CONTACTS 

SUBJECTS
Meeting Examination Doctor 14th Review Start Treatment #16 After Mas

1403 -
1403 -    ..
1404 - Summary/Objective
1405 -
140501 - Follow up ref SDS D5 0000. ref SDS B9 0000.
140502 -
140503 - CT scans, ref SDS 0 EY5O, and blood test diagnostics, ref SDS 0 087J,
140504 - indicate improvement treating IBC.  Rash that spread during transition
140505 - for referral to UCSF has not increased, and intensity of all sites has
140506 - subsided, most notably the left chest area.  Examination today
140507 - indicates Millie has responded well to treatment with cetuximab alone
140508 - on clinical study. ref SDS 0 025H  Sudden increasing intensity of rash
140509 - on the upper left arm with IBC, ref SDS 0 T87G, and new rash on the
140510 - upper right chest occurred with elevated temperature, and following
140511 - increased exercise, suggesting complications of lymphedema rather than
140512 - rising IBC, especially in light of falling CA 15-3. ref SDS 0 7C8G
140513 - Keflex antibiotics were prescribed to treat Cellulitis in line with
140514 - patient history.  In this case, the rash subsided substantially within
140515 - a few hours, so Keflex treatment was deferred pending consultation at
140516 - UCSF. ref SDS 0 N75M  Kaiser failed to perform the thin slice spiral
140517 - CT test ordered by the doctor to evaluate pulmonary embolism and
140518 - enlarged right entricle. ref SDS 0 B74K  Hectic schedule creates
140519 - stress that creates mistakes using conversation for communication of
140520 - critical details.  Lack of feedback loops increases mistakes.  Worry
140521 - about medical mistakes failing to perform procedures and tests ordered
140522 - by the doctor increases emotional stress. ref SDS 0 ZG6I  Favorable CT
140523 - and blood test results bring relief from the stress of cancer.
140524 - ref SDS 0 Y642
140525 -
140526 -        [On 070426 examination at UCSF approve start 4th cycle clinical
140527 -        study cetuximab alone. ref SDS E0 0001
140529 -         ..
140530 -        [On 070524 examination at UCSF approve start 5th cycle clinical
140531 -        study cetuximab alone. ref SDS E1 0001
140533 -         ..
140534 -        [On 070607 recurrent cellulitis diagnosed during examination at
140535 -        UCSF for treatment of IBC with cetuximab, ref SDS E3 8H3I;
140536 -        condition worsened during treatment in the Infusion Clinic,
140537 -        temperature over 102, ref SDS E3 8J37; UCSF treated Millie with
140538 -        ceftriaxone antibiotics, ref SDS E3 8J9R, cellulitis seemed to
140539 -        subside, and temperature dropped to 101.4, UCSF released Millie
140540 -        to go home, ref SDS E3 8J5C; Kaiser prescribed outpatient
140541 -        ceftriaxone antibiotics for 5 days. ref SDS E3 8L46
140542 -
140543 -
140544 -
140546 -  ..
1406 -
1407 -
1408 - Progress
1409 -
140901 - Agenda Develop Work Plan Stage IV Breast Cancer 15 Mos after Mastectomy
140902 -
140903 - Follow up ref SDS D5 SM6M, ref SDS B9 SM6M.
140905 -  ..
140906 - This is the 14th physician meeting and follows starting the 10th
140907 - chemotherapy cycle since treatment began on 060711, ref SDS 80 SM6M,
140908 - for the 3rd relapse of IBC. ref SDS 80 8Y8I  This is the 2nd meeting
140909 - with the primary care physician at Kaiser to review progress on
140910 - referral for treatment through clinical study that began 070201.
140911 - Millie met at UCSF yesterday to start the 3rd cycle of weekly
140912 - treatments with cetuximab. ref SDS D5 0001  Background on referral to
140913 - UCSF is reported in the record on 070105. ref SDS A5 PK68  The doctor
140914 - had a hectic schedule, and so the meeting scheduled to start at 1540
140915 - actually started at 1717, as shown in the Medical Chart. ref SDS 0
140916 - I49O  The doctor seemed tired, ref SDS 0 V66M, and will get a much
140917 - needed vacation next week.
140919 -  ..
140920 - Complete patient history of treatments for IBC 3rd relapse is reported
140921 - in the record of treatment following the meeting today. ref SDS D6
140922 - SG8I
140924 -  ..
140925 - Agenda for meeting at Kaiser on 070202 provides a structure for
140926 - planning the meeting today...
140927 -
140928 -    1.  CA 15-3 33 improvement......................... ref SDS 0 GJ5M
140929 -    2.  Lymphedema restricts exercise.................. ref SDS 0 4Y93
140930 -    3.  Breast exam IBC stable subsides................ ref SDS 0 025H
140931 -    4.  Side effects minimal........................... ref SDS 0 TQ6L
140932 -    5.  CT no distant metastasis, no test for PE....... ref SDS 0 EY5O
140933 -    6.  Patient work up continue strategy.............. ref SDS 0 K36G
140934 -    7.  Treatment plan weekly clinical trial........... ref SDS 0 PF3O
140935 -    8.  Pulmonary emboli how serious r ventricle....... ref SDS 0 CV5L
140937 -  ..
140938 - Scheduled next meeting for Thursday 070524 1100, to review progress
140939 - treating IBC at UCSF on clinical study, and for general patient care,
140940 - as reported below. ref SDS 0 N96O
140941 -
140942 -
140943 -
140944 -
140945 -
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 D5 LU3J, ref SDS B9 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 Cor 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 Blood Pressure Pulse Temperature 99.4 Slight Fever SaO2 Weigh

2903 -
290401 -  ..
290402 - Vitals Show Stable Medical Condition with Slight Temp 99.4
290403 -
290404 - Follow up ref SDS D5 KB5L, ref SDS B9 KB5L.
290405 -
290406 - Millie had a slight temperature today, 99.4, which may relate to
290407 - elevated rash, possibly Cellulitis, discussed below. ref SDS 0 4Y93
290408 - Lower than usual pulse at 52 was not discussed.
290410 -                           ..
290411 -                          Bld Prssr   Pulse   Temp   Weight  SaO2
290412 -     ..
290413 -    070330 1540............ 136 92     52     99.4    150     98%
290414 - *  070329 0800............  [see treatment record, ref SDS D6 7T3H]
290415 - *  070301 1330............  [see treatment record, ref SDS C0 AW4L]
290416 - *  070130 1300............ 140 83     87     98
290417 -    070105 1040............
290418 -    061208 1226............ 152 90     76     97.8    147     99%
290419 -    061201 1430............ 123 76     76     97.5
290420 -    061110................. 136 83     73     97.0    150     98%
290421 -    061020 1534............ 140 79     67     99.8    151     97
290422 -    060929 1452............ 141 78     66     98.3
290423 -    060908 1335............ 139 79     73     98.1
290424 -    060814 1610............ 139 80     59     98.2
290425 - *  060808.................
290426 -    060711................. 172 87     54     97.5    147
290427 -    060623................. 141 87     71     98.0    147     99%
290428 -    060428................. 129 73     80     99.4    149     99%
290429 -    060217................. 153 81     61     98.6    150     99%
290430 -
290431 - *  For some reason, vitals not submitted.
290433 -  ..
290434 - High blood pressure reflects pressure on patient worrying about
290435 - effectiveness of new treatment and arrangements between UCSF and
290436 - Kaiser for timely care, discussed on 070130, ref SDS A9 Y642, and
290437 - again last month on 070301. ref SDS B9 Y642
290439 -  ..
290440 - Today, Millie's vitals are mostly normal, similar to yesterday during
290441 - treatment at UCSF, ref SDS D6 AW4L, indicating reduced emotional
290442 - strain at this time, as discussed at UCSF on 070315, ref SDS C8 6A7J,
290443 - and again during examination yesterday ref SDS D5 Y642
290444 -
290445 -
290446 -
290447 -
2905 -

SUBJECTS
Coordination Plan Communication Collaboration UCSF Kaiser Referral K

8003 -
800401 -  ..
800402 - Coordination Plan Divided Responsibilities Kaiser UCSF Referral
800403 - Collaboration Primary Care at Kaiser with UCSF Clinical Study Cetuximab
800404 -
800405 - Follow up ref SDS D5 RM4G, ref SDS B9 RM4G.
800406 -
800407 - Coordination and teamwork between Kaiser and UCSF has been complex,
800408 - exposing risks to stakeholders, reported in the record meeting at UCSF
800409 - yesterday on 070329, ref SDS D5 RM4G, including case study,
800410 - ref SDS D5 S63K, that extends initial study on 070130. ref SDS B0 2X6L
800412 -  ..
800413 - On 070215 the doctor advised that coordination is critical to satisfy
800414 - requirements of clinical study for treating IBC with cetuximab at
800415 - UCSF. ref SDS B5 HK5O  Today, Kaiser prescribed treatment without
800416 - coordination, because there wasn't enough time to check the record due
800417 - a hectic schedule, per below. ref SDS 0 V66M
800419 -  ..
800420 - Medical Chart for today fails to list lab results for blood test on
800421 - 070329, shown below, ref SDS 0 128S, illustrates impact of poor
800422 - coordination on referral cases.
800424 -  ..
800425 - Kaiser's Medical Chart can display the CT test for 070326 on the
800426 - doctor's computer, but not for the doctor at UCSF.  Similarly,
800427 - computers at UCSF display blood tests on 070329, but doctors at Kaiser
800428 - cannot find tests for Millie's blood work on their computers.  Blood
800429 - tests and image tests are complementary; each supports the other.
800430 - This record indicates referral hospitals can access half of patient
800431 - diagnostics, and are missing the other half needed to make sense of
800432 - the half that is available.  This reduces effectiveness of teamwork
800433 - for patient care on referral.
800435 -  ..
800436 - Case management of Coumadin treatment for pulmonary embolism presents
800437 - similar teamwork problems coordinating blood test results from UCSF
800438 - for use in Kaiser's computer system by the Coagulation Control Clinic,
800439 - reported on 070307. ref SDS C4 UA3L  This morning Millie submitted a
800440 - letter coordinating blood test work at UCSF with Kaiser's work
800441 - prescribing treatment to manage pulmonary embolism, below. ref SDS 0
800442 - 793M
800444 -  ..
800445 - Kaiser's Team Care model suffers equally.
800447 -  ..
800448 - Coordination between Kaiser Oncology and the Imaging department places
800449 - patients at risk.  Failure to perform doctor's orders, reviewed below
800450 - in connection with CT tests, ref SDS 0 0136, prevents timely diagnosis
800451 - and treatment, and undermines communication essential for effective
800452 - care, called out in Kaiser's Healthwise Handbook, reviewed on 990625.
800453 - ref SDS 3 4185
800455 -  ..
800456 - Poor communication reduces coordination, driving up the high cost of
800457 - medical mistakes, reported on 990912. ref SDS 4 0001
800459 -  ..
800460 - Today, the doctor advised that he will be on vacation for the next few
800461 - weeks.  Arlette assisted using the computer to schedule Millie's next
800462 - meeting at Kaiser, per below. ref SDS 0 UI8N  A few weeks ago, she
800463 - reported on 070309 the doctor wanted Arlette to avoid coordinating
800464 - work with email on Millie's case, ref SDS C6 VP73, arising from issues
800465 - on 070307, ref SDS C4 9Z9N, to correct problems on 070301. ref SDS B9
800466 - MP58  Today, everything went smoothly with Arlette assisting doctor
800467 - and patient.
800469 -  ..
800470 - The doctor further advised today that coordination with email can go
800471 - through Michele.  This solves the problem reported on 070123, when
800472 - Millie tried to coordinate directly with the doctor, and was notified
800473 - that the doctor was not available, on vacation, out of the office,
800474 - etc. ref SDS A8 LP4L
800475 -
800476 -        [On 070418 Millie sent a copy to Michele for coordinating with
800477 -        the doctor based on correspondence to UCSF explaining findings
800478 -        today of new rash activity, and that the rash quickly subsided,
800479 -        ref SDS D9 UP4F, so it was not necessary to take Keflex
800480 -        prescribed today, per below. ref SDS 0 KZ6L
800481 -
800482 -
800483 -
800484 -
8005 -

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

8803 -
880401 -  ..
880402 - CA 15-3 Cancer Marker 36 Showing Significant Improvement
880403 -
880404 - Follow up ref SDS D5 087J, ref SDS B9 087J.
880405 -
880406 - Millie had a blood test yesterday morning at UCSF; results reported a
880407 - few days later on 070403 show CA 15-3 33 continuing decline from 36,
880408 - set out in the record getting treatment on 070329. ref SDS D6 A16M
880409 - This is well below the Kaiser standard of 39, however, UCSF standard
880410 - is 31, so 33 is still a bit high by this standard...
880412 -           ..
880413 -         Test Date                         Date Received
880414 -          070329......... 33 H............. 070329, ref SDS D6 2N5J
880415 -          070301......... 36 H............. 070307, ref SDS C0 A16M
880416 -          070215......... 52 H............. 070307, ref SDS B4 ER5O
880417 -          070208......... 55 H...31........ 070307, ref SDS B4 ER5O
880418 -          070201.....cetuximab begins...... 070201, ref SDS B2 G68I
880419 -          070131......... 56 H............. 070202, ref SDS B3 087J
880420 -          070123......... 52 H............. 070202, ref SDS B3 087J
880421 -          070118......... 68 H............. 070123, ref SDS A8 GK5B
880422 -          070104......... 56 H............. 070110, ref SDS A6 087J
880423 -          061218......... 74 H............. 061227, ref SDS A0 6P9F
880424 -          061214......... 63 H............. 061227, ref SDS A0 6P9F
880425 -          061201....Pause treatments..... . 061201, ref SDS 96 GJ5M
880426 -          061130......... 67 H............. 061201, ref SDS 96 087J
880427 -          061116......... 66 H............. 061201, ref SDS 96 087J
880428 -          061110......... 56 H............. 061201, ref SDS 96 087J
880429 -          061109......... 61 H............. 061110, ref SDS 94 087J
880430 -          061026......... 57 H............. 061110, ref SDS 94 087J
880431 -          061019......... 56 H............. 061020, ref SDS 91 087J
880432 -          060928......... 51 H............. 060929, ref SDS 88 087J
880433 -          060907......... 68 H............. 060929, ref SDS 88 087J
880434 -          060813......... 73 H............. 060817, ref SDS 85 U24M
880435 -          060809......... 87 H............. 060810, ref SDS 84 2N5J
880436 -          060721..Taxotere capecitabine.... 060721, ref SDS 81 0001
880437 -          060708......... 71 H............. 060711, ref SDS 80 087J
880438 -          060616......... 63 H............. 060623, ref SDS 79 UQ5Q
880439 -          060522......... 59 H............. 060605, ref SDS 78 UQ5Q
880440 -          060501......... 49 H............. 060522, ref SDS 77 MC4F
880441 -          060421......... 44 H............. 060428, ref SDS 75 087J
880442 -          060330......... 40 H............. 060428, ref SDS 75 087J
880443 -          060303......... 36............... 060428, ref SDS 75 087J
880444 -          060210......... 33............... 060217, ref SDS 74 087J
880445 -          060109......... 34............... 060126, ref SDS 73 KV59
880446 -          051223......... 34............... 060106, ref SDS 72 087J
880447 -          051202......... 28............... 060106, ref SDS 72 087J
880448 -          051116......... 31............... 051121, ref SDS 71 087J
880449 -          051109......... 30............... 051121, ref SDS 71 087J
880450 -          051102......... 34............... 051121, ref SDS 71 087J
880451 -          051021..Mastectomy surgery....... 051021, ref SDS 70 0001
880452 -          050916...end treatment........... 050916, ref SDS 68 407N
880453 -          050909......... 45 H............. 051007, ref SDS 69 087J
880454 -          050826......... 45 H............. 050913, ref SDS 67 087J
880455 -          050819......... 45 H............. 050913, ref SDS 67 087J
880456 -          050812......... 39 .............. 050819, ref SDS 66 3K6L
880457 -          050729......... 45 H............. 050819, ref SDS 66 EA5G
880458 -          050708......... 46 H............. 050729, ref SDS 65 087J
880459 -          050701......... 37 .............. 050729, ref SDS 65 087J
880460 -          050617......... 45 H............. 050729, ref SDS 65 087J
880461 -          050527......... 56 H............. 050610, ref SDS 63 087J
880462 -          050512......... 67 H............. 050520, ref SDS 61 087J
880463 -          050506......... 80 H............. 050520, ref SDS 61 087J
880464 -  ..
880465 -          050415.........105 H............. 050422, ref SDS 60 087J
880466 -          050415..Taxoter capecitabie begin 050415, ref SDS 59 407N
880467 -          050325.........100 H............. 050329, ref SDS 58 087J
880468 -          050318.........101 H............. 050325, ref SDS 57 2N5J
880469 -          050304......... 88 H............. 050311, ref SDS 55 087J
880470 -          050225......... 95 H............. 050308, ref SDS 54 0001
880471 -          050211......... 78 H............. 050214, ref SDS 53 02BB
880472 -          050128......... 67 H............. 050204, ref SDS 52 087J
880473 -          050104...AC start treatment...... 050104, ref SDS 51 407N
880474 -          041228......... 56 H............. 041230, ref SDS 50 087J
880475 -          041204......... 43 H............. 041210, ref SDS 49 087J
880476 -          041021...Taxol bevczmb ends...... 041021, ref SDS 46 0001
880477 -          041007......... 39............... 041104, ref SDS 47 087J
880478 -          040923......... 49 H............. 041005, ref SDS 45 087J
880479 -          040908......... 44 H............. 040909, ref SDS 44 087J
880480 -          040825......... 47 H............. 040909, ref SDS 44 087J
880481 -          040811......... 42 H............. 040812, ref SDS 43 087J
880482 -          040728......... 43 H............. 040729, ref SDS 41 2N5J
880483 -          040712......... 47 H............. 040713, ref SDS 40 087J
880484 -          040614......... 55 H............. 040615, ref SDS 39 PX6X
880485 -          040517......... 78 H............. 040601, ref SDS 37 2N5J
880486 -          040420...Taxol bevczmb starts.... 040420, ref SDS 35 9Z5J
880487 -          040311......... 70 H............. 040318, ref SDS 30 SM6M
880488 -          040205......... 60 H............. 040211, ref SDS 27 SM6M
880489 -          031201......... 62 H............. 031205, ref SDS 26 SM6M
880490 -          030912......... 66 H............. 030915, ref SDS 25 SM6M
880491 -          030708......... 68 H............. 030710, ref SDS 24 SM6M
880492 -          030503......... 54 H............. 030508, ref SDS 22 SM6M
880493 -          030403......... 45 H............. 030508, ref SDS 22 SM6M
880494 -          030215......... 46 H............. 030220, ref SDS 21 5E6L
880495 -          030106......... 37 H............. 030109, ref SDS 20 SM6M
880496 -          021204..Adjuvant chemo ends...... 021204, ref SDS 19 SQ5I
880497 -          021202......... 41 H?............ 021204, ref SDS 19 SP5G
880498 -          021111......... 36 H?............ 021113, ref SDS 18 Y65I
880499 -          021023......... 33 H?............ 021023, ref SDS 17 SQ5I
880500 -          020930......... 33 H?..39........ 021002, ref SDS 16 SQ5I
880501 -          020917......... 36 H?............ 020924, ref SDS 15 SQ5I
880502 -          020717......... 59 H?............ 020726, ref SDS 14 YN5K
880503 -          020629......... 75 H ............ 020705, ref SDS 13 UX6I
880504 -          020608........  67 H ............ 020614, ref SDS 12 0001
880505 -          020603........ 108 H ............ 020607, ref SDS 11 X67F
880506 -          020511........ 117 H ............ 020603, ref SDS 10 PJ4J
880507 -          020419......... 81 H ............ 020430, ref SDS 9 7N5H
880508 -          020321......... 85 H ............ 020405, ref SDS 8 6T8K
880509 -
880510 -
880511 -
880512 -
880514 -  ..
8806 -
8807 -
8808 - Analysis
8809 -
880901 - CA 15-3 33 Cancer Marker Strong Response to Treatment Cetuximab
880902 -
880903 - Follow up ref SDS D5 GJ5M, ref SDS B9 GJ5M.
880904 -
880905 - Research and confidence in biomarkers to improve early detection, and
880906 - accurate assessment for response to treatment of cancer was reported
880907 - recently on 070328. ref SDS D4 0001
880909 -  ..
880910 - Background on Millie's patient history applying CA 15-3 is shown in a
880911 - case study on 030710. ref SDS 24 IA7H
880913 -  ..
880914 - On 070315, Millie reported blood test results showing CA 15-3 fell
880915 - significantly to 36. ref SDS C7 HR9G  The doctor was very pleased by
880916 - favorable response to treatment with cetuximab on referral to UCSF.
880917 - ref SDS C7 E43H  A few days after the meeting today, on 070403 CA 15-3
880918 - fell further during the past month to 33, which aligned with
880919 - examination yesterday at UCSF, ref SDS D5 Q48G, and again today at
880920 - Kaiser. ref SDS 0 Z85L  This further aligned with rising ANC to levels
880921 - that support continuing treatments with cetuximab. ref SDS 0 VF5M
880923 -         ..
880924 -        [On 070406 Millie received a letter from UCSF confirming CA
880925 -        15-3 33 for the blood test on 070329. ref SDS D8 EQ6I
880927 -  ..
880928 - Today, alignment was less certain, because there seemed to be elevated
880929 - intensity of rash on the left arm, ref SDS 0 527G, and there was a new
880930 - and prominent small rash on the right chest above the breast and below
880931 - the collar bone. ref SDS 0 583G  Close correlation between patient
880932 - history of rising IBC rash and CA 15-3 cancer marker, listed on
880933 - 070130, ref SDS A9 SE9O, together with elevated temperature today,
880934 - yielded confidence that sudden new rash today is less likely rising
880935 - IBC than Cellulitis or side effects of cetuximab. ref SDS 0 7C8G
880936 -
880937 -
880938 -
880939 -
880940 -
8810 -

SUBJECTS
Lymphadenopathy Axillary No Findings Left Arm Patient No Complaint S

9603 -
960401 -  ..
960402 - Axillary Left Arm No Lymphadenopathy Lymphedema Prominent
960403 - Lymphadenopathy Axillary Left Arm No Evidence Local Edema
960404 -
960405 - Follow up ref SDS D5 MW8J, ref SDS B9 MW8J.
960406 -
960407 - Patient has a long history of IBC on the left breast and associated
960408 - lymphadenopathy in the left axillary, see case study on 040517.
960409 - ref SDS 36 OW3I
960411 -  ..
960412 - Examination of the left axilla palpated no findings suggestive of
960413 - Lymphadenopathy, and aligns with examination at UCSF yesterday.
960414 - ref SDS D5 VU6O
960416 -  ..
960417 - The CT test on 070326 makes no findings of lymphadenopathy, shown in
960418 - the record meeting at UCSF yesterday on 070329, ref SDS D5 12GK,
960419 - though no indication the analyst actually looked at the left and right
960420 - axillary, also, reported yesterday. ref SDS D5 VU6O
960421 -
960422 -
960423 -
960424 -
960425 -
9605 -

SUBJECTS
Lymphedema Left Arm Swelling Rash Upper Left Arm Increased Intensity

AA03 -
AA0401 -  ..
AA0402 - Lymphedema New Complications Elevated Rash Upper Left Arm
AA0403 - Swelling Rash Left Arm Lymphedema Complications Above Normal
AA0404 - Left Arm Lymphedema Cellulitis Complications Swelling Above Normal
AA0405 - Rash Lymphedema Complications Left Arm Swelling Above Normal
AA0406 -
AA0407 - Follow up ref SDS D5 4Y93, ref SDS B9 4Y93.
AA0408 -
AA0409 - Medical history of lymphedema in the left arm is reported in a case
AA0410 - study on 070130. ref SDS A9 VX6F
AA0412 -  ..
AA0413 - There wasn't enough time yesterday during the meeting at UCSF to
AA0414 - discuss correlations between exercise, ref SDS D5 RV8O, to strengthen
AA0415 - the immune system that resists cancer, and relieves stress, reviewed
AA0416 - at UCSF on 070315, ref SDS C8 6A7J, but may compound lymphedema with
AA0417 - increased swelling, and complications of Cellulitis, discussed at UCSF
AA0418 - on 070222. ref SDS B7 GG4H  Similarly, there wasn't enough time for
AA0419 - coordination to distribute the list of side effects for comprehensive
AA0420 - review yesterday. ref SDS D5 M84I
AA0422 -  ..
AA0423 - This morning, Millie worked out in the gym, doing exercises, lifting
AA0424 - weights, and riding the stationary bike.  A few hours prior to meeting
AA0425 - with the doctor Millie hiked around the reservoir at Lafayette park,
AA0426 - about 2.5 miles.
AA0428 -  ..
AA0429 - The left arm today has continued swelling from lymphedema, reported at
AA0430 - UCSF yesterday on 070329. ref SDS D5 4Y93  The doctor further observed
AA0431 - elevated intensity of rash on the upper left arm, and wrapping toward
AA0432 - the under arm at the same location reported on 070202. ref SDS B3 JP6F
AA0433 - A few weeks later on 070222, Brigid diagnosed this new rash location
AA0434 - on the upper arm as IBC. ref SDS B7 B64F  Since that time, the rash
AA0435 - has gotten less intense, responding to treatment on the cetuximab
AA0436 - clinical study, reported yesterday at UCSF on 070329. ref SDS D5 527G
AA0438 -  ..
AA0439 - Sudden elevated intensity of rash today, especially compared to
AA0440 - examination yesterday at UCSF reporting subsiding intensity,
AA0441 - ref SDS D5 527G, was therefore startling, and may present worsening
AA0442 - IBC conditions along with the new rash also seen today on the right
AA0443 - chest above the right breast, explained below. ref SDS 0 583G
AA0445 -  ..
AA0446 - Rising intensity of IBC on the left arm seems conflicting with patient
AA0447 - history of declining CA 15-3, per above. ref SDS 0 UZ8N
AA0449 -  ..
AA0450 - Increased rash intensity could also be a side effect of cetuximab
AA0451 - treatment for IBC, cited in product documentation reviewed on 070116,
AA0452 - ref SDS A7 MH4Q, complications of lymphedema causing Cellulitis, or
AA0453 - some combination, noted previously by the doctor in a letter on
AA0454 - 070315. ref SDS B5 HK5O
AA0456 -  ..
AA0457 - The doctor noticed elevated temperature today, 99.4, per above.
AA0458 - ref SDS 0 KB5L  Similar elevated temperature on 061027, ref SDS 92
AA0459 - 3N8K, and increased rash inflammation on the left arm, ref SDS 92
AA0460 - WO6N, like today, was treated for Cellulitis, ref SDS 92 V759, which
AA0461 - required treatment in the hospital for 5 days with discharge on
AA0462 - 061101. ref SDS 93 JR9N
AA0464 -  ..
AA0465 - Millie has a long history of erratic changes in rash intensity and
AA0466 - spreading, which was mostly Cellulitis, shown in a case study on
AA0467 - 070130. ref SDS A9 SE9O
AA0469 -  ..
AA0470 - The doctor further noticed patient history listed in the record
AA0471 - meeting with Doctor Rugo at UCSF on 070130, ref SDS A9 VX6F, which
AA0472 - shows Millie's left arm relapsed with Cellulitis on 061112,
AA0473 - ref SDS 95 HP52, and required treatment again at Kaiser. ref SDS 95
AA0474 - 029E  A few weeks later on 061203 there was another flare-up of
AA0475 - Cellulitis on the left arm, ref SDS 97 MF9H, possibly associated with
AA0476 - over exertion in exercising, and reaction to a cat bite a week or so
AA0477 - earlier. ref SDS 97 T55X
AA0479 -  ..
AA0480 - The doctor decided that extended exercise today, ref SDS 0 7C7F, in
AA0481 - relation to impaired lymphatics on the left side may have created
AA0482 - complications of lymphedema leading to Cellulitis recurrence, causing
AA0483 - elevated temperature.
AA0485 -  ..
AA0486 - Biopsy was not ordered to evaluate change in patient condition today.
AA0488 -  ..
AA0489 - The primary care physician feels that patient history, suggests, in
AA0490 - the absence of biopsy, that Millie may have recurrent Cellulitis on
AA0491 - the upper left arm that complicates IBC and lymphedema, leading to a
AA0492 - brightly intense rash, compared to observations yesterday at UCSF when
AA0493 - the rash seemed to be subsiding. ref SDS D5 527G
AA0495 -         ..
AA0496 -        [On 070607 recurrent cellulitis diagnosed during examination at
AA0497 -        UCSF for treatment of IBC with cetuximab, ref SDS E3 8H3I;
AA0498 -        condition worsened during treatment in the Infusion Clinic,
AA0499 -        temperature over 102, ref SDS E3 8J37; UCSF treated Millie with
AA0500 -        ceftriaxone antibiotics, ref SDS E3 8J9R, cellulitis seemed to
AA0501 -        subside, and temperature dropped to 101.4, UCSF released Millie
AA0502 -        to go home, ref SDS E3 8J5C; Kaiser prescribed outpatient
AA0503 -        ceftriaxone antibiotics for 5 days. ref SDS E3 8L46
AA0505 -         ..
AA0506 -        [On 080409 Millie treated for Cellulitis recurrence at Kaiser
AA0507 -        Emergency with tempeature of 101.9. ref SDS E5 0001
AA0509 -         ..
AA0510 -        [On 080411 increased rash on upper left arm, and on IBC
AA0511 -        sites on the chest attributed to cetuximab side effects the
AA0512 -        day after seeming full recovery from severe episode of
AA0513 -        Cellulitis treated at the hospital Emergency on 080410.
AA0514 -        ref SDS E6 V45J
AA0516 -  ..
AA0517 - Previously, when rash on the upper left arm first appeared, Kaiser
AA0518 - deferred to UCSF for prescribing treatment, and in order to maintain
AA0519 - control for the cetuximab clinical study, noting in a letter on 070315
AA0520 - possibility of cetuximab side effects. ref SDS B5 HK5O
AA0522 -  ..
AA0523 - Today, the doctor prescribed Keflex to treat Cellulitis recurrence,
AA0524 - per below. ref SDS 0 V66M
AA0525 -
AA0526 -        [On 070607 UCSF prescribed Keflex antibiotics to treat
AA0527 -        recurrent cellulitis again. ref SDS E3 ZI37
AA0528 -
AA0530 -  ..
AA06 -
AA07 -
AA08 - 2022
AA09 -
AA0901 - Millie has Keflex left over from prior episodes of Cellulitis.
AA0902 -
AA0903 - This evening at home, Millie prepared to start Keflex, prescribed
AA0904 - during the meeting at Kaiser.  Millie noticed that elevated intensity
AA0905 - of the rash on the upper left arm, and the new rash on the upper
AA0906 - right chest, per below, ref SDS 0 583G, have both completely subsided.
AA0907 - The upper left arm now looks the same as yesterday on 070329 at UCSF,
AA0908 - when examination showed reduced IBC rash intensity, ref SDS D5 527G,
AA0909 - compared to examination several weeks earlier on 070315.
AA0911 -  ..
AA0912 - As a result, Keflex treatment was not performed.
AA0913 -
AA0914 -        [On 070418 Kaiser notified that inflammation was resolved
AA0915 -        without taking prescribed Keflex medication. ref SDS D9 PZ3P
AA0916 -        and ref SDS D9 PZ7X
AA0917 -
AA0918 -
AA0919 -
AA0920 -
AA10 -

SUBJECTS
IBC Left Arm Examination Swelling Erratic Rash Inflammation Fever 99

AM03 -
AM0401 -  ..
AM0402 - IBC Left Arm Stable Subsiding Responds Treatment Cetuximab Drug Trial
AM0403 - Left Arm IBC Stable Subsiding Responds Treatment Cetuximab Drug Trial
AM0404 -
AM0405 - Follow up ref SDS D5 527G, ref SDS B9 527G.
AM0406 -
AM0407 - See discussion of rising rash intensity on upper left arm, and
AM0408 - prospects that this is a reaction to cetuximab treatments for IBC,
AM0409 - and/or recurrent Cellulitis, rather than increased IBC, and in light
AM0410 - of falling CA 15-3 biomarker. ref SDS 0 T87G
AM0411 -
AM0412 -
AM0413 -
AM05 -

SUBJECTS
Right Axillary Lymphadenopathy No Findings Right Arm Patient No Comp

AU03 -
AU0401 -  ..
AU0402 - Right Axillary Possible Involvement Red Rash Spreads Right Breast
AU0403 -
AU0404 - Follow up ref SDS D5 3D6K, ref SDS B9 3D6K.
AU0405 -
AU0406 - Background on patient history testing for lymphadenopathy in the right
AU0407 - axilla is reported in the record on 060929. ref SDS 88 3D6K
AU0409 -  ..
AU0410 - Examination of the right axillary yielded same negative results
AU0411 - finding no evidence of lymphadenopathy, as occurred examining the left
AU0412 - axilla, per above. ref SDS 0 I63O  Aligns with CT test on 070326,
AU0413 - reviewed yesterday on 070329. ref SDS D5 12GK
AU0414 -
AU0415 -
AU0416 -
AU0417 -
AU05 -

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

B103 -
B10401 -  ..
B10402 - IBC Right Arm New Minimal Red Rash Not Diagnosed IBC or Cellulitis
B10403 -
B10404 - Follow up ref SDS D5 H15M, ref SDS B9 H15M.
B10405 -
B10406 - Background on slight red dots, rash or blemishes on the right arm is
B10407 - reported on 070301. ref SDS B9 H15M  Examination at UCSF concluded the
B10408 - rash is not IBC.  Further examination at UCSF on 070315 reached the
B10409 - same conclusion, ref SDS C8 FO6H, supported by another review on
B10410 - 070322. ref SDS C9 LI4M
B10412 -  ..
B10413 - Review at UCSF yesterday on 070329 notes possibility this condition is
B10414 - very moderate IBC that is responding to treatment, as with IBC in
B10415 - other areas listed on 070301. ref SDS B9 4140
B10417 -  ..
B10418 - The primary care physician looked at the right arm today, and
B10419 - concurred with analysis yesterday that IBC has not spread to the right
B10420 - arm, and Cellulitis has not occurred in the right arm.
B10422 -  ..
B10423 - Discussion of side effects from cetuximab treatment for IBC is
B10424 - reported below. ref SDS D5 MF6I
B10425 -
B10426 -
B10427 -
B10428 -
B10429 -
B105 -

SUBJECTS
IBC Right Breast Examination Stable Subsides Rash Less Intense Respo

B903 -
B90401 -  ..
B90402 - Right Breast Red Rash Spreads Possible Involvement Right Axillary
B90403 - Red Rash Right Breast Spreads Possible Involvement Right Axillary
B90404 -
B90405 - Follow up ref SDS D5 W58J, ref SDS B9 T99I.
B90407 -  ..
B90408 - On 061204 IBC inflammation spread from the left chest area infected
B90409 - with IBC across the sternum and slightly onto the right breast.
B90410 - ref SDS 98 AE5I
B90412 -  ..
B90413 - The doctor concurred with examination of the right breast yesterday at
B90414 - UCSF on 070329. ref SDS D5 613F
B90415 -
B90416 -
B90417 -
B905 -

SUBJECTS
Rash Chest Right Side Above Breast Below Collar Bone Above Port Cath
IBC Right Breast Examination Stable Subsides Rash Less Intense Respo

BJ04 -
BJ0501 -  ..
BJ0502 - Right Chest Rash Distinct Above Breast and Port Catheter
BJ0503 - Rash Above Port Catheter on Right Upper Chest Very Distinct Today
BJ0504 -
BJ0505 - Follow up ref SDS D5 583G, ref SDS C9 KU3L.
BJ0507 -  ..
BJ0508 - Today, the doctor observed distinct, solid, and intense rash area that
BJ0509 - formed an approximate oval 1" high, and 2" long, and located high
BJ0510 - above the right breast, and below the collar bone, above and slightly
BJ0511 - left of the port catheter.  This rash has similar appearance and
BJ0512 - elevated intensity as the rash observed on the left arm today, per
BJ0513 - above. ref SDS 0 T87G
BJ0514 -
BJ0515 -     [...below doctor's Progress Notes say "States rash on chest and
BJ0516 -     LUE is present, evidently refers to this part of the examination.
BJ0517 -     ref SDS 0 4S5I
BJ0519 -  ..
BJ0520 - Like the left arm today, sudden appearance of an intense new rash was
BJ0521 - startling. ref SDS 0 N19J
BJ0523 -  ..
BJ0524 - The doctor asked about background?
BJ0526 -  ..
BJ0527 - Millie reviewed patient history listed yesterday on 070329 meeting at
BJ0528 - UCSF. ref SDS D5 583G  Nurse's Notes for treatment at UCSF on 070315
BJ0529 - report a rash above the port catheter on the right side of the chest,
BJ0530 - ref SDS C8 KU3L, as seen today.  There is no other history of a rash
BJ0531 - at this location, and it evidently quickly subsided at that time,
BJ0532 - since the patient never noticed it, until today.  For example, a week
BJ0533 - later, on 070322 Nurse's Notes report no continuing rash at this
BJ0534 - location. ref SDS C9 KU3L
BJ0536 -  ..
BJ0537 - Case study on 070130 shows erratic changes in severity/intensity of
BJ0538 - IBC rash on left chest area, which led to referral to UCSF.
BJ0539 - ref SDS A9 5N6L
BJ0541 -  ..
BJ0542 - Previously, when rash on the upper left arm first appeared, Kaiser
BJ0543 - deferred to UCSF for prescribing treatment, and in order to maintain
BJ0544 - control for the cetuximab clinical study, noting in a letter on 070315
BJ0545 - possibility of cetuximab side effects. ref SDS B5 HK5O
BJ0547 -  ..
BJ0548 - Today, the doctor decided to avoid biopsy, and treat for Cellulitis.
BJ0549 - Based on analysis for similar new condition on the left arm, as set
BJ0550 - out above, ref SDS 0 7C7G, the doctor prescribed treatment with Keflex
BJ0551 - antibiotic, per below. ref SDS 0 474O
BJ0552 -
BJ0554 -  ..
BJ06 -
BJ07 -
BJ08 - 2020
BJ09 -
BJ0901 - This evening at home, Millie prepared to start Keflex, prescribed
BJ0902 - during the meeting at Kaiser this afternoon.  Millie noticed that rash
BJ0903 - on the upper right chest, and elevated rash intensity on the upper
BJ0904 - left arm, per above, ref SDS 0 T87G, have both completely subsided.
BJ0905 - The chest seems totally clear of any rash, similar to yesterday at
BJ0906 - UCSF, when previous reports of rash at this location in the Nurse's
BJ0907 - Notes could not be confirmed, per above. ref SDS 0 DH5H  As a result,
BJ0908 - Keflex antibiotic medication was not taken, per below. ref SDS 0 KZ6L
BJ0909 -
BJ0910 -        [On 070418 Kaiser notified that inflammation was resolved
BJ0911 -        without taking prescribed Keflex medication. ref SDS D9 PZ3P
BJ0912 -        and ref SDS D9 PZ7X
BJ0913 -
BJ0914 -
BJ0915 -
BJ0916 -
BJ10 -

SUBJECTS
Left Supraclavicular Examination Palpation Neck Lymphadenopathy No F

BR03 -
BR0401 -  ..
BR0402 - Left Supraclavicular Examination PET Test Report Finding SUV 4.5
BR0403 - Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
BR0404 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
BR0405 -
BR0406 - Follow up ref SDS D5 8R6M, ref SDS B9 8R6M.
BR0407 -
BR0408 - Background is reported on 070130 meeting with Doctor Rugo at UCSF.
BR0409 - ref SDS A9 8R6M
BR0411 -  ..
BR0412 - Like the left and right axillary locations, examination today for
BR0413 - cancer in left supraclavicular region found no evidence of lumps or
BR0414 - other indications of lymphadenopathy, as reported above. ref SDS 0
BR0415 - I63O  CT test on 070326 shows no findings of lymphadenopathy, reported
BR0416 - below. ref SDS D5 12GK  There is no express finding that the analyst
BR0417 - actually looked at the left and right supraclavicular.
BR0418 -
BR0419 -
BR0420 -
BR05 -

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

C703 -
C70401 -  ..
C70402 - 2 Scenarios Conflict IBC Expanding Intensity Subsides
C70403 - IBC Rash Left Breast Stomach and Back Seems to Be Subsiding
C70404 - Examination IBC Rash Subsiding Responding to Treatment Cetuximab
C70405 - Cetuximab Effective Treatment IBC Subsiding Left Breast Stomach Back
C70406 -
C70407 - Follow up ref SDS D5 025H, ref SDS B9 025H.
C70408 -
C70409 - Left chest presents the primary IBC disease site.  Recent patient
C70410 - history on this issue with case studies is presented in examination at
C70411 - UCSF yesterday on 070329. ref SDS D5 025H  All case studies with
C70412 - lessons learned are listed on 061018. ref SDS 90 0001
C70414 -  ..
C70415 - On 070315, Millie submitted a report to the primary care physician at
C70416 - Kaiser about progress getting treatment with cetuximab clinical study
C70417 - starting on 070201 at UCSF for the 3rd relapse of IBC. ref SDS C7 VP5N
C70419 -  ..
C70420 - Examination today shows intensity and spread of IBC rash subsiding,
C70421 - confirming observations yesterday at UCSF. ref SDS D5 M68J  Since new
C70422 - rash on the right chest, and increased rash on the left arm are
C70423 - initially diagnosed as Cellulitis, IBC condition remains stable
C70424 - today...
C70425 -
C70426 -            left breast chest................. 060623, ref SDS 79 025H
C70427 -            right breast...................... 061204, ref SDS 98 AE5I
C70428 -            stomach........................... 070130, ref SDS A9 M68J
C70429 -            back.............................. 070130, ref SDS A9 M68J
C70430 -            left arm.......................... 070202, ref SDS B3 6Q5N
C70432 -  ..
C70433 - The doctor feels that subsiding IBC rash intensity shown by
C70434 - examination today, and no additional disease sites, including findings
C70435 - of no distant metastasis in the CT test on 070326, as shown below,
C70436 - ref SDS 0 EY5O, indicates treatment with cetuximab alone seems
C70437 - effective, as reported at UCSF yesterday on 070329. ref SDS D5 ST4J
C70438 - This analysis is supported by declining CA 15-3 cancer biomarker, per
C70439 - above. ref SDS 0 UZ8N
C70441 -  ..
C70442 - This is tempered by erratic changes in rash today initially diagnosed
C70443 - as Cellulitis, and adding to the case study on 070130. ref SDS A9 SE9O
C70444 -
C70445 -
C70446 -
C70447 -
C705 -

SUBJECTS
Prognosis Stable Low Intensity IBC Rash Very Good Response Treatment

CE03 -
CE0401 -  ..
CE0402 - Prognosis Very Good IBC Stable Cetuximab Clinical Study
CE0403 - Stable Low Intensity IBC Rash Very Good Response to Treatment
CE0404 - Cetuximab Prognosis Good Chance IBC Rash 3rd Relapse Will Clear Up Again
CE0405 -
CE0406 - Follow up ref SDS D5 M645, ref SDS B9 M645.
CE0407 -
CE0408 - At this time, the primary care physician concurs with favorable
CE0409 - prognosis presented during examination yesterday at UCSF. ref SDS D5
CE0410 - M645  The doctor defers to experience at UCSF with patients on the
CE0411 - cetuximab clinical study.  Yesterday on 070329, Millie's condition of
CE0412 - stable to subsiding IBC rash was described as "very good," and another
CE0413 - patient was cited who has been treated with cetuximab for 10 months
CE0414 - without progression of cancer. ref SDS D5 WT9K
CE0415 -
CE0416 -
CE0417 -
CE05 -

SUBJECTS
Distant Metastasis No Evidence 6 Years Patient History Examinations

CM03 -
CM0401 -  ..
CM0402 - Distant Metastasis No Evidence Patient History Examinations Tests
CM0403 - Local IBC Infection No Record Distant Metastasis Improves Chances
CM0404 - Prognosis Favorable No Lymphadenopathy 2006 No Distant Metastasis 5 Years
CM0405 -
CM0406 - Follow up ref SDS D5 FF4H, ref SDS B9 FF4H.
CM0407 -
CM0408 - The doctor further concurred today with the record yesterday meeting
CM0409 - at UCSF on 070329, which reports no evidence of distant metastasis,
CM0410 - including the recent CT test on 070326, ref SDS D5 FF4H, and discussed
CM0411 - today, shown below. ref SDS 0 EY5O
CM0412 -
CM0413 -
CM0414 -
CM05 -

SUBJECTS
Wicked Problem Resolved Disease Subsides Cetuximab Effective Treatme

D303 -
D30401 -  ..
D30402 - Wicked Problem Resolved Disease Subsides ANC Rises to Safe Level
D30403 - ANC 1.81 Blood Counts Rise Above Safe Level for Treatment with Cetuximab
D30404 -
D30405 - Follow up ref SDS D5 VF5M, ref SDS B9 VF5M.
D30406 -
D30407 - The doctor concurred with analysis yesterday at UCSF that rising ANC
D30408 - blood counts show Millie's immune system is strong enough to safely
D30409 - continue chemotherapy treatments with cetuximab, and further that
D30410 - falling CA 15-3 biomarker shows cancer treatments are effective.
D30411 - These favorable conditions have resolved the previous dilemma, as
D30412 - reported on 070329. ref SDS D5 VF5M
D30413 -
D30414 -
D30415 -
D305 -

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

DH03 -
DH0401 -  ..
DH0402 - Measurable Disease IBC No New Sites No Expansion Intensity Declines
DH0403 - Photographs Record Measurable Disease IBC Tumor in Dermal Tissue
DH0404 - Measurable Disease IBC Observed with Tape Measure Photograph Pictures
DH0405 - CA 15-3 Diagnostic Measurable Disease IBC Not Measured by Image Testing
DH0406 -
DH0407 - Follow up ref SDS D5 M652, ref SDS B9 M652.
DH0408 -
DH0409 - There was no discussion of measurable disease, since UCSF is
DH0410 - performing work to measure and photograph IBC rash for evaluating
DH0411 - response to treatment with cetuximab chemotherapy on referral through
DH0412 - clinical study, as reported yesterday on 070329. ref SDS D5 M652
DH0414 -  ..
DH0415 - The doctor noted today improvement treating IBC shown by subsiding
DH0416 - rash, per above, ref SDS 0 M68J, and falling cancer biomarker, CA
DH0417 - 15-3, also per above. ref SDS 0 GJ5M
DH0418 -
DH0419 -
DH0420 -
DH0421 -
DH0422 -
DH05 -

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

DP03 -
DP0401 -  ..
DP0402 - Lung Cancer Lymph Nodes Doctor's Progress Notes Medical Chart
DP0403 - Metastatic Cancer Lung Lymph Node Progress Notes Medical Chart
DP0404 -
DP0405 - Follow up ref SDS D5 G25K, ref SDS B9 G25K.
DP0406 -
DP0407 - Background is reported on 070130 in the record meeting with Doctor
DP0408 - Rugo at UCSF. ref SDS A9 G25K
DP0410 -  ..
DP0411 - Review on 070329 of the CT test on 070326 shows findings that indicate
DP0412 - there is no evidence in patient history for lung cancer.  ref SDS D5
DP0413 - 123I
DP0415 -  ..
DP0416 - CT scan testing on 070326 further reported no findings of
DP0417 - "interstitial disease" in the lungs indicating this side effect of
DP0418 - cetuximab treatment has not occurred in Millie's case so far.
DP0419 - ref SDS D5 5S6L  Interstitial lung disease was listed in the clincial
DP0420 - study Consent documents received from UCSF on 070116. ref SDS A7 0256
DP0421 - Interstitial disease is discussed further below in connection with
DP0422 - failure to perform thin slice spiral CT testing for pulmonary embolism
DP0423 - to assess cetuximab compounding risks of
DP0424 - blood clots in the lungs.
DP0426 -  ..
DP0427 - There was no discussion of this issue today, so that attention could
DP0428 - focus on assessing Millie's response to treatment for IBC.
DP0429 -
DP0430 -
DP0431 -
DP0432 -
DP0433 -
DP05 -

SUBJECTS
Biopsy Left Right Breasts Left Arm Right Chest Erratic Changes Inten

DW03 -
DW0401 -  ..
DW0402 - Biopsy Erratic Changes Rash Intensity Verify IBC Left Arm
DW0403 -
DW0404 - Follow up ref SDS D5 KT7J, ref SDS B9 KT7J.
DW0405 -
DW0406 - Background avoiding biopsy to diagnose erratic rash on left and right
DW0407 - chest is reported in the record on 070130. ref SDS A9 KT7J
DW0409 -  ..
DW0410 - Similarly, biopsy was avoided today for diagnosing rash on the left
DW0411 - arm showing sudden and significantly elevated intensity, compared to
DW0412 - just yesterday, per above. ref SDS 0 T87G. and to evaluate the new
DW0413 - rash on the upper right chest, per above, ref SDS 0 583G, and
DW0414 - following practice at UCSF analysing similar issues, including the
DW0415 - right arm, reported yesterday on 070329. ref SDS D5 PY4L
DW0417 -  ..
DW0418 - Beginning in October 2006 there may have been concurrent IBC on the
DW0419 - upper left arm, and similarly IBC may be infecting the upper right
DW0420 - chest, and the right arm under the theory in the 2nd opinion received
DW0421 - from Doctor Benz on 041117 that IBC rash can "wax and wane," referring
DW0422 - to patient history of symptoms that occurred with the left breast in
DW0423 - 2003, ref SDS 48 OS6W, but was not diagnosed as IBC until biopsy was
DW0424 - performed a year later on 040419. ref SDS 34 789F  A month later on
DW0425 - 040517 the doctor submitted a pathology report that presents IBC.
DW0426 - ref SDS 36 6T5G
DW0428 -  ..
DW0429 - Research a few days ago on 070328 reported advances in biomarkers
DW0430 - aimed at early detection and treatment of cancer, ref SDS D4 PC6G,
DW0431 - indicated by Millie's patient history in 2003, listed in the study on
DW0432 - 050812. ref SDS 66 XX8G
DW0433 -
DW0434 -
DW0435 -
DW0436 -
DW05 -

SUBJECTS
CT Test Distant Metastasis No Findings Lymphadenopathy Cancer CT Sca

E103 -
E10401 -  ..
E10402 - CT Test 070326 No Findings Metastatic Disease
E10403 -
E10404 - Follow up ref SDS D5 EY5O, ref SDS B9 EY5O.
E10405 -
E10406 - The doctor noted good news finding no evidence of distant metastasis
E10407 - from the CT test at Kaiser on 070326, reported in the record meeting
E10408 - at UCSF yesterday on 070329. ref SDS D5 EY5O  He feels that CT test
E10409 - results align with falling CA 15-3 testing, above, ref SDS 0 UZ8N, and
E10410 - with clinical examinations showing stable and improving IBC rash
E10411 - responding to treatment, also, per above. ref SDS 0 Z85L  Testing at
E10412 - this time supports favorable prognosis, per above, ref SDS 0 M645
E10413 - Consistent success avoiding distant metastasis improves Millie's long
E10414 - term prognosis, also above. ref SDS 0 FF4H
E10415 -
E10416 -
E10417 -
E10418 -
E10419 -
E105 -

SUBJECTS
CT Test 070326 History Identifies Breast Cancer Mistakes Testing Fai

EF03 -
EF0401 -     ..
EF0402 -    History Missing Context Pulmonary Embolism Enlarged Right Ventricle
EF0403 -
EF0404 -    Follow up ref SDS D5 GH5L, ref SDS B3 0Z6O.
EF0406 -  ..
EF0407 - There was no discussion today of history showing persistent failure to
EF0408 - report relevant patient history for accurate understanding of context
EF0409 - presenting image test findings, reported in the record yesterday on
EF0410 - 070329. ref SDS D5 GH5L
EF0412 -  ..
EF0413 - The primary care physician reports in the medical chart that the
EF0414 - patient has a history of pulmonary embolism, initially on 041104.
EF0415 - ref SDS 47 RZ4I  The Medical Chart on 061020 further reports patient
EF0416 - history of recurrent pulmonary embolism, ref SDS 91 279I, which
EF0417 - reflects the CT test on 060930, reported in the record on 061012.
EF0418 - ref SDS 89 294Q  The Medical Chart since that time failed to report
EF0419 - recurrent PE, per below, ref SDS 0 J59N, but consistently shows
EF0420 - history of PE as follows...
EF0421 -
EF0422 -                Hx of PE; on warfarin
EF0423 -
EF0424 - ...in the Impression section, ref SDS 0 1248
EF0426 -  ..
EF0427 - Cor Pulmonale heart disorder of enlarged right ventricle also
EF0428 - diagnosed in the CT test on 060930 as a complication of pulmonary
EF0429 - embolism, reviewed on 061012, ref SDS 89 7E5L, for some reason is not
EF0430 - shown in the Medical Chart, per below. ref SDS 0 J58L
EF0432 -  ..
EF0433 - Failure to present accurate patient history may have contributed to
EF0434 - Imaging Department failing to perform thin slice spiral CT test
EF0435 - ordered by the doctor to update the status of pulmonary embolism and
EF0436 - enlarged right ventricle.
EF0438 -  ..
EF0439 - Imaging Department may have changed procedures and now requires orders
EF0440 - to test for pulmonary embolism and enlarged right ventricle only from
EF0441 - lung and heart doctors, and so only reports history on cancer for
EF0442 - orders from the cancer department.  This requirement did not prevent
EF0443 - Kaiser from performing thin slice spiral CT tests for pulmonary
EF0444 - embolism ordered by the doctor on...............
EF0446 -             ..
EF0447 -            041103....................... 041104, ref SDS 47 RZ4I
EF0448 -            041218....................... 041230, ref SDS 50 PW3K
EF0449 -            060930....................... 061012, ref SDS 89 294Q
EF0450 -
EF0451 -
EF0452 -
EF0453 -
EF0454 -
EF05 -

SUBJECTS
CT Test 070326 Comparison Failed Perform Context Management Missing

EV03 -
EV0401 -     ..
EV0402 -    Comparison:  070131 061230 060930 Prior Related Tests Omitted
EV0403 -
EV0404 -    Follow up ref SDS D5 0136, ref SDS B3 0136.
EV0406 -  ..
EV0407 - The doctor noted failure to perform comparisons in the CT test on
EV0408 - 070326 with prior tests to assess changes in pulmonary embolism and
EV0409 - enlarged right ventricle, planned by the doctor on 070202, but missing
EV0410 - from the report received yesterday at UCSF on 070329. ref SDS D5 0136
EV0411 - The doctor advised that findings in the report, shown below, indicate
EV0412 - Kaiser did not perform the thin slice spiral CT test, which the doctor
EV0413 - was reminded to order on 070307, ref SDS C4 9Z9N, and was planned
EV0414 - during the meeting on 070202, ref SDS B3 T85K, as shown in the Medical
EV0415 - Chart at that time. ref SDS B3 125V
EV0416 -
EV0417 -
EV0418 -
EV05 -

SUBJECTS
CT Test 070326 Findings Indicate Thin Slice Spiral CT Scan Doctor Or

F103 -
F10401 -     ..
F10402 -    CT Test Pending for Pulmonary Embolism Ordered by Doctor
F10403 -
F10404 -    Follow up ref SDS D5 B74K, ref SDS B3 013T.
F10405 -
F10406 - The doctor explained that findings in the CT test for 070326 indicate
F10407 - cancer has been contained to only local IBC sites, consistent with
F10408 - prior favorable tests listed in patient history. see above,
F10409 - ref SDS 0 EY5O
F10411 -  ..
F10412 - Millie asked about the technician's report on 070326 that the work
F10413 - order did not specify a spiral CT scan needed to test for pulmonary
F10414 - embolism? ref SDS D1 SK8L  Errors listing patient history, per above,
F10415 - ref SDS 0 GH5L, aligns with failure to test for pulmonary embolism and
F10416 - compare with the prior test on 060930 per above. ref SDS 0 0136
F10418 -  ..
F10419 - The doctor advised that reference to "interstitial disease" in the
F10420 - report on the CT test, shown in the record receiving the report at
F10421 - UCSF yesterday on 070329, ref SDS D5 5S6L, does not relate to
F10422 - pulmonary embolism, nor to Cor Pulmonale (enlarged right ventricle).
F10423 - He said there is no indication that Kaiser performed the thin slice
F10424 - spiral CT scan ordered by the doctor on 070307 to test for pulmonary
F10425 - embolism and enlarged right ventricle. ref SDS C4 9Z9N
F10427 -  ..
F10428 - This frustrates plans on 070202 for medical tests, ref SDS B3 P45O, to
F10429 - avoid "wicked problems" of compound symptoms for lung and heart
F10430 - disease that occur concurrent with side effects for cancer treatments.
F10431 - ref SDS B3 TN7J
F10433 -  ..
F10434 - Difficulty coordinating between Oncology and Imaging at Kaiser is
F10435 - shown by the case study on 061012. ref SDS 89 A55J  Coordination
F10436 - efforts are further shown by the study on 070307, ref SDS C4 G56L,
F10437 - listed in the larger study on 070130, ref SDS B0 ET4N, and discussed
F10438 - above under coordination. ref SDS 0 GH4G  The high cost of medical
F10439 - mistakes was reported nationally on 990912, ref SDS 4 0001, and
F10440 - supported by study in this case on 040416. ref SDS 33 GN7J
F10441 -
F10442 -
F10443 -
F10444 -
F10445 -
F105 -

SUBJECTS
Emotional Trauma Stress Moderate Pulse Normal Cancer Subsides Confid

FB03 -
FB0401 -  ..
FB0402 - Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
FB0403 - Exercise Vigor Strength Engagement Ease Distress Living with Cancer
FB0404 - Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
FB0405 -
FB0406 - Follow up ref SDS D5 Y642, ref SDS B9 Y642.
FB0407 -
FB0408 - Medical issues create an emotional roller coaster explained on 070105,
FB0409 - ref SDS A5 Y642, and reviewed on 070301. ref SDS B9 Y642  Stress and
FB0410 - trauma are compounded with rising complexity of case history, listed
FB0411 - above. ref SDS 0 LU3J  Millie's letter to Kaiser on 070315 illustrate
FB0412 - recent swings in emotional state from changes in prognosis.
FB0413 - ref SDS C7 VP5N
FB0415 -  ..
FB0416 - Millie's vitals taken before the meeting are calmer today, e.g., pulse
FB0417 - below 60, per above, ref SDS 0 KB5L, similar to yesterday reported in
FB0418 - patient history for treatment at UCSF. ref SDS D6 AW4L
FB0420 -  ..
FB0421 - During the meeting, the doctor discovered severely increased rash
FB0422 - intensity on the left arm, ref SDS 0 T87G, and new rash on the upper
FB0423 - right chest. ref SDS 0 583G  These findings illustrate emotional
FB0424 - swings that occur with cancer, discussed at UCSF yesterday on 070329.
FB0425 - ref SDS D5 Q18K  When the rash subsided, ref SDS 0 N75M, at both sites
FB0426 - later in the evening today, this brought significant relief from worry
FB0427 - about failed treatment. ref SDS 0 N95F
FB0429 -  ..
FB0430 - Millie was worried on 070306 about coordination getting results of
FB0431 - blood tests at UCSF for prescribing Coumadin treatments at Kaiser.  At
FB0432 - that time, she requested feedback from Kaiser verifying accuracy to
FB0433 - avoid mistakes treating pulmonary embolism managed by the Coagulation
FB0434 - Control Clinic. ref SDS C3 UI5H  On 070307 Kaiser reported that
FB0435 - feedback with email to verify accuracy takes too much time; people
FB0436 - prefer to work by conversation. ref SDS C4 UH4M
FB0438 -  ..
FB0439 - Discovery that doctor's orders are ignored, per above, ref SDS 0 B74K,
FB0440 - increases worry about communication coordinating the work for
FB0441 - effective treatment, per above, ref SDS 0 GH4G, and cited in the
FB0442 - meeting yesterday at UCSF on 070329. ref SDS D5 II7H  At this time,
FB0443 - there is no evidence that previously observed defects for pulmonary
FB0444 - embolism and enlarged right ventricle have been repaired, and are not
FB0445 - getting worse.  Increased energy and subsiding shortness of breath are
FB0446 - encouraging, reported below. ref SDS 0 E44L
FB0447 -
FB0448 -
FB0449 -
FB0450 -
FB05 -

SUBJECTS
Sleep Difficulty Worry Emotional Trauma Stress New Increasing Rash L

FM03 -
FM0401 -  ..
FM0402 - Sleeping Difficulty Worry Cancer Health Issues Medical Management
FM0403 -
FM0404 - Follow up ref SDS D5 MR99, ref SDS C9 NG3I.
FM0405 -
FM0406 - Sleeping disorders were not discussed today, as presented during the
FM0407 - meeting yesterday at UCSF. ref SDS D5 MR99
FM0409 -  ..
FM0410 - As noted, anxiety about rising symptoms, discussed above, ref SDS 0
FM0411 - O38H, contribute to difficulty sleeping.  This is compounded by
FM0412 - failing to follow doctor's orders to test for recovery or progression
FM0413 - of disease. ref SDS 0 B74K
FM0414 -
FM0415 -
FM0416 -
FM0417 -
FM0418 -
FM05 -

SUBJECTS
Strategy Continue Work Plan Weekly Treatments Cetuximab for IBC Cont

FR03 -
FR0401 -  ..
FR0402 - Planning Case Management from Patient Profile Work Up
FR0403 - Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
FR0404 - Strategy Cetuximab Continued with Low ANC Expanding IBC Disease
FR0405 -
FR0406 - Follow up ref SDS D5 K36G, ref SDS B9 K36G.
FR0407 -
FR0408 - Background is reported on 070301. ref SDS B9 K36G  Coordination issues
FR0409 - are presented above. ref SDS 0 RM4G
FR0411 -  ..
FR0412 - Millie's letter on 070315 commends Kaiser for successful strategy,
FR0413 - ref SDS C7 HR9G, set by the primary care physician on 070105 to target
FR0414 - treatment of Millie's IBC disease with cetuximab on referral to UCSF.
FR0415 - ref SDS A5 PK7L
FR0417 -  ..
FR0418 - CT testing shows no evidence of disease, per below, ref SDS 0 EY5O
FR0419 - Improved blood counts for CA 15-3 cancer marker, above, ref SDS 0
FR0420 - GJ5M, and ANC, ref SDS 0 VF5M, further indicate that the doctor's
FR0421 - strategy is yielding results treating IBC, also discussed at UCSF
FR0422 - yesterday. ref SDS D5 X68N
FR0424 -  ..
FR0425 - Consideration of pulmonary embolism and Cor Pulmonale heart disorder
FR0426 - of enlarged right ventricle seem to require no change in treatment
FR0427 - strategy using Coumadin to control blood coagulation conditions,
FR0428 - reported in a letter today to the Coagulation Control Clinic at Kaiser
FR0429 - in Martinez, CA, ref SDS D7 ZH4H, and following up planning on 070307.
FR0430 - ref SDS C4 IY6I
FR0431 -
FR0432 -
FR0433 -
FR05 -

SUBJECTS
Treatment IBC 3rd Relapse Prescribed UCSF 3rd Cycle 1st Treatment St

G603 -
G60401 -  ..
G60402 - Treatment 3rd Cycle Cetuximab Carboplatin 070329 10th Cycle 3rd Relapse
G60403 - 10th Cycle Treatment IBC 3rd Relapse 3rd Cycle Cetuximab Clinical Study
G60404 - Cetuximab 3rd Cycle 1st Treatment IBC 3rd Relapse Clinical Study Drug Trial
G60405 -
G60406 - Follow up ref SDS D5 PF3O, ref SDS B9 PF3O.
G60407 -
G60408 - Patient history of cetuximab treatments is listed in the record
G60409 - yesterday working with the Infusion Clinic. ref SDS D6 7T3H
G60411 -  ..
G60412 - Millie had treatment with cetuximab for IBC yesterday starting cycle
G60413 - #3 at UCSF. ref SDS D6 1M6H
G60414 -
G60415 -
G60417 -  ..
G60418 - Keflex Treatment Cellulitis Defer UCSF Clinical Study Control
G60419 -
G60420 - As noted, when rash on the upper left arm first appeared in February,
G60421 - Kaiser deferred to UCSF for prescribing treatment that maintains
G60422 - control of cetuximab side effects for clinical study, cited in a
G60423 - letter on 070215. ref SDS B5 HK5O
G60425 -  ..
G60426 - Today, there wasn't enough time to check the record on 070215 due to a
G60427 - hectic schedule. ref SDS 0 SM6M  The doctor prescribed Keflex to treat
G60428 - sudden increased intensity of rash on the left arm for Cellulitis
G60429 - diagnosed above. ref SDS 0 7C5F, and for similar erratic rash on the
G60430 - upper right chest, also, observed today, per above. ref SDS 0 DH6F
G60432 -  ..
G60433 - Reporting on 990912 cited fatigue, limited time, hectic schedule cause
G60434 - medical mistakes. ref SDS 4 0285
G60435 -
G60436 -        [...below Medical Chart shows Keflex prescribed in treatment
G60437 -        plan. ref SDS 0 GF5O
G60439 -         ..
G60440 -        [On 070418 Millie notified UCSF of new rash activity, and that
G60441 -        the rash quickly subsided, ref SDS D9 PZ3P, so it was not
G60442 -        necessary to take Keflex prescribed today, per below.
G60443 -        ref SDS 0 KZ6L
G60445 -  ..
G60446 - The prescription was sent to the Kaiser pharmacy at the Park
G60447 - Shadelands clinic in Walnut Creek.  Millie will pick up the medication
G60448 - tomorrow.  Millie planned to begin taking Keflex antibiotic this
G60449 - evening using medication on hand from prior prescription ordered by
G60450 - the primary care physician at Kaiser on 070217,
G60451 - and approved by Brigid
G60452 - at UCSF on 070222. ref SDS B7 IS5K
G60454 -  ..
G60455 - Keflex has been prescribed previously to treat Millie for Cellulitis,
G60456 - shown by case study on 061203. ref SDS 97 YT4M
G60457 -
G60459 -  ..
G605 -
G606 -
G607 - 2020
G608 -
G60801 - Millie prepared to take Keflex antibiotic medication prescribed to
G60802 - treat increased intensity of rash on the left arm, and new rash on the
G60803 - upper right chest for recurrent Cellulitis, per above. ref SDS 0 474O
G60805 -  ..
G60806 - By this time, however, intensity of the rash on the left arm
G60807 - substantially subsided to the prior "improved" IBC condition observed
G60808 - yesterday at UCSF, per above. ref SDS 0 N75M  As well, the rash above
G60809 - the right breast and below the collar bone, completely disappeared,
G60810 - also, per above. ref SDS 0 N95F  As a result, Millie did not take
G60811 - Keflex antibiotic medication prescribed to treat for Cellulitis, per
G60812 - above. ref SDS 0 474O
G60813 -
G60814 -        [On 070418 Millie sent a copy to Michele for coordinating with
G60815 -        the doctor based on correspondence to UCSF explaining findings
G60816 -        today of new rash activity, and that the rash quickly subsided,
G60817 -        ref SDS D9 UP4F, so it was not necessary to take Keflex
G60818 -        prescribed today, per below. ref SDS 0 KZ6L
G60820 -         ..
G60821 -        [On 080314 Millie considered increased inflammation on upper
G60822 -        left arm might be recurrence of Cellulitis, ref SDS E4 JK50;
G60823 -        she took a Keflex pill to start another round of treatment,
G60824 -        ref SDS E4 JK6G, but then decided based on the prior record of
G60825 -        similar false positive symptom to wait another day to continue
G60826 -        treatment, and by that time inflammation subsided, and so
G60827 -        treatment was not continued. ref SDS E4 JK6G
G60828 -
G60829 -
G60830 -
G609 -

SUBJECTS
Side Effects Cetuximab Millie Looks Great Face Skin Cetuximab Possib

GL03 -
GL0401 -  ..
GL0402 - Side Effects Cetuximab Similar Symptoms Pulmonary Embolism
GL0403 - Energy Strength Rising Minimal Side Effects Cetuximab Treatment
GL0404 - Facial Skin Dryness New Side Effect Cetuximab Curel Lotion Prescribed
GL0405 - Curel Lotion Prescribed Facial Skin Dryness New Side Effect Cetuximab
GL0406 -
GL0407 - Follow up ref SDS D5 TQ6L, ref SDS B9 TQ6L.
GL0408 -
GL0409 - On 070326 Millie submitted a list of side effects for discussion at
GL0410 - UCSF on 070329, ref SDS D0 627X, citing review on 070322, ref SDS C9
GL0411 - QU8K, and prepared under the doctor/patient partnership model, set out
GL0412 - in Kaiser's Healthwise Handbook, shown on 990625. ref SDS 3 4185
GL0414 -  ..
GL0415 - The list was not reviewed during the meeting at UCSF on 070329.  Work
GL0416 - was based on personal memory. ref SDS D5 TQ6L
GL0418 -  ..
GL0419 - Millie reported today that her energy seems restored, indicating this
GL0420 - side effect of cetuximab has not been significant so far. ref SDS D5
GL0421 - QG4G
GL0423 -  ..
GL0424 - Millie did not discuss difficulty sleeping.  This was addressed
GL0425 - yesterday at UCSF. ref SDS D5 N49G
GL0427 -  ..
GL0428 - The doctor commented on how well, fit, and healthy Millie looks,
GL0429 - echoing favorable assessment during the meeting at UCSF yesterday with
GL0430 - the medical team in the Breast Care Center, ref SDS D5 N49K; and
GL0431 - presented again in Nurse's Notes for treatment in the Infusion Clinic,
GL0432 - also, yesterday on 070329. ref SDS D6 QU8K
GL0434 -  ..
GL0435 - Good health reflects renewed energy that enables returning to the gym
GL0436 - for regular exercise, reported on 070218, ref SDS B6 N05H, and cited
GL0437 - in case study on exercise issue. ref SDS B6 OB8H
GL0438 -
GL0439 -        [On 070418 Millie writes to UCSF with copy to Kaiser advising
GL0440 -        she cannot remember feeling better. ref SDS D9 PY6W
GL0442 -  ..
GL0443 - As noted, the doctor observed during examination today an intense rash
GL0444 - on the upper right chest, ref SDS 0 583G, originally reported by the
GL0445 - nurse in the Infusion Clinic on 070315, and cited in the list of side
GL0446 - effects on 070322. ref SDS C9 KU3L  The doctor also noticed elevated
GL0447 - intensity of IBC rash area on the upper left arm. ref SDS 0 T87G
GL0448 - Whether these events are side effects of cetuximab, or rising IBC,
GL0449 - Cellulitis, or something else is not known.  Initial analysis cites
GL0450 - elevated temperature, ref SDS 0 7C8G, and trauma that may complicate
GL0451 - lymphedema, perhaps from increased exercise, per above. ref SDS 0 7C7F
GL0453 -  ..
GL0454 - The doctor concurred with review at UCSF yesterday, ref SDS D5 MF6I,
GL0455 - indicating no findings of IBC, nor any rash, or other indication of
GL0456 - side effects from cetuximab to the right arm, as discussed above.
GL0457 - ref SDS 0 H15M
GL0459 -  ..
GL0460 - The doctor was pleased that "restless legs" was easily resolved
GL0461 - yesterday on 070329 by reducing the dose for pre-treatment Benadryl.
GL0462 - from 50 mg to 25 mg. ref SDS D5 WS3F
GL0463 -
GL0464 -
GL0465 -
GL0466 -
GL05 -

SUBJECTS
Cetuximab Clinical Study Kaiser Drug Trial Subsiding Stable IBC Meta

GR03 -
GR0401 -  ..
GR0402 - Cetuximab UCSF Clinical Study Treatment Begins 070201
GR0403 - UCSF Clinical Study Treatment Cetuximab Drug Trial Begins 070201
GR0404 - Drug Trials UCSF Has Other Clinical Study Treatments May Help Millie
GR0405 -
GR0406 - Follow up ref SDS D5 ZJ9N, ref SDS B9 ZJ9N.
GR0407 -
GR0408 - Background on Kaiser referral to UCSF for treatment on clinical study
GR0409 - is reported on 070105. ref SDS A5 P256  Purpose of referral is to
GR0410 - improve patient care with new treatment. ref SDS A5 PK7L  Case study
GR0411 - on Kaiser and UCSF collaborating to expedite treatment is listed on
GR0412 - 070130, ref SDS A9 4T5N, and reviewed again yesterday at UCSF on
GR0413 - 070329, ref SDS D5 RM4G, as further set out in the record for today,
GR0414 - per above. ref SDS 0 RM4G
GR0416 -  ..
GR0417 - Results of referral have been very good, with IBC rash subsiding or at
GR0418 - worst stable on the upper left arm, and diagnostics all improving
GR0419 - shown by examination today, per above. ref SDS 0 M68J  This was
GR0420 - reported to Kaiser in a letter on 070315. ref SDS C7 HR9G
GR0422 -  ..
GR0423 - Moreover, Millie feels and looks better now, per above, ref SDS 0
GR0424 - N49K, than before starting treatment on 070201.
GR0425 -
GR0426 -
GR0427 -
GR0428 -
GR0429 -
GR0430 -
GR05 -

SUBJECTS
Schedule Treatment Cetuximab 070329 Weekly Through 070524 Clinical S

GY03 -
GY0401 -  ..
GY0402 - Schedule Treatment Start Cetuximab Carboplatin 070201
GY0403 -
GY0404 - Follow up ref SDS D5 N96O, ref SDS B9 N96O.
GY0405 -
GY0406 - Scheduling and coordinating, per above, ref SDS 0 RM4G, have become a
GY0407 - continuing challenge, reviewed yesterday on 070329. ref SDS D5 S63K
GY0409 -  ..
GY0410 - On 070315 Nola, the administrator for the Infusion Clinic at UCSF,
GY0411 - submitted a schedule for meetings with the medical team, and Millie's
GY0412 - treatments through 070524. ref SDS C8 QK6L
GY0414 -  ..
GY0415 - During the meeting today, the doctor scheduled the next meeting in
GY0416 - eight (8) weeks on 070525 1100 to assess treatment for IBC with the
GY0417 - cetuximab clinical study on referral to UCSF, as reported on 070202.
GY0418 - ref SDS B3 LX4I
GY0420 -  ..
GY0421 - When the meeting ended today, the doctor requested help from the
GY0422 - Medical Assistant.  Arlette used the doctor's computer in the
GY0423 - examination room to demonstrate procedures using Kaiser's system to
GY0424 - schedule meetings according to the doctor's requirements.  He asked
GY0425 - that status of pending on several matters be removed, which required
GY0426 - knowledge on manipulating the software program.  Arlette executed the
GY0427 - commands to accomplish the doctor's objective.
GY0428 -
GY0429 -
GY0430 -
GY0431 -
GY05 -

SUBJECTS
Pulmonary Embolism Blood Clots Lungs Enlarged Right Ventricle Heart

HC03 -
HC0401 -  ..
HC0402 - Tired Breathing Difficulty Routine Activity Signals Pulmonary Emboli
HC0403 - Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
HC0404 - Pulmonary Emboli Hypercoagulable Work Up PET Scan Test Compare History
HC0405 -
HC0406 - Follow up ref SDS D5 CV5L, ref SDS B9 CV5L.
HC0407 -
HC0408 - Background on pulmonary embolism and correlation with IBC treatment at
HC0409 - UCSF is reported in the record meeting at UCSF on 070130. ref SDS A9
HC0410 - CV5L  Doctor Rugo planned to avoid overlooking symptoms of pulmonary
HC0411 - embolism that appear similar to side effects of chemotherapy
HC0412 - treatment. ref SDS A9 MO7K  The plan called for a thin slice spiral CT
HC0413 - test to evaluate cancer and to also check for pulmonary embolism.
HC0414 - ref SDS A9 915J   The test at Kaiser the next day on 070131, failed to
HC0415 - perform requirements for thin slice spiral CT testing, reported on
HC0416 - 070202. ref SDS B3 TN6N
HC0418 -  ..
HC0419 - At that time, on 070202 the primary care physician at Kaiser planned
HC0420 - to correct the problem by ordering thin slice spiral CT scan that
HC0421 - tests for pulmonary embolism. ref SDS B3 P45O  The doctor requested a
HC0422 - reminder to order the test for pulmonary embolism with Millie's next
HC0423 - CT test on the clinical study at UCSF. ref SDS B3 T85K
HC0425 -  ..
HC0426 - On 070307 the doctor was reminded to order the test, as requested.
HC0427 - ref SDS C4 9Z9N
HC0429 -  ..
HC0430 - Testing was performed on 070326.  Review on 070329 shows no reference
HC0431 - to thin slice spiral CT, nor to findings on pulmonary embolism, as
HC0432 - commonly occurs when Kaiser tests this issue, shown by patient history
HC0433 - listed on 070202.
HC0435 -  ..
HC0436 - Millie asked if references to "interstitial disease" in the report for
HC0437 - the CT test indicate Kaiser followed the doctor's order but described
HC0438 - the work with different terminology from prior tests that expressly
HC0439 - described pulmonary embolism, shown in patient study on 070202.
HC0440 - ref SDS B3 T85F
HC0442 -  ..
HC0443 - The doctor noted there is no evidence in the report for the CT test on
HC0444 - 070326 that Kaiser used thin slice spiral CT technology that tests for
HC0445 - pulmonary embolism and enlarged right ventricle, as shown in the
HC0446 - record on 070329 reviewing Kaiser's test report. ref SDS D5 0136,
HC0448 -  ..
HC0449 - At this time, status of pulmonary embolism remains unknown.  Millie's
HC0450 - energy has improved, indicating reduced risk; however, affirmative
HC0451 - assessment with tests present better evidence than assumptions from
HC0452 - absence of clinical symptoms, especially for highly lethal conditions,
HC0453 - like pulmonary embolism, where rising symptoms can be hidden by side
HC0454 - effects and other benign maladies, reported on 060722. ref SDS 82 BI5J
HC0455 -
HC0457 -  ..
HC0458 - INR 2.4 Blood Test Patient Stable for Coumadin Treatments Pulmonary Emboli
HC0459 -
HC0460 - Follow up ref SDS D5 FE9I, ref SDS B9 FE9I.
HC0461 -
HC0462 - The doctor was pleased that INR has finally stabilized the past few
HC0463 - months, shown in the blood test at UCSF yesterday on 070329, reported
HC0464 - in the record getting treatment. ref SDS D6 SE6N  INR was also
HC0465 - discussed with the medical team at UCSF on 070329. ref SDS D5 FE9I
HC0467 -  ..
HC0468 - This morning Millie sent a letter to Gloria coordinating notice for
HC0469 - the Kaiser Coagulation Control Clinic in Martinez CA about results of
HC0470 - the blood test at UCSF on 070329, ref SDS D7 ZH4H, and which Gloria
HC0471 - requested to help manage Millie's Coumadin treatments for pulmonary
HC0472 - embolism, discussed in a telephone call on 070307. ref SDS C4 723G  At
HC0473 - that time, Gloria explained that conversation makes reporting
HC0474 - fast-and-easy for Kaiser to get results on blood testing at UCSF,
HC0475 - ref SDS C4 UA3L, also discussed in connection with coordination,
HC0476 - above. ref SDS 0 LF5L
HC0477 -
HC0478 -
HC0479 -
HC0480 -
HC05 -

SUBJECTS
Examination Stethoscope No Findings Enlarged Right Ventricle Heart S

HK03 -
HK0401 -  ..
HK0402 - Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
HK0403 -
HK0404 - Follow up ref SDS D5 Q35O, ref SDS B9 Q35O.
HK0405 -
HK0406 - Examination with a stethoscope today included multiple locations on
HK0407 - Millie's back and chest.  The doctor reported no findings of cardio
HK0408 - pulmonary issues from clinical examination.  This method aligns with
HK0409 - the practice reported on 061020, ref SDS 91 PC6H, citing research on
HK0410 - 061012 about monitoring heart disorder of enlarged right ventricle,
HK0411 - Cor Pulmonale. ref SDS 89 IR5T
HK0413 -  ..
HK0414 - SaO2 diagnostic for oxygenated blood cited at Kaiser, on 061208,
HK0415 - ref SDS 99 1E5G, to indicate cardio-pulmonary functioning due to
HK0416 - pulmonary embolism, including enlarged right ventricle, was tested
HK0417 - three (3) times yesterday during treatment after examination, and was
HK0418 - consistently above 98%, demonstrating no immediate danger. ref SDS D6
HK0419 - AW4L  Vitals today showing Sa02 98% demonstrate continuing strong
HK0420 - cardio-pulmonary system. ref SDS 0 KB5L
HK0421 -
HK0422 -
HK0423 -
HK0424 -
HK05 -

SUBJECTS
Enlarged Right Ventricle Heart Disorder Cor Pulmonale Related Pulmon

HU03 -
HU0401 -  ..
HU0402 - Cor Pulmonale Heart Disorder Enlarged Right Ventricle
HU0403 - Heart Examination Not Ordered Investigate Enlarged Right Ventricle
HU0404 - Enlarged Right Ventricle CT Test Aligns Patient Symptoms How Serious
HU0405 -
HU0406 - Follow up ref SDS D5 VJ4J, ref SDS B9 VJ4J.
HU0407 -
HU0408 - Background on heart disorder Cor Pulmonale from enlarged right
HU0409 - ventricle, and plans for CT testing is reported on 070130. ref SDS A9
HU0410 - VJ4J  Kaiser failed to perform the spiral CT test ordered by the
HU0411 - primary care physician to evaluate enlarged right ventricle, reported
HU0412 - above. ref SDS 0 B74K
HU0414 -  ..
HU0415 - This issue is closely related to pulmonary embolism, reported by the
HU0416 - primary care physician on 061228. ref SDS A1 JU7L  Continued subsiding
HU0417 - of symptoms for pulmonary embolism reported on 070301, ref SDS B9
HU0418 - SX6N, and again today signal Cor Pulmonale, also, seems under control,
HU0419 - however, the actual status is unknown, per above. ref SDS 0 E44L
HU0421 -  ..
HU0422 - During the meeting today, the primary care physician did not make
HU0423 - referral for examination by a heart specialist, nor to get a treadmill
HU0424 - test, ref SDS B3 UN9F, discussed by Doctor Rugo during the meeting at
HU0425 - UCSF on 070130. ref SDS A9 RV3O
HU0426 -
HU0427 -
HU0428 -
HU0429 -
HU0430 -
HU05 -

SUBJECTS
Work Plan Doctor Submits Doctor/Patient Partnership Communications I

IJ03 -
IJ0401 -  ..
IJ0402 - Work Plan Received Communications Doctor/Patient Partnership
IJ0403 - Communications Doctor Submits Work Plan Doctor/Patient Partnership
IJ0404 - Doctor/Patient Partnership Communications Doctor Submits Work Plan
IJ0405 -
IJ0406 - Follow up ref SDS B3 FE4I, ref SDS 97 FE4I.
IJ0412 -  ..
IJ0413 - Issues from Kaiser's Progress Notes continue from prior review on
IJ0414 - 061110, ref SDS 84 EN4K, and listed again on 061208. ref SDS 89 EN4K
IJ0416 -  ..
IJ0417 - New issues include...
IJ0418 -
IJ0419 -    1.  Current medications do not show cetuximab begun on 070201,
IJ0420 -        ref SDS 0 SE86, and cited in plan section. ref SDS 0 125V
IJ0421 -
IJ0422 -    2.  New rash observed by doctor on upper left arm not cited in
IJ0423 -        examination. ref SDS 0 ZL5W
IJ0425 -         ..
IJ0426 -    3.  Orders Placed during this visit for Keflex, ref SDS 0 1153, is
IJ0427 -        not listed for Current Medications. ref SDS 0 SE86
IJ0429 -         ..
IJ0430 -    4.  Progress Notes represent IBC expanded after mastectomy surgery
IJ0431 -        on 051021, when this was not reported until 060623. ref SDS 0
IJ0432 -        J58L
IJ0434 -         ..
IJ0435 -    5.  Pulmonary embolism reported in Progress Notes diagnosed in
IJ0436 -        2004, ref SDS 0 J58L; but, Medical Chart fails to report
IJ0437 -        recurrent PE diagnosed with CT test on 060930. ref SDS 0 J59N
IJ0439 -         ..
IJ0440 -    6.  Enlarged right ventricle heart disorder Cor Pulmonale
IJ0441 -        complication pulmonary embolism has never been reported in the
IJ0442 -        Medical Chart. ref SDS 0 LF5R
IJ0444 -         ..
IJ0445 -    7.  Progress Notes last sentence vague and incomplete evidently
IJ0446 -        referring to new rash on the upper right chest below the collar
IJ0447 -        bone, and separate from other IBC rash sites.  Since the doctor
IJ0448 -        observed new rash, presenting these conditions as mere patient
IJ0449 -        statements is misleading and incomplete. ref SDS 0 J59N
IJ0451 -         ..
IJ0452 -    8.  Physical Examination report is incomplete and vague failing to
IJ0453 -        present observation of new rash on the upper right chest; no
IJ0454 -        context is explained diagnosing Cellulitis and treatment with
IJ0455 -        Keflex. ref SDS 0 ZL5W
IJ0457 -         ..
IJ0458 -    9.  Lab section says only "at UCSF," which fails to report lab
IJ0459 -        results for blood test on 070301 was submitted to Kaiser on
IJ0460 -        070315. ref SDS 0 128S  Equally, blood test at UCSF yesterday
IJ0461 -        on 070329 is not reported. ref SDS D6 A64L  Medical Chart takes
IJ0462 -        notice of small fraction of lab results at UCSF for INR,
IJ0463 -        indicating critical details can be tracked with minimal effort.
IJ0464 -        ref SDS 0 Y55K  "at UCSF" is therefore vague, incomplete, and
IJ0465 -        misleading in failing to convey the number of tests, the data,
IJ0466 -        and implications for patient care interpreting other clinical
IJ0467 -        and test diagnostics.
IJ0469 -         ..
IJ0470 -   10.  Failure to notice lab results essential for continuity of care
IJ0471 -        indicates requirements for coordination plan. ref SDS 0 4T4L
IJ0473 -         ..
IJ0474 -   11.  CT test on 070326 is missing from list of Image Tests in the
IJ0475 -        Medical Chart. ref SDS 0 129Y
IJ0477 -         ..
IJ0478 -   12.  Medical Chart does not report failure of Imaging Department to
IJ0479 -        perform thin slice spiral CT test ordered by the doctor for the
IJ0480 -        test on 070326. ref SDS 0 L14O
IJ0482 -         ..
IJ0483 -   13.  Medical Chart continues to omit 3 imaging tests between 060414
IJ0484 -        and 060708, in addition to not reporting the most recent test
IJ0485 -        on 070326. ref SDS 0 129Y
IJ0487 -         ..
IJ0488 -   14.  Imp section presents vague reference to "INR 2-3," which may
IJ0489 -        reflect reliance on blood tests at UCSF on 070329, but are not
IJ0490 -        listed in the Medical Chart. ref SDS 0 1248
IJ0492 -         ..
IJ0493 -   15.  Medical Chart saying "lymphedema; stable," conflicts with
IJ0494 -        finding new rash on upper left arm, where similar findings have
IJ0495 -        previously been diagnosed as Cellulitis, ref SDS B3 JP6F, and
IJ0496 -        further conflicts with increased intensity of rash on the upper
IJ0497 -        left arm, per above. ref SDS 0 F04H
IJ0498 -
IJ0500 -  ..
IJ0501 - Progress continues toward good management using the doctor patient
IJ0502 - partnership for timely review of patient history, called out in
IJ0503 - Kaiser's Healthwise Handbook, reviewed on 990625, ref SDS 1 TD5S, and
IJ0504 - reported on 060106. ref SDS 58 FE4I
IJ0505 -
IJ0506 -    1.  3/30/2007      5:40 PM
IJ0507 -
IJ0508 -            Wcr-ONnc2 > Main Campus
IJ0511 -         ..
IJ0512 -    2.  Your primary care clinician is listed as...
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