THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com


S U M M A R Y


DIARY: May 15, 2009 11:40 AM Friday; Rod Welch

Millie meeting at Kaiser primary care physician review UCSF referral.

1...Summary/Objective
2...Dislocated Shoulder Recovering Extensive Brusing Subsides
3...Examination IBC Finds 7th Relapse Radiation Side Effects Subside
4...IBC 8th Relapse Following Radiation Hyperthermi Evident Left Arm
5...Cancer Marker CA 15-3 320 Rises Highest Ever
6...Disease Trajectory Rapid Decline Shortens Time for Delivering Care
7...7th Relapse Increases Risks of Rapid Decline Timely Care Critical
8...Hospice Care Patients Avoid Discomfort of Decline
9...Clinical Trial Millie's Next Treatment for 8th Relapse Cancer
10...UCSF Proposes MPA Study Anti-Metastatic Anti-Angiogenic Therapy
11...Stress Relieved Successful Case Management and Treatment on Vacation
12...Vacation Relieves Stress Overwhelming Level of Effort Case Management
13...Lab Mistakes Delays Hamper Referral Care Providers Angry Stressed
14...Case Study Treat Millie's Cancer as Chronic Disease at UCSF
15...Chronic Disease Case Study Doctor Orders Treat Millie's Cancer at UCSF
16...Radiation Side Effects Increased Request Pain Relief from Burn
17...Side Effects Radiation Burn Increased Significantly Request Relief
18...Domeboro Prescribed Treat Radiation Side Effects Supplement Silvadene
19...Linck Prescribed Treat Radiation Side Effects Supplement Silvadene
20...Proactive Case Management Treat Cancer Chronic Disease
21...Medical Tests Ordered at Kaiser for Millie's Examinations at UCSF
22...Research Solves Diminshing Treatments with Proactive Case Management
23...Thinking Through Writing Advancing at Kaiser
24...Medical Chart Reports Examination Diagnosis Prescription Prognosis
....4...History of Present Illness:
....5...Current Medications
....6...Review of systems:
....7...Physical Exam:
....8...Lab:
....9...Imaging:
....4...Assessment:
....5...Plan:

ACTION ITEMS.................. Click here to comment!

1...Anemia due to chemotherapy

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 F (36.2 C) (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 -