CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 12 0000, ref SDS 8 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie received a call on Wedensday, 090603 1524, from Queenie in the
040902 - Oncology Pharmacy for Kaiser in Walunt Creek. ref SDS 10 6W9H  This
040903 - followed up the call from Brad on 090601 advising that Doctor Johnson
040904 - prescribed Gemzar for Millie. ref SDS 8 PQ7V
040906 -  ..
040907 - At that time on Wednesday, Queenie talked to Millie for 30 - 40
040908 - minutes telling her to be sure and do various things to prepare for
040909 - getting Gemzar, and efforts Kaiser is taking to mitigate side effects
040910 - of treatment. ref SDS 10 7J9L
040912 -  ..
040913 - Queenie was asked to send a letter to Millie confirming the long
040914 - complex discussion explaining how Kaiser's general guidance relates to
040915 - Millie's patient history. ref SDS 10 7J4P
040917 -  ..
040918 - On 090605 Millie received a letter that only mentions plans to treat
040919 - neausa with compazine, and ignores many extreme risks getting Gemzar
040920 - that cause death or infirmity for Millie's patient profile.
040922 -  ..
040923 - This evening Millie noticed there is now a bleeding sore on her
040924 - breastbone area that has not healed, which Doctor Hsu described as
040925 - radiation side effects, and expected would heal within a few weeks,
040926 - reported on 090423 0830. ref SDS 7 EX4I
040928 -  ..
040929 - Submitted following letter to medical team requesting examination for
040930 - treatment of radiation side effects from radiation treatment in
040931 - February and March...
040932 -
040933 -    1.  Subject: Radiation Side Effects Treatment Vitamin E Plus Pentoxifylline
040934 -        Date: Sun, 07 Jun 2009 23:14:15 -0700
040946 -         ..
040947 -    2.  In the meeting at UCSF on 090330 1200 you advised that if side
040948 -        effects from radiation and hyperthermia completed on 090317
040949 -        continue for several months, then you would prescribe Vitamin E
040950 -        Plus Pentoxifylline to aid recovery. ref SDS 5 T487
040952 -         ..
040953 -    3.  This planning was confirmed in a letter to the medical team
040954 -        later that day on 090330. ref SDS 6 6F5R
040956 -         ..
040957 -    4.  During the meeting at UCSF on 090423 you observed continued
040958 -        side effects from radiation prominently on the middle of my
040959 -        chest, ref SDS 7 YN5N, which received the most treatment
040960 -        because this area had the greatest concentration of IBC leading
040961 -        up to treatment in your office starting on February 19, 2009.
040962 -        ref SDS 2 E57G  [As reported in Doctor Rugo's letter on 090129
040963 -        notifying Doctor Johnson at Kaiser Millie suffered progression
040964 -        of cancer with IBC heat and pain in the "chest wall," and
040965 -        recommending Doctor Hus's care in Radiation Oncology, reported
040966 -        in the record on 090130. ref SDS 1 TZ6H, and which further
040967 -        reported findings of rising heat from IBC in the "breastbone
040968 -        area," also reported to the medical team on 090130. ref SDS 1
040969 -        AY7T  On 090510 Millie notified the medical team of continued
040970 -        open sore in the breastbone area, and asked if this might be
040971 -        untreated IBC,
040973 -         ..
040974 -    5.  Thankfully, most of the severe burn sores have recovered.
040975 -        There is however still a bleeding sore previously reported
040976 -        along a vertical line adjacent to the inner right breast.
040977 -        Areas near to this bleeding sore also look bad, so I am
040978 -        worried.
040980 -         ..
040981 -    6.  On the positive side, my cancer marker declined for the first
040982 -        time in several months.  Recent lab at Kaiser reported CA 15-3
040983 -        289 dropped 30 points from the prior test on 090512, evidently
040984 -        supporting your prognosis on 090312 that radiation treatment at
040985 -        the levels I received continues to have significant effects
040986 -        months after ending treatment under your care on 090317.
040988 -         ..
040989 -    7.  I will be in the City tomorrow after 1000.  Can I stop by for a
040990 -        quick examination tomorrow to see if continuing side effects
040991 -        from radiation and hyperthermia require implementing your
040992 -        treatment plan on 090330 to prescribe Vitamin E Plus
040993 -        Pentoxifylline?  If tomorrow is inconvenient, can you please
040994 -        let me know when I come to UCSF soon to evaluate treating
040995 -        radiation side effects?
040996 -
040997 -            [On 090608 1018 Millie received a letter from Doctor Hsu
040998 -            requesting a meeting for examination on 090610. ref SDS 15
040999 -            KS5N
041001 -             ..
041002 -            [On 090608 1030 Millie asks to meet on Wednesday at 0800,
041003 -            or proposes to meet tomorrow on 090609. ref SDS 16 TH6L
041005 -             ..
041006 -            [On 090608 1331 Doctor Hsu proposes meeting on 090609 0900
041007 -            at UCSF to examine radiation side effects and prescribe
041008 -            treatment. ref SDS 17 FC3K
041010 -             ..
041011 -            [On 090608 1346 Millie notifies medical team meeting with
041012 -            Doctor Hsu at UCSF on 090609 0900 to evaluate radiatoin
041013 -            side effects and prescribe treatment for recovery in
041014 -            breastbone area. ref SDS 18 FC3K
041016 -             ..
041017 -            [On 090609 0900 Doctor Hsu examination at UCSF finds that
041018 -            skin blistering in Millie's breastbone area is not
041019 -            radiation side effects; but rather worsening IBC disease
041020 -            which has been untreated since 090122 due to a medical
041021 -            mistake laying out radiation treatment zones that caused
041022 -            this area in the breastbone area to not be treated with
041023 -            radiation during February and March. ref SDS 19 TP9L
041025 -         ..
041026 -    8.  I received a call on 090601 advising that Kaiser has prescribed
041027 -        follow up chemotherapy with Gemzar.  I'm scheduled to start on
041028 -        Thursday 090611.  This past Friday on 090605 I received a
041029 -        letter from Kaiser with a link to a web site listing Kaiser's
041030 -        guidance for patients getting Gemzar. ref SDS 12 V37O
041031 -
041032 -           http://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=11338
041034 -         ..
041035 -    9.  As you can see, guidance from Kaiser says in part...
041037 -         ..
041038 -     .  "Gemcitabine should be used with extreme caution if you have
041039 -        just received radiation therapy." ref SDS 12 745O
041041 -         ..
041042 -   10.  I was startled by this information, since nobody has discussed
041043 -        caution using Gemzar after receiving radiation.
041044 -
041045 -            [On 090607 2337 Millie's letter to Zoe confirms planning
041046 -            for Kaiser Quality Control to conference with the primary
041047 -            care physician on advisability of Gemzar for Millie's
041048 -            patient profile. ref SDS 14 5K3K
041050 -         ..
041051 -   11.  As attending physician for my radiation treatment can you
041052 -        comment on what "extreme caution" should be considered for my
041053 -        patient profile getting treatment for the 8th relapse of IBC?
041055 -         ..
041056 -   12.  Another source, Durgs.com says in part...
041057 -
041058 -           http://www.drugs.com/mmx/gemcitabine.html
041060 -             ..
041061 -        a.  "Radiation therapy: (additive bone marrow depression may
041062 -            occur; dosage reduction may be required when two or more
041063 -            bone marrow depressants, including radiation, are used
041064 -            concurrently or consecutively {10})
041066 -             ..
041067 -        b.  "gemcitabine is a potent {08} {09} radiosensitizer {02}
041068 -            {08} {09}; depending on the site being irradiated,
041069 -            concurrent use of gemcitabine may cause severe,
041070 -            life-threatening esophagitis or pneumonitis {01} {02}; in
041071 -            one study, gemcitabine with radiation therapy caused severe
041072 -            stomatitis or pharyngeal damage requiring patients to be
041073 -            fed via feeding tube for as long as 10 to 12 months, even
041074 -            when gemcitabine was given in doses as low as 300 mg per
041075 -            square meter of body surface area [25% or less of the usual
041076 -            adult dose] {11})"
041078 -         ..
041079 -   13.  This does not sound good.
041081 -         ..
041082 -   14.  However, another source seems to suggest that Gemzar used with
041083 -        radiation can increase effectiveness.  Is this similar to
041084 -        Doctor Rugo's prescription on 090129 for using Doxil with
041085 -        hyperthermia?  I realize you wound using radiation with
041086 -        hyperthermia, but could using Gemzar following radiation
041087 -        enhance therapeutic benefits for me, or is this a big risk?
041089 -         ..
041090 -   15.  What is your practice exercising extreme caution using Gemzar
041091 -        in my case?
041093 -         ..
041094 -   16.  Hope to see you tomorrow about prescribing Vitamin E Plus
041095 -        Pentoxifylline to recover from continuing radiation burn.
041096 -
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0412 -