CONTACTS 

SUBJECTS
Meeting Doctor Examine Recovery from Mastectomy Surgery Response to

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS A6 0000. ref SDS A0 0000.
040502 -
040503 - Received the full PET scan test report today; very favorable with no
040504 - findings of metastatic disease. ref SDS 0 D49K  CA 15-3 dropped
040505 - slightly underscoring patient status NED. ref SDS 0 GJ5M  PET test
040506 - reported esophagitis, which requires work up to avoid problems from
040507 - cascading out of control. ref SDS 0 W34G  Swelling in the left axilla
040508 - seems greatly reduced today; the doctor scheduled meeting with
040509 - physical therapyst for treatment of lymphedema. ref SDS 0 T56K
040510 - General examination showed mastectomy incision healing normally, and
040511 - supports findings of NED. ref SDS 0 GF6K  This allows treatment
040512 - "holiday," to continue, ref SDS 0 AW5G, which greatly contributes to
040513 - patient vigor and strength from exercise enabled by being off
040514 - chemotherapy since September 2005. ref SDS 0 Y642  Emotional feelings
040515 - of wariness and worry were addressed today by referral to a support
040516 - team. ref SDS 0 Y64H  Prior mild dizziness has returned, and was
040517 - treated by referral for treatment by HEENT. ref SDS 0 PT4K
040518 -
040519 -     [On 060320 letter to the doctor asks about follow up examination
040520 -     for esophagitis, and reports patient history of symptoms.
040521 -     ref SDS B1 X93U
040522 -
040523 -
040524 -
040525 -
040526 -
040527 -
040529 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Agenda for Work Plan After Switching to Taxotere and Capecitabine
040902 -
040903 - Follow up ref SDS A6 SM6M, ref SDS A0 SM6M.
040905 -  ..
040906 - This is the 3rd review meeting with primary care physician following
040907 - mastectomy surgery on 051021, ref SDS 94 0001, and following post op
040908 - examination by the surgeon on 051027 when Millie's status was reported
040909 - "no evidence of disease (NED)". ref SDS 98 M58G
040911 -  ..
040912 - Millie listed an agenda on the marking board in the examination room
040913 - to guide discussions...
040914 -
040915 -    1.  CA 15-3 cancer marker report............... ref SDS 0 GJ5M
040916 -    2.  Blood tests all normal..................... ref SDS 0 GJ5M
040917 -    3.  Port flush................................. ref SDS 0 SH5N
040918 -    4.  PET test full report....................... ref SDS 0 NL4N
040919 -    5.  CT contrast study to supplement PET........ ref SDS 0 II4L
040920 -    6.  Lump left axillary lymphedema.............. ref SDS 0 MW8J
040921 -    7.  Lump under right arm....................... ref SDS 0 II4L
040922 -    8.  Breast exam recovering IBC................. ref SDS 0 025H
040923 -    9.  Emotional support.......................... ref SDS 0 Y642
040924 -   10.  Dizziness.................................. ref SDS 0 PT4K
040925 -   11.  Cholesterol test LIPOD Panel............... ref SDS 0 TE5N
040926 -   12.  Surgeon's pre-op patient history........... ref SDS 0 355G
040927 -   13.  Treatment plan............................. ref SDS 0 AW5G
040928 -   14.  Status change treatment options............ ref SDS 0 ZR6J
040930 -  ..
040931 - Scheduled next meeting in 8 weeks on 060417.
040932 -
040933 -
040934 -
040935 -
040936 -
040937 -
0410 -

SUBJECTS
Vitals Show Stable Medical Condition Meeting Primary Care Physician

0603 -
060401 -  ..
060402 - Vitals Show Stable Medical Condition
060403 -
060404 - The admitting attendant now enters this data into the doctor's
060405 - computer prior to each meeting...
060406 -
060407 -    Blood Pressure....................... 153 81
060408 -    Pulse................................ 61
060409 -    Temp................................. 98.6
060410 -    Weight............................... 150
060411 -    Sa02................................. 99%
060412 -
060413 - ...per Doctor's report, shown below. ref SDS 0 JQ4J
060414 -
060415 -
060416 -
060417 -
060418 -
060419 -
0605 -

SUBJECTS
CA 15-3 33 and 6 Points Below Normal 39 and 1 Point Drop from 34 abo

1603 -
160401 -  ..
160402 - CA 15-3 Cancer Marker 33 Fell from 33 the Past 4 Weeks
160403 -
160404 - Follow up ref SDS A6 087J, ref SDS A0 087J.
160405 -
160406 - The most recent blood test on 060210 shows CA 15-3 fell to 33, after
160407 - dropping to an all time low of 28 on 051202, then rising to 34 on
160408 - 060106, and the same on 060126.  The test received today shows...
160410 -           ..
160411 -          Test Date                         Date Received
160412 -          060210......... 33............... 060217, ref SDS 0 087JL
160413 -          060109......... 34............... 060126, ref SDS A7 KV59,
160414 -          051223......... 34............... 060106, ref SDS A6 087JL
160415 -          051202......... 28............... 060106, ref SDS A6 087JL
160416 -          051116......... 31............... 051121, ref SDS A0 087JL
160417 -          051109......... 30............... 051121, ref SDS A0 087JL
160418 -          051102......... 34............... 051121, ref SDS A0 087JL
160471 -
160472 -
160474 -  ..
1605 -
1606 -
1607 - Analysis
1608 -
160801 - CA 15-3 33 Cancer Marker Drops Still Significantly Below Target Level
160802 -
160803 - Follow up ref SDS A6 GJ5M, ref SDS A0 GJ5M.
160804 -
160805 - The most recent CA 15-3 test on 060210 dropped very slightly to 33
160806 - from 34, and remains significantly below the danger level of 39.
160807 - Patient history supports the doctor's analysis on 060106 that this
160808 - critical diagnostic is "stable," ref SDS A6 GJ5M, and supports patient
160809 - status based on all tests and examinations as NED and stable, reported
160810 - by the doctor on 060106. ref SDS A6 GV6K
160811 -
160812 -
160813 -
160814 -
160815 -
1609 -

SUBJECTS
Blood Tests on 060109 All Normal 1st Time 4 Years No Evidence Relaps

1803 -
180401 -  ..
180402 - Blood Tests All Normal 1st Time 4 Years Supports Diagnosis NED
180403 -
180404 - Follow up ref SDS A6 SZ9L.
180405 -
180406 - On 060126 the doctor submitted results of blood tests taken on 060109,
180407 - ref SDS A7 SZ9L  This test was ordered during the meeting on 060106 to
180408 - monitor recovery from stage IV cancer, ref SDS A6 SZ9L, diagnosed as
180409 - IBC on 040614. ref SDS 38 6T5G
180411 -  ..
180412 - Millie cited results showing all counts are normal for the 1st time in
180413 - about 4 years. ref SDS A7 YZ3N
180415 -  ..
180416 - The more recent CA 15-3 has dropped very slightly, and so remains well
180417 - below the target danger level of 39, per above. ref SDS 0 GJ5M
180419 -  ..
180420 - The doctor indicated that these blood test results support continuing
180421 - diagnosis on 060106 that patient is NED and stable. ref SDS A6 GV6K
180422 -
180423 -        [...below, examination finds continuing stable condition of
180424 -        NED. ref SDS 0 GF6K
180425 -
180426 -
180427 -
180428 -
1805 -

SUBJECTS
Cholesterol Blood Test Scheduled Lipid Profile Preventive Medicine A

2103 -
210401 -  ..
210402 - Cholesterol Blood Test Scheduled Preventive Medicine
210403 -
210404 - Millie asked about adding a cholosteral blood test to the order with
210405 - the next CA 15-3.
210406 -
210407 - Kaiser issued a recent notice that this preventive medicine test is
210408 - due before April.
210410 -  ..
210411 - The doctor prepared an order for a lipid profile to tests cholesterol
210412 - levels, per report below. ref SDS 0 1153
210414 -  ..
210415 - Research at...
210416 -
210417 -    Lab Tests Online
210418 -
210419 -              http://www.labtestsonline.org/understanding/analytes/lipid/glance.html
210420 -
210421 - ...explains lipid profile tests for risk assessment of coronary heart
210422 - disease or stroke.
210423 -
210424 -
210425 -
210426 -
210427 -
210428 -
210429 -
2105 -

SUBJECTS
PET Scan Test Doctor Reports Very Favorable Results Support Diagnosi

3403 -
340401 -  ..
340402 - PET Scan Test Full Report Received Email Efficiencies Not Available
340403 - Email Efficiencies Not Available to Distribute PET Scan Test Report
340404 - No Evidence of Disease Favorable PET Scan Test Following Mastectomy
340405 -
340406 - Follow up ref SDS A6 NL4N, ref SDS A0 NL4N.
340407 -
340408 - During the meeting on 060106 the doctor scheduled a PET scan to follow
340409 - up the test on 051005, which was received during the meeting on
340410 - 051007, ref SDS 89 WJ6G, and for the purpose of evaluating mastectomy
340411 - surgery later performed on 051021. ref SDS 95 0001  Regular post
340412 - operative testing implements plans on 051121 to vigorously test for
340413 - relapse, ref SDS A0 NL4N, including evaluation of new swelling in the
340414 - left axilla reported on 060106. ref SDS A6 MW8J
340416 -  ..
340417 - On 060126 the doctor submitted email, ref SDS A7 E53H, transmitting
340418 - the "impression" part of the report for the PET scan test performed on
340419 - 060120. ref SDS A7 MW6K
340421 -  ..
340422 - Patient history of PET and CT tests is listed on 060126. ref SDS A7
340423 - XU7N
340425 -  ..
340426 - The doctor indicated results of PET testing are favorable, showing no
340427 - evidence of disease.  Blood tests discussed above, ref SDS 0 SZ9L, and
340428 - examination today, reported below, ref SDS 0 GF6K, all show that
340429 - Millie's condition remains officially NED.
340431 -  ..
340432 - Millie requested the full PET scan test report, per planning on 060126
340433 - when only part of the report was received from Kaiser. ref SDS A7 0G7G
340434 -
340435 -    [On 060428 doctor submitted via electronic transmission (email)
340436 -    full report for PET scan test on 060414, and this was enabled
340437 -    being prepared to facilitate a productive meeting; Millie is
340438 -    doctor's only patient who requests medical reports to be prepared
340439 -    for effective meetings. ref SDS B6 YU3H
340441 -  ..
340442 - The doctor explained that the "Impression" part of test reports, which
340443 - was sent to the patient on 060126, has the content important for
340444 - diagnosis and treatment planning.  Professional analysts summarize the
340445 - details to save time for doctors and patients.
340447 -  ..
340448 - There was discussion that the full report supports doctor-patient
340449 - partnership to aid the analyst and doctor in discovering correlations,
340450 - implications, and nuance critical to diagnosis and treatment, and is
340451 - accomplished using the 8 steps of Communication Metrics for working
340452 - intelligently, as set out in POIMS. ref OF 6 685K
340453 -
340454 -    This is illustrated by the record on 060126 showing review of the
340455 -    full report after receipt from the doctor today. ref SDS A7 IG9K
340457 -  ..
340458 - The doctor proposed printing the full test report.
340460 -  ..
340461 - There was discussion about improving productivity, saving time, and
340462 - reducing costs by sending the full report with email, as the doctor
340463 - did on 060126 submitting part of the report. ref SDS A7 E53H  Today,
340464 - the doctor was unsure about using email to send the full report.
340465 - Better productivity would require learning how to send 7 paragraphs
340466 - via email, 6 more than was submitted on 060126.  Learning new skills
340467 - requires contacting Kaiser technicians for support.  There could be
340468 - delay getting connected to a technician or leaving a message, and
340469 - waiting for a response, then struggling to cross-train from technology
340470 - to medical skills.  The doctor felt there wasn't enough time for
340471 - cognitive overhead today.  He decided it would be faster and easier to
340472 - print the report and transfer to the patient the burden of cognitive
340473 - overhead spending a few hours converting the report into a useful
340474 - medium for working intelligently to save lives, time, and money, as
340475 - called out in POIMS. ref OF 3 1X6G
340477 -  ..
340478 - The doctor printed the full report for the PET scan test on 060120,
340479 - and handed it to the patient.  There was no time for review during the
340480 - meeting.  For convenience the full findings received today have been
340481 - manually typed for incorporation into the record on 060126 for
340482 - continuity with receiving the section on impressions. ref SDS A7 697N
340483 -
340484 -    [On 060428 doctor submitted via electronic transmission (email)
340485 -    full report for PET scan test on 060414, and this was enabled
340486 -    being prepared to facilitate a productive meeting; Millie is
340487 -    doctor's only patient who requests medical reports to be prepared
340488 -    for effective meetings. ref SDS B6 YU3H
340489 -
340490 -
340491 -
340492 -
340493 -
3405 -

SUBJECTS
Esophagitis Requires Examination and Treatment to Prevent Achalasia

3703 -
370401 -  ..
370402 - Esophagitis Requires Examination and Treatment to Prevent Achalasia
370403 -
370404 - Follow up ref SDS A7 DH4O.
370405 -
370406 - After the meeting, review of the PET scan test report shows findings
370407 - of esophagitis.  This is disclosed in the full report received from
370408 - the doctor today, per above. ref SDS 0 DU9O  The doctor did not
370409 - discuss findings of esophagitis, which are reported in the record on
370410 - 060126 for continuity receiving initial impressions. ref SDS A7 DH4O
370412 -  ..
370413 - The doctor's report on the meeting does not mention esophagitis
370414 - diagnosis and treatment. ref SDS 0 1248
370416 -  ..
370417 - Review in the record on 060126 cites alignment of symptoms with
370418 - recent patient history. ref SDS A7 D68K  This requires professional
370419 - assessment.
370420 -
370421 -     [On 060320 letter to the doctor asks about follow up examination
370422 -     for esophagitis, and reports patient history of symptoms.
370423 -     ref SDS B1 X93U
370425 -      ..
370426 -     [On 060322 Arlette forwarded letter with notice of the problem to
370427 -     the primary care physician. ref SDS B2 LS8N
370429 -      ..
370430 -     [On 060428 PET scan test report omits report to compare with prior
370431 -     findings; patient reports mild infrequent symptoms; treatment plan
370432 -     deferred pending rise of symptoms. ref SDS B6 PR9J
370434 -      ..
370435 -     [On 060523 CT contrast study for PET scan test on 060414 reports
370436 -     findings of less than 1 cm lymph nodes within the "right
370437 -     paratracheal region" may relate to esophagitis, ref SDS B7 PA5G,
370438 -     reported in the PET scan test on 060116, per above. ref SDS A7
370439 -     DH4O
370440 -
370441 -
370442 -
3705 -

SUBJECTS
FDG Right Axillary Evaluate PET Test April then CT Contrast Study Me

4203 -
420401 -  ..
420402 - CT Contrast Study FDG Right Axillary Deferred After PET Test in April
420403 - FDG Right Axillary Evaluate PET Test April then CT Contrast Test
420404 - PET Scan Test Scheduled April for Evaluation During Next Examination
420405 -
420406 - Follow up ref SDS A7 XF41.
420408 -  ..
420409 - Millie asked about the analysts "Impression" that calls for contrast
420410 - CT study of right axillary, shown on 060126. ref SDS A7 MW6K
420412 -  ..
420413 - The doctor did not recall this comment.  He pulled up the PET scan
420414 - report on the computer and read the "Impression" section that says...
420415 -
420416 -        A tiny right axillary focus with mild FDG activity is noted,
420417 -        which may represent local inflammatory process.  However,
420418 -        metastatic disease cannot be excluded.  Further evaluation with
420419 -        a contrast CT study may be helpful. ref SDS A7 MW6K
420421 -  ..
420422 - The doctor proposed that, based on blood work showing everything
420423 - normal for the first time in four (4) years, including a slight drop
420424 - in CA 15-3, which is well below the danger target level, contrast CT
420425 - study can be deferred until after the next PET scan test in April.
420426 -
420427 -
420428 -
420429 -
420430 -
4205 -

SUBJECTS
Left Axillary Lump Under Arm Examination Finds Size Significantly Re

5103 -
510401 -  ..
510402 - Left Axillary Lump Under Arm Diagnosis Lymphedema Not Cancer
510403 - Lymphedema Left Axillary Not Cancer Lump Under Arm Diagnosis
510404 - Post Operation Localized Edema Left Axillary Swelling Reduced
510405 -
510406 - Follow up ref SDS A6 MW8J, ref SDS A0 MW8J.
510407 -
510408 - Millie asked about following up on plans during the meeting on 060106
510409 - to evaluate lymphedema with PET scan testing. ref SDS A6 CN4I
510411 -  ..
510412 - The doctor noted absence of findings in the PET scan test report for
510413 - the left axillary. [... see review on 060126 showing no findings on
510414 - left axillary, ref SDS A7 MW8J]  He said that absence of findings
510415 - metastatic disease indicates swelling observed during the meeting on
510416 - 060106, ref SDS A6 MW8J, is not a relapse of lymphadenopathy.
510418 -  ..
510419 - Research reported on 060106 indicates that a work up on lymphedema,
510420 - ref SDS A6 S28I, and timely treatment helps prevent disease from
510421 - cascading out of control. ref SDS A6 PG5J
510423 -  ..
510424 - Background on patient history of left axillary lymphadenopathy and
510425 - possible lymphedema in the left arm is also reported on 060106.
510426 - ref SDS A6 S164
510428 -  ..
510429 - Today, the doctor examined the left axilla and observed significantly
510430 - reduced swelling compared with examination on 060106. ref SDS A6 MW8J
510432 -  ..
510433 - The left arm has swelling compared to the right arm; this is more
510434 - evident above the elbow.
510436 -  ..
510437 - In his report on the meeting today, the doctor describes this
510438 - condition as "post op localized edema" (see para 3), ref SDS 0 1248,
510439 - which seems like a reaction to surgery on 051021. ref SDS 95 EG5L  On
510440 - 051027 the surgeon advised that additional lymph nodes were not
510441 - removed during mastectomy surgery a week earlier on 051021 in order to
510442 - avoid lymphedema to the left arm. ref SDS 99 LI3K
510444 -  ..
510445 - The doctor proposed examination by lymphedema clinic for consideration
510446 - of treatment, and prepared a referral. per doctor's report, shown
510447 - below. ref SDS 0 125V
510448 -
510449 -     [On 060306 0927 examination in lymphedema clinic reports worsening
510450 -     swelling in left arm, orders physicial therapy. ref SDS A8 Q05H
510452 -  ..
510453 - Findings today of significantly reduced swelling of left axillary,
510454 - together with slightly falling CA 15-3, per above, ref SDS 0 087J, and
510455 - absence of findings in PET test on 060120, reported on 060126,
510456 - ref SDS A7 MW8J, all seem to support deferring work up called out in
510457 - research on 060106. ref SDS A6 S28I
510458 -
510459 -     [On 060306 examination at lyphedema clinic showed worsening
510460 -     condition; follow up meeting for personalized treatment scheduled.
510461 -     ref SDS A8 Q05H
510463 -      ..
510464 -     [On 060308 lymphedema symptoms increase, report at work.
510465 -     ref SDS A9 0001
510467 -      ..
510468 -     [On 060314 physical therapy treatment and new guidance for
510469 -     lymphedema; begin regimin of personal massage treatments to reduce
510470 -     swelling left arm. ref SDS B0 Q05H
510472 -      ..
510473 -     [On 060320 letter to primary care physician reports research
510474 -     showing bandage should be worn during exercise; lymphedema may
510475 -     have accelerated because exercise was performed without bandage
510476 -     for several months prior to notce. ref SDS B1 EU40
510478 -      ..
510479 -     [On 060320 letter to primary care physician requests meeting with
510480 -     surgeon to review work on 051021 for clues about cause and
510481 -     treatment for lymphedema. ref SDS B1 VR6M
510483 -      ..
510484 -     [On 060328 symptoms improve shown by slight decrease in
510485 -     measurements of left forearm. ref SDS B3 HO7F
510487 -      ..
510488 -     [On 060331 further improvement swelling decreases to 11", best
510489 -     reading in a month indicates lymphedema symptoms decline.
510490 -     ref SDS B4 0001
510492 -      ..
510493 -     [On 060417 therapyst finds decreased swelling, marked improvement
510494 -     compared to examination on 060314; explains that removal of lymph
510495 -     nodes during surgery on 051021 may have triggered increased
510496 -     symptoms of lymphedema. ref SDS B5 2Z9M
510497 -
510498 -
510499 -
510500 -
5106 -

SUBJECTS
Lumps in Neck Reported 040309 Currently Resolved Establish Stage IV

6603 -
660401 -  ..
660402 - Prognosis Stage IV Metastatic Disease Currently in Remission
660403 - Palliation Mastectomy Surgery for Future Relapse Stage IV Cancer
660404 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
660405 -
660406 - Follow up ref SDS A6 8R6M, ref SDS A0 8R6M.
660407 -
660408 - There was no examination of the neck today.
660410 -  ..
660411 - Doctor's notes today restate analysis during the meeting on 051121,
660412 - ref SDS A0 LH7M, and diagnose recurrent (metastatic) disease based on
660413 - findings in neck reported on 040303. ref SDS 0 NP6L  On 040303 Doctor
660414 - Lau took a biopsy of lumps in the left supraclavicular. ref SDS 30
660415 - Y171  The lumps were initially reported on 040211. ref SDS 28 WP7L
660416 - Following treatment with antibiotics, on 040227 the primary care
660417 - physician ordered biopsy examination. ref SDS 29 0001  On 040309
660418 - Doctor Lau reported that biopsy found metastatic disease. ref SDS 31
660419 - 0001  On 040517 another biopsy taken on 040419 found inflammatory
660420 - breast cancer (IBC). ref SDS 36 6T5G  Since IBC occurred as a relapse
660421 - from original diagnosis on 020312 treated with lumpectomy surgery,
660422 - ref SDS 4 0001, IBC is described as "secondary." Research indicated
660423 - that swelled lymph nodes in supraclavicular and auxillary on the same
660424 - side as the infected breast are symptoms of IBC. ref SDS 36 N23J  In
660425 - four years, of treatment, all of the CT tests and PET scan tests have
660426 - reported finding no evidence of distant metastasis, as shown in the
660427 - report received on 060126. ref SDS A7 XU7N
660429 -  ..
660430 - No new evidence was presented today on findings of distant metastasis.
660431 -
660432 -
660433 -
660434 -
660435 -
660436 -
6605 -

SUBJECTS
Examination Finds No Evidence of Disease NED Patient Recovering Mast

7603 -
760401 -  ..
760402 - No Evidence of Disease NED Patient Recovering Mastectomy Surgery
760403 - Examination Left Breast Surgical Wound Mastectomy Incision Healing
760404 - Healing Surgical Wound Mastectomy Incision Examination Left Breast
760405 -
760406 - Follow up ref SDS A6 025H, ref SDS A0 025H.
760408 -  ..
760409 - The doctor examined the incision wound from mastectomy surgery on
760410 - 051021, ref SDS 95 YG4R, and indicated the wound is still healing
760411 - normally without complications, which extends findings on 060106.
760412 - ref SDS A6 VN7I
760414 -  ..
760415 - Kaiser has still been unable to find the surgeon's pre-op patient
760416 - history, which was missing from the record prior to surgery on 051021,
760417 - ref SDS 95 DG6J, and then discussed with the surgeon a week later on
760418 - 051027. ref SDS 99 PO5J
760420 -  ..
760421 - Prior mild and periodic, general discomfort all along the left side,
760422 - including ear ache was not experienced since the meeting on 060106.
760423 - ref SDS A6 5P7I
760425 -  ..
760426 - The doctor used a stethoscope to examine lung and heart function.  He
760427 - seemed satisfied with these conditions, as shown below in the doctor's
760428 - report. ref SDS 0 BU7I
760429 -
760430 -     [...see above for more. ref SDS 0 D49K
760432 -  ..
760433 - At this time, patient status is NED and stable, based on history and
760434 - analysis reported on 051121. ref SDS A0 GV6K
760436 -  ..
760437 - Favorable PET scan test results, ref SDS 0 D49K, favorable blood test
760438 - results, ref SDS 0 SZ9L, including CA 15-3 falling slightly to 33, and
760439 - so stable well below danger level of 39, ref SDS 0 GJ5M, and
760440 - significantly reduced swelling left axillary, ref SDS 0 MW8J, all
760441 - reduce prior worries of relapse reported on 060106. ref SDS A6 MW8J
760443 -  ..
760444 - Doctor scheduled follow up examination on 060417, per below.
760445 - ref SDS 0 2S33
760446 -
760447 -
760448 -
760449 -
7605 -

SUBJECTS
Exercise Vigor Strength Engagement Restored after Chemotherapy Ends

8203 -
820401 -  ..
820402 - Exercise Vigor Strength Engagement Restored after Chemotherapy Ends
820403 - Emotional Trauma Eased by Counseling Exercise Engagement with World
820404 - Behavior Medical Specialist (BMS) Referral for Emotional Counseling
820405 -
820406 - Millie has returned to full-time rigorous exercise, following up plans
820407 - reported on 050729 to re-join a Health Club. ref SDS 68 Y86K  She is
820408 - working out at the gym about 4 times a week.  Without debilitating
820409 - effects of chemotherapy (see work plan to continue treatment
820410 - "holiday," reported below, ref SDS 0 AW5G), vigor, strength, and
820411 - engagement with a broad base of activities have returned.  Millie
820412 - plans to renew membership in the health club, and is looking forward
820413 - to trips abroad next month, and to a resort this July.
820414 -
820415 -     [On 060306 possibility improved health and vigor enable increased
820416 -     exercise that has accelerated symptoms of lymphedema. ref SDS A8
820417 -     5Q7H
820419 -  ..
820420 - Millie described emotional trauma dealing with recovery from cancer
820421 - the past few months.  She asked about counseling services to discuss
820422 - negative feelings.
820424 -  ..
820425 - The doctor observed that cancer is very stressful.  There have been
820426 - many ups and downs the past 24 months.  Besides relapse on 040306,
820427 - being taken off treatment due to pulmonary emboli was a huge emotional
820428 - jolt on 041104. ref SDS 48 RZ4I  With a second relapse came difficult
820429 - decisions and initial poor results in 2005, causing tensions to rise,
820430 - illustrated by analysis of 2nd opinions during the meeting on 050913.
820431 - ref SDS 76 5T4J  On 050923 Kaiser advised that proposed surgery was
820432 - very high risk. ref SDS 82 F144  On 050927 Kaiser restated high risks
820433 - of surgery for secondary IBC patient. ref SDS 84 UM4I  The fact that
820434 - surgery appears to have been helpful on 051021, ref SDS 95 0001, and
820435 - testing currently shows no evidence of disease (NED) presents an
820436 - enormous relief, ref SDS 0 GV6K, yet entails adjustment to life
820437 - planning and perspective from wild swings in prognosis from "no cure"
820438 - possible reported on 041210. ref SDS 51 NQ9J  Mental adjustments are
820439 - often emotionally charged.
820441 -  ..
820442 - The doctor explained that full engagement with familiar activities,
820443 - including exercise, and outward focus on getting things done are good
820444 - medicine to strengthen the immune system that prevents disease
820445 - recurrence.  Exercise and engagement are also good medicine for
820446 - recovering from emotional trauma from dramatic swings in health that
820447 - Millie has experienced.  This aligns with recommendations at Stanford
820448 - by Doctor Guardino on 041019, ref SDS 47 NN6N, and earlier by the
820449 - primary care physician on 020924, ref SDS 16 EV7N, and again on
820450 - 030606, ref SDS 24 Y45M, when the doctor commented on Millie's
820451 - remarkable good health. ref SDS 24 NE57
820452 -
820453 -     [On 060428 patient reports increased engagement, and exercise, as
820454 -     recommended today have helped relieve prior emotional distress.
820455 -     ref SDS B6 617I
820457 -  ..
820458 - The doctor scheduled Millie for referral to Kaiser counseling by a
820459 - Behaviorial Medical Specialist (BMS), as shown in the report below.
820460 - ref SDS 0 125V
820461 -
820462 -     [On 060320 Millie reported poor results consulting with Mental
820463 -     Health Department. ref SDS B1 RE4Y
820465 -      ..
820466 -     [On 060428 the doctor reported having not seen Millie's letter;
820467 -     Millie reported again poor results consulting with Mental Health
820468 -     Department who indicated she was too healthy for treatment.
820469 -     ref SDS B6 619N
820471 -      ..
820472 -     [On 070921 doctor makes referral to mental health again to cope
820473 -     with emotional stress from poor handling of billings by Kaiser and
820474 -     UCSF. ref SDS B8 QY54
820476 -  ..
820477 - Research at...
820478 -
820479 -              http://www.healthpsych.com/practice/ipc/primarycare2.html
820480 -
820481 - ...shows that beginning in about 1998 Kaiser has implemented a strong
820482 - integrated primary care program that includes psychologists
820483 - Behaviorial Medicine Specialists.  Kaiser's research found that
820484 -
820485 -        ...a staggering 70% of all primary care visits are driven by
820486 -        psychological factors.
820487 -
820488 - ...which can include...
820489 -
820490 -        depression, anxiety, somatization, chronic pain, job/family
820491 -        problems, and miscellaneous concerns (borderline personalities
820492 -        and substance abuse were mentioned).
820493 -
820494 -
820495 -
820496 -
8205 -

SUBJECTS
Diziness Occurs Occassionally Treatment Ordered by HEENT Cerumen Plu

8603 -
860401 -  ..
860402 - Diziness Occurs Occassionally Treatment Ordered by HEENT Cerumen Plug
860403 -
860404 - For the past 2 weeks the patient has felt mild dizziness for 5 - 10
860405 - seconds when getting out of bed in the morning.  Sitting up and
860406 - waiting 5 - 10 seconds clears dizziness.  Also, laying down in the
860407 - morning causes feeling of dizziness.  Patient history shows similar
860408 - dizziness symptoms reported on 030710. ref SDS 25 WS47
860410 -  ..
860411 - Correlation with mastectomy surgery, and subsequent recovery from IBC
860412 - enabling increased exercise, regaining strength and energy, per above,
860413 - ref SDS 0 Y642, was not discussed during the meeting.
860415 -  ..
860416 - The doctor examined head, eyes, ears nose, throat (HEENT) and found
860417 - possible ear issues described as bilateral cerumen plug, which may
860418 - cause dizziness symptoms. ref SDS 0 BU7I
860420 -  ..
860421 - The doctor prescribed referral for bilateral ear washing to relieve
860422 - cerumen plugs.  This treatment was effective relieving prior symptoms,
860423 - as reported on 030915. ref SDS 26 WS47
860424 -
860425 -     [On 060308 following treatment dizziness symptoms continue.
860426 -     ref SDS A9 TO9G
860428 -  ..
860429 - Research at...
860430 -
860431 -              http://www.looksmartcolds.com/p/articles/mi_m0BUM/is_8_81/ai_90869479
860432 -
860433 - ...shows in part...
860434 -
860435 -    Update on cerumen and ceruminolytics Ear, Nose & Throat Journal,
860436 -    August, 2002  by Michael Hawke
860438 -     ..
860439 -    The term cerumen is generally considered to be synonymous with
860440 -    earwax, but technically it is not.  Cerumen refers only to the
860441 -    secretory product of the ceruminous glands in the external auditory
860442 -    canal, and it is just one component of earwax.  Other components
860443 -    include large sheets of desquamated keratin squames (the dead,
860444 -    flattened cells on the outer layer of the skin), sweat, sebum, and
860445 -    various foreign substances.  These foreign substances can include
860446 -    any exogenous matter that is capable of entering the external ear
860447 -    canal--for example, hair spray, shampoo, shaving cream, bath oil,
860448 -    Cosmetics, dirt, and the like.  The primary component of earwax is
860449 -    keratin.
860451 -  ..
860452 - Another article
860453 -
860454 -              http://www.dizziness-and-balance.com/disorders/hearing/wax2.html
860455 -
860456 - ...says...
860457 -
860458 -    When cotton tipped applicators are used to clean out ear wax,
860459 -    there is a risk of breaking the ear drum (perforation). Although
860460 -    we realize that this is commonly done, we recommend against using
860461 -    cotton tipped applicators, hair pins, and similar devices to clean
860462 -    the ear.
860464 -  ..
860465 - Thus, professional care seems the best course for initial treatment of
860466 - minor dizziness.  As noted, this treatment was effective relieving
860467 - prior symptoms, as reported on 030915. ref SDS 26 WS47
860468 -
860469 -     [On 060308 following treatment dizziness symptoms continue.
860470 -     ref SDS A9 TO9G
860471 -
860472 -
860473 -
860474 -
860475 -
860476 -
8605 -

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

8903 -
890401 -  ..
890402 - Discomfort Below Right Breast Likely Muscle Pull
890403 -
890404 - Follow up ref SDS A6 6R6G, ref SDS A0 6R6G.
890405 -
890406 - There was no discussion of this today; the problem has decreased in
890407 - severity and frequency.
890408 -
890409 -
890410 -
890411 -
890412 -
8905 -

SUBJECTS
Treatment Plan Testing for Relapse Patient NED Metastatic Cancer Tre

AD03 -
AD0401 -  ..
AD0402 - Treatment Plan Testing for Relapse Patient NED Metastatic Cancer
AD0403 - Holiday Treatment Patient NED Test for Relapse Metastatic Cancer
AD0404 -
AD0405 - Follow up ref SDS A6 AW5G, ref SDS A0 AW5G.
AD0406 -
AD0407 - Treatment holiday following chemotherapy on 050916, ref SDS 77 407N,
AD0408 - continues in alignment with examination showing patient status
AD0409 - continues NED, per above. ref SDS 0 025H
AD0411 -  ..
AD0412 - Strength, stamina, vigor, and engagement has been significantly
AD0413 - restored, per report above. ref SDS 0 Y642
AD0415 -  ..
AD0416 - Testing for relapse based on prognosis of metastatic cancer, most
AD0417 - recently on 051121, ref SDS A0 8R6M, is primary treatment concern
AD0418 - going forward.  Implementation with CA 15-3 and PET scan testing is
AD0419 - reported on 060106, ref SDS A6 SZ9H and ref SDS A6 NL4N
AD0421 -  ..
AD0422 - This regimen is continued today, shown in the doctor's report.
AD0423 - ref SDS 0 125V
AD0424 -
AD0425 -
AD0426 -
AD0427 -
AD0428 -
AD0429 -
AD05 -

SUBJECTS
Port Catheter Flush Performed at Kaiser to Maintain Chemo Treatment

AF03 -
AF0401 -  ..
AF0402 - Port Catheter Flush Performed at Kaiser to Maintain Chemo Treatment
AF0403 -
AF0404 - Follow up ref SDS A6 SH5N, ref SDS A0 SH5N.
AF0405 -
AF0406 - While we waited in the reception area to be called for meeting with
AF0407 - the doctor, a nurse in the Chemotherapy Clinic asked Millie to go with
AF0408 - her to have the port flush procedure performed.  So, this was
AF0409 - accomplished today, per planning on 051121. ref SDS A6 SH5N
AF0411 -  ..
AF0412 - Millie understands that Kaiser will no longer support port flush
AF0413 - operations at the Walnut Creek facility.  This may require separate
AF0414 - trip to Kaiser in Martinez to get the port catheter flushed.
AF0416 -  ..
AF0417 - Millie subsequently scheduled a meeting to get the port catheter
AF0418 - flushed again on 060331.
AF0419 -
AF0420 -
AF0421 -
AF0422 -
AF0423 -
AF05 -

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

AH03 -
AH0401 -  ..
AH0402 - Status Change Retest Biopsy 040419 Treatment Options
AH0403 - Treatment Options Status Change Retest Biopsy 040419
AH0404 -
AH0405 - Follow up ref SDS A6 ZR6J, ref SDS A0 ZR6J.
AH0406 -
AH0407 - There was no action on this today, which is not urgent in light of
AH0408 - patient NED status, per above, ref SDS 0 025H,
AH0410 -  ..
AH0411 - This issue will become very important in the event of relapse, which
AH0412 - is likely for stage 4 patient.
AH0413 -
AH0414 -
AH0415 -
AH0416 -
AH0417 -
AH0418 -
AH05 -

SUBJECTS
Disability Claim Recovery from Cancer Entitlement Form Submitted to

AL03 -
AL0401 -  ..
AL0402 - Disability Recovery from Cancer Millie Returning to Work
AL0403 -
AL0404 - Follow up ref SDS A6 J29L, ref SDS A0 J29L.
AL0405 -
AL0406 - Millie received a disability entitlement form recently from Unum
AL0407 - Provident, and requesting signature by the doctor to maintain
AL0408 - disability benefits for the next three (3) months or so.
AL0410 -  ..
AL0411 - After the meeting, Millie took the form to the Business Office for
AL0412 - processing, and submission to the primary care physician.  This form
AL0413 - needs signature and submission to Unum Provident.
AL0414 -
AL0415 -     [On 060322 letter to the doctor asks about status of filing signed
AL0416 -     disability entitlement form. ref SDS B2 LS6N
AL0417 -
AL0418 -
AL0419 -
AL0420 -
AL0421 -
AL0422 -
AL05 -

SUBJECTS
Work Plan Doctor Submits Doctor/Patient Partnership Communications I

AQ03 -
AQ0401 -  ..
AQ0402 - Work Plan Doctor Submits Doctor/Patient Partnership Communications
AQ0403 - Communications Doctor Submits Work Plan Doctor/Patient Partnership
AQ0404 - Doctor/Patient Partnership Communications Doctor Submits Work Plan
AQ0405 -
AQ0406 - Follow up ref SDS A6 FE4I, ref SDS A0 FE4I.
AQ0407 -
AQ0408 - The doctor printed the PET scan report, and submitted this to the
AQ0409 - patient, per above. ref SDS 0 DU7K
AQ0411 -  ..
AQ0412 - During the meeting, the doctor prepared a report on examination,
AQ0413 - findings, diagnosis, and work plan.  At the end of the meeting, the
AQ0414 - doctor printed and submitted his report to the patient.  This
AQ0415 - continues progress toward good management reported on 060106.
AQ0416 - ref SDS A6 FE4I
AQ0418 -  ..
AQ0419 - Earlier, on 051121 the doctor reported Kaiser has implemented tools
AQ0420 - for electronic communication to increase speed and accuracy of daily
AQ0421 - work. ref SDS A0 DO6F
AQ0423 -  ..
AQ0424 - This has been implemented sparingly.  On 060126 Millie sent a letter
AQ0425 - requesting results of blood tests and PET scan tests.  At that time,
AQ0426 - the doctor submitted partial results of tests. ref SDS A7 0001  Today,
AQ0427 - when asked for full reports, including results of the meeting today,
AQ0428 - the doctor expressed preference to print these instruments, and hand
AQ0429 - them to the patient, rather than use electronic transmission which is
AQ0430 - 1000% more efficient.
AQ0431 -
AQ0432 -     [On 060320 Kaiser electronic communication does not yet support
AQ0433 -     full communication; patient uses standard electronic communication
AQ0434 -     for feedback on issues in meeting on 060217. ref SDS B1 NL4H
AQ0436 -  ..
AQ0437 - As a result, Mil had to type everything over again to accomodate slow
AQ0438 - transformation at Kaiser.  This aligns with experience at Boeing,
AQ0439 - Lockheed, Microsoft, Harvard, Johns Hopkins, CIA, SRI, et al.  At the
AQ0440 - beginning of the 21st century, transformation to intelligence support
AQ0441 - still struggles to advance, cited previouly on 980517. ref SDS 1 1233
AQ0442 -
AQ0629 -
AQ0630 -
AQ0631 -
AQ0632 -
AQ0633 -
AQ07 -