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 6, 2009 03:12 PM Monday;
Rod Welch
Millie letter to medical team proposes deferring medical tests pneumonia.
1...Summary/Objective
2...Symptoms Subside Monitor Health Assess Need for More Testing
3...Shortness Breath Episode Not Repeated
4...Radiation Side Effects Recovered Substantially Treatment Ended 090317
5...IBC Spreading Lower Left Arm Seem Possibly Subsiding
6...Schedule Examination UCSF on 090423 Plan Treatment 7th Relapse IBC
..............
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS D4 0000. ref SDS D3 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 46 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 57 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 57 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 57 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 60 4S8O
040945 - ..
040946 - 6. Doctor Rugo prescribes immediate
040947 - treatment at UCSF in radiation
040948 - oncology department for
040949 - 7th relapse....................... 090130, ref SDS 60 TZ6H
040951 - ..
040952 - 7. Urgent treatment was delayed a week
040953 - due to communication problems
040954 - at UCSF........................... 090130, ref SDS 60 AY8Q
040956 - ..
040957 - 8. Approval for Kaiser referral to UCSF
040958 - was delayed by documentation
040959 - errors............................ 090202, ref SDS 62 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 61 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 62 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 63 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 64 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 66 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 68 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 73 9R61
041006 - ..
041007 - 16. Examination primary care physician
041008 - at Kaiser finds severe progression
041009 - of IBC in 6th
041010 - relapse........................... 090213, ref SDS 75 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 75 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 75 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 75 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 75 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 75 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 75 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 75 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 75 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 75 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 75 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 75 R75G
041113 - ..
041114 - 28. Doctor Rugo has responded by scheduling
041115 - a meeting with Millie at UCSF on
041116 - 090312............................ 090213, ref SDS 75 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 75 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 75 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 75 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 75 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 75 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 75 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 75 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 75 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 76 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 76 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 76 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 77 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 78 EA4Q
041221 - ..
041222 - 42. Hyperthermia treatment planning
041223 - on 090209 report received
041224 - from UCSF......................... 090220, ref SDS 79 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 79 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 80 3N9J
041238 - and asks for scientific paper
041239 - using radiation to treat
041240 - IBC............................... 090223, ref SDS 80 T49U
041242 - ..
041243 - 45. Radiation combined with hyperthermia
041244 - treatment plan received from
041245 - UCSF.............................. 090226, ref SDS 81 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 83 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 84 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 85 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 86 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 87 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 90 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 90 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 90 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 90 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 90 F88K
041322 - discloses side effects severely
041323 - blistering skin will worsen for a
041324 - month, and then gradually
041325 - recover........................... 090312, ref SDS 90 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 90 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 91 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 92 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 94 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 94 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 95 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 96 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 97 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 98 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 98 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 98 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 98 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 98 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 98 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 98 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 98 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 98 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 98 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 98 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 98 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 98 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 98 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 99 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 A0 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 A1 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 A1 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 99 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 99 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 A2 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 A2 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 A3 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 A3 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 A4 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 A5 4S9W
041603 - ..
041604 - 89. Millie reports continued recovery from
041605 - IBC after completing radiation and
041606 - hyperthermia 2 weeks
041607 - earlier........................... 090328, ref SDS A5 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 A6 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 A7 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 A8 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 A9 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 B0 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 B1 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 B2 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 B4 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 B4 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 B4 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 B4 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 B4 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 B4 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 B5 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 B5 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 B6 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 B6 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 B7 E54L
041732 - ..
041733 - 108. Doctor Hsu letter says rash on
041734 - lower left arm likely
041735 - IBC............................... 090401, ref SDS B7 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 B8 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 B8 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 B8 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 B8 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 B9 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 C0 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 C0 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 C1 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 C1 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 C2 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 C2 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 C3 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 C3 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 C4 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 C5 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 C6 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 C7 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 C8 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 C9 XZ6I
041891 - ..
041892 - 128. Doctor Hsu letter asks Millie to get
041893 - examination at Kaiser for
041894 - pneumonia.......................... 090403, ref SDS D0 Z66M
041896 - ..
041897 - 129. Doctor Rugo letter asks Millie to
041898 - get examination at Kaiser for
041899 - shortness of breath................ 090403, ref SDS D1 3G3N
041901 - ..
041902 - 130. Millie notifies medical team that UCSF
041903 - recommends examination for pneumonia
041904 - with symptoms of shortness of
041905 - breath............................. 090403, ref SDS D2 NW4N
041907 - ..
041908 - 131. Millie notifies medical team fever occurs
041909 - for 3rd time with temperature 99.4; explains
041910 - home care has previously been
041911 - effective.......................... 090403, ref SDS D2 DX7S
041913 - ..
041914 - 132. Millie notifies medical team side effects
041915 - of radiation and hyperthermia skin "burn"
041916 - healing, and pain subsides
041917 - substantially...................... 090403, ref SDS D2 DX8R
041919 - ..
041920 - 133. Millie sends supplemental letter to medical
041921 - team advising UCSF recommends CRX and
041922 - CBC to assess pneumonia symptoms; reports
041923 - symptoms subside, feels great proposes
041924 - monitoring condition to decide
041925 - on need for additional
041926 - testing............................ 090403, ref SDS D3 ZG7H
041928 - ..
041929 - 134. Kaiser responds 3 days later to 1 of 2
041930 - letters submitted 20 minutes apart on
041931 - 090403 reporting new symptoms and that
041932 - symptoms subsided; with only half the
041933 - story Kaiser asks Millie to call about
041934 - scheduling examination; and asks medical
041935 - team to use Kaiser's internal Knowledge
041936 - Management email system for Healthcare
041937 - Connect to increase efficiency of
041938 - case management through electronic
041939 - communication; overlooks medical
041940 - team cannot access Kaiser's
041941 - proprietary email
041942 - system............................. 090406, ref SDS D4 M19I
041943 -
041944 -
041945 -
041946 -
0420 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Symptoms Subside Monitor Health Assess Need for More Testing
050403 -
050404 - Follow up ref SDS D4 E54L, ref SDS D3 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 90 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 B4 9A66
050418 - ..
050419 - On 090331 Millie reported temperature 99.4 from side effects of
050420 - radiation treatment ended on 090317. ref SDS B6 E54L Doctor Hsu
050421 - asked about other symptoms, e.g., cough, pain. ref SDS B7 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 B8
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 C7 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 C9 XZ6I
050436 - ..
050437 - This afternoon Doctor Hsu responded to Millie's report of new symptoms
050438 - coughing and shortness of breath, ref SDS D0 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 C9 XZ6I, reporting new symptoms, and asking Millie to get
050442 - examination at Kaiser for shortness of breath. ref SDS D1 3G3N
050444 - ..
050445 - Millie letter notifies medical team that UCSF recommends examination,
050446 - ref SDS D2 NW4N, but fever recurs with temperature 99.3. ref SDS D2
050447 - DX7S Millie sent another letter to the medical team supplementing
050448 - notice in the letter sent at 1954, and saying UCSF recommends CRX and
050449 - CBC tests for pneumonia, ref SDS D3 ZG7H; Millie reports symptoms
050450 - subside, and proposes monitoring conditions to determine need for
050451 - further testing. ref SDS D3 OA4R
050453 - ..
050454 - On 090406 1237 Millie received a letter from Doctor Johnson,
050455 - ref SDS D4 M19I, responding to Millie's first letter sent to Kaiser on
050456 - 090403 1954 reporting rising temperature, and recomendation of UCSF
050457 - that Kaiser make examination. ref SDS D2 NW4N The doctor does not
050458 - respond to Millie's second letter sent 20 minutes later on 090403 2012
050459 - and clarifying that symptoms subsided, and so further diagnostics can
050460 - be deferred pending monitoring condition. ref SDS D3 ZG7H
050461 -
050463 - ..
050464 - Shortness Breath Episode Not Repeated
050465 -
050466 - Millie sent a letter resonding to Kaiser's proposal for calling Kaiser
050467 - to schedule a meeting, ref SDS D4 M19I, Millie again clarifies medical
050468 - circumstances and proposes deferring meeting at Kaiser...
050469 -
050470 - 1. Subject: Shortness of Breath and Temperature Problems Improved
050471 - Date: Mon, 06 Apr 2009 15:23:27 -0700
050481 - ..
050482 - 2. Thanks for your letter today following up correspondence with
050483 - the team last Friday on 090403 [2-letters were sent; the first
050484 - at 090403 1954, ref SDS D2 NW4N, and the second on 090403 2012.
050485 - ref SDS D3 ZG7H]
050487 - ..
050488 - 3. As noted in the 2nd letter on Friday at 2025, I began to feel
050489 - better with lower temperature. ref SDS D3 OA4R I only had the
050490 - one night with shortness of breath and coughing the day before.
050491 - [reported on 090403 11107 ref SDS C9 XZ6I]. Earlier that day
050492 - on Thursday, I hiked Lafayette at a faster pace, and noticed
050493 - during the lap that my breathing did not recover between hills
050494 - as it usually does. That night on Thursday, I had shortness of
050495 - breath and coughing that kept me up most of the night. As
050496 - reported, symptoms subsided by 0400 Friday morning, and have
050497 - not been repeated. Previously, on 041005 symptoms were
050498 - diagnosed as lack of fitness, because I had not been able to
050499 - exercise due to chemotherapy. ref SDS 7 OG5L
050501 - ..
050502 - 4. Subsequently, we learned symptoms in 2004 correlated to PE [as
050503 - reported on 041104, ref SDS 8 RZ4I]. At that time, symptoms
050504 - were occurring daily, just walking around the house. At this
050505 - time, symptoms were a one time event, and have not repeated.
050506 - My fitness has suffered from not exercising since November due
050507 - to side effects of sunitinib, and more recently radiation and
050508 - hyperthermia.
050510 - ..
050511 - 5. This morning I did about 33% of a lap. Took it easy, just to
050512 - test my breathing. Seemed okay today, so may do a full lap
050513 - tomorrow. Guess the real test will be this evening. [shows
050514 - recovery from shortness of breath hiking at Lafayette
050515 - Reservoire on 090331, ref SDS B6 Q69Q, and which occurred again
050516 - preventing sleeping at night, reported 090403 1107. ref SDS C9
050517 - UV4X]
050519 - ..
050520 - 6. Temperature seems to be trending down. For 5 nights in a row
050521 - beginning about 0700p I would go above 99, take Tylenol and
050522 - drop back to normal by midnight. Last night broke the pattern,
050523 - only got to 98.3, which is still a bit high for me, but shows
050524 - improvement. Today, have remained at 98.3, even after the
050525 - hike.
050527 - ..
050528 - 7. Doctor Hsu raised an issue about pneumonia in his letter on
050529 - 090403, based on the one episode of persistent cough and
050530 - shortness of breath the night of April 2nd. Since that has not
050531 - been repeated, hopefully, there is no pneumonia. Patient
050532 - history shows I was hospitalized in the ER with penumonia on
050533 - 060607. ref SDS 14 PT7S
050534 -
050535 - [On 090407 1009 Kaiser did not respond; called Arlette to
050536 - coordinate requirements for meeting with Doctor Johnson for
050537 - examination requested by Doctor Hsu and Doctor Rugo at UCSF
050538 - to evaluate shortness of breath. ref SDS D5 IF54
050540 - ..
050541 - 8. At that time in 2006, symptoms of cough and shortness of breath
050542 - persisted for days, while I was on a cruise ship in Alaska, and
050543 - then suddenly worsened a few days after I returned home. In
050544 - this case, symptoms have not been repeated for about 4 days.
050545 -
050547 - ..
050548 - Radiation Side Effects Recovered Substantially Treatment Ended 090317
050549 -
050550 -
050551 - 9. Doctor Hsu has been concerned about infection from the big
050552 - sores on my chest recovering from radiation, which may cause
050553 - high temperature. Doctor Hsu suggested in his letter on 090403
050554 - considering a "CXR, and CBC(blood count) just to be sure" (I
050555 - believe about the pneumonia).
050556 -
050557 - [On 090407 1009 Kaiser did not respond; called Arlette to
050558 - coordinate requirements for meeting with Doctor Johnson for
050559 - examination requested by Doctor Hsu and Doctor Rugo at UCSF
050560 - to evaluate shortness of breath. ref SDS D5 IF54
050562 - ..
050563 - 10. Radiation burn has recovered substantially, most evident on the
050564 - upper left arm, and lower abdomen. The right breast now looks
050565 - close to normal skin. The big wound on the upper chest has
050566 - gotten much smaller. So, the skin is healing.
050568 - ..
050569 - 11. I feel much better, and am taking less medication for pain,
050570 - including the right shoulder that is recovering from the
050571 - accident on 090122.
050572 -
050574 - ..
050575 - IBC Spreading Lower Left Arm Seem Possibly Subsiding
050576 -
050577 -
050578 - 12. Have been concerned about new sprinkled lightly red patches on
050579 - the lower right arm [reported to medical team on 090331 2047,
050580 - ref SDS B6 Q69V, and Doctor Hsu diagnosed likely IBC on 090401
050581 - 0032, ref SDS B7 R24X]. These seem to be subsiding now as
050582 - well, similar to the report for a similar condition on the
050583 - right arm in 2007. Hopefully, we don't have an IBC scenario,
050584 - but time will tell. I am thankful it seems to be getting
050585 - better and definitely not worse in the past week.
050586 -
050587 - [On 090408 1030 Millie reported IBC rash on lower left arm
050588 - may be lighter. ref SDS D7 QW4R
050590 - ..
050591 - [On 090412 2241 Millie's letter to medical reports IBC
050592 - worsening on left arm, ref SDS D0 XN8J, requests treatment
050593 - next week to prevent cancer from cascading out of control.
050594 - ref SDS D8 9S9Y
050596 - ..
050597 - 13. I got a message when I returned from hiking today. Maggie in
050598 - your office said she has results from the bone scan performed 3
050599 - or 4 weeks ago. Please submit the report for review.
050601 - ..
050602 - 14. If you feel an examination is needed, I can come in today or
050603 - tomorrow anytime at your convenience. Just let know the time.
050604 - We are already scheduled to visit in a few weeks after the lab
050605 - and CT test on 090413. Additionally, please call if we can do
050606 - a telephone consultation rather than an office visit.
050607 -
050608 - [On 090407 1009 Kaiser did not respond; called Arlette to
050609 - coordinate requirements for meeting with Doctor Johnson for
050610 - examination requested by Doctor Hsu and Doctor Rugo at UCSF
050611 - to evaluate shortness of breath. ref SDS D5 IF54
050612 -
050614 - ..
050615 - Schedule Examination UCSF on 090423 Plan Treatment 7th Relapse IBC
050616 -
050617 -
050618 - 15. I still have not heard from UCSF to schedule the meeting with
050619 - Doctor Rugo on 090423. Glenna coordinated a week ago, per
050620 - Doctor Rugo's letter saying the system is complicated.
050621 - Hopefully, things are on track.
050622 -
050629 -
050630 -
050631 -
050632 -
050633 -
050634 -
050635 -
050636 -
050637 -
050638 -
0507 -