THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: July 22, 2006 10:50 PM Saturday;
Rod Welch
Case study Millie mastectomy surgery treatment for 3rd relapse IBC.
1...Summary/Objective
2...Mastectomy Surgery Performed Recovery and Relapse Monitoring
3...Disease-free Status Local Control No Distant Metastasis by Testing
4...Complete Response to Treatment Tests Show No Local Nor Distant Disease
5...Ductal Carcinoma in Situ (DCIS) Found Not Shown by PET Mammogram Tests
6...NED Shown CT Test PET Scan Reports Possible Disease Rising CA 15-3
7...CA 15-3 Rising PET Test Evidence Possible Relapse CT Test Shows Clear
8...Red Rash Left Breast Evidence IBC Relapse with Rising CA 15-3
9...Cancer Relapse IBC New Evidence of Disease Aligns Rising CA 15-3
10...Pulmonary Embolism 1st Degree Relative Report Genetic Cause
11...Coagulapathy Report 1st Degree Relative Finds Genetic Cause PE
12...2nd Opinion Requested UCSF Treament Planning IBC Recurrence
13...Taxotere Capecitiabine (Xeloda) Treatment Delayed Response
14...Treatment Delayed Response Doctor Recommends Continue Protocol
15...IBC Rash Rises Significantly Then Begins to Subside and Breakup
16...CT Test 060930 Finds Pulmonary Embolism Recurrence
17...Pulmonary Embolism Recurrence Heart Disorder Enlarged Right Ventricle
18...Cor Pulmonale Heart Disorder Enlarged Right Ventricle Causes PE
..............
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CONTACTS
SUBJECTS
Medical Management Case Study History Organizational Memory Meetings
2703 -
2703 - ..
2704 - Summary/Objective
2705 -
270501 - Follow up ref SDS 83 0000. ref SDS 82 0000.
270502 -
270503 -
270504 -
270505 -
270506 -
270507 -
270509 - ..
2706 -
2707 -
2708 - Progress
2709 -
270901 - On 060721 begin work on obtaining 2nd opinion for work plan to treat
270902 - IBC relapse, ref SDS B8 0001, following up meeting with primary care
270903 - physician on 060711. ref SDS B7 0001
270905 - ..
270906 - Case history from initial presentation on 020208 through planning for
270907 - surgery on 051020, is reported in the record on 050812 prepared to
270908 - obtain 2nd opinion on having surgery. ref SDS 83 6L4M
270910 - ..
270911 - This patient history begins with mastectomy surgery on 051021 and
270912 - continues through finding of relapse OA 060711.
270913 -
270915 - ..
270916 - Mastectomy Surgery Performed Recovery and Relapse Monitoring
270917 - Disease-free Status Local Control No Distant Metastasis by Testing
270918 - Complete Response to Treatment Tests Show No Local Nor Distant Disease
270919 - Ductal Carcinoma in Situ (DCIS) Found Not Shown by PET Mammogram Tests
270920 -
270921 - Follow up ref SDS 83 UF4J.
270922 -
270923 - 1. Mastectomy surgery performed
270924 - following scope based on test
270925 - biopsies to reduce risk of
270926 - relapse recommended by Grissom
270927 - 2nd opinion to remove skin
270928 - previously irratiated and
270929 - infected with IBC.................... 051021, ref SDS A4 EG5L
270931 - ..
270932 - Due diligence surgeon's report
270933 - waived to explain necessity for
270934 - surgery missing from patient
270935 - history.............................. 051021, ref SDS A4 DG6J
270937 - ..
270938 - Pathology on thin skin biopsies
270939 - show no evidence of IBC.............. 051021, ref SDS A4 LH6O
270941 - ..
270942 - Millie recovered exceptionally
270943 - well after surgery................... 051021, ref SDS A4 QZ84
270945 - ..
270946 - 2. Mastectomy wound heals normally;
270947 - surgeon examination finds no
270948 - evidence of disease (NED), and says
270949 - patient at this time appears to be
270950 - disease-free; local control and
270951 - no distant metastasis indicates
270952 - complete response to treatment,
270953 - based on biopsy and image
270954 - testing.............................. 051027, ref SDS A5 0001
270955 -
270956 - [...patient responds to treatment
270957 - proposed by Doctor Benz 2nd
270958 - opinion implemented on 050329,
270959 - ref SDS 83 8O8J; and reduces risk
270960 - of relapse with surgery guided
270961 - by 2nd opinions reviewed on 050923.
270962 - ref SDS 83 XX97
270964 - ..
270965 - [On 051007 PET test shows no
270966 - evidence of cancer. ref SDS 83 MI3Y
270968 - ..
270969 - [...disease-free status requires review
270970 - of possible DCIS in right breast.
270971 - ref SDS 83 XO99
270973 - ..
270974 - Case study purpose of mastectomy
270975 - surgery for cure, local control
270976 - and palliation....................... 051027, ref SDS A5 F25H
270978 - ..
270979 - Biopsy from surgery on 051021 shows
270980 - clear margins; no evidence of
270981 - IBC.................................. 051027, ref SDS A5 616P
270983 - ..
270984 - Ductal carcinoma in situ (DCIS)
270985 - atypical cells reported in biopsy
270986 - not found by mammogram and PET
270987 - scan tests........................... 051027, ref SDS A5 615K
270988 - right breast showed no evidence of
270989 - DCIS by PET and mammogram tests,
270990 - so may require biopsy to verify
270991 - disease-free status.................. 051027, ref SDS A5 BA5G
270993 - ..
270994 - Relapse high risk secondary IBC
270995 - stage IV patient requires initial
270996 - frequent, vigorous testing and
270997 - examination for early detection
270998 - and treatment........................ 051027, ref SDS A5 L05O
271000 - ..
271001 - Surgeon relying on team care with
271002 - Oncology Department for notice to
271003 - perform examinations when needed;
271004 - following practice that discovered
271005 - IBC in 2004.......................... 051027, ref SDS A5 OZ70
271007 - ..
271008 - Status change retesting biopsy on
271009 - 040419 still pending; surgeon
271010 - following up......................... 051027, ref SDS A5 964L
271012 - ..
271013 - Pulmonary emboli treatment resumed
271014 - with Coumadin to align with Kaiser
271015 - policy for cancer patients; pending
271016 - workup on hypercoagulable
271017 - state................................ 051027, ref SDS A5 6Y7X
271019 - ..
271020 - 3. Doctor Guardino at Stanford notify
271021 - favorable results patient status
271022 - NED after implementing 2nd opinion
271023 - received on 041209 to consider
271024 - surgery.............................. 051108, ref SDS A6 3H7K
271026 - ..
271027 - Doctor Benz at UCSF notify
271028 - favorable results patient status
271029 - NED after implementing 2nd opinion
271030 - received on November 17, 2004
271031 - recommending systemic
271032 - treatment............................ 051108, ref SDS A6 F53N
271034 - ..
271035 - 4. Doctors Bailey, Grissom, and Shim
271036 - notify favorable results patient
271037 - status disease-free; commendation
271038 - excellent work product on 2nd
271039 - opinions contributing to Millie's
271040 - recovery, reviewed with surgeon
271041 - on 050923............................ 051109, ref SDS A7 R29J
271043 - ..
271044 - CA 15-3 cancer marker test drops
271045 - dramatically to 34, lowest level
271046 - below bench mark of 39 ever
271047 - achieved in patient history past
271048 - 4 years.............................. 051109, ref SDS A7 R29J
271050 - ..
271051 - 5. CA 15-3 drops to 31 patient shows
271052 - strongest recovery status in 4
271053 - years; surgical wound from mastectomy
271054 - healing well; patient currently
271055 - NED on treatment "holiday"........... 051121, ref SDS A8 0001
271057 - ..
271058 - Pulmonary emboli treatment with
271059 - Coumadin ended again................. 051121, ref SDS A8 RZ4I
271061 - ..
271062 - 6. CA 15-3 drops to 28, rises to 34,
271063 - still well below danger mark of
271064 - 39; patient remains NED on
271065 - treatment "holiday".................. 060106, ref SDS A9 0001
271067 - ..
271068 - Major new swelling left axillary
271069 - initial diagnosis lymphedema;
271070 - work plan test for lymphadenopathy
271071 - with PET scan........................ 060106, ref SDS A9 MW8J
271073 - ..
271074 - 7. PET scan test favorable; FDG SUV
271075 - 1.9 right axillary; no findings
271076 - swelling left
271077 - axillary............................. 060126, ref SDS B0 0001
271079 - ..
271080 - Esophagitis - likely finding in PET
271081 - scan test............................ 060126, ref SDS B0 DH4O
271083 - ..
271084 - 8. CA 15-3 at 33 stable below cancer
271085 - mark; aligns with favorable PET
271086 - scan test; patient remains NED on
271087 - treatment holiday.................... 060217, ref SDS B1 0001
271089 - ..
271090 - Esophagitis reported in PET scan
271091 - test findings; no review, no
271092 - treatment considerations due to
271093 - delayed reporting.................... 060217, ref SDS B1 DH4O
271095 - ..
271096 - Lymphedema diagnosed left arm due
271097 - to left breast mastectomy, and
271098 - heavy exercise with restored
271099 - vigor; begin treatments.............. 060217, ref SDS B1 MW8J
271100 -
271102 - ..
271103 - NED Shown CT Test PET Scan Reports Possible Disease Rising CA 15-3
271104 - CA 15-3 Rising PET Test Evidence Possible Relapse CT Test Shows Clear
271105 -
271106 - Follow up ref SDS 83 YV6Y.
271107 -
271108 - 9. CA 15-3 at 44 rises above cancer
271109 - signal 39............................ 060428, ref SDS B2 087J
271111 - ..
271112 - PET scan test right axillary FDG
271113 - SUV 2,6 increased from 1.9 from
271114 - prior test on 060106................. 060428, ref SDS B2 OX68
271116 - ..
271117 - PET scan new findings FDG SUV
271118 - 4.5 left supraclavicular............. 060428, ref SDS B2 MU5M
271120 - ..
271121 - Contrast CT study ordered evaluate
271122 - relapse.............................. 060428, ref SDS B2 II4L
271124 - ..
271125 - Cancer treatment options planning
271126 - considerations begin................. 060428, ref SDS B2 K36G
271128 - ..
271129 - Lymphedema improving with physical
271130 - therapy treatments................... 060428, ref SDS B2 K75S
271132 - ..
271133 - 10. Read medical test findings - case
271134 - study doctors do not have enough
271135 - time to read findings and correlate
271136 - clinically with compelx patient
271137 - history that discovers symptomatic
271138 - trends in time for proactive
271139 - management; there is only enough
271140 - time to read summaries and rely
271141 - on 1st impression from the
271142 - gist of findings..................... 060428, ref SDS B3 VG5L
271144 - ..
271145 - 11. CT test finds no evidence of
271146 - disease (NED) in right axilla, and
271147 - in left supraclavicular; great
271148 - news; conflicts with CA 15-3
271149 - rising to 49......................... 060523, ref SDS B4 4R82
271151 - ..
271152 - Esophagitis - CT test finds several
271153 - less than 1 cm nodes right paratracheal
271154 - region, may align with PET scan test
271155 - on 060120 finding likely
271156 - esophagitis.......................... 060523, ref SDS B4 4O8P,
271158 - ..
271159 - Contrast study with PET scan test
271160 - on 060414 omitted; analyst only
271161 - compared with CT test a year
271162 - ago on 050530........................ 060523, ref SDS B4 006P
271164 - ..
271165 - 12. Request contrast study compare CT
271166 - test on 060505 with PET scan test
271167 - on 060414............................ 060526. ref SDS B5 7D8K
271168 -
271170 - ..
271171 - Red Rash Left Breast Evidence IBC Relapse with Rising CA 15-3
271172 - Cancer Relapse IBC New Evidence of Disease Aligns Rising CA 15-3
271173 -
271174 - Follow up ref SDS 83 JD5K.
271175 -
271176 - 13. IBC relapse likely CA 15-3
271177 - rise accelerating.................... 060623, ref SDS B6 GJ5M
271179 - ..
271180 - Red rash left breast signals IBC
271181 - relapse, wide mastectomy may not
271182 - have been wide enough; resume
271183 - chemotherapy pending verify recovery
271184 - from pneumonia....................... 060623, ref SDS B6 025H
271186 - ..
271187 - Need treatment plan strategy consider
271188 - surgery, and plastic surgery to
271189 - re-build left breast skin grafts;
271190 - status change to expand
271191 - chemotherapy options................. 060623, ref SDS B6 K36G
271193 - ..
271194 - 14. CA 15-3 71 rise continues............ 060711, ref SDS B7 087J
271195 -
271196 - Red rash left breast concentrated
271197 - left of sternum IBC relapse
271198 - diagnosed............................ 060711, ref SDS B7 025H
271199 - Observation of patient IBC
271200 - condition reported................... 060711, ref SDS B7 8Z8G
271202 - ..
271203 - Study IBC relapse correlation to
271204 - scope of mastectomy surgery on
271205 - 051021............................... 060711, ref SDS B7 9T46,
271207 - ..
271208 - 3rd relapse study.................... 060711, ref SDS B7 8Y8I
271210 - ..
271211 - Distant metastasis no findings
271212 - in tests............................. 060711, ref SDS B7 C56O
271214 - ..
271215 - Treatment scheduled using same dose
271216 - capecitabine (Xeloda - 1.5 500 MG
271217 - tablets taken 2 times per day) and
271218 - Taxotere that was successful last
271219 - year................................. 060711, ref SDS B7 PF3O
271221 - ..
271222 - HDC analysis alternate treatment
271223 - considerations....................... 060711, ref SDS B7 KY4G
271225 - ..
271226 - Chemotherapy pool of available
271227 - drugs and combinations............... 060711, ref SDS B7 FP9H
271229 - ..
271230 - Drug trial options................... 060711, ref SDS B7 WB9K
271232 - ..
271233 - Surgery options...................... 060711, ref SDS B7 X54L
271235 - ..
271236 - Radiation options.................... 060711, ref SDS B7 Z26K
271238 - ..
271239 - 15. Treatment 9th cycle Taxotere 102 MG
271240 - drip treatment, begin capecitabine
271241 - (Xeloda) with 1.5 500 MB pills twice
271242 - per day; 1st cycle treatment using
271243 - previously successful chemotherapy
271244 - agents for 3rd relapse IBC after 9
271245 - months off treatment following
271246 - mastectomy surgery................... 060721, ref SDS B9 4N5M
271248 - ..
271249 - Blood counts good.................... 060721, ref SDS B9 0N7Q
271251 - ..
271252 - 3-day treatment delay harmful to
271253 - patient - schedule next treatment 1
271254 - day ahead of regular 3-week cycle to
271255 - accomodate Kaiser's schedule; cannot
271256 - accomodate patient's schedue with
271257 - treatment 3 days later on Monday,
271258 - because diluting concentration of
271259 - chemotherapy reduces
271260 - effectiveness........................ 060721, ref SDS B9 KP6J
271261 -
271263 - ..
271264 - Pulmonary Embolism 1st Degree Relative Report Genetic Cause
271265 - Coagulapathy Report 1st Degree Relative Finds Genetic Cause PE
271266 -
271267 -
271268 - 16. Pulmonary emboli - family history
271269 - recurrence; report genetic cause
271270 - of blood clots; may require workup
271271 - hypercoagulable state, resume
271272 - Coumadin treatments, and adjusting
271273 - chemotherapy treatment with Taxotere
271274 - capecitabine (Xeloda)................ 060722, ref SDS C0 3D9T
271276 - ..
271277 - Side effects case study patient
271278 - history for new phase
271279 - treatment............................ 060724, ref SDS C1 QX8K
271280 -
271282 - ..
271283 - 2nd Opinion Requested UCSF Treament Planning IBC Recurrence
271284 - Taxotere Capecitiabine (Xeloda) Treatment Delayed Response
271285 - Treatment Delayed Response Doctor Recommends Continue Protocol
271286 - IBC Rash Rises Significantly Then Begins to Subside and Breakup
271287 -
271288 -
271289 - 17. UCSF 2nd opinion requested Doctor
271290 - Benz on treatment planning IBC
271291 - recurrence........................... 060725, ref SDS C2 YK6N
271293 - ..
271294 - 18. IBC worsening notify Kaiser
271295 - treatment with Taxotere and
271296 - capecitabine failing, request
271297 - instructions on going ahead
271298 - with next cycle scheduled for
271299 - 060810............................... 060806, ref SDS C3 IJ5O
271301 - ..
271302 - 19. Treatment change urgent meeting
271303 - scheduled with backup doctor on
271304 - prescribing new treatment of
271305 - advancing IBC........................ 060807, ref SDS C4 QE8G
271307 - ..
271308 - 20. Submit patient history for backup
271309 - doctor to prepare for emergency
271310 - meeting on changing protocol
271311 - to treat IBC relapse................. 060807, ref SDS C4 5P65
271313 - ..
271314 - 21. Red rash IBC seems to subside today;
271315 - backup doctor decides to test delayed
271316 - response to treatment rather than
271317 - conclude failure; CA 15-3 test not
271318 - available so decide to continue
271319 - prescription for Taxotere Xeloda until
271320 - more evidence previously successful
271321 - treatment has failed; doctor
271322 - continues schedule of 3-week
271323 - treatment cycle to optimize drug
271324 - effectiveness by maintaining
271325 - level of chemotherapy agent in
271326 - the body............................. 060808, ref SDS C5 0001
271328 - ..
271329 - Secenario #2 defined rash appears
271330 - stable to slight improvement or
271331 - worsening, while underlying IBC
271332 - progression of disease............... 060808, ref SDS C5 J458
271334 - ..
271335 - Patient history during 2003 red rash
271336 - waxes and wanes while rising CA 15-3
271337 - tracks rising IBC disease not
271338 - sufficient evidence to change
271339 - treatment protocol at this
271340 - time................................. 060808, ref SDS C5 X86L
271342 - ..
271343 - 22. UCSF 2nd opinion scheduled for 060821
271344 - staff makes progress applying Knowledge
271345 - Management efficient review complex
271346 - patient history using precision
271347 - access............................... 060809, ref SDS C6 0001
271349 - ..
271350 - 23. CA 15-3 87 rise in blood test on
271351 - 060809 from 73 over 4 weeks from
271352 - prior test on 060708; big jump in
271353 - 5 year patient history; 7 above level
271354 - 80 previously discussed to consider
271355 - changing course of
271356 - treatment............................ 060810, ref SDS C7 5T9J
271358 - ..
271359 - 7-day treatment delay because ANC
271360 - 1408 blood counts below 1500......... 060810, ref SDS C7 NH8T
271361 - doctor on vacation, no one available
271362 - to sign approval to waive standing
271363 - orders............................... 060810, ref SDS C7 NW9K
271365 - ..
271366 - Case study patient history treatment
271367 - routinely given when blood counts low
271368 - in order to maintain constant level
271369 - for effectiveness of
271370 - chemotherapy......................... 060810, ref SDS C7 HV45
271372 - ..
271373 - 4-day treatment delay reduced from
271374 - 7-day delay after consideration of
271375 - patient history...................... 060810, ref SDS C7 NW4J
271377 - ..
271378 - 24. Red rash IBC seems to continue
271379 - subsiding............................ 060817, ref SDS C8 CJ3H
271381 - ..
271382 - CA 15-3 73 dramatic improvement for
271383 - blood test on 060815 significant
271384 - fall from 87 in just 6 days since
271385 - prior test on 060809; aligns with
271386 - observation IBC rash subsiding;
271387 - validates delayed response to
271388 - treatment............................ 060817, ref SDS C8 PQWQ
271390 - ..
271391 - 25. UCSF 2nd opinion consultation with
271392 - Doctor Benz not enough time learn
271393 - to use patient history with precision
271394 - access; doctor created manual
271395 - chronology based on
271396 - conversation......................... 060821, ref SDS C9 0001
271398 - ..
271399 - Drug trials Millie qualifies for 2
271400 - clinical studies at UCSF requires
271401 - measurable disease showing progression
271402 - of IBC with imaging tests
271403 - and biopsy........................... 060821, ref SDS C9 W66J
271405 - ..
271406 - 26. Broken finger from fall due to chronic
271407 - fatigue, shortness of breath, dizziness,
271408 - left arm swelling from complications
271409 - lymphedema; at this time patient
271410 - not aware that finger was
271411 - broken............................... 060914, ref SDS D0 ZQ5I
271413 - ..
271414 - 27. CA 15-3 53 significant drop in cancer
271415 - marker seems conflicting with slow
271416 - recovery of IBC rash on left breast
271417 - region............................... 060929, ref SDS D1 GJ5M
271419 - ..
271420 - Mastectomy "very wide" surgery on
271421 - 051021 removed blood vessels may be
271422 - causing slow response to treatment
271423 - due to pockets of resistance
271424 - to chemotherapy
271425 - treatment............................ 060929, ref SDS D1 T53L
271427 - ..
271428 - Millie reports continuing fatigue,
271429 - shortness of breath with normal
271430 - activity, illustrated by fall at BART
271431 - station a few weeks
271432 - ago.................................. 060929, ref SDS D1 SV3N
271434 - ..
271435 - Doctor requests coagulapathy study on
271436 - hyercoabulable state work up for first
271437 - degree relative who suffered pulmonary
271438 - embolism recurrence 2 months
271439 - ago.................................. 060929, ref SDS D1 QT6N
271441 - ..
271442 - CT scan ordered within 10 days evaluate
271443 - for pulmonary embolism recurrence;
271444 - specifies comparison with CT test on
271445 - 041103 that diagnosed original
271446 - disease.............................. 060929, ref SDS D1 DY5M
271448 - ..
271449 - 28. UCSF 2nd opinion for consultation
271450 - on 060821, and received from Kaiser
271451 - during meeting for examination and
271452 - planning............................. 060929, ref SDS D2 6L9O
271454 - ..
271455 - 29. Drug trials Doctor Benz confirms
271456 - Millie qualifies for 2 clinical
271457 - studies; lists other treatment
271458 - options.............................. 060929, ref SDS D2 UI9K
271459 -
271461 - ..
271462 - CT Test 060930 Finds Pulmonary Embolism Recurrence
271463 - Pulmonary Embolism Recurrence Heart Disorder Enlarged Right Ventricle
271464 - Cor Pulmonale Heart Disorder Enlarged Right Ventricle Causes PE
271465 -
271466 -
271467 - 30. Pulmonary embolism recurrence reported
271468 - by doctor in phone message on results
271469 - expedited CT test on 060930; Millie
271470 - resumes treatment.................... 061002, ref SDS D3 0001
271472 - ..
271473 - 31. CT test report received from Kaiser
271474 - analyst failed to make comparison to
271475 - assess advance of disease since prior
271476 - test on 041103 that diagnosed
271477 - pulmonary emoblism................... 061012, ref SDS D4 2935
271479 - ..
271480 - Case study imaging department fails
271481 - to make comparisons ordered by
271482 - doctor required for trend
271483 - analysis............................. 061012, ref SDS D4 A55J
271485 - ..
271486 - Comparison CT scan test reports
271487 - for 041103 finding pulmonary emboli
271488 - with current test on 060930 seems to
271489 - show significant differences;
271490 - requires professional
271491 - review............................... 061012, ref SDS D4 7E7G,
271493 - ..
271494 - Heart disorder enlarged right ventricle
271495 - Cor Pulmonale discovered CT test on
271496 - 060929; analyst fails to report
271497 - severity............................. 061012, ref SDS D4 7E5L
271499 - ..
271500 - 32. Letter to Kaiser asks how to assess
271501 - severity of enlarged right
271502 - ventricle............................ 061013, ref SDS D5 US6H
271504 - ..
271505 - 33. Case studies sumamary list of
271506 - major issues in breast cancer
271507 - diagnosis, treatment, and
271508 - collateral issues.................... 061018, ref SDS D6 N55F
271510 - ..
271511 - 34. CA 15-3 56 sudden rise cancer marker
271512 - aligns with slow recovry and increase
271513 - IBC rash may signal progression of
271514 - disease.............................. 061020, ref SDS D8 GJ5M
271516 - ..
271517 - Communications meeting productivity
271518 - 7 agenda items too complex to remember;
271519 - doctor proposes simplifying to
271520 - expedite examination of 3 - 4
271521 - issues............................... 061020, ref SDS D8 MO4K
271523 - ..
271524 - Doctor patient partnership collaboration
271525 - reduces 32 pending treatment issues
271526 - down to 7 that people can manage
271527 - working from memory and conversation
271528 - without losing track of critical
271529 - details.............................. 061020, ref SDS D8 PB3H
271531 - ..
271532 - Communication collaboration mistakes
271533 - coordination between Oncology Clinic
271534 - and Coagulation Treatment Clinic
271535 - reliance on computer fails to notify
271536 - staff to balance Coumadin (Warfarin)
271537 - treatment for pulmonary emboli with
271538 - capecitabine (Xeloda) treatment for
271539 - cancer; feedback doctor patient
271540 - partnership avoided small problem
271541 - cascading out of
271542 - control.............................. 061020, ref SDS D7 TZ4I
271544 - ..
271545 - 35. Heart disorder Cor Pulmonale doctor
271546 - not aware of CT test 060930 finding
271547 - enlarged right ventricle; hectic
271548 - schedule not enough time to read
271549 - test findings cannot remember patient's
271550 - letter asking about severity; Kaiser
271551 - cannot determine severity of
271552 - pulmonary embolism comparing with
271553 - original findings on 041103; cannot
271554 - compare right and left ventricle
271555 - for impact on pulmonary
271556 - embolism............................. 061020, ref SDS D8 VJ4J
271558 - ..
271559 - Pulmonary embolism not related
271560 - to enlarged right ventricle Cor
271561 - Pulmonale Kaiser says no
271562 - need to investigate
271563 - severity............................. 061020, ref SDS D8 3Q5H
271565 - ..
271566 - 36. Cellulitis Millie hospitalized
271567 - 5 days elevated temperature,
271568 - left arm severely swollen and
271569 - inflammation......................... 061027, ref SDS D9 HP52
271570 - complications of lymphedema
271571 - from mastectomy surgery compounded
271572 - by broken finger 2 months
271573 - earlier.............................. 061027, ref SDS D9 V65J
271575 - ..
271576 - 37. Treatment Taxotere capecitabine
271577 - (Xeloda) 14th cycle and 6th treatment
271578 - for 3rd relapse IBC.................. 061110, ref SDS E1 0001
271580 - ..
271581 - Examination IBC rash spreading on
271582 - left breast area..................... 061110, ref SDS E2 025H
271583 - IBC not be responding to systemic
271584 - treatment under scenario #2,
271585 - may requiring changing
271586 - treatment............................ 061110, ref SDS E2 P66G
271588 - ..
271589 - Cellulitis subsides; treatment
271590 - anibiotics for 10 days; released
271591 - from hospital........................ 061101, ref SDS E0 JR9N
271593 - ..
271594 - CA 15-3 61 continues rising aligns with
271595 - slow recovery IBC rash left breast
271596 - region............................... 061110, ref SDS E2 GJ5M
271598 - ..
271599 - Pulmonary embolism no comparison yet
271600 - between CT test diagnosis on 041103
271601 - and recent test on 060930 that
271602 - diagnosed pulmonary embolism
271603 - recurrence........................... 061110, ref SDS E2 LZ3M
271605 - ..
271606 - Procrit prescribed for low hemoglobin
271607 - blood counts that may compound patient
271608 - low energy, fatigue, weakness, and
271609 - shortness of breath.................. 061110, ref SDS E2 CV5L
271611 - ..
271612 - Coagulapathy report hypercoagulable
271613 - state work up 1st degree relative shows
271614 - no elevated genetic risk for Millie,
271615 - e.g., factor IV not
271616 - found................................ 061110, ref SDS E2 626L
271618 - ..
271619 - 38. Cellulitis relapse, Kaiser renews
271620 - prescription for antibiotics resume
271621 - treatments........................... 061112, ref SDS E3 FP5O
271622 -
271624 - ..
271625 - 39. Treatment Taxotere capecitabine
271626 - (Xeloda) 15th cycle and 7th treatment
271627 - for 3rd relapse IBC.................. 061201, ref SDS E4 0001
271629 - ..
271630 - Examination IBC rash spreading on
271631 - left breast area doctor finds
271632 - increased erythema on lower
271633 - left chest wall ..................... 061201, ref SDS E5 025H
271634 - IBC not be responding to systemic
271635 - treatment under scenario #2,
271636 - doctor planning to change
271637 - treatment............................ 061201, ref SDS E5 K36G
271639 - ..
271640 - CA 15-3 67 rising tracks with rising
271641 - IBC rash spreading on left
271642 - chest; doctor cites erratic
271643 - chages in cancer marker signal
271644 - treatment failing; need to
271645 - change protocol...................... 061201, ref SDS E5 GJ5M
271647 - ..
271648 - Pulmonary embolism no comparison yet
271649 - between CT test diagnosis on 041103
271650 - and recent test on 060930 that
271651 - diagnosed pulmonary embolism
271652 - recurrence........................... 061201, ref SDS E5 LZ3M
271654 - ..
271655 - 40. Cellulitis relapse left arm, Kaiser
271656 - renews prescription for antibiotics
271657 - treatments........................... 061203, ref SDS E6 MF9H
271659 - ..
271660 - 41. CA 16-3 67 continues rising after
271661 - falling to 56 aligns with reports
271662 - of improving then worsening IBC
271663 - rash................................. 061208, ref SDS E7 GJ5M
271665 - ..
271666 - IBC rash spreads from left to
271667 - right breast, may show measurable
271668 - progression of disease qualify
271669 - for drug trials proposed
271670 - by UCSF.............................. 061208, ref SDS E7 025H
271672 - ..
271673 - Doctor prescribes Navelbine 10-year
271674 - old chemotherapy technology because
271675 - very few treatments available
271676 - due to complex patient
271677 - profile.............................. 061208, ref SDS E7 Q74O
271679 - ..
271680 - Chemotherapy holiday end treatment with
271681 - Taxotere capecitabine (Xeloda) until
271682 - after Christmas
271683 - season............................... 061208, ref SDS E7 N96O
271685 - ..
271686 - Kaiser reports there are no clinical
271687 - studies available to treat Millie
271688 - because patient profile is too
271689 - complex to qualify for drug
271690 - trial protocols...................... 061208, ref SDS E7 VT7F,
271692 - ..
271693 - Patient requests Kaiser perform due
271694 - diligence investigating UCSF proposals;
271695 - doctor requests support finding UCSF
271696 - proposal notifying Kaiser that
271697 - Millie qualifies for 2
271698 - drug trials.......................... 061208, ref SDS E7 P256
271700 - ..
271701 - Diflucan Fluconazole 200 MG antibiotics
271702 - prescribed evaluate spread of rash may
271703 - be a "ring" infection rather than
271704 - IBC.................................. 061208, ref SDS E7 KW45
271706 - ..
271707 - PET/CT test ordered evaluate distant
271708 - metastatis, measurable disease, order
271709 - comparisons evaluate pulmonary embolism
271710 - and enlarged right ventricle, and
271711 - esophagitis.......................... 061208, ref SDS E7 EY5O
271713 - ..
271714 - Tumor Board review appropriate for major
271715 - change patient profile failing treatment
271716 - consideration strategy review
271717 - patient history...................... 061208, ref SDS E7 K36G
271719 - ..
271720 - Surgery options treat pockets of
271721 - resistance to systemic cheomotherapy
271722 - treatment because blood vessels removed
271723 - by mastectomy on 051021 prevent
271724 - delivering chemotherapy drugs to
271725 - infected tissue...................... 061208, ref SDS E7 ZZ5F
271727 - ..
271728 - Pulmonary embolism patient complains
271729 - continuing symptoms despite
271730 - treatment............................ 061208, ref SDS E7 CV5L
271731 - examination with stethoscope indicates
271732 - no evidence advanced Cor Pulmanele,
271733 - supported by Sa02 99%................ 061208, ref SDS E7 Q35O
271735 - ..
271736 - Heart specialist examination requested
271737 - by patient, deferred by Kaiser; doctor
271738 - orders comparison PET/CT test to evaluate
271739 - severity heart disorder Cor
271740 - Pulmonale............................ 061208, ref SDS E7 HZ39
271742 - ..
271743 - Complex patient history raises 8 new
271744 - issues in doctor progress notes for
271745 - the medical chart including construction
271746 - that conveys lung cancer, which has
271747 - not previously been
271748 - submitted............................ 061208, ref SDS E7 EN4K
271750 - ..
271751 - 42. Hemorraging elevated risk Coagulation
271752 - Treatment Clinic advises Diflucan
271753 - prescribed to assess ring infection
271754 - conflicts with Coumadin INR jumps to
271755 - 6.4, Millie must stop taking treatment
271756 - pulmonary embolism for 3 days; get
271757 - tested in 3 days to assess
271758 - recovery............................. 061214, ref SDS E8 0001
271760 - ..
271761 - 43. Correspondence doctor patient partnership
271762 - reminds pending issues Kaiser needs
271763 - follow up............................ 061218, ref SDS E9 0001
271765 - ..
271766 - Drug trials support Kaiser due diligence
271767 - investigating UCSF proposals on
271768 - clincial trials...................... 061218, ref SDS E9 YV38
271770 - ..
271771 - Commend primary care physician and
271772 - Kaiser managing complex case for 5
271773 - years................................ 061218, ref SDS E9 K36G
271775 - ..
271776 - Tumor Board requested by patient
271777 - with panel experienced treating
271778 - secondary IBC and pulmonary
271779 - embolism............................. 061218, ref SDS E9 MN9L
271781 - ..
271782 - 44. Tumor Board quality control
271783 - oncology medical practice; research
271784 - purpose finds uneven
271785 - implementation....................... 061218, ref SDS F0 0001
271786 - case study Millie's patient
271787 - history reflects
271788 - research............................. 061218, ref SDS F0 6W3X
271790 - ..
271791 - 45. Kaiser collaborating with UCSF on
271792 - due diligence review clincial trials
271793 - available to help
271794 - Millie............................... 061226, ref SDS F1 0001
271796 - ..
271797 - 46. Correspondence doctor patient
271798 - partnership report progress
271799 - pending issues Kaiser
271800 - following up......................... 061227, ref SDS F2 0001
271802 - ..
271803 - Hemorraging risk subsides Coagulation
271804 - Treatment Clinic advises INR falls within
271805 - target range after ending treatment with
271806 - diflucan; Millie resumes normal
271807 - treatment pulmonary
271808 - embolism............................. 061227, ref SDS F2 8U5L
271810 - ..
271811 - CA 16-3 74 big rise following erratic
271812 - changes; may align with evident spread
271813 - of IBC rash from left to right
271814 - breast indicating measurable
271815 - disease.............................. 061227, ref SDS F2 6P9F
271817 - ..
271818 - Commend Brad in Oncology Pharmacy
271819 - excellent verbal explanation Nabelvine
271820 - compatibility with patient history;
271821 - plans to submit written
271822 - confirmation......................... 061227, ref SDS F2 427M
271824 - ..
271825 - 47. Pulmonary embolism caused enlarged
271826 - right ventricle Cor Pulmonale Kaiser
271827 - recommends deferring examination of
271828 - heart disorder by heart specialist, and
271829 - proposes waiting to consider treatment
271830 - with diruetics untile patient shows
271831 - edema in the lower
271832 - extremities.......................... 061228, ref SDS F3 JU7L
271834 - ..
271835 - 48. Drug trials Kaiser due diligence to
271836 - investigate UCSF proposals on
271837 - clincial study to expand treatments
271838 - with drug trials..................... 061228, ref SDS F3 086H
271840 - ..
271841 - 49. Drug trials Kaiser and UCSF collaborating
271842 - on Millie qualifications for treatment on
271843 - cetuximab carboplatin clinical
271844 - study................................ 061230, ref SDS F4 086H
271846 - ..
271847 - 50. Kaiser agrees to pay for any costs
271848 - not covered by drug trial funding
271849 - including standard of care for
271850 - Millie's treatment at
271851 - UCSF................................. 061230, ref SDS F4 3X6K
271853 - ..
271854 - 51. UCSF agrees to schedule treatment
271855 - for Millie on cetuximag carboplatin
271856 - clinical study....................... 070101, ref SDS F5 E23W
271858 - ..
271859 - 52. PET/CT test no evidence distant
271860 - metastasis, no local, regional
271861 - disease reported..................... 070102, ref SDS F6 RG4J
271863 - ..
271864 - Test report failed to follow doctor's
271865 - order to compare with CT test on
271866 - 060930 for trend analysis on pulmonary
271867 - embolism............................. 070102, ref SDS F6 AK9H
271869 - ..
271870 - 53. Examination at Kaiser shows IBC rash
271871 - worsening aligns with rising CA 15-3
271872 - cancer marker 74, signals urgency
271873 - changing treatments.................. 070105, ref SDS F7 J44H
271875 - ..
271876 - Doctor recommends defer treatment with
271877 - remaining 10-year old chemotherapies
271878 - using Navelbine and Gemzar and replace
271879 - treatment with Taxotere and capecitabine
271880 - (Xeloda) with clinical study using
271881 - cetuximab and
271882 - carboplatin.......................... 070105, ref SDS F7 PF3O
271884 - ..
271885 - Doctor recommended Millie approve
271886 - switching treatment to cetuximab and
271887 - carboplatin which will be provided
271888 - on clinical study at UCSF, because
271889 - this is the best treatment available
271890 - for Millie's patient provile of
271891 - secondary IBC 3rd relapse, and
271892 - triple negative...................... 070105, ref SDS F7 PK7L
271894 - ..
271895 - Patient requests Kaiser expedite
271896 - treatment at UCSF to stop sreading
271897 - disease due to delayed treatment
271898 - for over a month..................... 070105, ref SDS F7 Y47J
271900 - ..
271901 - Pulmonary embolism patient complains
271902 - continuing symptoms despite
271903 - treatment............................ 070105, ref SDS F7 BE6L
271904 - examination with stethoscope indicates
271905 - no evidence advanced Cor Pulmanele,
271906 - supported by Sa02 99%................ 070105, ref SDS F7 Q35O
271907 - requests professional review differences
271908 - pulmonary embolism findings CT test
271909 - 041103 with CT test on 060930 finding
271910 - recurrence........................... 070105, ref SDS F7 YE4H
271912 - ..
271913 - Doctor notified Millie that she likely
271914 - has permanent lung damage and may never
271915 - recover normal fitness; says okay to
271916 - resume working out in the
271917 - gym.................................. 070105, ref SDS F7 WR4J
271919 - ..
271920 - Cor pulmonael heart disorder enlarged
271921 - right ventricle Millie requests referral
271922 - for examination by heart specialist;
271923 - doctor defers referral until more
271924 - evidence of symptoms................. 070105, ref SDS F7 J14I
271926 - ..
271927 - 54. Patient asks Kaiser to expedite
271928 - treatment for IBC by UCSF on clincal
271929 - study................................ 070109, ref SDS F8 WZ4L
271931 - ..
271932 - 55. Kaiser contacted UCSF about Millie
271933 - starting treatment................... 070110, ref SDS F9 NM4O
271935 - ..
271936 - 56. Lung cancer inquiry Millie's letter
271937 - to Kaiser asking about notation
271938 - in medical chart..................... 070112, ref SDS G0 NM6G
271940 - ..
271941 - 57. UCSF contacts Millie about starting
271942 - treatment; submits consent documents
271943 - for clinical study................... 070116, ref SDS F0 0001
271945 - ..
271946 - 58. Primary care physician at Kaiser reports
271947 - lung cancer notations in Medical Chart
271948 - reflects CT test findings of nodes less
271949 - than 5 mm found in right
271950 - lung................................. 070117, ref SDS G3 NM6G
271952 - ..
271953 - Case study lists expressions of
271954 - nodules in lungs from findings in
271955 - CT tests that give no evident
271956 - support for lung
271957 - cancer............................... 070117, ref SDS G3 4Q46
271959 - ..
271960 - 59. UCSF schedules Millie for treatment
271961 - on 070119............................ 070117, ref SDS G2 5S85
271963 - ..
271964 - 60. Blood work for starting treatments
271965 - at UCSF on 070119.................... 070118, ref SDS G4 5S6L
271967 - ..
271968 - 61. Treatment at UCSF delayed until 070123
271969 - because UCSF has not received referral
271970 - authorization from Kaiser
271971 - previously agreed on
271972 - 061230............................... 070119, ref SDS G5 AS96
271974 - ..
271975 - 62. Blood tests scheduled for Millie to
271976 - start treatments on
271977 - 070123............................... 070122, ref SDS G6 0001
271979 - ..
271980 - 63. Treatment at UCSF delayed until Kaiser
271981 - submits referral authorization
271982 - previously agreed on
271983 - 061230............................... 070123, ref SDS G7 4Q54
271985 - ..
271986 - 64. UCSF reports referral authorization
271987 - resolved............................. 070125, ref SDS G8 0001,
271989 - ..
271990 - 65. Examination at UCSF by Doctor Rugo and
271991 - clinical study team.................. 070130, ref SDS G9 0001
271993 - ..
271994 - IBC rash spreading toward stomach and
271995 - back................................. 070130, ref SDS G9 M68J
271997 - ..
271998 - 66. CT test and more blood work to
271999 - prepare for treatment................ 070131, ref SDS H0 TZ6O
272001 - ..
272002 - 67. Treatment at UCSF cetuximab only
272003 - 1st cycle............................ 070201, ref SDS H1 0001
272005 - ..
272006 - Randomized for treatment with cetuximab
272007 - only benefits Millie with options
272008 - for additional treatments if
272009 - needed............................... 070201, ref SDS H1 XR3M
272011 - ..
272012 - Measurable disease based on photographs
272013 - with tape measure grid starting
272014 - today................................ 070201, ref SDS H1 6T6M
272015 -
272016 -
272017 -
272018 -
272019 -
272020 -
272021 -
272022 -
272023 -
272024 -
2721 -