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: December 30, 2004 02:00 PM Thursday;
Rod Welch
Meeting at Kaiser to develop work plan for treating IBC relapse.
1...Summary/Objective
2...Agenda Planning Scheduling Resumption of New Treatment for IBC
3...CA 15-3 Cancer Marker 56 Rises Dramatically
4...CA 15-3 56 Cancer Marker Rises Again Signaling Active IBC
5...IBC Progressing Clinical Symptoms Rise Aligns with Rising CA 15-3
6...CT Scan Test No Distant Metastasis No Pulomnary Emboli
7...Cascade Out of Control Patient Stabalized with Treatment of IBC
8...Surgery Stabalize Patient without Distant Metastasis Case Study
9...Quality of Life Stabalize Patient Maintain Control IBC with Treatment
10...Case Study Stabalize Treat Patient Avoid Cancer Cascade Out of Control
11...50% Growth May Signal Advancing Cancer Not Stabalized Disease
12...Cancer Lymph Nodes 50% Increase Requires Further Review by Analyst
13...CT Test Requires Review of Analysis Overlooks 50% Growth Lymph Nodes
14...Lymph Node Growth Right Axillary Conflicting History Left Activity
15...Cough Heavy Chest Shortness of Breath Symptoms End
16...Pulmonary Emoboli Symptoms Cough Heavy Chest Breathing End
17...Lumps Under Arm Seems Like Increase in Lumpiness
18...Lumps in Neck No Evidence of Swelling Indicating Cancer Receded
19...Wound Punch Biopsy Slow Recovery Treatment Antibiotics Ended
20...Surgery Review Meeting Scheduled for 050107 to Collaborate on Criteria
21...Collaborate Oncologist with Surgeon on Criterai for Mastectomy Surgery
22...IBC Symptoms Rise Slow Healing Biopsy Wound Rising CA 15-3 Redness
23...Redness IBC Worsens Left Breast Infected IBC Needs Immediate Treatment
24...Disability Authorizations New Treatments Due to Relapse
25...Qualify for Trial Novel Epothilones BMS-247550 Plus Capecitabine
26...Clinical Trial Qualify Novel Epothilones BMS-247550 Plus Capecitabine
27...Stanford 2nd Opinion Synthesized with Ideas from UCSF 2nd Opinion
28...2nd Opinions Synthesize Adopt Recommendations Continuous Treatment
29...AC Proposed by Stanford to Qualify for Capecitabine Proposed by UCSF
30...Relapse Requires Immediate Treatment Worsening IBC Symptoms
31...Work Plan Try AC Treatments Again to Qualify Capecitiabine Protocol
32...Reason AC Treatments Stopped Guide Decision to Prescribe Again Today
33...Best Guess Case Management Improved by Written Records for Accuracy
34...Knowledge Management Dilemma Resolved with Doctor Patient Partnership
35...Timely Precision Access Finding Critical Details Aids Decision Support
36...Taxol Proven Effective Can Be Resumed for Immediate Treatment
37...Treatment Plan IBC Chemotherapy Clinical Trial Surgery Radiation
38...Adriamycin Cytoxan AC 2 Cycles Qualify for Clinical Trial Protocol
39...Schedule Treatment 2 Cycles Adriamycin Cytoxan AC Begin on 050104
40...Treatment Plan Summary for IBC Relapse Recovery
41...Summary Work Plan Schedules Immediate Action to Treat IBC Relapse
42...Kaiser's Doctor-Patient Partnership Model Yields Written Work Plan
43...Transformation Relentless exposure Awareness Change to Good Management
44...Good Management Relentless Pressure Yields Awareness Transformation
..............
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CONTACTS
SUBJECTS
Meeting Doctor Planning Start of Chemotherapy Treatments for IBC Inc
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 81 0000. ref SDS 75 0000.
040502 -
040503 - Strong symptoms signal relapse of IBC. ref SDS 0 025H Good news that
040504 - CT testing does not report distant metastasis. This impression gives
040505 - hope of achieving normal to near-normal quality of life by stabalizing
040506 - disease in the left breast with immediate treatment. ref SDS 0 XV7M
040507 - All symptoms of pulmonary emboli are resolved, suggesting successful
040508 - treatment by ending Avastin clinical trial. ref SDS 0 RZ4I The doctor
040509 - wants expedited review of prospects for surgery to treat problematic
040510 - left breast. ref SDS 0 6T5G The doctor prepared disability filings
040511 - for the patient to devote time for treating IBC relapse. ref SDS 0
040512 - 2V83 Treatment was delayed because the patient did not have enough
040513 - cycles of AC to meet requirements for a drug trial protocol.
040514 - ref SDS 0 028N Stanford's 2nd opinion suggests chemotherapy with AC
040515 - followed by surgery if IBC can be controlled. ref SDS 0 IM5H The
040516 - doctor therefore scheduled two (2) cycles of AC treatments in order to
040517 - qualify for the drug trial. ref SDS 0 XQ41 Work plan shows
040518 - comprehensive analysis of symptoms and treatment opportunities,
040519 - ref SDS 0 475F, to prevent disease from cascading out of control,
040520 - noted by the doctor at the end of the meeting. ref SDS 0 LU6K
040521 -
040522 - [On 050104 treatments begin with Adriamycin Cytoxan (AC); four (4)
040523 - cycles were prescribed, which exceeds the nominal limit by 50% to
040524 - avoid cumulative damage to the heart. ref SDS 86 DB65
040526 - ..
040527 - [On 050104 Rosalie advises that further review of the protocol
040528 - indicates Millie may not qualify to participate in the drug trial
040529 - by getting more AC treatments; she will notify the doctor.
040530 - ref SDS 86 407N
040532 - ..
040533 - [On 050107 meeting with surgeon determined that IBC has not been
040534 - sufficiently controlled to permit masectomy on the left breast.
040535 - ref SDS 87 IS5N
040537 - ..
040538 - [On 050204 turns out that Millie cannot participate in new drug
040539 - trial after completing 2 additional treatments with AC,
040540 - ref SDS 90 028N; IBC symptoms worsening, prescribe 2 more cycles
040541 - of AC treatments, ref SDS 90 XQ41; schedule MUGA test for heart
040542 - damage side effects. ref SDS 90 J55L
040544 - ..
040545 - [On 050311 cancer still progressing with new sores on left breast;
040546 - presents concerns about continuing treatment with Adriamycin
040547 - Cytoxen (AC). ref SDS 94 UA8N
040549 - ..
040550 - [On 050329 switched treatment to Taxotere and capecitabine
040551 - (Xeloda). ref SDS 98 887S
040553 - ..
040554 - [On 050414 patient, Kelly, inquires about doctor-patient
040555 - partnership and organizational memory for efficient, accurate
040556 - communication. ref SDS 99 TE4P
040558 - ..
040559 - [On 050422 doctor introduces Kelly at Kaiser prior to meeting with
040560 - Millie, ref SDS A0 6U6K; Kelly comfortable with SDS support for
040561 - timely, accurate communication, and, also case history for lessons
040562 - learned that helps others. ref SDS A0 F499
040564 - ..
040565 - [On 050520 dramatic improvement after 2 cycles of treatment with
040566 - Taxotere and Xeloda. ref SDS A3 R19I
040567 -
040568 -
040569 -
040571 - ..
0406 -
0407 -
0408 - Discussion
0409 -
040901 - Agenda Planning Scheduling Resumption of New Treatment for IBC
040902 -
040903 - Follow up ref SDS 81 SM6M, ref SDS 75 SM6M.
040904 -
040905 - The meeting today develops new work plan after scheduled treatment was
040906 - cancelled, reported on 041221. ref SDS 83 0001 Urgency to start
040907 - chemotherapy, as soon as possible, recommended by the doctor at Kaiser
040908 - on 041104, ref SDS 73 WT60, and again during the follow up meeting
040909 - three (3) weeks later on 041130. ref SDS 75 Y66F
040911 - ..
040912 - Millie created an agenda on the marking board...
040913 -
040914 - CA 15-3 dramatic rise...................... ref SDS 0 GJ5M
040915 - CT Test report no distant metastatis....... ref SDS 0 NL4N
040916 - Coughing, heavy chest, breathing
040917 - issues eliminated.......................... ref SDS 0 RZ4I
040918 - Lumps under arm more severe................ ref SDS 0 MW8J
040919 - Lumps in neck disappeared.................. ref SDS 0 8R6M
040920 - Wound punch biopsy worse end prescription.. ref SDS 0 6T5G
040921 - Breast redness worse....................... ref SDS 0 IM5H
040922 - Trial protocol failed...................... ref SDS 0 028N
040923 - Treatment for IBC relapse.................. ref SDS 0 YR8F
040924 - Taxol proven treatment..................... ref SDS 0 2V85
040925 -
040926 -
040927 -
040928 -
040929 -
040930 -
0410 -
SUBJECTS
CA 15-3 Cancer Marker 56 Rises Dramatically Signaling Active IBC Wou
1103 -
110401 - ..
110402 - CA 15-3 Cancer Marker 56 Rises Dramatically
110403 -
110404 - Follow up ref SDS 81 087J, ref SDS 75 087J.
110405 -
110406 - Blood test on 041228 shows CA 15-3 has rising dramatically to 56
110407 - from 42...
110409 - ..
110410 - 041228......... 56 H............. 041230, ref SDS 0 087J
110411 - 041204......... 43 H............. 041210, ref SDS 81 087J
110412 - 041007......... 39............... 041104, ref SDS 73 087J
110413 - 040923......... 49 H............. 041006, ref SDS 66 087J
110414 - 040908......... 44 H............. 040909, ref SDS 65 087J
110415 - 040825......... 47 H............. 040812, ref SDS 65 087J
110416 - 040811......... 42 H............. 040812, ref SDS 62 087J
110417 - 040728......... 43 H............. 040729, ref SDS 60 2N5J
110418 - 040712......... 47 H............. 040713, ref SDS 58 087J
110419 - 040614......... 55 H............. 040615, ref SDS 57 PX6X
110420 - 040517......... 78 H............. 040601, ref SDS 53 2N5J
110421 - 040311......... 70 H............. 040318, ref SDS 41 SM6M
110422 - 040205......... 60 H............. 040211, ref SDS 38 SM6M
110423 - 031201......... 62 H............. 031205, ref SDS 36 SM6M
110424 - 030912......... 66 H............. 030915, ref SDS 34 SM6M
110425 - 030708......... 68 H............. 030710, ref SDS 32 SM6M
110426 - 030503......... 54 H............. 030508, ref SDS 29 SM6M
110427 - 030403......... 45 H............. 030508, ref SDS 29 SM6M
110428 - 030215......... 46 H............. 030220, ref SDS 28 5E6L
110429 - 030106......... 37 H............. 030109, ref SDS 27 SM6M
110430 - 021202......... 41 H?............ 021204, ref SDS 25 SP5G
110431 - 021111......... 36 H?............ 021113, ref SDS 24 Y65I
110432 - 021023......... 33 H?............ 021023, ref SDS 23 SQ5I
110433 - 020930......... 33 H?..29........ 021002, ref SDS 22 SQ5I
110434 - 020917......... 36 H?............ 020924, ref SDS 21 SQ5I
110435 - 020717......... 59 H?............ 020726, ref SDS 20 YN5K
110436 - 020629......... 75 H ............ 020705, ref SDS 19 UX6I
110437 - 020608........ 67 H ............ 020614, ref SDS 18 0001
110438 - 020603........ 108 H ............ 020607, ref SDS 17 X67F
110439 - 020511........ 117 H ............ 020603, ref SDS 16 PJ4J
110440 - 020419......... 81 H ............ 020430, ref SDS 14 7N5H
110441 - 020321......... 85 H ............ 020405, ref SDS 13 6T8K
110442 -
110443 -
110444 -
110446 - ..
1105 -
1106 -
1107 - Analysis
1108 -
110801 - CA 15-3 56 Cancer Marker Rises Again Signaling Active IBC
110802 - IBC Progressing Clinical Symptoms Rise Aligns with Rising CA 15-3
110803 -
110804 - Follow up ref SDS 81 GJ5M, ref SDS 75 GJ5M.
110805 -
110806 - There was no discussion of CA 15-3 rising dramatically from 43 to 56,
110807 - since this is obviously a major change in the trend line for Millie.
110808 - Rising CA 15-3 correlates with suspending treatment for about ten (10)
110809 - weeks beginning on 041021, due to finding pulmonary emboli, reported
110810 - on 041104. ref SDS 73 N438 The rise further aligns with analysis on
110811 - 041210 of worsening biopsy wound on the left breast, ref SDS 81 6T5G,
110812 - which has not responded to treatment with antibiotics, reported today,
110813 - per below. ref SDS 0 6T5G Worsening inflammation in the breast,
110814 - reported today, ref SDS 0 025H, and renewed discomfort under the left
110815 - arm reported by the patient, ref SDS 0 MW8J, all align with rising CA
110816 - 15-3.
110818 - ..
110819 - The doctor prepared a new request for another CA 15-3 test that
110820 - enables close order monitoring of current conditions, in light of the
110821 - change toward a worsening condition reported today, that will support
110822 - the overall treatment plan, per below.
110823 -
110824 -
110825 -
110826 -
110827 -
1109 -
SUBJECTS
CT Test Pulmonary Emboli Blood Clots No Visualization Found Skin Thi
2703 -
270401 - ..
270402 - CT Scan Test No Distant Metastasis No Pulomnary Emboli
270403 -
270404 - Follow up ref SDS 81 NL4N, ref SDS 75 NL4N.
270405 -
270406 - The doctor submitted a report on the CT test performed a few weeks ago
270407 - on 041217, ordered on 041210 by the Protocol Nurse for requirements of
270408 - a new drug trial, ref SDS 81 OZ8H, and following up the test on
270409 - 041103, which was received during a meeting with the doctor on 041104.
270410 - ref SDS 73 NL4N
270412 - ..
270413 - Prior Tests...
270415 - ..
270416 - 041217 reported on 041230.............. ref SDS 0 G75L
270417 - 041103 reported on 041104.............. ref SDS 73 NL4N
270418 - 040921 reported on 041005.............. ref SDS 66 NL4N
270419 - 040710 reported on 040811.............. ref SDS 61 DU9I
270420 - 040410 reported on 040416.............. ref SDS 47 HX4K
270421 - 040307 reported on 040318.............. ref SDS 42 LK5L
270422 - 031031 reported on 031205.............. ref SDS 37 IG9K
270423 - 030626 reported on 030710.............. ref SDS 33 AL6N
270424 - 030428 reported on 030508.............. ref SDS 30 LK5L
270426 - ..
270427 - CT test dated 041217 shows....
270428 -
270429 - Patient
270436 - ..
270437 - 68/F Radiology Report Exam 1 of 1
270438 - Page 1
270440 - ..
270441 - CT Thorax W Contrast; CT Abdomen W Contrast; CT Pelvis w Contra
270442 - (digital)
270444 - ..
270448 - ..
270449 - History
270451 - ..
270452 - Hx Met breast CA. Enrolling in oncology clinical trial.
270454 - ..
270455 - Findings
270457 - ..
270458 - IV and oral contrast given. Scans of chest, abdomen, and
270459 - pelvis done. Compare to 041103.
270461 - ..
270462 - Chest again shows skin thickening of the left breast, unchanged.
270463 - Left apical interstitial fibrotic like densities also unchanged.
270464 - A few mediastinal (right anterior paratrachael) nodes measuring
270465 - up to 9.4 mm also seen unchanged. No change in the right chest
270466 - nodules: image #37 shows 3 mm right lateral subpleural nodule
270467 - and a 4 mm anterior subpleural nodule: image #45 shows a 4 mm
270468 - lateral subpleural nodule. No new nodules seen in either lung.
270470 - ..
270471 - Several right axillary lymph nodes noted, unchanged in size, and
270472 - not pathologic by size criteria (largest is 15 mm x 13 mm). No
270473 - effusion. Venous access catheter noted in the right subclavian
270474 - vein. Previous noted right pulmonary arterial emboli are no
270475 - longer visiualized.
270476 -
270477 - [On 070329 CT test on 070326 does not experssly state that
270478 - previously visualized PE in test on 060929 is no longer
270479 - visualized. ref SDS B8 BN7L
270481 - ..
270482 - The record on 041104 describes "subcentimeter" nodes without
270483 - identifying right or left side; the report today says nodes on the
270484 - right side are up to 15 x 13 mm, which sounds like 1.5 x 1.3
270485 - centimeters that does not fit a category of "subcentimeter."
270486 - ref SDS 73 QP74
270487 -
270488 - [...see below patient reports renewed discomfort under left arm.
270489 - ref SDS 0 LO6N
270491 - ..
270492 - [On 050610 CT test on 050530 shows growth on right axillary has
270493 - stopped; swelled lymph nodes have subsided to less than 1 cm;
270494 - findings this issue is almost totally resolved. ref SDS A4 B58M
270496 - ..
270497 - [On 061012 CT test on 060930 made findings of pulmonary embolism
270498 - recurrence, and additional findings of enlarged right ventricle.
270499 - ref SDS B1 M36G
270501 - ..
270502 - [On 061208 doctor orders CT test to evaluate recovery from
270503 - pulmonary embolism recurrence after 2 months treatment.
270504 - ref SDS B3 Q93H
270506 - ..
270507 - [On 070102 Kaiser failed to carry out the doctor's order on
270508 - evaluating pulmonary embolism. ref SDS B4 AK9H
270510 - ..
270511 - [On 070130 CT test required to distinguish symptoms of pulmonary
270512 - embolism from side effects of cetuximab treatments. ref SDS B6
270513 - 915J and ref SDS B6 R16N
270515 - ..
270516 - Great to see pulmonary emboli that ended treatments on 041104,
270517 - ref SDS 73 RZ4I, seems to no longer be a problem. Aligns with
270518 - patient's report today that harmful symptoms have receded. ref SDS 0
270519 - RZ4I
270520 -
270521 - [On 050422 next CT test on 050325 reported no evidence of
270522 - pulmonary emboli. ref SDS A0 RZ4I
270524 - ..
270525 - CT Test report continues...
270526 -
270527 - Abdomen shows sharply circumscribed low density focus of 14 - 15
270528 - mm in dome of liver, unchanged. Otherwise negative liver.
270529 - Splenic calcifications again noded. Adrenals, pancreas, and
270530 - kidneys are unremarkable. No free fluid or adenopathy. Aorta
270531 - appears normal size.
270533 - ..
270534 - No significant bone lesions noted.
270536 - ..
270537 - Pelvis is negative. no free fluid. No mass or adenopathy.
270539 - ..
270540 - Impression
270542 - ..
270543 - Small right pulmonary nodules (3 - 4 mm size) are unchanged. No
270544 - evidence to suggest recurrent pulmonary emboli. Post
270545 - therapeutic changes again noted in left lung apex and left
270546 - breast.
270547 -
270548 -
270549 -
270550 -
2706 -
SUBJECTS
Case Study Spinning Out of Control Close Attention Symptoms Timely T
CT Test Case Study Shows Distant Matastasis None by Size Criteria CT
Skin Thickening Left Breast CT Test Shows Pulmonary Emboli Blood Clo
3705 -
3706 - Analysis
370701 - ..
370702 - Cascade Out of Control Patient Stabalized with Treatment of IBC
370703 - Surgery Stabalize Patient without Distant Metastasis Case Study
370704 - Quality of Life Stabalize Patient Maintain Control IBC with Treatment
370705 - Case Study Stabalize Treat Patient Avoid Cancer Cascade Out of Control
370706 -
370707 - Follow up ref SDS 81 SO9N.
370708 -
370709 - The doctor explained that the history of CT tests in Millie's case,
370710 - including today, shows no evidence of cancer anywhere, ref SDS 0 XU7N,
370711 - except thickening skin in the left breast, ref SDS 0 PV6L, and
370712 - earlier, swelled lymph nodes on the left side of the neck, and under
370713 - the left arm, which are all symptoms of IBC, reported on 040517,
370714 - ref SDS 51 S65H, and which are now seemingly resolved.
370716 - ..
370717 - There is no continuing evidence of pulmonary emobli, ref SDS 0 PW3K,
370718 - which caused treatments to be stopped on 041104. ref SDS 73 RZ4I
370720 - ..
370721 - These results suggest opportunity to stabalize cancer by treating IBC
370722 - in the left breast using chemotherapy, and then surgery for a
370723 - masectomy to prevent cancer from spinning out of control, as discussed
370724 - on 041210. ref SDS 81 ZV5J Timely treatment of IBC to maintain local
370725 - control is essential for a normal, to near-normal, quality of life
370726 - over a period of years, discussed previously on...
370728 - ..
370729 - 1. Biopsy unnecessary for
370730 - early discovery, timely
370731 - treatment to prevent
370732 - cancer from getting out of
370733 - control and achieve goals
370734 - to prolong quality of
370735 - life........................... 030508, ref SDS 29 7C98
370737 - ..
370738 - 2. Cancer cascades quickly out
370739 - of control without timely
370740 - treatment, and changing
370741 - chemotherapy drugs when
370742 - treatment is no longer
370743 - effective...................... 030606, ref SDS 31 N27L
370745 - ..
370746 - 3. Cancer not cured, goal to
370747 - stabalize disease; requires
370748 - close attention to symptoms
370749 - for early discovery, timely
370750 - treatment...................... 030606, ref SDS 31 NE4G
370752 - ..
370753 - 4. Delay treatment until
370754 - clinical symptoms damage
370755 - quality of life................ 030710, ref SDS 32 FZ55
370757 - ..
370758 - 5. Article 50% cancer patients
370759 - relapse in 2 years............. 031010, ref SDS 35 IM6N
370761 - ..
370762 - 6. Great CT Test shows cancer
370763 - controlled; good personal
370764 - habits of diet and exercise
370765 - help stabalize and control
370766 - disease........................ 031205, ref SDS 36 7C6W
370768 - ..
370769 - 7. IBC rare, aggressive, most
370770 - lethal form of breast cancer
370771 - requires immediate treatment
370772 - to maintain local control
370773 - that extends quality
370774 - of life........................ 040517, ref SDS 51 L17O
370776 - ..
370777 - 8. Cancer grows progressively
370778 - resistant to chemotherapy
370779 - and cascades out of
370780 - control........................ 041130, ref SDS 75 EV7M
370782 - ..
370783 - 9. Stanford 2nd opinion 66%
370784 - chance of patient relapse
370785 - requires close attention
370786 - of symptoms for early
370787 - discovery and timely
370788 - treatment to maintain
370789 - control of disease............ 041209, ref SDS 79 SN6K
370791 - ..
370792 - 10. Surgery masectomy may be
370793 - needed to avoid cancer from
370794 - spinning out of control........ 041210, ref SDS 81 ZV5J
370796 - ..
370797 - 11. Patient's daughter asks why
370798 - mom can't be cured; doctor
370799 - explains cancer rarely cured;
370800 - disease can be managed to
370801 - stabalize patient so that
370802 - disease does not spin out of
370803 - coontrol enabling near
370804 - normal quality of life for
370805 - some period of time............ 041210, ref SDS 81 NQ9J
370807 - ..
370808 - 12. IBC in left breast may need
370809 - surgery to avoid cancer
370810 - spinning out of control;
370811 - doctor wants examination by
370812 - surgeon for masectomy.......... 041230, ref SDS 0 CW6J
370814 - ..
370815 - 13. New cancer sores, rising CA
370816 - 15-3, expanding inflammation
370817 - indicates pockets of resistance
370818 - to chemotherapy; cancer may
370819 - be getting out of control;
370820 - primary care physician orders
370821 - another examination by
370822 - surgeon........................ 050311, ref SDS 93 PA4N
370824 - ..
370825 - 14. Metastatic cancer involving
370826 - regional lymph nodes,
370827 - diagnosed on 040318,
370828 - ref SDS 95 8R6M, may be
370829 - operable to reduce chances
370830 - of relapse, which is
370831 - different from "distant
370832 - metastasis," that surgery
370833 - cannot cure, but may play a
370834 - palliative role, further
370835 - explained on 050712,
370836 - ref SDS A5 B65G, and
370837 - referenced in research
370838 - on............................. 050324, ref SDS 95 O84N
370840 - ..
370841 - 15. CA 15-3 rising, IBC redness
370842 - spreads; treatment changed
370843 - from AC to Taxoter and
370844 - capecitabine to prevent
370845 - cancer from getting out of
370846 - control........................ 050329, ref SDS 97 AW5G
370848 - ..
370849 - 16. CA 15-3 still rising, IBC
370850 - symptoms worsen attributed
370851 - to AC regimine, too soon to
370852 - evaluate effect of changing
370853 - treatment to Taxotere
370854 - and capecitabine............... 050422, ref SDS A0 GJ5M
370856 - ..
370857 - 17. CA 15-3 jumps 25% after all
370858 - time low of 37; doctor balances
370859 - discomfort tollerating side
370860 - effects by maintaining dose of
370861 - chemotherapy for two (2) more
370862 - cycles to prevent losing
370863 - control causing another
370864 - relapse........................ 050729, ref SDS A7 AW5G
370866 - ..
370867 - 18. Treatment delay from 061201 for
370868 - 2 months; Millie notifies Kaiser
370869 - cancer may be cascading out of
370870 - control during delay authorizing
370871 - prescribed treatment at UCSF
370872 - that targets Millie's
370873 - disease........................ 070123, ref SDS B5 J94L
370875 - ..
370876 - 19. Doctor Johnson's medical chart begins
370877 - planning for Millie's 6th relapse
370878 - because mutated cancer has less
370879 - time to prevent cancer from
370880 - spinning out of
370881 - control........................ 080829 ref SDS B9 PX5V
370883 - ..
370884 - 20. Doctor Johnson reminds medical team
370885 - to plan Millie's next treatment so
370886 - administrative delays that occurred
370887 - starting the 6th relapse are avoided
370888 - for the 7th relapse because
370889 - there is less time to
370890 - control aggressive
370891 - cancer......................... 081024, ref SDS C0 BO9F
370893 - ..
370894 - 21. Doctor Johnson worried Millie's cancer
370895 - has mutated through multiple relapses to
370896 - become more aggressive disease; asks UCSF
370897 - to plan for Millie's next treatment
370898 - to change modalities
370899 - in time to be
370900 - effective...................... 081219, ref SDS C1 KU6F
370902 - ..
370903 - 22. Doctor Johnson calls to remind medical
370904 - team that Millie's 7th relapse shown by
370905 - cancer marker suddenlty jumping to highest
370906 - level in patient history requires
370907 - treating cancer as a chronic
370908 - disease with alternative drugs
370909 - identified to change treatment
370910 - immediatley.................... 090123, ref SDS C2 RK6O
370912 - ..
370913 - 23. Alternative therapies identified
370914 - to treat Millie's cancer as a
370915 - chronic disease................ 090204, ref SDS C3 4R3S
370917 - ..
370918 - 24. Doctor Johnson warns the medical team
370919 - timely treatment required for 8th relapse
370920 - because Millie's paitent profile has narrow
370921 - margin for delay starting treatment to
370922 - prevent stage IV cancer rapidly
370923 - cascading out of
370924 - control........................ 090213, ref SDS C4 PL5K
370926 - ..
370927 - 25. Doctor Hsu at UCSF diagnoses
370928 - Millie relapses for 8th time
370929 - a few weeks after completing
370930 - treatment for 7th
370931 - relapse........................ 090401, ref SDS C5 R24X
370933 - ..
370934 - Millie reports cancer worsesn;
370935 - requests treatment for 8th relapse of
370936 - cancer to implement Doctor Johnson's
370937 - guidance that timely
370938 - care essential to
370939 - recover........................ 090412, ref SDS C6 9S9R
370940 -
370941 -
370942 -
370943 -
370944 -
370945 -
370946 -
3710 -
SUBJECTS
50% Increase Swelled Lymph Nodes Right Axilliary 15 mm x 13 mm Incre
4203 -
420401 - ..
420402 - 50% Growth May Signal Advancing Cancer Not Stabalized Disease
420403 - Cancer Lymph Nodes 50% Increase Requires Further Review by Analyst
420404 - CT Test Requires Review of Analysis Overlooks 50% Growth Lymph Nodes
420405 -
420406 -
420407 - Growth of lymph nodes from "subcentimeter," which means less than 1
420408 - cm, to increase up to 1.5 x 1.3 cm (assuming the math is correct) on
420409 - the "right side," per the report, ref SDS 0 PW3K, seems like
420410 - significant growth of over 50% in about 5 weeks, from 041103 to
420411 - 041217. This is comparable to 50% growth reported on 030710,
420412 - ref SDS 32 7M7M, which presaged discovery of relapse when lumps were
420413 - reported in the neck on 040211, and biopsy identified cancer on
420414 - 040309. ref SDS 40 0001
420416 - ..
420417 - [On 050610 CT test on 050530 shows growth on righ axillary has
420418 - stopped; swelled lymph nodes have subsided to less than 1 cm;
420419 - findings this issue is almost totally resolved. ref SDS A4 B58M
420420 -
420421 -
420422 -
420423 -
420424 -
420425 -
4205 -
SUBJECTS
PET Test Shows Cancer Lump Under Arm Left Side Where Lymph Nodes Ali
Pain Left Arm Left Leg Caused by Heavy Exercise in Combination with
Lymph Node Growth Right Axillary Conflicting History Left Activity N
Arm Left Sensations Above Elbow Mild Irregular Short Duration Normal
4906 -
490701 - ..
490702 - Lymph Node Growth Right Axillary Conflicting History Left Activity
490703 -
490704 - There is no history of lymph node growth on the right side. The
490705 - patient reports increasing discomfort from swelled lump under the left
490706 - arm, where cancerous lymph nodes were originally removed with surgery.
490707 - During the meeting the doctor checked the computer and found the CT
490708 - scan images. He further found an image which he described as showing
490709 - the swelled lymph nodes on the right side, confirming the
490710 - representation in the report. ref SDS 0 PW3K
490712 - ..
490713 - Millie mentioned there has been reporting on tests that describe right
490714 - and left nodes on the left axillary, and so this could have gotten
490715 - mixed up in describing a right axillary. ref SDS 0 PW3K In any case,
490716 - there has been no history of cancer on the right side. If cancer has
490717 - travelled to the right side, this seems significant for distant
490718 - metastasis.
490719 -
490720 - [...see below patient reports renewed discomfort under left arm.
490721 - ref SDS 0 LO6N
490722 -
490723 -
490724 -
490725 -
490726 -
4908 -
SUBJECTS
Pulmonary Emboli Blood Clots Symptoms Cough Heavy Chest Breathing En
5703 -
570401 - ..
570402 - Cough Heavy Chest Shortness of Breath Symptoms End
570403 - Pulmonary Emoboli Symptoms Cough Heavy Chest Breathing End
570404 -
570405 - Follow up ref SDS 81 RZ4I, ref SDS 75 RZ4I.
570406 -
570407 - Millie reported symptoms of the pulmonary emboli, diagnosed on 041104.
570408 - ref SDS 73 RZ4I, have completely ended. This aligns with the CT test
570409 - report today showing pulmonary emboli is no long visualized.
570410 - ref SDS 0 PW3K On 041211 coughing worsened; spitting up blood caused
570411 - great concern. ref SDS 82 SE5O Since then, coughing, weakness,
570412 - fatigure, heavy chest, and shortness of breath have not occurred, as
570413 - planned by the doctor in the meeting on 041210. ref SDS 81 YK8K
570414 -
570415 - [On 050422 next CT test on 050325 reported no evidence of
570416 - pulmonary emboli. ref SDS A0 RZ4I
570417 -
570418 -
570419 -
570420 -
570421 -
570422 -
5705 -
SUBJECTS
Arm Lumps Lymph Nodes Swelled Under Left Side No Examination Patient
Arm Lumps Under Left Side No Examination Patient Reports Favorable C
6104 -
610501 - ..
610502 - Lumps Under Arm Seems Like Increase in Lumpiness
610503 -
610504 - Follow up ref SDS 81 MW8J, ref SDS 75 MW8J.
610505 -
610506 - Millie reported slight discomfort, or more accurately awareness of
610507 - some lumpiness under the left arm, which is a change from the
610508 - examination on 041210, ref SDS 81 MW8J, and previously on 041130,
610509 - ref SDS 75 MW8J, and the CT test on 041103, reviewed during the
610510 - meeting on 041104. ref SDS 73 MW8J
610512 - ..
610513 - The doctor did not examine this, and noted that the CT test report
610514 - today does not discuss swelled lymph nodes on the left side. There is
610515 - discussion of lymph nodes in the range of 15 mm x 13 mm on the right
610516 - side, but there is no complaint today about the right side, per above.
610517 - ref SDS 0 XV9N
610518 -
610519 -
610520 -
610521 -
610522 -
610523 -
6106 -
SUBJECTS
Neck Lumps Lymph Nodes Left Side No Examination Patient Reports Favo
6703 -
670401 - ..
670402 - Lumps in Neck No Evidence of Swelling Indicating Cancer Receded
670403 -
670404 - Follow up ref SDS 81 8R6M, ref SDS 75 8R6M.
670405 -
670406 - There was no examination of the neck, because of favorable
670407 - examinations and testing the past few months, reported on 041104.
670408 - ref SDS 73 8R6M
670410 - ..
670411 - CT test reports no findings on the neck. ref SDS 0 PV5X The prior CT
670412 - test received on 041104 reports no findings of swelled lymph nodes in
670413 - the neck. ref SDS 73 5F3R
670414 -
670415 -
670416 -
670417 -
670418 -
670419 -
6705 -
SUBJECTS
Wound Punch Biopsy Left Breast Worsens Indicates Diagnosis IBC Requi
Dilemma Patient Difficult Decision Surgery or Continue Avastin Trial
IBC Surgery Masectomy Not Required Dilemma Surgery or Avastin Trial
Surgery Possibility After Regression of IBC Stanford 2nd Opinion Tre
Surgery Dilemma Patient Difficult Decision Surgery or Continue Avast
Collaborate Oncologist to Call Surgeon for Criteria Recovering from
8208 -
820901 - ..
820902 - Wound Punch Biopsy Slow Recovery Treatment Antibiotics Ended
820903 - Surgery Review Meeting Scheduled for 050107 to Collaborate on Criteria
820904 - Collaborate Oncologist with Surgeon on Criterai for Mastectomy Surgery
820905 -
820906 - Follow up ref SDS 81 6T5G, ref SDS 75 6T5G.
820907 -
820908 - The doctor found that the biopsy wound on the left breast has not
820909 - responded to treatment with antibiotics prescribed on 041130,
820910 - ref SDS 75 JU6N, and extended on 041210. ref SDS 81 6T5G Millie had
820911 - placed a bandaid to contain leakage from the worsening wound, which is
820912 - now very pussy.
820913 -
820914 - [On 050204 doctor observes improved healing of biopsy wound after
820915 - 2 treatments with AC. ref SDS 90 6T5G
820917 - ..
820918 - [On 050324 surgeon observes improved healing of biopsy wound after
820919 - 3 treatments with AC. ref SDS 95 906K
820921 - ..
820922 - Therefore, the prescription for antibiotics to treat infection was
820923 - ended today, because the underlying IBC problem is preventing the
820924 - wound from healing, and this problem will now be treated with
820925 - chemtheropy scheduled today to begin on 050105, per below. ref SDS 0
820926 - YR8F
820928 - ..
820929 - The doctor asked when Millie is meeting with the surgeon to examine
820930 - the wound on the left breast, recommended by Doctor Parsley during
820931 - emergency treatment at Kaiser on 041202? ref SDS 78 BI4Y Doctor
820932 - Johnson explained today his work plan to to expedite referral to the
820933 - Surgery Department for mastectomy on the left breast implementing
820934 - analysis this afternoon, per above, ref SDS 0 XV7M, and implementing
820935 - considerations a few weeks ago on 041210, for surgery to prevent
820936 - cancer from spinning out of control on the left breast, ref SDS 81
820937 - 025H, as a result of interrupted treatment reported on 041104.
820938 - ref SDS 73 RZ4I The doctor feels the surgeon can report on criteria
820939 - required for successful surgical solution to IBC with a masectomy of
820940 - the left breast.
820942 - ..
820943 - Surgery has become a critical part of the treatment plan, summarized
820944 - below, ref SDS 0 O48I, and further supported by Doctor Guardino's 2nd
820945 - opinion from Stanford, reviewed today, per below. ref SDS 0 UL6H The
820946 - history considering surgery in this case is reported in a study on
820947 - 041210. ref SDS 81 ZV5J
820949 - ..
820950 - The doctor plans to call the surgeon and collaborate on criteria for
820951 - recovering from IBC that must be met in order to perform a masectomy,
820952 - as the doctor discussed on 041210. ref SDS 81 ZV5J
820954 - ..
820955 - Millie advised that a meeting is scheduled with the surgeon for next
820956 - week on 050107.
820957 -
820958 - [On 050107 meeting with surgeon determined that patient is not
820959 - ready for surgery, ref SDS 87 IS5N; surgeon plan to call the
820960 - doctor for collaboration. ref SDS 87 778F
820962 - ..
820963 - [On 050204 doctor notes progress healing the biopsy wound helps
820964 - prospects for surgery to reduce the risk of distant metastatis
820965 - with a masectomy. ref SDS 90 6T5G; collaboration with surgeon on
820966 - criteria for surgery pending discussion. ref SDS 90 RD3M
820968 - ..
820969 - [On 050311 doctor requests examination by surgeon again to get
820970 - criteria for performing surgery on patient with IBC. ref SDS 93
820971 - XQ41
820973 - ..
820974 - [On 050324 patient discusses criteria establishing sufficient
820975 - recovery from IBC for surgery to perform a masectomy discussed
820976 - with surgeon. ref SDS 95 OV5H
820978 - ..
820979 - [On 050329 doctor asks for results of examination by surgeon.
820980 - ref SDS 97 XQ41
820981 -
820982 -
820983 -
820984 -
820985 -
820986 -
820987 -
820988 -
8210 -
SUBJECTS
IBC Worse Redness Examination Left Breast Infected IBC Needs Immedia
IBC Worse Redness Coloration Inflammation Examination Left Breast In
9604 -
960501 - ..
960502 - IBC Symptoms Rise Slow Healing Biopsy Wound Rising CA 15-3 Redness
960503 - Redness IBC Worsens Left Breast Infected IBC Needs Immediate Treatment
960504 -
960505 - Follow up ref SDS 81 025H, ref SDS 75 025H.
960506 -
960507 - Examination found the left breast is much redder than on prior visits,
960508 - which aligns with elevated CA 15-3 showing signals of relapse to
960509 - worsening IBC, ref SDS 0 GJ5M, and reversing improvement following the
960510 - last treatment on 041021, ref SDS 72 9P6U, as reported on 041104, when
960511 - treatment on the Taxol Avastin trial was suspended due to pulmonary
960512 - emboli. ref SDS 73 LP7F
960513 -
960514 - [On 050729 treatment plan strives to balance need to maintain
960515 - progress treating IBC against rising debilitations from side
960516 - effects of chemotherapy accumulating. ref SDS A7 Z26O
960518 - ..
960519 - The doctor discussed plans and scheduled immediate treatment,
960520 - ref SDS 0 YR8F, called out on 041104, ref SDS 73 WT60, and again
960521 - during the meeting at Kaiser on 041130 to treat worsening IBC before
960522 - disease cascades out of control. ref SDS 75 Y66F He, also, presented
960523 - options for timely follow up in the event disease begins to progress
960524 - during treatment with a particular regimen. There are now specific
960525 - options for trying different drugs. ref SDS 0 Y36M
960526 -
960527 - [On 050204 examination after two (2) treatments with AC shows some
960528 - improvement and some worsening of IBC. ref SDS 90 025H
960530 - ..
960531 - [On 050311 examination shows cancer progresses with new sores on
960532 - left breast; presents concerns about continuing treatment with
960533 - Adriamycin Cytoxen (AC). ref SDS 94 UA8N
960535 - ..
960536 - [On 050520 dramatic improvement after 2 cycles of treatment with
960537 - Taxotere and Xeloda. ref SDS A3 R19I
960538 -
960539 -
960540 -
960541 -
960542 -
960543 -
9606 -
SUBJECTS
Disability Authorizations Prepared to Support New Treatments for Rel
9903 -
990401 - ..
990402 - Disability Authorizations New Treatments Due to Relapse
990403 -
990404 - The doctor reported that he prepared documents authorizing Millie for
990405 - further medical disability payments, as part of the new treatment
990406 - plan, per below. ref SDS 0 LU6K Millie understands she no longer
990407 - qualifies for medical disability; however, the doctor decided to file
990408 - recommendations for medical disability based on findings today of new
990409 - cancer activity that signals relapse, and consequent prescription for
990410 - chemotherapy treatments with Adriamycin Cytoxan, per below,
990411 - ref SDS 0 YR8F, which is very draining on personal energy.
990412 -
990413 -
990414 -
990415 -
990416 -
990417 -
9905 -
SUBJECTS
Qualify for Trial Novel Epothilones BMS-247550 Plus Capecitabine Aft
Proposal Treatment Plan After Avastin Trial Cancelled Due to Blood C
Treatment Trial Novel Epothilones BMS-247550 Plus Capecitabine Appro
A605 -
A60601 - ..
A60602 - Qualify for Trial Novel Epothilones BMS-247550 Plus Capecitabine
A60603 - Clinical Trial Qualify Novel Epothilones BMS-247550 Plus Capecitabine
A60604 -
A60605 - Follow up ref SDS 81 028N, ref SDS 77 4P9L.
A60606 -
A60607 - The doctor was disappointed that Millie couldn't start treatment last
A60608 - week because the Protocol Nurse, Rosalie, reported on 041221 finding
A60609 - conflicts between patient history and the clinical trial protocol the
A60610 - doctor had prescribed. Millie has received only two (2) treatments
A60611 - with Adriamycin (AC) and Cytoxan, but the clinical trial protocol for
A60612 - Novel Epothilones BMS-247550 with capecitabine requires patients to
A60613 - have had four treatments with AC. ref SDS 83 E66I This frustrated
A60614 - planning to treat Millie with a couplet involving capecitabine,
A60615 - prescribed on 041210. ref SDS 81 028N The doctor feels the work plan
A60616 - developed today will qualify Millie to participate in the new clinical
A60617 - trial after completing a few more cycles of treatment with AC, as
A60618 - prescribed today. ref SDS 0 YR8F
A60619 -
A60620 - [On 050104 Rosalie advises that further review of the protocol
A60621 - indicates Millie may not qualify to participate in the drug trial
A60622 - by getting more AC treatments; she will notify the doctor.
A60623 - ref SDS 86 407N
A60625 - ..
A60626 - [On 050204 doctor confirms Millie cannot participate in new drug
A60627 - trial after completing 2 additional treatments with AC,
A60628 - ref SDS 90 028N; symptoms worsening, prescribe 2 more cycles of AC
A60629 - treatments, ref SDS 90 XQ41; schedule MUGA test for heart damage
A60630 - side effects. ref SDS 90 J55L
A60631 -
A60632 -
A60633 -
A607 -
SUBJECTS
Stanford 2nd Opinion Synthesize with UCSF 2nd Opinion Develop Work P
Stanford 2nd Opinion Received by Kaiser Synthesize 2nd Opinions Adop
AO04 -
AO0501 - ..
AO0502 - Stanford 2nd Opinion Synthesized with Ideas from UCSF 2nd Opinion
AO0503 - 2nd Opinions Synthesize Adopt Recommendations Continuous Treatment
AO0504 - AC Proposed by Stanford to Qualify for Capecitabine Proposed by UCSF
AO0505 -
AO0506 - Follow up ref SDS 81 IM5H, ref SDS 75 5X4J.
AO0507 -
AO0508 - The doctor discussed findings from the Stanford 2nd opinion, which
AO0509 - were cited as received during the meeting on 041210, but not discussed
AO0510 - at that time. ref SDS 81 IM5H
AO0512 - ..
AO0513 - During the meeting on 041019 at Stanford, and confirmed in the 2nd
AO0514 - opinion received about two (2) months later on 041209, Doctor Guardino
AO0515 - talked about getting more treatments with Adriamycin and Cytoxan (AC).
AO0516 - ref SDS 79 SN88 Today, the doctor plans treatment with AC in order to
AO0517 - qualify Millie for participation in a trial with capecitabine combined
AO0518 - with another agent, recommended in the UCSF 2nd opinion, per below.
AO0519 - ref SDS 0 YR8F This treatment plan meets the model of synthesizing
AO0520 - recommendations from 2nd opinsions discussed on 041130. ref SDS 75
AO0521 - 5X4J
AO0523 - ..
AO0524 - [On 050204 doctor confirms Millie cannot participate in new drug
AO0525 - trial after completing 2 additional treatments with AC,
AO0526 - ref SDS 90 028N; symptoms worsening, prescribe 2 more cycles of AC
AO0527 - treatments, ref SDS 90 XQ41; schedule MUGA test for heart damage
AO0528 - side effects. ref SDS 90 J55L
AO0530 - ..
AO0531 - [On 050311 examination shows cancer progresses with new sores on
AO0532 - left breast; presents concerns about continuing treatment with
AO0533 - Adriamycin Cytoxen (AC). ref SDS 94 UA8N
AO0535 - ..
AO0536 - [On 050329 switched treatment to Taxotere and capecitabine
AO0537 - (Xeloda), because disease progressing during treatments with AC.
AO0538 - ref SDS 98 887S
AO0540 - ..
AO0541 - [On 050520 dramatic improvement after 2 cycles of treatment with
AO0542 - Taxotere and Xeloda. ref SDS A3 R19I
AO0544 - ..
AO0545 - Stanford's 2nd opinion further proposes consideration for surgery
AO0546 - after progress treating IBC, reported on 041209. ref SDS 79 SN97 This
AO0547 - may conflict in some respects with the 2nd opinion from UCSF, received
AO0548 - a month earlier on 041117. ref SDS 74 OU5P Today, the doctor asks for
AO0549 - review by the surgeon to assess viabiity of surgery, because the left
AO0550 - breast seems problematic. ref SDS 0 CW6J
AO0551 -
AO0552 -
AO0553 -
AO0554 -
AO06 -
SUBJECTS
KM Dilemma AC Ineffective CA 15-3-Rising Dilemma Why Prescribe Treat
Precision Access Finding Critical Details Aids Decision Support to P
Written Work Plan Treatment Work Up Patient Requests to Study Refine
Taxol Can Be Used Immediately because There Was no Basis for Ending
Treatment Plan AC Complete to Qualify for Trial Protocol 2 Cycles Ad
Start Radiation Treatment Schedule Lost Doctor Cannot Find in Patien
Tumor Board Minutes Lost 1st Hearing Millie's Case Doctor Cannot Fin
C209 -
C21001 - ..
C21002 - Relapse Requires Immediate Treatment Worsening IBC Symptoms
C21003 - Work Plan Try AC Treatments Again to Qualify Capecitiabine Protocol
C21004 -
C21005 - Follow up ref SDS 75 YR8F.
C21006 -
C21007 - For immediate treatment of rising IBC symptoms that signal relapse,
C21008 - per above, ref SDS 0 025H, the doctor proposed implementing Stanford's
C21009 - 2nd opinion recommendations, also above, ref SDS 0 IM5H, by starting
C21010 - treatments with two (2) cycles of Adriamycin and Cytoxan (AC)
C21011 - administered once every three weeks. This is the initial regimen when
C21012 - Millie started chemotherapy following initial surgery 2 years ago,
C21013 - reported on 020405 ref SDS 13 6SWS The doctor explained this strategy
C21014 - today of treating with AC again will qualify Millie for the clinical
C21015 - trial using capecitabine proposed in a 2nd opinion by Doctor Benz at
C21016 - UCSF, and planned but then halted last week on 041221, because Kaiser
C21017 - feels Millie needs more treatments with AC to qualify for a trial
C21018 - protocol, per above. ref SDS 0 028N
C21019 -
C21020 - [On 050104 Rosalie advises that further review of the protocol
C21021 - indicates Millie may not qualify to participate in the drug trial
C21022 - by getting more AC treatments; she will notify the doctor.
C21023 - ref SDS 86 407N
C21025 - ..
C21026 - [On 050204 Protocol Nurse says Millie cannot qualify for trial
C21027 - with capecitabine. ref SDS 90 JF4M
C21029 - ..
C21030 - [On 050913 doctor objects that 2nd opinions delay mastectomy
C21031 - surgery for patient with secondary IBC, history of relapse, and
C21032 - pulmonary emboli. ref SDS A8 G44O
C21033 -
C21035 - ..
C21036 - Reason AC Treatments Stopped Guide Decision to Prescribe Again Today
C21037 - Best Guess Case Management Improved by Written Records for Accuracy
C21038 - Knowledge Management Dilemma Resolved with Doctor Patient Partnership
C21039 - Timely Precision Access Finding Critical Details Aids Decision Support
C21040 -
C21041 - Today, the doctor asked why treatments with Adriamycin Cytoxan (AC)
C21042 - were stopped in 2002? He explained that AC causes cumulative damage
C21043 - to the heart, which only reaches a level of concern after four (4)
C21044 - treatments. Damage can be tested after the fourth cycle to see if a
C21045 - patient can withstand further treatments with AC. The doctor glanced
C21046 - through the medical chart, and checked Kaiser's records using a
C21047 - computer in the examination room. He could not find the date and
C21048 - reason for previously ending AC treatments in 2002.
C21049 -
C21050 - [...below, after determining Millie has received 2 cycles of AC,
C21051 - the doctor prescribed 2 more cycles today making a total of 4,
C21052 - that does not exceed guidance, discussed here, ref SDS 0 XQ84, and
C21053 - meets screening criteria for a clinical trial the doctor has in
C21054 - mind for Millie. ref SDS 0 XQ41
C21056 - ..
C21057 - [On 050104 begin treatment with AC; turns out that four (4) cycles
C21058 - were prescribed, rather than 2 discussed today, and so seems to
C21059 - exceed the nominal limit by two (2) cycles of cumulative damage
C21060 - to the heart. ref SDS 86 DB65
C21062 - ..
C21063 - [On 050115 letter to Knowledge Management group illustrates method
C21064 - of personal and organizational memory through writing. ref SDS 88
C21065 - QA8W
C21067 - ..
C21068 - [On 050204 Kaiser plans to add another 2 cycles of AC, making a
C21069 - total of 8; plans to order Muga test for heart damage. ref SDS 90
C21070 - J544
C21072 - ..
C21073 - [On 050311 MUGA test scheduled to assess continued treatments with
C21074 - AC beyond fourth cycle. ref SDS 93 J55L
C21076 - ..
C21077 - [On 050328 Millie at Kaiser for MUGA test to assess damage to the
C21078 - heart from AC treatments. ref SDS 96 0Y6I
C21080 - ..
C21081 - [On 050329 Kaiser changed prescription to treat 1st relapse of IBC
C21082 - from AC that has been ineffective, to capecitabine and Taxotere.
C21083 - ref SDS 97 T58M
C21085 - ..
C21086 - [On 050414 Knowledge Management cited at work in medical practice
C21087 - for many years; Kaiser leader on implementation. ref SDS 99 AG4I
C21089 - ..
C21090 - [On 050422 MUGA test report shows no evidence heart damage.
C21091 - ref SDS A0 UG4H
C21093 - ..
C21094 - [On 051007 reasoning for palliative mastectomy surgery conflicts
C21095 - with patient history calling for local control. ref SDS A9 WX6F
C21097 - ..
C21098 - [On 051007 Kaiser cannot remember and cannot find date pulmonary
C21099 - embolism diagnosed and Coumadin treatment started in order to
C21100 - decide on ending treatment. ref SDS A9 EQ7K
C21102 - ..
C21103 - [On 061024 case study medical practice computer access limited
C21104 - even with everything on the computer, people can't find details
C21105 - stored in parts of the computer (software modules) that are not
C21106 - frequently used. ref SDS B2 JD9L
C21108 - ..
C21109 - Similar problem finding organizational memory occurred on 961218 when
C21110 - the USACE management team could not remember why change order RFP #19
C21111 - was issued, and so rescinded it. Error from reliance on personal
C21112 - memory and failure to find critical details in the files and records
C21113 - of organizational memory, ref SDS 5 U24X, cost the government an extra
C21114 - $10M, reported two (2) years later on 981027. ref SDS 7 9152
C21116 - ..
C21117 - [On 051007 doctor asks when pulmonary emboli was diagnosed that
C21118 - requires treatment with anticoagulants (Coumadin) for life in the
C21119 - case of cancer patients. ref SDS A9 EQ7K
C21121 - ..
C21122 - [On 070221 computers at the VA provide a "miracle" giving doctor's
C21123 - instant access to legible patient history with a few clicks.
C21124 - ref SDS B7 HH5N
C21126 - ..
C21127 - On 020217 management productivity falls when communication fails;
C21128 - people point fingers in accusation and blame in meetings because they
C21129 - cannot point to an accurate, contextually relevant record. ref SDS 11
C21130 - B58N Case study on 040416 shows cognitive overhead for diligence,
C21131 - study and analyse that separates "signal from noise" in medical test
C21132 - reports avoids errors in diagnosis and treatment. ref SDS 46 PTSX
C21134 - ..
C21135 - Kaiser's Healthwise Handbook calls out review of the Medical Chart for
C21136 - accurate understanding of patient history to enable analysis,
C21137 - diagnosis, and prescribe treatment, reported on 990625. ref SDS 8 TD5S
C21138 - Limited time reduces compliance with requirements for medical
C21139 - practice. ref SDS 8 1978 On 020504 study indicates widespread failure
C21140 - to implement policies, standards and regulations that mandate good
C21141 - practice. ref SDS 15 NS6F
C21143 - ..
C21144 - On 041130 discussed writing down the work plan to confirm verbal
C21145 - presentations in order to reduce guess work in analysis of diagnosis
C21146 - and prescribing treatment plans. ref SDS 75 8P8F
C21148 - ..
C21149 - An example of reliance on written records, rather than conversation
C21150 - occurred during the meeting at Stanford Medical Center for a 2nd
C21151 - opinion. At that time, Doctor Guardino asked an aide to check the
C21152 - record for the date of a CT test, rather than rely on conversation.
C21153 - At that time the aid left the meeting and verified critical details on
C21154 - patient history. ref SDS 71 BV92
C21155 -
C21156 - [On 050104 treatments begin with Adriamycin Cytoxan (AC); four (4)
C21157 - cycles were prescribed, which exceeds the nominal limit by 50% to
C21158 - avoid cumulative damage to the heart. ref SDS 86 DB65
C21160 - ..
C21161 - [On 050204 doctor scheduled MUGA test for heart damage from
C21162 - exceeding 4 treatments with AC. ref SDS 90 WY5F
C21168 - ..
C21169 - Today, the doctor recalled from memory that three (3) years ago in
C21170 - 2002 treatment may have been switched from AC to another agent before
C21171 - the 4th cycle of chemotherapy, because treatment with AC was not
C21172 - effective. The doctor asked the patient why treatment was changed;
C21173 - does the patient have a different memory of events three years ago in
C21174 - connection with deciding to prescribe the same treatment today?
C21176 - ..
C21177 - If true that AC was not effective for the patient in 2002, then why
C21178 - consider prescribing treatment again that was ineffective?
C21180 - ..
C21181 - Lack of knowledge, because people cannot find and verify critical
C21182 - details within the time available during examinations presents a
C21183 - dilemma cited in articles reviewed on 990912 reporting the high cost
C21184 - of medical mistakes. ref SDS 10 0001 Without written records,
C21185 - prescribing AC in this case rests on a "best guess" that risks heart
C21186 - damage, per above, ref SDS 0 XQ84, and, also, failed treatment with
C21187 - progression of desease and death from following Stanford's
C21188 - recommenation in order to qualify for subsequent treatment in a trial
C21189 - to investigate effectiveness of a new drug, per above. ref SDS 0 IM5H
C21190 - If AC was previously ineffective, prescribing this treatment compounds
C21191 - delay providing the correct treatment to reverse rising symptoms of a
C21192 - rare, highly aggressive disease. ref SDS 0 025H Written records
C21193 - remove guess work on patient history for guiding treatment decisions,
C21194 - discussed previously on 041130. ref SDS 75 1G8F
C21196 - ..
C21197 - [On 050204 doctor confirms Millie cannot participate in new drug
C21198 - trial after completing 2 additional treatments with AC,
C21199 - ref SDS 90 028N; IBC symptoms worsening, prescribe 2 more cycles
C21200 - of AC treatments, ref SDS 90 XQ41; schedule MUGA test for heart
C21201 - damage side effects. ref SDS 90 J55L
C21203 - ..
C21204 - [On 050212 patient hospitalized to treat "fairly dangerous"
C21205 - infection from cat bite; Emergency Room physician did not have
C21206 - time to obtain patient history from computer accessing Kaiser's
C21207 - Knowledge Data Base for patient patient history in the medical
C21208 - chart. ref SDS 91 VC8H
C21210 - ..
C21211 - [On 050214 doctor examins patient in hospital being treated for
C21212 - infection from cat bite; defers 3rd treatment with AC for a week;
C21213 - reports CA 15-3 rose again from 66 to 78, plans changing
C21214 - chemotherapy drug to Xeloda if CA 15-3 still rising after 3rd
C21215 - treatment with AC. ref SDS 92 D177
C21217 - ..
C21218 - [On 050311 after 3rd treatment of AC CA 15-3 rises significantly
C21219 - from 78 to 95, then drops a week later to 88, ref SDS 93 HU5K, and
C21220 - cancer sores appear on the left breast, which is startling a new
C21221 - development in progression of desease, ref SDS 93 025H, healing of
C21222 - biopsy wound on left breast continues, ref SDS 93 6T5G, and
C21223 - results in decision to continuing treatment with Adriamycin
C21224 - Cytoxen (AC). ref SDS 93 XQ41
C21226 - ..
C21227 - [On 050329 CA 15-3 spikes to 101; switched treatment to Taxotere
C21228 - and capecitabine (Xeloda), because disease progressing during
C21229 - treatments with AC. ref SDS 98 887S
C21231 - ..
C21232 - [On 050520 dramatic improvement after 2 cycles of treatment with
C21233 - Taxotere and Xeloda. ref SDS A3 887P
C21235 - ..
C21236 - [On 060126 medical analyst cannot find prior report for PET scan
C21237 - test on 051005; caused failure to perform comparison and trend
C21238 - analysis with results of test on 060120. ref SDS A0 LC7N
C21240 - ..
C21241 - Patient records on 020603 indicated Adriamycin Cytoxan (AC) was given
C21242 - to the patient for only two cycles; it was effective, based on rise of
C21243 - CA 15-3 marker for breast cancer. ref SDS 16 WO4O Treatment was
C21244 - halted with AC because of perception at the time that CA 15-3
C21245 - diagnostics did not decline, cited in minutes of the Tumor Board
C21246 - reported in the record on 040517. ref SDS 51 4R59 This appears now to
C21247 - have been an error correlating test results with the sequence of
C21248 - treatments. ref SDS 16 WO4O Since it appears AC was in fact
C21249 - effective, and so there was no reason to have changed course in 2002,
C21250 - resuming treatments with two (2) more cycles of AC seems to present a
C21251 - good opportunity to control disease again, as noted in Stanford's 2nd
C21252 - opinion. ref SDS 0 IM5H The ability to test for heart damage, noted
C21253 - by the doctor above, offers assurance of avoiding problems continuing
C21254 - with AC. ref SDS 0 XQ84
C21255 -
C21256 - [On 050204 similar pattern examination shows worsening symptoms of
C21257 - IBC after two (2) treatments with AC; doctor continues
C21258 - prescription for AC based on prior record of eventual improvement.
C21259 - ref SDS 90 J544
C21261 - ..
C21262 - [On 050328 Millie at Kaiser for MUGA test to assess damage to the
C21263 - heart from AC treatments. ref SDS 96 0Y6I
C21265 - ..
C21266 - [On 050520 the doctor began capturing the record, and disclosed
C21267 - Kaiser's plans to equip patient examination rooms with ergonomic
C21268 - work stations for efficiently investing intellectual capital.
C21269 - ref SDS A3 R35L
C21270 -
C21271 -
C21272 -
C213 -
SUBJECTS
Taxol Can Be Used Immediately because There Was no Basis for Ending
C903 -
C90401 - ..
C90402 - Taxol Proven Effective Can Be Resumed for Immediate Treatment
C90403 -
C90404 - Millie asked about resuming treatment with Taxol alone, since analysis
C90405 - on 041104 found that halting treatment on 041104 was unnecessary,
C90406 - ref SDS 73 Q59K, because pulminary emboli found in a CT test is a side
C90407 - effect of bevacizumab (Avastin), as discussed again on 041130.
C90408 - ref SDS 75 0293 Rather than begin with double-agent Adriamycin and
C90409 - Cytoxin (AC), which failed in 2002, Kaiser could begin treatments with
C90410 - Taxol, since this drug may have been the main factor for reduced IBC
C90411 - activity over the past 6 months up until 041104, in combination with
C90412 - Avastin.
C90414 - ..
C90415 - Previously, on 041130 Taxotere was also considered as a single-agent
C90416 - treatment option, based on prior success treating Millie in 2002.
C90417 - ref SDS 75 0293
C90419 - ..
C90420 - Millie asked about starting treatment with other established
C90421 - chemotherapy drugs like Gemzar, and capecitabine and Taxotere, which
C90422 - Doctor Benz had recommended in his 2nd opinion, reviewed on 041117.
C90423 - ref SDS 74 OU5V
C90424 -
C90425 - [On 050329 switched treatment to Taxotere and Xeloda
C90426 - (Capecitabine), because disease progressing during treatments with
C90427 - AC. ref SDS 97 T58M
C90428 -
C90429 -
C90430 -
C90431 -
C905 -
SUBJECTS
Metastatic Cancer No Cure Requirements Continuous Treatment Recommen
CF03 -
CF0401 - ..
CF0402 - Treatment Plan IBC Chemotherapy Clinical Trial Surgery Radiation
CF0403 - Adriamycin Cytoxan AC 2 Cycles Qualify for Clinical Trial Protocol
CF0404 -
CF0405 - The doctor decided to prescribe two (2) cycles of treatment using
CF0406 - Adriamycin and Cytoxin (AC), recommended by Stanford, per above,
CF0407 - ref SDS 0 IM5H, and in order to qualify for the clinical trial with
CF0408 - Novel Epothilones BMS-247550 and capecitabine, per above, ref SDS 0
CF0409 - 028N, and prescribed by Kaiser on 041130. ref SDS 75 028N Previously,
CF0410 - on 040318 the doctor explained clinical trials are oncology standard
CF0411 - of care to expand the "tool kit" for treating cancer. ref SDS 41 DG4J
CF0412 - Prescribing 2 cycles of AC seems to align with guidance presented
CF0413 - today that limits AC to 4 cycles in order to avoid cumulative damage
CF0414 - to the heart, per above. ref SDS 0 XQ84
CF0415 -
CF0416 - [On 050104 begin treatment with AC; turns out that four (4) cycles
CF0417 - were prescribed, rather than 2 discussed today, and so seems to
CF0418 - exceed the nominal limit by two (2) cycles of cumulative damage
CF0419 - to the heart. ref SDS 86 DB65
CF0421 - ..
CF0422 - [On 050104 begin treatment with AC; turns out that four (4) cycles
CF0423 - were prescribed, rather than 2 discussed today, and so seems to
CF0424 - exceed the nominal limit by two (2) cycles of cumulative damage
CF0425 - to the heart. ref SDS 86 DB65
CF0427 - ..
CF0428 - [On 050104 Rosalie advises that further review of the protocol
CF0429 - indicates Millie may not qualify to participate in the drug trial
CF0430 - by getting more AC treatments; she will notify the doctor.
CF0431 - ref SDS 86 407N
CF0433 - ..
CF0434 - [On 050128 Millie completes 2nd cycle of AC to qualify for the new
CF0435 - drug trial. ref SDS 89 0001
CF0437 - ..
CF0438 - [On 050204 doctor confirms Millie cannot participate in new drug
CF0439 - trial after completing 2 additional treatments with AC,
CF0440 - ref SDS 90 028N; IBC symptoms worsening, ref SDS 90 XQ41;
CF0441 - prescribe 2 more cycles of AC treatments, ref SDS 90 J544;
CF0442 - schedule MUGA test for heart damage side effects. ref SDS 90 FH68
CF0444 - ..
CF0445 - [On 050329 Kaiser changed prescription to treat 1st relapse of IBC
CF0446 - from AC that has been ineffective, to capecitabine and Taxotere.
CF0447 - ref SDS 97 T58M
CF0449 - ..
CF0450 - [On 050422 MUGA test report shows no evidence heart damage.
CF0451 - ref SDS A0 UG4H
CF0453 - ..
CF0454 - [On 050913 doctor objects that 2nd opinions delay mastectomy
CF0455 - surgery for patient with secondary IBC, history of relapse, and
CF0456 - pulmonary emboli. ref SDS A8 G44O
CF0458 - ..
CF0459 - The doctor reviewed planning on 041130 for chemotherapy options to
CF0460 - maintain vigorous treatment. ref SDS 75 FY5F He explained today that,
CF0461 - if there is not favorable progress on AC or the new trial, then Taxol
CF0462 - can be tried again as a single agent without Avastin that caused the
CF0463 - blood clots, as discussed on 041104. ref SDS 73 Q59K Additionally,
CF0464 - capecitabine (Xeloda is a product name) can be combined with Taxotere
CF0465 - to achieve sufficient progress treating IBC for surgery to eliminate
CF0466 - cancer from the left breast, as planned above. ref SDS 0 CW6J
CF0467 -
CF0468 - [On 050214 CA 15-3 rises dramatically again to 77; decide to have
CF0469 - another treatment with AC, then switch to Xeloda if CA 15-3
CF0470 - continues to rise. ref SDS 92 D183
CF0472 - ..
CF0473 - [On 050311 examination shows CA 15-3 rises to 95, then falls
CF0474 - slightly to 88, with net increase reflecting cancer progresses
CF0475 - with new sores on left breast; presents concerns again about
CF0476 - continuing treatment with Adriamycin Cytoxen (AC). ref SDS 93 J53N
CF0478 - ..
CF0479 - [On 050329 switched treatment to Taxotere and capecitabine
CF0480 - (Xeloda), because disease progressing during treatments with AC.
CF0481 - ref SDS 98 887S
CF0483 - ..
CF0484 - [On 050520 dramatic improvement after 2 cycles of treatment with
CF0485 - Taxotere and Xeloda. ref SDS A3 R19I
CF0487 - ..
CF0488 - After surgery, treatments can continue with radiation, as needed to
CF0489 - control metastatic disease, cited in Doctor Guardino's 2nd opinion,
CF0490 - received yesterday. ref SDS 79 O29W On 041222 the radiologist at Mt
CF0491 - Diablo Hospital seemed to indicate further radiation treatment could
CF0492 - be considered following further surgery. ref SDS 84 0001 Today, The
CF0493 - doctor discussed how Gemzar can be combined with Taxotere, cited by
CF0494 - Doctor Benz at UCSF in a report received on 041117, ref SDS 74 OU6S,
CF0495 - to expand available agents for continual treatment of metastatic
CF0496 - disease listed by the doctor on 041130. ref SDS 75 FY5F
CF0497 -
CF0498 - [On 050104 Rosalie researching trial protocol; advises Millie may
CF0499 - not meet qualifications to participate in the trial by getting
CF0500 - more AC treatments. ref SDS 86 407N
CF0501 -
CF0502 -
CF0503 -
CF0504 -
CF0505 -
CF0506 -
CF06 -
SUBJECTS
Schedule Treatment 2 Cycles Adriamycin Cytoxan AC Begin on 050104 Do
CL03 -
CL0401 - ..
CL0402 - Schedule Treatment 2 Cycles Adriamycin Cytoxan AC Begin on 050104
CL0403 -
CL0404 - The doctor recommended starting treatments as soon as possible,
CL0405 - discussed previously on 041130, ref SDS 75 Y66F, and again a few weeks
CL0406 - ago on 041210. ref SDS 81 028N He asked when Millie can start
CL0407 - treatments?
CL0409 - ..
CL0410 - Millie said she is ready to start treatments today.
CL0412 - ..
CL0413 - The doctor left the examination room.
CL0415 - ..
CL0416 - About 20 minutes later, he returned with documents showing a meeting
CL0417 - in the Chemotherapy Clinic is scheduled for 050104, next Tuesday,
CL0418 - which is the earliest date treatments can begin for Millie.
CL0420 - ..
CL0421 - Millie asked about scheduling treatments on Friday for better
CL0422 - coordination with work scheduling?
CL0424 - ..
CL0425 - The doctor suggested talking to staff in the Chemotherapy Clinc about
CL0426 - scheduling treatments on Fridays. He feels this can be accomdated.
CL0427 -
CL0428 -
CL0429 -
CL0430 -
CL0431 -
CL05 -
SUBJECTS
Treatment Plan Summary IBC Relapse Control Disease Schedule Treatmen
CT03 -
CT0401 - ..
CT0402 - Treatment Plan Summary for IBC Relapse Recovery
CT0403 - Summary Work Plan Schedules Immediate Action to Treat IBC Relapse
CT0404 -
CT0405 - Inflammatory Breast Cancer (IBC) was improving on the Taxol Avastin
CT0406 - trial, following treatment on 041021. Interruption of treatment on
CT0407 - 041104 due to pulmonary emboli presented a delimma that risked
CT0408 - relapse. ref SDS 73 F47L Accelerating relapse risks cancer cascading
CT0409 - out of control. ref SDS 0 025H The work today sets a plan that
CT0410 - resolves the dilemma by scheduling immediate treatment using proven
CT0411 - agents to backup considerations for new drug trials...
CT0412 -
CT0413 - 1. CA 15-3 test ordered to maintain
CT0414 - control................................. ref SDS 0 CX38
CT0415 -
CT0416 - [On 050204 CA 15-3 jumps to 67. ref SDS 90 087J
CT0418 - ..
CT0419 - [On 050311 CA 15-3 rises again to 88, above level of 80
CT0420 - that signals action required. ref SDS 93 087J
CT0422 - ..
CT0423 - [On 050329 CA 15-3 rises above 100; change treatment to
CT0424 - Taxotere Xeloda. ref SDS 97 087J
CT0426 - ..
CT0427 - [On 050422 CA 15-3 rises to 105, still under AC
CT0428 - treatments. ref SDS A0 GJ5M
CT0430 - ..
CT0431 - 2. Disability authorizations signed
CT0432 - to prepare for aggressive, and
CT0433 - debilitating treatments................. ref SDS 0 2V83
CT0435 - ..
CT0436 - 3. Treatment scheduled to start next
CT0437 - next week on 050104 with AC to
CT0438 - qualify for new drug trial with
CT0439 - capecitabine............................ ref SDS 0 8948
CT0440 -
CT0441 - [On 050104 treatments with AC started. ref SDS 86 0001
CT0443 - ..
CT0444 - [On 020504 IBC seems to worsen. ref SDS 90 XQ41
CT0446 - ..
CT0447 - [On 050311 IBC worsens, more AC treatments ordered.
CT0448 - ref SDS 93 J53N
CT0450 - ..
CT0451 - [On 050329 AC treatments ended; switched to Taxotere
CT0452 - capecitabine (Xeloda). ref SDS 97 AW5G
CT0454 - ..
CT0455 - 4. MUGA test for heart damage with more
CT0456 - than 4 AC treatments.................... ref SDS 0 XQ84
CT0457 -
CT0458 - [On 050311 MUGA test scheduled to assess continued
CT0459 - treatments with AC beyond fourth cycle. ref SDS 93 J55L
CT0461 - ..
CT0462 - [On 050328 Millie at Kaiser for MUGA test to assess damage to the
CT0463 - heart from AC treatments. ref SDS 96 0Y6I
CT0465 - ..
CT0466 - [On 050422 MUGA test report shows no evidence heart
CT0467 - damage. ref SDS A0 UG4H
CT0469 - ..
CT0470 - 5. Qualify for new drug trial with
CT0471 - capecitabine previously denied
CT0472 - due to lack of enough treatments
CT0473 - with AC................................. ref SDS 0 XQ41
CT0474 -
CT0475 - [On 050104 Protocol Nurse says Millie may not qualify
CT0476 - for new drug trial. ref SDS 86 407N
CT0478 - ..
CT0479 - [On 050204 Protocol Nurse says Millie cannot qualify
CT0480 - for trial with capecitabine. ref SDS 90 JF4M
CT0482 - ..
CT0483 - 6. Taxol, Taxotere, Capecitabine
CT0484 - backups for AC.......................... ref SDS 0 2R7G
CT0485 -
CT0486 - [On 050329 IBC worsens, CA 15-3 rises to over 100 after
CT0487 - treating with AC; Kaiser switches prescription to
CT0488 - Taxotere and Xeloda, which is a commercial name for
CT0489 - capecitabine. ref SDS 97 AW5G
CT0491 - ..
CT0492 - [On 050520 dramatic improvement after 2 cycles of
CT0493 - treatment with Taxotere and capecitabine (Xeloda),
CT0494 - ref SDS A2 025H, despite temporarily stopping
CT0495 - treatments beginning on 050514 due to severe side
CT0496 - effects, ref SDS A1 RU9M; on 050520 treatment dose for
CT0497 - capecitabine (Xeloda) reduced to reduce side effects.
CT0498 - ref SDS A2 NT3I
CT0500 - ..
CT0501 - 7. Surgery perform review on 050107
CT0502 - to determine requirements for
CT0503 - sufficient progress treating
CT0504 - IBC..................................... ref SDS 0 CW6J
CT0505 -
CT0506 - [On 050107 surgeon recommends continued progress with
CT0507 - chemotherapy to clear the site of disease. ref SDS 87
CT0508 - UM6I
CT0510 - ..
CT0511 - [On 050311 doctor requests further review of worsening
CT0512 - IBC for treating "pockets of resistance" to
CT0513 - chemotherapy with surgery for masectomy; requests
CT0514 - criteria for when IBC is sufficiently reduced for
CT0515 - surgery. ref SDS 93 XQ41
CT0517 - ..
CT0518 - [On 050324 surgeon restates recovery from IBC predicate
CT0519 - to surgery, ref SDS 95 WH5L; criteria for surgery
CT0520 - discussed. ref SDS 95 OV5H
CT0522 - ..
CT0523 - [On 050610 window of opportunity for surgery to perform
CT0524 - masectomy after switching treatments to Taxotere and
CT0525 - capecitabine (Xeloda), and dramatic recovery from IBC
CT0526 - with 3 treatments; doctor calls surgeon for follow up
CT0527 - examination to schedule surgery. ref SDS A4 XQ41
CT0529 - ..
CT0530 - [On 050725 surgeon approves masectomy after dramatic
CT0531 - recovery from IBC from treatment with Taxotere and
CT0532 - capecitabine. ref SDS A6 YY7F
CT0534 - ..
CT0535 - 8. Trial protocol implementing 2nd
CT0536 - opinion recommendations to try
CT0537 - capecitabine............................ ref SDS 0 028N
CT0538 -
CT0539 - [On 050204 participation in trial with capecitabine
CT0540 - reported not available because four (4) consecutive
CT0541 - treatments with AC are required by the protocol, and
CT0542 - patient originally had only 2, and getting more
CT0543 - treatments with AC does not meet qualifications for the
CT0544 - study. ref SDS 90 028N
CT0546 - ..
CT0547 - 9. Taxol, Taxotere capecitabine
CT0548 - (Xeloda) treatment after
CT0549 - trying AC and after trial if
CT0550 - needed.................................. ref SDS 0 2R7G
CT0551 -
CT0552 - [On 050329 IBC worsens, CA 15-3 rises to over 100 after
CT0553 - treating with AC; Kaiser switches prescription to
CT0554 - Taxotere and Xeloda, which is a commercial name for
CT0555 - capecitabine. ref SDS 97 AW5G
CT0557 - ..
CT0558 - [On 050520 dramatic improvement after 2 cycles of
CT0559 - treatment with Taxotere and capecitabine (Xeloda),
CT0560 - ref SDS A2 025H, despite temporarily stopping
CT0561 - treatments beginning on 050514 due to severe side
CT0562 - effects, ref SDS A1 RU9M; on 050520 treatment dose for
CT0563 - capecitabine (Xeloda) reduced to reduce side effects.
CT0564 - ref SDS A2 NT3I
CT0566 - ..
CT0567 - 10. Gemzar-Taxotere after trying
CT0568 - Taxoter-capecitabine (Xeloda)........... ref SDS 0 2R7G
CT0569 -
CT0570 - [On 050610 this step skipped (saved for later use),
CT0571 - because Taxoter capecitabine appears sufficient; doctor
CT0572 - requests examination by surgeon for scheduling
CT0573 - masectomy. ref SDS A4 2L4M
CT0575 - ..
CT0576 - 11. Surgery, masectomy after sufficient
CT0577 - recovery of IBC to maintain control
CT0578 - of disease.............................. ref SDS 0 UJ5M
CT0580 - ..
CT0581 - [On 050727 surgeon reports left breast appears ready
CT0582 - for masectomy, ref SDS A6 YY7F, begin due diligence on
CT0583 - criteria for surgery, ref SDS A6 O85O, and on criteria
CT0584 - for approving surgery to extend quality of life.
CT0585 - ref SDS A6 VL4O
CT0587 - ..
CT0588 - [On 050729 begin considerations for surgery after
CT0589 - substantial recovery from IBC in left breast and
CT0590 - regional lymph nodes. ref SDS A7 BZ56
CT0592 - ..
CT0593 - 12. Chemotherapy and possible radiation
CT0594 - following surgery....................... ref SDS 0 UM4J
CT0595 -
CT0596 -
CT0597 -
CT0598 -
CT0599 -
CT0600 -
CT0601 -
CT0602 -
CT0603 -
CT0604 -
CT07 -
SUBJECTS
Written Work Plan Treatment Work Up Patient Requests to Study Refine
Kaiser Doctor-Patient Partnership Model Yields Written Work Plan Tra
Illegible Writing Communication Failure Medical Mistakes Treatment P
Kaiser Doctor-Patient Partnership Model Yields Written Work Plan Tra
DQ06 -
DQ0701 - ..
DQ0702 - Kaiser's Doctor-Patient Partnership Model Yields Written Work Plan
DQ0703 - Transformation Relentless exposure Awareness Change to Good Management
DQ0704 - Good Management Relentless Pressure Yields Awareness Transformation
DQ0705 -
DQ0706 - Follow up ref SDS 75 YR8F.
DQ0707 -
DQ0708 - At the end of the meeting, the doctor noted that discussion today
DQ0709 - yielded a good treatment plan. ref SDS 0 475F This helps accomplish
DQ0710 - objectives called out last month for controlling advance of disease,
DQ0711 - during the meeting on 041130. ref SDS 75 YR8F Planning through
DQ0712 - collaboration in the doctor/patient partnership fits the model of good
DQ0713 - management reported on 041130, ref SDS 75 8P8F, and meets requirements
DQ0714 - in Kaiser's Healthwise Handbook, reviewed on 990625. ref SDS 8 4185
DQ0715 - Capturing the record with analysis and feedback helps confirm
DQ0716 - understandings in meetings like today. Confirmation increases
DQ0717 - accuracy, which necessarily reduces mistakes. ref SDS 8 TD6Q Since
DQ0718 - meetings are the primary unit of management productivity, reviewed on
DQ0719 - 020217. ref SDS 11 1332, better accuracy through collaboration, and
DQ0720 - partnership makes communication effective for saving lives, time, and
DQ0721 - money, as the doctor demonstrated today. ref SDS 0 XQ84
DQ0723 - ..
DQ0724 - Scheduled next meeting for 050128 to assess improvement from AC
DQ0725 - treatments and schedule start of drug trial, per planning today.
DQ0726 - ref SDS 0 Y36M
DQ0727 -
DQ0728 - [On 050204 doctor confirms Millie cannot participate in new drug
DQ0729 - trial after completing 2 additional treatments with AC,
DQ0730 - ref SDS 90 028N; IBC symptoms worsening, prescribe 2 more cycles
DQ0731 - of AC treatments, ref SDS 90 XQ41; schedule MUGA test for heart
DQ0732 - damage side effects. ref SDS 90 J55L
DQ0733 -
DQ0734 -
DQ0735 -
DQ0736 -
DQ0737 -
DQ0738 -
DQ0739 -
DQ08 -