CONTACTS 

SUBJECTS
White Blood Cell Condition Blood Test Shows Too Low Doctor Johnson A

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 60 0000. ref SDS 43 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie met with the medical team this morning, initially at 0800 with
040902 - Tara Lacey in the Breast Care Clinic on the 2nd floor, and then with
040903 - Doctor Hsu at 1200 in the Radiation Oncology Department.
040905 -  ..
040906 - This evening, she submitted a letter to the medical team reporting
040907 - findings, and plans for follow up...
040908 -
040909 -    1.  Subject: Favorable Examinations UCSF IBC 90% Recovery Follow Up Doctor Rugo May 14th
040910 -        Date: Thu, 23 Apr 2009 23:49:56 -0700
040924 -         ..
040925 -    2.  Dear Doctor Rugo and Doctor Hsu,
040927 -         ..
040928 -    3.  I am greatly relieved today by examinations at UCSF finding
040929 -        strong response to treatment.
040931 -         ..
040932 -    4.  Meeting at 0830 in the Breast Care Clinic - Tara was very
040933 -        pleased seeing significant recovery from severe IBC,
040934 -        ref SDS 60 QR3M, reported on 090129 that led Doctor Rugo to
040935 -        prescribe treatment in Radiation Oncology [reported in the
040936 -        record on 090130. ref SDS 22 TZ6H  Review today confirmed my
040937 -        report to the medical team on 090402, and sustains Tara's
040938 -        interim examination on 090312 that anticipated strong recovery.
040939 -        At that time on 090312, I was concerned, after 3 weeks of
040940 -        treatment, about continuing IBC nodularity with severe and
040941 -        worsening rash.  Today, this has almost entirely disappeared.
040943 -         ..
040944 -    5.  Tara did not express concerns today about findings from the CT
040945 -        test at Kaiser on 090413, submitted to UCSF in my letter on
040946 -        090420.  The report on "progression" of nodules in the lungs
040947 -        was not discussed during the meeting today.  Earlier, on 090416
040948 -        Doctor Johnson at Kaiser reported viewing the scans and
040949 -        concluding this likely did not represent cancer in the lungs.
040950 -        As further noted in the letter to the medical team on 090416,
040951 -        the CT test shows reduced lymph nodes in the supraclavicular
040952 -        and axilla in line with findings today that I have responded
040953 -        well to radiation and hyperthermia treatments.
040955 -         ..
040956 -    6.  Tara found new and likely IBC occurring on the lower left arm,
040957 -        first reported to the medical team on 090331.  She described
040958 -        this as light and sprinkled beginning below the lower edge of
040959 -        radiation and hyperthermia treatment on the upper left arm.
040960 -        She also noted there is as yet no thickness of skin, which
040961 -        indicates IBC rash in beginning stages.  Tara had me remove my
040962 -        wrist watch to differentiate this new rash from  any
040963 -        association with reaction to metal or pressure from the band.
040965 -         ..
040966 -    7.  Tara further considered possibility of Cellulitis and
040967 -        lymphedema, which has occurred numerous times to the left arm.
040968 -        She concluded that while some swelling exists compared with the
040969 -        right arm, this has been long standing for several years.  Tara
040970 -        asked for the date of the last episode?  Patient history shows
040971 -        I was treated in the ER on 080409.  Tara feels Cellulitis and
040972 -        lymphedema are not factors in evaluating patches of red rash on
040973 -        the lower left arm.
040975 -         ..
040976 -    8.  Tara noted a row of 4 or 5 nodules along a vertical line to the
040977 -        left of the right breast.  She plans to consult with Doctor Hsu
040978 -        to assess this condition. ref SDS 60 R15K
040980 -         ..
040981 -    9.  Findings of likely new IBC rash may align with slight 20 point
040982 -        increase in CA 15-3 271 for the cancer marker tested in the lab
040983 -        at Kaiser on 090413, submitted to UCSF in my letter on 090420.
040985 -         ..
040986 -   10.  After meeting with Tara, I visited briefly with Sarah Schwab,
040987 -        the Practice Manager for the Breast Care Clinic, and submitted
040988 -        printed copies of the CT test and lab report at Kaiser on
040989 -        090413.  Sara plans to submit this documentation to support
040990 -        Tara's record on the examination today.
040992 -         ..
040993 -   11.  Follow up will be in 3 weeks with Doctor Rugo on 090514 0830.
040994 -
040995 -
040997 -  ..
040998 - 90% Recovery So Far from IBC Expect Full Recovery Treated Areas
040999 -
041000 -
041001 -   12.  In the afternoon at 115p, I met with Doctor Hsu in Radiation
041002 -        Oncology. ref SDS 60 4H5G
041004 -         ..
041005 -   13.  The doctor concurred with Tara that I have made substantial
041006 -        recovery.  I thought Doctor Hsu said at least a 90% recovery
041007 -        has been achieved in the treated areas. ref SDS 60 YN5N
041008 -
041010 -  ..
041011 - Vertical Line Breastbone May be IBC or Reaction to Radiation
041012 - IBC Breastbone Vertical Line Will Recover from Prior Radiation
041013 - Breastbone Vertical Line IBC or Reaction to Radiation Will Recover
041014 -
041015 -
041016 -   14.  Doctor Hsu indicated the nodules in the middle of my chest next
041017 -        to the right breast may or may not be IBC, and if it is IBC, he
041018 -        expects radiation and hyperthermia that ended on 090317 to
041019 -        continue treating this and all covered areas for perhaps
041020 -        another month or so. ref SDS 60 EX4I
041021 -
041022 -
041024 -  ..
041025 - Nothing Can Grow in Skin Treated with Radiation and Hyperthermia
041026 - Radiation Hyperterthermia Successful Nothing Can Grow in Treated Areas
041027 -
041028 -
041029 -   15.  In sum, Doctor Hsu feels the treatment has been successful.
041031 -         ..
041032 -   16.  Moreover, the doctor expects that IBC is not likely to reappear
041033 -        in the treated areas, saying something along the lines that
041034 -        "nothing can grow in this treated skin."  He cautioned that
041035 -        biopsy should not be performed in these regions.  Skin will
041036 -        have difficulty healing, because the normal flow of nutrients
041037 -        has been degraded. ref SDS 60 V46K
041038 -
041039 -               [On 090522 1351 Millie asks the medical team how
041040 -               hyperthermia, radiation, and Doxil which has been very
041041 -               effective fit in the treatment plan, and Millie confirms
041042 -               choice, absent medical advice, to rely on care with
041043 -               these modalities to recover from the 8th relapse of
041044 -               cancer, which were effective in Feb and Mar recovering
041045 -               from 7th relapse of cancer. ref SDS 61 2T4Y
041047 -                ..
041048 -               [On 090609 Doctor Hsu advises there was a mistake
041049 -               performing radiation in February and March at UCSF that
041050 -               missed treating IBC in the breastbone area to the left
041051 -               of the right breast, and this untreated IBC tumor may be
041052 -               causing problems in Millie's lungs. ref SDS 62 TP9L
041053 -
041055 -  ..
041056 - Radiation Outside Previously Radiated Areas
041057 - Hyperthermia Effective Previously Radiated Areas
041058 - Treatment Options Radiation Outside Previously Radiated Areas
041059 -
041060 -
041061 -   17.  Doctor Hsu explained I cannot have more radiation in the
041062 -        treated areas, but these areas can get more hyperthermia.  The
041063 -        doctor seemed to indicate that, even though hyperthermia by
041064 -        itself is not very effective as initial treatment, in my case,
041065 -        skin that has been radiated will likely respond well to
041066 -        additional hyperthermia by itself, if needed in the future.  He
041067 -        does not expect IBC to return in the treated areas.  But, if
041068 -        IBC does recur, it can be treated with more hyperthermia by
041069 -        itself.
041070 -
041071 -
041073 -  ..
041074 - IBC Lower Left Arm Other Isolated Areas Not Yet Significant Threat
041075 -
041076 -
041077 -   18.  Doctor Hsu also concurred with Tara's findings that isolated
041078 -        rash on the lower left arm is the beginning stages of IBC
041079 -        spreading. He related that IBC often crops up in other
041080 -        locations, and is successfully treated with radiation and
041081 -        hyperthermia outside the previously treated areas.
041082 -
041083 -
041085 -  ..
041086 - 8th Relapse Treat Cancer Chronic Disease Maintenance Program
041087 - Chronic Disease Treat 8th Relapse Cancer Maintenance Program
041088 - Maintenance Program Treat 8th Relapse Cancer as Chronic Disease
041089 - Treat Cancer Chronic Disease Design Maintenance Program
041090 -
041091 -
041092 -   19.  Doctor Hsu plans to discuss the case with Doctor Rugo for
041093 -        designing a "maintenance program."  This aligns with Doctor
041094 -        Johnson's planning at Kaiser for UCSF to treat my cancer as a
041095 -        "chronic disease."  Doctor Hsu advised that radiation and
041096 -        hyperthermia treatment is like a "bullet."  In the case of the
041097 -        left arm he can treat IBC only twice, due to limited tolerance
041098 -        for radiation.  His strategy is to hold in reserve these
041099 -        "2-bullets" until and unless IBC becomes very serious on the
041100 -        left arm, as Doctor Rugo found occurred with my chest on
041101 -        090129.
041103 -         ..
041104 -   20.  Based on examinations today, neither Tara nor Doctor Hsu
041105 -        proposed any interim remedies nor that I limit my activities in
041106 -        any way to restrain progression of disease, pending examination
041107 -        by Doctor Rugo on 090514 and commencement of maintenance
041108 -        treatment to address new IBC observed today.  This addresses
041109 -        questions in my letter to the team on 090422.
041111 -         ..
041112 -   21.  Findings today align with Doctor Rugo's letter on 090331
041113 -        reporting that treatment would be very effective.  Looking
041114 -        forward to Doctor Hsu's report to Doctor Rugo for guidance on
041115 -        planning maintenance care.
041117 -         ..
041118 -   22.  I am extremely pleased and very grateful.
041120 -         ..
041121 -   23.  I began plans in December for a vacation with my daughter
041122 -        starting tomorrow.  At that time, I had a spectacular recovery
041123 -        from the 5th relapse.  Just a few weeks later I was relapsing
041124 -        severely and for a 6th time.  Cancer diagnostics soared to
041125 -        historic highs for my history.  I wasn't sure I would even make
041126 -        it to May, much less have a vacation.  Kaiser and UCSF have
041127 -        seen me through.
041129 -         ..
041130 -   24.  Today was a wonderful start to my vacation.
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