CONTACTS 

SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 49 0000. ref SDS 47 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Background...
040902 -
040903 -    1.  Case study dilemma balancing sunitinib treatments to optimize
040904 -        recovery from 5th relapse IBC, and without increasing
040905 -        debilitating side effects that prevent exercise required to
040906 -        benefit from recovery. ref SDS 22 I87N
040908 -         ..
040909 -    2.  On 090108 examination at UCSF showed possible progression of
040910 -        IBC in breastbone area, as set out in Millie's letter to the
040911 -        medical team on 090109. ref SDS 24 UC4H  Millie reported severe
040912 -        side effects shown by wide range of blood counts falling.
040913 -        ref SDS 24 UF3Q  Medical team prescribed another cycle
040914 -        sunitinib treatment, with cyclophosphamide paused until blood
040915 -        counts increase to a safe level. ref SDS 24 UF3T
040917 -         ..
040918 -    3.  On 090109 Millie's letter reports rise of IBC with sunitinib
040919 -        seen at UCSF on 090108 occurred previously, cited in Millie's
040920 -        letter on 081125, ref SDS 15 XX4P; there was rise of IBC and
040921 -        then substantial recovery reported again on 081217, ref SDS 16
040922 -        YJ4V; on 081230 Millie's letter reported on 081224 and 081225
040923 -        rise of IBC, and then improvement on 081226, ref SDS 22 JV5M;
040924 -        most recently on 090106 Millie cited again advance of IBC on
040925 -        081224 and 081225, and now disease seems to be subsiding again.
040926 -        ref SDS 23 YO4V]
040928 -         ..
040929 -    4.  On 090115 Millie letter to Catherine and Diane in the Infusion
040930 -        Clinic at UCSF reported rising side effects of sunitinib
040931 -        protocol, ref SDS 27 5J9Y; she tried hiking a few times, but
040932 -        this hurts her feet (peripheral neuropathy) and legs are very
040933 -        weak, shown in patient history on daily treatments. ref SDS 26
040934 -        KL4J  Have been spending more time in the gym doing aerobics,
040935 -        which is a little more tolerable. ref SDS 26 3E4K
040937 -         ..
040938 -    5.  On 090116 Glenna called to ask about response to treatment and
040939 -        side effects, ref SDS 28 JY6L, and was advised that IBC in the
040940 -        breastbone area was stable to worse, and other sites are stable
040941 -        to improved with sunitinib protocol, citing the record of
040942 -        patient history the day before on 090115. ref SDS 26 124N
040944 -         ..
040945 -    6.  On 090116 during call from Glenna advised that Millie wants to
040946 -        reduce the dose of sunitinib in order to reduce debilitating
040947 -        side effects, and requested remedy to reduce side effects with
040948 -        full dose of sunitinib in order to optimize recovery.
040949 -        ref SDS 28 JY7J
040951 -         ..
040952 -    7.  On 090116 Millie received a letter from Glenna transmitting a
040953 -        copy of a letter Glenna wrote to the doctor reporting
040954 -        understandings from telecon in the morning on 090116,
040955 -        ref SDS 30 YN9H; Glenna's letter to the doctor described
040956 -        difficulty tolerating side effects of sunitinib, ref SDS 30
040957 -        4P5M, that Millie wants to reduce the dose to reduce side
040958 -        effects, but is afraid about losing benefits of recovering
040959 -        from IBC. ref SDS 30 HV3M
040961 -         ..
040962 -    8.  On 090116 Glenna's letter to the doctor asked about changing to
040963 -        another treatment. ref SDS 30 HV3O
040965 -         ..
040966 -    9.  On 090116 Glenna planned to meet with the doctor later in the
040967 -        day on 090116 to discuss changing Millie's treatment.
040968 -        ref SDS 30 HP4J
040970 -         ..
040971 -   10.  On 090116 Millie's letter to the medical team clarifies telecon
040972 -        on condition following examination at UCSF on 090108, reporting
040973 -        IBC in breastbone area looks stable to worse, and everywhere
040974 -        else looks improved to stable, indicating recovery has slowed
040975 -        ref SDS 31 IS6G, relative to findings on 081218, ref SDS 17
040976 -        VD4F, confirmed in Millie's letter later that day reporting
040977 -        significant recovery. ref SDS 18 GF8V
040979 -         ..
040980 -   11.  On 090118 Millie talks about wanting to end treatment with
040981 -        sunitinib that seems now less effective and has severe side
040982 -        effects after adding cycloposphamide. ref SDS 32 UC41
040984 -         ..
040985 -   12.  On 090121 Millie letter to primary care physician says very
040986 -        pleased to take this occasion on my birthday to say thanks for
040987 -        such great care the past 7 years.  You noted in our first
040988 -        meeting on 020321 that Oncology presents unique challenges.
040989 -        ref SDS 1 R94H  My case has been complicated by other maladies
040990 -        that strain resources of time, money, and emotion.  Having you
040991 -        at the helm with Arlette's assistance has been a blessing.
040992 -        ref SDS 35 F23Y
040994 -         ..
040995 -   13.  On 090121 Glenna calls and asks again about Millie's response
040996 -        to treatment, ref SDS 36 AJ3J, following up her call on 090116,
040997 -        ref SDS 28 JY6L, and per background above. ref SDS 36 JY5I
040999 -         ..
041000 -   14.  On 090121 during call from Glenna reported patient history,
041001 -        ref SDS 36 ZO4F, on 090120 shows IBC rash looks improved to
041002 -        stable, and nodules in the breastbone area seem worse,
041003 -        ref SDS 34 124N, relative to detailed review on 090110,
041004 -        ref SDS 25 124N, and after 11 days of treatment with only
041005 -        sunitinib, and 25 total treatments with sunitinib, since the
041006 -        pause on 081218 and resuming on 081226. ref SDS 33 6C4J
041008 -         ..
041009 -   15.  On 090121 during call from Glenna reported patient history
041010 -        reported IBC worsening in breastbone area has progressed onto
041011 -        the right breast and spread toward the left chest reflects
041012 -        rising cancer marker, ref SDS 36 N95K, Labs at Kaiser on 090116
041013 -        report CA 15-3 303. ref SDS 29 PQTQ  This record indicates
041014 -        Millie has suffered 6th relapse of IBC.
041016 -         ..
041017 -   16.  On 090121 Glenna asked for most severe side effects from
041018 -        continuing with sunitinib treatment. ref SDS 36 TW53
041020 -         ..
041021 -   17.  On 090121 Glenna asked for Millie's records on Doctor Rugo's
041022 -        plans for follow on treatments?  During the call developed
041023 -        background on UCSF planning for Millie's future treatment after
041024 -        sunitinib. ref SDS 36 Y67L
041026 -         ..
041027 -   18.  On 090121 Glenna reported during the call that she would send
041028 -        another letter to Doctor Rugo explaining Millie's slow response
041029 -        to treatment with sunitinib, and supplementing Glenna's letter
041030 -        to the doctor on 090116, ref SDS 47 SY5J; Glenna further advised
041031 -        during the call on 090121 that she would meet again with Doctor
041032 -        Rugo to discuss plans for changing Millie's treatment to
041033 -        recover from Millie's 6th IBC relapse. ref SDS 36 N976
041035 -         ..
041036 -   19.  On 090121 patient history summarized to faciliate Glenna's
041037 -        meeting with Doctor to figure out Millie's next treatment.
041038 -        ref SDS 36 NU5H
041040 -             ..
041041 -        a.  Laboratory blood tests listed for Millie to facilitate UCSF
041042 -            considering Millie's next treatment. ref SDS 36 6Y9K
041044 -             ..
041045 -        b.  Image test history of PET, CT, Xray, MRI listed for Glenna
041046 -            to discuss with Doctor Rugo discussing Millie's next
041047 -            treatment. ref SDS 36 216F
041049 -             ..
041050 -        c.  Treatment history listed for Glenna to discuss with Doctor
041051 -            Rugo discussing Millie's next treatment. ref SDS 36 H16M
041053 -             ..
041054 -        d.  Strategy considerations for selecting Millie's next
041055 -            treatment. ref SDS 36 558O
041057 -         ..
041058 -   20.  On 090122 telephone message from Glenna reported that the
041059 -        doctor ended treament with sunitinib protocol; Glenna met with
041060 -        Doctor Rugo to develop treatment plan for Millie, and UCSF
041061 -        scheduled Millie to start new treatment on 090129. ref SDS 40
041062 -        K96F
041064 -         ..
041065 -   21.  On 090123 primary care physician at Kaiser cited sudden relapse
041066 -        of IBC with nodules spreading in the breastbone area, and
041067 -        cancer marker elevated to CA 15-3 303 in the labs at Kaiser on
041068 -        090116, ref SDS 29 PQTQ, shows Millie needs immediate change of
041069 -        treatment to prevent cancer from cascading out of control, and
041070 -        that UCSF should prescribe treatment, ref SDS 45 RK6O, because
041071 -        Millie's 6th relapse of IBC shows cancer has mutated to cells
041072 -        that are now very resistant to treatments available at Kaiser,
041073 -        as discussed previously during the meeting at Kaiser on 080829,
041074 -        and cited in Millie's letter to the medical team. ref SDS 13
041075 -        RP9R
041077 -         ..
041078 -   22.  On 090123 Millie's letter to medical team reports progress at
041079 -        UCSF scheduling Millie to start on a new treatment. ref SDS 41
041080 -        KR4P
041082 -         ..
041083 -   23.  On 090123 Glenna called and she was asked for documentation on
041084 -        new treatment, ref SDS 42 TR80, in order to be prepared for
041085 -        meeting with the medical team at UCSF next Thursday on 090129
041086 -        0830, and which was presented in Glenna's telephone message on
041087 -        090122, ref SDS 40 AT6N,
041089 -         ..
041090 -   24.  On 090123 during Glenna's call she advised there was not enough
041091 -        time to meet with Doctor Rugo, and she is not aware of the
041092 -        specific treatment Doctor Rugo plan on 090129. ref SDS 42 118M
041094 -         ..
041095 -   25.  On 090123 Doctor Johnson, Millie's primary care physician at
041096 -        Kaiser, called and confirmed prior advice that Doctor Rugo can
041097 -        prescribe follow on treatment for Millie because her cancer has
041098 -        become resistant to drugs available at Kaiser. ref SDS 45 8K6K
041100 -         ..
041101 -   26.  On 090127 Millie letter to medical team reporting Doctor
041102 -        Johnson called on 090123 to advise of approval for Doctor Rugo
041103 -        to prescribe Millie's follow on treatment at UCSF to start
041104 -        immediately on 090129. ref SDS 47 TY5W
041106 -         ..
041107 -   27.  On 090127 Millie's letter to the medical team submitted patient
041108 -        history to facilitate prescribing new treatment for Millie's
041109 -        6th relapse of IBC. ref SDS 47 TY6S
041111 -         ..
041112 -   28.  On 090127 Millie's letter reported side effects of sunitinib
041113 -        have begun to subside after stopping treatment on 090122 in
041114 -        order to prepare to start new treatment on 090129. ref SDS 47
041115 -        TY8T
041117 -         ..
041118 -   29.  On 090128 Millie letter to primary care physician and the
041119 -        medical team reported IBC worsening, and taking Vicadin for
041120 -        pain. ref SDS 49 2S8X
041122 -  ..
041123 - Millie sent a letter to the medical team confirming understandings
041124 - from meeting at UCSF on 090129; Doctor Rugo wrote a letter to Millie's
041125 - primary care physician at Kaiser prescribed treatment with
041126 - hyperthermia and Doxil.
041127 -
041128 -    1.  Subject: UCSF Treatment Plan Hyperthermia Doxil
041129 -        Date: Fri, 30 Jan 2009 17:56:30 -0800
041140 -         ..
041141 -    2.  Thanks for your letter on 090128, ref SDS 50 OR4F, following up
041142 -        ER issues to recover from my shoulder injury last week [cited
041143 -        in Millie's letter to Kaiser earlier in the day on 090128].
041144 -        ref SDS 49 OR4F
041146 -         ..
041147 -    3.  Yesterday at UCSF, Tara cited rise in vitals show I am fighting
041148 -        pain issues.  Pain in my upper right arm will dissipate with
041149 -        recovery from the shoulder injury, as you noted in a call on
041150 -        the 28th.  There is also rising heat from IBC in the breastbone
041151 -        area, mentioned in my letter to the team on Jan 28th.
041152 -        ref SDS 49 2S8X  Last week [on 090122], Doctor Lilienstein in
041153 -        the ER prescribed combining Tylenol and Vicadin at different
041154 -        intervals. ref SDS 38 TD4L  I held off to avoid over
041155 -        medicating.  Tara encouraged multiple pain treatments, so I am
041156 -        experimenting to find a solution.
041158 -  ..
041159 - Previously, on 070921 Doctor Johnson diagnosed emotional anxiety from
041160 - elevated vitals, ref SDS 9 QY9V, and prescribed drugs with
041161 - psychological therapy to cope with communication problems helping
041162 - Kaiser, UCSF, and Medicare implement referral requirements for
041163 - Millie's care, where a stage IV cancer patient suffering a 3rd relapse
041164 - has been inundated with hundreds of erroneous and unsupported invoices
041165 - from UCSF that should be resolved by Kaiser. ref SDS 9 QY4P
041166 -
041167 -            [...below in the record today on 090130 1722 Doctor Rugo's
041168 -            letter on 090129 cites rising heat and pain from IBC.
041169 -            ref SDS 0 TZ6H
041171 -             ..
041172 -            [On 090201 Millie reports IBC getting worse by the hour;
041173 -            asks for advice to treat rising pain, ref SDS 58 KN9T,
041174 -            further requests getting treatment the next day at UCSF on
041175 -            090202. ref SDS 58 KN9W
041177 -             ..
041178 -            [On 090202 1437 Millie reports to medical team IBC disease
041179 -            progressed significantly with rising pain, since meeting at
041180 -            UCSF on 090129, ref SDS 61 R23S, when hyperthermia
041181 -            treatment was prescribed to achieve local control in time
041182 -            to be effective because communication mishaps delayed
041183 -            treatment a week, reported on 090130 1722. ref SDS 0 AY8Q
041185 -             ..
041186 -            [On 090203 Millie experiences rising pain that interrupts
041187 -            sleep at night, ref SDS 63 KE5I, checks medication
041188 -            prescriptions and discovers taking 30% of prescribed dose.
041189 -            ref SDS 63 L74H
041191 -             ..
041192 -            [On 090203 1417 Millie reports pain control with Tylenol
041193 -            and Vicodin using increased dose above prescribed levels;
041194 -            asks for confirmation. ref SDS 62 IS6U
041196 -             ..
041197 -            [On 090204 1528 Millie reported calling Kaiser on 090203
041198 -            for pain relief from interrupting sleep caused by worsening
041199 -            IBC and shoulder injury, as reported in the record on
041200 -            090203 2217, ref SDS 63 KE5I; Millie advised on 090204 1528
041201 -            implementing Kaiser instructions, ref SDS 64 135F, to
041202 -            double the dose for pain medication, and if pain persists,
041203 -            the doctor will prescribe low-dose morphine, ref SDS 64
041204 -            D64W, resolving fears of over medicating by taking only 30%
041205 -            of prescribed dose levels, also reported on 090203 2217.
041206 -            ref SDS 63 L74H
041208 -             ..
041209 -            [On 090213 1100 primary care physician at Kaiser describes
041210 -            hyperthermia treatment for Millie at UCSF provides
041211 -            palliation to relieve suffering from advancing cancer --
041212 -            Millie's 6th relapse of IBC; expects less than 1 year to
041213 -            live. ref SDS 68 WZ6K
041215 -             ..
041216 -            [On 090220 1548 hyperthermia provides palliation relief
041217 -            from pain with rising cancer, and from side effects of
041218 -            chemotherapy and radiation treatments, and even where there
041219 -            is no hope for survival, reported in BSD 2002 research
041220 -            paper received from UCSF. ref SDS 71 01G6
041222 -         ..
041223 -    4.  I was hoping to get treatment for IBC yesterday at UCSF,
041224 -        indicated in Glenna's phone message, when I returned from ER on
041225 -        090122. ref SDS 40 AT6N [and on 090123 primary care physician
041226 -        recommended immediate treatment to prevent IBC from cascading
041227 -        out of control, ref SDS 45 RK6O, noted in Millie's letter to
041228 -        medical team on 090127. ref SDS 47 TY5W
041229 -
041230 -            [On 090201 Millie proposes coming to UCSF the next day on
041231 -            090202 in the early morning at 0600 to stand-by for seeing
041232 -            doctor Hsu at the earliest possible time in order to
041233 -            expedite hyerthermia treatment prescribed by Doctor Rugo to
041234 -            prevent losing control of cancer caused by delayed
041235 -            treatment from the prior week. ref SDS 58 KN9W
041236 -
041238 -         ..
041239 -        6th Relapse IBC 7th Relapse Cancer Case Study
041240 -        Case Study Millie's 7th Relapse Cancer 6th Relapse IBC
041241 -        Treatment Needed Immediately for Local Control 7th Relapse IBC
041242 -        7th Relaspe Cancer 6th Relapse IBC Requires Immediate Treatment
041243 -
041244 -        Follow up ref SDS 14 8V5O, ref SDS 11 0T8H.
041245 -
041246 -    5.  Doctor Rugo said I need hyperthermia right away for local
041247 -        control of IBC spreading most obviously in the breastbone area
041248 -        [reported 081224 and 081225, ref SDS 21 1Y4I], but now becoming
041249 -        prominent in other sites, e.g., abdomen; and, evident from
041250 -        cancer marker at Kaiser on 090116 CA 15-3 303, ref SDS 29 PQTQ]
041251 -
041252 -              [...below Doctor Rugo's letter to Kaiser on 090129
041253 -              reports IBC increasing on chest wall, ref SDS 0 TZ6H, and
041254 -              recommends referral for treatment with hyperthermia.
041255 -              ref SDS 0 HK3V
041257 -               ..
041258 -              [On 090205 0830 Doctor Hsu examination finds
041259 -              concentration of severe IBC in breastbone area,
041260 -              ref SDS 65 PR5K, and asks about patient history getting
041261 -              radiation treatments. ref SDS 65 PN8H
041263 -               ..
041264 -              [On 090205 Millie received Kaiser's authorization dated
041265 -              090202 for treatment at UCSF on referral, as requested by
041266 -              Doctor Rugo. ref SDS 66 278T
041267 -
041268 -        1.  Lymph node biopsy positive start
041269 -            bevacizumab Taxotere.............. 040318, ref SDS 2 8R6M
041270 -        2.  Cancer marker IBC increase end
041271 -            bevacizumab Taxotere due to
041272 -            pulmonary embolism................ 041210, ref SDS 5 025H
041273 -        3.  Cancer marker IBC recurs 9 months
041274 -            months after mastectomy........... 060711, ref SDS 6 025H
041275 -        4.  Cancer marker IBC worsens end
041276 -            capeticabine Taxotere............. 061201, ref SDS 8 RU6J
041277 -        5.  IBC progression with increased
041278 -            lymph nodes in axilla add
041279 -            Carboplatin to cetuximab.......... 080306, ref SDS 11 NW3N
041280 -        6.  IBC worsesn CT test swelled
041281 -            LN left supraclavicular; treatment
041282 -            cetuximab and Carboplatin end;
041283 -            begin work plan for sunitinib
041284 -            metronomic protocol............... 081016, ref SDS 14 J34U
041285 -        7.  IBC spreading severely, cancer
041286 -            marker soars CA 15-3 303; sunitinib
041287 -            treatment ended 090122; doctor
041288 -            prescribes hyperthermia and doxil
041289 -            to recover local
041290 -            control........................... 090129, ref SDS 0 4S8O
041291 -
041292 -                [On 090205 0900 UCSF discloses that hyperhermia is
041293 -                actually part of a radiation treatment.
041295 -                 ..
041296 -                [On 090323 case study cancer marker CA 15-3 correlated
041297 -                to dates of treatment. ref SDS 75 J13O
041299 -                 ..
041300 -                [On 090331 2047 8th relapse of cancer, and 7th relapse
041301 -                of IBC and 8th relapse of cancer occurs on lower left
041302 -                arm, below area treated with radiation and
041303 -                hyperthermia. ref SDS 77 Q69V
041305 -  ..
041306 - Letter to medical team continues...
041307 -
041308 -        Tara explained during examination that she treats a lot of
041309 -        patients with IBC, and has good results clearing up serious
041310 -        inflammation like I have now.
041311 -
041312 -            [On 090201 Millie reports IBC getting worse by the hour;
041313 -            asks for advice to treat rising pain, ref SDS 58 KN9T,
041314 -            further requests getting treatment the next day at UCSF on
041315 -            090202. ref SDS 58 KN9W
041317 -             ..
041318 -            [On 090205 1426 Millie received Pam's letter that explains
041319 -            Kaiser's authorization for Millie's care on referral to
041320 -            UCSF. ref SDS 66 278T
041322 -             ..
041323 -            [On 090310 0351 Millie reports again IBC seems to look
041324 -            worse, but realizes this may be reaction to radiation.
041325 -            ref SDS 72 O56X
041327 -             ..
041328 -            [On 090312 Tara clarified that she has very limited
041329 -            experience caring for patients with IBC who have been
041330 -            treated with radiation and hyperthermia in the UCSF
041331 -            Radication Oncology Department, ref SDS 73 SP8J; Doctor Hsu
041332 -            cited extensive experience treating IBC patients with
041333 -            radiation and hyperthermia, and advised that examination
041334 -            shows rising IBC symptoms are actually evidence of side
041335 -            effects from treatment with radiation and hyperthremia, and
041336 -            this worsening condition will get worse, but eventually
041337 -            recover, and further signals expected recovery from IBC.
041338 -            ref SDS 73 F84U
041340 -             ..
041341 -            [On 090401 0121 Doctor Rugo's letter to the medical team
041342 -            delays starting Millie's treatment for 8th relapse of
041343 -            cancer due to "wound" in the breastbone area which was
041344 -            diagnosed as reaction to radiation, and notes that
041345 -            treatment for 7th relapse with radiation and hyperthermia
041346 -            is very effective. ref SDS 78 PD5H
041348 -             ..
041349 -            [On 090514 0830 examination at UCSF shows substantial
041350 -            recovery from radiation side effects, and this permits
041351 -            determination of recovery from IBC to achieve local
041352 -            control. ref SDS 79 HX4L
041353 -
041354 -
041356 -         ..
041357 -        Communication Delays Between Kaiser UCSF Delayed Treatment
041358 -        Authorization Delayed by Communication Delays Treatment
041359 -
041360 -    6.  Doctor Rugo explained [during the meeting at UCSF yesterday on
041361 -        090129] communication with Kaiser [delayed coordinating
041362 -        referral on 090122 for Millie to get hyperthermia treatment in
041363 -        time to be effective, reported in telecon with Glenna on
041364 -        090123, ref SDS 42 TR7L, and this] delayed treatment yesterday,
041365 -        because authorization is not on file at UCSF.  You discussed
041366 -        this on 090123 saying Doctor Rugo should prescribe follow on
041367 -        treatment for local control. ref SDS 45 8K6K
041369 -  ..
041370 - On 041125 HHS publication by AHRQ attributes major cause of medical
041371 - mistakes to communication problems. ref SDS 4 JF5V
041372 -
041373 -            [On 090131 Millie received notice from primary care
041374 -            physician at Kaiser that authorization was issued on 090130
041375 -            for treatment with hyperthermia and Doxil. ref SDS 57 GV4M
041377 -             ..
041378 -            [On 090201 Millie proposes coming to UCSF the next day on
041379 -            090202 in the early morning at 0600 to stand-by for seeing
041380 -            doctor Hsu at the earliest possible time in order to
041381 -            expedite hyerthermia treatment prescribed by Doctor Rugo to
041382 -            prevent losing control of cancer caused by delayed
041383 -            treatment from the prior week. ref SDS 58 KN9W
041385 -  ..
041386 - Letter to medical team continues...
041387 -
041388 -    7.  This was confirmed in a letter to the medical team on 090127
041389 -        with the agenda for meeting at UCSF yesterday on 090129.
041390 -        ref SDS 47 TY5W
041392 -         ..
041393 -    8.  During the meeting yesterday, Doctor Rugo sent a letter to you
041394 -        for authorization of treatment [requested by the primary care
041395 -        physician at Kaiser, Doctor Johnson, on 081219, ref SDS 19 V93O
041396 -        and ref SDS 19 E84J] with hyperthemia and Doxil [to gain local
041397 -        control].  She sent a copy to Doctor Hsu to schedule treatment
041398 -        in UCSF Radiation Oncology.  There were problems using the
041399 -        computer.  The server was very slow handling a lot of
041400 -        transactions.  Tara found your your email address on another
041401 -        computer, and so Doctor Rugo was able to send the letter to
041402 -        you.
041404 -  ..
041405 - Doctor Rugo's letter to Kaiser says...
041406 -
041407 -    1.  Subject:  PHI
041408 -        Date: Mon, 29 Jan 2009 10:36:09 -0800
041414 -         ..
041415 -    2.  I saw Millie today, progression [of cancer since her treatment
041416 -        was stopped 090122, ref SDS 40 AT6N] on chest wall with much
041417 -        more nodularity [in the breastbone area reflecting dramatic
041418 -        rise of cancer marker CA 15-3 303, cited in Millie's letter to
041419 -        the medical team confirming findings from meeting with Doctor
041420 -        Rugo yesterday on 090129, per above, ref SDS 0 4S8O], she has a
041421 -        bit more in the way of pain and heat. ([reported to medical
041422 -        team on 090128. ref SDS 49 2S8X]
041423 -
041424 -            [...confirms examination findings that elevated vitals
041425 -            signal Millie is suffering rising pain, per above.
041426 -            ref SDS 0 AY7T
041428 -             ..
041429 -            [On 090201 Millie reports IBC getting worse by the hour;
041430 -            asks for advice to treat rising pain, ref SDS 58 KN9T,
041431 -            further requests getting treatment the next day at UCSF on
041432 -            090202. ref SDS 58 KN9W
041434 -             ..
041435 -            [On 090205 0830 Doctor Hsu examination finds concentration
041436 -            of severe IBC in breastbone area, ref SDS 65 PR5K, and asks
041437 -            about patient history getting radiation treatments.
041438 -            ref SDS 65 PN8H
041440 -         ..
041441 -    3.  I would love her to be able to see Joe Hsu in our department
041442 -        of radiation oncology, who is an expert in hyperthermia, we
041443 -        have had a lot of success with this in the past, and we could
041444 -        give her Doxil, as well, as we have prior data that we get
041445 -        more drug into skin when it is heated.
041446 -
041447 -            [On 090312 0800 Chris, Doctor Hsu's physicist in
041448 -            Hyperthermia Clinic advises this therpay can be combined
041449 -            wtih a "new" form of Doxil. ref SDS 73 T95N
041451 -  ..
041452 - On 041117 Doctor Benz in 2nd opinion for UCSF recommended
041453 - consideration of Doxil, possibly in combination with Gemzar; and also
041454 - cited possible regimen of capecitabine with Gemzar. ref SDS 3 OU5V
041456 -  ..
041457 - On 060929 2nd opinion from Doctor Benz at UCSF seems to say Millie
041458 - would likely not receive much benefit from newer formulations of
041459 - anthracyclines such as Doxil or Abraxane. ref SDS 7 WR3Y
041461 -  ..
041462 - Research on 090129 describes hyperthermia as an FDA approved
041463 - alternative treatment. ref SDS 53 BR57
041464 -
041465 -            [On 090205 Millie received Kaiser's authorization dated
041466 -            090202 for treatment at UCSF on referral, as requested by
041467 -            Doctor Rugo. ref SDS 66 278T
041469 -             ..
041470 -            [On 090205 treatment plan changed from Doxil to "lower
041471 -            dose" radiation to complement hyperthermia. ref SDS 65 EY5F
041473 -             ..
041474 -            [On 090213 1100 primary care physician at Kaiser describes
041475 -            hyperthermia treatment for Millie at UCSF provides
041476 -            palliation to relieve suffering from advancing cancer --
041477 -            Millie's 6th relapse of IBC; expects less than 1 year to
041478 -            live. ref SDS 68 WZ6K
041480 -             ..
041481 -            [On 090218 1205 Millie's letter to the medical team
041482 -            requests explanation of treatment plan using hyperthermia
041483 -            and radiation for recovering local control of IBC.
041484 -            ref SDS 69 TH5W
041486 -             ..
041487 -            [On 090219 during meeting with Doctor Hsu and Chris at UCSF
041488 -            requested medical orders for Millie's ratiation and
041489 -            hyperthermia treatments, similar to Chemotherapy Orders
041490 -            issued to the Infusion Clinic for Millie's care the past 2
041491 -            years. ref SDS 70 4254
041493 -             ..
041494 -            [On 090220 1548 paper received from UCSF describes
041495 -            hyperthermia combined with ionizing radiation provides
041496 -            effective treatment even for mutated cancer cells that
041497 -            resist treatment with chemotherapy. ref SDS 71 00FS  Since
041498 -            hyperthermia combined with radiation and/or chemotherapy,
041499 -            ref SDS 71 0129, "kills" cancer cells, ref SDS 71 00EI,
041500 -            this does not seem to fit the model of "palliation" as mere
041501 -            relief from suffering while cancer progresses toward near
041502 -            term demise. "Killing" cancer cells through heat sounds
041503 -            like aggressive curative therapy. ref SDS 71 GK6F
041505 -             ..
041506 -            [On 090220 1548 research paper received from UCSF explains
041507 -            hyperthermia heats cancer cells enabling increased delivery
041508 -            of drugs through the circulation system, which thereby
041509 -            kills more cancer cells, and further enhances drug toxicity
041510 -            in cancer cells rendered resistant to chemotherapy drugs
041511 -            through mutation, increasing efficiency of treatments.
041512 -            ref SDS 71 0129
041514 -         ..
041515 -    4.  Would you be willing to refer her?  thanks very much!
041516 -
041517 -            [On 090130 1453 call from Krshna in Doctor Hsu's office
041518 -            advises Radiation Oncology cannot schedule Millie for
041519 -            treatment on Monday 090202, because Kaiser has not
041520 -            submitted authorization for payment. ref SDS 54 NM6V
041522 -             ..
041523 -            [On 090130 1506 Millie notified Arlette asking about status
041524 -            of Doctor Johnson issuing Kaiser authorization for Millie's
041525 -            treatment using hyperthemia at UCSF responding to Doctor
041526 -            Rugo's letter today. ref SDS 55 RY4G
041528 -             ..
041529 -            [On 090130 1559 Arlette called back and advised that Doctor
041530 -            Johnson was in a meeting and would file authorization for
041531 -            Millie's treatment with hyperthemia later in the evening.
041532 -            ref SDS 55 PPYY
041534 -             ..
041535 -            [On 090131 Millie received notice from primary care
041536 -            physician at Kaiser that authorization was issued on 090130
041537 -            for treatment with hyperthermia and Doxil. ref SDS 57 GV4M
041539 -             ..
041540 -            [On 090202 0920 Michelle Williams Jones called and said
041541 -            Millie cannot get treatment prescribed on 090129 by Doctor
041542 -            Rugo, because Kaiser has not authorized payment.
041543 -            ref SDS 60 9Y5I
041545 -             ..
041546 -            [On 090205 1426 Millie received Pam's letter that explains
041547 -            Kaiser's authorization for Millie's care on referral to
041548 -            UCSF. ref SDS 66 278T
041550 -             ..
041551 -            [On 090219 Millie gets first treatment with radiation and
041552 -            hyperthermia. ref SDS 70 E57G
041554 -             ..
041555 -            [On 090220 1548 Millie received notes of a planning meeting
041556 -            at UCSF on designing her treatment for IBC wtih lower dose
041557 -            radiation and hyperthermia. ref SDS 71 PR4Y
041559 -             ..
041560 -            [On 090220 1548 hyperthermia provides palliation relief
041561 -            from pain with rising cancer, and from side effects of
041562 -            chemotherapy and radiation treatments, and even where there
041563 -            is no hope for survival, reported in BSD 2002 research
041564 -            paper received from UCSF. ref SDS 71 01G6
041566 -             ..
041567 -            [On 090317 0915 Millie gets final treatment with radiation
041568 -            and hyperthermia to complete work plan for local control.
041569 -            ref SDS 74 MK8N
041571 -             ..
041572 -            [On 090326 0058 Millie's letter to medical team confirms
041573 -            understandings on favorable examiantion at Kaiser on 090325
041574 -            finding strong response to treatment and reports success
041575 -            with treatment with radiation and hyperthermia at UCSF is
041576 -            very encouraging. ref SDS 76 DV4Q
041578 -             ..
041579 -            [On 090401 0121 Doctor Rugo's letter to the medical team
041580 -            delays starting Millie's treatment for 8th relapse of
041581 -            cancer due to "wound" in the breastbone area which was
041582 -            diagnosed as reaction to radiation, and notes that
041583 -            treatment for 7th relapse with radiation and hyperthermia
041584 -            is very effective. ref SDS 78 PD5H
041586 -             ..
041587 -            [On 090514 0830 examination at UCSF shows substantial
041588 -            recovery from radiation side effects, and this permits
041589 -            determination of recovery from IBC to achieve local
041590 -            control. ref SDS 79 HX4L
041591 -
041592 -
041593 -
041604 -  ..
041605 - Millie's letter to medical team continues...
041606 -
041607 -    6.  I stopped in your office yesterday afternoon on the way to
041608 -        meeting with Orthopedics about my shoulder injury.  The meeting
041609 -        at UCSF ran over several hours, so by the time I arrived at 1p,
041610 -        you had already left, and Arlette was at lunch.  So, I was
041611 -        unable to coordinate follow up on Doctor Rugo's letter.
041612 -        ref SDS 52 KR8G
041614 -         ..
041615 -    7.  Today, I got a call from Krshna in Doctor Hsu's office to
041616 -        schedule hyperthermia treatment. ref SDS 54 NM5H  She advised
041617 -        that the Kaiser referral office does not yet have authorization
041618 -        for my treatment on file. ref SDS 54 XU6I  Krshna asked for
041619 -        help getting authorization.
041621 -         ..
041622 -    8.  Additionally, Krsna said Doctor Hsu needs Millie's medical
041623 -        records from Kaiser.  Upon discussion, Krsna indicated that she
041624 -        will obtain medical records Doctor Hsu needs from Doctor Rugo's
041625 -        office. ref SDS 54 DL4J
041626 -
041627 -              [On 090201 Millie's letter to Doctor Rugo advises again
041628 -              that Doctor Hsu's office requests medical records from
041629 -              Kaiser, and asks Doctor Ruog to coordinate with Doctor
041630 -              Hsu's office on any additional medical records Millie
041631 -              should bring from Kaiser to prevent delaying treatment.
041632 -              ref SDS 59 5R4S
041634 -         ..
041635 -    9.  Called and talked to Arlette. ref SDS 55 RY4G
041637 -         ..
041638 -   10.  Arlette said you are out of the office.  She feels my cancer
041639 -        marker CA 15-3 303 and Doctor Rugo's examination [on 090129]
041640 -        indicate urgency to start treatment, and so is trying to reach
041641 -        you by page. ref SDS 55 KW5N
041642 -
041643 -              [On 090202 UCSF scheduled treatment to start on 090219.
041645 -               ..
041646 -              [On 020202 Doctor Rugo notified the medical team that
041647 -              Millie's condition is urgent, and requires starting
041648 -              treatment quickly.
041650 -         ..
041651 -   11.  Good news...
041653 -         ..
041654 -   12.  Arlette just called back and reported she contacted you
041655 -        attending a meeting off-site.  I think you are at the Kaiser
041656 -        campus in Antiock on Friday afternoons.  Arlette advised that
041657 -        you plan to file authorization for my treatment at UCSF this
041658 -        evening.  Hope the Kaiser computer system doesn't have a
041659 -        glitch. ref SDS 55 PPYY
041661 -         ..
041662 -   13.  Called Krshna (415 353 9807) at UCSF, and got a recording.
041663 -        Left a message that authorization will be filed this evening,
041664 -        and requested treatment scheduled for Monday or Tuesday next
041665 -        week, or as soon as possible. ref SDS 54 PPYR
041667 -         ..
041668 -   14.  Would like to get feedback from you that authorization has been
041669 -        filed, hopefully with some kind of identification number, so
041670 -        that follow up with UCSF can be expedited with clarity in the
041671 -        record.
041672 -
041673 -            [On 090131 Millie received notice from primary care
041674 -            physician at Kaiser that authorization was issued on 090130
041675 -            for treatment with hyperthermia and Doxil. ref SDS 57 GV4M
041677 -             ..
041678 -            [On 090201 Millie letter to medical team thanks Doctor
041679 -            Johnson for implementing request for referral from Doctor
041680 -            Rugo on 090129. ref SDS 58 GV4M
041682 -         ..
041683 -   15.  Good news for Gloria in the Coagulation Control Clinic.
041685 -         ..
041686 -   16.  Lab at UCSF yesterday on 090129 shows INR 2.5 has returned to
041687 -        balance, ref SDS 51 K66J, after ending treatment with sunitinib
041688 -        and cyclophosphamide on 090123 [ordered by Doctor Rugo via
041689 -        telephone message from Glenna on 090122, ref SDS 40 AT6N],
041690 -        indicating current Coumadin treatment is effective controlling
041691 -        INR.  Further alert I will be starting treatment with
041692 -        hyperthemia, and Doxil, hopefully next week.  INR 2.5 yesterday
041693 -        corrects problem of INR 3.7 in lab at Kaiser on 090122.
041694 -
041695 -            [On 090207 1428 Millie received letter from Gloria asking
041696 -            for results of INR blood test since prior test at Kaiser on
041697 -            090122, and so indicates Kaiser has not read the mail from
041698 -            a week ago received on 090130 submitting updated INR 2.5
041699 -            resutls. ref SDS 67 4P8N
041701 -         ..
041702 -   17.  NEUTS 1.76 (ANC 1760), platelets 190 remain good.  EOS is 100%
041703 -        high, down from 700% high on the test at Kaiser on 090116.
041704 -        ref SDS 51 075H  So far, no explanation of implications on
041705 -        escalating EOS.
041707 -         ..
041708 -   18.  As noted, had a good meeting with Kaiser Orthopedics yesterday
041709 -        afternoon. ref SDS 52 VF7I  The PA (Mike) wanted to send me to
041710 -        the ER, but after discussion he removed, stitches from the cut
041711 -        over my right eye, and said it is healing well.  Xray on the
041712 -        right arm and shoulder shows no evidence of fracture, and the
041713 -        shoulder is positioned correctly.  The doctor feels I should
041714 -        spend more time in a shoulder immobilizer for the next 2 weeks,
041715 -        and I have to avoid driving.
041717 -         ..
041718 -   19.  Feeling stronger today.  Planning to go hiking on Sunday, and
041719 -        then get back in the gym after exam on the shoulder in 2 weeks.
041720 -        As long as I don't trip, I can do most of the aerobics.
041722 -         ..
041723 -   20.  Research yielded good prospects for IBC recovery with
041724 -        hyperthemia, so I am feeling a lot better now, especially with
041725 -        side effects of sunitnib fading.
041727 -         ..
041728 -   21.  Called and thanked Glenna for outstanding coordination the past
041729 -        few months, assisting Doctor Rugo.
041731 -         ..
041732 -   22.  Thanks to a great team for comprehensive care with expertise
041733 -        and caring hearts.
041734 -
041743 -
041744 -
041745 -
041746 -
041747 -
041748 -
041749 -
0418 -