CONTACTS 

SUBJECTS
Meeting Doctor Examine Response to Chemotherapy Treatments Taxol Xel

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 73 0000, ref SDS 65 0000.
040502 -
040503 - CA 15-3 rose to 105, which is near the highest level ever, and so may
040504 - confirm decision to switch treatments. ref SDS 0 GJ5M  Report on CT
040505 - test performed on 050325 continues to indicate no distant metastasis.
040506 - ref SDS 0 NL4N  Compound growth over the past few months of right
040507 - axillary adenopathy (under the arm) is still microscopic and so does
040508 - not indicate cancer activity. ref SDS 0 B58M  Report on MUGA test
040509 - shows no evidence of heart damage from exceeding nominal dosage of
040510 - four (4) treatments with AC. ref SDS 0 IL7F  CT test report finding no
040511 - further evidence of pulmonary emboli indicates current treatment with
040512 - Coumadin is effective. ref SDS 0 RZ4I  The patient did not report
040513 - tingling for several days along the left arm because feelings finally
040514 - subsided.  Clinical examination of lumps under both arms found no
040515 - evidence of cancer. ref SDS 0 MW8J  Examination of the neck also found
040516 - not evidence of swelling, indicating prior cancer has been resolved,
040517 - supported by the CT test report. ref SDS 0 8R6M  Examination of left
040518 - breast shows further healing of biopsy wound, and IBC red rash about
040519 - the same; too soon for new treatments to effect recovery. ref SDS 0
040520 - 025H  There wasn't enough time to discuss report on 050324 that
040521 - examined criteria for masectomy, as requested by the doctor.
040522 - ref SDS 0 XQ41  Treatment plan was maintained despite rising IBC
040523 - symptoms, because latency in test reporting cannot accurately assess
040524 - changes in the treatment protocol. ref SDS 0 AW5G  Patient diary
040525 - indicates mild side effects from the new trial so far after one (1)
040526 - week of new treatment. ref SDS 0 NT3I  The doctor executed
040527 - documentation for reducing the work week to three (3) days a week to
040528 - accommodate cumulative disabling effects of continuous chemotherapy
040529 - treatments. ref SDS 0 8X8L
040531 -             ..
040532 -            [On 050502 visual improvement sores and inflammation are
040533 -            receding, ref SDS 86 EO5J
040535 -             ..
040536 -            [On 050510 further improvement inflammation (redness) seems
040537 -            entirely gone, and softness has returned to the breast.
040538 -            ref SDS 87 EO5J
040540 -             ..
040541 -            [On 050520 dramatic improvement after 2 cycles of treatment
040542 -            with Taxotere and Xeloda. ref SDS 92 R19I
040543 -
040544 -
040545 -
0406 -
0407 -
040701 -
0408 -

SUBJECTS
Patients Meet at Kaiser Commend Doctor in Oncology Department Kelly
Commend SDS Records Quality Prepared by Doctor Cites Records on Inte
Time Limited Pressured by Heavy Schedule Complex Cases

1905 -
1906 - 1800
190701 -  ..
190702 - Patient Medical History Shows Outstanding Care by the Doctor
190703 -
190704 - Follow ref SDS 81 I15M, ref SDS 76 AD5I.
190706 -  ..
190707 - We saw the doctor about 90 minutes late today.  When we arrived for
190708 - the meeting at 1645, there was a notice posted at the reception area
190709 - that the doctor was 30 minutes behind schedule.
190711 -  ..
190712 - The doctor came into the reception area with a patient.  He introduced
190713 - Kelly, and said to give him 5 minutes or so to prepare for our
190714 - meeting.
190716 -  ..
190717 - By this time all the staff had left, and the lights in the reception
190718 - counter area were dimmed signaling the end of the business day.
190720 -  ..
190721 - We visited for about 10 minutes with Kelly, before the doctor came
190722 - back to the reception area and called for the meeting.
190724 -  ..
190725 - Kelly said she asked the doctor to introduce her today, following up
190726 - correspondence on 050414. ref SDS 76 1T3L  Kelly was generous
190727 - complimenting the quality of reporting on patient history, e.g., she
190728 - thought the record for 041230, ref SDS 55 0001, and cited in Kelly's
190729 - letter on 050414, ref SDS 76 AD5I, was prepared by a doctor.
190730 -
190731 -        Previously, on 940728 Doctor Zipperstein commented favorably on
190732 -        SDS records for patient history that saves time working with an
190733 -        accurate record. ref SDS 2 0001  Later, on 000208, Doctor
190734 -        Racah found SDS records accurate. ref SDS 8 0001
190736 -         ..
190737 -        Writing effective records on medical, engineering, management,
190738 -        governance, science, etc, is aided by writing in the context of
190739 -        knowledge, explained in POIMS, ref OF 7 3742, and as set out in
190740 -        the scope for intelligence support in NWO. ref OF 12 FV4G
190741 -
190742 -            [On 050613 writing in the context of knowledge has been
190743 -            considered in public literature. ref SDS 95 E65R
190745 -  ..
190746 - Kelly has been a cancer patient for 6 years, and is currently
190747 - diagnosed with stage IV, like Millie.  Kelly was gracious and effusive
190748 - saying she was thrilled to learn in the record that Millie is working
190749 - hard to fight her cancer.  Millie thanked Kelly for concern, and
190750 - credited the doctor's good care.
190752 -  ..
190753 - Millie asked Kelly how she is doing?
190755 -  ..
190756 - Kelly seemed to indicated that at this time she is responding well to
190757 - treatment, and again expressed gratitude for outstanding care by
190758 - Kaiser and her doctor, underscoring her letter on 050414. ref SDS 76
190759 - TE5X
190761 -  ..
190762 - This complements review of the Kaiser Papers on 020221. ref SDS 9
190763 - EG4K
190764 -
190765 -        [On 060809 Millie letter to advice nurse explains Kaiser
190766 -        provided adequate care. ref SDS B0 1L5X
190767 -
190768 -        [On 060809 patient history shows challenges treating complex
190769 -        medical conditions that arise with cancer. ref SDS B0 LX5H
190771 -  ..
190772 - Kelly was pleased to get the letter yesterday on 050421. ref SDS 81
190773 - VQ3O  She liked hearing that another patient was helped by SDS records
190774 - on the Internet. ref SDS 81 I15M  Kelly said this example helps
190775 - overcome initial surprise and concern about privacy after seeing
190776 - patient history on the Internet for the first time, cited in Kelly's
190777 - initial letter on 050414. ref SDS 76 TE4P  Publishing case history
190778 - that does not identify individuals provides lessons learned for
190779 - educating doctors and patients, previously discussed in our
190780 - correspondence on 050414. ref SDS 76 Q16F  Kelly commented that breast
190781 - cancer brings unique experiences for each patient.  She suggested
190782 - patient history can also be useful for care givers and partners of
190783 - patients.
190784 -
190785 -
190786 -
1908 -

SUBJECTS
Agenda for Work Plan After Switching to Taxotere and Capecitabine

2003 -
2004 - 1815
200501 -  ..
200502 - Agenda for Work Plan After Switching to Taxotere and Capecitabine
200503 -
200504 - Follow up ref SDS 73 SM6M, ref SDS 65 SM6M.
200505 -
200506 - This is the first review following change in treatment from AC to
200507 - Taxotere and capecitabine (Xeloda) initiated on 050329. ref SDS 73
200508 - T58M  The first treatment was on 050415. ref SDS 77 0001
200510 -  ..
200511 - Millie created an agenda on the marking board...
200512 -
200513 -        CA 15-3 dramatic rise...................... ref SDS 0 GJ5M
200514 -        CT test results............................ ref SDS 0 NL4N
200515 -        Breast exam worsening IBC.................. ref SDS 0 025H
200516 -        Surgeon examination report................. ref SDS 0 XQ41
200517 -        Treatment plan............................. ref SDS 0 AW5G
200518 -
200519 -
200520 -
200521 -
200522 -
200523 -
200524 -
2006 -

SUBJECTS
CA 15-3 105 Up from 100 Continues Rise from AC Treatments Not Arrest

2803 -
280401 -  ..
280402 - CA 15-3 Cancer Marker 105 Rises Again from 100
280403 -
280404 - Follow up ref SDS 73 087J, ref SDS 65 087J.
280405 -
280406 - Blood test on 050415 shows CA 15-3 rises to 105 from the prior test on
280407 - 050325 reported during the meeting on 050329. ref SDS 73 087J
280409 -           ..
280410 -          050415.........105 H............. 050422, ref SDS 0 087J
280411 -          050325.........100 H............. 050329, ref SDS 73 087J
280412 -          050318.........101 H............. 050325, ref SDS 71 2N5J
280413 -          050304......... 88 H............. 050311, ref SDS 65 087J
280414 -          050225......... 95 H............. 050308, ref SDS 64 0001
280415 -          050211......... 78 H............. 050214, ref SDS 62 02BB
280416 -          050128......... 67 H............. 050204, ref SDS 60 087J
280417 -          041228......... 56 H............. 041230, ref SDS 55 087J
280418 -          041204......... 43 H............. 041210, ref SDS 52 087J
280419 -          041007......... 39............... 041104, ref SDS 45 087J
280420 -          040923......... 49 H............. 041005, ref SDS 43 087J
280421 -          040908......... 44 H............. 040909, ref SDS 42 087J
280422 -          040825......... 47 H............. 040812, ref SDS 42 087J
280423 -          040811......... 42 H............. 040812, ref SDS 41 087J
280424 -          040728......... 43 H............. 040729, ref SDS 39 2N5J
280425 -          040712......... 47 H............. 040713, ref SDS 38 087J
280426 -          040614......... 55 H............. 040615, ref SDS 37 PX6X
280427 -          040517......... 78 H............. 040601, ref SDS 36 2N5J
280428 -          040311......... 70 H............. 040318, ref SDS 32 SM6M
280429 -          040205......... 60 H............. 040211, ref SDS 31 SM6M
280430 -          031201......... 62 H............. 031205, ref SDS 30 SM6M
280431 -          030912......... 66 H............. 030915, ref SDS 29 SM6M
280432 -          030708......... 68 H............. 030710, ref SDS 28 SM6M
280433 -          030503......... 54 H............. 030508, ref SDS 26 SM6M
280434 -          030403......... 45 H............. 030508, ref SDS 26 SM6M
280435 -          030215......... 46 H............. 030220, ref SDS 25 5E6L
280436 -          030106......... 37 H............. 030109, ref SDS 24 SM6M
280437 -          021202......... 41 H?............ 021204, ref SDS 23 SP5G
280438 -          021111......... 36 H?............ 021113, ref SDS 22 Y65I
280439 -          021023......... 33 H?............ 021023, ref SDS 21 SQ5I
280440 -          020930......... 33 H?..29........ 021002, ref SDS 20 SQ5I
280441 -          020917......... 36 H?............ 020924, ref SDS 19 SQ5I
280442 -          020717......... 59 H?............ 020726, ref SDS 18 YN5K
280443 -          020629......... 75 H ............ 020705, ref SDS 16 UX6I
280444 -          020608........  67 H ............ 020614, ref SDS 15 0001
280445 -          020603........ 108 H ............ 020607, ref SDS 14 X67F
280446 -          020511........ 117 H ............ 020603, ref SDS 13 PJ4J
280447 -          020419......... 81 H ............ 020430, ref SDS 12 7N5H
280448 -          020321......... 85 H ............ 020405, ref SDS 11 6T8K
280449 -
280450 -
280452 -  ..
2805 -
2806 -
2807 - Analysis
2808 -
280801 - CA 15-3 105 Cancer Marker Rise Attributed to AC Treatments
280802 -
280803 - Follow up ref SDS 73 GJ5M, ref SDS 65 GJ5M.
280804 -
280805 - The doctor explained that, since the first treatment with the new
280806 - regimen using Taxotere and capecitabine (Xeloda) was started just
280807 - last week on 050415, ref SDS 77 0001, the rise in CA 15-3 for the test
280808 - on the same date does not indicate results of the new treatment.
280809 - Worsening IBC conditions supports the decision to change treatment on
280810 - 050329. ref SDS 73 T58M
280811 -
280812 -
280813 -
280814 -
280815 -
280816 -
280817 -
280818 -
2809 -

SUBJECTS
CT Test Distant Matastasis None by Size Criteria CT Test Shows No Re

2903 -
290401 -  ..
290402 - CT Scan Test Performed 050325 No Evidence of Distant Metastasis
290403 -
290404 - Follow up ref SDS 73 NL4N, ref SDS 65 NL4N.
290405 -
290406 - The doctor submitted a radiology report on the CT test performed a few
290407 - weeks ago on 050325, which was ordered on 050311 to evaluate new
290408 - cancer sores and rising CA 15-3 cancer marker, ref SDS 65 NL4N, and
290409 - further following up the CT test on 041217, and received during a
290410 - meeting with the doctor on 041230. ref SDS 55 NL4N
290412 -               ..
290413 -              Prior Tests
290415 -               ..
290416 -              050325 reported on 050422.............. ref SDS 0 G75L
290417 -              041217 reported on 041230.............. ref SDS 55 G75L
290418 -              041103 reported on 041104.............. ref SDS 45 NL4N
290419 -              040921 reported on 041005.............. ref SDS 43 NL4N
290420 -              040710 reported on 040811.............. ref SDS 40 DU9I
290421 -              040410 reported on 040416.............. ref SDS 33 HX4K
290422 -              040307 reported on 040318.............. ref SDS 32 LK5L
290423 -              031031 reported on 031205.............. ref SDS 30 IG9K
290424 -              030626 reported on 030710.............. ref SDS 28 AL6N
290425 -              030428 reported on 030508.............. ref SDS 26 LK5L
290427 -  ..
290428 - CT test dated 050325 shows....
290429 -
290430 -       Patient
290437 -        ..
290438 -       68/F Radiology Report               Exam  1 of 1
290439 -       Page 1
290441 -        ..
290442 -       CT SCAN OF NECK, CHEST & Abdomen (digital)
290444 -        ..
290448 -        ..
290449 -       History
290451 -        ..
290452 -       CA Follow up.
290454 -        ..
290455 -       Findings
290457 -        ..
290458 -       Technique:  Routine CT scan of neck, chest and abdomen wit IV
290459 -       and PO contrast.
290461 -        ..
290462 -       Comparison:  041103 and 041217
290464 -        ..
290465 -       Findings
290467 -  ..
290468 - Unclear why two headings in the report for "Findings"
290470 -  ..
290471 - Report Findings continue...
290472 -
290473 -       There is interval increase in right axillary lymphadenopathy,
290474 -       the largest one about 18 x 20 mm.  No significant
290475 -       lymphadenopathy in the left axilla, scalene region, juglar chain
290476 -       or posterior triangle per size criteria.  No new lung nodules.
290477 -       No pericardial effusion.  Small liver cyst unchanged.
290478 -       Calcification of the spleen, consistent with old granulomatous
290479 -       disease.  Remainder of the visualized abdominal organs is
290480 -       unremarkable.  No retroperitoneal or mesenteric lymphadenopathy.
290482 -        ..
290483 -       Impression
290485 -        ..
290486 -       Interval increase of right axillary lymphdenopathy.
290488 -        ..
290489 -       1A
290491 -        ..
290494 -        ..
290495 -       DD:  050331   DT:  050331    SMP
290497 -        ..
290498 -       MTZRAJ  050401 1348
290499 -       Personal letter with report by
290501 -
290502 -
290503 -
290504 -
290505 -
290506 -
290507 -
2906 -

SUBJECTS
100% Increase Swelled Lymph Nodes Right Auxillary 18 x 20 with 360 S

3503 -
350401 -  ..
350402 - 100% Growth May Signal Advancing Cancer Not Stabilized Disease
350403 - Cancer Lymph Nodes 100% Increase Requires Further Review by Analyst
350404 - Distant Metastasis Not Indicated Growth of Right Axillary Adenopathy
350405 - CT Test Requires Review of Analysis Overlooks 100% Growth Lymph Nodes
350406 -
350407 - Follow up ref SDS 55 B58M.
350408 -
350409 - The report received today on right axillary lymphadenopathy, from test
350410 - on 050325, showing the largest about 18 x 20 mm, ref SDS 0 WJ8J, has a
350411 - surface area of about 360 square millimeters; compares with report for
350412 - the test on 041217 showing several right axillary lymph nodes the
350413 - largest about 15 mm x 13 mm, reported on 041230, ref SDS 55 PW3K, has
350414 - a surface area of about 175 square millimeters, which seems to
350415 - represent an approximate 100% growth in these nodes.  Since growth
350416 - increased 50% in prior test, does 100% growth in current test signal
350417 - compound growth of cancer consistent with CA 15-3 rising from 56 on
350418 - 041217 to 100 on 050325, shown in patient history, per above?
350419 - ref SDS 0 KV59
350420 -
350421 -    [...see below, examination found no lumpiness under right arm.
350422 -    ref SDS 0 MW8J
350424 -  ..
350425 - There was not enough time during the meeting for the doctor to comment
350426 - on evident growth pattern. ref SDS 0 B58M  The doctor indicated the
350427 - report overall is favorable.  Activity at the microscopic level
350428 - reported today often can reflect short term activity which the body's
350429 - immune system routinely controls.  Therefore, the report today does
350430 - not yet rise to a level indicating distant metastasis.
350431 -
350432 -    [On 050520 doctor orders new CT test to assess possible new, and
350433 -    accelerated growth reported today. ref SDS 91 B58M
350435 -     ..
350436 -    [On 050610 CT test on 050530 shows growth on righ axillary has
350437 -    stopped; swelled lymph nodes have subsided to less than 1 cm;
350438 -    findings this issue is almost totally resolved. ref SDS 94 B58M
350439 -
350440 -
350441 -
350442 -
350443 -
350444 -
350445 -
350446 -
350447 -
3505 -

SUBJECTS
MUGA Test Report Shows No Evidence Heart Damage from AC Treatments

3903 -
390401 -  ..
390402 - MUGA Test Shows No Evidence Heart Damage from AC Treatments
390403 -
390404 - Follow up ref SDS 73 IL7F, ref SDS 72 0001.
390405 -
390406 - The doctor advised that results of the MUGA test on 050328
390407 - ref SDS 72 0001, show Millie is within a normal range.
390409 -  ..
390410 - This indicates that AC treatments have not begun to impact the heart,
390411 - which was a concern reported during the meeting on 041230. ref SDS 55
390412 - XQ84
390414 -  ..
390415 - AC remains a treatment that might be used for Millie later, following
390416 - the switch from AC to Taxotere and capecitabine on 050325. ref SDS 73
390417 - T58M
390418 -
390419 -
390420 -
390421 -
390422 -
3905 -

SUBJECTS
Pulmonary Emboli Blood Clots No Clinical Symptoms Heavy Chest Shortn

4803 -
480401 -  ..
480402 - Pulmonary Emoboli Symptoms End Treatment with Coumadin Continue
480403 - Coumadin Treatment Continues for Pulmonary Emboli after Symptoms End
480404 -
480405 - Follow up ref SDS 73 RZ4I, ref SDS 65 RZ4I.
480406 -
480407 - Doctor indicated that CT test today finding no evidence of pulmonary
480408 - emboli, ref SDS 0 HX8V, supports prior report on 041230 with same
480409 - findings, ref SDS 55 RZ4I; suggests current treatment with Coumadin is
480410 - effective, and aligns with patient report on 041230 that prior
480411 - symptoms of coughing, spitting up blood, heaviness in the chest, and
480412 - difficulty breathing ended four (4) months ago. ref SDS 55 RZ4I
480414 -  ..
480415 - Considered ending Coumadin treatments, as planned on 050204.
480416 - ref SDS 60 S34O
480418 -  ..
480419 - Doctor advised that treatments for pulmonary emboli continue with
480420 - Coumadin because Kaiser policy recognizes cancer patients diagnosed
480421 - with pulmonary emboli require lifetime treatment for risk management,
480422 - as reported on 041104. ref SDS 44 4Y9G
480423 -
480424 -    [On 051007 patient removed from treatment for blood clots
480425 -    based on ending treatment with chemotherapy drug Avastin a
480426 -    year earlier, and in order to remove concerns about blood
480427 -    clots that make surgery high risk. ref SDS A6 EQ7K
480429 -     ..
480430 -    [On 060722 research 10% pulmonary emboli patients have recurrence,
480431 -    and 45% of those who suffer recurrence die, indicating high risk
480432 -    that supports continuing treatments to avoid recurrence.
480433 -    ref SDS A7 BI5J
480435 -     ..
480436 -    [On 061002 Millie diagnosed with recurrence pulmonary emboli;
480437 -    requires treatment again with Lovenox to relieve blood clots, then
480438 -    continuing treatment with Coumadin to prevent recurrence.
480439 -    ref SDS A0 JK7J
480440 -
480441 -
480442 -
480443 -
480444 -
480445 -
480446 -
480447 -
4805 -

SUBJECTS
Tingling Along Left Arm for Several Days Beginning before 050415 Not
Arm Lumps Lymph Nodes Left Axillary No Swelling Observed from Examin
Arm Swelled Lymph Nodes Under Right Arm Getting Bigger Testing with

5705 -
570601 -  ..
570602 - Tingling Along Left Arm Several Days Finally Subsided
570603 - Lumps Under Arms from Clinical Examination Do Not Effect Diagnosis
570604 -
570605 - Follow up ref SDS 73 MW8J, ref SDS 65 MW8J.
570606 -
570607 - The doctor examined under the left and right arms (axillary).  He
570608 - reported slight lumpiness under the left arm, where surgery was
570609 - performed on 020312, ref SDS 10 0001, and then radiation on 020708.
570610 - ref SDS 17 0001  The doctor reported no findings under the right arm.
570611 - This seems somewhat in conflict with CT test report showing compound
570612 - growth under the right axillary, ref SDS 0 B58M, except at this time
570613 - the size is microscopic and so would not be expected to be recognized
570614 - by clinical examination.
570616 -  ..
570617 - Tingling for a few days along the left forearm cited in the record on
570618 - 050418 was not reported to the doctor today, because the report also
570619 - states that tingling subsided and has not returned. ref SDS 78 71A9
570621 -  ..
570622 - Tingling sensations along the left arm were previously reported on
570623 - 031205, and attributed to removal of lymph nodes. ref SDS 30 WP7L
570624 -
570625 -     [On 050520 tingling sensations have not occurred again.
570626 -     ref SDS 91 NM6J
570627 -
570628 -
570629 -
570630 -
5707 -

SUBJECTS
Neck Lumps No Evidence Left and Right Side Doctor Clinical Examinati
Neck Lumps Lymph Nodes Left Side No Examination Patient Reports Favo

6304 -
630501 -  ..
630502 - Lumps in Neck No Evidence of Swelling Indicating Cancer Receded
630503 -
630504 - Follow up ref SDS 73 8R6M, ref SDS 65 8R6M.
630505 -
630506 - The doctor examined each side of Millie's neck.  He reported finding
630507 - no lumps nor other evidence of new cancer in the neck area, similar to
630508 - the original report on 040211. ref SDS 31 WP7L  Examination today
630509 - aligns with the the CT test performed on 050325, per above,
630510 - ref SDS 0 HX8V, and further reflects prior favorable examinations and
630511 - testing the past six (6) months, illustrated by the report on 041104.
630512 - ref SDS 45 8R6M
630513 -
630514 -
630515 -
630516 -
630517 -
6306 -

SUBJECTS
Wound Punch Biopsy Left Breast Healing Improves after 4 Treatments w
Wound Biopsy Left Breast Healing Continues after 1 Treatment Taxoter

7004 -
700501 -  ..
700502 - Wound Biopsy Continues Healing with Treatment Taxotere Capecitabine
700503 -
700504 - Follow up ref SDS 73 6T5G, ref SDS 65 6T5G.
700505 -
700506 - The doctor examined the left breast and again noted progress healing
700507 - the biopsy wound following the 1st treatment of chemotherapy for IBC
700508 - with Taxotere and capecitabine (Xeloda) beginning on 050415.
700509 - ref SDS 77 0001
700510 -
700511 -
700512 -
700513 -
700514 -
7006 -

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

7604 -
760501 -  ..
760502 - Blistering Sores Cancer Left Breast IBC May be Drying Up
760503 - Redness IBC Spreads Rising CA 15-3 Slow Progress AC Change Treatment
760504 - IBC Redness Inflammation About Same Too Soon New Treatment Have Effect
760505 -
760506 - Follow up ref SDS 73 025H, ref SDS 65 025H.
760507 -
760508 - Visual examination indicates red coloration seems about the same.
760509 - Millie indicated that some of the cancer sores that were blistering
760510 - may be "drying up."  The doctor said that even though CT test
760511 - indicates 100% increase in size of right axillary lymphadenopathy
760512 - under the arm, ref SDS 0 B58M, this is too small for tactile
760513 - awareness.  He indicated that rising CA 15-3 to a high point during
760514 - treatment of relapse, as reported today, ref SDS 0 087J, requires
760515 - caution against allowing hopes for recovery to generate overly
760516 - optimistic observations.
760518 -  ..
760519 - The doctor commented that not seeing a worse condition than the prior
760520 - examination on 050329 is positive; however, it is too soon to assess
760521 - response to the new treatment begun on 050415. ref SDS 77 407N  The
760522 - rise of CA 15-3 cancer marker is attributed to poor response with the
760523 - AC treatments, per above. ref SDS 0 GJ5M
760525 -  ..
760526 - The doctor examined Millie's left knee.  A severe sore on the knee
760527 - from falling a few weeks ago is healing well, which indicates strong
760528 - immune system, further suggesting that chemotherapy treatments are
760529 - being tolerated.
760531 -      ..
760532 -     [On 050502 visual improvement sores and inflammation are receding,
760533 -     ref SDS 86 EO5J
760535 -      ..
760536 -     [On 050510 further improvement inflammation (redness) seems
760537 -     entirely gone, and softness has returned to the breast.
760538 -     ref SDS 87 EO5J
760540 -      ..
760541 -     [On 050520 dramatic improvement after 2 cycles of treatment with
760542 -     Taxotere and capecitabine (Xeloda), ref SDS 91 025H, despite
760543 -     temporarily stopping treatments beginning on 050514 due to severe
760544 -     side effects, ref SDS 89 RU9M; on 050520 treatment dose for
760545 -     capecitabine (Xeloda) reduced to reduce side effects. ref SDS 91
760546 -     NT3I
760547 -
760548 -
760549 -
760550 -
760551 -
760552 -
7606 -

SUBJECTS
Management Standards Healthwise Handbook Communication Collaboration
Hectic Busy Being Busy Not Enough Time to Think Continual Bumbling I
Patient Organize Medical Record Organizational Memory Critical Facto
Surgery Examination on 050324 to Evaluate Readiness for Masectomy Pr

A306 -
A30701 -  ..
A30702 - Hectic Schedule Report on Surgeon Examination Pending Review
A30703 - Examination by Surgeon Recommends Healing IBC Prior to Surgery
A30704 -
A30705 - Follow up ref SDS 73 XQ41, ref SDS 65 XQ41.
A30706 -
A30707 - Since the doctor was running late today, per above, ref SDS 0 9V8M,
A30708 - there was no time for discussion of the surgeon's examination on
A30709 - 050324 to evaluate performing a masectomy as treatment for "pockets of
A30710 - resistance" to chemotherapy, ref SDS 69 GK9M, which was requested by
A30711 - the doctor on 050311, ref SDS 65 XQ41, and deferred during the
A30712 - previous meeting on 050329. ref SDS 73 X76G
A30714 -  ..
A30715 - There was no discussion today on the follow up examination on 050401
A30716 - by Doctor Choi, who recommended against surgery at that time.
A30717 - ref SDS 75 PPSU
A30719 -  ..
A30720 - Criteria for masectomy requested by the doctor on 050311, ref SDS 65
A30721 - PA4N, is pending review of issues the patient discussed with surgery
A30722 - on 050324. ref SDS 69 OV5H
A30723 -
A30724 -     [On 050520 surgeon's report on examinations not discussed; doctor
A30725 -     noted dramatic improvement treating IBC. ref SDS 91 XQ41
A30726 -
A30727 -
A30728 -
A30729 -
A30730 -
A30731 -
A308 -

SUBJECTS
Taxotere Capecitabine (Xeloda) Chemotherapy Effectiveness Treatment

A703 -
A70401 -  ..
A70402 - Treatment Plan Chemotherapy Taxotere Capecitabine Continued
A70403 - Taxotere Capecitabine (Xeloda) Chemotherapy Treatment Plan Continued
A70404 -
A70405 - Follow up ref SDS 73 AW5G, ref SDS 65 J53N.
A70406 -
A70407 - There has not been enough time to assess effectiveness of treatment
A70408 - with the new protocol using Taxotere and capecitabine (Xeloda), begun
A70409 - just a week ago on 050415. ref SDS 77 407N  Nothing in the examination
A70410 - today shows a dramatic worsening of the patient profile.  Latency
A70411 - reporting diagnostics for CA 15-3 seven (7) days ago, ref SDS 0 087J,
A70412 - does not support assessment of the new treatment.  Since, as noted,
A70413 - rising CA 15-3 is attributed at this time to AC, ref SDS 0 C56M, the
A70414 - doctor proposed to continue...
A70416 -         ..
A70417 -    a.  Taxotere and capecitabine (Xeloda) couplet to implement the
A70418 -        work plan on 041230, ref SDS 55 D49F, and modified on 050329 to
A70419 -        schedule four (4) cycles of treatment, ref SDS 73 FP57, based
A70420 -        on the 2nd opinion received from Doctor Benz on 041117.
A70421 -        ref SDS 46 OU6S
A70422 -
A70423 -            [On 050502 visual improvement sores and inflammation are
A70424 -            receding, ref SDS 86 EO5J
A70426 -             ..
A70427 -            [On 050510 further improvement inflammation (redness) seems
A70428 -            entirely gone, and softness has returned to the breast.
A70429 -            ref SDS 87 EO5J
A70431 -             ..
A70432 -            [On 050520 dramatic improvement after 2 cycles of treatment
A70433 -            with Taxotere and capecitabine (Xeloda), ref SDS 91 025H,
A70434 -            despite temporarily stopping treatments beginning on 050514
A70435 -            due to severe side effects, ref SDS 89 RU9M; on 050520
A70436 -            treatment dose for capecitabine (Xeloda) reduced to reduce
A70437 -            side effects. ref SDS 91 NT3I
A70439 -             ..
A70440 -            [On 050617 completed 4th treatment. ref SDS 98
A70441 -            407N
A70443 -             ..
A70444 -            [On 060806 IBC progressing rapidly after 1st cycle Taxotere
A70445 -            capecitabine treating recurrence. ref SDS A9 7Q95
A70446 -
A70447 -
A70448 -
A70449 -
A705 -

SUBJECTS
Diary Health Care Doctor Patient Partnership Medical Chart Patient H
Side Effects Minimal So Far Shown by Diary Patient History
Cancer Case Study Side Effects Taxotere Capecitabine (Xeloda) Chemot

AJ05 -
AJ0601 -         ..
AJ0602 -        Case Study Side Effects Taxotere Capecitabine (Xeloda)
AJ0603 -        Patient History Side Effects Taxotere Capecitabine (Xeloda)
AJ0604 -        Diary Patient History Shows Side Effects Minimal So Far
AJ0605 -        Side Effects Minimal So Far Shown by Diary Patient History
AJ0606 -
AJ0607 -        Follow up ref SDS 73 NT3I, ref SDS 77 PS6X.
AJ0608 -
AJ0609 -        The doctor asked how Millie is tolerating the new treatments?
AJ0611 -         ..
AJ0612 -        Previously, on 050329 the doctor discussed possible side
AJ0613 -        effects of new treatments. ref SDS 73 NT3I  A few weeks later,
AJ0614 -        on 050415 the pharmacist met with Millie in the chemotherapy
AJ0615 -        clinic to start new treatments, and submitted documents
AJ0616 -        explaining side effects for Taxotere and capecitabine (Xeloda),
AJ0617 -        like low energy (tired), blistering and peeling of feet and
AJ0618 -        hands, and further explained actions the patient should take
AJ0619 -        under various scenarios. ref SDS 77 7F8Q
AJ0621 -         ..
AJ0622 -        At that time on 050415, Zan, the pharmacist, advised that the
AJ0623 -        dosage of treatment can be adjusted to reduce severity of side
AJ0624 -        effects; he recommended keeping a diary to track side effects
AJ0625 -        accurately. ref SDS 77 XT5F
AJ0626 -
AJ0627 -            [On 060724 diary side effects for 2nd phase taking Taxotere
AJ0628 -            and capecitabine (Xeloda). ref SDS A8 QX8K
AJ0630 -         ..
AJ0631 -        Millie's diary on side effects shows...
AJ0632 -
AJ0633 -          1.  After 1st treatment on 050415
AJ0634 -              tingling for a few days along
AJ0635 -              left arm, then subsided; high
AJ0636 -              energy followed by difficulty
AJ0637 -              sleeping, diarrhea once; eyes
AJ0638 -              tearing; day or so later
AJ0639 -              anxious queasy, nauseous at
AJ0640 -              work; considered coming home
AJ0641 -              early, but didn't.............. 050418, ref SDS 78 71A9
AJ0643 -               ..
AJ0644 -          2.  Side effects subside........... 050419, ref SDS 79 AQ6G
AJ0646 -               ..
AJ0647 -          3.  Slept well, energetic in
AJ0648 -              morning, good breakfast;
AJ0649 -              took Compazine at work,
AJ0650 -              feels energetic; at end
AJ0651 -              of day 1700 seems very
AJ0652 -              tired, but recovered after
AJ0653 -              dinner......................... 050420, ref SDS 80 AQ6G
AJ0655 -               ..
AJ0656 -          4.  Very tired at end of day,
AJ0657 -              1700, more energy after
AJ0658 -              dinner......................... 050421, ref SDS 82 P064
AJ0660 -               ..
AJ0661 -          5.  Side effects minimal........... 050422, ref SDS 83 AQ6G
AJ0662 -
AJ0663 -              Side effects minimal execpt
AJ0664 -              very tired..................... 050426, ref SDS 85 AQ6G
AJ0666 -               ..
AJ0667 -          6.  Pain in spine from neupogen
AJ0668 -              treatments for immune system
AJ0669 -              WBC to restore damage caused
AJ0670 -              by chemotherapy................ 050502, ref SDS 86 AQ6G
AJ0672 -               ..
AJ0673 -          7.  Blistering right foot from
AJ0674 -              capecitabine (Xeloda) began
AJ0675 -              5 days ago, and got worse;
AJ0676 -              right foot inflammed........... 050502, ref SDS 86 WG90
AJ0678 -               ..
AJ0679 -          8.  Pain in back ended after
AJ0680 -              completing neupogen
AJ0681 -              treatments..................... 050510, ref SDS 87 AQ6G
AJ0683 -               ..
AJ0684 -          9.  Very tired; stomache queasy
AJ0685 -              hands and feet hurt, but no
AJ0686 -              blisters....................... 050510, ref SDS 87 DX54
AJ0688 -               ..
AJ0689 -         10.  Energy higher after more
AJ0690 -              time since Taxotere;
AJ0691 -              slight pain in hands and
AJ0692 -              feet; small blisters
AJ0693 -              beginning right foot went
AJ0694 -              shopping for new shoes......... 050513, ref SDS 88 DX54
AJ0696 -               ..
AJ0697 -         11.  Energy higher; no blisters
AJ0698 -              nor peeling hands; blisters
AJ0699 -              suddenly much worse on right
AJ0700 -              foot; difficult to
AJ0701 -              walk........................... 050514, ref SDS 89 AQ6G
AJ0703 -               ..
AJ0704 -         12.  Millie notified Kaiser of
AJ0705 -              sudden increase in severity
AJ0706 -              of side effects; Kaiser says
AJ0707 -              to stop taking capecitabine
AJ0708 -              (Xeloda)....................... 050514, ref SDS 89 RU9M
AJ0710 -               ..
AJ0711 -         13.  Side effects rise, hard to
AJ0712 -              tolerate; Millie feels
AJ0713 -              terrible, joked about death
AJ0714 -              is better than more cancer
AJ0715 -              treatments; Kaiser says stop
AJ0716 -              treatments with capecitabine
AJ0717 -              (Xeloda) until new guidance
AJ0718 -              from primary care physician;
AJ0719 -              applying balm to treat pain
AJ0720 -              and blisters................... 050516, ref SDS 90 AQ6G
AJ0722 -               ..
AJ0723 -         14.  Dose options reduce
AJ0724 -              capecitabine (Xeloda)
AJ0725 -              chemotherapy to reduce
AJ0726 -              reduce to reduce side
AJ0727 -              effects........................ 050516, ref SDS 90 BD4G
AJ0729 -               ..
AJ0730 -         15.  Dose capecitabine (Xeloda)
AJ0731 -              reduced 25% to reduce side
AJ0732 -              effects and maintain
AJ0733 -              benefits....................... 050520, ref SDS 91 VP3N
AJ0735 -               ..
AJ0736 -         16.  Peeling hands begin new
AJ0737 -              side effects, disappointing
AJ0738 -              to occur after stopping
AJ0739 -              treaments with capecitabine
AJ0740 -              (Xeloda) on 050514............. 050527, ref SDS 93 0001
AJ0742 -               ..
AJ0743 -         17.  Millie hike's 3 miles at end
AJ0744 -              3rd cycle; energy curve rises
AJ0745 -              after significant fall about
AJ0746 -              3 days after treatment Taxotere;
AJ0747 -              over a period of 10 days
AJ0748 -              energy rises, and pain in feet
AJ0749 -              subsides to point where
AJ0750 -              Millie feels like exercising;
AJ0751 -              can exercise because no
AJ0752 -              blisters after reducing
AJ0753 -              dose capecitabine (Xeloda)
AJ0754 -              on 050520...................... 050613, ref SDS 96 0001
AJ0756 -               ..
AJ0757 -         18.  Millie hike's 3 miles in
AJ0758 -              record time over hilly
AJ0759 -              terraine; side effects seem
AJ0760 -              completely gone at this time
AJ0761 -              in treatment cycle; quality
AJ0762 -              of life seems very
AJ0763 -              normal......................... 050617, ref SDS 97 0001
AJ0765 -               ..
AJ0766 -         19.  Difficult week side effects
AJ0767 -              peeling on right foot,
AJ0768 -              blister on right toe; very
AJ0769 -              tired 2nd week 4th cycle....... 050702, ref SDS 99 0001
AJ0771 -               ..
AJ0772 -         20.  Peeling blistering on feet
AJ0773 -              ended; new side effect
AJ0774 -              swelled feet and lower
AJ0775 -              legs, but subsides over
AJ0776 -              night.......................... 050708, ref SDS A0 0001
AJ0778 -               ..
AJ0779 -         21.  Peeling blistering feet
AJ0780 -              and hands still controlled,
AJ0781 -              Millie feeling very tired
AJ0782 -              and queasy at noon............. 050712, ref SDS A1 QB7K
AJ0784 -               ..
AJ0785 -         22.  Blistering and discomfort
AJ0786 -              in feet........................ 050720, ref SDS A2 0001
AJ0788 -               ..
AJ0789 -         23.  Eyes tearing, and swelling
AJ0790 -              in lower legs, feet, and
AJ0791 -              abdomen........................ 050729, ref SDS A3 846O
AJ0793 -               ..
AJ0794 -         24.  Energy sapped, can barely
AJ0795 -              hike 10 feet up stairs to
AJ0796 -              bed; ill feeling accumulating
AJ0797 -              rapidly again and extending
AJ0798 -              for longer period of time
AJ0799 -              into 2nd week, after reducing
AJ0800 -              dose of capecitabine (Xeloda)
AJ0801 -              by 25% on 050520; difficult
AJ0802 -              to engage normal life
AJ0803 -              activity; taking vacation
AJ0804 -              week off work to recuperate
AJ0805 -              starting next treatment
AJ0806 -              cycle.......................... 050729, ref SDS A3 DS5J
AJ0808 -               ..
AJ0809 -         25.  Dose capecitabine (Xeloda)
AJ0810 -              maintained for 2 more
AJ0811 -              treatments to reach stable
AJ0812 -              condition for pausing when
AJ0813 -              patient takes chemotherapy
AJ0814 -              holiday........................ 050729, ref SDS A3 VP4N
AJ0816 -               ..
AJ0817 -         26.  Vivian, the pharmacist,
AJ0818 -              explained strategy to start
AJ0819 -              patients with maximum
AJ0820 -              strength of capecitabine
AJ0821 -              (Xeloda), then experiment
AJ0822 -              to reduce the dose down to
AJ0823 -              a level patients can
AJ0824 -              tolerate....................... 050729, ref SDS A4 407N
AJ0826 -               ..
AJ0827 -         27.  Energy very low 1st week
AJ0828 -              starting 6th cycle of
AJ0829 -              treatments; patient takes
AJ0830 -              week off to recover; begins
AJ0831 -              to recover in 2nd week;
AJ0832 -              continue inflammation feet
AJ0833 -              hands; feet hurt while
AJ0834 -              walking; swelling lower
AJ0835 -              legs, abdomen; tingling
AJ0836 -              toes, fingers and tounge;
AJ0837 -              discoloration and bleeding
AJ0838 -              of fingers and toes;
AJ0839 -              fingernails separating
AJ0840 -              from fingers................... 050809, ref SDS A5 0001
AJ0842 -         ..
AJ0843 -        [On 060724 diary side effects for 2nd phase taking Taxotere and
AJ0844 -        capecitabine (Xeloda). ref SDS A8 QX8K
AJ0845 -
AJ0846 -
AJ0847 -
AJ0848 -
AJ0849 -
AJ09 -

SUBJECTS
Disability Documents Prepared to Work Three (3) Days Per Week

AL03 -
AL0401 -  ..
AL0402 - 3 Days Reduce Work Week for Chemotherapy Side Effects
AL0403 - Disability Documents Prepared to Work Three (3) Days Per Week
AL0404 -
AL0405 - Cumulative effects of dual cancer treatments are taking a toll, per
AL0406 - side effects. ref SDS 0 NT3I
AL0408 -  ..
AL0409 - The doctor prepared the form recommending work limited to 3 days a
AL0410 - week until there is more progress on recovery, and treatments can be
AL0411 - reduced or eliminated, based on patient history of side effects, per
AL0412 - above. ref SDS 0 NT3I
AL0414 -  ..
AL0415 - Millie will submit the form prepared by the doctor today, to the
AL0416 - Kaiser Business Office next week.
AL0417 -
AL0418 -
AL0419 -
AL0420 -
AL0421 -
AL0422 -
AL0423 -
AL0424 -
AL0425 -
AL0426 -
AL0427 -
AL0428 -
AL05 -