THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: December 3, 2009 10:17 AM Thursday;
Millie letter to medical team sets agenda for urgent care 9th relaspe of cancer.
Click here to comment!
Default Null Subject Account for Blank Record
0403 - ..
0404 - Summary/Objective
040501 - Follow up ref SDS 7 0000. ref SDS 6 0000.
040508 - ..
0408 - Progress
040901 - On 091202 Millie had the 3rd treatment in the 1st cycle of Navelbine.
040902 - ref SDS 7 625I
040904 - ..
040905 - She is experiencing some possible recovery, but also evident worsening
040906 - of cancer due to lack of treatment targeted to her patient profile.
040908 - ..
040909 - Millie submitted a letter notifying the medical team about possible
040910 - progression of disease, and requesting treatment targeted to her
040911 - patient profile, following up the letter on 091112, ref SDS 3 IL8L,
040912 - and meeting with Doctor Johnson at Kaiser later that day on 091112.
040913 - ref SDS 4 UT7M The following letter confirms understandings from
040914 - meeting on 091112, and sets agenda for meeting at Kaiser on 091210...
040916 - 1. Subject: Pain Relief and Treatment Plan 9th Relapse Cancer
040917 - Date: Thu, 03 Dec 2009 11:09:28 -0800
040931 - ..
040932 - 2. Confirming plans in the meeting with at Kaiser on 091112, you
040933 - changed treatment from Gemzar to Navelbine based on examination
040934 - showing spread of IBC across my right chest. This is a new
040935 - development. For the past 8 years IBC has occurred only on the
040936 - left side, except for a very small incursion onto the right
040937 - breast adjacent to the breastbone area. ref SDS 4 H54F
040939 - ..
040940 - 3. Your findings in the medical chart on 091112 that IBC has
040941 - spread to my right side [discussed during the meeting,
040942 - ref SDS 4 8G6O, and findings in medical chart, ref SDS 4 EZ4R],
040943 - reflect untreated cancer in the breastbone area from 090122
040944 - until 090728, and caused by medical mistakes performing
040945 - radiation services on referral to UCSF from 090219 to 090317.
040947 - ..
040948 - 4. You indicated in the meeting on 091112 that Kaiser and UCSF
040949 - have coordinated, as represented in Tara Lacy's call to me on
040950 - 090716, to find treatment of my cancer as a chronic disease,
040951 - appropriate to my patient profile for stage V cancer (i.e.,
040952 - stage IV continual treatment for 8 years), and as further
040953 - planned during your meeting with Rod on 090909. At that time
040954 - on 090909, you indicated your schedule had sufficient time for
040955 - you to investigate with Doctor Rugo which of the 20 or so
040956 - treatments identified as possibly suitable to my condition
040957 - should be tried next.
040959 - ..
040960 - 5. During the meeting on 091112, you left the examination room to
040961 - locate your correspondence with Doctor Rugo at UCSF on
040962 - prescribing my next treatment. Upon returning to the
040963 - examination room, you explained that no such correspondence
040964 - could be found.
040966 - ..
040967 - 6. You further commented that HIPAA may prevent submitting
040968 - correspondence on patient care to the patient. My
040969 - understanding is that HIPPA requires disclosure of all
040970 - communication on patient care to to the patient.
040972 - ..
040973 - 7. As you know, all correspondence on my care and particularly
040974 - between Kaiser and UCSF has in fact been submitted to me in
040975 - order to support the medical team under Kaiser's Doctor/patient
040976 - partnership practice for case management, and illustrated by
040977 - your submission on 061230 of correspondence with Doctor Rugo on
040978 - my getting treatment at UCSF with cetuximab and carboplatin.
040980 - ..
040981 - 8. You have noted numerous times that effective case management
040982 - has enabled me to survive beyond disease trajectory. This
040983 - requires submission of communication for a comprehensive
040984 - understanding of issues and remedies that guide treatment
040985 - decisions in time to be effective. Accordingly, if Kaiser has
040986 - any correspondence with UCSF on my care since the call from
040987 - Tara Lacy on 090716, this should be submitted to guide the work
040988 - going forward. At this time, the record indicates there has
040989 - been no coordination between Kaiser and UCSF on correcting
040990 - medical mistakes at UCSF providing medical services for my care
040991 - under referral from Kaiser.
040993 - ..
040994 - 9. There was an error in the lab on 091117 failing to set a
040995 - baseline with the cancer marker to evaluate Navelbine started
040996 - the next day on 091118. As a result, I requested CA 15-3 for
040997 - the next lab, though out of sequence.
040999 - ..
041000 - 10. Good news... breathing continues to improve. I still don't
041001 - feel strong enough to resume hiking, but am grateful for
041002 - stronger breathing.
041004 - ..
041005 - 11. Good news... CA 15-3 266 for the lab on 091124 declined
041006 - substantially again, after being stable at 299 for the prior 2
041007 - labs at the end of treatment with Gemzar. This indicates
041008 - possible response to Naveline.
041010 - ..
041011 - 12. Bad news... a substantial bulge has occurred the past few weeks
041012 - at the point where my left chest connects to the left arm. I
041013 - am experiencing elevated pain in this swelled area. Have tried
041014 - taking 2 Vicodin, but this has not been effective.
041016 - ..
041017 - 13. This swelling or bulge is in front of the armpit, and so
041018 - seemingly different from prior fluid that caused discomfort
041019 - during 2002 and 2003 that turned out to be cancer, shown by CT
041020 - testing. During treatment in the Infusion Clinic yesterday,
041021 - the nurse, Barbara, noticed this new problem, and planned to
041022 - notify the medical team in her work report.
041024 - ..
041025 - 14. Possibly this new condition has been driving elevated blood
041026 - counts well above the target range for ANC. WBC 14.3 and
041027 - neutrophils 72 increased ANC to 10.3 in the lab on Tuesday,
041028 - 091201. Brad indicated in a call yesterday that you approved
041029 - ending all Neupogen for this cycle of cancer treatment.
041031 - ..
041032 - 15. This new swelling at the upper left chest might be related to
041033 - lymphedema, but presents much more pronounced swelling compared
041034 - to patient history of even distribution along the left arm. In
041035 - fact swelling of the left arm seems reduced in recent weeks.
041037 - ..
041038 - 16. This morning, Becky, the Triage nurse called me asking about
041039 - follow up from treatment with Navelbine yesterday. I reported
041040 - rising pain from new swelling, per above. Becky planned to
041041 - send an "urgent" letter to you reporting this new problem and
041042 - requesting a meeting today for determination of treatment.
041044 - ..
041045 - 17. Yesterday, I received a call from Gwen. She asked me to
041046 - designate a new primary care physician. I explained that you
041047 - are my primary care physician. Becky said you have changed
041048 - your assignment to treat only my oncology issues, and so I need
041049 - to designate a new primary care physician. We reviewed patient
041050 - history showing my medical issues the past 8 years have flowed
041051 - from oncology. Gwen suggested discussing scope changes in my
041052 - care with you during the meeting next week.
041054 - ..
041055 - 18. Hopefully, we can meet today on this new problem causing rising
041056 - pain. We can discuss the PCP issue at that time.
041058 - ..
041059 - 19. Based on CA 15-3 266 dropping substantially, there may be a
041060 - positive response to the first treatment with Navelbine. Next
041061 - week a follow up lab will add another "dot" for this
041062 - assessment. Clinically, my condition seems worse with rising
041063 - pain from the new bluge on my upper chest near the left arm.
041064 - Therefore, we need to have the next treatment for IBC lined up
041065 - soon for the 10th relapse.
041067 - ..
041068 - 20. During the meeting on 091112, you advised that Doctor Rugo is
041069 - looking for an effective treatment. This is very good news. I
041070 - would like to get a report on these investigations. You also
041071 - planned to consider Abraxane and another drug, Ixempra, as
041072 - noted in the medical chart. I would like to get trade-offs
041073 - between abraxane in combnation with other agents, and compared
041074 - to Ixempra, PARP, and other treatments Doctor Rugo proposes,
041075 - evaluating issues of effectiveness and side effects [see case
041076 - study requesting trade-offs reported on 090725 2017,
041077 - ref SDS 2 X66O].
041079 - ..
041080 - 21. I am very grateful for Becky's call this morning, and that she
041081 - is requesting a meeting for me today with you on getting pain
041082 - relief. If you cannot meet until tomorrow, I will try to hold
041083 - out, rather than go to the ER.
041085 - ..
041086 - 22. Becky suggested I try oxycodone (Percocet), which was
041087 - prescribed when I injured my back in a fall a few months ago
041088 - on 090728, the day I started Gemzar). I advised Becky that
041089 - oxycodone was not effective at that time. None-the-less,
041090 - after the call from Becky, I found the remaining supply of
041091 - oxycodone, and will try it today starting at 1100. Hopefully
041092 - we can meet today or tomorrow for thorough determination of
041093 - cause and treatment.
041095 - [On 091203 1224 Millie reported good response taking
041096 - oxychodone (Percocet) for relief from increased pain.
041097 - ref SDS 8 S69G
041099 - ..
041100 - 23. Becky just called back at 1053. She reported having notified
041101 - you about this new problem, and gathered that you diagnose
041102 - rising lymphedema, and further prescribed percocet (oxycodone).
041103 - I asked for a meeting today to evaluate other possibilities for
041104 - swelling, and alternatives to Percocet, since this was
041105 - ineffective, as explained above. Naturally, if you cannot fit
041106 - me into the schedule for 10 or 20 minutes today, I will
041107 - understand limitations from congested work load. Can you in
041108 - any case propose alternative pain relief, based on patient
041109 - history. I am taking the Percocet now at 1100, per Becky's
041110 - guidance, and hopefully this will be effective despite prior
041111 - non-response.
041113 - [On 091203 1224 Millie reported good response taking
041114 - oxychodone (Percocet) for relief from increased pain.
041115 - ref SDS 8 S69G
041117 - ..
041118 - 24. Thanks very much for your care and support.