CONTACTS 

SUBJECTS
Meeting Doctor Assess Treatment Review Progress after 3 Chemotherapy

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 51 0000. ref SDS 47 0000.
040502 -
040503 - Spike in CA 15-3 to 95, and then drop to 88 may indicate trauma of
040504 - infection from cat bite, that placed patient in "fairly dangerous"
040505 - condition.  Drop could signal AC is beginning to affect improvement
040506 - treating IBC, or that CA 15-3 is actually rising, consistant with
040507 - progression of disease. ref SDS 0 HU5K  CT scan ordered to test for
040508 - distant metastasis. ref SDS 0 NL4N  Biopsy wound beginning to heal
040509 - indicates positive results from AC treatment. ref SDS 0 6T5G  Spread
040510 - of red inflammation and blistering new sores on the left breast signal
040511 - advancing IBC, consistant with rising CA 15-3; could reflect reduced
040512 - concentration of chemotherapy medication due to missing treatments
040513 - caused by low WBC. ref SDS 0 025H  Doctor requests review by surgeon
040514 - to treat "pockets of resistance" to chemotherapy with masectomy or
040515 - other surgical procedure, ref SDS 0 XQ41, implementing Kaiser's Team
040516 - Care practice. ref SDS 0 PB4N  Considered changing the treatment plan
040517 - from AC to Taxol, Taxotere, capecitabine, etc.  Decision was made to
040518 - continue with AC. ref SDS 0 J53N  MUGA test was scheduled for 050328
040519 - to assess heart damage from exceeding four (4) treatments of AC, now
040520 - scheduled for six (6). ref SDS 0 WY5F
040521 -
040522 -
040523 -
040524 -
040525 -
040526 -
040527 -
040528 -
040530 -  ..
0406 -
0407 -
0408 - Discussion
0409 -
040901 - Agenda for Work Plan After 2 Treatments of AC
040902 -
040903 - Follow up ref SDS 51 SM6M, ref SDS 47 SM6M.
040905 -  ..
040906 - Millie created an agenda on the marking board...
040907 -
040908 -        CA 15-3 dramatic rise...................... ref SDS 0 GJ5M
040909 -        CT test schedule evaluate progress......... ref SDS 0 NL4N
040910 -        Wound punch biopsy better.................. ref SDS 0 6T5G
040911 -        Breast redness worse....................... ref SDS 0 025H
040912 -        Trial protocol............................. ref SDS 0 028N
040913 -
040914 -
040915 -
040916 -
0410 -

SUBJECTS
CA 15-3 Cancer Marker 88 Rises from 66 in 5 Weeks after Reaching 88

1203 -
120401 -  ..
120402 - CA 15-3 Cancer Marker 88 Rises Dramatically Again to 78 95 88
120403 -
120404 - Follow up ref SDS 51 087J, ref SDS 47 087J.
120405 -
120406 - Blood test on 050304 shows CA 15-3 dropped to 88 from the prior test
120407 - on 050225 which increased to 95 from 78 reported in the test on
120408 - 050211, continuing a rise from 67 reported five (5) weeks ago during
120409 - the meeting on 050204...
120411 -           ..
120412 -          050304......... 88 H............. 050311, ref SDS 0 087J
120413 -          050225......... 95 H............. 050308, ref SDS 55 0001
120414 -          050211......... 78 H............. 050214, ref SDS 53 02BB
120415 -          050128......... 67 H............. 050204, ref SDS 51 087J
120416 -          041228......... 56 H............. 041230, ref SDS 47 087J
120417 -          041204......... 43 H............. 041210, ref SDS 44 087J
120418 -          041007......... 39............... 041104, ref SDS 39 087J
120419 -          040923......... 49 H............. 041005, ref SDS 37 087J
120420 -          040908......... 44 H............. 040909, ref SDS 36 087J
120421 -          040825......... 47 H............. 040812, ref SDS 36 087J
120422 -          040811......... 42 H............. 040812, ref SDS 35 087J
120423 -          040728......... 43 H............. 040729, ref SDS 34 2N5J
120424 -          040712......... 47 H............. 040713, ref SDS 33 087J
120425 -          040614......... 55 H............. 040615, ref SDS 32 PX6X
120426 -          040517......... 78 H............. 040601, ref SDS 30 2N5J
120427 -          040311......... 70 H............. 040318, ref SDS 27 SM6M
120428 -          040205......... 60 H............. 040211, ref SDS 26 SM6M
120429 -          031201......... 62 H............. 031205, ref SDS 25 SM6M
120430 -          030912......... 66 H............. 030915, ref SDS 24 SM6M
120431 -          030708......... 68 H............. 030710, ref SDS 23 SM6M
120432 -          030503......... 54 H............. 030508, ref SDS 21 SM6M
120433 -          030403......... 45 H............. 030508, ref SDS 21 SM6M
120434 -          030215......... 46 H............. 030220, ref SDS 20 5E6L
120435 -          030106......... 37 H............. 030109, ref SDS 19 SM6M
120436 -          021202......... 41 H?............ 021204, ref SDS 18 SP5G
120437 -          021111......... 36 H?............ 021113, ref SDS 17 Y65I
120438 -          021023......... 33 H?............ 021023, ref SDS 16 SQ5I
120439 -          020930......... 33 H?..29........ 021002, ref SDS 15 SQ5I
120440 -          020917......... 36 H?............ 020924, ref SDS 14 SQ5I
120441 -          020717......... 59 H?............ 020726, ref SDS 13 YN5K
120442 -          020629......... 75 H ............ 020705, ref SDS 12 UX6I
120443 -          020608........  67 H ............ 020614, ref SDS 11 0001
120444 -          020603........ 108 H ............ 020607, ref SDS 10 X67F
120445 -          020511........ 117 H ............ 020603, ref SDS 9 PJ4J
120446 -          020419......... 81 H ............ 020430, ref SDS 7 7N5H
120447 -          020321......... 85 H ............ 020405, ref SDS 6 6T8K
120448 -
120449 -
120451 -  ..
1205 -
1206 -
1207 - Analysis
1208 -
120801 - CA 15-3 Cancer Marker Rises Again Signaling Active IBC
120802 - IBC Progressing Clinical Symptoms Rise Aligns with Rising CA 15-3
120803 -
120804 - Follow up ref SDS 51 GJ5M, ref SDS 47 GJ5M. ref SDS 44 GJ5M.
120805 -
120806 - Millie had blood drawn on Friday, 050211.  The next day, on Saturday
120807 - 050212, she was treated in Emergency for a cat bite, which caused a
120808 - feaver of 101.9, and a significant rash on the back of the right hand
120809 - where the bite occurred. ref SDS 52 5V8J  This placed Millie in a
120810 - "fairly dangerous" condition because the immune system is lowered by
120811 - chemotherapy, which enables infection to spread rapidly. ref SDS 52
120812 - I34W  Millie was hospitalized for continued treatment to prevent the
120813 - situation from cascading out of control. ref SDS 52 0T6O  The doctor
120814 - examined Millie in the hospital on 050214.  At that time, he reported
120815 - CA 15-3 cancer marker from the test on 050212 made another big jump to
120816 - 78 from 66.  He deferred chemotherapy treatment with AC scheduled on
120817 - 050218 for a week.  They also discussed changing treatment from AC to
120818 - Xeloda, if CA 15-3 continues to rise. ref SDS 53 02BB  As a result,
120819 - treatment with Adriamycin Cytoxan (AC) was on 050225. ref SDS 54 407N
120820 - The blood test for chemo treatment on 050225 yielded another jump in
120821 - CA 15-3 to 95.  A week later on 050304 Millie included CA 15-3 in the
120822 - weekly blood test for Coumadin treatments.  The report on that test
120823 - shows a slight drop in CA 15-3 to 88. ref SDS 0 087J
120825 -  ..
120826 - The doctor indicated during the meeting today that the spike in CA
120827 - 15-3 to 95 may reflect trauma from the cat bite incident.  Therefore,
120828 - the test on 050304 is a more true reading of continual rising, rather
120829 - than declining, cancer activity.  Slight drop in CA 15-3 after 5
120830 - months or so of increasing cancer marker and combined with visible
120831 - healing of the biopsy wound, discussed below, ref SDS 0 6T5G, are
120832 - hopeful signs that AC may be starting to stop progression of desease,
120833 - as planned on 041230. ref SDS 47 437N
120834 -
120835 -
120836 -
120837 -
120838 -
120839 -
1209 -

SUBJECTS
CT Test Scheduled to Evaluate Distant Metastasis in Face of Rapidly

1303 -
130401 -  ..
130402 - CT Scan Scheduled Evaluate Distant Metastasis Due to Rising CA 15-3
130403 -
130404 - Follow up ref SDS 51 NL4N, ref SDS 47 NL4N.
130405 -
130406 - The doctor ordered a new CT test on 050325 to assess rapidly rising CA
130407 - 15-3, per above, ref SDS 0 HU5K, and appearance of new cancer sores
130408 - that have appeared for the first time on the left breast, indicating
130409 - progression of IBC, per below. ref SDS 0 UA8N
130410 -
130411 -     [On 050325 Millie at Kaiser for CT test. ref SDS 59 0001
130413 -      ..
130414 -     [On 050329 test results not available for meeting with doctor.
130415 -     ref SDS 61 NL4N
130416 -
130417 -
130418 -
130419 -
130420 -
1305 -

SUBJECTS
Pulmonary Emoboli Symptoms End Treatment with Coumadin Continue

2003 -
200401 -  ..
200402 - Pulmonary Emoboli Symptoms End Treatment with Coumadin Continue
200403 - Coumadin Treatment Continues for Pulmonary Emoboli after Symptoms End
200404 -
200405 - Follow up ref SDS 51 RZ4I, ref SDS 47 RZ4I.
200406 -
200407 - No discussion based on planning during the meeting on 050204 to assess
200408 - Coumadin requirements in a few months time. ref SDS 51 S34O
200410 -  ..
200411 - No symptoms pulmonary emboli, blood clots.
200412 -
200413 -
200414 -
200415 -
200416 -
2005 -

SUBJECTS
Arm Lumps Lymph Nodes Swelled Under Left Side No Examination Patient

2203 -
220401 -  ..
220402 - Lumps Under Arm Seems Unchanged
220403 -
220404 - Follow up ref SDS 51 MW8J, ref SDS 47 MW8J.
220405 -
220406 - There was no examination and no discussion of lump under the arm due
220407 - to focus on new problems in the left breast.
220408 -
220409 -
220410 -
220411 -
2205 -

SUBJECTS
Neck Lumps Lymph Nodes Left Side No Examination Patient Reports Favo

2703 -
270401 -  ..
270402 - Lumps in Neck No Evidence of Swelling Indicating Cancer Receded
270403 -
270404 - Follow up ref SDS 51 8R6M, ref SDS 47 8R6M.
270405 -
270406 - No examination of the neck, because of prior favorable examinations
270407 - and testing the past few months, illustrated by the report on 041104.
270408 - ref SDS 39 8R6M
270409 -
270410 -
270411 -
270412 -
2705 -

SUBJECTS
Wound Punch Biopsy Left Breast Healing Improves after 3 Treatments w

3703 -
370401 -  ..
370402 - Wound Biopsy Beginning to Heal Treatment with Adriamycin Cytoxan AC
370403 -
370404 - Follow up ref SDS 51 6T5G, ref SDS 47 6T5G.
370405 -
370406 - The doctor examined the left breast and was pleased there has been
370407 - further healing of the punch biopsy wound following the 3rd treatment
370408 - of chemotherapy for IBC with AC on 050225. ref SDS 54 407N  This
370409 - suggests significant improvement since the meeting on 041210, when the
370410 - wound got suddenly worse, ref SDS 44 6T5G, and reported again on
370411 - 041230. ref SDS 47 6T5G
370413 -  ..
370414 - Millie asked about results of the surgeon's examination of the biopsy
370415 - wound on 050107, ref SDS 49 IS5N, which the doctor requested on 041230
370416 - for an evaluation to perform surgery. ref SDS 47 CW6J  During the
370417 - meeting on 020504 the doctor could not find the surgeon's report.  Has
370418 - the report now been reviewed, and has the doctor discussed this matter
370419 - with the surgeon? ref SDS 51 RD3M
370421 -  ..
370422 - The doctor indicated that the surgeon's report has not been examined,
370423 - and there has not been time for discussion with the surgeon on
370424 - reasoning presented in a meeting on 040429 that sets criteria for
370425 - surgery, ref SDS 28 SD7F, discussed later in the chemotherapy clinic
370426 - by the doctor on 040504, ref SDS 29 WI8F, and then again last month on
370427 - 050204. ref SDS 51 RD3L
370428 -
370429 -
370430 -
370431 -
370432 -
370433 -
3705 -

SUBJECTS
IBC Worsens Cancer Sores Begin to Blister on Left Breast Redness IBC

4503 -
450401 -  ..
450402 - Cancer Sores on Left Breast Blistering IBC Worsens with AC Treatment
450403 - Blistering Sores Cancer on Left Breast IBC Worsens with AC Treatment
450404 - Relapse Worsens IBC Cancer Sores Begin to Blister on Left Breast
450405 - IBC Symptoms Worsen Cancer Sores Begin to Blister on Left Breast
450406 -
450407 - Follow up ref SDS 51 025H, ref SDS 47 025H.
450409 -  ..
450410 - Redness IBC Spreads Cancer Sores Blister with Treatment Using AC
450411 - Pockets of Resistance to Chemotherapy May Require Surgery to Treat IBC
450412 -
450413 - There is noticable improvement in the lower half of the left breast.
450414 - Coloration and softness seem more normal today, and the sore from the
450415 - punch biopsy taken on 040419 has nearly healed, indicating response to
450416 - treatment with Adriamycin Cytoxan (AC), per above. ref SDS 0 6T5G
450418 -  ..
450419 - AC treatment was interrupted on 050212 by hospital stay of 4 days due
450420 - to infection from a cat bite. ref SDS 52 0001  The White Blood Cell
450421 - (WBC) dropped, which reduced strength of the immune system, so the
450422 - doctor skipped a week of treatment, reported on 050214. ref SDS 53
450423 - 02BB  Missing treatment, in turn, reduced concentration of
450424 - chemotherapy drugs, which may have caused cancer to increase, shown by
450425 - continued rise of CA 15-3, per above. ref SDS 0 GJ5M
450427 -  ..
450428 - The upper left area of the breast has new cancer sores blistering on
450429 - the skin.  This is an alarming new development that reflects analysis
450430 - of striking increase in CA 15-3 cancer marker over the past four (4)
450431 - months, noted above. ref SDS 0 GJ5M  There have never been any cancer
450432 - sores on the breast over three (3) years of disease, beginning on
450433 - 020208.  Additionally, IBC redness coloration is now stronger in this
450434 - area, and has spread upward toward the neck.  This is similar to the
450435 - condition reported on 041202 that caused Millie to get treatment at
450436 - the emergency room. ref SDS 43 0001  In that case, it turned out that
450437 - increased inflammation and temperature were only temporary and
450438 - expected side effects of treating the biopsy wound. ref SDS 43 RC92
450440 -  ..
450441 - Today, the doctor feels these new more severe conditions may indicate
450442 - the breast has "pockets" of cancer that resist treatment with
450443 - chemotherapy, particularly with concentration of chemotherapy reduced
450444 - by deferred application, as occurred this past cycle when Millie was
450445 - treated for infection from a cat bite, per above. ref SDS 0 7B4F
450447 -  ..
450448 - The doctor indicated that a breast with pockets of resistance to
450449 - chemotherapy may require a surgical solution to prevent cancer from
450450 - spinning out of control, considered previously, as shown in the study
450451 - on 041210. ref SDS 44 ZV5J  This amends analysis on 040812 indicating
450452 - surgery is not an option. ref SDS 35 SE61  On 041117 received a report
450453 - from UCSF where Doctor Benz recommended against surgical solution.
450454 - ref SDS 40 OU5P
450455 -
450456 -     [On 050318 treatment deferred again due to blood test that shows
450457 -     immune system too weak to recover from treatment, further reducing
450458 -     concentration of AC treatment below design strength. ref SDS 57
450459 -     0001
450461 -      ..
450462 -     [On 050329 switched treatment to Taxotere and capecitabine
450463 -     (Xeloda), because disease progressing during treatments with AC.
450464 -     ref SDS 61 0001
450466 -      ..
450467 -     [On 050502 visual improvement sores and inflamation are receding,
450468 -     ref SDS 64 EO5J
450470 -      ..
450471 -     [On 050510 further improvement inflammation (redness) seems
450472 -     entirely gone, and softness has returned to the breast.
450473 -     ref SDS 65 EO5J
450475 -      ..
450476 -     [On 050520 dramatic improvement after 2 cycles of treatment with
450477 -     Taxotere and capecitabine (Xeloda), ref SDS 67 025H, despite
450478 -     temporarily stopping treatments beginning on 050514 due to severe
450479 -     side effects, ref SDS 66 RU9M; on 050520 treatment dose for
450480 -     capecitabine (Xeloda) reduced to reduce side effects. ref SDS 67
450481 -     NT3I
450483 -      ..
450484 -     [On 050610 window of opportunity for surgery to perform masectomy
450485 -     after 3 treatments; doctor calls surgeon for follow up examination
450486 -     to schedule surgery. ref SDS 69 XQ41
450488 -      ..
450489 -     [On 050913 primary care physician urges approval of immediate
450490 -     mastectomy surgery on the left breast without investing time for
450491 -     due diligence review, despite complete recovery from red rash IBC
450492 -     on the left breast. ref SDS 74 5T5N
450494 -      ..
450495 -     [On 051011 pockets of resistance to treatment for cancer might be
450496 -     compounded if IBC cancer relapses after surgery that removes blood
450497 -     vessels, which would prevent delivery of chemotherapy systemic
450498 -     drug agents. ref SDS 75 G65S
450500 -      ..
450501 -     [On 061110 stable and rising red rash on left breast after
450502 -     mastectomy surgery on 051021, and after 6 treatments with
450503 -     chemotherapy, aligns with findings of "pockets" that resist
450504 -     systemic treatments with drugs, and may require surgery.
450505 -     ref SDS 76 RU7M
450506 -
450507 -
450508 -
450509 -
450510 -
450511 -
450512 -
4506 -

SUBJECTS
Management Standards Healthwise Handbook Communication Collaboration

6303 -
630401 -  ..
630402 - Examination Ordered Again for Surgery Criteria on IBC Patient
630403 -
630404 - Follow up ref SDS 51 RD3M, ref SDS 49 IS5N.
630405 -
630406 - During the meeting, the doctor called and left a voice mail message
630407 - asking the surgeon to examine Millie again for surgery to perform a
630408 - masectomy that improves local control.  He said that a few areas on
630409 - the left breast may have "pockets of resistance" to chemotherapy
630410 - drugs, shown by examination today, per above. ref SDS 0 PA4N  This
630411 - aligns with planning on 041230, ref SDS 47 UJ5M, which cites analysis
630412 - on 041210, when the doctor previously indicated masectomy may be
630413 - needed, based on considerations summarized by a case study,
630414 - ref SDS 44 ZV5J, and aimed to prevent disease from getting out of
630415 - control so that quality of life is extended, also, studied in this
630416 - case on 041230. ref SDS 47 XV7M
630418 -         ..
630419 -        [On 050727 surgeon finds left breast shows regression of IBC
630420 -        symptoms after 5 treatments with Taxoter and capecitabine
630421 -        (Xeloda), ref SDS 71 YY7F; begin due diligence to assess
630422 -        chances of successful surgery. ref SDS 71 OV5H
630424 -  ..
630425 - Millie mentioned that inflammatory breast cancer (IBC) in the left
630426 - breast is now worse today, per above, ref SDS 0 UA8N, than observed by
630427 - the surgeon during the meeting on 050107. ref SDS 49 IS5N  The prior
630428 - analysis explaining surgery requires healing the site of disease with
630429 - chemotherapy is pending review by Oncology. ref SDS 49 UM5W
630431 -  ..
630432 - The doctor noted that the surgeon can report options and criteria to
630433 - guide planning on 041230 for scheduling treatments to get Millie ready
630434 - for performing a surgical component of treatment with a masectomy to
630435 - better control advance of disease using chemotherapy, under Kaiser's
630436 - Team Care policy. ref SDS 47 UJ5M
630437 -
630438 -        [On 050324 criteria for masectomy were discussed with the
630439 -        surgeon. ref SDS 58 OV5H
630441 -         ..
630442 -        [On 050324 research indicates distinction between metastatic
630443 -        disease involving regional lymph nodes, which may be operable
630444 -        to reduce chances of relapse, and distant metastasis, which
630445 -        surgery cannot cure, but may play a palliative role,
630446 -        ref SDS 58 O84N, further explained from research on 050712.
630447 -        ref SDS 70 B65G
630449 -  ..
630450 - Millie asked if Kaiser's doctor-patient partnership policy, called out
630451 - in the Healthwise Handbook, reviewed on 990625, ref SDS 2 4185, can
630452 - facilitate collaboration for Team Care practice, also reviewed at that
630453 - time on 990625? ref SDS 2 UF65
630455 -  ..
630456 - The doctor asked how the doctor-patient partnership can facilitate
630457 - Team Care practice that entails communication among the professional
630458 - staff?
630459 -
630460 -     [On 050824 Advice Nurse in Surgery Department expects surgeon
630461 -     applied Team Care practice to collaborate with a referral doctor
630462 -     in Kaiser's Oakland office by providing background and explaining
630463 -     patient history so that the referral doctor can be prepared to
630464 -     conduct a productive meeting with the patient. ref SDS 72 HX48
630466 -      ..
630467 -     [On 050826 referral doctor in Oakland was not familiar with Kaiser
630468 -     organizational memory on patient history; background submitted
630469 -     during the meeting was described as the only summary available, as
630470 -     helpful, but was too late for the doctor to be prepared, so the
630471 -     entire meeting was based on recollections of personal memory.
630472 -     ref SDS 73 BL8N
630474 -  ..
630475 - Collaboration that drives the Team Care model to prepare, distribute,
630476 - and review communication has proven problematic in health care,
630477 - reported on 990912, ref SDS 3 0960, and supported by the study on
630478 - 020504. ref SDS 8 NS6F  This is largely a labor shortage issue,
630479 - because communication is labor intensive.  Doctor-patient partnership
630480 - helps with this problem by adding resources to prepare and distribute
630481 - timely, accurate analysis.  The doctor then need merely review, edit,
630482 - and correct the record, rather than bear the full burden to craft
630483 - useful analysis.  Getting everyone on the same page with a common
630484 - story facilitates collaboration for Team Care, and reduces mistakes
630485 - due to a hectic schedule.  On 020402 investing time to review
630486 - communications and provide feedback for accuracy on collaboration,
630487 - called out by Kaiser's Healthwise Handbook, was discouraged by the
630488 - staff. ref SDS 5 C24N  On 040614 the doctor generally confirmed these
630489 - understandings. ref SDS 31 9E8O
630491 -      ..
630492 -     [On 050329 things have been hectic in Oncology; Surgery report was
630493 -     not reviewed, and no consultation occurred to collaborate
630494 -     following examination on 050324 by Surgery. ref SDS 61 X76K
630496 -  ..
630497 - Continued difficulty reviewing the surgeon's report on 050107, ordered
630498 - by Doctor Parsley in the Emergency department, as discussed on 050204,
630499 - ref SDS 51 RD3M, and again today, per above, ref SDS 0 RD3M, displays
630500 - continuing weakness in Team Care communication.  Since the request
630501 - today covers the same scope, as the prior report still pending review,
630502 - some added ingredient seems required to get a better result.  The
630503 - patient can help by providing reports.  For example, the doctor can
630504 - review the record on 050107, as called out in the Healthwise Handbook,
630505 - if there is leaway on avoiding written records, discussed on 041130.
630506 - ref SDS 41 8P8F
630508 -  ..
630509 - The doctor indicated that, since today he is ordering a consultation
630510 - with the surgeon on this matter, there is stronger incentive to follow
630511 - up getting feedback under the Team Care policy, especially in light of
630512 - worsening conditions, ref SDS 0 UA8N, that have everyone's attention,
630513 - similar to the situation on 030606. ref SDS 22 VY7G  Previously,
630514 - guidance on quality team care was presented in a memo by Kaiser's CEO,
630515 - reviewed on 991028. ref SDS 4 0800
630516 -
630517 -     [On 050324 surgeon advised again that worsening IBC conditions
630518 -     make surgery high risk; and recommends further chemotherapy for
630519 -     recovery from IBC prior to a masectomy, ref SDS 58 0001, as
630520 -     reported previously on 050107, ref SDS 49 UM5W, and based on
630521 -     reasoning in the meeting on 040429. ref SDS 28 SD7F
630523 -      ..
630524 -     [On 050329 things have been hectic in Oncology; Surgery report was
630525 -     not reviewed, and no consultation occurred to collaborate
630526 -     following examination on 050324 by Surgery. ref SDS 61 X76K
630528 -      ..
630529 -     [On 050727 discussed with surgeon due diligence to collaborate and
630530 -     communicate in order to leverage experience through a Tumor Board
630531 -     and investigate for treating patient with rare disease.
630532 -     ref SDS 71 O85O
630533 -
630534 -
630535 -
630536 -
630537 -
630538 -
6306 -

SUBJECTS
Adriamycin Cytoxan AC 2 Cycles Doctor Prescribes Additional Cycles a
Treatment Plan Extend Adriamycin Cytoxan AC 2 Additional Cycles Orde

7004 -
700501 -  ..
700502 - Treatment Plan Extend Treatments with AC Test Heart for Damage
700503 - Heart Test for Damage from More than 4 Cycles of AC
700504 - Adriamycin Cytoxan AC 2 Cycles Additional Cycles and MUGA Test
700505 - MUGA Test Cumulative Heart Damage from Exceeding 4 AC Treatments
700506 -
700507 - Millie asked about changing treatments to Taxol, or to Taxotere and
700508 - capecitabine, planned on 041230, ref SDS 47 XQ41, since examination
700509 - today indicates AC does not seem effective, per above, ref SDS 0 UA8N,
700510 - and the doctor discussed making a change during the meeting on 050214,
700511 - if CA 15-3 did not improve. ref SDS 53 W58T
700513 -  ..
700514 - The doctor proposed continuing treatment with AC, based on prior
700515 - history indicating there may have been delayed improvement in
700516 - diagnostics and clinical observations, previously discussed on 041230,
700517 - ref SDS 47 XQ88, and again last month on 050204. ref SDS 51 J544  The
700518 - doctor cited reduced concentration of AC from delayed treatment,
700519 - discussed above, ref SDS 0 7B4F, may account for ineffectiveness, and
700520 - indicated that more treatment without interruptions could show
700521 - progress treating disease.
700523 -  ..
700524 - Millie has now received a total of five (5) cycles of AC, adding two
700525 - completed on 020603, ref SDS 9 WO4O, to treat initial diagnosis, which
700526 - planned four (4) cycles on 020405, ref SDS 6 549R, but seemed
700527 - ineffective; and three (3) more cycles of AC completed on 050225,
700528 - ref SDS 54 0001, treating relapse, beginning on 050104. ref SDS 48
700529 - 0001  Adding another treatment will make a total of six (6) with AC.
700531 -  ..
700532 - The basis of continuing AC treatment was not clear.  This might meet
700533 - requirements for having four (4) consequtive cycles of AC to qualify
700534 - for the drug trial, as discussed on 050204. ref SDS 51 JF4M
700535 - Additional AC treatments may test effectiveness with full potency, if
700536 - normal concentrations can be achieved without further missed
700537 - treatments due to low blood counts.
700539 -  ..
700540 - The doctor scheduled a MUGA test on 050328 for impact on the heart
700541 - from extending AC beyond four (4) treatments, cited on 041230 as the
700542 - point of potiential risk to patients. ref SDS 47 XQ84  Since Millie
700543 - has now had 5 cycles, and there is one more scheduled, the doctor
700544 - prescribed testing for heart damage.
700545 -
700546 -     [On 050328 Millie at Kaiser for MUGA test. ref SDS 60 0001
700548 -      ..
700549 -     [On 050422 MUGA test report shows no evidence heart damage.
700550 -     ref SDS 63 UG4H
700551 -
700552 -
700553 -
700554 -
700555 -
700556 -
700557 -
700558 -
700559 -
700560 -
7006 -