THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: March 13, 2009 01:27 AM Friday;
Rod Welch
Millie's letter to Kaiser reports UCSF finds recovery from IBC responding
to treatment with radiation and hyperthermia examination on March 12th.
1...Summary/Objective
2...IBC Recovering Radiation Hyperthermia Finding Examination UCSF
..............
Click here to comment!
CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS C0 0000. ref SDS B9 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - 1. On 090218 1205 Millie requests explanation of treatment plan.
040902 - Doctor Rugo's letter to Kaiser on 090129 discussed hyperthermia
040903 - with Doxil, reported on 090130. ref SDS 66 TZ6H Has the plan
040904 - changed to use "lower dose" radiation rather than Doxil. Will
040905 - both be used, or some other agent? At this time, the record is
040906 - confusing about scope. Please explain initial assessment, and
040907 - prognosis. If this has already been submitted to Doctor
040908 - Johnson and Doctor Rugo, send a copy to Millie. ref SDS A7 TH5W
040910 - ..
040911 - 2. On 090218 1205 Millie reports to medical team good meeting with
040912 - Doctor Johnson at Kaiser on 090213. He seemed optimistic that
040913 - Millie might have 3 - 6 months of recovery, but will need
040914 - treatment from Doctor Rugo for cancer as a "chronic disease." A
040915 - week or so ago on 090210, Lena called to scheduling meeting
040916 - with Doctor Rugo on 090312 0830, reflecting comprehensive
040917 - follow up ordered by Kaiser during the meeting on 090203.
040918 - ref SDS A7 TH6U
040920 - ..
040921 - 3. On 090218 1205 Millie asks UCSF about obtaining records from Mt
040922 - Diablo Medical Center of prior radiation in 2002, which Doctor
040923 - Hsu discussed doing during the meeting at UCSF on 090205.
040924 - ref SDS A0 PN8H, and which cites Doctor Benz 2nd opinion at
040925 - UCSF on 041018 saying Millie likely cannot tolerate more
040926 - radiation. ref SDS A0 YO9G Was that so long ago, there is risk
040927 - from additional radiation now? ref SDS A7 TH6X
040929 - ..
040930 - 4. On 090218 1205 Millie asks UCSF about responding, ref SDS A7
040931 - TH7V, to the letter a week ago on 090209 requesting explanation
040932 - of side effects from radiation and hyperthermia, ref SDS A3
040933 - 745R, following Doctor Hsu's comments during the meeting on
040934 - 090205. ref SDS A0 GM4N Does the treatment plan address this
040935 - prospectively, or as needed? For example, as noted in the
040936 - letter on 090209, research found that side effects of radiation
040937 - are sometimes treated with Vitamin E plus pentoxifylline
040938 - (Trental), ref SDS A3 745R, which can be problematic with
040939 - Coumadin, so Gloria in the Coagulation Control Clinic at Kaiser
040940 - will need input. ref SDS A7 TH7V
040942 - ..
040943 - 5. On 090218 1205 Millie looking forward to starting treatment on
040944 - 090219, and despite worry about delays that prevent treatment
040945 - from being effective. ref SDS A7 TH7Y Millie Thanks Doctor Hsu
040946 - for expediting care, reported on 090203, ref SDS 86 XX5I, and
040947 - to Doctor Rugo for guidance through troubled waters, shown by
040948 - UCSF letter on 090202 1722. ref SDS 81 Y15J
040950 - ..
040951 - 6. On 090220 Millie's letter to Doctor Hsu requests...
040952 -
040953 - a. Computer file of picture showing typical configuration
040954 - of hyperthermia treatment. ref SDS A9 XX5O
040955 -
040956 - b. Computer file of picture showing typical configuration
040957 - of radiation treatment. ref SDS A9 XX5O
040959 - ..
040960 - c. Summary/general explanatoin of radiation and
040961 - hyperthermia treatments. Radiation on 090219 took much
040962 - longer than radiation Millie had in 2002, so there seems
040963 - to be a qualitative difference in technology and
040964 - process. Initially assumed IBC in the skin is not
040965 - treated with radiation, and is directed instead to treat
040966 - lymphadenopathy. After today, seems like maybe UCSF is
040967 - treating IBC with both radiation and hyperthermia?? Can
040968 - you please clarify. ref SDS A9 EA4Q
040970 - ..
040971 - d. Hyperthermia is a sonar process of some kind.
040972 - ref SDS A9 EA4T
040974 - ..
040975 - e. Orders for Millie's radiation and hyperthermia
040976 - treatments, similar to "Chemotherapy Orders" received
040977 - for treatments in the Infusion Clinic the past 2 years.
040978 - If possible, UCSF should submit a computer file to
040979 - reduce the time and cost for adding the treatment plan
040980 - to patient history. ref SDS A9 EA4W
040982 - ..
040983 - f. Metrics for evaluating when treatment concludes.
040984 - ref SDS A9 EA5P
040986 - ..
040987 - When Millie was treated at Kaiser with capecitabine and
040988 - Taxotere from Apr - Sep 2005, IBC rash seemed totally
040989 - resolved by visual examination. There was then a
040990 - mastectomy in October 2005. Biopsy of removed tissue
040991 - affirmatively reported no findings of IBC. Yet, years
040992 - later Millie is being treated again for IBC. ref SDS A9
040993 - EA5T This raises two questions...
040995 - ..
040996 - 1. How comprehensively can the current treatment
040997 - resolve IBC, and how is this assessed, beyond simple
040998 - visual inspection, and drop in the cancer marker?
040999 - Is there an xray, PET scan, or other diagnostic that
041000 - shows where we are for planning follow on steps?
041001 - ref SDS A9 EA5T
041003 - ..
041004 - 2. Can hyperthermia treatment be done again, if IBC
041005 - pops up later, as obviously happened to me? Will
041006 - there be follow up at least for a month or so in
041007 - radiation oncology, in case IBC does recur in the
041008 - near term? ref SDS A9 WF5I
041010 - ..
041011 - 7. On 090220 0915 Millie radiation and hyperthermia treatment at
041012 - UCSF. ref SDS B0 0G5I Millie receivd a copy of notes Chris
041013 - prepared of a meeting on 090209 with the UCSF medical team on
041014 - planning Millie's treatment. ref SDS B0 4254
041016 - ..
041017 - 8. On 090220 1548 reviewed UCSF memo dated 090209 explaining
041018 - treatment plan using radiation and hyperthermia for Millie to
041019 - recover from IBC. ref SDS B1 PR4Y
041021 - ..
041022 - 9. On 090220 1548 reviewed BSD paper explaining hyperthermia
041023 - treatment for recovering from cancer, ref SDS B1 GK6F,
041024 - including hyperthermia alone...
041025 -
041026 - hyperthermia................. ref SDS B1 004P
041028 - ..
041029 - In combination with....
041030 -
041031 - radiation.................... ref SDS B1 TT6L
041032 - chemotherapy................. ref SDS B1 0129
041033 - biological vaccines.......... ref SDS B1 0164
041035 - ..
041036 - 10. On 090223 0237 Millie's letter to medical team....
041037 -
041038 - a. Thanks UCSF for submitting memo dated 090209 on
041039 - planning hyperthermia treatments. ref SDS B2 T47U
041041 - ..
041042 - b. Requests work plan for radiation treatments.
041043 - ref SDS B2 3N9J and ref SDS B2 T49U, similar to work
041044 - plan for hyperthermia.
041046 - ..
041047 - c. Notes clinical findings that swelled lymph node in left
041048 - supraclavicular occurred again, ref SDS B2 T48S, and
041049 - asks if this will be radiated, and what other areas
041050 - will be radiated. ref SDS B2 T49R
041052 - ..
041053 - d. Reports upper left arm looks worse than before
041054 - treatment started, asks if this is expected side
041055 - effects of radiation and hyperthermia treatment.
041056 - ref SDS B2 T49Y
041058 - ..
041059 - e. Reports Cellulitis and lymphadema have been continuing
041060 - problems on left arm, ref SDS B2 T44R, asks if Keflex
041061 - should be started to prevent recurrence caused by
041062 - treatment for IBC? ref SDS B2 T44W
041064 - ..
041065 - f. Requests picture of Millie getting hyperthermia
041066 - treatment showing configuration of work process.
041067 - ref SDS B2 T45S
041069 - ..
041070 - 11. On 090223 1428 Millie receives letter from Chris saying UCSF
041071 - looking for radiation treatment plan. ref SDS B3 PR4Y
041073 - ..
041074 - 12. On 090223 1428 Millie receives file of picture showing scope of
041075 - hyperthermia treatments at UCSF for recovering from IBC.
041076 - ref SDS B3 GZ4H
041078 - ..
041079 - 13. On 090309 Millie had blood draw at Kaiser for test to support
041080 - examination at UCSF on 090312 to evaluate response to
041081 - treatment. ref SDS B5 S65I Included INR test required once a
041082 - month to verify dose of Coumadin treatments of pulmonary
041083 - embolism. ref SDS B5 PU7Y Blood draw flushes port catheter,
041084 - also, required at least within 5 weeks, when patient not
041085 - getting chemotherapy treatments, as planned during meeting at
041086 - Kaiser on 090213. ref SDS A6 6P3F
041088 - ..
041089 - 14. On 090310 0351 Millie letter to medical team submits agenda for
041090 - meeting at UCSF on 090312 0800, ref SDS B6 PR4Y, scheduled by
041091 - Doctor Rugo on 090210 to evaluate response to treatment with
041092 - hyperthermia and Doxil to establish local control of IBC,
041093 - ref SDS A5 XU5N, and begin planning follow on care to treat
041094 - cancer as chronic disease, ordered by Doctor Johnson at Kaiser
041095 - on 090213. ref SDS A6 GD3I
041096 -
041097 - a. Treatment plan - Millie's invites Doctor Hsu to attend
041098 - meeting with Breats Care Clinic on 090312 to collaborate on
041099 - clarifying work plan for Millie to recover from IBC based
041100 - on evaluation of response to treatment in relatino to
041101 - original plan for 4 - 6 weeks of radiation treatment.
041102 - ref SDS B6 O55W
041104 - ..
041105 - b. Slow recovery disappointing becasue breastbone area looks
041106 - much worse. ref SDS B6 O56X
041108 - ..
041109 - c. Blood test report of labs at Kaiser on 090309 requested for
041110 - submision to UCSF to support meeting on 090312 that
041111 - evaluates response to treatment. ref SDS B6 O63Q
041113 - ..
041114 - d. CA 15-3 blood test cancer marker diagnostic only objective
041115 - metric on response to treatment. ref SDS B6 O63T
041116 - Significant rise of cancer marker at Kaiser in recent
041117 - months, and extreme differences with cancer marker at UCSF
041118 - present challenges evaluating response to treatment.
041119 - ref SDS B6 O63Y
041121 - ..
041122 - e. Complicated diagnostic status increases requirements for
041123 - interim assessment of response to teratment. ref SDS B6
041124 - O64Y
041126 - ..
041127 - f. Anemia seems to be recovering evidenced by labs at Kaiser
041128 - on 090309 indicating effects of ending treatment on 090122
041129 - with sunitinib protocol. ref SDS B6 O65R
041131 - ..
041132 - g. Energy still low, but recovering shown by increased hiking
041133 - at Lafayette reservoir. May be able to tolerate adding
041134 - chemotherapy with hyperthermia if needed to recover from
041135 - IBC. ref SDS B6 O65V
041137 - ..
041138 - h. Shoulder injury recovering with increased range of motion
041139 - will be demonstrated during examination at Kaiser on 090312
041140 - 1300 in Orthopedics Department. ref SDS B6 O65Y
041142 - ..
041143 - i. INR 2.2 within target range shows eliminating sunitinib
041144 - chemotherapy treatment on 090122 has caused blood counts to
041145 - fall back to normal continuing Coumadin treatment for
041146 - pulminary embolism. ref SDS B6 O66R
041148 - ..
041149 - 15. On 090310 1142 called Kaiser to get the report for the blood
041150 - test on 090309 in time for distribution to the medical team for
041151 - being prepared to meet at UCSF on 090312. ref SDS B7 JH4H
041152 - Florida checked the computer and found that CA 15-3 has not yet
041153 - been posted to the report; she said to call back the next day
041154 - on 090311 just before noon to arrange for getting the full
041155 - report. ref SDS B7 QP6H
041157 - ..
041158 - 16. On 090310 1735 Millie received a letter from Tara suggesting
041159 - the meeting tomorrow on 090312 0800 at UCSF be deferred because
041160 - Doctor Rugo cannot attend, ref SDS B8 PR4Y, which was known on
041161 - 090210 when UCSF called and scheduled the meeting. ref SDS A5
041162 - XU5N
041164 - ..
041165 - 17. On 090311 1047 Millie letter to primary care physician at
041166 - Kaiser coordinates getting report for blood test on 090309 for
041167 - meeting at Kaiser on 090312. ref SDS B9 S84F
041169 - ..
041170 - a. Requests advice from primary care physician at Kaiser on
041171 - meeting with Tara at UCSF for evaluating response to
041172 - treatment, ref SDS B9 TE3Y, for interim assessment after 3
041173 - weeks of treatment to assess adjusting the course of
041174 - action. ref SDS B9 TE4R
041176 - ..
041177 - b. Begin planning treatment for next relapse. ref SDS B9 TE4U
041179 - ..
041180 - c. Requests analysis of UCSF letter on 090310 asking about
041181 - deferring meeting, ref SDS B9 TE4X, and notes advantages of
041182 - examination based on Tara's experience treating Millie,
041183 - expertise performing examinations, and experience caring
041184 - for patients being treated for IBC with hyperthremia.
041185 - ref SDS B9 TE5Q
041187 - ..
041188 - d. Expresses preference to have the meeting in order to
041189 - prevent new issues from delaying treatment. ref SDS B9 TE5T
041191 - ..
041192 - 18. On 090311 1431 Millie letter to UCSF with copy to Kaiser...
041193 -
041194 - a. Thanks Doctor Johnson and Arlette for expediting blood test
041195 - report, ref SDS C0 5Z9K, needed for meeting at UCSF to
041196 - evaluate response to treatment, which was scheduled by UCSF
041197 - on 090210 for tomorrow on 090312 0800 with Tara.
041198 - ref SDS A5 XU5N
041200 - ..
041201 - b. Asks Tara to submit a date and time for rescheduling the
041202 - meeting to evaluate response to treatment, ref SDS C0 O15X,
041203 - if she feels the meeting should be deferred until Doctor
041204 - Rugo is available, as set out in Tara's letter the day
041205 - before on 090311 1935. ref SDS B8 PR4Y Doctor Hsu and
041206 - Chris have been terrific in Radiation Oncology; Millie
041207 - requests Tara's assessment of recovery, ref SDS C0 O16S,
041208 - based on the meeting in January when Tara discussed
041209 - experience caring for IBC patients treated with
041210 - hyperthermia [reported in a letter to the medical team on
041211 - 090130. ref SDS 66 4S8O].
041213 - ..
041214 - c. Millie will stop by the Breast Care Clinic in the morning
041215 - on 090312 0800, since treatment does not start until 0915
041216 - in the Radiation Oncology Department, so that Tara can
041217 - evaluate response to treatment, if she feels this can be a
041218 - productive meeting. ref SDS C0 O16V
041220 - ..
041221 - 19. On 090311 1517 called Kaiser to get the report with CA 15-3 for
041222 - the blood test at Kaiser on 090309, and as planned in telecon
041223 - with Florida the day before on 090310. Problems contacting
041224 - someone at Kaiser to implement Kaiser's instructions required
041225 - being on hold for an hour. ref SDS C1 6Z4F In the afternoon,
041226 - Millie received blood test report from Kaiser without CA 15-3
041227 - diagnostic for evaluating response to treatment at UCSF on
041228 - 090312. ref SDS C1 1U7J
041230 - ..
041231 - 20. On 090312 0800 Millie meeting in Breast Care Clinic;
041232 - receptionist said Tara would meet with Millie. ref SDS C2 TP9L
041233 -
041234 - a. Lab report for blood test on 090309 at Kaiser, ref SDS B5
041235 - 075H, submitted to UCSF, and without CA 15-3 diagnostics.
041236 - ref SDS C2 337K
041238 - ..
041239 - b. Radiation treatment plan which also controls the schedule
041240 - for Millie's hyperthermia treatments, and which was
041241 - received from Doctor Hsu on 090226, ref SDS B4 D452, was
041242 - submitted to Tara for Millie's record in the Breast Care
041243 - Clinic. ref SDS C2 8V60
041245 - ..
041246 - c. Examination shows many open, oozing sores in the breastbone
041247 - area, ref SDS C2 9L7K, where IBC was most acute during
041248 - prior examintion on 090129, ref SDS 66 4S8O, and IBC
041249 - appears worse, reported to the medical team on 090130 that
041250 - Millie is disappointed by evident slow recovery from IBC.
041251 - ref SDS B6 O56X Tara diagnosed this condition as reaction
041252 - to radiation and concluded Millie shows a strong response
041253 - to treatment. ref SDS C2 YX9F
041255 - ..
041256 - d. Doctor Rugo has a number of treatment ideas for helping
041257 - Millie continue recovering from IBC, ref SDS C2 QQ9L, after
041258 - radiation and hyperthermia by treating Millie's IBC as a
041259 - chronic disease, requested by Doctor Johnson at Kaiser
041260 - during the meeting on 090213. ref SDS A6 GD3I
041262 - ..
041263 - 21. On 090312 0800 Millie meeting in Radiation Oncology at 0930
041264 - with Doctor Hsu, ref SDS C2 02AC, and Chris joined the meeting
041265 - at 0952. ref SDS C2 F935
041266 -
041267 - a. Doctor Hsu advises review on 090312 was timely to assess
041268 - Millie's progress responding to radiation and hyperthermia
041269 - treatments; examination shows strong recovery from IBC
041270 - compared with severe disease found during examination 5
041271 - weeks earlier on 090205. ref SDS C2 F88K
041273 - ..
041274 - b. Asked about UCSF metrics to evaluate recovery from IBC
041275 - after treatment with radiation and hyperthermia; research
041276 - on 090129 indicates enhanced MRI technology can show
041277 - severity of IBC in the skin after treatment, ref SDS 63
041278 - SQ6L; Doctor Hsu advised that severe blistering and open
041279 - sores on Millie's chest are a positive result of treatment
041280 - that shows maximum recovery from IBC and do not signal
041281 - worsening IBC. ref SDS C2 1R5I
041283 - ..
041284 - c. Radiation and hyperthermia treatments will be completed on
041285 - 090317 calculated from the UCSF work plan submitted to
041286 - Millie on 090226. ref SDS C2 8P7G
041288 - ..
041289 - d. Recovery from radiation and hyperthermia will continue for
041290 - weeks and possibly months after treatment ends on 090317.
041291 - ref SDS C2 VL4O, and so will take weeks and months to fully
041292 - assess recovery after side effects from treatment of severe
041293 - inflammation subside. ref SDS C2 F89Y
041295 - ..
041296 - e. Cream will be supplied to treat side effects of radiation
041297 - and hyperthermia. ref SDS C2 F852
041299 - ..
041300 - f. Hyperthermia works best in multimodel combinations using
041301 - radiation, chemotherapy, and biological vaccine therapies.
041302 - ref SDS C2 E65L Hyperthermia and radiation provide the
041303 - strongest treatment for IBC, ref SDS C2 F97T; Millie's
041304 - treatment was changed from hyperthermia and chemotherapy to
041305 - hyperthermia and radiation, because examination on 090205
041306 - showed IBC was more severe than expected. ref SDS C2 F96V
041307 -
041308 -
041309 -
041310 -
0414 -
SUBJECTS
Agenda Meeting Scheduled 090312 UCSF Breast Care Clinic and Radiatio
2503 -
250401 - ..
250402 - IBC Recovering Radiation Hyperthermia Finding Examination UCSF
250403 -
250404 - Follow up ref SDS C0 PR4Y, ref SDS B9 PR4Y.
250405 -
250406 - On 090204 Doctor Rugo planned to meet after hyperthermia treatment and
250407 - evaluate next steps, following up the doctor's letter the day before
250408 - on 090203 saying she hopes to continue treating Millie after
250409 - hyperthermia. ref SDS 90 L36S
250411 - ..
250412 - On 090210 Doctor Rugo's assistant called and scheduled a meeting on
250413 - 090312 0800 with Tara, because the doctor will be traveling at that
250414 - time. ref SDS A5 XU5N
250416 - ..
250417 - On 090309 blood test at Kaiser was performed, ref SDS B5 S65I,
250418 - previously scheduled on 090213, ref SDS A6 WY5M, to support meeting at
250419 - UCSF on 090312.
250421 - ..
250422 - On 090310 0351 Millie submitted a letter with an agenda for meeting at
250423 - UCSF on 090912 0800 to evaluate response to treatment and consider
250424 - adjustments in order for Millie recover from IBC. ref SDS B6 O64Y
250426 - ..
250427 - On 090310 1735 Millie received a letter from Tara responding to the
250428 - agenda on a meeting scheduled by UCSF for tomorrow on 090312
250429 - evaluating response to treaement, and which was submitted to the
250430 - medical team in a letter earlier on 090312 0351. ref SDS B6 PR4Y Tara
250431 - asks whether the meeting should scheduled for a month to occur on
250432 - 090312 should be be deferred until Doctor Rugo can attend. ref SDS B8
250433 - PR4Y
250435 - ..
250436 - On 090311 Millie asked Tara submit a revised schedule for meeting with
250437 - Doctor Rugo; advised will stop by Breast Care Clinis at currently
250438 - scheduled time of 0800 to meet for examination if Tara has enough
250439 - time. ref SDS C0 O15X
250441 - ..
250442 - On 090312 0800 Millie went to the Breast Care Clinic. Tara was able
250443 - to meet and made an examination. ref SDS C2 TP9L Later on 090312 at
250444 - 0930 in the Radiation Oncology Department, Doctor Hsu and Chris also
250445 - had time to meet with Millie. ref SDS C2 02AC
250447 - ..
250448 - This morning, Millie sent a letter to the medical team explaining
250449 - results of meetings at UCSF yesterday...
250450 -
250451 - 1. Subject: IBC Responding to Treatment Meeting at UCSF
250452 - Date: Fri, 13 Mar 2009 01:32:59 -0800
250464 - ..
250465 - 2. Productive meetings yesterday morning at UCSF with Tara in the
250466 - Breast Care Clinic, ref SDS C2 TP9L, and with Doctor Hsu, and
250467 - Chris in Radiation Oncology. ref SDS C2 02AC
250469 - ..
250470 - 3. Tara noted that rapid advance of IBC during treatment with
250471 - sunitinib immediately following rapid recovery reflects
250472 - mutation of my cancer into a more aggressive disease.
250473 - ref SDS C2 XJ43 This seems to align with your analysis at
250474 - Kaiser on 090213. ref SDS A6 GC6N
250476 - ..
250477 - 4. Tara explained that IBC and reaction to radiation are difficult
250478 - to distinguish, ref SDS C2 YX40 (noted later by Doctor Hsu,
250479 - ref SDS C2 F893); she feels IBC is at least stable, and likely
250480 - much improved. Nodules in the breastbone area are now much
250481 - smaller and less "angry." ref SDS C2 ME3N
250483 - ..
250484 - 5. Tara indicated that open sores on my chest are likely not
250485 - advancing IBC, but "reaction to radiation" that signal maximum
250486 - treatment delivered to diseased tissue. ref SDS C2 YX9F
250488 - ..
250489 - 6. Tara wrote an Outpatient Progress Note on findings, ref SDS C2
250490 - R45H, which I will submit for your files. It says...
250491 -
250505 - ..
250506 - 7. Tara explained that Doctor Rugo is following patient progress
250507 - via email, while traveling this week. ref SDS C2 SS4F
250509 - ..
250510 - 8. Tara has discussed my case with Doctor Rugo, and plans to
250511 - provide more detailed update on examination today during
250512 - regular patient reviews. This will supplement Doctor Hsu's
250513 - assessments (discussed below, ref SDS 0 MY7J). Tara seemed to
250514 - indicate Doctor Rugo has several follow on treatments in mind
250515 - for my care, ref SDS C2 QQ9L, per your planning in the meeting
250516 - at Kaiser on Feb 13th. ref SDS A6 GD3I
250518 - ..
250519 - 9. Doctor Hsu indicated that my hyperthermia treatments were
250520 - calculated based on the amount of additional radiation I can
250521 - tolerate after previous treatments in 2002. ref SDS C2 F866
250522 - Ending treatment in a week or so, will not be based on
250523 - assessment of having fully recovered from IBC, but will be
250524 - required to prevent exceeding my tolerance for radiation.
250526 - ..
250527 - 10. Expectation is that the combination of radiation with
250528 - hyperthermia has significantly reduced IBC toward local
250529 - control. ref SDS C2 AH6L I can get more hyperthermia later, if
250530 - needed, but my skin will have to recover from reaction to
250531 - radiation. ref SDS C2 F973 [...metrics requested in Millie's
250532 - letter to the medical team on 090220, ref SDS A9 EA5P, were not
250533 - discussed during the meeting yesterday, ref SDS C2 BY8L,
250534 - considering research on 090129 that indicates enhanced MRI
250535 - technology can directly measure IBC that requires treatment.
250536 - ref SDS 63 JU4H...].
250537 -
250538 - [On 090324 0548 Millie reports to medical team being
250539 - encouraged, ref SDS C7 CT4U, after completing treatments at
250540 - UCSF with radiation and hyperthermia on 090317, and getting
250541 - favorable prognosis from Doctor Hsu during the meeting on
250542 - 090312. ref SDS C2 AH6L
250544 - ..
250545 - [On 090330 1200 Doctor Hsu indicated that weakness of
250546 - visual examiantion for evaluating response to radiation and
250547 - hyperthermia treatment recovering from IBC has will work
250548 - better than enhanced MRI in Millie's case. ref SDS D0 LO5N
250550 - ..
250551 - 11. Doctor Hsu said that after radiation and hyperthermia are
250552 - stopped, I will continue to recover from IBC for weeks,
250553 - possibly months. ref SDS C2 VL4O Additionally, my skin will
250554 - also suffer more severe reaction to radiation, but will
250555 - eventually heal. ref SDS C2 F860 He will provide a cream
250556 - treatment to aid healing. After the skin heals, a better
250557 - assessment of local control can be made, I understood in 4 - 6
250558 - weeks. Evidently, my skin will look normal, but may have a
250559 - different texture. ref SDS C2 F852
250560 -
250561 - [On 090328 0909 Millie notifies medical team pain and
250562 - suffering rising from radiation side effects 2 weeks after
250563 - ending treatments at UCSF on 090317; side effects have been
250564 - tolerated in order to benefit from treating IBC; Millie
250565 - considering adding zink and Domeboro to increase relief
250566 - from radiation "burn" side effects. ref SDS C0 4S4P
250568 - ..
250569 - [On 090604 1021 Millie's cancer marker drops 30 points in 2
250570 - weeks after rising 70 points in 6 weeks, demonstrates
250571 - continuing recovery from radiation treatments that ended on
250572 - 090317. ref SDS D2 07AD
250574 - ..
250575 - 12. I can have more hyperthermia, but not with radiation.
250576 - ref SDS C2 F973 The doctor indicated best results occur
250577 - combining hyperthermia with other modalities. Chemotherapy
250578 - would be an option. ref SDS C2 F984 Another would be
250579 - biological therapy cited in UCSF documentation received on
250580 - 090220. ref SDS B1 0164
250582 - ..
250583 - 13. Doctor Hsu emphasized today that biological therapies are just
250584 - coming on stream, and so have less of a track record.
250585 - ref SDS C2 F991
250587 - ..
250588 - 14. Notice as well that the paper supports your discussion [at
250589 - Kaiser on 090213, ref SDS A6 GD3I] of hyperthermia applied for
250590 - "palliation." ref SDS B1 01G6 The meeting today gives hope
250591 - that this consideration can be addressed effectively in the
250592 - future.
250594 - ..
250595 - 15. CA 15-3 is another metric for assessment. Since CA 15-3 was
250596 - not listed on the report from Kaiser for the blood test last
250597 - Monday on 090310 [noted during the meeting at UCSF on 090312
250598 - 0800, ref SDS C2 6I9L], I called [in the afternoon] after
250599 - getting back from UCSF. I was on hold so long I heard "Hound
250600 - Dog" twice. ref SDS C3 6Z4F Finally, Cisi came on the line
250601 - after an hour, and said they have no record of CA 15-3 having
250602 - been ordered. Cisi indicated your department has had a re-org
250603 - with new procedures, so things are hectic. She suggested I
250604 - contact you for CA 15-3 results. ref SDS C3 EM9K
250605 -
250606 - [...in another record later today on 090313 0943 Arlette
250607 - investigating to get results for CA 15-3 diagnostic for
250608 - blood test on 090309. ref SDS C4 3R7J
250610 - ..
250611 - [On 090317 1120 Arlette ordered make up blood draw to
250612 - test CA 15-3. ref SDS C5 YP6S
250614 - ..
250615 - [On 090317 1120 Millie went to Kaiser on the way home
250616 - from treatment at UCSF and got another blood draw to test
250617 - CA 15-3. ref SDS C5 PQ6R
250619 - ..
250620 - [On 090323 1352 CA 15-3 251 cancer marker declined for
250621 - blood test at Kaiser on 090317 on the last day of
250622 - Millie's treatment with radiation and hyperthermia at
250623 - UCSF, ref SDS C6 NR4H; net improvement dropping 54 points
250624 - from prior test at Kaiser on 090116, may represent much
250625 - greater decline based on trend lines where Millie's
250626 - cancer was rising rapidly during 4 weeks without
250627 - treatment. ref SDS C6 NR4O
250629 - ..
250630 - [On 090325 0830 primary care physician disappointed by
250631 - continual delays submittng data to UCSF, and notes conflict
250632 - with requirements to streamline delivery of care in order
250633 - to treat Millie's cancer at this time as a chronic disease.
250634 - ref SDS C8 RB3G
250636 - ..
250637 - [On 090420 1451 Doctor Mason reported that other patients have
250638 - not reported problems having labs performed at Kaiser and
250639 - submitted to UCSF for referral treatment. ref SDS D1 2H8J
250641 - ..
250642 - 16. Overall, recovery seems to be on track, as much as possible for
250643 - a 6th relapse. I feel much better understanding what lies
250644 - ahead, including options for evolving scenarios. ref SDS C2
250645 - F973
250647 - ..
250648 - 17. Thanks to the medical team at UCSF for progress review today.
250649 -
250656 -
250657 -
250658 -
250659 -
250660 -
250661 -
250662 -
250663 -
250664 -
2507 -