CONTACTS 

SUBJECTS
Meeting Doctor Examine Response to Chemotherapy Treatments Taxol Xel

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS A6 0000, ref SDS 99 0000.
040502 -
040503 - Clinical examination of breast condition waived today, because of
040504 - favorable report by the surgeon. ref SDS 0 025H  Spike in CA 15-3 by
040505 - 25%, ref SDS 0 Y44G, requires due diligence for patient to undergo
040506 - two (2) more chemotherapy treatments, and to maintain current dosage,
040507 - ref SDS 0 VP4N, despite escalating side effects. ref SDS 0 VP3N
040508 - Patient plans to begin exercising again at health club as side effects
040509 - decline over the next several months. ref SDS 0 Y86K  Patient reports
040510 - meeting with surgeon yielded planning for due diligence to assess
040511 - criteria for a mastectomy, ref SDS 0 U24K, with considerations to
040512 - perform an operation in mid-September, after the patient returns from
040513 - a short vacation to Chicago. ref SDS 0 U265  Doctor examined problem
040514 - of heavy chest, and difficult breathing.  Initial diagnosis of
040515 - symptoms is loss of fitness as a side effect of chemotherapy, and not
040516 - pulmonary emboli that requires continuing Coumadin treatment.
040517 - ref SDS 0 JP9J  The doctor prescribed continuing Coumadin as a
040518 - precautionary measure. ref SDS 0 RZ4I  Fitness should improve with
040519 - increased exercise after the last cycle of current chemotherapy
040520 - treatments.
040521 -
040522 -
040523 -
040524 -
040525 -
040526 -
040527 -
040529 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Agenda for Work Plan After Switching to Taxotere and Capecitabine
040902 -
040903 - Follow up ref SDS A6 SM6M, ref SDS 99 SM6M.
040904 -
040905 - This is the 4th review after changing treatment to Taxotere and
040906 - capecitabine (Xeloda) initiated on 050329, ref SDS 81 T58M, and
040907 - starting on 050415, ref SDS 85 0001, and occurs before starting the
040908 - 6th cycle.
040910 -  ..
040911 - The meeting today was originally scheduled for 050715, and was delayed
040912 - two (2) weeks due to doctor health issues. ref SDS B1 0001
040914 -  ..
040915 - Millie created an agenda on the marking board...
040916 -
040917 -        CA 15-3 rise needs due diligence........... ref SDS 0 GJ5M
040918 -        Breast exam recovering IBC................. ref SDS 0 025H
040919 -        Surgeon planning mastectomy due diligence.. ref SDS 0 XQ41
040920 -        Treatment plan............................. ref SDS 0 AW5G
040921 -        Side Effects adjust dosage................. ref SDS 0 NT3I
040922 -        Urinary system............................. ref SDS 0 VT3O
040923 -
040924 -
040925 -
040926 -
040927 -
0410 -

SUBJECTS
CA 15-3 46 Rise from 37 Continues Overall Favorable Response to Trea

1203 -
120401 -  ..
120402 - CA 15-3 Cancer Marker 46 Rise from 37
120403 -
120404 - Follow up ref SDS A6 087J, ref SDS 99 087J.
120405 -
120406 - Blood test on 050617 shows CA 15-3 dropped to 45 from 56 for the prior
120407 - test on 050527, reported during the meeting on 050610. ref SDS A6 087J
120408 - Subsequent testing on 050701 CA 15-3 dropped again to 37, reported on
120409 - 050708, ref SDS B0 2N5J, then bounced back to 46 for the most recent
120410 - test on 050708...
120412 -           ..
120413 -          050708......... 46 H............. 050729, ref SDS 0 087J
120414 -          050701......... 37 .............. 050708, ref SDS B0 2N5J
120415 -          050617......... 45 H............. 050729, ref SDS 0 087J
120416 -          050527......... 56 H............. 050610, ref SDS A6 087J
120417 -          050512......... 67 H............. 050520, ref SDS 99 087J
120418 -          050506......... 80 H............. 050520, ref SDS 99 087J
120419 -    050415.........105 H............. 050422, ref SDS 92 087J
120420 -          050325.........100 H............. 050329, ref SDS 81 087J
120421 -          050318.........101 H............. 050325, ref SDS 79 2N5J
120422 -          050304......... 88 H............. 050311, ref SDS 73 087J
120423 -          050225......... 95 H............. 050308, ref SDS 72 0001
120424 -          050211......... 78 H............. 050214, ref SDS 70 02BB
120425 -          050128......... 67 H............. 050204, ref SDS 68 087J
120426 -          041228......... 56 H............. 041230, ref SDS 63 087J
120427 -          041204......... 43 H............. 041210, ref SDS 60 087J
120428 -          041007......... 39............... 041104, ref SDS 51 087J
120429 -          040923......... 49 H............. 041005, ref SDS 47 087J
120430 -          040908......... 44 H............. 040909, ref SDS 46 087J
120431 -          040825......... 47 H............. 040812, ref SDS 46 087J
120432 -          040811......... 42 H............. 040812, ref SDS 45 087J
120433 -          040728......... 43 H............. 040729, ref SDS 43 2N5J
120434 -          040712......... 47 H............. 040713, ref SDS 42 087J
120435 -          040614......... 55 H............. 040615, ref SDS 41 PX6X
120436 -          040517......... 78 H............. 040601, ref SDS 40 2N5J
120437 -          040311......... 70 H............. 040318, ref SDS 35 SM6M
120438 -          040205......... 60 H............. 040211, ref SDS 34 SM6M
120439 -          031201......... 62 H............. 031205, ref SDS 33 SM6M
120440 -          030912......... 66 H............. 030915, ref SDS 32 SM6M
120441 -          030708......... 68 H............. 030710, ref SDS 31 SM6M
120442 -          030503......... 54 H............. 030508, ref SDS 29 SM6M
120443 -          030403......... 45 H............. 030508, ref SDS 29 SM6M
120444 -          030215......... 46 H............. 030220, ref SDS 28 5E6L
120445 -          030106......... 37 H............. 030109, ref SDS 27 SM6M
120446 -          021202......... 41 H?............ 021204, ref SDS 25 SP5G
120447 -          021111......... 36 H?............ 021113, ref SDS 24 Y65I
120448 -          021023......... 33 H?............ 021023, ref SDS 23 SQ5I
120449 -          020930......... 33 H?..29........ 021002, ref SDS 22 SQ5I
120450 -          020917......... 36 H?............ 020924, ref SDS 21 SQ5I
120451 -          020717......... 59 H?............ 020726, ref SDS 20 YN5K
120452 -          020629......... 75 H ............ 020705, ref SDS 18 UX6I
120453 -          020608........  67 H ............ 020614, ref SDS 17 0001
120454 -          020603........ 108 H ............ 020607, ref SDS 16 X67F
120455 -          020511........ 117 H ............ 020603, ref SDS 15 PJ4J
120456 -          020419......... 81 H ............ 020430, ref SDS 14 7N5H
120457 -          020321......... 85 H ............ 020405, ref SDS 13 6T8K
120458 -
120459 -
120461 -  ..
1205 -
1206 -
1207 - Analysis
1208 -
120801 - CA 15-3 46 Cancer Marker Rises 25% from Low of 37 on Prior Test
120802 -
120803 - Follow up ref SDS A6 GJ5M, ref SDS 99 GJ5M.
120804 -
120805 - The doctor was encouraged by 15% downward trend of CA 15-3, since the
120806 - last meeting on 050610, ref SDS A6 GJ5M, and overall since starting
120807 - Taxotere and capecitabine (Xeloda) on 050415, when CA 15-3 was near an
120808 - all time high for Millie of 105. ref SDS 0 8888  Reaching the lowest
120809 - level of 37 for the first time was promising a month ago, when patient
120810 - history briefly tested below the target level of 39 for CA 15-3.
120811 - Subsequent 25% rise bouncing back to 46 a week ago suggests possible
120812 - microscopic cancer activity somewhere that may fit the most recent CT
120813 - testing.
120815 -  ..
120816 - Review on 050610 of the CT scan test on 050530 indicated lymph node
120817 - activity almost totally resolved, ref SDS A6 WA52, and so may align
120818 - with significant rise in CA 15-3 today, indicating regional metastasis
120819 - since the CT test on 050530 may be rising again.
120820 -
120821 -     [On 051007 PET scan test does not discuss finding of CT test on
120822 -     050530 reported today, but impliedly resolves all pending matters;
120823 -     need confirmation of comparison with CT test on 050530.
120824 -     ref SDS C4 5D9J
120826 -  ..
120827 - While only a single report, a rise of 25% in CA 15-3, which suddenly
120828 - and dramatically reverses a long decline to reach an all-time low in
120829 - this diagnostic, could presage another relapse, shown by patient
120830 - history, where, on both prior occasions, when CA 15-3 reached a low
120831 - point, along with signs of recovery, and treatment was suspended, then
120832 - there began a rise in CA 15-3 with increased cancer. ref SDS 0 KV59
120833 - The record on 021206 illustrates the first time this kind of reversal
120834 - occurred. ref SDS 26 5E6L  The second reversal occurred on 041230,
120835 - ref SDS 63 GJ5M, that supported diagnosis of IBC relapse. ref SDS 63
120836 - 025H
120838 -         ..
120839 -        [...see below, doctor performs due diligence maintains
120840 -        chemotherapy treatment for two (2) more cycles to avoid another
120841 -        relapse. ref SDS 0 VP4N
120843 -         ..
120844 -        [On 050819 CA 15-3 dropped to 39 after 6th cycle of Taxotere
120845 -        and capecitabine (Xeloda), and for blood test drawn on 050812,
120846 -        which was reported during chemotherapy treatment. ref SDS B7
120847 -        VK8K
120849 -         ..
120850 -        [On 050913 CA 15-3 rises back to 45 on 2 consecutive tests.
120851 -        ref SDS C0 ST6G
120853 -  ..
120854 - The doctor characterized CA 15-3 test history presented and reviewed
120855 - today, per above, ref SDS 0 GJ5M, as demonstrating, in conjunction
120856 - with clinical examination and other test results, a "window of
120857 - opportunity" that supports recommendations to perform mastectomy
120858 - surgery
120859 -
120860 -
120861 -
120862 -
1209 -

SUBJECTS
CT Test 050530 Shows No Distant Metastasis by Size Criteria CT Test

1503 -
150401 -  ..
150402 - CT Test Shows Progress with New Protocol Taxotere Capecitabine Xeloda
150403 -
150404 - Follow up ref SDS A6 NL4N, ref SDS 99 NL4N.
150405 -
150406 - See discussion on rising CA 15-3, per above. ref SDS 0 ST6G
150407 -
150408 -
150409 -
1505 -

SUBJECTS
Axillary Right Lymph Nodes CT Test 050530 Shows No Distant Matastasi

2403 -
240401 -  ..
240402 - Lymph Nodes Right Axillary Subside to Less that 1 CM Almost Resolved
240403 - Right Axillary Almost Resolved Lymph Nodes Subside to Less that 1 CM
240404 -
240405 - Follow up ref SDS A6 B58M, ref SDS 99 B58M.
240406 -
240407 - See discussion on rising CA 15-3, per above. ref SDS 0 ST6G
240408 -
240409 -
240410 -
240411 -
240412 -
2405 -

SUBJECTS
Pulmonary Emboli Blood Clots Clinical Symptoms Low Energy Heavy Ches

3303 -
330401 -  ..
330402 - Fitness Falls Lack Exercise Explain Symptoms Pulmonary Embolism
330403 - Pulmonary Emboli Symptoms End Treatment with Coumadin Continue
330404 - Coumadin Treatment Continues for Pulmonary Emboli after Symptoms End
330405 -
330406 - Follow up ref SDS 92 RZ4I, ref SDS 81 RZ4I.
330407 -
330408 - Reporting today of clinical symptoms for pulmonary emboli (e.g.,
330409 - fatigue, heavy chest, difficulty breathing climbing stairs), shown
330410 - below, are attributed to loss of physical fitness due to debilitating
330411 - side effects of cancer treatments, ref SDS 0 JP9J, reported for
330412 - example on 050520, ref SDS 99 NT3I, and again today, per below.
330413 - ref SDS 0 DS5J  As a result, the doctor concludes there has been no
330414 - relapse of pulmonary emboli that requires Coumadin.
330415 -
330416 -     [On 070516 patient reports working out training hard in the gym to
330417 -     build fitness. ref SDS C8 TN3M
330419 -      ..
330420 -     [On 070607 Millie suffers recurrence Cellulitis
330421 -     inflammation envelopes left arm trauma complications
330422 -     lymphedema, high fever possibly from working out and
330423 -     training too hard in the gym. ref SDS C9 ZH6I
330425 -  ..
330426 - Doctor commented that even though there is no evidence of pulmonary
330427 - emboli by CT testing on 050530, and reported on 050610, ref SDS A6
330428 - WA8N, he feels Millie should continue on Coumadin indefinitely, as
330429 - planned on 041104, ref SDS 50 4Y9G, and further following up review a
330430 - few months ago during the meeting on 050422 to assess Coumadin
330431 - requirements. ref SDS 92 D64K
330433 -  ..
330434 - Previously, on 041104 reasoning for diagnosis of pulmonary emboli in a
330435 - single CT test report was supported by patient history of chronic
330436 - fatigue, heavy chest, and difficulty breathing. ref SDS 50 N43I
330438 -  ..
330439 - The basis for continuing Coumadin was discussed on 041104 citing
330440 - Kaiser policy of "proactive management" for preventive maintenance to
330441 - treat cancer patients for life, after once having an episode of
330442 - pulmonary emboli, because of high risk of death. ref SDS 50 4Y9G
330444 -  ..
330445 - Per below, the doctor plans to pause treatments with Coumadin for
330446 - pulmonary emboli about 10 days in advance of the date for surgery.
330447 - ref SDS 0 5B5F
330449 -  ..
330450 - Does continuing treatment with Coumadin relate to prior treatment with
330451 - bevacizumab (Avastin), also, reported on 041104? ref SDS 50 Q54I
330452 -
330453 -    [On 050922 Doctor Bailey recommends in 2nd opinion that patient
330454 -    hypercoabulable state work up required to assess risks of
330455 -    mastectomy surgery. ref SDS C1 XD9X
330457 -     ..
330458 -    [On 051007 patient removed from treatment for blood clots
330459 -    based on ending treatment with chemotherapy drug Avastin a
330460 -    year earlier, and in order to remove concerns about blood
330461 -    clots that make surgery high risk. ref SDS C4 EQ7K
330463 -     ..
330464 -    [On 060722 oldest son reports doctors performed tests and found
330465 -    genetic cause of blood clots that will require continuing
330466 -    treatment. ref SDS C5 3D9T
330468 -     ..
330469 -    [On 060722 research indicates pulmonary emboli "wicked problem,"
330470 -    difficult to diagnose, because symptoms are common to benign
330471 -    conditions. ref SDS C5 346F
330473 -     ..
330474 -    [On 060722 research 10% pulmonary emboli patients have recurrence,
330475 -    and 45% of those who suffer recurrence die, indicating high risk
330476 -    that supports continuing treatments to avoid recurrence.
330477 -    ref SDS C5 BI5J
330479 -     ..
330480 -    [On 061002 Millie diagnosed recurrence pulmonary emboli; requires
330481 -    treatment again with Lovenox to relieve blood clots, then
330482 -    continuing treatment with Coumadin to prevent recurrence.
330483 -    ref SDS C6 JK7J
330484 -
330485 -
330486 -
330487 -
330488 -
3305 -

SUBJECTS
Axillary Right Side Lump Under Right Arm Regional Metastasis Lymph N

3703 -
370401 -  ..
370402 - Lumps Under Arms No Clinical Examination No Problems Reported
370403 -
370404 - Follow up ref SDS A6 MW8J, ref SDS 99 MW8J.
370405 -
370406 - There was no examination of left and right axiliary, based on CT test
370407 - reporting previously swelled lymph nodes under right arm are almost
370408 - totally resolved and are now subcentimeter, ref SDS A6 B58M, which
370409 - cannot be examined clinically.
370411 -  ..
370412 - See discussion of rising CA 15-3, per above. ref SDS 0 ST6G
370413 -
370414 -
370415 -
370416 -
370417 -
370418 -
3705 -

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

4304 -
430501 -  ..
430502 - Lumps in Neck No Examination
430503 -
430504 - Follow up ref SDS A6 8R6M, ref SDS 99 8R6M.
430505 -
430506 - There was no examination of lymph nodes in the neck based on CT test
430507 - reporting on 050610 showing no adenopathy. ref SDS A6 PJ8M
430508 -
430509 -
430510 -
430511 -
430512 -
430513 -
4306 -

SUBJECTS
Wound Biopsy Left Breast Fully Healed after 3 Treatment Taxotere Cap

5003 -
500401 -  ..
500402 - Wound Biopsy Fully Healed with Treatment Taxotere Capecitabine
500403 -
500404 - Follow up ref SDS A6 6T5G, ref SDS 99 6T5G.
500405 -
500406 - There was no examination of biopsy wound on the left breast following
500407 - the 5th cycle of chemotherapy treatment for IBC with Taxotere and
500408 - capecitabine (Xeloda) on 050708. ref SDS B0 0001  Examination by the
500409 - surgeon a few days ago on 050725 found the biopsy wound that occurred
500410 - on 040419, ref SDS 37 1572, is now fully healed. ref SDS B2 906K
500411 -
500412 -
500413 -
500414 -
500415 -
5005 -

SUBJECTS
Breast Examination IBC Nearly Healed Recovery Inflammation Greatly R

5503 -
550401 -  ..
550402 - Regression IBC Symptoms Achieve by Taxotere Capecitabine Xeloda
550403 - Blistering Sores Cancer Left Breast IBC Fully Subsided and Healed
550404 - Redness Blisters Sores Thickened IBC Symptoms Healed by Appearance
550405 - IBC Appears Entirely Resolved with No Inflammation and Thickened Skin
550406 -
550407 - Follow up ref SDS A6 025H, ref SDS 99 025H.
550408 -
550409 - There was no examination today of the left breast, however, as noted
550410 - above, the doctor reasonably relied on the surgeon's examination two
550411 - (2) days ago on 050727, ref SDS B2 YY7F, and discussed further below.
550412 - ref SDS 0 BZ4M
550414 -  ..
550415 - This seems to be close to the condition described by Doctor Guardino
550416 - at Stanford for considering surgery, in a 2nd opinion received on
550417 - 041209. ref SDS 58 SN97
550418 -
550419 -     [On 050826 examination by a surgeon in Kaiser's Oakland office
550420 -     found substantially similar conditions, i.e., that the patient has
550421 -     recovered sufficiently from IBC to be ready for surgery.
550422 -     ref SDS B8 AY5N
550423 -
550424 -
550425 -
550426 -
550427 -
5505 -

SUBJECTS
Surgery Schedule 050918 10 Days after Vacation in mid-September Obje

7803 -
780401 -  ..
780402 - Schedule Surgery 10 Days after Vacation in mid-September
780403 - Window of Opportunity for Mastectomy Left Breast Local Control
780404 - Surgery Reduce Chances IBC Relapse Schedule 10 Days After Vacation
780405 - Due Diligence on Criteria Masectomy Performed by Surgery Department
780406 -
780407 - Follow up ref SDS A6 XQ41, ref SDS 99 XQ41.
780408 -
780409 - Background on considerations for surgery in this case are summarized
780410 - on 041210, ref SDS 60 ZV5J, and case study to extend quality of life
780411 - by preventing disease from cascading out of control is reported on
780412 - 041230. ref SDS 63 XV7M
780414 -  ..
780415 - Criteria for performing a successful mastectomy in this case was
780416 - discussed with the surgeon on 050324, ref SDS 77 OV5H, upon request by
780417 - the doctor during a meeting with the patient on 050311. ref SDS 73
780418 - PB4N  Analysis of criteria for mastectomy surgery occurred during the
780419 - meeting with the surgeon a few days ago on 050727, ref SDS B2 OV5H,
780421 -  ..
780422 - Criteria for the patient to approve mastectomy to extend quality of
780423 - life was reviewed by the surgeon, also, on 050727. ref SDS B2 VL4O
780425 -  ..
780426 - The doctor asked today about results of meeting with the surgeon 2
780427 - days ago on 050727, which was requested by the doctor during a call to
780428 - the surgeon on 050610. ref SDS A6 2L4M  Collaboration and Team Care
780429 - were reviewed previously on 050329, ref SDS 81 XQ41, following up
780430 - prior planning to discuss examination findings by surgery on 050311.
780431 - ref SDS 73 PB6J
780433 -  ..
780434 - Millie explained understandings reported on 050727 that the surgeon
780435 - found substantial healing and recovery from IBC, ref SDS B2 YY7F,
780436 - continuing improvement observed by the doctor on 050610, ref SDS A6
780437 - 025H, and based on observing normal coloration of skin compared with
780438 - right breast, and further improving skin texture with reduced
780439 - thickening, and after five (5) treatments with Taxotere and
780440 - capecitabine (Xeloda), beginning on 050415, ref SDS 85 407N, and
780441 - further after reducing the dosage of capecitabine by 25% on 050520 to
780442 - reduce side effects. ref SDS 99 V43H
780444 -  ..
780445 - The doctor asked when surgery is scheduled for a mastectomy, called
780446 - out in the treatment plan developed on 041230? ref SDS 63 6O5O
780448 -  ..
780449 - Millie related plans to perform Time Out due diligence on mastectomy
780450 - surgery discussed with the surgeon on 050727.  Complexity of patient
780451 - history and limited experience performing surgery involving IBC in
780452 - this case requires careful review of scope, benefits, and risks to
780453 - avoid complications that increase harm rather than achieve goals for
780454 - local control.  Kaiser's Time Out due diligence practices provide for
780455 - 2nd opinions, including support by the Tumor Board to assist the
780456 - doctor/patient partnership with complex issues. ref SDS B2 O85O
780457 -
780458 -     [...see below, doctor discusses due diligence ordering additional
780459 -     treatments to avoid another relapse. ref SDS 0 VP4N
780461 -      ..
780462 -     [...see below doctor on vacation during August provides time for
780463 -     due diligence. ref SDS 0 U27O
780465 -      ..
780466 -     [On 050913 primary care physician objected that performing 2nd
780467 -     opinions on the Time out checklist for due diligence evaluating
780468 -     mastectomy surgery delayed surgery. ref SDS C0 5T4J
780470 -  ..
780471 - Doctor Shim in Kaiser's Oakland Surgery Department called Millie this
780472 - morning on referral from the surgeon in Kaiser's Walnut Creek Surgery
780473 - Department, and discussed scheduling a mastectomy about 10 days after
780474 - Millie returns from vacation on 050908, which would mean surgery on or
780475 - about 050918. ref SDS B3 VY6M
780476 -
780477 -     [On 050805 Doctor Shim's assistant requests Millie meet with the
780478 -     surgeon in Oakland; scheduled meeting for 050826 0930. ref SDS B5
780479 -     V15F
780481 -  ..
780482 - The doctor today recommended that Millie consent to surgery for Kaiser
780483 - to perform a mastectomy on the left breast, as soon as possible.  He
780484 - cited favorable factors, including CA 15-3 testing, discussed above,
780485 - ref SDS 0 GJ5M, together with CT testing showing no distant
780486 - metastasis, and lymph adenopathy almost totally resolved, reported on
780487 - 050610, ref SDS A6 PJ8M, and further that clinical examination, all
780488 - taken together, shows that IBC has subsided sufficiently for a
780489 - successful mastectomy.  The doctor feels that Millie's patient profile
780490 - presents a "window of opportunity" at this time for a surgical
780491 - solution to improve local control of disease in the left breast that
780492 - can help prevent relapse in the breast, and occurrance of distant
780493 - metastasis.
780495 -      ..
780496 -     [On 050826 examination by a surgeon in Kaiser's Oakland office
780497 -     found substantially similar conditions, i.e., that the patient has
780498 -     recovered sufficiently from IBC to be ready for surgery.
780499 -     ref SDS B8 AY5N
780501 -      ..
780502 -     [On 050909 Doctor Bailey examined the patient and recommends
780503 -     continuing chemotherapy for local control, and advises that
780504 -     mastectomy surgery could worsen local control. ref SDS B9 1G4X
780506 -      ..
780507 -     [On 050913 examination by primary care physician found patient
780508 -     maintained condition ready for mastectomy surgery. ref SDS C0 NT7O
780510 -      ..
780511 -     [On 050913 Doctor Bailey's 2nd opinion that mastectomy surgery
780512 -     could worsen local control was reported to Kaiser. ref SDS B9 MA5F
780514 -      ..
780515 -     [On 051007 primary care physician presents purpose of standard
780516 -     mastectomy is for palliation in the event of future relapse.
780517 -     ref SDS C4 6A4N
780519 -  ..
780520 - Millie indicated she would like mastectomy surgery if this is safe
780521 - and can end chemotherapy treatments by reducing chances of another
780522 - relapse.
780524 -  ..
780525 - The doctor discussed during the meeting today requirements for pausing
780526 - treatments with Coumadin for pulmonary emboli about 10 days in advance
780527 - of the date for surgery.  This is unrelated to general requirements
780528 - for continuing Coumadin treatment, discussed above. ref SDS 0 WE9H
780529 -
780530 -     [On 051006 Gloria in the Coagulation Clinic at the Kaiser hospital
780531 -     in Martinez advised that Coumadin is paused for a maximum of seven
780532 -     (7) days when patients have severe surgery, like a heart
780533 -     transplant or brain bypass. ref SDS C3 TP8O
780535 -      ..
780536 -     [On 050922 Doctor Bailey 2nd opinion cites risk of surgery for
780537 -     pulmonary emboli patients could be death while Coumadin treatment
780538 -     is paused. ref SDS C1 6Z5Q
780540 -      ..
780541 -     [On 051006 nurse in Coagulation Clinic at the Kaiser Martinez
780542 -     hospital recommends reducing period to five (5) days for pausing
780543 -     Coumadin for minor, outpatient biopsy surgery, and in order to
780544 -     reduce the risk of adverse impact on pulmonary emoboli.
780545 -     ref SDS C3 YV7Q
780547 -      ..
780548 -     [On 051007 primary care physician ends Coumadin treatment for
780549 -     pulmonary emboli in Millie's case, because pulmonary emboli is a
780550 -     side effect of Avastin chemotherapy, and Millie ended treatment
780551 -     with Avastin about a year ago. ref SDS C4 EQ7K
780553 -  ..
780554 - There was further discussion of substituting another treatment during
780555 - the 10 day hiatus taking Coumadin that would be required for recovery
780556 - from surgery.
780557 -
780558 -     [On 050922 Doctor Bailey cites risks to patient from pausing
780559 -     Coumadin treatments for pulmonary emboli, in the event of surgery.
780560 -     ref SDS C1 CL3O; recommends workup on hypercoagulant state to
780561 -     evaluate patient history in relation to family medical history.
780562 -     ref SDS C1 XD9X
780564 -      ..
780565 -     [On 050928 plastic surgeon at Kaiser in Walnut Creek cites risk of
780566 -     bleeding that can be avoided by using a standard closure, rather
780567 -     than immediate reconstructive surgery. ref SDS C2 J34O
780568 -
780569 -
780570 -
780571 -
780572 -
780573 -
780574 -
7806 -

SUBJECTS
Vacation Patient Trip to Chicago August 28 - September 8 Vacation We

8103 -
810401 -  ..
810402 - Vacation Patient Trip to Chicago August 28 - September 8
810403 -
810404 - The doctor was pleased to learn that Millie will take a 10 day
810405 - vacation at the end of August, returning on 050908.
810407 -  ..
810408 - Millie is also taking the entire 1st week beginning the next two (2)
810409 - cycles of chemotherapy for vacation time to recover from side effects,
810410 - discussed further below. ref SDS 0 DS5J
810411 -
810412 -
810413 -
810414 -
810415 -
810416 -
810417 -
8105 -

SUBJECTS
Work Plan 2 More Cycles Taxotere Capecitabine (Xeloda) Chemotherapy

9103 -
910401 -  ..
910402 - Treatment Plan 2 More Cycles then Pause Recover from Side Effects
910403 - Chemotherapy Holiday from Mid-August to After Surgery in September
910404 - Holiday from Treatment Planned Recover from Side Effects After Surgery
910405 -
910406 - Follow up ref SDS A6 AW5G, ref SDS 99 AW5G.
910407 -
910408 - After five (5) cycles of treatment yielding substantial recovery from
910409 - IBC symptoms, per above, ref SDS 0 025H, doctor proposes completing
910410 - two (2) more cycles, number six (6) starting today, and number seven
910411 - (7) in three weeks on 050819 and continuing with the same protocol....
910413 -         ..
910414 -    a.  Taxotere and capecitabine (Xeloda) couplet to implement the
910415 -        work plan on 041230, ref SDS 63 D49F, and starting on 050329
910416 -        with four (4) cycles of treatment, ref SDS 81 FP57, with dosage
910417 -        of capecitabine (Xeloda) reduced by 25% on 050520 to reduce
910418 -        side effects. ref SDS 99 VP3N
910420 -         ..
910421 -        Patient returns from vacation on 050908, per above, ref SDS 0
910422 -        O64I, and may consider surgery 10 days later. ref SDS 0 U265
910424 -         ..
910425 -        The doctor decided to maintain current dose of treatment with
910426 -        capecitabine (Xeloda) for two (2) more cycles, rather than
910427 -        further reduce dosage to help tolerate rising side effects,
910428 -        reported today, per below. ref SDS 0 NT3I  The rise of CA 15-3
910429 -        today supports aggressive treatment. ref SDS 0 GJ5M  The doctor
910430 -        commented that Millie has two (2) more "rough" weeks, with the
910431 -        first beginning today, and then another in three (3) weeks time
910432 -        on 040819.  Follow on CA 15-3 tests over the next few weeks
910433 -        will provide more "dots" to make this assessment, as the doctor
910434 -        discussed previously on 040812. ref SDS 45 CT9J  These
910435 -        additional two (2) cycles of treatment provide due diligence
910436 -        that may help avoid relapse, as the patient discussed under
910437 -        similar circumstances on 030606, ref SDS 30 NE7L, and again two
910438 -        (2) days ago with the surgeon on 050727, noted above.
910439 -        ref SDS 0 BZ6L  Background on 041230 lists analysis of
910440 -        treatment to avoid cancer spinning out of control. ref SDS 63
910441 -        P19O
910442 -
910443 -            [On 050729 Vivian, the pharmacist, explained strategy to
910444 -            start patients with maximum strength of capecitabine
910445 -            (Xeloda), then experiment to reduce the dose down to a
910446 -            level patients can tolerate. ref SDS B4 407N
910448 -             ..
910449 -            [On 050819 7th and final cycle of current treatment plan
910450 -            begins. ref SDS B7 0001
910452 -             ..
910453 -            [On 050819 CA 15-3 dropped to 39 after 6th cycle of
910454 -            Taxotere and capecitabine (Xeloda), and for blood test
910455 -            drawn on 050812, which was reported during chemotherapy
910456 -            treatment. ref SDS B7 VK8K
910458 -             ..
910459 -            [On 050819 Zan, the pharmacist, reports that Millies side
910460 -            effects are on low end of scale suffered by most patients
910461 -            treated with Taxotere and capecitabine. ref SDS B7 NY4F
910463 -         ..
910464 -        The doctor seemed to indicate that chemotherapy treatments will
910465 -        be paused after the 7th treatment on 050819, and until after
910466 -        surgery on or about 050918.  At that time a new regimen will be
910467 -        developed, assuming the patient approves surgery, as discussed
910468 -        on 050727. ref SDS B2 VL4O
910470 -         ..
910471 -        This work plan balances patient's need for a break to recover
910472 -        from rising debilitations of chemotherapy side effects,
910473 -        discussed below, ref SDS 0 DS5J, and previously described as
910474 -        a...
910475 -
910476 -                        chemotherapy holiday
910477 -
910478 -        ...on 041130, when the patient was off treatment for about
910479 -        three (3) months. ref SDS 53 Y660  The aim is to prevent cancer
910480 -        from cascading out of control, as seemed to be occurring
910481 -        041230, after a prolonged pause in treatment due to a report of
910482 -        pulmonary emboli, ref SDS 63 025H, and then compounding on
910483 -        050311 under treatment with Adriamicyn Cytoxan (AC).
910484 -        ref SDS 73 UA8N
910485 -
910486 -
910487 -
910488 -
910489 -
910490 -
910491 -
910492 -
9105 -

SUBJECTS
Side Effects Increase Diary Patient History Shows Tolerance for Chem

A703 -
A70401 -         ..
A70402 -    b.  Side Effects Rise Capecitabine (Xeloda) Patient to Exercise
A70403 -        Heavy Chest Difficult Breathing Side Effect Lack of Exercise
A70404 -        Exercise Maintain Fitness Strengthen Immune System Challenging
A70405 -
A70406 -        Follow up ref SDS A6 NT3I, ref SDS 99 NT3I.
A70407 -
A70408 -        The doctor explained side effects of Taxotere and capecitabine
A70409 -        (Xeloda) on 050329, ref SDS 81 NT3I; on 050415 the pharmacist
A70410 -        submitted documents detailing side effects. ref SDS 85 7F8Q  On
A70411 -        050516 considerations for reducing the potency of capecitabine
A70412 -        (Xeloda) were developed. ref SDS 97 BD4G
A70414 -         ..
A70415 -        The doctor asked about patient history from Millie's diary
A70416 -        following Kaiser's instructions on 050415, ref SDS 85 XT5F,
A70417 -        which the doctor used on 050520 to reduce the dosage of
A70418 -        capecitabine (Xeloda) by 25% in order to reduce side effects
A70419 -        with a tolerable range. ref SDS 99 VP3N
A70421 -         ..
A70422 -        Milled summarized side effects listed in the diary on 050422,
A70423 -        ref SDS 92 OC49, since the last meeting on 050610...
A70424 -
A70425 -               [On 050809 diary shows new side effects following 6th
A70426 -               cycle of Taxotere and capecitiabine. ref SDS B6 0001
A70427 -
A70428 -        a.  Blistering and peeling of feet and hands has returned,
A70429 -            ref SDS 92 DZ3L, though not as severe as reported on 050520
A70430 -            that led to reducing the dosage of capecitabine (Xeloda) by
A70431 -            25%. ref SDS 99 6W3I
A70433 -             ..
A70434 -        b.  Eyes tearing.
A70436 -             ..
A70437 -        c.  Swelled lower legs and ankles, and swelled abdomen,
A70438 -            bloated feeling.  Disappears overnight.
A70440 -             ..
A70441 -            The doctor cited personal experience with problem of
A70442 -            swelled lower legs and ankles; and recommended getting
A70443 -            support socks that extend toward the knee, and using a foot
A70444 -            rest to elevate the feet while sitting at the desk at work.
A70446 -             ..
A70447 -            Previously, on 050708 the pharmacist, Vivian, and the
A70448 -            nurse, Toni, in the Chemotherapy clinic commented during
A70449 -            treatment to start the 5th cycle that tearing eyes, and
A70450 -            swelling problems are cumulative side effects of Taxotere
A70451 -            that causes the body to retain water. ref SDS B0 H45G
A70452 -            Plans to begin exercising at a health club were discussed
A70453 -            at that time for recovering from side effects, but based on
A70454 -            ending chemotherapy treatments, ref SDS B0 1V4I, which have
A70455 -            now been continued through 050819, as of today. ref SDS 0
A70456 -            AW5G
A70458 -             ..
A70459 -        d.  Energy falls more after each treatment cycle.
A70460 -
A70461 -            Millie reported that energy and ability to focus, including
A70462 -            general interest in life are increasingly impaired during
A70463 -            the 1st week beginning a new cycle, similar to the report
A70464 -            on 050516. ref SDS 97 AQ6G  Lower strength of capecitabine
A70465 -            (Xeloda) by 25% on 050520, ref SDS 99 VP4N, was helpful for
A70466 -            tolerating treatments, shown by taking several 3 mile hikes
A70467 -            reported on 050613. ref SDS A8 0001  However, side effects
A70468 -            have gradually increased, and now extend into the 2nd week,
A70469 -            shown by patient history in the diary on 050422.
A70470 -            ref SDS 92 DZ3L  This impairs keeping a balance of exercise
A70471 -            and engagement in family and work, with attendant concern
A70472 -            about vitality of the immune system, discussed previously
A70473 -            on 030606. ref SDS 30 ED8H  Right now, hiking 10 feet up
A70474 -            stairs to bed is a big challenge, and she has scheduled to
A70475 -            take vacation time off work for the 1st week starting the
A70476 -            next two (2) treatment cycles.
A70477 -
A70478 -                [On 070218 energy increases, shortness of breath,
A70479 -                fatigue, weakness subside 10 weeks after ending
A70480 -                treatment for 3rd relapse of IBC with Taxotere and
A70481 -                cacecitabine; Millie is exercising in the gym again,
A70482 -                playing tennis 2 days her pulse reached 144. ref SDS C7
A70483 -                N05H
A70485 -             ..
A70486 -            The doctor appreciated Millie's challenge to undergo more
A70487 -            treatments without further reducing the dosage for better
A70488 -            tolerance, based on analysis during the meeting on 030606,
A70489 -            ref SDS 30 ED8H, and discussed above. ref SDS 0 VP4N
A70490 -
A70491 -                [On 050729 Vivian, the pharmacist, explained strategy
A70492 -                to start patients with maximum strength of capecitabine
A70493 -                (Xeloda), then experiment to reduce the dose down to a
A70494 -                level patients can tolerate. ref SDS B4 407N
A70496 -                 ..
A70497 -                [On 050819 Zan, the pharmacist, reports that Millie's
A70498 -                side effects are on low end of scale suffered by most
A70499 -                patients treated with Taxotere and capecitabine.
A70500 -                ref SDS B7 NY4F
A70502 -             ..
A70503 -            The doctor related personal trials forcing himself to
A70504 -            exercise, even when not feeling well, because exercise
A70505 -            helps maintain the immune system, and engagement in family
A70506 -            and work provide a forward, positive mental frame.  The
A70507 -            doctor feels this has been a positive factor in Millie's
A70508 -            ability to fight disease the past few years, see the report
A70509 -            on 030606, ref SDS 30 JP7G and ref SDS 30 NE57, and
A70510 -            mentioned again on 031205 that Millie's good habits of
A70511 -            vigorous exercise contribute to tolerating aggressive
A70512 -            treatment. ref SDS 33 GW8F  More recently, last month on
A70513 -            050609, exercise was cited in published literature for
A70514 -            helping to maintain the immune system. ref SDS A5 F88M
A70516 -             ..
A70517 -            Millie explained plans to renew membership in a health club
A70518 -            and begin working out again.  She had expected treatments
A70519 -            with Taxotere and capecitabine (Xeloda) would be over after
A70520 -            the 4th cycle, as planned on 050329, ref SDS 81 FP57, so
A70521 -            that she can return to routine exercise; this was raised in
A70522 -            a note to the doctor on 050617 that asked about delays in
A70523 -            the schedule to meet with the surgeon. ref SDS A9 EF6N
A70525 -             ..
A70526 -            The doctor emphasized this is the time that good habits
A70527 -            over a lifetime of exercising payoff by permitting a few
A70528 -            more treatments to continue good progress recovering from
A70529 -            IBC, reported this morning, ref SDS 0 BZ4M, and discussed
A70530 -            previously on 030606 when Millie asked about age as a
A70531 -            factor in prescribing treatment. ref SDS 30 XR7I
A70533 -             ..
A70534 -            Millie said that next week, she will go ahead and renew her
A70535 -            membership at the healthclub toward getting back into the
A70536 -            old routines of regular exercise, and so is really looking
A70537 -            forward to pausing treatments after 050819, as shown in the
A70538 -            doctor's treatment plan today. ref SDS 0 6W6H
A70539 -
A70540 -                 [On 050809 membership renewed. ref SDS B6 QB7K
A70542 -                  ..
A70543 -                 [On 070218 energy increases, shortness of breath,
A70544 -                 fatigue, weakness subside 10 weeks after ending
A70545 -                 treatment for 3rd relapse of IBC with Taxotere and
A70546 -                 cacecitabine; Millie is exercising in the gym again,
A70547 -                 playing tennis 2 days her pulse reached 144.
A70548 -                 ref SDS C7 N05H
A70550 -             ..
A70551 -        e.  Heavy chest, difficult breathing
A70552 -
A70553 -            Doctor made clinical examination of lungs with stethoscope,
A70554 -            and said the lungs sound healthy.
A70556 -             ..
A70557 -            Doctor ordered a chest xray for further diagnostics.
A70559 -             ..
A70560 -            On 041104 symptoms heavy chest, cough, fatigue, difficult
A70561 -            breathing attributed to pulmonary emboli from CT test on
A70562 -            041103, ref SDS 51 N43I, and this analysis supported
A70563 -            treatment with blood thinner, Coumadin, discussed above.
A70564 -            ref SDS 0 RZ4I  At this time, CT testing has not shown
A70565 -            pulmonary emboli, indicating something else may be causing
A70566 -            current symptoms.
A70568 -             ..
A70569 -            Doctor explained that physical fitness declines from not
A70570 -            exercising due to cumulative effects of chemotherapy,
A70571 -            reported above, ref SDS 0 DS5J, He feels that Mil's plans
A70572 -            to get back in the gym and start working out again during
A70573 -            the pause in chemotherapy treatments will help restore
A70574 -            physical conditioning to relieve symptoms of chronic
A70575 -            fatigue, shortness of breath, and heavy chest during
A70576 -            routine activity like walking up stairs, doing the laundry,
A70577 -            walking from the parking lot to the BART station, etc.
A70578 -            ref SDS 0 Y86K
A70580 -                  ..
A70581 -                 [On 070218 energy increases, shortness of breath,
A70582 -                 fatigue, weakness subside 10 weeks after ending
A70583 -                 treatment for 3rd relapse of IBC with Taxotere and
A70584 -                 cacecitabine; Millie is exercising in the gym again,
A70585 -                 playing tennis 2 days her pulse reached 144.
A70586 -                 ref SDS C7 N05H
A70587 -
A70588 -
A70589 -
A70590 -
A706 -

SUBJECTS
Trial Chemotherapy New Drug Treatment UCSF Millie Asks Primary Care

AA03 -
AA0401 -         ..
AA0402 -    c.  Trial Chemotherapy New Drug Treatment UCSF
AA0403 -        New Drug Trial Chemotherapy Treatment UCSF
AA0404 -
AA0405 -        Follow up ref SDS A6 L27G, ref SDS 99 L27G.
AA0406 -
AA0407 -        There was no discussion of contacting UCSF about the
AA0408 -        announcement of a new trial, cited by Millie on 050520,
AA0409 -        ref SDS 99 L27G, by following up on the offer from Doctor Benz
AA0410 -        to collaborate on Millie's treatment, cited in a 2nd opinion
AA0411 -        received on 041117. ref SDS 52 OV3T
AA0412 -
AA0413 -
AA0414 -
AA0415 -
AA0416 -
AA0417 -
AA05 -

SUBJECTS
Side Effects Incontenance Urinary Bladder Problem Chemotherapy Bened
Diabetes Symptom Incontenance Blood Sugar Test Ordered Meeting Docto

AH04 -
AH0501 -  ..
AH0502 - Side Effect Chemotherapy Benedryl Steriods Incontinence Problem
AH0503 - Bladder Incontinence Problem from Steriods in Benedryl Treatments
AH0504 - Incontinence Side Effect Steriods in Beyedryl with Chemo Treatment
AH0505 - Urinary Problem Incontinence Steriods in Beyedryl with Chemo Treatment
AH0506 -
AH0507 - Follow up ref SDS A6 VT3O, ref SDS 99 VT3O.
AH0508 -
AH0509 - Millie reported a new problem of near incontinence for a few days
AH0510 - after treatments with Taxotere.  She barely makes it to the bathroom
AH0511 - in time to avoid a problem.  This was experienced previously and
AH0512 - treated during the meeting on 021206. ref SDS 26 KV6F
AH0514 -  ..
AH0515 - The doctor explained that this problem is a side effect of benedryl
AH0516 - which is a steriod administered with Taxotere to boost energy.  Millie
AH0517 - takes Benedryl the day before, the day of, and the day after getting
AH0518 - Taxotere chemotherapy treatments.  When treatments are paused after
AH0519 - 050819, per the schedule today, ref SDS 0 6W6H, buildup of the steriod
AH0520 - should end, and Millie will be back to normal.
AH0522 -  ..
AH0523 - The doctor prescribed an antibiotic to treat infection.
AH0524 -
AH0525 -     [On 050913 problem treated successfully. ref SDS C0 VT3O
AH0527 -  ..
AH0528 - The doctor said that this problem is also a symptom of diabetes.  He
AH0529 - ordered a test to evaluate blood sugar, following prior testing for
AH0530 - diabetes with similiar symptoms on 021206. ref SDS 26 KV6F
AH0531 -
AH0532 -
AH0534 -  ..
AH06 -
AH07 -
AH08 - 1517
AH09 -
AH0901 - Visited the pharmacy on the 2nd floor and picked up the antibiotics
AH0902 - medicine prescribed by the doctor.
AH0903 -
AH0904 -     [On 050913 test for diabetes was negative. ref SDS C0 VT3O
AH0905 -
AH0906 -
AH0907 -
AH0908 -
AH10 -

SUBJECTS
Dental Cleaning Scheduled for 050616 to Evaluate Infection and Treat
Dental Cleaning Important for Chemotherapy Patients to Detect Infect

AJ04 -
AJ0501 -  ..
AJ0502 - Dental Cleaning Important for Chemotherapy Patients
AJ0503 -
AJ0504 - Follow up ref SDS A6 YU8N, ref SDS 99 YU8N.
AJ0505 -
AJ0506 - Millie reported her dental examination approved by the doctor on
AJ0507 - 050520, ref SDS 99 YU8N, was performed on 050616 and found no evidence
AJ0508 - of infection.
AJ0509 -
AJ0510 -
AJ0511 -
AJ0512 -
AJ06 -

SUBJECTS
Vacation Doctor During August Schedule Next Visit in 6 Weeks Provide
Vacation Primary Care Physician During August Schedule Next Visit in

AL04 -
AL0501 -  ..
AL0502 - Vacation Doctor During August Schedule Next Visit in 6 Weeks
AL0503 -
AL0504 - The doctor advised he will be out of the office during August on
AL0505 - vacation.  He scheduled the next visit with Millie in six (6) weeks
AL0506 - after she returns from a vacation in September, per the schedule
AL0507 - above. ref SDS 0 O64I
AL0509 -  ..
AL0510 - This provides time for due diligence planned to evaluate mastectomy
AL0511 - treatment, discussed with the surgeon on 050727, ref SDS B2 O85O, and
AL0512 - discussed above. ref SDS 0 BZ56
AL0513 -
AL0514 -
AL0515 -
AL0516 -
AL0517 -
AL0518 -
AL0519 -
AL0520 -
AL0521 -
AL06 -