CONTACTS 

SUBJECTS
Give Up Treatment Laura IBC Relapse Emotional Fatigue Trauma Lose Fa

3403 -
3403 -    ..
3404 - Summary/Objective
3405 -
340501 - Follow up ref SDS 1 0000.
340502 -
340503 -
340504 -
340506 -  ..
3406 -
3407 -
3408 - Progress
3409 -
340901 - We've seen Laura a few times since the report on 090204.  At that
340902 - time, she looked better and sounded in good spirits. ref SDS 1 7Z6I
340904 -  ..
340905 - About a month ago, we saw Laura and her mom in the cafeteria.  She was
340906 - not well.  Her treatments that seemed to bring improvement in
340907 - February, failed again by April or May.
340909 -  ..
340910 - Laura was diagnosed with IBC spreading cancer to her brain.  Doctor
340911 - Rugo prescribed a "gamma knife" theraputic radiology procedure to
340912 - "cut" the cancer from Laura's brain.  Evidently this was successful
340913 - treating cancer in Laura's brain, but since then her cancer has
340914 - continue to spread internally.
340915 -
340916 -            [On 100309 1001 Ed diagnosed with lung cancer spread to the
340917 -            brain, scheduled for radiation treatment at Travis AFB
340918 -            which may be gamma knife procedure. ref SDS 5 PX96
340920 -  ..
340921 - Research shows...
340922 -
340923 -        Radiology Info
340924 -
340925 -        Gama Knife...
340926 -
340927 -              http://www.radiologyinfo.org/en/info.cfm?pg=gamma_knife
340929 -         ..
340930 -        What is this equipment used for?
340932 -         ..
340933 -        The gamma knife and its associated computerized treatment
340934 -        planning software enable physicians to locate and irradiate
340935 -        relatively small targets in the head (mostly inside the brain)
340936 -        with extremely high precision.  Intense doses of radiation can
340937 -        be given to the targeted area(s) while largely sparing the
340938 -        surrounding tissues.  The gamma knife can be used for a wide
340939 -        variety of problems.  For example, it can be used to treat
340940 -        selected malignant tumors that arise in or spread to the brain
340941 -        (primary brain tumors or metastatic tumors), benign brain
340942 -        tumors (meningiomas, pituitary adenomas, acoustic neuromas),
340943 -        blood vessel defects (arteriovenous malformations) and
340944 -        functional problems (trigeminal neuralgia).  Possible future
340945 -        uses are being evaluated for epilepsy and Parkinson's disease.
340947 -         ..
340948 -        The gamma knife is usually unsuitable for targets larger than
340949 -        three or four centimeters in size.
340951 -         ..
340952 -        How does the equipment work?
340954 -         ..
340955 -        The gamma knife utilizes a technique called stereotactic
340956 -        radiosurgery, which uses multiple beams of radiation
340957 -        converging in three dimensions to focus precisely on a small
340958 -        volume, such as a tumor, permitting intense doses of radiation
340959 -        to be delivered to that volume safely. Current models of the
340960 -        gamma knife use advanced robotic technology to move the
340961 -        patient in submillimeter increments during treatment, to focus
340962 -        radiation successfully to all parts of the target. Gamma knife
340963 -        treatments are given in a single session.
340965 -         ..
340966 -        Under local anesthesia, a special rigid head frame
340967 -        incorporating a three-dimensional coordinate system is
340968 -        attached to the patient's skull with four screws. Imaging
340969 -        studies, such as magnetic resonance imaging (MRI), computed
340970 -        tomography (CT), or angiography are then obtained and the
340971 -        results are sent to the gamma knife's planning computer
340972 -        system. Together, physicians (radiation oncologists and
340973 -        neurosurgeons) and medical radiation physicists delineate
340974 -        targets and normal anatomical structures and use the planning
340975 -        computer to determine the exact relationship between them and
340976 -        the headframe and calculate gamma knife treatment parameters.
340977 -        Targets often are best treated during the treatment session
340978 -        with combinations of several successive aimings, commonly
340979 -        known as "shots." The physicians and physicists routinely
340980 -        consider numerous fine-tuning adjustments of treatment
340981 -        parameters until an optimal plan and dose are determined.
340983 -         ..
340984 -        Using the three-dimensional coordinates determined in the
340985 -        planning process, the frame is then precisely attached to the
340986 -        gamma knife unit to guarantee that when the unit is activated,
340987 -        the target is placed exactly in the center of approximately
340988 -        200 precision-aimed, converging beams of (Cobalt-60 generated)
340989 -        gamma radiation. Treatment takes anywhere from several minutes
340990 -        to a few hours to complete depending on the shape and size of
340991 -        the target and the dose required. Patients do not feel the
340992 -        radiation. Following treatment the headframe is removed and
340993 -        the patient may return to normal activity.
340995 -  ..
340996 - Laura was crying today because she is now too weak to work; her state
340997 - disability entitlement had expired, and so since she was unable to
340998 - work, her medical insurance was terminated.  Laura's mom said she was
340999 - exhausted filling out forms to get replacement medical coverage for
341000 - Laura.  They may have been trying to get early Mediare coverage, but
341001 - this would take 60 days.  Laura was worried about not having money and
341002 - no medical care.
341004 -  ..
341005 - Today, when we arrived at 1000 in the Breast Care Clinic on the 2nd
341006 - floor for Millie's biopsy to start treatment on the MPA study, Laura
341007 - and her mom were in the lobby.  They joined us for brief visit about
341008 - 15 minutes, until Laura was called for her meeting.
341010 -  ..
341011 - Laura does not look well.  She is much thinner than in February, and
341012 - she was thin then.
341014 -  ..
341015 - Laura has decided to give up on Doctor Rugo and will not continue in
341016 - clinical trials at UCSF.  She cried softly explaining plans to sell
341017 - her home in Livermore, and move back to live with her mom in
341018 - Minnesota.  Her brothers and sisters are also in Minnesota, so this
341019 - sounds like a good move to have family with her.
341020 -
341021 -            [On 090826 Millie received a letter from Laura on progress
341022 -            moving to Minnesota. ref SDS 2 KS6M
341024 -             ..
341025 -            [On 091125 Millie notified that Laura has ended cancer
341026 -            treatments and is getting hospice care. ref SDS 3 155V
341028 -             ..
341029 -            [On 100106 0301 Millie received notice that Laura died.
341030 -            ref SDS 4 LP5I
341032 -  ..
341033 - Millie explained difficulties the past few months lining up treatment
341034 - for the 8th relapse, and that this week there is hope that Doctor
341035 - Rugo's MPA clinical trial will be effective.  But this is just a hope.
341036 - The critical factor is having a program of treaments lined up.
341038 -  ..
341039 - Hugged Laura goodby and wished her well.
341040 -
341041 -
341042 -
341043 -
341044 -
341045 -
3411 -