CONTACTS 

SUBJECTS
Meeting Examination Doctor 13th Review Start Treatment #16 After Mas

1403 -
1403 -    ..
1404 - Summary/Objective
1405 -
140501 - Follow up ref SDS B1 0000. ref SDS A3 0000.
140502 -
140503 - Examination today shows subsiding and stable IBC rash, with no new
140504 - sites since treatment started 070201 on the cetuximab clinical study.
140505 - ref SDS 0 LB5L  Oncology practice seems to regard "stable" cancer as
140506 - favorable, while patients strive for no evidence of disease (NED).
140507 - ref SDS 0 M645  Results of blood tests today were not available in
140508 - time for the meeting.  A few days later the report shows CA 15-3 33
140509 - dropped from 36 over the past 4 weeks.  Declining biomarker indicates
140510 - response to treatment, aligned with clinical findings of subsiding IBC
140511 - rash. ref SDS 0 GJ5M  CT test on 070326 shows no evidence of distant
140512 - metastasis. ref SDS 0 EY5O  The doctor's order for a spiral CT scan to
140513 - test for pulmonary embolism and enlarged right ventricle was not
140514 - performed. ref SDS 0 0136  Rising energy and fewer symptoms suggest
140515 - recovery, but the actual condition is not known. ref SDS 0 E44L and
140516 - ref SDS 0 VJ4J  Stable INR blood tests within the target range further
140517 - indicates effective treatment for pulmonary embolism. ref SDS 0 FE9I
140518 - Brigid modified the chemotherapy order to reduce the dose of Benadryl
140519 - in order to avoid side effects of "restless legs." ref SDS 0 MF6N  ANC
140520 - blood counts rising above the target range indicate strengthening
140521 - immune system for safe chemotherapy treatments. ref SDS 0 VF5M  Good
140522 - news today helps relieve emotional stress from doubt and worry about
140523 - the future. ref SDS 0 XU6M
140524 -
140525 -     [On 070330 examination at Kaiser by primary care physician finds
140526 -     significantly increased intensity of rash on upper left arm,
140527 -     ref SDS C9 N19J, and new rash above the right chest below the
140528 -     colar bone; Keflex antibiotics was prescribed, ref SDS C9 474O;
140529 -     about 3 hours later self-examination showed these erruptive rash
140530 -     conditions had subsided, and so Keflex treatment was not
140531 -     performed. ref SDS C9 KZ6L
140532 -
140533 -
140534 -
140535 -
140537 -  ..
1406 -
1407 -
1408 - Progress
1409 -
140901 - Agenda Develop Work Plan Stage IV Breast Cancer 15 Mos after Mastectomy
140902 -
140903 - Follow up ref SDS B1 SM6M, ref SDS A5 SM6M.
140905 -  ..
140906 - Millie met today with the medical team at UCSF starting the 3rd cycle
140907 - and 9th treatment of IBC with cetuximab, as planned in the launch
140908 - meeting on 070130. ref SDS A3 WM7G  Treatment at UCSF is on referral
140909 - from Kaiser for participation in a clinical study drug trial ordered
140910 - by the primary care physician on 070105. ref SDS 98 PK68  This is the
140911 - 13th physician meeting scheduled to start the 10th chemotherapy cycle
140912 - since treatments began on 060711, ref SDS 77 SM6M, for the 3rd relapse
140913 - of IBC. ref SDS 77 8Y8I  It is the 3rd meeting scheduled with Doctor
140914 - Rugo, and precedes a meeting with the primary care physician at Kaiser
140915 - tomorrow on 070330.
140917 -  ..
140918 - Complete list of treatments for IBC 3rd relapse is reported in the
140919 - record of treatment following the meeting today. ref SDS C7 SG8I
140921 -  ..
140922 - Agenda for meeting at UCSF on 070301 provides a structure for planning
140923 - the meeting today...
140924 -
140925 -    1.  Coordination plan.............................. ref SDS 0 RM4G
140926 -    2.  CA 15-3 33 improvement......................... ref SDS 0 GJ5M
140927 -    3.  Lymphedema restricts exercise.................. ref SDS 0 4Y93
140928 -    4.  Breast exam IBC stable subsides................ ref SDS 0 025H
140929 -    5.  Measurable disease declines.................... ref SDS 0 M652
140930 -    6.  Side effects minimal........................... ref SDS 0 TQ6L
140931 -    7.  CT no distant metastasis, no test for PE....... ref SDS 0 EY5O
140932 -    8.  Patient work up continue strategy.............. ref SDS 0 K36G
140933 -    9.  Treatment plan weekly clinical trial........... ref SDS 0 PF3O
140934 -   10.  Pulmonary emboli how serious r ventricle....... ref SDS 0 CV5L
140936 -  ..
140937 - Scheduled next meeting for Thursday 070426 0800, reported in the
140938 - record on 070315. ref SDS C0 159O
140940 -  ..
140941 - The doctor could not support the meeting today;  Millie met with two
140942 - (2) assistants...
140943 -
140944 -        1.  Brigid, Nurse Practitioner
140945 -        2.  Jackie, Clinical Research Coordinator
140946 -
140947 -
140948 -
1410 -

SUBJECTS
Complex Patient History 43 Issues Overwhelms Span of Attention Drive

2203 -
220401 -  ..
220402 - Complex Patient History Knowledge Management Dilemma Issues Grow 43
220403 -
220404 - Follow up ref SDS B1 LU3J, ref SDS A3 LU3J.
220405 -
220406 - Sampling of issues patient history diagnosis and treatment...
220407 -
220408 -    1.  CA 15-3 monitors advance of cancer response to treatment
220409 -    2.  Lymphedema complicated by mastectomy surgery
220410 -    3.  Broken finger from minor fall complicates lymphedema
220411 -    4.  Esophagitis reflux digestion issues
220412 -    5.  Immune system chemotherapy increases risk of infection
220413 -        Chemotherapy increase risk of infection
220414 -    6.  Cat bites increase risk of infection complicates lymphedema
220415 -    7.  Pneumonia chemotherapy increases risk of infection
220416 -    8.  Metastatic cancer increases risk pulmonary embolism
220417 -    9.  Lymphadenopathy left axilla local regional metastasis
220418 -   10.  Lymphadenopathy right axilla distant metastasis
220419 -   11.  Lymphadenopathy left supraclavicular diagnose metastatic cancer
220420 -   12.  Breast cancer secondary IBC 3rd relapse left breast
220421 -   13.  Cancer mutates slow response chemotherapy treatment
220422 -   14.  Mastectomy surgery impact on treatment IBC relapse
220423 -   15.  Blood vessels removed mastectomy slow chemotherapy treatments
220424 -   16.  Treatment options, strategy, planning, schedule
220425 -   17.  Drug trials increase declining pool chemotherapy agents
220426 -   18.  UCSF Doctor Benz 2nd opinion apply diagnosis and treatment
220427 -   19.  Pulmonary embolism blood clots in lungs
220428 -   20.  INR weekly adjustments Coumadin treatment blood clots
220429 -   21.  Enlarged right ventricle heart problem core pulmonale
220430 -   22.  Dizziness symptom enlarged right ventricle cor pulmonale
220431 -   23.  Fatigue shortness breath side effect chemotherapy loss fitness
220432 -   24.  Fatigue shortness breath symptom pulmonary embolism
220433 -   25.  Shortness breath fatigue dizzy symptoms pulmonary embolism
220434 -   26.  Coagulapathy hypercoagulable state work up genetic risks
220435 -   27.  Testing resolution of errors (see Benz 2nd opinion 060821)
220436 -   28.  Testing distant metastatic disease
220437 -   29.  Testing pulmonary embolism and heart disease
220438 -   30.  Communication hectic schedule not enough time to manage details
220439 -   31.  Emotional stress and well being
220440 -   32.  Cellulitis inflammation temperature 102.6 on chemotherapy
220441 -   33.  Urinary tract bladder infection
220442 -   34.  IBC rash spreads to right breast
220443 -   35.  Right breast rash may be "ring" infection, not cancer
220444 -   36.  Lung cancer seems to be diagnosed in the Medical Chart
220445 -   37.  IBC rash spreads to stomach and toward back
220446 -   38.  IBC rash spreads to left arm
220447 -   39.  Dry skin face chest arm
220448 -   40.  Right arm evidence light red rash, may be IBC spreading
220449 -   41.  Rash right upper right chest near port catheter
220450 -   42.  Restless legs side effect Benadryl pre-treatment
220451 -   43.  Sleeping difficulty side effect cetuximab
220452 -
220453 -
220454 -
220455 -
2205 -

SUBJECTS
Vitals Submitted by Doctor UCSF Blood Pressure Pulse Normal Low Anxi

2803 -
280401 -  ..
280402 - Vitals Show Stable Medical Condition
280403 -
280404 - Follow up ref SDS B1 KB5L, ref SDS A3 KB5L.
280406 -                           ..
280407 -                          Bld Prssr   Pulse   Temp   Weight  SaO2
280408 -     ..
280409 - *  070329 0800............  [see treatment record, ref SDS C7 AW4L]
280410 - *  070301 1330............  [see treatment record, ref SDS B2 AW4L]
280411 - *  070130 1300............ 140 83     87     98
280412 -    070105 1040............
280413 -    061208 1226............ 152 90     76     97.8    147     99%
280414 -    061201 1430............ 123 76     76     97.5
280415 -    061110................. 136 83     73     97.0    150     98%
280416 -    061020 1534............ 140 79     67     99.8    151     97
280417 -    060929 1452............ 141 78     66     98.3
280418 -    060908 1335............ 139 79     73     98.1
280419 -    060814 1610............ 139 80     59     98.2
280420 - *  060808.................
280421 -    060711................. 172 87     54     97.5    147
280422 -    060623................. 141 87     71     98.0    147     99%
280423 -    060428................. 129 73     80     99.4    149     99%
280424 -    060217................. 153 81     61     98.6    150     99%
280425 -
280426 - *  For some reason, vitals not submitted.
280428 -  ..
280429 - High blood pressure reflects pressure on patient about effectiveness
280430 - of new treatment and arrangements between UCSF and Kaiser for timely
280431 - care, discussed on 070130, ref SDS A3 Y642, and again last month on
280432 - 070301. ref SDS B1 Y642
280434 -  ..
280435 - Today, Millie's vitals are normal, indicating reduced emotional strain
280436 - at this time, as discussed with Brigid on 070315, ref SDS C0 6A7J, and
280437 - reviewed again during the meeting today, per below. ref SDS 0 Y642
280438 -
280439 -
280440 -
280441 -
2805 -

SUBJECTS
Coordination Plan Communication UCSF Kaiser Collaboration Object Dil

6003 -
600401 -  ..
600402 - Coordination Plan Divided Responsibilities Kaiser UCSF Referral
600403 - Collaboration Primary Care at Kaiser with UCSF Clinical Study Cetuximab
600404 -
600405 - Follow up ref SDS B1 RM4G, ref SDS A3 RM4G.
600406 -
600407 - Background on coordination plan to manage divided responsibilities
600408 - between Kaiser and referral to UCSF is reported on 070301. ref SDS B1
600409 - RM4G  Case study on 070130 shows requirements for communication to
600410 - strengthen care. ref SDS A3 4T5N  Scope of coordination requirements
600411 - is listed on 070222. ref SDS A9 KL5G
600413 -  ..
600414 - On 070301 Brigid notified Millie that UCSF policy requires patients to
600415 - coordinate communications with Kaiser for comprehensive care.
600416 - ref SDS B1 O67N
600418 -  ..
600419 - Coordination problems occurred on 070307 getting blood test results
600420 - from Kaiser on CA 15-3 cancer biomarker for review at UCSF.
600421 - ref SDS B7 Q65K  Similar problems occurred the day before on 070306
600422 - getting feedback from Kaiser that blood test results at UCSF were
600423 - satisfactory to continue Coumadin treatments for pulmonary embolism.
600424 - ref SDS B5 UI5H  On 070308 coordination scheduling blood tests was not
600425 - performed, ref SDS B8 1M6H; a week later on 070315 similar problems
600426 - occurred when treatment was not scheduled. ref SDS C0 1M6H  Another
600427 - challenge was ordering a CT test for measurable disease required for
600428 - the clinical study. ref SDS B7 G56L  Coordination further failed
600429 - today, when Kaiser could not submit results of the CT test on 070326
600430 - despite notice on 070326 to UCSF, ref SDS C2 FU6G, and notice to
600431 - Kaiser yesterday on 070328 that the report was needed in time for
600432 - meeting at 0800 today. ref SDS C5 VP5N ref SDS 0 EY5O
600433 -
600434 -        [On 070419 meeting with Doctor Rugo to review progress reports
600435 -        improved coordination receiving test results from UCSF via
600436 -        email. ref SDS D2 RM4G
600438 -         ..
600439 -        [On 070608 Kaiser urges patient to continue making extra
600440 -        effort sending patient history to the doctor using
600441 -        Kaiser's dedicated email system. ref SDS D8 6S3F
600443 -  ..
600444 - Coordination to review side effects on the cetuximab clinical study
600445 - was facilitated this week with a letter to UCSF on 070326. ref SDS C2
600446 - 627X  The letter submitted a comprehensive listing on 070322 from
600447 - meetings the past two (2) months in the Infusion Clinic. ref SDS C1
600448 - QU8K  During the meeting today, Jackie disclosed that coordination was
600449 - not performed.  Brigid did not get the list of pending side effects to
600450 - prepare for review with the patient today, per below. ref SDS 0 TQ6L
600452 -  ..
600453 - Jackie seemed to cite "links" for withholding distribution of side
600454 - effects to prepare for meeting today.  Rationale seems unclear.
600455 -
600456 -        [On 070419 Brigid made effort to improve coordination by using
600457 -        precision access with links in email, ref SDS D2 DI8J; Jackie's
600458 -        concerns about links was supported by Brigid's experience
600459 -        showing need for orientation and initial assistance.
600460 -        ref SDS D2 DI9F
600462 -         ..
600463 -        [On 070419 coordination submitting side effects via email with
600464 -        precision access was not accessed during the meeting for
600465 -        comprehensive review. ref SDS D2 DI4F
600467 -  ..
600468 - Links strengthen coordination by efficiently connecting issues to
600469 - context with "precision access" to patient history, explained in NWO,
600470 - ref OF 5 PX6J  Understanding context "augments intelligence" for good
600471 - management (see POIMS, ref OF 1 1X6G).  There evidently was not enough
600472 - time for feedback to notify the patient that coordination was withheld
600473 - that prevented being prepared so that corrective action could be taken
600474 - to discuss issues comprehensively during the meeting today.  Jackie
600475 - called a few days ago on 070327 and notified that blood tests were
600476 - ordered. ref SDS C4 407N  This morning tests were performed, as
600477 - required, ref SDS C7 Q659, indicating benefits of timely notice, and
600478 - correcting previous problems on 070308. ref SDS B8 1M6H  There was no
600479 - mention during the call on 070327 that coordination on side effects
600480 - did not occur.  Resistance to feedback that refines accuracy of
600481 - knowledge for expediting work is explained in NWO. ref OF 5 2670
600483 -  ..
600484 - Research on 040312 shows energy transferred through connections (i.e.,
600485 - links) yields the power of knowledge under the locality principle.
600486 - ref SDS 28 HS6O  Earlier on 960205 published studies show people waste
600487 - 70% of the day in meetings that are unproductive because nobody
600488 - invests time to be prepared. ref SDS 2 5902  The UCSF coordinator role
600489 - helps solve the problem, reported on 070116. ref SDS A0 NK8F  Tools
600490 - for electronic transfer with precision access greatly reduce the time
600491 - to coordinate and be prepared for working accurately, so that meetings
600492 - are productive.  Roles and tools for working quickly and accurately
600493 - solve the weak link in management by being prepared for meetings that
600494 - makes communication effective, reported on 940114. ref SDS 1 2290
600496 -  ..
600497 - Fearing the power of knowledge from connecting issues to context with
600498 - links in email, cited today, ref SDS 0 L55G, extends to antiquity, in
600499 - the Legend of Prometheus reviewed 991108. ref SDS 4 5810  In 400 BC,
600500 - Plato presented the tension between orality and literacy for accuracy,
600501 - in the Phaedrus dialogs, reviewed on 991209. ref SDS 5 5658  More
600502 - recently on 000503, research at SRI shows fear of knowledge remains
600503 - dominate in a world overwhelmed by first impressions from sensory
600504 - perception of information. ref SDS 6 5033
600506 -  ..
600507 - Brigid commented that patient history in email is ignored, and that
600508 - UCSF relies on conversation from memories during emotional moments of
600509 - medical examinations rather than deliberation constructing writings
600510 - that yield comprehensive lists for comprehensive care.  Resistance to
600511 - email seems conflicting with UCSF using email to review patient
600512 - history on 061230. ref SDS 95 OU5K  UCSF used efficiencies of email
600513 - again on 070101 coordinating referral for Millie to get comprehensive
600514 - care at UCSF. ref SDS 96 YP8O  On 070305 Brigid used email for timely
600515 - clarification of conflicting blood test standards. ref SDS B4 SN5O
600516 -
600517 -        [On 070406 UCSF made good progress learning to use email for
600518 -        accurate communication via email to support the doctor patient
600519 -        partnership with timely coordination and collaboration.
600520 -        ref SDS D0 EQ6I
600522 -         ..
600523 -        [On 070418 Millie letter to UCSF thanks Brigid for taking time
600524 -        to support doctor patient collaboration notifying good news of
600525 -        continued decline in CA 15-3. ref SDS D1 EQ6I
600527 -         ..
600528 -        [On 070419 meeting with Doctor Rugo to review progress reports
600529 -        improved coordination receiving test results from UCSF via
600530 -        email. ref SDS D2 RM4G
600532 -         ..
600533 -        [On 070419 Brigid made effort to improve coordination by using
600534 -        precision access with links in email, ref SDS D2 DI8J; Jackie's
600535 -        concerns about links was supported by Brigid's experience
600536 -        showing need for orientation and initial assistance.
600537 -        ref SDS D2 DI9F
600539 -         ..
600540 -        [On 070501 letter from UCSF via email improves timely, accurate
600541 -        communication. ref SDS D4 EQ6I
600543 -         ..
600544 -        [On 070509 Millie commended UCSF and recognized Brigid for
600545 -        continued timely communication, coordination, and collaboration
600546 -        via email supporting an effective doctor/patient partnership.
600547 -        ref SDS D5 KR6K
600549 -         ..
600550 -        [On 070510 improved communication using email reduces stress by
600551 -        relieving worry and doubt about medical mistakes. ref SDS D6
600552 -        TK6J
600554 -  ..
600555 - Timely, uniform distribution of "intelligence support" with email aids
600556 - comprehensive coordination. (see NWO, ref OF 5 A56M)  Literacy
600557 - complements orality leveraged by intelligence with precision access to
600558 - patient history.  Being prepared by reviewing patient history, in this
600559 - case side effects listed on 070322, ref SDS C1 QU8K, does not replace
600560 - discussion during meetings.  Reviewing the record prior to meeting
600561 - expands span of attention to prevent critical details from slipping
600562 - through the cracks during conversation, as set out in POIMS.
600563 - ref OF 3 5106
600564 -
600565 -        [On 070419 Brigid made effort to improve coordination by using
600566 -        precision access with links in email, ref SDS D2 DI8J; Jackie's
600567 -        concerns about links was supported by Brigid's experience
600568 -        showing need for orientation and initial assistance.
600569 -        ref SDS D2 DI9F
600570 -
600571 -
600572 -
600573 -
6006 -

SUBJECTS
Case Study Coordination Failure Perform Communication Planning Feedb

6503 -
650401 -  ..
650402 - Case Study Coordination Complex Communication Problems
650403 - Problems Coordination Communication Planning Feedback Follow Up
650404 -
650405 - Coordination issues compound complexity case managemnet this cycle add
650406 - to the prior list on 070130, ref SDS A3 4T5N, and include...
650407 -
650408 -        1.  Communication with Kaiser blood
650409 -            test results for prescribing
650410 -            Coumadin to treat pulmonary
650411 -            embolism, Coagulation Control
650412 -            Clinic requests report by
650413 -            conversation rather than
650414 -            in writing.................... 070307, ref SDS B7 UH4M
650416 -             ..
650417 -        2.  Communication very difficult
650418 -            coordinating getting results
650419 -            on blood tests at Kaiser
650420 -            for use at UCSF on
650421 -            referral...................... 070307, ref SDS B7 Q65K
650423 -             ..
650424 -        3.  Coordination very difficult
650425 -            reminding Kaiser to perform
650426 -            CT test with correct
650427 -            scope......................... 070307, ref SDS B7 G56L
650429 -             ..
650430 -        4.  Coordinating schedule for blood
650431 -            test ordered to assess
650432 -            treatment..................... 070308, ref SDS B8 1M6H
650434 -             ..
650435 -        5.  Coordinating schedule for
650436 -            treatments.................... 070315, ref SDS C0 1M6H
650438 -             ..
650439 -        6.  Communication poor obtaining
650440 -            CT test results from Kaiser
650441 -            for review at
650442 -            UCSF.......................... 070329, ref SDS 0 ZF4I
650444 -             ..
650445 -        7.  Communication failed to empower
650446 -            being prepared to review side
650447 -            effects during the meeting
650448 -            today......................... 070329, ref SDS 0 945F
650450 -             ..
650451 -        8.  Kaiser Imaging department failed
650452 -            to follow doctor's order for CT
650453 -            scan to test for pulmonary
650454 -            embolism...................... 070329, ref SDS 0 B74K
650456 -             ..
650457 -        9.  CT test report ignores patient
650458 -            history of pulmonary embolism;
650459 -            and lack of comparison drive
650460 -            doubt and worry about
650461 -            efficacy of
650462 -            tests......................... 070329, ref SDS 0 GH5L
650464 -             ..
650465 -       10.  Collaboration failure referral coordination
650466 -            blood test at UCSF on 080306 sent to Kaiser
650467 -            on 080307 was not evaluated for emergency
650468 -            care at Kaiser on 080409; Kaiser compared
650469 -            blood test on 080409 with data on 071017
650470 -            because nobody entered 6 months of test
650471 -            data in Kaiser computer; if data is
650472 -            not in the computer it does not
650473 -            exist......................... 080409, ref SDS D9 439L
650474 -
650475 -
650476 -
650477 -
650478 -
650479 -
650480 -
650481 -
650482 -
6505 -

SUBJECTS
CA 15-3 33 Trend Falls through March Cetuximab Clinical Study Drug T

7203 -
720401 -  ..
720402 - CA 15-3 Cancer Marker 33 Significant Improvement
720403 -
720404 - Follow up ref SDS B1 087J, ref SDS A3 087J.
720405 -
720406 - Millie had a blood test this morning, and results were not reported
720407 - until 070403, and show continuing decline from 36 to 33, reported in
720408 - another record today. ref SDS C7 A16M
720409 -
720410 -    [On 070406 received letter from UCSF confirming CA 15-3 33.
720411 -    ref SDS D0 EQ6I
720413 -           ..
720414 -         Test Date                         Date Received
720415 -          070329......... 33 H............. 070329, ref SDS C7 2N5J
720416 -          070301......... 36 H............. 070307, ref SDS B2 A16M
720417 -          070215......... 52 H............. 070307, ref SDS A7 ER5O
720418 -          070208......... 55 H............. 070307, ref SDS A7 ER5O
720419 -          070201.....cetuximab begins...... 070201, ref SDS A5 G68I
720420 -          070131......... 56 H............. 070202, ref SDS A6 087J
720421 -          070123......... 52 H............. 070202, ref SDS A6 087J
720422 -          070118......... 68 H............. 070123, ref SDS A2 GK5B
720423 -          070104......... 56 H............. 070110, ref SDS 99 087J
720424 -          061218......... 74 H............. 061227, ref SDS 93 6P9F
720425 -          061214......... 63 H............. 061227, ref SDS 93 6P9F
720426 -          061201....Pause treatments..... . 061201, ref SDS 90 GJ5M
720427 -          061130......... 67 H............. 061201, ref SDS 90 087J
720428 -          061116......... 66 H............. 061201, ref SDS 90 087J
720429 -          061110......... 56 H............. 061201, ref SDS 90 087J
720430 -          061109......... 61 H............. 061110, ref SDS 89 087J
720431 -          061026......... 57 H............. 061110, ref SDS 89 087J
720432 -          061019......... 56 H............. 061020, ref SDS 88 087J
720433 -          060928......... 51 H............. 060929, ref SDS 85 087J
720434 -          060907......... 68 H............. 060929, ref SDS 85 087J
720435 -          060813......... 73 H............. 060817, ref SDS 82 U24M
720436 -          060809......... 87 H............. 060810, ref SDS 81 2N5J
720437 -          060721..Taxotere capecitabine.... 060721, ref SDS 78 0001
720438 -          060708......... 71 H............. 060711, ref SDS 77 087J
720439 -          060616......... 63 H............. 060623, ref SDS 76 UQ5Q
720440 -          060522......... 59 H............. 060605, ref SDS 75 UQ5Q
720441 -          060501......... 49 H............. 060522, ref SDS 74 MC4F
720442 -          060421......... 44 H............. 060428, ref SDS 72 087J
720443 -          060330......... 40 H............. 060428, ref SDS 72 087J
720444 -          060303......... 36............... 060428, ref SDS 72 087J
720445 -          060210......... 33............... 060217, ref SDS 71 087J
720446 -          060109......... 34............... 060126, ref SDS 70 KV59
720447 -          051223......... 34............... 060106, ref SDS 69 087J
720448 -          051202......... 28............... 060106, ref SDS 69 087J
720449 -          051116......... 31............... 051121, ref SDS 68 087J
720450 -          051109......... 30............... 051121, ref SDS 68 087J
720451 -          051102......... 34............... 051121, ref SDS 68 087J
720452 -          051021..Mastectomy surgery....... 051021, ref SDS 67 0001
720453 -          050916...end treatment........... 050916, ref SDS 65 407N
720454 -          050909......... 45 H............. 051007, ref SDS 66 087J
720455 -          050826......... 45 H............. 050913, ref SDS 64 087J
720456 -          050819......... 45 H............. 050913, ref SDS 64 087J
720457 -          050812......... 39 .............. 050819, ref SDS 63 3K6L
720458 -          050729......... 45 H............. 050819, ref SDS 63 EA5G
720459 -          050708......... 46 H............. 050729, ref SDS 62 087J
720460 -          050701......... 37 .............. 050729, ref SDS 62 087J
720461 -          050617......... 45 H............. 050729, ref SDS 62 087J
720462 -          050527......... 56 H............. 050610, ref SDS 60 087J
720463 -          050512......... 67 H............. 050520, ref SDS 58 087J
720464 -          050506......... 80 H............. 050520, ref SDS 58 087J
720465 -  ..
720466 -          050415.........105 H............. 050422, ref SDS 57 087J
720467 -          050415..Taxoter capecitabie begin 050415, ref SDS 56 407N
720468 -          050325.........100 H............. 050329, ref SDS 55 087J
720469 -          050318.........101 H............. 050325, ref SDS 54 2N5J
720470 -          050304......... 88 H............. 050311, ref SDS 52 087J
720471 -          050225......... 95 H............. 050308, ref SDS 51 0001
720472 -          050211......... 78 H............. 050214, ref SDS 50 02BB
720473 -          050128......... 67 H............. 050204, ref SDS 49 087J
720474 -          050104...AC start treatment...... 050104, ref SDS 48 407N
720475 -          041228......... 56 H............. 041230, ref SDS 47 087J
720476 -          041204......... 43 H............. 041210, ref SDS 46 087J
720477 -          041021...Taxol bevczmb ends...... 041021, ref SDS 44 0001
720478 -          041007......... 39............... 041104, ref SDS 45 087J
720479 -          040923......... 49 H............. 041005, ref SDS 43 087J
720480 -          040908......... 44 H............. 040909, ref SDS 42 087J
720481 -          040825......... 47 H............. 040909, ref SDS 42 087J
720482 -          040811......... 42 H............. 040812, ref SDS 41 087J
720483 -          040728......... 43 H............. 040729, ref SDS 39 2N5J
720484 -          040712......... 47 H............. 040713, ref SDS 38 087J
720485 -          040614......... 55 H............. 040615, ref SDS 37 PX6X
720486 -          040517......... 78 H............. 040601, ref SDS 35 2N5J
720487 -          040420...Taxol bevczmb starts.... 040420, ref SDS 33 9Z5J
720488 -          040311......... 70 H............. 040318, ref SDS 29 SM6M
720489 -          040205......... 60 H............. 040211, ref SDS 26 SM6M
720490 -          031201......... 62 H............. 031205, ref SDS 25 SM6M
720491 -          030912......... 66 H............. 030915, ref SDS 24 SM6M
720492 -          030708......... 68 H............. 030710, ref SDS 23 SM6M
720493 -          030503......... 54 H............. 030508, ref SDS 21 SM6M
720494 -          030403......... 45 H............. 030508, ref SDS 21 SM6M
720495 -          030215......... 46 H............. 030220, ref SDS 20 5E6L
720496 -          030106......... 37 H............. 030109, ref SDS 19 SM6M
720497 -          021204..Adjuvant chemo ends...... 021204, ref SDS 18 SQ5I
720498 -          021202......... 41 H?............ 021204, ref SDS 18 SP5G
720499 -          021111......... 36 H?............ 021113, ref SDS 17 Y65I
720500 -          021023......... 33 H?............ 021023, ref SDS 16 SQ5I
720501 -          020930......... 33 H?..39........ 021002, ref SDS 15 SQ5I
720502 -          020917......... 36 H?............ 020924, ref SDS 14 SQ5I
720503 -          020717......... 59 H?............ 020726, ref SDS 13 YN5K
720504 -          020629......... 75 H ............ 020705, ref SDS 12 UX6I
720505 -          020608........  67 H ............ 020614, ref SDS 11 0001
720506 -          020603........ 108 H ............ 020607, ref SDS 10 X67F
720507 -          020511........ 117 H ............ 020603, ref SDS 9 PJ4J
720508 -          020419......... 81 H ............ 020430, ref SDS 8 7N5H
720509 -          020321......... 85 H ............ 020405, ref SDS 7 6T8K
720510 -
720511 -
720512 -
720513 -
720515 -  ..
7206 -
7207 -
7208 - Analysis
7209 -
720901 - CA 15-3 33 Cancer Marker Strong Response to Treatment Cetuximab
720902 -
720903 - Follow up ref SDS B1 GJ5M, ref SDS A3 GJ5M.
720904 -
720905 - Yesterday on 070328 the McNeil Lehrer television broadcast reported
720906 - research on biomarkers that identify cancer and guide treatment.
720907 - ref SDS C6 0001  Doctor Barker, Deputy Director NCI, and Doctor
720908 - Woodcock, Chief Medical Officer FDA explained goals and projects to
720909 - improve biomarkers for early detection of cancer, and timely, targeted
720910 - treatment. ref SDS C6 PK7G   CA 15-3 cancer marker used in Millie's
720911 - case to assess response to treatment shows alignment with this
720912 - research. ref SDS 0 087J
720914 -  ..
720915 - Background on Millie's patient history applying CA 15-3 is shown in a
720916 - case study on 030710. ref SDS 23 IA7H
720918 -  ..
720919 - CA 15-3 for the blood test today was not available in time for the
720920 - meeting, as shown in another record reporting treatment at 0840 in the
720921 - Infusion Clinic. ref SDS C7 2N5J  Subsequently, on 070403 Catherine
720922 - called and reported CA 15-3 was 33 for the test on 070329, as shown
720923 - above. ref SDS 0 087J
720924 -
720925 -        [On 070406 Millie received a letter from UCSF confirming CA
720926 -        15-3 33 for the blood test on 070329. ref SDS D0 EQ6I
720928 -  ..
720929 - Continued dramatic decline of the cancer marker CA 15-3 33, per above,
720930 - ref SDS 0 087J, aligns with clinical findings today of IBC rash
720931 - subsiding, and that there has been no expansion of IBC since
720932 - examination OA 070130 despite expanding cancer for several months
720933 - while off treatment, shown below, ref SDS 0 LB5L.  As noted, recent
720934 - research on 070328, ref SDS C6 0001 indicates that consistent decline
720935 - of cancer marker during the period of clinical trial so far in
720936 - Millie's case, and beginning on 070201, further aligns with Doctor
720937 - Rugo's assessment on 070301 finding response to treatment with
720938 - cetuximab. ref SDS B1 M68J
720939 -
720940 -
720941 -
720942 -
720943 -
720944 -
7210 -

SUBJECTS
Lymphadenopathy Axillary No Findings Left Arm Patient No Complaint S

8003 -
800401 -  ..
800402 - Axillary Left Arm No Lymphadenopathy Lymphedema Prominent
800403 - Lymphadenopathy Axillary Left Arm No Evidence Local Edema
800404 -
800405 - Follow up ref SDS B1 MW8J, ref SDS A3 MW8J.
800406 -
800407 - Patient has a long history of IBC on the left breast and associated
800408 - lymphadenopathy symptoms in the left axillary, see case study on
800409 - 040517. ref SDS 34 OW3I
800411 -  ..
800412 - Brigid examined the left axilla.  Clinical palpation made no findings
800413 - of lumps or other indications of cancer, including swelled lymph nodes
800414 - that might indicate lymphadenopathy.  The patient made no complaint of
800415 - lumps or discomfort from swelling under the left arm.  CT test on
800416 - 070326 shows no findings of lymphadenopathy, reported below.
800417 - ref SDS 0 12GK  There is no express finding that the analyst actually
800418 - looked at the left and right axillary.
800419 -
800420 -
800421 -
8005 -

SUBJECTS
Lymphedema Left Arm Swelling Increased No Evident Red Rash Inflammat

9003 -
900401 -  ..
900402 - Lymphedema Cellulitis Complications Left Arm Swelling
900403 - Swelling Left Arm Lymphedema Cellulitis Complications
900404 - Left Arm Lymphedema Cellulitis Complications Swelling Above Normal
900405 - Cellulitis Lymphedema Complications Left Arm Swelling Above Normal
900406 -
900407 - Follow up ref SDS B1 4Y93.
900408 -
900409 - Medical history of lymphedema in the left arm is reported in a case
900410 - study on 070130. ref SDS A3 VX6F
900412 -  ..
900413 - The left arm today has continued swelling from lymphedema.  Recent
900414 - measurement below the elbow was 11.5 inches, significantly increased
900415 - above previous norms reported in a study on 060509. ref SDS 73 HO7F
900417 -  ..
900418 - There wasn't enough time today for discussing correlations between
900419 - exercise to strengthen the immune system that resists cancer, and
900420 - helps dissipate emotional stress, reviewed at UCSF on 070315,
900421 - ref SDS C0 6A7J, but may compound lymphedema with increased swelling,
900422 - and complications of Cellulitis, discussed at UCSF on 070222.
900423 - ref SDS A9 GG4H  Lymphedema and Cellulitis in relation to side effects
900424 - on the cetuximab clinical study are shown below. ref SDS 0 M84I
900425 -
900426 -     [On 070330 examination at Kaiser by primary care physician finds
900427 -     significantly increased intensity of rash on upper left arm,
900428 -     ref SDS C9 N19J, and a similar new rash above the right breast and
900429 -     below the colar bone; these dramatic changes in condition were
900430 -     diagnosed without biopsy as complications of lymphedema causing
900431 -     Cellulitis with elevated temperature, and possibly triggered by
900432 -     patient's increased exercise that overtaxed the system.
900433 -     ref SDS C9 583G  Keflex antibiotics was prescribed, ref SDS C9
900434 -     474O; about 3 hours later self-examination showed these erruptive
900435 -     rash conditions had subsided, and so Keflex treatment was not
900436 -     performed. ref SDS C9 KZ6L
900437 -
900438 -
900439 -
900440 -
9005 -

SUBJECTS
IBC Left Arm Examination Stable Subsides Rash Less Intense Responds

A403 -
A40401 -  ..
A40402 - IBC Left Arm Stable Subsiding Responds Treatment Cetuximab Drug Trial
A40403 - Left Arm IBC Stable Subsiding Responds Treatment Cetuximab Drug Trial
A40404 -
A40405 - Follow up ref SDS B1 527G.
A40406 -
A40407 - Examination of upper left arm indicates IBC rash area stable and
A40408 - intensity stable to subsiding, i.e., improving by responding to
A40409 - treatment.
A40410 -
A40411 -     [On 070330 examination at Kaiser by primary care physician finds
A40412 -     significantly increased intensity of rash on upper left arm,
A40413 -     ref SDS C9 N19J, and a similar new rash above the right breast and
A40414 -     below the colar bone; these dramatic changes in condition were
A40415 -     diagnosed without biopsy as Cellulitis, possibly complications of
A40416 -     lymphedema. ref SDS C9 583G  Keflex antibiotic was prescribed,
A40417 -     ref SDS C9 474O; about 3 hours later self-examination showed these
A40418 -     erruptive rash conditions had subsided, and so Keflex treatment
A40419 -     was not performed. ref SDS C9 KZ6L
A40421 -  ..
A40422 - Aligns with declining measurable disease cancer marker CA 15-3, per
A40423 - above. ref SDS 0 UZ8N
A40425 -  ..
A40426 - Jackie took photographs for measurable disease.  Brigid held a
A40427 - measuring tape in several directions to record the spread of IBC
A40428 - inflammation in several directions, per below. ref SDS 0 EX8O
A40429 -
A40430 -
A40431 -
A40432 -
A405 -

SUBJECTS
Right Axillary Lymphadenopathy No Findings Right Arm Patient No Comp

AC03 -
AC0401 -  ..
AC0402 - Right Axillary Possible Involvement Red Rash Spreads Right Breast
AC0403 -
AC0404 - Follow up ref SDS B1 3D6K, ref SDS A3 3D6K.
AC0405 -
AC0406 - Background on patient history testing for lymphadenopathy in the right
AC0407 - axilla is reported in the record on 060929. ref SDS 85 3D6K
AC0409 -  ..
AC0410 - Examination of the right axillary yielded same negative results
AC0411 - finding no evidence of lymphadenopathy, as occurred examining the left
AC0412 - axilla, per above. ref SDS 0 VU6O  Also aligns with CT test on 070326,
AC0413 - reviewed below. ref SDS 0 12GK
AC0414 -
AC0415 -
AC0416 -
AC0417 -
AC05 -

SUBJECTS
Right Arm Examination Rash Slight Blemishes No Evidence IBC No Findi

AJ03 -
AJ0401 -  ..
AJ0402 - IBC Right Arm New Minimal Red Rash Not Diagnosed IBC or Cellulitis
AJ0403 -
AJ0404 - Follow up ref SDS B1 H15M.
AJ0405 -
AJ0406 - Background on slight red dots, rash or blemishes on the right arm is
AJ0407 - reported on 070301. ref SDS B1 H15M  Examination at that time
AJ0408 - concluded the rash is not IBC.  Further examination on 070315 reached
AJ0409 - the same conclusion, ref SDS C0 FO6H, supported by another review on
AJ0410 - 070322. ref SDS C1 LI4M
AJ0412 -  ..
AJ0413 - There is the possibility this is IBC and is responding to treatment,
AJ0414 - as with IBC in other areas listed on 070301. ref SDS B1 4140
AJ0416 -  ..
AJ0417 - Examination today yielded no change in analysis that IBC has not
AJ0418 - spread to the right arm, and Cellulitis has not occurred in the right
AJ0419 - arm.
AJ0421 -  ..
AJ0422 - Similarly, there is no evidence of side effects in the right arm from
AJ0423 - cetuximab treatment for IBC, reported further below. ref SDS 0 MF6I
AJ0425 -  ..
AJ0426 - This aligns with examination during treatment today in the Infusion
AJ0427 - Clinic. ref SDS C7 LI4M
AJ0428 -
AJ0429 -
AJ0430 -
AJ0431 -
AJ0432 -
AJ05 -

SUBJECTS
IBC Right Breast Examination Stable Subsides Rash Less Intense Respo

AS03 -
AS0401 -  ..
AS0402 - Right Breast Red Rash Spreads Possible Involvement Right Axillary
AS0403 - Red Rash Right Breast Spreads Possible Involvement Right Axillary
AS0404 -
AS0405 - Follow up ref SDS B1 T99I.
AS0407 -  ..
AS0408 - On 061204 IBC inflammation spread from the left chest area infected
AS0409 - with IBC across the sternum and slightly onto the right breast.
AS0410 - ref SDS 91 AE5I
AS0412 -  ..
AS0413 - Examination of right breast shows reduced intensity of IBC rash, and
AS0414 - there is no spreading of the rash, suggesting favorable response to
AS0415 - treatment.  At the time of examination today, CA 15-3 was not known.
AS0416 - Subsequently, report of testing this past month, including today
AS0417 - showing CA 15-3 has dropped to 36, ref SDS B1 GJ5M, seems to align
AS0418 - with observing that IBC on the right breast is subsiding.
AS0420 -  ..
AS0421 - Jackie took photographs for measurable disease.
AS0422 -
AS0423 -
AS0424 -
AS0425 -
AS05 -

SUBJECTS
Rash Chest Right Side Above Breast Below Collar Bone Above Port Cath

B203 -
B20401 -  ..
B20402 - Right Chest Rash Not Visible Above Breast and Port Catheter
B20403 - Rash Above Port Catheter on Right Upper Chest Not Visible Today
B20404 -
B20405 - Follow up ref SDS C1 KU3L, ref SDS C0 KU3L.
B20406 -
B20407 - Background on 070315 Nurse's Notes for treatment in the Infusion
B20408 - Clinic report rash above the port catheter on the right side of the
B20409 - chest, and well above the right breast.  This is a new condition not
B20410 - previously reported at Kaiser nor at UCSF.  Following review of
B20411 - Nurse's Notes there was no evident rash observed by the patient.
B20412 - ref SDS C0 KU3L  The following week, on 070322 Nurse's Notes for
B20413 - treatment report no continuing rash at this location. ref SDS C1 KU3L
B20415 -  ..
B20416 - Case study on 070130 shows erratic changes in severity/intensity of
B20417 - IBC rash on left chest area, which led to referral to UCSF.
B20418 - ref SDS A3 5N6L
B20420 -  ..
B20421 - Examination today observed no identifiable rash above the port
B20422 - catheter area on the right chest.  Brigid noted a few blemishes and
B20423 - possibly one or two may have reddish coloration.  These seem different
B20424 - from early observation of IBC on the left breast area, and on the
B20425 - stomach, and then the left arm, per patient history reported on
B20426 - 070301. ref SDS B1 H15M
B20427 -
B20428 -     [On 070330 examination at Kaiser by primary care physician finds
B20429 -     significantly increased intensity of rash on upper left arm,
B20430 -     ref SDS C9 N19J, and a similar new rash above the right breast and
B20431 -     below the colar bone; these dramatic changes in condition were
B20432 -     diagnosed without biopsy as complications of lymphedema causing
B20433 -     Cellulitis with elevated temperature, and possibly triggered by
B20434 -     patient's increased exercise that overtaxed the system.
B20435 -     ref SDS C9 583G  Keflex antibiotics was prescribed, ref SDS C9
B20436 -     474O; about 3 hours later self-examination showed these erruptive
B20437 -     rash conditions had subsided, and so Keflex treatment was not
B20438 -     performed. ref SDS C9 KZ6L
B20440 -  ..
B20441 - Discussion of side effects from cetuximab treatment for IBC is
B20442 - reported below. ref SDS 0 ID5M
B20443 -
B20444 -
B20445 -
B20446 -
B20447 -
B205 -

SUBJECTS
Left Supraclavicular Examination Palpation Neck Lymphadenopathy No F

BA03 -
BA0401 -  ..
BA0402 - Left Supraclavicular Examination PET Test Report Finding SUV 4.5
BA0403 - Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
BA0404 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
BA0405 -
BA0406 - Follow up ref SDS B1 8R6M, ref SDS A3 8R6M.
BA0407 -
BA0408 - During examination on 070130, Doctor Rugo asked about history of
BA0409 - radiation to the neck, and sequence of finding recurrence from Doctor
BA0410 - Laio's biopsy reported on 040309. ref SDS 27 0001  Background of image
BA0411 - testing, and consideration for radiation treatment of left
BA0412 - supraclavicular is reported on 060623. ref SDS 76 8R6M
BA0414 -  ..
BA0415 - Like the left and right axillary locations, examination today for
BA0416 - cancer in left supraclavicular region found no evidence of lumps or
BA0417 - other indications of lymphadenopathy, as reported above. ref SDS 0
BA0418 - VU6O CT test on 070326 shows no findings of lymphadenopathy, reported
BA0419 - below. ref SDS 0 12GK  There is no express finding that the analyst
BA0420 - actually looked at the left and right supraclavicular.
BA0421 -
BA0422 -
BA0423 -
BA05 -

SUBJECTS
IBC Left Breast Examination 2 Scenarios End Stable Area No New Sites

BR03 -
BR0401 -  ..
BR0402 - 2 Scenarios Conflict IBC Expanding Intensity Subsides
BR0403 - IBC Rash Left Breast Stomach and Back Seems to Be Subsiding
BR0404 - Examination IBC Rash Subsiding Responding to Treatment Cetuximab
BR0405 - Cetuximab Effective Treatment IBC Subsiding Left Breast Stomach Back
BR0406 -
BR0407 - Follow up ref SDS B1 025H, ref SDS A3 025H.
BR0408 -
BR0409 - Background of IBC recurrence on left breast beginning on 060623, and
BR0410 - treatment with Taxotere and capecitabine ending on 061201, with
BR0411 - subsequent progression of disease spreading to other areas is reported
BR0412 - on 070301. ref SDS B1 025H
BR0414 -  ..
BR0415 - Case study on 070130 shows erratic changes in severity/intensity of
BR0416 - IBC rash on left chest area, which led to referral to UCSF.
BR0417 - ref SDS A3 5N6L  All case studies are listed on 061018. ref SDS 87
BR0418 - 0001
BR0420 -  ..
BR0421 - Cetuximab treatment started at UCSF on 070201. ref SDS A5 G68I
BR0423 -  ..
BR0424 - Strategy for treating progression of disease was reviewed on 070301.
BR0425 - ref SDS B1 1T4O
BR0427 -  ..
BR0428 - Examination today shows intensity of IBC rash seems to continue
BR0429 - subsiding or remains stable, and there is no evident expansion of IBC
BR0430 - rash areas, and further there are no new IBC rash sites, as listed on
BR0431 - 070301. ref SDS B1 4140  Since blemishes on the right arm have not
BR0432 - been diagnosed as IBC, per above, ref SDS 0 H15M; and, the same for
BR0433 - blemishes on the right chest, also, per above, ref SDS 0 583G, the
BR0434 - current condition today is...
BR0435 -
BR0436 -            left breast chest................. 060623, ref SDS 76 025H
BR0437 -            right breast...................... 061204, ref SDS 91 AE5I
BR0438 -            stomach........................... 070130, ref SDS A3 M68J
BR0439 -            back.............................. 070130, ref SDS A3 M68J
BR0440 -            left arm.......................... 070202, ref SDS A6 6Q5N
BR0442 -  ..
BR0443 - IBC conditions of subsiding intensity and no new disease sites support
BR0444 - cancelling a meeting on 070308 to assess changing treatment protocol,
BR0445 - ref SDS B8 FO6H, possibly adding carboplatin, as part of a strategy
BR0446 - to improve effectiveness based on information available 070301.
BR0447 - ref SDS B1 T85J  At this time, treatment with cetuximab alone seems
BR0448 - effective.
BR0450 -  ..
BR0451 - At the time of examination today, CA 15-3 biomarker for the blood
BR0452 - test this morning was not known, similar to the meeting at UCSF on
BR0453 - 070301. see above. ref SDS 0 UZ8N  On 070307 CA 15-3 36 was a dramatic
BR0454 - decline of the cancer marker that seems to align with visual findings
BR0455 - that disease likely expanded before starting treatment in the clinical
BR0456 - trial on 070201, ref SDS B7 U85L, and has yielded subsiding intensity,
BR0457 - and no evident expansion of IBC sites, as observed today. ref SDS 0
BR0458 - M68J
BR0460 -  ..
BR0461 - On 070315 Millie submitted a report notifying the primary care
BR0462 - physician at Kaiser about progress with treatment for the 3rd relapse
BR0463 - of IBC with treatment starting on 070201 clinical study cetuximab at
BR0464 - UCSF. ref SDS B9 VP5N  Millie meets tomorrow at Kaiser for review.
BR0465 -
BR0466 -
BR0467 -
BR0468 -
BR05 -

SUBJECTS
Prognosis Stable Low Intensity IBC Rash Very Good Response Treatment

BY03 -
BY0401 -  ..
BY0402 - Stable Good for Treating Cancer as Chronic Disease Brigid's Rule
BY0403 - Prognosis Very Good IBC Stable Cetuximab Clinical Study
BY0404 - Stable Low Intensity IBC Rash Very Good Response to Treatment
BY0405 - Cetuximab Prognosis Good Chance IBC Rash 3rd Relapse Will Clear Up Again
BY0406 -
BY0407 - Follow up ref SDS B1 M645, ref SDS A3 M645.
BY0409 -  ..
BY0410 - Millie asked today about possible slowing subsidence of IBC rash
BY0411 - intensity?  She cited rapid response to treatment during 2005, when
BY0412 - the expanding IBC rash was nearly completely gone after 4 weeks of
BY0413 - treatment with Taxotere and capecitabine (Xeloda), reported on 050520.
BY0414 - ref SDS 58 025H
BY0416 -  ..
BY0417 - Brigid seemed to explain that for cancer, including this case of IBC,
BY0418 - "stable" conditions of low intensity rash is a "very good" response to
BY0419 - treatment for the patient, the medical team, and the clinical study.
BY0420 - There was comment that patients live for many years with disease
BY0421 - "stable."  The goal is to prevent "progression of cancer," as found
BY0422 - today. ref SDS 0 M68J
BY0424 -  ..
BY0425 - Laughed and credited Brigid with...
BY0426 -
BY0427 -        Brigid's rule:  stable is good for treating cancer as a
BY0428 -        chronic disease.
BY0430 -  ..
BY0431 - Previously, on 070315 Brigid commented that one patient has been
BY0432 - treated for 10 months without progression of her breast cancer.
BY0433 - ref SDS C0 6A9H
BY0434 -
BY0435 -    [On 070510 the patient was subsequently moved to treatment with
BY0436 -    Gemzar because disease began to progress. ref SDS D6 5P8J
BY0438 -     ..
BY0439 -    [On 091028 0830 applied Brigid's rule to continue Gemzar another
BY0440 -    cycle, during meeting at Kaiser considering treatment plan for
BY0441 -    Millie's 9th relapse. ref SDS E0 GN9H
BY0442 -
BY0443 -
BY0444 -
BY0445 -
BY05 -

SUBJECTS
Distant Metastasis No Evidence 6 Years Patient History Examinations

C603 -
C60401 -  ..
C60402 - Distant Metastasis No Evidence Patient History Examinations Tests
C60403 - Local IBC Infection No Record Distant Metastasis Improves Chances
C60404 - Prognosis Favorable No Lymphadenopathy 2006 No Distant Metastasis 5 Years
C60405 -
C60406 - Follow up ref SDS B1 FF4H, ref SDS A3 FF4H.
C60407 -
C60408 - There is no evidence of distant metastasis in internal organs,
C60409 - unchanged from the meeting at Kaiser on 070301, when CT test on 070131
C60410 - was reviewed. ref SDS A6 013T  Results of recent CT testing this past
C60411 - Monday on 070326 were not available from Kaiser at the time of the
C60412 - meeting this morning.  Subsequent review after the meeting indicate
C60413 - continuing favorable response to treatment with no findings of
C60414 - progression, shown below. ref SDS 0 EY5O
C60416 -  ..
C60417 - IBC expanding during December and January, ref SDS B1 4140, presented
C60418 - grave concern, which now seems to be coming under control again.
C60419 -
C60420 -
C60421 -
C60422 -
C605 -

SUBJECTS
Wicked Problem Resolved Disease Subsides Cetuximab Effective Treatme

CN03 -
CN0401 -  ..
CN0402 - Wicked Problem Resolved Disease Subsides ANC Rises to Safe Level
CN0403 - ANC 1.81 Blood Counts Rise Above Safe Level for Treatment with Cetuximab
CN0404 -
CN0405 - Follow up ref SDS B1 VF5M.
CN0406 -
CN0407 - Millie had a blood test this morning at 0800 in the Infusion Clinic,
CN0408 - required to start a new 4-week treatment cycle with cetuximab,
CN0409 - reported in another record. ref SDS C7 Q659  Blood tests verify the
CN0410 - immune system is strong enough for chemotherapy.  Millie is scheduled
CN0411 - to start cycle #3 today.  Starting cycle #2 on 070301 presented a
CN0412 - wicked problem.  Cancer was spreading which required increasing
CN0413 - chemotherapy; but, low blood counts prevented increasing treatment in
CN0414 - order to prevent cancer from cascading out of control. ref SDS B1 3K6H
CN0416 -  ..
CN0417 - On 070301, Doctor Rugo devised a plan based on patient history to
CN0418 - continue treatments and increase testing. ref SDS B1 528F  This was
CN0419 - successful.  A week later on 070308, testing showed that blood counts
CN0420 - rose above the level for safe treatments, ref SDS B8 WX7I, and
CN0421 - continuing treatments improved Millie's cancer marker CA 15-3 to the
CN0422 - best level in over a year. ref SDS B8 B35O
CN0424 -  ..
CN0425 - During the meeting this morning, blood test results were not
CN0426 - available.  Brigid relied on the prior results for the test on 070308
CN0427 - showing rising ANC blood counts to approve continuing treatment for
CN0428 - the next cycle.  Results for the test today were received a few hours
CN0429 - later during treatment in the Infusion Clinic and show continued
CN0430 - improvement in blood counts, ANC increased again to 1810. ref SDS C7
CN0431 - P560
CN0433 -  ..
CN0434 - Rising blood counts, together with falling cancer marker, CA 15-3
CN0435 - resolves the prior wicked problem reported on 070301. ref SDS B1 VF6O
CN0436 -
CN0437 -
CN0438 -
CN0439 -
CN05 -

SUBJECTS
Measurable Disease IBC CA 15-3 33 Cancer Marker Improves Shows Respo

D203 -
D20401 -  ..
D20402 - Measurable Disease IBC No New Sites No Expansion Intensity Declines
D20403 - Photographs Record Measurable Disease IBC Tumor in Dermal Tissue
D20404 - Measurable Disease IBC Observed with Tape Measure Photograph Pictures
D20405 - CA 15-3 Diagnostic Measurable Disease IBC Not Measured by Image Testing
D20406 -
D20407 - Follow up ref SDS B1 M652, ref SDS A3 M652.
D20408 -
D20409 - Background on measurable disease for IBC using cancer biomarker CA
D20410 - 15-3 and photographic records showing spread of cancer is reported in
D20411 - a case study on 070101. ref SDS 96 4Q6K
D20413 -  ..
D20414 - There wasn't enough time to get CA 15-3 results from the blood test
D20415 - this morning at 0800 to evaluate progression of disease, per above.
D20416 - ref SDS 0 GJ5M  Subsequently, on 070403 CA 15-3 33 was reported, and
D20417 - continues the trend showing substantial response to treatment, which
D20418 - means cetuximab continues to be effective treating IBC, cited in the
D20419 - examination today, per above. ref SDS 0 M68J
D20421 -  ..
D20422 - Procedures to assess measureable disease of IBC inflammation were
D20423 - developed and used for the previous two (2) cycles on 070301,
D20424 - ref SDS B1 EX8O, and earlier on 070201. ref SDS A5 6T6M
D20426 -  ..
D20427 - Jackie and Brigid took pictures again today for the clinical study
D20428 - protocol to show measurable disease of IBC has not expanded, and that
D20429 - intensity of rash sites has subsided, since evaluation of the previous
D20430 - cycle on 070301, also, reported above. ref SDS 0 M68J   Brigid held a
D20431 - tape measure in several directions at each IBC site.  Measurements
D20432 - were entered in the Medical Chart.  Jackie used a camera to take
D20433 - pictures with the tape measure in each position to clarify the
D20434 - meaning of the measurements, since IBC inflammation presents randomly
D20435 - with no consistent boundary.
D20436 -
D20437 -     [On 070426 measurements were taken, and photographs to make sense
D20438 -     of the data were not taken for some reason. ref SDS D3 F15J
D20440 -  ..
D20441 - Jackie advised that pictures of IBC rash are not digitized, and so
D20442 - cannot be transmitted electronically.  There is no written analysis of
D20443 - the photographic record to describe quantification of changes in
D20444 - measurable disease.
D20445 -
D20446 -
D20447 -
D20448 -
D20449 -
D205 -

SUBJECTS
Lung Cancer No Discussion Metastatic Disease Nodes Doctor's Progress

DA03 -
DA0401 -  ..
DA0402 - Lung Cancer Lymph Nodes Doctor's Progress Notes Medical Chart
DA0403 - Metastatic Cancer Lung Lymph Node Progress Notes Medical Chart
DA0404 -
DA0405 - Follow up ref SDS B1 G25K, ref SDS A3 G25K.
DA0406 -
DA0407 - Background is reported on 070130 in the record meeting with Doctor
DA0408 - Rugo at UCSF. ref SDS A3 G25K
DA0410 -  ..
DA0411 - Findings for the CT test on 070326 (shown below, ref SDS 0 DA6Q)...
DA0412 -
DA0413 -               Lungs
DA0414 -
DA0415 -               The previously described 4 very small 2-3mm nodules are
DA0416 -               all stable.  No new lung nodules identified. no
DA0417 -               interstitial disease.  Scarring in the left apex is
DA0418 -               stable. ref SDS 0 5S6L
DA0419 -
DA0420 - ...do not support concern about lung cancer first reported in Kaiser's
DA0421 - Medical Chart on 061208, ref SDS 92 G25K, since there has been no
DA0422 - change for 5 years, noted in case study on patient history on 070117,
DA0423 - per above, ref SDS 0 5S6L,
DA0425 -  ..
DA0426 - Finding no "interstitial disease" further indicates this side effect
DA0427 - of cetuximab treatment has not occurred in Millie's case so far.
DA0428 - ref SDS 0 5S6L  Interstitial lung disease was listed in the clincial
DA0429 - study Consent documents received from UCSF on 070116. ref SDS A0 0256
DA0430 -
DA0431 -         [On 070330 primary care physician noted that Kaiser did not
DA0432 -         perform thin slice spiral CT test ordered by the doctor to
DA0433 -         evaluate pulmonary embolism in connection with related risks
DA0434 -         of cetuximab treatment for IBC ordered on referral to UCSF.
DA0435 -         ref SDS C9 NU55
DA0437 -  ..
DA0438 - There was no discussion of this issue today, so that attention could
DA0439 - focus on assessing Millie's response to treatment for IBC.
DA0440 -
DA0441 -
DA0442 -
DA0443 -
DA0444 -
DA05 -

SUBJECTS
Biopsy Left Right Breasts Left Arm Erratic Changes Intensity Rash In

DF03 -
DF0401 -  ..
DF0402 - Biopsy Erratic Changes Rash Intensity Verify IBC Left Arm
DF0403 -
DF0404 - Follow up ref SDS B1 KT7J, ref SDS A3 KT7J.
DF0405 -
DF0406 - Background on biopsy to diagnose erratic rash on left and right chest
DF0407 - is reported in the record on 070130. ref SDS A3 KT7J  On 070202 a new
DF0408 - rash was observed on the upper left arm, ref SDS A6 JP6F, which has
DF0409 - since been considered expanding IBC, reported on 070222. ref SDS A9
DF0410 - B643  This new rash on the left arm has not been verified by biopsy,
DF0411 - as reported on 070202. ref SDS A6 JP6L  More recently consideration of
DF0412 - possible rash on right arm is reported on 070301. ref SDS B1 KT7J
DF0414 -  ..
DF0415 - There was no discussion today of taking biopsies to verify diagnosis
DF0416 - of rash on the left arm. ref SDS B1 527G   The rash on the right arm
DF0417 - was also not biopsied. ref SDS B1 H15M
DF0418 -
DF0419 -
DF0420 -
DF0421 -
DF05 -

SUBJECTS
CT Test Distant Metastasis No Findings Lymphadenopathy Cancer CT Sca

DK03 -
DK0401 -  ..
DK0402 - CT Test 070326 No Findings Metastatic Disease
DK0403 -
DK0404 - Follow up ref SDS B1 EY5O, ref SDS A3 EY5O.
DK0405 -
DK0406 - Report on results for the CT test on 070326, ref SDS C3 VP5N, was
DK0407 - received today after the meeting.  Findings of no metastatic disease,
DK0408 - ref SDS 0 LV57, aligns with patient history showing no evidence of
DK0409 - regional nor distant metastasis, reported previously on 070202.
DK0410 - ref SDS A6 GB8J
DK0412 -         ..
DK0413 -        Test History No Evidence Distant Metastasis
DK0414 -        Distant Metastasis No Evidence 5 Years Imaging Tests
DK0415 -
DK0416 -        Follow up ref SDS A6 GB8J, ref SDS 97 1Y8G.
DK0417 -
DK0418 -        Type    Date           Received          Source
DK0419 -         CT     070326 reported on 070329........... ref SDS 0 DA6Q
DK0420 -         CT     070131 reported on 070202........... ref SDS A6 1Y8G
DK0421 -         PET/CT 061227 reported on 070102........... ref SDS 97 1Y8G
DK0422 -         CT     060930 reported on 061012........... ref SDS 86 284J
DK0423 -         MRI    060708 reported on 060711........... ref SDS 77 PT4K
DK0424 -         Xray   060623 reported on 060711........... ref SDS 77 WJ6G
DK0425 -         CT     060505 reported on 060523........... ref SDS 74 E355
DK0426 -         PET    060414 reported on 060428........... ref SDS 72 WJ6G
DK0427 -         PET    060120 reported on 060126........... ref SDS 70 WJ6G
DK0428 -         PET/CT 051005 reported on 051007........... ref SDS 66 WJ6G
DK0429 -         CT     050530 reported on 050610........... ref SDS 60 G75L
DK0430 -         CT     050325 reported on 050422........... ref SDS 57 G75L
DK0431 -         CT     041217 reported on 041230........... ref SDS 47 G75L
DK0432 -         CT     041103 reported on 041104........... ref SDS 45 WV7H
DK0433 -         CT     040921 reported on 041005........... ref SDS 43 NL4N
DK0434 -         CT     040710 reported on 040811........... ref SDS 40 H85S
DK0435 -         CT     040410 reported on 040416........... ref SDS 29 HX4K
DK0436 -         CT     040307 reported on 040318........... ref SDS 29 LK5L
DK0437 -         CT     031031 reported on 031205........... ref SDS 25 IG9K
DK0438 -         CT     030626 reported on 030710........... ref SDS 23 AL6N
DK0439 -         CT     030428 reported on 030508........... ref SDS 21 LK5L
DK0440 -         PET    021218 reported on 030109........... ref SDS 19 LK5L
DK0441 -         PET    020529 reported on 020603........... ref SDS 9 0001
DK0442 -
DK0444 -         ..
DK0445 -        Patient        Personal Physician     71/F Radiology Report
DK0449 -         ..
DK0450 -        CT Scan Chest, Abdomen and Pelvis with Contrast (Digital)
DK0453 -         ..
DK0454 -        Ordered on 03/26/2007 17:09 at WCR OUTPATIENT
DK0456 -
DK0457 -
DK0458 -
DK0459 -
DK05 -

SUBJECTS
CT Test 070326 History Identifies Breast Cancer Mistakes Testing Fai

DY03 -
DY0401 -     ..
DY0402 -    History Missing Context Pulmonary Embolism Enlarged Right Ventricle
DY0403 -
DY0404 -    Follow up ref SDS A6 0Z6O.
DY0406 -         ..
DY0407 -        HISTORY
DY0408 -
DY0409 -            Recurrent metastatic breast cancer. On clinical trial at
DY0410 -            UCSF.
DY0412 -  ..
DY0413 - This report repeats past practice on 070131 omitting context of
DY0414 - patient history on pulmonary embolism and Cor Pulmonale heart disorder
DY0415 - enlarged right ventricle, reported on 070202. ref SDS A6 0Z6O
DY0417 -  ..
DY0418 - Background on the importance of context is also presented on 070202.
DY0419 - ref SDS A6 4I3N
DY0421 -  ..
DY0422 - CT test report continues...
DY0423 -
DY0424 -        Methods
DY0425 -
DY0426 -            Scans were done through the chest, abdomen and pelvis in
DY0427 -            the axial projection.
DY0429 -             ..
DY0430 -            IV contrast: Yes
DY0431 -            Oral contrast: Yes
DY0432 -            Reformations: No
DY0433 -
DY0434 -
DY0435 -
DY0436 -
DY05 -

SUBJECTS
CT Test 070326 Comparison Failed Perform Context Management Missing

EF03 -
EF0401 -     ..
EF0402 -    Comparison:  070131 061230 060930 Prior Related Tests Omitted
EF0403 -
EF0404 -    Follow up ref SDS A6 0136, ref SDS 97 AK9H.
EF0406 -         ..
EF0407 -        Comparison [omitted]
EF0409 -  ..
EF0410 - On 070202 the doctor planned to order comparison with the CT test on
EF0411 - 060930 that diagnosed pulmonary embolism by performing another spiral
EF0412 - CT test for pulmonary embolism and enlarged left ventricle (Cor
EF0413 - Pulmonale) with the test for measurable disease required to assess
EF0414 - progression of disease on the clinical study at UCSF.  At that time,
EF0415 - the doctor requested a one month reminder to order the test and
EF0416 - comparison for pulmonary embolism. ref SDS A6 P45O   Millie notified
EF0417 - Kaiser on 070302 to order the thin slice spiral CT test along with
EF0418 - testing for the clinical trial at the end of the month. ref SDS B3
EF0419 - EZ6T  On 070306 Millie asked Kaiser about progress ordering the CT
EF0420 - test. ref SDS B6 HS3X  This was followed up the next day on 070307.
EF0421 - ref SDS B7 044V  Kaiser submitted feedback later on 070307 affirming
EF0422 - the doctor was reminded to order the CT test, ref SDS B7 9Z9N, which
EF0423 - was subsequently scheduled for 070326, as planned on 070202.
EF0425 -  ..
EF0426 - On 070326 Millie went to Kaiser for the test, and was advised by CT
EF0427 - technician that the Imaging Department at Kaiser failed to specify the
EF0428 - thin slice spiral CT scan ordered by the doctor to test for pulmonary
EF0429 - embolism and enlarged right ventricle (Cor Pulmonale). ref SDS C3 SK8L
EF0431 -  ..
EF0432 - Kaiser's report received today for the CT test on 070326 does not have
EF0433 - a section for Comparison, unlike all the other CT test reports over
EF0434 - the past 6 years, shown above. ref SDS 0 DA8O  This compounds mistakes
EF0435 - in the CT test on 070131, which made "comparison" with only a single
EF0436 - test on 060505, and even that incomplete comparison was incorrectly
EF0437 - presented, reported on 070202. ref SDS A6 1J41
EF0439 -                ..
EF0440 -               [On 070330 primary care physician at Kaiser seemed to
EF0441 -               advise that reference to "interstitial disease" in
EF0442 -               Kaiser's report on the CT test does not relate to
EF0443 -               pulmonary embolism, and that there is no indication in
EF0444 -               the report that Kaiser performed the test ordered by the
EF0445 -               doctor for pulmonary embolism. ref SDS C9 B74K
EF0447 -  ..
EF0448 - Failure to perform the doctor's order for evaluation to diagnose,
EF0449 - plan, and prescribe treatment in the context of patient history
EF0450 - continues prior problems reported in a study on 061012. ref SDS 86
EF0451 - A55J
EF0453 -  ..
EF0454 - Numerous references to "stable" suggest the reader, ref SDS 0 1I69,
EF0455 - made comparisons with something, otherwise there is no basis for
EF0456 - findings of "stable."
EF0458 -  ..
EF0459 - Comparisons Kaiser made are needed in order to assess and implement
EF0460 - findings of the CT test report.
EF0462 -  ..
EF0463 - In particular, on 070307 the doctor ordered comparison with the CT
EF0464 - test on 060930 that found recurrence of pulmonary embolism,
EF0465 - ref SDS 86 294Q, and also found a new problem described as "enlarged
EF0466 - right ventricle". ref SDS 86 7E5L  Research indicates this new problem
EF0467 - presents a heart disorder of Cor Pulmonale. ref SDS 86 IM5J  The
EF0468 - purpose of comparison between the recent CT test on 070326, and the
EF0469 - test on 060930 is illustrated by comparison Kaiser made between tests
EF0470 - on 041217 and 041103, reported on 041230. ref SDS 47 WZ6H, and which
EF0471 - yielded findings that pulmonary embolism in a CT test on 041103 was no
EF0472 - longer visualized. ref SDS 47 PW3K
EF0474 -  ..
EF0475 - Additionally, the doctor and patient need current findings on severity
EF0476 - of enlarged right ventricle, reported on 061012, ref SDS 86 7E6G, and
EF0477 - discussed with the doctor on 070105, ref SDS 98 VJ4J, and again on
EF0478 - 070202, ref SDS A6 P45O, leading to the current CT test on 070326,
EF0479 - which, as shown today, failed again to implement the doctor's order.
EF0480 - ref SDS 0 0136
EF0481 -
EF0482 -
EF0483 -
EF05 -

SUBJECTS
CT Test 070326 Findings No Cancer Lymphadenopathy No Evidence Metast

EM03 -
EM0401 -     ..
EM0402 -    CT Scan Failed Ignored Doctor's Order Test for Pulmonary Embolism
EM0403 -    Cancer No Findings Lymphadenopathy No Evidence Metastatic Disease
EM0404 -
EM0405 -    Follow up ref SDS A6 013T, ref SDS 97 RG4J.
EM0407 -         ..
EM0408 -        FINDINGS
EM0410 -             ..
EM0411 -            Chest CT:
EM0412 -
EM0413 -               Mediastinum: No abnormally enlarged lymph nodes.
EM0414 -
EM0415 -               Great Vessels stable.
EM0417 -             ..
EM0418 -            Heart: Normal
EM0420 -             ..
EM0421 -            Hila: No abnormally enlarged lymph nodes
EM0423 -             ..
EM0424 -            Lungs:
EM0425 -
EM0426 -               The previously described 4 very small 2-3mm nodules are
EM0427 -               all stable.  No new lung nodules identified. no
EM0428 -               interstitial disease.  Scarring in the left apex is
EM0429 -               stable.
EM0431 -  ..
EM0432 - Stable 4 2-3 mm nodules in the lungs, have been stable for 4 years,
EM0433 - reported in case study on 070117, ref SDS A1 RY6K, and so does not
EM0434 - seem to support diagnosis of lung cancer, also, reviewed on 070117,
EM0435 - ref SDS A1 NM6G, and citing original entry in the Medical Chart
EM0436 - reported on 061208. ref SDS 92 G25K
EM0438 -  ..
EM0439 - "Interstitial disease" is listed as a side effect of cetuximab in the
EM0440 - clinical study constent documents received from UCSF on 070116.
EM0441 - Shortness of breath is the main symptom, ref SDS A0 0256
EM0443 -  ..
EM0444 - Research on the Internet seems to associate pulmonary embolism and
EM0445 - "interstitial disease" which may indicate this test resolves prior
EM0446 - findings in the test on 060930, as reported on 061012. ref SDS 86 294Q
EM0447 - Lack of detail in this test, and failure to present comparison data
EM0448 - makes findings indeterminate on this issue.  Failure to state
EM0449 - expressly that previous pulmonary embolism is no longer visualized as
EM0450 - reported on 041230, ref SDS 47 PW3K, adds to confusion interpreting
EM0451 - the test on 070326.
EM0453 -  ..
EM0454 - On 070326 Millie was advised by CT technician that Imaging Department
EM0455 - failed to follow the doctor's order to test for pulmonary embolism
EM0456 - with spiral CT technology. ref SDS C3 SK8L
EM0458 -  ..
EM0459 - The CT scan test report makes no findings on continuing, increased,
EM0460 - decreased, or resolved lung disorders of pulmonary embolism blood
EM0461 - clots, and hear disorders enlarged right ventricle Cor Pulmonale,
EM0462 - which aligns with the History section that fails to recognize these
EM0463 - disorders, ref SDS 0 GH5L; as well, there is no comparison with the
EM0464 - test on 060930 to show enable trend analysis, per above. ref SDS 0
EM0465 - 0136
EM0467 -                ..
EM0468 -               [On 070330 primary care physician at Kaiser seemed to
EM0469 -               advised that reference to "interstitial disease" in
EM0470 -               Kaiser's report on the CT test does not relate to
EM0471 -               pulmonary embolism, and that there is no indication in
EM0472 -               the report that Kaiser performed the test ordered by the
EM0473 -               doctor for pulmonary embolism.
EM0475 -  ..
EM0476 - CT Test Findings continue...
EM0477 -
EM0478 -            Pleura: Normal
EM0480 -             ..
EM0481 -            Effusions: None
EM0483 -             ..
EM0484 -            Bony thorax and soft tissues:
EM0485 -
EM0486 -                S/P left mastectomy.  Portacath remains in right
EM0487 -                anterior chest wall entering rt subclavian vein.
EM0489 -             ..
EM0490 -            ABDOMEN CT:
EM0491 -
EM0492 -                Liver: Normal size. Cyst in the dome unchanged.
EM0493 -                Gallbladder and bile ducts: Normal
EM0495 -                 ..
EM0496 -                Spleen:
EM0497 -
EM0498 -                    Stable. Calcified granuloma and calcified splenic
EM0499 -                    artery aneurysm are stable.
EM0501 -                 ..
EM0502 -                Pancreas: Normal
EM0503 -                Right Kidney: Normal
EM0504 -                Left Kidney: Normal
EM0505 -                Adrenal glands: Normal
EM0506 -                Aorta: Normal
EM0507 -                Adenopathy: No abnormally enlarged lymph nodes.
EM0508 -                Ascites: None
EM0510 -                 ..
EM0511 -                Bowel and Mesentery:
EM0512 -
EM0513 -                   Normal. Diverticuli in the sigmoid colon.
EM0515 -             ..
EM0516 -            Pelvis CT: Stable.
EM0517 -
EM0519 -         ..
EM0520 -        IMPRESSION **:
EM0521 -
EM0522 -            Stable chest, abdomen and pelvis CT. No evidence of
EM0523 -            metastatic disease.
EM0525 -         ..
EM0528 -         ..
EM0529 -        DD: 03/27/2007 DT: 03/27/2007 CDS
EM0530 -
EM0531 -
EM0532 -
EM0533 -
EM0534 -
EM06 -

SUBJECTS
Emotional Trauma Stress Moderate Pulse Normal Cancer Subsides Confid

EY03 -
EY0401 -  ..
EY0402 - Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
EY0403 - Exercise Vigor Strength Engagement Ease Distress Living with Cancer
EY0404 - Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
EY0405 -
EY0406 - Follow up ref SDS B1 Y642, ref SDS A3 Y642.
EY0407 -
EY0408 - Medical issues create an emotional roller coaster explained on 070105,
EY0409 - ref SDS 98 Y642, and reviewed on 070301. ref SDS B1 Y642  Stress and
EY0410 - trauma are compounded with rising complexity of case history, listed
EY0411 - above. ref SDS 0 LU3J
EY0413 -  ..
EY0414 - Millie's vitals are calmer today, e.g., pulse below 60, reported in
EY0415 - patient history for treatment today after examination by Brigid and
EY0416 - Jackie. ref SDS C7 AW4L
EY0418 -  ..
EY0419 - Increased energy and fitness from reduced side effects, discussed
EY0420 - below, ref SDS 0 TQ6L, enables vigorous exercise that moderates
EY0421 - emotional swings and worry, reviewed previously on 070315. ref SDS C0
EY0422 - 6A7J
EY0424 -  ..
EY0425 - Additionally....
EY0426 -
EY0427 -        1.  IBC stable and subsiding...... 070329, ref SDS 0 M68J
EY0429 -             ..
EY0430 -        2.  CA 15-3 33 continuing decline
EY0431 -            to lowest level in over a
EY0432 -            year.......................... 070329, ref SDS 0 087J
EY0434 -             ..
EY0435 -        3.  ANC 1810 (neuts 1.81) rising
EY0436 -            to level for safe chemotherapy
EY0437 -            treatment and reversing long
EY0438 -            decline....................... 070329, ref SDS 0 VF5M
EY0440 -             ..
EY0441 -        4.  CT test showing no evidence
EY0442 -            of distant metastasis.......... 070329, ref SDS 0 LV57
EY0443 -
EY0444 - ...all significantly relieve stress and worry reported previously on
EY0445 - 070301, ref SDS B1 XU6M, and discussed with Brigid during the meeting
EY0446 - on 070315. ref SDS C0 6A7J
EY0448 -  ..
EY0449 - Millie explained this morning that living with cancer brings continual
EY0450 - worry about progression of disease, and effectiveness of treatment,
EY0451 - including how life will change with decline from disease.  As noted,
EY0452 - this moderates with good medical news the past month, ref SDS 0 XU6M,
EY0453 - but is always present since chronic metastatic disease has a natural
EY0454 - inevitability.
EY0456 -  ..
EY0457 - Stress increases from communication difficulties described generally
EY0458 - on 070301, ref SDS B1 O24J, and reviewed again with the UCSF medical
EY0459 - team on 070315, ref SDS C0 OR5K, citing stress coordinating schedule
EY0460 - for the CT test on 070326, and shown by case study on 070307.
EY0461 - ref SDS B7 G56L  Continuing communication issues compound emotional
EY0462 - stress, reviewed with coordination, above. ref SDS 0 S63K
EY0463 -
EY0464 -               [...below difficulty sleeping may reflect emotional
EY0465 -               stress, and side effects of cetuximab treatment for IBC.
EY0466 -               ref SDS 0 MR99
EY0467 -
EY0468 -
EY0469 -
EY05 -

SUBJECTS
Sleeping Difficulty Worry Emotional Trauma Stress Prognosis Cetuxima

FA03 -
FA0401 -  ..
FA0402 - Sleeping Difficulty Worry Cancer Health Issues Medical Management
FA0403 -
FA0404 - Follow up ref SDS C1 NG3I.
FA0405 -
FA0406 - Millie has not been sleeping well the past few weeks, and has trouble
FA0407 - falling asleep after going to the bathroom, a possible side effect of
FA0408 - cetuximab, along with worry about cancer, per above, ref SDS 0 IS8G,
FA0409 - and emotional stress coordinating complex communications. ref SDS 0
FA0410 - II7H  Difficulty sleeping was previously reviewed last week on 070322.
FA0411 - ref SDS C1 NG3I
FA0413 -  ..
FA0414 - Brigid indicated this morning that difficulty sleeping can be a side
FA0415 - effect of cetuximab, discussed further below. ref SDS 0 TQ6L  Getting
FA0416 - 4.5 hours of continuous sleep is a target for good health.
FA0418 -  ..
FA0419 - Millie feels she generally gets at least 4 5 hours of continuous
FA0420 - sleep.  She has Atavin previously prescribed at Kaiser, which aids
FA0421 - getting to sleep when problems seem overwhelming, also, reported on
FA0422 - 070322, ref SDS C1 NG4N, citing work at Kaiser to cope with anxiety
FA0423 - from 3rd relapse of IBC, beginning on 060721. ref SDS 78 FZ5N
FA0424 -
FA0425 -
FA0426 -
FA0427 -
FA0428 -
FA05 -

SUBJECTS
Strategy 3 Issues Resolved Sucessfully Work Plan Continue Weekly Tre

FM03 -
FM0401 -  ..
FM0402 - Planning Case Management from Patient Profile Work Up
FM0403 - Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
FM0404 - Strategy Cetuximab Continued with Low ANC Expanding IBC Disease
FM0405 -
FM0406 - Follow up ref SDS B1 K36G, ref SDS A3 K36G.
FM0407 -
FM0408 - Background is reported on 070301. ref SDS B1 K36G  Coordination issues
FM0409 - are presented above. ref SDS 0 RM4G
FM0411 -  ..
FM0412 - Doctor Rugo's strategy was effective resolving issues on 070301,
FM0413 - ref SDS B1 1T4O, noted by examination today, per above. ref SDS 0 M68J
FM0415 -  ..
FM0416 - Evident success of current treatment, including declining CA 15-3 33
FM0417 - to lowest level in over a year, and IBC rash subsiding significantly,
FM0418 - with no new sites, indicates successful strategy continuing weekly
FM0419 - treatments with cetuximab alone, and preserving additional treatment
FM0420 - by adding carboplatin when disease progresses, planned on 070130,
FM0421 - ref SDS A3 N13L, and discussed with the primary care physician at
FM0422 - Kaiser on 070202. ref SDS A6 QO6O
FM0424 -  ..
FM0425 - Consideration of pulmonary embolism and Cor Pulmonale heart disorder
FM0426 - of enlarged right ventricle seem to require no change in treatment
FM0427 - strategy, since Millie has gained energy with reduction of former
FM0428 - shortness of breath, after ending treatment with Taxotere and
FM0429 - capecitabine on 061201.
FM0430 -
FM0431 -
FM0432 -
FM0433 -
FM0434 -
FM05 -

SUBJECTS
Treatment IBC 10th Cycle 3rd Relapse 3rd Cycle 1st Treatment Chemoth

FT03 -
FT0401 -  ..
FT0402 - Treatment 3rd Cycle Cetuximab Carboplatin 070329 10th Cycle 3rd Relapse
FT0403 - 10th Cycle Treatment IBC 3rd Relapse 3rd Cycle Cetuximab Clinical Study
FT0404 - Cetuximab 3rd Cycle 1st Treatment IBC 3rd Relapse Clinical Study Drug Trial
FT0405 -
FT0406 - Follow up ref SDS B1 PF3O, ref SDS A3 PF3O.
FT0407 -
FT0408 - Patient history of cetuximab treatments is listed in the record today
FT0409 - for working with the Infusion Clinic. ref SDS C7 7T3H
FT0411 -  ..
FT0412 - Examination today supported approval for Millie to start cycle #3
FT0413 - treatment with cetuximab alone, in accordance with strategy, discussed
FT0414 - above. ref SDS 0 1R9H
FT0416 -  ..
FT0417 - Brigid reviewed the UCSF Chemotherapy Order on 070201 that guides
FT0418 - Millie's treatment in the Infusion Clinic, ref SDS A5 IJ41, and which
FT0419 - was considered in the record for treatment last week on 070322.
FT0420 - ref SDS C1 WR4H
FT0422 -  ..
FT0423 - Brigid reduced the prescription for pre-treatment Benadryl from 50 mg
FT0424 - to 25 mg in order to reduce side effects of "restless legs," discussed
FT0425 - below. ref SDS 0 MF6N   There was no change to the prescription that
FT0426 - pre-treatment with Benadryl and Decadron should be given 30 - 60
FT0427 - minutes before treatment with cetuximab. ref SDS C1 IJ41
FT0428 -
FT0429 -        [On 070329 "restless legs" problem with Benadryl resolved with
FT0430 -        Brigid's change in treatment dose. ref SDS C7 F77K
FT0432 -  ..
FT0433 - Following the meeting with the doctor, treatment was given today at
FT0434 - 0900 in the Infusion Clinic, reported in another record, ref SDS C7
FT0435 - 1M6H  Blood vials were drawn for drug trial research required for the
FT0436 - cetuximab clinical study, ref SDS C7 O56V, ordered by Jackie, reported
FT0437 - on 070328. ref SDS C4 5V6J
FT0438 -
FT0439 -
FT0440 -
FT0441 -
FT0442 -
FT05 -

SUBJECTS
Side Effects Cetuximab Acne-like Rash Face Dry Skin Face Chest Arms

G703 -
G70401 -  ..
G70402 - Side Effects Cetuximab Similar Symptoms Pulmonary Embolism
G70403 - Energy Strength Rising Minimal Side Effects Cetuximab Treatment
G70404 - Facial Skin Dryness New Side Effect Cetuximab Curel Lotion Prescribed
G70405 - Curel Lotion Prescribed Facial Skin Dryness New Side Effect Cetuximab
G70406 -
G70407 - Follow up ref SDS B1 TQ6L.
G70408 -
G70409 - On 070326 Millie submitted a list of side effects for discussion
G70410 - today, ref SDS C2 627X, citing recent review on 070322, ref SDS C1
G70411 - QU8K, and prepared under the doctor/patient partnership model, set out
G70412 - in Kaiser's Healthwise Handbook, shown on 990625. ref SDS 3 4185
G70414 -  ..
G70415 - Jackie disclosed this morning there was no coordination to prepare for
G70416 - discussing side effects today. ref SDS 0 945F  Brigid did not get the
G70417 - list, also, above. ref SDS 0 W25L  She asked Millie if she remembers
G70418 - any side effects?
G70420 -  ..
G70421 - Millie advised that her energy seems restored, continuing favorable
G70422 - report on 070315, ref SDS C0 J18M, and presented in the list of side
G70423 - effects on 070322. ref SDS C1 CA4K
G70425 -  ..
G70426 - Millie explained difficulty sleeping, which can be aided by Atavin,
G70427 - discussed above. ref SDS 0 MR99  This may be a side effect of
G70428 - cetuximab, and/or an emotional response coping with cancer, discussed
G70429 - above, ref SDS 0 IS8G, and further coping with complex communications
G70430 - required to coordinate effective treatment. ref SDS 0 II7H
G70432 -  ..
G70433 - Brigid commented on how well Millie looks.  Her skin seems soft and
G70434 - smooth, with little evidence of acne-like rash associated with
G70435 - cetuximab.  Millie feels fortunate to have genetically avoided severe
G70436 - side effects of facial rash, and that treatment Brigid prescribed on
G70437 - 070222 has been effective. ref SDS A9 FO66
G70438 -
G70439 -        [On 070330 primary care physician at Kaiser comments on how
G70440 -        well Millie looks. ref SDS C9 N49K
G70442 -         ..
G70443 -        [On 070418 Millie writes to UCSF with copy to Kaiser advising
G70444 -        she cannot remember feeling better. ref SDS D1 PY6W
G70446 -  ..
G70447 - Millie reported having further followed Brigid's guidance on 070301 to
G70448 - use Curel lotion for reducing dry skin. ref SDS B1 5V73  Brigid
G70449 - recalled there was initial improvement reported during examination on
G70450 - 070315. ref SDS C0 6B8H  Last week on 070322 treatment was
G70451 - supplemented with Aquaphor, recommended by the UCSF pharmacy.
G70452 - ref SDS C1 JS6M  Skin dryness, including flaking and peeling on the
G70453 - chest and arms continue, but the combination of Curel and Aquaphor
G70454 - seem to help, as noted by Brigid this morning.
G70456 -  ..
G70457 - That was all anyone could remember.
G70459 -  ..
G70460 - Experience preparing the list of side effects yielded comments by the
G70461 - nurse in the Infusion Clinic on 070315 reporting a new rash on the
G70462 - right chest, and cited in the list on 070322. ref SDS C1 KU3L  Whether
G70463 - this is a side effect of cetuximab, IBC, or something else is not
G70464 - known, per above. ref SDS 0 583G  Brigid examined this area and noted
G70465 - no evidence of rash today, per above. ref SDS 0 BI5K
G70467 -  ..
G70468 - Brigid examined Millie's right arm.  She commented that various minor
G70469 - blemishes fit the model of normal skin, and show no evidence of rash,
G70470 - including IBC rash, as reported on 070322, ref SDS C1 LI4M, and
G70471 - discussed above. ref SDS 0 H15M
G70473 -  ..
G70474 - The list on 070322 presents "restless legs." ref SDS C1 F77K   Brigid
G70475 - seemed to comment that increasing the time from 10 to 20 minutes would
G70476 - not relieve "restless legs" problems.  She changed the prescription in
G70477 - the Chemotherapy Order for pre-treatment with Benadryl from 50 mg to
G70478 - 25 mg, per above. ref SDS 0 WS3F
G70480 -  ..
G70481 - There was no discussion of lymphedema and complications of Cellulitis
G70482 - which present problems that limit exercise to strengthen the immune
G70483 - system for resisting cancer, listed on 070322, ref SDS C1 SU6L, and
G70484 - shown above in connection with monitoring the left arm. ref SDS 0 4Y93
G70485 - Possible correlations and solutions with respect to side effects of
G70486 - treatment with cetuximab for IBC, were not considered because
G70487 - coordination was not supported to prepare for the meeting today, per
G70488 - above. ref SDS 0 945F
G70489 -
G70490 -     [On 070330 examination at Kaiser by primary care physician finds
G70491 -     significantly increased intensity of rash on upper left arm,
G70492 -     ref SDS C9 N19J, and a similar new rash above the right breast and
G70493 -     below the colar bone; these dramatic changes in condition were
G70494 -     diagnosed without biopsy as complications of lymphedema causing
G70495 -     Cellulitis with elevated temperature, and possibly triggered by
G70496 -     patient's increased exercise that overtaxed the system.
G70497 -     ref SDS C9 583G  Keflex antibiotic was prescribed, ref SDS C9
G70498 -     474O; about 3 hours later self-examination showed these erruptive
G70499 -     rash conditions had subsided, and so Keflex treatment was not
G70500 -     performed. ref SDS C9 KZ6L
G70501 -
G70502 -        [On 070607 recurrent cellulitis diagnosed during examination at
G70503 -        UCSF for treatment of IBC with cetuximab, ref SDS D7 8H3I;
G70504 -        condition worsened during treatment in the Infusion Clinic,
G70505 -        temperature over 102, ref SDS D7 8J37; UCSF treated Millie with
G70506 -        ceftriaxone antibiotics, ref SDS D7 8J9R, cellulitis seemed to
G70507 -        subside, and temperature dropped to 101.4, UCSF released Millie
G70508 -        to go home, ref SDS D7 8J5C; Kaiser prescribed outpatient
G70509 -        ceftriaxone antibiotics for 5 days. ref SDS D7 8L46
G70510 -
G70511 -
G70512 -
G706 -

SUBJECTS
Cetuximab Clinical Study UCSF Drug Trial Subsiding Stable IBC Metast

GF03 -
GF0401 -  ..
GF0402 - Clinical Study Cetuximab Treatment UCSF Begins 070201
GF0403 - UCSF Clinical Study Treatment Cetuximab Drug Trial Begins 070201
GF0404 - Drug Trials UCSF Has Other Clinical Study Treatments May Help Millie
GF0405 -
GF0406 - Follow up ref SDS B1 ZJ9N, ref SDS A3 ZJ9N.
GF0407 -
GF0408 - Background on Kaiser referral to UCSF for treatment on clinical study
GF0409 - is reported on 070105. ref SDS 98 P256  Purpose of referral is to
GF0410 - improve patient care with new treatment. ref SDS 98 PK7L  Case study
GF0411 - on Kaiser and UCSF collaborating to expedite treatment is listed on
GF0412 - 070130, ref SDS A3 4T5N, and reviewed again today, per above.
GF0413 - ref SDS 0 RM4G
GF0415 -  ..
GF0416 - Consideration on 070301 to upgrade treatment by adding carboplatin for
GF0417 - better effectiveness than cetuximab alone, ref SDS B1 NY7N was
GF0418 - unnecessary, because Doctor Rugo's strategy was effective on 070308,
GF0419 - discussed further above. ref SDS 0 X68N
GF0421 -  ..
GF0422 - Millie recovering with cetuximab treatment alone, and no
GF0423 - carboplatin...
GF0424 -
GF0425 -        1.  Clinical examination shows IBC inflammation subsiding.
GF0426 -            ref SDS 0 M68J,
GF0427 -
GF0428 -        2.  CA 15-3 testing shows evidence of cancer falling.
GF0429 -            ref SDS 0 087J
GF0431 -             ..
GF0432 -        3.  CT testing finds no evidence of metastatic disease.
GF0433 -            ref SDS 0 LV57
GF0435 -  ..
GF0436 - Jackie coordinated on 070327 to schedule blood draw for seven (7)
GF0437 - vials today, required to start the next cycle on the cetuximab study.
GF0438 - ref SDS C4 407N  This was successful this morning with blood drawn in
GF0439 - the Infusion Clinic. ref SDS C7 Q659
GF0440 -
GF0441 -
GF0442 -
GF0443 -
GF05 -

SUBJECTS
Schedule Treatment Cetuximab 070329 Weekly Through 070524 Clinical S

GN03 -
GN0401 -  ..
GN0402 - Schedule Treatment Start Cetuximab Carboplatin 070201
GN0403 -
GN0404 - Follow up ref SDS B1 N96O, ref SDS A3 N96O.
GN0405 -
GN0406 - Scheduling has proven a continuing challenge, listed above.
GN0407 - ref SDS 0 S63K
GN0409 -  ..
GN0410 - On 070315 Nola in the Infusion Clinic scheduled Millie for weekly
GN0411 - treatments through May 24th. ref SDS C0 159O  This aligns with
GN0412 - examination today showing current protocol has been effective, per
GN0413 - above. ref SDS 0 M68J and further fits the strategy. ref SDS 0 K36G
GN0415 -  ..
GN0416 - Meetings and treatments continue on Thursdays, so the next treatment
GN0417 - at UCSF will be on 070405.
GN0418 -
GN0419 -
GN0420 -
GN0421 -
GN0422 -
GN05 -

SUBJECTS
Pulmonary Embolism Blood Clots Lungs Enlarged Right Ventricle Heart

H003 -
H00401 -  ..
H00402 - Tired Breathing Difficulty Routine Activity Signals Pulmonary Emboli
H00403 - Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
H00404 - Pulmonary Emboli Hypercoagulable Work Up PET Scan Test Compare History
H00405 -
H00406 - Follow up ref SDS B1 CV5L, ref SDS A3 CV5L.
H00407 -
H00408 - Background on pulmonary embolism and correlation with IBC treatment at
H00409 - UCSF is reported in the record meeting at UCSF on 070130. ref SDS A3
H00410 - CV5L  Doctor Rugo planned to avoid overlooking symptoms of pulmonary
H00411 - embolism that appear similar to side effects of chemotherapy
H00412 - treatment. ref SDS A3 MO7K  The plan called for a CT test to evaluate
H00413 - cancer and to also check for pulmonary embolism. ref SDS A3 915J   The
H00414 - CT test the next day on 070131, however, failed to do this, reported
H00415 - on 070202. ref SDS A6 TN6N  At that time, on 070202 the primary care
H00416 - physician at Kaiser planned to correct the problem by ordering a
H00417 - spiral CT test for pulmonary embolism with Millie's next test for the
H00418 - clinical study at UCSF. ref SDS A6 T85K  The doctor was reminded on
H00419 - 070307 to order a spiral CT test. ref SDS B7 9Z9N
H00421 -  ..
H00422 - Kaiser performed a CT test on 070326, but failed to perform the thin
H00423 - slice spiral CT test ordered by the doctor to evaluate pulmonary
H00424 - embolism and enlarged right ventricle, reported above, ref SDS 0 0136,
H00425 - repeating past mistakes.
H00427 -  ..
H00428 - At this time, status of pulmonary embolism remains unknown, which
H00429 - presents a risk to the patient getting treatment with cetuximab,
H00430 - since side effects can compound existing heart and lung problems,
H00431 - reported in research at....
H00432 -
H00433 -        About Drug Finder
H00434 -        Cetuximab
H00435 -        Patient Education
H00436 -
H00437 -              http://gsm.about.com/compact/showtext.asp?cpnum=2710&monotype=full&gname=Cetuximab&r=6078
H00439 -         ..
H00440 -        In a small number of patients, cetuximab has caused or
H00441 -        worsened lung disease. If you notice difficulty breathing,
H00442 -        increased shortness of breath, or other changes in your
H00443 -        breathing, notify your health care provider.
H00445 -  ..
H00446 - Millie's energy has improved, indicating reduced risk.  She continues
H00447 - increased exercise at the gym.  Recently Millie hiked the trail at
H00448 - Lafayette reservoir for the first time in about a year.
H00450 -  ..
H00451 - Affirmative test evidence with a this slice spiral CT scan supports
H00452 - assumptions from absence of clinical symptoms, e.g., hear attack
H00453 - caused by highly lethal conditions like pulmonary embolism, reported
H00454 - on 060722. ref SDS 79 BI5J  Activities like tennis that spikes the
H00455 - heart rate reported on 070218, ref SDS A8 N06R, must performed with a
H00456 - level of care that reduces benefits.
H00457 -
H00458 -
H00460 -  ..
H00461 - INR 2.4 Blood Test Patient Stable for Coumadin Treatments Pulmonary Emboli
H00462 -
H00463 - Follow up ref SDS B1 FE9I.
H00464 -
H00465 - Brigid advised that the blood test this morning shows INR 2.4.  This
H00466 - was confirmed an hour or so later, ref SDS C7 SE6N, when Diane
H00467 - submitted the blood test report, while Millie was getting treatment in
H00468 - the Infusion Clinic. ref SDS C7 A64L
H00470 -  ..
H00471 - INR 2.4 today indicates Millie has stabilized conditions that reduce
H00472 - risks of pulmonary embolism with the current Coumadin treatment
H00473 - regimen.  Favorable status supports relying on monthly blood tests
H00474 - currently scheduled at UCSF, reported on 070315, ref SDS C0 159O, and
H00475 - planned in the letter to Kaiser on 070302. ref SDS B3 X84G  This
H00476 - schedule was discussed with Gloria a week later on 070307. ref SDS B7
H00477 - 723G
H00479 -  ..
H00480 - These results need to be submitted to Gloria at Kaiser's Coagulation
H00481 - Control Clinic in Martinez, CA to prescribe Coumadin treatments for
H00482 - pulmonary embolism, as set out Millie's letter to UCSF on 070326,
H00483 - ref SDS C2 627T, and discussed with Jackie the next day on 070327.
H00484 - ref SDS C4 MT6Y
H00485 -
H00486 -    [On 070330 letter to Kaiser notified Gloria of INR stable blood
H00487 -    tests for past 2 months; continuing current Coumadin regimen.
H00488 -    ref SDS C8 ZH4H
H00489 -
H00490 -
H00491 -
H00492 -
H005 -

SUBJECTS
Examination Stethoscope No Findings Enlarged Right Ventricle Heart S

H803 -
H80401 -  ..
H80402 - Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
H80403 -
H80404 - Follow up ref SDS B1 Q35O, ref SDS A3 Q35O.
H80405 -
H80406 - Examination with a stethoscope today included multiple locations on
H80407 - Millie's back and chest.  Brigid reported no findings of cardio
H80408 - pulmonary issues from the clinical examination.  This method aligns
H80409 - with the practice at Kaiser, reported on 061020, ref SDS 88 PC6H,
H80410 - citing research on 061012 on monitoring heart disorder of enlarged
H80411 - right ventricle, Cor Pulmonale. ref SDS 86 IR5T
H80413 -  ..
H80414 - SaO2 diagnostic for oxygenated blood cited at Kaiser, on 061208,
H80415 - ref SDS 92 1E5G, to indicate cardio-pulmonary functioning due to
H80416 - pulmonary embolism, including enlarged right ventricle, was tested
H80417 - three (3) times today during treatment after the examination, and was
H80418 - consistently above 98%, demonstrating no immediate danger. ref SDS C7
H80419 - AW4L
H80420 -
H80421 -
H80422 -
H80423 -
H805 -

SUBJECTS
Enlarged Right Ventricle Heart Disorder Cor Pulmonale Related Pulmon

HI03 -
HI0401 -  ..
HI0402 - Cor Pulmonale Heart Disorder Enlarged Right Ventricle
HI0403 - Heart Examination Not Ordered Investigate Enlarged Right Ventricle
HI0404 - Enlarged Right Ventricle CT Test Aligns Patient Symptoms How Serious
HI0405 -
HI0406 - Follow up ref SDS B1 VJ4J, ref SDS A3 VJ4J.
HI0407 -
HI0408 - Background on heart disorder Cor Pulmonale from enlarged right
HI0409 - ventricle, and plans for CT testing is reported on 070130. ref SDS A3
HI0410 - VJ4J  Kaiser failed to perform the spiral CT test ordered by the
HI0411 - primary care physician to evaluate enlarged right ventricle, reported
HI0412 - above. ref SDS 0 0136
HI0414 -  ..
HI0415 - This issue is closely related to pulmonary embolism, reported by the
HI0416 - primary care physician on 061228. ref SDS 94 JU7L  Continued subsiding
HI0417 - of symptoms for pulmonary embolism reported on 070301, ref SDS B1
HI0418 - SX6N, and again today signal Cor Pulmonale, also, seems under control,
HI0419 - however, the actual status is unknown, per above. ref SDS 0 E44L
HI0421 -  ..
HI0422 - During the meeting at Kaiser on 070202, the primary care physician did
HI0423 - not make referral for examination by a heart specialist, nor to get a
HI05 -       dmill test, ref SDS A6 UN9F, discussed by Doctor Rugo during the