CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 7 0000. ref SDS 6 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
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...
040915 -
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.
041094 -
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.
041112 -
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.
041119 -
041126 -
041127 -
041128 -
041129 -
041130 -
041131 -
0412 -