CONTACTS 

SUBJECTS
White Blood Cell Condition Blood Test Shows Too Low Doctor Johnson A

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 35 0000, ref SDS 26 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie went to the Breast Care Clinic on the 2nd floor, as planned in
040902 - her letter yesterday on 090311 1431, and expected that the meeting
040903 - today was canceled, ref SDS 39 O16V, because Tara's letter the day
040904 - before on 090310 1935 proposed deferring examination to a date when
040905 - Doctor Rugo is available. ref SDS 38 PR4Y  The attendant at the front
040906 - desk said that Tara was ready to meet with Millie, as scheduled by
040907 - Doctor Rugo's assistant on 090210 0937, ref SDS 26 XU5N, and for the
040908 - purpose presented in the agenda submitted in Millie's letter to the
040909 - medical team on 090310 0236, ref SDS 37 PR4Y, and confirmed in the
040910 - letter yesterday on 090311. ref SDS 39 O15X
040911 -
040912 -            [On 090313 Millie's letter to the medical team reported
040913 -            favorable examinations at UCSF. ref SDS 43 Q49L
040915 -  ..
040916 - Tara said she did not receive the report for Millie's lab work at
040917 - Kaiser on 090309, which was cited in Millie's letter to the medical
040918 - team on 090312 submitting the agenda. ref SDS 37 O63Q  Tara asked the
040919 - practice manager to call and ask Kaiser to fax the report for the
040920 - meeting, but she has been able to through.
040921 -
040922 -            [On 090325 0830 primary care physician disappointed by
040923 -            continual delays submittng data to UCSF, and notes conflict
040924 -            with requirements to streamline delivery of care in order
040925 -            to treat Millie's cancer at this time as a chronic disease.
040926 -            ref SDS 49 RB3G
040928 -             ..
040929 -            [On 090420 1451 Doctor Mason reported that other patients
040930 -            have not reported problems having labs performed at Kaiser
040931 -            and submitted to UCSF for referral treatment. ref SDS 58
040932 -            2H8J
040934 -  ..
040935 - Millie said she brought a backup copy of the lab report received from
040936 - Kaiser yesterday on 090311 1517, ref SDS 40 1U7J, for the blood test
040937 - performed at Kaiser on 090309 1500. ref SDS 36 075H
040939 -  ..
040940 - Tara posted results to the UCSF medical chart.
040942 -  ..
040943 - Tara asked why CA 15-3 was not listed in the report for the lab at
040944 - Kaiser on 090309, since the cancer marker has been used consistenly
040945 - the past 8 years for evaluating response to traetment?
040946 -
040947 -            [...below in this record on 090312 0800 CA 15-3 only
040948 -            objective diagnostic for evaluating response to treatment.
040949 -            ref SDS 0 YX5F
040951 -             ..
040952 -            [...below in this record on 099213 0800 Doctor Hsu cited CA
040953 -            15-3 provides objective metric on response to treatment.
040954 -            ref SDS 0 6I9L
040956 -  ..
040957 - Millie recalled that on 090213 the doctor ordered CA 15-3 for the lab
040958 - at Kaiser on 090309. ref SDS 27 6P3F
040960 -  ..
040961 - Tara requested that Millie follow up with Kaiser to complete the
040962 - record for the lab on 090309.
040963 -
040964 -            [On 090325 0830 primary care physician disappointed by
040965 -            continual delays submittng data to UCSF, and notes conflict
040966 -            with requirements to streamline delivery of care in order
040967 -            to treat Millie's 6th relapse of cancer as a chronic
040968 -            disease. ref SDS 49 RB3G
040970 -             ..
040971 -            [On 090420 1451 Doctor Mason reported that other patients
040972 -            have not reported problems having labs performed at Kaiser
040973 -            and submitted to UCSF for referral treatment. ref SDS 58
040974 -            2H8J
040976 -  ..
040977 - Millie further submitted the radiation treatment plan which also
040978 - controls the schedule for Millie's hyperthermia treatments, and which
040979 - was received from Doctor Hsu on 090226. ref SDS 34 D452
040981 -  ..
040982 - Tara reviewed the treatment plan and entered notes in Millie's medical
040983 - chart.
040985 -  ..
040986 - Examination today shows IBC seems worse in the breastbone area, where
040987 - cancer was most acute during Doctor Rugo's prior examintion on 090129.
040988 - and cited in the record the next day on 090130. ref SDS 20 4S8O  This
040989 - aligns with Millie's letter on 090310, submitting the agenda to the
040990 - medical team for meetings today at UCSF, noting disappointment that
040991 - IBC in the breastbone area seems worse. ref SDS 37 O56X
040992 -
040993 -            [...below, Doctor Hse advises that Millie's report on
040994 -            090310 that IBC in breastbone seems worse is a mistake; he
040995 -            explains rising inflammation in breastbone area is reaction
040996 -            to radiation, and this will get worse, before healing
040997 -            without any IBC disease. ref SDS 0 UL5L
040999 -             ..
041000 -            [On 090401 0121 Doctor Rugo notifies Millie and the medical
041001 -            team that treatment of IBC recurrence on the lower left arm
041002 -            diagnosed by Doctor Hsu, reported on 090401 0032,
041003 -            ref SDS 55 R24X, must be delayed until Millie's wound heals
041004 -            in breastbone area diagnosed as reaction to radiation in
041005 -            the meeting on 090330 1200, ref SDS 53 MN6F, and so defers
041006 -            meeting scheduled on 090402 0800; expects recovery from IBC
041007 -            in areas treated with radiation and hyperthermia to be very
041008 -            effective. ref SDS 56 K56O,
041010 -  ..
041011 - Millie asked why IBC showed significant improvement after 4 weeks
041012 - treatment with sunitinib, found during examination on 081218 at UCSF,
041013 - then suddenly became much worse after pausing treatment for a week on
041014 - 081219 to 081226?  Worsening IBC was first observed on 081224 and
041015 - 081225, ref SDS 6 1Y4I, reported to the medical team on 081230.
041016 - ref SDS 7 JV5M  On 090108 the medical team concurred that IBC had
041017 - begun to increase, reported in Millie's letter to the medical team on
041018 - 090109. ref SDS 9 UE6R, and adjusted treatment in order to maintain
041019 - consistent treatment with sunitinib. ref SDS 9 UF3T  On 090115 IBC in
041020 - the breastbone area began to increase again. ref SDS 10 124N  This
041021 - continued on 090116. ref SDS 11 124N  This was reported to Glenna in a
041022 - call from UCSF on 090116, ref SDS 12 JY70, and Glenna sent a letter to
041023 - Doctor Rugo reporting IBC worsening 8 days after starting sunitib
041024 - treatment again. ref SDS 14 6P3W  This was confirmed in Millie's
041025 - letter to the medical team on 090116, ref SDS 15 IS6G, and further
041026 - reflected in huge increase of cancer marker CA 15-3 303. ref SDS 13
041027 - PQTQ  On 090121 Glenna called to ask about Millie; reported IBC
041028 - worsening. ref SDS 16 AJ3J  Glenna sent a letter to Doctor Rugo
041029 - reporting Millie relapsed, ref SDS 16 N976, with patient history to
041030 - guide consideration of changing treatments. ref SDS 16 NU5H  On 090122
041031 - Glenna called and advised that Doctor Rugo ordered Millie's treatment
041032 - with sunitinib to end due to relapse, and that Millie would meet the
041033 - following week on 090129 to start a new treatment. ref SDS 17 AT6N
041034 - Examination at UCSF on 090129 showed IBC relapsed severely, cited in
041035 - the letter to the medical team the next day on 090130. ref SDS 20 4S8O
041036 - This was presented again in the agenda for the meeting on 090108,
041037 - submitted on 090106. ref SDS 8 YO4V
041039 -  ..
041040 - Tara noted that rapid advance of IBC during treatment with sunitinib
041041 - immediately following rapid recovery, shown in patient history, per
041042 - above, ref SDS 0 XJ43, reflects mutation  of cancer into a more
041043 - aggressive disease.  This aligns with analysis at Kaiser on 090213.
041044 - ref SDS 27 GC6N
041046 -  ..
041047 - Tara advised that worsening inflammation and increased open nodules in
041048 - the breastbone area observed by examination today show good progress
041049 - recovering from IBC, as planned in Doctor Rugo's letter to Kaiser on
041050 - 090129, and shown in the record the next day on 090130. ref SDS 20
041051 - TZ6H
041052 -
041053 -            [...below, Doctor Hse advises that Millie's report on
041054 -            090310 that IBC in breastbone seems worse is a mistake; he
041055 -            explains rising inflammation in breastbone area is reaction
041056 -            to radiation, and this will get worse, before healing
041057 -            without any IBC disease. ref SDS 0 UL5L
041059 -             ..
041060 -            [On 090328 0909 Millie reports continuing recovery from IBC
041061 -            with reduced nodularity; but increased pain from radiation
041062 -            side effects. ref SDS 52 4S4V
041064 -  ..
041065 - Millie asked how examination today finding "open nodules and worsening
041066 - inflammation" in the breastbone area establishes recovery from IBC
041067 - rather than worsening IBC disease?  Kaiser did not have time to
041068 - publish results of the CA 15-3 cancer marker from the blood test on
041069 - 090309, as reported in the record yesterday on 090311 receiving the
041070 - report from Kaiser. ref SDS 40 CV9M  What metrics support belief that
041071 - worsening conditions today signal recovry from IBC?
041072 -
041073 -            [On 090401 0121 Doctor Rugo notifies Millie and the medical
041074 -            team that treatment of IBC recurrence on the lower left arm
041075 -            diagnosed by Doctor Hsu, reported on 090401 0032,
041076 -            ref SDS 55 R24X, must be delayed until Millie's wound heals
041077 -            in breastbone area diagnosed as reaction to radiation in
041078 -            the meeting on 090330 1200, ref SDS 53 MN6F, and so defers
041079 -            meeting scheduled on 090402 0800; expects recovery from IBC
041080 -            in areas treated with radiation and hyperthermia to be very
041081 -            effective. ref SDS 56 K56O
041083 -  ..
041084 - Tara advised that clinically trying to separate worsening from
041085 - subsiding IBC is difficult for evaluating response to radiation and
041086 - hyperthermia because these treatments cause side effects that look
041087 - similar to IBC symptoms.  This presents a very complex, "wicked
041088 - problem," discussed in the record on 060722. ref SDS 2 346F
041090 -  ..
041091 - Complexity evaluating response to treatment and patient status is
041092 - evident from conflicting data for the cancer marker.  Kaiser labs
041093 - report CA 15-3 303 on 090116, ref SDS 13 PQTQ, and less than 2 weeks
041094 - later the UCSF lab reports CA 15-3 113 on 090129. ref SDS 18 A16M
041095 - This huge (200%) disparity in diagnostics was cited in Millie's letter
041096 - to the medical team on 090310, ref SDS 37 O63T, and so requires timely
041097 - review with professional judgement to assess requirements for
041098 - adjusting treatment. ref SDS 37 O64Y  Millie's follow up letter to the
041099 - medical team yesterday on 090311 1431 requested review to help
041100 - evaluate conflicting data and confusing appearance, ref SDS 39 O16S,
041101 - because the primary care physician at Kaiser advised on 090213 that
041102 - Millie has less time now, ref SDS 27 R75G, to make adjustments in
041103 - order to recover from advancing cancer, see as well patient history...
041105 -                  ..
041106 -                 080829.................... ref SDS 3 RP8T
041107 -                 081024.................... ref SDS 4 BO9F
041108 -                 081219.................... ref SDS 5 KU6F
041109 -                 090213.................... ref SDS 27 R75G
041111 -  ..
041112 - Tara clarified discussions on 090129 on experience treating patients
041113 - with hyperthermia for recovering from IBC. ref SDS 20 4S8O  Today, she
041114 - reported having minimal experience treating patients who have IBC and
041115 - are getting hyperthermia with lower dose radiation.  Tara feels that
041116 - Doctor Hsue has more experience to evaluate Millie's response to
041117 - treatment with radiation and hyperthermia.
041118 -
041119 -        [...below in the record today on 090312 0800 meeting in the
041120 -        Radiation Oncology Department prior to starting treatment,
041121 -        Millie meets with Doctor Hsu and Chris for evaluation of
041122 -        response to treatment. ref SDS 0 02AC  Doctor Hsu confirms that
041123 -        it is difficult to distinguish by observation alone IBC disease
041124 -        from side effects of radiation and hyperthermia, ref SDS 0
041125 -        F893, the doctor indicated that visual examination finding open
041126 -        sores oozing puss in the breastbone area, and severe
041127 -        inflammation in other IBC sites that have been treated with
041128 -        radiation and hyperthermia is consistent with appearance of
041129 -        other patients who have recovered with IBC after radiation and
041130 -        hyperthermia. ref SDS 0 F84U
041132 -  ..
041133 - Tara explained that Millie's condition today seems similar to past
041134 - experience treating patients with IBC who recovered after radiation
041135 - and hyperthermia.  Therefore, without CA 15-3 cancer marker to
041136 - indicate rising, falling, or stable cancer burden, since the open
041137 - sores and inflammation seen today are consistent with side effects of
041138 - getting maximum treatment with radiation and hyperthermia into the IBC
041139 - cancer cells, the condition observed today seems likely to reflect
041140 - recovery, rather than advancing or stable IBC.
041141 -
041142 -        [...below in this record on 099213 0800 Doctor Hsu cited CA
041143 -        15-3 provides objective metric on response to treatment.
041144 -        ref SDS 0 6I9L
041146 -         ..
041147 -        [...in another record later today on 090312 1437 called Kaiser
041148 -        talked to Cisi; she reported that CA 15-3 was not ordered for
041149 -        blood test on 090309, and recommended Millie contact the doctor
041150 -        to order the test. ref SDS 42 SV90
041152 -         ..
041153 -        [On 090313 0943 called Arlette to ask Doctor Johnson about
041154 -        getting CA 15-3 results for the blood test on 090309 to support
041155 -        the record of examination at UCSF on 090312. ref SDS 44 Y077
041157 -         ..
041158 -        [On 090323 1352 CA 15-3 251 cancer marker declined for blood
041159 -        test at Kaiser on 090317 on the last day of Millie's treatment
041160 -        with radiation and hyperthermia at UCSF, ref SDS 47 NR4H; net
041161 -        improvement dropping 54 points from prior test at Kaiser on
041162 -        090116, may represent much greater decline based on trend lines
041163 -        where Millie's cancer was rising rapidly during 4 weeks without
041164 -        treatment. ref SDS 47 NR4O
041166 -         ..
041167 -        [On 090325 0830 primary care physician disappointed by
041168 -        continual delays submittng data to UCSF, and notes conflict
041169 -        with requirements to streamline delivery of care in order to
041170 -        treat Millie's cancer at this time as a chronic disease.
041171 -        ref SDS 49 RB3G
041173 -         ..
041174 -        [On 090420 1451 Doctor Mason reported that other patients have
041175 -        not reported problems having labs performed at Kaiser and
041176 -        submitted to UCSF for referral treatment. ref SDS 58 2H8J
041178 -  ..
041179 - This addresses Millie's letter to the medical team on 090213 reporting
041180 - no evident change in symptoms. ref SDS 33 T45P
041182 -  ..
041183 - Tara described specific findings from examination today...
041184 -
041185 -    1.  Left arm IBC skin seems less thick and smaller.
041187 -         ..
041188 -    2.  Breastbone area nodules seem flatter and less "angry."
041190 -         ..
041191 -    3.  Nodules that have "opened up" and become "pussy," are expected
041192 -        reaction to radiation and hyperthermia that "burns" the skin,
041193 -        and so indicates patient responding to treatment.
041195 -  ..
041196 - Tara advised that Doctor Rugo has been following Millie's progress
041197 - from email traffic.  When Doctor Rugo returns to the office, Tara will
041198 - meet with the doctor and present findings from the meeting today.
041199 -
041200 -        [On 090326 0054 Millie's letter to the medical team reports on
041201 -        meeting with primary care physician at Kaiser on 090325 and
041202 -        presenting UCSF schedule for Tara to brief Doctor Rugo on
041203 -        patient response to radiation and hyperthermia in order to
041204 -        support planning for Millie's next treatment at UCSF.
041205 -        ref SDS 51 DW3U
041207 -         ..
041208 -        [On 090407 1121 Amanda calls and schedules Millie for another
041209 -        meeting with Tara, because Doctor Rugo will be out of town
041210 -        again on 090423 0830. ref SDS 57 4N3F
041212 -  ..
041213 - Tara advised that Doctor Rugo has a number of treatments she is
041214 - planning for Millie after completing radiation and hyperthermia which
041215 - will treat Millie's cancer as a chronic disease, requested by Doctor
041216 - Johnson at Kaiser during the meeting on 090213, ref SDS 27 GD3I, and
041217 - cited in the letter to the medical team on 090218, ref SDS 29 TH6U,
041218 - and again yesterday on 090311 1431 for the agenda of the meeting
041219 - today. ref SDS 39 O15X
041221 -             ..
041222 -            [On 090514 0830 Doctor Rugo explained a number of
041223 -            treatments becoming available at UCSF targeted to Millie's
041224 -            patient profile, including triple negative, and which can
041225 -            treat Millie's cancer as a chronic disease, as ordered by
041226 -            Doctor Johnson at Kaiser. ref SDS 60 YW48
041228 -  ..
041229 - Treatment planning on 090204 may support Doctor Rugo's review for
041230 - Millie's care. ref SDS 22 4R3S
041231 -
041232 -            [...below in this record today 090323 0800 Doctor Hsu
041233 -            discusses follow on treatments for Millie. ref SDS 0 F973
041235 -  ..
041236 - Tara prepared a letter to Kaiser summarizing findings today and using
041237 - the UCSF standard form for....
041238 -
041239 -        UCSF Cancer Center
041240 -        Outpatient Progress Notes
041241 -
041255 -         ..
041256 -        Dear Doctor Johnson
041258 -         ..
041259 -        Millie **** was seen today 3/12/09.  Her skin appears less
041260 -        thick in the areas she is being treated than the last time we
041261 -        saw her [on 090129, reported on 090130, ref SDS 20 4S8O].
041263 -         ..
041264 -        Thank you.
041267 -
041268 -            [On 090313 Millie's letter to the medical team included
041269 -            Tara's letter to Kaiser, with comment that Millie would
041270 -            hand deliver a copy of the printed doucment to Doctor
041271 -            Johnson. ref SDS 43 MY3M
041273 -             ..
041274 -            [On 090326 0054 during meeting at Kaiser Millie submitted
041275 -            Tara's printed report to Doctor Johnson. ref SDS 50 6A6X
041276 -
041277 -
041278 -
041280 -  ..
0413 -
0414 -
0415 - 0910
0416 -
041601 - Millie's radiation treatment was scheduled for 0915.  Arrived in
041602 - Radiation Oncology about 0910 located in the basement floor.  Millie
041603 - was already dressed down for treatment wearing a hospital gown from
041604 - examination in the Breast Care Clinic on the 2nd floor.
041606 -  ..
041607 - Millie entered the dressing area for radiation, and then was taken to
041608 - the radiation treatment room.
041610 -  ..
041611 - Asked the attendant, Missy, to see Doctor Hsu and Chris, planned in
041612 - the letter to the medical team on 090310 submitting an agenda for
041613 - today. ref SDS 37 O55W
041615 -  ..
041616 - Missy said that Doctor Hsu is very busy today, and that he usually
041617 - does not visit with patient assistants.  This aligns with patient
041618 - history showing the doctor has not had time to communicate with the
041619 - medical team.
041621 -  ..
041622 - Missy made some calls, and said Chris can meet between 0945 - 1000.  A
041623 - few minutes later she said Doctor Hsu can meet at 0930.  Missy gave
041624 - directions to an examination room down the hall in the treatment area.
041626 -  ..
041627 - Missy will ask Chris to join the meeting when he is available after
041628 - 0945.
041629 -
041630 -        [...below, in the record today on 090312 0952 Chris joins
041631 -        meeting after Millie leaves to start radiation treatment.
041632 -        ref SDS 0 F935
041634 -  ..
041635 - Walked through the double doors into the treatment area, and down the
041636 - hall to the last examination room on the left.  Millie was already in
041637 - the room.  She advised that the doctor had instructed the technicians
041638 - in the radiation department to send Millie to the meeting, as well.
041640 -  ..
041641 - Millie was concerned that someone else would get her treatment time,
041642 - and then everything would be delayed for an hour or more, which
041643 - interferes with plans to meet a friend for lunch at Nixon Peabody
041644 - downtown in Embarcadero 2.
041646 -  ..
041647 - Went and found the technician for Millie's radiation treatment.  He
041648 - agreed to stand-by and hold Millie's treatment time, until after she
041649 - meets with Doctor Hsu and Chris, rather than start another patient
041650 - for Millie's time slot.
041652 -  ..
041653 - Millie was relieved to hear her treatment could start as soon as the
041654 - meeting ends.
041655 -
041657 -  ..
0417 -
0418 -
0419 - 0930
0420 -
042001 - Doctor Hsu arrived in the examination room.
042002 -
042003 - The doctor had reviewed Millie's letter sent to him on 090310, with
042004 - copies to the medical team, and requesting a meeting to review
042005 - progress after 3 weeks of treatment with radiation and hyperthermia.
042006 - ref SDS 37 O55W
042008 -  ..
042009 - Doctor Hsu also received a copy of Millie's letter to Tara sent last
042010 - night, indicating the meeting in the Breast Care Clinic scheduled for
042011 - this morning at 0800 may be canceled. ref SDS 39 O16V
042013 -  ..
042014 - The doctor was pleased to hear that Tara was able to meet with Millie
042015 - at 0800 this morning afterall, per above, ref SDS 0 TP9L, and as
042016 - previously scheduled by Doctor Rugo's staff on 090210, ref SDS 26
042017 - XU5N, and reported in Millie's letter to the medical team on 090218.
042018 - ref SDS 29 TH6U
042020 -  ..
042021 - Doctor Hsu said that today is a good time for review of Millie's
042022 - response after 3 weeks of treatment with radiation and hyperthermia.
042024 -  ..
042025 - The doctor examined Millie's chest, and left arm.  He seemed to feel
042026 - that observation today shows expected and definite response to
042027 - treatment for recovering from IBC, and comparing to prior examination
042028 - on 090205. ref SDS 23 R29M
042029 -
042030 -            [On 090328 0909 Millie reports continuing recovery from IBC
042031 -            with reduced nodularity; but increased pain from radiation
042032 -            side effects. ref SDS 52 4S4V
042034 -  ..
042035 - Millie was pleased with favorable findings from examination.
042037 -  ..
042038 - She related similar findings by Tara this morning, ref SDS 0 YX9F, who
042039 - explained that distinguishing IBC from radiation side effects is
042040 - difficult, ref SDS 0 YX40, and that Doctor Hsu is the "expert" at
042041 - UCSF, because he sees more patients with this condition. ref SDS 0
042042 - SP8J
042043 -
042044 -
042045 -
042047 -  ..
0421 -
0422 -
0423 - 0945
0424 -
042401 - Millie thanked the doctor for taking time to visit, and then left the
042402 - meeting to get treatment.
042404 -  ..
042405 - After Millie left for treatment, there was further discussion on
042406 - metrics for evaluating response to treatment, asked in Millie's letter
042407 - to the team on 090310. ref SDS 37 O63T
042408 -
042409 -            [...below, Doctor Hsu explains UCSF relies on visual
042410 -            examination to assess resonse to radiation and hyperthermia
042411 -            for recovering from IBC in the skin; notes experienced
042412 -            doctors are expert in evaluating treatment effectiveness,
042413 -            ref SDS 0 F893; there was no comment today on Millie's
042414 -            request to use MRI testing for evaluating IBC recovery with
042415 -            radiation and hyperthermia. ref SDS 0 BY8L
042417 -             ..
042418 -            [On 090330 1200 Doctor Hsu indicated that weakness of
042419 -            visual examiantion for evaluating response to radiation and
042420 -            hyperthermia treatment recovering from IBC has will work
042421 -            better than enhanced MRI in Millie's case. ref SDS 53 LO5N
042423 -  ..
042424 - Doctor Hsu corrected "mistakes" in Millie's letter on 090310, worrying
042425 - about slow recovery based on visual observation of worsening "IBC"
042426 - disease, particularly on the breastbone area showing new sores
042427 - beginning to open and bleed. ref SDS 37 O56X
042429 -  ..
042430 - Discussed research on 090129, indicates that enhanced MRI technology
042431 - shows the extent of IBC in the skin, ref SDS 19 SQ6L  Millie's letter
042432 - on 090220 asked the medical team to explain metrics for evaluating
042433 - response to treatment beyond visual examination, which has been
042434 - problematic in patient history. ref SDS 31 EA5P
042436 -  ..
042437 - Doctor Hsu concurred with Tara's assessment during examination in the
042438 - Breast Care Clinic that IBC symptoms are similar to side effects of
042439 - radiation and hyperthermia, and therefore distinguishing IBC disease
042440 - from side effects of radiation and hyperthermia is difficult.
042441 - ref SDS 0 YX40  The doctor feels Millie is making a mistake worrying
042442 - needlessly, because he is sure the wound in Millie's breastbone area
042443 - is reaction to radiation, which looks like IBC, and so can mislead
042444 - patients.
042446 -  ..
042447 - The doctor explained that experience treating many patients with
042448 - radiation and hyperthermia helps doctors in the UCSF Radiation
042449 - Oncology department distinguish visually IBC inflammation from similar
042450 - skin rash caused by reaction to radiation and hyperthermia heat.
042452 -  ..
042453 - The doctor further noted that visual evaluation recovering from IBC is
042454 - not an exact metric, like CA 15-3 cancer marker discussed in Millie's
042455 - letter to the medical team on 090310. ref SDS 37 O63T  The cancer
042456 - marker directly indicates effectiveness of treatment, also, cited by
042457 - Tara meeting in the Breast Care Clinic at 0800 this morning, per
042458 - above. ref SDS 0 YX5F  Doctor Hsu feels CA 15-3 should be coming down,
042459 - based on observations today; he asked if testing shows any changes to
042460 - the cancer marker since starting treatments on 090219?
042461 -
042462 -        [On 090330 1200 Doctor Hsu indicated that weakness of visual
042463 -        examiantion for evaluating response to radiation and
042464 -        hyperthermia treatment recovering from IBC has will work better
042465 -        than enhanced MRI in Millie's case. ref SDS 53 LO5N
042467 -  ..
042468 - Patient history shows CA 15-3 303 increased 100 points from 081226 to
042469 - 090116, ref SDS 13 PQTQ, prior to starting treatment on 090219.  There
042470 - were delays getting results for CA 15-3 for the lab at Kaiser this
042471 - past Monday on 090309, reported yesterday on 090311. ref SDS 40 1U7J
042472 -
042473 -        [On 090312 1437 Kaiser discloses that cancer marker was omitted
042474 -        from testing for the lab on 090309, and so would have to be
042475 -        done over. ref SDS 42 SV90
042477 -         ..
042478 -        [On 090317 1120 Kaiser orders another blood draw to test CA
042479 -        15-3 omitted from the test on 090309. ref SDS 46 3R7J  Blood
042480 -        draw performed at Kaiser. ref SDS 46 PQ6R
042482 -         ..
042483 -        [On 090323 1352 CA 15-3 251 cancer marker declined for blood
042484 -        test at Kaiser on 090317 on the last day of Millie's treatment
042485 -        with radiation and hyperthermia at UCSF, ref SDS 47 NR4H; net
042486 -        improvement dropping 54 points from prior test at Kaiser on
042487 -        090116, may represent much greater decline based on trend lines
042488 -        where Millie's cancer was rising rapidly during 4 weeks without
042489 -        treatment. ref SDS 47 NR4O
042491 -         ..
042492 -        [On 090325 0830 primary care physician disappointed by
042493 -        continual delays submittng data to UCSF, and notes conflict
042494 -        with requirements to streamline delivery of care in order to
042495 -        treat Millie's cancer at this time as a chronic disease.
042496 -        ref SDS 49 RB3G
042498 -         ..
042499 -        [On 090420 1451 Doctor Mason reported that other patients have
042500 -        not reported problems having labs performed at Kaiser and
042501 -        submitted to UCSF for referral treatment. ref SDS 58 2H8J
042503 -  ..
042504 - Doctor Hsu advised that Millie's letter on 090223 asking about
042505 - possible worsening IBC on the upper left arm since starting radiation
042506 - and hyperthermia treatments on 090219, ref SDS 33 T49Y, reflects
042507 - similarity in symptoms, and in his judgement examination today of the
042508 - upper left arm has the appearance of responding to treatment, and does
042509 - not show signs of increased IBC.
042511 -  ..
042512 - Doctor Hsu noted that full assessment of local control reducing IBC
042513 - from all sites cannot be made for several weeks and even months after
042514 - treatment ends, and Millie's skin recovers from radiation side
042515 - effects observed during the meeting today.
042516 -
042517 -            [...below in this record on 090312 0800 Doctor Hsu advises
042518 -            that theraputic recovery from cancer continues for months
042519 -            after ending radiation treatment. ref SDS 0 F860
042521 -             ..
042522 -            [...below in this record on 090312 0800 doctor indicates
042523 -            examination today shows substantial progress toward local
042524 -            control, and completion of treatment on 090317 with
042525 -            continuing recovery will achieve local control of Millie's
042526 -            IBC. ref SDS 0 AH6L
042528 -  ..
042529 - The doctor confirmed Tara's comments this morning that oozing, open
042530 - sores on Millie's chest, which have caused increased concern the past
042531 - week or so about rising IBC, actually presents a positive sign of
042532 - effective radiation, showing Millie is getting maximum treatment into
042533 - infected tissue. ref SDS 0 9L7K  The doctor feels Millie's seemingly
042534 - poor condition today signals strong progress toward local control of
042535 - IBC.  This was good news resolving growing emotional worry about
042536 - worsening IBC in the breastbone area, reported in Millie's letter to
042537 - the medical team on 090310. ref SDS 37 O56X
042539 -             ..
042540 -            [On 090323 Kaiser reports cancer marker CA 15-3 251 from
042541 -            blood test on 090317 shows significant decline for the
042542 -            first time in 6 months. ref SDS 47 Y077
042544 -             ..
042545 -            [On 090401 0121 Doctor Rugo notifies Millie and the medical
042546 -            team that treatment of IBC recurrence on the lower left arm
042547 -            diagnosed by Doctor Hsu, reported on 090401 0032,
042548 -            ref SDS 55 R24X, must be delayed until Millie's wound heals
042549 -            in breastbone area diagnosed as reaction to radiation in
042550 -            the meeting on 090330 1200, ref SDS 53 MN6F, and so defers
042551 -            meeting scheduled on 090402 0800; expects recovery from IBC
042552 -            in areas treated with radiation and hyperthermia to be very
042553 -            effective. ref SDS 56 K56O
042555 -             ..
042556 -            [On 090607 2253 Millie notified medical team that wound in
042557 -            the breastbone area diagnosed as reaction to readiation
042558 -            treatment was worse; requested additional treatment planned
042559 -            by UCSF. ref SDS 64 KS62
042561 -             ..
042562 -            [On 090609 Doctor Hsu advises that the wound in Millie's
042563 -            breastbone area is not caused by reaction to radiation
042564 -            treatments; the bleeding wound was caused by a mistake
042565 -            performing radiation in February and March at UCSF that
042566 -            missed treating IBC in the breastbone area and this
042567 -            untreated IBC tumor has caused cancer to spread, and causes
042568 -            problems in Millie's lungs that prevent breathing.
042569 -            ref SDS 65 TP9L
042571 -  ..
042572 - The doctor said more "open sores" will occur with blistering getting
042573 - much worse for a few weeks after treatment ends, but will definitely
042574 - heal based on experience treating other patients.  He explained that
042575 - Millie received a lot of radiation, because delay starting treatment
042576 - caused her IBC to become very severe by 090219, as discussed during
042577 - the initial meeting with the doctor on 090209. ref SDS 25 TW7O  Since
042578 - Millie is getting a lot of radiation to recover control of cancer,
042579 - theraputic benefits will be prolonged for months after treatment ends.
042580 - This will also extend the time required for recovering from radiation
042581 - burn. (see below, ref SDS 0 Q16N)
042583 -             ..
042584 -            [On 090313 Millie's letter to medical team confirms
042585 -            understandings that radiation side effects will get worse
042586 -            for several weeks or a month or more, and that recovery
042587 -            from radiation will continue for a month or more.
042588 -            ref SDS 43 B25R
042590 -             ..
042591 -            [On 090317 Millie receives Silvadene Cream 1% from Doctor
042592 -            Hsu, ref SDS 45 M442, and also received instructions from
042593 -            Miranda for application, including an orientation for
042594 -            bandaging to recover from expanding sores caused by
042595 -            radiation and hyperthermia treatments. ref SDS 45 ET46
042597 -             ..
042598 -            [On 090328 0909 Millie notifies medical team pain and
042599 -            suffering rising from radiation side effects 2 weeks after
042600 -            ending treatments at UCSF on 090317; side effects have been
042601 -            tolerated in order to benefit from treating IBC; Millie
042602 -            considering adding zink and Domeboro to increase relief
042603 -            from radiation "burn" side effects. ref SDS 52 4S4P
042605 -             ..
042606 -            [On 090328 0909 Millie notifies medical team considering
042607 -            adding zink and Domeboro treatment prescribed by Kaiser to
042608 -            supplement treatment with Silvadene prescribed by UCSF to
042609 -            reduce pain and suffering side effects from radiation
042610 -            treatments, and asks Doctor Hsu again of any conflicts with
042611 -            Silvadene cream prescribed by UCSF for treating radiation
042612 -            side effects. ref SDS 52 4S4P
042614 -             ..
042615 -            [On 090423 0830 Doctor Hsu advised again that radiation
042616 -            will continue to treating Millie for months after ending
042617 -            treatmet on 090317, and so he expects full elimination of
042618 -            cancer in treatment zones, because nothing can grow in the
042619 -            areas treated with radiation. ref SDS 59 YN5N
042621 -             ..
042622 -            [On 091112 0930 CT test on 090919 found ground glass
042623 -            opacity nodues resolved in some areas of the lungs, and new
042624 -            ones appear in other areas, ref SDS 66 WY8J, reflecting
042625 -            Doctor Hsu's report that radiation effects last for months
042626 -            after ending treatment, per above. ref SDS 0 F860
042628 -  ..
042629 - Doctor Hsu discussed Millie's letter to the medical team on 090218
042630 - asking about treating side effects of radiation and hypertheria, and
042631 - requesting comments on using Vitamin E plus pentoxifylline (Trental),
042632 - reported in the record on 090209, ref SDS 24 745R, and which can be
042633 - problematic with Coumadin, so, if this treatment is prescribed, then
042634 - Gloria in the Coagulation Control Clinic at Kaiser will need input.
042635 - ref SDS 29 TH7V
042637 -  ..
042638 - The doctor explained UCSF prescribes Vitamin E plus pentoxifylline
042639 - (Trental) in some cases as a secondary solution for patients who
042640 - suffer severe and prolonged side effects for 2 - 3 months from
042641 - radiation and hyperthermia.  Normally, this remedy is not needed for
042642 - most patients.
042643 -
042644 -            [On 090330 during emergency examination at UCSF Doctor Hsu
042645 -            plans to monitor Millie's recovery from radiation, and if
042646 -            there are continuing signs of radiation burn several months
042647 -            after ending treatment on 090317, then Vitamin E plus
042648 -            pentoxifylline (Trental) will be prescribed for a 6 month
042649 -            regimen. ref SDS 53 T487
042651 -  ..
042652 - Doctor Hsu advised that he will initially supply a special cream to
042653 - speed recovery of skin inflammation caused by reaction to radiation.
042654 - He seemed to say that the skin will eventually recover to look normal,
042655 - without distortions in color and appearance.  The texture may be
042656 - altered in some degree for some time.
042657 -
042658 -            [On 090317 Millie receives Silvadene Cream 1% from Doctor
042659 -            Hsu, ref SDS 45 M442, and also received instructions from
042660 -            Miranda for application, including an orientation for
042661 -            bandaging to recover from expanding sores caused by
042662 -            radiation and hyperthermia treatments. ref SDS 45 ET46
042663 -
042664 -
042666 -  ..
0427 -
0428 -
0429 - 0952
0430 -
043001 - Chris arrived in the examination room.
043002 -
043003 - Doctor Hsu gave a brief summary of discusisons with Millie.
043005 -  ..
043006 - Chris was familiar with the agenda, from getting copies of Millie's
043007 - correspondence on 090310, ref SDS 37 PR4Y, and the next day on 090311.
043008 - ref SDS 39 5Z9K  Chris had previously talked generally with Millie
043009 - about combining Doxil with hyperthermia.
043011 -  ..
043012 - Doctor Hsu emphasized again that radiation and hyperthermia continue
043013 - to destroy IBC cells for weeks and even months after treatment ends.
043014 - He expects that because Millie received a lot of radiation, there will
043015 - a longer period of radiation affects, which will prolong recovery from
043016 - side effects, per above. ref SDS 0 F860
043017 -
043018 -        [On 090313 Millie's letter to medical team confirms
043019 -        understandings that radiation side effects will get worse for
043020 -        several weeks or a month or more, and that recovery from
043021 -        radiation will continue for a month or more. ref SDS 43 B25R
043023 -         ..
043024 -        [On 090328 0909 Millie notifies medical team pain and suffering
043025 -        rising from radiation side effects 2 weeks after ending
043026 -        treatments at UCSF on 090317; side effects have been tolerated
043027 -        in order to benefit from treating IBC; Millie considering
043028 -        adding zink and Domeboro to increase relief from radiation
043029 -        "burn" side effects. ref SDS 52 4S4P
043031 -         ..
043032 -        [On 090604 1021 Millie's cancer marker drops 30 points in 2
043033 -        weeks after rising 70 points in 6 weeks, demonstrates
043034 -        continuing recovery from radiation treatments that ended on
043035 -        090317. ref SDS 63 07AD
043037 -  ..
043038 - Doctor Hsu clarified changes to the original work plan on 090129
043039 - calling for treatment with hyperthermia and Doxil, ref SDS 20 HK3V,
043040 - and further responded to Millie's letter on 090220 asking for metrics
043041 - applied to evaluate when the patient has recovered from IBC so that
043042 - radiation and hyperthermia treatments can end. ref SDS 31 EA5P
043044 -  ..
043045 - Sounded like UCSF calculated how much radiation Millie can tolerate
043046 - based on prior treatments in 2002, an issue presented in the Benz 2nd
043047 - opinion on 041117. ref SDS 1 OU4U  The lower dose levels then
043048 - established by calculation the total number of days Millie can get
043049 - radiation, and this is listed in the treatment plan received from UCSF
043050 - on 090226, ref SDS 34 D452, following request in Millie's letter on
043051 - 090223. ref SDS 33 3N9J
043053 -  ..
043054 - Hyperthermia treatments were correlated to the number of days the
043055 - patient gets radiation, and in order to provide synergy of multiple
043056 - modalities.  There is then hope and expectation that getting the
043057 - maximum amount of radiation and hyperthermia the patient can tolerate
043058 - will be sufficient to completely recover from IBC.  This seems
043059 - conflicting with representation in research on 090129 that patients
043060 - continue getting treatment until testing shows all IBC is resolved.
043061 - ref SDS 19 OI6N  That research seems conflicting with Millie's
043062 - experience getting radiation and hyperthermia that causes side effecs
043063 - similar to IBC symptoms, per above, ref SDS 0 1R5I, raising a question
043064 - of how doctor's cited in the research decided to end treatments based
043065 - on recovery from IBC, since this cannot be assessed for weeks and
043066 - months after treatment ends?
043068 -  ..
043069 - The doctor explained today that initial prescription on 090129 for
043070 - hyperthermia with Doxil chemotherapy, reported on 090130, ref SDS 20
043071 - HK3V, was changed because hyperthermia and lower dose radiation
043072 - provides the maximum strength treatment for IBC.  Examination in the
043073 - Radiation Oncology Department on 090205 showed that Millie's IBC was
043074 - more severe than expected. ref SDS 23 R29M  Since treatment was
043075 - delayed, severity of IBC increased, and so required maximum strength
043076 - treatment, per above. ref SDS 0 F860
043078 -  ..
043079 - Doctor Hsu seemed to say that hyperthermia is more effectinve when
043080 - combined with another modality.  Radition and chemotherapy are the 2
043081 - most commonly used treatments with hypethermia.  This aligns with
043082 - research on 090129 indicating "multimodality" treatment works best to
043083 - recover from IBC. ref SDS 19 NJ6H
043085 -  ..
043086 - The doctor further seemed to indicate that hyperthermia combined with
043087 - radiation is stronger than when combined with chemotherapy for direct
043088 - treatment of cancer, including IBC, which occurs in the skin.
043089 - Therefore, in order to provide the maximum treatment to enable Millie
043090 - to recover from IBC, Doctor Hsu changed the prescription from
043091 - hyperthermia with Doxil proposed to Kaiser on 090129, and instead
043092 - prescribed radiation with hyperthermia.
043094 -  ..
043095 - During the meeting today, the doctor used the computer to check the
043096 - radiation plan submitted to Millie on 090226. ref SDS 34 D452  He
043097 - said the plan allows for only 4 weeks of treatments 4 days per week.
043098 - There is nothing evident in the file received from UCSF on 090226
043099 - that says 4 weeks of treatment 4 days per week.  The following line
043100 - in the listing...
043101 -
043102 -    Rad Rx:  L arm - AP/PA -   6MV PHOT Dose: 4256 cGy @ 266 cGy x 16   A 2/12/2009 | H
043103 -
043104 - ....could be interpreted to call for 16 treatments to the left arm.
043105 - This could correlate with Millie getting radiation to the left arm for
043106 - 4 days a week and 4 weeks, which would equal 16 total treatments.
043108 -  ..
043109 - The doctor did not explain how the 4 weeks were calculated, and
043110 - whether other IBC sites might require more and/or could tolerate more
043111 - radiation and/or hyperthermia treatments in order to recover from IBC.
043113 -  ..
043114 - The doctor asked when Millie started treatments with radiation and
043115 - hyperthermia?
043117 -  ..
043118 - Chris could not recall.  The doctor checked the computer and could not
043119 - find the date of the first treatment.  Millie's patient history shows
043120 - the first treatment with radiation and hyperthermia was on 090219.
043121 - ref SDS 30 E57G
043123 -  ..
043124 - Doctor Hsu said that based on Millie having started treatments on
043125 - 090219, and based on the listing of radiation treatments reviewed
043126 - today on the computer and submitted to Millie on 090226 calling for 16
043127 - total treatments (i.e., 4 x 4), then Millie's last treatment will be
043128 - next Tuesday on 090317.
043130 -  ..
043131 - There was discussion about treating Millie until she recovers from
043132 - IBC, i.e., achieves "local control," regardless of whether she can
043133 - tolerate more radiation.  The purpose of referral on 090129 for
043134 - treatment with hyperthermia and Doxil was to accomplish "local
043135 - control," cited in Millie's letter to the medical team on 090130.
043136 - ref SDS 20 4S8O
043138 -  ..
043139 - The letter to the medical team on 090310 asked about requirements to
043140 - adjust the treatment plan to accomplish referral objectives.
043141 - ref SDS 37 O64Y  For example, the paper prepared by BSD and which UCSF
043142 - submitted on 090220, explains many ways to adjust treatment of IBC by
043143 - combining hyperthermia with other modalities. ref SDS 32 5V7K
043145 -  ..
043146 - For example, research on 090218 reports combining hyperthermia with
043147 - Thermodox, being tested in a clinical trial. ref SDS 28 P734
043149 -  ..
043150 - Doctor Hsu indicated that examination today finding likely strong
043151 - response to treatment, ref SDS 0 F89Y, indicates no adjustments are
043152 - required in the original treatment plan received from UCSF on 090226.
043153 - ref SDS 34 D452  Doctor Hsu seemed to indicate that examination today
043154 - shows Millie has made substantial progress toward local control.  The
043155 - doctor seemed confident there is strong liklihood that after Millie
043156 - recovers from side effects in several weeks to a month, and as
043157 - theraputic effects of radiation and hyperthermia continue for weeks
043158 - and possible a month or more, per above, ref SDS 0 VL4O, Millie's
043159 - treatments with radiation and hyperthermia scheduled to end next week
043160 - on 090317 will have accomplished "local control," as planned in the
043161 - meeting on 090129, reported in Millie's letter on 090130. ref SDS 20
043162 - 4S8O
043164 -         ..
043165 -        [On 090313 0127 Millie's letter to the medical team confirms
043166 -        understandings that examination today shows progresss toward
043167 -        local control. ref SDS 43 MY7J
043169 -         ..
043170 -        [On 090324 0548 Millie reports to medical team being
043171 -        encouraged, ref SDS 48 CT4U, after completing treatments at
043172 -        UCSF with radiation and hyperthermia on 090317, and getting
043173 -        favorable prognosis from Doctor Hsu during the meeting on
043174 -        090312. ref SDS 41 AH6L
043176 -  ..
043177 - Discussed UCSF treatment plan for Millie to recover from IBC, based on
043178 - patient history of 6 relapses, and Kaiser's prescription for UCSF to
043179 - treat Millie's cancer as a chronic disease, presented by Doctor
043180 - Johnson, Millie's primary care physician, most recently on 090213.
043181 - ref SDS 27 GC6N
043182 -
043183 -        [On 090325 Doctor Johnson discussed Millie's disease trajectory
043184 -        entering critical phase, ref SDS 49 P39M, and explained this
043185 -        requires treating Millie's cancer at UCSF as a chronic disease.
043186 -        ref SDS 49 P43G
043188 -  ..
043189 - Doctor Hsu feels Millie's history with IBC indicates strong liklihood
043190 - of recurrence.  This aligns with research on 090129 showing that IBC
043191 - successfully treated with radiation and hyperthermia can occur at
043192 - other sites, but continued treatment can fully resolve the disease.
043193 - ref SDS 19 OI6N
043195 -  ..
043196 - Doctor Hsu explained that radiation and hyperthermia combined with
043197 - other modalities, including chemotherapy (e.g., Doxil) can be
043198 - effective resolving Millie's IBC, as originally proposed in the UCSF
043199 - letter to Kaiser on 090129 for treating Millie's 6th relapse of IBC,
043200 - and reported in the record on 090130. ref SDS 20 HK3V
043202 -  ..
043203 - Doctor Hsu and Chris did not discuss today treatment response metrics
043204 - with enhanced MRI technology to assess IBC in the skin after radiation
043205 - and hyperthermia, as shown in research on 090129, ref SDS 19 SQ6L, and
043206 - cited in Millie's letter to the team on 090220. ref SDS 31 EA5P
043207 -
043208 -            [...above, Doctor Hsu explains UCSF relies on visual
043209 -            examination to assess resonse to radiation and hyperthermia
043210 -            for recovering from IBC in the skin; notes experienced
043211 -            doctors are expert in evaluating treatment effectiveness,
043212 -            ref SDS 0 F893
043214 -  ..
043215 - This seems more important for evaluating a 7th relapse in time to make
043216 - treatment effective, based on Doctor's Johnson's analysis on 090213
043217 - that any remaining cancer cells will be very aggressive. ref SDS 27
043218 - R75G  If enhanced MRI technology can show "local control" has been
043219 - accomplished with 5% of cancer remaining, this seems more manageable
043220 - than local control with 15% or 20% cancer cells remaining.
043222 -         ..
043223 -        [On 090330 1200 Doctor Hsu indicated that weakness of visual
043224 -        examiantion for evaluating response to radiation and
043225 -        hyperthermia treatment recovering from IBC has will work better
043226 -        than enhanced MRI in Millie's case. ref SDS 53 LO5N
043228 -  ..
043229 - Chris and the doctor seemed to say that Millie can get more treatments
043230 - with hyperthermia, because there no side effects.  Radiation, however,
043231 - can have severe, cumulative, and long lasting side effects; so, after
043232 - the current work plan, Millie will have no tolerance for additional
043233 - radiation in areas previously treated, similar to Doctor Benz's report
043234 - on 041117. ref SDS 1 OU4U
043236 -  ..
043237 - 2F979
043238 - One exception, might be if IBC occurs later outside of the treatment
043239 - areas UCSF has carefully documented.  In that case, more radiation
043240 - and hyperthermia might be tried.
043241 -
043242 -        [On 090331 0847 Millie reported possible IBC on the lower left
043243 -        arm. ref SDS 54 Q64R
043245 -         ..
043246 -        [On 090401 0032 Doctor Hsu responded that isolated rash on the
043247 -        lower left arm was likely IBC. ref SDS 55 R24X
043249 -         ..
043250 -        [On 090423 0830 Doctor Hsu explains radiation treatment is
043251 -        limited to only 2 regimines, like a gun loaded with only
043252 -        "2-bullets," and so has to be used with great care for maximum
043253 -        effect. ref SDS 59 UG6L
043255 -  ..
043256 - Doctor Rugo's ideas, cited by Tara earlier this morning, per above,
043257 - ref SDS 0 SS4F, and research on 090204 may support review in the UCSF
043258 - Radiation and Oncology Department for Millie's care. ref SDS 22 4R3S
043260 -  ..
043261 - If IBC occurs within the currently defined treatment sites, then
043262 - Millie can be treated with hyperthermia and a chemotherapy agent, as
043263 - called out in the BSD professional paper submitted by Chris on 090221,
043264 - to explaining the hyperthermia program at UCSF. ref SDS 32 0129  An
043265 - exammple is Doxil, which was initially considered in Doctor Rugo's
043266 - letter to Kaiser on 090129, reported on 090130. ref SDS 20 HK3V
043267 - Additional hyperthermia treatment could not be given immediatley,
043268 - however, because the skin must first recover from severe side effects
043269 - reacting to radiation for a few weeks, even months.
043271 -  ..
043272 - Millie reported after the meeting today that Chris commented during
043273 - hyperthermia treatment that a new form of Doxil will be available in a
043274 - few months that is expected to increase effectiveness treating IBC.
043275 - This updated Doctor Rugo's letter reported on 090130. ref SDS 20 HK3V
043277 -  ..
043278 - There was discussion of combining hypethermia with vaccines, presented
043279 - in documentation received from UCSF on 090220. ref SDS 32 0164  Doctor
043280 - Hsu explained that treatment combining hyperthermia with anti-tumor
043281 - vaccines are experimental in clincial trials.  This aligns with
043282 - research on 090204. ref SDS 22 4S3P
043283 -
043284 -        [On 090522 1351 Millie notifies medical team that absent
043285 -        medical advice, she chooses treatment with hyperthermia and
043286 -        radiation and Doxil or other appropriate agent, previously
043287 -        prescribed by Doctor Rugo at UCSF Cancer Center, and
043288 -        effective during Feb - Mar recovering from 7th relapse of
043289 -        cancer. ref SDS 61 2T5R
043291 -         ..
043292 -        [On 090528 1652 Millie responds to Doctor Rugo prescribing
043293 -        gemcitabine treatment for Millie at Kaiser and asks how this
043294 -        compares to getting hyperthermia and Doxil proposed by UCSF?
043295 -        ref SDS 62 B24S
043296 -
043297 -
043298 -
043299 -
043300 -
043301 -
0434 -