CONTACTS 

SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - The cancer marker increased 50 points for the blood test 2 weeks ago.
040902 -
040903 - IBC seems visibly worse now, including increased swelling of left that
040904 - has lymphedema from IBC.
040906 -  ..
040907 - On 091019 0007 Millie notified the medical team that UCSF efforts to
040908 - treat Millie's cancer at Kaiser for Millie to recover from medical
040909 - mistakes performing radiaton at UCSF during Feb and Mar, now need to
040910 - end, ref SDS 0 WV63, and a new treatment is needed...
040911 -
040912 -    1.  Subject: Treatment Plan 9th Relapse Cancer and Breathing Problems Caused by Medical Mistakes at UCSF
040913 -        Date: Mon, 19 Oct 2009 00:39:44 -0700
040930 -         ..
040931 -    2.  I have had several problems using my Power Port.
040933 -         ..
040934 -    3.  On 090720 the ER would not use the Power Port for a CT test
040935 -        that was ordered.  This resulted in considerable trauma for me,
040936 -        the nurses who cried because they could not find a vein for a
040937 -        conventional needle injection, my daughter who happened to be
040938 -        observing, and for the CT crew who put in extra time due to
040939 -        delays [reported on 090720 1437. ref SDS 9 TV8H].
040941 -         ..
040942 -    4.  Good news, on the most recent visit to the ER for assistance
040943 -        with breathing problems, the ER improved procedures to correct
040944 -        prior problems supporting the Power Port for CT tests [reported
040945 -        on 090919 0742. ref SDS 10 1K6M]  Unfortunately, the lack of a
040946 -        protocol resulted in someone in the CT department mistakenly
040947 -        not using the Huber needle, because it was not a Bard needle,
040948 -        not realizing that Kaiser has standardized on Lifeguard, per
040949 -        Paula Vannicola.  This mistake resulted in more trauma, delay,
040950 -        and extra cost. ref SDS 10 MI9Q
040952 -         ..
040953 -    5.  More recently, nurses in the Chemotherapy Infusion Clinic got
040954 -        upset because my blood would not flow for a lab, and again the
040955 -        next day for my chemo treatment.  [Previously, nurses were
040956 -        tramatized trying to use conventional needle penetrations for a
040957 -        blood draw in the Emergency Room Department, because nobody has
040958 -        had time to prepare a protocol on using Millie's Power Port,
040959 -        reported on 090720. ref SDS 9 PQ4V]  Review showed they were
040960 -        trying to use a .75" needle, when a 1" needle is needed.  This
040961 -        is an easy mistake to make because .75" needles work well for
040962 -        standard port catheters, which most patients still have.  I
040963 -        usually remind the nurses to use a 1" needle, but people get
040964 -        annoyed by continual reminders.  This can be solved by writing
040965 -        a protocol which can be cited in my medical chart that explains
040966 -        Kaiser has adopted a Lifeguard Huber needle, it needs high
040967 -        strength steel, and should be 1" for use with the Bard Power
040968 -        Port.  Can you please let me know progress on this issue so I
040969 -        can be prepared to avoid future problems.
040970 -
040971 -            [On 091112 0752 letter to medical team requests copy of
040972 -            protocol for using Power Port with 1" Huber needle to
040973 -            perform blood draws and infusion treatments. ref SDS 12
040974 -            L64R
040976 -             ..
040977 -            [On 091112 0930 Doctor Johnson sent an internal electronic
040978 -            letter to Paula notifying the Chemotherapy Infusion Clinic
040979 -            that the doctor prescribes blood draws and chemotherapy
040980 -            infusion treaments using Millie's Power Port with a 1"
040981 -            high-strength Huber Needle in order to avoid the high risk
040982 -            of compounding Millie's cancer and lymphedema from using
040983 -            conventional needle penetrations in her arms. ref SDS 13
040984 -            UN8F
040986 -         ..
040987 -    6.  IBC seems to be getting worse now.  Swelling in my left arm
040988 -        that subsided after starting Gemzar on 090721, has now seems
040989 -        increased the past few weeks.  The cancer marker which fell
040990 -        from about 390 to 302, bounced back to 350 or so 2 weeks ago.
040991 -        I suspect the lab next Tuesday will show 400, perhaps higher.
040992 -        I will feel very lucky if CA 15-3 actually falls below 300 for
040993 -        the test on Tuesday.
040994 -
040995 -            [On 091027 0830 Doctor Johnson reports decline in cancer
040996 -            marker, and maintains examination indicates Millie's cancer
040997 -            has not progressed, i.e., is "stable," and so prescribed
040998 -            continuing Gemzar chemotherapy for another cycle.
040999 -            ref SDS 11 GN84
041001 -             ..
041002 -            [On 091112 0930 Doctor Johnson examined Millie again and
041003 -            concurred with the report on 091019 that cancer is
041004 -            progressing, and so switched Millie to Navelbine
041005 -            chemotherapy, because the medical team still has not had
041006 -            time to find a targeted treatment for Millie that does not
041007 -            have difficult side effects. ref SDS 13 H54F
041009 -         ..
041010 -    7.  Breathing has improved.  I can at least finish a sentence
041011 -        without huffing and puffing, and I can walk upstairs or from
041012 -        the parking lot to the grocery store without having to stop and
041013 -        catch my breath.
041015 -         ..
041016 -    8.  We therefore need a new treatment plan to recover from the 9th
041017 -        relapse of cancer in accordance with your stategy to treat my
041018 -        cancer as a chronic disease, see case study on 090325.
041019 -        ref SDS 4 L15M
041021 -         ..
041022 -    9.  On 090616 Doctor Rugo advised that everybody is now on board
041023 -        with your strategy. ref SDS 7 VD8M
041025 -         ..
041026 -   10.  Tara Lacey called on 090716 and advised that, since MPA,
041027 -        initially prescribed by Doctor Hsu to recover from mistakes
041028 -        with radiation treatments, seemed to be causing increased
041029 -        breathing problems compounding problems from radiation
041030 -        treatment at UCSF in Feb and Mar, UCSF did not have time to
041031 -        find another treatment targeted to my patient profile, as
041032 -        planned in the meeting on 090616.  Tara explained that Doctor
041033 -        Rugo asked me to get treatment with Gemzar at Kaiser in order
041034 -        to reduce costs for UCSF providing care for me to recover from
041035 -        radiation problems.
041037 -         ..
041038 -   11.  We have implemented in good faith UCSF's work plan, and did
041039 -        achieve some recovery.  Doctor Hsu will be pleased to hear that
041040 -        the severe IBC wound in my breastbone area caused by the snafu
041041 -        that missed treatment with radiation, has mostly healed.
041042 -        Recall I requested treatment on 090401 to recover from
041043 -        progression of cancer, but UCSF delayed care on grounds that
041044 -        this wound was a reaction to radiation.  When it turned out
041045 -        later on 090609 that the wound was caused by failing to provide
041046 -        radiation to the breastbone area, UCSF took responsibility on
041047 -        090616, and began treatment for both my cancer and the new
041048 -        breathing problems also caused by radiation errors under
041049 -        referral from Kaiser, and according to Doctor Hsu on 090609,
041050 -        and by Doctor Rugo earlier on 090515.
041052 -         ..
041053 -   12.  My treatment history is listed on 090213, expanding on
041054 -        discussions in your office at that time. ref SDS 3 ES7I
041056 -         ..
041057 -   13.  Treatment options targeted to my patient profile considered by
041058 -        Kaiser and UCSF are listed on 090121, ref SDS 1 EV53, when
041059 -        Glenna called to figure out my next treatment at UCSF for the
041060 -        6th relapse.
041062 -         ..
041063 -   14.  Treatment options include 10 clinical trials listed on 090204.
041064 -        ref SDS 2 4R3S [treatment options were submitted to the medical
041065 -        team on 090326 0058. ref SDS 5 DW5S].
041067 -         ..
041068 -   15.  Doctor Rugo may have many more treatments adding to the list
041069 -        (based on the doctor's representation on 090616 that after
041070 -        treatment with MPA, UCSF would treat Millie with PARP cancer
041071 -        agents targeted to Millie's patient profile, implementing
041072 -        Doctor Johnson's order for UCSF to treat Millie's cancer as a
041073 -        chronic disease, ref SDS 7 KD6L, and as confirmed in a letter
041074 -        to the medical team the next day on 090617. ref SDS 8 VS9P]
041076 -         ..
041077 -   16.  Of paramount concern is to restore my breathing and vitality.
041078 -        With Gemzar, I have maybe 1 or 2 somewhat "good" days, and 5
041079 -        days when I am too tired to get out of bed due to fatigue side
041080 -        effects of Gemzar, which Brad warned about on 090601.
041081 -        ref SDS 6 8J8L
041083 -         ..
041084 -   17.  That is why my patient profile requires a targeted drug like
041085 -        cetuximab that does not cause fatigue nor low blood counts.
041086 -        Doctor Rugo planned PARP for targeted treatments on 090616.
041087 -        Doctor Hsu talked about vaccines with hyperthermia in the
041088 -        meeting on 090312.  This record indicates UCSF has many
041089 -        treatments for me to recover from medical mistakes that have
041090 -        caused my current condition.
041092 -         ..
041093 -   18.  I assume that Kaiser is recovering the cost for my Gemzar
041094 -        treatments from UCSF, as prescribed by Doctor Rugo on 090716,
041095 -        and I request that Kaiser represent my interests in good faith
041096 -        to recover my damages from treatment under Kaiser's referral
041097 -        for radiation performed by UCSF during February and March, as
041098 -        previously presented, based on the meeting at UCSF on 090609
041099 -        when radiation mistakes were discovered which caused cancer to
041100 -        spread and caused severe breathing problems.
041102 -         ..
041103 -   19.  I request a written report, similar to the UCSF Benz reports on
041104 -        041018, and 060821 evaluating and comparing my treatment
041105 -        options cited above for effectiveness, side effects, and cost,
041106 -        so that I can make a reasoned determination on Doctor Johnson's
041107 -        Hospice proposals.  If there is evidence that no treatments can
041108 -        help me recover, then I would end treatment efforts.
041110 -         ..
041111 -   20.  I am ready to continue the 4th cycle of Gemzar beginning on
041112 -        Wednesday.  Request a meeting with Doctor Johnson on Friday to
041113 -        review progress on the work plan for the 9th relapse as related
041114 -        herein.
041115 -
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041122 -
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