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 12, 2009 10:41 PM Sunday; Rod Welch

Millie requests treatment 7th relapse IBC to prevent cancer from cascading
out of control, letter to Kaiser and UCSF.

1...Summary/Objective
2...Millie Asks for Treatment Before Leaving Town on 090426
3...IBC Expanding Outside Areas Treated with Radiation Hyperthermia
4...Radiation Hyperthermia or Doxil on Lower Left Arm
5...Treatment Requested 7th Relapse IBC Prevent Losing Control Cancer
6...Local Control Reduce Morbidity from Delayed Treatment


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CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 15 0000. ref SDS 14 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - The letter today follows up patient history of 106 tasks from 081219
040902 - to 090331 arranging care for Millie to recover from 8th relapse of
040903 - cancer by treating cancer as a "chronic disease" reported in the
040904 - record on 090409 1520 for telecon with Doctor Johnson. ref SDS 18 4W5I
040906 -  ..
040907 - Patient history of 56 tasks from 090401 to 090409 is reported on
040908 - 090410. ref SDS 19 4W5I
040910 -  ..
040911 - On 090331 2047 Millie notified the medical team that IBC rash appears
040912 - to be spreading on lower left arm.  Hoped it might be Cellulitis.
040913 - ref SDS 14 Q69V  Another possiblity would be reaction to radiation,
040914 - even though this area was not radiated. ref SDS 14 Q64U   Later that
040915 - day on 090401 0032 Doctor Hsu advised that rash appearing on lower
040916 - left arm is likely IBC progression. ref SDS 15 R24X
040918 -  ..
040919 - On 090406 1512 Millie reported concern about IBC spreading, and
040920 - advises medical team that the rash may be subsiding a little.
040921 - ref SDS 16 RE6V
040923 -  ..
040924 - On 090408 Millie reports possible IBC in radiation and hyperthermia
040925 - treated area, ref SDS 17 QW3Y, and says possible sprinkled IBC on
040926 - lower left arm seems lighter. ref SDS 17 QW4R
040928 -  ..
040929 - On 090410 0143 Millie notified medical team that mechanics seem to be
040930 - in place for efficient case management of the 8th relapse of cancer.
040931 - ref SDS 19 E57K  Millie also reported progress recovering from severe
040932 - side effects caused by radiation treatment for the 7the relapse of
040933 - cancer. ref SDS 19 JT4T
040935 -  ..
040936 - Today, Millie sent the following letter notifying the medical team
040937 - that IBC seems to be getting worse on left arm...
040938 -
040939 -    1.  Subject: IBC Spread Lower Left Arm
040940 -        Date: Sun, 12 Apr 2009 22:48:08 -0700
040948 -         ..
040949 -    3.  On March 31, I reported to the medical team a few minor red
040950 -        blotches on my lower left arm. ref SDS 14 Q69V  Doctor Hsu
040951 -        indicated this was likely IBC [reported on 090401 0032,
040952 -        ref SDS 15 R24X].
040953 -
040954 -
040956 -  ..
040957 - Millie Asks for Treatment Before Leaving Town on 090426
040958 - IBC Expanding Outside Areas Treated with Radiation Hyperthermia
040959 -
040960 -
040961 -    4.  I think this is worsening now, though not rapidly like IBC
040962 -        expanded on my chest in January and February [e.g., reported on
040963 -        090202, 1437 IBC disease increased significantly since meeting
040964 -        at UCSF on 090129, ref SDS 11 R23S; progression of disease
040965 -        shown by cancer marker CA 15-3 303 from Kaiser lab on 090116,
040966 -        ref SDS 11 R23Y].  There seems to be a neat line approximately
040967 -        on the lower edge of radiation and hyperthermia [aligns with
040968 -        research on 090129 reporting IBC popped up outside the treated
040969 -        areas, but continued treatment eventually resolved all IBC.
040970 -        ref SDS 9 OI6N].  Other isolated very light and small/minor
040971 -        rash areas occur on the forearm and on the inner arm below the
040972 -        elbow, and just above the wrist, i.e., rash areas are dispersed
040973 -        on the arm.
040974 -
040975 -            [On 090415 1519 Doctor Johnson reported another IBC patient
040976 -            at Kaiser suffered recurrence along the line of radiation
040977 -            and hyperthermia treatments, similar to Millie. ref SDS 21
040978 -            E042
040980 -             ..
040981 -            [On 090420 2352 Millie's letter to medical team submits
040982 -            agenda for meeting at UCSF on 090423 cites new IBC on lower
040983 -            left arm; and, also, reports a vertical line in the
040984 -            breastbone area of possible IBC or continuing reaction to
040985 -            radiation. ref SDS 22 MS5Q
040987 -             ..
040988 -            [On 090609 Doctor Hsu advises there was a mistake
040989 -            performing radiation in February and March at UCSF that
040990 -            missed treating IBC in the breastbone area to the left of
040991 -            the right breast, and this untreated IBC tumor may be
040992 -            causing problems in Millie's lungs. ref SDS 24 TP9L
040994 -         ..
040995 -    5.  Rate of progression, assuming this is IBC, seems slow enough to
040996 -        wait for meeting on [090423] with Tara.  My concern is that I
040997 -        will be out of town for 2 weeks until OA 090508.  If we defer
040998 -        action until 090508 this could delay treatment for another week
040999 -        or so getting things set up.  Since this is my 6th or 7th
041000 -        relapse, delaying treatment until mid-to-late May seems like a
041001 -        big risk [based on Doctor Johnson's continued warnings since
041002 -        August that starting new treatment quickly is essential for
041003 -        Millie, shown in case study on 041230, ref SDS 6 KF3H],
041005 -         ..
041006 -    6.  My last chemotherapy with sunitinib was on 090122. ref SDS 8
041007 -        AT6N  Radiation and hyperthermia ended on 090317. ref SDS 13
041008 -        9L7K
041010 -         ..
041011 -    7.  Would it be advisable to make an examination on Monday,
041012 -        Tuesday, Wednesday..., and if IBC is diagnosed should this be
041013 -        treated before I leave town on 090424, in order to avoid
041014 -        another urgent situation, where everyone is scrambling? [see
041015 -        case study on 090205. ref SDS 12 LQ3O]
041016 -
041017 -            [On 090415 0949 Millie notifies medical team IBC spreading;
041018 -            asks about getting treatment of cancer as a chronic
041019 -            disease. ref SDS 20 KG8Q
041021 -             ..
041022 -            [On 090420 2352 Millie's letter to medical team submits
041023 -            agenda for meeting at UCSF on 090423 cites new IBC on lower
041024 -            left arm; and, also, reports a vertical line in the
041025 -            breastbone area of possible IBC or continuing reaction to
041026 -            radiation. ref SDS 22 MS5Q
041028 -             ..
041029 -            [On 090521 2006 Doctor Johnson's letter to Millie without
041030 -            copy to medical team refuses to prescribe treatment and
041031 -            tells Millie she can "choose" any treatment she wants,
041032 -            because no treatment is superior for Millie's patient
041033 -            profile, ref SDS 23 9Q9H; Doctor Johnson warns Millie that
041034 -            she needs treatment by the end of the week, which is in
041035 -            just 12 hours, because her 8th relapse of cancer is
041036 -            progressing rapidly, ref SDS 23 HC8O, and Kaiser tells
041037 -            Millie to call Medicare rather than Kaiser for prescribing
041038 -            her treatment to recover from 8th relapse of cancer.
041039 -            ref SDS 23 9Q9H
041041 -         ..
041042 -    8.  Not sure this would be a 7th relapse.  There are no signs of
041043 -        IBC in areas treated during February and March.  The treated
041044 -        areas continue to look better, subject to review by you and
041045 -        Doctor Hsu.
041046 -
041048 -  ..
041049 - Radiation Hyperthermia or Doxil on Lower Left Arm
041050 - Treatment Requested 7th Relapse IBC Prevent Losing Control Cancer
041051 -
041052 -
041053 -    9.  I might be able to have radiation and hyperthermia on the lower
041054 -        arm, since this did not get treatment during the prior cycle.
041055 -        Alternatively, hyperthermia and Doxil discussed in your letter
041056 -        on 090129 might be considered, or another agent.  Chris, Doctor
041057 -        Hsu's colleague, seemed to say during the meeting on 090312
041058 -        that a newer more effective form of Doxil would be available in
041059 -        a month or so.
041061 -         ..
041062 -   10.  Just wondering if there are interim measures to prevent what
041063 -        seems minor at this time from becoming much worse, so there is
041064 -        time to design a comprehensive treatment?
041065 -
041066 -            [On 090519 1613 Millie letter to medical team asks again
041067 -            about getting treatment on interim basis to prevent cancer
041068 -            from cascading out of control.
041070 -  ..
041071 - Local Control Reduce Morbidity from Delayed Treatment
041072 -
041073 -
041074 -   11.  Hoping to avoid waiting until 090423 and then have to stand
041075 -        down on my trip in order to gain control of IBC again.  Would
041076 -        like to try getting treatment this week and next, if needed, so
041077 -        we don't risk an extended period without treatment.
041079 -  ..
041080 - Millie's treatment was delayed on 030109, ref SDS 1 645O
041081 -                                   030606, ref SDS 2 N66J
041082 -                                   030710, ref SDS 3 VM7I
041083 -                                   041104, ref SDS 4 Q59K
041084 -                                   041130, ref SDS 5 028N
041085 -                                   061208, ref SDS 7 RW5I
041086 -                                   090130, ref SDS 10 AY8Q
041087 -
041089 -  ..
041090 - Millie's letter to medical team continues...
041091 -
041092 -   12.  Otherwise I feel much better physically after recovering from
041093 -        radiation side effects.  Have started aerobics again.  Today
041094 -        did a good time on the 3-mile hike at Lafayette.
041096 -         ..
041097 -   13.  I am getting CT and blood tests at Kaiser tomorrow afternoon.
041098 -        This was intended for the meeting on 090423, but we can
041099 -        scramble to submit results in a few days, if necessary.
041101 -         ..
041102 -   14.  Please advise.
041103 -
041110 -
041111 -
041112 -
041113 -
041114 -
041115 -
041116 -
041117 -
041118 -
041119 -
041120 -
041121 -
041122 -
041123 -
041124 -
041125 -
041126 -
041127 -
041128 -
041129 -
041130 -
0412 -