278T
040986 -             ..
040987 -       13.  Doctor Rugo's letter explains planning
040988 -            to evaluate response to hyperthermia
040989 -            treatment and arrange continuing
040990 -            care based on another
040991 -            CT scan........................... 090204, ref SDS 62 278T
040993 -             ..
040994 -       14.  UCSF advances Millie's care in Radiation
040995 -            Oncology Department 3 weeks; scope of
040996 -            radiation and hyperthermia evaluated
040997 -            by Dcotor Hsu and Doctor
040998 -            Chang............................. 090205. ref SDS 64 0001
041000 -             ..
041001 -       15.  CT and xray tests taken, and layout
041002 -            of treatment fields performed to
041003 -            build molds for Millie's
041004 -            radiation......................... 090209. ref SDS 68 9R61
041006 -             ..
041007 -       16.  Examination primary care physician
041008 -            at Kaiser finds severe progression
041009 -            of IBC in 6th
041010 -            relapse........................... 090213, ref SDS 70 4W5I
041012 -             ..
041013 -       17.  Millie lucky to survive stage IV cancer
041014 -            for 8 years because cancer mutates to
041015 -            defeat treatments; and medical maladies
041016 -            increase which makes recovery
041017 -            more difficult to
041018 -            achieve........................... 090213, ref SDS 70 NY7L
041020 -             ..
041021 -       18.  Complexity of case management grows
041022 -            during long term survival prevents
041023 -            keeping a well ordered record
041024 -            essential for effective
041025 -            care.............................. 090213, ref SDS 70 9L8O
041027 -             ..
041028 -       19.  Emotional trauma occurs from surprise
041029 -            by medical professionals that Kaiser
041030 -            and UCSF have enabled long term surivial
041031 -            for a disease that normally is
041032 -            difficult to control.............. 090213, ref SDS 70 ML4I
041034 -             ..
041035 -       20.  Communication leverages synergy
041036 -            for Millie's care at Kaiser and UCSF
041037 -            which helps prevent problems from
041038 -            "falling through the cracks; fewer
041039 -            mistakes, and timely response
041040 -            helps the medical team
041041 -            increase longevity,
041042 -            also seems very
041043 -            annoying.......................... 090213, ref SDS 70 FZ4H
041045 -             ..
041046 -       21.  Doctor urges proactive management to
041047 -            plan Millie's next treatment because
041048 -            there will be less time to recover
041049 -            before cancer gets out of control
041050 -            for Millie's next
041051 -            relapse........................... 090213, ref SDS 70 UP6L
041053 -             ..
041054 -       22.  Millie's efforts the past 8 years to
041055 -            combine medical treatment with vigorous
041056 -            exercise was supported by research
041057 -            showing exercise can be a strong
041058 -            component of cancer
041059 -            care.............................. 090213, ref SDS 70 GC40
041061 -             ..
041062 -       23.  Indian fable illustrates long-term survival
041063 -            getting continuous treatment for cancer
041064 -            becomes increasingly difficult to perform
041065 -            complex clinical, logistical, and financial
041066 -            case management; study of Millie's patient
041067 -            history shows level of effort to maintain
041068 -            well ordered record for effective
041069 -            management increases exponentially
041070 -            into a crushing burden
041071 -            for patients and
041072 -            providers......................... 090213, ref SDS 70 IG5O
041074 -             ..
041075 -       24.  Graph prepared by primary care physician
041076 -            shows Millie's good fortune surviving a
041077 -            very aggressive cancer with relatively
041078 -            high quality of life into an 8th year
041079 -            of continuous treatment that normally
041080 -            causes early demise due to emotional
041081 -            trauma and clincial failures from
041082 -            complex case management........... 090213, ref SDS 70 4W72
041084 -             ..
041085 -       25.  Millie felt life was slipping away in
041086 -            October when the 5th relapse was diagnosed
041087 -            leading Millie to ask what was going to
041088 -            happen to her; Doctor Rugo provided
041089 -            encouragement saying "We're not
041090 -            going to let anything happen
041091 -            to you"........................... 090213, ref SDS 70 F148
041093 -             ..
041094 -       26.  Collaboration between Kaiser and UCSF
041095 -            combines experience with research;
041096 -            communication optimizes Millie's care
041097 -            beating the odds for long-term survival
041098 -            by integrating Kaiser's team care
041099 -            practice with UCSF model
041100 -            of comprehensive
041101 -            care.............................. 090213, ref SDS 70 685I
041103 -             ..
041104 -       27.  Multiple relapse of cancer causes cells
041105 -            to mutate into disease that resists
041106 -            treatment; Millie surviving 6 relapses
041107 -            needs highly specialized care and
041108 -            so should ask Doctor Rugo to begin
041109 -            planning for the next relapse
041110 -            to treat Millie's cancer as
041111 -            a chronic disease................. 090213, ref SDS 70 R75G
041113 -             ..
041114 -       28.  Doctor Rugo has responded by scheduling
041115 -            a meeting with Millie at UCSF on
041116 -            090312............................ 090213, ref SDS 70 6P7G
041118 -             ..
041119 -       29.  Doctor Johnson underscored importance
041120 -            timely care for Millie by offering
041121 -            religious perspective on transition
041122 -            from a vigorous life that may end
041123 -            for Millie in less than a
041124 -            year.............................. 090213, ref SDS 70 646L
041126 -             ..
041127 -       30.  Hospice care helps patients and families
041128 -            cope with final days of life without
041129 -            suffering significant physical
041130 -            and emotional pain................ 090213, ref SDS 70 VW63
041132 -             ..
041133 -       31.  Life ending scenarios have been presented
041134 -            to Millie many times the past 5 years;
041135 -            case study reflects Millie's physical
041136 -            resiliance and strength of character
041137 -            that enables exceptional longevity
041138 -            for her aggressive
041139 -            cancer............................ 090213, ref SDS 70 L19H,
041141 -             ..
041142 -       32.  Collaboration on case management for
041143 -            long-term survivors of cancer becomes
041144 -            frustrating because everybody loses
041145 -            control of increasingly
041146 -            complex medical
041147 -            records........................... 090213, ref SDS 70 JL9L
041149 -             ..
041150 -       33.  Lab and CT test reports illustrate
041151 -            frustration, because providers do not
041152 -            have enough time to enter results
041153 -            from other doctorsrs in the medical
041154 -            chart, because doctors prefer to
041155 -            rely on local diagnostics
041156 -            rather than referral
041157 -            data.............................. 090213, ref SDS 70 NY4H
041159 -             ..
041160 -       34.  Cancer marker CA 15-3 wide disparities
041161 -            between Kaiser and UCSF illustrates
041162 -            why doctor's rely on local data
041163 -            rather than referral
041164 -            diagnostics....................... 090213, ref SDS 70 A46O
041166 -             ..
041167 -       35.  Case management takes a lot of will
041168 -            power for due diligence to
041169 -            maintain a well ordered
041170 -            record............................ 090213, ref SDS 70 J27J
041172 -             ..
041173 -       36.  Meeting at Kaiser changed to 4 week
041174 -            interval, rather than 8, as done the
041175 -            past 2 years, provides effective support
041176 -            for UCSF to start next treatment in
041177 -            time to avoid losing control of
041178 -            Millie's cancer................... 090213, ref SDS 70 QX5O
041180 -             ..
041181 -       37.  Millie requests explanation of treatment
041182 -            plan.  Doctor Rugo's letter to Kaiser on
041183 -            090129 discussed hyperthermia with Doxil,
041184 -            reported on 090130. Has the plan changed
041185 -            to use "lower dose" radiation rather
041186 -            than Doxil.  Will both be
041187 -            used, or some other
041188 -            agent............................. 090218, ref SDS 71 TH5W
041190 -             ..
041191 -       38.  Millie reports to medical team meeting
041192 -            with Doctor Johnson at Kaiser on 090213
041193 -            was optimistic Millie might have 3 - 6
041194 -            months of recovery, but will need
041195 -            treatment from Doctor Rugo for
041196 -            cancer as a "chronic
041197 -            disease".......................... 090218, ref SDS 71 TH6U
041199 -             ..
041200 -       39.  Millie requests reponse from UCSF to the
041201 -            letter on 090209 requesting explanation
041202 -            of treatments for side effects from
041203 -            radiation and hyperthermia described by
041204 -            Doctor Hsu during the meeting on
041205 -            090205. Does the treatment
041206 -            plan address side effects
041207 -            prospectively..................... 090218, ref SDS 71 TH7V
041209 -             ..
041210 -       40.  Radiation and hyperthermia begins
041211 -            at UCSF for Millie to recover from
041212 -            6th relapse of
041213 -            IBC............................... 090219, ref SDS 72 E57G
041215 -             ..
041216 -       41.  Millie's letter to UCSF requests
041217 -            explanation of radiation and hyperthermia
041218 -            treatments for recovering from
041219 -            IBC............................... 090220, ref SDS 73 EA4Q
041221 -             ..
041222 -       42.  Hyperthermia treatment planning
041223 -            on 090209 report received
041224 -            from UCSF......................... 090220, ref SDS 74 PR4Y
041226 -             ..
041227 -       43.  Hyperthermia science, theraputic
041228 -            rationale and applications with
041229 -            other modalities presented in
041230 -            BSD professional paper received
041231 -            from UCSF......................... 090220, ref SDS 74 GK6F
041233 -             ..
041234 -       44.  Millie's letter to UCSF requests work
041235 -            plan for radiation treatments to
041236 -            recover from 6th relapse of
041237 -            IBC............................... 090223, ref SDS 75 3N9J
041238 -            and asks for scientific paper
041239 -            using radiation to treat
041240 -            IBC............................... 090223, ref SDS 75 T49U
041242 -             ..
041243 -       45.  Radiation combined with hyperthermia
041244 -            treatment plan received from
041245 -            UCSF.............................. 090226, ref SDS 76 D452
041247 -             ..
041248 -       46.  Blood test at Kaiser for meeting
041249 -            at UCSF on 090312 to evaluate
041250 -            effectiveness of radiation
041251 -            and hyperthermia after
041252 -            3 weeks........................... 090309, ref SDS 78 6Z4F
041254 -             ..
041255 -       47.  Agenda submitted to medical team to
041256 -            be prepared for productive meetings
041257 -            at UCSF scheduled on 090312 to evaluate
041258 -            response to treatment after getting
041259 -            3 weeks of radiation and hyperthermia
041260 -            to recover from 6th relapse
041261 -            of IBC............................ 090310, ref SDS 79 PR4Y
041263 -             ..
041264 -       48.  Called Kaiser to get results of blood
041265 -            test on 090309 for submission to medical
041266 -            team for being prepared to meet at
041267 -            UCSF on 090312; Florida says results
041268 -            pending from lab; says to call back
041269 -            on 090311 to get the report
041270 -            for distribution.................. 090310, ref SDS 80 JH4H
041272 -             ..
041273 -       49.  UCSF letter from Tara proposed canceling
041274 -            meeting scheduled by Doctor Rugo for
041275 -            090312 to evaluate response to
041276 -            treatment, and also Millie's
041277 -            concern about growing
041278 -            side effects...................... 090310, ref SDS 81 PR4Y
041280 -             ..
041281 -       50.  Millie letter to primary care physician
041282 -            at Kaiser coordinates getting report
041283 -            for blood test on 090309 for
041284 -            meeting at UCSF on
041285 -            090312............................ 090311, ref SDS 82 S84F
041287 -             ..
041288 -       51.  Blood test report for Millie's lab on
041289 -            090209 was not submitted by Kaiser to
041290 -            UCSF due to telephone and fax machine
041291 -            problems; UCSF relied on backup
041292 -            copy hand delivered by
041293 -            Millie............................ 090312, ref SDS 85 XE3K
041295 -             ..
041296 -       52.  Examination at UCSF Breast Care Clinic
041297 -            finds signs of recovery from 6th relapse
041298 -            of IBC; Millie responding well after
041299 -            3 weeks of treatment with radiation
041300 -            and hyperthermia; severe side
041301 -            effects observed.................. 090312, ref SDS 85 YX9F
041303 -             ..
041304 -       53.  Cancer marker CA 15-3 missing from
041305 -            blood test for Millie's lab at Kaiser
041306 -            on 090309; missing diagnostic
041307 -            complicates evaluating
041308 -            response to treatment............. 090312, ref SDS 85 YX5F
041310 -             ..
041311 -       54.  Doctor Rugo planning to implement
041312 -            request by Doctor Johnson at Kaiser
041313 -            for UCSF to treat Millie's cancer
041314 -            as a chronic disease.............. 090312, ref SDS 85 QQ9L
041316 -             ..
041317 -       55.  Examination at UCSF Radiation Oncology
041318 -            department concurs Millie recovering
041319 -            from 6th relapse of IBC by responding
041320 -            to radiation and
041321 -            hyperthermia...................... 090312, ref SDS 85 F88K
041322 -            discloses side effects severely
041323 -            blistering skin will worsen for a
041324 -            month, and then gradually
041325 -            recover........................... 090312, ref SDS 85 F860
041326 -            that radiation and hyperthermia
041327 -            will continue to destroy cancer cells
041328 -            for weeks and even months after ending
041329 -            treatments on
041330 -            090317............................ 090312, ref SDS 85 VL4O
041332 -             ..
041333 -       56.  After meeting with UCSF at 0800, called
041334 -            Kaiser at 1437; was on "hold" for 90
041335 -            minutes; Cisi in the Chemotherapy
041336 -            Clinic came online and advised that
041337 -            CA 15-3 was not listed in Kaiser's
041338 -            for Millie's lab on
041339 -            090309............................ 090312, ref SDS 86 JO8O
041341 -             ..
041342 -       57.  Millie's letter to medical team reports
041343 -            productive meetings at UCSF on 090312
041344 -            with favorable findings that Millie
041345 -            is recovering from 6th
041346 -            relapse of
041347 -            IBC............................... 090313, ref SDS 87 Q49L
041349 -             ..
041350 -       58.  Millie's final treatment at UCSF with
041351 -            radiation and hyperthermia to
041352 -            recover from 6th relapse
041353 -            IBC............................... 090317, ref SDS 89 9L7K
041355 -             ..
041356 -       59.  Millie received at UCSF orientation and
041357 -            medications for home care to treat severe
041358 -            side effects from radiation treatments
041359 -            that will get worse for a few weeks
041360 -            before starting to get
041361 -            better............................ 090317, ref SDS 89 M442
041363 -             ..
041364 -       60.  Arlette checked the computer and
041365 -            concluded a mistake occurred at the
041366 -            lab not testing for the cancer marker
041367 -            on the blood test for 090309.  Arlette
041368 -            entered a supplemental order for
041369 -            Millie to get another blood
041370 -            draw at no charge
041371 -            later today....................... 090317, ref SDS 90 Y04R
041373 -             ..
041374 -       61.  Kaiser reported CA 15-3 251 for blood
041375 -            test on 090317 that corrected problems
041376 -            with lab on 090309 which omitted cancer
041377 -            marker needed for the meeting at UCSF
041378 -            on 090312 to evaluate response to
041379 -            treatment; results today indicate
041380 -            strong recovery from 6th relapse
041381 -            of IBC............................ 090323, ref SDS 91 Y077
041383 -             ..
041384 -       62.  Millie's letter notifies medical team
041385 -            radiation and hyperthermia treatments
041386 -            were completed on 090317; submits agenda
041387 -            for meeting today evaluating response
041388 -            to treatment with, and recovery from
041389 -            side effects from radiation
041390 -            and hyperthermia on
041391 -            referral to
041392 -            UCSF.............................. 090324, ref SDS 92 PR4Y
041394 -             ..
041395 -       63.  Meeting at Kaiser reveiw response to
041396 -            treatment at UCSF for 6th relapse of
041397 -            cancer, planning arrangements
041398 -            for treating next
041399 -            relapse........................... 090325, ref SDS 93 E54L
041401 -             ..
041402 -       64.  Shoulder injury recovering on schedule
041403 -            following treatment in ER on 090122,
041404 -            physical therapy; increased energy
041405 -            after ending chemotherapy enables
041406 -            faster recovery with
041407 -            exercise.......................... 090325, ref SDS 93 YU6K
041409 -             ..
041410 -       65.  Examination finds strong response to
041411 -            treatment with radiation and hyperthermia
041412 -            at UCSF ended on 090317 aligns with
041413 -            significant decline in cancer
041414 -            marker reversing continuous
041415 -            rising tread for the
041416 -            past year......................... 090325, ref SDS 93 D452
041418 -             ..
041419 -       66.  Disease trajectory graph shows Millie
041420 -            may be nearing a point of rapid
041421 -            decline with next relapse
041422 -            of cancer......................... 090325, ref SDS 93 P39M
041424 -             ..
041425 -       67.  Hospice care can be investigate in order
041426 -            to be prepared for smooth transition
041427 -            as patient enters decline phase
041428 -            of cancer trajectory.............. 090325, ref SDS 93 JS5I
041430 -             ..
041431 -       68.  Streamlined referral procedures
041432 -            delivering care required in order
041433 -            for the medical team to be
041434 -            prepared treating cancer
041435 -            as a chronic
041436 -            disease........................... 090325, ref SDS 93 P43G
041438 -             ..
041439 -       69.  Stress increases beyond capacity to cope
041440 -            managing chronic disease with procedures
041441 -            designed for routine cancer care;
041442 -            doctor approves Millie for
041443 -            vacation to get needed
041444 -            rest.............................. 090325, ref SDS 93 M35H
041446 -             ..
041447 -       70.  Lab mistakes and delays hamper delivering
041448 -            referral care in time to be effective
041449 -            treating stage IV cancer; patient facing
041450 -            7th relapse at risk; providers under
041451 -            stress angry that someone is
041452 -            changing doctor's orders
041453 -            for patient care.................. 090325, ref SDS 93 RB3G
041455 -             ..
041456 -       71.  Lab mistakes and delays chronic problems
041457 -            prevent treating cancer as chronic
041458 -            disease on referral to UCSF
041459 -            case study........................ 090325, ref SDS 93 KZ6N
041461 -             ..
041462 -       72.  Cancer chronic disease timely treatment
041463 -            essential for Millie's 7th relapse
041464 -            stage IV IBC; Kaiser has no chemotherapy
041465 -            agents for Millie's narrow patient profile
041466 -            triple negative; prescribes care
041467 -            on referral to UCSF;
041468 -            case study........................ 090325, ref SDS 93 L15M
041470 -             ..
041471 -       73.  Pain relief needed; Millie suffering
041472 -            physically and emotionally from severe
041473 -            radiation side effects; pain and
041474 -            suffering will get worse for several
041475 -            more weeks until Millie begins to recover
041476 -            from radiation burn; Doctor Johnson
041477 -            prescribes zink and Domeboro supplement
041478 -            treatment prescribed at UCSF for
041479 -            severe radiation side
041480 -            effects........................... 090325, ref SDS 93 P39I
041482 -             ..
041483 -       74.  Medical tests ordered at Kaiser for
041484 -            examinations at UCSF on planning
041485 -            Millie's treatment for the
041486 -            next relapse of
041487 -            IBC............................... 090325, ref SDS 93 P36O
041489 -             ..
041490 -       75.  Medical tests ordered 10 days prior to
041491 -            meetings at UCSF allows enough time
041492 -            for correcting mistakes and expediting
041493 -            delays so that data is delivered
041494 -            when needed....................... 090325, ref SDS 93 LX5I
041496 -             ..
041497 -       76.  Patient asked to coordinate on correcting
041498 -            mistakes in CT Department by consolidating
041499 -            findings in a single report, rather than
041500 -            publising multiple reports for
041501 -            each test......................... 090325, ref SDS 93 P53O
041503 -             ..
041504 -       77.  Letter to Kaiser confirms understandings
041505 -            from meeting on 090325 that reported a
041506 -            favorable response after completeing
041507 -            treatment at UCSF on 090317 with
041508 -            radiation and hyperthermia
041509 -            protocol.......................... 090326, ref SDS 94 5V7O
041511 -             ..
041512 -       78.  Kaiser plans visual examination with
041513 -            CT tests to evaluate response to treatment
041514 -            at UCSF with hyperthermia and
041515 -            radiation......................... 090326, ref SDS 95 1V4N
041517 -             ..
041518 -       79.  Millie submits patient history showing
041519 -            Kaiser has had problems relying on visual
041520 -            examination and CT tests to assess IBC;
041521 -            she submits research showing enhanced
041522 -            MRI is reported to be effective
041523 -            supplementing visual and
041524 -            CT test modalities................ 090326, ref SDS 96 5V7O
041526 -             ..
041527 -       80.  Millie's letter asks about progress
041528 -            reviewing research to solve problem
041529 -            of diminishing treatments for
041530 -            Millie's expanding patient
041531 -            profile........................... 090326, ref SDS 96 QM3V
041533 -             ..
041534 -       81.  Millie's letter notifies medical team
041535 -            meetings scheduled at UCSF on 090423
041536 -            will evaluate response to radiation and
041537 -            hyperthermia treatments that ended
041538 -            on 090317, and develop plan
041539 -            to treat Millie's cancer
041540 -            as a chronic
041541 -            disease........................... 090326, ref SDS 94 DW4R
041543 -             ..
041544 -       82.  Millie's letter notifies medical team
041545 -            Doctor Johnson scheduled lab and CT
041546 -            tests 10 days early on 090413 in order
041547 -            to have enough time to submit reports
041548 -            to UCSF for preparing to have a
041549 -            productive meeting on 090423
041550 -            that will plan next
041551 -            treatments........................ 090326, ref SDS 94 DW5Y
041553 -             ..
041554 -       83.  Millie's letter thanks Doctor Stritter
041555 -            for continued interest in her case, and
041556 -            advises that Stritter 2nd opinion research
041557 -            to solve problems of diminishing treatments
041558 -            for Millie's expading patient profile
041559 -            were submitted to the medical
041560 -            team.............................. 090326, ref SDS 97 1V4N
041562 -             ..
041563 -       84.  Millie's letter reports to Doctor
041564 -            Stritter suffering caused by radiation
041565 -            side effects; does not feel well
041566 -            after 4 weeks of intense
041567 -            treatments........................ 090326, ref SDS 97 PX6Y
041569 -             ..
041570 -       85.  Doctor Johnson responds to Millie's
041571 -            submission of research showing enhanced
041572 -            MRI technology can effectively supplement
041573 -            visual and CT modalities to assess
041574 -            response to treatment of IBC 6th
041575 -            relapse, saying he will talk about
041576 -            it at the next visit in 6
041577 -            weeks............................. 090326, ref SDS 98 T64N
041579 -             ..
041580 -       86.  Doctor Johnson responds to Millie's
041581 -            request for progress reviewing research
041582 -            to solve problems of diminishing treatments
041583 -            for expanding patient profile, saying
041584 -            he will talk about it at the
041585 -            next visit in 6
041586 -            weeks............................. 090326, ref SDS 98 T64N
041588 -             ..
041589 -       87.  Millie letter from Doctor Stritter asks
041590 -            to be notified about progress considering
041591 -            2nd opinion options for solving problem
041592 -            of diminishing treatments for
041593 -            Millie's 7th relapse
041594 -            of IBC............................ 090326, ref SDS 99 Q16O
041596 -             ..
041597 -       88.  Millie letter to medical team reports
041598 -            rising pain from radiation side effects,
041599 -            asks about using Domeboro
041600 -            to supplement
041601 -            silvadene......................... 090328, ref SDS A0 4S9W
041603 -             ..
041604 -       89.  Millie reports continued recovery from
041605 -            IBC after completing radiation and
041606 -            hyperthermia 2 weeks
041607 -            earlier........................... 090328, ref SDS A0 4S4V
041609 -             ..
041610 -       90.  Doctor Hsu letter to Millie schedules
041611 -            examination to relieve pain and suffering
041612 -            side effects from radiation side
041613 -            effects following treatment
041614 -            to recover from IBC that
041615 -            ended on 090317................... 090328, ref SDS A1 H27I
041617 -             ..
041618 -       91.  Millie's letter to UCSF confirms meeting
041619 -            with Doctor Hsu on 090401 to get pain
041620 -            relief from radiation side
041621 -            effects........................... 090328, ref SDS A2 H27I
041623 -             ..
041624 -       92.  Doctor Hsu asks Millie to change time
041625 -            of meeting on 090401 to afternoon
041626 -            to accomodate tumor board
041627 -            meeting........................... 090328, ref SDS A3 SA4J
041629 -             ..
041630 -       93.  Millie letter to UCSF asks Doctor Hsu
041631 -            to meet on Monday 090330, rather than
041632 -            Wedensday 090401 to expedite
041633 -            pain relief....................... 090328, ref SDS A4 CM5K
041635 -             ..
041636 -       94.  Doctor Hsu agrees to advance examination
041637 -            of Millie for prescribing pain relief
041638 -            proposes meeting on 090330 in the
041639 -            afternoon......................... 090328, ref SDS A5 4Z6I
041641 -             ..
041642 -       95.  Millie letter to UCSF asks to meet on
041643 -            090330 0800 rather than in the
041644 -            afternoon to expedite getting
041645 -            pain relief....................... 090328, ref SDS A6 MR3K
041647 -             ..
041648 -       96.  Doctor Hsu letter schedules meeting
041649 -            at UCSF 090330 1200 to expedite pain
041650 -            relief for Millie from radiation
041651 -            side effects...................... 090328, ref SDS A7 F34O
041653 -             ..
041654 -       97.  Millie letter confirms meeting at
041655 -            UCSF 090330 1200 to expedite pain
041656 -            relief from radiation
041657 -            side effects...................... 090328, ref SDS A9 W55N
041659 -             ..
041660 -       98.  Meeting at UCSF Doctor Hsu advises
041661 -            Millie shows response to treatment
041662 -            with radiation and hyperthermia
041663 -            treatments........................ 090330, ref SDS A9 E54L
041665 -             ..
041666 -       99.  UCSF prescribes increase Silvadene
041667 -            1% Cream to reduce severe pain
041668 -            suffering from radiation and
041669 -            hyperthermia treatment side
041670 -            effects........................... 090330, ref SDS A9 9A66
041672 -             ..
041673 -      100.  Writing things down reduces mistakes
041674 -            at UCSF so people do not forget complex
041675 -            details; prevents things from falling
041676 -            through the cracks, because people
041677 -            can find the "needle in a haystack"
041678 -            essential for effective
041679 -            comprehensive care................ 090330, ref SDS A9 9B65
041681 -             ..
041682 -      101.  Vitamin E plus pentoxifylline (Trental)
041683 -            prescribed by UCSF when severe side effects
041684 -            from radiation and hyperthermia continue
041685 -            2 - 3 months after completing
041686 -            treatments........................ 090330, ref SDS A9 T487
041688 -             ..
041689 -      102.  Vitamin E plus pentoxifylline (Trental)
041690 -            to recover from radiation and hyperthermia
041691 -            side effects, this will be a
041692 -            minimum 6 month
041693 -            treatment......................... 090330, ref SDS A9 T54H
041695 -             ..
041696 -      103.  Millie letter reports to medical team
041697 -            results of interim, exigent examination
041698 -            at UCSF that finds severe radiation side
041699 -            effects subsiding slowly as expected,
041700 -            and Millie is recovering from 6th
041701 -            relapse of IBC; prescribes
041702 -            increased dose of
041703 -            silvadene cream................... 090330, ref SDS B0 E54L
041705 -             ..
041706 -      104.  Millie requests correction of error
041707 -            scheduling meeting with Doctor
041708 -            Rugo on 090402, since meeting
041709 -            already scheduled for
041710 -            090423............................ 090330, ref SDS B0 6F8Y
041711 -
041712 -
041713 -
041714 -
0418 -

SUBJECTS
Default Null Subject Account for Blank Record

0503 -
050401 -  ..
050402 - Temperature Rises 99.4 Feeling Chills
050403 - Shortness Breath Hiking 3 Miles Good Time Slow Recovery
050404 -
050405 - Follow up ref SDS B0 E54L, ref SDS A9 E54L.
050406 -
050407 - Millie sent a letter to the medical team this evening to supplement
050408 - the letter sent late last night on 090330 2351, ref SDS B0 E54L,
050409 - confirming understandings from the meeting earlier yesterday on 090330
050410 - 1200, ref SDS A9 E54L, at UCSF prescribing solution to rising pain and
050411 - suffering from side effects of radiation and hyperthermia treatments
050412 - that ended on 090317. ref SDS 89 9L7K
050414 -  ..
050415 - Millie's letter says...
050416 -
050417 -    1.  Subject: Temperature 99.4 Monitoring for Cellulitis
050418 -        Date:  31 Mar 2009 20:52:00 -0800
050426 -         ..
050427 -    2.  Just an update from the meeting yesterday at UCSF...
050429 -         ..
050430 -    3.  I forgot to mention the past few days I have felt chilled.
050431 -        This evening temperature is 99.4.  If it gets above 100.5
050432 -        protocol at Kaiser for cancer patients calls for treatment in
050433 -        ER, listed on 041202. ref SDS 7 IX9N
050435 -  ..
050436 - Millie went hiking at Lafayette Reservoir today.  She did 1 lap in a
050437 - good time, faster than in recent weeks, which have been infrequent.
050438 - Millie's breathing seemed under stress for the entire hike, after
050439 - getting up the first hill.  Normally, she recovers well, but today
050440 - breathing was heavy the rest of the way, about 2 miles.
050442 -  ..
050443 - On 090205 0830 UCSF disclosed treatment plan for Millie to recover
050444 - from 7th relapse of cancer includes radiation with hyperthermia; the
050445 - doctor asked Millie abour patient history getting prior radiation, but
050446 - did not present risks and side effects from getting additional
050447 - radiation. ref SDS 64 PN8H
050448 -
050449 -               [On 090401 0032 Doctor Hsu asks about other symptoms,
050450 -               like fever, pain. ref SDS B1 K56O
050452 -                ..
050453 -               [On 090402 1947 Millie reports body felt hot, and in
050454 -               late afternoon another episode of temperature 99.7;
050455 -               icing upper left arm. ref SDS B4 684J
050457 -                ..
050458 -               [On 090402 1947 Millie's letter to medical team reports
050459 -               fever 99.7 correlated with hiking and exercise in the
050460 -               gym; asks if exercise should be avoided until recovery
050461 -               from radiation side effects? ref SDS B4 H93S
050463 -                ..
050464 -               [On 090403 1107 Millie's letter notifies medical team of
050465 -               another episode; experienced continual cough and
050466 -               shortness of breath that prevented sleep for 8 hours.
050467 -               ref SDS B5 UV4X
050469 -                ..
050470 -               [On 090406 1512 Millie hiked about 1.5 miles at
050471 -               Lafayette Reservoir and did not experience recurrent
050472 -               shortness of breath. ref SDS B6 RE4R
050473 -
050475 -  ..
050476 - IBC Rash Lightly Sprinkled on Lower Left Arm 7th Relapse
050477 -
050478 -
050479 -    4.  There are some slight red blotches sort of sprinkled on my
050480 -        lower left arm, which can signal Cellulitis; however, this has
050481 -        also been present for a day or so along with being chilled.
050482 -        Patient history shows Cellulitis typically expands rapidly
050483 -        within a few hours  to envelope the entire left arm along with
050484 -        lymphedema that swells the left arm.  So far no swelling in
050485 -        left arm, and no rapid expansion of red rash, just isolated
050486 -        blotches at this time.
050488 -         ..
050489 -    5.  Will hold off on starting Keflex unless temp increases.
050490 -        Actually, I took an aspirin and temperature seems to be coming
050491 -        down now.  Will continue monitoring.
050493 -  ..
050494 - IBC 7th Relapse 8th Relapse Cancer Evident Lower Left Arm
050495 -
050496 -
050497 -    6.  Concerned IBC may have moved to the lower left arm below where
050498 -        radiation and hyperthermia occurred on the upper arm.  This
050499 -        would be a new situation. [comprise 8th relapse of cancer, and
050500 -        7th relapse of IBC...]
050501 -
050502 -               [On 090401 0032 Doctor Hsu advises new red rash on lower
050503 -               left arm likely IBC recurrence. ref SDS B1 R24X
050505 -                ..
050506 -               [On 090401 0046 Millie asks if treatment can be started
050507 -               to recover from cancer relapse diagnosed by Doctor Hsu.
050508 -               ref SDS B2 RE8P
050510 -                ..
050511 -               [On 090401 0121 Doctor Rugo reports Millie's wound in
050512 -               breastbone area diagnosed as reaction to radiation must
050513 -               heal further before starting treatment for IBC relapse,
050514 -               and so defers meeting scheduled on 090402 0800; expects
050515 -               recovery from IBC in areas with radiation and
050516 -               hyperthermia to be very effective. ref SDS B3 K56O
050518 -                ..
050519 -               [On 090406 1512 Millie concerned about spreading IBC;
050520 -               seems to be subsiding now. ref SDS B6 RE6V
050522 -                ..
050523 -               [On 090408 1030 Millie reported IBC rash on lower left
050524 -               arm may be lighter. ref SDS B0 QW4R
050526 -                ..
050527 -               [On 090412 2241 Millie's letter reports to medical team
050528 -               that IBC worsening on left arm, and occurs along a neat
050529 -               line at the perimeter of area treated with radiation and
050530 -               hyperthermia, ref SDS B9 XN8J; requests treatment next
050531 -               week to prevent cancer from cascading out of control.
050532 -               ref SDS B9 9S9Y
050534 -                ..
050535 -               [On 090415 0949 Millie notifies medical team IBC
050536 -               spreading; asks about getting treatment of cancer as a
050537 -               chronic disease. ref SDS C2 KG8Q
050539 -                ..
050540 -               [On 090415 Millie's recurrence similar to another
050541 -               patient treated for IBC with radiation and hyperthermia;
050542 -               a 23 year old woman suffered IBC recurrence along the
050543 -               perimeter of treated areas, ref SDS C3 E042, as Millie
050544 -               reported in her letter on 090412 2241. ref SDS B9 9S8Y
050546 -                ..
050547 -               [On 090420 2352 Millie's letter to medical team submits
050548 -               agenda for meeting at UCSF on 090423 cites new IBC on
050549 -               lower left arm; and, also, reports a vertical line in
050550 -               the breastbone area of possible IBC or continuing
050551 -               reaction to radiation. ref SDS C5 MS5Q
050553 -                ..
050554 -               [On 090521 2006 Doctor Johnson's letter to Millie
050555 -               without copy to medical team refuses to prescribe
050556 -               treatment and tells Millie she can "choose" any
050557 -               treatment she wants, because no treatment is superior
050558 -               for Millie's patient profile, ref SDS C6 9Q9H; Doctor
050559 -               Johnson warns Millie that she needs treatment by the end
050560 -               of the week, which is in just 12 hours, because her 8th
050561 -               relapse of cancer is progressing rapidly, ref SDS C6
050562 -               HC8O, and Kaiser tells Millie to call Medicare rather
050563 -               than Kaiser for prescribing her treatment to recover
050564 -               from 8th relapse of cancer. ref SDS C6 9Q9H
050566 -  ..
050567 - Case study shows this is Millie's 8th relapse of cancer...
050568 -
050569 -        1.  Lymph node biopsy positive start
050570 -            bevacizumab Taxotere.............. 040318, ref SDS 5 8R6M
050572 -             ..
050573 -        2.  Cancer marker IBC increase end
050574 -            bevacizumab Taxotere due to
050575 -            pulmonary embolism................ 041210, ref SDS 8 025H
050577 -             ..
050578 -        3.  Cancer marker IBC recurs 9 months
050579 -            months after mastectomy........... 060711, ref SDS 12 025H
050581 -             ..
050582 -        4.  Cancer marker IBC worsens end
050583 -            capeticabine Taxotere............. 061201, ref SDS 15 RU6J
050585 -             ..
050586 -        5.  IBC progression with increased
050587 -            lymph nodes in axilla add
050588 -            Carboplatin to cetuximab.......... 080306, ref SDS 26 NW3N
050590 -             ..
050591 -        6.  IBC worsesn CT test swelled
050592 -            LN left supraclavicular; treatment
050593 -            cetuximab and Carboplatin end;
050594 -            begin work plan for sunitinib
050595 -            metronomic protocol............... 081016, ref SDS 34 J34U
050597 -             ..
050598 -        7.  IBC spreading severely, cancer
050599 -            marker soars CA 15-3 303; sunitinib
050600 -            treatment ended 090122; doctor
050601 -            prescribes hyperthermia and doxil
050602 -            to recover local
050603 -            control........................... 090129, ref SDS 56 4S8O
050605 -             ..
050606 -        8.  IBC begins spreading on lower
050607 -            left arm below area treated with
050608 -            radiation completed on
050609 -            090317............................ 090331, ref SDS 0 Q69V
050611 -         ..
050612 -    7.  Alternatively, might this be a radiation side effect, even
050613 -        though radiation was all above the elbow?
050614 -
050615 -               [On 090401 0032 Doctor Hsu advises new red rash on lower
050616 -               left arm likely IBC recurrence. ref SDS B1 R24X
050618 -         ..
050619 -    8.  Doctor Rugo and Tara can investigate, if we do the meeting on
050620 -        Thursday, according to the call from UCSF yesterday.  Have not
050621 -        received confirmation on coming in Thursday, requested in the
050622 -        letter yesterday. ref SDS B0 6F8Y
050623 -
050630 -
050631 -
050632 -
050633 -
050634 -
050635 -
050636 -
050637 -
050638 -
050639 -
050640 -
0507 -