CONTACTS 

SUBJECTS
Meeting Doctor Examination 5th Review Prepare for Treatment #5 After

1903 -
1903 -    ..
1904 - Summary/Objective
1905 -
190501 - Follow up ref SDS F1 0000. ref SDS E4 0000.
190502 -
190503 - Continuing rise of CA 15-3 cancer marker, ref SDS 0 GJ5M, aligns with
190504 - examination showing stable to worsening areas of IBC rash on left
190505 - breast. ref SDS 0 025H  Treatment strategy and plan for changing
190506 - protocol can consider the doctor previously proposed surgery to remove
190507 - "pockets of resistance" to chemotherapy. ref SDS 0 K36G  Rising
190508 - indigestion remains mild and infrequent.  Investigation of image
190509 - testing diagnosing "likely esophagitis" not scheduled. ref SDS 0 JP6K
190510 - Millie suffered sudden elevated temperature while on chemotherapy.
190511 - Hospitalized for 5 days to treat Cellulitis that presents complication
190512 - of lymphedema in left arm due to loss of lymphatics from surgery, and
190513 - triggered by broken finger a month earlier.  Treatment ended today,
190514 - and examination indicates arm seems clear of symptoms. ref SDS 0 A68L
190515 - Hectic schedule prevented consideration of pending issues, e.g.,
190516 - impaired delivery of systemic treatment agents due to blood vessels
190517 - removed by surgery, ref SDS 0 H544, study opportunity for biopsy to
190518 - establish measurable disease and expand treatment options for mutated
190519 - cancer, ref SDS 0 KT7J, to compare CT tests for trend analysis on
190520 - pulmonary embolism. ref SDS 0 QQ4N  Patient reports continuing
190521 - symptoms pulmonary embolism after 3 weeks treatment with Coumadin.
190522 - Fatigue, shortness of breath, heavy chest occur with normal activity.
190523 - ref SDS 0 CV5L  Procrit prescribed based on low hemoglobin blood count
190524 - to treat anemia symptoms of continuing fatigue. ref SDS 0 OY4H
190525 - Examination by stethoscope indicates enlarged right ventricle may not
190526 - present serious condition. ref SDS 0 Q35O  The doctor feels the
190527 - coagulapathy report on a family member does not suggest increased risk
190528 - for Millie that requires change diagnosis, treatment, nor further
190529 - investigation. ref SDS 0 626L  Kaiser support for Knowledge Management
190530 - demonstrates opportunities to strengthen medical practice. ref SDS 0
190531 - FE4I
190532 -
190533 -    [On 061201 primary care physician took immediate action to correct
190534 -    schedule mistake so that examination occurs on schedule, allowing
190535 -    timely consideration of changing treatment. ref SDS G4 N96O
190536 -
190537 -
190538 -
190540 -  ..
1906 -
1907 -
1908 - Progress
1909 -
190901 - Agenda Develop Work Plan Stage IV Breast Cancer 8 Mos after Mastectomy
190902 -
190903 - Follow up ref SDS F1 SM6M, ref SDS E4 SM6M.
190904 -
190905 - This is the 6th review meeting for 14th overall, and 6th chemotherapy
190906 - cycle, reported in another record today, ref SDS G1 407N, following
190907 - start of treatments on 060711 for 3rd relapse of IBC. ref SDS B8 SM6M
190908 - The doctor had a hectic schedule today, and so the meeting scheduled
190909 - for 1540 actually started at 1710.
190911 -  ..
190912 - Millie submitted ref DIT 1 0001 with an agenda to guide discussions,
190913 - and provided background, ref DIT 1 F26L, to support the doctor in
190914 - preparing for the meeting, as follows...
190915 -
190916 -    1.  CA 15-3 review seems negative.................. ref SDS 0 GJ5M
190917 -    2.  Lymphedema/Cellulitis treatment effective...... ref SDS 0 MW8J
190918 -    3.  Breast exam IBC biopsy measurable disease...... ref SDS 0 025H
190919 -    4.  Treatment plan strategy........................ ref SDS 0 K36G
190920 -    5.  Pulmonary emboli how serious r ventricle....... ref SDS 0 VJ4J
190921 -    6.  PE symptoms cough clearing throat fatigue...... ref SDS 0 CV5L
190922 -    7.  Hypercoagulable state work up.................. ref SDS 0 626L
190923 -    8.  Coagulapathy report Millie's son............... ref SDS 0 626L
190924 -    9.  Esophagitis, heart burn........................ ref SDS 0 JP6K
190926 -  ..
190927 - Today, rather than Millie list the agenda on the marking board, the
190928 - doctor worked from list transferred from Millie's letter into the
190929 - electronic Medical Chart, shown below, ref SDS 0 684G as was done last
190930 - month on 061020. ref SDS F1 K84N  The doctor displayed the agenda on
190931 - the computer screen showing the Medical Chart in the examination room.
190932 -
190933 -            [On 061208 hectic schedule not enough time to work from
190934 -            agenda in the Medical Chart. ref SDS G7 K84N
190936 -  ..
190937 - Scheduled next meeting in about 3 weeks to start the 8th cycle, and
190938 - assess progress on December 1, 2006
190939 -
190940 -
190941 -
1910 -

SUBJECTS
Complex Patient History 34 Issues Overwhelms Span of Attention Drive

2003 -
200401 -  ..
200402 - Complex Patient History Knowledge Management Dilemma Issues Grow 34
200403 -
200404 - Follow up ref SDS F1 MO4K.
200405 -
200406 - Sampling of issues patient history diagnosis and treatment...
200407 -
200408 -    1.  CA 15-3 monitors advance of cancer response to treatment
200409 -    2.  Lymphedema complicated by mastectomy surgery
200410 -    3.  Broken finger from minor fall complicates lymphedema
200411 -    4.  Esophagitis reflux digestion issues
200412 -    5.  Immune system chemotherapy increases risk of infection
200413 -    6.  Chemotherapy increase risk of infection
200414 -    7.  Cat bites increase risk of infection complicates lymphedema
200415 -    8.  Pneumonia chemotherapy increases risk of infection
200416 -    9.  Metastatic cancer increases risk pulmonary embolism
200417 -   10.  Lymphadenopathy left axilla local regional metastasis
200418 -   11.  Lymphadenopathy right axilla distant metastasis
200419 -   12.  Lymphadenopathy left supraclavicular diagnose metastatic cancer
200420 -   13.  Mastectomy surgery impact on cancer treatment and lymphedema
200421 -   14.  Breast cancer secondary IBC 3rd relapse
200422 -   15.  Cancer mutates slow response chemotherapy treatment
200423 -   16.  Blood vessels removed mastectomy slow chemotherapy treatments
200424 -   17.  Treatment options, strategy, planning, schedule
200425 -   18.  Drug trials increase declining pool chemotherapy agents
200426 -   19.  UCSF Doctor Benz 2nd opinion apply diagnosis and treatment
200427 -   20.  Pulmonary embolism blood clots in lungs
200428 -   21.  INR weekly adjustments Coumadin treatment blood clots
200429 -   22.  Enlarged right ventricle heart problem core pulmonale
200430 -   23.  Dizziness symptom enlarged right ventricle cor pulmonale
200431 -   24.  Fatigue shortness breath side effect chemotheapy loss fitness
200432 -   25.  Fatigue shortness breath symptom pulmonary embolism
200433 -   26.  Shortness breath fatigue dizzy symptoms pulmonary embolism
200434 -   27.  Coagulapathy hypercoagulable state work up genetic risks
200435 -   28.  Testing resolution of errors (see Benz 2nd opinions)
200436 -   29.  Testing distant metastatic disease
200437 -   30.  Testing resolution pulmonary emoblism and heart disease
200438 -   31.  Communication hectic schedule not enough time to manage details
200439 -   32.  Emotional stress and well being
200441 -  ..
200442 - Issues added today...
200443 -
200444 -   33.  Cellulitis inflammation temperature 102.6 on chemotherapy
200445 -   34.  Urinary tract bladder infection
200446 -
200447 -
200448 -
200449 -
200450 -
2005 -

SUBJECTS
Vitals Obtain from Infusion Clinic Progress Note Meeting Doctor John

2203 -
220401 -  ..
220402 - Vitals Show Stable Medical Condition
220403 -
220404 - Follow up ref SDS F1 KB5L, ref SDS E4 KB5L.
220406 -                           ..
220407 -                          Bld Prssr   Pulse   Temp   Weight  SaO2
220408 -     ..
220409 -    061110................. 136 83     73     97.0    150     98%
220410 -    061020 1534............ 140 79     67     99.8    151     97
220411 -    060929 1452............ 141 78     66     98.3
220412 -    060908 1335............ 139 79     73     98.1
220413 -    060814 1610............ 139 80     59     98.2
220414 - *  060808.................
220415 -    060711................. 172 87     54     97.5    147
220416 -    060623................. 141 87     71     98.0    147     99%
220417 -    060428................. 129 73     80     99.4    149     99%
220418 -    060217................. 153 81     61     98.6    150     99%
220419 -
220420 - ...per Doctor's report, shown below, vitals were obtained from the
220421 - record on treatment today in the Infusion Clinic. ref SDS 0 JQ4J
220422 -
220423 -
220424 -
220425 -
220426 -
220427 -
2205 -

SUBJECTS
CA 15-3 61 Rise from 56 Continues Increase Indicates Slow Response T

3203 -
320401 -  ..
320402 - CA 15-3 Cancer Marker 56 Rises Slightly from Prior Test on 060928
320403 -
320404 - Follow up ref SDS F1 087J, ref SDS E4 087J.
320405 -
320406 - The test yesterday shows CA 15-3 cancer marker at 61 has ticked up
320407 - again the past 3 weeks during cycle 4. ref SDS G1 2N5J  An interim
320408 - test on 061026 was up only 1 tick at 57...
320410 -           ..
320411 -          Test Date                         Date Received
320412 -          061109......... 61 H............. 061110, ref SDS 0 087J
320413 -          061026......... 57 H............. 061110, ref SDS 0 087J
320414 -          061019......... 56 H............. 061020, ref SDS F1 087J
320415 -          060928......... 51 H............. 060929, ref SDS E4 087J
320416 -          060907......... 68 H............. 060929, ref SDS E4 087J
320417 -          060813......... 73 H............. 060817, ref SDS D9 U24M
320418 -          060809......... 87 H............. 060810, ref SDS D7 2N5J
320419 -          060708......... 71 H............. 060711, ref SDS B8 087J
320420 -          060616......... 63 H............. 060623, ref SDS B6 UQ5Q
320421 -          060522......... 59 H............. 060605, ref SDS B1 UQ5Q
320422 -          060501......... 49 H............. 060522, ref SDS A8 MC4F
320423 -          060421......... 44 H............. 060428, ref SDS A1 087J
320424 -          060330......... 40 H............. 060428, ref SDS A1 087J
320425 -          060303......... 36............... 060428, ref SDS A1 087J
320426 -          060210......... 33............... 060217, ref SDS 91 087J
320427 -          060109......... 34............... 060126, ref SDS 90 KV59
320428 -          051223......... 34............... 060106, ref SDS 89 087J
320429 -          051202......... 28............... 060106, ref SDS 89 087J
320430 -          051116......... 31............... 051121, ref SDS 87 087J
320431 -          051109......... 30............... 051121, ref SDS 87 087J
320432 -          051102......... 34............... 051121, ref SDS 87 087J
320433 -          050909......... 45 H............. 051007, ref SDS 81 087J
320434 -          050826......... 45 H............. 050913, ref SDS 75 087J
320435 -          050819......... 45 H............. 050913, ref SDS 75 087J
320436 -          050812......... 39 .............. 050819, ref SDS 68 3K6L
320437 -          050729......... 45 H............. 050819, ref SDS 68 EA5G
320438 -          050708......... 46 H............. 050729, ref SDS 67 087J
320439 -          050701......... 37 .............. 050729, ref SDS 67 087J
320440 -          050617......... 45 H............. 050729, ref SDS 67 087J
320441 -          050527......... 56 H............. 050610, ref SDS 64 087J
320442 -          050512......... 67 H............. 050520, ref SDS 62 087J
320443 -          050506......... 80 H............. 050520, ref SDS 62 087J
320444 -  ..
320445 -          050415.........105 H............. 050422, ref SDS 59 087J
320446 -          050325.........100 H............. 050329, ref SDS 57 087J
320447 -          050318.........101 H............. 050325, ref SDS 56 2N5J
320448 -          050304......... 88 H............. 050311, ref SDS 54 087J
320449 -          050225......... 95 H............. 050308, ref SDS 53 0001
320450 -          050211......... 78 H............. 050214, ref SDS 52 02BB
320451 -          050128......... 67 H............. 050204, ref SDS 51 087J
320452 -          041228......... 56 H............. 041230, ref SDS 50 087J
320453 -          041204......... 43 H............. 041210, ref SDS 49 087J
320454 -          041007......... 39............... 041104, ref SDS 45 087J
320455 -          040923......... 49 H............. 041005, ref SDS 43 087J
320456 -          040908......... 44 H............. 040909, ref SDS 42 087J
320457 -          040825......... 47 H............. 040909, ref SDS 42 087J
320458 -          040811......... 42 H............. 040812, ref SDS 41 087J
320459 -          040728......... 43 H............. 040729, ref SDS 39 2N5J
320460 -          040712......... 47 H............. 040713, ref SDS 38 087J
320461 -          040614......... 55 H............. 040615, ref SDS 37 PX6X
320462 -          040517......... 78 H............. 040601, ref SDS 35 2N5J
320463 -          040311......... 70 H............. 040318, ref SDS 28 SM6M
320464 -          040205......... 60 H............. 040211, ref SDS 26 SM6M
320465 -          031201......... 62 H............. 031205, ref SDS 25 SM6M
320466 -          030912......... 66 H............. 030915, ref SDS 24 SM6M
320467 -          030708......... 68 H............. 030710, ref SDS 23 SM6M
320468 -          030503......... 54 H............. 030508, ref SDS 21 SM6M
320469 -          030403......... 45 H............. 030508, ref SDS 21 SM6M
320470 -          030215......... 46 H............. 030220, ref SDS 20 5E6L
320471 -          030106......... 37 H............. 030109, ref SDS 19 SM6M
320472 -          021202......... 41 H?............ 021204, ref SDS 18 SP5G
320473 -          021111......... 36 H?............ 021113, ref SDS 17 Y65I
320474 -          021023......... 33 H?............ 021023, ref SDS 16 SQ5I
320475 -          020930......... 33 H?..39........ 021002, ref SDS 15 SQ5I
320476 -          020917......... 36 H?............ 020924, ref SDS 14 SQ5I
320477 -          020717......... 59 H?............ 020726, ref SDS 13 YN5K
320478 -          020629......... 75 H ............ 020705, ref SDS 11 UX6I
320479 -          020608........  67 H ............ 020614, ref SDS 9 0001
320480 -          020603........ 108 H ............ 020607, ref SDS 8 X67F
320481 -          020511........ 117 H ............ 020603, ref SDS 7 PJ4J
320482 -          020419......... 81 H ............ 020430, ref SDS 5 7N5H
320483 -          020321......... 85 H ............ 020405, ref SDS 4 6T8K
320484 -
320485 -
320486 -
320487 -
320489 -  ..
3205 -
3206 -
3207 - Analysis
3208 -
320801 - CA 15-3 61 Cancer Marker Test Tomorrow Influence Treatment Decision
320802 -
320803 - Follow up ref SDS F1 GJ5M, ref SDS E4 GJ5M.
320804 -
320805 - Consecutive rise of CA 15-3 cancer marker from 56 to 61 and a total
320806 - rise of 20% from 51 to 61 during the current treatment cycle aligns
320807 - with the doctor's examination today finding that IBC red rash has been
320808 - stable, showing no response to treatment. ref SDS 0 025H  Rising
320809 - symptoms may indicate scenario #2 developed on 060808, ref SDS D4
320810 - HT5K, where effectiveness of treatment protocol has fallen, and/or
320811 - that treatment is not being delivered to infected tissue because
320812 - mastectomy surgery created "pockets of resistance" by removing blood
320813 - vessels that were not replaced with reconstructive surgery, as related
320814 - in the record for the meeting on 061020, ref SDS F1 KU4L, and
320815 - discussed further below. ref SDS 0 P66G
320816 -
320817 -
320818 -
320819 -
320820 -
3209 -

SUBJECTS
Digestion Problems Increasing Relatively Infrequent Mild Esophagitis

3603 -
360401 -  ..
360402 - Digestion Problems Increasing Relatively Infrequent Mild
360403 - Esophagitis Not Compared in Current PET Test with Prior Report
360404 -
360405 - Follow up ref SDS F1 JP6K, ref SDS E4 JP6K.
360406 -
360407 - Millie reported increasing, though still relatively infrequent, 4 - 5
360408 - times a month, episodes of discomfort from indigestion.
360410 -  ..
360411 - The doctor reviewed background on diagnosis of "likely esophagitis"
360412 - reported in PET scan test performed on 060120, and received on 060126.
360413 - ref SDS 90 DH4O  Follow up on 060623, ref SDS B6 DH4O, reviewed
360414 - contrast CT study on 060505.  Pathology findings reported nodes within
360415 - the right paratracheal that might relate to the earlier findings, as
360416 - shown on 060523. ref SDS A8 4O8P  At about the same time, attending
360417 - physicians who treated Millie for pneumonia in the Emergency Room on
360418 - 060607 reported Kaiser diagnosed Millie with esophagitis. ref SDS B2
360419 - K66E  Research indicates possible correlations with pneumonia.
360420 - ref SDS B2 HX7L  At the time on 060623, consideration of esophagitis
360421 - was deferred due to computer access issues and limited time.
360422 - ref SDS B6 463H
360424 -  ..
360425 - On 060711 the doctor determined that infrequent episodes of symptoms
360426 - do not support diagnosis of esophagitis and prescribed continued over
360427 - the counter treatment. ref SDS B8 4R6K
360429 -  ..
360430 - The doctor indicated today that the CT test on 060505 finding nodes
360431 - within the right paratracheal, reviewed on 060523, ref SDS A8 4O8P,
360432 - likely do not support the earlier PET scan test findings of likely
360433 - esophagitis, because the locations are different.
360435 -  ..
360436 - The doctor commented that rising indigestion reported today may relate
360437 - to esophagitis, but symptoms remain too mild for diagnosis, except to
360438 - continue treatment with Tums.  Doctor's progress notes reflect these
360439 - understandings, noting GERD stable with Tums. ref SDS 0 1248
360440 -
360441 -
360442 -
360443 -
360444 -
360445 -
3605 -

SUBJECTS
Left Axillary Lymphadenopathy Patient No Complaint of Swelling Disco

5303 -
530401 -  ..
530402 - Cellulitis Complications Lymphedema Cleared Treatment Ends
530403 - Left Axillary No Evidence Lymphadenopathy Cellulitis Treatment Ends
530404 - Lymphedema Left Arm Lump Under Arm Diagnosis Not Cancer
530405 - Post Operation Localized Edema Left Axillary Swelling Reduced
530406 -
530407 - Follow up ref SDS F1 MW8J, ref SDS E4 MW8J.
530409 -  ..
530410 - Patient history of left axillary lymphadenopathy and lymphedema is
530411 - reported on 060106. ref SDS 89 S164
530413 -  ..
530414 - There was no examination today for cancer in left axilla.  The patient
530415 - made no complaint of lumps or discomfort from swelling under the left
530416 - arm.
530418 -  ..
530419 - On 060914 Millie fell and injured the middle index finger on her left
530420 - hand; complications of lymphedema increased causing the left arm to
530421 - swell. ref SDS E5 ZQ5I  Over the next week, swelling increased.  On
530422 - 060922 Millie notified Kaiser of this new problem. ref SDS E6 0D5Y  On
530423 - 060929 the primary care physician examined the left arm and injured
530424 - finger.  Physical therapy was prescribed for continuing treatment of
530425 - lymphedema. ref SDS E4 IW9J
530427 -  ..
530428 - On 061016 swelling and pain in the left finger, and running up her arm
530429 - led to further examination.  Xrays at Kaiser showed the finger was
530430 - broken.  This was treated with a soft-cast for 5 days.  On 061020 the
530431 - primary care physician examined Millie's arm and hand.  Continuing
530432 - treatment with physical therapy was prescribed. ref SDS F1 153G
530434 -  ..
530435 - On 061027 Millie was treated in the Emergency Room and hospitalized
530436 - with a temperature of 102.6.  Her left arm was severely swelled and
530437 - inflamed. ref SDS F4 Q265  Doctors diagnosed Cellulitis complications
530438 - of lymphedema, and the broken finger, ref SDS F4 V759, suffered on
530439 - 060914.  She was treated with antibiotics for 5 days, and released on
530440 - 061101 after the inflammation and swelling subsided. ref SDS F7 JR9N
530442 -  ..
530443 - Bladder (urinary tract) infection was also diagnosed on 061027, and
530444 - this was treated with antibiotics. ref SDS F4 V76H
530446 -  ..
530447 - Millie was treated with Nupigen for 5 days to increase blood counts,
530448 - and, also, with antibiotics to treat Cellulitis for the next 10 days,
530449 - which ends today.
530451 -  ..
530452 - Examination today shows the left arm appears still completely cleared
530453 - of Cellulitis inflammation, and that lymphedema swelling continues, as
530454 - shown in doctor progress notes. ref SDS 0 1248  Treatment for
530455 - lymphedema is under direction of the physical therapy department,
530456 - reported on 061020. ref SDS F1 EP7P
530458 -  ..
530459 - Below left elbow measures 11.25" continued improvement shown in case
530460 - study on 060509. ref SDS A6 HO7F
530461 -
530462 -
530463 -     [On 061112 patient relapses, ref SDS G2 HP52, examined by Doctor
530464 -     Seier at Internal Medicine Clinic, Kaiser in Walnut Creek.
530465 -     ref SDS G2 FP67
530467 -      ..
530468 -     [On 061112 doctor orders prescription for antibiotics for another
530469 -     10 days; recommends patient examination by primary care physician.
530470 -     ref SDS G2 BX4G
530472 -      ..
530473 -     [On 061203 patient relapses, ref SDS G5 MF9H, very slight
530474 -     temperature; notify primary care physician. ref SDS G5 5X3N
530475 -
530476 -
530477 -
530478 -
530479 -
530480 -
5305 -

SUBJECTS
Right Axillary Clinical Examination Finds No Lump Patient Complains

5803 -
580401 -  ..
580402 - Right Axillary FDG SUV 2.5 Lump Discomfort Not Reported by Patient
580403 -
580404 - Follow up ref SDS F1 3D6K, ref SDS E4 3D6K.
580405 -
580406 - Background on patient history of testing for lymphedanopathy in the
580407 - right axilla is reported in the record on 060929. ref SDS E4 3D6K
580409 -  ..
580410 - There was no examination today for cancer in right axilla.  The
580411 - patient made no complaint of lumps or discomfort from swelling under
580412 - the right arm.  This work aligns with CT test on 060930 that found no
580413 - evidence of disease in the right axillary, reported on 061020.
580414 - ref SDS F1 8T4S
580415 -
580416 -
580417 -
580418 -
580419 -
5805 -

SUBJECTS
Left Supraclavicular Neck CT Test Contrast Study on 060505 Finds No

6603 -
660401 -  ..
660402 - Left Supraclavicular Examination PET Test Report Finding SUV 4.5
660403 - Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
660404 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
660405 -
660406 - Follow up ref SDS F1 8R6M, ref SDS E4 8R6M.
660407 -
660408 - Background of image testing, and consideration for radiation treatment
660409 - of left supraclavicular is reported on 060623. ref SDS B6 8R6M
660411 -  ..
660412 - Like the left and right axillary locations, there was no examination
660413 - today for cancer in left supraclavicular region.  The patient made no
660414 - complaint of lumps or discomfort from swelling in this area.  This
660415 - work aligns with CT test on 060930 that found no evidence of disease
660416 - in the left supraclavicular location, reported on 061020. ref SDS F1
660417 - LP5G
660418 -
660419 -
660420 -
660421 -
660422 -
6605 -

SUBJECTS
Examination IBC Red Rash Left Breast Stable Unchanged to Worse After

8103 -
810401 -  ..
810402 - IBC Red Rash Left Breast Stable Not Responding to Treatment
810403 - Red Rash Stable Left Breast Rising CA 15-3 No Response to Treatment
810404 - Examination Left Breast IBC Inflammation Red Rash Seems Stable Rising
810405 -
810406 - Follow up ref SDS F1 025H, ref SDS E4 025H.
810407 -
810408 - Background on prior relapse examinations is listed on 060711.
810409 - ref SDS B8 8Y7O
810411 -  ..
810412 - Millie's letter, ref DIP 1 ZL6L, to Kaiser on 061027 asks for review
810413 - of treatment strategy to address slow response to treatment.
810414 - ref SDS F3 KJ7K
810416 -  ..
810417 - The doctor looked briefly at the left breast.  Examination today shows
810418 - IBC red rash seems stable to worsening, as indicated might be
810419 - occurring during the examination on 061020. ref SDS F1 XO5L  The
810420 - doctor's progress notes describe "stable lesions." ref SDS 0 ZL5W
810422 -  ..
810423 - Observation again shows "pockets" of red rash above and below the
810424 - surgery incision line for mastectomy performed on 051021, as seen
810425 - previously on 061020. ref SDS F1 YP6F
810427 -  ..
810428 - One location above the incision line about 1" left of the sternum area
810429 - and approximately .5" diameter, shows rising intensity.  Previously,
810430 - on 060808 the area of greatest intensity was nearer to the sternum.
810431 - ref SDS D4 NS5J  The sternum region now seems less intense, possibly
810432 - responding to treatment, perhaps getting chemotherapy agent from
810433 - capillaries in the right breast.
810435 -  ..
810436 - Overall there seems to be more red rash above and below the incision
810437 - line than observed on 060711, ref SDS B8 8Z8G, again on 060808, after
810438 - report of slight reduction in IBC rash. ref SDS D4 8Z8G  More
810439 - importantly, IBC rash seems stable to worse today after 6 cycles of
810440 - chemotherapy than on 061020 after the 5th cycle. ref SDS F1 XO5L
810442 -  ..
810443 - Stable to worsening IBC rash aligns with rising CA 15-3 cancer marker,
810444 - reported above. ref SDS 0 GJ5M
810446 -  ..
810447 - IBC may not be responding to systemic treatment under scenario #2
810448 - presented in the record on 060808. ref SDS D4 HT5K  On 050311 the
810449 - doctor described this condition as presenting "pockets" of cancer that
810450 - resist treatment with chemotherapy. ref SDS 54 PA4N  This may be
810451 - occurring due to cancer mutating, and compounded by mastectomy surgery
810452 - that removed blood vessels which normally deliver treatment to
810453 - infected tissue, discussed further below. ref SDS 0 EH3F
810455 -  ..
810456 - Kaiser continues to avoid measurements, photographs, and biopsy to
810457 - assess measurable disease, as presented in the UCSF 2nd opinion
810458 - submitted by Doctor Benz, and reviewed with the primary care physician
810459 - on 061020. ref SDS F1 JQ3J
810460 -
810461 -
810462 -
810463 -
810464 -
810465 -
810466 -
810467 -
8105 -

SUBJECTS
Mastectomy Removes Blood Vessels Prevents Delivery Chemotherapy Trea

8703 -
870401 -  ..
870402 - Blood Vessels Removed Mastectomy Create Pockets that Resist Treatment
870403 - Slow Response to Treatment Mastectomy Removed Blood Vessels
870404 - Expectations Recovery Rate Reduced Mastectomy Remove Blood Vessels
870405 - Alternate Treatment Method Blood Vessels Cannot Deliver Chemotherapy
870406 -
870407 - Follow up ref SDS F1 EH3F, ref SDS E4 EH3F.
870408 -
870409 - Background on slow response to treatment and impending progression of
870410 - disease due to mastectomy surgery on 051021 was reviewed in the record
870411 - for the meeting on 061020. ref SDS F1 EH3F
870413 -  ..
870414 - Millie's letter to Kaiser, ref DIP 1 ZL6L, on 051027 asks about slow
870415 - recovery from IBC caused by mastectomy surgery removing blood vessels
870416 - needed to deliver treatment. ref SDS F3 MS3Y
870418 -  ..
870419 - Review on 061012 of CT test on 060930 shows no findings of local,
870420 - regional, nor distant metastasis. ref SDS E8 2967  Findings were
870421 - discussed with the primary care physician during the previous meeting
870422 - on 061020. ref SDS F1 EY5O
870424 -  ..
870425 - Examination today shows no improvement and either stable, or
870426 - progression of disease, per above. ref SDS 0 RU6J
870428 -  ..
870429 - This recent evidence may indicate the patient is being treated with
870430 - chemotherapy that has harsh side effects, including increased risk for
870431 - pulmonary embolism, ref SDS C4 KN5L, and with no evidence of
870432 - metastatic disease, except at a location on the left chest breast area
870433 - that cannot be treated effectively with chemotherapy due to mastectomy
870434 - surgery that removed blood vessels, or possibly with the current
870435 - protocol due to mutation of disease, or some combination of both
870436 - factors.
870438 -  ..
870439 - If treatment cannot be delivered through a conventional method using
870440 - the blood system, then alternatives need to be investigated, such as
870441 - direct application to infected tissue or further surgery.
870443 -  ..
870444 - If the disease has mutated in the normal course, then consideration
870445 - for changing chemotherapy agents seems required.
870447 -  ..
870448 - Hectic schedule today, ref SDS 0 SM6M, the doctor did not have enough
870449 - time to consider these issues.
870450 -
870451 -
870452 -
870453 -
870454 -
870455 -
8705 -

SUBJECTS
Biopsy Left Breast Investigate for Mutated Cancer IBC Red Rash Statu

9303 -
930401 -  ..
930402 - Treatment Options Expand Pool of Drugs Biopsy Test for Status Change
930403 - Biopsy to Determine Biology of IBC and Guide Choice of Treatment
930404 - Status Change Did Not Occur Retest Biopsy 040419 Treatment Options
930405 -
930406 - Follow up ref SDS F1 KT7J, ref SDS E4 KT7J.
930407 -
930408 - Can a biopsy contribute to patient work up for developing a strategy
930409 - and treatment plan, discussed on 060711, ref SDS B8 K36G, and more
930410 - recently on 061020? ref SDS F1 KH6H
930412 -  ..
930413 - If cancer has mutated, shown by no response to treatment that was
930414 - previously effective, per examination above, ref SDS 0 025H, this
930415 - change in biology of the cancer, may yield a status change??
930417 -  ..
930418 - Tissue from the biopsy on 051021 and from current tissue may be
930419 - conducive to investigation, although the pathology analysis received
930420 - on 051027 for the biopsy on 051021 reported finding no evidence of
930421 - cancer, except for DCIS. ref SDS 86 616P  Nominally, status change
930422 - requires testing tissue infected with cancer.  This may require a skin
930423 - scrapping of the red rash on on the left breast area.
930425 -  ..
930426 - With a hectic schedule today, ref SDS 0 SM6M, the primary care
930427 - physician did not have time to review this issue.
930428 -
930429 -
930430 -
930431 -
930432 -
930433 -
930434 -
9305 -

SUBJECTS
CT Scan Test 060930 Pulmonary Embolism Analyst Failed Perform Doctor

A203 -
A20401 -  ..
A20402 - PET CT Image Testing Distant Metastasis Risks Secondary Cancer
A20403 - IBC Test Distant Metastasis Discouraged Avoid Risk Secondary Cancer
A20404 - Radiation Image Tests PET CT Limit to Reduce Risk Secondary Cancer
A20405 - Risk Secondary Cancer Exposure Radiation Image Testing CT PET Scan
A20406 -
A20407 - Follow up ref SDS F1 EY5O, ref SDS E4 EY5O.
A20408 -
A20409 - Kaiser ordered a CT scan on 060929 to test for pulmonary embolism
A20410 - following notice of rising symptoms. ref SDS E4 B56N  The test was
A20411 - performed on an expedited basis the next day on 060930. ref SDS E6
A20412 - MI5I  The doctor called on 061002 and reported the test was positive
A20413 - for pulmonary embolism recurrence, and prescribed treatments to
A20414 - resume, ref SDS E7 MI5I, which were previously stopped on 061007.
A20415 - ref SDS 81 GC6K
A20417 -  ..
A20418 - Review on 061012 shows the imaging department did not compare and
A20419 - assess differences between pathology for recurrent and original
A20420 - pulmonary embolism. ref SDS E8 2935  The patient's letter on 061013
A20421 - asks the doctor about making the comparison?  During the meeting on
A20422 - 061020 the doctor had a hectic schedule so there was not enough time
A20423 - to review this issue. ref SDS F1 UQ5G, noted as well in the section on
A20424 - image tests shown on 061020. ref SDS F1 N96N
A20425 -
A20426 -     [On 061208 doctor ordered PET scan test to set new baseline for
A20427 -     changing chemotherapy to treat IBC; and added to the order request
A20428 -     for analysis of pulmonary embolism, and enlarged right ventricle
A20429 -     by comparing and contrasting with prior CT tests on 041103 and on
A20430 -     060930, even though CT scan tests are a better diagnostic for this
A20431 -     comparison. ref SDS G7 ZY5L
A20433 -  ..
A20434 - The doctor's schedule was hectic again today, ref SDS 0 SM6M, and so
A20435 - did not have time to discuss Kaiser's progress and findings on making
A20436 - the comparison.
A20438 -  ..
A20439 - The doctor commented today that the technical method of the CT scan on
A20440 - 060930 to test for pulmonary embolism recurrence provides a better,
A20441 - more rigorous test for metastatic disease than is normally performed
A20442 - for cancer.  This aligns with the report on 061020 that the test for
A20443 - pulmonary embolism is different from testing for cancer, ref SDS F1
A20444 - S56G; today, this is clarified as also being "better" for evaluating
A20445 - cancer than the test normally done to evaluate response to treatment
A20446 - for cancer.
A20447 -
A20448 -
A20449 -
A20450 -
A20451 -
A20452 -
A20453 -
A20454 -
A205 -

SUBJECTS
Emotional Trauma Rises Abrupt Changes IBC Worsening Spreading Red Ra

A703 -
A70401 -  ..
A70402 - Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
A70403 - Exercise Vigor Strength Engagement Ease Distress Living with Cancer
A70404 - Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
A70405 -
A70406 - Follow up ref SDS F1 Y642, ref SDS E4 Y642.
A70407 -
A70408 - Emotional roller coaster of good news mixed with concern from mounting
A70409 - medical issues listed on 061020, ref SDS F1 PB3H, increases stress
A70410 - because limited time due to a hectic schedule prevents timely
A70411 - consideration, noted again today with the meeting starting 90 minutes
A70412 - late. ref SDS 0 SM6M  The gap between problems listed on 061020,
A70413 - ref SDS F1 R24G, and time for professional review increases trauma
A70414 - from emotional stress.
A70416 -  ..
A70417 - Relief from physical exercise discussed in the letter on 061013 has
A70418 - not yet been addressed by Kaiser, per below, reviewing new matter of
A70419 - pulmonary embolism. ref SDS 0 CR5N
A70420 -
A70421 -
A70422 -
A70423 -
A705 -

SUBJECTS
Strategy Treatment Plan IBC 3rd Relapse Scope Chemotherapy Drug Agen

AD03 -
AD0401 -  ..
AD0402 - Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
AD0403 - Strategy Treatment Options Scenarios Planning Patient Work Up Deferred
AD0404 -
AD0405 - Follow up ref SDS F1 K36G, ref SDS E4 K36G.
AD0406 -
AD0407 - Background on requirements and challenge performing requirements for
AD0408 - planning and proactive management in time for action to be effective
AD0409 - is reported on 060825. ref SDS E1 K36G
AD0411 -  ..
AD0412 - During the meeting on 041210, the primary care physician proposed
AD0413 - surgery to treat worsening IBC. ref SDS 49 ZV5J  Case study on surgery
AD0414 - for IBC was developed at that time on 041210. ref SDS 49 657F  When
AD0415 - IBC spread during treatment with chemotherapy the doctor again
AD0416 - recommended surgery on 050311 to remove "pockets of resistance" that
AD0417 - failed to respond to treatment, ref SDS 54 PA4N, as observed by
AD0418 - examination on the left breast area the past several months, noted
AD0419 - above. ref SDS 0 025H
AD0421 -  ..
AD0422 - The prospect that mastectomy surgery may have removed blood vessels
AD0423 - which normally deliver treatment to infected tissue, but now create
AD0424 - pockets of resistance to chemotherapy, reviewed above, ref SDS 0 J39O,
AD0425 - requires review of treatment strategy, including prospects of for
AD0426 - further surgery, as recommended by the primary care physician on
AD0427 - 050311 to treat pockets of resistance to chemotherapy. ref SDS 54 AU9G
AD0428 - On 050913 the doctor strongly favored a surgical solution even after
AD0429 - IBC red rash had subsided. ref SDS 75 5T5N  This raises the question
AD0430 - about ideas and stratagems for corrective surgery.
AD0432 -  ..
AD0433 - With a hectic schedule today, ref SDS 0 SM6M, the primary care
AD0434 - physician did not have time to review this issue.
AD0435 -
AD0436 -
AD0437 -
AD0438 -
AD0439 -
AD05 -

SUBJECTS
Treatment IBC 6th Cycle for 3rd Relapse Continue Chemotherapy Agents

AI03 -
AI0401 -  ..
AI0402 - Treatment Continue 6th Cycle Taxotere and Capecitabine (Xeloda)
AI0403 - 6th Cycle Taxotere and Capecitabine (Xeloda) Treatment Continue
AI0404 - Taxotere and Capecitabine (Xeloda) 6th-Cycle Treatment Continue
AI0405 -
AI0406 - Follow up ref SDS F1 PF3O, ref SDS E4 PF3O.
AI0407 -
AI0408 - The doctor proposed continuing current treatment with Taxotere and
AI0409 - capecitabine (Xeloda) for the 6th cycle of treatment given in the
AI0410 - Infusion Clinic today. ref SDS G1 407N
AI0412 -  ..
AI0413 - With a hectic schedule there was not enough time for presentation of
AI0414 - ideas, research, and strategy, as noted above, ref SDS 0 K36G, to
AI0415 - improve the rate of recovery for IBC on the left breast, which has
AI0416 - shown no improvement for several cycles, per above, ref SDS 0 025H,
AI0417 - and as noted in the doctor's treatment plan that continues current
AI0418 - chemotherapy, see below. ref SDS 0 125V
AI0419 -
AI0420 -
AI0421 -
AI0422 -
AI0423 -
AI05 -

SUBJECTS
Schedule Treatment 061201 on Friday for 7th Cycle Taxotere Capecitab

AK03 -
AK0401 -  ..
AK0402 - Schedule Treatment Continue Prescription Taxotere Capecitabine Xeloda
AK0403 -
AK0404 - Follow up ref SDS F1 N96O, ref SDS E4 N96O.
AK0405 -
AK0406 - The doctor scheduled the next meeting for 061201 prior to chemotherapy
AK0407 - treatment in the afternoon.  This will provide an opportunity to
AK0408 - assess changing the treatment plan to redress slow response the past
AK0409 - several cycles, per above showing cancer seems to be increasing.
AK0410 - ref SDS 0 025H
AK0411 -
AK0412 -     [On 061201 primary care physician took immediate action to correct
AK0413 -     schedule mistake so that examination occurs on schedule, allowing
AK0414 -     timely consideration of changing treatment. ref SDS G4 N96O
AK0415 -
AK0416 -
AK0417 -
AK0418 -
AK0419 -
AK0420 -
AK0421 -
AK05 -

SUBJECTS
Pulmonary Emboli Blood Clots Lungs Symptoms Continue Fatigue Shortne

AV03 -
AV0401 -  ..
AV0402 - Procrit Prescribe to Treat Symptoms Pulmonary Embolism Fatigue
AV0403 - Tired Breathing Difficulty Routine Activity Signals Pulmonary Emboli
AV0404 - Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
AV0405 - Pulmonary Emboli Genetic Cause Hypercoagulable Work Up Family History
AV0406 -
AV0407 - Follow up ref SDS F1 CV5L, ref SDS E4 CV5L.
AV0408 -
AV0409 - Background on discovering and treating pulmonary embolism recurrence
AV0410 - is reported for the meeting on 061020. ref SDS F1 CV5L
AV0412 -  ..
AV0413 - Millie's patient history reported recently on 061108, ref SDS G0 VR6F,
AV0414 - confirms her letter to Kaiser on 061027 reporting slow recovery from
AV0415 - pulmonary embolism. ref SDS F3 MS5P, She continues to tire quickly and
AV0416 - suffers fatigue, weakness, shortness of breath with normal exertion
AV0417 - walking up stairs at home, at BART, walking a few blocks to work, or
AV0418 - shopping.  There is also noticable cough, and clearing of her throat
AV0419 - concurrent with treatments for pulmonary embolism beginning on 061002,
AV0420 - as reported to the nurse and pharmacist in the Infusion Clinic again
AV0421 - today, while getting chemotherapy treatment. ref SDS G1 SK9O
AV0423 -  ..
AV0424 - The doctor advised that prescription today for Procrit may improve
AV0425 - Millie's fatigue and low energy problem, since it treats low blood
AV0426 - counts for hemoglobin shown in the blood test yesterday, and presented
AV0427 - during treatment in the Infusion Clinic today, ref SDS G1 0N7Q, as
AV0428 - explained by the pharmacist, Masha. ref SDS G1 6Z8J
AV0430 -  ..
AV0431 - The doctor's notes describe Procrit treats anemia, shown below.
AV0432 - ref SDS 0 1248
AV0434 -  ..
AV0435 - There wasn't enough time today for the doctor to review patient
AV0436 - history of fairly frequent low hemoglobin, which did not result in
AV0437 - prescription for Procrit, and explain how the current condition
AV0438 - differs in sufficient degree to require treatment? ref SDS G1 DT7O
AV0440 -  ..
AV0441 - With a hectic schedule today, ref SDS 0 SM6M, the doctor did not have
AV0442 - time to present treatment plans and estimate on when Millie will
AV0443 - recover enough for working out in the gym to restore fitness that
AV0444 - strengthens immune system, as requested in her letter to Kaiser on
AV0445 - 061027 advising that pulmonary embolism symptoms continue with
AV0446 - fatigue, shortness of breath. ref SDS F3 MS5P
AV0447 -
AV0449 -  ..
AV0450 - Comparison CT Test 060930 with Test 041103 Original Diagnosis
AV0451 -
AV0452 - Follow up ref SDS F1 UQ5G.
AV0453 -
AV0454 - As noted earlier, per above, ref SDS 0 LZ3M, Kaiser has not performed
AV0455 - the comparison ordered by the doctor on 060929 with the earlier CT
AV0456 - test on 041103 to assess trends in pulmonary embolism findings, as
AV0457 - reported on 061012. ref SDS E8 2935
AV0459 -  ..
AV0460 - The doctor's hectic schedule did not have enough time again, as on
AV0461 - 061020, ref SDS F1 UQ5M, to review the patient's preliminary analysis
AV0462 - on 061012, and comment on significance of several differences between
AV0463 - the two tests, ref SDS E8 7E7G, including a new heart disorder caused
AV0464 - by an enlarged right ventricle, ref SDS E8 IM5J, discussed briefly
AV0465 - with the doctor during the meeting on 061020. ref SDS F1 VJ4J
AV0466 -
AV0467 -
AV0468 -
AV0469 -
AV0470 -
AV0471 -
AV0472 -
AV05 -

SUBJECTS
Examination Clinical Findings Correlate with Research Stethoscope No

B703 -
B70401 -  ..
B70402 - Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
B70403 -
B70404 - Follow up ref SDS F1 PC6H.
B70405 -
B70406 - The doctor examined Millie with a stethoscope again today.  This
B70407 - included multiple locations on her her back, and on her chest.  He
B70408 - reported finding no evidence of cardio pulmonary issues from clinical
B70409 - examination.
B70410 -
B70411 -
B70412 -
B70413 -
B70414 -
B70415 -
B705 -

SUBJECTS
Enlarged Right Ventricle Heart Examination Not Ordered Kaiser Not En

BS03 -
BS0401 -  ..
BS0402 - Heart Examination Not Ordered Investigate Enlarged Right Ventricle
BS0403 - Enlarged Right Ventricle CT Test Aligns Patient Symptoms How Serious
BS0404 -
BS0405 - Follow up ref SDS F1 VJ4J. ref SDS E8 7E5L.
BS0406 -
BS0407 - The doctor feels that enlarged right ventricle reported in the CT test
BS0408 - on 060930, and reviewed on 061012, ref SDS E8 T95G, has been carefully
BS0409 - analyzed in diagnosis and treatment protocols following the meeting on
BS0410 - 061020, when this matter was first discussed. ref SDS F1 3Q9H
BS0412 -  ..
BS0413 - As noted above citing continuing infirmities from pulmonary embolism,
BS0414 - ref SDS 0 VD4G, Kaiser has had not time to answer the patient's letter
BS0415 - on 061027, ref SDS 0 P15N, asking when cardio-pulmonary condition will
BS0416 - recover to resume working out in the gym. ref SDS F3 MS5P  Exercise is
BS0417 - a major part of patient commitment to physical fitness strengthening
BS0418 - the immune system, and builds emotional stability, reviewed above,
BS0419 - ref SDS 0 Y642, and discussed previously with the doctor during the
BS0420 - meeting on 061020. ref SDS F1 VJ4J
BS0422 -  ..
BS0423 - Kaiser has not had enough time to determine how severely the right
BS0424 - ventricle is enlarged, as discussed, also, on 061020. ref SDS F1 VJ4J
BS0426 -  ..
BS0427 - The doctor seemed satisfied that examination today by stethoscope, as
BS0428 - called out in research for clinical assessment, reported 061012.
BS0429 - ref SDS E8 IR5T, and discussed earlier, ref SDS 0 Q35O, indicates
BS0430 - enlarged right ventricle does not present a serious enough problem to
BS0431 - consider directed treatment, nor require further investigation,
BS0432 - including referral to a heart specialist, and that continuing with
BS0433 - Coumadin is the best course.
BS0435 -  ..
BS0436 - The doctor cited vitals that show So2 test result of 98%, reported
BS0437 - during treatment in the Infusion Clinic earlier today, ref SDS G1
BS0438 - AW4L.  He explained that 98% shows high oxygen content, indicating
BS0439 - effective cardio pulmonary functioning, rather than diminished
BS0440 - capacity that would signal significant impact of enlarged right
BS0441 - ventricle. (see also doctor's progress notes in the Medical Chart
BS0442 - citing O2 Sat 98%. ref SDS 0 ZL5W)
BS0443 -
BS0444 -
BS0445 -
BS0446 -
BS0447 -
BS0448 -
BS05 -

SUBJECTS
Coagulapathy Report Family Genetic Disposition Pulmonary Emboli Hype

C103 -
C10401 -  ..
C10402 - Coagulapathy Report Family Genetic Disposition Pulmonary Emboli
C10403 - Hypercoagulable State Work Up Risk Assessment Treatment Guidance
C10404 -
C10405 - Follow up ref SDS F1 626L.
C10406 -
C10407 - The doctor received the coagulapathy report on first-degree family
C10408 - member with recurrent pulmonary embolism, first reported to Kaiser on
C10409 - 060714. ref SDS B9 0001  Millie's letter, ref DIP 2 0001, submitted to
C10410 - Kaiser on 061103, ref SDS F9 VR6F, responded to the doctor's request
C10411 - on 060929, ref SDS E4 QT6N, and repeated a few weeks ago during
C10412 - another meeting at Kaiser on 061020. ref SDS F1 ES3I
C10414 -  ..
C10415 - The doctor highlighted the paragraph in Millie's transmittal letter to
C10416 - Kaiser that says...
C10417 -
C10418 -        Hypercoagulable state work up of family member who recently
C10419 -        suffered recurrent pulmonary emboli indicates factor V and
C10420 -        prothrombin G20210A mutations are negative.  Test results are,
C10421 -        however, consistent with a Lupus Anticoagulant (an
C10422 -        antiphospholipid antibody).  Cardiolipin AB IGM tested at 23,
C10423 -        well above the target range of 15 that signals positive
C10424 -        results.  The number "23" is circled in handwriting, indicating
C10425 -        heightened interest.  There is no analysis nor summary
C10426 -        explanation expressly stating genetic risk for thrombosis,
C10427 -        including pulmonary emboli.  Prior research seems to suggest
C10428 -        these findings demonstrate genetic disposition for PE in the
C10429 -        family member. and further that patients with family history of
C10430 -        blood clot problems together with recurrent thrombosis present
C10431 -        as "strongly thrombophilic" and should get extensive evaluation
C10432 -        for thrombophilias to guide diagnosis and treatment.
C10433 -        ref SDS F9 N18S
C10435 -  ..
C10436 - The coagulapathy report is reviewed in the record of patient history
C10437 - on 061102. ref SDS F8 0001
C10439 -  ..
C10440 - During the meeting today, the doctor discussed coagulapathy results in
C10441 - the report that show...
C10442 -
C10443 -        1.  Factor V tested negative, ref SDS F8 TK3V, further at
C10444 -            ref SDS F8 ME6X, and
C10445 -
C10446 -        2.  Prothrombin G20210A mutation, also, tested negative.
C10447 -            ref SDS F8 PRXX
C10449 -             ..
C10450 -        3.  Lupus Anticoagulant (an antiphospholipid antibody) test
C10451 -            consistent with this criteria. ref SDS F8 6E5M
C10453 -             ..
C10454 -        4.  Cardiolipin AB IGM shows results of 23, which is above the
C10455 -            target range of 15, and is circled in handwriting, likely
C10456 -            indicating focus on positive finding. ref SDS F8 6F49
C10458 -  ..
C10459 - The doctor interprets these results to show positive findings for DNA
C10460 - risk of pulmonary embolism, as cited in the record on 061102,
C10461 - ref SDS F8 4N55  The doctor describes findings as "acquired" rather
C10462 - than inherited genetic risk for pulmonary embolism, based on researh
C10463 - submitted today, as shown below. ref SDS 0 PD69  The doctor further
C10464 - noted that test results of "23" represent only a "weak" risk, rather
C10465 - than strongly positive.
C10466 -
C10467 -            [On 061113 Millie commends doctor's analysis of
C10468 -            coagulapathy report. ref SDS G3 0F5H
C10470 -  ..
C10471 - The doctor advised that the report will be retained in Millie's
C10472 - medical chart, and that findings of "acquired" rather than inherited
C10473 - condition signals no increased risk of blood clot problems for Millie,
C10474 - does not require hypercoagulable state work up, nor other measures to
C10475 - evaluate patient profile, and requires no adjustments in diagnosis and
C10476 - treatment, addressing issue presented in Millie's letter to Kaiser on
C10477 - 061103. ref SDS F9 N18S
C10479 -             ..
C10480 -            [...below, progress notes in medical chart make no mention
C10481 -            of performing this work on the coagulapathy report -
C10482 -            nothing in the narrative reporting that documents requested
C10483 -            last month were received today, no narrative on research of
C10484 -            significance, nothing is mentioned summarizing extensive
C10485 -            guidance to customer (patient), ref SDS 0 279I, no
C10486 -            impression on findings, ref SDS 0 1248, and no plan to
C10487 -            follow up by for example filing the coagulapathy report in
C10488 -            the medical report. ref SDS 0 125V
C10490 -  ..
C10491 - The doctor submitted research in an article...
C10492 -
C10493 -    Medic8 GeneticDisorders
C10495 -     ..
C10496 -    Antiphospholipid Syndrome
C10497 -    What is antiphospholipid syndrome (APS)?
C10498 -
C10500 -  ..
C10501 - Article is dated:  September 1, 2006
C10502 -
C10503 -        http://www.medic8.com/genetics/antiphosolipid-syndrome.htm
C10505 -  ..
C10506 - APS is explained in the article as associated with lupus anticoagulant
C10507 - antibody, ref OF 3 2X5H, which was reported in the coagulapathy test
C10508 - reviewed in Millie's family history on 060722. ref SDS F8 KJ3H
C10510 -  ..
C10511 - The doctor highlighted the paragraph that says...
C10512 -
C10513 -        Is APS inherited?
C10514 -
C10515 -        Although APS has been reported to occur in multiple members of
C10516 -        the same family, no clear inheritance pattern has been
C10517 -        identified and no gene has been found to be the sole cause of
C10518 -        this condition.  One report in 1999 studied families with more
C10519 -        than one affected member, examined possible modes of
C10520 -        inheritance, and examined links with certain genes.  In seven
C10521 -        families, 30 out of 101 family members met diagnostic criteria
C10522 -        for the syndrome.  The data were fitted best by either a
C10523 -        dominant (one copy of the altered gene inherited from one
C10524 -        parent causes the condition) or codominant (features related to
C10525 -        the condition from both parents are observed) model.
C10526 -        ref OF 3 0L3G
C10528 -  ..
C10529 - The doctor also highlighted and discussed the sentence...
C10530 -
C10531 -        ...no clear inheritance pattern has been identified and no gene
C10532 -        has been found to be the sole cause of this condition.
C10533 -
C10534 -
C10535 -
C10536 -
C10537 -
C10538 -
C10539 -
C10540 -
C106 -

SUBJECTS
Work Plan Doctor Submits Doctor/Patient Partnership Communications I

CS03 -
CS0401 -  ..
CS0402 - Work Plan Received Communications Doctor/Patient Partnership
CS0403 - Communications Doctor Submits Work Plan Doctor/Patient Partnership
CS0404 - Doctor/Patient Partnership Communications Doctor Submits Work Plan
CS0405 -
CS0406 - Follow up ref SDS F1 FE4I, ref SDS E4 FE4I.
CS0412 -  ..
CS0413 - Issues from Kaiser's Progress Notes...
CS0414 -
CS0415 -    1.  Narrative near the end, says
CS0416 -
CS0417 -             The patient is here for cycle #5.
CS0419 -         ..
CS0420 -        This repeats language from the prior report that should be
CS0421 -        edited to reflect an update.  Consideration should be given to
CS0422 -        say "cycle #6," consistent with the Plan section. ref SDS 0
CS0423 -        125V
CS0425 -         ..
CS0426 -    2.  Cellulitis - patient hospitalized 5 days complications of
CS0427 -        lymphedema, not mentioned anywhere in the doctor's report.
CS0428 -        ref SDS 0 M75J
CS0430 -         ..
CS0431 -    3.  Coagulapathy report received and discussed with patient,
CS0432 -        including submission of research to the patient on issues in
CS0433 -        the report - consideration might be given to reporting these
CS0434 -        results, which are an action item in the doctor's report for
CS0435 -        the prior period. ref SDS 0 YH6K
CS0437 -         ..
CS0438 -    4.  Current medications - this might be updated to list Taxotere
CS0439 -        for cancer, antibiotics treatment for Cellulitis, Coumadin for
CS0440 -        pulmonary emboli, and Procrit to increase hemoglobin blood
CS0441 -        count for better energy.  Additionally, during the reporting
CS0442 -        period, Lovenox was prescribed, and the patient is taking Tums
CS0443 -        for emerging digestion problems. ref SDS 0 SE86
CS0445 -         ..
CS0446 -    5.  Impression section might mention resolution of coagulapathy
CS0447 -        report review. ref SDS 0 1248
CS0449 -         ..
CS0450 -        Reporting on lymphedema which repeats expression from prior
CS0451 -        report on 061020, might be updated to report complication of
CS0452 -        Cellulitis. ref SDS 0 1P8H
CS0454 -  ..
CS0455 - Doctor's initiative today transferring the agenda from Millie's letter
CS0456 - into Kaiser's electronic Medical Chart, per above, ref SDS 0 NO6O, and
CS0457 - using the list to guide the meeting, per below, ref SDS 0 684G, shows
CS0458 - progress applying the doctor patient partnership model presented in
CS0459 - Kaiser's Healthwise Handbook, reviewed on 990625, ref SDS 2 4185, and,
CS0460 - also, for timely review of patient history, further called out in the
CS0461 - Handbook, 990625, ref SDS 2 TD5S, and reported on 060106. ref SDS 89
CS0462 - FE4I
CS0464 -             ..
CS0465 -            [On 061208 hectic schedule not enough time to work from
CS0466 -            agenda in the Medical Chart. ref SDS G7 K84N
CS0467 -
CS0468 -    1.  11/10/2006     03:40 PM
CS0469 -
CS0470 -            Wcr-ONnc2 > Main Campus
CS0473 -         ..
CS0474 -    2.  Your primary care clinician is listed as...
CS0475 -
CS0477 -
CS0900 -
CS0901 -
CS0902 -
CS0903 -
CS0904 -
CS0905 -
CS0906 -
CS10 -