CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 21 0000. ref SDS 18 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 5 G68H, while Millie was
040903 - treated to recover from a very severe case of shingles infection,
040904 - reported earlier on 100104 1115. ref SDS 4 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 8 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 8 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 8 023N   The doctor further ordered a CT
040923 - test to evaluate rising pain. ref SDS 8 ES40
040925 -  ..
040926 - On 100218 1230 Millie had emergency CT test. ref SDS 8 PQ6R
040928 -  ..
040929 - On 100301 0005 letter to medical team cites findings of "improvement"
040930 - reported in CT test on 100218, and increased energy may indicate
040931 - Navelbine can continue another cycle. ref SDS 9 ER95  Cancer marker CA
040932 - 15-3 328 suddenly increasing more than 100 points in a month, reflects
040933 - 3-week pause in treatment for cancer, orderd by the doctor as
040934 - necessary to treat shingles. ref SDS 9 OO3X  The doctor prescribed
040935 - Abraxane to start the next cycle of chemotherapry to recover from the
040936 - 10th relapse of cancer; Millie is concerned about side effects.
040937 - ref SDS 9 OO4Q  Chemotherapy is not appropriate care for treating
040938 - stage V cancer. ref SDS 9 OO7Q  Millie needs another cetuximab
040939 - solution "targeted" to her patient profile to recover from cancer
040940 - without severe side effects. ref SDS 9 4Y6K  Millie requests
040941 - explanation in writing of trade-offs comparing alternate oncology
040942 - treatments. ref SDS 9 OO7T  Millie notifies Kaiser that
040943 - representations in the medical chart for the meeting on 091116 that
040944 - the doctor explained trade-offs is incorrect. ref SDS 9 OO9S  Millie
040945 - notes that advantage of "targeted" treatments for cancer enables
040946 - concurrent treatment for recurrent shingles, rather than pausing,
040947 - which causes cancer to rapidly increase. ref SDS 9 OP6Q
040949 -  ..
040950 - On 100302 0830 meeting at Kaiser, ref SDS 10 ER95; Doctor Johnson
040951 - prescribed Abraxane for Millie starting treatment tomorrow for
040952 - recovering from 10th relapse of cancer. ref SDS 10 FB67  Blood counts
040953 - dropped significantly, ref SDS 10 IC4N; since Abraxane side effects
040954 - reduce blood counts this increases chances of shingles recurrence; the
040955 - doctor advised that treatment for cancer will be paused again, if
040956 - shingles recurs. ref SDS 10 FC68  Only way for Millie to get treatment
040957 - for shinges concurrent with cancer is to switch from Abraxane to a
040958 - "targeted" treatment for cancer that does not injure bone marrow
040959 - producing blood. ref SDS 10 IC85
040961 -  ..
040962 - On 100303 0730 Millie received 1st treatment 1st cycle Abraxane at
040963 - Kaiser Oncology Chemotherapy Clinic in Walnut Creek. ref SDS 11 625I
040965 -  ..
040966 - On 100304 2251 Millie notifies medical team that 1st treatment of 1st
040967 - cycle started with Abraxane to recover from 10th relapse of cancer.
040968 - ref SDS 12 ER95  Reports possible recurrence of shingles. ref SDS 12
040969 - OP6W  Millie asks Kaiser for written report on trade-offs for
040970 - prescribing agents "targeted" to treat her cancer that do no injure
040971 - the bone marrow producing new blood. ref SDS 12 OQ4Y
040973 -  ..
040974 - On 100305 0822 Millie notifies medical team that shingles seems to
040975 - have subsided again, so that treatment with Abraxane can continue.
040976 - ref SDS 13 ER95  Millie requests prescription for medication to have
040977 - available in time to treat shingles recurrence so that treatment for
040978 - cancer can continue. ref SDS 13 0W3T  Millie further requests that the
040979 - medical team submit analysis of trade-offs for alternative oncologic
040980 - treatments. ref SDS 13 0W3W
040982 -  ..
040983 - On 100309 1238 Millie notifies medical team that shingles seems not to
040984 - have recurred despite side effects of Abraxane that lower immunity by
040985 - degrading bone marrow that replenishes blood counts. ref SDS 14 ER95
040987 -  ..
040988 - On 100309 1238 Millie notifies medical team that Kaiser's Knowledge
040989 - Management system is off-line, and so requests results of blood test
040990 - to evaluate getting treatment with Abraxane chemotherapy tomorrow for
040991 - recovering from cancer. ref SDS 14 HL4V
040993 -  ..
040994 - On 100309 1643 Millie notifies medical team that results of lab today
040995 - show "good-to-go" for getting 2nd Abraxane treatment tomorrow.
040996 - ref SDS 15 ER95
040998 -  ..
040999 - On 100310 0730 Millie gets 2nd treatment 1st cycle of Abraxane to
041000 - recover from 10th relapse of cancer. ref SDS 16 KE4K; Doctor Johnson
041001 - visits Millie at 0810, during treatment, and approves getting
041002 - treatment. ref SDS 16 OR3H
041004 -  ..
041005 - On 100310 1350 Millie thanks Doctor Johnson for visiting during
041006 - treatment today, ref SDS 17 ER95; notifies medical team that Kaiser
041007 - completed the 2nd treatment of the 1st cycle with Abraxane for
041008 - recovering from the 10th relapse of cancer. ref SDS 17 ER95  Doctor
041009 - Johnson advised that Kaiser's Knowledge Management internal email
041010 - system makes communication faster for emergency communications on
041011 - patient care. ref SDS 17 GY4U  Millie reported that Kaiser's Knowledge
041012 - Management system has been off-line for more than a week. ref SDS 17
041013 - GY4X; Millie explains that public domain email addresses for doctors
041014 - at Kaiser enable comprehensive care that optimizes patient outcome,
041015 - even though it may be a little slower for emergencies. ref SDS 17 GY6P
041016 - Millie will continue to support the medical team through continuity of
041017 - communications for the doctor/patient partnership. ref SDS 17 GZ3U
041019 -  ..
041020 - On 100311 0811 Doctor Johnson's letter dated 100310 said Millie may
041021 - need to get a new password. ref SDS 18 ER95
041023 -  ..
041024 - On 100316 Millie went to Kaiser in Martinez for weekly blood draw to
041025 - test immune system to evaluate starting 2nd treatment for 3rd cycle of
041026 - Navelbine, and how much Nupigen treatment is needed to maintain blood
041027 - counts. ref SDS 19 AS5H  Also testing INR 3.2 again, which was still
041028 - slightly high for interim blood test on 100205. ref SDS 7 IS7Q
041030 -  ..
041031 - On 100317 0730 Millie received the 3rd treatment that completes the
041032 - 1st cycle with Abraxane to recover from the 10th relapse of cancer.
041033 - At this time, Millie is experiencing rising pain from progressing IBC,
041034 - and rising lymphedema, most noticably in the right arm, which has been
041035 - free of disease for 10 years. ref SDS 20 KE4K
041037 -  ..
041038 - On 100319 0843 Millie notfies medical team that 1st cycle with
041039 - Abraxane chemotherapy was completed on 100317, and that she needs
041040 - dental work, which she will try to schedule for next week, which is
041041 - the bye-week for chemotherapy. ref SDS 21 ER95  Evident improvment in
041042 - cancer marker aligns with some initial reduction in IBC rash, which
041043 - together signal recovery from 10th relapse of cancer. ref SDS 21 1T3Y
041044 - Avoiding recurrence of shingles and avoiding drop in blood counts
041045 - supports the medical team treating Millie's cancer as a chronic
041046 - disease, planned by Doctor Rugo. ref SDS 21 1T4U
041048 -  ..
041049 - On 100329 2322 Millie sent a letter notifying the medical team of
041050 - agenda for meeting at Kaiser tomorrow morning at 0830 with primary
041051 - care physician and for the purpose of evaluating continuing treatment
041052 - for a 2nd cycle with Abraxane chemotherapy, and comparing trade-offs
041053 - of alternate oncology treatments for recovering from the next relapse
041054 - of cancer. ref SDS 0 ER95
041055 -
041056 -
041058 -  ..
0411 -
0412 -
0413 - Progress
0414 -
041401 - Millie's letter to medical team says...
041402 -
041403 -    1.  Subject: Agenda Meeting at Kaiser Start Abraxane 2nd Cycle 10th Relapse Cancer
041404 -        Date: Mon, 29 Mar 2010 23:58:20 -0700
041417 -         ..
041418 -    2.  We are meeting in the morning to evaluate starting 2nd cycle
041419 -        with Abraxane to recover from the 10th relapse of cancer.
041420 -
041421 -            [On 100330 0830 during the meeting at Kaiser Doctor Johnson
041422 -            advised that he received and read Millie's letter today
041423 -            submitting an agenda of issues for review to approve Millie
041424 -            starting the 2nd cycle of chemotherapy. ref SDS 23 ER95
041426 -         ..
041427 -    3.  Initial results from the lab today show NEUTS (ANC) 3.2 within
041428 -        the range 2.1 - 7.7 specified for safe chemotherapy, and well
041429 -        above the minimum used in my case of 1.0 for approving
041430 -        chemotherapy [...which was a major concern starting Abraxane,
041431 -        because chemotherapy lowers blood counts, and Millie's blood
041432 -        counts were below the level for safe chemotherapy on 100302
041433 -        0830. ref SDS 10 FC68; but, the next lab showed dramatic
041434 -        recovery of blood counts a week after the first treatment with
041435 -        Abraxane, reported on 100309 1643. ref SDS 15 2O8W...]
041437 -         ..
041438 -    4.  I don't have a strong sense of recovery as yet, in that
041439 -        reduction of IBC rash seems significant some days, and at
041440 -        different times of the day, but not sure on other days.
041442 -         ..
041443 -    5.  Similarly, lymphedema in the left arm and across my chest seems
041444 -        less, but not sure.
041445 -
041446 -            [On 100330 0830 Doctor Johnson finds during examination at
041447 -            Kaiser that first cycle of treatment with Abraxane has
041448 -            reduced Millie's cancer, ref SDS 23 FB9Y, including "drying
041449 -            up" of IBC nodules. ref SDS 23 HR9K, and, so orders
041450 -            starting 2nd cycle of Abraxane of 100303. ref SDS 23 FB67
041452 -         ..
041453 -    6.  Lymphedema has increased in the right arm, which requires
041454 -        taking blood pressure and heart rate from my lower leg
041455 -        (reported by Anne in the Chemotherapy Clinic on 100317 0730.
041456 -        ref SDS 20 QR4X], and requires drawing blood from the Power
041457 -        Port, rather than using the arms [... Millie requested support
041458 -        from the doctor to assist the Chemotherapy Clinic balance
041459 -        conflicting protocols in favor of patient safety to draw blood
041460 -        for lab tests from the Power Port, reported on 100204 1325.
041461 -        ref SDS 6 SB8U...]
041463 -             ..
041464 -            [On 100330 0830 Doctor Johnson again observed rising
041465 -            lymphedema in Millie's right arm, signaling beginning of
041466 -            IBC, and which Kaiser protocol prevents needle penetrations
041467 -            for blood draws, taking blood pressure on the right arm, as
041468 -            well as the left arm. ref SDS 23 C54N
041470 -             ..
041471 -            [On 100427 0830, during examination at Kaiser Doctor
041472 -            Johnson entered in Millie's medical chart work plan
041473 -            instruction to use Power Port for blood draws due to
041474 -            bilateral lymphedema. ref SDS 24 X74Q
041476 -         ..
041477 -    7.  Since the cancer marker CA 15-3 369 dropped significantly from
041478 -        426 for the blood test 2 weeks ago, which was after the 2nd
041479 -        treatment with Abraxane [reported in Millie's letter to the
041480 -        medical team on 100319 0843, ref SDS 21 1T3Y], I am hopeful for
041481 -        further decline after the 3rd treatment of the 1st cycle, and
041482 -        which will be reported possibly tomorrow afternoon, or
041483 -        Wednesday for the lab today.
041484 -
041485 -            [On 100330 0830 Doctor Johnson finds during examination at
041486 -            Kaiser that first cycle of treatment with Abraxane has
041487 -            reduced Millie's cancer, ref SDS 23 FB9Y, including "drying
041488 -            up" of IBC nodules. ref SDS 23 HR9K, and, so orders
041489 -            starting 2nd cycle of Abraxane of 100303. ref SDS 23 FB67
041491 -         ..
041492 -    8.  Energy declined and pain increased during last week, which was
041493 -        the "bye-week" when no chemotherapy was given.  Spent a good
041494 -        deal of time in bed [reflecting concerns in the letter to the
041495 -        medical team on 100301 0005. ref SDS 9 OO4Y].  On several days
041496 -        had to increase Percocet (oxycodone) to 2-pills every 3 hours
041497 -        from original prescription for 1 every 4 hours, and based on
041498 -        your approval several cycles ago.  Thanks very much for
041499 -        approving refill for Percocet last Friday.  This ensured I
041500 -        would have pain medication over the weekend.
041502 -         ..
041503 -    9.  Pain persists on my right forehead, head, and now has
041504 -        progressed down my neck to across my upper back.  Hopefully,
041505 -        this is not shingles related.  My forehead at least does not
041506 -        show shingles blisters.
041507 -
041508 -            [On 100330 0830 Doctor Johnson examination finds no
041509 -            evidence of shingles recurrence, makes no assessment of the
041510 -            cause for increased pain on the forehead, head, neck, and
041511 -            across the upper back, ref SDS 23 FU5F, which was reported
041512 -            to the medical team the day before on 100329, ref SDS 0
041513 -            WA8Y; the doctor does not extend prescription for Acyclovir
041514 -            (Zovirax) medication to be prepared for shingles
041515 -            recurrence, requested on 100305, ref SDS 13 0W3T, and
041516 -            rather than prescribe treatment targeted to Millie's
041517 -            cancer, and which does not cause painful side effects, and
041518 -            does not require Neupogen to recover blood counts, the
041519 -            doctor prescribed additional pain medication with morphine,
041520 -            which Millie can supplement with Percocet to treat
041521 -            "breakthrough pain" from rising cancer, and side effects of
041522 -            Abraxane chemotherapy and Neupogen. ref SDS 23 QX3K
041524 -         ..
041525 -   10.  The past 2 days I have been more energetic.  On Saturday went
041526 -        to Lafayette Reservoir for the 1st time in 6 or 8 months.
041527 -        Walked up and down the dam, while Rod did a few laps.
041528 -
041529 -            [On 100330 0830 Doctor Johnson indicated that continued
041530 -            improved breathing aligns with CT test showing reduced
041531 -            radiation injury from treatment at UCSF. ref SDS 23 FB85
041533 -         ..
041534 -   11.  Critical issue is identifying trade-offs comparing alternate
041535 -        oncology treatments to recover from the next progression, as
041536 -        requested in the letter to the medical team on 100319 0843,
041537 -        ref SDS 21 1T5V
041538 -
041539 -            [On 100330 0830 Doctor Johnson did not have time to provide
041540 -            standard of care comparing trade-offs on treatments for
041541 -            Millie to recover from UCSF medical mistakes. ref SDS 23
041542 -            ZV4N
041544 -             ..
041545 -            [On 100501 1037 Millie's cancer marker rises to CA 15-3 424
041546 -            for lab on 100424, ref SDS 25 U44U, highest in patient
041547 -            history; examination on 100426 found cancer; worsening;
041548 -            Millie reports cancer continues to rise after examination
041549 -            on 100426, she fears losing control, ref SDS 25 U46W; she
041550 -            requests changing treatments, ref SDS 25 U44V; and,
041551 -            requests again standard of care trade-offs for treatments
041552 -            comparing effectiveness, side effects, and cost.
041553 -            ref SDS 25 U45R
041554 -
041561 -
041562 -
041563 -
041564 -
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0416 -