CONTACTS 

SUBJECTS
Meeting Doctor Examine Response Chemotherapy Taxotere Capecitiabine
Notes Meeting Primary Care Physician Received for Meeting at Kaiser

0504 -
0504 -    ..
0505 - Summary/Objective
0506 -
050601 - Follow up ref SDS 88 0000. ref SDS 74 0000.
050602 -
050603 - Doctor's notes substantially align with the record of meeting on
050604 - 051007.
050605 -
050606 -
050607 -
050608 -
050610 -  ..
0507 -
0508 -
0509 - Progress
0510 -
051001 - Doctor's Notes Meeting With Patient Examination on 051007
051002 -
051003 - Follow up ref SDS 88 SM6M, ref SDS 74 SM6M.
051004 -
051005 - Received ref DRT 1 0001 with the doctor's filing of disability
051006 - entitlement.
051008 -         ..
051009 -    1.  The patient is a 69 year old woman with a history of
051010 -        inflammatory cancer of left breast who was initially diagnosed
051011 -        3/04/02 who comes for re-evaluation.  She currently has
051012 -        recurrent disease noted initially in cervical LN's 03/03/04.
051013 -        She has been treated on several salvage regimes (see previous
051014 -        notes).  The patient was started on Taxotere/Xeloda 4/15/05.
051015 -        She has had a total of 8 cycles, the last was 9/16.  She was
051016 -        seen by Plastic Surgery and the decision was that
051017 -        reconstruction would add no value to our current palliative
051018 -        strategy.  She has some abdominal wall tenderness in RUQ.
051020 -  ..
051021 - "Palliative strategy" was first presented during the meeting on
051022 - 051007. ref SDS 88 6A4N  Except for this one (1) sentence, there is no
051023 - further mention nor explanation of a "strategy" nor of palliation in
051024 - the doctor's record.  Complete patient history on considerations of
051025 - surgery is reported on 051210. ref SDS 46 657F
051026 -
051027 -           [On 051027 case study developed on purpose of mastectomy
051028 -           surgery in patient history. ref SDS 92 XA5N
051030 -  ..
051031 - Doctor's notes for meeting on 051007 continue...
051032 -
051033 -    2.  Current medications include
051034 -
051035 -        XELODA 500MG TABLETS
051036 -        TIMONOL MALEATE 0.5%  EYE DR
051037 -        DEXAMETHASONE 4MG TABLETS
051038 -        WARFARIN 4MG TABLETS
051039 -        HYDROCOCONE/ACETAMINOPHEN 5
051040 -
051042 -         ..
051043 -    3.  PE: wt 149lb
051044 -        Breasts:  firmness of medial border of left breast
051045 -        Lymphatics:  negative
051046 -        Extremities:  no edema
051047 -        Lungs:  Clear
051048 -        CVS: S1, S2
051049 -        Abd:  RUQ superficial abdominal wall pain, no rebound
051050 -        or guarding
051051 -
051053 -         ..
051054 -    4.  Lab:
051055 -
051056 -           WBC                       4.3   K/uL
051057 -           RBC                L      3.10  M/uL
051058 -           Hemoglobin         L     10.5   g/dL
051059 -           Hematocrit         L     30.5   %
051060 -           MCV                      98     fL
051061 -           RDW                H     17.0   %
051062 -           Plt                     236     K/uL
051063 -           Alkaline Phos            45     U/L
051064 -           Bili, Tot Adult           0.4   mg/dL
051065 -           Creatinine                0.8   mg/dL
051066 -           ALT (SGPT)               23     U/L
051068 -  ..
051069 - There is no date presented in the doctor's notes for this lab report,
051070 - and valuations do not align with most recent lab report dated 050915
051071 - and listed in the record on 050916. ref SDS 75 8W46
051072 -
051073 -        [On 051021 received lab report for blood drawn on 050916 with
051074 -        figures shown in the doctor's notes today, per above,
051075 -        ref SDS 91 7P9J, and which update figures in the record on
051076 -        050916 for a lab report on blood drawn the previous day on
051077 -        050915.
051079 -  ..
051080 - Doctor's notes for meeting on 051007 continue...
051081 -
051082 -    5.  CA 15-3
051083 -
051084 -           45 H
051085 -           45 H
051086 -           45 H
051087 -           39
051088 -           45 H
051089 -           46 H
051090 -           37
051091 -           45 H
051092 -           56 H
051093 -           67 H
051094 -           80 H
051095 -           105 H
051096 -
051098 -         ..
051099 -    6.  Imaging:
051100 -
051101 -        a.  10/05/2005 WHOLE BODY FDG PET/CT STUDY
051102 -
051103 -            IMPRESSION:
051104 -
051105 -            1.  Body FDG PET/CT study demonstrating no definite
051106 -                hypermetabolic foci to confirm the presence residual or
051107 -                recurrent disease.
051109 -                 ..
051110 -            2.  Compared to the most recent PET study 12/16/04,
051111 -                resolution of the previously noted multiple
051112 -                abnormalities is identified.
051113 -
051115 -                 ..
051116 -        b.  5/30/2005 CT SCAN - NECK, CHECK, ABDOMEN
051117 -
051118 -            Impression:
051119 -
051120 -                Almost total resolution of the right axillary enlarged
051121 -                lymph node compared to the prior study.  No significant
051122 -                findings.
051123 -
051125 -         ..
051126 -    7.  Imp:
051128 -         ..
051129 -        VIS.DET.......MTZRAJ 10/09/05 15:36
051130 -
051131 -        1.  Metastatic breast  cancer (IBC)
051132 -        2.  Hx of PE on Avastin
051133 -        3.  Abdominal wall pain; probably muscular
051134 -
051136 -         ..
051137 -    8.  Plan:
051138 -
051139 -        1.  Completed cycle #8 Xeloda/Taxotere 9/16
051140 -        2.  Biopsies of breast pre-op to determine margins 10/12
051141 -        3.  FU surgery for palliative mastectomy
051142 -        4.  Have another cycle (#8) depending on when surgery is
051143 -            scheduled
051144 -        5.  D/C coumadin, PE 11/3/04, on therapy 11 month, NED off
051145 -            Avastin
051146 -        6.  RTC post op
051147 -        7.  Additional cycle if surgery postponed.
051148 -
051150 -         ..
051151 -    9.  Visit Date:  10/7/2005
051153 -  ..
051154 - The doctor's notes do not mention discussion on retesting the biopsy
051155 - on 040419 for status change, discussed on 051007. ref SDS 88 ZR6J
051156 - There is nothing the doctor's work plan showing pending action.
051157 - ref SDS 0 WB4S
051158 -
051159 -
051160 -
051161 -
051162 -
051163 -
051164 -
051165 -
051166 -
051167 -
0512 -