CONTACTS 

SUBJECTS
Meeting Doctor Examination Prepare for 12th Cycle Treatment 3rd Rela

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS D9 0000. ref SDS D2 0000.
040502 -
040503 - Significant drop in CA 15-3 seems conflicting with stable IBC red rash
040504 - on left breast. ref SDS 0 GJ5M  Examination shows continuing slow
040505 - response to treatment. ref SDS 0 FQ6G  The doctor ordered treatment
040506 - with Taxotere and capecitabine (Xeloda) to continue. ref SDS 0 PF3O
040507 - Mastectomy surgery last year removed blood vessels which may be
040508 - preventing delivery of chemotherapy treatment to infected tissue.
040509 - ref SDS 0 T53L  Surgery also removed lympatics which caused lymphedema
040510 - in the left arm.  A few weeks ago Millie was tired and possibly
040511 - disoriented, causing her to fall down.  Injury to a finger on the left
040512 - hand increased lymphedema swelling that was previously under control.
040513 - ref SDS 0 UT8M  Millie reported continuing fatigue, shortness of
040514 - breath, and heaviness in the chest, which are symptoms of chemotherapy
040515 - treatment and loss of fitness due to loss of energy from regular
040516 - cancer treatments. ref SDS 0 B56N  The doctor requested a coagulapathy
040517 - lab study performed on a family member to help assess Millie risks for
040518 - pulmonary embolism recurrence. ref SDS 0 QT6N  The doctor further
040519 - ordered a CT scan test for pulmonary emboli. ref SDS 0 DY5M
040520 -
040521 -       [...in another record today, UCSF 2nd opinion prepared by
040522 -       Doctor Benz is reviewed. ref SDS E3 0001
040524 -        ..
040525 -       [On 061002 CT test positive for pulmonary emboli; Millie must
040526 -       resume treatment previously ended on 051007. ref SDS E5 MI5I
040528 -        ..
040529 -       [On 061012 CT test findings enlarged right ventricle complicate
040530 -       pulmonary embolism. ref SDS E6 7E5L
040532 -        ..
040533 -       [On 061027 Millie hospitalized temperature 102.6, ref SDS F1
040534 -       HP52, severe red rash envelops left arm and shoulder; diagnosis
040535 -       cellulitus complications of lymphedema, reaction to tramua from
040536 -       fall and breaking finger on 060914. ref SDS F1 V759
040537 -
040538 -
040539 -
040540 -
040542 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Agenda Progress Review Assess Work Plan and New Symptoms PE
040902 -
040903 - Follow up ref SDS D9 SM6M, ref SDS D2 SM6M.
040904 -
040905 - This is the 4th review meeting to start the 4th (12th overall)
040906 - treatment with Taxotere and capecitabine (Xeloda) chemotherapy,
040907 - ref SDS E2 407N, since start of recovery on 060711 for 3rd relapse of
040908 - IBC. ref SDS B7 SM6M  It is the 3rd meeting with the primary care
040909 - physician, and the 2nd since he returned from vacation on 060825.
040910 - ref SDS D9 SM6M
040912 -  ..
040913 - There was an innovation today with the primary care physician meeting
040914 - the patient during treatment.  This reduced the overall time at the
040915 - Kaiser facility today by about 50%, from 4 hours to only 2.  After
040916 - treatment was started in the Infusion Clinic, Angela assisted Millie
040917 - walking along with IV equipment connected through the halls to the
040918 - doctor's examination room, as reported in another record. ref SDS E2
040919 - 5I6K  Meeting with the doctor was held while Millie received treatment
040920 - concurrently.
040922 -  ..
040923 - Millie submitted an agenda for the doctor to be prepared.  Prior to
040924 - meeting, Millie listed the agenda on the marking board to guide
040925 - discussions in the examination room...
040926 -
040927 -    1.  CA 15-3 review seems favorable............. ref SDS 0 GJ5M
040928 -    2.  Lymphedema rising broken finger............ ref SDS 0 MW8J
040929 -    3.  PET CT Exam defer.......................... ref SDS 0 EY5O
040930 -    4.  Breast exam IBC relapse diagnosis.......... ref SDS 0 025H
040931 -    5.  UCSF Dr Benz 2nd Opinion trials............ ref SDS 0 025H
040932 -    6.  Treatment plan strategy.................... ref SDS 0 K36G
040934 -  ..
040935 - The doctor scheduled next the meeting in about 5 weeks to start the
040936 - 5th cycle of treatment on October 20, 2006 for recovery from the 3rd
040937 - IBC relapse.
040938 -
040939 -
040940 -
040941 -
040942 -
040943 -
0410 -

SUBJECTS
Vitals Pending Primary Care Physician Not Submitted with Doctor's Pr

0603 -
060401 -  ..
060402 - Vitals Show Stable Medical Condition
060403 -
060404 - Follow up ref SDS D9 KB5L, ref SDS D2 KB5L.
060406 -                           ..
060407 -                          Bld Prssr   Pulse   Temp   Weight  SaO2
060408 -     ..
060409 -    060929 1452............ 141 78     66     98.3
060410 -    060908 1335............ 139 79     73     98.1
060411 -    060814 1610............ 139 80     59     98.2
060412 -    060808.................
060413 -    060711................. 172 87     54     97.5    147
060414 -    060623................. 141 87     71     98.0    147     99%
060415 -    060428................. 129 73     80     99.4    149     99%
060416 -    060217................. 153 81     61     98.6    150     99%
060417 -
060418 -
060419 -
060420 -
060421 -
0605 -

SUBJECTS
CA 15-3 51 Only 12 Above 39 Another Big Drop fromn 87 Improvement In

1603 -
160401 -  ..
160402 - CA 15-3 Cancer Marker 51 Another Significant Drop
160403 -
160404 - Follow up ref SDS D9 087J, ref SDS D2 087J.
160405 -
160406 - There have been two (2) tests since the last meeting on 060825.  The
160407 - test for treatment on 060908 was not available at that time, and was
160408 - received about a week later showing 68.  The more recent test
160409 - yesterday on 060928 for treatment today shows another significant drop
160410 - to 51.
160412 -           ..
160413 -          Test Date                         Date Received
160414 -          060928......... 51 H............. 060929, ref SDS 0 087J
160415 -          060907......... 68 H............. 060929, ref SDS 0 087J
160416 -          060813......... 73 H............. 060817, ref SDS D7 U24M
160417 -          060809......... 87 H............. 060810, ref SDS D5 2N5J
160418 -          060708......... 71 H............. 060711, ref SDS B7 087J
160419 -          060616......... 63 H............. 060623, ref SDS B5 UQ5Q
160420 -          060522......... 59 H............. 060605, ref SDS B0 UQ5Q
160421 -          060501......... 49 H............. 060522, ref SDS A7 MC4F
160422 -          060421......... 44 H............. 060428, ref SDS A0 087J
160423 -          060330......... 40 H............. 060428, ref SDS A0 087J
160424 -          060303......... 36............... 060428, ref SDS A0 087J
160425 -          060210......... 33............... 060217, ref SDS 90 087J
160426 -          060109......... 34............... 060126, ref SDS 89 KV59
160427 -          051223......... 34............... 060106, ref SDS 88 087J
160428 -          051202......... 28............... 060106, ref SDS 88 087J
160429 -          051116......... 31............... 051121, ref SDS 86 087J
160430 -          051109......... 30............... 051121, ref SDS 86 087J
160431 -          051102......... 34............... 051121, ref SDS 86 087J
160432 -          050909......... 45 H............. 051007, ref SDS 79 087J
160433 -          050826......... 45 H............. 050913, ref SDS 73 087J
160434 -          050819......... 45 H............. 050913, ref SDS 73 087J
160435 -          050812......... 39 .............. 050819, ref SDS 66 3K6L
160436 -          050729......... 45 H............. 050819, ref SDS 66 EA5G
160437 -          050708......... 46 H............. 050729, ref SDS 65 087J
160438 -          050701......... 37 .............. 050729, ref SDS 65 087J
160439 -          050617......... 45 H............. 050729, ref SDS 65 087J
160440 -          050527......... 56 H............. 050610, ref SDS 62 087J
160441 -          050512......... 67 H............. 050520, ref SDS 60 087J
160442 -          050506......... 80 H............. 050520, ref SDS 60 087J
160443 -  ..
160444 -          050415.........105 H............. 050422, ref SDS 57 087J
160445 -          050325.........100 H............. 050329, ref SDS 55 087J
160446 -          050318.........101 H............. 050325, ref SDS 54 2N5J
160447 -          050304......... 88 H............. 050311, ref SDS 52 087J
160448 -          050225......... 95 H............. 050308, ref SDS 51 0001
160449 -          050211......... 78 H............. 050214, ref SDS 50 02BB
160450 -          050128......... 67 H............. 050204, ref SDS 49 087J
160451 -          041228......... 56 H............. 041230, ref SDS 48 087J
160452 -          041204......... 43 H............. 041210, ref SDS 47 087J
160453 -          041007......... 39............... 041104, ref SDS 43 087J
160454 -          040923......... 49 H............. 041005, ref SDS 42 087J
160455 -          040908......... 44 H............. 040909, ref SDS 41 087J
160456 -          040825......... 47 H............. 040909, ref SDS 41 087J
160457 -          040811......... 42 H............. 040812, ref SDS 40 087J
160458 -          040728......... 43 H............. 040729, ref SDS 38 2N5J
160459 -          040712......... 47 H............. 040713, ref SDS 37 087J
160460 -          040614......... 55 H............. 040615, ref SDS 36 PX6X
160461 -          040517......... 78 H............. 040601, ref SDS 34 2N5J
160462 -          040311......... 70 H............. 040318, ref SDS 28 SM6M
160463 -          040205......... 60 H............. 040211, ref SDS 26 SM6M
160464 -          031201......... 62 H............. 031205, ref SDS 25 SM6M
160465 -          030912......... 66 H............. 030915, ref SDS 24 SM6M
160466 -          030708......... 68 H............. 030710, ref SDS 23 SM6M
160467 -          030503......... 54 H............. 030508, ref SDS 21 SM6M
160468 -          030403......... 45 H............. 030508, ref SDS 21 SM6M
160469 -          030215......... 46 H............. 030220, ref SDS 20 5E6L
160470 -          030106......... 37 H............. 030109, ref SDS 19 SM6M
160471 -          021202......... 41 H?............ 021204, ref SDS 18 SP5G
160472 -          021111......... 36 H?............ 021113, ref SDS 17 Y65I
160473 -          021023......... 33 H?............ 021023, ref SDS 16 SQ5I
160474 -          020930......... 33 H?..39........ 021002, ref SDS 15 SQ5I
160475 -          020917......... 36 H?............ 020924, ref SDS 14 SQ5I
160476 -          020717......... 59 H?............ 020726, ref SDS 13 YN5K
160477 -          020629......... 75 H ............ 020705, ref SDS 11 UX6I
160478 -          020608........  67 H ............ 020614, ref SDS 9 0001
160479 -          020603........ 108 H ............ 020607, ref SDS 8 X67F
160480 -          020511........ 117 H ............ 020603, ref SDS 7 PJ4J
160481 -          020419......... 81 H ............ 020430, ref SDS 5 7N5H
160482 -          020321......... 85 H ............ 020405, ref SDS 4 6T8K
160483 -
160484 -
160485 -
160486 -
160488 -  ..
1605 -
1606 -
1607 - Analysis
1608 -
160801 - CA 15-3 51 Cancer Marker Improving Faster than IBC Rash Subsides
160802 -
160803 - Follow up ref SDS D9 GJ5M, ref SDS D2 GJ5M.
160804 -
160805 - Consistent fall of CA 15-3 cancer marker since 060817 combined with
160806 - another big drop in the cancer marker today seems inconsistent with
160807 - slow recovery from IBC red rash on left breast cited by the patient in
160808 - a letter to Kaiser on 060922, ref SDS E1 MG6F, and further shown by
160809 - examination today, reported below. ref SDS 0 025H
160811 -  ..
160812 - The doctor feels this supports continuing current treatment.
160813 -
160814 -
160815 -
160816 -
160817 -
160818 -
1609 -

SUBJECTS
Esophagitis Continued Mild Refulx Treated with Tums Meeting Primary

1903 -
190401 -  ..
190402 - Esophagitis Not Compared in Current PET Test with Prior Report
190403 -
190404 - Follow up ref SDS D9 JP6K, ref SDS D2 JP6K.
190405 -
190406 - Background beginning on 060126 when testing reported "likely
190407 - esophagitis" is summarized in the record on 060825, ref SDS D9 JP6K,
190408 - citing the record on 060711 when the doctor deferred further action
190409 - until symptoms increase. ref SDS B7 4R6K
190411 -  ..
190412 - There continue to be mild episodic digestion issues commonly described
190413 - as "heart burn," which is treated with over-the-counter remedies like
190414 - Tums.
190416 -  ..
190417 - There was no discussion of esophagitis today, shown by the doctor's
190418 - record. ref SDS 0 1248
190419 -
190420 -
190421 -
190422 -
190423 -
190424 -
1905 -

SUBJECTS
Left Axillary Lymphadenopathy Patient No Complaint Swelling Discomfo

3003 -
300401 -  ..
300402 - Left Axillary No Evidence Lymphadenopathy
300403 - Fall Finger Injury Rising Swelling Lymphedema Complications
300404 - Lymphedema Left Arm Swelling Complications Fall Sprained Left Finger
300405 - Post Operation Localized Edema Left Axillary Swelling Reduced
300406 -
300407 - Follow up ref SDS D9 MW8J, ref SDS D2 MW8J.
300409 -  ..
300410 - Patient history of left axillary lymphadenopathy and lymphedema is
300411 - reported on 060106. ref SDS 88 S164
300413 -  ..
300414 - Examination today found no evidence of cancer in left axilla.  The
300415 - patient made no complaint of lumps or discomfort from swelling.
300416 - Imaging tests in April and May were reviewed during the meeting on
300417 - 060623, and showed no findings of lymphadenopathy at this time,
300418 - ref SDS B5 MW8J, therefore, suggesting cancer relapse seems primarily
300419 - local.
300421 -  ..
300422 - On 060710 physical therapist found lymphedema has significantly
300423 - improved; Kaiser ended physical therapy, since the patient is making
300424 - good progress with self-care, ref SDS B6 Q05H, further reported during
300425 - the examination on 060711. ref SDS B7 U433
300427 -  ..
300428 - On 060914 Millie fell at the BART station as a result of fatigue, and
300429 - injured the middle finger on her left hand; since this was the side of
300430 - mastectomy surgery on 051021, lymphedema increased causing the left
300431 - arm to swell. ref SDS E0 ZQ5I  Over the next week, swelling increased,
300432 - so on 060922 Millie notified Kaiser of significant swelling.
300433 - ref SDS E1 0D5Y
300435 -  ..
300436 - Examination showed swelling continues throughout the left arm and
300437 - hand.  The doctor feels this is a complication of lymphedema from the
300438 - fall on 060914. ref SDS 0 1248  Below left elbow still measures 11.5
300439 - inches, listed in case study on 060509. ref SDS A5 HO7F
300441 -  ..
300442 - The doctor continued prescription of home therapy and treatment by
300443 - Kaiser's Physicial Therapy clinic, described as "Return to Lymphedema
300444 - Clinic" in the Progress Notes. ref SDS 0 125V
300445 -
300446 -    [On 061016 Millie had her finger examined at Kaiser to assess slow
300447 -    healing from fall on 060914; xrays showed the finger is broken,
300448 -    requiring a cast for a week to facilitate healing. ref SDS E8 IP5I
300450 -     ..
300451 -    [On 061019 orthopedic doctor removed the cast, and prescribed
300452 -    continued exercise to maintain range of motion; prognosis is
300453 -    long slow healing process. ref SDS E9 087I
300455 -     ..
300456 -    [On 061027 Millie hospitalized temperature 102.6, ref SDS F1 HP52,
300457 -    severe red rash envelops left arm and shoulder; diagnosis
300458 -    cellulitus complications of lymphedema, reaction to tramua from
300459 -    fall and breaking finger on 060914. ref SDS F1 V759
300460 -
300461 -
300462 -
300463 -
300464 -
3005 -

SUBJECTS
Right Auxillary Lymphadenopathy Patient No Complaint Swelling Discom

3503 -
350401 -  ..
350402 - Right Axillary FDG SUV 2.5 Lump Discomfort Not Reported by Patient
350403 -
350404 - Follow up ref SDS D9 3D6K, ref SDS D2 3D6K.
350405 -
350406 - Patient history of rising FDG SUV activity by PET testing, reported on
350407 - 060428, ref SDS A0 CZ8L, and no adenopathy found in contrast CT test
350408 - on 060505, as reported on 060523, ref SDS A7 4O8P, which further
350409 - failed to perform contrast study with prior PET test findings,
350410 - ref SDS A6 WT6M, was reviewed during a meeting with the doctor on
350411 - 060623. ref SDS B5 CZ8L
350413 -  ..
350414 - The doctor examined the right axillary and found no evidence of
350415 - swelling.  The patient does not complain of discomfort in this region.
350416 -
350417 -
350418 -
350419 -
350420 -
350421 -
3505 -

SUBJECTS
Left Neck Supraclavicular No Examination Benz 2nd Opinion Finds No E

4303 -
430401 -  ..
430402 - Left Supraclavicular Examination PET Test Report Finding SUV 4.5
430403 - Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
430404 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
430405 -
430406 - Follow up ref SDS D9 8R6M, ref SDS D2 8R6M.
430407 -
430408 - Background of image testing, and consideration for radiation treatment
430409 - of left supraclivicular is reported on 060623. ref SDS B5 8R6M
430411 -  ..
430412 - Like the left and right axillary, the patient made no complaint of
430413 - swelling or discomfort in the left supraclavicular, consistent with
430414 - image testing reported on 060623, though also noting conflict between
430415 - PET and CT reports. ref SDS B5 8R6M
430417 -  ..
430418 - Examination of left supraclavicular found no evidence of swelling or
430419 - other indication of cancer.
430420 -
430421 -    [On 060929 Doctor Benz 2nd opinion notes that failure of CT test on
430422 -    060505 to report findings in left supraclavicular where PET test
430423 -    finds nodes progressing in size raises concerns, ref SDS E3 WI4I,
430424 -    as related in analysis on 060523. ref SDS A7 4R82
430425 -
430426 -
430427 -
430428 -
4305 -

SUBJECTS
Examination IBC Red Rash Seems Unchanged from 060825 Conflicts 30% D

5703 -
570401 -  ..
570402 - 2nd Opinion UCSF Received from Kaiser on Consultation 060821
570403 - Examination Left Breast IBC Inflammation Red Rash Stable Slow Response
570404 - IBC Inflammation Left Breast Rash Stable Slow Response to Treatment
570405 - Response to Treatment Slow IBC Inflammation Left Breast Red Rash Stable
570406 -
570407 - Follow up ref SDS D9 025H, ref SDS D2 025H.
570408 -
570409 - Background on prior relapse examinations is listed on 060711.
570410 - ref SDS B7 8Y7O
570412 -  ..
570413 - Millie asked the doctor if Kaiser has received the 2nd opinion from
570414 - consultation with Doctor Benz at UCSF on 060821?
570416 -  ..
570417 - The doctor left the room.  He returned in a few minutes and submitted
570418 - a copy of the 2nd opinion from UCSF following up the meeting with
570419 - Doctor Benz on 060821. ref SDS D8 0001  For some reason UCSF failed to
570420 - submit the report to the patient, who ordered the work on 060725,
570421 - ref SDS C6 ST9O, and later paid for the work.  Additionally, the
570422 - patient expedited UCSF's support on 060809, ref SDS D4 YK6N, and
570423 - further facilitated handling of patient history to save time and money
570424 - and increase the quality of UCSF's work, also reported on 060809.
570425 - ref SDS D4 I73H
570426 -
570427 -        [...in another record today, UCSF 2nd opinion prepared by
570428 -        Doctor Benz is reviewed. ref SDS E3 0001
570430 -  ..
570431 - Today, the doctor looked briefly at the red rash on the left breast
570432 - area, and noted stable to somewhat improved conditions with red rash
570433 - possibly slightly less or slightly more spread out.  Without
570434 - measurements this issue is indeterminate, because of slow change in
570435 - the spread and severity of the rash.
570436 -
570437 -        [...below, doctor's progress notes describe "decreasing
570438 -        lesions. ref SDS 0 ZL5W
570440 -  ..
570441 - Observation indicates IBC rash seems stable relative to the #2
570442 - scenario framework reported on 060825. ref SDS D9 8Z8G
570444 -  ..
570445 - There is little change since the prior examination by the primary care
570446 - physician on 060825 citing worsening of IBC since 060711, then some
570447 - improvement. ref SDS D9 025H  The 2nd opinion from UCSF received today
570448 - from Kaiser describes conditions found on 060821 by Doctor Benz,
570449 - ref SDS D8 KR6I, and represents current progress, with some minor
570450 - improvement or worsening, i.e., essentially stable after two more
570451 - treatments. ref SDS E3 WQ8V
570453 -  ..
570454 - The doctor feels today that CA 15-3 at 51, 30% drop from examination
570455 - on 060825, per above, ref SDS 0 087J, may not be fully represented as
570456 - yet by slow recovery from IBC rash on the left breast.
570457 -
570458 -        [On 060929 Benz 2nd opinion finds red rash on left breast area
570459 -        previously found by biopsy on 040419 to be IBC, and later found
570460 -        clear of IBC disease by biopsy on 051021 is not established as
570461 -        recurrent IBC by biopsy this year in 2006, ref SDS E3 WY79;
570462 -        caution presented in the Benz examination resisting association
570463 -        of red rash lesions and inflammation on the left breast area
570464 -        with IBC disease, and in relation to rising CA 15-3 cancer
570465 -        marker, doctor indicates there may be wide spread distant
570466 -        metastasis too small for recognition by image testing and
570467 -        currently being treated systemcially with chemotherapy.
570468 -        ref SDS E3 WQ8V
570470 -         ..
570471 -        [On 061110 doctor reports IBC rash on left breast area is
570472 -        "stable," ref SDS F5 ZL5W, indicating recovery is very slow,
570473 -        because on 051021 blood vessels were removed from the treatment
570474 -        area by mastectomy surgery, per analysis of expectations in the
570475 -        record today. 060929. ref SDS 0 EH3F
570477 -  ..
570478 - Mastectomy surgery effect on slow response to treatment is reviewed
570479 - below. ref SDS 0 EH3F
570481 -  ..
570482 - Review on 060922 indicates that evident slow response to treatment for
570483 - IBC relapse of red rash on the left breast area may be misleading, and
570484 - that recovery this year could actually be ahead of recovery in 2005.
570485 - ref SDS E1 0D4T
570487 -  ..
570488 - The doctor ordered a CT test to evaluate distant metastasis, as
570489 - reported below discussing the 2nd opinion from UCSF, ref SDS 0 J44G,
570490 - and further to investigate pulmonary emboli, also, reported below.
570491 - ref SDS 0 CV5L
570492 -
570493 -        [On 061012 CT test results show no evidence of distant
570494 -        metastatis and make no findings of any kind for cancer.
570495 -        ref SDS E6 2967
570497 -         ..
570498 -        [On 061020 meeting with doctor at Kaiser, primary care
570499 -        physician seems to concur that CT test on 060930 shows no
570500 -        evidence of cancer. ref SDS F0 YQ6I
570501 -
570502 -
570503 -
570504 -
570505 -
570506 -
5706 -

SUBJECTS
Mastectomy Removes Blood Vessels Slows Rate Recovery IBC Relapse Exp

6303 -
630401 -  ..
630402 - Blood Vessels Removed Mastectomy Surgery Slow Response Treatment
630403 - Slow Response to Treatment Mastectomy Removed Blood Vessels
630404 - Expectations Recovery Rate Tempered by Mastectomy Surgery
630405 - Mastectomy Removes Blood Vessels Slows Rate Recovery IBC Relapse
630406 -
630407 - Follow up ref SDS D9 G57I, ref SDS D8 NN3H.
630408 -
630409 - Background of mastectomy surgery performed on 051021 with impacts on
630410 - expectations for recovery from IBC red rash is reported on 060825,
630411 - ref SDS D9 G57I, citing a case study on 041210 considering mastectomy
630412 - surgery for Millie, ref SDS 47 657F, including 2nd opinion review on
630413 - 060821. ref SDS D8 NN3H
630415 -  ..
630416 - A letter to the doctor on 060922 cites slower recovery from IBC rash
630417 - with the same treatment used in 2005. ref SDS E1 MG6F  Subsequent
630418 - analysis develops factors that contribute to slower response to
630419 - treatment. ref SDS E1 9E6L
630421 -  ..
630422 - Mastectomy surgery on 051021 removed blood vessels and capillaries
630423 - from the breast area.  Review on 060922 reviewed impact on slow
630424 - response to treatment based on 2nd opinions. ref SDS E1 ML3I
630426 -  ..
630427 - Analysis of Doctor Smith' report received from the primary care
630428 - physician on 051007, ref SDS 79 KO49, and supported by Doctor Bailey a
630429 - few days later on 051011, explaining that loss of blood vessels with
630430 - removal of the breast could reduce effectiveness of treatment for
630431 - future IBC relapse, ref SDS 80 G65S, may account for disparity in
630432 - large decline of CA 15-3 cancer marker, and slower decline of IBC red
630433 - rash on the left chest wall, noted by examination today, per above.
630434 - ref SDS 0 FQ6G
630435 -
630436 -        [On 061020 sudden rise CA 15-3 cancer marker and stable to
630437 -        worsening IBC red rash left breast area may indicated that
630438 -        effectiveness of treatment has expired under scenario #2
630439 -        reviewed on 060808, ref SDS D2 HT5K, or that treatment is not
630440 -        being delivered because mastectomy surgery removed blood
630441 -        vessels. ref SDS F0 EH3F
630443 -         ..
630444 -        [On 061110 doctor reports IBC rash on left breast area is
630445 -        "stable," ref SDS F5 ZL5W, indicating recovery is very slow,
630446 -        because on 051021 blood vessels were removed from the treatment
630447 -        area by mastectomy surgery, per analysis today of expectations,
630448 -        shown here. ref SDS 0 EH3F
630449 -
630450 -
630451 -
630452 -
630453 -
630454 -
6305 -

SUBJECTS
Status Change Biopsy Tissue IBC Recurrence Update Biopsy 040419 for

6803 -
680401 -  ..
680402 - Treatment Options Expand Pool of Drugs Biopsy Test for Status Change
680403 - Biopsy to Determine Biology of IBC and Guide Choice of Treatment
680404 - Status Change Did Not Occur Retest Biopsy 040419 Treatment Options
680405 - Treatment Options Limited Status Not Changed by Retest Biopsy 040419
680406 -
680407 - Follow up ref SDS D9 KT7J, ref SDS D2 KT7J.
680408 -
680409 - Can a biopsy contribute to patient work up for developing a strategy
680410 - and treatment plan, discussed on 060711? ref SDS B7 K36G
680412 -  ..
680413 - Alternate theories on changes in patient status are listed in the
680414 - record of the meeting on 060808, ref SDS D2 J16O, and were not further
680415 - reviewed today.
680417 -  ..
680418 - Considerations for biopsy to verify IBC disease, check for status
680419 - change to expand pool of treatment drug agents, and to qualify for
680420 - drug trials, and based on 2nd opinions from Doctor Grissom, and Doctor
680421 - Benz at UCSF were reviewed recently with Kaiser during a meeting on
680422 - 060825. ref SDS D9 KT7J
680423 -
680424 -        [On 060929 Benz 2nd opinion finds red rash on left breast area
680425 -        previously found by biopsy on 040419 to be IBC, and later found
680426 -        clear of IBC disease by biopsy on 051021 is not established as
680427 -        recurrent IBC by biopsy this year in 2006, ref SDS E3 WY79;
680428 -        caution presented in the Benz examination resisting association
680429 -        of red rash lesions and inflammation on the left breast area
680430 -        with IBC disease, and in relation to rising CA 15-3 cancer
680431 -        marker, doctor indicates there may be wide spread distant
680432 -        metastasis too small for recognition by image testing and
680433 -        currently being treated systemcially with chemotherapy.
680434 -        ref SDS E3 WQ8V
680436 -  ..
680437 - There was no further work on these issues today.
680438 -
680439 -
680440 -
680441 -
680442 -
6805 -

SUBJECTS
IBC Image Tests CT Scan Scheduled Investigate Symptoms Pulmonary Emb

7303 -
730401 -  ..
730402 - CT Image Testing Distant Metastasis and Pulmonary Emboli Scheduled
730403 - Scheduled CT Image Testing Distant Metastasis and Pulmonary Emboli
730404 - Distant Metastasis Pulmonary Emboli CT Test Scheduled Assess Risks
730405 -
730406 - Follow up ref SDS D9 EY5O, ref SDS D2 EY5O.
730407 -
730408 - Patient history of image tests following surgery on 051021 have not
730409 - identified cancer, as reported in the CT test reviewed with the doctor
730410 - on 060623. ref SDS B5 II4L  In fact, PET scan and CT imaging tests
730411 - listed on 060711, ref SDS B7 FE8F, have never reported distant
730412 - metastasis.
730414 -  ..
730415 - Following mastectomy surgery on 051021, the primary care physician
730416 - planned to assess patient NED status with CA 15-3 blood tests every 2
730417 - weeks complemented by image testing every 3 months, reported on
730418 - 051121. ref SDS 86 NL4N  Recently, on 060802 a 2nd opinion by Doctor
730419 - Grissom, who helped guide Millie's surgery on 051021, proposed another
730420 - PET scan test for distant metastasis in light of rising IBC symptoms,
730421 - including CA 15-3 rising for the past 6 months. ref SDS C8 IT8U  The
730422 - last PET scan test was on 060414.  Quarterly testing calls for a test
730423 - in July.  Since a contrast CT test was done on 060505 (received on
730424 - 060523, ref SDS A7 E355), adjusting for this date would make August an
730425 - appropriate time for another image test within the diagnostic plan
730426 - schedule.
730428 -  ..
730429 - UCSF 2nd opinion received today indicates disease is likely
730430 - progressing slowly based on rising CA 15-3 and no firm evidence of IBC
730431 - relapse, reported in another record today. ref SDS E3 WQ8V
730433 -  ..
730434 - As a result, the doctor ordered a CT test today to assess distant
730435 - metastasis since the test on 060505, and it will also test for
730436 - pulmonary emboli.  Based on growing concerns, reported below,
730437 - ref SDS 0 B56N, the doctor ordered a comparison with the prior test on
730438 - 041103 that first identified pulmomary embolism. ref SDS 0 DY5M
730439 -
730440 -
730441 -
730442 -
730443 -
730444 -
730445 -
730446 -
730447 -
7305 -

SUBJECTS
Emotional Trauma Rises Pulmonary Emboli Symptoms Rise Failure Invest

7803 -
780401 -  ..
780402 - Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
780403 - Exercise Vigor Strength Engagement Ease Distress Living with Cancer
780404 - Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
780405 -
780406 - Follow up ref SDS D9 Y642, ref SDS D2 Y642.
780407 -
780408 - Recent fall due to fatigue on 060914, ref SDS E0 ZQ5I, and rise of
780409 - other symptoms for pulmonary emboli, reported below, ref SDS 0 CV5L,
780410 - report of family member recurrence, and challenge of timely
780411 - investigation shown by research on 060722, ref SDS C2 346F, and
780412 - patient history, reported on 060825, ref SDS D9 9W4L, and together
780413 - with slow recovery from IBC compared to prior experience, per above,
780414 - ref SDS 0 TV7L, along with prospects that mastectomy surgery may have
780415 - diminished response to treatment, per below, ref SDS 0 EH3F, all
780416 - present emotional waves of growing concern.
780418 -  ..
780419 - Current plan to restore testing regimen, ref SDS 0 J446, and
780420 - investigate PE symptoms, ref SDS 0 QT6N, help restore emotional
780421 - equilibrium.
780422 -
780423 -
780424 -
7805 -

SUBJECTS
Strategy Treatment Plan IBC 3rd Relapse Scope Strategy Options Plann

8303 -
830401 -  ..
830402 - Pool Chemotherapy Drugs Available to Treat IBC
830403 - Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
830404 - Strategy Treatment Options Scenarios Planning Patient Work Up Deferred
830405 -
830406 - Follow up ref SDS D9 K36G, ref SDS D2 K36G.
830407 -
830408 - Background on requirements and challenge performing planning and
830409 - proactive management, including Tumor Board support, in time for
830410 - action to be effective is reported on 060825. ref SDS D9 K36G
830411 -
830412 -
830413 -
830414 -
830415 -
830416 -
8305 -

SUBJECTS
Treatment IBC 5th Relapse Continue Chemotherapy Agents Taxotere Cape

8803 -
880401 -  ..
880402 - Treatment Continue 4th Cycle Taxotere and Capecitabine (Xeloda)
880403 - 4th Cycle Taxotere and Capecitabine (Xeloda) Treatment Continue
880404 - Taxotere and Capecitabine (Xeloda) 4th-Cycle Treatment Continue
880405 -
880406 - Follow up ref SDS D9 PF3O, ref SDS D2 PF3O.
880407 -
880408 - The doctor proposed continuing current treatment, and ordered two
880409 - more cycles of Taxotere and capecitabine (Xeloda).
880410 -
880411 -
880412 -
880413 -
8805 -

SUBJECTS
Schedule Treatment 061020 on Friday for 5th Cycle Taxotere Capecitab

9003 -
900401 -  ..
900402 - Schedule Treatment Continue Prescription Taxotere Capecitabine Xeloda
900403 -
900404 - Follow up ref SDS D9 N96O, ref SDS D2 N96O.
900405 -
900406 - The doctor scheduled the next meeting for 061020, after chemotherapy
900407 - treatment.
900408 -
900409 -
900410 -
900411 -
9005 -

SUBJECTS
Pulmonary Emboli Blood Clots Lungs Rising Symptoms Fatigue Normal Ac

9503 -
950401 -  ..
950402 - Tired Breathing Difficulty Routine Activity Signals Pulmonary Emboli
950403 - Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
950404 - Pulmonary Emboli Genetic Cause Hypercoabullary Work Up Family History
950405 -
950406 - Follow up ref SDS D9 CV5L, ref SDS D2 CV5L.
950407 -
950408 - On 060711 chemotherapy treatment was reviewed in connection with
950409 - patient history of blood clots, ref SDS B7 S33L, first reported in a
950410 - CT test received on 041104, while being treated with Avastin
950411 - chemotherapy drugs. ref SDS 43 RZ4I  Millie was treated with Coumadin
950412 - until 051121; at that time, she was removed from Coumadin treatment,
950413 - ref SDS 86 RZ4I, because treatments with Avastin were ended, presented
950414 - earlier on 051007. ref SDS 79 XN7K
950416 -  ..
950417 - The doctor further proposed on 051121 that hypercoagulable state work
950418 - up recommended in Doctor Bailey's 2nd opinion is not helpful, because
950419 - pulmonary emboli was associated with the Avastin drug trial for breast
950420 - cancer. ref SDS 86 GW7G
950422 -  ..
950423 - On 060724 Kaiser was notified of a current medical study that found
950424 - genetic disposition for blood clot problems, ref SDS C5 NL5Q, when a
950425 - family member was treated for recurrence of pulmonary emboli from two
950426 - (2) years earlier. reported on 060722. ref SDS C2 3D9T, The doctor has
950427 - not previously commented on updated family history in relation to
950428 - Millie's high risk for pulmonary emboli, reviewed on 060722,
950429 - ref SDS C2 6G6O, and as shown by the doctor's Progress notes in the
950430 - record on 060825.
950432 -  ..
950433 - Today, Millie reported being tired the past week or so.  Normally,
950434 - after the first week of treatment with Taxotere and capecitabine
950435 - (Xeloda), energy begins to rise, and is normal by the 3rd week.
950436 - Earlier today, Millie expected treatment would be delayed by low blood
950437 - counts because she has been unusually tired all week.  She was
950438 - surprised to learn blood counts are actually high today. ref SDS E2
950439 - P560 ref SDS E2 QU8K
950441 -        ..
950442 -       [On 061012 CT test report received; confirms pulmonary embolism
950443 -       recurrence, reconciles pattern of symptoms, ref SDS E6 N26L;
950444 -       current conditions seem less severe than PE on 041103,
950445 -       ref SDS E6 7E7G, except new finding of enlarged right ventricle
950446 -       presents new problem of heart disorder. ref SDS E6 7E5L
950448 -  ..
950449 - Millie also advised that she has been increasingly fatigued walking
950450 - two (2) blocks from the BART station at Market and Davis to her office
950451 - at Embarcadero Two in San Francisco.  She has difficulty breathing
950452 - climbing the stairs at BART and at home.  The fall suffered at BART on
950453 - 060914 occurred from tiring quickly with normal effort, discussed
950454 - above as causing complications of lymphedema. ref SDS 0 UT8M  Last
950455 - year, on 050729, the doctor attributed these symptoms to loss of
950456 - fitness from lack of exercise while on chemotherapy for a year.
950457 - ref SDS 65 JP9J  At that time, pulmonary emboli was not evaluated
950458 - because Millie was already being treated with Coumadin. ref SDS 65
950459 - RZ4I
950460 -
950461 -       [On 061002 primary care physician leaves message that CT test is
950462 -       positive for pulmonary emboli; Millie must resume treatment
950463 -       previously ended on 051007. ref SDS E5 MI5I
950465 -        ..
950466 -       [On 061012 review of CT test discloses findings of enlarged
950467 -       right ventricle that complicates pulmonary embolism. ref SDS E6
950468 -       7E5L
950470 -        ..
950471 -       [On 061020 symptoms may have reduced, but continue. ref SDS F0
950472 -       VD4G
950474 -        ..
950475 -       [On 061108 Millie cough, clearing throat PE symptoms more
950476 -       prominent; chronic fatigue continues. ref SDS F4 VR6F
950478 -  ..
950479 - The doctor indicated that notice to Kaiser on 060724 of a first-degree
950480 - relative suffering recurrent pulmonary emboli, ref SDS C5 NL5Q, should
950481 - be reviewed to assess Millie's risks for recurrence, listed on 060722,
950482 - ref SDS C2 6G6O, and consequent urgency for proactive management,
950483 - including resuming treatments, in light of research on 060722 showing
950484 - that 45% of recurrent pulmonary emboli patients die. ref SDS C2 BI5J
950486 -  ..
950487 - The doctor asked Millie to request the hypercoagulable state work up
950488 - that shows a DNA inherited or acquired increased genetic risk for
950489 - pulmonary emboli, as cited in the Progress Notes today describing a
950490 - "coagulapathy" lab report prepared by the other doctor. ref SDS 0 125V
950491 -
950492 -    [On 061102 coagulapathy report received; indicates possible
950493 -    grounds for finding Millie has increased genetic risk for blood
950494 -    clots, which includes pulmonary embolism. ref SDS F2 KJ3H
950496 -     ..
950497 -    [On 061110 primary care physician received the coagulapathy
950498 -    report on first-degree relative submitted today on 061103,
950499 -    ref SDS F3 VR6F; the paragraph on risks and follow up to
950500 -    treat pulmonary emboli, ref SDS F3 N18S, was highlighted in
950501 -    the doctor's printed version, ref SDS E4 N18S; the doctor
950502 -    advised that the report shows positive findings for
950503 -    acquired rather than inherited DNA genetic risk for blood
950504 -    clots, and in this case pulmonary emboli, ref SDS E4 626L;
950505 -    the doctor recommended against further measures to evaluate
950506 -    patient profile, including defer hypercoagulable state work
950507 -    up, and indicated no adjustments required in diagnosis and
950508 -    treatment. ref SDS E4 JT6N
950510 -  ..
950511 - Millie asked about getting a CT test to evaluate pulmonary emboli and
950512 - distant metastatis, per planning on 051121 for quarterly testing
950513 - following up mastectomy surgery. ref SDS 86 FV6L
950515 -  ..
950516 - The doctor asked when image testing was last performed?
950518 -  ..
950519 - Millie recalled the last CT test was on 060505, and reported in the
950520 - record on 060523, ref SDS A7 4O60, and was ordered by the doctor on
950521 - 060428 for a contrast study recommended by the PET scan test on
950522 - 060414, and reviewed on 060428. ref SDS 99 MU5M
950524 -  ..
950525 - The doctor calculated that ordering another CT test today would be
950526 - about 5 months after the last one.  He therefore ordered another test.
950528 -  ..
950529 - The doctor asked when the CT test was performed that originally
950530 - diagnosed pulmonary emboli several years ago?  He wants the test and
950531 - the analyst to compare the location where pulmonary emboli was first
950532 - found, similar to the contrast study recommended by the PET scan
950533 - analyst for the CT contrast study proposed on 060428. ref SDS 99 MU5M
950534 - The doctor explained that earlier image testing could have missed
950535 - pulmonary emboli because attention was focused on cancer locations in
950536 - the axilla, supraclavicular, and left chest areas.  By specifying
950537 - where to test, there is a better chance to avoid overlooking problems,
950538 - as occurred previously on 060523. ref SDS A7 006P
950540 -  ..
950541 - Millie advised that patient history shows pulmonary emboli was
950542 - diagnosed in a CT test on 041103 received from the backup doctor the
950543 - next day on 041104. ref SDS 43 RZ4I
950545 -  ..
950546 - The doctor entered this date of 041103 in the order for a CT test to
950547 - evaluate whether pulmonary emboli has relapsed.  Review on 060722
950548 - indicates that in 2004 studies show that 10% of pulmonary emboli
950549 - patients suffer recurrence, and that 45% of patients who recur for
950550 - pulmonary emboli die. ref SDS C2 BI5J
950552 -  ..
950553 - The doctor said the CT test should be in the next 10 days or so, and
950554 - the results should be available for the next meeting on 061020.
950555 -
950556 -       [On 040930 Kaiser called and scheduled CT test the same day.
950557 -       ref SDS E4 MI5I
950558 -
950559 -       [On 061002 primary care physician leaves message that CT test is
950560 -       positive for pulmonary emboli; Millie must resume treatment
950561 -       previously ended on 051007. ref SDS E5 MI5I
950563 -        ..
950564 -       [On 061012 CT test report received; analyst failed to perform
950565 -       comparison with prior test on 041103 that discovered pulmonary
950566 -       embolism. ref SDS E6 M431
950568 -        ..
950569 -       [On 061013 letter to Kaiser asks how to get comparison
950570 -       ordered by the doctor for effective trend analysis.
950571 -       ref SDS E7 I75V
950573 -        ..
950574 -       [On 061020 primary care physician did not have time to make
950575 -       comparison during examination. ref SDS F0 N96N and further
950576 -       reported in discussion of pulmonary embolism. ref SDS F0 UQ5G
950578 -        ..
950579 -       [On 061020 symptoms may have reduced, but continue. ref SDS F0
950580 -       VD4G
950582 -        ..
950583 -       [On 061108 Millie cough, clearing throat symptoms more
950584 -       prominent; chronic fatigue continues. ref SDS F4 VR6F
950585 -
950586 -
950587 -
950588 -
9506 -

SUBJECTS
Work Plan Doctor Submits Doctor/Patient Partnership Communications I

A003 -
A00401 -  ..
A00402 - Work Plan Received Communications Doctor/Patient Partnership
A00403 - Communications Doctor Submits Work Plan Doctor/Patient Partnership
A00404 - Doctor/Patient Partnership Communications Doctor Submits Work Plan
A00405 -
A00406 - Follow up ref SDS D9 FE4I, ref SDS D2 FE4I.
A00408 -  ..
A00409 - The doctor did not mention during the meeting nor in Progress Notes
A00410 - for the medical chart the patient's letter submitted on 060922,
A00411 - ref SDS E1 0001, giving notice of change in patient status to guide
A00412 - being prepared for the meeting, per above. ref SDS 0 UT8M
A00414 -  ..
A00415 - Progress continues toward good management using the doctor patient
A00416 - partnership for timely review of patient history, called out in
A00417 - Kaiser's Healthwise Handbook, reviewed on 990625, ref SDS 2 TD5S, and
A00418 - recently reported on 060106. ref SDS 88 FE4I
A00419 -
A00420 -    1.  09/29/2006     15:00 PM
A00421 -
A00422 -            Wcr-ONnc2 > Main Campus
A00425 -         ..
A00426 -    2.  Your primary care clinician is listed as...
A00427 -
A00429 -
A00664 -
A00665 -
A00666 -
A00667 -
A00668 -
A00669 -
A00670 -
A007 -