THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: June 26, 2009 11:40 AM Friday; Rod Welch

Millie meeting at Kaiser on recovery 8th relapse with MPA at UCSF.

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...Thinking Through Writing Advancing at Kaiser
12...Medical Chart Reports Examination Diagnosis Prescription Prognosis
....3...History of Present Illness:
....4...Current Medications
....5...Review of systems:
....6...Physical Exam:
....7...Lab:
....8...Imaging:
....9...Assessment:
...10...Plan:


..............
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CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS C2 0000. ref SDS A0 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
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 46 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 58 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 61 4S8O
040924 -             ..
040925 -        4.  Doctor Rugo prescribes immediate
040926 -            treatment at UCSF in radiation
040927 -            oncology department for
040928 -            7th relapse....................... 090130, ref SDS 61 TZ6H
040930 -             ..
040931 -        5.  Urgent treatment was delayed a week
040932 -            due to communication problems
040933 -            at UCSF........................... 090130, ref SDS 61 AY8Q
040935 -             ..
040936 -        6.  Approval for Kaiser referral to UCSF
040937 -            was delayed by documentation
040938 -            errors............................ 090202, ref SDS 63 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 62 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 63 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 64 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 65 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 67 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 69 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 74 9R61
040985 -             ..
040986 -       14.  Examination primary care physician
040987 -            at Kaiser finds severe progression
040988 -            of IBC in 6th
040989 -            relapse........................... 090213, ref SDS 76 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 76 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 76 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 76 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 76 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 76 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 76 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 76 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 76 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 76 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 76 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 76 R75G
041092 -             ..
041093 -       26.  Doctor Rugo has responded by scheduling
041094 -            a meeting with Millie at UCSF on
041095 -            090312............................ 090213, ref SDS 76 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 76 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 76 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 76 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 76 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 76 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 76 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 76 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 76 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 77 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 77 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 77 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 78 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 79 EA4Q
041200 -             ..
041201 -       40.  Hyperthermia treatment planning
041202 -            on 090209 report received
041203 -            from UCSF......................... 090220, ref SDS 80 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 80 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 81 3N9J
041217 -            and asks for scientific paper
041218 -            using radiation to treat
041219 -            IBC............................... 090223, ref SDS 81 T49U
041221 -             ..
041222 -       43.  Radiation combined with hyperthermia
041223 -            treatment plan received from
041224 -            UCSF.............................. 090226, ref SDS 82 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 84 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 85 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 86 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 87 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 88 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 91 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 91 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 91 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 91 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 91 F88K
041301 -            discloses side effects severely
041302 -            blistering skin will worsen for a
041303 -            month, and then gradually
041304 -            recover........................... 090312, ref SDS 91 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 91 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 92 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 93 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 95 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 95 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 96 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 97 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 98 PR4Y
041372 -
041373 -
041374 -
0414 -

SUBJECTS
Default Null Subject Account for Blank Record

0503 -
050401 -  ..
050402 - On 090616 Millie started treatment for 8th relapse of cancer with MPA
050403 - on a clinical trial at UCSF. ref SDS E5 JH4F  During the meeting at
050404 - UCSF on 090616 Doctor said everybody is now on board after weeks of
050405 - conflict with Kaiser refusing treatment, to now collaborating with
050406 - UCSF on treating Millie's cancer as a chronic disease. ref SDS E5 D647
050408 -  ..
050409 - Today, the doctor reported receiving Millie's letter this morning
050410 - submitting the agenda for the meeting, reported on 090626 1057.
050411 - ref SDS E9 SA6R  During the meeting, Doctor Johnson reviewed issues
050412 - presented in the agenda.
050413 -
050414 -
050416 -  ..
050417 - Dislocated Shoulder Recovering Extensive Brusing Subsides
050418 -
050419 - Follow up ref SDS C2 E54L, ref SDS A0 E54L.
050420 -
050421 -
050422 -
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 C2 D452, ref SDS A0 D452.
060406 -
060407 - The doctor made examination.
060408 -
060409 -
060410 -
060411 -
060412 -
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 C2 WU5O, ref SDS A0 WU5O.
070405 -
070406 -
070407 -
070408 -
070409 -
070410 -
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 C2 P39M, ref SDS A0 P39M.
080406 -
080407 -
080408 -
080409 - Doctor Johnson advised today that recurrent IBC reported to the
080410 - medical team on 090331, ref SDS A7 Q69V, and so soon after treatment
080411 - with radiation and hyperthermia ended at UCSF on 090317, and as
080412 - observed today shows Millie's cancer is now very aggressive and so
080413 - needs immediate treatment.  He feels this reflects the challenge
080414 - Millie faces with the 8th relapse, which was discussed on 090325 in
080415 - connection with rapid decline in Millie's disease trajectory.
080416 - ref SDS A0 P39M
080417 -
080418 -                [On 090627 0221 Millie's letter to the medical team
080419 -                confirms Doctor Johnson approved the UCSF treatment
080420 -                plan using MPA for Millie to recover from medical
080421 -                mistakes when UCSF provided radiation medical services.
080422 -                ref SDS F0 2X5U
080423 -
080424 -
080425 -
080426 -
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 C2 JS5I, ref SDS A0 JS5I.
090405 -
090406 -
090407 -
090408 -
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 C2 P43G, ref SDS A0 P43G.
100406 -
100407 -
100408 -
100409 -
1005 -

SUBJECTS
Default Null Subject Account for Blank Record

1103 -
110401 -  ..
110402 - Thinking Through Writing Advancing at Kaiser
110403 - Medical Chart Reports Examination Diagnosis Prescription Prognosis
110404 -
110405 - Follow up ref SDS C2 YT5N, ref SDS A0 YT5N.
110406 -
110407 - Millie received through Kaiser's Knowledge Management system the
110408 - doctor's medical chart from meeting this morning on 090626 1140...
110409 -
110410 -    1.  Received:  6/26/09 1:30 PM
110412 -         ..
110413 -    2.  Patient presents with:  recheck - r/s 1mo ret
110415 -         ..
110416 -    3.  History of Present Illness:
110417 -
110418 -        Follow up ref SDS C2 4R7J, ref SDS A0 4R7J.
110419 -
110421 -        [patient] is a 73 Y female with a history of IBC of left breast
110422 -        who was initially diagnosed 03/04/02.  S/P AC x's 4 from
110423 -        04/23/02 through 07/01/02 followed by Taxotere ending 12/04/02.
110424 -        She had recurrent disease noted initially in the cervical LN's
110425 -        03/03/04.  On E2100 Study with Taxol/Avastin, but she had a PE
110426 -        noted on CT 11/03/2004.  Then, because of progression of
110427 -        disease, the patient was started on Taxotere and Xeloda
110428 -        4/15/05.  She had a total of 8 cycles ending 9/16/05.  She had
110429 -        a palliative left mastectomy performed 10/21/05.  Then her left
110430 -        chest lesions began expanding again.  The patient started
110431 -        Taxotere and Xeloda again 07/21/06 for 7 cycles.  She was
110432 -        started on a Clinical Trial 02/01/07 at UCSF and was randomized
110433 -        to the Erbitux only (no Carbo) Arm.  She had weekly Carboplatin
110434 -        added 03/13/08 because of progression of disease.  Her disease
110435 -        progressed again and she began a Phase I/II Study of Sunitinib
110436 -        (SU11248) at UCSF 11/14/08.  Lengthy discussion about current
110437 -        status and response to therapy.
110439 -         ..
110440 -        Because of cytopenia, MTX to be D/C'd and Sutent and CTX held
110441 -        and then dose reduced.  The patient started hyperthermia/XRT at
110442 -        UCSF 02/19/09 and completed it 03/17/09.  She has started the
110443 -        MPA Clinical Trial at UCSF 06/16/09. They are here today to
110444 -        discuss, 1) response, 2) treatment plan 3) breathing problems,
110445 -        4) labs.
110447 -  ..
110448 - Clarifications entered for the medical chart on 090213, ref SDS 76
110449 - 694F, and also for the medical chart on 090325, ref SDS 99 UW7G,
110450 - continue to apply for the medical chart today.
110452 -  ..
110453 - Medical Chart continues...
110455 -         ..
110456 -    4.  Current Medications
110457 -
110458 -        Follow up ref SDS C2 EX3M, ref SDS A0 EX3M.
110459 -
110460 -        A lot of prior medications ended because Millie stopped
110461 -        chemotherapy on 090122, ref SDS 56 AT6N, and then beginning on
110462 -        090219 was treated with radiation and hyperthermia that did not
110463 -        entail medications.
110465 -         ..
110466 -        HYDROCODONE/ACETAMINOPHEN 5 5
110467 -        combined in tablets of...... Vicodin/Lortab...... 080708, ref SDS 44 BT8C
110468 -        WARFARIN 4 MG TABLETS....... Coumadin............ 061002, ref SDS 27 MI5I
110469 -        TIMOLOL MALEATE 0.5% EYE.... Eye drops
110470 -        LORAZEPAM 1 MG.............. Ativan.............. 070921, ref SDS 35 3N8J
110472 -  ..
110473 - Treatment to recover from 7th relapse of cancer missing from Current
110474 - Medications, and so should be added as follows...
110475 -
110476 -        MPA.............................................. 090616, ref SDS E5 YO4J,
110478 -  ..
110479 - Medical Chart continues...
110481 -         ..
110482 -    5.  Review of systems:
110483 -
110484 -        Follow up ref SDS C2 DY3M, ref SDS A0 DY3M.
110485 -
110486 -        Seems to be same scope for prior exam on 081216.
110487 -
110488 -        a.  Constitutional: Appetite and energy level are stable still
110489 -            able to walk Lafayette Reservoir.
110491 -  ..
110492 - Reporting that Millie can still walk Lafayette Reservoir is
110493 - incorrect; Millie has not been able hike at Lafayette Reservoir since
110494 - last year, due to fatigue from Sunitinib, then radiation, and most
110495 - recently difficulty breathing due to radiation mistakes at UCSF.
110497 -  ..
110498 - The record on 090609 reports Millie tried hiking at Lafayette 4-times
110499 - in a row the week before in order to evaluate rising breathing
110500 - problems.  She experienced increasing breathing problems, and so had
110501 - to stop again.  Now she can barely walk upstairs at home twice in a
110502 - row. ref SDS D8 KQ9G
110504 -  ..
110505 - Millie confirmed rising breathing problems on 090618 1743 in a letter
110506 - to the medical team reporting that she tried hiking at Lafayette
110507 - Reservoir to test her breathing. ref SDS E7 LE7M, and reported that
110508 - difficulty breathing prevented completing evan half of a lap, when
110509 - normally she can do 2 - 3 laps. ref SDS E7 TF4U
110511 -  ..
110512 - On 090619 1224 Millie reported to the medical team that she completed
110513 - 1.5 laps at Lafayette reservior; asks medical team if breathing
110514 - capacity can increase similar to eventual recovery of lymphatic
110515 - system. ref SDS E2 2T8L
110517 -             ..
110518 -            [On 090701 0301 Millie notifies medical team she is
110519 -            planning to try hiking at Lafayette Reservoir to evaluate
110520 -            recovery from breathing problems. ref SDS F2 UP3U
110522 -             ..
110523 -            [On 090702 2241 Millie notifies medical team she is
110524 -            frightened about having to think about breathing.
110525 -            ref SDS F3 D14S
110527 -  ..
110528 - Medical Chart continues...
110529 -
110530 -        b.  Eyes: Vision is OK.
110532 -             ..
110533 -        c.  ENT: No nose bleeds.
110535 -             ..
110536 -        d.  Cardiovascular: No SOB, palpitations or chest pain
110538 -             ..
110539 -        e.  Respiratory: No hemoptysis or cough. Some DOE noted
110541 -  ..
110542 - DOE - dyspnea on exertion...
110544 -  ..
110545 - Millie has been reporting breathing and cough problems, beginning on
110546 - 090403 1107. ref SDS A8 UV4U   On 090415 Doctor Johnson called and
110547 - advised that the CT test on 090413 indicates some progression of
110548 - nodules in the lungs, like due to radiation injury, ref SDS B3 VG8M,
110549 - Millie's letter this morning on 090926 1057, submitting the agenda for
110550 - the meeting says cough has improved. ref SDS E9 0F3U  The letter this
110551 - morning further related extensive discussion with Doctor Mates, Chief
110552 - of Radiology at Kaiser in Walnut Creek, on prospects for lung injury
110553 - from mistakes by UCSF providing radiation treatments may heal over
110554 - time. ref SDS E9 0F5V
110555 -
110556 -               [On 090627 2122 Millie requested treatment from UCSF for
110557 -               another prolonged attack of breathing problems from
110558 -               persistent cough. ref SDS F1 MH3U
110560 -                ..
110561 -               [On 090701 0301 Millie reported to medical team severe
110562 -               coughing episode. ref SDS F2 UP3U
110564 -                ..
110565 -               [On 090702 2241 Millie reports to the medical team
110566 -               rising pain on the left side of her chest for the past 2
110567 -               weeks. ref SDS F3 D13Q
110569 -                ..
110570 -               [On 090706 0301 Millie received a letter from Mike,
110571 -               Doctor Rugo's coordinator, saying his investigation
110572 -               discovered that nobody at UCSF ordered review of
110573 -               Millie's CT test scan files, ref SDS F5 1L6N, which were
110574 -               same-day hand- delivered to UCSF on 090612, ref SDS E3
110575 -               UD5H, per Mike's request on 090610 for timely review by
110576 -               UCSF. ref SDS D9 S537
110578 -                ..
110579 -               [On 090706 0301 telecon with Mike, Doctor Rugo's
110580 -               coordinator, discussed UCSF work plan for Millie to
110581 -               recover from medical mistakes providing radiation
110582 -               services on referral from Kaiser, and which caused
110583 -               radiation injury to Millie's breathing, and spread
110584 -               Millie's cancer. ref SDS F4 QY5H
110586 -                ..
110587 -               [On 090708 1343 Arlette calls and reports that Doctor
110588 -               Johnson ordered xray tests to evaluate Millie's
110589 -               breathing problems caused by progressive radiation
110590 -               injury from medical mistakes providing radiation
110591 -               services provided by UCSF. ref SDS F6 FS6G
110593 -                ..
110594 -               [On 090708 1343 Arlette called and reported that Doctor
110595 -               Johnson ordered xray tests to evaluate Millie's
110596 -               breathing problems caused by progressive radiation
110597 -               injury from medical mistakes providing radiation
110598 -               services provided by UCSF. ref SDS F6 FS6G
110600 -                ..
110601 -               [On 090708 0301 Doctor Johnson calls and advises that
110602 -               Kaiser has also ordered a pulmonary funciton test (PFT)
110603 -               to further evaluate Millie's breathing problems.
110604 -               ref SDS F7 FS6G
110606 -             ..
110607 -        f.  GI: Diarrhea from ReadiCat
110609 -  ..
110610 - Millie suffered severe problems taking Barium Sulfate Suspension for
110611 - CT test contrast medium on 090612 1120. ref SDS E2 PPWX
110612 -
110613 -               [...below doctor's work plan is to replace Barium
110614 -               Sulfate with gastrogafin contrast medium on future CT
110615 -               tests. ref SDS 0 839F
110617 -  ..
110618 - Medical Chart continues...
110619 -
110620 -        g.  GU: No hematuria or dysuria
110622 -             ..
110623 -        h.  Musculoskeletal: Recent dislocation, right shoulder with
110624 -            fracture right humeral head; disease is now spreading down
110625 -            left arm
110627 -  ..
110628 - Dislocated right shoulder occurred on 090122 0925. ref SDS 55 WS5K
110629 - Findings of IBC spreading on lift arm continue condition reported in
110630 - medical chart on 090515. ref SDS C2 OT8N and ref SDS C2 WE7K
110632 -  ..
110633 - Medical Chart continues...
110634 -
110635 -        i.  Skin: Chest wall with evidence of gross progression right
110636 -            to midline
110638 -  ..
110639 - Fails to cite Doctor Hsu's finding of IBC progression in breastbone
110640 - area, which previously was diagnosed and treated as reaction to
110641 - radiation, reported on 090609 0900. ref SDS D8 W65W
110643 -  ..
110644 - IBC has seemed to increase during the first 2 weeks after starting MPA
110645 - treatment at UCSF on 090616, shown in Millie's letter today on 090626
110646 - 1057, ref SDS E9 0E8T, and saying IBC is so bad that Millie hates
110647 - looking at herself in the mirror. ref SDS E9 0E9Y
110649 -  ..
110650 - Millie had similar response starting cetuximab on 070201, ref SDS 19
110651 - 0001, and starting sunitinib on 081114. ref SDS 42 505G
110653 -  ..
110654 - Medical Chart continues...
110655 -
110656 -        j.  Neurological: No confusion, sensory changes or motor
110657 -            weakness
110659 -             ..
110660 -        k.  Psychiatric: Less anxiety; going on cruise 04/24/09
110662 -  ..
110663 - Repeats error in medical chart on 090515, since Millie has already
110664 - gone and returned from the cruise a month ago. ref SDS C1 EF9R
110666 -  ..
110667 - Millie has significantly less anxiety today, because Doctor Rugo
110668 - reported on 090616 that everybody at Kaiser and UCSF is now on board
110669 - to perform Kaiser's responsibility providing standard of care to treat
110670 - Millie's cancer as a chronic disease, ref SDS E5 D647, using
110671 - modalities based on best evidence targeted to her patient profile for
110672 - recovering from UCSF medical mistakes, reported on 090609, ref SDS D8
110673 - W65W, that caused Millie's 7th relapse of cancer, per below.
110674 - ref SDS 0 Z76J
110676 -  ..
110677 - Millie is very anxious about rising breathing problems, per above.
110678 - ref SDS 0 EF7R
110679 -
110680 -               [...below, Assessment Depression stable, reflects relief
110681 -               from anxiety Millie experienced from everybody on board
110682 -               to perform requirements for standard of care.
110683 -               ref SDS 0 GK3T
110685 -  ..
110686 - Medical Chart continues...
110688 -         ..
110689 -    6.  Physical Exam:
110690 -
110691 -        Follow up ref SDS C2 YF9L, ref SDS A0 YF9L.
110692 -
110693 -        a.  ECOG Performance Score 0
110695 -  ..
110696 - Same analysis of ECOG reported on 090515, ref SDS C1 YF9L, except
110697 - Millie having more difficulty breathing.
110699 -  ..
110700 - Hospice care is listed in the doctor's treatment plan, per below.
110701 - ref SDS 0 TR7K
110703 -  ..
110704 - Medical Chart continues...
110705 -
110706 -        b.  BP 127/71
110707 -            Pulse 88
110708 -            Temp (Src) 98.9 F (37.2 C) (Oral)
110709 -            Wt 144 lb (65.318 kg)
110710 -            SpO2 98%
110712 -             ..
110713 -        c.  Eyes: normal conjunctiva
110715 -             ..
110716 -        d.  Ears: bilateral cerumen but no occlusion or impaction
110718 -             ..
110719 -        e.  Lymph: no nodes palpable in neck, axillae or groin
110721 -             ..
110722 -        f.  Breasts: IBC progression on chest wall, vertical linear
110723 -            area of scabbing
110725 -             ..
110726 -        g.  Chest wall: evidence of disease progression right to
110727 -            midline
110729 -  ..
110730 - Same error as for "Review of Systems, above, ref SDS 0 EF8U, fails to
110731 - cite Doctor Hsu's finding of IBC progression in breastbone area, which
110732 - previously was diagnosed and treated as reaction to radiation,
110733 - reported on 090609 0900. ref SDS D8 W65W
110735 -  ..
110736 - IBC has seemed to increase during the first 2 weeks after starting MPA
110737 - treatment at UCSF on 090616, shown in Millie's letter today on 090626
110738 - 1057, ref SDS E9 0E8T, and saying IBC is so bad that Millie hates
110739 - looking at herself in the mirror. ref SDS E9 0E9Y
110741 -  ..
110742 - Medical Chart continues...
110743 -
110744 -        h.  Lungs: clear to percussion and auscultation
110746 -             ..
110747 -        i.  Heart: regular without murmur or gallop
110749 -             ..
110750 -        j.  Abd: soft with normal bowel sounds. No masses or
110751 -            organomegaly
110753 -             ..
110754 -        k.  Ext: evidence of disease progression down left arm into
110755 -            forearm
110757 -  ..
110758 - This report aligns with examination today, per above. ref SDS C2 OT8N
110760 -  ..
110761 - Medical Chart continues...
110762 -
110763 -        l.  Skin: IBC rash worsening progression down the left arm
110765 -  ..
110766 - Corrects error in medical chart on 090515, ref SDS C2 YE3S  New
110767 - mistake today failing to report UCSF changed diagnosis of breastbone
110768 - during meeting on 090609 from reaction to radiation to untreated IBC.
110769 - ref SDS D8 W65W
110771 -  ..
110772 - IBC has seemed to increase during the first 2 weeks after starting MPA
110773 - treatment at UCSF on 090616, shown in Millie's letter today on 090626
110774 - 1057, ref SDS E9 0E8T, and saying IBC is so bad that Millie hates
110775 - looking at herself in the mirror. ref SDS E9 0E9Y
110777 -  ..
110778 - Medical Chart continues...
110779 -
110780 -        m.  Bones: no tenderness
110782 -             ..
110783 -        n.  Neuro: awake, alert, and oriented. Moves all extremities
110784 -            well. Normal gait.
110786 -         ..
110787 -    7.  Lab:
110788 -
110789 -        Follow up ref SDS C2 YE3Y, ref SDS A0 YE3Y.
110790 -
110791 -            Alkaline Phos 58 U/L
110792 -            BUN 11 mg/dL
110793 -            Bili, Tot Adult 0.5 mg/dL
110794 -            Creatinine 0.59 mg/dL
110795 -            AST (SGOT) H 41 U/L
110796 -            ALT (SGPT) 18 U/L
110798 -  ..
110799 - This part of the lab listed in the medical chart today, per above,
110800 - ref SDS 0 YE3Y, appears to repeat results from the blood draw at
110801 - Kaiser on 090612, ref SDS E1 OT8J, which supplemented the blood draw
110802 - on 090602, and was requested by Mike at UCSF for Millie to start MPA
110803 - treatment. ref SDS E1 LW5I
110805 -  ..
110806 - Medical Chart continues...
110807 -
110808 -            WBC 5.2 K/uL
110809 -            RBC 3.98 M/uL
110810 -            Hemoglobin L 11.3 g/dL
110811 -            Hematocrit 34.7 %
110812 -            MCV 87 fL
110813 -            RDW H 14.6 %
110814 -            Plt 240 K/uL
110816 -             ..
110817 -            Anticoag Ther? WARFARIN
110818 -            PT, Patient H 29.9 Sec
110819 -            PT INR 2.9 Ratio
110821 -  ..
110822 - The CBC and INR parts of the lab listed in the medical chart today,
110823 - per above, ref SDS 0 ZR5N, appear to repeat results from the blood
110824 - draw at Kaiser on 090602, ref SDS D6 OT8J,
110826 -  ..
110827 - The chart fails to list the most recent blood test on 090616 performed
110828 - at UCSF for Millie to start MPA treatment for 7th relapse of cancer.
110829 - ref SDS E4 075H, and which was submitted to the medical team the next
110830 - day on 090617 0112, ref SDS E6 TP9L, reporting more blood work was
110831 - performed.
110833 -  ..
110834 - Medical Chart continues...
110835 -
110836 -            CA 15-3
110837 -            ----------
110838 -            289 H ............................. 090602 ref SDS D6 PQTQ
110839 -            320 H
110840 -            271 H
110841 -            251 H
110842 -            303 H
110843 -            202 H
110844 -            197 H
110845 -            141 H
110846 -            75 H
110847 -            74 H
110848 -            56 H
110849 -            52 H
110850 -            55 H
110851 -            56 H
110852 -
110854 -         ..
110855 -    8.  Imaging:
110856 -
110857 -        Follow up ref SDS C2 WO8H, ref SDS A0 WO8H.
110858 -
110859 -        a.  06/12/09 CT THORAX, ABDOMEN, PELVIS W CONTRAST
110860 -            06/12/09 CT NECK W CONTRAST
110862 -             ..
110863 -        b.  04/13/09 CT NECK, THORAX, ABDOMEN, PELVIS W CONTRAST -
110864 -
110865 -            1.  There is decrease in size of the previously identified
110866 -                large right axillary lymph nodes.  There is however
110867 -                increase in the degree of small nodular densities as
110868 -                well as from the fat involving the right axillae which
110869 -                is nonspecific.
110871 -                 ..
110872 -            2.  Reticular nodular as well as ground glass opacities are
110873 -                seen involving bilateral lung zones which demonstrate
110874 -                progression since the previous examination.
110876 -             ..
110877 -        c.  03/17/09 DXA BONE DENSITY, AXIAL -
110878 -
110879 -            1.  Bone mineral density calculated for the LUMBAR SPINE is
110880 -                statistically consistent with osteopenia.
110882 -                 ..
110883 -            2.  Bone mineral density calculated for the TOTAL HIP is
110884 -                statistically consistent with osteopenia.
110886 -             ..
110887 -        d.  01/29/09 SHOULDER, COMPLETE 2+ VIEWS
110888 -
110889 -            This is follow up examination evaluaing separated shoulder
110890 -            on 090122 that was evaluated with image test at Kaiser on
110891 -            090129.  Shoulder was xrayed.  Mike advised that xray scan
110892 -            test today shows no fracture, and that Millie's shoulder
110893 -            appears correctly positioned in the socket for effective
110894 -            healing and recovery. ref SDS 86 ZF7J
110896 -             ..
110897 -        e.  01/22/09 SHOULDER, COMPLETE 2+ VIEWS
110898 -
110899 -            Second and third xrays on 090122 found that 1st reduction
110900 -            procedure attempt to restor shoulder failed, ref SDS 80
110901 -            074F, and second attempt was successful, reported on
110902 -            090122. ref SDS 80 LV3O
110904 -             ..
110905 -        f.  01/22/09 SHOULDER, ONE VIEW - Dislocation, right shoulder.
110906 -            Fracture right humeral head
110908 -             ..
110909 -            First xray at Emergency Room Department on 090122 found
110910 -            dislocated shoulder. ref SDS 80 PR3U
110912 -             ..
110913 -        g.  01/22/09 CT CERV SPINE W/O CONTRAST - Degenerative changes
110914 -            of the cervical spine without evidence of acute C spine
110915 -            fracture or loss in alignment.
110917 -             ..
110918 -            CT test in Emergency Room to evaluate scope of injury that
110919 -            caused dislocated shoulder. ref SDS 80 PP8S
110921 -             ..
110922 -        h.  01/22/09 CT HEAD W/O CONTRAST -
110923 -
110924 -            1.  No evidence of acute infarct or hemorrhage.
110925 -
110926 -            2.  Sinus disease. Mild nasal septal deviation to the
110927 -                right.
110929 -             ..
110930 -            CT test in Emergency Room to evaluate scope of injury that
110931 -            caused dislocated shoulder. ref SDS 80 W16E
110933 -             ..
110934 -        i.  09/11/08 CT THORAX, ABDOMEN, PELVIS W CONTRAST - Status
110935 -            post left mastectomy.  There has been little interval
110936 -            change.  Prominent right axillary lymph nodes are again
110937 -            noted, little changed in size, which could be accounted for
110938 -            by sampling variability.  Reticular densities and tiny
110939 -            punctate densities in the lungs are not significantly
110940 -            changed, and there are no new identifiable lesions.  No new
110941 -            adenopathy or ascites.
110943 -  ..
110944 - Complete history of imaging tests shows no evidence distant metastsis,
110945 - listed on 090107, ref SDS 73 GM3N, and shows that after the test on
110946 - 080911, ref SDS 47 DA6Q, Millie has had 2 CT tests to evaluate cancer
110947 - (1) on 081107, which was published in 2 parts, the first received on
110948 - 081112, ref SDS 59 DA6Q, and a second report received on 081113.
110949 - ref SDS 62 DA6Q; and the next report (2) on 081230 also issued in 2
110950 - parts, but received on the same day, 090107. ref SDS 73 DA6Q
110952 -  ..
110953 - Medical Chart continues...
110955 -         ..
110956 -    9.  Assessment:
110957 -
110958 -        Follow up ref SDS C2 KG6O, ref SDS A0 KG6O.
110959 -
110960 -        1.  Metastatic breast cancer (IBC) lung, lymph node and chest
110961 -            wall; S/P hyperthermia/XRT with increasing CA 15-3.
110963 -  ..
110964 - During the meeting today, Doctor Johnson explained Kaiser now supports
110965 - Millie's treatment at UCSF with MPA, cited in the medical chart below,
110966 - ref SDS 0 197L, and for the purpose of recovering from UCSF medical
110967 - mistakes, reported by Doctor Hsu on 090609 0900. ref SDS D8 W65W, and
110968 - Doctor Johnson further confirmed today that everbody is now on board
110969 - to treat Millie's cancer as a chronic disease, as related by Doctor
110970 - Rugo during the meeting at UCSF on 090616, ref SDS E5 D647, and
110971 - reported to the medical team in Millie's letter on 090617 0112.
110972 - ref SDS E6 VS9P
110974 -  ..
110975 - IBC has seemed to increase during the first 2 weeks after starting MPA
110976 - treatment at UCSF on 090616, shown in Millie's letter today on 090626
110977 - 1057, ref SDS E9 0E8T, and saying IBC is so bad that Millie hates
110978 - looking at herself in the mirror. ref SDS E9 0E9Y
110980 -  ..
110981 - Medical Chart continues...
110982 -
110983 -            Anemia due to chemotherapy
110985 -  ..
110986 - This section reported on 090325, ref SDS 99 IH88, is missing from the
110987 - medical chart again today, reflecting blood test at UCSF on 090616
110988 - showing recovery of blood counts with ANC 2440 (NEUTS 2.44 at UCSF),
110989 - and resulting from Millie not having chemotherapy systemic treatment
110990 - for cancer since 090122. ref SDS 56 AT6N
110992 -  ..
110993 - Medical Chart continues...
110994 -
110995 -        2.  MPA Clinical Trial at UCSF
110997 -  ..
110998 - Today, Doctor Johnson approved MPA treatment prescribed by UCSF on
110999 - 090514, ref SDS B8 D647, for Millie to recover from UCSF medical
111000 - mistakes that caused Millie's 7th relapse of cancer, per above.
111001 - ref SDS 0 Z76J
111003 -  ..
111004 - IBC has seemed to increase during the first 2 weeks after starting MPA
111005 - treatment at UCSF on 090616, shown in Millie's letter today on 090626
111006 - 1057, ref SDS E9 0E8T, and saying IBC is so bad that Millie hates
111007 - looking at herself in the mirror. ref SDS E9 0E9Y
111009 -  ..
111010 - Medical Chart continues...
111011 -
111012 -        3.  ACD stable
111014 -  ..
111015 - This updates the medical chart for examination on 090325 that made no
111016 - report on ACD. ref SDS 99 197L
111018 -  ..
111019 - Medical Chart continues...
111020 -
111021 -        4.  Depression stable
111023 -  ..
111024 - See prior report for examination on 090325, ref SDS 99 GK3T, and most
111025 - recent report on 090515, when Millie was severely depressed by
111026 - Kaiser's failure to perform requirements for standard of care.
111027 - ref SDS C1 GK3T
111029 -  ..
111030 - Doctor Rugo's report on 090616 and confirmed today by Doctor Johnson
111031 - at Kaiser that everybody is now on board for Millie to get treatment
111032 - with MPA prescribed by UCSF targeted to her patient profile to recover
111033 - from 7th relapse of cancer caused by medical mistakes at UCSF, has
111034 - helped relieve Millie's prior depression, per above. ref SDS 0 EF9R
111036 -  ..
111037 - Millie is very anxious about rising breathing problems, per above.
111038 - ref SDS 0 EF7R
111040 -  ..
111041 - See comment in medical chart today for "Psychiatric." ref SDS 0 EF9R
111043 -  ..
111044 - Medical Chart continues...
111046 -         ..
111047 -   10.  Plan:
111048 -
111049 -        Follow up ref SDS C2 TR7K, ref SDS A0 TR7K.
111050 -
111051 -        1.  Gemzar infusions postponed
111053 -  ..
111054 - Gemzar was postponed because UCSF prescribed treatment with MPA which
111055 - is targeted to Millie's patient profile for recovering from UCSF
111056 - medical mistakes, discussed under Assessment, per above, ref SDS 0
111057 - KG6O, and Gemzar has many disadvantages for Millie's patient profile,
111058 - as further explained in Millie's letter to the medical team on 090610
111059 - 2213. ref SDS E0 WX4W
111061 -  ..
111062 - Medical Chart continues...
111063 -
111064 -        2.  Continue Medroxyprogesterone acetate (MAP) Clinical Trial
111066 -  ..
111067 - The doctor means "MPA," not MAP, and this treatment was prescribed to
111068 - replace Gemzar, per above. ref SDS 0 TR7K
111070 -  ..
111071 - During the meeting, the doctor asked Millie to veriyu the MPA
111072 - acronym.
111074 -  ..
111075 - The doctor advised that Kaiser supports Doctor Hsu's prescription on
111076 - 090609, for UCSF to use MPA for Millie to recover from spread of
111077 - cancer caused by UCSF medical mistakes providing radiation medical
111078 - services on referral from Kaiser, ref SDS D8 W66W, and implementing
111079 - Doctor Rugo's report on 090616 that everbody at Kaiser and UCSF is now
111080 - on board to treat Millie's cancer as a chronic disease with treatment
111081 - targeted to Millie's patient profile. ref SDS E5 D647
111082 -
111083 -                [On 090627 0221 Millie's letter to the medical team
111084 -                confirms Doctor Johnson approved the UCSF treatment
111085 -                plan using MPA for Millie to recover from medical
111086 -                mistakes when UCSF provided radiation medical services.
111087 -                ref SDS F0 2X5U
111089 -                 ..
111090 -                [On 090627 0221 Millie's letter to the medical team
111091 -                confirms MPA acronym. ref SDS F0 OO7N
111093 -  ..
111094 - IBC has seemed to increase during the first 2 weeks after starting MPA
111095 - treatment at UCSF on 090616, shown in Millie's letter today on 090626
111096 - 1057, ref SDS E9 0E8T, and saying IBC is so bad that Millie hates
111097 - looking at herself in the mirror. ref SDS E9 0E9Y
111099 -  ..
111100 - Medical Chart continues...
111101 -
111102 -        3.  Continue serial CA 15-3's
111104 -             ..
111105 -        4.  Use Gastrografin instead of Readi-cat for next CT
111107 -  ..
111108 - The doctor's work plan will relieve severe problems Millie suffered
111109 - with Barium Sulfate contrast medium, reported above. ref SDS 0 EF7U
111111 -  ..
111112 - Medical Chart continues...
111113 -
111114 -        5.  Consider Hospice in the future
111116 -  ..
111117 - Consideration of Hospice is pending medical team analysis of
111118 - treatments targeted to Millie's patient profile, discussed during the
111119 - meeting at Kaiser on 090325 0830. ref SDS A0 QT9V
111121 -  ..
111122 - Medical Chart continues...
111123 -
111124 -        6.  RTC 4 weeks
111125 -
111129 -
111130 -
111131 -
111132 -
111133 -
111134 -
111135 -
111136 -
111137 -
111138 -
111139 -
1112 -