CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 14 0000. ref SDS 13 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 090423 Millie met with Tara in the Breast Care Clinic at UCSF for
040902 - examination, which showed recovery from side effects of radiation and
040903 - hyperthermia treatments during February and March 2009. ref SDS 12 QR3M
040904 - This was confirmed in Millie's letter to the medical team later that
040905 - day on 090423. ref SDS 13 ZL6T  Tara also found expanding IBC on the
040906 - lower left arm, ref SDS 12 DW6F, also confirmed in the letter to the
040907 - medical team. ref SDS 13 ZL7P
040909 -  ..
040910 - At that time, on 090423 Tara planned to discuss with Doctor Hsu in the
040911 - UCSF Radition Oncology Department concerns about slow healing of
040912 - radiation side effects in Millie's breastbone area. ref SDS 12 R15K
040913 - Collaboration plans were further confirmed in Millie's letter to the
040914 - medical team on 090423. ref SDS 13 ZL7V
040916 -  ..
040917 - In the afternoon on 090423 1315 Millie met with Doctor Hsu to check on
040918 - recovery from radiation side effects. ref SDS 12 4H5G  Doctor Hsu gave
040919 - Millie a "thumbs up" that she was well enough to take time from
040920 - treatment to go on a 2-week vacation, ref SDS 12 FJ6K, and despite
040921 - confirming diagnosis of IBC relapse on the lower left arm, ref SDS 12
040922 - 5G4G, and despite growing doubts about vertical line of sking infected
040923 - either by IBC or radiation side effects. ref SDS 12 EX4I  The doctor
040924 - recommended against taking a biopsy because the skin was thought to be
040925 - radiated, and surrounding tissue was radiated, and so this would delay
040926 - and prevent normal recovery from a biopsy wound. ref SDS 12 456H
040928 -  ..
040929 - On 090423 2337 Millie's letter to medical team reports Doctor Hsu's
040930 - favorable report that IBC cannot recur in treated areas, because
040931 - nothing can grow in treated areas. ref SDS 13 ZL9V  The letter further
040932 - confirms UCSF plans to treat IBC recurrence on the lower left arm as a
040933 - chronic disease with systemic agents prescribed by Doctor Rugo in the
040934 - Breast Care Clinic, ref SDS 13 ZL4X, and notes the meeting scheduled
040935 - with Doctor Rugo on 090514. ref SDS 13 ZL5Q
040937 -  ..
040938 - Earlier today on 090510 1553, Millie submitted an agenda for the
040939 - meeting on 090514 to start treatment of the 8th relapse. ref SDS 14
040940 - QH9J  The letter was hurried to fit commitments for attending Mother's
040941 - Day family event.
040943 -  ..
040944 - After retrurning, Millie sent a second letter to further explain the
040945 - agenda for meeting on Thursday 090514 at UCSF with Doctor Rugo...
040946 -
040947 -    1.  Subject: Labs Monday May 11th and IBC Symptoms
040948 -        Date: Sun, 10 May 2009 20:10:05 -0700
040959 -         ..
040960 -    2.  Quick follow up on the letter sent earlier this afternoon [on
040961 -        090510 1553, ref SDS 14 QH9J].  I was rushed to attend a
040962 -        Mother's day event, and left out contextual framing...
040963 -
040965 -  ..
040966 - Surgery Radiation Treat IBC Vertical Line Breastbone Area?
040967 - Vertical Line Breastbone Worsens May be IBC Needs Timely Treatment
040968 -
040969 -
040970 -        1.  In addition to IBC symptoms expanding on the left arm,
040971 -            since examination on 090423, the sliver of intense red skin
040972 -            running in a vertical line on the inner left side of the
040973 -            right breast, about   5 mm x 50 mm (1/8" x 2").   During
040974 -            the meeting at UCSF on 090423, Doctor Hsu seemed to expect
040975 -            this would clear up. ref SDS 12 EX4I  It is, however, more
040976 -            intense now, and there are still 3 or 4 nodules in this
040977 -            sliver of tissue.  I'm hoping it is continuing effects of
040978 -            radiation [cited by Doctor Rugo in a letter to the medical
040979 -            team on 090401 for delaying treatment 6 weeks which Millie
040980 -            needs to recover from the 8th relapse of cancer,
040981 -            ref SDS 6 K56O, based on Doctor Hsu's diagnosis that
040982 -            bleeding wound in Millie's breastbone was reaction to
040983 -            radiation, reported on 090330 1200. ref SDS 5 MN6F].
040984 -            Another scenario is that the angle of radiation treatments
040985 -            may have missed this narrow location, and we have
040986 -            progressing IBC.
040987 -
040988 -                [On 090513 1654 Millie's letter to medical team hopeful
040989 -                sliver of intense skin rash on breastbone area may be
040990 -                getting better. ref SDS 19 ZA3X
040992 -             ..
040993 -        2.  Might this be a candidate for surgery to remove infected
040994 -            tissue, since Doctor Hsu indicated that nothing can grow in
040995 -            the skin that was radiated.
040997 -             ..
040998 -        3.  Should it be biopsied?  [Note: on 090423 1330 Doctor Hsu
040999 -            advised that the vertical line of inflammed tissue in the
041000 -            breastbone area should not be biopsied, because radiated
041001 -            skin has difficulty healing, ref SDS 12 456H; however, if
041002 -            this condition turns out to be IBC that was not radiated
041003 -            due to a mistake of some kind, then a biopsy might be
041004 -            effective for early diagnosis and treatment, before the
041005 -            condition gets out of hand].
041006 -
041007 -               [On 090609 Doctor Hsu advises there was a mistake
041008 -               performing radiation in February and March at UCSF that
041009 -               missed treating IBC in the breastbone area to the left
041010 -               of the right breast, and this untreated IBC tumor may be
041011 -               causing problems in Millie's lungs. ref SDS 22 TP9L
041012 -
041014 -  ..
041015 - Breathing Problems Radiation Lung Injuries Persistent Dry Cough
041016 -
041017 -
041018 -        4.  I have a persistent cough and need to clear my throat,
041019 -            beginning the past few days [continuing breathing problems
041020 -            reported on 090403 1107. ref SDS 7 UV4X].  The CT test on
041021 -            090413 reported progression of nodules in the lungs [shown
041022 -            by review on 090415 1642, ref SDS 11 RV78; and research
041023 -            that found radiation treatments can cause lung damage,
041024 -            ref SDS 11 GO6G; earlier that same day on 090415 1519...]
041025 -            Doctor Johnson looked at the scans and compared with scans
041026 -            for the prior test on 081230. ref SDS 10 GT4M  He indicated
041027 -            any progression of nodules was very slight and would not be
041028 -            expected to cause respiratory problems [confirmed in a
041029 -            letter from Doctor Johnson on 090415 1642, ref SDS 11
041030 -            YO7M].  If radiation and hyperthermia treatments continue
041031 -            to have effects for weeks and possibly several months after
041032 -            ending treatment on 090317, could there be continued
041033 -            progression of lung nodules, which may now be causing
041034 -            symptoms?
041035 -
041036 -               [On 090514 0830 Doctor Rugo concerned that ground glass
041037 -               opacities reported in Millie's CT test at Kaiser on
041038 -               090413 were caused by radiation treatments in February
041039 -               and March, and are now causing breathing problems with
041040 -               cough. ref SDS 20 DE8M
041042 -                ..
041043 -               [On 090609 Doctor Hsu advises there was a mistake
041044 -               performing radiation in February and March at UCSF that
041045 -               missed treating IBC in the breastbone area to the left
041046 -               of the right breast, ref SDS 22 TP9L, and this untreated
041047 -               IBC tumor may be causing problems in Millie's lungs.
041048 -               ref SDS 22 W65W
041050 -                ..
041051 -               [On 090616 1245 Doctor Rugo requested Kaiser's radiology
041052 -               report for Millie's CT test on 090612 in order to check
041053 -               for progression of ground glass opacities in the lungs,
041054 -               ref SDS 23 YS4J, which reflect Doctor Hsu's concern on
041055 -               090609 that medical mistakes performing radiation in
041056 -               Feb-Mar failing to treat IBC in the breastbone area
041057 -               could be causing problems in Millie's lungs evidenced by
041058 -               recent breathing and cough problems. ref SDS 22 W65W
041060 -                ..
041061 -               [On 090617 1954 Millie's letter asks medical team if
041062 -               "ground glass opacities" causing breathing problems will
041063 -               be treated as cancer with MPA, or presents a new problem
041064 -               that requires separate treatment? ref SDS 24 7J4Q
041066 -                ..
041067 -               [On 090708 0301 Kaiser orders xray test to evaluate
041068 -               scope of Millie's breathing problems. ref SDS 25 UT6U
041070 -             ..
041071 -        5.  I have slowed down, including speech and reacting while
041072 -            driving.  So that is a concern.  Hoping this is just jet
041073 -            lag, but that is one reason for checking blood counts,
041074 -            possibly doing another CT test.
041075 -
041076 -
041078 -  ..
041079 - Referral Coordination Innovation Required Stave V Cancer Care
041080 - Labs Delay Kaiser Sending to UCSF Innovation Needed Stage V Care
041081 - Chronic Disease Treating Stage V Cancer Requires Referral Coordination
041082 - Delays Kaiser Transmitting Labs to UCSF Referral Coordination Problems
041083 -
041084 -
041085 -        6.  I got a blood draw at Kaiser on 090413 allowing 10 days to
041086 -            correct for mistakes getting data submitted to UCSF in time
041087 -            for the meeting on 090423.  As noted in the record, UCSF
041088 -            still did not get the lab data from Kaiser on 090423.  This
041089 -            failure aligned with the case study on 090325 showing
041090 -            integrated services for referral treatment is a big
041091 -            challenge. ref SDS 4 KZ6N
041093 -             ..
041094 -            Doctor Johnson exercised prudent discretion to implement
041095 -            Kaiser's coverage "Plan" according to medical necessity for
041096 -            treating my 7th relapse of cancer as a chronic disease, and
041097 -            which requires innovation to care for "stage V" cancer that
041098 -            has a narrowing margin for error.  Deference to doctor
041099 -            discretion for evolving standards of care needs support at
041100 -            Kaiser as aging demographics expand demand for effective
041101 -            oncology  practice saving lives, time, and money.
041102 -
041104 -  ..
041105 - Blood Draw Order 090511 at Kaiser for Examination at UCSF on 090514
041106 -
041107 -
041108 -        7.  At that time on 090413, Anne in the Chemotherapy Infusion
041109 -            Clinic said that she scheduled a blood draw for Monday,
041110 -            090511 to comply with Kaiser policy for testing INR
041111 -            monthly, and to flush the port.  I have not however
041112 -            received notice from Kaiser that this work has been
041113 -            scheduled.  My letter earlier today asked about doing a
041114 -            blood test tomorrow on Monday 090511 as part of the blood
041115 -            draw for INR.
041117 -             ..
041118 -            The typical scope for blood draws needed at UCSF is listed
041119 -            in the record on 090129 for the lab to support my last
041120 -            visit with Doctor Rugo. ref SDS 1 YN8O
041121 -
041122 -                [On 090511 0934 Millie called and talked to Amanda
041123 -                about requirements for blood draw at Kaiser to support
041124 -                meeting with Doctor Rugo at UCSF on 090514, ref SDS 15
041125 -                YM6I; Millie submitted a letter to Amanda confirming
041126 -                understandings from the telecon and with a link to this
041127 -                letter explaining issues related to getting another lab
041128 -                done at Kaiser. ref SDS 15 9P5P
041130 -                 ..
041131 -                [On 090511 1427 Millie learned that Doctor Johnson has
041132 -                entered a standing order for Millie to get a monthly
041133 -                blood draw at Kaiser; she went to Kaiser and got the
041134 -                lab done in the Infusion Clinic; Millie notified the
041135 -                medical team that the lab was done, and report will be
041136 -                submitted to UCSF for the meeting with Doctor Rugo on
041137 -                Thursday, 090514. ref SDS 16 UK8R
041139 -                 ..
041140 -                [On 090511 2013 Doctor Rugo notifies medical team that
041141 -                scope of blood tests at Kaiser performed to support
041142 -                examinations by Doctor Rugo at UCSF should be
041143 -                determined by Doctor Johnson at Kaiser, ref SDS 17
041144 -                RF4J, and appears conflicting with patient history,
041145 -                e.g., on 090325 0830. ref SDS 4 V86J
041147 -                 ..
041148 -                [On 090511 2313 Millie notifies Doctor Rugo that
041149 -                patient history shows UCSF specifies scope of lab work
041150 -                at Kaiser to support Millie's treatment at UCSF, and
041151 -                this is performed as a component of referral
041152 -                coordination. ref SDS 18 4Q6H
041154 -             ..
041155 -            Some items show "no report."  UCSF should clarify the
041156 -            scope, and whether a follow up blood draw is needed for the
041157 -            meeting on Thursday.
041159 -             ..
041160 -            Please let me know if a blood draw is needed for tomorrow?
041161 -            We could do the test tomorrow, but this reduces the chance
041162 -            of getting CA 15-3 from the lab in time for the meeting on
041163 -            Thursday.
041164 -
041165 -                [On 090511 1427 Millie learned that Doctor Johnson has
041166 -                entered a standing order for Millie to get a monthly
041167 -                blood draw at Kaiser; she went to Kaiser and got the
041168 -                lab done in the Infusion Clinic; Millie notified the
041169 -                medical team that the lab was done, and report will be
041170 -                submitted to UCSF for the meeting with Doctor Rugo on
041171 -                Thursday, 090514. ref SDS 16 UK8R
041173 -                 ..
041174 -                [On 090513 1654 Millie submits lab results at Kaiser to
041175 -                UCSF for the meeting on 090514. ref SDS 19 ZH6R
041177 -             ..
041178 -            If UCSF does not need a lab, there is less pressure on
041179 -            getting the limited scope blood draw to test only for INR
041180 -            and flush the port.
041181 -
041188 -
041189 -
041190 -
041191 -
041192 -
041193 -
041194 -
041195 -
041196 -
041197 -
0412 -