THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: September 13, 2005 09:40 AM Tuesday;
Rod Welch
Millie at Kaiser for Time Out due diligence checklist on surgery to treat IBC.
1...Summary/Objective
2...Agenda for Work Plan After Switching to Taxotere and Capecitabine
3...CA 15-3 Cancer Marker 45 Rise from 37
4...CA 15-3 46 Cancer Marker Rises 25% from Low of 37 on Prior Test
5...PET Scan Test Ordered to Evaluate Mastectomy Surgery
6...Lymph Nodes Right Left Axillary No Evidence Adenopathy
7...Right Left Axillary No Evidence Lumps Lympadenopathy Under Arms
8...Pulmonary Emboli Symptoms End Treatment with Coumadin Continue
9...Coumadin Treatment Continues for Pulmonary Emboli after Symptoms End
10...Right Left Axillary No Evidence Lumps Lympadenopathy Under Arms
11...Lumps Under Arms No Clinical Examination No Problems Reported
12...Lumps in Neck Examination Found No Adenopathy PET Test Ordered
13...Wound Biopsy Fully Healed with Treatment Taxotere Capecitabine
14...Examination Left Breast No Clinical Evidence IBC Inflammation Subsides
15...Regression IBC Symptoms Achieve by Taxotere Capecitabine Xeloda
16...IBC Appears Entirely Resolved with No Inflammation and Thickened Skin
17...Schedule Surgery after Review 2nd Opinions
18...Surgery Reduce Chances IBC Relapse Schedule 10 Days After Vacation
19...Due Diligence on Criteria Mastectomy Performed by Surgery Department
....When patient ready for surgery...
........Shim 2nd Opinion Examination Shows Patient Ready for Surgery
........Bailey 2nd Opinion Test Assess When Patient Ready for Surgery
........Grissom 2nd Opinion Test Assess When Patient Ready for Surgery
20...Criteria Mastectomy Surgery for Patient Consent
21...Mastectomy Surgery Close Call for Millie's Patient Profile
....Shim Proposes Curative Treatment Model with Mastectomy Surgery
....Bailey Recommends Systemic Treatment, or Wide Area of Skin
....Grissom Mastectomy Surgery Best Chance for Interim Remission
22...Due Diligence Time Out Delays Surgery to Verify Accuracy and Scope
23...2nd Opinions Delay Mastectomy Oncologist Refuses to Discuss Options
24...Time Out Delays Surgery Verify Accuracy and Scope for Risk Management
25...2nd Opinion Internal Kaiser Doctor Expert Treating IBC
26...Joint Meeting Requested for Collaboration of Team Care Practice
27...Collaboration Team Care Practice Requested to Plan High Risk Surgery
28...Partnership Doctor Patient Joint Meeting Requested Team Care Practice
29...Treatment Plan 2 More Cycles then Pause Recover from Side Effects
30...Chemotherapy Holiday from Mid-August to After Surgery in September
31...Holiday from Treatment Planned Recover from Side Effects After Surgery
....a...Taxotere and capecitabine (Xeloda) couplet to implement the
....b...Side Effects Rise Capecitabine (Xeloda) Patient to Exercise
........Heavy Chest Difficult Breathing Side Effect Lack of Exercise
........Exercise Maintain Fitness Strengthen Immune System Challenging
....c...Trial Chemotherapy New Drug Treatment UCSF
........New Drug Trial Chemotherapy Treatment UCSF Proposed by Bailey
32...Bladder Incontinence Problem from Steriods in Benedryl Treatments
33...Incontinence Side Effect Steriods in Beyedryl with Chemo Treatment
34...Urinary Problem Incontinence Steriods in Beyedryl with Chemo Treatment
..............
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CONTACTS
SUBJECTS
Meeting Doctor Examine Response Chemotherapy Taxol Capecitiabine Xel
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 51 0000. ref SDS 48 0000.
040502 -
040503 - Patient reported progress on due diligence evaluating mastectomy
040504 - surgery. ref SDS 0 T46F The doctor feels CA 15-3 testing at 45 shows
040505 - a stable cancer marker, ref SDS 0 GJ5M, that complements examination
040506 - showing continued absence of IBC symptoms. ref SDS 0 M56N Millie
040507 - requested implementing 2nd opinions calling for PET scan test on
040508 - response to treatment of local and distant disease. The doctor
040509 - ordered this test. ref SDS 0 NL4N The doctor also ordered further
040510 - chemotherapy to maintain local control of disease, as recommended by
040511 - 2nd opinions. ref SDS 0 AW5G The doctor objected that 2nd opinions to
040512 - consider risks and benefits of mastectomy surgery on the left breast,
040513 - risk losing a "window of opportunity" for performing mastectomy
040514 - surgery to maintain local control. ref SDS 0 5T9N Millie requested a
040515 - joint meeting with the surgeon and the primary care physician to
040516 - facilitate team care collaboration on Kaiser's proposal for mastectomy
040517 - surgery. The doctor indicated that scheduling meetings with patients,
040518 - the surgeon and the primary care physician is too complex. He plans
040519 - direct communication with the surgeon, and without the patient.
040520 - ref SDS 0 6W4L During the meeting he called and left a message
040521 - telling the surgeon to schedule surgery. ref SDS 0 T646
040522 -
040523 - [On 050922 received Doctor's Bailey's 2nd opinion. ref SDS 61 HP3H
040525 - ..
040526 - [On 050920 Doctor Grissom's 2nd opinion received. ref SDS 60 PQ5S
040528 - ..
040529 - [On 050923 surgeon orders thin skin biopsies to verify IBC
040530 - subsided, and determine scope of mastectomy. ref SDS 63 SZ6M
040532 - ..
040533 - [On 050929 left breast biopsies scheduled for 051012. ref SDS 65
040534 - PPUQ
040536 - ..
040537 - [On 051006 Coumadin paused to prepare for biopsy surgery on
040538 - 051012. ref SDS 67 5E6O
040539 -
040540 -
040541 -
040543 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Agenda for Work Plan After Switching to Taxotere and Capecitabine
040902 -
040903 - Follow up ref SDS 51 SM6M, ref SDS 48 SM6M.
040904 -
040905 - This is the 5th review after changing treatment to Taxotere and
040906 - capecitabine (Xeloda) initiated on 050329, ref SDS 43 T58M, and
040907 - starting on 050415, ref SDS 44 0001, and occurs before starting the
040908 - 8th cycle.
040910 - ..
040911 - Millie created an agenda on the marking board...
040912 -
040913 - CA 15-3 rise............................... ref SDS 0 GJ5M
040914 - Breast exam recovering IBC................. ref SDS 0 025H
040915 - Surgeon planning mastectomy due diligence.. ref SDS 0 XQ41
040916 - Treatment plan............................. ref SDS 0 AW5G
040917 - Side Effects adjust dosage................. ref SDS 0 NT3I
040918 - Urinary system............................. ref SDS 0 VT3O
040919 -
040920 -
040921 -
040922 -
040923 -
0410 -
SUBJECTS
CA 15-3 45 Rise from 39 Continues Overall Favorable Response to Trea
1203 -
120401 - ..
120402 - CA 15-3 Cancer Marker 45 Rise from 37
120403 -
120404 - Follow up ref SDS 51 087J, ref SDS 48 087J.
120405 -
120406 - Blood test on 050729 shows CA 15-3 dropped to 45 from 46 for the prior
120407 - test on 050708, and then dropped again in a test on 050812 down to 39,
120408 - which is the high end of normal, reported on 050819, when Millie had a
120409 - treatment in the chemotherapy clinic. ref SDS 5 EA5G Subsequent
120410 - testing on 0508??, prior to going on vacation, and another test on
120411 - 0509??, after returning from vacation, CA 15-3 rose to 45, and 45
120412 - again, shown by the report submitted by the doctor today...
120414 - ..
120415 - Test Date Date Received
120416 - 050826......... 45 H............. 050913, ref SDS 0 087JL
120417 - 050819......... 45 H............. 050913, ref SDS 0 087JL
120418 - 050812......... 39 .............. 050819, ref SDS 53 3K6L
120419 - 050729......... 45 H............. 050819, ref SDS 53 EA5G
120420 - 050708......... 46 H............. 050729, ref SDS 51 087J
120421 - 050701......... 37 .............. 050708, ref SDS 49 2N5J
120422 - 050617......... 45 H............. 050729, ref SDS 51 087J
120423 - 050527......... 56 H............. 050610, ref SDS 48 087J
120424 - 050512......... 67 H............. 050520, ref SDS 47 087J
120425 - 050506......... 80 H............. 050520, ref SDS 47 087J
120426 - ..
120427 - 050415.........105 H............. 050422, ref SDS 45 087J
120428 - 050325.........100 H............. 050329, ref SDS 43 087J
120429 - 050318.........101 H............. 050325, ref SDS 42 2N5J
120430 - 050304......... 88 H............. 050311, ref SDS 40 087J
120431 - 050225......... 95 H............. 050308, ref SDS 39 0001
120432 - 050211......... 78 H............. 050214, ref SDS 38 02BB
120433 - 050128......... 67 H............. 050204, ref SDS 37 087J
120434 - 041228......... 56 H............. 041230, ref SDS 35 087J
120435 - 041204......... 43 H............. 041210, ref SDS 34 087J
120436 - 041007......... 39............... 041104, ref SDS 31 087J
120437 - 040923......... 49 H............. 041005, ref SDS 29 087J
120438 - 040908......... 44 H............. 040909, ref SDS 28 087J
120439 - 040825......... 47 H............. 040812, ref SDS 28 087J
120440 - 040811......... 42 H............. 040812, ref SDS 27 087J
120441 - 040728......... 43 H............. 040729, ref SDS 26 2N5J
120442 - 040712......... 47 H............. 040713, ref SDS 25 087J
120443 - 040614......... 55 H............. 040615, ref SDS 24 PX6X
120444 - 040517......... 78 H............. 040601, ref SDS 22 2N5J
120445 - 040311......... 70 H............. 040318, ref SDS 21 SM6M
120446 - 040205......... 60 H............. 040211, ref SDS 20 SM6M
120447 - 031201......... 62 H............. 031205, ref SDS 19 SM6M
120448 - 030912......... 66 H............. 030915, ref SDS 18 SM6M
120449 - 030708......... 68 H............. 030710, ref SDS 17 SM6M
120450 - 030503......... 54 H............. 030508, ref SDS 16 SM6M
120451 - 030403......... 45 H............. 030508, ref SDS 16 SM6M
120452 - 030215......... 46 H............. 030220, ref SDS 15 5E6L
120453 - 030106......... 37 H............. 030109, ref SDS 14 SM6M
120454 - 021202......... 41 H?............ 021204, ref SDS 13 SP5G
120455 - 021111......... 36 H?............ 021113, ref SDS 12 Y65I
120456 - 021023......... 33 H?............ 021023, ref SDS 11 SQ5I
120457 - 020930......... 33 H?..29........ 021002, ref SDS 10 SQ5I
120458 - 020917......... 36 H?............ 020924, ref SDS 9 SQ5I
120459 - 020717......... 59 H?............ 020726, ref SDS 8 YN5K
120460 - 020629......... 75 H ............ 020705, ref SDS 7 UX6I
120461 - 020608........ 67 H ............ 020614, ref SDS 6 0001
120462 - 020603........ 108 H ............ 020607, ref SDS 5 X67F
120463 - 020511........ 117 H ............ 020603, ref SDS 4 PJ4J
120464 - 020419......... 81 H ............ 020430, ref SDS 3 7N5H
120465 - 020321......... 85 H ............ 020405, ref SDS 2 6T8K
120466 -
120467 -
120469 - ..
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 51 GJ5M, ref SDS 48 GJ5M.
120804 -
120805 - The doctor characterized the recent record over the past 45 days since
120806 - the prior meeting on 050729, where CA 15-3 dropped to 39, then rose
120807 - back to 45 with two (2) tests, per the report today, shown above, as a
120808 - positive development showing a stable trend line.
120810 - ..
120811 - The doctor feels this record does not suggest cancer activity that
120812 - disrupts prior recommendations for mastectomy surgery proposed by the
120813 - doctor on 050729. ref SDS 51 5B9K
120815 - ..
120816 - Review on 050610 of the CT scan test on 050530 indicated lymph node
120817 - activity almost totally resolved, ref SDS 48 WA52, and so may align
120818 - with persistent CA 15-3 history of 45, slightly above normal, reported
120819 - today, per above, ref SDS 0 KV59, and in accordance with analysis on
120820 - 050729. ref SDS 51 Y44G
120821 -
120822 -
120823 -
120824 -
1209 -
SUBJECTS
PET Scan Test Ordered to Evaluate Metastatic Disease in Order to Dec
2503 -
250401 - ..
250402 - PET Scan Test Ordered to Evaluate Mastectomy Surgery
250403 -
250404 - Follow up ref SDS 51 NL4N, ref SDS 48 NL4N.
250405 -
250406 - See discussion on rising CA 15-3, per above. ref SDS 0 ST6G
250408 - ..
250409 - PET scan test ordered today to evaluate patient response to treatment
250410 - for local and distant metastatic disease, complementing history of CT
250411 - testing showing no distant metastasis, and assess local and regional
250412 - disease, as recommended by 2nd opinions for evaluating chances of
250413 - success for mastectomy surgery, per below. ref SDS 0 VO50
250414 -
250415 - [On 051005 PET scan test performed at Kaiser in Walnut Creek.
250416 - ref SDS 66 0001
250418 - ..
250419 - [On 051007 PET scan test report favorable no findings of local,
250420 - regional nor distant metastatic disease, ref SDS 68 NL4N,
250421 - impression prior abnormalities resolved. ref SDS 68 L66M
250422 -
250423 -
250424 -
250425 -
250426 -
250427 -
2505 -
SUBJECTS
Axillary Right Lymph Nodes CT Test 050530 Shows No Distant Matastasi
Axillary Right Left Lymph Nodes Examination Finds No Adenopathy Evid
3404 -
340501 - ..
340502 - Lymph Nodes Right Left Axillary No Evidence Adenopathy
340503 - Right Left Axillary No Evidence Lumps Lympadenopathy Under Arms
340504 -
340505 - Follow up ref SDS 51 B58M, ref SDS 48 B58M.
340506 -
340507 - See discussion on rising CA 15-3, per above. ref SDS 0 ST6G
340509 - ..
340510 - PET scan ordered today to follow up CT test findings on 050610.
340511 - ref SDS 48 B58M
340512 -
340513 -
340514 -
340515 -
340516 -
3406 -
SUBJECTS
Pulmonary Emboli Blood Clots No Clinical Symptoms Heavy Chest Shortn
Pulmonary Emboli Blood Clots Symptoms End Coumadin Treatment Continu
4004 -
400501 - ..
400502 - Pulmonary Emboli Symptoms End Treatment with Coumadin Continue
400503 - Coumadin Treatment Continues for Pulmonary Emboli after Symptoms End
400504 -
400505 - Follow up ref SDS 51 RZ4I, ref SDS 48 RZ4I.
400506 -
400507 - No discussion of PE during this meeting.
400508 -
400509 - [On 051006 Coumadin paused to prepare for biopsy surgery on
400510 - 051012. ref SDS 67 5E6O
400511 -
400512 -
400513 -
400514 -
400515 -
4006 -
SUBJECTS
Axillary Right Left Lymph Nodes Examination Finds No Adenopathy Evid
4603 -
460401 - ..
460402 - Right Left Axillary No Evidence Lumps Lympadenopathy Under Arms
460403 - Lumps Under Arms No Clinical Examination No Problems Reported
460404 -
460405 - Follow up ref SDS 51 MW8J, ref SDS 48 MW8J.
460406 -
460407 - See discussion of rising CA 15-3, per above. ref SDS 0 ST6G
460408 -
460409 - The doctor examined the right and left axillary and commented finding
460410 - no lumps or other indications of adenopqathy.
460412 - ..
460413 - PET scan ordered today to follow up CT test findings on 050610.
460414 - ref SDS 48 B58M
460415 -
460416 -
460417 -
460418 -
460419 -
460420 -
460421 -
4605 -
SUBJECTS
Neck Lumps Examination Found No Adenopathy PET Test Ordered
5203 -
520401 - ..
520402 - Lumps in Neck Examination Found No Adenopathy PET Test Ordered
520403 -
520404 - Follow up ref SDS 51 8R6M, ref SDS 48 8R6M.
520405 -
520406 - The doctor examined the right and left clavicular and commented
520407 - finding no lumps or other indications of adenopqathy.
520409 - ..
520410 - PET scan ordered today to follow up CT test findings on 050610.
520411 - ref SDS 48 B58M
520412 -
520413 -
520414 -
520415 -
520416 -
520417 -
5205 -
SUBJECTS
Wound Biopsy Left Breast Fully Healed after 3 Treatment Taxotere Cap
5803 -
580401 - ..
580402 - Wound Biopsy Fully Healed with Treatment Taxotere Capecitabine
580403 -
580404 - Follow up ref SDS 51 6T5G, ref SDS 48 6T5G.
580405 -
580406 - Biopsy wound examined with left breast shows fully healed, as reported
580407 - previously on 050727. ref SDS 51 6T5G
580408 -
580409 -
580410 -
580411 -
580412 -
5805 -
SUBJECTS
Examination Left Breast No Clinical Evidence IBC Inflammation Subsid
6303 -
630401 - ..
630402 - Examination Left Breast No Clinical Evidence IBC Inflammation Subsides
630403 - Regression IBC Symptoms Achieve by Taxotere Capecitabine Xeloda
630404 - IBC Appears Entirely Resolved with No Inflammation and Thickened Skin
630405 -
630406 - Follow up ref SDS 51 025H, ref SDS 48 025H.
630407 -
630408 - Before the doctor came into the examination room, Millie did a
630409 - self-examination in the mirror, and commented that the left breast
630410 - seemed slightly inflamed or flushed. Observation confirmed that the
630411 - left breast seemed slightly reddish, and raised worrisome concerns
630412 - that this condition aligned with findings by Doctor Bailey on 050909.
630413 - ref SDS 57 1G4N
630414 -
630415 - [On 050922 Doctor Bailey's final version 2nd opinion cites
630416 - coloration left breast findings indicating patient may have
630417 - active IBC. ref SDS 61 6Y7N
630419 - ..
630420 - A few minutes later, the doctor came into the room, and examined both
630421 - breasts, along with axilla and supraclavicular in the neck area, per
630422 - above. ref SDS 0 MW8J
630424 - ..
630425 - The doctor commented that both breasts appear similar and normal, with
630426 - no coloration, flushness, nor inflammation, and in all respects
630427 - aligned with findings by the surgeon on 050727. ref SDS 50 YY7F
630428 - Observation seemed to confirm the doctor's comments, and this was
630429 - related to Millie that there seemed a marked change from moments
630430 - earlier, and so suggested the earlier condition in the left breast was
630431 - nervous reaction to stress, and which may also account for Doctor
630432 - Bailey's examination albeit in reverse order from 050909, in that
630433 - today coloration seemed evident while standing and less pronounced to
630434 - non-existent while laying down. ref SDS 57 1G4N
630436 - ..
630437 - The doctor concluded the patient is ready for surgery, based on having
630438 - maintained prior favorable conditions reported by the surgeon from
630439 - examination on 050727. ref SDS 50 YY7F
630440 -
630441 -
630442 -
630443 -
630444 -
630445 -
6305 -
SUBJECTS
Schedule Mastectomy Surgery Review 2nd Opinions Due Diligence Criter
9303 -
930401 - ..
930402 - Schedule Surgery after Review 2nd Opinions
930403 - Surgery Reduce Chances IBC Relapse Schedule 10 Days After Vacation
930404 - Due Diligence on Criteria Mastectomy Performed by Surgery Department
930405 -
930406 - Follow up ref SDS 51 XQ41, ref SDS 48 XQ41.
930407 -
930408 - Background on considerations for surgery in this case are summarized
930409 - on 041210, ref SDS 34 ZV5J, and case study to extend quality of life
930410 - by preventing disease from cascading out of control is reported on
930411 - 041230. ref SDS 35 XV7M
930413 - ..
930414 - Criteria for performing a successful mastectomy in this case was
930415 - discussed with the surgeon on 050324, ref SDS 41 OV5H, upon request by
930416 - the doctor during a meeting with the patient on 050311. ref SDS 40
930417 - PB4N Analysis of criteria for mastectomy surgery occurred during the
930418 - meeting with the surgeon on 050727, ref SDS 50 OV5H,
930420 - ..
930421 - This morning, the doctor asked when mastectomy surgery is scheduled to
930422 - be performed?
930424 - ..
930425 - Millie explained progress on due diligence required by notice in the
930426 - doctor's examination room calling for a "Time Out" checklist to
930427 - investigate proposals on medical procedures (see below, ref SDS 0
930428 - Q95M, and further by Kaiser's requirements in the Healthwise Handbook,
930429 - reviewed on 990625, ref SDS 1 455N; also, as discussed with the
930430 - surgeon on 050727. ref SDS 50 OV5H A Kaiser doctor has filed a 2nd
930431 - opinion, and two (2) more opinions will be filed next week to support
930432 - due diligence on evaluating surgery for Millie's patient profile.
930433 -
930434 - [On 050923 Healthwise Handbook contains a checklist of
930435 - requirements for doctors to take "Time Out" and perform due
930436 - diligence answering patient questions on proposed surgery.
930437 - ref SDS 63 O85O
930439 - ..
930440 - Millie submitted a summary of preliminary understandings from 2nd
930441 - opinion consultations to guide discussion during the meeting today
930442 - (see below, ref SDS 0 T533).
930444 - ..
930445 - The doctor said there isn't enough time to review the summary of 2nd
930446 - opinions. He asked the patient to present verbal impressions from
930447 - memory of 2nd opinions.
930448 -
930449 - [On 060821 Doctor Benz at UCSF did not have time to read the
930450 - agenda for meeting on 2nd opinion, nor to review written record
930451 - of patient history; wants the gist from patient verbal
930452 - recollections of chronology for 5 years. ref SDS 74 TQ4I
930454 - ..
930455 - [On 080109 report Doctor Johnson providing 2nd opinion
930456 - support on internal referral from Kaiser Oncology in
930457 - Walnut Creek. ref SDS 77 XV8M
930459 - ..
930460 - Millie generally related the text handed to the doctor that says...
930461 -
930462 -
930463 -
930464 -
930465 -
930466 -
930467 -
9305 -
SUBJECTS
Status Test ER PR HER2/neu for Positive from Original Negative Test
2nd Opinion Final Draft Received Kaiser Internal Referral Examinatio
Mastectomy Surgery Criteria When Patient Ready IBC Subsides PET Scan
Axilliary Node Disection Surgery with Breast Mastectomy Recommended
A606 -
A60701 - ..
A60702 - When patient ready for surgery...
A60703 -
A60704 -
A60705 - Shim 2nd Opinion Examination Shows Patient Ready for Surgery
A60706 -
A60707 - 1. Doctor Shim referral surgeon in Kaiser's Oakland office issued
A60708 - draft opinion received on 050907, ref SDS 55 R448, and
A60709 - indicated....
A60710 -
A60711 - [On 080109 report Doctor Johnson providing 2nd opinion
A60712 - support on internal referral from Kaiser Oncology in
A60713 - Walnut Creek. ref SDS 77 XV8M
A60714 -
A60715 - a. Examination on 050826, ref SDS 54 555G, showed that patient
A60716 - has recovered sufficiently from IBC for surgery, see Shim
A60717 - 2nd opinion draft on 050907, ref SDS 55 AE4V, aligns with
A60718 - examination by surgeon at Kaiser Walnut Creek on 050727.
A60719 - ref SDS 50 YY7F
A60721 - ..
A60722 - During the meeting today, Millie requested a copy of Doctor
A60723 - Shim's opinion, because the doctor did not have enough time
A60724 - to submit a final version on 050909. ref SDS 56 QZ6F This
A60725 - enables the patient to type the final version and integrate
A60726 - into the record for verification, alignment and access.
A60727 - For convenience this was entered in the record on 050909.
A60728 - ref SDS 56 1O4I
A60730 - ..
A60731 - b. breast exam: no palpable supraclavicular or axillary
A60732 - lymphadenopathy; well healed lumpectomy and ALND incisions
A60733 - in the left breast, reported 050907. ref SDS 55 AE4V
A60735 - ..
A60736 - c. surgery: my recommendation is mastectomy with axillary node
A60737 - dissection. Pt has had great clinical response to systemic
A60738 - treatment. Since our intent is for cure (since she does
A60739 - not have metastatic disease), I recommend mastectomy.
A60740 - Since there are only four lymph nodes obtained at her
A60741 - initial surgery and also because she had axillary
A60742 - lymphadenopathy with her recurrence, i recommend another...
A60743 -
A60744 - axillary lymph node dissection.
A60746 - ..
A60747 - As I mentioned above, I don't see true value in right
A60748 - prophylactic mastectomy. ref SDS 55 JS4H
A60750 - ..
A60751 - d. Retesting biopsy on 040419 for changing status on ER PR and
A60752 - HER2/neu to assess prospect of expanding treatment options,
A60753 - also, reported on 050907. ref SDS 55 AE6P Later, on 050909
A60754 - Veronica clarified 2nd opinion proposal to test biopsy on
A60755 - 040419. ref SDS 56 P58N On 050912 Doctor Grissom explains
A60756 - requirement to test status while patient suffers disease.
A60757 - ref SDS 58 MX5N
A60758 -
A60759 - [On 050923 surgeon at Kaiser concurs retest for status,
A60760 - and notes that biopsy on 040419 may not have enough
A60761 - tissue; discusses using tissue from new biopsies
A60762 - planned for following week to test for IBC recovery.
A60763 - ref SDS 63 U94M
A60765 - ..
A60766 - [On 050927 received surgeon notes; review shows no
A60767 - indications ordering retest of the biopsy on 040419 for
A60768 - status change. ref SDS 64 WV5O
A60770 - ..
A60771 - [On 051007 primary care physician planned to order
A60772 - retest of biopsy for status change. ref SDS 68 KE5L
A60774 - ..
A60775 - [On 051022 surgeon reported retest was ordered with no
A60776 - record in surgeon's notes received on 050927, and that
A60777 - results of retesting have not been received; doctor
A60778 - following up to obtain results. ref SDS 71 NE9J
A60780 - ..
A60781 - [On 051027 surgeon has not received results of
A60782 - retesting for status change; will check with pathology
A60783 - department on finding correct biopsy slide to test.
A60784 - ref SDS 72 964L
A60786 - ..
A60787 - [On 060711 discovered that status change was tested for
A60788 - biopsy on 040419 and test was negative. ref SDS 73 SW7O
A60789 -
A60790 -
A60791 -
A60792 -
A60793 -
A60794 -
A60795 -
A608 -
SUBJECTS
Status Test ER PR HER2/neu for Positive from Original Negative Test
2nd Opinion Doctor Lisa Bailey Patient Notes from Meeting on 050909
Mastectomy Surgery Criteria When Patient Ready IBC Subsides PET Scan
AB05 -
AB0601 - ..
AB0602 - Bailey 2nd Opinion Test Assess When Patient Ready for Surgery
AB0603 -
AB0605 - ..
AB0606 - 2. Doctor Bailey indicated on 050909 that examination suggests IBC
AB0607 - may not be fully recovered, because some skin thickening and
AB0608 - inflammation appears to remain where patient previously
AB0609 - received radiation treatments, ref SDS 57 1G4N, this aligns
AB0610 - with concern this morning, per above. ref SDS 0 025H
AB0611 -
AB0612 - [On 050922 received Doctor's Bailey's 2nd opinion.
AB0613 - ref SDS 61 HP3H; notes examination indicates IBC may not
AB0614 - have fully subsided. ref SDS 61 6Y7N
AB0615 -
AB0616 - a. Recommends against surgery at this time, ref SDS 57 1G4Q,
AB0617 - and suggests continuing systemic treatment for local
AB0618 - control, per below. ref SDS 0 X584
AB0619 -
AB0620 - [On 050922 Doctor Bailey's 2nd opinion recommends
AB0621 - against surgery, and continuing chemotherapy for local
AB0622 - control. ref SDS 61 XD6U
AB0624 - ..
AB0625 - b. Proposes testing to verify IBC has subsided with
AB0626 - mammography, MRI breast test, and also PET scan testing,
AB0627 - ref SDS 57 1G75, further supported by Grissom, per below.
AB0628 - ref SDS 0 VO6T
AB0629 -
AB0630 - [...see above, PET scan test ordered. ref SDS 0 NL4N
AB0632 - ..
AB0633 - [On 050922 Doctor Bailey's 2nd opinion recommends
AB0634 - testing. ref SDS 61 XD7U
AB0636 - ..
AB0637 - [On 050922 bilateral mammogram performed at Kaiser in
AB0638 - Walnut Creek office. ref SDS 4 EA5H
AB0640 - ..
AB0641 - [On 051005 PET scan test performed at Kaiser in Walnut
AB0642 - Creek. ref SDS 7 0001
AB0644 - ..
AB0645 - c. Retesting biopsy on 040419 for changing status on ER PR and
AB0646 - HER2/neu to assess prospect of expanding treatment options,
AB0647 - concurring with Doctor Shim, reported on 050909.
AB0648 - ref SDS 57 1G8R
AB0649 -
AB0650 - [On 050922 Doctor Bailey's 2nd opinion recommends
AB0651 - testing. ref SDS 61 XD4S
AB0652 -
AB0653 -
AB0654 -
AB0655 -
AB0656 -
AB07 -
SUBJECTS
Status Test ER PR HER2/neu for Positive from Original Negative Test
2nd Opinion Doctor Nima Grissom Patient Notes from Meeting on 050912
Mastectomy Surgery Criteria When Patient Ready IBC Subsides PET Scan
AG05 -
AG0601 - ..
AG0602 - Grissom 2nd Opinion Test Assess When Patient Ready for Surgery
AG0603 -
AG0605 - ..
AG0606 - 3. Doctor Grissom commented during a meeting on 050912 that
AG0607 - examination indicates patient may be ready for surgery,
AG0608 - ref SDS 58 FH6O, and recommends...
AG0609 -
AG0610 - a. Thin skin biopsies on left breast to test prior radiation
AG0611 - sites for distinguishing coloration and skin thickening
AG0612 - caused by radiation or by IBC. ref SDS 58 NM4J
AG0613 -
AG0614 - [On 050920 Doctor Grissom's 2nd opinion received and
AG0615 - confirms recommendations on additional biopsies.
AG0616 - ref SDS 60 XL7P and ref SDS 60 GT3M
AG0618 - ..
AG0619 - [On 050923 surgeon orders thin skin biopsies to verify
AG0620 - IBC subsided, and determine scope of mastectomy.
AG0621 - ref SDS 63 SZ6M
AG0623 - ..
AG0624 - [On 050929 left breast biopsies scheduled for 051012.
AG0625 - ref SDS 65 PPUQ
AG0627 - ..
AG0628 - [On 051006 Coumadin paused to prepare for biopsy
AG0629 - surgery on 051012. ref SDS 67 5E6O
AG0631 - ..
AG0632 - b. PET scan testing to look for potential cancer activity that
AG0633 - may be missed by CT testing, ref SDS 58 NM4J, also,
AG0634 - recommended by Doctor Bailey, per above. ref SDS 0 VO50
AG0635 -
AG0636 - [...see above, PET scan test ordered. ref SDS 0 NL4N
AG0637 -
AG0638 - [On 051005 PET scan test performed at Kaiser in Walnut
AG0639 - Creek. ref SDS 66 0001
AG0640 -
AG0642 - ..
AG0643 - c. Retesting biopsy on 040419 for changing status on ER PR and
AG0644 - HER2/neu to assess prospect of expanding treatment options,
AG0645 - reported on 050912, ref SDS 58 YD4U, concurring with Doctor
AG0646 - Shim, reported 050909, per above, ref SDS 0 X546, and,
AG0647 - also, Doctor Bailey on 050909, per above. ref SDS 0 X561
AG0648 -
AG0649 -
AG0650 -
AG0651 -
AG07 -
SUBJECTS
Mastectomy Surgery Criteria Patient Consent to Extend Quality of Lif
Shim Proposes Curative Treatment Model with Mastectomy Surgery Post-
AI04 -
AI0501 - ..
AI0502 - Criteria Mastectomy Surgery for Patient Consent
AI0503 - Mastectomy Surgery Close Call for Millie's Patient Profile
AI0504 -
AI0505 - Patient approval of mastectomy to extend quality of life was reviewed
AI0506 - initially at Kaiser in Walnut Creek on 050727. ref SDS 50 VL4O
AI0507 -
AI0508 - Shim Proposes Curative Treatment Model with Mastectomy Surgery
AI0509 -
AI0510 - 1. Doctor Veronica Shim recommends mastectomy surgery for a
AI0511 - curative treatment model based on patient history showing no
AI0512 - evidence of distant metastasis, cited in 2nd opinion draft
AI0513 - received on 050907. ref SDS 55 F49H
AI0515 - ..
AI0516 - Mastectomy yields biopsy tissue to fully assess potential for
AI0517 - cure based on finding cancer eliminated from left breast, and
AI0518 - testing history showing supraclaviclular and left axilla have
AI0519 - fully subsided, discussed on 050826. ref SDS 54 XG5J
AI0520 -
AI0521 -
AI0522 -
AI0523 -
AI06 -
SUBJECTS
Mastectomy Surgery Criteria Patient Consent to Extend Quality of Lif
Bailey Proposes Systemic Treatment with Chemotherapy and Avoid Maste
AK04 -
AK0501 - ..
AK0502 - Bailey Recommends Systemic Treatment, or Wide Area of Skin
AK0503 -
AK0504 -
AK0505 - 2. Doctor Lisa Bailey recommends against mastectomy surgery at
AK0506 - this time, until further testing establishes IBC has fully
AK0507 - subsided, per above. ref SDS 0 VO44
AK0509 - ..
AK0510 - Doctor Bailey indicated during a consultation on 050909 that
AK0511 - mastectomy surgery in this case is very complex, and so could
AK0512 - spread IBC disease, rather than increase local control.
AK0513 - ref SDS 57 MA5F
AK0514 -
AK0515 - [On 050916 during brief visit with patient in Chemotherapy
AK0516 - Clinic, the primary care physician reports reports having
AK0517 - discussed Millie's case with the surgeon. ref SDS 59 PF3G
AK0519 - ..
AK0520 - Doctor Bailey indicates that mastectomy surgery in this case is
AK0521 - much different from performing surgery on a patient who does
AK0522 - not have IBC, and explained that establishing the scope of the
AK0523 - operation requires careful planning. ref SDS 57 DLD8
AK0525 - ..
AK0526 - Doctor Bailey recommends continuing current treatment regimen,
AK0527 - ref SDS 57 1G4X, and plans to discuss new trial with Doctor
AK0528 - Parks at UCSF; possible that treatments could be given by
AK0529 - Kaiser in Walnut Creek office. ref SDS 57 AL3N
AK0530 -
AK0531 -
AK0532 -
AK06 -
SUBJECTS
Mastectomy Surgery Criteria Patient Consent to Extend Quality of Lif
Grissom Proposes Mastectomy Surgery Best Chance for Interim Remissio
AM04 -
AM0501 - ..
AM0502 - Grissom Mastectomy Surgery Best Chance for Interim Remission
AM0503 -
AM0504 -
AM0505 - 3. Doctor Nima Grissom recommends that mastectomy surgery is the
AM0506 - best chance for the patient to achieve interim remission that
AM0507 - permits ending treatments for an interim-to-long-term period,
AM0508 - and notes that if further testing, discussed above, ref SDS 0
AM0509 - OY5M, confirms no distant metastasis, then mastectomy can be
AM0510 - effective in this case, reported in the meeting on 050912.
AM0511 - ref SDS 58 MW67
AM0513 - ..
AM0514 - Doctor Grissom indicated that IBC is a very rare form of cancer
AM0515 - that is normally diagnosed de novo. The doctor commented that
AM0516 - Millie's patient profile contracting IBC on relapse is a rare
AM0517 - condition of a rare disease. As a result, there are no studies
AM0518 - and very little literature on criteria and guidance for
AM0519 - assessing when a patient is ready for surgery, and on the scope
AM0520 - of the operation, reported on 050912. ref SDS 58 LY7K
AM0522 - ..
AM0523 - Doctor Grissom discussed during consultation on 050912 that
AM0524 - surgery in this case is highly complex requiring experience to
AM0525 - perform a "very wide mastectomy" to reduce the risk of relapse
AM0526 - by removing the area of skin on the left breast formerly
AM0527 - infected with IBC; reconstruction by a plastic surgeon would be
AM0528 - required to close the wound in a 10 hour operation using a
AM0529 - microvascular flap such as a DIEP flap or possibly a TRAM.
AM0530 - ref SDS 58 V150 These issues were previously and only
AM0531 - generally discussed with the surgeon in Kaiser's Walnut Creek
AM0532 - office on 050727; at that time, the surgeon indicated not
AM0533 - having experience with this scope of work. ref SDS 50 QJ3Q
AM0534 - Doctor Grissom has performed this type of surgery. She is
AM0535 - willing to consult with Kaiser's surgeon, as needed, and
AM0536 - indicated that a consultation could be sufficient for a doctor
AM0537 - already experienced performing routine mastectomy surgery to
AM0538 - prepare for doing successful surgery in this case, even without
AM0539 - having previously done such an operation on an IBC patient
AM0540 - where inflammation spread beyond the breast. ref SDS 58 MW47
AM0541 -
AM0542 - [On 050920 Doctor Grissom's 2nd opinion presents planning
AM0543 - for very wide mastectomy to reduce chance of relapse by
AM0544 - removing skin previously infected with IBC. ref SDS 60 XL8U
AM0546 - ..
AM0547 - [On 051007 primary care physician ordered a standard
AM0548 - mastectomy, ref SDS 68 P64J, for the purpose of a
AM0549 - palliation strategy to treat possibility of future relapse,
AM0550 - ref SDS 68 6A4N, and further asked the patient to notify
AM0551 - the Surgery Department to schedule an operation.
AM0552 - ref SDS 68 MW6O
AM0554 - ..
AM0555 - [On 051019 prepared letter asking Kaiser to take Time Out
AM0556 - for performing due diligence requirements presenting risks
AM0557 - and benefits, ref SDS 69 DY5P, on the scope of mastectomy
AM0558 - surgery in this case. ref SDS 69 DZ56
AM0560 - ..
AM0561 - [On 051021 surgeon reported performing a very wide
AM0562 - mastectomy and that a standard closure was accomplished.
AM0563 - ref SDS 70 8K6N
AM0565 - ..
AM0566 - Doctor Grissom indicated that surgery in this case is a "close
AM0567 - call," and that an equally effective path would be to continue
AM0568 - systemic treatment, ref SDS 58 MW5M, citing Doctor Benz 2nd
AM0569 - opinion received in the record on 041117. ref SDS 32 OU5P
AM0571 - ..
AM0572 - Doctor Grisson cited a current patient she has who suffered IBC
AM0573 - on relapse, similar to Millie. This patient has elected not to
AM0574 - have surgery and has been doing well on Taxotere. How long the
AM0575 - patient has survived was not discussed, but may be cited in
AM0576 - Doctor Grissom's 2nd opinion as a baseline reference point.
AM0577 - Other correlations on patient profile with respect to time of
AM0578 - diagnosis, findings on distant metastasis, age and health have
AM0579 - not been presented. ref SDS 58 O68F
AM0580 -
AM0581 -
AM0582 -
AM0583 -
AM06 -
SUBJECTS
2nd Opinions Object Delay Mastectomy Oncologist Primary Care Physici
AW03 -
AW0401 - ..
AW0402 - Due Diligence Time Out Delays Surgery to Verify Accuracy and Scope
AW0403 - 2nd Opinions Delay Mastectomy Oncologist Refuses to Discuss Options
AW0404 - Time Out Delays Surgery Verify Accuracy and Scope for Risk Management
AW0405 -
AW0406 - Preliminary understandings in advance of receiving 2nd opinions
AW0407 - complement prior analysis of mastectomy surgery issues reviewed by
AW0408 - Kaiser's surgeon during the meeting on 050727, ref SDS 50 YY7F, and
AW0409 - later discussed with the primary care physician on 050729. ref SDS 51
AW0410 - U24K
AW0412 - ..
AW0413 - During the meeting today, the doctor did not review preliminary notes
AW0414 - presented to facilitate the meeting. The doctor asked the patient to
AW0415 - verbally explain the gist of 2nd opinions, ref SDS 0 KJ4J, and this
AW0416 - was done following the outline of the record above. ref SDS 0 T533
AW0418 - ..
AW0419 - The doctor made a strongly emotional appeal with religious reference
AW0420 - to emphasize during the meeting today that saving Millie's life
AW0421 - requires immediate patient approval for mastectomy surgery without
AW0422 - performing Kaiser policy for 2nd opinions taking "Time Out" to
AW0423 - evaluate risks and benefits, reported by Millie above. ref SDS 0 E36I
AW0424 - The doctor was adament that implementing Kaiser's Time Out
AW0425 - requirements for risk management of surgery would place Millie in
AW0426 - grave danger.
AW0427 -
AW0428 - [On 090213 1140 Doctor Johnson presents religious explanation
AW0429 - of how patients face demize when science and medicine can no
AW0430 - longer resist progression of cancer. ref SDS 78 VW4G
AW0432 - ..
AW0433 - Demand for Millie to immediately approve surgery in order to save her
AW0434 - life presents urgency similar to 040614, when discovery of IBC
AW0435 - diagnosed as stage IV cancer led to concerns that survival would be a
AW0436 - matter of months, discussion of hospice, and telling Millie to "get
AW0437 - her affairs in order." ref SDS 23 QH8F
AW0438 -
AW0439 - [On 090213 case study patient advised to get affairs in
AW0440 - order for life ending in months. ref SDS 78 L19H
AW0442 - ..
AW0443 - The doctor commented emphatically that investing time for 2nd opinions
AW0444 - and comparing trade-offs of alternatives in Millie's case, delays
AW0445 - mastectomy surgery, which risks losing a "window of opportunity" for
AW0446 - local control of disease, now that testing shows IBC has subsided in
AW0447 - the left breast, following chemotherapy treatment with Taxotere and
AW0448 - capecitabine (Xeloda), discussed on 050729. ref SDS 51 5B9K The
AW0449 - doctor feels Millie erred requesting the medical team perform Kaiser's
AW0450 - "Time Out" due diligence checklist investigating proposed invasive
AW0451 - procedures, per above. ref SDS 0 E36I
AW0453 - ..
AW0454 - Guidance today insisting on immediate approval for surgery appears
AW0455 - conflicting with Kaiser's standard of care for "Time Out" listed on
AW0456 - the wall in every examination room of the Oncology Department alerting
AW0457 - doctors and patients to perform a checklist of 10 steps cross-checking
AW0458 - to verify surgery is correct for the patient, reported on 050128.
AW0459 - ref SDS 36 PJ5K
AW0461 - ..
AW0462 - [On 050923 surgeon asks patient for decision on performing
AW0463 - mastectomy surgery, and does not disclose risks of
AW0464 - recurring lymphedema and Cellulitis. ref SDS 63 G49M
AW0466 - ..
AW0467 - [On 051007 primary care physician ordered a standard
AW0468 - mastectomy, ref SDS 68 P64J, for the purpose of a
AW0469 - palliation strategy to treat possibility of future relapse,
AW0470 - ref SDS 68 6A4N, and further asked the patient to notify
AW0471 - the Surgery Department to schedule an operation.
AW0472 - ref SDS 68 MW6O
AW0474 - ..
AW0475 - [On 051019 prepared letter asking Kaiser to take Time Out
AW0476 - for performing due diligence requirements presenting risks
AW0477 - and benefits, ref SDS 69 DY5P, on the scope of mastectomy
AW0478 - surgery in this case. ref SDS 69 DZ56
AW0480 - ..
AW0481 - [On 051021 surgeon reported performing a very wide
AW0482 - mastectomy and that a standard closure was accomplished.
AW0483 - ref SDS 70 8K6N
AW0485 - ..
AW0486 - [On 061027 Millie diagnosed lymphedema and Cellulitis
AW0487 - caused by removing lymphatics during mastectomy surgery,
AW0488 - which was not a risk presented by Kaiser. ref SDS 75 HZ7N
AW0490 - ..
AW0491 - [On 070607 Cellulitis and lymphedema recurrence again,
AW0492 - Millie treated at UCSF after treatment for cancer,
AW0493 - ref SDS 76 ZH6I, Millie suffers significant emotional
AW0494 - stress. ref SDS 76 R46O
AW0496 - ..
AW0497 - Previously, on 050311 the doctor proposed surgery to treat "pockets"
AW0498 - on the left breast that resist chemotherapy treatment. ref SDS 40 PA4N
AW0499 - Subsequently, after changing treatment to Taxotere and capecitabine
AW0500 - (Xeloda), recommended by Doctor Benz in a 2nd opinion submitted by
AW0501 - UCSF, the doctor found on 060729 that IBC rash completely subsided.
AW0502 - ref SDS 51 BZ4M Examination today confirms strong response to
AW0503 - systemic treatment with chemotherapy. ref SDS 0 M57H Accordingly, the
AW0504 - rationale for left breast mastectomy surgery now appears resolved, and
AW0505 - does not present an emergency that requires immediate surgery without
AW0506 - due diligence review.
AW0508 - ..
AW0509 - For example, on 041018 Doctor Benz at UCSF advised that there is no
AW0510 - role for surgery in Millie's case. ref SDS 30 NZ6H His 2nd opinion
AW0511 - letter issued for UCSF and received from the primary care physician at
AW0512 - Kaiser on 041117 confirmed this advice. ref SDS 32 OU4U Doctor Benz
AW0513 - also recommended on 041018 that Millie be treated for pulmonary
AW0514 - embolism. ref SDS 30 LX42 Doctor Benz mentioned requirements to
AW0515 - investigate PE symptoms in his 2nd opinion reviewed on 041117.
AW0516 - ref SDS 32 OT5Q On 041104 Kaiser implemented this advice and
AW0517 - discovered pulmonary embolism. ref SDS 31 RZ4I The Benz 2nd opinion
AW0518 - received from Kaiser on 041117 also recommended Kaiser treat Millie
AW0519 - with capecitabine and Taxotere. ref SDS 32 OU6S On 050329 Kaiser
AW0520 - switches Millie's treatment to capecitabine and Taxotere. ref SDS 43
AW0521 - AW5G About 4 months later on 050727 examination finds this treatment
AW0522 - completely resolved Millie's IBC disease. ref SDS 50 YY7F
AW0524 - ..
AW0525 - After following Benz recommendations to investigate symptoms of PE,
AW0526 - and finding PE; and, after following Benz recommendations to treat IBC
AW0527 - with capecitabine and Taxotere, and cancer is completely resolved, why
AW0528 - would there be hesitation about performing due diligence to
AW0529 - investigate the role of surgery based on Benz recommendation to be
AW0530 - cautious about surgery?
AW0532 - ..
AW0533 - The doctor posed an analogy, where the role of the primary care
AW0534 - physician in the Oncology Department is like a "general contractor" or
AW0535 - "project manager" responsible for constructing a sturdy foundation to
AW0536 - ensure longevity of a new building. He explained that successful
AW0537 - treatment of the left breast to maintain local control is the
AW0538 - "foundation" for patient care in this case. The doctor compared 2nd
AW0539 - opinions on advisability, scope and performance of mastectomy surgery
AW0540 - on the left breast, per above, ref SDS 0 T533, as "cosmetics"; he gave
AW0541 - examples like painting and carpeting in his construction analogy, to
AW0542 - illustrate unnecessary delay of critical work on "foundational" issues
AW0543 - to treat the left breast with mastectomy surgery for local control.
AW0545 - ..
AW0546 - [On 050927 surgeon's notes of meeting on 050923 report that
AW0547 - mastectomy surgery is for local control and will have no
AW0548 - influence to distant disease nor survival. ref SDS 64 AK4T
AW0550 - ..
AW0551 - [On 080109 report Doctor Johnson providing 2nd opinion support on
AW0552 - internal referral from Kaiser Oncology in Walnut Creek.
AW0553 - ref SDS 77 XV8M
AW0555 - ..
AW0556 - Because of strong emotional presentation objecting to 2nd opinions,
AW0557 - the patient made no comment. Previously, the doctor supported 2nd
AW0558 - opinions for due diligence in this case...
AW0559 -
AW0560 - 1. Doctor recommended getting 2nd
AW0561 - opinions from Stanford and
AW0562 - UCSF.............................. 040318, ref SDS 21 AW6M
AW0564 - ..
AW0565 - 2. Doctor's personal practice of
AW0566 - synthesizing 2nd opinions......... 041130, ref SDS 33 5X4J
AW0568 - ..
AW0569 - 3. Doctor implemented Stanford
AW0570 - 2nd opinion in order to qualify
AW0571 - patient for trial to implement
AW0572 - UCSF 2nd opinion.................. 041230, ref SDS 35 YR8F
AW0574 - ..
AW0575 - 4. Doctor implemented UCSF 2nd
AW0576 - opinion which enabled recovery
AW0577 - from IBC in sufficient measure
AW0578 - for considering surgical
AW0579 - treatment......................... 050329, ref SDS 43 FP57
AW0581 - ..
AW0582 - The doctor's description of the primary care physician role in
AW0583 - Oncology to coordinate and collaborate, like a "project manager"
AW0584 - developing professional assistance for the patient to make a reasoned
AW0585 - decision on invasive procedures based on patient history, Kaiser's
AW0586 - analysis and recommendations, including 2nd opinions, fits the model
AW0587 - of "team care" practice for an effective "doctor patient partnership,"
AW0588 - called out in Kaiser's Healthwise Handbook, reviewed on 990625.
AW0589 - ref SDS 1 455N Doctor Grissom commented on 050912 that the oncologist
AW0590 - normally helps the patient analyse difficult choices about surgery.
AW0591 - ref SDS 58 1V8K
AW0593 - ..
AW0594 - Additionally, there is an express notice on the wall in the doctor's
AW0595 - examination room with guidance on performing the medical management
AW0596 - role. It shows a picture of a referee signaling "time out" in an
AW0597 - athletic event. The document has the title...
AW0598 -
AW0599 - Time Out
AW0600 -
AW0601 - ...and shows a due diligence checklist with approximately 10 steps for
AW0602 - the doctor to coordinate performance with the medical team in
AW0603 - verifying accuracy of diagnosis and assessment of treatment options
AW0604 - prior to invasive procedures, like mastectomy surgery in this case.
AW0605 - The "Time Out" checklist implements requirements for risk management
AW0606 - in the Healthwise Handbook to delay surgery so doctors and patients
AW0607 - can invest time verifying that a reasoned decision assessing risks and
AW0608 - benefits is supported by patient history, and that planning is
AW0609 - performed with discussions and briefings for affected doctors and
AW0610 - staff on the purpose of surgery, risks, and solutions, as shown in the
AW0611 - record on 990625. ref SDS 1 3190
AW0612 -
AW0613 - [...see below, patient proposes jont meeting to facilitate
AW0614 - collaboration on "Time Out" due diligence. ref SDS 0 6W4L
AW0616 - ..
AW0617 - [On 050923 Healthwise Handbook contains a checklist of
AW0618 - requirements for doctors to take a Time Out and perform due
AW0619 - diligence answering patient questions on proposed surgery.
AW0620 - ref SDS 63 O85O
AW0621 -
AW0622 -
AW0623 -
AW07 -
SUBJECTS
2nd Opinion Informal Verbal Internal Referral Kaiser Expert Treating
B503 -
B50401 - ..
B50402 - 2nd Opinion Internal Kaiser Doctor Expert Treating IBC
B50403 -
B50404 - During the meeting, the primary care physician cited reliance on
B50405 - another doctor, described today as the best source at Kaiser for 2nd
B50406 - opinion to treat Millie's patient history of secondary IBC. The name
B50407 - was stated too quickly for entry in the record. The doctor was asked
B50408 - for writings showing what was reviewed by this source, and what was
B50409 - presented to the primary care physician, as shown above for 2nd
B50410 - opinions consulted by the patient. ref SDS 0 T533 The doctor
B50411 - indicated there are no writings, but he feels strongly that Millie
B50412 - should consent to having a mastectomy in order to save her life.
B50413 -
B50414 - [On 080109 report Doctor Johnson providing 2nd opinion
B50415 - support on internal referral from Kaiser Oncology in
B50416 - Walnut Creek. ref SDS 77 XV8M
B50418 - ..
B50419 - At this point, Millie indicated consent to mastectomy surgery, and
B50420 - asked the doctor to schedule further testing recommended for
B50421 - determining the scope of surgery, and further to schedule another
B50422 - cycle of chemotherapy treatment to maintain the window of opportunity
B50423 - described by the doctor today.
B50425 - ..
B50426 - The doctor arranged for Millie to get a PET scan test, recommended by
B50427 - Doctor Bailey, and Doctor Grissom, per above. ref SDS 0 NL4N
B50428 -
B50429 - [On 051005 Millie got a PET and CT test combination at Kaiser in
B50430 - Walnut Creek. ref SDS 7 0001
B50432 - ..
B50433 - The doctor scheduled Millie to get another cycle of Taxotere and
B50434 - capecitabine (Xeloda) this Friday, per below, ref SDS 0 AW5G,
B50435 - recommended by Doctor Bailey 2nd opinion, per above. ref SDS 0 X594
B50437 - ..
B50438 - The doctor then called the surgeon and asked her to meet with the
B50439 - patient to schedule surgery for local control. He left a long message
B50440 - saying emphatically that he wants surgery for this patient during a
B50441 - current "window of opportunity."
B50443 - ..
B50444 - [On 050923 patient meets with surgeon, who orders thin skin
B50445 - biopsies to verify IBC subsided, and determine scope of
B50446 - mastectomy, as recommended by 2nd opinions. ref SDS 63 SZ6M
B50447 -
B50448 -
B50449 -
B50450 -
B50451 -
B505 -
SUBJECTS
Joint Meeting Requested for Collaboration of Team Care Practice to P
C803 -
C80401 - ..
C80402 - Joint Meeting Requested for Collaboration of Team Care Practice
C80403 - Collaboration Team Care Practice Requested to Plan High Risk Surgery
C80404 - Partnership Doctor Patient Joint Meeting Requested Team Care Practice
C80405 -
C80406 - Millie asked about "Time Out" for Tumor Board support on complex
C80407 - issues considering the doctor's proposal for mastectomy surgery, as
C80408 - discussed today, per above? ref SDS 0 TS5F
C80410 - ..
C80411 - The doctor feels there is not enough time for the Kaiser Tumor Board
C80412 - to review Millie's case, and objected this would delay urgently needed
C80413 - surgery, per above. ref SDS 0 5T5N
C80415 - ..
C80416 - Millie requested a joint meeting between the surgeon and the primary
C80417 - care physician, as the "general contractor" and "project manager," per
C80418 - the doctor's analogy above, ref SDS 0 5T4N, plus any others involved
C80419 - in Kaiser's team care practice supporting the case. A joint meeting
C80420 - allocates time for a "Time Out" review, per above, ref SDS 0 Q94H, to
C80421 - assess conflicting recommendations, including 2nd opinions, per above.
C80422 - ref SDS 0 E36I Since past efforts to collaborate between the Surgery
C80423 - Department and the Oncology Department have not been effective
C80424 - performing due diligence, reported on 050727, ref SDS 50 R36H, a joint
C80425 - meeting seems the only way for effective review.
C80427 - ..
C80428 - The primary care physician said that joint meetings across departments
C80429 - with a patient are hard to arrange. The doctor further indicated
C80430 - there is not enough time for doctors to perform requirements for a
C80431 - "Time Out" using a joint meeting with the patient; he expects to
C80432 - collaborate with the surgeon using Kaiser's standard team care
C80433 - practices of meetings, calls, and electronic messaging, where the
C80434 - patient is not involved. He feels strong today that a joint meeting
C80435 - is unnecessary overkill for the purpose of facilitating collaboration
C80436 - on due diligence.
C80437 -
C80438 - [On 050923 surgeon objected to joint meeting with plastic surgeon
C80439 - to review complex, high risk reconstruction of left breast.
C80440 - ref SDS 63 4G5F
C80442 - ..
C80443 - Previously, on 041130 the patient requested review by a Tumor Board to
C80444 - obtain cross-discipline collaboration on planning treatment for
C80445 - Millie, based on 2nd opinions from UCSF and from Stanford, and, also,
C80446 - after a major change in patient profile occurred. ref SDS 33 YR8F At
C80447 - that time, the request for review by the Tumor Board and a written
C80448 - work plan was rejected as unnecessary overkill. ref SDS 33 763L
C80449 -
C80450 - [On 050916 primary care physician reported during a brief meeting
C80451 - with the patient in the Chemotherapy Clinic that he had met and
C80452 - discussed Millie's case with the surgeon. Results of the meeting
C80453 - were not presented. ref SDS 59 PF3G
C80455 - ..
C80456 - [On 050923 the surgeon reported on meeting with the primary care
C80457 - physician in the hallway for a brief discussion. ref SDS 63 LP6H
C80458 -
C80459 -
C80460 -
C80461 -
C805 -
SUBJECTS
Work Plan Another Cycle Taxotere Capecitabine (Xeloda) Chemotherapy
CG03 -
CG0401 - ..
CG0402 - Treatment Plan 2 More Cycles then Pause Recover from Side Effects
CG0403 - Chemotherapy Holiday from Mid-August to After Surgery in September
CG0404 - Holiday from Treatment Planned Recover from Side Effects After Surgery
CG0405 -
CG0406 - Follow up ref SDS 51 AW5G, ref SDS 48 AW5G.
CG0407 -
CG0408 - Millie requested that Kaiser implement Doctor Bailey's recommendation
CG0409 - in a 2nd opinion consultation on 050909 to continue systemic
CG0410 - treatment, per above, ref SDS 0 X584, and while performing due
CG0411 - diligence with testing and analysis of mastectomy surgery for Millie's
CG0412 - patient profile. Due diligence will verify IBC has subsided, and,
CG0413 - also, that there is no distant metastasis, so that surgery is
CG0414 - possible, and will further determine the form of mastectomy that
CG0415 - offers the best chance for success to treat Millie's patient history,
CG0416 - reported on 050812. ref SDS 52 6L4M
CG0418 - ..
CG0419 - After discussion of objectives for foundational treatment, per above,
CG0420 - ref SDS 0 5T4J, the doctor agreed to schedule another treatment of
CG0421 - chemotherapy in order to maintain the "window of opportunity" with
CG0422 - substantial recovery from IBC symptoms, also, per above. ref SDS 0
CG0423 - 025H The doctor asked for the date of Millie's the last treatment?
CG0425 - ..
CG0426 - Millie recalled the seventh (7th) and most recent treatment cycle
CG0427 - started on 050819. She complimented the doctor for being Director of
CG0428 - such an accomplished Oncology clinic, with highly competent and
CG0429 - professional staff, but who, also, give patients a very human sense of
CG0430 - truly caring about the patient. Millie enjoyed getting a teddy bear
CG0431 - as a "graduation" present on her last visit, which was hoped at the
CG0432 - time would be her last treatment as least for some time. ref SDS 53
CG0433 - 0001
CG0435 - ..
CG0436 - The doctor calculated that Millie could have received another
CG0437 - treatment last Friday. He therefore scheduled treatment cycle number
CG0438 - eight (8) to begin this coming Friday, on 050916 and continuing with
CG0439 - the same protocol....
CG0441 - ..
CG0442 - a. Taxotere and capecitabine (Xeloda) couplet to implement the
CG0443 - work plan on 041230, ref SDS 35 D49F, and starting on 050329
CG0444 - with four (4) cycles of treatment, ref SDS 43 FP57, with dosage
CG0445 - of capecitabine (Xeloda) reduced by 25% on 050520 to reduce
CG0446 - side effects. ref SDS 47 VP3N
CG0448 - ..
CG0449 - The doctor left the examination to make arrangements with the staff in
CG0450 - the Chemotherapy Clinic. He returned a few later and advised that he
CG0451 - ordered treatment for Millie, and that this has been added to the
CG0452 - schedule for treatments in the Chemotherapy Clinic on 050916. Millie
CG0453 - will get a call on what time is assigned for treatment.
CG0454 -
CG0455 -
CG0456 -
CG0457 -
CG0458 -
CG0459 -
CG05 -
SUBJECTS
Side Effects Increase Diary Patient History Shows Tolerance for Chem
Side Effects Pharmacist Reports Millie at Low End of Severity Suffer
CL04 -
CL0501 - ..
CL0502 - b. Side Effects Rise Capecitabine (Xeloda) Patient to Exercise
CL0503 - Heavy Chest Difficult Breathing Side Effect Lack of Exercise
CL0504 - Exercise Maintain Fitness Strengthen Immune System Challenging
CL0505 -
CL0506 - Follow up ref SDS 3 NT3I, ref SDS 0 NT3I.
CL0507 -
CL0508 - The doctor explained side effects of Taxotere and capecitabine
CL0509 - (Xeloda) on 050329, ref SDS 43 NT3I; on 050415 the pharmacist
CL0510 - submitted documents detailing side effects. ref SDS 44 7F8Q On
CL0511 - 050516 considerations for reducing the potency of capecitabine
CL0512 - (Xeloda) were developed. ref SDS 46 BD4G
CL0514 - ..
CL0515 - On 050729 the doctor asked about patient history suffering side
CL0516 - effects, and Millie presented a summary. ref SDS 51 VP3N Later
CL0517 - on 050819, Zan, the pharmacist in the Chemotherapy Clinic
CL0518 - discussed side effects and commented that Millie's experience
CL0519 - is at the low end of severity compared with other patients
CL0520 - treated with chemotherapy. ref SDS 53 NY4F
CL0522 - ..
CL0523 - There was no discussion today of side effects because of time
CL0524 - performing due diligence on mastectomy surgery, including
CL0525 - review of 2nd opinions, ref SDS 0 XQ41, and scheduling another
CL0526 - treatment cycle. ref SDS 0 AW5G
CL0527 -
CL0528 -
CL0529 -
CL0530 -
CL0531 -
CL06 -
SUBJECTS
Trial Chemotherapy New Drug Treatment UCSF Millie Asks Primary Care
CP03 -
CP0401 - ..
CP0402 - c. Trial Chemotherapy New Drug Treatment UCSF
CP0403 - New Drug Trial Chemotherapy Treatment UCSF Proposed by Bailey
CP0404 -
CP0405 - Follow up ref SDS 51 L27G, ref SDS 48 L27G.
CP0406 -
CP0407 - There was no discussion of Doctor Bailey's planning on 050909
CP0408 - to contact Doctor Parks at UCSF about a new chemotherapy trial
CP0409 - which she feels might help Millie. ref SDS 57 AL3N
CP0411 - ..
CP0412 - There was, also, no follow up on the trial at UCSF cited by
CP0413 - Millie on 050520, ref SDS 47 L27G, and asking about
CP0414 - implementing the offer from Doctor Benz to collaborate on
CP0415 - Millie's treatment, cited in a 2nd opinion received on 041117.
CP0416 - ref SDS 32 OV3T
CP0417 -
CP0418 - [On 060711 Millie relapses; primary care physician
CP0419 - coordinating with protocol nurse to find drug trials that
CP0420 - may arrest progression of disease. ref SDS 73 ED4K
CP0421 -
CP0422 -
CP0423 -
CP0424 -
CP0425 -
CP05 -
SUBJECTS
Side Effects Incontinence Urinary Bladder Problem Chemotherapy Bened
Diabetes Symptom Incontinence Blood Sugar Test Ordered Meeting Docto
CW04 -
CW0501 - ..
CW0502 - Bladder Incontinence Problem from Steriods in Benedryl Treatments
CW0503 - Incontinence Side Effect Steriods in Beyedryl with Chemo Treatment
CW0504 - Urinary Problem Incontinence Steriods in Beyedryl with Chemo Treatment
CW0505 -
CW0506 - Follow up ref SDS 51 VT3O, ref SDS 48 VT3O.
CW0507 -
CW0508 - Millie reported that the bladder problem successfully treated with
CW0509 - antibiotics prescribed by the doctor on 050729. ref SDS 51 VT3O
CW0511 - ..
CW0512 - The doctor advised that tests for diabetes ordered on 050729 were
CW0513 - negative.
CW0514 -
CW0515 -
CW0516 -
CW0517 -
CW0518 -
CW0519 -
CW0520 -
CW06 -