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: April 1, 2009 00:46 AM Wednesday;
Rod Welch
Millie reports temperature improves; feels resolve to recover 7th relapse.
1...Summary/Objective
2...Temperature Declines No Other Symptoms Silvadene Minimal Pain Relief
..............
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Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS B2 0000. ref SDS B1 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 43 QW5J
040907 - ..
040908 - 2. Primary care physician calls about
040909 - Millie's fall and treatment in ER for
040910 - separated shoulder the day before on
040911 - 090122; advises review of patient history
040912 - requested in ER release instructions
040913 - shows Millie does not need
040914 - treatment for high
040915 - blood pressure.................... 090123, ref SDS 53 ZI5I
040917 - ..
040918 - 3. Doctor Johnson indicated during call
040919 - that Millie's patient history of CT
040920 - tests over the past 7 years shows no
040921 - evidence of distant metastasis, except
040922 - in the axilla and supraclavicular
040923 - regions, which are symptoms of IBC;
040924 - at this time, shows IBC is
040925 - only problem to
040926 - solve............................. 090123, ref SDS 53 8K6K
040928 - ..
040929 - 4. Primary care physician cites Millie's
040930 - blood test on 090116 shows cancer marker
040931 - CA 15-3 303 rising to historic highs
040932 - signals severe relapse of IBC for
040933 - 6th time; Millie needs immediate
040934 - treatment at UCSF for her
040935 - cancer as chronic
040936 - disease........................... 090123, ref SDS 53 RK6O
040938 - ..
040939 - 5. Sudden reversal with severe relapse
040940 - of IBC that requires immediate
040941 - change of treatment reported
040942 - from examination at
040943 - UCSF.............................. 090130, ref SDS 56 4S8O
040945 - ..
040946 - 6. Doctor Rugo prescribes immediate
040947 - treatment at UCSF in radiation
040948 - oncology department for
040949 - 7th relapse....................... 090130, ref SDS 56 TZ6H
040951 - ..
040952 - 7. Urgent treatment was delayed a week
040953 - due to communication problems
040954 - at UCSF........................... 090130, ref SDS 56 AY8Q
040956 - ..
040957 - 8. Approval for Kaiser referral to UCSF
040958 - was delayed by documentation
040959 - errors............................ 090202, ref SDS 58 SP6H
040961 - ..
040962 - 9. Kaiser expedites referral authorization
040963 - in order for UCSF to provide urgent
040964 - treatment quickly enough for
040965 - Millie to recover................. 090202, ref SDS 57 LC7H
040967 - ..
040968 - 10. UCSF proposes 3-week delay to begin
040969 - planning Millie's treatment for
040970 - recovering from 6th relapse of
040971 - of IBC............................ 090202, ref SDS 58 SP7M
040973 - ..
040974 - 11. Doctor Rugo notifies medical team
040975 - Millie needs urgent treatment quickly
040976 - in time to be effective recovering
040977 - from 6th relapse of
040978 - IBC............................... 090202, ref SDS 59 Y15J
040980 - ..
040981 - 12. Millie's letter to UCSF implements Doctor
040982 - Johnson's requests for UCSF strategy
040983 - to treat Millie's cancer as a
040984 - chronic disease................... 090203, ref SDS 60 278T
040986 - ..
040987 - 13. Doctor Rugo's letter explains planning
040988 - to evaluate response to hyperthermia
040989 - treatment and arrange continuing
040990 - care based on another
040991 - CT scan........................... 090204, ref SDS 62 278T
040993 - ..
040994 - 14. UCSF advances Millie's care in Radiation
040995 - Oncology Department 3 weeks; scope of
040996 - radiation and hyperthermia evaluated
040997 - by Dcotor Hsu and Doctor
040998 - Chang............................. 090205. ref SDS 64 0001
041000 - ..
041001 - 15. CT and xray tests taken, and layout
041002 - of treatment fields performed to
041003 - build molds for Millie's
041004 - radiation......................... 090209. ref SDS 68 9R61
041006 - ..
041007 - 16. Examination primary care physician
041008 - at Kaiser finds severe progression
041009 - of IBC in 6th
041010 - relapse........................... 090213, ref SDS 70 4W5I
041012 - ..
041013 - 17. Millie lucky to survive stage IV cancer
041014 - for 8 years because cancer mutates to
041015 - defeat treatments; and medical maladies
041016 - increase which makes recovery
041017 - more difficult to
041018 - achieve........................... 090213, ref SDS 70 NY7L
041020 - ..
041021 - 18. Complexity of case management grows
041022 - during long term survival prevents
041023 - keeping a well ordered record
041024 - essential for effective
041025 - care.............................. 090213, ref SDS 70 9L8O
041027 - ..
041028 - 19. Emotional trauma occurs from surprise
041029 - by medical professionals that Kaiser
041030 - and UCSF have enabled long term surivial
041031 - for a disease that normally is
041032 - difficult to control.............. 090213, ref SDS 70 ML4I
041034 - ..
041035 - 20. Communication leverages synergy
041036 - for Millie's care at Kaiser and UCSF
041037 - which helps prevent problems from
041038 - "falling through the cracks; fewer
041039 - mistakes, and timely response
041040 - helps the medical team
041041 - increase longevity,
041042 - also seems very
041043 - annoying.......................... 090213, ref SDS 70 FZ4H
041045 - ..
041046 - 21. Doctor urges proactive management to
041047 - plan Millie's next treatment because
041048 - there will be less time to recover
041049 - before cancer gets out of control
041050 - for Millie's next
041051 - relapse........................... 090213, ref SDS 70 UP6L
041053 - ..
041054 - 22. Millie's efforts the past 8 years to
041055 - combine medical treatment with vigorous
041056 - exercise was supported by research
041057 - showing exercise can be a strong
041058 - component of cancer
041059 - care.............................. 090213, ref SDS 70 GC40
041061 - ..
041062 - 23. Indian fable illustrates long-term survival
041063 - getting continuous treatment for cancer
041064 - becomes increasingly difficult to perform
041065 - complex clinical, logistical, and financial
041066 - case management; study of Millie's patient
041067 - history shows level of effort to maintain
041068 - well ordered record for effective
041069 - management increases exponentially
041070 - into a crushing burden
041071 - for patients and
041072 - providers......................... 090213, ref SDS 70 IG5O
041074 - ..
041075 - 24. Graph prepared by primary care physician
041076 - shows Millie's good fortune surviving a
041077 - very aggressive cancer with relatively
041078 - high quality of life into an 8th year
041079 - of continuous treatment that normally
041080 - causes early demise due to emotional
041081 - trauma and clincial failures from
041082 - complex case management........... 090213, ref SDS 70 4W72
041084 - ..
041085 - 25. Millie felt life was slipping away in
041086 - October when the 5th relapse was diagnosed
041087 - leading Millie to ask what was going to
041088 - happen to her; Doctor Rugo provided
041089 - encouragement saying "We're not
041090 - going to let anything happen
041091 - to you"........................... 090213, ref SDS 70 F148
041093 - ..
041094 - 26. Collaboration between Kaiser and UCSF
041095 - combines experience with research;
041096 - communication optimizes Millie's care
041097 - beating the odds for long-term survival
041098 - by integrating Kaiser's team care
041099 - practice with UCSF model
041100 - of comprehensive
041101 - care.............................. 090213, ref SDS 70 685I
041103 - ..
041104 - 27. Multiple relapse of cancer causes cells
041105 - to mutate into disease that resists
041106 - treatment; Millie surviving 6 relapses
041107 - needs highly specialized care and
041108 - so should ask Doctor Rugo to begin
041109 - planning for the next relapse
041110 - to treat Millie's cancer as
041111 - a chronic disease................. 090213, ref SDS 70 R75G
041113 - ..
041114 - 28. Doctor Rugo has responded by scheduling
041115 - a meeting with Millie at UCSF on
041116 - 090312............................ 090213, ref SDS 70 6P7G
041118 - ..
041119 - 29. Doctor Johnson underscored importance
041120 - timely care for Millie by offering
041121 - religious perspective on transition
041122 - from a vigorous life that may end
041123 - for Millie in less than a
041124 - year.............................. 090213, ref SDS 70 646L
041126 - ..
041127 - 30. Hospice care helps patients and families
041128 - cope with final days of life without
041129 - suffering significant physical
041130 - and emotional pain................ 090213, ref SDS 70 VW63
041132 - ..
041133 - 31. Life ending scenarios have been presented
041134 - to Millie many times the past 5 years;
041135 - case study reflects Millie's physical
041136 - resiliance and strength of character
041137 - that enables exceptional longevity
041138 - for her aggressive
041139 - cancer............................ 090213, ref SDS 70 L19H,
041141 - ..
041142 - 32. Collaboration on case management for
041143 - long-term survivors of cancer becomes
041144 - frustrating because everybody loses
041145 - control of increasingly
041146 - complex medical
041147 - records........................... 090213, ref SDS 70 JL9L
041149 - ..
041150 - 33. Lab and CT test reports illustrate
041151 - frustration, because providers do not
041152 - have enough time to enter results
041153 - from other doctorsrs in the medical
041154 - chart, because doctors prefer to
041155 - rely on local diagnostics
041156 - rather than referral
041157 - data.............................. 090213, ref SDS 70 NY4H
041159 - ..
041160 - 34. Cancer marker CA 15-3 wide disparities
041161 - between Kaiser and UCSF illustrates
041162 - why doctor's rely on local data
041163 - rather than referral
041164 - diagnostics....................... 090213, ref SDS 70 A46O
041166 - ..
041167 - 35. Case management takes a lot of will
041168 - power for due diligence to
041169 - maintain a well ordered
041170 - record............................ 090213, ref SDS 70 J27J
041172 - ..
041173 - 36. Meeting at Kaiser changed to 4 week
041174 - interval, rather than 8, as done the
041175 - past 2 years, provides effective support
041176 - for UCSF to start next treatment in
041177 - time to avoid losing control of
041178 - Millie's cancer................... 090213, ref SDS 70 QX5O
041180 - ..
041181 - 37. Millie requests explanation of treatment
041182 - plan. Doctor Rugo's letter to Kaiser on
041183 - 090129 discussed hyperthermia with Doxil,
041184 - reported on 090130. Has the plan changed
041185 - to use "lower dose" radiation rather
041186 - than Doxil. Will both be
041187 - used, or some other
041188 - agent............................. 090218, ref SDS 71 TH5W
041190 - ..
041191 - 38. Millie reports to medical team meeting
041192 - with Doctor Johnson at Kaiser on 090213
041193 - was optimistic Millie might have 3 - 6
041194 - months of recovery, but will need
041195 - treatment from Doctor Rugo for
041196 - cancer as a "chronic
041197 - disease".......................... 090218, ref SDS 71 TH6U
041199 - ..
041200 - 39. Millie requests reponse from UCSF to the
041201 - letter on 090209 requesting explanation
041202 - of treatments for side effects from
041203 - radiation and hyperthermia described by
041204 - Doctor Hsu during the meeting on
041205 - 090205. Does the treatment
041206 - plan address side effects
041207 - prospectively..................... 090218, ref SDS 71 TH7V
041209 - ..
041210 - 40. Radiation and hyperthermia begins
041211 - at UCSF for Millie to recover from
041212 - 6th relapse of
041213 - IBC............................... 090219, ref SDS 72 E57G
041215 - ..
041216 - 41. Millie's letter to UCSF requests
041217 - explanation of radiation and hyperthermia
041218 - treatments for recovering from
041219 - IBC............................... 090220, ref SDS 73 EA4Q
041221 - ..
041222 - 42. Hyperthermia treatment planning
041223 - on 090209 report received
041224 - from UCSF......................... 090220, ref SDS 74 PR4Y
041226 - ..
041227 - 43. Hyperthermia science, theraputic
041228 - rationale and applications with
041229 - other modalities presented in
041230 - BSD professional paper received
041231 - from UCSF......................... 090220, ref SDS 74 GK6F
041233 - ..
041234 - 44. Millie's letter to UCSF requests work
041235 - plan for radiation treatments to
041236 - recover from 6th relapse of
041237 - IBC............................... 090223, ref SDS 75 3N9J
041238 - and asks for scientific paper
041239 - using radiation to treat
041240 - IBC............................... 090223, ref SDS 75 T49U
041242 - ..
041243 - 45. Radiation combined with hyperthermia
041244 - treatment plan received from
041245 - UCSF.............................. 090226, ref SDS 76 D452
041247 - ..
041248 - 46. Blood test at Kaiser for meeting
041249 - at UCSF on 090312 to evaluate
041250 - effectiveness of radiation
041251 - and hyperthermia after
041252 - 3 weeks........................... 090309, ref SDS 78 6Z4F
041254 - ..
041255 - 47. Agenda submitted to medical team to
041256 - be prepared for productive meetings
041257 - at UCSF scheduled on 090312 to evaluate
041258 - response to treatment after getting
041259 - 3 weeks of radiation and hyperthermia
041260 - to recover from 6th relapse
041261 - of IBC............................ 090310, ref SDS 79 PR4Y
041263 - ..
041264 - 48. Millie reports in letter submitting
041265 - agenda for meeting with medical team on
041266 - 090312 that breastbone area worsening after
041267 - 3 weeks of radiation and hyperthermia
041268 - concerned this may be progression
041269 - of IBC............................ 090310, ref SDS 79 O56X
041271 - ..
041272 - 49. Called Kaiser to get results of blood
041273 - test on 090309 for submission to medical
041274 - team for being prepared to meet at
041275 - UCSF on 090312; Florida says results
041276 - pending from lab; says to call back
041277 - on 090311 to get the report
041278 - for distribution.................. 090310, ref SDS 80 JH4H
041280 - ..
041281 - 50. UCSF letter from Tara proposed canceling
041282 - meeting scheduled by Doctor Rugo for
041283 - 090312 to evaluate response to
041284 - treatment, and also Millie's
041285 - concern about growing
041286 - side effects...................... 090310, ref SDS 81 PR4Y
041288 - ..
041289 - 51. Millie letter to primary care physician
041290 - at Kaiser coordinates getting report
041291 - for blood test on 090309 for
041292 - meeting at UCSF on
041293 - 090312............................ 090311, ref SDS 82 S84F
041295 - ..
041296 - 52. Blood test report for Millie's lab on
041297 - 090209 was not submitted by Kaiser to
041298 - UCSF due to telephone and fax machine
041299 - problems; UCSF relied on backup
041300 - copy hand delivered by
041301 - Millie............................ 090312, ref SDS 85 XE3K
041303 - ..
041304 - 53. Examination at UCSF Breast Care Clinic
041305 - finds signs of recovery from 6th relapse
041306 - of IBC; Millie responding well after
041307 - 3 weeks of treatment with radiation
041308 - and hyperthermia; severe side
041309 - effects observed.................. 090312, ref SDS 85 YX9F
041311 - ..
041312 - 54. Cancer marker CA 15-3 missing from
041313 - blood test for Millie's lab at Kaiser
041314 - on 090309; missing diagnostic
041315 - complicates evaluating
041316 - response to treatment............. 090312, ref SDS 85 YX5F
041318 - ..
041319 - 55. Doctor Rugo planning to implement
041320 - request by Doctor Johnson at Kaiser
041321 - for UCSF to treat Millie's cancer
041322 - as a chronic disease.............. 090312, ref SDS 85 QQ9L
041324 - ..
041325 - 56. Examination at UCSF Radiation Oncology
041326 - department concurs Millie recovering
041327 - from 6th relapse of IBC by responding
041328 - to radiation and
041329 - hyperthermia...................... 090312, ref SDS 85 F88K
041330 - discloses side effects severely
041331 - blistering skin will worsen for a
041332 - month, and then gradually
041333 - recover........................... 090312, ref SDS 85 F860
041334 - that radiation and hyperthermia
041335 - will continue to destroy cancer cells
041336 - for weeks and even months after ending
041337 - treatments on
041338 - 090317............................ 090312, ref SDS 85 VL4O
041340 - ..
041341 - 57. After meeting with UCSF at 0800, called
041342 - Kaiser at 1437; was on "hold" for 90
041343 - minutes; Cisi in the Chemotherapy
041344 - Clinic came online and advised that
041345 - CA 15-3 was not listed in Kaiser's
041346 - for Millie's lab on
041347 - 090309............................ 090312, ref SDS 86 JO8O
041349 - ..
041350 - 58. Millie's letter to medical team reports
041351 - productive meetings at UCSF on 090312
041352 - with favorable findings that Millie
041353 - is recovering from 6th
041354 - relapse of
041355 - IBC............................... 090313, ref SDS 87 Q49L
041357 - ..
041358 - 59. Millie's final treatment at UCSF with
041359 - radiation and hyperthermia to
041360 - recover from 6th relapse
041361 - IBC............................... 090317, ref SDS 89 9L7K
041363 - ..
041364 - 60. Millie received at UCSF orientation and
041365 - medications for home care to treat severe
041366 - side effects from radiation treatments
041367 - that will get worse for a few weeks
041368 - before starting to get
041369 - better............................ 090317, ref SDS 89 M442
041371 - ..
041372 - 61. Arlette checked the computer and
041373 - concluded a mistake occurred at the
041374 - lab not testing for the cancer marker
041375 - on the blood test for 090309. Arlette
041376 - entered a supplemental order for
041377 - Millie to get another blood
041378 - draw at no charge
041379 - later today....................... 090317, ref SDS 90 Y04R
041381 - ..
041382 - 62. Kaiser reported CA 15-3 251 for blood
041383 - test on 090317 that corrected problems
041384 - with lab on 090309 which omitted cancer
041385 - marker needed for the meeting at UCSF
041386 - on 090312 to evaluate response to
041387 - treatment; results today indicate
041388 - strong recovery from 6th relapse
041389 - of IBC............................ 090323, ref SDS 91 Y077
041391 - ..
041392 - 63. Millie's letter notifies medical team
041393 - radiation and hyperthermia treatments
041394 - were completed on 090317; submits agenda
041395 - for meeting today evaluating response
041396 - to treatment with, and recovery from
041397 - side effects from radiation
041398 - and hyperthermia on
041399 - referral to
041400 - UCSF.............................. 090324, ref SDS 92 PR4Y
041402 - ..
041403 - 64. Meeting at Kaiser reveiw response to
041404 - treatment at UCSF for 6th relapse of
041405 - cancer, planning arrangements
041406 - for treating next
041407 - relapse........................... 090325, ref SDS 93 E54L
041409 - ..
041410 - 65. Shoulder injury recovering on schedule
041411 - following treatment in ER on 090122,
041412 - physical therapy; increased energy
041413 - after ending chemotherapy enables
041414 - faster recovery with
041415 - exercise.......................... 090325, ref SDS 93 YU6K
041417 - ..
041418 - 66. Examination finds strong response to
041419 - treatment with radiation and hyperthermia
041420 - at UCSF ended on 090317 aligns with
041421 - significant decline in cancer
041422 - marker reversing continuous
041423 - rising tread for the
041424 - past year......................... 090325, ref SDS 93 D452
041426 - ..
041427 - 67. Disease trajectory graph shows Millie
041428 - may be nearing a point of rapid
041429 - decline with next relapse
041430 - of cancer......................... 090325, ref SDS 93 P39M
041432 - ..
041433 - 68. Hospice care can be investigate in order
041434 - to be prepared for smooth transition
041435 - as patient enters decline phase
041436 - of cancer trajectory.............. 090325, ref SDS 93 JS5I
041438 - ..
041439 - 69. Streamlined referral procedures
041440 - delivering care required in order
041441 - for the medical team to be
041442 - prepared treating cancer
041443 - as a chronic
041444 - disease........................... 090325, ref SDS 93 P43G
041446 - ..
041447 - 70. Stress increases beyond capacity to cope
041448 - managing chronic disease with procedures
041449 - designed for routine cancer care;
041450 - doctor approves Millie for
041451 - vacation to get needed
041452 - rest.............................. 090325, ref SDS 93 M35H
041454 - ..
041455 - 71. Lab mistakes and delays hamper delivering
041456 - referral care in time to be effective
041457 - treating stage IV cancer; patient facing
041458 - 7th relapse at risk; providers under
041459 - stress angry that someone is
041460 - changing doctor's orders
041461 - for patient care.................. 090325, ref SDS 93 RB3G
041463 - ..
041464 - 72. Lab mistakes and delays chronic problems
041465 - prevent treating cancer as chronic
041466 - disease on referral to UCSF
041467 - case study........................ 090325, ref SDS 93 KZ6N
041469 - ..
041470 - 73. Cancer chronic disease timely treatment
041471 - essential for Millie's 7th relapse
041472 - stage IV IBC; Kaiser has no chemotherapy
041473 - agents for Millie's narrow patient profile
041474 - triple negative; prescribes care
041475 - on referral to UCSF;
041476 - case study........................ 090325, ref SDS 93 L15M
041478 - ..
041479 - 74. Pain relief needed; Millie suffering
041480 - physically and emotionally from severe
041481 - radiation side effects; pain and
041482 - suffering will get worse for several
041483 - more weeks until Millie begins to recover
041484 - from radiation burn; Doctor Johnson
041485 - prescribes zink and Domeboro supplement
041486 - treatment prescribed at UCSF for
041487 - severe radiation side
041488 - effects........................... 090325, ref SDS 93 P39I
041490 - ..
041491 - 75. Medical tests ordered at Kaiser for
041492 - examinations at UCSF on planning
041493 - Millie's treatment for the
041494 - next relapse of
041495 - IBC............................... 090325, ref SDS 93 P36O
041497 - ..
041498 - 76. Medical tests ordered 10 days prior to
041499 - meetings at UCSF allows enough time
041500 - for correcting mistakes and expediting
041501 - delays so that data is delivered
041502 - when needed....................... 090325, ref SDS 93 LX5I
041504 - ..
041505 - 77. Patient asked to coordinate on correcting
041506 - mistakes in CT Department by consolidating
041507 - findings in a single report, rather than
041508 - publising multiple reports for
041509 - each test......................... 090325, ref SDS 93 P53O
041511 - ..
041512 - 78. Letter to Kaiser confirms understandings
041513 - from meeting on 090325 that reported a
041514 - favorable response after completeing
041515 - treatment at UCSF on 090317 with
041516 - radiation and hyperthermia
041517 - protocol.......................... 090326, ref SDS 94 5V7O
041519 - ..
041520 - 79. Kaiser plans visual examination with
041521 - CT tests to evaluate response to treatment
041522 - at UCSF with hyperthermia and
041523 - radiation......................... 090326, ref SDS 95 1V4N
041525 - ..
041526 - 80. Millie submits patient history showing
041527 - Kaiser has had problems relying on visual
041528 - examination and CT tests to assess IBC;
041529 - she submits research showing enhanced
041530 - MRI is reported to be effective
041531 - supplementing visual and
041532 - CT test modalities................ 090326, ref SDS 96 5V7O
041534 - ..
041535 - 81. Millie's letter asks about progress
041536 - reviewing research to solve problem
041537 - of diminishing treatments for
041538 - Millie's expanding patient
041539 - profile........................... 090326, ref SDS 96 QM3V
041541 - ..
041542 - 82. Millie's letter notifies medical team
041543 - meetings scheduled at UCSF on 090423
041544 - will evaluate response to radiation and
041545 - hyperthermia treatments that ended
041546 - on 090317, and develop plan
041547 - to treat Millie's cancer
041548 - as a chronic
041549 - disease........................... 090326, ref SDS 94 DW4R
041551 - ..
041552 - 83. Millie's letter notifies medical team
041553 - Doctor Johnson scheduled lab and CT
041554 - tests 10 days early on 090413 in order
041555 - to have enough time to submit reports
041556 - to UCSF for preparing to have a
041557 - productive meeting on 090423
041558 - that will plan next
041559 - treatments........................ 090326, ref SDS 94 DW5Y
041561 - ..
041562 - 84. Millie's letter thanks Doctor Stritter
041563 - for continued interest in her case, and
041564 - advises that Stritter 2nd opinion research
041565 - to solve problems of diminishing treatments
041566 - for Millie's expading patient profile
041567 - were submitted to the medical
041568 - team.............................. 090326, ref SDS 97 1V4N
041570 - ..
041571 - 85. Millie's letter reports to Doctor
041572 - Stritter suffering caused by radiation
041573 - side effects; does not feel well
041574 - after 4 weeks of intense
041575 - treatments........................ 090326, ref SDS 97 PX6Y
041577 - ..
041578 - 86. Doctor Johnson responds to Millie's
041579 - submission of research showing enhanced
041580 - MRI technology can effectively supplement
041581 - visual and CT modalities to assess
041582 - response to treatment of IBC 6th
041583 - relapse, saying he will talk about
041584 - it at the next visit in 6
041585 - weeks............................. 090326, ref SDS 98 T64N
041587 - ..
041588 - 87. Doctor Johnson responds to Millie's
041589 - request for progress reviewing research
041590 - to solve problems of diminishing treatments
041591 - for expanding patient profile, saying
041592 - he will talk about it at the
041593 - next visit in 6
041594 - weeks............................. 090326, ref SDS 98 T64N
041596 - ..
041597 - 88. Millie letter from Doctor Stritter asks
041598 - to be notified about progress considering
041599 - 2nd opinion options for solving problem
041600 - of diminishing treatments for
041601 - Millie's 7th relapse
041602 - of IBC............................ 090326, ref SDS 99 Q16O
041604 - ..
041605 - 89. Millie letter to medical team reports
041606 - rising pain from radiation side effects,
041607 - asks about using Domeboro
041608 - to supplement
041609 - silvadene......................... 090328, ref SDS A0 4S9W
041611 - ..
041612 - 90. Millie reports continued recovery from
041613 - IBC after completing radiation and
041614 - hyperthermia 2 weeks
041615 - earlier........................... 090328, ref SDS A0 4S4V
041617 - ..
041618 - 91. Doctor Hsu letter to Millie schedules
041619 - examination to relieve pain and suffering
041620 - side effects from radiation side
041621 - effects following treatment
041622 - to recover from IBC that
041623 - ended on 090317................... 090328, ref SDS A1 H27I
041625 - ..
041626 - 92. Millie's letter to UCSF confirms meeting
041627 - with Doctor Hsu on 090401 to get pain
041628 - relief from radiation side
041629 - effects........................... 090328, ref SDS A2 H27I
041631 - ..
041632 - 93. Doctor Hsu asks Millie to change time
041633 - of meeting on 090401 to afternoon
041634 - to accomodate tumor board
041635 - meeting........................... 090328, ref SDS A3 SA4J
041637 - ..
041638 - 94. Millie letter to UCSF asks Doctor Hsu
041639 - to meet on Monday 090330, rather than
041640 - Wedensday 090401 to expedite
041641 - pain relief....................... 090328, ref SDS A4 CM5K
041643 - ..
041644 - 95. Doctor Hsu agrees to advance examination
041645 - of Millie for prescribing pain relief
041646 - proposes meeting on 090330 in the
041647 - afternoon......................... 090328, ref SDS A5 4Z6I
041649 - ..
041650 - 96. Millie letter to UCSF asks to meet on
041651 - 090330 0800 rather than in the
041652 - afternoon to expedite getting
041653 - pain relief....................... 090328, ref SDS A6 MR3K
041655 - ..
041656 - 97. Doctor Hsu letter schedules meeting
041657 - at UCSF 090330 1200 to expedite pain
041658 - relief for Millie from radiation
041659 - side effects...................... 090328, ref SDS A7 F34O
041661 - ..
041662 - 98. Millie letter confirms meeting at
041663 - UCSF 090330 1200 to expedite pain
041664 - relief from radiation
041665 - side effects...................... 090328, ref SDS A9 W55N
041667 - ..
041668 - 99. Meeting at UCSF Doctor Hsu advises
041669 - Millie shows response to treatment
041670 - with radiation and hyperthermia
041671 - treatments........................ 090330, ref SDS A9 E54L
041673 - ..
041674 - 100. UCSF prescribes increase Silvadene
041675 - 1% Cream to reduce severe pain
041676 - suffering from radiation and
041677 - hyperthermia treatment side
041678 - effects........................... 090330, ref SDS A9 9A66
041680 - ..
041681 - 101. Writing things down reduces mistakes
041682 - at UCSF so people do not forget complex
041683 - details; prevents things from falling
041684 - through the cracks, because people
041685 - can find the "needle in a haystack"
041686 - essential for effective
041687 - comprehensive care................ 090330, ref SDS A9 9B65
041689 - ..
041690 - 102. Vitamin E plus pentoxifylline (Trental)
041691 - prescribed by UCSF when severe side effects
041692 - from radiation and hyperthermia continue
041693 - 2 - 3 months after completing
041694 - treatments........................ 090330, ref SDS A9 T487
041696 - ..
041697 - 103. Vitamin E plus pentoxifylline (Trental)
041698 - to recover from radiation and hyperthermia
041699 - side effects, this will be a
041700 - minimum 6 month
041701 - treatment......................... 090330, ref SDS A9 T54H
041703 - ..
041704 - 104. Millie letter reports to medical team
041705 - results of interim, exigent examination
041706 - at UCSF that finds severe radiation side
041707 - effects subsiding slowly as expected,
041708 - and Millie is recovering from 6th
041709 - relapse of IBC; prescribes
041710 - increased dose of
041711 - silvadene cream................... 090330, ref SDS B0 E54L
041713 - ..
041714 - 105. Millie requests correction of error
041715 - scheduling meeting with Doctor
041716 - Rugo on 090402, since meeting
041717 - already scheduled for
041718 - 090423............................ 090330, ref SDS B0 6F8Y
041720 - ..
041721 - 106. Millie's letter notifies medical team
041722 - new symptoms chills and
041723 - temperature 99.4.................. 090331, ref SDS B1 E54L
041725 - ..
041726 - 107. Slight red blotches sprinkled on lower
041727 - left arm can signal Cellulitis; however,
041728 - concerned may be 7th relapse of
041729 - IBC............................... 090331, ref SDS B1 Q69V
041731 - ..
041732 - 108. Doctor Hsu letter asks beside fever and
041733 - chill any other symptoms? cough, pain, etc.
041734 - Did Silvadine help with the skin
041735 - pain.............................. 090401, ref SDS B2 E54L
041737 - ..
041738 - 109. Doctor Hsu letter says rash on
041739 - lower left arm likely
041740 - IBC............................... 090401, ref SDS B2 R24X
041741 -
041742 -
041743 -
041744 -
041745 -
041746 -
0418 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Temperature Declines No Other Symptoms Silvadene Minimal Pain Relief
050403 -
050404 - Follow up ref SDS B2 E54L, ref SDS B1 E54L.
050405 -
050406 - Millie sent a letter last night 090330 2047 notifying the medical team
050407 - of new symptoms. She has been suffering chills, temperature,
050408 - ref SDS B1 E54L, and there are now light red rashes sprinkled on the
050409 - lower left arm that could be IBC relapse. ref SDS B1 Q69V
050411 - ..
050412 - Early this morning, Millie received a reply from Doctor Hsu asking
050413 - about additional sysmptoms besides fever and cough, ref SDS B2 K56O,
050414 - and saying new rash on lower left arm likely IBC. ref SDS B2 R24X
050416 - ..
050417 - Millie sent a letter to the medical team saying...
050418 -
050419 - 1. Subject: Temperature Declined 97.8, No Pain
050420 - Date: Tue, 31 Mar 2009 23:50:32 -0800
050430 - ..
050431 - 2. Good news at this time (1113pm) temperature came down to 97.8
050432 - with aspirin, and drinking water. Will continue to monitor.
050434 - ..
050435 - 3. No other symptoms, e.g., no cough. Went hiking today and did
050436 - my best time in quite a few months. Only one lap, but seemed
050437 - to hold up pretty well doing the hills.
050439 - ..
050440 - 4. Your instructions yesterday to apply generous thickness of
050441 - Silvadine cream [during meeting at UCSF, 090330 1200,
050442 - ref SDS A9 9A66, and asked about in Doctor Hsu's letter this
050443 - morning on 090401 0032, ref SDS B2 1C4L] may relieve pain
050444 - slightly from radiation side effects.
050446 - ..
050447 - 5. I feel more resolved to tolerate the situation based on your
050448 - comments that my condition aligns with expectations at this
050449 - stage following treatments, reported during meeting with Doctor
050450 - Hsu at UCSF on 090330 1200. ref SDS A9 MN6F]. As well, I think
050451 - there is beginning to be less inflammation at least on the
050452 - right breast, and upper left arm. Seeing positive signs of
050453 - recovery helps overcome the trauma of dressing the wound [in
050454 - the breastbone area, which was a worry about IBC worsening
050455 - reported on 090310 0351. ref SDS 79 O56X] several times a day.
050456 - That is very scary to observe.
050457 -
050458 - [On 090401 0121 Doctor Rugo reports Millie's wound in
050459 - breastbone area diagnosed as reaction to radiation must
050460 - heal further before starting treatment for IBC relapse, and
050461 - so defers meeting scheduled on 090402 0800; expects
050462 - recovery from IBC in areas with radiation and hyperthermia
050463 - to be very effective. ref SDS B3 K56O
050465 - ..
050466 - [On 090607 2253 Millie notified medical team that wound in
050467 - the breastbone area diagnosed as reaction to readiation
050468 - treatment was worse; requested additional treatment planned
050469 - by UCSF. ref SDS B9 KS62
050471 - ..
050472 - [On 090609 Doctor Hsu advises that the wound in Millie's
050473 - breastbone area is not caused by reaction to radiation
050474 - treatments; the bleeding wound was caused by a mistake
050475 - performing radiation in February and March at UCSF that
050476 - missed treating IBC in the breastbone area and this
050477 - untreated IBC tumor has caused cancer to spread, and causes
050478 - problems in Millie's lungs that prevent breathing.
050479 - ref SDS B0 TP9L
050481 - ..
050482 - 6. Checked patient history and found symptoms of sprinkled red
050483 - rash occurred on the right arm in March of 2007. It persisted
050484 - for several weeks without change, then just faded away. Doctor
050485 - Rugo's team never diagnosed this as IBC. It occurred again in
050486 - late October 2007, and Brigid indicated on 071018 this may have
050487 - been a reaction to cetuximab chemotherapy. ref SDS 24 SL8M
050489 - ..
050490 - 7. Since I have currently been off chemotherapy from 090122 2321,
050491 - ref SDS 51 J47F, and completed radiation with hyperthermia
050492 - treatments on 090317 0915. ref SDS 89 9L7K, can small, isolated
050493 - IBC-like rash on the lower left arm be a delayed reaction to
050494 - radiation on the upper left arm? Has this occurred with other
050495 - patients?
050497 - ..
050498 - 8. If IBC has spread to the lower arm [reported by Millie to the
050499 - medical team on 090331 2047, ref SDS B1 Q69V, and diagnosed as
050500 - IBC relapse by Doctor Hsu on 090331, reported on 090401 0032,
050501 - ref SDS B2 R24X] could this be treated with more radiation and
050502 - hyperthermia, since it is outside the treated areas, and/or
050503 - would systemic treatment be needed?
050505 - ..
050506 - 9. I have not heard from Doctor Rugo, so don't know yet whether
050507 - the meeting UCSF called about for Thursday is really on? [which
050508 - was asked in Millie's letter to the medical team late yesterday
050509 - on 090301. ref SDS B0 6F8Y]
050510 -
050511 - [On 090401 0121 Doctor Rugo reports Millie's wound in
050512 - breastbone area diagnosed as reaction to radiation must
050513 - heal further before starting treatment for IBC relapse, and
050514 - so defers meeting scheduled on 090402 0800; expects
050515 - recovery from IBC in areas with radiation and hyperthermia
050516 - to be very effective. ref SDS B3 K56O
050518 - ..
050519 - [On 090412 2241 Millie's letter reports to medical team
050520 - that IBC worsening on left arm, and occurs along a neat
050521 - line at the perimeter of area treated with radiation and
050522 - hyperthermia, ref SDS B5 XN8J; requests treatment next week
050523 - to prevent cancer from cascading out of control.
050524 - ref SDS B5 9S9Y
050526 - ..
050527 - 10. Thanks for timely response.
050528 -
050533 -
050534 -
050535 -
050536 -
050537 -
050538 -
050539 -
0506 -