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 26, 2009 00:58 AM Thursday;
Rod Welch
Millie's letter to medical team reports meeting at Kaiser evaluate
response to radiation and hyperthermia completed at UCSF on 090317.
1...Summary/Objective
2...Medical Team Notified Kaiser Findings Response to Treatment at UCSF
..............
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 88 0000. ref SDS 65 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - The letter today follows up patient history...
040902 -
040903 - 1. Examination at Kaiser found significant
040904 - recovery with sunitinib protocol
040905 - at UCSF........................... 081219, ref SDS 37 QW5J
040907 - ..
040908 - 2. Primary care physician calls about
040909 - Millie's fall and treatment in ER for
040910 - separated shoulder, and explains rise
040911 - in Millie's cancer marker signals
040912 - severe relapse for the 6th time,
040913 - and Millie needs immediate treatment
040914 - for her cancer as chronic
040915 - disease........................... 090123, ref SDS 48 RK6O
040917 - ..
040918 - 3. Sudden reversal with severe relapse
040919 - of IBC that requires immediate
040920 - change of treatment reported
040921 - from examination at
040922 - UCSF.............................. 090130, ref SDS 51 4S8O
040924 - ..
040925 - 4. Doctor Rugo prescribes immediate
040926 - treatment at UCSF in radiation
040927 - oncology department for
040928 - 7th relapse....................... 090130, ref SDS 51 TZ6H
040930 - ..
040931 - 5. Urgent treatment was delayed a week
040932 - due to communication problems
040933 - at UCSF........................... 090130, ref SDS 51 AY8Q
040935 - ..
040936 - 6. Approval for Kaiser referral to UCSF
040937 - was delayed by documentation
040938 - errors............................ 090202, ref SDS 53 SP6H
040940 - ..
040941 - 7. Kaiser expedites referral authorization
040942 - in order for UCSF to provide urgent
040943 - treatment quickly enough for
040944 - Millie to recover................. 090202, ref SDS 52 LC7H
040946 - ..
040947 - 8. UCSF proposes 3-week delay to begin
040948 - planning Millie's treatment for
040949 - recovering from 6th relapse of
040950 - of IBC............................ 090202, ref SDS 53 SP7M
040952 - ..
040953 - 9. Doctor Rugo notifies medical team
040954 - Millie needs urgent treatment quickly
040955 - in time to be effective recovering
040956 - from 6th relapse of
040957 - IBC............................... 090202, ref SDS 54 Y15J
040959 - ..
040960 - 10. Millie's letter to UCSF implements Doctor
040961 - Johnson's requests for UCSF strategy
040962 - to treat Millie's cancer as a
040963 - chronic disease................... 090203, ref SDS 55 278T
040965 - ..
040966 - 11. Doctor Rugo's letter explains planning
040967 - to evaluate response to hyperthermia
040968 - treatment and arrange continuing
040969 - care based on another
040970 - CT scan........................... 090204, ref SDS 57 278T
040972 - ..
040973 - 12. UCSF advances Millie's care in Radiation
040974 - Oncology Department 3 weeks; scope of
040975 - radiation and hyperthermia evaluated
040976 - by Dcotor Hsu and Doctor
040977 - Chang............................. 090205. ref SDS 59 0001
040979 - ..
040980 - 13. CT and xray tests taken, and layout
040981 - of treatment fields performed to
040982 - build molds for Millie's
040983 - radiation......................... 090209. ref SDS 63 9R61
040985 - ..
040986 - 14. Examination primary care physician
040987 - at Kaiser finds severe progression
040988 - of IBC in 6th
040989 - relapse........................... 090213, ref SDS 65 4W5I
040991 - ..
040992 - 15. Millie lucky to survive stage IV cancer
040993 - for 8 years because cancer mutates to
040994 - defeat treatments; and medical maladies
040995 - increase which makes recovery
040996 - more difficult to
040997 - achieve........................... 090213, ref SDS 65 NY7L
040999 - ..
041000 - 16. Complexity of case management grows
041001 - during long term survival prevents
041002 - keeping a well ordered record
041003 - essential for effective
041004 - care.............................. 090213, ref SDS 65 9L8O
041006 - ..
041007 - 17. Emotional trauma occurs from surprise
041008 - by medical professionals that Kaiser
041009 - and UCSF have enabled long term surivial
041010 - for a disease that normally is
041011 - difficult to control.............. 090213, ref SDS 65 ML4I
041013 - ..
041014 - 18. Communication leverages synergy
041015 - for Millie's care at Kaiser and UCSF
041016 - which helps prevent problems from
041017 - "falling through the cracks; fewer
041018 - mistakes, and timely response
041019 - helps the medical team
041020 - increase longevity,
041021 - also seems very
041022 - annoying.......................... 090213, ref SDS 65 FZ4H
041024 - ..
041025 - 19. Doctor urges proactive management to
041026 - plan Millie's next treatment because
041027 - there will be less time to recover
041028 - before cancer gets out of control
041029 - for Millie's next
041030 - relapse........................... 090213, ref SDS 65 UP6L
041032 - ..
041033 - 20. Millie's efforts the past 8 years to
041034 - combine medical treatment with vigorous
041035 - exercise was supported by research
041036 - showing exercise can be a strong
041037 - component of cancer
041038 - care.............................. 090213, ref SDS 65 GC40
041040 - ..
041041 - 21. Indian fable illustrates long-term survival
041042 - getting continuous treatment for cancer
041043 - becomes increasingly difficult to perform
041044 - complex clinical, logistical, and financial
041045 - case management; study of Millie's patient
041046 - history shows level of effort to maintain
041047 - well ordered record for effective
041048 - management increases exponentially
041049 - into a crushing burden
041050 - for patients and
041051 - providers......................... 090213, ref SDS 65 IG5O
041053 - ..
041054 - 22. Graph prepared by primary care physician
041055 - shows Millie's good fortune surviving a
041056 - very aggressive cancer with relatively
041057 - high quality of life into an 8th year
041058 - of continuous treatment that normally
041059 - causes early demise due to emotional
041060 - trauma and clincial failures from
041061 - complex case management........... 090213, ref SDS 65 4W72
041063 - ..
041064 - 23. Millie felt life was slipping away in
041065 - October when the 5th relapse was diagnosed
041066 - leading Millie to ask what was going to
041067 - happen to her; Doctor Rugo provided
041068 - encouragement saying "We're not
041069 - going to let anything happen
041070 - to you"........................... 090213, ref SDS 65 F148
041072 - ..
041073 - 24. Collaboration between Kaiser and UCSF
041074 - combines experience with research;
041075 - communication optimizes Millie's care
041076 - beating the odds for long-term survival
041077 - by integrating Kaiser's team care
041078 - practice with UCSF model
041079 - of comprehensive
041080 - care.............................. 090213, ref SDS 65 685I
041082 - ..
041083 - 25. Multiple relapse of cancer causes cells
041084 - to mutate into disease that resists
041085 - treatment; Millie surviving 6 relapses
041086 - needs highly specialized care and
041087 - so should ask Doctor Rugo to begin
041088 - planning for the next relapse
041089 - to treat Millie's cancer as
041090 - a chronic disease................. 090213, ref SDS 65 R75G
041092 - ..
041093 - 26. Doctor Rugo has responded by scheduling
041094 - a meeting with Millie at UCSF on
041095 - 090312............................ 090213, ref SDS 65 6P7G
041097 - ..
041098 - 27. Doctor Johnson underscored importance
041099 - timely care for Millie by offering
041100 - religious perspective on transition
041101 - from a vigorous life that may end
041102 - for Millie in less than a
041103 - year.............................. 090213, ref SDS 65 646L
041105 - ..
041106 - 28. Hospice care helps patients and families
041107 - cope with final days of life without
041108 - suffering significant physical
041109 - and emotional pain................ 090213, ref SDS 65 VW63
041111 - ..
041112 - 29. Life ending scenarios have been presented
041113 - to Millie many times the past 5 years;
041114 - case study reflects Millie's physical
041115 - resiliance and strength of character
041116 - that enables exceptional longevity
041117 - for her aggressive
041118 - cancer............................ 090213, ref SDS 65 L19H,
041120 - ..
041121 - 30. Collaboration on case management for
041122 - long-term survivors of cancer becomes
041123 - frustrating because everybody loses
041124 - control of increasingly
041125 - complex medical
041126 - records........................... 090213, ref SDS 65 JL9L
041128 - ..
041129 - 31. Lab and CT test reports illustrate
041130 - frustration, because providers do not
041131 - have enough time to enter results
041132 - from other doctorsrs in the medical
041133 - chart, because doctors prefer to
041134 - rely on local diagnostics
041135 - rather than referral
041136 - data.............................. 090213, ref SDS 65 NY4H
041138 - ..
041139 - 32. Cancer marker CA 15-3 wide disparities
041140 - between Kaiser and UCSF illustrates
041141 - why doctor's rely on local data
041142 - rather than referral
041143 - diagnostics....................... 090213, ref SDS 65 A46O
041145 - ..
041146 - 33. Case management takes a lot of will
041147 - power for due diligence to
041148 - maintain a well ordered
041149 - record............................ 090213, ref SDS 65 J27J
041151 - ..
041152 - 34. Meeting at Kaiser changed to 4 week
041153 - interval, rather than 8, as done the
041154 - past 2 years, provides effective support
041155 - for UCSF to start next treatment in
041156 - time to avoid losing control of
041157 - Millie's cancer................... 090213, ref SDS 65 QX5O
041159 - ..
041160 - 35. Millie requests explanation of treatment
041161 - plan. Doctor Rugo's letter to Kaiser on
041162 - 090129 discussed hyperthermia with Doxil,
041163 - reported on 090130. Has the plan changed
041164 - to use "lower dose" radiation rather
041165 - than Doxil. Will both be
041166 - used, or some other
041167 - agent............................. 090218, ref SDS 66 TH5W
041169 - ..
041170 - 36. Millie reports to medical team meeting
041171 - with Doctor Johnson at Kaiser on 090213
041172 - was optimistic Millie might have 3 - 6
041173 - months of recovery, but will need
041174 - treatment from Doctor Rugo for
041175 - cancer as a "chronic
041176 - disease".......................... 090218, ref SDS 66 TH6U
041178 - ..
041179 - 37. Millie requests reponse from UCSF to the
041180 - letter on 090209 requesting explanation
041181 - of treatments for side effects from
041182 - radiation and hyperthermia described by
041183 - Doctor Hsu during the meeting on
041184 - 090205. Does the treatment
041185 - plan address side effects
041186 - prospectively..................... 090218, ref SDS 66 TH7V
041188 - ..
041189 - 38. Radiation and hyperthermia begins
041190 - at UCSF for Millie to recover from
041191 - 6th relapse of
041192 - IBC............................... 090219, ref SDS 67 E57G
041194 - ..
041195 - 39. Millie's letter to UCSF requests
041196 - explanation of radiation and hyperthermia
041197 - treatments for recovering from
041198 - IBC............................... 090220, ref SDS 68 EA4Q
041200 - ..
041201 - 40. Hyperthermia treatment planning
041202 - on 090209 report received
041203 - from UCSF......................... 090220, ref SDS 69 PR4Y
041205 - ..
041206 - 41. Hyperthermia science, theraputic
041207 - rationale and applications with
041208 - other modalities presented in
041209 - BSD professional paper received
041210 - from UCSF......................... 090220, ref SDS 69 GK6F
041212 - ..
041213 - 42. Millie's letter to UCSF requests work
041214 - plan for radiation treatments to
041215 - recover from 6th relapse of
041216 - IBC............................... 090223, ref SDS 70 3N9J
041217 - and asks for scientific paper
041218 - using radiation to treat
041219 - IBC............................... 090223, ref SDS 70 T49U
041221 - ..
041222 - 43. Radiation combined with hyperthermia
041223 - treatment plan received from
041224 - UCSF.............................. 090226, ref SDS 71 D452
041226 - ..
041227 - 44. Blood test at Kaiser for meeting
041228 - at UCSF on 090312 to evaluate
041229 - effectiveness of radiation
041230 - and hyperthermia after
041231 - 3 weeks........................... 090309, ref SDS 73 6Z4F
041233 - ..
041234 - 45. Agenda submitted to medical team to
041235 - be prepared for productive meetings
041236 - at UCSF scheduled on 090312 to evaluate
041237 - response to treatment after getting
041238 - 3 weeks of radiation and hyperthermia
041239 - to recover from 6th relapse
041240 - of IBC............................ 090310, ref SDS 74 PR4Y
041242 - ..
041243 - 46. Called Kaiser to get results of blood
041244 - test on 090309 for submission to medical
041245 - team for being prepared to meet at
041246 - UCSF on 090312; Florida says results
041247 - pending from lab; says to call back
041248 - on 090311 to get the report
041249 - for distribution.................. 090310, ref SDS 75 JH4H
041251 - ..
041252 - 47. UCSF letter from Tara proposed canceling
041253 - meeting scheduled by Doctor Rugo for
041254 - 090312 to evaluate response to
041255 - treatment, and also Millie's
041256 - concern about growing
041257 - side effects...................... 090310, ref SDS 76 PR4Y
041259 - ..
041260 - 48. Millie letter to primary care physician
041261 - at Kaiser coordinates getting report
041262 - for blood test on 090309 for
041263 - meeting at UCSF on
041264 - 090312............................ 090311, ref SDS 77 S84F
041266 - ..
041267 - 49. Blood test report for Millie's lab on
041268 - 090209 was not submitted by Kaiser to
041269 - UCSF due to telephone and fax machine
041270 - problems; UCSF relied on backup
041271 - copy hand delivered by
041272 - Millie............................ 090312, ref SDS 80 XE3K
041274 - ..
041275 - 50. Examination at UCSF Breast Care Clinic
041276 - finds signs of recovery from 6th relapse
041277 - of IBC; Millie responding well after
041278 - 3 weeks of treatment with radiation
041279 - and hyperthermia; severe side
041280 - effects observed.................. 090312, ref SDS 80 YX9F
041282 - ..
041283 - 51. Cancer marker CA 15-3 missing from
041284 - blood test for Millie's lab at Kaiser
041285 - on 090309; missing diagnostic
041286 - complicates evaluating
041287 - response to treatment............. 090312, ref SDS 80 YX5F
041289 - ..
041290 - 52. Doctor Rugo planning to implement
041291 - request by Doctor Johnson at Kaiser
041292 - for UCSF to treat Millie's cancer
041293 - as a chronic disease.............. 090312, ref SDS 80 QQ9L
041295 - ..
041296 - 53. Examination at UCSF Radiation Oncology
041297 - department concurs Millie recovering
041298 - from 6th relapse of IBC by responding
041299 - to radiation and
041300 - hyperthermia...................... 090312, ref SDS 80 F88K
041301 - discloses side effects severely
041302 - blistering skin will worsen for a
041303 - month, and then gradually
041304 - recover........................... 090312, ref SDS 80 F860
041305 - that radiation and hyperthermia
041306 - will continue to destroy cancer cells
041307 - for weeks and even months after ending
041308 - treatments on
041309 - 090317............................ 090312, ref SDS 80 VL4O
041311 - ..
041312 - 54. After meeting with UCSF at 0800, called
041313 - Kaiser at 1437; was on "hold" for 90
041314 - minutes; Cisi in the Chemotherapy
041315 - Clinic came online and advised that
041316 - CA 15-3 was not listed in Kaiser's
041317 - for Millie's lab on
041318 - 090309............................ 090312, ref SDS 81 JO8O
041320 - ..
041321 - 55. Millie's letter to medical team reports
041322 - productive meetings at UCSF on 090312
041323 - with favorable findings that Millie
041324 - is recovering from 6th
041325 - relapse of
041326 - IBC............................... 090313, ref SDS 82 Q49L
041328 - ..
041329 - 56. Millie's final treatment at UCSF with
041330 - radiation and hyperthermia to
041331 - recover from 6th relapse
041332 - IBC............................... 090317, ref SDS 84 9L7K
041334 - ..
041335 - 57. Millie received at UCSF orientation and
041336 - medications for home care to treat severe
041337 - side effects from radiation treatments
041338 - that will get worse for a few weeks
041339 - before starting to get
041340 - better............................ 090317, ref SDS 84 M442
041342 - ..
041343 - 58. Arlette checked the computer and
041344 - concluded a mistake occurred at the
041345 - lab not testing for the cancer marker
041346 - on the blood test for 090309. Arlette
041347 - entered a supplemental order for
041348 - Millie to get another blood
041349 - draw at no charge
041350 - later today....................... 090317, ref SDS 85 Y04R
041352 - ..
041353 - 59. Kaiser reported CA 15-3 251 for blood
041354 - test on 090317 that corrected problems
041355 - with lab on 090309 which omitted cancer
041356 - marker needed for the meeting at UCSF
041357 - on 090312 to evaluate response to
041358 - treatment; results today indicate
041359 - strong recovery from 6th relapse
041360 - of IBC............................ 090323, ref SDS 86 Y077
041362 - ..
041363 - 60. Millie's letter notifies medical team
041364 - radiation and hyperthermia treatments
041365 - were completed on 090317; submits agenda
041366 - for meeting today evaluating response
041367 - to treatment with, and recovery from
041368 - side effects from radiation
041369 - and hyperthermia on
041370 - referral to
041371 - UCSF.............................. 090324, ref SDS 87 PR4Y
041373 - ..
041374 - 61. Meeting at Kaiser reveiw response to
041375 - treatment at UCSF for 6th relapse of
041376 - cancer, planning arrangements
041377 - for treating next
041378 - relapse........................... 090325, ref SDS 88 E54L
041380 - ..
041381 - 62. Shoulder injury recovering on schedule
041382 - following treatment in ER on 090122,
041383 - physical therapy; increased energy
041384 - after ending chemotherapy enables
041385 - faster recovery with
041386 - exercise.......................... 090325, ref SDS 88 YU6K
041388 - ..
041389 - 63. Examination finds strong response to
041390 - treatment with radiation and hyperthermia
041391 - at UCSF ended on 090317 aligns with
041392 - significant decline in cancer
041393 - marker reversing continuous
041394 - rising tread for the
041395 - past year......................... 090325, ref SDS 88 D452
041397 - ..
041398 - 64. Disease trajectory graph shows Millie
041399 - may be nearing a point of rapid
041400 - decline with next relapse
041401 - of cancer......................... 090325, ref SDS 88 P39M
041403 - ..
041404 - 65. Hospice care can be investigate in order
041405 - to be prepared for smooth transition
041406 - as patient enters decline phase
041407 - of cancer trajectory.............. 090325, ref SDS 88 JS5I
041409 - ..
041410 - 66. Streamlined referral procedures
041411 - delivering care required in order
041412 - for the medical team to be
041413 - prepared treating cancer
041414 - as a chronic
041415 - disease........................... 090325, ref SDS 88 P43G
041417 - ..
041418 - 67. Stress increases beyond capacity to cope
041419 - managing chronic disease with procedures
041420 - designed for routine cancer care;
041421 - doctor approves Millie for
041422 - vacation to get needed
041423 - rest.............................. 090325, ref SDS 88 M35H
041425 - ..
041426 - 68. Lab mistakes and delays hamper delivering
041427 - referral care in time to be effective
041428 - treating stage IV cancer; patient facing
041429 - 7th relapse at risk; providers under
041430 - stress angry that someone is
041431 - changing doctor's orders
041432 - for patient care.................. 090325, ref SDS 88 RB3G
041434 - ..
041435 - 69. Lab mistakes and delays chronic problems
041436 - prevent treating cancer as chronic
041437 - disease on referral to UCSF
041438 - case study........................ 090325, ref SDS 88 KZ6N
041440 - ..
041441 - 70. Cancer chronic disease timely treatment
041442 - essential for Millie's 7th relapse
041443 - stage IV IBC; Kaiser has no chemotherapy
041444 - agents for Millie's narrow patient profile
041445 - triple negative; prescribes care
041446 - on referral to UCSF;
041447 - case study........................ 090325, ref SDS 88 L15M
041449 - ..
041450 - 71. Pain relief medication prescribed by
041451 - Kaiser supplements treatment at UCSF
041452 - for severe radiation side
041453 - effects........................... 090325, ref SDS 88 P39I
041455 - ..
041456 - 72. Medical tests ordered at Kaiser for
041457 - examinations at UCSF on planning
041458 - Millie's treatment for the
041459 - next relapse of
041460 - IBC............................... 090325, ref SDS 88 P36O
041462 - ..
041463 - 73. Medical tests ordered 10 days prior to
041464 - meetings at UCSF allows enough time
041465 - for correcting mistakes and expediting
041466 - delays so that data is delivered
041467 - when needed....................... 090325, ref SDS 88 LX5I
041469 - ..
041470 - 74. Patient asked to coordinate on correcting
041471 - mistakes in CT Department by consolidating
041472 - findings in a single report, rather than
041473 - publising multiple reports for
041474 - each test......................... 090325, ref SDS 88 P53O
041475 -
041476 -
041477 -
041478 -
041479 -
041480 -
0415 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Medical Team Notified Kaiser Findings Response to Treatment at UCSF
050403 -
050404 - Follow up ref SDS 88 E54L, ref SDS 65 PQTX.
050405 -
050406 - Millie met with the primary care physician at Kaiser yesterday and
050407 - reviewed response to treatment after completing radiation and
050408 - hyperthermia on referral to UCSF, and then to plan for Millie's next
050409 - treatment for the 7th relapse of IBC...
050411 - ..
050412 - Late this evening, she issued the following letter to the medical
050413 - team, including Doctor Stritter, reporting on results at Kaiser...
050414 -
050415 - 1. Subject: Meeting Kaiser on Recovery from IBC after Radiation Hyperthermia Treatment
050416 - Date: Thu, 26 Mar 2009 00:00:01 -0800
050428 - ..
050429 - 2. I was encouraged by your examination today at Kaiser finding
050430 - signs of recovery from my 6th relapse of IBC, ref SDS 88 P369,
050431 - following treatment on referral to UCSF with radiation and
050432 - hyperthermia prescribed by Doctor Rugo in a letter to Kaiser on
050433 - 090129. [reported in a letter to the medical team the next day
050434 - on 090130. ref SDS 51 TZ6H
050435 -
050436 - [On 090328 0909 Millie reports continuing recovery from IBC
050437 - with reduced nodularity; but increased pain from radiation
050438 - side effects. ref SDS 94 4S4V
050440 - ..
050441 - 3. As noted in the medical chart today, this work started on
050442 - 090219 and completed last week on 090317. ref SDS 84 9L7K The
050443 - radiation treatment plan dated 090209 was received from UCSF on
050444 - 090226, ref SDS 71 D452, and submitted to you today during the
050445 - meeting at Kaiser. ref SDS 88 AE4G
050447 - ..
050448 - 4. Scope and planning for hyperthermia dated 090209 and describing
050449 - microwave and ultrasound technology was received from UCSF on
050450 - 090220. ref SDS 69 PR4Y Thanks again to Chris for submitting
050451 - documents to complete the record.
050453 - ..
050454 - 5. Your examination today at Kaiser finding progress toward
050455 - improvement treating my IBC correlates with the UCSF report to
050456 - you and prepared by Tara for Doctor Rugo during the meeting at
050457 - UCSF on 090312. ref SDS 80 R45H The report was submitted today
050458 - during the meeting at Kaiser. ref SDS 88 LS6K
050460 - ..
050461 - 6. You asked today about follow up.
050463 - ..
050464 - 7. Tara will meet with Doctor Rugo and present results of
050465 - examination on 090312, ref SDS 80 SS4F, along with cancer
050466 - marker data showing Kaiser labs report CA 15-3 303 on 090116
050467 - declined to 251 for the recent test on 090317, ref SDS 85 Y04R,
050468 - [results reported in the record on 090323, ref SDS 86 Y077],
050469 - the last day of treatment with radiation and hyperthermia.
050470 - ref SDS 84 9L7K
050472 - ..
050473 - 8. Doctor Hsu scheduled examination on 090423 [1315, reported on
050474 - 090317, ref SDS 84 5Q42]
050476 - ..
050477 - 9. It would be great if Doctor Rugo can also make an examination
050478 - at or near that same time to collaborate on follow on
050479 - treatment. April 23rd is a Thursday, which is my normal day to
050480 - visit UCSF, so hopefully, that will fit Doctor Rugo's schedule.
050481 - Tara indicated during the meeting on 090312 that discussions
050482 - with Doctor Rugo have identified several treatment strategies
050483 - to meet your objective for treating my IBC as a chronic
050484 - disease. ref SDS 80 SS4F [shown in case study on patient
050485 - history considered during meeting at Kaiser on 090325 showing
050486 - Kaiser has prescribed treatment of Millie's cancer as a
050487 - "chronic disease. ref SDS 88 L15M] Doctor Hsu and Chris also
050488 - cited [on 090312] possibilities of further hyperthermia
050489 - combined with chemotherapy or biological therapies. ref SDS 80
050490 - F973
050492 - ..
050493 - 10. Research on 090204 identified a number of possible treatments
050494 - that may help guide discussions. ref SDS 56 UK62 [...
050495 - supplementing the list submitted to the team on 090121, when
050496 - Glenna called for Doctor Rugo at UCSF, ref SDS 44 EV53, and
050497 - further supplementing additional treatments with hyperthermia
050498 - and a new form of doxil, which Doctor Hsu reported on 090312,
050499 - that would be available at UCSF, ref SDS 80 T95N, and also
050500 - combining hyperthermia with vaccines, ref SDS 80 F991, ---- and
050501 - which list was requested by Doctor Johnson during the meeting
050502 - at Kaiser yesterday on 090325 0830. ref SDS 88 GO4O -- Doctor
050503 - Johnson's work plan in the medical chart on 090325 to consider
050504 - Hospice is premature while the medical team is reviewing
050505 - treatments targeted to Millie's patient profile, with Millie
050506 - ECOG performance score 0, and demonstrating strong response to
050507 - treatment with examination and cancer marker. ref SDS 88
050508 - QT9V...]
050510 - ..
050511 - [On 090326 0844 Millie received letter from Doctor Johnson
050512 - responding to the letter this morning on the issue of
050513 - assessing response to treatment, but did not indicate
050514 - having reveiwed research submitted as he requested in the
050515 - meeting yesterday. ref SDS 90 5V7O
050517 - ..
050518 - [On 090326 0947 Millie responds to Kaiser on diagnostic
050519 - modalities to assess IBC recovery, and asks if the doctor
050520 - has reviewed the research submitted to Kaiser on treating
050521 - Millie's next relapse. ref SDS 91 QM3V
050523 - ..
050524 - [On 090326 1028 Millie notified Doctor Stritter that the
050525 - 2nd opinion treatment research was submitted to the medical
050526 - team. ref SDS 92 PY3R
050528 - ..
050529 - [On 090326 1733 Doctor Johnson responded in a letter saying
050530 - he plans to talk about this at the next meeting.
050531 - ref SDS 93 WR5O
050533 - ..
050534 - [On 090528 1238 Millie re-submitted comprehensive list of
050535 - treatments cited by the medical team targeted to Millie's
050536 - patient profile for treating her cancer as a chronic
050537 - disease, ref SDS 93 4N5U, as shown in the record on 090121,
050538 - ref SDS 92 EV53, and including clinical trials researched
050539 - on 090204 1523, ref SDS 56 4R3S, and submitted to the
050540 - medical team on 090326 0054, at the request of Doctor
050541 - Johnson, the primary care physician at Kaiser. ref SDS 94
050542 - DW5S
050544 - ..
050545 - [On 090616 1245 Doctor Rugo reports UCSF and Kaiser have
050546 - agreed that Millie's next treatment at UCSF after MPA will
050547 - be with PARP. ref SDS A3 KD6L
050549 - ..
050550 - [On 090617 0112 Millie notifies medical team Doctor Rugo
050551 - reports everybody at Kaiser and UCSF is "on board" to treat
050552 - Millie's cancer as a chronic disease, ordered by Doctor
050553 - Johnson, and the next treatment after MPA will be PARP
050554 - targeted to Millie's patient profile. ref SDS A4 VS9P
050556 - ..
050557 - [On 090701 1652 Doctor Hsu reports he has another treatment
050558 - for Millie's symptoms of tightness on her left side.
050559 - ref SDS A5 4P51
050561 - ..
050562 - [On 090716 2106 Millie notifies medical team that
050563 - UCSF delayed starting Millie's treatment with
050564 - PARP until September, because Millie suffered
050565 - painful breathing that might be caused by MPA so
050566 - this treatment ended before PARP protocol was
050567 - ready in September. ref SDS A0 EE6P
050569 - ..
050570 - [On 090725 standard of care for Kaiser's evidence-based
050571 - medical practice requires the doctor to provide analysis
050572 - comparing trade-offs for treatment options, since patients
050573 - do not have the expertise to make independent analysis.
050574 - ref SDS A7 T58U
050576 - ..
050577 - [On 090909 Doctor Johnson advised that his schedule had
050578 - cleared to have enough time for reviewing treatment options
050579 - submitted on 090326, and providing analysis comparing
050580 - trade-offs in order to prescribe treatment with the best
050581 - chance of being effective. ref SDS A8 VF60
050583 - ..
050584 - [On 090922 0028 Millie's letter asks medical team for
050585 - results of collaborating to review 2nd opinion on
050586 - prescribing Millie's next treatment, ref SDS A9 NW6S,
050587 - planned on 090616 to be PARP. ref SDS A3 KD6L
050589 - ..
050590 - [On 091027 0830 Doctor Johnson disclosed that there still
050591 - has not been enough time to review follow on treatments for
050592 - Millie, and that he has not heard from Doctor Rugo on
050593 - UCSF's progress starting the PARP protocol. ref SDS B0 GN5G
050595 - ..
050596 - [On 091112 0930 Doctor Johnson proposes Abraxane for
050597 - Millie's 10th relapse, even though chemotherapy conflicts
050598 - with patient history of cancer mutating to resist
050599 - chemotherapy; the doctor disclosed that the medical team
050600 - has still not had time to compare trade-offs for treatments
050601 - targeted to Millie's patient profile to recover from 10th
050602 - relapse of cancer, ref SDS B1 CP9K; Kaiser has no record of
050603 - collaborating with UCSF to provide standard of care.
050604 - ref SDS B1 QN5G
050606 - ..
050607 - [On 100112 0830 Doctor Johnson reviews published guidance
050608 - on 2nd opinion PARP therapy targeted to treat Millie's
050609 - cancer with triple negavie patient profile. ref SDS B2 N586
050611 - ..
050612 - [On 100502 2143 Kaiser reports that all of the strategies
050613 - for "targeted" therapies have been executed for Millie,
050614 - which seems conflicting with the record in this case.
050615 - ref SDS B3 MZ4N
050617 - ..
050618 - 11. To facilitate Doctor Rugo's review [on 090423], you scheduled a
050619 - lab at Kaiser [10 days earlier] on 090413 3p, and a CT test
050620 - later the same day at 0330p. ref SDS 88 TE4O This provides
050621 - follow up on CA 15-3 to see if the cancer marker continues to
050622 - drop, and to assess my suitability for further chemo.
050623 - ref SDS 88 P44N
050624 -
050625 - [On 090330 2351 Millie reported getting a call from UCSF
050626 - scheduling meeting with Doctor Rugo on 090402 0800, which
050627 - conflicts with planning today for meetings at UCSF on
050628 - 090423 after getting diagnostic tests at Kaiser on 090413,
050629 - and Millie requests clarification of schedule from UCSF.
050630 - ref SDS 95 6F8Y
050632 - ..
050633 - [On 090401 0121 Doctor Rugo proposes meeting on 090414
050634 - rather than on 090402; meeting on 090414 conflicts with
050635 - planning today to meet on 090423. ref SDS 96 K56O
050637 - ..
050638 - [On 090401 0143 Millie's letter proposes meeting wtih
050639 - Doctor Rugo at UCSF on 090423 0830. ref SDS 97 R96P
050641 - ..
050642 - 12. Since we are getting a blood test at the same time, we don't
050643 - need to schedule a separate port access for the CT test.
050645 - ..
050646 - 13. Research indicates hyperthermia can reduce IBC by 40%, 80%,
050647 - sometimes close to 100% [reported on 090129. ref SDS 50 SQ6L]
050648 - After the meeting at UCSF on 090425 [actually on 090423, shown
050649 - in the record meeting at Kaiser on 090325. ref SDS 88 G946] I
050650 - am hoping Doctor Hsu and Chris can submit a written report
050651 - estimating results in my case [e.g., on 090325 Kaiser reported
050652 - strong resonse to treatment based on visual examination and
050653 - drop in cancer marker, ref SDS 88 P369], and how this is
050654 - determined. Will assessment use a special form of CT and/or
050655 - CT/PET technology that shows where IBC still exists in my
050656 - tissue?
050657 -
050658 - [On 090326 0844 Doctor Johnson plans visual assessment with
050659 - CT tests, and advises PET/CT not needed. ref SDS 90 W75V
050661 - ..
050662 - 14. After testing, examinations and assessments, Doctor Rugo can
050663 - submit recommendations to you for my treatment, like her letter
050664 - on 090129 that prescribed hyperthermia.
050666 - ..
050667 - 15. You asked today about cream Doctor Hsu prescribed to treat side
050668 - effects of radiation. This is listed in the record on 090317.
050669 - ref SDS 84 M442
050670 -
050671 - Silvadene Cream 1%
050672 - silver sulfadiazine
050673 - Monarch Pharmaceuticals
050675 - ..
050676 - 16. You indicated during the meeting that another agent called
050677 - something like "Domeboro" is used at Kaiser to treat radiation
050678 - burns. [reported in the record on 090325. ref SDS 88 FW5O
050679 -
050680 - [On 090328 0909 Millie letter to medical team reports
050681 - rising pain and suffering from radiation side effects.
050682 - ref SDS 94 H27I
050684 - ..
050685 - 17. By copy ask Doctor Hsu if there is any conflict with Silvadene.
050686 -
050687 - [On 090328 0909 Millie notifies medical team considering
050688 - adding zink and Domeboro treatment prescribed by Kaiser to
050689 - supplement treatment with Silvadene prescribed by UCSF to
050690 - reduce pain and suffering side effects from radiation
050691 - treatments, and asks Doctor Hsu again of any conflicts with
050692 - Silvadene cream prescribed by UCSF for treating radiation
050693 - side effects. ref SDS 94 4S4P
050694 -
050701 -
050702 -
050703 -
050704 -
050705 -
050706 -
050707 -
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050710 -
050711 -
050712 -
050713 -
050714 -
050715 -
050716 -
050717 -
050718 -
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050721 -
0508 -