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: March 30, 2010 08:30 AM Tuesday; Rod Welch

Millie meeting Doctor Johnson 2nd cycle Abraxane 10th relapse cancer.

1...Summary/Objective
2...Agenda Meeting Primary Care Physician Recover 10th Relapse Cancer
3...Breathing Improved CT Test Ground Glass Opacities Lungs Reduced
4...Radiation Injury Recovery Ground Glass Opacities Reduced CT Test
5...Skin Only Cancer Medical Problem CT Test Finds No Adenopathy
6...Distant Metastasis Not Found CT Test IBC in Skin Only Cancer Problem
7...IBC Intensity Lymphedema Subside after 1st Cycle Abraxane
8...Examination IBC Intensity Lymphedema subside 1st Cycle Abraxane
9...Lymphedema Right Arm Diagnosed Requires Using Power Port for Labs
10...Authorization Blood Draws Power Port Primary Care Physician
11...Power Port Blood Draws Authorization Primary Care Physician
12...Blood Draws Power Port Authorization Primary Care Physician
13...Stage V Cancer Unique Continuous Treatment 9 Years 10th Relapse
14...Unique Case Continuous Treatment 9 Years 10th Relapse Stage V Cancer
15...Pain Increases Requires More Percocet for IBC Shingles
16...Morphine with Percocet Prescribed to Reduce Pain from Rising Cancer
17...Shingles Vaccination Prevent Recurrence Maintain Recovery 10th Relapse
18...Acyclovir (Zovirax) Treatment for Shingles Maintain Recovery Cancer
19...Shingles Treatment Acyclovir (Zovirax) On Hand Maintain Recovery Cancer
20...Eye Iritation and Fuzy Vision Right Eye
21...10th Relapse Abraxane Continued Based on Examination Showing Response
22...Abraxane Chemotherapy Recover 10th Relapse Based on Initial Response
23...Side Effects Abraxane Tolerated Better than Navelbine
24...Trip 2-weeks May 2015 Kaiser Committed Millie Quality of Life
25...Quality of Life Kaiser Committed Millie 2-weeks Trip May 2015
26...Immune System Weakens Because Abraxane Lowers Blood Counts
27...Blood Counts Fall Risk Shingles Recurrence Pause Chemo Cancer Rises
28...Balance Treatment Shingles and Cancer Requires Targeted Drugs
29...Death Risk Increases Pause Treatment Cancer While Treating Shingles
30...Targeted Treatment Avoids Weakening Immune System
31...Bone Marrow Immune System Not Degraded with Targeted Cancer Agents
32...Cancer Shingles Concurrent Recovery Requires Targeted Cancer Treatment
33...Evidence-based Health Care Requires Trade-offs Balancing Risks
34...Due Process Life Threating Diseases Evidence-based Medical Practice
35...Targeted Treatment for Cancer Not Enough Time Present Trade-offs
36...Securemail Not Submitted for Patient Review
37...Kaiser's Medical Chart Knowledge Management System
....4...History of Present Illness:
....5...Current medications:
....6...Review of systems:
....7...Physical Exam:
....8...Lab:
....9...Imaging:
........Assessment:
........Plan:


..............
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CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 69 0000. ref SDS 68 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 55 G68H, while Millie was
040903 - treated to recover from a very severe case of shingles infection,
040904 - reported earlier on 100104 1115. ref SDS 50 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 66 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 66 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 66 023N   The doctor further ordered a CT
040923 - test to evaluate rising pain. ref SDS 66 ES40
040925 -  ..
040926 - On 100218 1230 Millie had emergency CT test. ref SDS 66 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 68 ER95
040933 -  ..
040934 - On 100302 0830 meeting at Kaiser, ref SDS 69 ER95; Doctor Johnson
040935 - prescribed Abraxane for Millie starting treatment tomorrow for
040936 - recovering from 10th relapse of cancer. ref SDS 69 FB67  Blood counts
040937 - dropped significantly, ref SDS 69 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 69 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 69 IC85
040945 -  ..
040946 - On 100330 0830 meeting with Doctor Johnson, primary care physician, to
040947 - evaluate staring 2nd cycle Abraxane chemotherapy treatment to recover
040948 - from 10th relapse of cancer. ref SDS 0 ER95
040949 -
040950 -
040951 -
040952 -
040954 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Agenda Meeting Primary Care Physician Recover 10th Relapse Cancer
041302 -
041303 - Follow up ref SDS 69 ER95.
041304 -
041305 - Doctor Johnson advised that he received and read Millie's letter
041306 - submitted yesterday on 100329 2322, ref SDS 80 ER95, and transmitting
041307 - agenda for the meeting today at 0830.  The doctor commented
041308 - extensively during the meeting on critical issues.
041309 -
041310 -    1.  Cancer skin only no distant metastasis
041311 -        CT test very favorable......................... ref SDS 0 FB90
041312 -    2.  Examination Cancer spreads on skin............. ref SDS 0 FB9Y
041313 -    3.  Pain subsides with shingles recovery........... ref SDS 69 FB55
041314 -    4.  Shingles improvement treatment stopped......... ref SDS 69 FU5F
041315 -    5.  Abraxane chemotherapy 10th relapse............. ref SDS 69 FB67
041316 -    6.  Blood counts fall high risk Abraxane........... ref SDS 0 IC4N
041317 -    7.  Balance treatment recover from cancer
041318 -        and shingles................................... ref SDS 69 FC68
041319 -    8.  Targeted cancer treatment needed for concurrent
041320 -        recovery from shingles......................... ref SDS 69 IC85
041321 -    9.  Trade-offs standard of care evidence-based
041322 -        health care requires "due process" for
041323 -        life-ending threats............................ ref SDS 69 ZV4N
041324 -   10.  Securemail from Kaiser dated 100208............ ref SDS 69 FC61
041325 -   11.  Authorization blood draws Power Port........... ref SDS 69 7M6H
041326 -
041327 -            [On 100304 2251 Millie notifies medical team on results
041328 -            meeting at Kaiser today with Doctor Johnson. ref SDS 71
041329 -            OP6R
041330 -
041331 -
041332 -
0414 -

SUBJECTS
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0503 -
050401 -  ..
050402 - Breathing Improved CT Test Ground Glass Opacities Lungs Reduced
050403 - Radiation Injury Recovery Ground Glass Opacities Reduced CT Test
050404 -
050405 - Follow up ref SDS 69 FB85.
050406 -
050407 - Millie reported further improved breathing, recovering from radiation
050408 - injury suffered during treatment last year at UCSF, reported by Doctor
050409 - Hsu on 090609. ref SDS 36 R24G  This continues recovery of pulmonary
050410 - function reported during the meeting at Kaiser on 100302 0830.
050411 - ref SDS 69 FB85  The doctor indicated that Millie's improved breathing
050412 - today aligns with analysis during the meeting on 100302, citing the
050413 - report for the CT test on 100218 that found reduced ground glass
050414 - opacaties in Millie's lungs. ref SDS 69 HB4I
050416 -  ..
050417 - But for rising fatigue and pain from cancer and Abraxane chemotherapy
050418 - side effects, discussed below, Millie can now take longer and more
050419 - frequent hikes, reported in her letter to the medical team yesterday
050420 - on 100329 2322. ref SDS 80 WA9R
050421 -
050422 -
050423 -
050424 -
0505 -

SUBJECTS
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0603 -
060401 -  ..
060402 - Skin Only Cancer Medical Problem CT Test Finds No Adenopathy
060403 - Distant Metastasis Not Found CT Test IBC in Skin Only Cancer Problem
060404 -
060405 - Follow up ref SDS 69 FB90.
060406 -
060407 - Doctor Johnson's letter from Kaiser dated 100225, was received on
060408 - 100228, and transmitted a report, ref SDS 67 565G, on Millie's CT test
060409 - on 100218. ref SDS 66 PQ6R  CT test findings of no adenopathy,
060410 - ref SDS 67 KL5X, indicates that Millie's only cancer issues now are
060411 - IBC rash and nodularity in the skin, noted in Doctor Johnson's
060412 - transmittal letter also received on 100228 2216. ref SDS 67 4Q54, and
060413 - as noted in Millie's letter to the medical team on 100301 0005.
060414 - ref SDS 68 OO5U
060416 -  ..
060417 - Examination today shows some improvement with IBC skin rash and
060418 - nodularity subsiding after the 1st cycle of Abraxane, signals initial
060419 - recovery from the 10th relapse of cancer, discussed below, ref SDS 0
060420 - FB9Y
060421 -
060422 -        [On 100427 0830 examination finds no evidence that cancer is
060423 -        progressing anywhere except in Millie's skin, ref SDS 81 FB90,
060424 -        as reported today, ref SDS 0 FB90; however, examination finds
060425 -        IBC is now progressing in the skin, and so Millie's needs to
060426 -        switch treatments, ref SDS 81 FB9Y, as Doctor Johnson did on
060427 -        100218, when he found IBC progressing in Millie's skin.
060428 -        ref SDS 66 023N
060429 -
060430 -
060431 -
0605 -

SUBJECTS
Default Null Subject Account for Blank Record

0703 -
070401 -  ..
070402 - IBC Intensity Lymphedema Subside after 1st Cycle Abraxane
070403 - Examination IBC Intensity Lymphedema subside 1st Cycle Abraxane
070404 -
070405 - Follow up ref SDS 69 FB9Y.
070406 -
070407 - Doctor Johnson examined Millie and found IBC rash has subsided, since
070408 - examination on 100302, when Millie was diagnosed with relapse of
070409 - cancer for the 10th time. ref SDS 69 FB9Y  This finding indicates
070410 - initial response to treatment with Abraxane started on 100303 0730.
070411 - ref SDS 70 625I
070413 -  ..
070414 - The doctor observed reduced intensity of IBC and lymphedema on the
070415 - entire left arm, across Millie's chest, and especially on the right
070416 - breast.  While IBC is spreading on the right side, seeing reduced
070417 - intensity of nodularity on the right side is a big emotional relief.
070418 - Millie's right side had not been infected with cancer for 8 years,
070419 - until IBC spread to the right following UCSF error failing to treat
070420 - cancer in the breastbone area.  Since the left side was treated with
070421 - radiation, and the right side was not radiated, becasue there was no
070422 - cancer, untreated cancer in the breastbone area can only spread to the
070423 - right, as discussed during the meeting at Kaiser on 100302.
070424 - ref SDS 69 HB9O
070425 -
070426 -        [On 100427 0830 examination finds progression of IBC rash, and
070427 -        cancer markre rising indicate Millie needs to switch treatments
070428 -        again. ref SDS 81 SO92
070430 -  ..
070431 - Examination further shows today that IBC nodularity, which increased
070432 - significantly following examination on 100218, and as reported during
070433 - examination on 100302 0830, ref SDS 69 FB9Y, have now significantly
070434 - "dried up" and reduced in size.
070436 -  ..
070437 - Doctor Johnson noted clinical findings today align with improvement in
070438 - the cancer marker for the blood test on 100319 with CA 15-3 369
070439 - dropping for the first time in several months after increasing 200
070440 - points in one month to CA 15-3 426 for the lab on 1000301, reported in
070441 - Millie's letter to the team on 100329 2322, ref SDS 80 WA8S, and
070442 - citing the earlier report on 100319 0843. ref SDS 79 1T3Y
070444 -  ..
070445 - Results for the cancer marker CA 15-3 from the blood draw yesterday on
070446 - 090329 have not yet been posted.
070448 -  ..
070449 - Case study on Millie's cancer marker shows for the prior two
070450 - treatments with Gemzar and Navelbine initial declines, then increases,
070451 - and then declines again, listed on 090323 1352. ref SDS 27 J13O
070453 -  ..
070454 - Millie's cancer marker again declined after the 1st 2 treatments with
070455 - Abraxane.  Continuing the prior pattern a small increase might be
070456 - expected for the lab yesterday.
070457 -
070458 -            [...below, cancer marker history listed in Medical Chart.
070459 -            ref SDS 0 Y74T
070461 -  ..
070462 - Since the report on 100301 for the CT test on 100218 found no evidence
070463 - of adenopathy in axilla nor supraclavicular areas, noted in Millie's
070464 - letter to the medical team on 100301 0005. ref SDS 68 ER95, and since
070465 - Millie's cancer marker CA 15-3 369 dropped from 426 for the lab on
070466 - 100319, and since examination shows evident reduced IBC today,
070467 - ref SDS 0 FB9Y, the doctor did not palpate left and right axilla, nor
070468 - the left and right supraclavicular, where lymph nodes swelled from
070469 - cancer have always occurred with past relapses.
070470 -
070471 -
070472 -
0705 -

SUBJECTS
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0803 -
080401 -  ..
080402 - Lymphedema Right Arm Diagnosed Requires Using Power Port for Labs
080403 -
080404 - Doctor Johnson found rising lymphedema throughout the right arm, with
080405 - slight coloration indicating beginning of IBC, and reflecting spread
080406 - of IBC from the breastbone area to Millie's right side, shown by
080407 - examination today, per above. ref SDS 0 HR9K
080409 -  ..
080410 - On 040318 Doctor Johnson ordered the Kaiser Laboratory and the
080411 - Chemotherapy Infusion Clinic in the Oncolody Department to avoid
080412 - needle penetrations and blood pressure tests on Millie's left arm,
080413 - because at that time her cancer was only on her left side, ref SDS 2
080414 - OF7H,
080416 -  ..
080417 - Millie's letter to the medical team yesterday on 100329 2322, reported
080418 - this new problem that prevents taking blood pressure and performing IV
080419 - needle penetrations in the right arm as well as the left arm, and so
080420 - requires blood draws and IV infusions using Millie's Power Port.
080421 - ref SDS 80 WA8P  This change to Millie's patient profile was reported
080422 - earlier in her letter on 100204 1325. ref SDS 62 SB7V  At that time,
080423 - Millie asked the doctor to enter in the medical chart instructions to
080424 - use the Power Port for medical necessity, ref SDS 62 SB8X, because
080425 - earlier on 100104, the nursing staff forced Millie to get a blood draw
080426 - with an IV needle penetration in her right arm. ref SDS 51 ZX4J  This
080427 - happened again 10 days ago in the Chemotherapy Clinic on 100317 0730.
080428 - ref SDS 78 QR54
080429 -
080430 -
0805 -

SUBJECTS
Default Null Subject Account for Blank Record

0903 -
090401 -  ..
090402 - Authorization Blood Draws Power Port Primary Care Physician
090403 - Power Port Blood Draws Authorization Primary Care Physician
090404 - Blood Draws Power Port Authorization Primary Care Physician
090405 -
090406 - Follow up ref SDS 69 7M6H.
090407 -
090408 - Discussed Millie's request in her letter on 100204, to enter in the
090409 - work plan of medical chart the doctor's instruction to use Millie's
090410 - Power Port for blood draws and infusions. ref SDS 62 SB8X
090412 -  ..
090413 - Today, the doctor feels this is a "silly" request, because there is no
090414 - rational basis for the nursing staff to refuse using Millie's Power
090415 - Port, based on her patient profile of lymphedema and IBC in both arms.
090416 -
090417 -            [...below, medical chart work plan omits instruction to use
090418 -            Millie's Power Port for blood draws and infusions.
090419 -            ref SDS 0 Y89X
090421 -             ..
090422 -            [On 100427 0830, during examination at Kaiser Doctor
090423 -            Johnson entered in Millie's medical chart work plan
090424 -            instruction to use Power Port for blood draws due to
090425 -            bilateral lymphedema. ref SDS 81 X74Q
090426 -
090427 -
090428 -
090429 -
0905 -

SUBJECTS
Default Null Subject Account for Blank Record

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 - Follow up ref SDS 69 FC67.
100406 -
100407 - During the meeting at Kaiser on 100302 0830, Doctor Johnson commented
100408 - that Millie's case is unique getting continuous treatment for 9 years,
100409 - and with 10 therapy changes, ref SDS 69 FC67, and further confirming
100410 - Millie's letter to the medical team on 100301 0005. ref SDS 68 PRYQ
100411 -
100412 -        [On 100427 0830 Doctor Johnson reported Millie's cancer has
100413 -        mutated to resist chemotherapy, and so she needs a new strategy
100414 -        to treat her cancer as a chronic disease with therapy targeted
100415 -        to her patient profile. ref SDS 81 SJ6N  Aligns with Doctor
100416 -        Johnson's review today of PARP targeted to Millie's triple
100417 -        negative status, reported on 100112 0830, ref SDS 55 N586
100419 -  ..
100420 - On 090213, the doctor cited comprehensive case management by Kaiser
100421 - and UCSF, ref SDS 26 JL5I, had extended Millie's survival and quality
100422 - of life by orders of magnituge compared to other patients with similar
100423 - disease prognosis, reported on 090213 1140. ref SDS 26 4W72
100425 -  ..
100426 - At the next meeting a month later on 090325 0830, Doctor Johnson drew
100427 - a similar graph, but added a mark indicating Millie is near the end of
100428 - sustainable quality of life, and would soon suffer rapid decline.
100429 - ref SDS 28 P39M
100431 -  ..
100432 - On 090725, Millie's letter to the medical team cited Doctor Johnson
100433 - explaining to Millie's daughter Pam, that surviving aggressive cancer
100434 - longer than expected takes "yoeman's work" performing comprehensive
100435 - case management in time to be effective. ref SDS 38 T58R
100437 -  ..
100438 - Today, Millie thanked Doctor Johnson for doing "yeoman's" work
100439 - treating Millie's cancer the past year as a "chonic disease," and
100440 - making progress recovering from the 10th relapse.
100441 -
100442 -
100443 -
100444 -
1005 -

SUBJECTS
Default Null Subject Account for Blank Record

1103 -
110401 -  ..
110402 - Pain Increases Requires More Percocet for IBC Shingles
110403 - Morphine with Percocet Prescribed to Reduce Pain from Rising Cancer
110404 -
110405 - Follow up ref SDS 69 FB55.
110406 -
110407 - On 100302 0830 Doctor Johnson indicated during a meeting at Kaiser
110408 - that Abraxane side effects are tolerated by most patients better than
110409 - Navelbine. ref SDS 69 X94G  On 100303 0730 Millie received the 1st
110410 - treatment of 1st cycle with Abraxane to recover from 10th relapse of
110411 - cancer. ref SDS 70 625I  On 100305 0810 Millie reported to the medical
110412 - team tolerating Abraxane well 2-days after the 1st treatment.
110413 - ref SDS 72 0V6X
110415 -  ..
110416 - Doctor Johnson is worried today about Millie suffering increased pain,
110417 - reported in the letter to the medical team yesterday on 100329 2322.
110418 - ref SDS 80 WA8V
110420 -  ..
110421 - Pain occurs from rising cancer, from cumulative side effects of
110422 - chemotherapy with Abraxane, and from Neupogen needed to maintain blood
110423 - counts in order to get Abraxane treatment that hopefully will reduce
110424 - Millie's cancer, and thus reduce pain.
110426 -  ..
110427 - Previously, on 100302, Doctor Johnson advised that prescribing
110428 - treatments "targeted" to attack the genetic profile of Millie's cancer
110429 - will avoid painful side effects of chemotherapy treatments, like
110430 - Abraxane, and also avoid Neupogen treatments to maintain blood counts,
110431 - because "targeted" cancer therapies do not destroy blood cells; and,
110432 - so this would further reduce pain caused by Neupogen.  Effective
110433 - "targeted" treatment for Millie's cancer would further maintain local
110434 - control of IBC, based on experience getting cetuximab for nearly 2
110435 - years, ref SDS 69 IC85  Thus, following Doctor Johnson's advice on
110436 - 100302 to replace Abraxane chemotherapy with treatment targeted to
110437 - Millie's patient profile would eliminate her pain, shown by patient
110438 - history during 2007 and 2008, when Millie was pain free getting
110439 - cetuximab therapy which was targeted to Millie's triple negative
110440 - patient profile.
110441 -
110442 -        [On 100427 0830 Doctor Johnson reported Millie's cancer has
110443 -        mutated to resist chemotherapy, and so she needs a new strategy
110444 -        to treat her cancer as a chronic disease with therapy targeted
110445 -        to her patient profile. ref SDS 81 SJ6N  Aligns with Doctor
110446 -        Johnson's review today of PARP targeted to Millie's triple
110447 -        negative status, reported on 100112 0830, ref SDS 55 N586
110449 -  ..
110450 - Since Millie's cancer has increased significantly above prior levels,
110451 - as reported during the meeting on 100302, ref SDS 69 FB4R, citing the
110452 - letter to the team the day before on 100301 0005, ref SDS 68 ON6V, and
110453 - since Millie may need additional Neupogen, beginning next week, see
110454 - below, the doctor therefore prescribed additional pain medication,
110455 - rather than prescribe therapy targeted to Millie's patient profile to
110456 - reduce pain from cancer, from Abraxane chemotherapy, and from Neupogen
110457 - to restore blood counts depleted by Abraxane.
110459 -  ..
110460 - Morphine was prescribed...
110461 -
110464 -            Morphine Sulfate 15 MG.................... 100 Tablets
110465 -
110466 -            Take 1 pill every 12 hours for chronic pain
110468 -             ..
110469 -            Do not take alchoholic beverages when taking this
110470 -            medication.
110472 -             ..
110473 -            May cause drowsiness and dizziness.  Alchohol may
110474 -            intensify this effect.  Use care when operating a car or
110475 -            dangerous machinery.
110477 -  ..
110478 - Doctor Johnson advised that morphine is stronger than Percocet
110479 - (oxycodine and Tylenol).  He explained the morphine treatment should
110480 - be taken only twice a day, and Millie can supplement this with
110481 - Percocet, when needed to relieve "breakthrough" pain, which occurs
110482 - despite taking prescribed morphine sulphate, per above. ref SDS 0 ZU4H
110484 -  ..
110485 - To reduce dependence on medications, discussed avoiding new morphine
110486 - treatment this first week, to see if reduced IBC observed during the
110487 - examination today, per above, ref SDS 0 FB9Y, will also reduce
110488 - Millie's pain, and therefore the need for additional medication with
110489 - morphine.
110491 -  ..
110492 - If pain persists at high levels for the 1st week in the treatment
110493 - cycle starting tomorrow, then Millie will try adding the new morphine
110494 - treatment next week.
110495 -
110496 -
110497 -
1105 -

SUBJECTS
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1203 -
120401 -  ..
120402 - Shingles Vaccination Prevent Recurrence Maintain Recovery 10th Relapse
120403 - Acyclovir (Zovirax) Treatment for Shingles Maintain Recovery Cancer
120404 - Shingles Treatment Acyclovir (Zovirax) On Hand Maintain Recovery Cancer
120405 -
120406 - Follow up ref SDS 69 FU5F.
120407 -
120408 - Doctor Johnson was pleased with Millie's notice to the medical team
120409 - yesterday that shingles blisers have not recurred, reported on 100329
120410 - 2322, ref SDS 80 WA8Y, and continuing findings from emergency
120411 - examination on 100310 0730. ref SDS 75 OR3H
120413 -  ..
120414 - Doctor Johnson examined Millie's right forehead, her head, neck, and
120415 - her back, to assess the cause of pain reported in Millie's letter to
120416 - the medical team on 100329 2322. ref SDS 80 WA8Y
120418 -  ..
120419 - The doctor concurred that examination today does not find evidence of
120420 - shingles on Millie's forehead nor on her head, which suffered severe
120421 - infection, first reported on 100103 1147, ref SDS 48 FZ6V, and then
120422 - later the same day at 2023, reporting rapid spread of disease,
120423 - ref SDS 49 RH7Y, and was diagnosed and treated the next day on 100104
120424 - 1115. ref SDS 50 0P9S
120426 -  ..
120427 - Therefore, the doctor did not prescribe additional medication with
120428 - Acyclovir (Zovirax) to have available for Millie to recover from
120429 - shingles recurrence, and which Millie requested in her letter to the
120430 - team on 100305 0822. ref SDS 72 0W3T, and further to recover from
120431 - shingles with enough time to maintain continuity of treatment for
120432 - cancer.  On 100302, Doctor Johnson advised during a meeting at Kaiser
120433 - that balancing timely treatment for both shingles and cancer presents
120434 - a high risk of death for Millie's patient profile. ref SDS 69 FC68
120436 -  ..
120437 - Doctor Johnson indicated during the meeting today that patients with
120438 - severe shingles, like Millie, suffer discomfort and pain for months
120439 - after initial diagnosis, in Millie's case on 100104. ref SDS 50 0P9S
120440 - The doctor diagnosed Millie's severe pain on her forehead, head, and
120441 - down her neck, reported in Millie's letter yesterday, on 100329 2322.
120442 - ref SDS 80 WA8Y is caused by continuing shingles infection, so he
120443 - prescribed morphine to suppress pain, per above. ref SDS 0 FB55
120444 -
120445 -            [...below, Millie asks about switching treatment for cancer
120446 -            from Abraxane chemotherapy that increases risks of fatal
120447 -            infection, to "targeted" drugs that increase recovery from
120448 -            cancer, and present no risk of fatal infection. ref SDS 0
120449 -            FC68
120451 -  ..
120452 - On 100120 Millie asked the medical team for shingles vaccination to
120453 - prevent another 3-week delay in treatment which caused cancer to
120454 - relapse for the 10th time, and to increase far more severely than for
120455 - any prior relapse for the past 9 years. ref SDS 56 HL4Q
120457 -  ..
120458 - Today, there was not enough time for the doctor to consider this
120459 - issue.
120460 -
120461 -
120462 -
120463 -
1205 -

SUBJECTS
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1303 -
130401 -  ..
130402 - Eye Iritation and Fuzy Vision Right Eye
130403 -
130404 - Millie has had continuing discomfort in the right eye from both a
130405 - persistent irritation and fuzzy vision.  The right eye was infected by
130406 - shingles diagnosed on 100104.  At that time, Doctor Zhang was worried
130407 - about injury to Millie's right eye. ref SDS 50 QR5K
130409 -  ..
130410 - Millie was examined later that day by Doctor Dossitor in Kaiser
130411 - Opthamology Department.  Initial examination reported no findings of
130412 - injury to the right eye. ref SDS 52 BW8I
130413 -
130414 -
130415 -
130416 -
1305 -

SUBJECTS
Default Null Subject Account for Blank Record

1403 -
140401 -  ..
140402 - 10th Relapse Abraxane Continued Based on Examination Showing Response
140403 - Abraxane Chemotherapy Recover 10th Relapse Based on Initial Response
140404 -
140405 - Follow up ref SDS 69 FB67.
140406 -
140407 - Evident response to treatment found today was accomplished by Doctor
140408 - Johnson's timely order ending Navelbine chemotherapy, and prescribing
140409 - Abraxane, reported on 100218 1000. ref SDS 66 023N, and further
140410 - confirmed during the meeting at Kaiser on 100302 0830, ref SDS 69
140411 - FC34, and which started on 100303 0730. ref SDS 70 625I
140413 -  ..
140414 - On 100319 0843 cancer marker CA 15-3 360 dropped about 60 points -
140415 - aligns with evident reduction in IBC rash that signals some recovery
140416 - achieved with first 2 treatments using Abraxane. ref SDS 79 1T4R
140418 -  ..
140419 - Based on favorable examination today, showing initial response to
140420 - treatment, ref SDS 0 FB9Y, and together with continued strong blood
140421 - counts indicating Millie can safely be treated with cheotherapy,
140422 - Doctor Johnson approved Millie to start the first treatment tomorrow
140423 - of the 2nd cycle with Abraxane.
140425 -  ..
140426 - Case study on Millie's cancer marker shows for the prior two
140427 - treatments with Gemzar and Navelbine initial declines, then increases,
140428 - and then declines again, listed on 090323 1352. ref SDS 27 J13O
140429 - Therefore, even though results for the cancer marker CA 15-3 from the
140430 - blood draw yesterday on 100329 have not yet been posted, and even if
140431 - there is a slight increase in the cancer marker, patient history in
140432 - combination with examination showing decline in IBC rash intensity,
140433 - ref SDS 0 FB9Y, justifies continuing Abraxane for a 2nd cycle.
140434 -
140435 -
140436 -
140437 -
1405 -

SUBJECTS
Default Null Subject Account for Blank Record

1503 -
150401 -  ..
150402 - Side Effects Abraxane Tolerated Better than Navelbine
150403 -
150404 - Follow up ref SDS 69 FC46.
150405 -
150406 - On 100302 0830 Doctor Johnson indicated during a meeting at Kaiser
150407 - that Abraxane side effects are tolerated by most patients better than
150408 - Navelbine. ref SDS 69 X94G
150410 -  ..
150411 - On 100303 0730 Millie received the 1st treatment of 1st cycle with
150412 - Abraxane to recover from 10th relapse of cancer. ref SDS 70 625I  On
150413 - 100305 0810 Millie reported to the medical team tolerating Abraxane
150414 - well 2-days after the 1st treatment. ref SDS 72 0V6X
150416 -  ..
150417 - Doctor Johnson was disappointed about side effects of Abraxane causing
150418 - rising fatigue and pain, reported in Millie's letter to the medical
150419 - team yesterday, on 100329 2322. ref SDS 80 WA8V, reflecting concerns
150420 - reported previously on 100301 0005. ref SDS 68 OO4Y  As noted, the
150421 - doctor prescribed increased pain medication with morphine, per above,
150422 - ref SDS 0 ZU4H, and explained how Millie can supplement this treatment
150423 - by continuing to use Percocet when needed for "breakthrough" pain.
150424 - ref SDS 0 QX3F
150425 -
150426 -
150427 -
150428 -
150429 -
1505 -

SUBJECTS
Default Null Subject Account for Blank Record

1603 -
160401 -  ..
160402 - Trip 2-weeks May 2015 Kaiser Committed Millie Quality of Life
160403 - Quality of Life Kaiser Committed Millie 2-weeks Trip May 2015
160404 -
160405 - Follow up ref SDS 69 FC40.
160406 -
160407 - Doctor Johnson was so pleased with findings of initial recovery from
160408 - the 10th relapse of cancer, per above, ref SDS 0 FB9Y, that he hugged
160409 - Millie and said that she will be well enough to take the 2-week trip
160410 - planned for mid-May, discussed during the meeting at Kaiser on 100302
160411 - 0830. ref SDS 69 FC40  The doctor entered into the medical chart work
160412 - plan that Millie will take a cruise in mid-May, leaving on 100515, and
160413 - returning on 100528, reported on 100316 1415. ref SDS 77 PF8O
160415 -  ..
160416 - Millie checked the chemotherapy schedule, and feels that one week of
160417 - the trip will occur during a "bye-week" for treatment.  As a result,
160418 - Millie will miss only 1 week of treatment...
160419 -
160420 -                Abraxane 2nd cycle start.............. 100331
160421 -                                   end................ 100414
160422 -                Abraxane 3rd cycle start.............. 100428
160423 -                                   end................ 100512
160425 -         ..
160426 -        Depart on trip................................ 100515
160427 -                Abraxane 4th cycle start..(scheduled). 100526
160428 -        Return from trip.............................. 100528
160429 -
160430 -                Abraxane 4th cycle start..(actual).... 100602
160432 -  ..
160433 - This schedule reduces risk of rapid rise of cancer that occurred when
160434 - Millie was diagnosed with shingles, and lost 3 weeks of treatment for
160435 - cancer while recovering from shingles, and as a result her cancer
160436 - increased over 100% from CA 15-3 211 to 426, reported during the
160437 - meeting at Kaiser on
160438 -
160439 -
160440 -
160441 -
160442 -
1605 -

SUBJECTS
Default Null Subject Account for Blank Record

1703 -
170401 -  ..
170402 - Immune System Weakens Because Abraxane Lowers Blood Counts
170403 - Blood Counts Fall Risk Shingles Recurrence Pause Chemo Cancer Rises
170404 -
170405 - Follow up ref SDS 69 IC4N.
170406 -
170407 - Doctor Johnson was further pleased Millie's blood counts held up with
170408 - continuing Neupogen treatments, so that Millie did not miss treatments
170409 - in the 1st cycle with Abraxane chemotherapy, as reported in Millie's
170410 - letter to the medical team yesterday on 100329. ref SDS 80 WA7P
170412 -  ..
170413 - Maintaining blood counts helps reduce the risk of shingles recurring,
170414 - which could cause fatal infection, reported during the meeting at
170415 - Kaiser on 100302 0830, ref SDS 69 FC68, and reported to the medical
170416 - team in Millie's letter on 100304 2251, citing Doctor Johnson's
170417 - concern. ref SDS 71 OQ3V
170419 -  ..
170420 - During the meeting today, the doctor appreciated Millie's letter on
170421 - 100309 1643, to medical team commending Doctor Johnson for case
170422 - management, because blood counts recovered substantially, ref SDS 74
170423 - 2O9P, and reversing sudden decline for 2 weeks, and thereby supporting
170424 - prescription on 100302, for only 1 Neupogne teatment, following the
170425 - 1st reatment of the 1st cycle for Abraxane chemotherapy. ref SDS 69
170426 - FC5U
170427 -
170428 -
170429 -
170430 -
1705 -

SUBJECTS
Default Null Subject Account for Blank Record

1803 -
180401 -  ..
180402 - Balance Treatment Shingles and Cancer Requires Targeted Drugs
180403 - Death Risk Increases Pause Treatment Cancer While Treating Shingles
180404 -
180405 - Follow up ref SDS 69 FC68.
180406 -
180407 - Millie asked again about balancing treatment for shingles and cancer,
180408 - related in her letter on 100301 0005, ref SDS 68 OP6Q, and discussed
180409 - the next day during a meeting with Doctor Johnson at Kaiser, reported
180410 - on 100302 0830. ref SDS 69 FC68  Today, Millie is concerned that
180411 - continuing pain from shingles presents continuing risk of fatal
180412 - infection caused by Abraxane chemotherapy, per Doctor Johnson's report
180413 - that severe cases of shingles extend for months. ref SDS 0 JT6K
180414 -
180415 -
180416 -
180417 -
1805 -

SUBJECTS
Default Null Subject Account for Blank Record

1903 -
190401 -  ..
190402 - Targeted Treatment Avoids Weakening Immune System
190403 - Bone Marrow Immune System Not Degraded with Targeted Cancer Agents
190404 - Cancer Shingles Concurrent Recovery Requires Targeted Cancer Treatment
190405 -
190406 - Follow up ref SDS 69 IC85.
190407 -
190408 - Doctor Johnson explained again he is waiting to hear from Doctor Rugo
190409 - on Millie starting PARP, discussed during the meeting a month ago on
190410 - 100302. ref SDS 69 L87L
190411 -
190412 -
190413 -
1905 -

SUBJECTS
Default Null Subject Account for Blank Record

2003 -
200401 -  ..
200402 - Evidence-based Health Care Requires Trade-offs Balancing Risks
200403 - Due Process Life Threating Diseases Evidence-based Medical Practice
200404 - Targeted Treatment for Cancer Not Enough Time Present Trade-offs
200405 -
200406 - Follow up ref SDS 69 ZV4N.
200407 -
200408 - The doctor did not have time today to present Kaiser's work plan for
200409 - switching treatment to a targeted drug, requested in Millie's letter
200410 - to the medical team on 100301 0005, ref SDS 68 OP6V, and in the event
200411 - that shingles recurs, and requires stopping chemotherapy with
200412 - Abraxane.
200414 -  ..
200415 - Millie's letter on 100301 0005 requested standard of care for
200416 - evidenced-based medical practice, required by Kaiser's policies,
200417 - reported on 090520 1153, ref SDS 34 4M9G, requires good-faith
200418 - performance of due process determining trade-offs for alternative
200419 - treatment modalities that extend life with a quality that makes life
200420 - worthwhile. ref SDS 68 OO8U
200422 -  ..
200423 - Millie suffers increased exposure to danger of losing her life because
200424 - Kaiser has failed to provide due process presenting trade-offs for the
200425 - patient to choose treatment that can be effective for both shingles
200426 - and cancer in time to be effective, as called out in for standard of
200427 - care, reviewed in the letter to the medical team on 090725 2017.
200428 - ref SDS 38 T58U
200430 -  ..
200431 - Millie has been patient reminding the team to provide due process for
200432 - standard of care comparing treatments for effectiveness, side effects,
200433 - and cost, shown in the case study on 090725 2017. ref SDS 38 X66O
200435 -  ..
200436 - On 100304 2251 Millie asked the medical team again to submit analysis
200437 - of trade-offs for treatments "targeted" to Millie's patient profile
200438 - which do not injure the bone marrow, and so reduce recurrence of
200439 - shingles, and permit concurrent treatment with cancer and shingles, in
200440 - the event that shingles does recur. ref SDS 71 OQ4Y
200442 -  ..
200443 - On 100305 0822 Millie asked medical team again to submit analysis of
200444 - trade-offs for treatments "targeted" to Millie's patient profile that
200445 - do not degrade bone marrow, and so reduce risk of shingles recurrence,
200446 - and in any event can be given concurrently with treatment for shingles
200447 - if this disease does recur. ref SDS 72 0W3W
200449 -  ..
200450 - On 100319 0843 Millie's letter to medical team reports initial
200451 - recovery from 10th relapse after 2 treatments with Abraxane gives time
200452 - to complete review and compare trade-offs for alternative oncology
200453 - treatments in time for Millie to recover from the 11th relapse by
200454 - treating Millie's cancer as a chronic disease. ref SDS 79 1T5V
200456 -  ..
200457 - Millie's letter yesterday on 100329, submitting the agenda for the
200458 - meeting today again requests standard of care comparing trade-offs of
200459 - treatments for Millie to recover from UCSF medical mistakes causing
200460 - her 11th relapse of cancer. ref SDS 80 WA9U
200461 -
200462 -
200463 -
200464 -
200465 -
200466 -
200467 -
2005 -

SUBJECTS
Default Null Subject Account for Blank Record

2103 -
210401 -  ..
210402 - Securemail Not Submitted for Patient Review
210403 -
210404 - Follow up ref SDS 69 FC61.
210405 -
210406 - Doctor Johnson did not submit the content of a "securemail" received
210407 - on 100208, and reported to the medical team that this has content
210408 - could not be accessed, reported also in the letter to the team on
210409 - 100301 0005. ref SDS 68 OP7T
210411 -  ..
210412 - On 100309 1238 Millie's letter notifies the medical team that Kaiser's
210413 - letter submitted on 100208 has still not been received. ref SDS 73
210414 - HL5R
210416 -  ..
210417 - On 100309 1238 Millie requests documentation for approving
210418 - communication, including confidential information, using the domestic
210419 - email addresses at Kaiser, and in order to provide timely, accurate
210420 - coordination among the doctors collaborating to provid Millie's health
210421 - care. ref SDS 73 HL6R
210422 -
210423 -
210424 -
210425 -
2105 -

SUBJECTS
Default Null Subject Account for Blank Record

2203 -
220401 -  ..
220402 - Kaiser's Medical Chart Knowledge Management System
220403 -
220404 - Follow up ref SDS 69 R45K.
220405 -
220406 -    1.  Received: 3/30/10 9:11 AM
220407 -
220408 -    2.  Subject:  Visit 03/30/10
220414 -         ..
220415 -    3.  Patient presents with: RECHECK
220417 -         ..
220418 -    4.  History of Present Illness:
220419 -
220420 -        Follow up ref SDS 69 9C98.
220421 -
220423 -        The patient is a 74 Y female with a history of IBC of left
220424 -        breast who was initially diagnosed 03/04/02.  S/P AC x's 4 from
220425 -        04/23/02 through 07/01/02 followed by Taxotere ending 12/04/02.
220426 -        She had recurrent disease noted initially in the cervical LN's
220427 -        03/03/04.  On E2100 Study with Taxol/Avastin, but she had a PE
220428 -        noted on CT 11/03/2004.  Then, because of progression of
220429 -        disease, the patient was started on Taxotere and Xeloda
220430 -        4/15/05.  She had a total of 8 cycles ending 9/16/05.  She had
220431 -        a palliative left mastectomy performed 10/21/05.  Then her left
220432 -        chest lesions began expanding again.  The patient started
220433 -        Taxotere and Xeloda again 07/21/06 for 7 cycles.  She was
220434 -        started on a Clinical Trial 02/01/07 at UCSF and was randomized
220435 -        to the Erbitux only (no Carbo) Arm.  She had weekly Carboplatin
220436 -        added 03/13/08 because of progression of disease.  Her disease
220437 -        progressed again and she began a Phase I/II Study of Sunitinib
220438 -        (SU11248) at UCSF 11/14/08.  Lengthy discussion about current
220439 -        status and response to therapy.  Because of cytopenias, MTX to
220440 -        be D/C'd and Sutent and CTX held and then dose reduced.  The
220441 -        patient started hyperthermia/XRT at UCSF 02/19/09 and completed
220442 -        it 03/17/09.  She has started the MPA Clinical Trial at UCSF
220443 -        06/16/09 but this has been D/C'd.  She started Gemzar 07/28/09
220444 -        and received Cycle #4 11/05/09.  Because of evidence of
220445 -        progression she was switched to Navelbine 11/18/09.  However,
220446 -        she then developed erythema and nodularity on her right breast.
220447 -        Because of this and a rising CA 15-3 she was switched to
220448 -        Abraxane 03/03/10.
220450 -         ..
220451 -        She states that lymphedema has increased in the right arm.
220452 -        Pain persists across right forehead, head, and down neck to
220453 -        across upper back. She is here for FU.
220455 -         ..
220456 -    5.  Current medications:
220457 -
220458 -        Follow up ref SDS 69 9C66.
220459 -
220460 -        HYDROCODONE/ACETAMINOPH 5-5
220461 -        WARFARIN 4 MG TABLETS
220462 -        LUMIGAN 0.03% EYE DROPS (2.
220463 -        TIMOLOL MALEATE 0.5% EYE DR
220464 -        OXYCODONE W/APAP 5-325 MG T
220465 -        AEROCHAMBER Z-STAT/PLUS W/O
220466 -        QVAR 80 MCG ORAL INHALER
220467 -        ALBUTEROL HFA 90MCG ORAL IN
220468 -        GUAIFEN/CODEIN 100-10MG/5ML
220469 -        LORAZEPAM 1 MG TABLETS
220471 -         ..
220472 -    6.  Review of systems:
220473 -
220474 -        Follow up ref SDS 69 9D39.
220475 -
220476 -        a.  Constitutional: Appetite and energy level are improving.
220477 -            Plans on taking trip to the Mediterranean in May; 12 day
220478 -            cruise
220480 -             ..
220481 -        b.  Eyes:  Seen by Ophthalmology 01/11/10; no evidence of
220482 -            ocular involvement with shingles
220484 -             ..
220485 -        c.  ENT: No nose bleeds.
220487 -             ..
220488 -        d.  Cardiovascular: No SOB, palpitations or chest pain
220490 -             ..
220491 -        e.  Respiratory: No hemoptysis or cough. Some DOE noted
220493 -             ..
220494 -        f.  GI: No nausea, vomiting or diarrhea
220496 -             ..
220497 -        g.  GU: No hematuria or dysuria
220499 -             ..
220500 -        h.  Musculoskeletal: Left neck spasm and right shoulder pain stable with Robaxin
220502 -             ..
220503 -        i.  Skin: Pruritis of chest wall resolved
220505 -             ..
220506 -        j.  Neurological: No confusion, sensory changes or motor
220507 -            weakness
220509 -             ..
220510 -        k.  Psychiatric: Anxious
220511 -
220513 -         ..
220514 -    7.  Physical Exam:
220515 -
220516 -        Follow up ref SDS 69 9D5U.
220517 -
220518 -        ECOG Performance Score 0
220519 -        BP 172/84 | Pulse 63 | Temp (Src) 98.5 F (36.9 C) (Oral) | Wt 136 lb 12.8 oz
220520 -        (62.052 kg) | SpO2 91%
220521 -        Head: shingles right side of forehead largely gone
220522 -        Eyes: normal conjunctiva
220523 -        Mouth: normal mucosa
220524 -        Lymph: no nodes palpable in neck or axillae
220525 -        Breasts: evidence of erythema to other breast. Less edema in both arms
220526 -        Lungs: clear to percussion and auscultation
220527 -        Heart: regular without murmur or gallop
220528 -        Abd: soft with normal bowel sounds. No masses or organomegaly
220529 -        Ext: Edema increasing in both arms now
220530 -        Bones: no tenderness
220531 -        Neuro: awake, alert, and oriented. Moves all extremities well.
220532 -        Normal gait.
220534 -         ..
220535 -    8.  Lab:
220536 -
220537 -        Follow up ref SDS 69 9D7R.
220538 -
220539 -        WBC 6.3 K/uL
220540 -        RBC 3.74 M/uL
220541 -        Hemoglobin L 11.3 g/dL
220542 -        Hematocrit 35.0 %
220543 -        MCV 94 fL
220544 -        RDW H 18.7 %
220545 -        Plt 336 K/uL
220546 -        DIF
220547 -        Neutrophils 51 %
220548 -        Neutrophils Abs 3.2 K/uL
220550 -         ..
220551 -        CA 15-3
220552 -        ----------
220553 -        03/16/10 10:38 | 369 H
220554 -        03/01/10 13:37 | 426 H
220555 -        02/16/10 10:58 | 328 H
220556 -        02/02/10 10:15 | 275 H
220557 -        01/11/10 10:47 | 212 H
220558 -        12/22/09 09:44 | 248 H
220559 -        12/15/09 08:50 | 211 H
220560 -        11/24/09 09:30 | 262 H
220561 -        11/03/09 08:40 | 299 H
220562 -        10/20/09 10:44 | 299 H
220563 -        10/06/09 09:15 | 343 H
220564 -        09/29/09 09:45 | 297 H
220565 -        09/21/09 05:35 | 302 H
220566 -        09/08/09 12:29 | 346 H
220567 -        08/25/09 10:13 | 335 H
220568 -        08/10/09 10:59 | 350 ?
220570 -  ..
220571 - Case study on CA 15-3 compared with changes in treatments listed in
220572 - the record on 090323 1352. ref SDS 27 J13O
220574 -  ..
220575 - Kaiser Medical Chart Lab Continues...
220576 -
220577 -        Bili, Tot Adult 0.4 mg/dL
220578 -        Creatinine 0.63 mg/dL
220579 -        ALT (SGPT) 11 U/L
220581 -         ..
220582 -        PT, Patient H 22.0 Sec
220583 -        PT INR 2.2 Ratio
220585 -         ..
220586 -    9.  Imaging:
220587 -
220588 -        Follow up ref SDS 69 9D4Y.
220589 -
220590 -        1.  02/18/10 CT THORAX W CONTRAST,.. received on 100228 2216.
220591 -            ref SDS 67 GU5L
220592 -
220593 -            a.  Mild interval improvement of the patchy ground glass
220594 -                opacities bilaterally.  There are still a few patchy
220595 -                densities noted predominantly in the bilateral lung
220596 -                bases. [...Doctor Johnson quotes from test summary in
220597 -                the Impression section, 100228 2216, ref SDS 67
220598 -                IN6I...]
220600 -                 ..
220601 -            b.  New area of subsegmental atelectasis vs
220602 -                post-inflammatory scarring right upper lobe.
220604 -                 ..
220605 -            c.  Resolution of small left pleural effusion.
220607 -             ..
220608 -        2.  01/19/10 MRI BRAIN WO/W CONTRAST(STD) -
220609 -
220610 -            No significant abnormalities.
220612 -             ..
220613 -            09/19/09 CT THORAX W CONTRAST -
220614 -
220615 -            a.  No pulmonary emboli on a technically good study.
220616 -
220617 -            b.  The lungs show multiple areas of groundglass opacity
220618 -                and multiple small areas of more confluent density.
220620 -                 ..
220621 -            c.  Tiny left pleural effusion.
220623 -                 ..
220624 -            d.  S/P left mastectomy.
220626 -                 ..
220627 -            e.  A few additional minor findings, as described above.
220629 -                 ..
220630 -            f.  Since July 20, 2009 CT scan of the chest, there has
220631 -                been resolution of many of the pulmonary opacities but
220632 -                there are now many new ones, especially in the left
220633 -                lower lobe and in the right upper lobe.  The left
220634 -                pleural effusion is much smaller.  Otherwise, no
220635 -                change.
220637 -             ..
220638 -        3.  09/19/09 CHEST, SINGLE
220640 -             ..
220641 -        4.  07/31/09 RIBS, UNILATERAL, 2 VIEWS -
220642 -
220643 -            Right ribs appear intact
220645 -             ..
220646 -        5.  07/20/09 CT THORAX W CONTRAST -
220647 -
220648 -            a.  Negative for pulmonary embolus.
220649 -
220650 -            b.  New small left pleural effusion.  No pleural
220651 -                enhancement or evidence of loculation.
220653 -                 ..
220654 -            c.  Otherwise stable chest CT compared with recent
220655 -                examination from one month earlier.
220657 -             ..
220658 -        6.  06/12/09 CT THORAX, ABDOMEN, PELVIS W CONTRAST
220660 -             ..
220661 -        7.  06/12/09 CT NECK W CONTRAST
220663 -             ..
220664 -        8.  03/17/09 DXA BONE DENSITY, AXIAL -
220665 -
220666 -            a.  Bone mineral density calculated for the LUMBAR SPINE
220667 -                is statistically consistent with osteopenia.
220668 -
220669 -            b.  Bone mineral density calculated for the TOTAL HIP is
220670 -                statistically consistent with osteopenia.
220672 -             ..
220673 -        9.  01/22/09 SHOULDER, COMPLETE 2+ VIEWS -
220675 -             ..
220676 -            Orthopedic follow up.  See Orthopedic note for details.
220677 -            S/P reduction of anterior shoulder dislocation.
220679 -             ..
220680 -       10.  01/22/09 SHOULDER, ONE VIEW -
220681 -
220682 -            Dislocation, right shoulder.  Fracture right humeral head
220684 -             ..
220685 -       11.  01/22/09 CT CERV SPINE W/O CONTRAST -
220687 -             ..
220688 -            Degenerative changes of the cervical spine without evidence
220689 -            of acute C spine fracture or loss in alignment.
220691 -             ..
220692 -       12.  01/22/09 CT HEAD W/O CONTRAST -
220693 -
220694 -            a. No evidence of acute infarct or hemorrhage.
220695 -
220696 -            b. Sinus disease. Mild nasal septal deviation to the right.
220697 -
220699 -         ..
220700 -        Assessment:
220701 -
220702 -        Follow up ref SDS 69 9E70.
220703 -
220704 -        1.  Persisting mild postherpetic neuropathy
220705 -
220706 -        2.  Metastatic breast cancer (IBC) lung, lymph node and chest
220707 -            wall
220709 -             ..
220710 -        3.  Anemia due to chemotherapy
220711 -        4.  Cancer pain
220712 -        5.  Lymphedema slightly worse on right
220713 -        6.  Anticoagulation monitoring
220714 -
220715 -
220717 -         ..
220718 -        Plan:
220719 -
220720 -        Follow up ref SDS 69 9E7Y.
220721 -
220722 -        1.  Continue Abraxane 100 mg/m2 or 150 mg/m2 iv qw x 3 weeks
220723 -            every 4 weeks
220725 -             ..
220726 -        2.  Continue serial CA 15-3's
220727 -        3.  Add (Morphine) MS 15 mg PO BID
220728 -        4.  Use Percocet for "breakthrough" pain
220729 -        5.  Plan for May 15th cruise
220731 -             ..
220732 -        6.  Continue Neupogen 480 mcg one day after chemotherapy with
220733 -            second treatment as needed.
220735 -             ..
220736 -        7.  RTC one month
220737 -
220741 -
220742 -
220743 -
220744 -
220745 -
220746 -
220747 -
220748 -
2208 -