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 11 0000. ref SDS 10 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie had radiation treatment, and then went to the Hyperthermia lab
040902 - for her final treatment, which began on 090219. ref SDS 7 E57G
040904 -  ..
040905 - This concludes treatment to recover local control for the 6th relapse
040906 - of IBC, and which was prescribed by Doctor Rugo on 090129, reported on
040907 - 090130. ref SDS 2 TZ6H
040908 -
040909 -        [On 090324 0548 Millie's letter notifies medical team about
040910 -        results of treatment today, and presents agenda for meeting at
040911 -        Kaiser on 090325 to review progress. ref SDS 13 PR4Y
040913 -  ..
040914 - The treatment for hyperthermia was described in a UCSF memo dated
040915 - 090209, and received from the medical team on 090220. ref SDS 8 DH3H
040916 - A week later on 090226 UCSF submitted the radiation treatment plan.
040917 - ref SDS 9 D452
040918 -
040919 -        [On 090324 0548 Millie's letter commends UCSF for expertise and
040920 -        high quality health care. ref SDS 13 CT4R
040922 -  ..
040923 - After Millie arrived in the Hyperthermia lab, and while getting set up
040924 - for treatment, she asked Chris about meeting with Doctor Hsu to get
040925 - the skin cream for recovering from side effects of radiation and
040926 - hyperthermia treatments the past 4 weeks, which the doctor planned to
040927 - provide during the review meeting last week on 090312. ref SDS 11 F852
040929 -  ..
040930 - Chris said Millie is lucky, because Doctor Hsu was out sick yesterday,
040931 - but recovered enough to come into the office today.
040933 -  ..
040934 - Chris made a call.  About 10 minutes later Doctor Hse came into the
040935 - Hyperthermia Lab to see Millie.
040937 -  ..
040938 - Doctor Hsu advised that he has scheduled Millie for follow up
040939 - examination at UCSF in 4 weeks on 090423 1315 to evaluate recovery
040940 - from IBC, including recovery of skin from side effects of radiation
040941 - and hyperthermia treatments.  Doctor Hsu will then collaborate with
040942 - Doctor Rugo on follow up treatments, as discussed during the meeting
040943 - last week on 090312. ref SDS 11 F973
040945 -         ..
040946 -        [On 090324 0548 Millie's letter notifies medical team that
040947 -        follow up meeting to assess response to treatment will be at
040948 -        UCSF on 090423 1315. ref SDS 13 CT9R
040950 -  ..
040951 - Planning for follow up treatment of IBC as a chronic disease was
040952 - requested by Doctor Johnson at Kaiser during the meeting on 090213,
040953 - ref SDS 5 GD3I, and was discussed in the Breast Care Clinic last week
040954 - on 090312. ref SDS 11 QQ9L  At that time on 090312, Doctor Hsu seemed
040955 - to say Millie cannot get more radiation unless IBC occurs outside the
040956 - areas radiated with current treatment, and further that Millie can get
040957 - more hyperthermia if cancer recurs within the treatment area, but
040958 - combined with chemotherapy or vaccine agents. ref SDS 11 F973
040960 -  ..
040961 - The doctor gave Millie two boxes with tubes of cream, as planned
040962 - during the meeting last week on 090312. ref SDS 11 F860  Specification
040963 - for the cream says...
040964 -
040965 -        Silvadene Cream 1%               20 grams
040966 -        silver sulfadiazine
040967 -        Monarch Pharmacuticals
040968 -
040969 -            [On 090324 0548 Millie notified medical team of treatment
040970 -            with Silvadene Creame 1% for radiation side effects.
040971 -            ref SDS 13 CT9W
040973 -             ..
040974 -            [On 090328 0909 Millie notifies medical team considering
040975 -            adding zink and Domeboro treatment prescribed by Kaiser to
040976 -            supplement treatment with Silvadene prescribed by UCSF to
040977 -            reduce pain and suffering side effects from radiation
040978 -            treatments, and asks Doctor Hsu again of any conflicts with
040979 -            Silvadene cream prescribed by UCSF for treating radiation
040980 -            side effects. ref SDS 14 4S4P
040981 -
040982 -
040984 -             ..
040985 -            [On 090330 2351 Kaiser filled the UCSF prescription by
040986 -            providing medication "SSD 1% Silver Sulfadiazine Cream"
040987 -            with a different name for Silvadene 1% cream to treat
040988 -            radiation burn with increased daily application.
040989 -            ref SDS 16 6F4Q
040991 -         ..
040992 -        Each gram of Silvadene Cream 1% contains 10 mg of micronized
040993 -        silver sulfadiazine in a hydrophilic (water washable) base
040994 -        consisting of white petrolatum stearyl alcholol, isopropyl
040995 -        myristate, sorbitan monooleate, poloyoxyl 40 stearate,
040996 -        propolyne glycol and water with methylparaben 0.3% as a
040997 -        preservative.
040999 -         ..
041000 -        For topical use only.
041001 -        Keep tube tightly closed.
041002 -        Keep out of reach of children.
041004 -         ..
041005 -        US Patent No. 3,761,590
041007 -         ..
041008 -        Dosage and administration.
041009 -        Read package insert for prescribing information.
041010 -        Store at controlled room temperature 59 - 86 degrees F (15 -
041011 -        30 c).
041013 -         ..
041014 -        Distributed by
041016 -         ..
041017 -        Monarch Pharmacuticals, Inc
041018 -        Bristol, TN  37620
041019 -        (A wholly owned subsidiary of King Pharmacuticals, Inc.)
041020 -        Manufactured by King Pharmacuticals, Inc.
041022 -         ..
041023 -        Tube says...
041025 -         ..
041026 -        51972 Expires May 2011
041028 -         ..
041029 -        Indications and Usage...
041031 -         ..
041032 -        Silvadene Cream 1% silver sulfadiazine is a topical
041033 -        antimicrobial drug indicated as an adjunct for the prevention
041034 -        and treatment of wound sepsis in patients with second and
041035 -        third degree burns.
041037 -         ..
041038 -        Dosage and Administration
041040 -         ..
041041 -        Prompt insititution of appropriate regimens for care of the
041042 -        burned patient is of prime importance and includes the control
041043 -        of shock and pain.  The burn wounds are then cleansed and
041044 -        debrided, and Silvadene Cream 1% (silver sulfadiazine) is
041045 -        applied under sterile conditions.  The burn areas should be
041046 -        covered with Silvadene Cream 1% at all times.  The cream
041047 -        should be applied once to twice daily to a thickness of
041048 -        approximabely 1/16 inch.
041050 -         ..
041051 -        Whenever necessary the cream should be reapplied to any areas
041052 -        from which it has been removed by patient activity.
041053 -        Administration may be accomplished in minimal time because
041054 -        dressings are not required.  However, if individual patient
041055 -        requirements make dressings necessary, they may be used.
041057 -         ..
041058 -        Reapply immediately after hydrotherapy.
041060 -  ..
041061 - There was no discussion on instructions for use of the cream to treat
041062 - radiated skin.
041063 -
041064 -            [On 090330 1200 Doctor Hsu increased dose and frequency
041065 -            applying Silvadene 1% creame to help Millie recover from
041066 -            radiation side effects and relieve pain. ref SDS 15 MO42
041068 -             ..
041069 -            [On 090330 2351 Kaiser filled the UCSF prescription by
041070 -            providing medication "SSD 1% Silver Sulfadiazine Cream"
041071 -            with a different name for Silvadene 1% cream to treat
041072 -            radiation burn with increased daily application.
041073 -            ref SDS 16 6F4Q
041075 -  ..
041076 - An hour-and-a-half or so later, after hyperthermia treatment, Millie
041077 - was preparing to leave the Radiation Oncology Department.
041079 -  ..
041080 - When Millie said goodby and was leaving the lab, Abby asked if Doctor
041081 - Hsu gave any instructions for skin care?
041083 -  ..
041084 - Millie recalled during the meeting on 090312 Doctor Hsu warned that
041085 - reaction to radiation will get worse for a week or so after treatment
041086 - ends, which is today, and then will recover over a period of 2 - 4
041087 - weeks using a cream that he would supply. ref SDS 11 F860  This
041088 - morning, Millie got two boxes of cream from the doctor, per above.
041089 - ref SDS 0 M442
041091 -  ..
041092 - Abby said that radiation patients also get an orientation and
041093 - assistance from a specialist nurse for post-radiation side effects.
041095 -  ..
041096 - Millie said guidance would be a big help, and asked where to visit
041097 - with the specialist?
041099 -  ..
041100 - Abby suggested the Radiation Nurse station.
041102 -  ..
041103 - Millie thanked Abby for great care the past 4 weeks.  She left and
041104 - went to the Radiation Nurse station down the hall and around corner
041105 - from the Hyperthermia Lab.
041107 -  ..
041108 - There were two attendants at the counter.  The nurse said that Miranda
041109 - is the specialist who sets up patients with dressing and provides
041110 - training for post-radiation skin care.
041112 -  ..
041113 - Could be that Millie has not received this care previously, because
041114 - the purpose of radiation in Millie's case is to treat the skin, and so
041115 - this requires maximum heat and "damage" to the skin in order to kill
041116 - all the cancer cells in the skin.  Therefore in Millie's case
041117 - continued trauma to the skin hopefully reflects optimum treatment of
041118 - IBC.
041120 -  ..
041121 - The nurse directed Millie to the women's waiting room for radiation
041122 - patients.
041124 -  ..
041125 - While waiting for Miranda, Millie got the call on the cell phone that
041126 - Arlette scheduled Millie for a blood draw at Kaiser in Walnut Creek at
041127 - 1330, to correct the mistake in the report for the test a week ago on
041128 - 030909 that omitted the CA 15-3. ref SDS 12 Y07Y
041130 -  ..
041131 - In order to get to Kaiser in Walnut Creek from UCSF in San Francisco
041132 - by 1330, Millie had to leave.
041134 -  ..
041135 - Millie went into the hallway to ask the nurse about expediting a
041136 - meeting with Miranda in order to get to Kaiser on time this afternoon.
041138 -  ..
041139 - On entering the hallway, Millie saw Chris walking with a woman toward
041140 - her.  Chris introduced Miranda.
041142 -  ..
041143 - Miranda took Millie to a consultation room.
041145 -  ..
041146 - Miranda put a special dressing on Millie's widening radiation wounds,
041147 - including a cross-like bandage that does not actually stick to the
041148 - skin.  She gave Millie a tube top, and helped her put this on, and
041149 - position to hold the cross-like bandage in place.  The cross-like
041150 - bandage has to be cut to the correct shape from a dressing called...
041151 -
041152 -        Mepilex Transfer
041153 -        with Safetac Technology
041155 -         ..
041156 -        20 x 50 cm / 8 x 20 in
041158 -  ..
041159 - After helping Millie apply the cross-like bandage on the large area of
041160 - her chest and abdomen where she has received radiation, Miranda gave
041161 - Millie a second Memilex Transfer, and said this should be changed in
041162 - 7 days.
041163 -
041164 -            [On 090324 0548 Millie reports to medical team getting
041165 -            instructions for home care to recover from radiation
041166 -            wounds. ref SDS 13 CT9W
041168 -  ..
041169 - Since Millie has 2 memilex Transfer bandages, this will last 14 days.
041171 -  ..
041172 - Miranda also gave Millie...
041173 -
041174 -        22 each Kendal Telfa non-adherent dressing packages
041175 -                Tyco Healthcare REF 1238
041176 -                3 inch x 8 inch (7.58 cm x 20 cm)
041178 -  ..
041179 - These are the dressing that Miranda used to cover open sores from
041180 - radiation.
041182 -  ..
041183 - Miranda said to...
041184 -
041185 -    1.  Take a shower everyday and carefully wash radiated areas with
041186 -        warm water and soap.  Gently pad (don't rub) radiated skin with
041187 -        a towel to dry off after the shower.
041188 -
041189 -    2.  Apply cream to all open sores only rather than to all radiated
041190 -        areas.  This appears conflicting with product literature, per
041191 -        above. ref SDS 0 VF58
041193 -         ..
041194 -        Miranda did not apply cream today, perhaps because the skin was
041195 -        radiated today.  Miranda did not review instructions for use
041196 -        which is extremely fine print (requires a magnifying glass to
041197 -        read) on a paper in the box of cream, per above. ref SDS 0 VF55
041199 -         ..
041200 -        Millie vaguely recalls guidance from working with Doctor Moini
041201 -        getting radiation at Mt Diablo 7 years ago in 2002 that cream
041202 -        is applied only to "open sores," rather than to all of the
041203 -        tissue "burned" by radiation.  At that time in 2002, Millie
041204 -        received a few seconds of radiation to 3 specific small areas
041205 -        (the tumor location in the left breast, the left axillary, and
041206 -        the node in the left supraclavicular).  Treatment at UCSF in
041207 -        2009 has covered a much larger area and lasted for over an hour
041208 -        each day.  Her skin today is much more inflammed than occurred
041209 -        in 2002.
041211 -         ..
041212 -        Since instructions specify applying cream to burn areas at the
041213 -        rate of 1/16 inch and once to twice daily, ref SDS 0 VF55, and
041214 -        further since Doctor Hsu indicated that open sores will
041215 -        increase in the days ahead, the question arises about the scope
041216 -        applying cream.
041218 -         ..
041219 -    3.  Place a new Kendal Telfa non-adherent dressing each day to all
041220 -        areas of open sores.
041222 -         ..
041223 -    4.  Put the Mepilex Transfer with Safetac Technology cross-like
041224 -        bandage over the Kendal Telfa non-adherent dressing.
041226 -         ..
041227 -    5.  Put the tube top over the cross-like Mepilex Transfer bandage
041228 -        to hold everthing in place.
041230 -  ..
041231 - On 090312, Doctor Hsu advised that radiation side effects will get
041232 - "much worse" for a week or so, and then get better. ref SDS 11 F860
041234 -  ..
041235 - Can cream treatment and various dressings received from UCSF today, be
041236 - obtained from Kaiser in Walnut Creek, as requirements expand until
041237 - the next meeting at UCSF in 4 weeks?
041239 -  ..
041240 - Miranda seemed to indicate that Millie will start to see her skin
041241 - recover in about 2 weeks.  Full recovery may take another 2 - 4 weeks,
041242 - as Doctor Hsu indicated on 090312.
041244 -  ..
041245 - Millie thanked Miranda for help applying dressings to recover from
041246 - radiation side effects.
041247 -
041248 -
041249 -
041250 -
041251 -
041252 -
041253 -
041254 -
041255 -
041256 -
041257 -
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041259 -
041260 -
0413 -