THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: February 28, 2010 10:16 PM Sunday;
Rod Welch
Millie CT test Feb 18th, very favorable only cancer IBC in skin.
1...Summary/Objective
........Test History No Evidence Distant Metastasis
........Distant Metastasis No Evidence 8 Years Imaging Tests
....1...Patient
....2...CT SCAN OF THE CHEST WITH CONTRAST
....3...HISTORY
....4...TECHNIQUE:
....5...COMPARISON: 9/19/09, 7/20/09.
....6...FINDINGS:
...11...IMPRESSION
2...Doctor Johnson comments in transmittal letter...
..............
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CONTACTS
SUBJECTS
CT Test 100218 No Adenopathy Axilla Supraclavicular Ground Glass Opa
0803 -
0803 - ..
0804 - Summary/Objective
0805 -
080501 - Follow up ref SDS 38 PQ6R.
080502 -
080503 -
080505 - ..
0806 -
0807 -
0808 - Progress
0809 -
080901 - On 100218, Doctor Johnson ordered a CT test to evaluate Millie's
080902 - reports of pain across her chest and wrapping onto her back.
080903 - ref SDS 38 ES3U
080905 - ..
080906 - Access to Kaiser's online Knowledge Management system has been blocked
080907 - the past few weeks.
080909 - ..
080910 - This evening Kaiser restored access to patient records online, and so
080911 - was able to retrieve Doctor Johnson's transmittal of the report on CT
080912 - test results...
080913 -
080914 - 1. Subject: CT Results
080915 - Received: 2/25/10 12:41 PM
080921 -
080922 - [...below, Doctor Johnson's comment on favorable test
080923 - findings. ref SDS 0 4Q54
080924 -
080926 - ..
080927 - Millie's last CT test was on 090919. ref SDS 37 AK5H
080929 - ..
080930 - Test History No Evidence Distant Metastasis
080931 - Distant Metastasis No Evidence 8 Years Imaging Tests
080932 -
080933 - Follow up ref SDS 37 AK5H, ref SDS 36 6I4G.
080934 -
080935 - CT test today on 100218 continues Millie's 8 year history of
080936 - testing that finds no evidence of distant metastasis.
080938 - ..
080939 - Type Date Received Source
080940 - 1. CT 100218 reported on 100228.............. ref SDS 0 DA6Q
080941 - 2. CT 090919 reported on 090919.............. ref SDS 37 DA6Q
080942 - 3. CT 090720 reported on 090720.............. ref SDS 36 DA6Q
080943 - 4. CT 090612 reported on 090617.(neck)....... ref SDS 35 DA6Q
080944 - CT 090612 reported on 090617.(1st part)... ref SDS 35 DA6Q
080945 - 5. CT 090413 reported on 090415.............. ref SDS 34 DA6Q
080946 - 6. CT 081230 reported on 090107.(neck)....... ref SDS 33 DA6Q
080947 - CT 081230 reported on 090107.(1st part)... ref SDS 33 5O6N
080948 - 7. CT 081107 reported on 081113 (neck)....... ref SDS 32 DA6Q
080949 - CT 081107 reported on 081112 (1st part)... ref SDS 31 5O6N
080950 - 8. CT 080911 reported on 080912.............. ref SDS 30 DA6Q
080951 - 9. CT 080718 reported on 080723.............. ref SDS 29 DA6Q
080952 - 10. CT 080425 reported on 080428.............. ref SDS 28 DA6Q
080953 - 11. CT 080212 reported on 080215.............. ref SDS 27 DA6Q
080954 - 12. CT 071210 reported on 071213.............. ref SDS 26 UG4L
080955 - 13. CT 070930 reported on 071018.............. ref SDS 25 VK8L
080956 - 14. CT 070723 reported on 070802.............. ref SDS 24 IM6M
080957 - 15. CT 070520 reported on 070524.............. ref SDS 23 DA6Q
080958 - 16. CT 070326 reported on 070329.............. ref SDS 22 DA6Q
080959 - 17. CT 070131 reported on 070202.............. ref SDS 21 1Y8G
080960 - 18. PET/CT 061227 reported on 070102.............. ref SDS 20 1Y8G
080961 - 19. CT 060930 reported on 061012.............. ref SDS 19 284J
080962 - 20. MRI 060708 reported on 060711.............. ref SDS 18 PT4K
080963 - 21. Xray 060623 reported on 060711.............. ref SDS 18 WJ6G
080964 - 22. CT 060505 reported on 060523.............. ref SDS 17 E355
080965 - 23. PET 060414 reported on 060428.............. ref SDS 16 WJ6G
080966 - 24. PET 060120 reported on 060126.............. ref SDS 15 WJ6G
080967 - 25. PET/CT 051005 reported on 051007.............. ref SDS 14 WJ6G
080968 - 26. CT 050530 reported on 050610.............. ref SDS 13 G75L
080969 - 27. CT 050325 reported on 050422.............. ref SDS 12 G75L
080970 - 28. CT 041217 reported on 041230.............. ref SDS 11 G75L
080971 - 29. CT 041103 reported on 041104.............. ref SDS 10 WV7H
080972 - 30. CT 040921 reported on 041005.............. ref SDS 9 NL4N
080973 - 31. CT 040710 reported on 040811.............. ref SDS 8 H85S
080974 - 32. CT 040410 reported on 040416.............. ref SDS 7 LK5L
080975 - 33. CT 040307 reported on 040318.............. ref SDS 6 LK5L
080976 - 34. CT 031031 reported on 031205.............. ref SDS 5 IG9K
080977 - 35. CT 030626 reported on 030710.............. ref SDS 4 AL6N
080978 - 36. CT 030428 reported on 030508.............. ref SDS 3 LK5L
080979 - 37. PET 021218 reported on 030109.............. ref SDS 2 LK5L
080980 - 38. PET 020529 reported on 020603.............. ref SDS 1 0001
080982 - ..
080983 - 1. Patient
080991 - ..
080992 - 2. CT SCAN OF THE CHEST WITH CONTRAST
080994 - ..
080995 - Since this test did not include the neck, Kaiser published a single
080996 - report, correcting past problems, reported on 090617. ref SDS 35 RU6R
080998 - ..
080999 - CT test 100218 report continues...
081000 -
081001 - 3. HISTORY
081002 -
081003 - 74 Y female with a history of IBC of left breast who was
081004 - initially diagnosed 03/04/02. On multiple therapies for prior
081005 - h/o progression of disease. Now with pain radiating from her
081006 - back along the left mid rib line.
081008 - ..
081009 - 4. TECHNIQUE:
081010 -
081011 - CT of the chest was performed per protocol. A total of 100 cc
081012 - of Omnipaque-300 administered IV without immediate
081013 - complication.
081015 - ..
081016 - 5. COMPARISON: 9/19/09, 7/20/09.
081018 - ..
081019 - 6. FINDINGS:
081020 -
081021 - Evaluation of the pulmonary parenchyma demonstrates interval
081022 - resolution of the trace left sided pleural effusion.
081023 - Previously noted confluent patchy ground glass opacity
081024 - predominantly within the left lower lobe is less pronounced
081025 - with some areas demonstrating interval improvement in
081026 - comparison to the previous study.
081028 - ..
081029 - There is persistent mild bronchiectatic changes of the lingula
081030 - of the left lung on images #30/67. Small 5 mm focal nodule is
081031 - present in the left lower lobe on image #36/67.
081033 - ..
081034 - 7. Within the right upper lobe posterior aspect on image #17/67,
081035 - there is a new linear area of atelectasis vs post inflammatory
081036 - / scarring. There is less ground glass opacity within the
081037 - right lung however few scattered patchy densities within the
081038 - right lower lobe and within the medial segments. No right
081039 - pleural effusion identified.
081041 - ..
081042 - 8. No significant adenopathy within the mediastinal, hilar or
081043 - axillary regions. There are post-surgical changes from prior
081044 - left mastectomy. A right sided Port-A-Catheter is present with
081045 - the distal tip within the superior vena cava.
081046 -
081047 - [...below Doctor Johnson's transmittal notes CT test
081048 - indicates progression of Millie's cancer is primarily in
081049 - the skin. ref SDS 0 4Q54
081051 - ..
081052 - 9. Again noted is a 2.4 cm low density lesion within the dome of
081053 - the liver compatible with a cyst. The adrenal glands are
081054 - without mass lesion. The visualized gallbladder, kidneys and
081055 - spleen are unremarkable. There is extensive calcification at
081056 - the level of the celiac axis and its branching vessels,
081057 - particularly the splenic artery. Few coarse calcifications are
081058 - noted in the spleen secondary to old old chronic granulomatous
081059 - disease.
081061 - ..
081062 - 10. Evaluation of the osseous structures demonstrates mild
081063 - degenerative changes. No worrisome lytic lesions are
081064 - identified. However, there is sclerosis of the pars
081065 - articularis on the right at the level of the fourth and fifth
081066 - ribs may be degenerative changes.
081068 - ..
081069 - 11. IMPRESSION
081070 -
081071 - 1. Mild interval improvement of the patchy ground glass
081072 - opacities bilaterally. There are still a few patchy densities
081073 - noted predominantly in the bilateral lung bases. New area of
081074 - subsegmental atelectasis vs post-inflammatory scarring right
081075 - upper lobe. Resolution of small left pleural effusion.
081080 - ..
081081 - 13. DD: 02/22/2010 DT: 02/25/2010 DJH
081082 -
081084 - ..
081085 - Doctor Johnson comments in transmittal letter...
081086 -
081087 - 1. So the CT has not significantly worsened. ref SDS 0 KL5X The
081088 - progression seems to be primarily in the skin.
081090 - ..
081091 - Doctor Johnson's analysis seems to reflect CT test findings of no
081092 - significant internal adenopathy, and no swelled lymph nodes in the
081093 - axilla. ref SDS 0 KL5X,
081095 - ..
081096 - Since "skin" is not mentioned in the report, the doctor's reference to
081097 - cancer progressing relates to physical examinations on 100218, which
081098 - showed significant progression, causing change in treatment to
081099 - Abraxane for the next cycle. ref SDS 38 MD4H
081100 -
081101 - [On 100301 0005 Millie notifies medical team that CT test
081102 - on 100218, with results reported today are very
081103 - encouraging. ref SDS 39 OO5U
081105 - ..
081106 - [On 100301 0005 Millie notifies medical team IBC shows
081107 - cancer is progressing aggressively in the skin; she looks
081108 - horrible. ref SDS 39 ER95
081110 - ..
081111 - [On 100302 0830 during meeting at Kaiser discussed Doctor
081112 - Johnson's analysis in his letter on 100301, reporting
081113 - resutls for the CT test today finding that the only problem
081114 - for the medical team to solve in Millie's case in cancer in
081115 - the skin. ref SDS 40 FB90
081117 - ..
081118 - [On 100330 0830 since Millie showed some initial response
081119 - to treatment after the 1st cycle with Abraxane, Doctor
081120 - Johnson's comment in his letter on 100301, should still be
081121 - accurate that the only cancer problem to solve is in the
081122 - skin. ref SDS 41 FB90
081124 - ..
081125 - [On 100501 1037 Millie reviews patient history on Doctor
081126 - Johnson's report that testing shows the only problem to
081127 - solve for Millie is cancer in her skin, i.e., IBC.
081128 - ref SDS 42 U48V
081130 - ..
081131 - [On 100606 1638 Millie thanks Doctor Johnson for submitting
081132 - results of lab on 100529, showing less increase in cancer
081133 - marker than exptected, even after 3 weeks without
081134 - treatment, ref SDS 43 036C, and indicating there is still
081135 - no internal involvement. ref SDS 43 PQ6V
081136 -
081141 -
081142 -
081143 -
081144 -
081145 -
081146 -
081147 -
081148 -
081149 -
0812 -