CONTACTS 

SUBJECTS
Meeting Doctor Examine Patient IBC Symptoms Increase Redness Colorat

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 71 0000. ref SDS 69 0000.
040502 -
040503 - IBC seems active with CA 15-3 rising again, ref SDS 0 GJ5M, the punch
040504 - biopsy wound is not responding to treatment, ref SDS 0 6T5G, and
040505 - worsening inflammation in the left breast. ref SDS 0 025H  There was
040506 - no discussion of lessons learned to avoid emergency care when expected
040507 - side effects occur from prescribed treatment. ref SDS 0 6A3M  Doctor
040508 - considering mastectomy surgery to stabalize IBC disease. ref SDS 0
040509 - ZV5J  Symptoms of pulmonary emboli have quieted, ref SDS 0 RZ4I, and
040510 - xray report shows no metastasis in the right hip and knee. ref SDS 0
040511 - GN8K  Kaiser has received the 2nd opinion from Stanford, which
040512 - complements the report from UCSF.  The doctor prescribed clinical
040513 - trial treatment must commence as soon as possible, and includes
040514 - capecitabine, as recommended by UCSF. ref SDS 0 028N  The doctor
040515 - explained treatment strategy to achieve remission.  The aim is quality
040516 - of life, since most patients eventually relapse. ref SDS 0 NQ9J  The
040517 - Protocol Nurse reviewed the consent agreement and explained side
040518 - effects. ref SDS 0 4R5J  She offered suggestions for over-the-counter
040519 - treatments to reduce peeling of hands and feet.  Millie signed the
040520 - consent agreement to participate in the trial.  Tests required to
040521 - participate in the protocol were scheduled for 041216. ref SDS 0 UI6M
040523 -      ..
040524 -     [On 041221 Rosalie advises Millie cannot participate in the new
040525 -     chemotherapy trial to treat cancer, because she only had two (2)
040526 -     treatments previously with Adriamycin (AC) and Cytoxan, and the
040527 -     protocol requires patients to have had four such treatments.
040528 -     ref SDS 78 E66I
040530 -      ..
040531 -     [On 041230 doctor prescribes chemotherapy treatment recommended by
040532 -     Doctor Guardino in Stanford's a 2nd opinion. ref SDS 80 XQ41
040534 -      ..
040535 -     [On 041230 doctor advised that surgery has become critical task in
040536 -     treatment plan; asks when the meeting is schedule for the surgeon
040537 -     to consider mastectomy. ref SDS 79 CW6J
040538 -
040539 -
040540 -
040541 -
040543 -  ..
0406 -
0407 -
0408 - Discussion
0409 -
040901 - Agenda Planning Scheduling Resumption of New Treatment for IBC
040902 -
040903 - Follow up ref SDS 71 SM6M, ref SDS 69 SM6M.
040904 -
040905 - The meeting today schedules Millie to start a new chemotherapy trial
040906 - to resume treating IBC, as soon as possible, recommended by a doctor
040907 - at Kaiser on 041104, ref SDS 69 WT60, and again during the follow up
040908 - meeting two weeks ago on 041130. ref SDS 71 Y66F  Millie's daughter,
040909 - Pam, attended the meeting to ask about curing cancer. ref SDS 0 NQ9J
040911 -  ..
040912 - Millie created an agenda on the marking board...
040913 -
040914 -        CA 15-3 normal best report 2 years......... ref SDS 0 GJ5M
040915 -        CT Test report............................. ref SDS 0 NL4N
040916 -        Coughing, heavy chest, breathing
040917 -        issues improve............................. ref SDS 0 RZ4I
040918 -        Hip and knee xray.......................... ref SDS 0 GN8K
040919 -        Lumps under arm disappeared................ ref SDS 0 MW8J
040920 -        Lumps in neck disappeared.................. ref SDS 0 8R6M
040921 -        Wound punch biopsy worse................... ref SDS 0 6T5G
040922 -        Breast redness worse....................... ref SDS 0 IM5H
040923 -        Treatment needed immediately............... ref SDS 0 028N
040924 -        Pam asks about curing cancer............... ref SDS 0 NQ9J
040925 -        Sign Docs set tests to begin trial......... ref SDS 0 4R5J
040926 -
040927 -
040928 -
040929 -
040930 -
040931 -
0410 -

SUBJECTS
CA 15-3 Cancer Marker 43 Rises Above Normal Again Signaling Active I

1103 -
110401 -  ..
110402 - CA 15-3 Cancer Marker 43 Rises Above Normal
110403 -
110404 - Follow up ref SDS 71 087J, ref SDS 69 087J.
110405 -
110406 - Blood test on 041204 shows CA 15-3 has reversed again and rose to 43
110407 - from 39, which is the high end of normal.
110409 -           ..
110410 -          041204......... 43............... 041210, ref SDS 0 087J
110411 -          041007......... 39............... 041104, ref SDS 69 087J
110412 -          040923......... 49 H............. 041006, ref SDS 62 087J
110413 -          040908......... 44 H............. 040909, ref SDS 61 087J
110414 -          040825......... 47 H............. 040812, ref SDS 61 087J
110415 -          040811......... 42 H............. 040812, ref SDS 58 087J
110416 -          040728......... 43 H............. 040729, ref SDS 56 2N5J
110417 -          040712......... 47 H............. 040713, ref SDS 54 087J
110418 -          040614......... 55 H............. 040615, ref SDS 53 PX6X
110419 -          040517......... 78 H............. 040601, ref SDS 49 2N5J
110420 -          040311......... 70 H............. 040318, ref SDS 36 SM6M
110421 -          040205......... 60 H............. 040211, ref SDS 34 SM6M
110422 -          031201......... 62 H............. 031205, ref SDS 32 SM6M
110423 -          030912......... 66 H............. 030915, ref SDS 30 SM6M
110424 -          030708......... 68 H............. 030710, ref SDS 28 SM6M
110425 -          030503......... 54 H............. 030508, ref SDS 25 SM6M
110426 -          030403......... 45 H............. 030508, ref SDS 25 SM6M
110427 -          030215......... 46 H............. 030220, ref SDS 24 5E6L
110428 -          030106......... 37 H............. 030109, ref SDS 23 SM6M
110429 -          021202......... 41 H?............ 021204, ref SDS 20 SP5G
110430 -          021111......... 36 H?............ 021113, ref SDS 19 Y65I
110431 -          021023......... 33 H?............ 021023, ref SDS 18 SQ5I
110432 -          020930......... 33 H?..29........ 021002, ref SDS 17 SQ5I
110433 -          020917......... 36 H?............ 020924, ref SDS 16 SQ5I
110434 -          020717......... 59 H?............ 020726, ref SDS 15 YN5K
110435 -          020629......... 75 H ............ 020705, ref SDS 14 UX6I
110436 -          020608........  67 H ............ 020614, ref SDS 13 0001
110437 -          020603........ 108 H ............ 020607, ref SDS 12 X67F
110438 -          020511........ 117 H ............ 020603, ref SDS 11 PJ4J
110439 -          020419......... 81 H ............ 020430, ref SDS 10 7N5H
110440 -          020321......... 85 H ............ 020405, ref SDS 9 6T8K
110441 -
110442 -
110443 -
110445 -  ..
1105 -
1106 -
1107 - Analysis
1108 -
110801 - CA 15-3 Cancer Marker Rises Again Signaling Active IBC
110802 - Wound Not Healing Inflammation Worse CA 15-3 Rise Shows Active IBC
110803 - IBC Active Wound Not Healing Inflammation Worse CA 15-3 Rise Shows
110804 -
110805 - Follow up ref SDS 71 GJ5M, ref SDS 69 GJ5M.
110806 -
110807 - The doctor noted that CA 15-3 rise from 39 to 43 from testing on
110808 - 041202 in the Emergency room, ref SDS 74 4Q49, is not a dramatic
110809 - change in the trend line for Millie, similar to analysis on 021206
110810 - when CA 15-3 reversed course and began to rise after treatment for the
110811 - original diagnosis of breast cancer. ref SDS 21 5E6L  Rising CA 15-3
110812 - shows evident correlation with not having received treatment for about
110813 - seven (7) weeks, since 041021, as a result of Kaiser prudently ending
110814 - treatment on the Taxol and Avastin trial due to findings of pulmonary
110815 - emboli, reported on 041104. ref SDS 69 N438  The rise further aligns
110816 - with wound worsening from punch biopsy on the left breast, not
110817 - responding to treatment, ref SDS 0 6T5G; and also worsening
110818 - inflammation in the breast. ref SDS 0 025H
110819 -
110820 -
110821 -
110822 -
110823 -
110824 -
110825 -
1109 -

SUBJECTS
CT Scan Test Scheduled for Baseline Participate New Chemotherapy Pro

1203 -
120401 -  ..
120402 - New Trial Requires Another CT Test Due to Delay Starting Treatment
120403 - CT Scan Scheduled for Baseline Participate New Chemotherapy Protocol
120404 -
120405 - Follow up ref SDS 71 NL4N, ref SDS 69 NL4N.
120406 -
120407 - The Protocol Nurse, Rosalie, scheduled Millie for anthother Ct test to
120408 - set a baseline for the new treatment trial, per below. ref SDS 0 OZ8H
120409 - The few weeks treating the wound on the left breast with antibiotics
120410 - prescribed during the meeting on 041130 has delayed start of the trial
120411 - beyond requirements for a CT test within 30 days, since the last test
120412 - was on 041103, reported on 041104. ref SDS 69 NL4N  Similar sequence
120413 - occurred on 040402, when a CT test was required, because of 2 week
120414 - delay treating Cellulitus. ref SDS 38 HS45
120415 -
120416 -
120417 -
1205 -

SUBJECTS
Cough Heavy Chest Shortness of Breath Improve Symptoms Subside Pulmo

2103 -
210401 -  ..
210402 - Cough Heavy Chest Shortness of Breath Symptoms Improve
210403 - Pulmonary Emoboli Symptoms Cough Heavy Chest Breathing Improve
210404 - Avastin Trial Stop Participation Seems to Have Positive Effect
210405 -
210406 - Follow up ref SDS 71 RZ4I, ref SDS 69 RZ4I.
210408 -  ..
210409 - Millie reported reduction in symptoms of the pulmonary emboli,
210410 - diagnosed on 041104. ref SDS 69 RZ4I  Coughing, heavy chest, and
210411 - shortness of breath seem improved, since the examination on 041130, as
210412 - planned by the doctor. ref SDS 72 MZ8M
210414 -  ..
210415 - Since ending treatment with bevacizumab on 041021, ref SDS 68 0001,
210416 - side effects of nose bleeding have subsided.
210418 -  ..
210419 - The doctor seemed to indicate that ending treatment with Avastin on
210420 - 041104, combined with normal activity, coumadin treatments, and
210421 - continuing today the prescription for antibiotics to treat the sore on
210422 - the breast, ref SDS 0 6T5G, will together help the cough from
210423 - compounding to a worsening condition.
210425 -      ..
210426 -     [On 041211 coughing worsens, spitting up blood; very concerned.
210427 -     ref SDS 77 SE5O
210429 -      ..
210430 -     [On 041230 meeting with doctor patient reports pulmonary emboli
210431 -     symptoms decline; coughing, heavy chest, shortness of breath have
210432 -     significantly improved. ref SDS 79 RZ4I
210434 -      ..
210435 -     [On 060722 Millie's son (now 52) was hospitalized for recurrence
210436 -     of pulmonary emboli, and his doctor did testing that found genetic
210437 -     disposition for pulmonary emboli, ref SDS 90 3D9T; research found
210438 -     that coughing up blood is a symptom. ref SDS 90 RP3H
210439 -
210440 -
210441 -
210442 -
210443 -
2105 -

SUBJECTS
Xray Test Shows Slight Arthritis Right Knee Hip Discomfort Xray Show

2403 -
240401 -  ..
240402 - Xray Test Shows Slight Arthritis in Knee and Hip
240403 - Knee Hip Discomfort Xray Shows No Distant Metastasis
240404 - Glucosamine and Chondroitin Treatment for Knee Hip Arthritis
240405 -
240406 - Follow up ref SDS 71 GN8K.
240407 -
240408 - The doctor submitted the report for the xray test performed on 041130,
240409 - which says....
240411 -  ..
240412 - Xray test dated 041130 shows....
240421 -        ..
240422 -       68/F Radiology Report               Exam  1 of 1
240423 -       Page 1
240425 -        ..
240426 -       Right Hip and Right Knee
240428 -        ..
240429 -       History
240430 -
240431 -            Pain
240433 -        ..
240434 -       Findings
240435 -
240436 -            Right Hip...
240437 -
240438 -            The hip shows slight narrowing of the joint space.  There
240439 -            are no fractures.  There are no osteoblastic or lytic
240440 -            areas.
240442 -             ..
240443 -            Right Knee...
240445 -             ..
240446 -            The right knee shows slight narrowing of the medial
240447 -            tibiofemoral joint space with slight spurring.  There are
240448 -            no osteoblastic or lytic areas.
240450 -             ..
240451 -            Impression...
240453 -             ..
240454 -            Degenerative change.
240456 -             ..
240459 -             ..
240460 -            DD:  041201   DT 041207  PZW
240462 -             ..
240463 -            MTZRAJ
240465 -             ..
240466 -            041207 1644
240468 -             ..
240470 -            Please see report.  No evidence of cancer.
240472 -  ..
240473 - The doctor submitted the xray report that shows no evidence of cancer
240474 - in the knee or the hip, previously shown in his letter to Millie
240475 - dated 041207.
240477 -  ..
240478 - There are indications of mild arthritis with spurring in the joint
240479 - space. ref SDS 0 W493
240481 -  ..
240482 - Millie is taking Glucosimine and Chondroitin, which is beginning to
240483 - help.
240484 -
240485 -
240486 -
240487 -
240488 -
240489 -
240490 -
2405 -

SUBJECTS
Lumps Under Left Arm No Examination Patient Reports Favorable Condit

2603 -
260401 -  ..
260402 - Lumps Under Arm Seem Less Severe Today
260403 -
260404 - Follow up ref SDS 71 MW8J, ref SDS 69 MW8J.
260405 -
260406 - Millie reported no evident renewal of activity under the left arm;
260407 - there is no discomfort, and no increase in lumpiness, reflecting
260408 - favorable examination on 041130, and the CT test on 041103, reviewed
260409 - during the meeting on 041104. ref SDS 69 MW8J
260411 -  ..
260412 - The doctor made no examination on this matter.
260413 -
260414 -
260415 -
260416 -
260417 -
2605 -

SUBJECTS
Neck Lumps Left Side No Examination Patient Reports Favorable Condit

3203 -
320401 -  ..
320402 - Lumps in Neck No Evidence of Swelling Indicating Cancer Receded
320403 -
320404 - Follow up ref SDS 71 8R6M, ref SDS 69 8R6M.
320405 -
320406 - There was no examination of the neck, because of favorable
320407 - examinations and testing the past few months, reported on 041104.
320408 - ref SDS 69 8R6M
320409 -
320410 -
320411 -
320412 -
320413 -
320414 -
3205 -

SUBJECTS
Lesson Learned Notify Patients Side Effects Elevated Temperature Spr
Wound Punch Biopsy Left Breast Slow Recovery Indicates Diagnosis IBC

4204 -
420501 -  ..
420502 - Wound Punch Biopsy Slow Recovery Continue Treatment Antibiotics
420503 -
420504 - Follow up ref SDS 71 6T5G, ref SDS 69 6T5G.
420505 -
420506 - The doctor examined the sore on the left breast, and commented that
420507 - recovery has been slow with antibiotics using penicillin, prescribed
420508 - on 041130. ref SDS 71 JU6N  He extended the prescription to run
420509 - concurrent with chemotherapy treatments, which he has scheduled to
420510 - start immediatlely after completing required baseline testing next
420511 - week.
420513 -  ..
420514 - There was no discussion of pathology reported on the biopsy for skin
420515 - tissue taken on 041130 to assess the worsening wound, ref SDS 71 HT7G
420516 - Pathology on the biopsy was discussed by Doctor Parsley on 041202 when
420517 - the patient was seen in the Emergency Room due to elevated
420518 - temperature, and the doctor indicated that the pathology diagnosed
420519 - cellulitus, ref SDS 74 4Q94; the report has not been submitted to the
420520 - patient.
420521 -
420522 -     [...see below doctor concnerned slow healing wound from punch
420523 -     biopsy may indicate breast is resistant to chemotherapy, and so
420524 -     considers surgical solution. ref SDS 0 ZV5J
420526 -      ..
420527 -     [On 041230 antibiotics prescription terminated for failure to heal
420528 -     wound from punch biopsy. ref SDS 80 2V58
420530 -  ..
420531 - The doctor asked about procedures that cost $50 to treat Millie in the
420532 - Emergency Room on 041202, when temperature rose above 101 and the red
420533 - rash spread suddenly over the left breast. ref SDS 74 0001
420535 -  ..
420536 - Millie cited Doctor Parsley's report to the primary care physician in
420537 - Oncology on Millie's treatment in the Emergency Department on 041202,
420538 - ref SDS 74 PT5Q, ans which explains....
420539 -
420540 -        1.  Blood test was performed and showed that white cell count
420541 -            was adequate, ref SDS 74 W47N
420543 -             ..
420544 -        2.  Lab report showed that a tissue sample taken by primary
420545 -            care physician in Oncology during the meeting on 041130
420546 -            showed cellulitus. ref SDS 74 4Q94
420548 -             ..
420549 -        3.  Symptoms of elevated temperature, and spread of red rash
420550 -            over the breast, as occurred in this case, are common,
420551 -            initial side effects of treatment with antibiotics
420552 -            prescribed on 041130 by the primary care physician in
420553 -            Oncology, ref SDS 71 BG6F, and routinely subside without
420554 -            harm to the patient after initial flare up. ref SDS 74 4Q40
420555 -
420557 -  ..
420558 - Lesson Learned Notify of Side Effects to Avoid Unnecessary Cost Alarm
420559 -
420560 - Lessons learned to reduce costs and alarm that patients suffer might
420561 - in future cases notify patients, for example, in this case on 041130,
420562 - ref SDS 71 JU6N, that side effects from treatment are a spreading rash
420563 - and rising temperature, similar to symptoms of worsening IBC.
420564 - ref SDS 74 4Q40
420565 -
420566 -
420567 -
420568 -
420569 -
420570 -
4206 -

SUBJECTS
Case Study Surgery Mastectomy IBC Worse Redness Examination Left Brea
Lessons Learned Case Studies Feedback
Surgery Case Study Mastectomy IBC Worse Redness Examination Left Brea
Avastin Taxol Trial Ends Avoid Blood Clots Pulmonary Emboli Coumadin
IBC Worse Redness Examination Left Breast Infected IBC Needs Immedia
Schedule Mastectomy Surgery Following Chemotherapy Treat Redness 4 -

7508 -
750901 -  ..
750902 - IBC Symptoms Rise Slow Healng Biopsy Wound Rising CA 15-3, Redness
750903 - Redness IBC Worsens Left Breast Infected IBC Needs Immediate Treatment
750904 - Surgery Mastectomy Slow Healing Biopsy Wound Indicates Persistant IBC
750905 - Mastectomy Surgery Slow Healing Biopsy Wound Indicates Persistant IBC
750906 -
750907 - Follow up ref SDS 71 025H.
750908 -
750909 - The doctor commented that red coloration in the left breast seems
750910 - worse than the last examination on 041130. ref SDS 71 025H
750912 -  ..
750913 - Millie said that inflammation is actually a lot less than when she
750914 - went into Emergency on 041202, per above, ref SDS 0 BI5L, reflecting
750915 - compound effect of inflammation from Cellulitis treated in the
750916 - Emergency Department at that time. ref SDS 74 4Q40
750917 -
750919 -  ..
750920 - Case Study Surgery Considerations
750921 - Surgery May be Needed to Treat IBC on Left Breast
750922 -
750923 - The doctor indicated that persistance of the wound from the biopsy on
750924 - 040419, now eight (8) months later and not responding to treatment
750925 - with antibiotics, noted above, ref SDS 0 6T5G, in combination with
750926 - return of IBC inflammation, and rising CA 15-3, per above, ref SDS 0
750927 - 087J, suggests Millie may need surgery on the left breast after all to
750928 - avoid cancer from getting out of control, as discussed on 041130.
750929 - ref SDS 71 EV7M
750931 -  ..
750932 - Millie recalled the wound was nearly healed after the last treatment
750933 - on 041021, shown by examination at Kaiser on 041104. ref SDS 69 LP7F
750934 - This dilemma was discussed on 041130 citing the surgeon's advice that
750935 - treating IBC is a predicate to performing surgery. ref SDS 69 F47L
750936 - During the meeting on 041202, Doctor Parsley recommended that the
750937 - surgeon perform follow up examination on the wound from the punch
750938 - biopsy, and mentioned this in the letter to the doctor, also, on that
750939 - date. ref SDS 74 BI4Y
750941 -  ..
750942 - The doctor asked when the surgeon will follow up on Doctor Parsley's
750943 - referral for examination?  He would like to get feedback on surgery
750944 - to treat persistant cancer in the left breast.
750946 -  ..
750947 - Millie advised that a meeting is scheduled with the surgeon for
750948 - 050107.
750950 -  ..
750951 - Case study shows mastectomy has been considered....
750952 -
750953 -    1.  Surgeon says IBC needs to be
750954 -        cured then mastectory............... 040429, ref SDS 45 SD7F
750956 -         ..
750957 -    2.  Doctor plans to monitor
750958 -        effects of treatment to
750959 -        decide on surgery in 4 -
750960 -        6 months...........................  040504, ref SDS 46 MG8G
750962 -         ..
750963 -    3.  IBC research shows surgery
750964 -        standard treatment after
750965 -        chemotherapy but tricky............. 040517, ref SDS 47 JK8L
750967 -         ..
750968 -    4.  Tumor Board discussed surgery
750969 -        after chemotherapy.................. 040517, ref SDS 47 F77M
750971 -         ..
750972 -    5.  Patient faces dilemma to get
750973 -        surgery or continue with Avastin
750974 -        trial chemotherapy.................. 040614, ref SDS 52 JK8L
750976 -         ..
750977 -    6.  Surgery was seen as no longer
750978 -        required............................ 040812, ref SDS 58 T75L
750980 -         ..
750981 -    7.  Doctor Benz during meeting at
750982 -        UCSF commented without explanation
750983 -        that surgery is not a viable
750984 -        solution in this case............... 041018, ref SDS 66 EO3Y
750986 -         ..
750987 -    8.  Doctor Guardino during meeting
750988 -        at Stanford proposes surgery
750989 -        may be an option after recovery
750990 -        from IBC; no criteria presented
750991 -        for evaluating sufficient
750992 -        IBC recovery........................ 041019, ref SDS 67 TX96
750994 -         ..
750995 -    9.  Patient dilemma resolved by
750996 -        ending treatment with Avastin
750997 -        due to pulmonary emboli; new
750998 -        dilemma on how to maintain
750999 -        progress with continued
751000 -        treatment........................... 041104, ref SDS 69 N440
751002 -         ..
751003 -   10.  2nd opinion submitted by Doctor
751004 -        Benz at UCSF confirms that
751005 -        surgery not an effective solution
751006 -        for Millie's patient profile........ 041117, ref SDS 70 OU5P
751008 -         ..
751009 -   11.  Cancer becomes progressively
751010 -        resistant to chemotherapy and
751011 -        cascades out of control............. 041130, ref SDS 71 EV7M
751013 -         ..
751014 -   12.  2nd opinion submitted by Doctor
751015 -        Guardino at Stanford confirms
751016 -        surgery may be possible after
751017 -        regression of inflammation
751018 -        occurs; no criteria submitted
751019 -        for determing when regression
751020 -        is sufficient for
751021 -        surgery............................. 041209, ref SDS 75 SN97
751023 -         ..
751024 -   13.  Case study CT tests indicate
751025 -        IBC only disease; no evidence
751026 -        distant metastasis; treatment
751027 -        with surgery for mastectomy
751028 -        may avoid cancer from getting
751029 -        out of control...................... 041230, ref SDS 79 XV7M
751031 -         ..
751032 -   14.  Primary care physician in
751033 -        Oncology advised that
751034 -        surgery has become critical
751035 -        task in treatment plan; asks
751036 -        when the meeting is scheduled
751037 -        for surgeon to consider
751038 -        mastectomy.......................... 041230, ref SDS 79 CW6J
751040 -         ..
751041 -   15.  Surgeon examination shows IBC
751042 -        relapse from lack of chemotherapy
751043 -        treatment beginning on 041104
751044 -        prevents surgery until further
751045 -        recovery from IBC, as called out
751046 -        by doctor Guardino in 2nd opinion
751047 -        at Stanford......................... 050107, ref SDS 81 IS5N
751049 -         ..
751050 -   16.  New cancer sores and rising CA
751051 -        15-3 with expanding inflammation
751052 -        indicates left breast may have
751053 -        "pockets of resistance" to
751054 -        chemotherapy beginning to get
751055 -        out of control; primary care
751056 -        physician orders another
751057 -        examination by surgeon............... 050311, ref SDS 82 PA4N
751059 -         ..
751060 -   17.  Surgery examination presents
751061 -        dilemma cites pior work on 050107
751062 -        patient needs chemotherapy before
751063 -        surgery; treatment loop Oncology
751064 -        wants surgery to aid
751065 -        chemotherapy......................... 050324, ref SDS 83 WH5L
751067 -         ..
751068 -   18.  Criteria for treating pockets
751069 -        of resistance to chemotherapy
751070 -        with surgery to solve dilemma
751071 -        of treatment loop.................... 050324, ref SDS 83 OV5H
751073 -         ..
751074 -   19.  Criteria to approve surgery for
751075 -        mastectomy to improve chances of
751076 -        avoiding relapse and extending
751077 -        quality of life...................... 050324, ref SDS 83 VL4O
751079 -         ..
751080 -   20.  Surgeon limited experience with
751081 -        mastectomy on IBC patients........... 050324, ref SDS 83 QJ3Q
751083 -         ..
751084 -   21.  Metastatic cancer involving
751085 -        regional lymph nodes, diagnosed
751086 -        on 040318, ref SDS 83 8R6M, may
751087 -        be operable to reduce chances of
751088 -        relapse, which is different from
751089 -        "distant metastasis," that surgery
751090 -        cannot cure, but may play a
751091 -        palliative role, further explained
751092 -        on 050712, ref SDS 85 B65G, and
751093 -        referenced in research on............ 050324, ref SDS 83 O84N
751095 -         ..
751096 -   22.  Primary care physician reviews
751097 -        results of surgeon's examination
751098 -        and criteria for deciding when
751099 -        patient has recovered sufficiently
751100 -        from IBC for mastectomy
751101 -        surgery.............................. 050329, ref SDS 84 XQ41
751103 -         ..
751104 -   23.  Prescription for chemotherapy
751105 -        changed from AC to Taxotere and
751106 -        capecitabine (Xeloda)................ 050329, ref SDS 84 T58M
751108 -         ..
751109 -   24.  Surgeon examins left breast
751110 -        discovers biopsy wound healed
751111 -        and recovery from IBC sufficient
751112 -        for surgery to perform a
751113 -        mastectomy on left breast............ 050727, ref SDS 86 YY7F
751115 -         ..
751116 -   25.  Surgeon proposes wider than
751117 -        normal boundary for mastectomy
751118 -        to reduce chances of relapse,
751119 -        by removing skin previously
751120 -        infected with
751121 -        IBC.................................. 050727, ref SDS 86 JV5F
751123 -         ..
751124 -   26.  Review Kaiser's experience
751125 -        treating IBC patients with
751126 -        mastectomy surgery; perform
751127 -        due diligence........................ 050727, ref SDS 86 QJ3Q
751129 -         ..
751130 -   27.  Criteria to approve surgery
751131 -        for treating metastatic cancer
751132 -        in left breast involving
751133 -        regional lymph nodes, but not
751134 -        distant metastasis; close
751135 -        call to extend quality of
751136 -        life................................. 050727, ref SDS 86 VL4O
751138 -         ..
751139 -   28.  2nd opinion surgeon with Kaiser
751140 -        in Oakland recommends against
751141 -        surgery to remove both breasts
751142 -        proposes mastectomy only on left
751143 -        breast............................... 050729, ref SDS 87 Z45N
751145 -         ..
751146 -   29.  Primary care physician reviews
751147 -        patients understandings from
751148 -        meeting with surgeon on planning
751149 -        mastectomy........................... 050729, ref SDS 88 XQ41
751151 -         ..
751152 -   30.  2nd opinion #2 on surgery for
751153 -        mastectomy solution; begin
751154 -        developing background................ 050811, ref SDS 89 0001
751156 -         ..
751157 -   31.  2nd opinion #2 consultation with
751158 -        Kaiser internal referral recommends
751159 -        mastectomy surgery for IBC
751160 -        cure................................. 050826, ref SDS 90 JS4H
751162 -         ..
751163 -   32.  2nd opinion #2 report from Kaiser
751164 -        internal referral recommends
751165 -        mastectomy surgery for
751166 -        cure................................. 050907, ref SDS 91 F49H
751168 -         ..
751169 -   33.  Primary care physician objects 2nd
751170 -        opinions for due diligence delays
751171 -        treatment of IBC with mastectomy
751172 -        surgery for local control............ 050913, ref SDS 92 5T9N
751174 -         ..
751175 -   34.  2nd opinion Doctor Grissom proposes
751176 -        thin skin biopsies verify IBC clear
751177 -        in left breast; recommends avoid
751178 -        standard mastectomy and treat with
751179 -        chemotherapy; if surgery performed,
751180 -        then very wide mastectomy to remove
751181 -        skin previously infected with IBC
751182 -        to reduce risk of
751183 -        relapse.............................. 050920, ref SDS 93 XL8U
751185 -         ..
751186 -   35.  2nd opinion Doctor Bailey proposes
751187 -        avoid standard mastectomy and treat
751188 -        only with chemotherapy as needed for
751189 -        local control; if surgery attempted
751190 -        use very wide mastectomy to remove
751191 -        skin previously infected with IBC
751192 -        to reduce risk of relapse; surgery
751193 -        high risk for Millie's patient
751194 -        profile of secondary IBC, no tumor
751195 -        to remove, history of relapse,
751196 -        and pulmonary emboli................. 050922, ref SDS 94 0001
751198 -         ..
751199 -   36.  Surgeon examination indicates
751200 -        patient ready for mastectomy
751201 -        surgery, agrees to perform thin
751202 -        skin biopsies to verify breast
751203 -        clear of IBC disease, and determine
751204 -        scope of very wide mastectomy to
751205 -        remove skin previously infected
751206 -        with IBC in order to reduce risk
751207 -        of relapse........................... 050923, ref SDS 95 SZ6M
751209 -         ..
751210 -   37.  Surgeon consultation relates risks
751211 -        of standard mastectomy for Millie's
751212 -        patient profile secondary IBC, no
751213 -        tumor to remove, history of relapse,
751214 -        and pulmonary emboli................. 050923, ref SDS 95 VL4O
751216 -         ..
751217 -   38.  Plastic surgeon relates risks
751218 -        immediate reconstruction proposes
751219 -        standard closure for very wide
751220 -        mastectomy........................... 050928, ref SDS 96 245N
751222 -         ..
751223 -   39.  Plastic surgeon's consultation
751224 -        notes say patient profile extremely
751225 -        high risk for mastectomy surgical
751226 -        complications from secondary
751227 -        IBC, history of
751228 -        relapse.............................. 051007, ref SDS 97 KO64
751229 -        loss of blood vessels reduces
751230 -        ability to deliver treatment
751231 -        and nutrients to breast skin
751232 -        in the case of relapse, and
751233 -        pulmonary emboli..................... 051007, ref SDS 97 KO49
751235 -         ..
751236 -   40.  Mastectomy surgery ordered that
751237 -        leaves in place skin previously
751238 -        infected with secondary IBC which
751239 -        spread beyond the breast, and is
751240 -        currently clear by examination and
751241 -        by tests which also show no evidence
751242 -        of tumor within the breast; appears
751243 -        conflicting with published guidance
751244 -        to perform mastectomy to remove a
751245 -        tumor in the breast when IBC has not
751246 -        spread beyond the breast............. 051007, ref SDS 97 P64J
751248 -         ..
751249 -   41.  Mastectomy surgery reduces palliation
751250 -        prospects and benefits, and also
751251 -        reduces ability to treat patient
751252 -        for IBC relapse; surgery removes
751253 -        blood vessels and capillaries in
751254 -        breast tissue, which prevents
751255 -        delivery of chemotherapy drug
751256 -        treatment and immune system
751257 -        nutrients 2nd opinion consultation
751258 -        Doctor Bailey........................ 051011, ref SDS 98 G65S
751260 -         ..
751261 -   42.  Palliation does not justify
751262 -        mastectomy surgery for patient
751263 -        NED 2nd opinion consultation
751264 -        Doctor Bailey........................ 051011, ref SDS 98 G66W
751266 -         ..
751267 -   43.  Due diligence analysis requirements
751268 -        for "Time Out" to evaluate need
751269 -        for surgery, scope, schedule,
751270 -        tasks, and risks were not performed
751271 -        by medical team...................... 051019, ref SDS 99 O95W
751273 -         ..
751274 -   44.  Surgeon's analysis on necessity for
751275 -        operation showing alignment with
751276 -        patient history missing from medical
751277 -        records required for due diligence
751278 -        to avoid mistakes; not corrected
751279 -        prior to surgery because not
751280 -        enough time.......................... 051021, ref SDS A0 QV4H
751282 -         ..
751283 -   45.  Mastectomy surgery performed......... 051021, ref SDS A0 0001
751285 -         ..
751286 -   46.  Surgeon hopeful all infected tissue
751287 -        was removed by mastectomy to avoid
751288 -        future relapse....................... 051021, ref SDS A0 SD7L
751290 -         ..
751291 -   47.  Case study on purpose of surgery
751292 -        for patient with secondary IBC to
751293 -        cure or reduce chance of relapse by
751294 -        removing previously infected skin
751295 -        on breast infected with IBC, may
751296 -        be an innovation perform very wide
751297 -        mastectomy with standard closure;
751298 -        however, purpose evolved from local
751299 -        control, to cure, to removing
751300 -        "pockets of resistance" to systemic
751301 -        chemotherapy treatment, and then
751302 -        to only palliation................... 051027, ref SDS A1 F25H
751304 -         ..
751305 -   48.  Breast replacement surgery to recover
751306 -        from IBC 3rd relapse consideration of
751307 -        previously postponed procedure to
751308 -        remove infected tissue in pockets of
751309 -        resistance due to mastectomy surgery
751310 -        that removed blood vessels needed for
751311 -        delivering chemotherapy treatment;
751312 -        replace with healthy skin that has blood
751313 -        vessels which enable systemic
751314 -        treatment with chemotherapy
751315 -        in the event of further
751316 -        relapse.............................. 060711, ref SDS A2 X54L
751318 -         ..
751319 -   49.  Slow response to treatment presented
751320 -        for 2nd opinion review of surgery
751321 -        effect removing blood vessels without
751322 -        breast replacement that prevents
751323 -        delivery of chemotherapy
751324 -        treatments........................... 060821, ref SDS A4 PE6N
751326 -         ..
751327 -   50.  Expections for recovery tempered by
751328 -        disparity between rapid drop in
751329 -        CA 15-3 cancer marker, and slow
751330 -        recovery of IBC rash, possibly related
751331 -        to mastectomy surgery removing blood
751332 -        vessels not yet restored by
751333 -        postponed breast replacement
751334 -        surgery.............................. 060929, ref SDS A5 EH3F
751336 -         ..
751337 -   51.  Cellulitus complications of lymphedema
751338 -        diagnosed on 060217 compounded by
751339 -        trauma from broken finger on 060914
751340 -        patient treated in Emergency Room;
751341 -        hospitalized 5 days temperature
751342 -        rising during cancer treatments,
751343 -        left arm engulfed with inflammation,
751344 -        red rash and excessive swelling
751345 -        diagnosed due to loss of lymphatics
751346 -        removed on 051021 for mastectomy
751347 -        surgery.............................. 061027, ref SDS A6 V759
751349 -         ..
751350 -   52.  Doctor reports IBC rash on left
751351 -        breast area is now "stable"
751352 -        indicating slow response to
751353 -        treatment because on 051021
751354 -        blood vessels were removed
751355 -        from the treatment area by
751356 -        mastectomy surgery that creates
751357 -        pockets of resistance to
751358 -        chemotherapy, per per analysis
751359 -        of expectations...................... 061110, ref SDS A7 ZL5W
751361 -         ..
751362 -   53.  Surgery to remove pockets of infected
751363 -        tissue that resist treatment and
751364 -        breast reconstruction to increase
751365 -        response from treatment for future
751366 -        relapse.............................. 061208, ref SDS A8 ZZ5F
751367 -
751368 -
751369 -
751370 -
751371 -
751372 -
751373 -
751374 -
751375 -
751376 -
7514 -

SUBJECTS
Stanford 2nd Opinion Received by Kaiser Synthesize 2nd Opinions Adop
2nd Opinions UCSF Stanford Synthesize Recommendations Adopt Continuo

9404 -
940501 -  ..
940502 - Stanford 2nd Opinion Received by Kaiser
940503 - 2nd Opinions Synthesize Adopt Recommendations Continuous Treatment
940504 - Treatment Proposals in 2nd Opinions Try If Chemotherapy Trial Fails
940505 -
940506 - Follow up ref SDS 71 5X4J.
940507 -
940508 - The doctor reported that Kaiser has received 2nd opinion from Stanford
940509 - Cancer Center with findings and recommendations from meeting on
940510 - 041019. ref SDS 67 0001  Today, there was no discussion of Stanford's
940511 - report, which is set out in the record yesterday on 041209.
940512 - ref SDS 75 0001  Stanford's report complements the 2nd opinion from
940513 - UCSF cited during the meeting on 041130; the doctor plans to
940514 - synthesize ideas into a comprehensive treatment plan for Millie.
940515 - ref SDS 71 5X4J  He advised that recommendations in 2nd opinions by
940516 - UCSF and Stanford can be tried later if disease progresses after
940517 - trying the new trial, also, discussed on 041130, ref SDS 71 Y66F,
940519 -      ..
940520 -     [On 041221 Kaiser reports Millie cannot get treatment in the new
940521 -     chemotherapy trial. ref SDS 78 E66I
940523 -      ..
940524 -     [On 041230 worsening IBC symptoms; treatment prescribed based on
940525 -     Stanford 2nd opinion recommending Adriamycin/Cytoxan chemotherapy
940526 -     which Kaiser believed would qualify Millie for referral to
940527 -     clinical trial with capecitabine recommended by UCSF. ref SDS 79
940528 -     IM5H
940529 -
940530 -
940531 -
940532 -
9406 -

SUBJECTS
Treatment Clinical Trial Novel Epothilones BMS-247550 Plus Capecitab

9803 -
980401 -  ..
980402 - Cancer Relapses 2nd Time and 1st Relapse for IBC
980403 - Treatment Clinical Trial Novel Epothilones BMS-247550 Plus Capecitabine
980404 -
980405 - Follow up ref SDS 73 4P9L, ref SDS 71 028N.
980406 -
980407 - The doctor cited rising CA 15-3, ref SDS 0 GJ5M, worsening
980408 - inflammation (redness), ref SDS 0 025H, and a persistant wound that
980409 - resists treatment with antibiotics, ref SDS 0 6T5G, all support
980410 - impressions on 041130 that IBC is relapsing.  Chemotherapy is needed,
980411 - as soon as possible for local control of IBC in the left breast.
980412 - ref SDS 71 Y66F
980413 -
980414 -     [On 060711 0930 Millie's cancer relpases 3rd time following
980415 -     mastectomy surgery; 2nd relapse of IBC. ref SDS A2 8Y8I
980417 -  ..
980418 - The doctor advised that the Protocol Nurse, Rosalie, has proposed a
980419 - new chemotherapy clinical trial, as planned on 041130. ref SDS 71 028N
980420 - This treatment combines Novel Epothilones BMS-247550 with
980421 - capecitabine, which aligns with the 2nd opinion received from Doctor
980422 - Benz at UCSF, who recommended capecitabine, reported on 041117,
980423 - ref SDS 70 OU5V, and cited by the doctor during the meeting at Kaiser
980424 - on 041130. ref SDS 71 5X4J  Combining capecitabine with Novel
980425 - Epothilones BMS-247550 is also supported by the Benz report suggesting
980426 - multi-agent treatments. ref SDS 70 OU6S
980428 -  ..
980429 - Millie related background on 041201 when Rosalie submitted information
980430 - explaining the new protocol. ref SDS 73 4P9L
980432 -  ..
980433 - The doctor feels this new clinical trial is the best treatment plan
980434 - for Millie, rather than resume treatments with Taxol, discussed on
980435 - 041104, ref SDS 69 Q59K, and again a few weeks ago during the meeting
980436 - on 041130. ref SDS 71 0293
980437 -
980438 -     [On 041221 Rosalie advises Millie cannot participate in the new
980439 -     chemotherapy trial to treat cancer, due to an administrative mixup
980440 -     that overlooked her prior record of getting only two (2)
980441 -     treatments with Adriamycin (AC) and Cytoxan, whereas, the protocol
980442 -     requires patients to have had four treatments. ref SDS 78 E66I
980444 -      ..
980445 -     [On 041230 worsening IBC symptoms; treatment prescribed based on
980446 -     Stanford 2nd opinion recommending Adriamycin/Cytoxan chemotherapy
980447 -     which Kaiser believed would qualify Millie for referral to
980448 -     clinical trial with capecitabine recommended by UCSF. ref SDS 79
980449 -     IM5H
980450 -
980451 -
980452 -
980453 -
9805 -

SUBJECTS
Cancer Cure Not Primary Objective Treatment Maintains Quality of Lif

A203 -
A20401 -  ..
A20402 - Cancer Cure Not Primary Objective Treatment Maintains Quality of Life
A20403 -
A20404 - Pam asked why her mom's cancer cannot be cured?  She cited examples of
A20405 - friends who have had cancer, get treatment, and then no longer need
A20406 - treatment.  Pam asked why the 2nd opinion from Stanford says there is
A20407 - no cure? (reported yesterday on 041209. ref SDS 75 SN6K)
A20409 -  ..
A20410 - Relapse was discussed at Kaiser previously on 030606. ref SDS 27 589J
A20411 - On 031010 article reports breast cancer relapses in 50% of cases
A20412 - within 2 years. ref SDS 31 IM6N  Doctor Benz discussed liklihood of
A20413 - relapse at UCSF on 041018, ref SDS 66 EO3Y, and confirmed his view in
A20414 - a 2nd opinion received on 041117. ref SDS 70 OU5V
A20416 -  ..
A20417 - The doctor explained today that cancer is rarely "cured."  It can be
A20418 - stabalized with treatment to below a level that is detectable with
A20419 - current technology, as related previously on 030606. ref SDS 27 NE4G
A20420 - Some patients remain stable in remission for long periods.  Nearly all
A20421 - patients, who get cancer, eventually relapse.  The effort in Millie's
A20422 - case is to manage and control disease below a level that impacts
A20423 - quality of life, discussed during a prior meeting on 030508.
A20424 - ref SDS 25 7C98
A20425 -
A20426 -     [On 050826 surgeon in Kaiser's Oakland office explains mastectomy
A20427 -     surgery for patients with metastatic cancer limited to regional
A20428 -     disease and no evidence of distant metastasis fits a curative
A20429 -     treatment model for stage III cancer. ref SDS 90 947O
A20431 -  ..
A20432 - The doctor cited the renowned case of Lance Armstrong, who recovered
A20433 - from a particular type of cancer sufficiently to race and win the Tour
A20434 - De France bicycle race.  The doctor noted that Armstrong's recovery is
A20435 - remarkable and rare among millions of people who get cancer, and that
A20436 - breast cancer is more persistant than the disease Armstrong had.
A20437 -
A20438 -
A20439 -
A20440 -
A205 -

SUBJECTS
Trial Side Effects Reviewed Medications Suggested to Reduce Damage B

A403 -
A40401 -  ..
A40402 - New Trial Planning for Testing and Commence Trial Treatment
A40403 - Side Effects Reviewed Sign Consent for New Chemotherapy Trial
A40404 -
A40405 - After meeting with the doctor, the Protocol Nurse, Rosalie, reviewed
A40406 - consent documents, including possible side effects, for treatment on
A40407 - the drug trial protocol for Novel Epothilones BMS-247550 Plus
A40408 - Capecitabine.
A40410 -  ..
A40411 - Rosalie highlighted the explanation of capecitabine side effects that
A40412 - cause swelling and peeling feet and hands, and even sometimes lips.
A40413 - She recommended treating these side effects with medication that can
A40414 - be purchased from Long's Drugs...
A40415 -
A40416 -            Vermont's Orignial
A40417 -            Bag Balm
A40418 -
A40419 - ...and apply according to instructions, if symptoms occur.
A40421 -  ..
A40422 - Millie signed consent to participate in new treatment trial protocol,
A40423 - based on review of protocol received on 041201. ref SDS 73 RO3L
A40425 -  ..
A40426 - Rosalie asked when Millie would like to begin treatments?
A40428 -  ..
A40429 - Millie requested that treatment commence as soon as possible to avoid
A40430 - further complications, discussed with the doctor today, per above.
A40431 - ref SDS 0 028N  She asked if treatment can begin today or tomorrow?
A40433 -  ..
A40434 - Rosalie said the system doesn't move quite that fast.
A40436 -  ..
A40437 - Now that Millie has signed the consent to participate in the trial,
A40438 - some tests are needed to set a baseline for measuring results of the
A40439 - protocol.
A40441 -  ..
A40442 - She will schedule all of the tests....
A40443 -
A40444 -                     blood
A40445 -                     EKG
A40446 -                     bone scan
A40447 -                     CT
A40448 -
A40449 - ....to occur next week on 041216, and expects that treatment can begin
A40450 - the following week on 041222, approximately 2 months after her last
A40451 - treatment on 041021. ref SDS 68 0001  Rosalie advised that another CT
A40452 - test is required, because the last test on 041103 now falls outside
A40453 - the 30 day requirements for the protocol, per above. ref SDS 0 NL4N
A40454 -
A40455 -     [On 041221 Rosalie advises Millie cannot participate in the new
A40456 -     chemotherapy trial to treat cancer, due to an administrative mixup
A40457 -     that overlooked her prior record of getting only had two (2)
A40458 -     treatments with Adriamycin (AC) and Cytoxan, whereas, the protocol
A40459 -     requires patients to have had four treatments. ref SDS 78 E66I
A40460 -
A40461 -
A40462 -
A40463 -
A40464 -
A40465 -
A40466 -
A40467 -
A40468 -
A405 -