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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 26 0000. ref SDS 25 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Yesterday, on 071022 Millie asked the primary care physician at Kaiser
040902 - to submit cancer marker CA 15-3 and ANC lab results for the blood test
040903 - on 071017 at Kaiser, in order to support considerations on returning
040904 - to work, ref SDS 26 UW5J, following up correspondence with UCSF on
040905 - 071019. ref SDS 25 JC6X
040907 -  ..
040908 - Today, Millie received a letter from the primary care physician at
040909 - Kaiser saying...
040910 -
040911 -        Subject:  CA 15-3 and ANC Blood Test 071017
040912 -        Sent: 10/23/2007 09:08 AM
040916 -         ..
040917 -        Here are your labs:
040919 -         ..
040920 -        CA 15-3 H 75 U/mL
040922 -         ..
040923 -        Albumin 4.3 g/dL
040924 -        Alkaline Phos 66 U/L
040925 -        BUN 13 mg/dL
040926 -        Magnesium 1.7 mg/dL
040927 -        Bili, Tot Adult 0.6 mg/dL
040928 -        Calcium 9.2 mg/dL
040929 -        Chloride 103 mEq/L
040930 -        CO2 25 mEq/L
040932 -         ..
040933 -        Creatinine 0.57 mg/dL
040934 -        Glucose Random 133 mg/dL
040935 -        Potassium 3.9 mEq/L
040936 -        CA 15-3 H 74 U/mL
040937 -        Protein, Total 6.6 g/dL
040938 -        AST (SGOT) 31 U/L
040939 -        ALT (SGPT) 18 U/L
040940 -        Sodium 138 mEq/L
040942 -         ..
040943 -        PT, Patient H 23.2 Sec
040944 -        PT INR 2.3 Ratio
040946 -         ..
040947 -        WBC 4.3 K/uL
040948 -        RBC 4.56 M/uL
040949 -        Hemoglobin 13.9 g/dL
040950 -        Hematocrit 41.0 %
040951 -        MCV 90 fL
040952 -        RDW 12.7 %
040953 -        Plt 218 K/uL
040955 -         ..
040956 -        You should review these with Dr. Rugo before you decide to
040957 -        return to work.
040958 -
040959 -            [...below, Millie notified Doctor Rugo about results of
040960 -            cancer marker rising to 74, ref SDS 0 JL54, and asks about
040961 -            returning to work. ref SDS 0 LU8R
040963 -  ..
040964 - The doctor's blood test listing is incomplete, omitting neutrophils,
040965 - lymphocytes, etc., shown in the Kaiser report received via fax at UCSF
040966 - on 071018. ref SDS 24 QK4L  It also appears that CA 15-3 was 74 for
040967 - the test on 071017, ref SDS 0 JL54, and not 75, reported by the
040968 - doctor. ref SDS 0 JL9N
040970 -  ..
040971 - Additionally, for some reason the doctor did not submit ANC, requested
040972 - in the letter on 071022, even though CA 15-3 was submitted, as also
040973 - requested. ref SDS 26 X453
040974 -
040975 -
040977 -  ..
0410 -
0411 -
0412 - 1102
0413 -
041301 - Millie submitted a letter to Doctor Rugo asking about advisability to
041302 - return to work...
041303 -
041304 -    1.  Subject: CA 15-3 75 Against Kaiser Standard 39
041305 -        Date: Tue, 23 Oct 2007 11:14:16 -0700
041313 -         ..
041314 -    2.  Dear Doctor Rugo,
041316 -         ..
041317 -    3.  [Primary care physician at Kaiser] submitted results of the
041318 -        blood test on 071017, last Wednesday, noting that CA 15-3
041319 -        increased to 75, up from 56 for the last test at Kaiser on
041320 -        070511, shown in the record on 070524. ref SDS 9 KV59
041322 -         ..
041323 -    4.  I was hoping to be able to return to work, as shown in the
041324 -        letter to Jackie on the 19th. ref SDS 25 JC6X
041326 -        says today this should be reviewed with you in light of cancer
041327 -        marker trends. ref SDS 0 GL3G
041329 -         ..
041330 -    5.  At this time, rise of cancer marker to 75 approaches 80, which
041331 -        Kaiser has used to signal consideration of treatment regimen,
041332 -        reported on 030710. ref SDS 3 WS42
041334 -         ..
041335 -    6.  As noted in your examination on 071018, there is no visual
041336 -        evidence of advancing IBC, ref SDS 24 EP5F, and the recent
041337 -        scans were clear, ref SDS 24 4N7K, so the cancer marker seems
041338 -        anomalous, but certainly has my attention.
041340 -         ..
041341 -    7.  As you know, I got the last lab done at Kaiser to assess impact
041342 -        on billings.  As well, it helps periodically to cross check the
041343 -        numbers.  Based on Jackie's letter received on the 19th,
041344 -        showing confusion on "NEUTS" blood counts, ref SDS 25 EU5U, we
041345 -        should probably go back to having this work done at UCSF for
041346 -        reasons in the record meeting with Bob Schwartz at UCSF on
041347 -        070830. ref SDS 12 T176
041349 -         ..
041350 -    8.  If Bob can assure me I am not being charged by UCSF for blood
041351 -        tests, as seemingly set out in his letter on 071010,
041352 -        ref SDS 20 OH7W, yet invoicing shows Medicare denied payment
041353 -        for blood tests so I am being charged for this work [see
041354 -        example from Millie's letter on 071015, ref SDS 22 KH5Q, then
041355 -        consideration should be given to having labs done at UCSF who
041356 -        has primary responsibility for applying test results.
041358 -         ..
041359 -    9.  Please let me know your thoughts.
041360 -
041362 -  ..
0414 -
0415 -
0416 - 1723
0417 -
041701 - Millie received a letter from Doctor Rugo responding to her letter
041702 - this morning, per above, ref SDS 0 HT5I, asking about returning to
041703 - work, ref SDS 0 LU8R, which the primary care physician suggested
041704 - should be reviewed by Doctor Rugo in light of rising cancer marker.
041705 - ref SDS 0 GL3G
041707 -  ..
041708 - Doctor Rugo says....
041709 -
041710 -    1.  Subject:  CA 15-3 75 Against Kaiser Standard 39
041711 -        Date: Tue, 23 Oct 2007 15:00:36 -0700
041719 -         ..
041720 -    2.  I am not at all worried about a small increase in the marker,
041721 -        time will tell with this.  The marker is best used, in  my
041722 -        opinion, as a reason to look more carefully, not as a reason to
041723 -        change treatment.  It can be variable, and there is no cutoff
041724 -        that is concerning such as 80.
041725 -
041734 -  ..
041735 - The doctor does not advise on Millie returning to work, which was
041736 - requested in Millie's letter, per above, ref SDS 0 LU8R, and citing
041737 - suggestion of primary care physician at Kaiser for comment on this
041738 - issue by UCSF. ref SDS 0 GL3G
041740 -  ..
041741 - Comment on application of the cancer marker as a guide for increased
041742 - scrutiny, ref SDS 0 V65R, aligns with Kaiser's practice shown by case
041743 - study on 030710. ref SDS 3 IA7H  On 030508 the primary care physician
041744 - explained correlating cancer marker diagnostics with examinations and
041745 - image testing. ref SDS 1 7C7K  On 030606 Kaiser explained practice of
041746 - using the cancer marker for looking more carefully, ref SDS 2 VY7G,
041747 - noted by UCSF today, per above. ref SDS 0 V65R
041749 -  ..
041750 - On 070301 UCSF seemed to consider changing treatments based on a
041751 - variety of factors, ref SDS 6 1T4O, as indicated by Doctor Rugo today.
041752 - ref SDS 0 V65R  On 070308 meeting cancelled to consider changing
041753 - treatment because new diagnostics were very favorable. ref SDS 7 FO6H
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0418 -