CONTACTS 

SUBJECTS
Cure Goal Treatment No Evidence Distant Metastasis Patient Stage III
Curative Treatment Model Stage III Not Stage IV Metastatic Cancer Re
Criteria Approve Surgery for Extending Quality of Life Patient Decis

2505 -
2505 -    ..
2506 - Summary/Objective
2507 -
250701 - Follow up ref SDS 36 F49H, ref SDS 35 F49H.
250702 -
250703 -
250704 -
250705 -
250707 -  ..
2508 -
2509 -
2510 - Progress
2511 -
251101 - Retest Biopsy for Changing Status Expand Treatment Options
251102 - Treatment Options May Be Expanded Retest for Status Change
251103 - Test Status Change Possible Huge Improvement Treatment Options
251104 - Stage III Regional Cancer Presents Chance for Curative Treatment
251105 -
251106 - Submitted ref DIT 1 0001 responding to Veronica's letter, ref DRP 3
251107 - 0001, received last night that discussed retesting a biopsy to
251108 - evaluate Millie's "status" for ER PR HER2/neu positive, which would
251109 - increase treatment options, ref SDS 36 F49H, and asking if recent
251110 - improvement in patient recovering from IBC would provide a stronger
251111 - test of current status? ref SDS 35 TX7G
251113 -  ..
251114 - The letter to Veronica says...
251115 -
251116 -    1.  There were three (3) biopsies in 2004:  the first on 040303
251117 -        tested swelled lymph nodes, ref DIT 1 0001, on the left side of
251118 -        the neck, ref SDS 4 Y171, which describes "fine needle
251119 -        aspirations," so I guess this one is excluded per your letter
251120 -        received yesterday on 050908. ref SDS 36 VN5V
251122 -         ..
251123 -    2.  2nd event described a "punch biopsy" on the left breast,
251124 -        ref DIT 1 M36J, performed on 040419. ref SDS 7 1572 and this
251125 -        test diagnosed IBC on 040517. ref SDS 9 7D6F
251127 -         ..
251128 -    3.  3rd biopsy was taken on 041130 when Mil relapsed and the wound
251129 -        from the punch biopsy on 040419 worsened. ref DIT 1 M37K  Our
251130 -        record describes Doctor Johnson taking a "skin sample" from the
251131 -        wound itself. ref SDS 17 HT7G, for testing in the lab.  We
251132 -        never received a copy of the biopsy report, and so really do
251133 -        not know the content, but were told it shows "cellulitus," as
251134 -        set out in the meeting on 041210. ref SDS 19 D56I
251136 -         ..
251137 -    4.  So, sounds like you want the biopsy on 041130 that mentions
251138 -        "skin" retested. ref DIT 1 628J
251140 -         ..
251141 -    5.  In any case, please consider specifying in the text of your 2nd
251142 -        opinion the date of the biopsy you recommend for retesting, and
251143 -        we will support this in meeting with the doctor next week.
251144 -        ref DIT 1 549F
251146 -         ..
251147 -    6.  Thanks for reviewing the record and clarifying issues to avoid
251148 -        snafus. ref DIT 1 A49K
251149 -
251150 -
251151 -
251153 -  ..
2512 -
2513 -
2514 - 2210
2515 -
251501 - Status New Evaluation Retest Biopsy on 040419 that Found IBC
251502 - Biopsy on 040419 that Found IBC Retest to Assess Current Status
251503 -
251504 - Received ref DRT 2 0001 from Veronical responding to the letter this
251505 - morning asking which of the biopsies in 2004 she proposes for retest
251506 - to evaluate status of Millie, per above. ref SDS 0 435L
251508 -  ..
251509 - Veronica says...
251510 -
251511 -    1.  The "punch biopsy" that shows inflammatory breast cancer (2nd
251512 -        event)  is the one that should be sent to path for
251513 -        re-evaluation of ER, PR, and HER-2.
251515 -  ..
251516 - This answers the letter this morning, per above, ref SDS 0 435L, and
251517 - clarifies Veronica's 2nd opinion draft received on 050907, and calling
251518 - for retesting for status change. ref SDS 35 AE6P
251520 -            ..
251521 -           [On 050912 Doctor Grissom during 2nd opinion meeting
251522 -           concurrs with retesting status, and indicates the test
251523 -           requires tissue from a biopsy when the patient suffers from
251524 -           cancer, as found by the biopsy on 040419. ref SDS 37 YD4U
251526 -            ..
251527 -           [On 050913 discussed with primary care physician during
251528 -           meeting to evaluate treatment options. ref SDS 38 X546
251530 -            ..
251531 -           [On 050923 surgeon at Kaiser concurs retest for status, and
251532 -           notes that biopsy on 040419 may not have enough tissue;
251533 -           discusses using tissue from new biopsies planned for
251534 -           following week to test for IBC recovery. ref SDS 41 U94M
251536 -  ..
251537 - Veronica concludes...
251538 -
251539 -    2.  Sorry - I already made the second opinion final last night - if they have
251540 -        any problems, please have them call me.
251541 -
251542 -
251543 -
251544 -
251546 -  ..
2516 -
2517 -
2518 - 2238
2519 -
251901 - Submitted ref DIT 2 0001 responding to Veronica's letter and
251902 - requesting a copy of the final version of her opinion.
251904 -  ..
251905 - The letter to Veronica says...
251906 -
251907 -    1.  Responding to your letter earlier today, and saying you have
251908 -        submitted a 2nd opinion, ref SDS 0 5A3W, thanks for timely
251909 -        action.  Please let us know the distribution.  Was this to the
251910 -        referring physician, Doctor Riley-Paul and to the primary care
251911 -        physician, Doctor Johnson? ref DIT 2 0001
251912 -
251913 -             [...below, Veronica says 2nd opinion distributed commonly.
251914 -             ref SDS 0 QZ6F
251916 -         ..
251917 -    2.  If the final version was different from the draft we discussed
251918 -        yesterday, on 050908, ref SDS 36 LJ3X, including your response,
251919 -        ref SDS 36 1W9L, please submit a copy with those changes.  You
251920 -        indicated on 050907 reluctance to refine the work, ref SDS 35
251921 -        OL4L, so if we already have the final version, just let us
251922 -        know. ref DIT 2 IW6L
251923 -
251924 -             [...below, Veronica says she clarified issue on metastatic
251925 -             cancer in the final version. ref SDS 0 QZ6F
251927 -              ..
251928 -             [On 050909 final draft received; still says CT and bone
251929 -             scan tests show no metastatic disease. ref SDS 0 JX7S
251931 -         ..
251932 -    3.  Millie visited with Doctor Lisa Bailey this morning.  The
251933 -        doctor spoke highly of your work; she concurs with your idea to
251934 -        retest for status, and will support this in a 2nd opinion to
251935 -        Kaiser.  This made Mil feel good seeing experts on treating IBC
251936 -        are on the "same page" in her case.  Doctor Bailey also
251937 -        recommends other tests to make sure IBC has regressed
251938 -        sufficiently for surgery.  Her letter should be available next
251939 -        week.  Please let me know if you want a copy. ref DIT 2 RW8F
251940 -
251941 -             [...below, Veronica requests copy of Doctor Bailey's 2nd
251942 -             opinion. ref SDS 0 N44Q
251944 -         ..
251945 -    4.  Thanks for all your help.
251946 -
251947 -
251948 -
251950 -  ..
2520 -
2521 -
2522 - 2358
2523 -
252301 - Received ref DRT 3 0001 from Doctor Shim saying...
252302 -
252303 -    1.  At Kaiser, our reports are available on the computer record.
252304 -        There was no major change to the final ( only thing I clarified
252305 -        was I made a comment that she does not have distant metastasis.
252306 -        ref DRT 3 0001
252308 -  ..
252309 - This addresses the question on getting a final version, per above,
252310 - ref SDS 0 TX4W, guess we can get it only from a printed copy from
252311 - primary care physician during the meeting on 050913.
252313 -  ..
252314 - Veronica's reference in this letter to changing the 2nd opinion to say
252315 - the patient does not have distant metastasis, refers to review of the
252316 - 1st draft on 050907 that proposed consideration of a revision to this
252317 - part of the opinion, and elsewhere where metastasis is mentioned in
252318 - the report, ref SDS 35 555G; on 050908 the doctor indicated this was
252319 - changed, ref SDS 36 1W9L, and seems to confirm today that this change
252320 - was made.
252322 -              ..
252323 -             [...see below final version received from Kaiser still
252324 -             says "CT and bone scan: no evidence of metastatic
252325 -             disease", ref SDS 0 325I
252327 -              ..
252328 -             [On 050913 primary care physician printed a copy of
252329 -             Veronica's 2nd opinion. ref SDS 38 6G4I
252331 -  ..
252332 - Doctor Shim's letter concludes...
252333 -
252334 -    2.  Lisa Bailey is excellent -  I would love to get Lisa's
252335 -        comments. ref DRT 3 J65O
252336 -
252337 -            [On 050922 submitted Doctor Bailey's report to Veronica.
252338 -            ref SDS 39 TL3I
252339 -
252340 -
252342 -  ..
2524 -
2525 -
2526 - 1229
2527 -
252701 - Received received ref DRT 1 0001  Veronica's final draft of a 2nd
252702 - opinion on Millie having mastectomy surgery, following the 1st draft
252703 - received and reviewed on 500907. ref SDS 35 R448
252705 -             ..
252706 -            [On 050923 surgeon at Kaiser in Walnut Creek office
252707 -            received Doctor Shim's 2nd opinion; discussed during
252708 -            meeting with patient. ref SDS 41 7J67
252710 -         ..
252711 -        Subject:  Second Opinion Millie Buck
252712 -                  Patient Visit August 26, 2005
252714 -         ..
252715 -        Pt is a postmenopausal women with loco-regional recurrence of
252716 -        her left breast cancer.  Ms.  Buck had a great clinical
252717 -        response to chemotherapy.  She is here for a second opinion
252718 -        regarding her surgical options at this point.
252720 -         ..
252721 -    3.  Her breast cancer was detected by the patient February, 2002.
252722 -        The mammogram at the time did not show the disease process.  It
252723 -        seems to be that it was very high at the axillary tail which
252724 -        the mammogram has low sensitivity.  Her lumpectomy/SLN/ALND in
252725 -        March, 2002 showed 2 cm ER negative, PR negative, and HER-2
252726 -        negative disease with 4/4 lymph nodes with disease.  She
252727 -        subsequently had AC-taxotere.  Her radiation was done at
252728 -        Mt.Diablo hospital.  I do not have the record.  According to
252729 -        the pt and her husband, they were told that the patient
252730 -        received boost to the lymphatic areas.
252732 -         ..
252733 -    4.  Her recurrence was detected in March, 2004.  Pt presented with
252734 -        inflammatory breast cancer with axillary and supraclavicular
252735 -        lymphadenopathy.  Her chemotherapy regimen have included
252736 -        avastin/taxol/xeloda.  Her chemotherapy was complicated by PE.
252738 -         ..
252739 -    5.  Currently, she is finished with the chemoregimen and was
252740 -        recommended that she undergoes mastectomy.
252742 -         ..
252743 -    6.  FH: no family history of breast or ovarian cancer
252745 -         ..
252746 -    7.  last mammo: Feb, 2002
252748 -         ..
252749 -    8.  CT and bone scan: no evidence of metastatic disease
252751 -  ..
252752 - Per above, Veronica earlier today seemed to indicate that this
252753 - construction was changed, ref SDS 0 QZ6F, however, the above final
252754 - version says the same as the 1st draft reviewed on 050907. ref SDS 35
252755 - 555G
252756 -
252757 -           [...see below, change was made to another location with
252758 -           similar language. ref SDS 0 JX8P
252760 -            ..
252761 -           [...see further below error repeated, change was not made to
252762 -           another location. ref SDS 0 PN4K
252764 -  ..
252765 - Veroinica's 2nd opinion continues...
252766 -
252767 -    9.  breast exam:  no palpable supraclavicular or axillary
252768 -        lymphadenopathy; well healed lumpectomy and ALND incisions in
252769 -        the left breast
252771 -         ..
252772 -   10.  A/P:  Pt has a very complicated history.  I am going to limit
252773 -        my discussion to surgery mostly.  Pt has very aggressive
252774 -        locoregional recurrence of her left breast cancer.  Anytime
252775 -        when breast cancer recurs within the first five years, it is
252776 -        telling us the aggressive nature of the disease.  I am not
252777 -        completely surprised since her initial tumor was ER, PR, as
252778 -        well as HER-2 negative.  The good news is that is loco-regional
252779 -        recurrence and pt does NOT have distant metastatic disease.
252780 -        Thus, our goal is for CURE.  Here are some of my thoughts:
252782 -  ..
252783 - This changes construction in 1st draft from "...does not have
252784 - metastastic disease." to "...does not have distant metastatic disease,
252785 - and so aligns with analysis on 050907, ref SDS 35 TY7M; however,
252786 - conflicts with language above, ref SDS 0 JX7S, reflecting challenge
252787 - of limited time getting consistancy in reporting and analysis, which
252788 - confuses decisions.
252789 -
252790 -           [...see further below error repeated, change was not made to
252791 -           another location. ref SDS 0 PN4K
252793 -  ..
252794 - Veroinica's 2nd opinion continues...
252795 -
252796 -            1)  repeat ER, PR, and HER-2 status in the breast skin
252797 -                biopsy done in 2004.  I do not see that it was
252798 -                repeated.  There is small reported cases when ER, PR,
252799 -                and/or HER-2 status change in the recurrent tumor.
252800 -                This still can be performed in the skin biopsy
252801 -                performed in 2004.  Since it makes a huge impact on her
252802 -                further treatment options, this needs to be repeated.
252803 -
252804 -                    [On 060711 Kaiser Oncology in Walnut Creek reports
252805 -                    discovering that biopsy on 040419 tested for status
252806 -                    change, which was not reported at the time the
252807 -                    biopsy was submitted on 040517. ref SDS 9 6T5G and
252808 -                    found triple negative again. ref SDS 45 SW7O
252810 -                     ..
252811 -                    [On 081016 Doctor Rugo at UCSF orders FNA biopsy to
252812 -                    test for cancer in left supraclavicular, and check
252813 -                    for status change again, based on Veronica's
252814 -                    reasoning today. ref SDS 46 J36R
252816 -                 ..
252817 -            2)  imaging: her last breast imaging was in Feb 2002 before
252818 -                the diagnosis of her initial breast cancer.  It is true
252819 -                that it was non-mamographic finding, I recommend that
252820 -                she gets bilateral mammogram before her next surgery.
252821 -                Her mammographic quality is probably better now that
252822 -                she is older.
252823 -
252824 -                    [On 050922 bilateral mammogram performed at Kaiser
252825 -                    in Walnut Creek office. ref SDS 40 EA5H
252827 -                     ..
252828 -                    [On 051019 letter prepared for Millie cites
252829 -                    favorable report on mammogram test that found no
252830 -                    evidence of cancer. ref SDS 42 DY8R
252832 -                     ..
252833 -                    [On 051027 biopsy on mastectomy surgery finds
252834 -                    ductal carcinoma in situ (DCIS) in nipple tissue
252835 -                    that is commonly discovered with mammogram tests,
252836 -                    and conflicts with PET scan and mammogram testing
252837 -                    which reported no findings of cancer. ref SDS 44
252838 -                    615K
252840 -                 ..
252841 -                The only reason to offer her right mastectomy will be
252842 -                if there is any sign of disease.  Pt's survival will
252843 -                depend on her left breast cancer and performing right
252844 -                prophylactic mastectomy under this current situation at
252845 -                her age would only increase the complication rate.
252847 -                 ..
252848 -            3)  surgery: my recommendation is mastectomy with axillary
252849 -                node dissection.  Pt has had great clinical response to
252850 -                systemic treatment.  Since our intent is for cure
252851 -                (since she does not have metastatic disease), I
252852 -                recommend mastectomy.  Since there are only four lymph
252853 -                nodes obtained at her initial surgery and also because
252854 -                she had axillary lymphadenopathy with her recurrence, i
252855 -                recommend another axillary lymph node dissection.  As I
252856 -                mentioned above, I don't see true value in right
252857 -                prophylactic mastectomy.
252859 -  ..
252860 - This repeats error above of not making uniform changes to describe
252861 - patient status as not having distant metastatic disease. ref SDS 0
252862 - JX7S  Conflicting representations on status and work history cause
252863 - confusion and errors in decisions. ref SDS 0 AQ9L
252864 -
252865 -     [On 051019 prepared letter asking Kaiser to perform Time Out
252866 -     requirements for due diligence and present plans for scope of
252867 -     surgery, including another axillary lymph node dissection, as
252868 -     recommended by Doctor Shim. ref SDS 43 DZ52
252870 -      ..
252871 -     [On 051021 surgeon evidently related to Millie that another
252872 -     axillary lymph node dissection was not performed during surgery
252873 -     in order to reduce risk of lymphadema. ref SDS 43 QU5I
252875 -  ..
252876 - Veroinica's 2nd opinion continues...
252877 -
252878 -            4)  radiation:  I would make sure that she already received
252879 -                maximum radiation at Mt.  Diablo.  If not, boost needs
252880 -                to be given to the supraclavicular, axilla, as well as
252881 -                intrammary nodes.
252883 -         ..
252884 -   11.  If questions, please call me.
252885 -
252886 -
252887 -
252888 -
252889 -
252890 -
252891 -
252892 -
252893 -
252894 -
252895 -
252896 -
252897 -
252898 -
252899 -
252900 -
252901 -
252902 -
252903 -
252904 -
252905 -
252906 -
252907 -
252908 -
252909 -
252910 -
252911 -
252912 -
252913 -
252914 -
252915 -
252916 -
252917 -
252918 -
252919 -
252920 -
2530 -