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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 4 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Sent a letter to the medical team confirming plans for meeting on
040902 - Millie's next treatment.
040903 -
040904 -    1.  Subject: ER Temp 101.2, Treatment Plan 8th Relapse Cancer Breathing Problems
040905 -        Date: Mon, 21 Sep 2009 10:10:03 -0700
040924 -         ..
040925 -    3.  Good news - IBC has continued to subside substantially.
040926 -        Lymphedema finally reduced so my left arm no longer looks
040927 -        inflated like a balloon.  The skin is now soft and normal like
040928 -        the right arm.  The severe IBC sore in the breastbone area that
040929 -        caused the 8th relapse, with breathing and cough problems due
040930 -        to a glitch with radiation treatments in February and March,
040931 -        has suddenly improved significantly, reducing from 3" to about
040932 -        .5", and has a nice scab, rather than continuing to ooze blood
040933 -        and puss.
040935 -         ..
040936 -    4.  Accordingly, I expect CA 15-3 to reduce after going up slightly
040937 -        (10 points) in the test 2 weeks ago on 090808 prior to starting
040938 -        the 3rd treatment of the 2nd cycle on 090909.  A CT test on
040939 -        Saturday 090919 reports no findings of internal cancer.  Could
040940 -        not get the team to include the neck in the CT test.  In any
040941 -        case, palpation of the neck does not indicate lumps, suggesting
040942 -        no evident relapse of cancer progressing.
040944 -         ..
040945 -    5.  This record seems to support at least starting the 3rd cycle in
040946 -        order to maintain recovery.
040948 -         ..
040949 -    6.  On the negative side I had to go the ER on Saturday, 090919
040950 -        because of persistent fever the past week, and not feeling
040951 -        well, with continuing cough and breathing problems. ref SDS 5
040952 -        PQ4U
040954 -         ..
040955 -    7.  Breathing and cough problems which pre-date starting Gemzar,
040956 -        might be compounded by side effects of Gemzar, which is why we
040957 -        are trying to find a treatment that is effective but not so
040958 -        difficult to tolerate.
040960 -         ..
040961 -    8.  This morning in the hospital I asked for CA 15-3 with the lab.
040962 -        The nurse drew the vial, but returned an hour later and said
040963 -        the lab wants a confirmation from Doctor Johnson, despite the
040964 -        standing order for the cancer marker.  Evidently the hospital
040965 -        lab is different from the oncology lab, or something.  Please
040966 -        coordinate this approval; although I feel pretty sure that the
040967 -        marker has come down again based on physical evidence of
040968 -        reduced IBC and lymphedema.
040970 -         ..
040971 -    9.  While in the hospital, would like to get examination and
040972 -        opinion from cardio-pulmonary specialist on diagnosis and
040973 -        prescription to solve breathing and cough problems, which seem
040974 -        to persist despite recovery from IBC.  If we have to go outside
040975 -        Kaiser, perhaps to UCSF or elsewhere, then that should be
040976 -        scheduled, because this now seems to be a major challenge for
040977 -        my recovery that has stumped the team for several months.
040979 -         ..
040980 -   10.  Since my temperature continues to go up and down, I may not be
040981 -        released from the hospital today, so we may have to do the
040982 -        meeting scheduled for tomorrow in my hospital room, 3050A,
040983 -        instead of your office in the Oncology Department.
040985 -         ..
040986 -   11.  Good news - blood counts have held up through 2 cycles of
040987 -        Gemzar; most recent test at Kaiser in Martinez on 090908 show
040988 -        ANC 2442 (NEUTS 2.442 at UCSF).
040990 -         ..
040991 -   12.  However, recent blood work on Saturday and again today show a
040992 -        lot of counts falling below and above the target range, further
040993 -        suggesting the need to solve breathing and cough problems.  My
040994 -        ANC is still within a range that permits getting Gemzar
040995 -        treatment on Wednesday, unless the team feels this may be
040996 -        driving the overall counts out of range.
040998 -         ..
040999 -   13.  Thanks very much for meeting with Rod in the cafeteria while I
041000 -        was getting treatment in the Chemotherapy Clinic on 090909
041001 -        1330; and, further for taking immediate action ordering 2
041002 -        Neupogen treatments for last week that implements planning in
041003 -        the letter to the medical team on 090812.  Adding a second
041004 -        Neupogen treatment aligns the regimen developed through trial
041005 -        and error for maintaining my blood counts to get cetuximab and
041006 -        Carboplatin at UCSF during 2008.
041008 -         ..
041009 -   14.  Should we consider Neupogen today to ensure counts are high
041010 -        enough for treatment on Wedensday?
041012 -         ..
041013 -   15.  Please submit results from the pulmonary function test
041014 -        performed a few weeks ago.  The attending technician did not
041015 -        have time to give me the results, which I need to prepare for
041016 -        the meeting with you on Tuesday.
041018 -         ..
041019 -   16.  Would also like to get report on the Xray and CT tests on
041020 -        090919.
041022 -         ..
041023 -   17.  We need UCSF's work plan for treating my patient profile listed
041024 -        on 090213. ref SDS 2 ES7I
041026 -         ..
041027 -   18.  In the meeting with Rod on 090909, you planned to coordinate
041028 -        with Doctor Rugo on prescribing my next treatment to recover
041029 -        from mistakes in radiation causing spread of IBC and collateral
041030 -        damage to breathing, ref SDS 4 VF60, reported previously on
041031 -        090401, 090412, 090510, etc.  You seemed to indicate in the
041032 -        meeting on 090909 that your schedule has now cleared to have
041033 -        enough time for researching prospective treatments [,
041034 -        ref SDS 4 3P4G], submitted to the team and suited to my patient
041035 -        profile, as listed on 090204. ref SDS 1 4R3S
041037 -         ..
041038 -   19.  On 090616 Doctor Rugo discussed a line of treatments with PARP
041039 -        technology. ref SDS 3 KD6L
041041 -         ..
041042 -   20.  Hopefully, I can start the 3rd cycle to maintain continuity of
041043 -        recovery on Wednesday.  You and Doctor [Rugo] can collaborate
041044 -        as planned in Tara's call on 090716 for arranging transition to
041045 -        my next treatment in time to be effective.
041046 -
041053 -
041054 -
041055 -
041056 -
041057 -
0411 -