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 16, 2009 00:10 AM Thursday;
Rod Welch
Millie submits CT test to medical team favorable findings no lung cancer.
1...Summary/Objective
2...Coordinate Care Millie's 8th Relapse Treat Cancer Chronic Disease
3...Heavy Chest Reported Concern about Lung Damage from Radiation
..............
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS F2 0000. ref SDS E6 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - The letter today follows up patient history...
040902 -
040903 - Patient history of 106 tasks from 081219 to 090331 arranging care for
040904 - Millie to recover from 8th relapse of cancer by treating cancer as a
040905 - "chronic disease" is reported in the record on 090409 1520 telecon
040906 - with Doctor Johnson. ref SDS E3 4W5I
040908 - ..
040909 - 1. Doctor Hsu letter asks beside fever and
040910 - chill any other symptoms? cough, pain, etc.
040911 - Did Silvadine help with the skin
040912 - pain.............................. 090401, ref SDS B9 E54L
040914 - ..
040915 - 2. Doctor Hsu letter says rash on
040916 - lower left arm likely
040917 - IBC............................... 090401, ref SDS B9 R24X
040919 - ..
040920 - 3. Millie reports to medical team temperature
040921 - came down to 97.8 with aspirin, and
040922 - drinking water; no other symptoms
040923 - of cough and pain responding
040924 - to Doctor Hsu's
040925 - inquiry........................... 090401, ref SDS C0 AE4G
040927 - ..
040928 - 4. Millie advises medical team that UCSF
040929 - instructions on 090330 to apply generous
040930 - thickness of Silvadine cream may relieve
040931 - pain slightly from radiation
040932 - side effects...................... 090401, ref SDS C0 RE6V
040934 - ..
040935 - 5. Millie more resolved to tolerate severe
040936 - side effects from radiation and hyperthermia
040937 - in order to recover from 6th relapse of
040938 - IBC because examination at UCSF shows
040939 - results; and further side effects are
040940 - subsiding in some areas; signs of recovery
040941 - helps overcome the trauma of dressing
040942 - the wound several times a day;
040943 - which is very scary to
040944 - observe............................ 090401, ref SDS C0 RE6Y
040946 - ..
040947 - 6. Millie's letter to medical team reports
040948 - UCSF has not clarified schedule for meeting
040949 - with Doctor Rugo on Thursday 090402,
040950 - which seems like a
040951 - mistake............................ 090401, ref SDS C0 RE8S
040953 - ..
040954 - 7. Doctor Rugo advises Millie will not be
040955 - ready for examination on 090402 to plan
040956 - treatment for 7th relapse of IBC; proposes
040957 - meeting at UCSF on 090416; notes Millie
040958 - suffering wound from radiation
040959 - side effects, and advises
040960 - treatment will be very
040961 - effective.......................... 090401, ref SDS C1 K56O
040963 - ..
040964 - 8. Millie's letter to medical team explains
040965 - Kaiser's schedule for medical tests on
040966 - on 090413 to support meetings at
040967 - 090423............................. 090401, ref SDS C2 R43V
040969 - ..
040970 - 9. Millie cites concern about new IBC on
040971 - lower left arm and asks UCSF to
040972 - confirm meetings on
040973 - 090423............................. 090401, ref SDS C2 R43V
040975 - ..
040976 - 10. Telecon Kaiser Outside Referral Department
040977 - advises the referral for Millie's treatment
040978 - at UCSF expires on 090602 is automatically
040979 - extended 1 year to 100202 in order
040980 - to implement Kaiser prescription
040981 - for UCSF to treat Millie's
040982 - cancer as a chronic
040983 - disease............................ 090401, ref SDS C3 KT8G
040985 - ..
040986 - 11. Kaiser Outside Referral Department lists
040987 - UCSF professionals providing services
040988 - for Millie's care to ensure
040989 - continuity of treatment to
040990 - resolve IBC........................ 090401, ref SDS C3 5W4G
040992 - ..
040993 - 12. Kaiser Outside Referral Department explains
040994 - primary care physician can amend referral for
040995 - Millie's treatment with hyperthermia and
040996 - radiation to have labs done at UCSF in order
040997 - to reduce mistakes and save lives,
040998 - time and money..................... 090401, ref SDS C3 RG5K
041000 - ..
041001 - 13. Millie's letter notifies medical team
041002 - Kaiser Outside Referrals indicates
041003 - current authorization enables continuity
041004 - of care at UCSF from Doctor Rugo in Breast
041005 - Care Clinic, and Doctor Hsu in
041006 - Radiation Oncology................. 090401, ref SDS C4 LG4G
041008 - ..
041009 - 14. Millie's letter notifies team that Kaiser
041010 - Outside Referrals authorizes continuity
041011 - of care by automatically extending
041012 - payment for 6 months until
041013 - 100202............................. 090401, ref SDS C4 WC6Y
041015 - ..
041016 - 15. Millie's letter notifies team that
041017 - referral for Millie's hyperthermia and
041018 - ratiation can be amended by primary care
041019 - physician to add labs at UCSF in order
041020 - streamline care for medical necessity
041021 - to reduce mistakes and save
041022 - time and money..................... 090401, ref SDS C4 WC7Y
041024 - ..
041025 - 16. Doctor Rugo thanks Millie for facilitating
041026 - Kaiser clarifying referral authorization
041027 - for UCSF to treat Millie's 7th relapse
041028 - of cancer as a chronic disease; and
041029 - advises information should be sent
041030 - to the UCSF authorization
041031 - person............................. 090402, ref SDS C5 LA6H
041033 - ..
041034 - 17. Doctor Rugo advises that clarifying
041035 - confusion in scheudling next meeting
041036 - should be resolved by UCSF schedule
041037 - department because UCSF has a
041038 - complex schedule system............ 090402, ref SDS C5 117O
041040 - ..
041041 - 18. Millie letter asks Doctor Rugo if Lena
041042 - who called Millie in February about
041043 - scheduling meetings with the doctor
041044 - can clarify the schedule in
041045 - April, as requested by
041046 - the doctor......................... 090402, ref SDS C6 WM8M
041048 - ..
041049 - 19. Millie sent a letter to Glenna who
041050 - coordinated Millie's treatment on pior
041051 - sunitinib clinical trial, and asking
041052 - for assistance finding who to notify
041053 - about Kaiser referral authorization,
041054 - who can assist clarifying the
041055 - schedule for meeting with
041056 - Doctor Rugo........................ 090402, ref SDS C7 WM8M
041058 - ..
041059 - 20. Glenna called and advised she coordinated
041060 - contacts at UCSF for Millie's referral
041061 - authorization, and to clarify schedule
041062 - for Millie to meet with Doctor
041063 - Rugo on planning treatment
041064 - for the 7th relapse
041065 - of IBC............................. 090402, ref SDS C8 JA6L
041067 - ..
041068 - 21. Millie letter notified medical team
041069 - elevated temperature 99.7 fever occurred
041070 - again; icing upper left arm, and is
041071 - monitoring fever to
041072 - evaluate........................... 090402, ref SDS C9 684J
041074 - ..
041075 - 22. Millie letter to medical team thanks Doctor
041076 - Rugo for Glenna's support coordinating case
041077 - management on referral authorizations,
041078 - and on scheduling a meeting to plan
041079 - treatment for recovering from 7th
041080 - relapse of IBC..................... 090402, ref SDS C9 H94R
041082 - ..
041083 - 23. Millie letter to Doctor Rugo's assistant
041084 - requests confirmation of schedule to
041085 - with the doctor at UCSF on 090423
041086 - for planning treatment of
041087 - Millie's 8th relapse of
041088 - cancer............................. 090403, ref SDS D0 375Y
041090 - ..
041091 - 24. Millie letter notifies medical team that
041092 - temperature 99.7 subsided by midnight;
041093 - cough and shortness of breath persisted
041094 - and prevented sleep; evantually
041095 - recovered about
041096 - 0400............................... 090403, ref SDS D1 XZ6I
041098 - ..
041099 - 25. Doctor Hsu letter asks Millie to get
041100 - examination at Kaiser for
041101 - pneumonia.......................... 090403, ref SDS D2 Z66M
041103 - ..
041104 - 26. Doctor Rugo letter asks Millie to
041105 - get examination at Kaiser for
041106 - shortness of breath................ 090403, ref SDS D3 3G3N
041108 - ..
041109 - 27. Millie notifies medical team that UCSF
041110 - recommends examination for pneumonia
041111 - with symptoms of shortness of
041112 - breath............................. 090403, ref SDS D4 NW4N
041114 - ..
041115 - 28. Millie notifies medical team fever occurs
041116 - for 3rd time with temperature 99.4; explains
041117 - home care has previously been
041118 - effective.......................... 090403, ref SDS D4 DX7S
041120 - ..
041121 - 29. Millie notifies medical team side effects
041122 - of radiation and hyperthermia skin "burn"
041123 - healing, and pain subsides
041124 - substantially...................... 090403, ref SDS D4 DX8R
041126 - ..
041127 - 30. Millie letter to Doctor Johnson 090403
041128 - 2012 supplements letter sent 20 minutes
041129 - earlier 1941 to explain symptoms subside
041130 - proposes monitoring and then assess
041131 - need for examination at
041132 - Kaiser............................. 090403, ref SDS D5 ZG7H
041134 - ..
041135 - 31. Letter from Doctor Johnson responds to
041136 - Mil's first letter sent 090403 1954,
041137 - ref SDS D4 NW4N, but not this 2nd letter
041138 - sent 20 minutes later, and reporting symptoms
041139 - subside, see 090403 2012, ref SDS D5 OA4R;
041140 - doctor evidently did not see the 2nd letter;
041141 - asks Millie to call Kaiser and schedule
041142 - a meeting, recommends medical team use
041143 - Kaiser's internal proprietary Knowledge
041144 - Management system for email to
041145 - increase efficiency
041146 - performing case
041147 - management......................... 090406, ref SDS D6 M19I
041149 - ..
041150 - 32. Millie letter to medical team relates
041151 - report in Millie's 2nd letter on 090403
041152 - that symptoms have not repeated, and
041153 - so proposes deferring examination
041154 - at Kaiser.......................... 090406, ref SDS D7 OC5F
041156 - ..
041157 - 33. Called UCSF talked to Roy, who advises
041158 - there is no record scheduling meeting
041159 - on 090423; Roy plans to notify Amanda,
041160 - who is another assistant for Doctor Rugo,
041161 - about scheduling meeting on 090423
041162 - 0830, which Doctor Rugo
041163 - ordered............................ 090407, ref SDS D8 PP8X
041165 - ..
041166 - 34. Amanda called, she assists Doctor Rugo;
041167 - advised UCSF cannot find Millie's letter
041168 - to medical team on 090401 1520, ref SDS C4
041169 - LG4G, and further advised that UCSF has no
041170 - record Kaiser has authorized referral for
041171 - Millie to meet with Doctor Rugo on 090423,
041172 - and so a meeting has not been scheduled;
041173 - Millie's letter on 090401 1520 was
041174 - resubmitted to Amanda
041175 - at UCSF............................ 090407, ref SDS E0 MV5K
041177 - ..
041178 - 35. Amanda called after receiving Millie's
041179 - letter on 090401 1520, and schedules
041180 - Millie for another meeting with Tara,
041181 - because Doctor Rugo will be
041182 - out of town again
041183 - on 090423 0830..................... 090407, ref SDS E0 4N3F
041185 - ..
041186 - 36. Called Kaiser CT Department Loretta confirmed
041187 - test scheduled on 090413 allows 10 days
041188 - for Kaiser to send report in time to meet
041189 - at UCSF 090423; CT Department changes time
041190 - for test from 1520 to 1500 requested by
041191 - Interventional Radiology Services to avoid
041192 - overtime for Millie's CT test; Loretta
041193 - asks Millie to coordinate with Chemotherpay
041194 - Infusion Department to change the time
041195 - for Millie's blood on 090413 from
041196 - 1500 to 1430, so that the CT Department
041197 - can make use of the nurse accessing
041198 - Millie's Power Port with a Huber
041199 - needle that can be used to
041200 - inject contrast medium
041201 - for the CT test
041202 - at 1500............................ 090407, ref SDS E1 L76N
041204 - ..
041205 - 37. Kaiser CT Department discloses the
041206 - computer indicates somebody changed
041207 - doctor's order for consolidating findings
041208 - into single report to correct mistakes
041209 - in past reports; Loretta to investigate
041210 - why doctor's order was
041211 - changed............................ 090407, ref SDS E1 1163
041213 - ..
041214 - 38. Called Kaiser Oncology Department and
041215 - changed time for blood draw from 090413
041216 - 1500 to 1430 to facilitate request by
041217 - IS to avoid overtime
041218 - expense............................ 090407, ref SDS D9 R16X
041220 - ..
041221 - 39. Kaiser CT Department called back; Katie
041222 - advised that the doctor's order for Millie's
041223 - CT test was changed by the department
041224 - to eliminate requirement for consolidated
041225 - findings because government regulations
041226 - require separate reports for scans above
041227 - the neck from scans below the
041228 - neck............................... 090407, ref SDS E1 L87J
041230 - ..
041231 - 40. CT Department called back and Katie advised
041232 - test scheduled on 090414 1500, which
041233 - conflicted with doctor's order for
041234 - test on 090413..................... 090407, ref SDS E1 YK64
041236 - ..
041237 - 41. CT Department called back and advised
041238 - an error occurred in data entry changing
041239 - the time for the test on 090413 from 1520
041240 - to 1500, resulting to scheduling the
041241 - test on 090414; Katie corrected
041242 - mistake............................ 090407, ref SDS E1 W47V
041244 - ..
041245 - 42. CT Department investigates why doctor's
041246 - order for consolidating findings into
041247 - a single report for each CT test
041248 - was changed........................ 090407, ref SDS E1 YZ95
041250 - ..
041251 - 43. UCSF notified Millie will be examined
041252 - in breast care clinic on 090423 0830
041253 - evaluate progression IBC 7th
041254 - relapse and plan for next
041255 - treatment.......................... 090408, ref SDS E2 E54L
041257 - ..
041258 - 44. Medical team notified Kaiser CT Department
041259 - changed time of test on 090413 to accomodate
041260 - IS overtime cost containment objectives;
041261 - requires coordinating with Chemotherapy
041262 - Infusion Clinic to correlate time of
041263 - blood draw with revised time
041264 - for CT test........................ 090408, ref SDS E2 QW4X
041266 - ..
041267 - 45. Fever high temperature occurred for several
041268 - days during 3 - 5 hours in late evening
041269 - but this stopped several days ago, and other
041270 - symptoms cough and shortness of breath
041271 - subside, so no need for examination at
041272 - Kaiser by primary care physician
041273 - requested by Doctor Hsu and
041274 - Doctor Rugo at
041275 - UCSF............................... 090408, ref SDS E2 QW6R
041277 - ..
041278 - 46. Arlette coordinated with Bella to change
041279 - time of blood test to 1330 that aligns
041280 - with CT Department changing time of CT
041281 - test on 090413 from 1520 to
041282 - 1500............................... 090409, ref SDS E3 E54L
041284 - ..
041285 - 47. Examination to evaluate treatment of
041286 - radiation side effects requested by
041287 - Doctor Hsu and Doctor Rugo at UCSF
041288 - was deferred by Doctor Johnson because
041289 - patient reports symptoms
041290 - subsided........................... 090409, ref SDS E3 TH61
041292 - ..
041293 - 48. Notified Doctor Johnson on progress with
041294 - coordination he requested for CT Department
041295 - to consolidate findings into single report
041296 - for each CT test in order to enable
041297 - efficient case management; under
041298 - review by Doctor
041299 - Davidson........................... 090409, ref SDS E3 FU6J
041301 - ..
041302 - 49. Doctor Johnson amended Kaiser referral
041303 - authorization for Millie's treatment
041304 - at UCSF with hyperthermia and related
041305 - modalities to include labs at UCSF
041306 - required for efficient case
041307 - management......................... 090409, ref SDS E3 6O6N
041309 - ..
041310 - 50. Doctor Davidson Director of Radiology
041311 - for Kaiser Diablo Service Region disclosed
041312 - CT Department made mistakes issuing multiple
041313 - reports for a single CT test in order to
041314 - increase revenues from billings; advised
041315 - this practice would be changed to consolidate
041316 - findings that enable efficient patient
041317 - care for saving lives time
041318 - and money.......................... 090409, ref SDS E4 L14I
041320 - ..
041321 - 51. Letter to Doctor Davidson with copy to
041322 - medical team confirms Kaiser will correct
041323 - CT test reports for efficient
041324 - patient care....................... 090409, ref SDS E5 WB6G
041326 - ..
041327 - 52. Millie notifies medical team Doctor Johnson
041328 - amended Kaiser's referral to include labs
041329 - at UCSF for efficient case
041330 - management......................... 090410, ref SDS E6 JT7H
041332 - ..
041333 - 53. Medical team notified Doctor Davidson
041334 - corrected past problems in Kaiser CT
041335 - Department so that test reports
041336 - will consolidate findings
041337 - for efficient case
041338 - management......................... 090410, ref SDS E6 JT9Y
041340 - ..
041341 - 54. Millie asks medical team if anything
041342 - else is needed for efficient case management
041343 - to prepare for meeting at UCSF on 090423
041344 - on planning to treat her cancer at UCSF
041345 - as a chronic disease, as requested
041346 - by primary care physician at
041347 - Kaiser............................. 090410, ref SDS E6 JT5V
041349 - ..
041350 - 55. Millie recovering from severe side effects
041351 - caused by radiation treatments that
041352 - ended on 090317.................... 090410, ref SDS E6 JT4T
041354 - ..
041355 - 56. Millie reports energy improves so that
041356 - she is a good candidate for cancer
041357 - treatment.......................... 090410, ref SDS E6 JT5S
041359 - ..
041360 - 57. Millie's letter to medical team
041361 - reports IBC worsening on
041362 - left arm........................... 090412, ref SDS E7 XN8J
041364 - ..
041365 - 58. Millie letter to medical team requests
041366 - treatment next week to prevent cancer
041367 - from cascading out of
041368 - control............................ 090412, ref SDS E7 9S9Y
041370 - ..
041371 - 59. Millie went to Kaiser for lab to evaluate
041372 - progression of cancer, and suitability
041373 - for treatment, and to access the port
041374 - for a CT test also on 090413 to
041375 - assess cancer...................... 090413. ref SDS E8 VF6G
041377 - ..
041378 - 60. Millie had CT test at
041379 - Kaiser............................. 090413, ref SDS E9 0E4I
041381 - ..
041382 - 61. Millie calls Kaiser to get reports for
041383 - labs and CT test on 090413; Kaiser
041384 - will print reports for Millie to pick
041385 - at Oncology front desk after
041386 - lunch.............................. 090415, ref SDS F0 R18A
041388 - ..
041389 - 62. Millie drove to Kaiser after lunch
041390 - but reports were not ready, and were
041391 - incomplete when eventually
041392 - received........................... 090415, ref SDS F0 RY4Y
041394 - ..
041395 - 63. Arlette called in mid-afternoon with
041396 - timely notice of CT test findings
041397 - progression of nodules in lungs
041398 - which appears systemic
041399 - cancer............................. 090415, ref SDS F0 RW9K
041401 - ..
041402 - 64. Millie letter notifies medical team
041403 - CT test on 090413 shows progression
041404 - of nodules that may indicate
041405 - lung cancer........................ 090415, ref SDS F3 R18A
041407 - ..
041408 - 65. Millie notifies medical team IBC
041409 - spreading.......................... 090415, ref SDS F1 KG8Q
041411 - ..
041412 - 66. Millie letter assists Kaiser coordinating
041413 - with UCSF on getting results of the
041414 - blood test and CT test on 090413 to
041415 - UCSF for meeting on 090423 to plan
041416 - next treatment of 8th
041417 - relapse............................ 090415, ref SDS F1 KG8Y
041419 - ..
041420 - 67. Millie letter notifies medical team
041421 - that labs and CT test reports have not
041422 - been received, and are incomplete
041423 - reflects communication difficulties
041424 - rising factor reducing
041425 - productivity health
041426 - care............................... 090415, ref SDS F2 JT7H
041428 - ..
041429 - 68. Heavy chest for a week Millie notifies
041430 - medical team for review CT test and
041431 - examination to evaluate
041432 - expanding symptoms................. 090415, ref SDS F2 GU8X
041434 - ..
041435 - 69. Doctor Johnson called Millie to discuss
041436 - CT test findings on progression of lung
041437 - nodules in relation to Millie's report
041438 - heavy chest for a week; he personally
041439 - reviewed scans from Millie's CT test
041440 - on 090413 and determined there no
041441 - evidence of lung
041442 - cancer............................. 090415, ref SDS F4 GT4M
041444 - ..
041445 - 70. Doctor Johnson frustrated by continual
041446 - delays sending test data from Kaiser
041447 - to UCSF; expects amended referral
041448 - filed on 090409 authorizing lab work
041449 - at UCSF for Millie's care at UCSF
041450 - will relieve stress causing
041451 - continual errors at
041452 - Kaiser............................. 090415, ref SDS F4 MJ4G
041454 - ..
041455 - 71. Doctor Johnson advised that spread of
041456 - IBC on Millie's lower left arm reported
041457 - in Millie's letter this morning shows
041458 - it is critical for UCSF to treat
041459 - Millie's cancer as a chronic
041460 - disease............................ 090415, ref SDS F4 J55M
041462 - ..
041463 - 72. Doctor Johnson advised that Millie's
041464 - recurrence similar to another patient
041465 - treated for IBC with radiation and
041466 - hyperthermia; 23 year old woman suffered
041467 - IBC spreading along perimeter and
041468 - outside of treated
041469 - areas.............................. 090415, ref SDS F4 E042
041470 -
041471 -
041472 -
041473 -
041474 -
0415 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Coordinate Care Millie's 8th Relapse Treat Cancer Chronic Disease
050403 - Heavy Chest Reported Concern about Lung Damage from Radiation
050404 -
050405 - Follow up ref SDS F2 6O6N, ref SDS E6 6O6N.
050406 -
050407 - Background on Doctor Johnson asking Millie to coordinate with UCSF on
050408 - arrangements for treating Millie's 8th relaspe of cancer as a chronic
050409 - disease, as listed in the record on 090409. ref SDS E3 4W5I
050411 - ..
050412 - Millie sent a letter to the medical team submitting the report for
050413 - the CT test on 090413 and received from Doctor Johnson today...
050414 -
050415 - 1. Subject: CT Test Submit to UCSF Lung Nodules Minimal Progression
050416 - Date: Thu, 16 Apr 2009 00:30:51 -0700
050428 - ..
050429 - 2. Thanks for your call this afternoon at 1519 [on 090415 1519,
050430 - ref SDS F4 R18A], responding to my letter at 1502 discussing
050431 - findings from my CT test at Kaiser on 090413 [reported on
050432 - 090415 1458, ref SDS F3 R18A].
050434 - ..
050435 - 3. During the call, you reported having read the report on the CT
050436 - test and you also examined the scans directly. ref SDS F4 GT4M
050438 - ..
050439 - 4. I was relieved to hear your comments that, while the report
050440 - cites "progression" of nodules in the lungs, your review of
050441 - test scans found this is minimal and so should not be causing
050442 - respiratory problems, such as pneumonia considered in prior
050443 - correspondence [by Doctor Hsu in his letter on 090403 1324,
050444 - ref SDS D2 Z66M]. You commented that "changes" in the lungs
050445 - compared to the CT test on 081230 could be due to radiation
050446 - treatments last month, or even differences in the angle at
050447 - which the CT scan equipment was applied for the 2 tests.
050448 - ref SDS F4 E09J
050449 -
050450 - [On 090514 0830 Doctor Rugo seemed to concur during a
050451 - meeting at UCSF that slight increase in ground glass
050452 - opacities listed in Millie's CT test on 090413, and reviewed
050453 - on 090415, see below, ref SDS F5 RV78, were likely reaction
050454 - to radiation, rather than spread of cancer. ref SDS F9 U85I
050456 - ..
050457 - 5. Accordingly, the heavy chest I have experienced the past week
050458 - may have some other cause [reported in Millie's letter on
050459 - 090415 1424, ref SDS F2 GU8X]. Perhaps increased hiking and
050460 - gym work to improve fitness, which declined the past 6 months,
050461 - causes slight respiratory issues that feels like heavy chest.
050462 - I emphasized during the call today that my energy is up, and I
050463 - feel very good.
050465 - ..
050466 - 6. I am attaching a copy of your letter on these matters [dated
050467 - 090415 1610], ref SDS F5 YO7M, along with the report for CT
050468 - test on 090413, received from you through Kaiser's Knowledge
050469 - Management system. This submission gives the medical team time
050470 - to prepare for meetings at UCSF planning my next treatment.
050471 -
050472 - [On 090514 0830 Doctor Rugo seemed to concur during a
050473 - meeting at UCSF that slight increase in ground glass
050474 - opacities listed in Millie's CT test on 090413, and reviewed
050475 - on 090415, see below, ref SDS F5 RV78, were likely reaction
050476 - to radiation, rather than spread of cancer. ref SDS F9 U85I
050478 - ..
050479 - 7. Thanks to Doctor Davidson in the Kaiser Radiology Department
050480 - for consolidating findings in a single report to facilitate
050481 - review by the medical team.
050483 - ..
050484 - 8. My general impression is that the CT test report presents
050485 - favorable findings of reduced adenopathy in the right axilla
050486 - and supraclavicular. Recall that LN in the left
050487 - supraclavicular increased reported in the CT test on 081107.
050488 - This was prior to starting treatment with sunitinib on 081114,
050489 - and then declined during treatment, reported in the test on
050490 - 081230. The LN in the neck then increased again reported by
050491 - Doctor Rugo in the examination on 090129 signaling progression
050492 - of IBC, leading to changing treatment. Doctor Hsu also
050493 - palpated LN in the neck during examination on 090205.
050494 - Therefore "stable" findings in the test on 090413 compared with
050495 - the test on 081230 that reported reduced LN, seems to
050496 - demonstrate favorable response with radiation performed at UCSF
050497 - during February and March.
050499 - ..
050500 - 9. Slight rise in CA 15-3 271 on 090413, from 251 for the lab at
050501 - Kaiser on 090317. This may reflect reduced cancer in the areas
050502 - treated with radiation and hyperthermia, and increased IBC on
050503 - my lower left arm.
050505 - ..
050506 - 10. During the call today, you gave an example of a patient with
050507 - IBC who was treated with radiation and/or hyperthermia. In
050508 - that case, after treatment, IBC popped up along the perimeter
050509 - of the treatment, which is also occurring in my case on the
050510 - lower left arm, reported to the medical team on 090412. I was
050511 - pleased to hear that experience at Kaiser indicates there is a
050512 - good chance this latest flare up of IBC can be successfully
050513 - treated at UCSF. ref SDS F4 E042
050515 - ..
050516 - 11. Looking forward to the treatment plan from Doctor Rugo and
050517 - Doctor Hsu at UCSF.
050519 - ..
050520 - 12. Thanks again for timely response to clarify implications from
050521 - the report on the CT test. I assume the file on the test scans
050522 - can be submitted to UCSF for direct examination, if needed.
050524 - ..
050525 - 13. Thanks also to Arlette for facilitating communication today and
050526 - getting reports submitted.
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0506 -