CONTACTS 

SUBJECTS
CA 15-3 68 Down from 73 IBC Rash Slow Improvement Patient Fell Sprai

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 19 0000, ref SDS 18 0000.
060502 -
060503 - Millie notified Kaiser about a number of issues that have occurred
060504 - since meeting with the doctor last month.  The most serious is evident
060505 - slow recovery. ref SDS 0 0D4T  However, review indicates recovery may
060506 - be better than last year. ref SDS 0 9F35  Low blood pressure seems
060507 - fairly serious, ref SDS 0 0D6V, and may relate to mistake doubling
060508 - treatments Tuesday evening. ref SDS 0 0D5R
060509 -
060510 -
060511 -
060513 -  ..
0606 -
0607 -
0608 - Progress
0609 -
060901 - CA 15-3 68 Improvement Rate Seems Less than Previously Using Xeloda
060902 -
060903 - Submitted ref DIT 1 0001 to the primary care physician on recent
060904 - events that may impact decisions on treatment and care.
060905 -
060906 -    1.  Thanks for the report CA 15-3 has dropped again to 68, shown in
060907 -        your letter on Sep 17.  Seems like the rate of decline has
060908 -        slowed compared to last year. ref DIT 1 0001
060910 -  ..
060911 - Slow recovery was discussed in the record meeting with the doctor on
060912 - 060825 in relation to expectations following mastectomy surgery that
060913 - removed blood vessels that normally deliver treatment and nutrients to
060914 - infectecd tissue, ref SDS 18 G57I, reviewed in analysis below.
060915 - ref SDS 0 KG6H
060917 -  ..
060918 - This test was at the end of the 2nd cycle, and beginning the 3rd cycle
060919 - of chemotherapy treatment on 060908. ref SDS 19 407N
060921 -  ..
060922 - Rate of recovery from IBC rash presented in the letter to the doctor
060923 - today, is reviewed further below. ref SDS 0 UX8M
060924 -
060925 -
060926 -
060927 -
060928 -
0610 -

SUBJECTS
IBC Rash Improvement Below Incision Line Less Improvement Sternum an

1903 -
190401 -  ..
190402 - Response to Treatment Case Study Indicates Possible Effectiveness
190403 - Treatment Effectiveness Compares Favorably with Recovery in 2005
190404 - IBC Rash Improving Below Incision Line Other Rash Improving Slowly
190405 -
190406 - Follow up ref SDS 19 407N, ref SDS 18 025H.
190407 -
190408 - Millie's letter to Kaiser continues...
190410 -         ..
190411 -    2.  The rash on my chest has improved, especially below the
190412 -        surgical incision line. ref DIT 1 0X5N
190414 -  ..
190415 - The rash remains prominent though with possibly reduced intensity at
190416 - the sternum and along the area above the surgery line, reported on
190417 - 060825. ref SDS 18 FQ9N  Together with slow rate of decline in CA 15-3
190418 - reported above, ref SDS 0 MG6F, the slow rate of recovery from IBC red
190419 - rash, raises concern about effectiveness of treatment.
190420 -
190421 -            [On 061020 cancer marker CA 15-3 rise with stable to worse
190422 -            IBC rash may indicate pockets of resistance to chemotherapy
190423 -            due to removing blood vessels with mastectomy surgery; or
190424 -            effectivenss of current treatment with Taxotere and
190425 -            capecitabine (Xeloda) may have begun to decline.
190426 -            ref SDS 25 725L
190428 -  ..
190429 - Response to treatment was reviewed in the record on meeting with the
190430 - doctor on 060825. ref SDS 18 YF5J  Study of patient history raises
190431 - further question about effectiveness of treatment...
190432 -
190433 -        1.  Treatment begins Taxotere and
190434 -            capecitabine (Xeloda) 2 pills
190435 -            500 MG twice a day, after 4
190436 -            cycles AC beginning on
190437 -            050105........................... 050415, ref SDS 2 407N
190439 -             ..
190440 -        2.  CA 15-3 105...................... 050422, ref SDS 3 GJ5M
190442 -             ..
190443 -        3.  IBC rash big improvement after
190444 -            2 cycles Taxoter and capecitatine
190445 -            (Xeloda)......................... 050520, ref SDS 5 0001
190447 -             ..
190448 -            Reduce dose to 1.5 pills twice
190449 -            per day to reduce side
190450 -            effects.......................... 050520, ref SDS 5 V43H
190452 -             ..
190453 -            CA 15-3 67 fall from
190454 -            105.............................. 050520, ref SDS 5 GJ5M
190456 -             ..
190457 -        4.  Breast IBC rash almost gone skin
190458 -            near normal color and softness
190459 -            after 3 treatments............... 050610, ref SDS 7 025H
190461 -             ..
190462 -            CA 15-3 56 fall from
190463 -            67............................... 050610, ref SDS 7 087J
190465 -  ..
190466 - Previously, from 050415 to 050610 after 3 cycles to treat the 2nd IBC
190467 - relapse, the red rash, which was spreading on the entire breast and
190468 - toward the neck on 050415, was nearly fulled healed, and CA 15-3 had
190469 - dropped from 105 to 56, about 50 points by 050610. ref SDS 0 GG6H
190471 -  ..
190472 - During comparable period, beginning on 060721, ref SDS 14 0001, after
190473 - 3 cycles to treat the 3rd IBC relapse, today the red rash remains
190474 - evident, with only partial recovery of a much smaller area of skin,
190475 - ref SDS 0 0D4T, and CA 15-3 has dropped from 87 to 68, ref SDS 0 MG6F,
190476 - about 19 points.  This record presents a substantial difference in
190477 - response to the same treatment in the same amounts and for a nominally
190478 - less severe condition.
190480 -  ..
190481 - Is treatment less effective this year than in 2005; is it time to
190482 - consider changing treatments again?
190484 -  ..
190485 - Several factors may account for slower recovery this year compared to
190486 - last year...
190487 -
190488 -        1.  Last year, in 2005, Millie was treated with 4 cycles of AC
190489 -            before starting treatment with Taxotere and capecitabine
190490 -            (Xeloda). ref SDS 0 GG6H  Even though there was no evident
190491 -            recovery with AC, and symptoms increased (case study on
190492 -            050812 and citing patient history on 050329, ref SDS 8
190493 -            SK7K), benefits of AC treatment may have been delayed, and
190494 -            so substantial recovery after starting Taxotere and
190495 -            capecitabine (Xelda), may have been partially due to the
190496 -            prior treatment.
190498 -             ..
190499 -            This year, in 2006, Millie had received no treatment for
190500 -            about 9 months, because there were no symptoms of disease,
190501 -            with the last treatment on 050916, ref SDS 9 0001, before
190502 -            starting treatment for recurrence on 060721. ref SDS 14
190503 -            0001
190505 -             ..
190506 -        2.  Treatment in 2005 with Taxotere and capecitabine (Xeloda)
190507 -            started on 050415 with 2 cycles of high dose strategy;
190508 -            Millie took 2 pills twice a day, ref SDS 0 GG6H, until this
190509 -            was reduced on 050520 to 1.5 pills twice a day to reduce
190510 -            side effects. ref SDS 0 SJ9W
190512 -             ..
190513 -            Treatment this year in 2006 started without the high dose
190514 -            strategy, as shown in the meeting on 060711. ref SDS 13
190515 -            PF3O
190517 -             ..
190518 -        3.  Treatment in 2005 beginning on 050415 was delivered by the
190519 -            full complement of blood vessels and capillaries in a
190520 -            normal breast.  On 0510021 Kaiser performed a very wide
190521 -            mastectomy surgery.  Doctor Bailey had earlier advised on
190522 -            051011 that this surgery removes blood vessels needed to
190523 -            deliver treatment to infected skin tissues. ref SDS 12 G65S
190524 -            Doctor Smith in Kaiser's Surgery Department made a similar
190525 -            point during a meeting on 050928, ref SDS 10 248I, which
190526 -            was reviewed with the primary care physician on 051007.
190527 -            ref SDS 11 KO49  Review on 060711 shows replacement breast
190528 -            surgery was deferred by Kaiser, which means there may be
190529 -            pockets of resistance to treatment, ref SDS 13 X54L, under
190530 -            reasoning by Doctors Smith and Bailey, as further set out
190531 -            in scenario #2 developed on 060808. ref SDS 15 J458
190532 -
190533 -               [On 061020 cancer marker CA 15-3 rise with stable to
190534 -               worse IBC rash may indicate pockets of resistance to
190535 -               chemotherapy due to removing blood vessels with
190536 -               mastectomy surgery; or effectivenss of current treatment
190537 -               with Taxotere and capecitabine (Xeloda) may have begun
190538 -               to decline. ref SDS 25 725L
190540 -             ..
190541 -            Slow recovery is cited in the letter to the doctor today,
190542 -            per above, ref SDS 0 MG6F, was discussed in the record
190543 -            meeting with the doctor on 060825 in relation to
190544 -            expectations following mastectomy surgery that removed
190545 -            blood vessels that normally delivery treatment and
190546 -            nutrients to infectec tissue. ref SDS 18 G57I  This has
190547 -            been a pending issue for 2nd opinion review by UCSF, noted
190548 -            on 060821. ref SDS 17 NN3H
190549 -
190550 -               [On 061027 Millie asks about slow recovery from IBC
190551 -               caused by mastectomy surgery removing blood vessels
190552 -               needed to deliver treatment. ref SDS 26 MS3Y
190554 -                ..
190555 -               [On 061110 doctor reports IBC rash on left breast area
190556 -               is "stable," ref SDS 28 ZL5W, indicating recovery is
190557 -               very slow, because on 051021 blood vessels were removed
190558 -               from the treatment area by mastectomy surgery, per
190559 -               analysis of expectations on 050929. ref SDS 22 EH3F
190561 -             ..
190562 -        4.  Treatment in 2005 with AC was irregular, possibly causing
190563 -            delayed response.  After switching to Taxotere and Xeloda,
190564 -            treatments were all given on schedule.  Every 3 weeks
190565 -            Kaiser treated the patient maintaining a steady level of
190566 -            chemotherapy agent...
190567 -                                                                Days
190568 -                1st treatment.......... 050415, ref SDS 2 0001
190569 -                2nd treatment.......... 050506, ref SDS 4 0001   21
190570 -                3rd treatment.......... 050527, ref SDS 6 0001   21
190572 -             ..
190573 -            Treatment in 2006 so far has been delayed causing irregular
190574 -            and diluted levels of chemotherapy drugs, as occurred with
190575 -            AC in 2005, and shown as follows...
190576 -                                                                Days
190577 -                1st treatment.......... 060721, ref SDS 14 0001
190578 -                2nd treatment.......... 060814, ref SDS 16 0001  24
190579 -                3rd treatment.......... 060908, ref SDS 19 0001  25
190580 -
190581 -                    [...see below patient error taking 2 treatments
190582 -                    together, also, changes concentration of
190583 -                    chemotherapy drugs. ref SDS 0 024I
190585 -  ..
190586 - Even though the rate of recovery seems less today than occurred in
190587 - 2005 for a comparable amount of treatment, ref SDS 0 LE48, Millie may
190588 - actually be doing as well or better.  There is nothing in the record
190589 - to assess the impact of having received in 2005 4 cycles of AC, and
190590 - that treatment for first 2 cycles of Taxotere and capecitabine
190591 - (Xeloda) were 33% higher dose than given this year in 2006.
190592 - ref SDS 0 9E91  Irregular and delayed treatments in 2006, ref SDS 0
190593 - 5F5L, further diluted the amount of chemotherapy agent fighting
190594 - disease compared to treatment in 2005.  Roughly, after the 3rd cycle
190595 - of Taxotere and capecitabine in 2005 that showed substantial recovery
190596 - from IBC, the patient had received 2 - 3 times more chemotherapy drug
190597 - than has been given at this stage in the current treatment regimin.
190599 -  ..
190600 - After 3 cycles of treatment this year there is actually better
190601 - response than after 4 cycles of AC in 2005, when disease got much
190602 - worse, before starting to get better after 2 cycles of Taxotere and
190603 - capecitabine (Xeloda).
190605 -  ..
190606 - Since IBC does not seem to be spreading, and there has been some
190607 - subsidence, continuing the current treatment and returning to regular
190608 - cycles seems supported by the record.
190609 -
190610 -
190611 -
190612 -
190613 -
1907 -

SUBJECTS
Fall Slipped Exiting BART Train Sprained Finger No Evident Effects L

2303 -
230401 -  ..
230402 - Fall Slipped Exiting BART Train Sprained Finger No Evident Effects
230403 -
230404 -
230405 - Millie's letter to Kaiser continues...
230406 -
230407 -    3.  About a week ago I fell getting off the BART train, and seem to
230408 -        have sprained a finger catching myself. ref DIT 1 DX6H
230410 -  ..
230411 - This occurred on Thursday, 060914, ref SDS 20 ZQ5I, about a week
230412 - after starting the 11th cycle of Taxotere and capecitabine (Xeloda)
230413 - treatment on 060908. ref SDS 19 0001
230414 -
230415 -            [...see below lymphedema symptoms rise. ref SDS 0 034F
230416 -
230417 -            [On 061016 finger healed very slowly; Millie went to
230418 -            Kaiser for treatment; xrays showed her finger is
230419 -            broken, and ligaments are torn. ref SDS 23 IP5I
230421 -             ..
230422 -            [On 061019 orthopedic doctor removed the cast, and
230423 -            prescribed continued exercise to maintain range of motion;
230424 -            prognosis is long slow healing process. ref SDS 24 087I
230425 -
230426 -
230427 -
230428 -
2305 -

SUBJECTS
Treatment Mistake Capecitabine Xeloda Chemotherapy Pills Taken Twice

2503 -
250401 -  ..
250402 - Treatment Mistake Xeloda Taken Twice 1 Hour Apart No Evident Effects
250403 -
250404 -
250405 - Millie's letter to Kaiser continues...
250406 -
250407 -    4.  This past Tuesday, I goofed and took two treatments of Xeloda
250408 -        about an hour apart, so that would be 3 total pills of 500 MG.
250409 -        The next morning, did not take pills.  There were no noticable
250410 -        side effects from this error, so just letting you know.
250411 -        ref DIT 1 LX6L
250413 -  ..
250414 - This is another factor that changes the concentration of treatment
250415 - that may impact the rate of recovery and effectiveness, per above.
250416 - ref SDS 0 GA4U
250417 -
250418 -          [On 060929 pharmacist reviews prespription for capecitabine
250419 -          (Xeloda), Kaiser's quality control to support the patient.
250420 -          ref SDS 21 WK95
250421 -
250422 -
250423 -
250424 -
250425 -
2505 -

SUBJECTS
Lymphedema Rises Left Arm 1" Bigger Possibly Due to Fall or Cancer T

3003 -
300401 -  ..
300402 - Lymphedema Rises Left Arm Possibly Due to Fall or Treament Error
300403 -
300404 -
300405 - Millie's letter to Kaiser continues...
300406 -
300407 -    5.  Lymphadema on my left arm has suddenly increased.  My foremam
300408 -        and left hand are now noticably swollen.  An indication is the
300409 -        change in forearm which is about 1" bigger now than it has been
300410 -        for a few months.  Possibly this is a reaction to the fall, or
300411 -        the extra pills. ref DIT 1 DY7I
300413 -  ..
300414 - Seems like the fall Millie had the other day, per above, ref SDS 0
300415 - 0D4X, could have induced trauma that caused lymphedema to rise.
300417 -  ..
300418 - The doctor responded in a letter saying that trauma to the left arm
300419 - from injuring her finger in the fall is an event that can trigger
300420 - complications of lymphedema, causing increased swelling.
300421 -
300422 -            [On 061016 Millie had her finger examined at Kaiser to
300423 -            assess slow healing from fall on 060914; xrays showed the
300424 -            finger is broken, requiring a cast for a week to facilitate
300425 -            healing. ref SDS 23 IP5I
300427 -             ..
300428 -            [On 061027 Millie hospitalized temperature 102.6,
300429 -            ref SDS 27 HP52, major, severe red rash envelops left arm
300430 -            and shoulder; diagnosis cellulitus complications of
300431 -            lymphedema, reaction to tramua from fall and breaking
300432 -            finger on 060914. ref SDS 27 V759
300433 -
300434 -
300435 -
300436 -
300437 -
300438 -
300439 -
3005 -

SUBJECTS
Vitals Blood Pressure 94 57 Falls Dangerously Low Possibly Due to Tr

3403 -
340401 -  ..
340402 - Blood Pressure Falls Dangerously Low Possibly Due to Treatment Error
340403 -
340404 -
340405 - Millie's letter to Kaiser continues...
340406 -
340407 -    6.  My blood pressure dropped yesterday to 94 57.  It seems back to
340408 -        normal today. ref DIT 1 ZY8F
340410 -         ..
340411 -    7.  Just a heads up for our meeting next week. ref DIT 1 UY8J
340412 -
340413 -
340414 -
340415 -
340416 -
340417 -
340418 -
340419 -
340420 -
340421 -
340422 -
3405 -