CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 68 0000. ref SDS 67 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 091202 Millie had the 3rd treatment in the 1st cycle of Navelbine.
040902 - ref SDS 44 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 - On 091203, Millie submitted a letter notifying the medical team about
040910 - possible progression of disease, and requesting treatment targeted to
040911 - her patient profile, ref SDS 45 4P7G, following up the letter on
040912 - 091112, ref SDS 40 IL8L, and meeting with Doctor Johnson at Kaiser
040913 - later that day on 091112. ref SDS 41 UT7M  The following letter
040914 - confirms understandings from meeting on 091112, and sets agenda for
040915 - meeting at Kaiser on 091210.
040917 -  ..
040918 - On 091210 0830 Millie met with Doctor Johnson primary care physician;
040919 - examination showed possible progression of cancer after 1st cycle of
040920 - Navelbine, ref SDS 46 0J4L; doctor prescribed 2nd cycle to evaluate
040921 - effectivness. ref SDS 46 BW53
040923 -  ..
040924 - On 091211 0018 Millie letter confirms understandings from meeting at
040925 - Kaiser and thanks thanked medical team for excellent care, ref SDS 47
040926 - BW8I, based on Doctor Johnson's report in the meeting at Kaiser on
040927 - 091210 that Kaiser is collaborating with Doctor Rugo for UCSF to
040928 - prescribe treatment targeted to Millie's patient profile. ref SDS 47
040929 - XM3X
040931 -  ..
040932 - On 091211 1452 Doctor Johnson reports collaborating with Doctor Rugo
040933 - for UCSF as planned during the meeting yesterday. ref SDS 48 BW8I
040935 -  ..
040936 - On 091211 1648 Millie notifies Doctor Johnson to submit correspondence
040937 - of Kaiser collaborating with Doctor Rugo at UCSF on prescribing
040938 - treatment targeted to Millie's patient profile. ref SDS 49 BW8I
040940 -  ..
040941 - On 091214 1649 Doctor Johnson notifies Millie that Doctor Rugo has not
040942 - replied to Kaiser's letter on 091211. ref SDS 50 BW8I
040944 -  ..
040945 - On 091215 0852 Millie asks Doctor Johnson about sending a copy of
040946 - Kaiser's letter to Tara for assisting Doctor Rugo developing UCSF's
040947 - treatment plan targeted to Millie's patient profile. ref SDS 51 BW8I
040949 -  ..
040950 - On 091215 1557 Millie reports blood counts fall, still permit getting
040951 - 1st treatment 2nd cycle Navelbine, ref SDS 52 BW8I, asks about
040952 - progress collaborating on prescribing next treatment to recover from
040953 - 10th relapse of cancer.
040955 -  ..
040956 - On 100103 1147 Millie asks medical team about progress prescribing
040957 - treatment targeted to Millie's patient profile to recover from 10th
040958 - relapse of cancer. ref SDS 53 BW8I  Millie reports new symptom of rash
040959 - on right side of forehead, which is swelling the right eye; requests
040960 - examination tomorrow to prescribe immediate remedy. ref SDS 53 FZ6V
040961 - Reports IBC seems worse, and so need UCSF work plan to recover from
040962 - medical mistakes. ref SDS 53 FZ7U
040964 -  ..
040965 - On 100103 1652 Millie receives automated reply that Doctor Johnson is
040966 - out of the office until 100105, and so cannot make examination
040967 - tomorrow on 100104 requested in Millie's letter this afternoon.
040968 - ref SDS 54 BW8I
040970 -  ..
040971 - On 100103 2023 Millie reponds to notice that Doctor Johnson is out of
040972 - the office tomorrow and so cannot make examination requested in
040973 - Millie's letter earlier today. ref SDS 55 BW8I
040975 -  ..
040976 - On 100104 0830 Millie needs examination of facial blisters today.
040977 - ref SDS 56 BW8I
040979 -  ..
040980 - On 100104 1115 Millie examination Doctor Zhang at Kaiser Adult Care
040981 - diagnoses facial blisters are shingles, 100104 1115, ref SDS 57 0P9S,
040982 - and prescribed 2 week treatment. ref SDS 57 QB5K
040984 -  ..
040985 - On 100104 2144 Mille notified medical team on results of meetings
040986 - today at Kaiser that diagnosed and prescirbed treatment for Shingles.
040987 - ref SDS 59 BW8I
040989 -  ..
040990 - On 100106 1327 Doctor Johnson called to ask about meeting with Millie
040991 - to review progress recovering from shingles, ref SDS 62 BW8I,
040992 - diagnosed by Doctor Zhang at Kaiser, as reported in Millie's letter to
040993 - the medical team on 100104 2144. ref SDS 59 BW8I  Millie is too ill
040994 - for meeting at Kaiser; hoping to be able to meet next week as
040995 - currently scheduled on 100112. ref SDS 62 TF4F  Doctor Johnson
040996 - reported that Kaiser has not received a response from UCSF to Doctor's
040997 - letter requesting support for Millie's treatment to recover from 10th
040998 - relapse of cancer; doctor asks if Millie has been contacted by Doctor
040999 - Rugo. ref SDS 62 216K  Doctor Johnson sent a copy to Tara of his
041000 - letter on 091211 to Doctor Rugo, so that Tara can assist Doctor Rugo
041001 - developing a treatment plan in time to be effective. ref SDS 62 CX5F
041002 - Doctor Johnson sent a copy of his letter on 091211 to Doctor Rugo at
041003 - UCSF to Millie, so that the medical team can be supported by the
041004 - doctor/patient partnership. ref SDS 62 KN66
041006 -  ..
041007 - On 100108 0852 Millie thanks the medical team for collaborating to
041008 - prescribe treatment in time to be effective recovering from the 10th
041009 - relapse of cancer. ref SDS 63 BW8I  Millie reports Doctor Johnson's
041010 - submission to Millie using "secure-email" of a letter Kaiser sent to
041011 - Doctor Rugo at UCSF on 091211 could not be accessed, and so requests
041012 - alternate submission. ref SDS 63 MW4P
041014 -  ..
041015 - On 100108 1053 Mona called and advised that Doctor Dossetor advanced
041016 - the date for follow up meeting to examine recovery from shingles to
041017 - 100111 1100, which was originally scheduled on 100118. ref SDS 64 Z35H
041019 -  ..
041020 - On 100108 1330 Millie notifies medical team that Kaiser Opthalmology
041021 - changed the date for follow up examination to evaluate recovery from
041022 - shingles was changed from 100118 to 100111. ref SDS 65 BW8I
041024 -  ..
041025 - On 100108 1618 drove to Kaiser in Walnut Creek and received from the
041026 - customer couner for Oncology an evelope that contained a printed copy
041027 - of Doctor Johnson's letter to Doctor Rugo dated 091211, ref SDS 66
041028 - BW8I; a second printed document on a single sheet of paper showed
041029 - Doctor Johnson's transmittal forwarding the letter on 091211 to Tara,
041030 - ref SDS 66 HT7L, and Tara's report back to Doctor Johnson saying Doctor
041031 - Rugo prescribes PARP at UC Davis, rather than at UCSF. ref SDS 66 FM5I
041033 -  ..
041034 - On 100111 1120 Millie examined by Doctor Dossetor found shingles
041035 - blisers worse than when examined on 100104, but much improved than
041036 - several days ago. ref SDS 67 BW8I  Examination found no evidence of
041037 - disease in the right eye.
041039 -  ..
041040 - On 100112 0047 Millie notified medical team of agenda meeting with
041041 - primary care physician at Kaiser today for prescribing treatment to
041042 - recover from 9th relapse, or changing treatment to begin recovering
041043 - from 10th relapse. ref SDS 68 BW8I
041045 -  ..
041046 - On 100112 0830 Millie met with Doctor Johnson, primary care physician,
041047 - at Kaiser and discussed issues in the agenda submitted to the medical
041048 - team earlier this morning, per above. ref SDS 0 6J4K, specifically
041049 - recovery from shingles and from 9th relapse of cancer, and progresss
041050 - prescribing treatment for the 10th relapse. ref SDS 0 BW8I
041051 -
041052 -
041053 -
041055 -  ..
0411 -
0412 -
0413 - Progress
0414 -
041401 - Agenda Review Record Pending Issues
041402 -
041403 - Follow up ref SDS 46 BW8I.
041404 -
041405 - After entering the examination room and greeting Millie, Doctor
041406 - Johnson returned to his office and read Millie's letter sent to the
041407 - medical team earlier this morning, and submitting the agenda for the
041408 - meeting today, 100112 0047, ref SDS 68 BW8I, and citing Millie's prior
041409 - letter asking about progress on the medical team identifying treaments
041410 - targeted to Millie's patient profile, and explaining trade-offs that
041411 - optimize Millie recovering from the next (10th) relapse of cancer,
041412 - reported on 100103 1147, ref SDS 53 BW8I, and further asking for
041413 - medical care to treat new symptoms in time to be effective.
041414 - ref SDS 53 FZ6V
041415 -
041416 -        Shingles recovery............................ ref SDS 0 377T
041417 -        Oxychodone prescription renewal
041418 -        to control pain.............................. ref SDS 0 RF6M
041419 -        Vaccine prevent shincles recurrence.......... ref SDS 0 OZ6O
041420 -        Examination IBC.............................. ref SDS 0 3U7H
041421 -        Treatment plan 3rd
041422 -        cycle Navelbine..............................
041423 -        Planning for 10th
041424 -        relapse treating Millie's
041425 -        cancer as chronic
041426 -        disease......................................
041427 -
041428 -
0415 -

SUBJECTS
Default Null Subject Account for Blank Record

0503 -
050401 -  ..
050402 - Shingles Recovery on Track Medications Continued Another 2 Weeks
050403 -
050404 - On 100103 1147 Millie reported new symptoms of facial rash and
050405 - requested examination the next day on 100104 for diagnosis and
050406 - treatment. ref SDS 53 FZ6V  Later that day, symptoms worsened, and
050407 - Millie notified the medical team again, 100103 2023, ref SDS 55 RH7Y,
050408 - asking if she should get treatment in the Emergency Department.
050409 - ref SDS 55 RH4R
050411 -  ..
050412 - Since there was no response from the medical team, and since facial
050413 - blisters worsened the next day, Millie was examined at Kaiser Adult
050414 - Care, and diagnosed with shingles, reported on 100104 1115.
050415 - ref SDS 59 0P9S  Treatment was prescribed for 2 week recovery.  Doctor
050416 - Zhang recommended that Millie be examined by primary care physician
050417 - last week, rather than wait for the meeting today on 100112, reported
050418 - on 100104 1115, ref SDS 57 0P4Y, and confirmed in Millie's letter to
050419 - the medical team later on 100104 2144. ref SDS 59 0P4Y
050421 -  ..
050422 - Doctor Johnson called on 100106 1317 to discuss Millie's new diagnosis
050423 - of shingles, and decided to defer examination recommended by Doctor
050424 - Zhang to the meeting today. ref SDS 61 BW8I
050426 -  ..
050427 - Today, Doctor Johnson observed Millie's condition of open, bleeding
050428 - blisters on the right side of her face and right eye, extending above
050429 - the hairline onto her head.  This was described as significantly
050430 - improved in Millie's letter to the medical team this morning, compared
050431 - to the past week, with visible recovery starting about 2 days ago.
050432 - ref SDS 68 IS8P
050434 -  ..
050435 - The doctor indicated Millie has a very severe case of shingles
050436 - compared to his experience treating other patients with shingles.
050447 -  ..
050448 - Doctor Johnson decided to extend Doctor Zhang's prescription on
050449 - 100104, with another 10-day treatment for Millie to recover from
050450 - shingles.  This answers the question in the letter this morning
050451 - submitting the agenda, ref SDS 68 IS9T
050452 -
050453 -        [On 100120 0301 Millie letter to medical team with agenda for
050454 -        meeting with Kaiser on 1001021 reports shingles still covering
050455 -        30% of forehead, the day before began significant recovery from
050456 -        shingles. ref SDS 70 HL3R
050458 -         ..
050459 -        [On 100128 2249 letter to medical team reports that 3rd 10-day
050460 -        treatment for shingles prescribed during meeting at Kaiser on
050461 -        100121. ref SDS 71 FM4T
050462 -
050463 -
050464 -
0505 -

SUBJECTS
Default Null Subject Account for Blank Record

0603 -
060401 -  ..
060402 - Oxychodone Percocet Prescription Renewal to Control Pain
060403 -
060404 - Millie also needs the prescription for oxychodone (Percocet) renewed
060405 - to control pain from shingles, IBC, and radiation.   On 091210 Doctor
060406 - Johnson approved Millie taking 2 pills of oxychodone for rising pain
060407 - from IBC getting worse at that time. ref SDS 46 4H59  Subsequently,
060408 - IBC seems to have subsided.  Millie was diagnosed with shingles, which
060409 - causes severe pain due to delay getting treatment, noted by Doctor
060410 - Zhang on 100104 1115. ref SDS 57 6E9M  Additionally, Millie feels pain
060411 - is occurring from effects of radiation on her bones in the chest, and
060412 - discussed further below in connection with bulge at the center
060413 - location of the left colar bone. ref SDS 0 448F
060414 -
060415 -        [On 100120 0301 Millie notifies medical team that oxychodone
060416 -        effective controlling pain from medication treating shingles.
060417 -        ref SDS 70 HL3R
060418 -
060419 -
060420 -
0605 -

SUBJECTS
Default Null Subject Account for Blank Record

0703 -
070401 -  ..
070402 - Shingles Vaccine Prevents Recurrence
070403 - Vaccine Prevents Recurrence Shingles
070404 -
070405 - There was no discussion today of research on 100104, ref SDS 57 IS5I,
070406 - showing vaccines help prevent recurrence of shingles.  Additional
070407 - research further shows...
070408 -
070409 -    Suite101.com
070411 -     ..
070412 -    Who Should Get the Shingles Vaccine?
070413 -
070414 -    Herpes Zoster Vaccination Designed for Seniors
070415 -    Sep 24, 2009 Tamiko Nicholson
070416 -
070417 -              http://seniors-health-medicare.suite101.com/article.cfm/who_should_get_the_shingles_vaccine
070419 -         ..
070420 -    1.  The risk of getting shingles increases with age and the only
070421 -        way to decrease the chances of getting the painful infection is
070422 -        to get the shingles vaccine.
070424 -         ..
070425 -    2.  Merck Frosst makes the vaccine which is called Zostavax.
070426 -        Studies have shown that it can help protect against shingles,
070427 -        which is also known as herpes zoster or zoster.
070429 -         ..
070430 -    3.  Shingles is a painful rash that is caused by the reactivation
070431 -        of the same virus that causes chickenpox.
070433 -         ..
070434 -    4.  Shingles Vaccine Recommended for People Aged 60 and Over
070436 -         ..
070437 -    5.  Never Too Old to Get Shingles Vaccination
070439 -         ..
070440 -    6.  People Who Had Shingles Before Can Get Shingles Vaccine
070441 -
070442 -        Ideally, a person who has shingles should wait until the rash
070443 -        has gone before getting the vaccine.
070444 -
070445 -            [On 100120 0301 Millie asks medical team about getting
070446 -            shingles vaccine to reduce risk of recurrence. ref SDS 70
070447 -            HL4Q
070449 -         ..
070450 -    7.  Who Should Not Get Shingles Vaccine?
070451 -
070452 -        CDC recommends that the following groups of people not get the
070453 -        Zostavax vaccine:
070454 -
070455 -        a.  Anyone who is at risk of having a severe or
070456 -            life-threatening allergic reaction to gelatin or the
070457 -            antibiotic neomycin.
070459 -             ..
070460 -        b.  Anyone who has a serious allergy to any other ingredients
070461 -            in the vaccine which include...
070462 -
070463 -            1)  Sucrose
070464 -            2)  Sodium chloride
070465 -            3)  Monosodium L-glutamate monohydrate Sodium phosphate
070466 -            4)  dibasic Potassium
070467 -            5)  phosphate monobasic
070468 -            6)  Potassium chloride
070470 -             ..
070471 -        c.  If the person has any serious allergies, he or she should
070472 -            make sure to talk about this with the doctor before
070473 -            getting the shot.
070475 -             ..
070476 -        d.  Anyone who has leukemia, lymphoma, or any kind of blood or
070477 -            bone cancer that has weakened the immune system.
070479 -  ..
070480 - Millie has IBC and lymphedema.  IBC nominally does not seem to
070481 - prevent getting shingles vaccine under this criteria.  Similarly,
070482 - research indicates lymphedema is different from lymphoma, and so
070483 - should not prevent Millie from getting shingles vaccine.
070484 -
070485 -            Lymphnotes.com
070486 -             ..
070487 -            Lymphoma and Lymphedema Contrasted
070488 -
070489 -              http://www.lymphnotes.com/article.php/id/175/
070491 -  ..
070492 - Who Should Get the Shingles Vaccine continued...
070493 -
070494 -        e.  Anyone with HIV/AIDS with a T-cell count that is below 200.
070496 -             ..
070497 -        f.  Anyone who is taking drugs like high-dose steroids that
070498 -            could affect the immune system.
070500 -             ..
070501 -        g.  Any woman who thinks she could possibly be pregnant or who
070502 -            is pregnant
070503 -
070505 -  ..
070506 - IBC Lymphedema Subsiding Significant Response Navelbine Treatment
070507 -
070508 - Follow up ref SDS 46 0J50.
070509 -
070510 - Doctor Johnson made examination and concurred with Millie's report to
070511 - the medical team this morning on 100112 0047, ref SDS 68 IS4W, that
070512 - IBC lesions on the left arm and across her chest appear reduced from
070513 - prior examination on 091210. ref SDS 46 0J50
070515 -  ..
070516 - The doctor further observed that IBC wound in Millie's breastbone area
070517 - has worsened, with more bleeding puss flowing mess, reported in
070518 - Millie's letter earlier this morning, ref SDS 68 IS5P, and reflecting
070519 - severe signal of cancer progressing, reflecting cancer marker holding
070520 - at high levels CA 15-3 212.
070521 -
070522 -        [On 100120 0301 Millie notifies medical team that cancer marker
070523 -        CA 15-3 212 improved significantly to correlate with findings
070524 -        from examination today showing cancer appears improved.
070525 -        ref SDS 70 HL7P
070526 -
070528 -  ..
070529 - Pause Treatment for Cancer While Recovering from Shingles
070530 - Chemotherapy with Shingles Risk Greater than Missing Treatment
070531 -
070532 - Millie is scheduled to start the 3rd cycle of Navelbine chemotherapy
070533 - tomorrow on 100113 in the Oncology Chemotherapy Infusion Clinic in
070534 - order to recover from UCSF medical mistakes that caused her cancer to
070535 - spread by delaying treatment for 6 months, reported by Doctor Hsu on
070536 - 090609. ref SDS 26 W65W
070538 -  ..
070539 - The doctor advised today that Millie must miss at least her next two
070540 - (2) chemotherapy treatments, because chemo lowers blood counts, and
070541 - this enables shingles infection to spread.  This aligns with Brad's
070542 - call on 090601, saying that chemotherapy can cause fatal infection for
070543 - Millie's patient profile of weakened immune system (i.e., low blood
070544 - counts). ref SDS 25 FR8L  Doctor Johnson explained that since Millie
070545 - cannot get treatment for shingles concurrent with chemotherapy, she
070546 - has to recover from shingles before she can get chemotherapy to
070547 - recover from cancer.
070549 -  ..
070550 - Doctor Johnson used the computer in the examination room to cancel
070551 - chemotherapy with Navelbine scheduled for tomorrow, and he cancelled
070552 - treatment for next week.  He scheduled Millie to return for
070553 - examination on shingles recovery in 2 weeks, in order to evaluate
070554 - resuming treatment for cancer with chemotherapy.
070555 -
070556 -            [On 100128 2249 Millie's letter to medical team reports
070557 -            Doctor Johnson examination found shingles subsided enough
070558 -            to start treatment for cancer with Navelbine chemotherapy
070559 -            again after 4-week pause to avoid compounding shingles
070560 -            infection, because Kaiser and UCSF have not yet scheduled
070561 -            "targeted" treatment for Millie to recover from 9th
070562 -            relapse, which can be given concurrent with shingles.
070563 -            ref SDS 71 FM5S
070565 -  ..
070566 - Cannot find research showing correlations or conflicts for Navelbine
070567 - with shingles or treatments for shingles, nor between chemotherapy
070568 - generally and shingles.
070570 -  ..
070571 - On 090922 Doctor Johnson examined Millie and found recovery with
070572 - Gemzar chemotherapy treatment from 8th relapse of cancer.  Examination
070573 - today finds possible improvement on Millie's left arm and chest, and
070574 - worsening cancer in the breastbone area, which has been the most
070575 - intense IBC since January 2009; thus, indicating that Millie's cancer
070576 - today recovering from 9th relapse with Navelbine treatments, per
070577 - above, ref SDS 0 3U7H, is no better and likely worse than on 090922.
070578 - At that time on 090922, the doctor decided Millie should not miss
070579 - treatments, and so Millie had her regular treatment on 090923.
070580 - ref SDS 38 W65H  Previously, Millie's cancer got much worse after
070581 - missing just 1 week of treatment with sunitinib, reported on 081225
070582 - 0700. ref SDS 17 1Y4I
070584 -  ..
070585 - This record indicates that pausing treatment due to conflict with
070586 - chemotherapy causing lower blood counts that cause shingles to
070587 - progress, presents a severe risk of Millie's cancer cascading out of
070588 - control.
070590 -  ..
070591 - Millie asked Doctor Johnson to solve the dilemma by prescribing
070592 - treatment "targeted" to Millie's patient profile, which does not lower
070593 - counts, and so enables treating shingles concurrently.
070595 -  ..
070596 - Doctor Johnson said he has called Doctor Rugo about treating Millie
070597 - with PARP that is targeted to Millie's cancer.  He was disappointed by
070598 - UCSF's letter last week delaying treatment with PARP for Millie,
070599 - because she was treated with carboplatin a year earlier in 2008,
070600 - reported on 100108 1618. ref SDS 66 FM5I  Unfortunately, Doctor Rugo
070601 - has not returned his call to discuss doctor discretion for medical
070602 - necessity in Millie's case.
070603 -
070604 -            [...below, during the meeting today, Doctor Johnson reviews
070605 -            PARP treatment targeted to Millie's patient profile that
070606 -            kills cancer cells without bad side effects, and so can be
070607 -            provided concurrent with treatment for shingles.
070608 -            ref SDS 0 OJ8G
070610 -             ..
070611 -            [On 100128 2249 Millie's letter to medical team reports
070612 -            Doctor Johnson examination found shingles subsided enough
070613 -            to start treatment for cancer with Navelbine chemotherapy
070614 -            again after 4-week pause to avoid compounding shingles
070615 -            infection, because Kaiser and UCSF have not yet scheduled
070616 -            "targeted" treatment for Millie to recover from 9th
070617 -            relapse, which can be given concurrent with shingles.
070618 -            ref SDS 71 FM5S
070620 -             ..
070621 -            [On 100218 1000 Millie suffers recurrence of shingles;
070622 -            rather than prescribe PARP, Kaiser prescribes Abraxane
070623 -            chemotherapy, because Doctor Rugo has not returned calls on
070624 -            implementing UCSF work plan for Millie to recover from
070625 -            medical mistakes. ref SDS 72 HQ4K
070627 -  ..
070628 - Doctor Johnson feels that missing treatments has been very problematic
070629 - in Millie's patient history...
070631 -  ..
070632 - On 080502 Doctor Johnson reported finding strong response after two
070633 - cycles adding Carboplatin to cetuximab. ref SDS 10 NH4N  Doctor Rugo
070634 - had previously advised on 080306 that patients typically have a longer
070635 - response with cetuximab and Carboplatin than with cetuximab alone.
070636 - ref SDS 9 5V4O  At the end of the month, Millie discovered that UCSF
070637 - made a mistake reducing the dose of Carboplatin contrary to
070638 - instructions from Millie to maintain the dose in order to maintain
070639 - recovery, reported on 080529 0930. ref SDS 11 MM9I  Reducing the dose
070640 - of carboplatin resulted in progression of disease on 080821, reported
070641 - at UCSF. ref SDS 12 4C6O  Doctor Johnson confirmed UCSF findings, when
070642 - he examined Millie a week later at Kaiser on 080829 1200. ref SDS 13
070643 - 1Z6O  This required ending treatment with cetuximab and carboplatin.
070644 - Doctor Rugo changed to sunitinib, reported on 081016 2342. ref SDS 14
070645 - J34U  Thus, reducing the dose of Carboplatin chemotherapy resulted in
070646 - this regimen lasting only 30% of the time Millie was treated with
070647 - cetuximab alone, contrary to expectations.
070649 -  ..
070650 - This record presents concern that pausing Millie's treatment with
070651 - Navelbine ordered today for 2 weeks, per above, ref SDS 0 G68H, may
070652 - cause progression of disease faster than maintaining a constant level
070653 - of treatment, cited by the doctor on 030606, ref SDS 1 JP7G, and the
070654 - following year on 040614. ref SDS 2 6T7F  Case study on 060810 shows
070655 - consistent effort to maintain steady level of treatments. ref SDS 5
070656 - R33L
070657 -
070658 -
070659 -
0707 -

SUBJECTS
Default Null Subject Account for Blank Record

0803 -
080401 -  ..
080402 - Bulge Lymphedema Upper Left Chest at Arm Joint
080403 - Bones Ache in Chest Due to Radiation Mistakes at UCSF
080404 -
080405 - There was no discussion during the meeting today that Millie feels
080406 - radiation treatments at UCSF in February and March 2009, have affected
080407 - rib bones inside her chest.  She just feels bad inside.  This could be
080408 - a side effect of Navelbine, which pausing chemotherapy today may help
080409 - resolve, but also risks losing control of cancer, discussed by Doctor
080410 - Johnson on 030606, ref SDS 1 N27L, see also case study on, ref SDS 4
080411 - P19O
080413 -  ..
080414 - There is also a significant bulge at the internal edge of the left
080415 - collar bone that ends near the throat, and does not occur with the
080416 - right colar bone.
080418 -         ..
080419 -        [On 100120 0301 Millie notifies medical team about worry that
080420 -        radiation treatments injured bones in her chest; she feels bad
080421 -        inside. ref SDS 70 HL5S
080422 -
080423 -
080424 -
080425 -
0805 -

SUBJECTS
Default Null Subject Account for Blank Record

0903 -
090401 -  ..
090402 - MRI Brain Cancer Headaches Ordered for Evaluation
090403 - Brain Cancer Headaches MRI Ordered for Evaluation
090404 - Headaches MRI Ordered for Evaluation of Brain Cancer
090405 -
090406 - Millie reported today severe headaches.  She is concerned about
090407 - spread of cancer to her brain.
090409 -  ..
090410 - Doctor Johnson ordered a CT test of the brain only.
090411 -
090412 -        [On 100113 1200 Chris called and advised that the doctor
090413 -        changed the prescription from CT to an MRI brain scan.
090414 -        ref SDS 69 MO5I
090415 -
090416 -
0905 -

SUBJECTS
Default Null Subject Account for Blank Record

1003 -
100401 -  ..
100402 - Hospice CT Scan Evaluate Viability Further Treatment
100403 - CT Scan Evaluate Viability Further Treatment or Hospice
100404 -
100405 - During the meeting today, there was discussion of getting a CT scan
100406 - that includes vital organs in the neck, chest, abdomen and pelvis, as
100407 - the medical team has been doing the past 8 years.
100409 -  ..
100410 - CT test can evaluate Millie's internal chest discomfort which was not
100411 - discussed today, but began sevreal weeks ago, per above. ref SDS 0
100412 - 448F
100414 -  ..
100415 - Millie's last CT scan was in the Emergency Department on 090919, to
100416 - evaluate painful breathing, ref SDS 36 EA3I, associated with mistakes
100417 - at UCSF providing radiation medical services on referral from Kaiser,
100418 - reported by Doctor Hsu on 090609. ref SDS 26 R24G
100420 -  ..
100421 - Doctor Johnson advised today, that adding the prior CT scope for which
100422 - there is an 8 year history of 40 or so radiology reports, to the test
100423 - ordered today checking for brain cancer to evaluate recent headaches,
100424 - per above, ref SDS 0 KC5J, is not needed because he feels nothing in a
100425 - CT test below the head would influence treatment.
100427 -  ..
100428 - Cancer spreading impacts Hospice considerations, listed in the medical
100429 - chart today.  Millie feels that if a CT test shows her cancer has
100430 - spead internally, then more treatment would seem like a "lost cause,"
100431 - and so she would prefer to spend remaining time without the constant
100432 - burden of medical logistics.  Can a CT scan provide a better picture
100433 - on how much effort to invest on further treatment?
100434 -
100435 -            [On 100120 0217, Millie notifies medical team CT test can
100436 -            evaluate Doctor Johnson's recommendation for Millie to
100437 -            enter Hospice, based on findings which may show cancer has
100438 -            progressed internally, making Millie a "lost cause."
100439 -            ref SDS 70 HL5V
100440 -
100442 -  ..
100443 - Treatment Plan 10th Relapse of Cancer Concurrent Treat Shingles
100444 -
100445 - On 090213 Doctor Johnson advised Millie to notify Doctor Rugo to
100446 - prescribe Millie's next treatment targeted to Millie's patient profile
100447 - that requires treating Millie's cancer as a "chronic disease."
100448 - ref SDS 21 GC6N
100450 -  ..
100451 - Durng the meeting today, Doctor Johnson paused Millie's chemotherapy
100452 - to recover from UCSF medical mistakes that spread her cancer, because
100453 - this would cause shingles infection to get worse, possibly causing
100454 - death.  He indicated this can be solved getting treatment at UCSF with
100455 - PARP, and he has called Doctor Rugo following a letter from UCSF on
100456 - 100108, per above. ref SDS 0 5M5M
100457 -
100458 -            [On 100128 2249 Millie's letter to medical team reports
100459 -            Doctor Johnson examination found shingles subsided enough
100460 -            to start treatment for cancer with Navelbine chemotherapy
100461 -            again after 4-week pause to avoid compounding shingles
100462 -            infection, because Kaiser and UCSF have not yet scheduled
100463 -            "targeted" treatment for Millie to recover from 9th
100464 -            relapse, which can be given concurrent with shingles.
100465 -            ref SDS 71 FM5S
100467 -             ..
100468 -            [On 100218 1000 Millie suffers recurrence of shingles;
100469 -            rather than prescribe PARP, Kaiser prescribes Abraxane
100470 -            chemotherapy, because Doctor Rugo has not returned calls on
100471 -            implementing UCSF work plan for Millie to recover from
100472 -            medical mistakes. ref SDS 72 HQ4K
100474 -  ..
100475 - Doctor Johnson seems to have high hopes for PARP to help Millie.  He
100476 - explained that PARP can be given for Millie to continue recovering
100477 - from cancer, while also getting treatment for shingles, because PARP
100478 - does not reduce blood counts like chemotherapy does.  As noted, he has
100479 - a call to Doctor Rugo, ref SDS 0 5M6R, following up Millie's letter
100480 - this morning requestng treatment with PARP to recover from UCSF
100481 - medical mistakes. ref SDS 68 IS5V  Since Doctor Rugo has not called
100482 - back, Kaiser has to pause Millie's treatment for cancer with Navelbine
100483 - chemotherapy, per above. ref SDS 0 067F
100484 -
100485 -            [On 100120 0217 Millie's letter to medical team confirmed
100486 -            that Doctor Johnson has called UCSF on starting Millie on
100487 -            PARP to recover from cancer spreading due to UCSF medical
100488 -            mistakes. ref SDS 70 HL9U
100490 -             ..
100491 -            [On 100302 0830 Doctor Johnson advised that Doctor Rugo has
100492 -            still not had time to return Kaiser's calls on starting
100493 -            Millie on PARP at UCSF in order for Millie to recover from
100494 -            cancer spreading due to UCSF medical mistakes. ref SDS 73
100495 -            L86L
100497 -  ..
100498 - During the meeting this morning, Doctor Johnson reviewed an article in
100499 - the Fall 2009 issue of "Cure," which on page 52 explains PARP
100500 - technology is targeted to Millie's triple negative patient profile,
100501 - and so attacks her cancer without debilitating side effects.  This
100502 - reflects success in 2007 and 2008 with cetuximab.  The article is also
100503 - on the Internet at...
100504 -
100505 -        Curetoday.com
100507 -         ..
100508 -        Targeting the Triple Threat
100509 -
100510 -        BY NICOLE LEBRASSEUR, PHD AND HEATHER L. VAN EPPS, PHD
100511 -
100512 -        There's now something to take aim at in triple-negative breast
100513 -        cancer.
100514 -
100515 -              http://www.curetoday.com/index.cfm/fuseaction/article.showArticleByTumorType/id/805/tumorCategory/Breast/article_id/1235
100517 -         ..
100518 -        Some of the biggest news comes from a class of drugs called
100519 -        PARP (poly ADP-ribose polymerase) inhibitors, which may be of
100520 -        particular help to patients such as Truesdale who carry a
100521 -        mutated BRCA1 gene.  Cells that lack a normal BRCA1 gene are
100522 -        robbed of a major DNA repair mechanism and thus must rely on
100523 -        backup pathways for life-saving DNA repair.  One of these
100524 -        backups involves repair proteins called PARPs, which mend
100525 -        breaks in DNA strands.  PARP inhibitors are thought to kill
100526 -        tumor cells by crippling this important repair mechanism, while
100527 -        leaving healthy cells unharmed. These drugs have completed
100528 -        phase II testing in TNBC and in breast and ovarian cancer
100529 -        patients with a BRCA1 mutation.  They are also being tested for
100530 -        the treatment of patients with melanoma and certain types of
100531 -        brain cancer.
100532 -
100533 -            [On 100218 1000 Millie discouraged by setbacks recovering
100534 -            from 9th relapse of cancer; chemotherapy is torgure, so she
100535 -            wants this to end; Doctor Johnson encouraged Millie to
100536 -            continue treatment because she is genrally very healthy,
100537 -            looks great, and new "tageted" treatments are becoming
100538 -            available to extend life without bad side effects.
100539 -            ref SDS 72 XE6I
100541 -             ..
100542 -            [On 100427 0830 Doctor Johnson reported Millie's cancer has
100543 -            mutated to resist chemotherapy, and so she needs a new
100544 -            strategy to treat her cancer as a chronic disease with
100545 -            therapy targeted to her patient profile. ref SDS 74 SJ6N
100546 -            Aligns with Doctor Johnson's review today of PARP targeted
100547 -            to Millie's triple negative status, reported on 100112
100548 -            0830, ref SDS 0 N586
100550 -         ..
100551 -        A phase II study unveiled this summer at the American Society
100552 -        of Clinical Oncology's annual meeting examined a PARP
100553 -        inhibitor called olaparib as a late-line therapy for patients
100554 -        with BRCA1 or BRCA2 mutation-related tumors. For 10 of the 27
100555 -        patients receiving high-dose olaparib, the tumor shrank by at
100556 -        least half, and most side effects were mild.
100558 -         ..
100559 -        Early analysis of a randomized phase II trial led by
100560 -        O'Shaughnessy showed promising results for another PARP
100561 -        blocker called BSI-201. With BSI-201, overall survival times
100562 -        reached 9.2 months compared with 5.7 months for those treated
100563 -        with chemotherapy alone, and progression-free survival
100564 -        doubled, from 3.3 months to 6.9 months. A phase III trial of
100565 -        BSI-201 in TNBC is now recruiting patients.
100567 -         ..
100568 -        Winer says that, so far, nothing else has been as impressive
100569 -        as the PARP inhibitors, but other targeted therapies are in
100570 -        the works. TNBC tumor cells often have high levels of the
100571 -        epidermal growth factor receptor, or EGFR, which may help the
100572 -        tumor cells grow. Drugs such as Erbitux (cetuximab), which is
100573 -        used to treat some cases of metastatic colorectal cancer,
100574 -        block EGFR and thus may also be useful in metastatic TNBC.
100576 -  ..
100577 - This is great news coorborating Doctor Rugo's treatment plan reported
100578 - on 090616 reporting that Kaiser and UCSF had agreed in correspondence
100579 - that UCSF would treat Millie's next relapse after MPA with PARP,
100580 - ref SDS 29 KD6L, implementing 2nd opinion recommendations received
100581 - from Stritter Medical Servies on 090204 1747. ref SDS 20 9J6Y  On
100582 - 090716 Doctor Rugo delayed treatment with PARP until September.
100583 - ref SDS 30 VS9P  In September, Millie asked the team about progress
100584 - starting PARP, but nobody had time to respond, reported on 090922
100585 - 0028. ref SDS 37 NW6S
100587 -  ..
100588 - On 070105 Doctor Johnson relied on "targeted" feature of PARP for
100589 - Kaiser prescribing cetuximab at UCSF on 070105. ref SDS 6 PK7L
100590 -
100591 -            [On 100120 0301 Millie notifies medical team Kaiser
100592 -            reviewed PARP for Millie's next treatment. ref SDS 70 HL7Y
100593 -
100594 -            [On 100218 1000 Millie discouraged by severe side effects
100595 -            from chemotherapy and difficulty getting timely care to
100596 -            recover from advancing cancer caused by medical mistakes at
100597 -            UCSF;, ref SDS 72 XE6I; Doctor Johnson reminds Millie she
100598 -            has a lot to live for, and that new treatments are becoming
100599 -            available everyday. ref SDS 72 XE6X
100601 -             ..
100602 -            [On 100218 1000 Millie discouraged by setbacks recovering
100603 -            from 9th relapse of cancer; chemotherapy is torgure, so she
100604 -            wants this to end; Doctor Johnson encouraged Millie to
100605 -            continue treatment because she is genrally very healthy,
100606 -            looks great, and new "tageted" treatments are becoming
100607 -            available to extend life without bad side effects.
100608 -            ref SDS 72 XE6I
100610 -  ..
100611 - Cure magazine reviewed today by Doctor Johnson, per above, ref SDS 0
100612 - N586, and it's online version, Curetoday.com, seem to have strong
100613 - credibility for patients and practitioners seeking guidance to recover
100614 - from cancer.  Millie saw a copy last week at Kaiser, while waiting to
100615 - see Doctor Dosetor to recover from shingles, reported on 100104 1355.
100616 - ref SDS 58 BW8I
100618 -  ..
100619 - Background on Cure is reported at...
100620 -
100621 -              http://www.curetoday.com/index.cfm/fuseaction/page.show/id/31
100623 -         ..
100624 -        CURE magazine, launched in 2002 for cancer patients, survivors,
100625 -        and caregivers, has become the largest consumer magazine in the
100626 -        United States focused entirely on cancer.  With a circulation
100627 -        of 325,000, home subscribers account for 180,000 of that figure
100628 -        with the remainder going to cancer centers and advocacy groups
100629 -        around the country.  Since its inception, CURE has expanded to
100630 -        reflect the entire cancer continuum, including supportive care
100631 -        issues and long-term and late effects.
100632 -
100633 -
100634 -
100635 -
100636 -
100637 -
100638 -
100639 -
1007 -

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