CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 63 0000. ref SDS 61 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 100203, Millie resumed treatment after a 3-week pause ordered by
040902 - Doctor Johnson, on 100112 0830, ref SDS 51 G68H, while Millie was
040903 - treated to recover from a very severe case of shingles infection,
040904 - reported earlier on 100104 1115. ref SDS 47 0P9S
040906 -  ..
040907 - On 100217 0730 Millie got the 3rd treatment of the 3rd cycle with
040908 - Navelbine for Millie to recover from the 9th relaspe of cancer.
040910 -  ..
040911 - On 100218 1000 Millie got Neupogen treatment at Kaiser to maintain
040912 - blood counts essential for getting Navelbine chemotherapy treatment
040913 - for cancer. ref SDS 61 ER95
040915 -  ..
040916 - On 100218 1000 Millie had emergency meeting with Doctor Johnson,
040917 - primary care physician at Kaiser, after getting Neupogen treatment;
040918 - the doctor diagnosed relapse of shingles, and prescribed a 4th cycle
040919 - of treatment, but only with Acyclovir (Zovirax) 800 MG tablets,
040920 - ref SDS 61 0Y6O; the doctor also diagnosed Millie's 10 relapse of
040921 - cancer, and ordered switching treatment from Navelbine to Abraxane,
040922 - beginning on 100303. ref SDS 61 023N   The doctor further ordered a CT
040923 - test to evaluate rising pain. ref SDS 61 ES40
040925 -  ..
040926 - On 100218 1230 Millie had emergency CT test. ref SDS 61 PQ6R
040928 -  ..
040929 - On 100301 0005 letter to medical team reports improvement from CT test
040930 - on 100218, and increased energy may indicate Navelbine can continue
040931 - another cycle. ref SDS 63 ER95
040933 -  ..
040934 - On 100302 0830 meeting at Kaiser, ref SDS 0 ER95; Doctor Johnson
040935 - prescribed Abraxane for Millie starting treatment tomorrow for
040936 - recovering from 10th relapse of cancer. ref SDS 0 FB67  Blood counts
040937 - dropped significantly, ref SDS 0 IC4N; since Abraxane side effects
040938 - reduce blood counts this increases chances of shingles recurrence; the
040939 - doctor advised that treatment for cancer will be paused again, if
040940 - shingles recurs. ref SDS 0 FC68  Only way for Millie to get treatment
040941 - for shinges concurrent with cancer is to switch from Abraxane to a
040942 - "targeted" treatment for cancer that does not injure bone marrow
040943 - producing blood. ref SDS 0 IC85
040944 -
040945 -
040946 -
040948 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Agenda Meeting Primary Care Physician Recover 10th Relapse Cancer
041302 -
041303 - Doctor Johnson advised that he received and read Millie's letter dated
041304 - 100301 with the agenda for the meeting today at 0830. ref SDS 63 ER95
041305 - He commented extensively during the meeting on critical issues.
041306 -
041307 -    1.  Patient Directive.............................. ref SDS 0 P58M
041308 -    2.  Breathing improves recovery radiation
041309 -        injury......................................... ref SDS 0 FB85
041310 -    3.  Cancer skin only no distant metastasis
041311 -        CT test very favorable......................... ref SDS 0 FB90
041312 -    4.  Examination Cancer spreads on skin............. ref SDS 0 FB9Y
041313 -    5.  Pain subsides with shingles recovery........... ref SDS 0 FB55
041314 -    6.  Shingles improvement treatment stopped......... ref SDS 0 FU5F
041315 -    7.  Abraxane chemotherapy 10th relapse............. ref SDS 0 FB67
041316 -    8.  Blood counts fall high risk Abraxane........... ref SDS 0 IC4N
041317 -    9.  Balance treatment recover from cancer
041318 -        and shingles................................... ref SDS 0 FC68
041319 -   10.  Targeted cancer treatment needed for concurrent
041320 -        recovery from shingles......................... ref SDS 0 IC85
041321 -   11.  Trade-offs standard of care evidence-based
041322 -        health care requires "due process" for
041323 -        life-ending threats............................ ref SDS 0 ZV4N
041324 -   12.  Securemail from Kaiser dated 100208............ ref SDS 0 FC61
041325 -   13.  Authorization blood draws Power Port........... ref SDS 0 7M6H
041326 -
041327 -            [On 100304 2251 Millie notifies medical team on results
041328 -            meeting at Kaiser today with Doctor Johnson. ref SDS 65
041329 -            OP6R
041330 -
041331 -
041332 -
041333 -
0414 -

SUBJECTS
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0503 -
050401 -  ..
050402 - Advance Directive Declining Life-sustaining Treatment
050403 - Physician Orders Life-sustaining Treatment (POLST) Declined by Millie
050404 -
050405 - Millie submitted signed EMSA #111B documentation on life-ending
050406 - directions, designating Pam with authority to decide medical issues
050407 - when Millie is medically unable to make her own decisions.  Doctor
050408 - Johnson filled out and signed his part of the form, as Millie's
050409 - primary care physician.  During the meeting Arlette came into the
050410 - examination room.  The doctor gave the signed documents to Arlette for
050411 - processing.
050413 -  ..
050414 - Millie also signed and received a copy of a pink document.  Doctor
050415 - Johnson said this is for efficient notice to care givers at home when
050416 - Millie suffers coma or dies.  It can be displayed on the refergerator
050417 - door for easy access.
050418 -
050419 -        [On 100309 1238 Millie requests documentation for approving
050420 -        communication, including confidential information, through the
050421 -        doctor's domestic email address at Kaiser, and in order to
050422 -        provide timely, accurate coordination among the doctors
050423 -        collaborating to provid Millie's health care. ref SDS 68 HL6R
050425 -         ..
050426 -        [On 100601 1531 Sharon asked Millie for Advance Directive on
050427 -        file at Kaiser, during call to start Hospice care. ref SDS 76
050428 -        NA6F
050430 -         ..
050431 -        [On 100602 0913 Liz asked again about Millie signing an Advance
050432 -        Directive on file at Kaiser. ref SDS 77 PE6G
050434 -         ..
050435 -        [On 100604 1350 Linda, Hospcie Case Manager, asked again for
050436 -        Millie's Advance Directive to avoid life-sustaining measures.
050437 -        ref SDS 78 MP4K
050439 -         ..
050440 -        [On 100607 1243 Judy reported that searching the records
050441 -        does not show Millie has an Advance Directive on file at
050442 -        Kaiser; Judy will investigate and let Millie know if this
050443 -        work needs to be done again. ref SDS 79 AO6J
050444 -
050445 -
050446 -
0505 -

SUBJECTS
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0603 -
060401 -  ..
060402 - Primary Care Physician Doctor Johnson
060403 -
060404 - Milie was pleased that Doctor Johnson confirmed today his assignment
060405 - as her primary care physician.  Other documents from Kaiser the past
060406 - year have listed various other doctors, whom Millie never sees, as her
060407 - primary care physician.  Millie has consistently listed Doctor Johnson
060408 - as her primary care doctor, because he has performed this work since
060409 - the first meeting 9 years ago on 020321. ref SDS 1 MA3F
060411 -  ..
060412 - Millie noticed that Doctor Johnson has today a new badge replacing the
060413 - prior promotion for palliative care.  The new badge now promotes
060414 - comprehensive care, or something other than palliation.
060416 -  ..
060417 - The doctor explained that Palliative Care has not been well received
060418 - by Kaiser's customers.  Many patients evidently feel that "palliation"
060419 - implies a "Doctor Kervorkian" assisted suicide/euthanasia practice
060420 - that replaces care to extend quality of life, with medication to
060421 - provide a comfortable demise.
060422 -
060423 -        [On 100311 0930 Doctor Johnson's letter presents current
060424 -        position as Chief, Pallicative Care for Kaiser's Diablo Service
060425 -        Area. ref SDS 71 ER95
060426 -
060427 -
060428 -
060429 -
0605 -

SUBJECTS
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0703 -
070401 -  ..
070402 - Breathing Improved CT Test Ground Glass Opacities Lungs Reduced
070403 - Radiation Injury Recovery Ground Glass Opacities Reduced CT Test
070404 -
070405 - The doctor was very pleased that Millie's breathing has finally
070406 - recovered enough to resume hiking, reported in her letter yesterday on
070407 - 100301. ref SDS 63 ON6Y
070409 -  ..
070410 - Doctor Johnson advised that increased energy and breathing capacity
070411 - for hiking, reported in Millie's letter yesterday, aligns with the CT
070412 - test at Kaiser on 100218 reporting findings that ground glass opacity
070413 - nodules in Millie's lungs appear reduced for the first time since the
070414 - test on 090413, that found increased ground glass opacities, presented
070415 - in the record on 090415. ref SDS 30 RV78  On 090514 Doctor Rugo
070416 - diagnosed Millie's breathing problems were caused by ground glass
070417 - opacities from radiation injury to the lungs. ref SDS 31 NL9I
070418 -
070419 -
0705 -

SUBJECTS
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0803 -
080401 -  ..
080402 - Skin Only Cancer Medical Problem CT Test Finds No Adenopathy
080403 - Distant Metastasis Not Found CT Test IBC in Skin Only Cancer Problem
080404 -
080405 - This morning, Doctor Johnson confirmed comment in his letter from
080406 - Kaiser dated 100225, and received on 100228, ref SDS 62 565G,
080407 - transmitting the report on Millie's CT test on 100218, ref SDS 61
080408 - PQ6R, and showing test findings of no adenopathy, see 100228 2216,
080409 - ref SDS 62 KL5X, as further related in Millie's letter to the medical
080410 - team on 100301, ref SDS 63 ER95, indicate that Millie's only medical
080411 - issues now are pulmonary embolism, IBC in the skin, and shingles,
080412 - noted in Millie's letter to the medical team yesterday. ref SDS 63
080413 - OO5U, and reflecting Doctor Johnson's letter dated 100225, received in
080414 - the record on 100228 2216. ref SDS 62 4Q54
080416 -  ..
080417 - Discussion today of results for CT test on 100218, and received on
080418 - 100228, per above, ref SDS 0 FB90, are reflected in Kaiser's Medical
080419 - Chart today listing test summary in the Impression section (see below,
080420 - ref SDS 0 9D4Y).
080421 -
080422 -
080423 -
080424 -
0805 -

SUBJECTS
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0903 -
090401 -  ..
090402 - Examination Finds IBC Spreads Near Untreated IBC Breastbone
090403 - IBC Spreads Right Side Chest Near Untreated IBC Breastbone
090404 -
090405 - Doctor Johnson examined Millie and found expanding IBC rash, since his
090406 - emergency examination on 100218 that found Millie's cancer has
090407 - relapsed for the 10th time, and so requires changing treatment,
090408 - beginning tomorrow, ref SDS 61 023N, and confirmed today, discussed
090409 - below. ref SDS 0 FB67
090411 -  ..
090412 - The doctor carefully palpated left and right axilla, and left and
090413 - right supraclavicular, where lymph nodes swelled from cancer have
090414 - always occurred in Millie's patient history of many relapse episodes.
090415 - Today, Doctor Johnson reported finding no evidence of LNs.  This
090416 - aligns with the CT test on 100218 which reported finding no
090417 - adenopathy in axilla nor supraclavicular lymph nodes.
090419 -  ..
090420 - Today, Millie is concerned about new nodules on the right breast and
090421 - on the upper left chest.
090423 -  ..
090424 - The doctor concurred that IBC enveloping the right breast is a
090425 - significant increase in cancer well above any prior condition in
090426 - Millie's 9-year patient history, as related in Millie's letter to the
090427 - team yesterday on 100301 0005. ref SDS 63 ON6V
090428 -
090429 -            [On 100303 0730 Millie begins 1st treatment of 1st cycle
090430 -            with Abraxane, ref SDS 64 625I; CA 15-3 426 reported for
090431 -            blood test yesterday on 100301; cancer marker more than
090432 -            doubling to rise over 200 in the past 4 weeks, signals
090433 -            Millie's cancer has mutated and is now progressing
090434 -            rapidly, which requires ending Navelbine, and starting
090435 -            another drug for Millie to recover from 10th relapse.
090436 -            ref SDS 64 EG9I
090438 -             ..
090439 -            [On 100304 2251 Millie notifies medical team that Doctor
090440 -            Johnson's prescription today on 100302 to start Abraxane
090441 -            treatment tomorrow, rather than try another cycle of
090442 -            Navelbine, was very effective because Millie's cancer
090443 -            marker, CA 15-3 426 increased to the highest level in
090444 -            patient history, and more than 200 points in the past
090445 -            month, following a 3 week pause in treatment to recover
090446 -            from shingles. ref SDS 65 OQ4T
090448 -             ..
090449 -            [On 100319 0843 cancer marker CA 15-3 360 dropped about 60
090450 -            points - aligns with evident reduction in IBC rash that
090451 -            signals some recovery achieved with first 2 treatments
090452 -            using Abraxane. ref SDS 72 1T4R
090454 -             ..
090455 -            [On 100330 0830 examination at Kaiser by Doctor Johnson,
090456 -            primary care physician, and starting 2nd cycle of
090457 -            Abraxane chemotherapy, Millie shows response to 1st
090458 -            cycle of treatment, ref SDS 74 FB9Y, including "drying
090459 -            up" of IBC nodules. ref SDS 74 HR9K
090461 -  ..
090462 - IBC first occurred in a small part of the inner right breast near the
090463 - breastbone originally reported at Kaiser during examination on 061208
090464 - 1200, ref SDS 6 AX6G, and confirming notice from Millie to the
090465 - medical team on 061204 0851. ref SDS 5 AE5I
090467 -  ..
090468 - IBC remained contained for 3 years until after UCSF made mistakes
090469 - failing to treat Millie's cancer in the breastbone for 6 months.
090470 - Untreated IBC has now spread to the entire right breast.
090472 -  ..
090473 - Doctor Johnson was pleased that in the past week or so intensity of
090474 - IBC seems to have subsided, and several bleeding lesions on Millie's
090475 - chest and left arm have improved by drying up, signaling some recovery
090476 - from responding to treatment with Navelbine, as related in Millie's
090477 - letter to the medical team on 100301 0005. ref SDS 63 ON6V
090478 -
090479 -
090480 -
0905 -

SUBJECTS
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1003 -
100401 -  ..
100402 - Stage V Cancer Unique Continuous Treatment 9 Years 10th Relapse
100403 - Unique Case Continuous Treatment 9 Years 10th Relapse Stage V Cancer
100404 -
100405 - Doctor Johnson commented that Millie's case is unique getting
100406 - continuous treatment for 9 years, and with 10 changes of modality,
100407 - noted in Millie's letter to the medical team on 100301 0005.
100408 - ref SDS 63 PRYQ
100410 -  ..
100411 - On 090213, the doctor cited comprehensive case management by Kaiser
100412 - and UCSF, ref SDS 25 JL5I, had extended Millie's survival and quality
100413 - of life by orders of magnituge compared to other patients with similar
100414 - disease prognosis, reported on 090213 1140. ref SDS 25 4W72
100416 -  ..
100417 - At the next meeting a month later on 090325 0830, Doctor Johnson drew
100418 - a similar graph, but added a mark indicating Millie is near the end of
100419 - sustainable quality of life, and would soon suffer rapid decline.
100420 - ref SDS 26 P39M
100422 -  ..
100423 - On 090725, Millie's letter to the medical team cited Doctor Johnson
100424 - explained to Millie's daughter Pam, that surviving aggressive cancer
100425 - longer than expected takes "yoeman's work" performing comprehensive
100426 - case management in time to be effective. ref SDS 37 T58R
100427 -
100428 -
100429 -
100430 -
100431 -
1005 -

SUBJECTS
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1103 -
110401 -  ..
110402 - Pain Controlled Less Oxycodone IBC and Shingles Subsiding
110403 -
110404 - Doctor Johnson asked Millie about pain she reported during the
110405 - emergency meeting on 100218, ref SDS 61 ES3U, and cited in her letter
110406 - to the team yesterday on 100301 0005. ref SDS 63 OP5U
110408 -  ..
110409 - Millie reported today now having less pain from shingles, and also
110410 - from cancer on her left arm and chest.  She indicated that pain is
110411 - controlled now with less oxycodone (Percocet), since ending treatment
110412 - a few days ago with Acyclovir (Zovirax) to recover from recurrent
110413 - shingles, and prescribed by the doctor during the meeting on 100218.
110414 - ref SDS 61 0Z33
110415 -
110416 -
110417 -
1105 -

SUBJECTS
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1203 -
120401 -  ..
120402 - Acyclovir (Zovirax) Treatment Ends Shingles Sufficient Recovery
120403 - Shingles Recoverd Sufficient End Treatment Acyclovir (Zovirax)
120404 -
120405 - This morning the doctor described Millie's forehead shows slight
120406 - coloration, and the shingles "bump" swelling, which he observed on
120407 - 100218, ref SDS 61 PP5Y, has subsided.  Doctor Johnson decided that
120408 - examination shows shingles has recovered sufficiently to end treatment
120409 - with Acyclovir (Zovirax), so that Millie can start treatment tomorrow
120410 - with Abraxane to recover from the 10th relapse of cancer.  Balancing
120411 - tratment for shingles and cancer is discussed further below.
120412 - ref SDS 0 FC68
120414 -             ..
120415 -            [On 100304 2251 Millie reports to medical team that
120416 -            shingles coloration on forehead seems more intense, and
120417 -            there is increased pain; Millie reports no new "bumps"
120418 -            appear on her forehead. ref SDS 65 OP6W
120420 -             ..
120421 -            [On 100305 0822 Millie reports shingles seems well
120422 -            controlled, so there is hope of getting the 2nd treatment
120423 -            of the 1st cycle with Abraxane next Wednesday, and to
120424 -            recover from the 10th relapse of cancer ref SDS 66 0V6U
120426 -  ..
120427 - Doctor Johnson seemed to recommend during the meeting today shingles
120428 - vaccination because shingles is contagious for Millie's care givers.
120429 - He cited virulent affect on Millie with shingles lasting now over 2
120430 - months.  Recommendation for shingles vaccination aligns with research
120431 - on 100104 1115. ref SDS 47 5D3J
120432 -
120433 -        [On 100305 1000 VA was notified that Millie diagnosed with
120434 -        shingles, and her doctor reported this is a contagious disease;
120435 -        as a result, Doctor Lee ordered shingles vaccination.
120436 -        ref SDS 67 4O4O; and vaccination was performed later that same
120437 -        day. ref SDS 67 GT5G
120438 -
120439 -
120440 -
120441 -
120442 -
120443 -
1205 -

SUBJECTS
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1303 -
130401 -  ..
130402 - 10th Relapse Abraxane Prescribed Navelbine End Treatment 9th Relapse
130403 - Abraxane Prescribed 10th Relapse Navelbine End Treatment 9th Relapse
130404 - Navelbine End Treatment 9th Relapse Abraxane Prescribed 10th Relapse
130405 -
130406 - Doctor Johnson did not have time yesterday nor this morning to contact
130407 - the lab for expediting the report on the cancer marker, as requested
130408 - in Millie's letter on 100301 0005. ref SDS 63 OO3R  After the meeting,
130409 - Arlette said she would get results on CA 15-3, and report to Millie
130410 - and the doctor for last minute consideration on changing treatments.
130412 -  ..
130413 - During the meeting, Doctor Johnson advised that regardless of results
130414 - from the CT test on 100218, and for the cancer marker from the lab on
130415 - 100301, examination today establishs that Millie has suffered her 10th
130416 - relapse of cancer, per above, ref SDS 0 FB9Y, and therefore the best
130417 - course of care is to end treatment with Navelbine and start Millie on
130418 - Abraxane tomorrow, as planned during the meeting on 100218.
130419 - ref SDS 61 023N
130420 -
130421 -            [On 100303 0730 Millie begins 1st treatment of 1st cycle
130422 -            with Abraxane, ref SDS 64 625I; CA 15-3 426 reported for
130423 -            blood test yesterday on 100301; cancer marker more than
130424 -            doubling to rise over 200 in the past 4 weeks, signals
130425 -            Millie's cancer has mutated and is now progressing
130426 -            rapidly, which requires ending Navelbine, and starting
130427 -            another drug for Millie to recover from 10th relapse.
130428 -            ref SDS 64 EG9I
130430 -             ..
130431 -            [On 100304 2251 Millie notifies medical team that Doctor
130432 -            Johnson's prescription today on 100302 to start Abraxane
130433 -            treatment tomorrow, rather than try another cycle of
130434 -            Navelbine, was very effective because Millie's cancer
130435 -            marker, CA 15-3 426 increased to the highest level in
130436 -            patient history, and more than 200 points in the past
130437 -            month, following a 3 week pause in treatment to recover
130438 -            from shingles. ref SDS 65 OQ4T
130440 -             ..
130441 -            [On 100319 0843 cancer marker CA 15-3 360 dropped about 60
130442 -            points - aligns with evident reduction in IBC rash that
130443 -            signals some recovery achieved with first 2 treatments
130444 -            using Abraxane. ref SDS 72 1T4R
130446 -             ..
130447 -            [On 100330 0830 examination at Kaiser by Doctor Johnson,
130448 -            primary care physician, and starting 2nd cycle of
130449 -            Abraxane chemotherapy, Millie shows response to 1st
130450 -            cycle of treatment, ref SDS 74 FB9Y, including "drying
130451 -            up" of IBC nodules. ref SDS 74 HR9K
130452 -
130453 -
130454 -
130455 -
130456 -
1305 -

SUBJECTS
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1403 -
140401 -  ..
140402 - Side Effects Abraxane Tolerated Better than Navelbine
140403 -
140404 - Doctor Johnson discussed concerns about side effects of Abraxane,
140405 - reported in Millie's letter to the medical team on 100301 0005.
140406 - ref SDS 63 OO4Y
140408 -  ..
140409 - Millie was pleased hearing Doctor Johnson comment that Abraxane side
140410 - effects are tolerated by most patients better than Navelbine.
140411 -
140412 -            [On 100303 0730 Millie at Kaiser for 1st treatment of 1st
140413 -            cycle with Abraxane to recover from 10th relapse of cancer.
140414 -            ref SDS 64 625I
140416 -             ..
140417 -            [On 100305 0810 Millie reports tolerating Abraxane well
140418 -            2-days after the 1st treatment. ref SDS 66 0V6X
140419 -
140420 -
140421 -
1405 -

SUBJECTS
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1503 -
150401 -  ..
150402 - Trip 2-weeks May 15 Kaiser Committed Millie Quality of Life
150403 - Quality of Life Kaiser Committed Millie 2-weeks Trip May 15
150404 -
150405 - Millie was further very pleased hearing the doctor's commitment today
150406 - on helping Millie recover from cancer with enough energy to make the
150407 - 2-week trip planned with her daughter, Pam, and daughter-in-law, Kim,
150408 - for May 10th.  Doctor Johnson mentioned the May 10th trip several
150409 - times during the meeting as a goal guiding the medical team.
150410 -
150411 -
150412 -
150413 -
1505 -

SUBJECTS
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1603 -
160401 -  ..
160402 - Immune System Weakens Because Abraxane Lowers Blood Counts
160403 - Blood Counts Fall Risk Shingles Recurrence Pause Chemo Cancer Rises
160404 -
160405 - Doctor Johnson was concerned today about the sudden and significant
160406 - decline in Millie's blood counts reported for the lab on Monday,
160407 - 100301.  NEUTS 1.2 is well below Kaiser's standard of care for safe
160408 - chemotherapy treatment.  The doctor confirmed Zan's letter from the
160409 - Kaiser Oncology Pharmacy on 100219 disclosing that Abraxane lower's
160410 - immunity to infection by lowering blood counts, reported in Millie's
160411 - letter to the medical team on 100301 0005. ref SDS 63 4R3P  The doctor
160412 - cited Millie's patient history of Kaiser and UCSF waiving policy to
160413 - withhold chemotherapy when NEUTS fall below 1.5.  Doctor Johnson
160414 - explained that since Millie has consistently tolerated chemotherapy
160415 - with NEUTS above 1.0, reported in case study on 060810, ref SDS 3
160416 - HV45, he feels comfortable today approving her to start treatment with
160417 - Abraxane tomorrow with NEUTS at 1.2
160419 -             ..
160420 -            [On 100304 2251 Millie notifies medical team that Doctor
160421 -            Johnson is concerned starting Abraxane with blood counts
160422 -            already below published guidance for safe chemotherapy,
160423 -            since Abraxane will further reduce blood counts, which will
160424 -            increase risk of shingles recurring. ref SDS 65 OQ3V
160426 -  ..
160427 - More recent study on 081023 reports that Millie required 2 Neupogen
160428 - treatments per week to maintain blood counts for getting chemotherapy
160429 - with Carboplatin. ref SDS 12 QQ8H
160431 -  ..
160432 - The doctor decided to continue Neupogen with only 1 treatment, rather
160433 - than increase this to 2 treatments, despite side effects of Abraxane
160434 - chemotherapy reducing blood counts, reported by Zan in a letter from
160435 - Kaiser on 100219, as reported in Millie's letter to the medical team
160436 - on 100301 0005. ref SDS 63 4R3P  Millie's risk of further infection
160437 - from shingles due to treatment with Abraxane is therefore compounded
160438 - by the recent record of Millie's blood counts starting below the safe
160439 - level for chemotherapy getting both 1 Neupogen treatment, and having a
160440 - week of rest with no chemotherapy following the end of the 3rd cycle
160441 - of Navelbine on 100217.
160442 -
160443 -        [On 100304 2251 Millie's letter to Kaiser confirms that the
160444 -        medical team will approve the 2nd treatment for Millie next
160445 -        Wednesday on 100310, even if blood counts fall further below
160446 -        safe levels and increase Neupogen to increase blood counts.
160447 -        ref SDS 65 OQ4Q
160449 -         ..
160450 -        [On 100309 1643 Millie letter to medical team commends Doctor
160451 -        Johnson for case management because blood counts recover
160452 -        substantially, reversing sudden decline the past 2 weeks;
160453 -        justifies prescription on 100302 for 1 Neupogne teatment,
160454 -        ref SDS 0 FC5U, following the 1st reatment of the 1st cycle for
160455 -        Abraxane chemotherapy. ref SDS 69 2O9P
160457 -  ..
160458 - Doctor Johnson indicated that he will approve Millie for treatment
160459 - again next week, even if her NEUTS falls below 1.0, and in that case
160460 - he would prescribe increasing support from 1 to 2 Neupogen treatments.
160461 -
160462 -
160463 -
1605 -

SUBJECTS
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1703 -
170401 -  ..
170402 - Balance Treatment Shingles and Cancer Requires Targeted Drugs
170403 - Death Risk Increases Pause Treatment Cancer While Treating Shingles
170404 -
170405 - Millie asked about balancing treatment for shingles and cancer, as
170406 - related in her letter yesterday on 100301 0005. ref SDS 63 OP6Q
170408 -  ..
170409 - Doctor Johnson confirmed this morning that treating Millie's cancer
170410 - with Abraxane chemotherapy risks fatal infection from  recurrent
170411 - shingles, because chemotherapy lowers blood counts, which then weaken
170412 - the immune system, as reported in Kaiser's letter dated 100219, on
170413 - side effects, and cited in Millie's letter to the medical team on
170414 - 100301. ref SDS 63 OO6Q
170416 -  ..
170417 - Doctor Johnson advised today that, if shingles recurs again, as
170418 - occurred recently on 100218, Millie will need treatment to recover
170419 - from shingles, which the doctor further noted today will require
170420 - pausing Millie's treatment again to recover for cancer, as was done
170421 - for 4 weeks, beginning on 100112, reported in Millie's letter to the
170422 - team on 100120 0217. ref SDS 52 HL3X
170424 -  ..
170425 - Since Millie has already suffered recurrence of shingles while getting
170426 - chemotherapy Navelbine, the chances another recurrence increase while
170427 - getting another cycle of chemotherapy, based on the sudden drop in
170428 - Millie's blood counts this week, discussed above. ref SDS 0 IC4N
170430 -             ..
170431 -            [On 100304 2251 Millie notifies medical team that Doctor
170432 -            Johnson plans to pause treatment with Abraxane essential
170433 -            for Millie to recover from the 10th relpase of cancer, of
170434 -            Millie suffers recurrence of shingles, and which will
170435 -            require immediediate treatment and recovery before resuming
170436 -            treatment for cancer. ref SDS 65 OQ4T
170437 -
170439 -  ..
170440 - Since Millie's cancer spread rapidly, with CA 15-3 426 more than
170441 - doubling to the highest level in patient history, during the 3-week
170442 - pause for treating shingles, any additional pause at this time
170443 - treating Millie's advancing cancer risks rapid decline to death from
170444 - losing control of her cancer.
170446 -  ..
170447 - This presents a dilemma like the team faced during treatment with
170448 - sunitinib, reported on 081230. ref SDS 18 I87N  At that time, rather
170449 - than increase Neupogen to strengthen the immune system, the team
170450 - paused treatment for cancer.  Pausing treatment, however, lost control
170451 - of cancer, forcing the team into emergency mode, when the cancer
170452 - marker doubled to CA 15-3 303 on 090116, at Kaiser. ref SDS 19 PQTQ
170454 -             ..
170455 -            [On 100305 0822 Millie reports shingles seems better
170456 -            controlled, ref SDS 66 ER95; she is more hopeful about
170457 -            getting through the 1st cycle without needing treatment for
170458 -            shingles, and so able to get 2nd treatment with Abraxane
170459 -            for recovering from 10th relapse of cancer. ref SDS 66 0W3Q
170460 -            Millie asks about prescription for treating shingles to
170461 -            have medication on hand to ensure timely recovery so that
170462 -            treatment for cancer is not interrupted. ref SDS 66 0W3T
170464 -             ..
170465 -            [On 100310 0730 Doctor Johnson visited with Millie in the
170466 -            Oncology Chemotherapy Infusion Clinic and made an
170467 -            examination.  The doctor concurred that shingles subsided,
170468 -            and that blood counts recovered to support getting Millie's
170469 -            2nd treatment with Abraxane, ref SDS 70 OR3H; the doctor
170470 -            did not prescribe treatment for shingles to maintain
170471 -            continuity of treatment for cancer. ref SDS 70 KE9I
170473 -             ..
170474 -            [On 100330 0830 Doctor Johnson examination at Kaiser finds
170475 -            no evidence of shingles recurrence, makes no assessment of
170476 -            the cause for increased pain on the forehead, head, neck,
170477 -            and across the upper back, ref SDS 74 FU5F; and, which was
170478 -            reported to the medical team the day before on 100329,
170479 -            ref SDS 73 WA8Y; the doctor does not extend prescription
170480 -            for Acyclovir (Zovirax) medication to be prepared for
170481 -            recovering from shingles recurrence, ref SDS 74 4E48, which
170482 -            Millie requested on 100305, ref SDS 66 0W3T, and in order
170483 -            to recover from shingles with enough time to maintain
170484 -            continuity of treatment to avoid death by recovering from
170485 -            cancer; instead, additional pain medication was prescribed
170486 -            with morphine. ref SDS 74 FB55
170488 -  ..
170489 - On 090202 Doctor Rugo notified the team to expedite treatment because
170490 - Millie's rapidly declining condition required "urgent" care "quickly."
170491 - ref SDS 22 Y15J  Kaiser immediately made a referral on 090202, for
170492 - UCSF to treat Millie with Hyperthermia and Doxil, reported in the
170493 - record on 090205. ref SDS 24 278T  Three (3) days after Doctor Rugo's
170494 - notice for "urgent" care, on 090205 delay getting treatment caused
170495 - cancer to worsen, most notably in the breastbone area. ref SDS 23 PR5K
170496 - Rapidly advancing cancer required Doctor Hsu to change the UCSF
170497 - treatment plan to radiation with hyperthermia. ref SDS 23 EY5F
170499 -  ..
170500 - Months after completing radiation and hyperthermia on 090317, Doctor
170501 - Hsu reported on 090609 that UCSF made two mistakes that injured
170502 - Millie...
170503 -
170504 -        1.  Cancer in the beastbone with the greatest concentration of
170505 -            IBC nodules, and which therefore required the most
170506 -            treatment, was not treated because radiation zones were
170507 -            layed out incorrectly. ref SDS 34 W65W
170509 -             ..
170510 -        2.  Radiation caused severe pain breathing from injury to the
170511 -            lungs, ref SDS 34 R24G, which was discovered from CT
170512 -            testing on 090413, finding ground glass opacities, and
170513 -            noted by Doctor Rugo on 090514. ref SDS 31 NL9I
170515 -  ..
170516 - As noted, after 8 months and two trips to the Emergency Department for
170517 - treatment of painful breathing, Millie's breathing has finally
170518 - improved the past few months.
170519 -
170520 -
170521 -
170522 -
170523 -
1706 -

SUBJECTS
Default Null Subject Account for Blank Record

1803 -
180401 -  ..
180402 - Targeted Treatment Avoids Weakening Immune System
180403 - Bone Marrow Immune System Not Degraded with Targeted Cancer Agents
180404 - Cancer Shingles Concurrent Recovery Requires Targeted Cancer Treatment
180405 -
180406 - Doctor Johnson said the only way for Millie to get treatment for both
180407 - cancer and shingles concurrently to maintain continunity of cancer
180408 - treatments and avoid exposure to fatal infection is to switch from
180409 - chemotherapy to prescribe agents, like PARP, targeted to the genetic
180410 - profile of cancer, because "targeted" cancer treatments, like
180411 - cetuximab and sunitinib, do not reduce bone marrow production that
180412 - replenishes blood counts.
180414 -  ..
180415 - PARP was cited by Doctor Rugo on 090616, as having been agreed with
180416 - Kaiser for Millie's next "targeted" treatment for Millie at UCSF after
180417 - starting with MPA to recover from cancer spreading due to UCSF medical
180418 - mistakes providing radiation services on referral from Kaiser.
180419 - ref SDS 35 KD6L  On 090716, UCSF ended MPA on 090716, and said PARP
180420 - would not be ready until September. ref SDS 36 EE6P  In September,
180421 - Doctor Johnson said UCSF had not contacted him about Millie starting
180422 - PARP.  On 090909, Doctor Johnson planned to invest time prescribing
180423 - "targeted" treatment for Millie to recover from UCSF medical mistakes.
180424 - ref SDS 38 3P4G
180426 -  ..
180427 - On 100108, Doctor Johnson submitted a letter he received from Doctor
180428 - Rugo's office worrying that treating Millie with PARP at UCSF was
180429 - complicated by Millie's prior treatment with Carboplatin. ref SDS 49
180430 - FM5I  Review showed that Doctor Rugo has doctor discretion for medical
180431 - necessity to resolve complications and provide essential care in time
180432 - to be effective.  UCSF can therefore provide PARP as necessary and
180433 - reasonable care for Millie to recover from cancer spreading due to
180434 - UCSF medical mistakes. ref SDS 49 WO9J  Millie's letter to the medical
180435 - team on 100112, requests medical services with PARP or equal to
180436 - recover from UCSF medical mistakes. ref SDS 50 IS5V
180438 -  ..
180439 - During the meeting at Kaiser on 100112, Doctor Johnson reviewed PARP,
180440 - and expressed high hopes that PARP will be effective for Millie,
180441 - because PARP is targeted to Millie's triple negative patient profile.
180442 - At that time, on 100112, Doctor Johnson called for Doctor Rugo at UCSF
180443 - to start Millie on PARP; he reported that Millie's treatment for
180444 - cancer with chemotherapy had to be paused to avoid risk of fatal
180445 - infection from shingles, because Doctor Rugo did not have time to
180446 - return his call on scheduling treatment with PARP that does not cause
180447 - any risk of fatal infections. ref SDS 51 OJ8G
180449 -  ..
180450 - Doctor Johnson's review on 100112, indicates PARP treatment targeted
180451 - to cancer, can be equal or better than results achieved for Millie
180452 - with cetuximab.  Millie confirmed these understanings in a letter to
180453 - the medical team requesting treatment with PARP to extend benefits of
180454 - prior treatment with cetuximab, reported on 100120 0217. ref SDS 52
180455 - HL7Y ref SDS 52 HL7Y
180457 -  ..
180458 - Doctor Johnson advised this morning that Doctor Rugo has still not had
180459 - time to return his calls on Millie starting treatment with PARP at
180460 - UCSF in order to recover from cancer spreading due to UCSF medical
180461 - mistakes.
180463 -  ..
180464 - Experience treating Millie for nearly 2 years with cetuximab shows
180465 - that targeted therapies control cancer without oncerous side effects.
180466 - This reduces pain in two (2) ways:  (1) preventing spread of cancer
180467 - prevents pain from rising cancer; and (2) treatment "targeted" to
180468 - cancer does not destroy blood cells, and so avoids pain from Neupogen
180469 - treatments to maintain the immune system, essential for survival, by
180470 - recovering from low blood counts caused by general chemotherapy agents
180471 - like Abraxane (see discussion above.
180472 -
180473 -            [On 100330 0830 doctor worried about Millie's rising pain
180474 -            from cancer spreading for 6 months during treatments with
180475 -            chemotherapy, and requiring Neupogen treatment needed to
180476 -            replenish blood cells destroyed by chemotherapy, and which
180477 -            causes additional pain, ref SDS 74 SM3L; prescribes more
180478 -            chemotherapy, ref SDS 74 FB67, adds morphine medication to
180479 -            mask pain, rather than prescribe therapy "targeted" to
180480 -            Millie's patient profile to eliminate pain by destroying
180481 -            cancer cells, and eliminating need for Neupogen.
180482 -            ref SDS 74 QX3K
180484 -             ..
180485 -            [On 100427 0830 Doctor Johnson reported Millie's cancer has
180486 -            mutated to resist chemotherapy, and so she needs a new
180487 -            strategy to treat her cancer as a chronic disease with
180488 -            therapy targeted to her patient profile. ref SDS 75 SJ6N
180489 -            Aligns with Doctor Johnson's review today of PARP targeted
180490 -            to Millie's triple negative status, reported on 100112
180491 -            0830, ref SDS 51 N586
180493 -  ..
180494 - Case study on Millie's patient history shows that treatments with
180495 - cetuximab and sunitinib were never paused due to low blood counts,
180496 - reported on 081205. ref SDS 15 EC5N
180497 -
180498 -            [On 100304 2251 Millie asks the medical team again to
180499 -            submit analysis of trade-offs for treatments "targeted" to
180500 -            Millie's patient profile which do not injure the bone
180501 -            marrow, and so reduce recurrence of shingles, and permit
180502 -            concurrent treatment with cancer and shingles, in the event
180503 -            that shingles does recur. ref SDS 65 OQ4Y
180505 -  ..
180506 - Accordingly, Kaiser and UCSF play "Russian Roulette" giving treatment
180507 - that is known to weaken the immune system, and thereby cause fatal
180508 - infection with shingles, diagnosed on 100104, ref SDS 47 PS49, and
180509 - which in turn can only be treated by stopping treatment for cancer at
180510 - a time when the cancer marker has exploded to the highest level in 9
180511 - years, reflecting the doctor's determination today that Millie's
180512 - cancer is spreading at record levels for her patient history.
180513 - ref SDS 0 FB9Y
180515 -             ..
180516 -            [On 100319 0843 Millie's letter to medical team reports
180517 -            initial recovery from 10th relapse after 2 treatments with
180518 -            Abraxane gives time to complete review and compare
180519 -            trade-offs for alternative oncology treatments in time for
180520 -            Millie to recover from the 11th relapse by treating
180521 -            Millie's cancer as a chronic disease. ref SDS 72 1T5V
180522 -
180523 -
1806 -

SUBJECTS
Default Null Subject Account for Blank Record

1903 -
190401 -  ..
190402 - Evidence-based Health Care Requires Trade-offs Balancing Risks
190403 - Due Process Life Threating Diseases Evidence-based Medical Practice
190404 - Targeted Treatment for Cancer Not Enough Time Present Trade-offs
190405 -
190406 - The doctor did not have enough time today to present Kaiser's work
190407 - plan for switching treatment to a targeted drug, requested in Millie's
190408 - letter to the medical team on 100301 0005, ref SDS 63 OP6V, and in the
190409 - event that shingles recurs, and requires stopping chemotherapy with
190410 - Abraxane.
190412 -  ..
190413 - Millie's letter on 100301 requested standard of care for
190414 - evidenced-based medical practice, required by Kaiser's policies,
190415 - reported on 090520 1153, ref SDS 32 4M9G, requires good-faith
190416 - performance of due process determining trade-offs for alternative
190417 - treatment modalities that extend life with a quality that makes life
190418 - worthwhile. ref SDS 63 OO8U
190420 -  ..
190421 - Millie suffers increased exposure to danger of losing her life because
190422 - Kaiser has failed to provide due process presenting trade-offs for the
190423 - patient to choose treatment that can be effective for both shingles
190424 - and cancer in time to be effective, as called out in for standard of
190425 - care, reviewed in the letter to the medical team on 090725 2017.
190426 - ref SDS 37 T58U
190428 -  ..
190429 - Millie has been patient reminding the team to provide due process for
190430 - standard of care comparing treatments for effectiveness, side effects,
190431 - and cost, shown in the case study on 090725 2017. ref SDS 37 X66O
190432 -
190433 -            [On 100304 2251 Millie asks the medical team again to
190434 -            submit analysis of trade-offs for treatments "targeted" to
190435 -            Millie's patient profile which do not injure the bone
190436 -            marrow, and so reduce recurrence of shingles, and permit
190437 -            concurrent treatment with cancer and shingles, in the event
190438 -            that shingles does recur. ref SDS 65 OQ4Y
190440 -             ..
190441 -            [On 100305 0822 Millie asks medical team again to submit
190442 -            analysis of trade-offs for treatments "targeted" to
190443 -            Millie's patient profile that do not degrade bone marrow,
190444 -            and so reduce risk of shingles recurrence, and in any event
190445 -            can be given concurrently with treatment for shingles if
190446 -            this disease does recur. ref SDS 66 0W3W
190448 -             ..
190449 -            [On 100319 0843 Millie's letter to medical team reports
190450 -            initial recovery from 10th relapse after 2 treatments with
190451 -            Abraxane gives time to complete review and compare
190452 -            trade-offs for alternative oncology treatments in time for
190453 -            Millie to recover from the 11th relapse by treating
190454 -            Millie's cancer as a chronic disease. ref SDS 72 1T5V
190455 -
190456 -
190457 -
1905 -

SUBJECTS
Default Null Subject Account for Blank Record

2003 -
200401 -  ..
200402 - Securemail Not Submitted for Patient Review
200403 -
200404 - Doctor Johnson did not submit the content of a "securemail" received
200405 - on 100208, and reported to the medical team that this has content
200406 - could not be accessed, reported also in the letter to the team on
200407 - 100301 0005. ref SDS 63 OP7T
200408 -
200409 -        [On 100309 1238 Millie's letter notifies the medical team that
200410 -        Kaiser's letter submitted on 100208 has still not been
200411 -        received. ref SDS 68 HL5R
200413 -         ..
200414 -        [On 100309 1238 Millie requests documentation for approving
200415 -        communication, including confidential information, using the
200416 -        domestic email addresses at Kaiser, and in order to provide
200417 -        timely, accurate coordination among the doctors collaborating
200418 -        to provid Millie's health care. ref SDS 68 HL6R
200419 -
200420 -
200421 -
200422 -
2005 -

SUBJECTS
Default Null Subject Account for Blank Record

2103 -
210401 -  ..
210402 - Authorization Blood Draws Power Port Primary Care Physician
210403 - Power Port Blood Draws Authorization Primary Care Physician
210404 - Blood Draws Power Port Authorization Primary Care Physician
210405 -
210406 - Doctor Johnson did not have time today to prepare instructions to the
210407 - Oncology Chemotherapy Infusion Clinic at Kaiser's Walnut Creek office
210408 - to perform blood draws using Millie's Power Port, and in order to
210409 - provide timely care required for Millie's patient profile, and
210410 - requested in Millie's letter to the medical team on 100301 0005.
210411 - ref SDS 63 OP5T
210412 -
210413 -
210414 -
2105 -

SUBJECTS
Default Null Subject Account for Blank Record

2203 -
220401 -  ..
220402 - Kaiser's Medical Chart Knowledge Management System
220403 -
220405 -  ..
220406 - Late this evening Millie tried to access Kaiser's medical chart for
220407 - Doctor Johnson's report on the meeting today.
220409 -  ..
220410 - Got a message saying the system is temporarily out of service for
220411 - repairs or improvement.
220413 -  ..
220414 - Finally access to Kaiser's Knowledge Management system was restored OA
220415 - 100315, using an alternate URL address provided in a letter from
220416 - Kaiser.  Was able to retrieve the doctor's report in the medical chart
220417 - for the meeting at Kaiser today.
220418 -
220419 -    1.  Received: 3/2/10 9:32 AM
220420 -
220421 -        Subject:  Visit 03/03/10
220429 -         ..
220430 -        Patient presents with: RECHECK
220431 -
220433 -         ..
220434 -        History of Present Illness:
220435 -
220436 -        Follow up
220437 -
220439 -        The patient is a 74 Y female with a history of IBC of left
220440 -        breast who was initially diagnosed 03/04/02.  S/P AC x's 4 from
220441 -        04/23/02 through 07/01/02 followed by Taxotere ending 12/04/02.
220442 -        She had recurrent disease noted initially in the cervical LN's
220443 -        03/03/04.  On E2100 Study with Taxol/Avastin, but she had a PE
220444 -        noted on CT 11/03/2004.  Then, because of progression of
220445 -        disease, the patient was started on Taxotere and Xeloda
220446 -        4/15/05.  She had a total of 8 cycles ending 9/16/05.  She had
220447 -        a palliative left mastectomy performed 10/21/05.  Then her left
220448 -        chest lesions began expanding again.  The patient started
220449 -        Taxotere and Xeloda again 07/21/06 for 7 cycles.  She was
220450 -        started on a Clinical Trial 02/01/07 at UCSF and was randomized
220451 -        to the Erbitux only (no Carbo) Arm.  She had weekly Carboplatin
220452 -        added 03/13/08 because of progression of disease.  Her disease
220453 -        progressed again and she began a Phase I/II Study of Sunitinib
220454 -        (SU11248) at UCSF 11/14/08.  Lengthy discussion about current
220455 -        status and response to therapy.  Because of cytopenias, MTX to
220456 -        be D/C'd and Sutent and CTX held and then dose reduced.  The
220457 -        patient started hyperthermia/XRT at UCSF 02/19/09 and completed
220458 -        it 03/17/09.  She has started the MPA Clinical Trial at UCSF
220459 -        06/16/09 but this has been D/C'd.  She started Gemzar 07/28/09
220460 -        and received Cycle #4 11/05/09.  Because of evidence of
220461 -        progression she was switched to Navelbine 11/18/09.  She states
220462 -        that her lymphedema bilaterally is improved.  Percocet alone is
220463 -        helping pain.  She developed a rash on her right forehead the
220464 -        first of the year which was shingles.  She continues taking
220465 -        Acyclovir and Prednisone.  She was seen by Ophthalmology
220466 -        01/11/10 and her eyes are fine.  She feels much better with
220467 -        less DOE.  However, erythema and nodularity have moved to her
220468 -        right breast.  Her 2nd exacerbation of shingles have now
220469 -        subsided.
220471 -         ..
220472 -    2.  Current medications:
220473 -
220474 -        HYDROCODONE/ACETAMINOPH 5-5
220475 -        WARFARIN 4 MG TABLETS
220476 -        LUMIGAN 0.03% EYE DROPS (2.
220477 -        TIMOLOL MALEATE 0.5% EYE DR
220478 -        OXYCODONE W/APAP 5-325 MG T
220479 -        AEROCHAMBER Z-STAT/PLUS W/O
220480 -        QVAR 80 MCG ORAL INHALER
220481 -        ALBUTEROL HFA 90MCG ORAL IN
220482 -        GUAIFEN/CODEIN 100-10MG/5ML
220483 -        LORAZEPAM 1 MG TABLETS
220485 -         ..
220486 -    3.  Review of systems:
220487 -
220488 -        Follow up
220489 -
220490 -        a.  Constitutional: Appetite and energy level are improving.
220491 -            Plans on taking trip to the Mediterranean in May; 12 day
220492 -            cruise
220494 -             ..
220495 -        b.  Eyes: Seen by Ophthalmology 01/11/10; no evidence of ocular
220496 -            involvement with shingles
220498 -             ..
220499 -        c.  ENT: No nose bleeds.
220501 -             ..
220502 -        d.  Cardiovascular: No SOB, palpitations or chest pain
220504 -             ..
220505 -        e.  Respiratory: No hemoptysis or cough. Some DOE noted
220506 -            GI: No nausea, vomiting or diarrhea
220507 -            GU: No hematuria or dysuria
220509 -             ..
220510 -        f.  Musculoskeletal: Left neck spasm and right shoulder pain
220511 -            stable with Robaxin
220513 -             ..
220514 -        g.  Skin: Pruritis of chest wall resolved
220516 -             ..
220517 -        h.  Neurological: No confusion, sensory changes or motor
220518 -            weakness
220520 -             ..
220521 -        i.  Psychiatric: Anxious
220522 -
220524 -         ..
220525 -        Physical Exam:
220526 -
220527 -        Follow up
220528 -
220529 -        a.  ECOG Performance Score 0
220530 -
220531 -        b.  BP 119/76
220532 -            Pulse 77
220533 -            Temp (Src) 98.6 øF (37 øC) (Oral)
220534 -            Wt 136 lb 6.4 oz (61.871 kg)
220535 -            SpO2 98%
220537 -             ..
220538 -        c.  Head: shingles right side of forehead largely gone
220540 -             ..
220541 -        d.  Eyes: normal conjunctiva
220543 -             ..
220544 -        e.  Mouth: normal mucosa
220546 -             ..
220547 -        f.  Lymph: no nodes palpable in neck or axillae
220549 -             ..
220550 -        g.  Breasts: evidence of erythema to other breast. Less edema
220551 -            in both arms
220553 -             ..
220554 -        h.  Lungs: clear to percussion and auscultation
220556 -             ..
220557 -        i.  Heart: regular without murmur or gallop
220559 -             ..
220560 -        j.  Abd: soft with normal bowel sounds. No masses or
220561 -            organomegaly
220563 -             ..
220564 -        k.  Ext: Edema increasing in both arms now
220566 -             ..
220567 -        l.  Bones: no tenderness
220569 -             ..
220570 -        m.  Neuro: awake, alert, and oriented. Moves all extremities
220571 -            well. Normal gait.
220573 -         ..
220574 -    4.  Lab:
220575 -
220576 -        Follow up
220577 -
220578 -        Creatinine 0.66 mg/dL
220579 -        ALT (SGPT) 33 U/L
220581 -         ..
220582 -        Anticoag Ther? WARFARIN
220583 -        PT, Patient H 18.1 Sec
220584 -        PT INR 1.8 Ratio
220586 -         ..
220587 -        WBC 4.0 K/uL
220588 -        RBC 4.05 M/uL
220589 -        Hemoglobin 12.1 g/dL
220590 -        Hematocrit 36.7 %
220591 -        MCV 91 fL
220592 -        RDW H 20.5 %
220593 -        Plt H 454 K/uL
220595 -         ..
220596 -        CA 15-3
220597 -        -----------------------------------
220598 -        02/16/10 10:58 | 328 H
220599 -        02/02/10 10:15 | 275 H
220600 -        01/11/10 10:47 | 212 H
220601 -        12/22/09 09:44 | 248 H
220602 -        12/15/09 08:50 | 211 H
220603 -        11/24/09 09:30 | 262 H
220604 -        11/03/09 08:40 | 299 H
220605 -        10/20/09 10:44 | 299 H
220606 -        10/06/09 09:15 | 343 H
220607 -        09/29/09 09:45 | 297 H
220608 -        09/21/09 05:35 | 302 H
220609 -        09/08/09 12:29 | 346 H
220610 -        08/25/09 10:13 | 335 H
220611 -        08/10/09 10:59 | 350 ?
220613 -         ..
220614 -    5.  Imaging:
220615 -
220616 -
220617 -        1.  02/18/10 CT THORAX W CONTRAST - received on 100228 2216.
220618 -            ref SDS 62 GU5L
220619 -
220620 -            a.  Mild interval improvement of the patchy ground glass
220621 -                opacities bilaterally.  There are still a few patchy
220622 -                densities noted predominantly in the bilateral lung
220623 -                bases.  [...Doctor Johnson quotes from test summary in
220624 -                the Impression section, 100228 2216, ref SDS 62
220625 -                IN6I...]
220627 -                 ..
220628 -            b.  New area of subsegmental atelectasis vs
220629 -                post-inflammatory scarring right upper lobe.
220631 -                 ..
220632 -            c.  Resolution of small left pleural effusion.
220634 -             ..
220635 -        2.  01/19/10 MRI BRAIN WO/W CONTRAST(STD) -
220636 -
220637 -            No significant abnormalities.
220639 -             ..
220640 -            09/19/09 CT THORAX W CONTRAST -
220641 -
220642 -            a.  No pulmonary emboli on a technically good study.
220643 -
220644 -            b.  The lungs show multiple areas of groundglass opacity
220645 -                and multiple small areas of more confluent density.
220647 -                 ..
220648 -            c.  Tiny left pleural effusion.
220650 -                 ..
220651 -            d.  S/P left mastectomy.
220653 -                 ..
220654 -            e.  A few additional minor findings, as described above.
220656 -                 ..
220657 -            f.  Since July 20, 2009 CT scan of the chest, there has
220658 -                been resolution of many of the pulmonary opacities but
220659 -                there are now many new ones, especially in the left
220660 -                lower lobe and in the right upper lobe.  The left
220661 -                pleural effusion is much smaller.  Otherwise, no
220662 -                change.
220664 -             ..
220665 -        3.  09/19/09 CHEST, SINGLE
220667 -             ..
220668 -        4.  07/31/09 RIBS, UNILATERAL, 2 VIEWS -
220669 -
220670 -            Right ribs appear intact
220672 -             ..
220673 -        5.  07/20/09 CT THORAX W CONTRAST -
220674 -
220675 -            a.  Negative for pulmonary embolus.
220676 -
220677 -            b.  New small left pleural effusion.  No pleural
220678 -                enhancement or evidence of loculation.
220680 -                 ..
220681 -            c.  Otherwise stable chest CT compared with recent
220682 -                examination from one month earlier.
220684 -             ..
220685 -        6.  06/12/09 CT THORAX, ABDOMEN, PELVIS W CONTRAST
220687 -             ..
220688 -        7.  06/12/09 CT NECK W CONTRAST
220690 -             ..
220691 -        8.  03/17/09 DXA BONE DENSITY, AXIAL -
220692 -
220693 -            a.  Bone mineral density calculated for the LUMBAR SPINE
220694 -                is statistically consistent with osteopenia.
220695 -
220696 -            b.  Bone mineral density calculated for the TOTAL HIP is
220697 -                statistically consistent with osteopenia.
220699 -             ..
220700 -        9.  01/22/09 SHOULDER, COMPLETE 2+ VIEWS -
220702 -             ..
220703 -            Orthopedic follow up.  See Orthopedic note for details.
220704 -            S/P reduction of anterior shoulder dislocation.
220706 -             ..
220707 -       10.  01/22/09 SHOULDER, ONE VIEW -
220708 -
220709 -            Dislocation, right shoulder.  Fracture right humeral head
220711 -             ..
220712 -       11.  01/22/09 CT CERV SPINE W/O CONTRAST -
220714 -             ..
220715 -            Degenerative changes of the cervical spine without evidence
220716 -            of acute C spine fracture or loss in alignment.
220718 -             ..
220719 -       12.  01/22/09 CT HEAD W/O CONTRAST -
220720 -
220721 -            a. No evidence of acute infarct or hemorrhage.
220722 -
220723 -            b. Sinus disease. Mild nasal septal deviation to the right.
220725 -         ..
220726 -    6.  Assessment:
220727 -
220728 -        Follow up
220729 -
220730 -        1.  Shingles exacerbation; improved but has mild neuropathy
220731 -
220732 -        2.  Metastatic breast cancer (IBC) lung, lymph node and chest
220733 -            wall; CT stable
220735 -             ..
220736 -        3.  Anemia due to chemotherapy
220738 -             ..
220739 -        4.  Cancer pain mild (left anterior chest wall and LUE pain)
220740 -            and improved on Percocet
220742 -             ..
220743 -        5.  Lymphedema slightly worse
220744 -
220746 -         ..
220747 -    7.  Plan:
220748 -
220749 -        Follow up
220750 -
220751 -        1.  D/C Navelbine
220752 -
220753 -        2.  Switch to Abraxane 100 mg/m2 or 150 mg/m2 iv qw x 3 weeks
220754 -            every 4 weeks; to start 03/03/10
220756 -             ..
220757 -        3.  Continue serial CA 15-3's
220758 -        4.  POLST completed
220759 -        5.  AD (Advance Directive) obtained
220760 -        6.  RTC one month
220761 -
220764 -
220765 -
220766 -
220767 -
220768 -
2208 -