CONTACTS 

SUBJECTS
CA 15-3 34 and 5 Points Below Normal 39 and Stable from Prior Test T

1303 -
1303 -    ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS A2 0000.
130502 -
130503 - The doctor submitted partial results of the PET scan test, ref SDS 0
130504 - E538, that are generally favorable. ref SDS 0 MW6K  CA 15-3 has been
130505 - stable.  Other blood test results now fall within target ranges for
130506 - the first time in many years.  Doctor monitoring new report of mild
130507 - FDG activity from tiny right axillary focus that could be local
130508 - inflammation or cancer. ref SDS 0 MW6K  Several action items present
130509 - from this record for follow up. ref SDS 0 F49I  After receiving the
130510 - full PET scan test report discovered the analyst could not find the
130511 - prior test on 051005 for comparison, ref SDS 0 XF3K, and did not
130512 - compare with prior CT test on 050530 that showed similar findings on
130513 - right axillary. ref SDS 0 XF41  New findings of esophagitis may
130514 - required GI examination for treatment of recent though occassional
130515 - digestion symptoms. ref SDS 0 DH4O
130516 -
130517 -     [On 060217 reviewed favorable blood tests with doctor. ref SDS A3
130518 -     SZ9L
130520 -      ..
130521 -     [On 060217 the doctor submitted the rest of the PET scan test
130522 -     ref SDS A3 NL4N, which was entered in this record for convenience.
130523 -     ref SDS 0 IG9K
130525 -      ..
130526 -     [On 060217 doctor proposed that blood work showing everything
130527 -     normal including CA 15-3 supports deferring contrast CT study
130528 -     until after the next PET scan test in April. ref SDS A3 DU5J
130530 -      ..
130531 -     [On 060217 doctor submits PET scan test report; no discussion of
130532 -     esophagitis; action item pending professional review. ref SDS A3
130533 -     W34G
130535 -      ..
130536 -     [On 060217 examination showed significantly reduced swelling of
130537 -     left axillary, and PET scan test on 060120 made no findings; CA
130538 -     15-3 fell slightly, ref SDS A3 MW8J; therefore doctor deferred
130539 -     work up and treatment for lymphedema until further examination in
130540 -     April 2006. ref SDS A3 SG3O
130541 -
130542 -
130543 -
130545 -  ..
1306 -
1307 -
1308 - Progress
1309 -
130901 - CA 15-3 Cancer Marker 34 Steady from Prior Report
130902 -
130903 - Follow up ref SDS A2 087J, ref SDS 96 087J.
130904 -
130905 - The most recent blood test on 060109 shows CA 15-3 remained steady at
130906 - 34, ref SDS 0 5K6K, after dropping to an all time low of 28 on 051202
130907 - as shown in a report submitted by the doctor today...
130909 -           ..
130910 -          Test Date                         Date Received
130911 -          060109......... 34............... 060125, ref SDS 0 087JL
130912 -          051223......... 34............... 060106, ref SDS A2 087JL
130913 -          051202......... 28............... 060106, ref SDS A2 087JL
130914 -          051116......... 31............... 051121, ref SDS 96 087JL
130915 -          051109......... 30............... 051121, ref SDS 96 087JL
130916 -          051102......... 34............... 051121, ref SDS 96 087JL
130917 -          050909......... 45 H............. 051007, ref SDS 85 087JL
130918 -          050826......... 45 H............. 050913, ref SDS 72 087JL
130919 -          050819......... 45 H............. 050913, ref SDS 72 087JL
130920 -          050812......... 39 .............. 050819, ref SDS 65 3K6L
130921 -          050729......... 45 H............. 050819, ref SDS 65 EA5G
130922 -          050708......... 46 H............. 050729, ref SDS 63 087J
130923 -          050701......... 37 .............. 050708, ref SDS 60 2N5J
130924 -          050617......... 45 H............. 050729, ref SDS 63 087J
130925 -          050527......... 56 H............. 050610, ref SDS 59 087J
130926 -          050512......... 67 H............. 050520, ref SDS 58 087J
130927 -          050506......... 80 H............. 050520, ref SDS 58 087J
130928 -    050415.........105 H............. 050422, ref SDS 56 087J
130929 -          050325.........100 H............. 050329, ref SDS 54 087J
130930 -          050318.........101 H............. 050325, ref SDS 53 2N5J
130931 -          050304......... 88 H............. 050311, ref SDS 51 087J
130932 -          050225......... 95 H............. 050308, ref SDS 50 0001
130933 -          050211......... 78 H............. 050214, ref SDS 49 02BB
130934 -          050128......... 67 H............. 050204, ref SDS 48 087J
130935 -          041228......... 56 H............. 041230, ref SDS 47 087J
130936 -          041204......... 43 H............. 041210, ref SDS 46 087J
130937 -          041007......... 39............... 041104, ref SDS 42 087J
130938 -          040923......... 49 H............. 041005, ref SDS 41 087J
130939 -          040908......... 44 H............. 040909, ref SDS 40 087J
130940 -          040825......... 47 H............. 040812, ref SDS 40 087J
130941 -          040811......... 42 H............. 040812, ref SDS 39 087J
130942 -          040728......... 43 H............. 040729, ref SDS 37 2N5J
130943 -          040712......... 47 H............. 040713, ref SDS 36 087J
130944 -          040614......... 55 H............. 040615, ref SDS 35 PX6X
130945 -          040517......... 78 H............. 040601, ref SDS 33 2N5J
130946 -          040311......... 70 H............. 040318, ref SDS 28 SM6M
130947 -          040205......... 60 H............. 040211, ref SDS 25 SM6M
130948 -          031201......... 62 H............. 031205, ref SDS 24 SM6M
130949 -          030912......... 66 H............. 030915, ref SDS 23 SM6M
130950 -          030708......... 68 H............. 030710, ref SDS 22 SM6M
130951 -          030503......... 54 H............. 030508, ref SDS 21 SM6M
130952 -          030403......... 45 H............. 030508, ref SDS 21 SM6M
130953 -          030215......... 46 H............. 030220, ref SDS 20 5E6L
130954 -          030106......... 37 H............. 030109, ref SDS 19 SM6M
130955 -          021202......... 41 H?............ 021204, ref SDS 18 SP5G
130956 -          021111......... 36 H?............ 021113, ref SDS 16 Y65I
130957 -          021023......... 33 H?............ 021023, ref SDS 15 SQ5I
130958 -          020930......... 33 H?..29........ 021002, ref SDS 14 SQ5I
130959 -          020917......... 36 H?............ 020924, ref SDS 13 SQ5I
130960 -          020717......... 59 H?............ 020726, ref SDS 12 YN5K
130961 -          020629......... 75 H ............ 020705, ref SDS 11 UX6I
130962 -          020608........  67 H ............ 020614, ref SDS 10 0001
130963 -          020603........ 108 H ............ 020607, ref SDS 9 X67F
130964 -          020511........ 117 H ............ 020603, ref SDS 8 PJ4J
130965 -          020419......... 81 H ............ 020430, ref SDS 6 7N5H
130966 -          020321......... 85 H ............ 020405, ref SDS 4 6T8K
130967 -
130968 -
130970 -  ..
1310 -
1311 -
1312 - Analysis
1313 -
131301 - CA 15-3 34 Cancer Marker Stable Significantly Below Target Level
131302 -
131303 - Follow up ref SDS A2 GJ5M, ref SDS 96 GJ5M.
131304 -
131305 - The report today fits the doctors analysis on 060106 of "stable"
131306 - condition at 34. ref SDS A2 GJ5M
131308 -  ..
131309 - PET scan test of possible activity in right axillary, ref SDS 0 FA9J,
131310 - may align with recent elevation of CA 15-3 above 28. ref SDS A2 GJ5M
131311 -
131312 -
131313 -
131314 -
131315 -
131316 -
131317 -
131318 -
1314 -

SUBJECTS
Blood Tests on 060109 Monitor Relapse Status Shows All Results withi
Blood Tests Scheduled to Monitor Relapse Status Meeting Doctor Johns

1704 -
170501 -  ..
170502 - Blood Tests Monitor Relapse Status Shows All Results within Range
170503 -
170504 - Follow up ref SDS A2 SZ9L.
170505 -
170506 - Millie submitted a letter to the doctor on 060124...
170507 -
170510 -        Sent: 1/24/2006 2:49 PM
170511 -        Subject: Lab Results
170513 -         ..
170514 -        I had lab work done on January 9 and don't recall
170515 -        if "letter" was checked off. If you have the results
170516 -        would you please send a copy to me either e-mail or
170517 -        snail mail. I also had a PET Scan done on 1/20/06 and
170518 -        if the results are available I would like a copy of it
170519 -        as well. Thanks a bunch, and we'll see you February 17.
170520 -
170521 -            [...below, see report on PET scan test. ref SDS 0 E53H
170523 -  ..
170524 - Today, she received a letter from the doctor...
170525 -
170528 -        Subject: RE: Recent Lab Results
170529 -        Received: 1/25/06 2:59 PM
170531 -         ..
170532 -        Here are you lab results:
170533 -
170534 -            WBC 3.6 K/uL
170535 -            RBC 4.12 M/uL
170536 -            Hemoglobin 12.7 g/dL
170537 -            Hematocrit 38.4 %
170538 -            MCV 93 fL
170539 -            RDW 13.6 %
170540 -            Plt 185 K/uL
170542 -             ..
170543 -            Alkaline Phos 47 U/L
170544 -            Bili, Tot Adult 0.6 mg/dL
170545 -            CA 15-3 34 U/mL
170546 -            AST (SGOT) 32 U/L
170548 -         ..
170549 -        ROBERT ALLSTON JOHNSON MD
170550 -
170552 -     ..
170553 -    Blood Tests All Normal for 1st Time in 4 years
170554 -
170556 -  ..
170557 - Incorporating the doctor's report into the standard table (see
170558 - template from report on 050916, ref SDS 73 0N7Q) shows the following
170559 - for the blood tests taken on 060109, per above. ref SDS 0 PJ9O  These
170560 - results are remarkable for all tests are within prescribed range.  For
170561 - the first time in many years, none of the tests are listed as too low,
170562 - or too high...
170563 -
170564 -       [On 060217 reviewed favorable blood tests with doctor.
170565 -       ref SDS A3 SZ9L
170567 -     ..
170568 -    Test Name              Value Unit     <-------- RANGE-------->
170569 -    @CBC
170570 -    WBC x 10-3               3.6 K/uL           3.5   -     12.5
170571 -    RBC x 10-6              4.12 M/uL           3.60  -      5.10
170572 -    Hemoglobin              12.7 g/dL          11.5   -     15.0
170573 -    Hematocrit              38.4 %             34.0   -     46.0
170574 -    MCV                       93 fL            80.0   -    100.0
170575 -    RDW                     13.6 %             11.9   -     14.3
170576 -    Plt x10-3              185   K/uL         140     -    400
170578 -     ..
170579 -    Neutrophils          No Test %             50     -     70
170580 -    Lymphocytes          No Test %             20     -     50
170581 -    Monocyte             No Test %              0     -     11
170582 -    Eosinophils          No Test %              1     -      5
170583 -    Basophil             No Test %              0     -      2
170584 -    Bands                No Test %              0     -      5
170585 -    Manual Diff?         No Test
170587 -     ..
170588 -    CA 15-3                   34               -<     -     39
170590 -     ..
170591 -    Seg Neutrophils      No Test %             50     -     70
170593 -     ..
170594 -    DIFF Method          No Test
170595 -    Anisocytosis         No Test
170596 -    Macrocytes           No Test
170597 -    Plt estimate         No Test
170599 -     ..
170600 -    Alkaline Phos             47 U/L           38     -    126
170601 -    Bili, Tot Adult         <0.6 mg/dL        0.2     -    1.3
170602 -    Creatinine           No Test mg/dL        0.6     -    1.2
170603 -    Phosphorus           No Test
170604 -    Alt (SGPT)           No Test               11     -     66
170605 -    AST (SGOT)                32 U/L           11     -     66
170606 -    Glucose Random       No Test mg/dL         60     -    159
170607 -
170608 -
170609 -
170610 -
170611 -
170612 -
1707 -

SUBJECTS
Test Reports Case Study Language Variance Meaning Align Difficult Ti
PET Scan Test on 060120 Pathology Report Analyst Finds No Evidence o

3004 -
300501 -  ..
300502 - PET Scan Test Tiny Right Axillary Mild FDG Recommend Contrast CT Study
300503 -
300504 - Follow up ref SDS A2 NL4N, ref SDS 96 NL4N.
300505 -
300506 - On 060106 the doctor scheduled PET scan test, ref SDS A2 NL4N, to
300507 - follow up the test on 051005, that was received on 051007. ref SDS 85
300508 - WJ6G  This implements planning on 051121 to vigorously test for
300509 - relapse. ref SDS 96 NL4N
300511 -  ..
300512 - At that time on 060106, the doctor indicated the PET scan test would
300513 - evaluate new swelling in the left axilla, ref SDS A2 MW8J, that may be
300514 - lymphedema, ref SDS A2 S28I, which research shows requires timely
300515 - diagnosis and treatment to prevent disease from cascading out of
300516 - control. ref SDS A2 PG5J
300517 -
300519 -         ..
300520 -        Test History No Evidence Distant Metastasis
300521 -
300522 -          Type  Date               Received          Source
300523 -           PET  060120 reported on 060126........... ref SDS 0 WJ6G
300524 -           PET  051005 reported on 051007........... ref SDS 85 WJ6G
300525 -           CT   050530 reported on 050610........... ref SDS 60 G75L
300526 -           CT   050325 reported on 050422........... ref SDS 57 G75L
300527 -           CT   041217 reported on 041230........... ref SDS 48 G75L
300528 -           CT   041103 reported on 041104........... ref SDS 44 NL4N
300529 -           CT   040921 reported on 041005........... ref SDS 42 NL4N
300530 -           CT   040710 reported on 040811........... ref SDS 39 DU9I
300531 -           CT   040410 reported on 040416........... ref SDS 31 HX4K
300532 -           CT   040307 reported on 040318........... ref SDS 29 LK5L
300533 -           CT   031031 reported on 031205........... ref SDS 25 IG9K
300534 -           CT   030626 reported on 030710........... ref SDS 23 AL6N
300535 -           CT   030428 reported on 030508........... ref SDS 22 LK5L
300536 -           PET  021218 reported on 030109........... ref SDS 20 LK5L
300537 -           PET  020529 reported on 020603........... ref SDS 9 0001
300538 -
300540 -  ..
300541 - The test was performed on 060120, and Millie wrote a letter to the
300542 - doctor on 060124 asking for results of the test, per above.
300543 - ref SDS 0 SZ9L
300545 -  ..
300546 - Today, Millie received an email response from the doctor...
300547 -
300550 -        Subject: RE: Lab Results
300551 -        Received: 1/25/06 3:02 PM
300553 -         ..
300554 -        Here are the findings for the PET.
300555 -
300556 -            BODY PET SCAN (Digital)
300561 -  ..
300562 - Note:  today, for some reason only the "Impression" section of the PET
300563 - scan test report was received from the doctor, per below. ref SDS 0
300564 - MW6K
300565 -
300566 -            [On 060217 during a regularly scheduled meeting, the doctor
300567 -            printed and submitted the full report for the PET scan test
300568 -            on 060120, ref SDS A3 NL4N, as follows...
300570 -             ..
300571 -            [On 060324 same problem occurred working with VA;
300572 -            electronic message system does not have enough space to
300573 -            send a meaningful message. ref SDS A5 N158
300575 -     ..
300576 -    Patient
300584 -     ..
300585 -    Body PET Scan (Digital) ................. 060120 0617
300586 -
300592 -     ..
300593 -    HISTORY
300594 -
300595 -        70 year old female with history of breast cancer diagnosed in
300596 -        3/02 and left cervical recurrence in 2004, S/P left palliative
300597 -        mastectomy in 10/05.  She was referred for PET scan for
300598 -        interval re-evaluation of disease status.
300600 -  ..
300601 - PET scan test report fails to report patient history cardiopulmonary
300602 - disorders diagnosed in CT test on 041103 and received from Kaiser on
300603 - 041104.
300605 -  ..
300606 - PET Scan Test report continues...
300607 -
300608 -    PROCEDURES:
300609 -
300610 -        Blood sugar was 121 mg/dl prior to injection of radioisotope.
300612 -         ..
300613 -        Radiopharmaceutical used:  15.63 mCi 18-F Fluorodexyglucose IV
300615 -         ..
300616 -        Time of tracer injection:  7:31
300618 -         ..
300619 -        Time of emission scan:  08:23
300621 -         ..
300622 -        Following intravenous injection of radioisotope, the uptake
300623 -        period and voiding, the patient was positioned on the full ring
300624 -        dedicated PET scanner.  Emission (5 min per bed position) and
300625 -        transmission (2 min per bed position) scans from the base of
300626 -        the skull through mid-thigh were acquired in 7 bed positions.
300627 -        The transmission scans were acquired using two Ge-68 rod
300628 -        sources.  Images were corrected for signal attenuation and
300629 -        reviewed in the coronal, sagittal and transaxial planes.
300631 -         ..
300632 -        Correlation:  None
300633 -
300634 -
300635 -
300636 -
3007 -

SUBJECTS
Comparison PET Scan Test 060120 Omitted Kaiser Cannot Find PET Test

4703 -
470401 -     ..
470402 -    Comparison Omitted Kaiser Cannot Find PET Test for 051005
470403 -    Lost PET Test Report Prevents Comparison for Medical Evaluation
470404 -
470405 -
470406 -    COMPARISON:
470407 -
470408 -        Images from body PET/CT study dated 10/5/05 not available for
470409 -        direct comparison.
470411 -  ..
470412 - Previously, on 040227 the doctor could not find a report for CT test
470413 - on 031031. ref SDS 27 YE4F  On 040318 CT tests could not be found in
470414 - Kaiser's computer nor in the medical chart to resolve conflicts on
470415 - expanding axillary lymphadenopathy. ref SDS 29 ZE5O  On 040812 doctor
470416 - could not find reports on prior tests; conflicts in test reports
470417 - explained as medical practice less precise than engineering.
470418 - ref SDS 40 LQ5L  On 041230 nobody could remember why treatment was
470419 - switched in June 2002 in order to decide on resuming similar treatment
470420 - in 2005. ref SDS 48 437N
470422 -  ..
470423 - Why no comparison with the test on 051005, received and reported
470424 - during the meeting on 051007? ref SDS 85 WJ6G  The analyst seems to
470425 - indicate that Kaiser cannot find the report for the prior test.  Why
470426 - wasn't the customer notified to get this information in order to
470427 - perform test requirements for comparison?  On 021108 Bill Gates
470428 - reported Microsoft research found that people cannot find information
470429 - on computers.  Microsoft planned a project to improve ability to find
470430 - critical detals. ref SDS 17 EF5I  This was not effective for helping
470431 - Kaiser find the PET scan test report on 051005 to compare for trend
470432 - analysis with the test on 060120, per above. ref SDS 0 XF3K
470433 -
470434 -        [On 061012 similar problem CT test analyst fails to perform
470435 -        comparison ordered by doctor. ref SDS B1 A56T
470437 -         ..
470438 -        [On 061024 case study medical practice computer access limited
470439 -        even with everything on the computer, people can't find details
470440 -        stored in parts of the computer (software modules) that are not
470441 -        frequently used. ref SDS B2 JD9L
470443 -         ..
470444 -        [On 070517 doctor reports Kaiser changed the policy to analyse
470445 -        only 20% of test data, and fail to evaluate progression of
470446 -        disease by making comparisons with prior test results.
470447 -        ref SDS B4 OS5G
470449 -         ..
470450 -        [On 070524 CT test on 070520 failed to cite patient history of
470451 -        lung and heart disorders, and failed to perform comparison to
470452 -        assess progression of pulmonary embolism and enlarged right
470453 -        ventricle. ref SDS B5 0136
470454 -
470456 -  ..
470457 - This presents a compound problem....
470459 -  ..
470460 - At that time on 051007, the test a few days earlier on 051005 cited
470461 - comparision with a test on 021218, ref SDS 85 S47F, and found that all
470462 - prior issues from that test were resolved. ref SDS 85 IE5R
470463 - Overlooked, however, in "comparison" analysis of the test on 051005
470464 - was resolution of findings on a CT test only a few months earlier on
470465 - 050530, and citing enlarged right axillary, as set out in the record
470466 - on 051007. ref SDS 85 OG5J
470468 -  ..
470469 - Similarly, failure to compare test results across test periods (i.e.,
470470 - looking back over 2 - 4 test periods, i.e., 6 - 12 months) prevents
470471 - comparing new findings today of possible FDG activity in the right
470472 - axillary. ref SDS 0 XF41
470474 -  ..
470475 - Difficulty managing organizational memory to find details in the
470476 - record is reported in a study on 040416. ref SDS 31 GN7J  On 021108
470477 - Microsoft is working on project to improve technology for finding
470478 - critical details, ref SDS 17 EF5I, which is a pervasive problem
470479 - reported on 960406. ref SDS 1 4249
470480 -
470481 -
470482 -
470483 -
4705 -

SUBJECTS
FDG Right Axillary Mild Activity May Represent Local Inflammatory Pr

5203 -
520401 -  ..
520402 - FDG Right Axillary Recommend Contrast CT Study Tiny Focus Activity
520403 - Right Axillary Findings Mild FDG Activity Need Comparison Test 050530
520404 -
520405 - PET scan test report continues...
520406 -
520407 -    FINDINGS:
520408 -
520409 -        A tiny focus with mild FDG activity (standardized uptake value,
520410 -        SUV, 1.9) is noted in the right axillary region (transaxial
520411 -        #579), which may represent a local inflammatory process,
520412 -        although metastatic disease cannot be entirely excluded.
520414 -  ..
520415 - Report of a "tiny" right axillary swelling, ref SDS 0 MW6K, may align
520416 - with the examination on 060106 that found some swelling, though much
520417 - less than the left side. ref SDS A2 G55I  Analysis today of CA 15-3
520418 - holding steady at 34, having risen from 28, ref SDS 0 FG6S, calls for
520419 - continued monitoring of this factor.
520421 -  ..
520422 - Analyst calls out in Impressions for contrast CT study to evaluate
520423 - findings of mild FDG in right axillary. ref SDS 0 686T  The doctor
520424 - plans observations for 3 months. ref SDS 0 686T
520426 -  ..
520427 - Need comparison with CT test on 050530 of enlarged right axillary
520428 - lymph node approximately 1 cm reported on 050610, ref SDS 60 TH9N, and
520429 - reviewed in the record of the meeting on 051007. ref SDS 85 OG5J
520430 -
520431 -     [On 060217 doctor proposed that blood work showing everything
520432 -     normal including CA 15-3 supports deferring contrast CT study
520433 -     until after the next PET scan test in April. ref SDS A3 DU5J
520435 -      ..
520436 -     [On 060217 doctor noted absence of findings in PET scan test
520437 -     report for left axillary indicates absence of lymphadenopathy; the
520438 -     test further makes no findings of lymphedema. ref SDS A3 MW8J
520439 -
520440 -
520441 -
520442 -
520443 -
5205 -

SUBJECTS
PET Scan Test on 060120 Pathology Report Analyst Finds No Evidence o
Esophagitis PET Scan Test Likely Findings Requires Examination and T

5704 -
570501 -  ..
570502 - Esophagitis Requires Examination and Treatment to Prevent Achalasia
570503 -
570504 - PET scan test report continues...
570505 -
570506 -        A focus with moderate hypermetabolic activity (SUV 4.4) in the
570507 -        lower thorax, to the left of midline (#515) likely represents
570508 -        esophagitis.
570510 -  ..
570511 - This finding aligns with recent difficulty patient experiences over
570512 - past 6 months of occassional reflux during sleep that requires sitting
570513 - up to avoid suffocation-type issues.
570514 -
570515 -     [On 060217 doctor submits PET scan test report; no discussion of
570516 -     esophagitis; action item pending professional review. ref SDS A3
570517 -     W34G
570519 -      ..
570520 -     [On 060320 letter to the doctor asks about follow up examination
570521 -     for esophagitis, and reports patient history of symptoms.
570522 -     ref SDS A4 X93U
570524 -      ..
570525 -     [On 060428 PET scan test report omits report to compare with prior
570526 -     findings; patient reports mild infrequent symptoms; treatment plan
570527 -     deferred pending rise of symptoms. ref SDS A6 PR9J
570529 -      ..
570530 -     [On 060523 CT contrast study for PET scan test on 060414 reports
570531 -     findings of less than 1 cm lymph nodes within the "right
570532 -     paratracheal region" may relate to esophagitis, ref SDS A7 PA5G,
570533 -     reported in the PET scan test on 060120, per above. ref SDS 0 DH4O
570535 -      ..
570536 -     [On 060607 Millie admitted to emergency room for temperature of
570537 -     104.2; xray shows pneumonia, ref SDS A8 PT7S, doctor reports
570538 -     Kaiser's computer says Millie has been diagnosed with esophagitis,
570539 -     and asks how esophagitis is being treated. ref SDS A8 LO3H
570540 -     Research indicates possible correlation between esophagitis and
570541 -     pneumonia. ref SDS A8 I24L
570543 -      ..
570544 -     [On 060623 doctor unable to access computer to review test
570545 -     findings on esophagitis. ref SDS A0 463H
570547 -      ..
570548 -     [On 060623 medical chart says esophagitis not symptomatic,
570549 -     ref SDS A9 7M5H; there is no record of receiving the letter
570550 -     submitted on 060320 and listing symptoms. ref SDS A4 X94Q
570552 -      ..
570553 -     [On 060711 primary care physician reports patient has not
570554 -     been diagnosed with esophagitis on the basis of imaging
570555 -     tests, since patient reports only mild, occassional
570556 -     symptoms. ref SDS B0 4R6K
570558 -      ..
570559 -     [On 061110 patient reports rising indigestion; symptoms
570560 -     still too infrequent to treat esophagatis. ref SDS B3 0R8J
570562 -  ..
570563 - Research shows esophagitis may require treatment for mild
570564 - indigestion...
570565 -
570566 -            http://www.emedicine.com/med/topic735.htm
570568 -     ..
570569 -    Emedicine
570570 -
570571 -        Last Updated: February 27, 2006
570573 -         ..
570574 -        Background:  The most common cause of esophagitis is
570575 -        Gastroesophageal Reflux Disease (GERD).  Other important but
570576 -        less common causes are infections, medications, radiation
570577 -        therapy, systemic disease, and trauma.  Eosinophilic
570578 -        esophagitis has recently emerged as an important cause of
570579 -        esophagitis in both children and adults.  This article does not
570580 -        discuss GERD-induced esophagitis.
570581 -
570583 -         ..
570584 -        Gastroesophageal Reflux Disease (GERD)
570585 -
570586 -
570587 -        "Heartburn" is another common term for this problem.
570588 -
570589 -            http://www.emedicine.com/med/topic857.htm
570591 -         ..
570592 -        Approximately 50% of patients with gastric reflux develop
570593 -        esophagitis. Esophagitis is classified into the following 4
570594 -        grades based on its severity
570595 -
570596 -        1.  Grade I - Erythema
570597 -
570598 -        2.  Grade II - Linear nonconfluent erosions
570600 -             ..
570601 -        3.  Grade III - Circular confluent erosions
570603 -             ..
570604 -        4.  Grade IV - Stricture or Barrett esophagus (Barrett
570605 -            esophagus [grade IV] is thought to be caused by the chronic
570606 -            reflux of gastric juice into the esophagus.  Barrett
570607 -            esophagus occurs when the squamous epithelium of the
570608 -            esophagus is replaced by the intestinal columnar
570609 -            epithelium.  Barrett esophagus is present in 8-15% of
570610 -            patients with GERD and may progress to adenocarcinoma.  See
570611 -            Esophageal Cancer.)
570612 -
570613 -
570614 -
570615 -
5707 -

SUBJECTS
Findings Unremarkable Favorable for No Evidence of Disease NED PET S

6103 -
610401 -  ..
610402 - Findings Unremarkable Favorable for No Evidence of Disease NED
610403 -
610404 - PET scan test report continues...
610405 -
610406 -        Physiologial tracer activity is seen in the myocardium,
610407 -        bilateral kidneys and in the urinary bladder.
610409 -         ..
610410 -        The remaining of the visualized body, including the pulmonary
610411 -        and hepatic parenchyma appear unremarkable.
610412 -
610413 -
610414 -
610415 -
610416 -
6105 -

SUBJECTS
Impressions PET Scan Test 060120 Mild FGD Right Axilla Recommend Con

7203 -
720401 -  ..
720402 - NED No Evidence of Disease Impression FDG Recommend Contrast Study
720403 - Impression Recommend Contrast Study FDG No Evidence of Disease NED
720404 -
720405 - PET scan test results received from the doctor today, per above.
720406 - ref SDS 0 WJ6G
720407 -
720408 -    IMPRESSION:
720409 -
720410 -        1. A tiny right axillary focus with mild FDG activity is noted,
720411 -           which may represent local inflammatory process.  However,
720412 -           metastatic disease cannot be excluded.  Further evaluation
720413 -           with a contrast CT study may be helpful.
720415 -            ..
720416 -        2. Otherwise unremarkable body PET study.
720418 -     ..
720421 -     ..
720422 -    DD:  01/23/2006 DT: 01/23/06 SST
720424 -  ..
720425 - The PET scan test on 051005, and received from the doctor on 0510007,
720426 - did not resolve prior findings of swelling in the right axilla,
720427 - ref SDS 85 1E8L, reported on 050610. ref SDS 60 WA52  At that time on
720428 - 051007, review indicated this could relate to elevated CA 15-3 test
720429 - results. ref SDS 85 5D9J
720431 -  ..
720432 - At this time, CA 15-3 at 34 remains well below the upper range of
720433 - safety, 39, though it is up from the recent low of 28.  This common
720434 - pattern is noted today. ref SDS 0 GJ5M
720436 -  ..
720437 - The Doctor's letter concludes...
720438 -
720439 -        We will keep an eye on this and follow up again in three
720440 -        months.
720442 -         ..
720445 -  ..
720446 - The plan to follow up on right axilla FDG activity, ref SDS 0 MW6K,
720447 - reflects prior practice on similar patient history and continued CA
720448 - 15-3 monitoring planned on 060106. ref SDS A2 SZ9H
720450 -  ..
720451 - We need the full report on findings that support the impressions
720452 - received today, per above. ref SDS 0 MW6K
720453 -
720454 -     [On 060217 during a regularly scheduled meeting, the doctor
720455 -     submitted the rest of the PET scan test ref SDS A3 NL4N, as
720456 -     follows...
720458 -  ..
720459 - Recommendation for contrast CT study can be considered immediately
720460 - during the meeting on 060217, ref SDS 0 MW6K, and based on patient
720461 - history of relapse, listed on 050812, ref SDS 65 GU6F, and stage IV
720462 - status reported on 040614, also, listed in the study on 050812.
720463 - ref SDS 65 MD5W
720464 -
720465 -     [On 060217 doctor proposed that blood work showing everything
720466 -     normal including CA 15-3 supports deferring contrast CT study
720467 -     until after the next PET scan test in April. ref SDS A3 DU5J
720469 -  ..
720470 - Study on 040416 indicates advantage of timely follow up on analyst
720471 - recommendations to avoid disease cascading out of control. ref SDS 31
720472 - GN7J
720473 -
720474 -
720475 -
720476 -
7205 -

SUBJECTS
Left Axillary Lump Under Arm PET Scan Test Impressions Does Not Ment

8003 -
800401 -  ..
800402 - Left Axillary Lump Under Arm Diagnosis Lymphedema Not Cancer
800403 - Lymphedema Left Axillary Not Cancer Lump Under Arm Diagnosis
800404 - Right Left Axillary Examination No Evidence Lumps Lymphedema
800405 -
800406 - Follow up ref SDS A2 MW8J, ref SDS 96 MW8J.
800407 -
800408 - On 060106 the doctor made preliminary diagnosis of lymphedema,
800409 - ref SDS A2 S16G, and planned to rely on the PET scan test for
800410 - verification. ref SDS A2 CN4I
800412 -  ..
800413 - Presumably the report is silent on lymphedema.  Does this mean there
800414 - is no lymphedema, or that other testing is required, or that the
800415 - problem, if any, is so mild as not to require treatment?
800416 -
800417 -        On 060217 the doctor submitted the full PET scan test report,
800418 -        and it does not mention findings on lymphedema (reported for
800419 -        convenience in this record above, ref SDS 0 697N).  Other
800420 -        testing may be needed to resolved the issue.
800422 -  ..
800423 - How does the test relate to research on 060106, ref SDS A2 RV3J,
800424 - calling for timely diagnosis, ref SDS A2 S28I, and early treatment?
800425 - ref SDS A2 PG5J
800427 -  ..
800428 - Why does the PET scan test report "local inflammatory process" on
800429 - right axillary that is tiny and does not mention larger problem on the
800430 - left axillary?
800432 -      ..
800433 -     [On 060217 examination showed significantly reduced swelling of
800434 -     left axillary, and PET scan test on 060120 made no findings; CA
800435 -     15-3 fell slightly, ref SDS A3 MW8J; therefore doctor deferred
800436 -     work up and treatment for lymphedema until further examination in
800437 -     April 2006. ref SDS A3 SG3O
800438 -
800439 -
800440 -
800441 -
800442 -
800443 -
800444 -
8005 -