CONTACTS 

SUBJECTS
Meeting Doctor Examine Response Chemotherapy Taxol Capecitabine Xel   0

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 78 0000. ref SDS 70 0000.
040502 -
040503 - PET scan tests shows local control with no evidence of local, regional
040504 - nor distant metastatic disease, a very favorable report. ref SDS 0
040505 - NL4N   CA 15-3 cancer marker remains steady and slightly high, but may
040506 - have declined following the last chemotherapy treatment on 050916.
040507 - ref SDS 0 GJ5M  Clinical examination today finds no evidence of
040508 - cancer. ref SDS 0 MW8J  Biopsies scheduled for 051012 will further
040509 - test recovery from IBC. ref SDS 0 I84F  A new complaint of discomfort
040510 - beneath the right breast was diagnosed as a slight muscle strain that
040511 - does not require treatment. ref SDS 0 6R6G  The doctor submitted notes
040512 - from the Plastic Surgeon which lists risks of mastectomy surgery
040513 - complications from patient history of prior radiation treatments and
040514 - diagnosis of IBC disease. ref SDS 0 MW6G  The doctor wants a standard
040515 - mastectomy surgery if biopsies are favorable, which aligns with the
040516 - surgeon. ref SDS 0 P64J  Previously, the surgeon discussed risks of a
040517 - standard mastectomy for a patient with a history of relapse, and
040518 - pulmonary emboli. ref SDS 0 638O  Research found that mastectomy
040519 - treatment is avoided for Millie's patient profile of secondary IBC
040520 - when there is no tumor within the breast to remove, or when disease
040521 - has spread beyond the breast. ref SDS 0 KE9N  The doctor presented a
040522 - palliation strategy where the purpose of surgery is not to remove
040523 - tumor within the breast causing IBC, but for future recovery if
040524 - microscopic cancer cells grow and cause eventual relapse. ref SDS 0
040525 - I482  Previously, "local control" was the purpose given for
040526 - mastectomy. ref SDS 0 MW4M  Palliation aims to relieve discomfort from
040527 - symptoms rather than treat for control and cure. ref SDS 0 676O  The
040528 - doctor ended treatment with Coumadin, explaining Kaiser's policy to
040529 - treat cancer patients with pulmonary emboli for life. ref SDS 0 GC6K
040530 - The doctor asked Millie to ask the Surgery Department to schedule
040531 - mastectomy surgery, and following the meeting this was done.
040532 - ref SDS 0 MW6O  If surgery is scheduled more than two (2) weeks ahead,
040533 - then the doctor will order another cycle of chemotherapy treatment.
040534 - ref SDS 0 AW5G  The doctor ordered retest of biopsy on 040419 to check
040535 - for status change that can significantly increase treatment options
040536 - for Millie. ref SDS 0 ZR6J  The doctor prepared a filing for
040537 - disability entitlement on cancer and mastectomy recovery. ref SDS 0
040538 - J29L
040539 -
040540 -     [On 051011 received doctor's notes of the meeting today.
040541 -     ref SDS 94 SM6M
040543 -      ..
040544 -     [On 051021 Millie has surgery for very wide mastectomy to reduce
040545 -     risks of relapse by removing skin previously infected with IBC and
040546 -     which main contain microscopic cancer cells that could otherwise
040547 -     cause relapse. ref SDS 99 EG5L
040549 -      ..
040550 -     [On 051027 surgeon reports successful mastectomy; plans to notify
040551 -     the Oncology Department about scheduling continuing treatment of
040552 -     DCIS and evaluating relapse. ref SDS A3 2562
040553 -
040554 -
040555 -
040556 -
040557 -
040559 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Agenda for Work Plan After Switching to Taxotere and Capecitabine
040902 -
040903 - Follow up ref SDS 78 SM6M, ref SDS 70 SM6M.
040904 -
040905 - This is the 6th review meeting after changing treatment to Taxotere
040906 - and capecitabine (Xeloda) initiated on 050329, ref SDS 59 T58M, and
040907 - starting on 050415, ref SDS 60 0001, and occurs after the 8th cycle of
040908 - treatments that began on 050916. ref SDS 79 407N
040910 -  ..
040911 - Millie created an agenda on the marking board...
040912 -
040913 -    1.  CA 15-3 cancer marker report............... ref SDS 0 GJ5M
040914 -    2.  Breast exam recovering IBC................. ref SDS 0 025H
040915 -    3.  Discomfort below right breast.............. ref SDS 0 6R6G
040916 -    4.  Surgeon due diligence...................... ref SDS 0 XQ41
040917 -    5.  Coumadin pause 5 days...................... ref SDS 0 RZ4I
040918 -    6.  Treatment plan............................. ref SDS 0 AW5G
040919 -    7.  Status change treatment options............ ref SDS 0 ZR6J
040920 -    8.  Medical disability......................... ref SDS 0 J29L
040921 -
040922 -
040923 -
040924 -
040925 -
040926 -
0410 -

SUBJECTS
CA 15-3 45 and 6 Points Above Normal 39 Stable for 3 Weeks Continues

1203 -
120401 -  ..
120402 - CA 15-3 Cancer Marker 45 Stable for 3 Weeks
120403 -
120404 - Follow up ref SDS 78 087J, ref SDS 70 087J.
120405 -
120406 - The most recent blood test on 050909 shows CA 15-3 remained steady at
120407 - 45, and within 6 points of the high end of normal (39), for several
120408 - tests since 050819, as shown in a report submitted by the doctor
120409 - today...
120411 -           ..
120412 -          Test Date                         Date Received
120413 -          050909......... 45 H............. 051007, ref SDS 0 087JL
120414 -          050826......... 45 H............. 050913, ref SDS 78 087JL
120415 -          050819......... 45 H............. 050913, ref SDS 78 087JL
120416 -          050812......... 39 .............. 050819, ref SDS 72 3K6L
120417 -          050729......... 45 H............. 050819, ref SDS 72 EA5G
120418 -          050708......... 46 H............. 050729, ref SDS 70 087J
120419 -          050701......... 37 .............. 050708, ref SDS 67 2N5J
120420 -          050617......... 45 H............. 050729, ref SDS 70 087J
120421 -          050527......... 56 H............. 050610, ref SDS 65 087J
120422 -          050512......... 67 H............. 050520, ref SDS 64 087J
120423 -          050506......... 80 H............. 050520, ref SDS 64 087J
120424 -    050415.........105 H............. 050422, ref SDS 61 087J
120425 -          050325.........100 H............. 050329, ref SDS 59 087J
120426 -          050318.........101 H............. 050325, ref SDS 58 2N5J
120427 -          050304......... 88 H............. 050311, ref SDS 56 087J
120428 -          050225......... 95 H............. 050308, ref SDS 55 0001
120429 -          050211......... 78 H............. 050214, ref SDS 54 02BB
120430 -          050128......... 67 H............. 050204, ref SDS 53 087J
120431 -          041228......... 56 H............. 041230, ref SDS 51 087J
120432 -          041204......... 43 H............. 041210, ref SDS 50 087J
120433 -          041007......... 39............... 041104, ref SDS 46 087J
120434 -          040923......... 49 H............. 041005, ref SDS 44 087J
120435 -          040908......... 44 H............. 040909, ref SDS 43 087J
120436 -          040825......... 47 H............. 040812, ref SDS 43 087J
120437 -          040811......... 42 H............. 040812, ref SDS 41 087J
120438 -          040728......... 43 H............. 040729, ref SDS 38 2N5J
120439 -          040712......... 47 H............. 040713, ref SDS 37 087J
120440 -          040614......... 55 H............. 040615, ref SDS 36 PX6X
120441 -          040517......... 78 H............. 040601, ref SDS 34 2N5J
120442 -          040311......... 70 H............. 040318, ref SDS 28 SM6M
120443 -          040205......... 60 H............. 040211, ref SDS 27 SM6M
120444 -          031201......... 62 H............. 031205, ref SDS 25 SM6M
120445 -          030912......... 66 H............. 030915, ref SDS 24 SM6M
120446 -          030708......... 68 H............. 030710, ref SDS 22 SM6M
120447 -          030503......... 54 H............. 030508, ref SDS 19 SM6M
120448 -          030403......... 45 H............. 030508, ref SDS 19 SM6M
120449 -          030215......... 46 H............. 030220, ref SDS 18 5E6L
120450 -          030106......... 37 H............. 030109, ref SDS 17 SM6M
120451 -          021202......... 41 H?............ 021204, ref SDS 16 SP5G
120452 -          021111......... 36 H?............ 021113, ref SDS 15 Y65I
120453 -          021023......... 33 H?............ 021023, ref SDS 14 SQ5I
120454 -          020930......... 33 H?..29........ 021002, ref SDS 13 SQ5I
120455 -          020917......... 36 H?............ 020924, ref SDS 12 SQ5I
120456 -          020717......... 59 H?............ 020726, ref SDS 11 YN5K
120457 -          020629......... 75 H ............ 020705, ref SDS 10 UX6I
120458 -          020608........  67 H ............ 020614, ref SDS 9 0001
120459 -          020603........ 108 H ............ 020607, ref SDS 8 X67F
120460 -          020511........ 117 H ............ 020603, ref SDS 7 PJ4J
120461 -          020419......... 81 H ............ 020430, ref SDS 5 7N5H
120462 -          020321......... 85 H ............ 020405, ref SDS 4 6T8K
120463 -
120464 -
120466 -  ..
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 78 GJ5M, ref SDS 70 GJ5M.
120804 -
120805 - The doctor indicated that the record of CA 15-3 tests showing steady
120806 - level at 45 for nearly a month, and 6 points above the high end of
120807 - normal (39), per above, ref SDS 0 087J, supports examination today,
120808 - and, also, the results of PET scan testing that indicates the patient
120809 - has a favorable response to treatment for IBC, and therefore the
120810 - patient is ready for mastectomy surgery proposed by the doctor on
120811 - 050729. ref SDS 70 5B9K
120813 -  ..
120814 - There is nothing in the PET scan test report received today that
120815 - indicates why CA 15-3 should remain steady at six (6) points above
120816 - normal.  Favorable PET scan test reporting suggests that prior
120817 - analysis on 050913 citing review on 050610 of the CT scan test on
120818 - 050530 indicated lymph node activity almost totally resolved,
120819 - ref SDS 65 WA52, and so may align with persistent CA 15-3 history of
120820 - 45, slightly above normal, ref SDS 78 KV59, and in accordance with
120821 - analysis on 050729, ref SDS 70 Y44G, now seems no longer supported.
120822 -
120823 -     [On 051027 biopsy on tissue from left breast mastecomy found
120824 -     atypical cells consistent with DCIS, which were not detected by
120825 -     PET and mammogram tests, and so was removed by surgery; but, could
120826 -     DCIS not detected by PET and mammogram testing also be causing
120827 -     elevated CA 15-3 and enlarged right axillary lymph nodes?
120828 -     ref SDS A3 BA5G
120830 -  ..
120831 - Since PET scan test was performed on 051005, ref SDS 88 0001, and
120832 - several weeks after the last chemotherapy treatment on 050916,
120833 - ref SDS 79 407N, CA 15-3 may now have dropped into the normal range,
120834 - subsequent to the last test on 050909, per above. ref SDS 0 087J
120836 -  ..
120837 - Results today appear to align with examination on 050923 by the
120838 - surgeon indicating compliance with criteria on CA 15-3 cancer marker
120839 - for determining that the patient is ready for mastectomy surgery.
120840 - ref SDS 84 YK6K
120841 -
120842 -
120843 -
120844 -
120845 -
120846 -
120847 -
1209 -

SUBJECTS
PET/CT Scan Local Control Test on 051005 Pathology Report Analyst Fi

2503 -
250401 -  ..
250402 - PET Scan Test Report Shows Local Control with No Evidence of Cancer
250403 -
250404 - Follow up ref SDS 78 NL4N, ref SDS 70 NL4N.
250405 -
250406 - See discussion on rising CA 15-3, per above. ref SDS 0 UW6F
250408 -  ..
250409 - On 050913 the doctor ordered PET scan, ref SDS 78 NL4N, recommended in
250410 - 2nd opinions by Grissom and Bailey to test for control of metastatic
250411 - cancer in connection with deciding on mastectomy surgery of the left
250412 - breast. ref SDS 78 VO50  On 051005 PET scan test performed at Kaiser
250413 - in Walnut Creek. ref SDS 88 0001
250415 -  ..
250416 - The last PET test for Millie was on 021218, and received from the
250417 - doctor during a meeting on 030109. ref SDS 17 LK5L  The last imaging
250418 - test with CT scan was on 050530 and received from the doctor during
250419 - a meeting on 050610. ref SDS 65 NL4N  This test history presents a
250420 - patient profile with no evidence of distant metastatic disease...
250422 -         ..
250423 -        Test History No Evidence Distant Metastasis
250424 -
250425 -          Type  Date               Received          Source
250426 -           PET  051005 reported on 051007........... ref SDS 0 WJ6G
250427 -           CT   050530 reported on 050610........... ref SDS 66 G75L
250428 -           CT   050325 reported on 050422........... ref SDS 62 G75L
250429 -           CT   041217 reported on 041230........... ref SDS 52 G75L
250430 -           CT   041103 reported on 041104........... ref SDS 47 NL4N
250431 -           CT   040921 reported on 041005........... ref SDS 45 NL4N
250432 -           CT   040710 reported on 040811........... ref SDS 40 DU9I
250433 -           CT   040410 reported on 040416........... ref SDS 32 HX4K
250434 -           CT   040307 reported on 040318........... ref SDS 29 LK5L
250435 -           CT   031031 reported on 031205........... ref SDS 26 IG9K
250436 -           CT   030626 reported on 030710........... ref SDS 23 AL6N
250437 -           CT   030428 reported on 030508........... ref SDS 20 LK5L
250438 -           PET  021218 reported on 030109........... ref SDS 17 LK5L
250439 -           PET  020529 reported on 020603........... ref SDS 7 0001
250441 -  ..
250442 - Today, the doctor submitted preliminary results of a combined PET and
250443 - CT scan test performed on 051005.
250445 -  ..
250446 - The report is marked throughout with the following notice...
250447 -
250448 -               ***** Report Not Authenticated *******
250449 -
250450 -            We need an authenticated report for the PET scan test.
250452 -      ..
250453 -     Patient
250461 -      ..
250462 -     68/F Radiology Report               Exam  1 of 1
250464 -      ..
250465 -     WHOLE BODY FDG PET/CET STUDY  (digital)
250467 -      ..
250468 -     Ordered by:
250471 -      ..
250472 -     Ordered on:  051005 0617 at WCR Outpatient
250474 -      ..
250475 -     Performed In:  WCR
250477 -      ..
250478 -     Read by:
250481 -      ..
250482 -     HISTORY
250483 -
250484 -        69-year old white female with hx of breast cancer and hx of
250485 -        left neck recurrence.  PET evaluation requested.
250486 -
250488 -      ..
250491 -      ..
250492 -     RADIOPHARMACEUTICAL:  F-18 2-deoxy-2-fluoro-D-glucose, 14.6 mCi IV
250494 -      ..
250495 -     COMPARISON:  Body FDG PET study 021218, ref SDS 17 LK5L
250497 -      ..
250498 -     TECHNIQUE:
250499 -
250500 -        A multi-slice spiral CT of the forehead through the distal
250501 -        thighs was obtained with oral contrast per standard protocol.
250502 -        Corresponding emission images were obtained using a ring PET/CT
250503 -        scanner in multiple bed positions.  AC corrected PET images, CT
250504 -        and fused PET/CT imaging were reviewed.
250506 -         ..
250507 -        The CT portion of the study is a relatively low dose study and
250508 -        intended only for attenuation correction and anatomic
250509 -        correlation of PET images.  A regular CT with contrast should
250510 -        be obtained for diagnostic and clinical decisions.
250512 -      ..
250513 -     Findings
250514 -
250515 -        Images of the visualized portions of the head and neck
250516 -        demonstrate symmetric uptake in the oropharyngeal regions
250517 -        consistent with physiologic activity.  No definite focal
250518 -        abnormalities are identified.
250520 -         ..
250521 -        Images of the thorax demonstrate physiologic myocardial
250522 -        activity without definite focal lessions noted.
250524 -         ..
250525 -        Images of the abdoman and pelvis demonstrate somewhat
250526 -        hetrogeneous distribution of the radioisotope throughout the
250527 -        liver.  However, definite hypermetabolic foci are identified.
250528 -        Other areas of uptake appear to relate to expected bowel and
250529 -        urinary tract activity.
250531 -         ..
250532 -        Review of the bone marrow demonstrates physiologic distribution
250533 -        without focal lessions noted.
250535 -         ..
250536 -        Compared to the prior PET examination 021218, the previously
250537 -        identified multiple abnormalities involving the left lung
250538 -        apex, the left 11th rib, and the left axillae and L5 are not
250539 -        noted on today's study.
250541 -  ..
250542 - Do these findings impliedly resolve prior findings of enlarged right
250543 - axillary lymph node in the CT test on 050530, and received from the
250544 - doctor on 050610, ref SDS 65 WA52, which was cited for possible cause
250545 - of persistently elevated CA 15-3, per the report today. ref SDS 0 087J
250546 -
250547 -     [On 051027 biopsy on tissue from left breast mastecomy found
250548 -     atypical cells consistent with DCIS, which were not detected by
250549 -     PET and mammogram tests, and so was removed by surgery; but, could
250550 -     DCIS not detected by PET and mammogram testing also be causing
250551 -     elevated CA 15-3 and enlarged right axillary lymph nodes?
250552 -     ref SDS A3 BA5G
250554 -      ..
250555 -     [On 051121 primary care physician submitted biopsy and considered
250556 -     findings of DCSI; no further testing was ordered, and the patient
250557 -     was found NED. ref SDS A4 KV9G
250559 -  ..
250560 - This finding appears to resolve prior PET test on 021218 and received
250561 - from the doctor on 030109 showing new mild diffuse increased uptakes
250562 - at the region of the left axilla as well as the left upper chest wall
250563 - both anteriorly and posteriorly including the left supraclavicular
250564 - region, ref SDS 17 L66M, which taken together indicate symptoms of IBC
250565 - diagnosed subsequently through a biopsy report received on 040517.
250566 - ref SDS 33 7D6F
250568 -  ..
250569 - This finding further aligns with bone scan report received on 040713
250570 - comparing PET scan test taken on 021218, and received from the doctor
250571 - on 030109, and where the bone scan test reported finding no evidence
250572 - of abnormalities on 11th rib. ref SDS 37 I27I
250574 -  ..
250575 - PET scan report continues...
250576 -
250577 -     Impression
250578 -
250579 -     1.  Body FDG PET/CT study demonstrating no definite hypermetabolic
250580 -         foci to confirm the presence residual or recurrent disease.
250582 -          ..
250583 -     2.  Compared to the most recent PET study 021216, resolution of
250584 -         the previously noted multiple abnormalities is identified.
250586 -  ..
250587 - This impression conveys finding that no tumor mass in the left breast
250588 - and no evidence of cancer of any kind anywhere else in the body was
250589 - detected by PET scan testing.
250590 -
250591 -         [...see below, doctor remains concerned about relapse from
250592 -         microscopic cancer cells not detected by the test today,
250593 -         ref SDS 0 IV4G, and so recommends mastectomy for palliation of
250594 -         future relapse. ref SDS 0 6A4N
250596 -          ..
250597 -         [On 051021 surgeon reported finding no evident tumor during
250598 -         mastectomy surgery to remove the left breast, and attempted a
250599 -         very wide mastectomy to remove previoulsy involved skin
250600 -         infected with IBC. ref SDS 98 MM6M
250602 -          ..
250603 -         [On 051027 biopsy on mastectomy surgery finds ductal carcinoma
250604 -         in situ (DCIS) in nipple tissue that is commonly discovered
250605 -         with mammogram tests, and conflicts with PET scan and
250606 -         mammogram testing. ref SDS A3 615K
250608 -  ..
250609 - Comparing the test today with a prior PET study dated "021216"
250610 - conflicts with Comparison section in the report listing a prior test
250611 - dated 021218. ref SDS 0 S47F
250613 -  ..
250614 - Why no comparison to resolve findings of enlarged right axillary lymph
250615 - node in the most recent CT test on 050530, and received from the
250616 - doctor on 050610? ref SDS 65 WA52  See further discussion below.
250617 - ref SDS 0 MF6L
250618 -
250619 -     [On 051027 analysis of disease-free status indicates microscopic
250620 -     cancer cells may present continuing risk of relapse. ref SDS A3
250621 -     F46J
250623 -      ..
250624 -     [On 051121 primary care physician submitted biopsy and considered
250625 -     findings of DCSI; no further testing was ordered, and the patient
250626 -     was found NED. ref SDS A4 KV9G
250628 -  ..
250629 - Millie was warmly congratulated during the meeting on such a favorable
250630 - PET scan test report showing local control and no evidence of distant
250631 - metastasis at this time, ref SDS 0 L66M, and therefore opening the
250632 - possibility that achieving local control might bring a period of
250633 - disease-free survival, as a result of timely change in treatment
250634 - strategy on 050329. ref SDS 59 E87M
250635 -
250636 -
250637 -
250638 -
250639 -
250640 -
2507 -

SUBJECTS
Axillary Right Lymph Nodes CT Test 050530 Shows No Distant Matastasi
Axillary Right Lymph Nodes PET Test Resolves Left Axilla No Express

3404 -
340501 -  ..
340502 - Lymph Nodes Right Left Axillary PET Test No Evidence Adenopathy
340503 - PET Test Right Left Axillary No Evidence Lumps Lympadenopathy
340504 -
340505 - Follow up ref SDS 78 B58M, ref SDS 70 B58M.
340506 -
340507 - See discussion on rising CA 15-3, per above. ref SDS 78 ST6G
340509 -  ..
340510 - PET scan test report seems to find no activity under the left or right
340511 - axilla.  The report expressly states prior abnormalities for the left
340512 - side axillary identified in 2002, are now resolved, and there is no
340513 - mention of findings for the right side. ref SDS 0 IE5R
340515 -  ..
340516 - The CT test report received on 050610 stated that activity in the
340517 - right axilla is almost totally resolved. ref SDS 65 WA52
340519 -  ..
340520 - The analyst for the PET scan test on 051005 should be asked if this
340521 - test now totally resolves prior findings on 050530, and received on
340522 - 050610. ref SDS 65 B58M  If not, then this might explain slightly and
340523 - persistently elevated CA 15-3. ref SDS 0 087J
340524 -
340525 -     [On 051121 primary care physician submitted biopsy and considered
340526 -     findings of DCSI; no further testing was ordered, and the patient
340527 -     was found NED. ref SDS A4 KV9G
340528 -
340529 -
340530 -
340531 -
340532 -
3406 -

SUBJECTS
Axillary Right Left Lymph Nodes Examination Finds No Adenopathy Evid

4003 -
400401 -  ..
400402 - Examination Right Left Axillary No Evidence Lumps Lympadenopathy
400403 - Right Left Axillary Examination No Evidence Lumps Lympadenopathy
400404 -
400405 - Follow up ref SDS 78 MW8J, ref SDS 70 MW8J.
400406 -
400407 - See discussion of stable CA 15-3, per above. ref SDS 0 GJ5M
400409 -  ..
400410 - During the meeting, the doctor examined both left and right axilla and
400411 - reported no findings of lumps nor other indications of adenopqathy.
400412 - This aligns with Millie's experience feeling no discomfort or swelling
400413 - for the past 3 to 4 months.
400415 -  ..
400416 - PET scan report received today indicates favorable findings, but does
400417 - not expressly resolve prior findings of the CT test reviewed on
400418 - 050610, per action item above. ref SDS 0 IE5R
400419 -
400420 -
400421 -
400422 -
400423 -
4005 -

SUBJECTS
Neck Lumps Clinical Examination Found No Adenopathy Aligns with Find

4603 -
460401 -  ..
460402 - Examination Lumps in Neck Found No Adenopathy
460403 - Lumps in Neck Examination Found No Adenopathy
460404 -
460405 - Follow up ref SDS 78 8R6M, ref SDS 70 8R6M.
460406 -
460407 - The doctor examined the right and left clavicular and commented
460408 - finding no lumps or other indications of lymphadenopqathy.
460410 -  ..
460411 - PET scan test report today indicates no evidence of cancer.
460412 - ref SDS 0 GJ4S
460413 -
460414 -
460415 -
460416 -
460417 -
4605 -

SUBJECTS
Biopsy Wound Left Breast 040419 Required Nearly a Year to Heal Cited

5603 -
560401 -  ..
560402 - Wound Biopsy Fully Healed with Treatment Taxotere Capecitabine
560403 -
560404 - Follow up ref SDS 78 6T5G, ref SDS 70 6T5G.
560405 -
560406 - Systemic treatment healed the biopsy wound after a long effort lasting
560407 - nearly a year, and after changing the chemotherapy protocol, reported
560408 - previously on 050727. ref SDS 70 6T5G
560410 -  ..
560411 - Extended healing time was cited by the surgeon on 050923 describing
560412 - increased risks of mastectomy surgery for Millie's patient profile of
560413 - secondary IBC, history of relapse, and pulmonary emboli. ref SDS 84
560414 - KF6I
560415 -
560416 -
560417 -
560418 -
560419 -
5605 -

SUBJECTS
Examination Left Breast No Clinical Evidence IBC Inflammation Subsid

6203 -
620401 -  ..
620402 - Examination Left Breast No Clinical Evidence IBC Inflammation Subsides
620403 - Regression IBC Symptoms Achieve by Taxotere Capecitabine Xeloda
620404 - IBC Appears Entirely Resolved with No Inflammation and Thickened Skin
620405 -
620406 - Follow up ref SDS 78 025H, ref SDS 70 025H.
620407 -
620408 - The doctor examined the left breast and commented that both breasts
620409 - still appear similar and normal, with no coloration, flushness, nor
620410 - inflammation, and in all respects aligned with findings from the prior
620411 - examination on 050913, ref SDS 78 M57H, when the doctor concluded that
620412 - the patient is ready for surgery, based on having maintained prior
620413 - favorable conditions reported by the surgeon from examination on
620414 - 050727. ref SDS 69 YY7F
620416 -  ..
620417 - PET scan test report today indicates no evidence of cancer tumor in
620418 - the left breast. ref SDS 0 GJ4S
620420 -  ..
620421 - On 050923 the surgeon ordered thin skin biopsies to assess recovery
620422 - from IBC in the left breast, and guide the scope of mastectomy surgery
620423 - for boundaries to remove previously infected breast skin that reduces
620424 - the risk of relapse, ref SDS 84 SZ6M, discussed earlier with the
620425 - primary care physician during the meeting on 050913. ref SDS 78 OY5M
620426 - Surgeon proposed on 050923 that if biopsies on the breast skin are
620427 - favorable and complement PET scan test report showing negative signs
620428 - of cancer, then Kaiser wants patient to consider a standard
620429 - mastectomy. ref SDS 84 4G4L  (see discussion below. ref SDS 0 P64J)
620431 -  ..
620432 - On 050929 Surgery Department called and scheduled surgical skin biopsy
620433 - tests on 051012. ref SDS 87 PPUQ
620434 -
620435 -     [On 051012 biopsies on left breast taken at Kaiser to further
620436 -     evaluate recovery from IBC. ref SDS 95 DG6J
620438 -      ..
620439 -     [On 051018 Millie notified of favorable results from skin
620440 -     biopsies, no evidence of cancer. ref SDS 96 QN3I
620441 -
620442 -
620443 -
620444 -
620445 -
6205 -

SUBJECTS
Stomach Muscle Pull Likely Discomfort New Below Right Breast No Trea

6503 -
650401 -  ..
650402 - New Discomfort Below Right Breast Likely Muscle Pull
650403 -
650404 - Millie reported a new problem within the past few days.  There is
650405 - mild discomfort now below the right breast.
650407 -  ..
650408 - The doctor examined this new complaint carefully.  Initial diagnosis
650409 - is a slight muscle pull.  There is no evident relation to cancer
650410 - diagnosis.  A muscle strain could have occurred a week ago while
650411 - visiting in Southern California.  Millie had some slight difficulty
650412 - getting up from a low easy chair.  Something like that event might
650413 - have caused the current problem.
650414 -
650415 -
650416 -
650417 -
650418 -
650419 -
650420 -
6505 -

SUBJECTS
Standard Mastectomy Surgery Ordered by Primary Care Physician If Bio
Meeting Notes Plastic Surgeon Consultation with Patient on 050928 Re

A204 -
A20501 -  ..
A20502 - Schedule Surgery Time Out for Due Diligence
A20503 - Surgery Reduce Chances IBC Relapse Schedule 10 Days After Vacation
A20504 - Due Diligence on Criteria Mastectomy Performed by Surgery Department
A20505 -
A20506 - Follow up ref SDS 78 XQ41, ref SDS 70 XQ41.
A20507 -
A20508 - Background on due diligence for surgery in this case is summarized on
A20509 - 041210, ref SDS 50 ZV5J, and case study to extend quality of life by
A20510 - preventing disease from cascading out of control is reported on
A20511 - 041230. ref SDS 51 XV7M
A20513 -  ..
A20514 - Criteria for performing mastectomy surgery in this case was discussed
A20515 - with the surgeon on 050324, ref SDS 57 OV5H, carrying out a request by
A20516 - the doctor during a meeting with the patient on 050311. ref SDS 56
A20517 - PB4N  Mastectomy was analysed again by the surgeon four (4) months
A20518 - later on 050727. ref SDS 69 OV5H
A20520 -  ..
A20521 - Two weeks ago during a meeting at Kaiser on 050923 the surgeon updated
A20522 - her analysis, citing risks of relapse from a standard mastectomy for a
A20523 - patient profile diagnosed with secondary IBC, multiple relapse, and
A20524 - pulmonary emboli being treated with Coumadin. ref SDS 84 O15H  At that
A20525 - time, the surgeon asked Millie about approving surgery based on
A20526 - presentation of risks and benefits. ref SDS 84 G49M  The surgeon's
A20527 - notes were received on 050927. ref SDS 85 T14N
A20528 -
A20529 -        [On 061027 Millie diagnosed lymphedema and Cellulitis
A20530 -        caused by removing lymphatics during mastectomy surgery,
A20531 -        which was not a risk presented by Kaiser. ref SDS B5 HZ7N
A20533 -  ..
A20534 - Last week on 050928 the Plastic Surgeon, Doctor Smith, explained risks
A20535 - of relapse for a wide mastectomy with reconstruction proposed by
A20536 - Doctor Grissom to reduce risks of a standard mastectomy. ref SDS 86
A20537 - UM4I
A20539 -  ..
A20540 - Today, the doctor related having recently discussed Millie's case with
A20541 - both the surgeon, and the Plastic Surgeon, Doctor Smith.  No record
A20542 - was submitted to the patient showing what was said between the
A20543 - doctors, as was submitted to Kaiser on 050913 showing consultations
A20544 - for 2nd opinions. ref SDS 78 KP9F  This follows up on collaboration
A20545 - issues reported on 050913, per below. ref SDS 0 6W4L
A20547 -  ..
A20548 - Millie explained discussions yesterday with the advice nurse in
A20549 - Plastic Surgery.  Chantel said that Doctor Smith's notes from
A20550 - consultation with the patient on 050928 were completed yesterday, and
A20551 - can be obtained from the primary care physician during the meeting
A20552 - today. ref SDS 90 XM9J
A20554 -  ..
A20555 - The doctor found Doctor Smith's notes on Kaiser's computer.  He
A20556 - printed a copy and handed it to Millie. ref DRT 1 0001  The doctor
A20557 - did not review Doctor Smith's report during the meeting.  Review
A20558 - after the meeting shows...
A20560 -  ..
A20561 - Doctor Smith's report for 050928...
A20562 -
A20563 -            The patient... [has] been somewhat confused by the variety
A20564 -            of opinions and would like my opinion with regard to
A20565 -            utilization of an abdominal myocutaneous or free
A20566 -            microvasular flap at the time of palliative mastectomy.
A20567 -            ref DRT 1 6E9L
A20569 -  ..
A20570 - Doctor Smith did not discuss "palliative mastectomy" during the
A20571 - meeting on 050928, and this term has not previously occurred in
A20572 - patient history, ref SDS 86 0001, until today when the primary care
A20573 - physician used the term after submitting Doctor Smith's report today,
A20574 - per below. ref SDS 0 6A4N
A20576 -  ..
A20577 - Doctor Smith's report for 050928 continues...
A20578 -
A20579 -            BREASTS:  Examination... diffuse slight erythema of the
A20580 -            skin.  There are no palpable dominant masses.  The right
A20581 -            breast is with grade I ptosis and more potitic than that of
A20582 -            the left breast. ref DRT 1 KO94
A20584 -  ..
A20585 - "ptosis" - from the practice of plastic surgery; the doctor here
A20586 - describes the right breast has normal suppleness, while the left
A20587 - breast is less so due to a surgical scar.
A20588 -
A20589 -              http://www.phudson.com/MASTO/FAQ/mastoclassify.html
A20591 -  ..
A20592 - Doctor Smith's report for 050928 continues...
A20593 -
A20594 -            ABDOMEN:  Notable for a vertical midline scar extending
A20595 -            from below the umbilicus to the suprapubic region.  There
A20596 -            is a separate scar, likely representing a previous drain
A20597 -            site in the left pubic area.  Abdomen is notable for
A20598 -            minimal but somewhat slight lipodystrophy.  No palpable
A20599 -            abdominal herniations.  The midline vertical scar
A20600 -            reportedly is secondary from a previous gynecologic
A20601 -            procedure. ref DRT 1 KO49
A20603 -  ..
A20604 - During the meeting on 050928 Doctor Smith explained that tissue from
A20605 - the abdomen may be proscribed for reconstruction due to lack of blood
A20606 - vessels, which would defeat the purpose of mastectomy to replace
A20607 - previously infected skin and breast mass with tissue that has healthy
A20608 - blood supply for delivering treatment and nutrients essential to
A20609 - prevent and treat a future relapse. ref SDS 86 248I
A20610 -
A20611 -                [On 060922 analysis of slow recovery with the same
A20612 -                chemotherapy treatment following IBC relapse on 060623,
A20613 -                ref SDS B1 9E6L, cites Doctor Smith's anlaysis on the
A20614 -                impact of diminished capacity for blood vessels.
A20615 -                ref SDS B1 ML3I
A20617 -                 ..
A20618 -                [On 051110 doctor reports IBC rash on left breast area
A20619 -                is "stable," ref SDS B6 ZL5W, indicating recovery is
A20620 -                very slow, because on 051021 blood vessels were removed
A20621 -                from the treatment area by mastectomy surgery, per
A20622 -                analysis of expectations on 060929. ref SDS A3 EH3F
A20623 -
A20625 -     ..
A20626 -    Postpone Aggressive Treatment Breast Reconstruction
A20627 -    Breast Reconstruction Postpone Aggressive Treatment
A20628 -    Conservative Initial Mastectomy Postpone Breast Replacement
A20629 -
A20631 -  ..
A20632 - Doctor Smith's report for 050928 continues...
A20633 -
A20634 -            ...general surgeon is recommending skin biopsies and a
A20635 -            conservative wide reapproximation of the margins.
A20636 -            ref DRT 1 KO58
A20638 -             ..
A20639 -            ...patient...is certainly at risk [for wound healing
A20640 -            complications] because of her previous radiation history
A20641 -            and the presence of potential inflammatory breast cancer...
A20642 -            ref DRT 1 KO64
A20644 -             ..
A20645 -            ...postpone... a TRAM or a DIEP flap in this case as the
A20646 -            patient is at extremely high risk for surgical and
A20647 -            postoperative and anesthetic complications given her
A20648 -            prolonged PT/PTT, history of pulmonary embolism, previous
A20649 -            abdominal surgery and the unknown nature of the extent of
A20650 -            her inflammatory breast cancer.  The potential wound which
A20651 -            may result with an immediate TRAM or DIEP flap procedure
A20652 -            may be far worse than the outcome from a more conservative
A20653 -            approach. ref DRT 1 LX3J
A20655 -  ..
A20656 - Doctor Smith's report substantially aligns with the record of meeting
A20657 - on 050928. ref SDS 86 UM4I  The doctor proposed on 050928 conservative
A20658 - surgery o perform a very wide mastectomy that reduces risk of relapse,
A20659 - and, also, reduce risks of complications by postponing concurrent and
A20660 - complex breast reconstruction, by making instead a standard closure
A20661 - until clear margins are established. ref SDS 86 245N
A20662 -
A20663 -                [On 060711 Millie relapses; consideration of performing
A20664 -                previously postponed breast reconstruction that will
A20665 -                reduce risk of relapse by replacing infected tissue
A20666 -                with skin grafts, and permit radiation in the event of
A20667 -                further relapse. ref SDS A6 X54L
A20669 -  ..
A20670 - Doctor Smith's report for 050928 concludes...
A20671 -
A20672 -            All questions were answered to the patient's and husband's
A20673 -            satisfaction, and I did call our regional microvasculature
A20674 -            tissue transfer surgeon to attain another opinion with
A20675 -            regard to her aggressiveness with the use of a DIEP flap in
A20676 -            this case and have discussed this with [general surgeon].
A20677 -            ref DRT 1 KP39
A20679 -  ..
A20680 - Stating that "all questions were answered" requires presenting
A20681 - questions asked, along with answers given, and including feedback to
A20682 - verify accuracy of understandings, as called out by Kaiser's
A20683 - Healthwise Handbook explaining due diligence on patient
A20684 - communications, reviewed on 990625. ref SDS 1 3960
A20686 -  ..
A20687 - Where is Doctor Smith's report on results of calling the regional
A20688 - microvasculature tissue transfer surgeon; what background was
A20689 - presented, and what response occurred?  What was discussed with the
A20690 - general surgeon?  How does that discussion align with patient history?
A20692 -  ..
A20693 - The primary care physician proposed today that, if biopsies ordered by
A20694 - the surgeon, per above, ref SDS 0 I84F, are favorable, like the PET
A20695 - scan test report today, again per above, ref SDS 0 L66M, and show no
A20696 - evidence of remaining cancer in the skin of the left breast, then
A20697 - Millie should consent to a standard mastectomy for palliation, rather
A20698 - than a very wide mastectomy with reconstruction for reducing the risk
A20699 - of relapse, as presented on 050913. ref SDS 78 X545  The doctor's
A20700 - recommendation today for a standard mastectomy aligns with the
A20701 - surgeon's proposal in the meeting on 050923, ref SDS 84 4G4L, as shown
A20702 - in the surgeon's notes received on 050927. ref SDS 85 EU67   At that
A20703 - time on 050923 the surgeon presented risks of what can wrong to harm
A20704 - the patient from mastectomy surgery, and asked Millie about approval
A20705 - to proceed. ref SDS 84 G49M
A20706 -
A20707 -     [On 051012 biopsies on left breast taken at Kaiser to further
A20708 -     evaluate recovery from IBC. ref SDS 95 DG6J
A20710 -      ..
A20711 -     [On 051011 Doctor Bailey comments that risks of mastectomy
A20712 -     are compounded for secondary IBC patients, because, where
A20713 -     there is no evident tumor to remove within the breast,
A20714 -     benefits of palliation are reduced by removing breast mass
A20715 -     with blood vessels needed to treat relapse of cancer.
A20716 -     ref SDS 93 G65S
A20718 -      ..
A20719 -     [On 051018 Millie notified of favorable results from skin
A20720 -     biopsies, no evidence of cancer. ref SDS 96 QN3I
A20722 -      ..
A20723 -     [On 051019 prepared letter asking Kaiser to take Time Out for
A20724 -     performing due diligence requirements presenting risks and
A20725 -     benefits, ref SDS 97 DY5P, on the scope of mastectomy surgery in
A20726 -     this case. ref SDS 97 DZ56
A20728 -      ..
A20729 -     [On 051021 surgeon reported performing a very wide mastectomy and
A20730 -     that a standard closure was accomplished. ref SDS 98 8K6N
A20732 -      ..
A20733 -     [On 061027 Millie diagnosed lymphedema and Cellulitis caused by
A20734 -     removing lymphatics during mastectomy surgery, which was not a
A20735 -     risk presented by Kaiser. ref SDS B5 HZ7N
A20737 -  ..
A20738 - Previously, on 050923 the surgeon cited high risks of a standard
A20739 - mastectomy for Millie's patient profile of secondary IBC, multiple,
A20740 - relapse, and pulmonary embolism. ref SDS 84 KF6I  Risks of surgery for
A20741 - Millie's patient profile were reviewed again by Doctor Smith on
A20742 - 050928, ref SDS 86 9W4I, and the doctor's report received today cite
A20743 - risks of surgical, postoperative, and anesthetic complications for
A20744 - Millie's prolonged patient history. ref SDS 0 KO64
A20746 -  ..
A20747 - Research on 040517 found common treatment for primary IBC is
A20748 - chemotherapy, then, if inflammation has not spread beyond the breast,
A20749 - surgery may be performed for the purpose of removing the tumor in the
A20750 - breast that drives IBC, and so helps prevent relapse, then more
A20751 - chemotherapy and finally radiation. ref SDS 33 YM3M  In this case,
A20752 - there is no evident tumor to remove in the breast, as shown by the PET
A20753 - scan test reported today, per above. ref SDS 0 IE5R  IBC inflammation
A20754 - in this case spread beyond the breast reported on 050311. ref SDS 56
A20755 - UA8N  On 050324 the surgeon advised that mastectomy surgery would be
A20756 - risky because IBC had spread toward the neck. ref SDS 57 WH5L  This
A20757 - patient history does not fit published guidelines for a standard
A20758 - mastectomy.
A20760 -  ..
A20761 - Therefore, the purpose and benefits of a standard mastectomy are not
A20762 - clear for a patient profile showing secondary IBC that spread beyond
A20763 - the breast, no tumor within the breast, multiple relapse, and
A20764 - pulmonary emboli treatments with Coumadin.
A20766 -  ..
A20767 - Kaiser has "Time Out" requirements for due diligence that verifies
A20768 - review of risk management issues and options, as called out in the
A20769 - Healthwise Handbook, reported during the meeting on 050923 with the
A20770 - surgeon. ref SDS 84 O85O
A20771 -
A20772 -        [On 051012 draft letter for Kaiser to perform Time Out due
A20773 -        diligence requirements for surgical procedure. ref SDS 95 6D4F
A20775 -         ..
A20776 -        [On 051018 review challenge of performing requirements for good
A20777 -        management that seems like unnecessary overkill, and presents
A20778 -        perceived threat to health care. ref SDS 96 5M9O
A20780 -         ..
A20781 -        [On 061027 Millie diagnosed lymphedema and Cellulitis caused by
A20782 -        removing lymphatics during mastectomy surgery, which was not a
A20783 -        risk presented by Kaiser. ref SDS B5 HZ7N
A20785 -  ..
A20786 - Kaiser has not submitted published guidance that supports ordering a
A20787 - standard mastectomy for Millie's patient profile, and justifies
A20788 - ignoring accepted practice for treating IBC.
A20789 -
A20791 -  ..
A20792 - Palliation Strategy Recommending Mastectomy Surgery
A20793 -
A20794 - The doctor advised that the purpose of a standard mastectomy which
A20795 - Kaiser proposes today is not to remove a tumor within the breast,
A20796 - called out by published guidance, per above, ref SDS 0 KE9N, since
A20797 - there is no evident tumor to remove, but rather for palliation of
A20798 - future cancer relapse in the left breast.
A20799 -
A20800 -            [On 051121 patient currently has no evidence of disease
A20801 -            based on estensive testing with biopsy, PET, CA 1503;
A20802 -            prognosis is for future relapse due to diagnosis of
A20803 -            metastatic cancer, and therefore mastectomy surgery on
A20804 -            051021 was palliation for furture relapse. ref SDS A4 LH7M
A20806 -             ..
A20807 -            [...see below, purpose of mastectomy for palliation because
A20808 -            microscopic cancer cells may cause relapse in the future.
A20809 -            ref SDS 0 IV4G
A20811 -  ..
A20812 - This reasoning seems conflicting with the surgeon's report received on
A20813 - 050927 saying the purpose is for "local control." ref SDS 85 AK4Q
A20815 -  ..
A20816 - Doctor Smith's report received today cites the need to maintain blood
A20817 - vessels for supply of treatment and nutrients to the breast skin in
A20818 - the event of relapse, per above. ref SDS 0 KO49  The importance of
A20819 - treatment "reasoning" was cited by the primary care physician on
A20820 - 041230, describing future impacts on life of the patient. ref SDS 51
A20821 - XQ84
A20822 -
A20823 -     [On 051011 Doctor Bailey comments that risks of mastectomy are
A20824 -     compounded for secondary IBC patients, because, where there is no
A20825 -     evident tumor to remove within the breast, benefits of palliation
A20826 -     are reduced by removing breast mass with blood vessels needed to
A20827 -     treat relapse of cancer. ref SDS 93 G65S
A20829 -  ..
A20830 - Palliation is a new term in patient history today working with the
A20831 - primary care physician, and follows submission of the plastic
A20832 - surgeon's report on the meeting last week on 050928, per above.
A20833 - ref SDS 0 MW6G  Previously, the doctor has recommended consideration
A20834 - of mastectomy for "local control."
A20836 -  ..
A20837 - Case study for local control shows...
A20838 -
A20839 -          [On 051027 follow up case study on purpose of mastectomy
A20840 -          surgery for secondary IBC possible innovation. ref SDS A3
A20841 -          F25H
A20842 -
A20843 -    1.  Timely treatment essential to prevent
A20844 -        cancer from cascading out of
A20845 -        control.............................. 030606, ref SDS 21 N27L
A20847 -         ..
A20848 -    2.  Millie removed from treatment on bevacizumab
A20849 -        and Taxol clinical study due to discovery
A20850 -        of pulmonary embolism; substitute doctor
A20851 -        examination finds Millie requires starting
A20852 -        treatment immediately in order
A20853 -        to prevent cancer from
A20854 -        cascading out of
A20855 -        control.............................. 041104, ref SDS 46 WT60
A20857 -         ..
A20858 -    3.  Local control was cited for starting
A20859 -        treatment immediately when progression
A20860 -        of cancer was diagnosed 6 weeks after
A20861 -        ending treatment on bevacizumab
A20862 -        and Taxol clinical trial
A20863 -        at Kaiser............................ 041130, ref SDS 49 Y66F
A20865 -         ..
A20866 -    4.  Rising symptoms IBC requires immediate
A20867 -        treatment for local control with
A20868 -        clinical study with for Novel
A20869 -        Epothilones BMS 247550 and
A20870 -        capecitabine......................... 041210, ref SDS 50 028N
A20872 -         ..
A20873 -    5.  PET scan test demonstrates local
A20874 -        control accomplished................. 051007, ref SDS 0 W18L
A20876 -         ..
A20877 -    6.  Surgeon's notes describe
A20878 -        purpose of mastectomy for
A20879 -        local control........................ 050927, ref SDS 85 AK4T
A20881 -         ..
A20882 -    7.  Patient meeting; surgeon describes
A20883 -        purpose of mastectomy in this
A20884 -        case for local control............... 050923, ref SDS 84 7K6K
A20886 -         ..
A20887 -    8.  2nd opinions threaten window of
A20888 -        of opportunity for local control
A20889 -        by delaying mastectomy surgery....... 050913, ref SDS 78 5T4J
A20891 -         ..
A20892 -    9.  Doctor recommends patient consent
A20893 -        to mastectomy surgery for
A20894 -        local control........................ 050729, ref SDS 70 5B9K
A20896 -         ..
A20897 -   10.  Doctor cites improvement from
A20898 -        systemic treatment opens window
A20899 -        of opportunity for increasing
A20900 -        local control; calls surgeon to
A20901 -        discuss plans for mastectomy
A20902 -        surgery.............................. 050610, ref SDS 65 XQ41
A20904 -         ..
A20905 -   11.  Doctor calls surgeon to schedule
A20906 -        examination for surgery to enable
A20907 -        local control of worsening cancer in
A20908 -        left breast due to pockets of
A20909 -        resistance to systemic chemotherapy
A20910 -        treatment............................ 050311, ref SDS 56 XQ41
A20912 -         ..
A20913 -   12.  Doctor wants mastectomy surgery
A20914 -        to prevent cancer in left breast
A20915 -        from spinning out of control......... 041230, ref SDS 51 CW6J
A20916 -
A20918 -  ..
A20919 - Plastic surgeon's notes for the meeting on 050928, and received today,
A20920 - per above, ref SDS 0 MW6G, say in part...
A20922 -             ..
A20923 -            The patient...would like my opinion with regard to
A20924 -            utilization of an abdominal myocutaneous or free
A20925 -            microvasular flap at the time of palliative mastectomy.
A20926 -            ref DRT 1 KO87
A20927 -
A20929 -  ..
A20930 - "Palliation" cited in the Plastic Surgeon's notes above was not
A20931 - reported for discussions on 050928, which instead centered on primary
A20932 - care physician objectives for "local control," ref SDS 86 LA6G, as
A20933 - shown in the general surgeon's notes, reported on 050927. ref SDS 85
A20934 - AK4Q  The doctor may have mentioned "palliation," as reported in her
A20935 - notes, and unlike today, this term, which is entirely new to patient
A20936 - history of doctor-patient communications, was omitted from the record
A20937 - on 050928.
A20939 -  ..
A20940 - Palliation was cited in research on 050712 that says...
A20941 -
A20942 -        Mastectomy-surgical removal of the breast-offers a good chance
A20943 -        of a cure for Stage I and II breast cancers.  Surgery may also
A20944 -        be successful for some Stage III cancers if they have not
A20945 -        invaded other parts of the body.  Women with Stage IV breast
A20946 -        cancer receive palliative treatment. ref SDS 68 B65G
A20948 -         ..
A20949 -        Palliative treatment relieves symptoms rather than cure.  Most
A20950 -        medical treatment is palliative, for heart disease or diabetes,
A20951 -        for example.  Palliative treatment may help someone to live
A20952 -        longer and to live comfortably, even if they cannot be cured.
A20953 -        ref SDS 68 CW5M
A20955 -  ..
A20956 - The primary care physician advised on 040614 that Kaiser policy treats
A20957 - secondary IBC as stage IV patients. ref SDS 35 SZ3I  There was no
A20958 - discussion today on changing the purpose of mastectomy surgery from
A20959 - local control to palliation in order to align with Kaiser policy and
A20960 - published guidance for stage IV patients to receive palliative
A20961 - treatment.  The doctor did not indicate that "palliation" is another
A20962 - expression for "local control."
A20964 -  ..
A20965 - Millie asked about the purpose of mastectomy surgery proposed by the
A20966 - doctor today for palliation, ref SDS 0 6A4N, since PET testing shows
A20967 - no evidence of disease, per above? ref SDS 0 L66M  Today, she suffers
A20968 - no distress nor symptoms of any kind that require palliation, as
A20969 - defined above. ref SDS 0 IU6K  Why palliation at a time when disease
A20970 - seems to be under control?
A20972 -  ..
A20973 - The doctor cited risks of microscopic cancer cells not detected by
A20974 - testing will cause cancer to relapse at some time in the future.  He
A20975 - feels that removing the breast without removing and replacing with
A20976 - plastic surgery all of the skin previously infected with IBC will
A20977 - provide palliation, if and when relapse occurs sometime in the future.
A20978 - The doctor feels that improving prospects for palliation before
A20979 - specific problems occur in the future justifies taking immediate risks
A20980 - of mastectomy, cited by the surgeon on 050923, ref SDS 0 MW4K, by the
A20981 - plastic surgeon on 050928, ref SDS 0 KO64, by research explaining
A20982 - risks of surgery stitching together previously radiated and infected
A20983 - skin for IBC patients, reported on 040517, ref SDS 33 YM3M, and by a
A20984 - 2nd opinion citing risk of death for being off treatment for pulmonary
A20985 - emboli during surgery, received on 050922. ref SDS 81 6Z5Q
A20986 -
A20987 -     [On 051011 Doctor Bailey comments that risks of mastectomy are
A20988 -     compounded for secondary IBC patients, because, where there is no
A20989 -     evident tumor to remove within the breast, benefits of palliation
A20990 -     are reduced by removing breast mass with blood vessels needed to
A20991 -     treat relapse of cancer. ref SDS 93 G65S
A20993 -      ..
A20994 -     [On 051027 biopsy on mastectomy surgery finds atypical cells
A20995 -     consistent with ductal carcinoma in situ (DCIS) in nipple tissue
A20996 -     that is commonly discovered with mammogram tests, and conflicts
A20997 -     with PET scan and mammogram testing. ref SDS A3 615K
A20999 -      ..
A21000 -     [On 060623 red rash and rising CA 15-3 indicate IBC cancer relapse
A21001 -     8 months after surgery. ref SDS A5 025H
A21003 -  ..
A21004 - The doctor decided to end treatments with Coumadin for pulmonary
A21005 - emboli, per below, ref SDS 0 RZ4I, which suggests recovery from cancer
A21006 - under Kaiser's policy.  Previously, on 040402 diagnosis of Cellulitus
A21007 - for treatment of inflammation in the left breast (later diagnosed as
A21008 - IBC on 040517, which prevented treatment on a drug trial, was changed
A21009 - to reaction from radiation which permitted participation in the
A21010 - treatment trial. ref SDS 30 IM6J
A21011 -
A21012 -     [On 051026 Gloria reported that the primary care physician changed
A21013 -     the prescription on 051007 for ending Coumadin treatment, and
A21014 -     ordered treatments resumed for pulmonary emboli, as required by
A21015 -     Kaiser's guidance for stage IV cancer patients. ref SDS A2 PO7J
A21017 -  ..
A21018 - The doctor was asked for written explanation of recommendations for
A21019 - mastectomy presented today, and with support from published guidance,
A21020 - as presented by the doctor during previous meetings, e.g., on 020321,
A21021 - ref SDS 3 R97G; later on 030508. ref SDS 19 M28G  The doctor explained
A21022 - today that there isn't enough time, and that discussion in the meeting
A21023 - is adequate, similar to the meeting on 041130. ref SDS 49 YR8F
A21025 -  ..
A21026 - The doctor wants Millie scheduled for immediate surgery.  Previously,
A21027 - on 050311 the doctor called the surgeon to request examination for
A21028 - surgery. ref SDS 56 XQ41  Later on 050610 the doctor called the
A21029 - surgeon again, while meeting with the patient, and requested
A21030 - mastectomy surgery. ref SDS 65 2L4M  This morning the doctor asked
A21031 - Millie to ask the surgeon for a standard mastectomy as soon as
A21032 - possible, and he further asked Millie to call him and report the date
A21033 - for surgery in order to avoid scheduling another cycle of chemotherapy
A21034 - treatment.
A21035 -
A21037 -  ..
A211 -
A212 -
A213 - 1138
A214 -
A21401 - After meeting with the primary care physician, Millie walked over to
A21402 - the Surgery Department and filled out a Kaiser form to make a written
A21403 - request for a standard mastectomy as soon as possible.
A21404 -
A21405 -     [On 051012 analysis of "Time Out" due diligence submitted.
A21406 -     ref SDS 95 6D4F
A21408 -      ..
A21409 -     [On 051021 Millie has surgery for very wide mastectomy to reduce
A21410 -     risks of relapse by removing skin previously infected with IBC and
A21411 -     which main contain microscopic cancer cells that could otherwise
A21412 -     cause relapse. ref SDS 99 EG5L
A21414 -      ..
A21415 -     [On 051027 surgeon reports successful mastectomy; plans to notify
A21416 -     the Oncology Department about scheduling continuing treatment of
A21417 -     DCIS and evaluating relapse. ref SDS A3 2562
A21418 -
A21419 -
A21420 -
A21421 -
A215 -

SUBJECTS
Pulmonary Emboli Blood Clots Treatment with Coumadin Ended Mistake f
Cannot Find Records Keywords Filing Records Management Inefficient F
Cannot Remember Doctor Reasons for Medication Asks Patient Degrees A
Cannot Remember Feel Confused Fear What Has Been Forgotten on Past M

AW06 -
AW0701 -  ..
AW0702 - Cannot Find Date Treatment with PE Diagnosed and Coumadin Started
AW0703 - Pulmonary Emboli Treatment with Coumadin Ended for Patient with IBC
AW0704 - Coumadin Treatment Stopped for Patient with Cancer and Pulmonary Emboli
AW0705 -
AW0706 - Follow up ref SDS 78 RZ4I, ref SDS 70 RZ4I.
AW0707 -
AW0708 - Gloria in the Coagulation Treatment Clinic at Kaiser in Martinez
AW0709 - called Millie yesterday, on 051006, and requested that the patient
AW0710 - notify the primary care physician that Coumadin treatment was paused
AW0711 - by order of the surgeon beginning today, ref SDS 89 5E6O, and for the
AW0712 - purpose of preparing for minor surgery to perform thin skin biopsies
AW0713 - on 051012.  Biopsy work was planned by the surgeon in a meeting on
AW0714 - 050923, ref SDS 84 SZ6M, and work was scheduled to be performed on
AW0715 - 051012 during a call from Kaiser on 050929. ref SDS 87 PPUQ
AW0717 -  ..
AW0718 - Gloria further explained that Coumadin can normally be paused for a
AW0719 - maximum of five (5) days prior to major surgery, ref SDS 89 5F48, and
AW0720 - that Coumadin treatments should resume on the day and shortly after
AW0721 - surgery is completed. ref SDS 89 5F43
AW0723 -  ..
AW0724 - Today, the doctor recalled considering plans to pause coagulation
AW0725 - treatments with Coumadin for surgery.  He asked when this discussion
AW0726 - occurred in patient history?
AW0728 -  ..
AW0729 - There have been several discussions on Coumadin treatments and
AW0730 - pulmonary emboli in relation to plans for surgery.
AW0732 -  ..
AW0733 - The Surgery Department reported on 050928 that Millie is at extreme
AW0734 - high risk for...
AW0735 -
AW0736 -          surgical and postoperative and anesthetic complications
AW0737 -
AW0738 - ...given her... history of pulmonary embolism..., per above.
AW0739 - ref SDS 0 635M
AW0741 -  ..
AW0742 - Millie related that previously on 050729 the doctor indicated plans to
AW0743 - pause Coumadin for 10 days in advance of mastectomy surgery being
AW0744 - considered at that time for the middle of September. ref SDS 70 5B5F
AW0746 -  ..
AW0747 - The doctor checked the computer for the date when pulmonary embolism
AW0748 - was diagnosed.  After a few minutes, the doctor indicated he could not
AW0749 - find the date, and so asked Millie when she recalls pulmonary emboli
AW0750 - was first reported that led to the current prescription for Coumadin
AW0751 - treatment?  Previously, on 041230 the doctor asked why AC treatments
AW0752 - for cancer were stopped in 2002. ref SDS 51 XQ84  Research on 010420
AW0753 - shows organizations have weak ability to remember details and find
AW0754 - critical information in time to be effective. ref SDS 2 474G
AW0756 -         ..
AW0757 -        [On 061024 case study medical practice computer access limited
AW0758 -        even with everything on the computer, people can't find details
AW0759 -        stored in parts of the computer (software modules) that are not
AW0760 -        frequently used. ref SDS B4 JD9L
AW0762 -  ..
AW0763 - Millie explained patient history showing pulmonary emboli was reported
AW0764 - during a meeting at Kaiser on 041104.  At that time, Doctor Kaufman
AW0765 - submitted results of a CT test performed the day before on 041103,
AW0766 - which reported findings of pulmonary embolism.  As a result, on 041104
AW0767 - Millie was removed from the Avastin chemotherapy drug trial, and began
AW0768 - daily treatment for pulmonary emboli with Coumadin. ref SDS 46 4Y9G
AW0770 -  ..
AW0771 - Doctor Bailey recommended in a 2nd opinion received on 050922 that
AW0772 - Kaiser perform a hypercoagulable state work-up, ref SDS 81 XD9X, based
AW0773 - on family history submitted to Kaiser on 040812, ref SDS 41 MG4M, and
AW0774 - later discussed with the protocol nurse on 040819. ref SDS 42 PI42
AW0775 -
AW0776 -     [On 060722 scope for work up on pulmonary emboli patients reported
AW0777 -     in professional article. ref SDS A8 7V7I
AW0779 -  ..
AW0780 - Today, the doctor advised that he is ordering Coumadin treatments
AW0781 - permanently stopped, rather than merely paused for surgery, becasue
AW0782 - pulmonary emboli is a side effect of the Avastin chemotherapy agent,
AW0783 - reported on 040812. ref SDS 41 RZ4I   The doctor indicated that, since
AW0784 - there is no further evidence of pulmonary emboli for the past year, it
AW0785 - is safe to end treatments with Coumadin.
AW0786 -
AW0787 -     [On 060722 patient risk factors for relapse of pulmonary emboli.
AW0788 -     ref SDS A8 6G6O
AW0790 -      ..
AW0791 -     [On 061012 CT test report received; confirms pulmonary embolism
AW0792 -     recurrence, reconciles pattern of symptoms, ref SDS B3 N26L;
AW0793 -     current conditions seem less severe than PE on 041103, ref SDS B3
AW0794 -     7E7G, except new finding of enlarged right ventricle presents new
AW0795 -     problem of heart disorder. ref SDS B3 7E5L
AW0797 -      ..
AW0798 -     [On 061228 primary care physician Kaiser advises enlarged right
AW0799 -     ventricle heart disorder Cor Pulmonale most likely due to
AW0800 -     pulmonary embolism, ref SDS B7 0M6O, after treatment ended a year
AW0801 -     earlier on 051007. ref SDS 0 RZ4I
AW0802 -
AW0804 -  ..
AW0805 - Lifetime Treatment Pulmonary Emboli Cancer Patients Kaiser Policy
AW0806 - Kaiser Policy Cancer Patients with Pulmonary Emboli Treated for Life
AW0807 -
AW0808 - The doctor cited Kaiser policy to treat patients for a year after
AW0809 - diagnosis of pulmonary emboli, except cancer patients are treated for
AW0810 - life, as reported originally on 041104. ref SDS 46 4Y9G  The doctor
AW0811 - explained that ending, rather than pausing, Millie's treatment for
AW0812 - pulmonary emboli, following diagnosis of stage IV cancer (IBC) on
AW0813 - 040614, ref SDS 35 6T5G, was because pulmonary emboli is a side effect
AW0814 - of Avastin, and Millie ended treatment with Avastin a year ago on
AW0815 - 041104, per above. ref SDS 0 XN7N
AW0817 -      ..
AW0818 -     [On 060714 oldest son hospitalized again with pulmonary emboli.
AW0819 -     ref SDS A7 8S6I
AW0821 -      ..
AW0822 -     [On 060722 oldest son reports doctors performed tests and found
AW0823 -     genetic cause of blood clots that will require continuing
AW0824 -     treatment. ref SDS A8 3D9T
AW0826 -      ..
AW0827 -     [On 060722 research 10% pulmonary emboli patients have recurrence,
AW0828 -     and 45% of those who suffer recurrence die, indicating high risk
AW0829 -     that supports continuing treatments to avoid recurrence.
AW0830 -     ref SDS A8 BI5J
AW0832 -      ..
AW0833 -     [On 060724 notified Kaiser of new information on family history of
AW0834 -     blood clot problems. ref SDS A9 NL5Q
AW0836 -      ..
AW0837 -     [On 060726 letter from Arlette says Kaiser received notice and
AW0838 -     forwarded to primary care physician. ref SDS B0 0001
AW0840 -  ..
AW0841 - Ending Coumadin treatment for Millie's patient profile of inflammatory
AW0842 - breast cancer (IBC) stage IV and pulmonary emboli needs further
AW0843 - support in relation to Kaiser's policy requirements to treat patients
AW0844 - for life when diagnosed with cancer and pulmonary emboli.  This
AW0845 - appears to fit the case study on 020504 listing challenge of following
AW0846 - requirements. ref SDS 6 NS6F  Not clear in the record why proposal for
AW0847 - hypercoagulable state work-up should not be performed, per above.
AW0848 - ref SDS 0 CW9J
AW0849 -
AW0850 -     [On 051009 Doctor's notes show the work plan to discontinue (D/C)
AW0851 -     Coumadin treatments 11 months after ending Avastin trial.
AW0852 -     ref SDS 94 WB4S
AW0854 -      ..
AW0855 -     [On 051019 prepare letter to notify Kaiser on performing Time Out
AW0856 -     requirements for due diligence to assess planning for mastectomy
AW0857 -     surgery with patient profile of secondary IBC and pulmonary
AW0858 -     emboli. ref SDS 97 D163
AW0860 -      ..
AW0861 -     [On 051021 Millie has mastectomy surgery; nurse draws blood to
AW0862 -     evaluate pulmonary emboli risk related to treatment with Coumadin.
AW0863 -     ref SDS 98 QW4I
AW0865 -      ..
AW0866 -     [On 051021 called Gloria in the Anticoagulation Clinic and
AW0867 -     explained the doctor's order that Coumadin treatments were ended
AW0868 -     because Millie has been off the Avastin trial for a year.
AW0869 -     ref SDS 98 RR9G
AW0871 -      ..
AW0872 -     [On 051025 Gloria called Millie and said the doctor has not
AW0873 -     notified the Anticoagulant clinic to end treatments with Coumadin;
AW0874 -     Gloria coordinating to complete the record on notice requirements
AW0875 -     for ending Coumadin treatment. ref SDS A1 DI9H
AW0877 -  ..
AW0878 - Has the doctor determined that the patient no longer has cancer, and
AW0879 - so ending treatment for pulmonary emboli meets policy requirements?
AW0880 - ref SDS 0 XN7K  Does this suggest a determination of cure that does
AW0881 - not support recommendations for surgery, per above? ref SDS 0 P64J
AW0882 -
AW0883 -     [On 051026 Gloria reported that the primary care physician changed
AW0884 -     the prescription on 051007 for ending Coumadin treatment, and
AW0885 -     ordered treatments resumed for pulmonary emboli, as required by
AW0886 -     Kaiser's guidance because Millie is a stage IV cancer patient.
AW0887 -     ref SDS A2 PO7J
AW0889 -      ..
AW0890 -     [On 051121 primary care physician ended Coumadin treatment for
AW0891 -     pulmonary emboli, and called the Anticoagulant Clinic in Martinez
AW0892 -     to confirm this change. ref SDS A4 RZ4I
AW0893 -
AW0894 -
AW0895 -
AW0896 -
AW0897 -
AW09 -

SUBJECTS
2nd Opinions Delay Mastectomy Oncologist Primary Care Physician Refu

AY03 -
AY0401 -  ..
AY0402 - Discuss 2nd Opinions Primary Care Physician Objects Delaying Surgery
AY0403 - Primary Care Physician Objects to Discuss 2nd Opinions Delay Surgery
AY0404 - 2nd Opinions Delay Mastectomy Oncologist Refuses to Discuss Options
AY0405 -
AY0406 - Follow up ref SDS 78 X645.
AY0407 -
AY0408 - The doctor did not discuss 2nd opinions today.
AY0410 -  ..
AY0411 - The doctor cited collaboration discussions with surgeon and plastic
AY0412 - surgeon, per above. ref SDS 0 OH9L
AY0413 -
AY0414 -
AY0415 -
AY0416 -
AY05 -

SUBJECTS
Joint Meeting Requested for Collaboration of Team Care Practice to P
Masectomy Evaluate Surgery for IBC 2nd Opinion Tumor Board Review No
Collaboration Teamwork Failed Due Diligence Requirements Ignored Fam
Collaboration Team Care Practice Perform Due Diligence Primary Care

BU06 -
BU0701 -  ..
BU0702 - Collaboration Team Care Practice Doctor Reports Discussions
BU0703 - Partnership Doctor Patient Joint Meeting Essential Team Care Practice
BU0704 -
BU0705 - Follow up ref SDS 78 6W4L.
BU0706 -
BU0707 - The doctor reported this morning that he collaborated separately with
BU0708 - the surgeon and Doctor Smith in Plastic Surgery, which seems to have
BU0709 - yielded conflicting understandings, per above. ref SDS 0 OH9L
BU0711 -  ..
BU0712 - The doctor asked the patient to collaborate directly with the surgeon
BU0713 - on scheduling mastectomy, rather than use readily available calls and
BU0714 - meetings used previously, per above. ref SDS 0 MW6O
BU0716 -  ..
BU0717 - This record presents a lesson learned on the need for joint meetings
BU0718 - for effective collaboration, and construction of a written record for
BU0719 - accurate case management, as requested during the meeting on 050913.
BU0720 - ref SDS 78 6W4L
BU0721 -
BU0722 -
BU0723 -
BU0724 -
BU0725 -
BU0726 -
BU0727 -
BU08 -

SUBJECTS
Work Plan Mastectomy Surgery Patient Notify Primary Care Physician D

C303 -
C30401 -  ..
C30402 - Treatment Plan 2 More Cycles then Pause Recover from Side Effects
C30403 - Chemotherapy Holiday from Mid-August to After Surgery in September
C30404 - Holiday from Treatment Planned Recover from Side Effects After Surgery
C30405 -
C30406 - Follow up ref SDS 78 AW5G, ref SDS 70 AW5G.
C30407 -
C30408 - The doctor asked Millie to call him about results of scheduling
C30409 - mastectomy surgery.  If surgery will occur more than two (2) weeks
C30410 - ahead, then the doctor will schedule Millie for another cycle of
C30411 - chemotherapy treatment.
C30413 -  ..
C30414 - Millie related expectations that she will need another treatment,
C30415 - because when Kaiser called on 05929 to schedule very minor surgical
C30416 - biopsies, Dana advised that the earliest this could be performed was
C30417 - 051020, nearly a month later.  Dana was asked about advancing this
C30418 - schedule, and she said this was difficult because the surgeon and the
C30419 - surgery room are already booked solid for October. ref SDS 87 HQ6J
C30420 - Dana managed to move the biopsy procedure estimated to take 40 minutes
C30421 - ahead by a week. ref SDS 87 PPUQ  This record indicates that a four
C30422 - (4) hour operation for mastectomy surgery will probably occur in
C30423 - November, and so another treatment should be scheduled.
C30425 -  ..
C30426 - The doctor explained again that he would like Millie to coordinate
C30427 - with the Surgery Department, and let him know the date of surgery, and
C30428 - that he will schedule another cycle of chemotherapy treatment, if
C30429 - mastectomy surgery is more than two (2) weeks ahead.
C30431 -  ..
C30432 - There was no discussion of treatment planning after surgery, or in the
C30433 - event that surgery is not performed.
C30435 -  ..
C30436 - Unlike past meetings, the doctor said today that he will not schedule
C30437 - Millie for another examination, because she will be working with the
C30438 - Surgery Department.
C30439 -
C30440 -     [On 051027 surgeon reports successful mastectomy; plans to notify
C30441 -     the Oncology Department about plans for continuing treatment of
C30442 -     Millie. ref SDS A3 2562
C30443 -
C30444 -
C30445 -
C30446 -
C30447 -
C30448 -
C305 -

SUBJECTS
Status Test for Change ER PR HER2/neu from Negative to Positive Trea

C503 -
C50401 -  ..
C50402 - Status Change Retest Biopsy 040419 Treatment Options
C50403 - Treatment Options Status Change Retest Biopsy 040419
C50404 -
C50405 - Millie related discussion with the surgeon on 050923 to retest the
C50406 - biopsy taken on 040419 for status change which might significantly
C50407 - expand treatment options, ref SDS 84 RX4I, as recommended by Doctor
C50408 - Shim in the Surgery Department of Kaiser's Oakland office, received on
C50409 - 050907, and reviewed with the primary care physician during the
C50410 - meeting on 050913. ref SDS 78 X546
C50412 -  ..
C50413 - Review of the surgeon's notes for the meeting on 050923 show no
C50414 - indication of ordering the retest. ref SDS 85 WV5O
C50416 -  ..
C50417 - The doctor said he would order this retest.
C50418 -
C50419 -      [On 051009 the doctor's notes for the meeting today do not
C50420 -      mention ordering retest of the biopsy for status change.
C50421 -      ref SDS 94 PJ5L
C50422 -
C50423 -      [On 051012 draft letter to Kaiser requests progress on
C50424 -      performing this task.
C50426 -       ..
C50427 -      [On 051012 revised draft recommends making inquiry. ref SDS 97
C50428 -      DY9X
C50430 -       ..
C50431 -      [On 051022 Millie asked the surgeon about follow up on retesting
C50432 -      the biopsy taken 040419 for changing status to increase treatment
C50433 -      options; the surgeon indicated having ordered the retest, but not
C50434 -      received results, and plans to inquire with the pathology
C50435 -      laboratory on progress completing the assignment. ref SDS A0 NE9J
C50436 -
C50437 -
C50438 -
C50439 -
C50440 -
C505 -

SUBJECTS
Side Effects Increase Diary Patient History Shows Tolerance for Chem
Side Effects Pharmacist Reports Millie at Low End of Severity Suffer

CA04 -
CA0501 -         ..
CA0502 -   13.  Side Effects Rise Capecitabine (Xeloda) Patient to Exercise
CA0503 -        Heavy Chest Difficult Breathing Side Effect Lack of Exercise
CA0504 -        Exercise Maintain Fitness Strengthen Immune System Challenging
CA0505 -
CA0506 -        Follow up ref SDS 78 NT3I, ref SDS 5 NT3I.
CA0507 -
CA0508 -        The doctor explained side effects of Taxotere and capecitabine
CA0509 -        (Xeloda) on 050329, ref SDS 59 NT3I; on 050415 the pharmacist
CA0510 -        submitted documents detailing side effects. ref SDS 60 7F8Q  On
CA0511 -        050516 considerations for reducing the potency of capecitabine
CA0512 -        (Xeloda) were developed. ref SDS 63 BD4G
CA0514 -         ..
CA0515 -        On 050729 the doctor asked about patient history suffering side
CA0516 -        effects, and Millie presented a summary. ref SDS 70 VP3N  Later
CA0517 -        on 050819, Zan, the pharmacist in the Chemotherapy Clinic
CA0518 -        discussed side effects and commented that Millie's experience
CA0519 -        is at the low end of severity compared with other patients
CA0520 -        treated with chemotherapy. ref SDS 72 NY4F
CA0522 -         ..
CA0523 -        There was no discussion again today of side effects because of
CA0524 -        time performing due diligence on mastectomy surgery.
CA0525 -        ref SDS 0 XQ41
CA0526 -
CA0527 -
CA0528 -
CA0529 -
CA0530 -
CA06 -

SUBJECTS
Trial Chemotherapy New Drug Treatment UCSF Millie Asks Primary Care

CE03 -
CE0401 -         ..
CE0402 -   14.  Trial Chemotherapy New Drug Treatment UCSF
CE0403 -        New Drug Trial Chemotherapy Treatment UCSF Proposed by Bailey
CE0404 -
CE0405 -        Follow up ref SDS 78 L27G, ref SDS 70 L27G.
CE0406 -
CE0407 -        There was no discussion of Doctor Bailey's planning on 050909
CE0408 -        to contact Doctor Parks at UCSF about a new chemotherapy trial
CE0409 -        which she feels might help Millie. ref SDS 76 AL3N
CE0411 -         ..
CE0412 -        There was, also, no follow up on the trial at UCSF cited by
CE0413 -        Millie on 050520, ref SDS 64 L27G, and asking about
CE0414 -        implementing the offer from Doctor Benz to collaborate on
CE0415 -        Millie's treatment, cited in a 2nd opinion received on 041117.
CE0416 -        ref SDS 48 OV3T
CE0417 -
CE0418 -
CE0419 -
CE0420 -
CE0421 -
CE05 -

SUBJECTS
Disability Authorizations Prepared to Support New Treatments for Rel
Disability Documents Prepared to Work Three (3) Days Per Week Cancer
Disability Extension Primary Care Physician to File Revised Elegibil

CI05 -
CI0601 -  ..
CI0602 - Disability Filing for Entitlements While Recovery from Cancer
CI0603 -
CI0604 - Follow up ref SDS 83 0001.
CI0605 -
CI0606 - The doctor said he has the forms on his desk which Millie submitted to
CI0607 - the Oncology Department on 050923. ref SDS 83 X05G
CI0609 -  ..
CI0610 - The doctor will prepare the forms in the next day or so.  Millie can
CI0611 - pick them up from the front desk in the Oncology Department and take
CI0612 - them to the Business Office.
CI0614 -  ..
CI0615 - We reviewed Kaiser policy presented by the Business Office on 050923
CI0616 - that the patient is not authorized to handle the forms, and in that
CI0617 - case should not Kaiser manage distribution? ref SDS 83 3R9G
CI0619 -  ..
CI0620 - The doctor feels that the Business Office made a mistake.  He can
CI0621 - authorize Millie to deliver the documents, rather than rely on Kaiser
CI0622 - for distribution.
CI0623 -
CI0624 -
CI0625 -
CI0626 -
CI0627 -
CI0628 -
CI0629 -
CI0630 -
CI07 -