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 -
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