CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 98 0000. ref SDS 74 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - The meeting today follows up patient history...
040902 -
040903 - 1. Examination at Kaiser found significant
040904 - recovery with sunitinib protocol
040905 - at UCSF........................... 081219, ref SDS 44 QW5J
040907 - ..
040908 - 2. Primary care physician calls about
040909 - Millie's fall and treatment in ER for
040910 - separated shoulder, and explains rise
040911 - in Millie's cancer marker signals
040912 - severe relapse for the 6th time,
040913 - and Millie needs immediate treatment
040914 - for her cancer as chronic
040915 - disease........................... 090123, ref SDS 56 RK6O
040917 - ..
040918 - 3. Sudden reversal with severe relapse
040919 - of IBC that requires immediate
040920 - change of treatment reported
040921 - from examination at
040922 - UCSF.............................. 090130, ref SDS 59 4S8O
040924 - ..
040925 - 4. Doctor Rugo prescribes immediate
040926 - treatment at UCSF in radiation
040927 - oncology department for
040928 - 7th relapse....................... 090130, ref SDS 59 TZ6H
040930 - ..
040931 - 5. Urgent treatment was delayed a week
040932 - due to communication problems
040933 - at UCSF........................... 090130, ref SDS 59 AY8Q
040935 - ..
040936 - 6. Approval for Kaiser referral to UCSF
040937 - was delayed by documentation
040938 - errors............................ 090202, ref SDS 61 SP6H
040940 - ..
040941 - 7. Kaiser expedites referral authorization
040942 - in order for UCSF to provide urgent
040943 - treatment quickly enough for
040944 - Millie to recover................. 090202, ref SDS 60 LC7H
040946 - ..
040947 - 8. UCSF proposes 3-week delay to begin
040948 - planning Millie's treatment for
040949 - recovering from 6th relapse of
040950 - of IBC............................ 090202, ref SDS 61 SP7M
040952 - ..
040953 - 9. Doctor Rugo notifies medical team
040954 - Millie needs urgent treatment quickly
040955 - in time to be effective recovering
040956 - from 6th relapse of
040957 - IBC............................... 090202, ref SDS 62 Y15J
040959 - ..
040960 - 10. Millie's letter to UCSF implements Doctor
040961 - Johnson's requests for UCSF strategy
040962 - to treat Millie's cancer as a
040963 - chronic disease................... 090203, ref SDS 63 278T
040965 - ..
040966 - 11. Doctor Rugo's letter explains planning
040967 - to evaluate response to hyperthermia
040968 - treatment and arrange continuing
040969 - care based on another
040970 - CT scan........................... 090204, ref SDS 65 278T
040972 - ..
040973 - 12. UCSF advances Millie's care in Radiation
040974 - Oncology Department 3 weeks; scope of
040975 - radiation and hyperthermia evaluated
040976 - by Dcotor Hsu and Doctor
040977 - Chang............................. 090205. ref SDS 67 0001
040979 - ..
040980 - 13. CT and xray tests taken, and layout
040981 - of treatment fields performed to
040982 - build molds for Millie's
040983 - radiation......................... 090209. ref SDS 72 9R61
040985 - ..
040986 - 14. Examination primary care physician
040987 - at Kaiser finds severe progression
040988 - of IBC in 6th
040989 - relapse........................... 090213, ref SDS 74 4W5I
040991 - ..
040992 - 15. Millie lucky to survive stage IV cancer
040993 - for 8 years because cancer mutates to
040994 - defeat treatments; and medical maladies
040995 - increase which makes recovery
040996 - more difficult to
040997 - achieve........................... 090213, ref SDS 74 NY7L
040999 - ..
041000 - 16. Complexity of case management grows
041001 - during long term survival prevents
041002 - keeping a well ordered record
041003 - essential for effective
041004 - care.............................. 090213, ref SDS 74 9L8O
041006 - ..
041007 - 17. Emotional trauma occurs from surprise
041008 - by medical professionals that Kaiser
041009 - and UCSF have enabled long term surivial
041010 - for a disease that normally is
041011 - difficult to control.............. 090213, ref SDS 74 ML4I
041013 - ..
041014 - 18. Communication leverages synergy
041015 - for Millie's care at Kaiser and UCSF
041016 - which helps prevent problems from
041017 - "falling through the cracks; fewer
041018 - mistakes, and timely response
041019 - helps the medical team
041020 - increase longevity,
041021 - also seems very
041022 - annoying.......................... 090213, ref SDS 74 FZ4H
041024 - ..
041025 - 19. Doctor urges proactive management to
041026 - plan Millie's next treatment because
041027 - there will be less time to recover
041028 - before cancer gets out of control
041029 - for Millie's next
041030 - relapse........................... 090213, ref SDS 74 UP6L
041032 - ..
041033 - 20. Millie's efforts the past 8 years to
041034 - combine medical treatment with vigorous
041035 - exercise was supported by research
041036 - showing exercise can be a strong
041037 - component of cancer
041038 - care.............................. 090213, ref SDS 74 GC40
041040 - ..
041041 - 21. Indian fable illustrates long-term survival
041042 - getting continuous treatment for cancer
041043 - becomes increasingly difficult to perform
041044 - complex clinical, logistical, and financial
041045 - case management; study of Millie's patient
041046 - history shows level of effort to maintain
041047 - well ordered record for effective
041048 - management increases exponentially
041049 - into a crushing burden
041050 - for patients and
041051 - providers......................... 090213, ref SDS 74 IG5O
041053 - ..
041054 - 22. Graph prepared by primary care physician
041055 - shows Millie's good fortune surviving a
041056 - very aggressive cancer with relatively
041057 - high quality of life into an 8th year
041058 - of continuous treatment that normally
041059 - causes early demise due to emotional
041060 - trauma and clincial failures from
041061 - complex case management........... 090213, ref SDS 74 4W72
041063 - ..
041064 - 23. Millie felt life was slipping away in
041065 - October when the 5th relapse was diagnosed
041066 - leading Millie to ask what was going to
041067 - happen to her; Doctor Rugo provided
041068 - encouragement saying "We're not
041069 - going to let anything happen
041070 - to you"........................... 090213, ref SDS 74 F148
041072 - ..
041073 - 24. Collaboration between Kaiser and UCSF
041074 - combines experience with research;
041075 - communication optimizes Millie's care
041076 - beating the odds for long-term survival
041077 - by integrating Kaiser's team care
041078 - practice with UCSF model
041079 - of comprehensive
041080 - care.............................. 090213, ref SDS 74 685I
041082 - ..
041083 - 25. Multiple relapse of cancer causes cells
041084 - to mutate into disease that resists
041085 - treatment; Millie surviving 6 relapses
041086 - needs highly specialized care and
041087 - so should ask Doctor Rugo to begin
041088 - planning for the next relapse
041089 - to treat Millie's cancer as
041090 - a chronic disease................. 090213, ref SDS 74 R75G
041092 - ..
041093 - 26. Doctor Rugo has responded by scheduling
041094 - a meeting with Millie at UCSF on
041095 - 090312............................ 090213, ref SDS 74 6P7G
041097 - ..
041098 - 27. Doctor Johnson underscored importance
041099 - timely care for Millie by offering
041100 - religious perspective on transition
041101 - from a vigorous life that may end
041102 - for Millie in less than a
041103 - year.............................. 090213, ref SDS 74 646L
041105 - ..
041106 - 28. Hospice care helps patients and families
041107 - cope with final days of life without
041108 - suffering significant physical
041109 - and emotional pain................ 090213, ref SDS 74 VW63
041111 - ..
041112 - 29. Life ending scenarios have been presented
041113 - to Millie many times the past 5 years;
041114 - case study reflects Millie's physical
041115 - resiliance and strength of character
041116 - that enables exceptional longevity
041117 - for her aggressive
041118 - cancer............................ 090213, ref SDS 74 L19H,
041120 - ..
041121 - 30. Collaboration on case management for
041122 - long-term survivors of cancer becomes
041123 - frustrating because everybody loses
041124 - control of increasingly
041125 - complex medical
041126 - records........................... 090213, ref SDS 74 JL9L
041128 - ..
041129 - 31. Lab and CT test reports illustrate
041130 - frustration, because providers do not
041131 - have enough time to enter results
041132 - from other doctorsrs in the medical
041133 - chart, because doctors prefer to
041134 - rely on local diagnostics
041135 - rather than referral
041136 - data.............................. 090213, ref SDS 74 NY4H
041138 - ..
041139 - 32. Cancer marker CA 15-3 wide disparities
041140 - between Kaiser and UCSF illustrates
041141 - why doctor's rely on local data
041142 - rather than referral
041143 - diagnostics....................... 090213, ref SDS 74 A46O
041145 - ..
041146 - 33. Case management takes a lot of will
041147 - power for due diligence to
041148 - maintain a well ordered
041149 - record............................ 090213, ref SDS 74 J27J
041151 - ..
041152 - 34. Meeting at Kaiser changed to 4 week
041153 - interval, rather than 8, as done the
041154 - past 2 years, provides effective support
041155 - for UCSF to start next treatment in
041156 - time to avoid losing control of
041157 - Millie's cancer................... 090213, ref SDS 74 QX5O
041159 - ..
041160 - 35. Millie requests explanation of treatment
041161 - plan. Doctor Rugo's letter to Kaiser on
041162 - 090129 discussed hyperthermia with Doxil,
041163 - reported on 090130. Has the plan changed
041164 - to use "lower dose" radiation rather
041165 - than Doxil. Will both be
041166 - used, or some other
041167 - agent............................. 090218, ref SDS 75 TH5W
041169 - ..
041170 - 36. Millie reports to medical team meeting
041171 - with Doctor Johnson at Kaiser on 090213
041172 - was optimistic Millie might have 3 - 6
041173 - months of recovery, but will need
041174 - treatment from Doctor Rugo for
041175 - cancer as a "chronic
041176 - disease".......................... 090218, ref SDS 75 TH6U
041178 - ..
041179 - 37. Millie requests reponse from UCSF to the
041180 - letter on 090209 requesting explanation
041181 - of treatments for side effects from
041182 - radiation and hyperthermia described by
041183 - Doctor Hsu during the meeting on
041184 - 090205. Does the treatment
041185 - plan address side effects
041186 - prospectively..................... 090218, ref SDS 75 TH7V
041188 - ..
041189 - 38. Radiation and hyperthermia begins
041190 - at UCSF for Millie to recover from
041191 - 6th relapse of
041192 - IBC............................... 090219, ref SDS 76 E57G
041194 - ..
041195 - 39. Millie's letter to UCSF requests
041196 - explanation of radiation and hyperthermia
041197 - treatments for recovering from
041198 - IBC............................... 090220, ref SDS 77 EA4Q
041200 - ..
041201 - 40. Hyperthermia treatment planning
041202 - on 090209 report received
041203 - from UCSF......................... 090220, ref SDS 78 PR4Y
041205 - ..
041206 - 41. Hyperthermia science, theraputic
041207 - rationale and applications with
041208 - other modalities presented in
041209 - BSD professional paper received
041210 - from UCSF......................... 090220, ref SDS 78 GK6F
041212 - ..
041213 - 42. Millie's letter to UCSF requests work
041214 - plan for radiation treatments to
041215 - recover from 6th relapse of
041216 - IBC............................... 090223, ref SDS 79 3N9J
041217 - and asks for scientific paper
041218 - using radiation to treat
041219 - IBC............................... 090223, ref SDS 79 T49U
041221 - ..
041222 - 43. Radiation combined with hyperthermia
041223 - treatment plan received from
041224 - UCSF.............................. 090226, ref SDS 80 D452
041226 - ..
041227 - 44. Blood test at Kaiser for meeting
041228 - at UCSF on 090312 to evaluate
041229 - effectiveness of radiation
041230 - and hyperthermia after
041231 - 3 weeks........................... 090309, ref SDS 82 6Z4F
041233 - ..
041234 - 45. Agenda submitted to medical team to
041235 - be prepared for productive meetings
041236 - at UCSF scheduled on 090312 to evaluate
041237 - response to treatment after getting
041238 - 3 weeks of radiation and hyperthermia
041239 - to recover from 6th relapse
041240 - of IBC............................ 090310, ref SDS 83 PR4Y
041242 - ..
041243 - 46. Called Kaiser to get results of blood
041244 - test on 090309 for submission to medical
041245 - team for being prepared to meet at
041246 - UCSF on 090312; Florida says results
041247 - pending from lab; says to call back
041248 - on 090311 to get the report
041249 - for distribution.................. 090310, ref SDS 84 JH4H
041251 - ..
041252 - 47. UCSF letter from Tara proposed canceling
041253 - meeting scheduled by Doctor Rugo for
041254 - 090312 to evaluate response to
041255 - treatment, and also Millie's
041256 - concern about growing
041257 - side effects...................... 090310, ref SDS 85 PR4Y
041259 - ..
041260 - 48. Millie letter to primary care physician
041261 - at Kaiser coordinates getting report
041262 - for blood test on 090309 for
041263 - meeting at UCSF on
041264 - 090312............................ 090311, ref SDS 86 S84F
041266 - ..
041267 - 49. Blood test report for Millie's lab on
041268 - 090209 was not submitted by Kaiser to
041269 - UCSF due to telephone and fax machine
041270 - problems; UCSF relied on backup
041271 - copy hand delivered by
041272 - Millie............................ 090312, ref SDS 89 XE3K
041274 - ..
041275 - 50. Examination at UCSF Breast Care Clinic
041276 - finds signs of recovery from 6th relapse
041277 - of IBC; Millie responding well after
041278 - 3 weeks of treatment with radiation
041279 - and hyperthermia; severe side
041280 - effects observed.................. 090312, ref SDS 89 YX9F
041282 - ..
041283 - 51. Cancer marker CA 15-3 missing from
041284 - blood test for Millie's lab at Kaiser
041285 - on 090309; missing diagnostic
041286 - complicates evaluating
041287 - response to treatment............. 090312, ref SDS 89 YX5F
041289 - ..
041290 - 52. Doctor Rugo planning to implement
041291 - request by Doctor Johnson at Kaiser
041292 - for UCSF to treat Millie's cancer
041293 - as a chronic disease.............. 090312, ref SDS 89 QQ9L
041295 - ..
041296 - 53. Examination at UCSF Radiation Oncology
041297 - department concurs Millie recovering
041298 - from 6th relapse of IBC by responding
041299 - to radiation and
041300 - hyperthermia...................... 090312, ref SDS 89 F88K
041301 - discloses side effects severely
041302 - blistering skin will worsen for a
041303 - month, and then gradually
041304 - recover........................... 090312, ref SDS 89 F860
041305 - that radiation and hyperthermia
041306 - will continue to destroy cancer cells
041307 - for weeks and even months after ending
041308 - treatments on
041309 - 090317............................ 090312, ref SDS 89 VL4O
041311 - ..
041312 - 54. After meeting with UCSF at 0800, called
041313 - Kaiser at 1437; was on "hold" for 90
041314 - minutes; Cisi in the Chemotherapy
041315 - Clinic came online and advised that
041316 - CA 15-3 was not listed in Kaiser's
041317 - for Millie's lab on
041318 - 090309............................ 090312, ref SDS 90 JO8O
041320 - ..
041321 - 55. Millie's letter to medical team reports
041322 - productive meetings at UCSF on 090312
041323 - with favorable findings that Millie
041324 - is recovering from 6th
041325 - relapse of
041326 - IBC............................... 090313, ref SDS 91 Q49L
041328 - ..
041329 - 56. Millie's final treatment at UCSF with
041330 - radiation and hyperthermia to
041331 - recover from 6th relapse
041332 - IBC............................... 090317, ref SDS 93 9L7K
041334 - ..
041335 - 57. Millie received at UCSF orientation and
041336 - medications for home care to treat severe
041337 - side effects from radiation treatments
041338 - that will get worse for a few weeks
041339 - before starting to get
041340 - better............................ 090317, ref SDS 93 M442
041342 - ..
041343 - 58. Arlette checked the computer and
041344 - concluded a mistake occurred at the
041345 - lab not testing for the cancer marker
041346 - on the blood test for 090309. Arlette
041347 - entered a supplemental order for
041348 - Millie to get another blood
041349 - draw at no charge
041350 - later today....................... 090317, ref SDS 94 Y04R
041352 - ..
041353 - 59. Kaiser reported CA 15-3 251 for blood
041354 - test on 090317 that corrected problems
041355 - with lab on 090309 which omitted cancer
041356 - marker needed for the meeting at UCSF
041357 - on 090312 to evaluate response to
041358 - treatment; results today indicate
041359 - strong recovery from 6th relapse
041360 - of IBC............................ 090323, ref SDS 95 Y077
041362 - ..
041363 - 60. Millie's letter notifies medical team
041364 - radiation and hyperthermia treatments
041365 - were completed on 090317; submits agenda
041366 - for meeting today evaluating response
041367 - to treatment with, and recovery from
041368 - side effects from radiation
041369 - and hyperthermia on
041370 - referral to
041371 - UCSF.............................. 090324, ref SDS 96 PR4Y
041372 -
041373 -
041374 -
0414 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - The doctor had a hectic schedule this morning providing care for other
050403 - patients that delayed the meeting for approximately 80 minutes.
050405 - ..
050406 - After entering the examination room at 1140, the nurse knocked at the
050407 - door about 1220 and advised the doctor was still with another patient.
050408 - The doctor came in briefly at 1250 and said he will see Millie next in
050409 - a few minutes. He returned at 1310 and conducted the examination.
050411 - ..
050412 - The doctor appoligized for the long delay, explaining he had several
050413 - complicated situations this morning that caused a long delay seeing
050414 - Millie.
050416 - ..
050417 - Oncology has been very busy lately, reported in case study meeting
050418 - with Doctor Johnson last time on 090325. ref SDS 97 JM8H
050419 -
050420 -
050422 - ..
050423 - Dislocated Shoulder Recovering Extensive Brusing Subsides
050424 -
050425 - Follow up ref SDS 98 E54L, ref SDS 74 PQTX.
050426 -
050427 - The doctor received Millie's letter sent last night on 090514 2346,
050428 - ref SDS B6 LF3H, and presenting results from meeting with Doctor Rugo
050429 - at UCSF yesterday morning at 0830, ref SDS B4 IP6F, and further
050430 - submitting an agenda for meeting today at Kaiser. The focus today is
050431 - ordering treatment with MPA for Millie's 8th relapse of cancer, and
050432 - 7th relapse of IBC, which Doctor Rugo proposed in her email letter to
050433 - Doctor Johnson, and composed in the examination room while meeting
050434 - with Millie. ref SDS B4 DI63
050436 - ..
050437 - Doctor Johnson was pleased with Millie's rapid recovery from injury on
050438 - 090122 that dislocated the right shoulder, ref SDS 53 WS5K, and was
050439 - treated in the Emergency Room (ER) Department. On 090213 the doctor
050440 - discussed Millie's injury and recovery extensively. ref SDS 74 PQTX
050441 - There was further reveiw during the meeting on 090325 showing
050442 - progress, ref SDS 97 LW7M, despite significant discomfort accomodating
050443 - movement of the arm by UCSF for medical necessity to treat Millie's
050444 - advancing cancer at that time. ref SDS 97 C949
050446 - ..
050447 - Examination today in the Oncology Department shows full recovery from
050448 - bruising that was very severe for several weeks following the injury,
050449 - observed during prior visit on 090213, ref SDS 74 8V5N, and found
050450 - still evident on 090325. ref SDS 97 TF7N
050452 - ..
050453 - Millie reported favorable meeting yesterday afternoon with Laura,
050454 - Nurse Practitioner, in the Orthopedic Department. ref SDS B5 6X9H
050455 - Laura had Millie perform several motion exercises against mild
050456 - resistance to test range of motion, strength, and pain. Millie was
050457 - pleased to understand that Laura indicated Millie is ahead of schedule
050458 - for recovery compared to other patients suffering similar severe
050459 - shoulder separation. ref SDS B5 N259 This has been achieved through
050460 - concentrated training, planned during the prior examination on 090325,
050461 - and made possible by recovery from severe side effects of radiation
050462 - and hyperthermia treatments. ref SDS 97 YU7M
050463 -
050464 - [...below medical chart "Review of Systems" reports same
050465 - status for examination last month on 090213; does not
050466 - mention progress with recovery discussed during the
050467 - meeting. ref SDS 0 WE7K
050468 -
050469 -
050470 -
0505 -
SUBJECTS
Default Null Subject Account for Blank Record
0603 -
060401 - ..
060402 - Examination IBC Finds 7th Relapse Radiation Side Effects Subside
060403 - IBC 8th Relapse Following Radiation Hyperthermi Evident Left Arm
060404 -
060405 - Follow up ref SDS 98 D452, ref SDS 74 S66M.
060406 -
060407 - The doctor made examination.
060409 - ..
060410 - Doctor Johnson was pleased seeing significant recovery from severe
060411 - radiation "burn" side effects, observed during the prior examination
060412 - at Kaiser on 090325. ref SDS 97 F553 The large open wound on the
060413 - upper chest observed on 090325 has completely healed.
060415 - ..
060416 - The doctor asked about pain from radiation side effects reported on
060417 - 090328 0909 ref SDS A4 4S4V
060419 - ..
060420 - Millie advised pain has fully subsided.
060422 - ..
060423 - Doctor Johnson palpated reduced lymphadenopathy again in both the
060424 - right axilla and left supraclavicular, where cancer increased during
060425 - January and February, shown by examination at UCSF on 090205,
060426 - ref SDS 67 OH88, and also at Kaiser a week later on 090213.
060427 - ref SDS 74 4M5Y
060429 - ..
060430 - The doctor concurred with results from examination at UCSF yesterday
060431 - on 090514 0830 finding IBC has fully subsided in all treated areas.
060432 - ref SDS B4 5U4H
060434 - ..
060435 - Doctor Johnson feels strong response to treatment for Millie's 6th
060436 - relapse of IBC indicates Kaiser's referral to UCSF for radiation and
060437 - hyperthermia was effective.
060439 - ..
060440 - The doctor further concurred with findings yesterday at UCSF that IBC
060441 - has spread to Millie's left arm, upper shoulder, and on the lower left
060442 - side wrapping toward the lower back, in areas that were not treated
060443 - with radiation and hyperthermia
060445 - ..
060446 - The doctor's medical chart describes in several sections possible
060447 - progression of IBC in "right to midline." ref SDS 0 EF8U This may be
060448 - the vertical line on the left of the right breast, which is darker in
060449 - color and has 3 small nodes. Examination at UCSF yesterday likewise
060450 - noted this condition. On 090330 Doctor Hsu examined Millie and
060451 - described this condition as continuing treatment with radiation and
060452 - hyperthermia. At this time, without biopsy, these are possibilities,
060453 - as suggested in Doctor Johnson's medical chart. ref SDS 0 EF8U
060454 -
060455 - [...below, in this record today on 090515 1140, the doctor
060456 - cites Millie's cancer marker CA 15-3 320 rising to the
060457 - highest level in patient history. ref SDS 0 WU5O
060459 - ..
060460 - [...below, in this record today on 090515 1140, medical
060461 - chart "Review of Systems" Musculoskeletal reports spread of
060462 - disease on left arm. ref SDS 0 WE7K
060463 -
060464 -
060465 -
060466 -
0605 -
SUBJECTS
Default Null Subject Account for Blank Record
0703 -
070401 - ..
070402 - Cancer Marker CA 15-3 320 Rises Highest Ever
070403 -
070404 - Follow up ref SDS 98 WU5O.
070405 -
070406 - The doctor indicated that CA 15-3 320 for the blood test at Kaiser on
070407 - 090512, ref SDS B3 PQTQ, aligns with Doctor Rugo's report in a letter
070408 - to Kaiser yesterday advising that Millie has suffered progression of
070409 - IBC disease, and with Millie's letters in recent weeks reporting IBC
070410 - getting worse.
070412 - ..
070413 - Doctor Johnson explained that cancer marker rising to the highest
070414 - level in Millie's 8-year patient history further aligns with
070415 - examination today at Kaiser also finding progression of IBC on the
070416 - lower left arm and other disparate sites, per above. ref SDS 0 OT8N
070417 - He indicated that Millie therefore requires timely treatment.
070418 -
070419 -
070420 -
070421 -
070422 -
0705 -
SUBJECTS
Default Null Subject Account for Blank Record
0803 -
080401 - ..
080402 - Disease Trajectory Rapid Decline Shortens Time for Delivering Care
080403 - 7th Relapse Increases Risks of Rapid Decline Timely Care Critical
080404 -
080405 - Follow up ref SDS 98 P39M, ref SDS 74 4W72.
080406 -
080407 - Doctor Johnson advised today that recurrent IBC reported to the
080408 - medical team on 090331, ref SDS A5 Q69V, and so soon after treatment
080409 - with radiation and hyperthermia ended at UCSF on 090317, and as
080410 - observed today shows Millie's cancer is now very aggressive and so
080411 - needs immediate treatment. He feels this reflects the challenge
080412 - Millie faces with the 8th relapse, which was discussed on 090325 in
080413 - connection with rapid decline in Millie's disease trajectory.
080414 - ref SDS 98 P39M
080415 -
080416 -
080417 -
080418 -
0805 -
SUBJECTS
Default Null Subject Account for Blank Record
0903 -
090401 - ..
090402 - Hospice Care Patients Avoid Discomfort of Decline
090403 -
090404 - Follow up ref SDS 98 JS5I, ref SDS 74 VW63.
090405 -
090406 - Doctor Johnson asked again today if Millie has contacted anyone about
090407 - Hospice care, discussed during the meeting on 090325, ref SDS 98 JS5I,
090408 - and initially during the earlier meeting on 090213? ref SDS 74 VW63
090410 - ..
090411 - Millie said she feels better now that side effects of radiation have
090412 - subsided, noted during examination today, per above. ref SDS 0 D452
090413 - She made a joke asking if "Hospice" has been added to her treatment
090414 - plan?
090416 - ..
090417 - Doctor Johnson said that Hospice is something that should be checked
090418 - out before too long so that everything goes smoothly, because he is
090419 - still concerned that his analysis in February (on 090213) giving
090420 - Millie less than a year to live, ref SDS 74 646L, requires planning
090421 - for this situation.
090422 -
090423 - [...below medical chart "Plan" proposes considering Hospice
090424 - in future. ref SDS 0 QQ7F
090426 - ..
090427 - Millie commented this sounds discouraging compared to ECOG performance
090428 - status 0, shown in the medical chart on 090325. She has begun to
090429 - increase exercise, and had a great vacation. Hospice sounds more like
090430 - a task for status performance 3 or 4, maybe 2. Why should someone
090431 - with ECOG performance status 0, which is the same as for the doctor,
090432 - her neighbors, everybody, be investing time on Hospice that is needed
090433 - to support the medical team so that critical tasks don't fall through
090434 - the cracks, as discussed previously on 090213? ref SDS 74 6L7I
090435 -
090436 - [...below medical chart "Physical Examination" lists ECOG
090437 - performance score 0. ref SDS 0 YF9L
090439 - ..
090440 - The doctor is concerned today that if the medical team is delayed
090441 - starting Millie's treatment, because despite best efforts mistakes
090442 - continue to delay treatment, Millie's excellent ECOG performance score
090443 - will quickly fall, because her cancer has become very aggressive after
090444 - mutating through 8 relapses, reported on 090213, ref SDS 74 UP6L, and
090445 - this significantly magnifies the effect of delaying treatment.
090447 - ..
090448 - This presents a dilemma. Should the patient invest time to support
090449 - the medical team start treatment on time to be effective for remaining
090450 - healthy, or spend the time on Hospice to be prepared for the medical
090451 - team failing to provide timely treatment?
090452 -
090453 -
090454 -
0905 -
SUBJECTS
Default Null Subject Account for Blank Record
1003 -
100401 - ..
100402 - Clinical Trial Millie's Next Treatment for 8th Relapse Cancer
100403 - UCSF Proposes MPA Study Anti-Metastatic Anti-Angiogenic Therapy
100404 -
100405 - Follow up ref SDS 98 P43G, ref SDS 74 WZ6K.
100407 - ..
100408 - Doctor Johnson received Doctor Rugo's letter sent yesterday through
100409 - email on 090514 0830 during the meeting at UCSF, ref SDS B4 DI63, and
100410 - recommending treatment with...
100411 -
100412 - Study Title: MPA Revisited: A Phase II Study of
100413 - Anti-Metastatic, Anti-Angiogenic Therapy in Postmenopausal
100414 - Patients with Hormone Receptor Negative Breast Cancer
100415 -
100416 - ...and which was transmitted a second time, ref SDS B4 A13N, with
100417 - Millie's letter to the medical team sent last night on 090514 2349,
100418 - and for the purpose of guiding discussion with Doctor Johnson during
100419 - the meeting at Kaiser today. ref SDS B6 WF9P
100421 - ..
100422 - The doctor asked if Millie brought a printed copy of Doctor Rugo's
100423 - letter and the MPA protocol, ref SDS B4 CT9K, to the meeting today,
100424 - because he has somehow misplaced the letter received yesterday. There
100425 - was discussion that Doctor Johnson can open his email with the
100426 - computer in the examination room to see Doctor Rugo's letter and the
100427 - MPA protocol for discussion, and if helpful, the computer files can be
100428 - printed, as he typically does with lab and test reports for patients.
100429 - He can further get Doctor Rugo's letter and the MPA protocol by
100430 - clicking the link in Millie's letter to the medical team sent last
100431 - night 090514 2346.
100433 - ..
100434 - The doctor decided this was not necessary to take time during the
100435 - meeting; he will check his mail again after the meeting today for the
100436 - original he received from Doctor Rugo yesterday on 090514. ref SDS B4
100437 - DI63
100438 -
100439 - [On 090519 1613 Millie's letter to the medical team reports
100440 - delivering another printed copy of the MPA protocol for Doctor
100441 - Johnson at the front desk of the Oncology Department.
100442 - ref SDS C0 TX5Y
100444 - ..
100445 - Doctor Johnson indicated that examination today at Kaiser aligns with
100446 - Doctor Rugo's letter yesterday reporting Millie has suffered
100447 - progression of cancer for the 8th time, per above. ref SDS 0 OT8N
100449 - ..
100450 - The doctor feels MPA treatment, recommended by UCSF yesterday on
100451 - 090514 0830, ref SDS B4 CT9K, is well suited for Millie's patient
100452 - profile, listed in the record on 090213. ref SDS 74 ES7I Doctor
100453 - Johnson indicated MPA is similar to the cetuximab and Carboplatin
100454 - regimen, which was effective for nearly 2 years, beginning on 070201,
100455 - and progression did not occur until 081016. ref SDS 35 J34U
100457 - ..
100458 - On 061208 Doctor Johnson prescribed Navelbine to treat Millie's 3rd
100459 - relapse of cancer, and this was scheduled to start on 070105.
100460 - ref SDS 12 RW5I When Millie arrived at Kaiser on 070105 to begin
100461 - treatment with Navelbine, Doctor Johnson changed Millie's prescription
100462 - to cetuximab and Carboplatin, because his research showed this
100463 - protocol was "targeted" to Millie's patient profile of triple
100464 - negative, and so was more likley to help Millie recover from the 3rd
100465 - relapse of cancer. The doctor also explained how "targeted" cancer
100466 - agents do not affect Millie's fragile blood counts, so her treatment
100467 - with cetuximab protocol would not be interrupted, as occurs with
100468 - standard chemotherapy drugs, like Gemzar and Navelbine. ref SDS 13
100469 - PK7L
100471 - ..
100472 - Doctor Johnson explained that these same advantages are likely to
100473 - occur with the MPA protocol to treat Millie's 8th relapse of cancer.
100474 - He concurs with Doctor Rugo that advantages of MPA treatment should
100475 - start right away. ref SDS B4 D647
100477 - ..
100478 - Doctor Johnson further explained today that after he got Doctor Rugo's
100479 - letter yesterday, he called and talked to Doctor Mason in Kaiser's
100480 - Outside Referrals Department. Doctor Johnson indicated during the
100481 - meeting today, that Doctor Mason told him that he can prescribe
100482 - treatment for Millie with radiaion and hyperthermia, and with Doxil,
100483 - or some other agent, previously authorized by Kaiser for Millie's
100484 - recent treatments beginning on 090219, and ending on 090317.
100486 - ..
100487 - Doctor Johnson explained today of having advised Doctor Mason that
100488 - Doctor Hsu, who provided radiation and hyperthermia treatment at UCSF
100489 - prescribed by Doctor Rugo, and approved by Doctor Johnson, notified
100490 - Millie during a meeting at UCSF on 090423 that "systemic" chemotherapy
100491 - through Doctor Rugo in the Breast Care Clinic is the best treatment
100492 - for Millie's 8th relapse of cancer. ref SDS B1 UG5L
100494 - ..
100495 - Doctor Mason was pleased that work in Outside Referrals was
100496 - accomplished in time to be effective for Millie. He suggested that
100497 - Doctor Johnson advise Millie to use her Medicare benefits to
100498 - self-refer for Doctor Rugo's treatment with clinical trials.
100500 - ..
100501 - Doctor Johnson pointed out to Doctor Mason that the patient refuses to
100502 - self-refer, because Kaiser is responsible to provide continuity on
100503 - standard of care for oncology. Self-referring makes the patient an
100504 - independent agent responsible for case management, which Kaiser has
100505 - performed for the past 8 years. Self-referral denies the patient
100506 - benefit of the bargain on cost containment. The patient expects her
100507 - doctor to prescribe the best care available for her patient profile,
100508 - whether a clinical trial or anything else, as shown by best evidence
100509 - possible for circumstances of the case.
100511 - ..
100512 - Up until now, and for 8-years Kaiser has deferred to doctor discretion
100513 - for medical necessity, including prescribing treatment in clinical
100514 - trials. Doctor received a letter from Doctor Rugo on 090814 saying
100515 - Millie needs treatment in a clinical trial.
100517 - ..
100518 - Doctor Mason asked during the call with Doctor Johnson what treatments
100519 - Doctor Johnson can prescribe for Millie other than a clinical trial?
100521 - ..
100522 - Doctor Johnson explained to Doctor Mason that Millie's complex patient
100523 - profile, reviewed on 090213, ref SDS 74 ES7I, can no longer be treated
100524 - by drugs Kaiser can provide. That is why Millie was referred to UCSF
100525 - cancer center on 070105. UCSF can provide "targeted" treatments for
100526 - Millie's patient profile, which are not available at Kaiser.
100528 - ..
100529 - Earlier on 040318, Doctor Johnson prescribed treatment for Millie in a
100530 - clinical trial. At that time, Millie objected, asking for treatment
100531 - with proven cancer drugs. Doctor Johnson explained that clinical
100532 - trials are standard of care to extend survival for Millie's patient
100533 - profile, and hold in reserve powerful drugs until they could be used
100534 - later for maximum effect. Kaiser's refusal to provide standard of
100535 - care for Millie now conflicts with patient history, and violates age
100536 - discrimination ristrictions with disparet treatment for medicare
100537 - patients based on age. As a result, Millie has been denied treatment
100538 - wih the drugs held in reserve, because they conflict with patient
100539 - profile. Therefore, drugs witheld from Millie when Kaiser insisted on
100540 - treatment in a clinical trial should be replaced with authorization
100541 - for drugs currently available in clinical trials.
100543 - ..
100544 - Doctor Johnson seemed to indicate today that Doctor Mason feels his
100545 - hands are tied by Kaiser procedures mandate treating Medicare patients
100546 - differently from younger patients by denying deferrence to doctor
100547 - discretion prescribing treatment in clinical trials for medical
100548 - necessity, as he has done 4-times previously for Millie, shown in case
100549 - study reported on 070830 0807. ref SDS 20 LQ5I
100550 -
100551 - [On 090616 1245 Doctor Rugo reports that Kaiser and UCSF have
100552 - agreed in writing on a treatment plan for Millie, ref SDS D3
100553 - KD6L, and that UCSF will treat other patients for Doctor
100554 - Johnson. ref SDS D3 U46K
100556 - ..
100557 - Doctor Johnson explained having concluded his call with Doctor Mason
100558 - about Millie's case, with Doctor Mason telling Doctor Johnson to file
100559 - an appeal on behalf of the patient with Member Services.
100560 -
100561 - [...below, Doctor Johnson "going to bat" for Millie,
100562 - ref SDS 0 655R, requests assistance to file appeal for Millie's
100563 - treatment at UCSF. ref SDS 0 655Y
100565 - ..
100566 - Doctor Johnson was angry and emotional in tears crying that the only
100567 - drugs he can prescribe for Millie at Kaiser are single-agent
100568 - chemotherapy with Navelbine and Gemzar, and that these drugs are now
100569 - no longer appropriate for Millie's patient profile that presents
100570 - weakened bone marrow ability to replenish blood counts destroyed by
100571 - chemotherapy, like Gemzar and Navelbine, and further Millie's cancer
100572 - has mutated to resist chemotherapy regimens. He advised that
100573 - prescribing chemo violates Kaiser's standard of care for Millie's
100574 - patient profile, and so he would get in trouble from an audit for
100575 - quality care.
100577 - ..
100578 - Doctor Johnson's report today that Kaiser has no treaments that are
100579 - appropriate for Millie's complex patient profile, aligns with prior
100580 - notice beginning on 080829 1200, ref SDS 33 PX5V, and continuing, as
100581 - shown in case study on 090325 0830. ref SDS 97 L15M
100583 - ..
100584 - [On 090520 1137 Millie's letter to Doctor Johnson cites
100585 - understandings today that Gemzare and Navelbine are the only
100586 - cancer drugs Kaiser has available for breast cancer, and they
100587 - are not appropriate for Millie's patient profile, ref SDS C1
100588 - SR5W; and, same point is presented again later in the same
100589 - letter. ref SDS C1 SS3T
100591 - ..
100592 - [On 090520 1703 Doctor Johnson notifies medical team that
100593 - Gemzar and Navelbine meeting Kaiser's standard of care for
100594 - treating cancer, but does not say they are suitable for
100595 - Millie's patient profile. ref SDS C3 HN4I
100597 - ..
100598 - [On 090520 1710 Millie's letter notified medical team,
100599 - ref SDS C4 P65H, that Doctor Johnson's letter on 090520 1703
100600 - saying Gemzar and Navelbine are options for Millie, ref SDS C3
100601 - HN4I, conflicts with guidance during the meeting at Kaiser on
100602 - 090515 1140 that Gemzar and Navelbine are not appropriate for
100603 - Millie's patient profile, and that Doctor Johnson would get in
100604 - trouble if an audit shows he prescribed these treatments for
100605 - Millie. ref SDS 0 658J
100607 - ..
100608 - [On 090521 0211 Millie's letter to Doctor Rugo at UCSF with
100609 - copy to Doctor Hsu asks if hyperthermia and Doxil can treat
100610 - Millie for 8th relapse of cancer until Kaiser resolves
100611 - delays authorizing treatment with MPA prescribed by Doctor
100612 - Rugo as the best course of care for Millie to recover from
100613 - 8th relapse of cancer. ref SDS C5 FM6R
100615 - ..
100616 - [On 090522 1953 Kaiser discloses that Millie's doctor has
100617 - "no idea" how treatment proposed with Gemzar and Navelbine
100618 - will affect Millie's complex patient profile; the doctor
100619 - says these single-agent chemotherapy treatments may not
100620 - work at all for Millie to recover from 8th relapse of
100621 - cancer. ref SDS C6 UW6G
100623 - ..
100624 - [On 090528 1603 Doctor Rugo notifies medical team that UCSF
100625 - prescribes gemcitabine for Millie to recover from the 8th
100626 - relapse of cancer. ref SDS C7 4T6K
100628 - ..
100629 - [On 090528 1652 Millie responded to Doctor Rugo's letter
100630 - notifying medical team again that she needs a prescription to
100631 - recover from the 8th relapse of cancer, and asking for
100632 - comparison of the new treatment gemcitabine proposed by Doctor
100633 - Rugo with other treatments the team has presented. ref SDS C8
100634 - MZ7N
100636 - ..
100637 - [On 090529 1109 Millie letter to medical team reports
100638 - research shows Doctor Rugo's prescription for gemcitatine
100639 - is the same as Gemzar, ref SDS C9 0M5X; Doctor Johnson
100640 - advised on 090515 that Gemzar is not standard of care for
100641 - Millie's patient profile, and he would get in trouble at
100642 - Kaiser if Gemzar was given to Millie. ref SDS 0 658J
100644 - ..
100645 - [On 090601 0818 at 1132 Brad in the Kaiser Pharmacy called and
100646 - advised that Doctor Johnson prescribed treatment for Millie
100647 - with Gemzar to start immediately this week; further reported
100648 - Millie's cancer has mutated to resist chemotherapy, and side
100649 - effects will be very difficult to tolerate, and may cause fatal
100650 - infection; Brad asked that Millie verify she agrees to get this
100651 - treatment. ref SDS D0 8J8L
100653 - ..
100654 - [On 090601 0818 at 1153 Sheree called in the Kaiser
100655 - Chemotherapy Infusion Clinic and advised that Millie cannot get
100656 - a blood draw to start Gemzar this week, because Doctor Johnson
100657 - submitted the chemoterhapy order without a signature, and then
100658 - went home with a headache, and so the order cannot be signed
100659 - until the doctor recovers and returns to work, ref SDS D0 I96J,
100660 - reflecting emotional stress expressed during the meeting at
100661 - Kaiser on 090515 saying he would get in trouble for prescribing
100662 - single-agent treatments for Millie's patient profile.
100663 - ref SDS 0 658J
100665 - ..
100666 - [On 090605 1447 Millie received documentation from Kaiser that
100667 - says Gemzar has high risks for Millie's patient profile;
100668 - requires extreme caution given after getting treatment with
100669 - radiation, which Millie received for 4 weeks in February and
100670 - March, and contiues to suffer side effects; Kaiser further says
100671 - treatment with Gemzar requires avoiding blood thinners, and
100672 - Millie is required to take blood thinners every day to prevent
100673 - death from pulmonary embolism; Gemzar can cause low blood
100674 - counts that leads to infection and death, Millie has a history
100675 - of low blood counts. ref SDS D1 V34K
100677 - ..
100678 - [On 090605 1523 Millie notified Kaiser Quality Care Department
100679 - that Gemzar presents same Quality Care problems for Millie's
100680 - patient profile, ref SDS D2 LE46, which Doctor Johnson cited
100681 - for not prescribing this treatment today. ref SDS 0 658J
100683 - ..
100684 - [On 090616 1245 Doctor Rugo reports that Kaiser and UCSF have
100685 - agreed in writing on a treatment plan for Millie, ref SDS D3
100686 - KD6L, and that UCSF will treat other patients for Doctor
100687 - Johnson. ref SDS D3 U46K
100689 - ..
100690 - [On 090724 1200 Doctor Johnson explained that Millie's cancer
100691 - has mutated through 8 relapses into cells that "outsmart"
100692 - chemotherapy drug treatments.
100694 - ..
100695 - [On 100317 0730 Chemotherapy Clinic Charge Nurse concerned
100696 - about violating Kaiser policy exposing patient confidentiality
100697 - from working in the Oncology Conference Room to extend the life
100698 - of the patient. ref SDS D5 AV5H
100700 - ..
100701 - Millie asked if Navelbine or Gemzar could be prescribed in a low dose
100702 - to reduce side effects of chemotherapy that are very difficult to
100703 - tolerate? On 050516, just a few weeks after starting treatment with
100704 - capecitabine, Millie called Doctor Johnson to reduce the dose, because
100705 - she felt like "the walking dead." ref SDS 8 AQ6G Yesterday on 090514,
100706 - Doctor Rugo advised that side effects of MPA treatment which UCSF
100707 - proposes, would be even less than for cetuximab and Carboplatin, which
100708 - Millie tolerated well for nearly 2 years. ref SDS B4 MM6O
100710 - ..
100711 - Today, Doctor Johnson advised that side effects of chemotherapy with
100712 - both Gemzar and Navelbine will be more like capecitabine, rather than
100713 - easily tolerated that occurs with "targeted" drugs, like cetuximab.
100714 - One reason he changed Millie's prescription on 070105 to cetuximab was
100715 - to avoid harsh side effects that are difficult for patients to
100716 - tolerate. ref SDS 13 PK7L Since Millie has been through several more
100717 - cancer treatment regimens, she is today much less able to tolerate
100718 - harsh side effects than in 2007.
100720 - ..
100721 - The doctor seemed to say that he would have to prescribe a full dose
100722 - of chemotherapy with Navelbine or Gemzar in order to have any chance
100723 - of stopping advance of Millie's cancer. If Millie has difficulty
100724 - tolerating treatments, as expected, based on experience with AC,
100725 - Taxotere, and capecitabine, and/or, if blood counts drop, as expected,
100726 - then he will have to reduce the dose by 25%, following Kaiser protocol
100727 - for standard of care. This will eliminate any chance of
100728 - effectiveness, since Millie's cancer has mutated to become highly
100729 - resistant standard chemotherapy agents, like Navelbine and Gemzar.
100730 - The doctor said that is why he will be cited in a practice audit for
100731 - prescribing Navelbine.
100733 - ..
100734 - Millie said uggg!
100736 - ..
100737 - Doctor Johnson was deeply frustrated during the meeting today. His
100738 - eyes teared decrying government regulations which Doctor Mason has
100739 - evidently indicated prevent Doctor Johnson from prescribing standard
100740 - of care to treat elderly Medicare patients with clinical trials like
100741 - all other patients. Doctor Johnson related having other patients
100742 - similarly situated, who are begging for treatment. Doctor Johnson was
100743 - adement today there should be a uniform standard of care expanding
100744 - treatment for all patients with clinical trials, as Doctor Johnson
100745 - prescribed for Millie on 040318. ref SDS 5 DG4J The doctor became
100746 - emotional again saying that a double standard of care for older
100747 - patients significantly complicates oncology practice by introducing
100748 - age as a restraint rather than patient health for prescribing care.
100750 - ..
100751 - Millie consoled the doctor saying...
100752 -
100753 - None of us will get out of this alive. Do the best you can,
100754 - and leave the rest to God.
100756 - ..
100757 - Millie recalled today that on 030606 the doctor said that withholding
100758 - treatment based on age is against the law. ref SDS 3 XR7I
100760 - ..
100761 - [On 090616 1245 Doctor Rugo reports that Kaiser and UCSF have
100762 - agreed in writing on a treatment plan for Millie, ref SDS D3
100763 - KD6L, and that UCSF will treat other patients for Doctor
100764 - Johnson. ref SDS D3 U46K
100766 - ..
100767 - Doctor Johnson was calmed. He asked Millie if she had seen a
100768 - television documentary on the health care system produced by Michael
100769 - Moore? The doctor explained the broadcast thunders against abuses
100770 - seniors suffer due to corruption alleged by Moore involving
100771 - politicians, health care providers, and drug companies. Doctor
100772 - Johnson was upset today by allegations in the Moore documentary of
100773 - high profile officials receiving large campaign contributions from
100774 - major players in health care that lead to gaming complex regulations
100775 - with cozy relationships that leave patients in the lurch, illustrated
100776 - by the meeting with UCSF claiming to charge the patient 20%
100777 - coinsurance, which turns out to be 56%, reported on 070830 0807.
100778 - ref SDS 20 X16N A week later, Doctor Rugo reported frustrations
100779 - trying to help Kaiser apply regulations correctly, reported on 070906
100780 - 0142. ref SDS 21 I49K The next day, Doctor Johnson advised that
100781 - health care regulations are so complex that he knows nothing about the
100782 - cost of care he prescribes, reported on 070907 1718. ref SDS 22 XH5H
100784 - ..
100785 - Millie had not seen the broadcast. She had heard about it from
100786 - friends. Her daughter-in-law, Kim, seems admiring of Michael Moore's
100787 - work, but has not mentioned that particular television program.
100789 - ..
100790 - Doctor Johnson said that since Kaiser has no treatments to prescribe
100791 - for Millie's complex patient profile, listed on 090213, ref SDS 74
100792 - AC6G, he will "go to bat" for Millie by following Doctor Mason's
100793 - recommendation, per above, ref SDS 0 8U6J, for Doctor Johnson to
100794 - personally notify Member Services that standard of care for Millie
100795 - requires continuing treatment the past 2 years at UCSF under Doctor
100796 - Rugo's new plan to treat Millie in the MPA clinical trial, which he
100797 - reviewed today during the meeting today and determined that evidence
100798 - shows MPA is the best course of care at this time, per above.
100799 - ref SDS 0 P43G
100801 - ..
100802 - The doctor requested assistance preparing a draft for him to file the
100803 - appeal with Member Services to support the doctor's authorization for
100804 - Millie's treatment at UCSF. Doctor Johnson emphasized that Millie
100805 - needs immediate treatment to recover from the 8th relapse of cancer.
100806 - He is concerned that writing an appeal for treatment authorization
100807 - takes a lot of time because Millie's patient profile is very complex,
100808 - and at this time the doctor is too busy for such an effort.
100810 - ..
100811 - [On 090518 0017 Millie submits letter to Doctor Johnson
100812 - with copy to Doctor Rugo at UCSF, and transmitting a draft
100813 - to assist Doctor Johnson file his appeal with Member
100814 - Services assisting Kaiser implement Doctor Johnson's
100815 - strategy to treat Millie's cancer as a chronic disease in
100816 - time for Millie to recover from the 8th relapse of cancer.
100817 - ref SDS B8 R16I
100819 - ..
100820 - [On 090519 1536 Doctor Johnson changed his mind; he sent
100821 - the draft appeal to Doctor Mason, and tells Millie to file
100822 - an appeal with Member Services, which is incorrect since at
100823 - this time Millie has not been denied services; and says he
100824 - is relieved from prescribing treatment for Millie to
100825 - recover from cancer, because he believes people in the
100826 - Outside Referrals Department have a better understanding of
100827 - Medicare. ref SDS B9 5K7H
100829 - ..
100830 - [On 090519 1613 Millie reminds Doctor Johnson to order her
100831 - treatment quickly in time to be effective; and, that the
100832 - doctor's letter on 090519 telling Millie to file an appeal
100833 - conflicts with the record that Doctor Johnson is
100834 - responsible for prescribing care. ref SDS C0 TX6S
100836 - ..
100837 - Doctor Johnson indicated today that experience working with Millie the
100838 - past few years shows that writing a draft appeal is a task for using
100839 - the doctor/patient partnership to save him time. He cited discussions
100840 - with Doctor Lee Davidson, who commended Millie's support last year on
100841 - helping the CT Department transform to use Power Port and Huber needle
100842 - technology for injecting contrast medium. Doctor Johnson said that
100843 - Doctor Davidson was further impressed with the patient's presentation
100844 - that led to correcting problems in CT test reporting. This was cited
100845 - in Doctor Davidson's letter last month on 090409. ref SDS A7 WB6G A
100846 - month before during the meeting at Kaiser on 090325 Doctor Johnson had
100847 - asked Millie to coordinate with the CT Department to correct the
100848 - problem. ref SDS 97 P53O
100850 - ..
100851 - The doctor asked Millie to visit Member Services after the meeting
100852 - today and get him the name of the chief for the department to address
100853 - his letter. He apologized again saying he could probably find a way
100854 - to look it up, but his schedule is very hectic the past few weeks
100855 - between seeing patients, helping the Oncology Department get started
100856 - for the new hospital in Antiock, and his Palliation Project initiative
100857 - has begun to take off here at Kaiser in Walnut Creek.
100859 - ..
100860 - Plan is to submit the draft to Doctor Johnson within the next few
100861 - days, so that the doctor can expedite filing the appeal to Member
100862 - Services and prescribe Millie's treatment with MPA, since time of the
100863 - essence for Millie to recover from the 8th relapse of cancer.
100864 -
100865 -
100866 -
100867 -
100868 -
1009 -
SUBJECTS
Default Null Subject Account for Blank Record
1103 -
110401 - ..
110402 - Stress Relieved Successful Case Management and Treatment on Vacation
110403 - Vacation Relieves Stress Overwhelming Level of Effort Case Management
110404 -
110405 - Follow up ref SDS 98 M35H.
110406 -
110407 - The doctor asked Millie about her vacation cruise, planned during the
110408 - meeting on 090325? ref SDS 98 M35H.
110410 - ..
110411 - Millie explained the trip was terrific, leaving on 090426, and
110412 - returning on 090507. The long flight home was difficult to recover
110413 - from jet-lag for several days. Traveling in Europe with her daughter
110414 - for 2 weeks provided great relief from stress of health care case
110415 - management, per study above. ref SDS 0 4W5I
110417 - ..
110418 - Right now she feels a lot of stress about her next treatment, because
110419 - of worry about IBC getting out of control, noted by the doctor
110420 - previously on 090325. ref SDS 97 L15M Stress and frustration of the
110421 - doctor today about difficulty prescribing treament for medical
110422 - necessity, further compounds psychological anxiety. ref SDS 0 GX4N
110423 -
110424 - [...below medical chart "Review of Systems" erroneously
110425 - reports patient emotional anxiety reduced, planning cruise.
110426 - ref SDS 0 EF9R
110428 - ..
110429 - [...below medical chart "Physical Examination" reports
110430 - elevated vitals compared to patient norms, illustrates
110431 - emotional stress. ref SDS 98 N26J
110432 -
110433 -
1105 -
SUBJECTS
Default Null Subject Account for Blank Record
1203 -
120401 - ..
120402 - Lab Mistakes Delays Hamper Referral Care Providers Angry Stressed
120403 -
120404 - Follow up ref SDS 98 RB3G.
120405 -
120406 - The doctor was disappointed that Doctor Mason did not approve his
120407 - amended referral on doing labs at UCSF for Millie's treatment,
120408 - reported on 090508. ref SDS B2 U25I
120410 - ..
120411 - The case study in the record for the meeting last month on 090325
120412 - shows continued difficulties for both Kaiser and UCSF coordinating lab
120413 - work for Millie's care at UCSF. ref SDS 97 H76O
120415 - ..
120416 - He wants to address this more comprehensively for Millie's next
120417 - treatment.
120418 -
120419 -
120420 -
120421 -
1205 -
SUBJECTS
Default Null Subject Account for Blank Record
1303 -
130401 - ..
130402 - Case Study Treat Millie's Cancer as Chronic Disease at UCSF
130403 - Chronic Disease Case Study Doctor Orders Treat Millie's Cancer at UCSF
130404 -
130405 - Follow up ref SDS 98 L15M, ref SDS 74 PL5K.
130406 -
130407 - Millie thanked Doctor Johnson for helping her get the treatment he
130408 - feels she needs at UCSF for treating her cancer as a chronic disease,
130409 - as disucssed previously on 090325. ref SDS 97 L15M
130410 -
130411 -
130412 -
130413 -
130414 -
130415 -
1305 -
SUBJECTS
Default Null Subject Account for Blank Record
1403 -
140401 - ..
140402 - Radiation Side Effects Increased Request Pain Relief from Burn
140403 - Side Effects Radiation Burn Increased Significantly Request Relief
140404 - Domeboro Prescribed Treat Radiation Side Effects Supplement Silvadene
140405 - Linck Prescribed Treat Radiation Side Effects Supplement Silvadene
140406 -
140407 - Follow up ref SDS 98 P39I.
140408 -
140409 - As noted the doctor was very pleased today seeing significantly
140410 - reduced side effects from radiation "burn," compared to examination on
140411 - 090325, and per examination noted above. ref SDS 0 D452
140413 - ..
140414 - Millie explained that his prescription on 090325 to use Domeboro, and
140415 - zink tablets helped Millie tolerate radiation side effects.
140416 - ref SDS 97 6E5I
140417 -
140418 -
140419 -
140420 -
1405 -
SUBJECTS
Default Null Subject Account for Blank Record
1503 -
150401 - ..
150402 - Proactive Case Management Treat Cancer Chronic Disease
150403 - Medical Tests Ordered at Kaiser for Millie's Examinations at UCSF
150404 - Research Solves Diminshing Treatments with Proactive Case Management
150405 -
150406 - Follow up ref SDS 98 P36O.
150407 -
150408 - Millie asked Doctor Johnson today about progress reviewing options for
150409 - treating Millie's cancer as a chronic disease, listed on 090121 1017.
150410 - ref SDS 52 EV53 Research on 090204 addresses diminishing treatments
150411 - for Millie's patient profile, ref SDS 64 4R3S, reported by the Doctor
150412 - Johnson at Kaiser during the meeting on 081219, ref SDS 44 V93O, again
150413 - on 090123, ref SDS 56 RK6O, and more recently on 090213. ref SDS 74
150414 - PL5K After resolving administrative delays starting treatment for the
150415 - 7th relapse, on 090204 Millie asked Doctor Rugo to implement Doctor
150416 - Johnson's instructions for planning Millie's next treatment after
150417 - radiation and hyperthermia. ref SDS 63 278T Doctor Rugo responded
150418 - that Millie's patient profile is very complicated; UCSF did not have
150419 - time to develop strategy with treatment options, reported on 090204
150420 - 1914, ref SDS 65 MW5F As a result, Millie ordered independent
150421 - research to identify options for treating Millie's cancer as a chronic
150422 - disease, ordered by Doctor Johnson, and received on 090204.
150423 - ref SDS 52 EV53
150425 - ..
150426 - During the meeting on 090325, Doctor Johnson asked for a copy of the
150427 - research to facilitate collaboration with Doctor Rugo at UCSF on
150428 - Millie's next treatment. ref SDS 97 GO4O This research was submitted
150429 - to the medical team on 090326 0058 for an opinion on which treatments
150430 - have the best chance of being effective for Millie's patient profile.
150431 - ref SDS 99 DW5S
150433 - ..
150434 - In the afternoon on 090326 1733 Doctor Johnson responded in a letter
150435 - saying he plans to talk about this at the next meeting, ref SDS A3
150436 - T64N, which is today.
150438 - ..
150439 - Today, Doctor Johnson feels MPA treatment presented by Doctor Rugo in
150440 - the UCSF letter sent to Kaiser yesterday shows the best evidence of
150441 - being effective for Millie's patient profile, and so should be the
150442 - primary focus of discussions today giving Millie the best chance to
150443 - recover from the 8th relapse of cancer. per above. ref SDS 0 P43G The
150444 - doctor feels trade-offs can be considered for additional treatment
150445 - options after Millie is treated with MPA at UCSF.
150446 -
150447 -
150448 -
150449 -
150450 -
1505 -
SUBJECTS
Default Null Subject Account for Blank Record
1603 -
160401 - ..
160402 - Thinking Through Writing Advancing at Kaiser
160403 - Medical Chart Reports Examination Diagnosis Prescription Prognosis
160404 -
160405 - Follow up ref SDS 98 YT5N, ref SDS 74 YT5N.
160406 -
160407 - Millie received through Kaiser's Knowledge Management system the
160408 - doctor's medical chart from meeting this morning on 090325 0830...
160410 - ..
160411 - 1. Received: 5/21/09 2:53 AM
160413 - ..
160414 - 2. Subject: Last Visit/Recommendation
160416 - ..
160417 - 3. Patient presents with: recheck - r/s 1mo ret
160419 - ..
160420 - 4. History of Present Illness:
160421 -
160422 - Follow up ref SDS 98 4R7J, ref SDS 74 4R7J.
160423 -
160425 - [patient] is a 73 Y female with a history of IBC of left breast
160426 - who was initially diagnosed 03/04/02. S/P AC x's 4 from
160427 - 04/23/02 through 07/01/02 followed by Taxotere ending 12/04/02.
160428 - She had recurrent disease noted initially in the cervical LN's
160429 - 03/03/04. On E2100 Study with Taxol/Avastin, but she had a PE
160430 - noted on CT 11/03/2004. Then, because of progression of
160431 - disease, the patient was started on Taxotere and Xeloda
160432 - 4/15/05. She had a total of 8 cycles ending 9/16/05. She had
160433 - a palliative left mastectomy performed 10/21/05. Then her left
160434 - chest lesions began expanding again. The patient started
160435 - Taxotere and Xeloda again 07/21/06 for 7 cycles. She was
160436 - started on a Clinical Trial 02/01/07 at UCSF and was randomized
160437 - to the Erbitux only (no Carbo) Arm. She had weekly Carboplatin
160438 - added 03/13/08 because of progression of disease. Her disease
160439 - progressed again and she began a Phase I/II Study of Sunitinib
160440 - (SU11248) at UCSF 11/14/08. Lengthy discussion about current
160441 - status and response to therapy.
160443 - ..
160444 - Because of cytopenia, MTX to be D/C'd and Sutent and CTX held
160445 - and then dose reduced. The patient started hyperthermia/XRT at
160446 - UCSF 02/19/09 and completed it 03/17/09. She is now
160447 - investigating next steps including the possibility of another
160448 - Clinical Trial at UCSF.
160450 - ..
160451 - Clarifications entered for the medical chart on 090213, ref SDS 74
160452 - 694F, and also for the medical chart on 090325, ref SDS 97 UW7G,
160453 - continue to apply for the medical chart today.
160455 - ..
160456 - Medical Chart continues...
160458 - ..
160459 - 5. Current Medications
160460 -
160461 - Follow up ref SDS 98 EX3M, ref SDS 74 EX3M.
160462 -
160463 - A lot of prior medications ended because Millie stopped
160464 - chemotherapy on 090122, ref SDS 54 AT6N, and then beginning on
160465 - 090219 was treated with radiation and hyperthermia that did not
160466 - entail medications.
160468 - ..
160469 - HYDROCODONE/ACETAMINOPHEN 5 5
160470 - combined in tablets of...... Vicodin/Lortab...... 080708, ref SDS 42 BT8C
160471 - WARFARIN 4 MG TABLETS....... Coumadin............ 061002, ref SDS 26 MI5I
160472 - TIMOLOL MALEATE 0.5% EYE.... Eye drops
160473 - LORAZEPAM 1 MG.............. Ativan.............. 070921, ref SDS 34 3N8J
160475 - ..
160476 - Treatments for radiation side effects prescribed by UCSF and by Kaiser
160477 - shown as missing from the medical chart on 090325, ref SDS 97 G65J,
160478 - have now been ended because Millie has recovered from side effects of
160479 - radiation and hyperthermia.
160481 - ..
160482 - Medical Chart continues...
160484 - ..
160485 - 6. Review of systems:
160486 -
160487 - Follow up ref SDS 98 DY3M, ref SDS 74 E15I.
160488 -
160489 - Seems to be same scope for prior exam on 081216.
160490 -
160491 - a. Constitutional: Appetite and energy level are good.
160493 - ..
160494 - b. Eyes: Vision is OK.
160496 - ..
160497 - c. ENT: No mucositis or nose bleeds.
160499 - ..
160500 - d. Cardiovascular: No SOB, palpitations or chest pain
160502 - ..
160503 - e. Respiratory: No hemoptysis or cough
160505 - ..
160506 - f. GI: None
160508 - ..
160509 - Millie recovered from problems taking Barium Sulfate Suspension for CT
160510 - test contrast medium, because the test was a one time event on 090413.
160512 - ..
160513 - Medical Chart continues...
160514 -
160515 - g. GU: No hematuria or dysuria
160517 - ..
160518 - h. Musculoskeletal: Recent dislocation, right shoulder with
160519 - fracture right humeral head; disease is now spreading down
160520 - left arm
160522 - ..
160523 - Aligns with examination today finding progression of IBC on left arm,
160524 - per above. ref SDS 0 OT8N
160526 - ..
160527 - Medical Chart continues...
160528 -
160529 - i. Skin: Chest wall improved, some evidence of progression
160530 - right to midline
160532 - ..
160533 - This report aligns with examination today showing strong response to
160534 - treatment at UCSF that began on 090219 and ended on 090317, per above.
160535 - ref SDS 0 OT76
160537 - ..
160538 - Report of "some evidence of progression right to midline" may reflect
160539 - the vertical line of coloration and 3 bumps left of the right breast,
160540 - which was identified during examination at UCSF yesterday on 090514,
160541 - and reported to the medical team in a letter on 090513 1706.
160543 - ..
160544 - Medical Chart continues...
160545 -
160546 - j. Neurological: No confusion, sensory changes or motor
160547 - weakness
160549 - ..
160550 - k. Psychiatric: Less anxiety; going on cruise 04/24/09
160552 - ..
160553 - This is an error evident from the date 090424, and caused by repeating
160554 - the report from the chart for the meeting on 090325. ref SDS 97 EF9R
160555 - Millie returned from the cruise on 090518; she reported a positive
160556 - experience that relieved anxiety, per the above. ref SDS 0 M35H
160557 -
160558 - [On 090626 1140 same error in medical chart for next
160559 - meeting at Kaiser. ref SDS D4 K97L
160561 - ..
160562 - Today, Millie reported greatly increased anxiety from symptoms of
160563 - rising cancer ref SDS 0 TO8K, together with resistance the doctor
160564 - reported with great anxiety and frustration is preventing him from
160565 - prescribing treatment in time to be effective, per above. ref SDS 0
160566 - GX4N
160567 -
160568 - [...below medical chart error reporting "Depression
160569 - stable," since as noted in this section, Millie has
160570 - significantly increased depression. ref SDS 0 GK3T
160572 - ..
160573 - Medical Chart continues...
160575 - ..
160576 - 7. Physical Exam:
160577 -
160578 - Follow up ref SDS 98 YF9L, ref SDS 74 YF9L.
160579 -
160580 - a. ECOG Performance Score 0
160582 - ..
160583 - Millie's ECOG performance score 0 is highest evaluation for
160584 - aggressively treating cancer, including clinical trials, reported on
160585 - 090205. ref SDS A6 JG5I This is similar to Karnsofsky scale, also,
160586 - reviewed on 090205. ref SDS A6 LH3O
160588 - ..
160589 - Today, the doctor was concerned that Millie's performance score can
160590 - fall quickly if she does not get timely treatment, because her cancer
160591 - has mutated into a much more aggressive disease, and so the doctor
160592 - feels Millie should investigate Hospice care, continuing to diagnose
160593 - less than a year to live, per above. ref SDS 0 JS5I
160595 - ..
160596 - Hospice care is listed in the doctor's treatment plan, per below.
160597 - ref SDS 0 TR7K
160599 - ..
160600 - Medical Chart continues...
160601 -
160602 - b. BP 125/75
160603 - Pulse 71
160604 - Temp (Src) 97.1 øF (36.2 øC) (Oral)
160605 - Wt 143 lb (64.864 kg)
160606 - SpO2 99%
160608 - ..
160609 - Improved vitals taken before meeting with the doctor and compared to
160610 - prior examination on 090325, ref SDS 97 N26J, do not reflect vitals
160611 - after the meeting when the doctor related delays prescribing Millie's
160612 - treatment. ref SDS 0 TO8K
160614 - ..
160615 - Medical Chart continues...
160616 -
160617 - c. Eyes: normal conjunctiva
160619 - ..
160620 - d. Mouth: normal mucosa
160622 - ..
160623 - e. Lymph: no nodes palpable in neck, axillae or groin
160625 - ..
160626 - This report shows marked improvement following treatment at UCSF with
160627 - radiation and hyperthermia, and compared with the medical chart for
160628 - examination at Kaiser on 090325. ref SDS 97 YD5U
160630 - ..
160631 - Medical Chart continues...
160632 -
160633 - f. Breasts: 2nd degree radiation burn on predominantly left
160634 - chest wall
160635 -
160636 - g. Chest wall: evidence of disease progression right to
160637 - midline
160639 - ..
160640 - Doctor changes description from "Breasts" in medical chart for
160641 - examination on 090325, ref SDS 97 YD5X, back to "Chest Wall" used in
160642 - medical chart on prior meeting 090213. ref SDS 74 YD5X
160644 - ..
160645 - This report does not present findings of radiation side effects,
160646 - reported in the prior examination on 090325, ref SDS 97 YD5X, which
160647 - aligns with examination today finding recovery from prior side
160648 - effects. ref SDS 0 P39I
160650 - ..
160651 - Medical chart "Physical examination Breasts" aligns with "Review of
160652 - Systems Skin," per above. ref SDS 0 EF8U
160654 - ..
160655 - Medical Chart continues...
160656 -
160657 - h. Lungs: clear to percussion and auscultation
160659 - ..
160660 - i. Heart: regular without murmur or gallop
160662 - ..
160663 - j. Abd: soft with normal bowel sounds. No masses or
160664 - organomegaly
160666 - ..
160667 - k. Ext: evidence of disease progression down left arm into
160668 - forearm
160670 - ..
160671 - This report aligns with examination today, per above. ref SDS 0 OT8N
160673 - ..
160674 - Medical Chart continues...
160675 -
160676 - l. Skin: no rashes or palpable masses
160678 - ..
160679 - This appears conflicting with examination, today. Other sections cite
160680 - progression of IBC disease, which is a skin rash, e.g., EXT.
160681 - ref SDS 0 DB6M
160682 -
160683 - [On 090626 1140 medical chart on 090626 at Kaiser
160684 - corrects mistakes today citing progression of IBC on
160685 - left arm; but, adds mistake failing to report discovery
160686 - of medical mistake -- breastbone previously diagnosed
160687 - as reaction to radiation was changed by UCSF on 090609
160688 - as untreated IBC. ref SDS D4 YE3S
160690 - ..
160691 - Medical Chart continues...
160692 -
160693 - m. Bones: no tenderness
160695 - ..
160696 - n. Neuro: awake, alert, and oriented. Moves all extremities
160697 - well. Normal gait.
160699 - ..
160700 - 8. Lab:
160701 -
160702 - Follow up ref SDS 98 YE3Y, ref SDS 74 YE3Y.
160703 -
160704 - Albumin 4.3 g/dL
160705 - Magnesium 1.9 mg/dL
160706 - Bili, Tot Adult 0.2 mg/dL
160707 - Calcium 9.4 mg/dL
160708 - Creatinine 0.68 mg/dL
160709 - Potassium 4.6 mEq/L
160710 - AST (SGOT) 35 U/L
160711 - ALT (SGPT) 21 U/L
160712 - Sodium 137 mEq/L
160714 - ..
160715 - WBC 4.0 K/uL
160716 - RBC 3.92 M/uL
160717 - Hemoglobin L 11.2 g/dL
160718 - Hematocrit 35.1 %
160719 - MCV 90 fL
160720 - RDW 14.3 %
160721 - Plt 238 K/uL
160723 - ..
160724 - CA 15-3
160725 - ----------
160726 - 320 H
160727 - 271 H
160728 - 251 H
160729 - 303 H
160730 - 202 H
160731 - 197 H
160732 - 141 H
160733 - 75 H
160734 - 74 H
160735 - 56 H
160736 - 52 H
160737 - 55 H
160738 - 56 H
160739 -
160741 - ..
160742 - 9. Imaging:
160743 -
160744 - Follow up ref SDS 98 WO8H, ref SDS 74 WO8H.
160745 -
160746 - a. 04/13/09 CT NECK, THORAX, ABDOMEN, PELVIS W CONTRAST -
160747 -
160748 - 1. There is decrease in size of the previously identified
160749 - large right axillary lymph nodes. There is however
160750 - increase in the degree of small nodular densities as
160751 - well as from the fat involving the right axillae which
160752 - is nonspecific.
160754 - ..
160755 - 2. Reticular nodular as well as ground glass opacities are
160756 - seen involving bilateral lung zones which demonstrate
160757 - progression since the previous examination.
160759 - ..
160760 - b. 03/17/09 DXA BONE DENSITY, AXIAL -
160761 -
160762 - 1. Bone mineral density calculated for the LUMBAR SPINE is
160763 - statistically consistent with osteopenia.
160765 - ..
160766 - 2. Bone mineral density calculated for the TOTAL HIP is
160767 - statistically consistent with osteopenia.
160769 - ..
160770 - c. 01/29/09 SHOULDER, COMPLETE 2+ VIEWS
160771 -
160772 - This is follow up examination evaluaing separated shoulder
160773 - on 090122 that was evaluated with image test at Kaiser on
160774 - 090129. Shoulder was xrayed. Mike advised that xray scan
160775 - test today shows no fracture, and that Millie's shoulder
160776 - appears correctly positioned in the socket for effective
160777 - healing and recovery. ref SDS 84 ZF7J
160779 - ..
160780 - d. 01/22/09 SHOULDER, COMPLETE 2+ VIEWS
160781 -
160782 - Second and third xrays on 090122 found that 1st reduction
160783 - procedure attempt to restor shoulder failed, ref SDS 78
160784 - 074F, and second attempt was successful, reported on
160785 - 090122. ref SDS 78 LV3O
160787 - ..
160788 - e. 01/22/09 SHOULDER, ONE VIEW - Dislocation, right shoulder.
160789 - Fracture right humeral head
160791 - ..
160792 - First xray at Emergency Room Department on 090122 found
160793 - dislocated shoulder. ref SDS 78 PR3U
160795 - ..
160796 - f. 01/22/09 CT CERV SPINE W/O CONTRAST - Degenerative changes
160797 - of the cervical spine without evidence of acute C spine
160798 - fracture or loss in alignment.
160800 - ..
160801 - CT test in Emergency Room to evaluate scope of injury that
160802 - caused dislocated shoulder. ref SDS 78 PP8S
160804 - ..
160805 - g. 01/22/09 CT HEAD W/O CONTRAST -
160806 -
160807 - 1. No evidence of acute infarct or hemorrhage.
160808 -
160809 - 2. Sinus disease. Mild nasal septal deviation to the
160810 - right.
160812 - ..
160813 - CT test in Emergency Room to evaluate scope of injury that
160814 - caused dislocated shoulder. ref SDS 78 W16E
160816 - ..
160817 - h. 09/11/08 CT THORAX, ABDOMEN, PELVIS W CONTRAST - Status
160818 - post left mastectomy. There has been little interval
160819 - change. Prominent right axillary lymph nodes are again
160820 - noted, little changed in size, which could be accounted for
160821 - by sampling variability. Reticular densities and tiny
160822 - punctate densities in the lungs are not significantly
160823 - changed, and there are no new identifiable lesions. No new
160824 - adenopathy or ascites.
160826 - ..
160827 - Complete history of imaging tests shows no evidence distant metastsis,
160828 - listed on 090107, ref SDS 71 GM3N, and shows that after the test on
160829 - 080911, ref SDS 45 DA6Q, Millie has had 2 CT tests to evaluate cancer
160830 - (1) on 081107, which was published in 2 parts, the first received on
160831 - 081112, ref SDS 57 DA6Q, and a second report received on 081113.
160832 - ref SDS 60 DA6Q; and the next report (2) on 081230 also issued in 2
160833 - parts, but received on the same day, 090107. ref SDS 71 DA6Q
160835 - ..
160836 - Medical Chart continues...
160838 - ..
160839 - 4. Assessment:
160840 -
160841 - Follow up ref SDS 98 KG6O, ref SDS 74 KG6O.
160842 -
160843 - 1. Metastatic breast cancer (IBC) lung, lymph node and chest
160844 - wall; S/P hyperthermia/XRT with increasing CA 15-3.
160845 - Discussed various options
160847 - ..
160848 - During the meeting today, the doctor was very pleased with recovery
160849 - from IBC and from side effects of radiation and hyperthermia in
160850 - treated areas, per above. ref SDS 0 D452 Doctor feels rising cancer
160851 - marker aligns with progression of disease on left arm. ref SDS 0 WU5O
160853 - ..
160854 - Doctor explained instructions from Doctor Mason for Doctor Johnson not
160855 - to prescribe treatment for Millie in clinical trial recommended by
160856 - Doctor Rugo at UCSF. ref SDS 0 T59N Doctor Johnson will request
160857 - guidance from member services for relief to prescribe treatment for
160858 - Millie based on evidence of treatment for medical necessity.
160859 - ref SDS 0 655R
160861 - ..
160862 - Medical Chart continues...
160863 -
160864 - 2. Anemia due to chemotherapy
160866 - ..
160867 - This section reported on 090325, ref SDS 97 IH88, is missing from the
160868 - medical chart today, and may be an error, since the blood test on
160869 - 090512 reported ANC 1320, well below requirements for chemotherapy.
160870 - ref SDS B3 B35J This may have been overlooked in the Assessment
160871 - today, because neutrophils are not listed in the lab, per above.
160872 - ref SDS 0 YE3Y Since WBC is within range, not having neutrophils,
160873 - presents an erroneous status.
160875 - ..
160876 - Low ANC presents concern about Millie sustaining more chemotherapy.
160877 - She might need Neupogen or other treatment to improve blood counts.
160879 - ..
160880 - Medical Chart continues...
160881 -
160882 - 2. ACD stable
160884 - ..
160885 - This updates the medical chart for examination on 090325 that made no
160886 - report on ACD. ref SDS 97 197L
160888 - ..
160889 - Medical Chart continues...
160890 -
160891 - 3. Dislocation, right shoulder with fracture right humeral
160892 - head
160894 - ..
160895 - This does not report examination today reporting Millie recovering
160896 - ahead of schedule, per above. ref SDS 0 E54L
160898 - ..
160899 - Medical Chart continues...
160900 -
160901 - 4. Ostepenia
160903 - ..
160904 - There is no comment, and so assessment seems to reflect findings from
160905 - bone density test on 090317, per above. ref SDS 0 SY6I
160906 -
160907 -
160908 - Anticoagulation monitoring
160910 - ..
160911 - This section is missing from the medical chart today, which was added
160912 - in the medical chart for prior examination, see report on 090325.
160913 - ref SDS 97 F63I
160915 - ..
160916 - Medical Chart continues...
160917 -
160918 - 5. Depression stable
160920 - ..
160921 - See comment for prior report on examination on 090325. ref SDS 97 GK3T
160923 - ..
160924 - Doctor's report of "stable" conflicts with patient's severe anxiety
160925 - reported above for "Psychiatric." ref SDS 0 K98H
160927 - ..
160928 - Medical Chart continues...
160930 - ..
160931 - 5. Plan:
160932 -
160933 - Follow up ref SDS 98 TR7K, ref SDS 73 TR7K.
160934 -
160935 - 1. Continue serial CA 15-3
160936 - 2. Consider Navelbine next
160937 - 3. In addition Gemzar and CPT 11 could be consider
160938 - 4. UCSF also has another proposed Clinical Trial
160939 - 5. Consider Hospice in the future
160941 - ..
160942 - Consideration of Hospice is pending medical team analysis of
160943 - treatments targeted to Millie's patient profile, discussed during the
160944 - meeting at Kaiser on 090325 0830. ref SDS 97 QT9V
160946 - ..
160947 - Medical Chart continues...
160948 -
160949 - 6. RTC 4 weeks
160951 - ..
160952 - After meeting with Doctor Johnson, Millie stopped at the front desk to
160953 - schedule the next meeting in 4 weeks. Jen said the doctor will be on
160954 - vacation in 4 weeks, and not due back for another week or so. She
160955 - said the doctor's next available meeting time is in about 6 weeks.
160956 - Jen said she will check with the doctor later and ask if it is okay to
160957 - delay seeing Millie for another 6 weeks, and if so, she will go ahead
160958 - and schedule the meeting for the first week in July, rather than
160959 - mid-June.
160960 -
160961 - [On 090520 1203 Pamela Powel advised for Kaiser Expedited
160962 - Claims Department that notation in Millie's medical chart
160963 - saying under Plan to "consider Navelbine next" meets
160964 - Kaiser's requirements for the doctor to prescribe treatment
160965 - appropriate for Millie's patient profile to recover from
160966 - the 8th relapse of cancer. ref SDS C2 I18Y
160968 - ..
160969 - [On 090522 1953 Doctor Johnson notifies Millie that CPT 11
160970 - is prescribed for patients with colon cancer; does not
160971 - confirm nor clarify if entry in Millie's medical chart is a
160972 - mistake, or that CPT 11 is a viable choice for her current
160973 - care to recover from the 8th relapse of cancer, and does
160974 - not present trade-offs with other treatments, which Millie
160975 - requested to facilitate choce of care. ref SDS C6 YT5M
160976 -
160977 -
160978 -
160979 -
160980 -
160981 -
160982 -
160983 -
160984 -
1610 -