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: April 3, 2009 07:54 PM Friday;
Rod Welch
Millie asks Kaiser about examination for shortness of breath ordered by UCSF.
1...Summary/Objective
2...Shortness of Breath Cough All Night after Temperature Subsides
3...Temperature 99.2 Rises 3rd Day in Row
4...Radiation Side Effects Skin Healing Pain Subsides
..............
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS C8 0000. ref SDS C7 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 54 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 54 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 54 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 57 4S8O
040945 - ..
040946 - 6. Doctor Rugo prescribes immediate
040947 - treatment at UCSF in radiation
040948 - oncology department for
040949 - 7th relapse....................... 090130, ref SDS 57 TZ6H
040951 - ..
040952 - 7. Urgent treatment was delayed a week
040953 - due to communication problems
040954 - at UCSF........................... 090130, ref SDS 57 AY8Q
040956 - ..
040957 - 8. Approval for Kaiser referral to UCSF
040958 - was delayed by documentation
040959 - errors............................ 090202, ref SDS 59 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 58 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 59 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 60 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 61 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 63 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 65 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 70 9R61
041006 - ..
041007 - 16. Examination primary care physician
041008 - at Kaiser finds severe progression
041009 - of IBC in 6th
041010 - relapse........................... 090213, ref SDS 72 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 72 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 72 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 72 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 72 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 72 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 72 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 72 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 72 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 72 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 72 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 72 R75G
041113 - ..
041114 - 28. Doctor Rugo has responded by scheduling
041115 - a meeting with Millie at UCSF on
041116 - 090312............................ 090213, ref SDS 72 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 72 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 72 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 72 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 72 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 72 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 72 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 72 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 72 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 73 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 73 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 73 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 74 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 75 EA4Q
041221 - ..
041222 - 42. Hyperthermia treatment planning
041223 - on 090209 report received
041224 - from UCSF......................... 090220, ref SDS 76 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 76 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 77 3N9J
041238 - and asks for scientific paper
041239 - using radiation to treat
041240 - IBC............................... 090223, ref SDS 77 T49U
041242 - ..
041243 - 45. Radiation combined with hyperthermia
041244 - treatment plan received from
041245 - UCSF.............................. 090226, ref SDS 78 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 80 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 81 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 82 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 83 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 84 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 87 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 87 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 87 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 87 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 87 F88K
041322 - discloses side effects severely
041323 - blistering skin will worsen for a
041324 - month, and then gradually
041325 - recover........................... 090312, ref SDS 87 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 87 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 88 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 89 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 91 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 91 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 92 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 93 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 94 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 95 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 95 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 95 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 95 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 95 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 95 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 95 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 95 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 95 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 95 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 95 P39I
041482 - ..
041483 - 74. Medical tests ordered at Kaiser for
041484 - 090413 for examinations at UCSF on
041485 - 090423 to plan Millie's treatment
041486 - for the next relapse
041487 - of IBC............................ 090325, ref SDS 95 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 95 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 95 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 96 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 97 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 98 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 98 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 96 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 96 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 99 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 99 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 A0 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 A0 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 A1 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 A2 4S9W
041603 - ..
041604 - 89. Millie reports continued recovery from
041605 - IBC after completing radiation and
041606 - hyperthermia 2 weeks
041607 - earlier........................... 090328, ref SDS A2 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 A3 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 A4 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 A5 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 A6 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 A7 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 A8 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 A9 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 B1 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 B1 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 B1 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 B1 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 B1 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 B1 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 B2 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 B2 6F8Y
041712 - ..
041713 - 105. Millie's letter notifies medical team
041714 - new symptoms chills and elevated
041715 - temperature 99.4 fever; experienced
041716 - unusual, prolonged shortness
041717 - of breath while
041718 - hiking............................ 090331, ref SDS B3 E54L
041720 - ..
041721 - 106. Slight red blotches sprinkled on lower
041722 - left arm can signal Cellulitis; however,
041723 - concerned may be 7th relapse of
041724 - IBC............................... 090331, ref SDS B3 Q69V
041726 - ..
041727 - 107. Doctor Hsu letter asks beside fever and
041728 - chill any other symptoms? cough, pain, etc.
041729 - Did Silvadine help with the skin
041730 - pain.............................. 090401, ref SDS B4 E54L
041732 - ..
041733 - 108. Doctor Hsu letter says rash on
041734 - lower left arm likely
041735 - IBC............................... 090401, ref SDS B4 R24X
041737 - ..
041738 - 109. Millie reports to medical team temperature
041739 - came down to 97.8 with aspirin, and
041740 - drinking water; no other symptoms
041741 - of cough and pain responding
041742 - to Doctor Hsu's
041743 - inquiry........................... 090401, ref SDS B5 AE4G
041745 - ..
041746 - 110. Millie advises medical team that UCSF
041747 - instructions on 090330 to apply generous
041748 - thickness of Silvadine cream may relieve
041749 - pain slightly from radiation
041750 - side effects...................... 090401, ref SDS B5 RE6V
041752 - ..
041753 - 111. Millie more resolved to tolerate severe
041754 - side effects from radiation and hyperthermia
041755 - in order to recover from 6th relapse of
041756 - IBC because examination at UCSF shows
041757 - results; and further side effects are
041758 - subsiding in some areas; signs of recovery
041759 - helps overcome the trauma of dressing
041760 - the wound several times a day;
041761 - which is very scary to
041762 - observe............................ 090401, ref SDS B5 RE6Y
041764 - ..
041765 - 112. Millie's letter to medical team reports
041766 - UCSF has not clarified schedule for meeting
041767 - with Doctor Rugo on Thursday 090402,
041768 - which seems like a
041769 - mistake............................ 090401, ref SDS B5 RE8S
041771 - ..
041772 - 113. Doctor Rugo advises Millie will not be
041773 - ready for examination on 090402 to plan
041774 - treatment for 7th relapse of IBC; proposes
041775 - meeting at UCSF on 090416; notes Millie
041776 - suffering wound from radiation
041777 - side effects, and advises
041778 - treatment will be very
041779 - effective.......................... 090401, ref SDS B6 K56O
041781 - ..
041782 - 114. Millie's letter to medical team explains
041783 - Kaiser's schedule for medical tests on
041784 - on 090413 to support meetings at
041785 - 090423............................. 090401, ref SDS B7 R43V
041787 - ..
041788 - 115. Millie cites concern about new IBC on
041789 - lower left arm and asks UCSF to
041790 - confirm meetings on
041791 - 090423............................. 090401, ref SDS B7 R43V
041793 - ..
041794 - 116. Telecon Kaiser Outside Referral Department
041795 - advises the referral for Millie's treatment
041796 - at UCSF expires on 090602 is automatically
041797 - extended 1 year to 100202 in order
041798 - to implement Kaiser prescription
041799 - for UCSF to treat Millie's
041800 - cancer as a chronic
041801 - disease............................ 090401, ref SDS B8 KT8G
041803 - ..
041804 - 117. Kaiser Outside Referral Department lists
041805 - UCSF professionals providing services
041806 - for Millie's care to ensure
041807 - continuity of treatment to
041808 - resolve IBC........................ 090401, ref SDS B8 5W4G
041810 - ..
041811 - 118. Millie's letter notifies medical team
041812 - Kaiser Outside Referrals indicates
041813 - current authorization enables continuity
041814 - of care at UCSF from Doctor Rugo in Breast
041815 - Care Clinic, and Doctor Hsu in
041816 - Radiation Oncology................. 090401, ref SDS B9 LG4G
041818 - ..
041819 - 119. Millie's letter notifies team that Kaiser
041820 - Outside Referrals authorizes continuity
041821 - of care by automatically extending
041822 - payment for 6 months until
041823 - 100202............................. 090401, ref SDS B9 WC6Y
041825 - ..
041826 - 120. Doctor Rugo thanks Millie for facilitating
041827 - Kaiser clarifying referral authorization
041828 - for UCSF to treat Millie's 7th relapse
041829 - of cancer as a chronic disease; and
041830 - advises information should be sent
041831 - to the UCSF authorization
041832 - person............................. 090402, ref SDS C0 LA6H
041834 - ..
041835 - 121. Doctor Rugo advises that clarifying
041836 - confusion in scheudling next meeting
041837 - should be resolved by UCSF schedule
041838 - department because UCSF has a
041839 - complex schedule system............ 090402, ref SDS C0 117O
041841 - ..
041842 - 122. Millie letter asks Doctor Rugo if Lena
041843 - who called Millie in February about
041844 - scheduling meetings with the doctor
041845 - can clarify the schedule in
041846 - April, as requested by
041847 - the doctor......................... 090402, ref SDS C1 WM8M
041849 - ..
041850 - 123. Millie sent a letter to Glenna who
041851 - coordinated Millie's treatment on pior
041852 - sunitinib clinical trial, and asking
041853 - for assistance finding who to notify
041854 - about Kaiser referral authorization,
041855 - who can assist clarifying the
041856 - schedule for meeting with
041857 - Doctor Rugo........................ 090402, ref SDS C2 WM8M
041859 - ..
041860 - 124. Glenna called and advised she coordinated
041861 - contacts at UCSF for Millie's referral
041862 - authorization, and to clarify schedule
041863 - for Millie to meet with Doctor
041864 - Rugo on planning treatment
041865 - for the 7th relapse
041866 - of IBC............................. 090402, ref SDS C3 JA6L
041868 - ..
041869 - 125. Millie letter notified medical team
041870 - elevated temperature 99.7 fever occurred
041871 - again; icing upper left arm, and is
041872 - monitoring fever to
041873 - evaluate........................... 090402, ref SDS C4 684J
041875 - ..
041876 - 126. Millie letter to Doctor Rugo's assistant
041877 - requests confirmation of schedule to
041878 - with the doctor at UCSF on 090423
041879 - for planning treatment of
041880 - Millie's 8th relapse of
041881 - cancer............................. 090403, ref SDS C5 375Y
041883 - ..
041884 - 127. Millie letter notifies medical team that
041885 - temperature 99.7 subsided by midnight;
041886 - cough and shortness of breath persisted
041887 - and prevented sleep; evantually
041888 - recovered about
041889 - 0400............................... 090403, ref SDS C6 XZ6I
041891 - ..
041892 - 128. Doctor Hsu letter asks Millie to get
041893 - examination at Kaiser for
041894 - pneumonia.......................... 090403, ref SDS C7 Z66M
041896 - ..
041897 - 129. Doctor Rugo letter asks Millie to
041898 - get examination at Kaiser for
041899 - shortness of breath................ 090403, ref SDS C8 3G3N
041900 -
041901 -
041902 -
041903 -
041904 -
041905 -
0420 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Shortness of Breath Cough All Night after Temperature Subsides
050403 -
050404 - Follow up ref SDS C8 E54L, ref SDS C7 E54L.
050405 -
050406 - On 090219 Millie started treatment with radiation and hyperthermia to
050407 - recover from severe IBC, which was Millie's 6th relapse of IBC.
050408 - Treatment was completed on 090317. During meeting with medical team
050409 - at UCSF on 090312, doctors said that severe side effects from
050410 - treatment signaled strong recovery, and would get worse for several
050411 - more weeks, before starting to improve. ref SDS 87 F860
050413 - ..
050414 - On 090330 Doctor Hsu at UCSF prescribed increasing the dose of
050415 - Silvadene 1% cream to reduce pain and side effects from radiation and
050416 - hyperthermia treatments that ended on 090317. ref SDS B1 9A66
050418 - ..
050419 - On 090331 Millie reported temperature 99.4 from side effects of
050420 - radiation treatment ended on 090317. ref SDS B3 E54L Doctor Hsu
050421 - asked about other symptoms, e.g., cough, pain. ref SDS B4 K56O On
050422 - 090401 0046 Millie reports to medical team that by midnight fever
050423 - declined to normal; and she suffered no other symptoms. ref SDS B5
050424 - E54L
050426 - ..
050427 - On 090402 1947 Millie notified medical team of high temperature again
050428 - fever 99.7, and she had other symptoms chills, skin hot to the touch.
050429 - ref SDS C4 684J
050431 - ..
050432 - This morning Millie reported further symptoms that occurred last night
050433 - with temperature subsiding, but cough and shortness of breath
050434 - continued through the night. ref SDS C6 XZ6I
050436 - ..
050437 - This afternoon Doctor Hsu responded to Millie's report of new symptoms
050438 - coughing and shortness of breath, ref SDS C7 Z66M, recovering from
050439 - radiation and hyperthermia side effects treating Millie's 6th relapse
050440 - of IBC Doctor Rugo also responded to Millie's letter this morning,
050441 - ref SDS C6 XZ6I, reporting new symptoms, and asking Millie to get
050442 - examination at Kaiser for shortness of breath. ref SDS C8 3G3N
050444 - ..
050445 - Millie letter notifies Kaiser that UCSF recommends examination...
050446 -
050447 - 1. Subject: Temperature 99.2 Shortness of Breath Check with Primary Care Physician
050448 - Date: Fri, 03 Apr 2009 20:08:02 -0700
050458 - ..
050459 - 2. Doctor Hsu earlier this afternoon, ref SDS C7 Z66M, and Doctor
050460 - Rugo this evening asked me to check with you about shortness of
050461 - breath, ref SDS C8 3G3N, experienced last night along with
050462 - persistent cough that interrupted sleep, reported to the
050463 - medical team this morning. ref SDS C6 XZ6I
050465 - ..
050466 - 3. Doctor Hsu cites concern about pneumonia. ref SDS C7 Z66M
050467 -
050468 - [On 090403 2012 Millie sent another letter to the medical
050469 - team notifying Kaiser that UCSF recommends CRX and CBC to
050470 - evaluate for pneumonia, ref SDS D0 ZG7H; Millie reports
050471 - symptoms subsided; she feels great; proposes monitoring
050472 - condition and ordering further diagnostics if symptoms
050473 - recur. ref SDS D0 OA4R
050475 - ..
050476 - [On 090406 0253 Millie received letter from Doctor Johnson
050477 - responding to Mil's first letter sent 090403 1954,
050478 - ref SDS C9 NW4N, but not this 2nd letter sent 20 minutes
050479 - later, and reporting symptoms subside, see 090403 2012,
050480 - ref SDS D0 OA4R; the doctor evidently did not see the 2nd
050481 - letter; asks Millie to call Kaiser about scheduling a
050482 - meeting, and recommending the medical team use Kaiser's
050483 - internal proprietary Knowledge Management system for email
050484 - to increase efficiency performing case management.
050485 - ref SDS D1 M19I
050487 - ..
050488 - [On 090408 1043 Millie notifies medical team again that
050489 - symptoms of severe radiation side effects subside, and so
050490 - examination at Kaiser may not be needed. ref SDS D4 QW6R
050492 - ..
050493 - [On 090409 1537 telecon Doctor Johnson examination deferred
050494 - because symptoms of radiation side effects subside.
050495 - ref SDS D5 TH5G
050496 -
050498 - ..
050499 - Temperature 99.2 Rises 3rd Day in Row
050500 -
050501 - Follow up ref SDS C4 H93P.
050502 -
050503 - 4. Throughout the day today my temperature has been normal,
050504 - although just now it has jumped to 99.2, repeating a pattern
050505 - the past few days of rising a bit in the evening (last night
050506 - about 8pm it was 99.7), then dropping back to normal by
050507 - midnight, similar to Tuesday).
050509 - ..
050510 - 5. Just now took Tylenol 1 tablet 500 mg to control temp. Will
050511 - continue as needed.
050512 -
050513 - [On 090403 2012 Millie sent another letter to the medical
050514 - team notifying Kaiser that UCSF recommends CRX and CBC to
050515 - evaluate for pneumonia, ref SDS D0 ZG7H; Millie reports
050516 - symptoms subsided; she feels great; proposes monitoring
050517 - condition and ordering further diagnostics if symptoms
050518 - recur. ref SDS D0 OA4R
050520 - ..
050521 - 6. I have not had a cough nor shortness of breath since about 0400
050522 - this morning. ref SDS C6 UV4X Did not feel well in the
050523 - morning, so stayed in bed all day. I feel better now, no
050524 - chills, nor does my skin feel hot, including the upper left arm
050525 - that I iced yesterday evening.
050526 -
050527 - [On 090406 0253 Millie received letter from Doctor Johnson
050528 - responding to Mil's first letter sent 090403 1954,
050529 - ref SDS C9 NW4N, but not this 2nd letter sent 20 minutes
050530 - later, and reporting symptoms subside, see 090403 2012,
050531 - ref SDS D0 OA4R; the doctor evidently did not see the 2nd
050532 - letter; asks Millie to call Kaiser about scheduling a
050533 - meeting, and recommending the medical team use Kaiser's
050534 - internal proprietary Knowledge Management system for email
050535 - to increase efficiency performing case management.
050536 - ref SDS D1 M19I
050538 - ..
050539 - [On 090406 1512 Millie letter to medical team relates
050540 - report in Millie's 2nd letter on 090403 that symptoms have
050541 - not repeated, and so proposes deferring examination at
050542 - Kaiser. ref SDS D2 OC5F
050543 -
050545 - ..
050546 - Radiation Side Effects Skin Healing Pain Subsides
050547 -
050548 -
050549 - 7. Checking the literature there seems to be reporting of
050550 - temperature as side effect of radiation, so that may be it. As
050551 - noted in the letter this morning, recovery from radiation
050552 - inflammation seems to be improving with Doctor Hsu's suggestion
050553 - to increase use of Silvadine cream. Good news, pain from
050554 - radiation side effects continues to decline.
050556 - ..
050557 - 8. Of course, today Doctor Hsu cites possibility of pneumonia,
050558 - ref SDS C7 Z66M, and Doctor Rugo requests your review as well.
050559 - ref SDS C8 3G3N
050561 - ..
050562 - 9. I think I am okay, and can go to emergency if temperature gets
050563 - above 100.5. Should I watch for anything else to signal other
050564 - remedies?
050565 -
050566 - [On 090406 1240 Kaiser responds 2 days later to notice for
050567 - examination to evaluate shortness of breath for pneumonia;
050568 - asks patient to call Kaiser about scheduling a meeting, and
050569 - further asking medical team to use Kaiser's proprietary
050570 - Knowledge Management system for communication efficiency.
050571 - ref SDS D1 M19I
050573 - ..
050574 - [On 090406 1512 Millie reports to medical team that
050575 - breathing did not recover normally during hiking at
050576 - Lafayette Reservoir on 090402; was only one time event, and
050577 - so was attributed to lack of fitness; there was no testing
050578 - for PE nor pneumonia. ref SDS D2 RE3T
050580 - ..
050581 - [On 090406 0253 Millie received letter from Doctor Johnson
050582 - responding to Mil's first letter sent 090403 1954,
050583 - ref SDS C9 NW4N, but not this 2nd letter sent 20 minutes
050584 - later, and reporting symptoms subside, see 090403 2012,
050585 - ref SDS D0 OA4R; the doctor evidently did not see the 2nd
050586 - letter; asks Millie to call Kaiser about scheduling a
050587 - meeting, and recommending the medical team use Kaiser's
050588 - internal proprietary Knowledge Management system for email
050589 - to increase efficiency performing case management.
050590 - ref SDS D1 M19I
050592 - ..
050593 - [On 090406 1512 Millie letter to medical team relates
050594 - report in Millie's 2nd letter on 090403 that symptoms have
050595 - not repeated, and so proposes deferring examination at
050596 - Kaiser. ref SDS D2 OC5F
050598 - ..
050599 - 10. Thanks to everyone for support.
050600 -
050607 -
050608 -
050609 -
050610 -
050611 -
050612 -
050613 -
050614 -
050615 -
050616 -
050617 -
050618 -
050619 -
050620 -
0507 -