CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 13 0000, ref SDS 10 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - The doctor received Millie's letter submitted to the medical team last
040902 - night on treatment yesterday in the ER for shoulder injury.
040903 - ref SDS 13 MN5I  Doctor Johnson further related having reviewed the
040904 - letter submitted to him by Doctor Lillenstein yesterday on 090122,
040905 - ref SDS 10 TQ8H, and which was cited in Millie's letter to the medical
040906 - team, and asking for the time to meet today with the primary care
040907 - physician. ref SDS 13 KR9T
040909 -  ..
040910 - During the call today, the doctor reviewed Millie's patient history on
040911 - Kaiser's computer.  He feels there is no evidence of high blood
040912 - pressure.  Additionally, Millie's blood pressure this morning is 158
040913 - 77 63, similar to conditions at discharge last night from the
040914 - Emergency Department.  Doctor Lillenstein indicated Millie's blood
040915 - pressure at time of release did not require treatment for high blood
040916 - pressure, but he wanted the primary care physician to consider this
040917 - issue today, because blood pressure was elevated above 190 for much of
040918 - the time yesterday, when Millie was being treated for her shoulder
040919 - injury.
040921 -  ..
040922 - Doctor Johnson decided during the call today that Millie's patient
040923 - history does not require medication for high blood pressure.
040925 -  ..
040926 - Thanked Doctor Johnson for submitting the cardiology report on
040927 - Millie's EKG test on 090112, received last night on 090122.
040928 - ref SDS 11 WA4F  The doctor indicated that nothing jumped out in the
040929 - report that indicates a medical problem.  He feels that the amount of
040930 - hiking and aerobic exercise Millie does gives her a strong heart.
040931 - This aligns with comments on 081110 during Millie's echocardiogram
040932 - test. ref SDS 5 BR9F
040933 -
040934 -        [On 090127 Millie received letter from Arlette asking for
040935 -        Glenna's fax number to send the cardiology report to UCSF for
040936 -        Millie's EKG test on 090112, ref SDS 15 OX6G, which was
040937 -        previously sent to UCSF by Bill Wilson on 090121, ref SDS 9
040938 -        2K8L, and again by Millie's letter to the medical team on
040939 -        090123. ref SDS 13 KR8V
040941 -  ..
040942 - Doctor Johnson was pleased to see in Millie's letter to the medical
040943 - team last night on 090123 that Doctor Rugo plans to start Millie on a
040944 - new treatment next week for recovering from sudden 6th relapse of IBC,
040945 - ref SDS 13 KR4U, and citing the list Millie submitted to the medical
040946 - team showing UCSF plans for treating Millie's cancer as a chronic
040947 - disease. ref SDS 8 EV53  He commented that Millie's history of CT
040948 - tests over the past 7 years shows no evidence of distant metastasis,
040949 - except in the axilla and supraclavicular regions, which are symptoms
040950 - of IBC.  So, at this time, the only problem to solve is IBC.
040952 -  ..
040953 -  ..
040954 - The doctor indicated that ending treatment with the sunitinib protocol
040955 - at UCSF will enable Millie to recover from cytopenia, diagnosed during
040956 - the meeting at Kaiser on 081219 1140, ref SDS 6 JK7H; low blood counts
040957 - should rise so Millie can recover from fatigue, muscle weakness, and
040958 - loss of vitality and vigor associated with chemotherapy, also,
040959 - discussed on 081219. ref SDS 6 LS6K
040960 -
040961 -            [On 090127 1344 Millie's letter to the medical team reports
040962 -            beginning to recover from side effects of chemotherapy that
040963 -            caused cytopenia with low counts with low vitality feeling
040964 -            "lousy" have begun to subside. ref SDS 14 TY8T
040966 -  ..
040967 - Doctor Johnson explained that sudden relapse of IBC with nodules
040968 - spreading in the breastbone area, and cancer marker elevated to CA
040969 - 15-3 303 in the labs at Kaiser on 090116, ref SDS 7 PQTQ, indicate
040970 - Millie's cancer has mutated to cells that are now very resistant to
040971 - treatments available at Kaiser.
040973 -  ..
040974 - Doctor Johnson complimented Doctor Rugo's proactive case management
040975 - yeserday requesting assistance from Millie to get a list of treatments
040976 - UCSF has planned for Millie, also, reported in Glenna's call on
040977 - 090121. ref SDS 8 Y67L
040979 -  ..
040980 - The doctor emphasized during the call that CA 15-3 303 is suddenly 3
040981 - times higher than at any time in Millie's 7 year patient history, and
040982 - this requires immediate treatment to prevent cancer from getting out
040983 - of control.
040984 -
040985 -            [On 090212 0017 Millie's letter to medical team reports
040986 -            rising fatigue, ref SDS 21 1N3U, even after ending
040987 -            chemotherapy on 090122, ref SDS 12 AT6N, and hoping does
040988 -            not signal cancer cascading out of control with CA 15-3 303
040989 -            at Kaiser on 090116, ref SDS 7 PQTQ, cited by primary care
040990 -            physician at Kaiser on 090123. ref SDS 0 RK6O
040992 -  ..
040993 - Doctor Johnson was disappointed that UCSF has not had time to submit a
040994 - list of agents for treating Millie's cancer as a chronic disease after
040995 - the current relapse.  He explained that planning ahead is difficult in
040996 - oncology.  Doctors have many patients who need immediate care and
040997 - coordination with complex organizational structures, and changing
040998 - business processes, including computer systems.  Doctors also have
040999 - administrative, and hospital management duties.  This makes daily work
041000 - very hectic, causing details that affect the future to slip through
041001 - the cracks.
041003 -  ..
041004 - He feels this requirement should be presented again so that UCSF and
041005 - Kaiser can be prepared for changing treatments quickly enough to be
041006 - effective.
041008 -  ..
041009 - Importance of timely treatment of multiple cancer relapses was
041010 - discussed previously on 081219, ref SDS 6 KU6F, following up prior
041011 - instructions on 081024, ref SDS 4 BO9F, and citing planning reported
041012 - in the medical chart for the meeting at Kaiser on 080829, ref SDS 2
041013 - PX5V, as reported in Millie's letter to the medical team. ref SDS 3
041014 - RP9R
041016 -  ..
041017 - Doctor Johnson has emphasized on many occasions importance of timely
041018 - treatment for local control of cancer, shown in the case study of
041019 - Millie's patient history listed on 051007. ref SDS 1 5W7F
041020 -
041021 -        [On 090127 Millie's letter notified medical team that primary
041022 -        care physician orders immediate treatment at UCSF for Millie's
041023 -        6th relapse from IBC, because recent rise of cancer marker CA
041024 -        15-3 303 for the labs at Kaiser on 090116 indicated Millie's
041025 -        cancer has mutated to a very aggressive disease which cannot be
041026 -        treated with drugs available at Kaiser. ref SDS 14 TY5W
041028 -         ..
041029 -        [On 090130 letter to medical team reports Doctor Rugo
041030 -        prescribes treatment right away with hyperthermia and Doxil to
041031 -        recover from severe progression of cancer that makes the 6th
041032 -        relapse of IBC and a total of 7 relapses of cancer. ref SDS 16
041033 -        4S8O
041035 -         ..
041036 -        [On 090130 letter to medical team reports communication delay
041037 -        cited during meeting the day before at UCSF on 090129 Doctor
041038 -        Rugo explained Glenna was coordinating a week earlier, i.e., on
041039 -        090122, with Kaiser for referral to provide hyperthermia
041040 -        treatment to Millie in time to be effective. ref SDS 16 AY8Q
041042 -         ..
041043 -        [On 090202 1732 Doctor Rugo notifies medical team that Millie
041044 -        needs urgent treatment quickly to be effective. ref SDS 17 Y15J
041046 -         ..
041047 -        [On 090204 0219 Millie's letter asks Doctor Rugo to submit
041048 -        proactive planning for follow on treatment after hyperthermia
041049 -        and Doxil for Millie's 6th relapse of IBC. ref SDS 18 278T
041051 -         ..
041052 -        [On 090204 1747 Millie received list of 10 additional
041053 -        treatments targeted for Millie's patient profile, so there is a
041054 -        list of drugs to treat Millie's cancer as a chronic disease, as
041055 -        recommended by Doctor Johnson. ref SDS 19 4R3S
041057 -         ..
041058 -        [On 090205 0830 Doctor Hsu reports that delay starting Millie's
041059 -        treatment for 7th relapse of cancer, which Doctor Johnson
041060 -        warned against on 090123 1326, ref SDS 0 RK6O, has now allowed
041061 -        IBC to progress too far for Doctor Rugo's prescription of
041062 -        hyperthermia and Doxil to be effective; severe cancer now
041063 -        requires changing treatment to radiation and hyperthermia.
041064 -        ref SDS 20 EY5F
041066 -         ..
041067 -        [On 090213 1140 doctor attributes sudden rapid advance of IBC
041068 -        after significant recovery signals mutated cancer into much
041069 -        more aggressive disease that requires getting treeatment in
041070 -        time to be effective. ref SDS 22 GC6N
041072 -         ..
041073 -        [On 090213 1140 Doctor Johnson authorizes Kaiser support for
041074 -        proactive planning at UCSF to treat Millie's next relapse of
041075 -        IBC as a chronic disease, ref SDS 22 GD3I, and approved meeting
041076 -        with Doctor Rugo at UCSF to start research so that treatment
041077 -        can begin in time to be effective. ref SDS 22 WZ6K
041079 -         ..
041080 -        [On 090218 1205 Millie's letter notifies medical team that
041081 -        Doctor Johnson has ordered Millie's continued care at UCSF,
041082 -        citing prior instructions on 080829, 081026, 081219, and on
041083 -        090123, all authorizing UCSF to begin planning for Millie's
041084 -        next treatment, so that past delays are avoided, because
041085 -        Millie's cancer has mutated through multiple relapses (total of
041086 -        7 so far) into a very aggressive disease which requires
041087 -        treatment quickly in order to be effective. ref SDS 23 TH6U
041089 -  ..
041090 - Forgot to ask about Eosinophils 700% high in blood test on 090116.
041091 - ref SDS 7 FV5M
041092 -
041093 -
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0412 -