CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 14 0000, ref SDS 13 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040508 -
040510 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie notified the medical team on Sunday night that side effects of
040902 - radiation treatment which ended on 090317 continued to be serious
040903 - problem, reported on 090607 2253. ref SDS 9 KS5N  On Monday, Doctor
040904 - Hsu scheduled a meeting for yesterday morning on 090609 0900 at UCSF
040905 - Radiology Oncology, reported on 090608 1331. ref SDS 10 KS5N  Millie
040906 - notified the medical team that Doctor Hsu was scheduled to meet with
040907 - Millie on 090609 about treatment for continuing side effects of
040908 - radiation treatments in the breastbone area, reported on 090608 1346,
040909 - ref SDS 11 FC3K
040911 -  ..
040912 - Yesterday, on 090609 0900 Millie met with Doctor Hsu, as requested.
040914 -  ..
040915 - The doctor made preliminary findings that IBC in the breastbone area
040916 - was not treated with radiation and hyperthermia, ref SDS 12 W65W,
040917 - contrary to treatment ordered by Doctor Rugo and authorized on
040918 - referral by Kaiser.
040920 -  ..
040921 - This appears to be a medical mistake.
040923 -  ..
040924 - Doctor Hsu advised that Millie's recent breathing problems with cough,
040925 - heavy chest, and shortnes of breath, especially hiking are caused by
040926 - buildup in the lungs resulting from progression of IBC that was not
040927 - treated during the Feb-Mar radiation and hyperthermia program.
040928 - ref SDS 12 EK8J  Allowing IBC to go untreated for 6 months has enabled
040929 - cancer to spreas, reported initially to the medcal team on 090331
040930 - 2047. ref SDS 4 Q69V  Another concern is that UCSF over-radiated the
040931 - lungs while treating IBC outside the breastbone area, shown in the
040932 - radiation treatment plan received from UCSF on 090226 1342.
040933 - ref SDS 3 D452  Millie may be suffering radiation injury from failure
040934 - to accurately coorelate radiation amounts with patient history of
040935 - prior radiation treatments, which was presented to UCSF during the
040936 - meeting on 090205 0830. ref SDS 2 PN8H  Doctor Hsu advised that the
040937 - best course of treatment for Millie to recover is with the MPA
040938 - protocol in the Breast Care Clinic, ref SDS 12 1P42, proposed by
040939 - Doctor Rugo to Kaiser on 090514. ref SDS 6 D647
040941 -  ..
040942 - Doctor Hsu requested a CT test to determine if Millie has fluid on
040943 - the lungs and whether if so, it is mild enough to still permit
040944 - treatment with MPA.
040946 -  ..
040947 - Early this morning, Millie sent the following letter to the medical
040948 - team...
040949 -
040950 -    1.  Subject: CT Test Scheduled Friday Jun 12 Evaluate Fluid in Lungs
040951 -        Date: Wed, 10 Jun 2009 01:19:13 -0700
040963 -         ..
040964 -    2.  Thanks again for meeting today in your office at UCSF at 0900.
040965 -        ref SDS 12 TP9L
040967 -         ..
040968 -    3.  You indicated that the bleeding vertical line of tissue in my
040969 -        breastbone area is more likely severe progression of IBC,
040970 -        rather than reaction to radiation.  As a result, you did not
040971 -        prescribe Vitamin E Plus Pentoxifylline, which was the purpose
040972 -        of meeting today. [reported on 090609 0900, ref SDS 12 W65W].
040974 -         ..
040975 -    4.  You explained there was a glitch laying out radiation zones,
040976 -        and this narrow location between the left and right chest zones
040977 -        "fell through the cracks" so to speak, and did not get treated
040978 -        during the 4-week February-March radiation and hyperthermia
040979 -        program performed on referral from Kaiser.  This explains
040980 -        bleeding and puss flowing from the open wound observed today,
040981 -        [reported on 090609 0900, ref SDS 12 W65W]. and cited in my
040982 -        letter to the medical team on 090510, and on 090607 requesting
040983 -        an exigent meeting today. ref SDS 9 MU6P
040985 -         ..
040986 -    5.  You further indicated today that this IBC tumor may be causing
040987 -        fluid on my lungs, which explains persistent cough the past few
040988 -        weeks, along with difficulty breathing while hiking. [reported
040989 -        on 090609 0900, ref SDS 12 EK8J].  I went out 4 times in a row
040990 -        last week, but have had increasing difficulty with heavy chest.
040991 -        Additionally, I have chest pain now climbing stairs at home,
040992 -        similar to when I had pulmonary embolism during August-October
040993 -        2004, and again in September 2006.
040995 -         ..
040996 -    6.  You asked that Kaiser schedule a CT test so you can evaluate my
040997 -        situation and develop a treatment plan.  You seemed to indicate
040998 -        this should be multi-modal, because my patient profile of 8
040999 -        relapses has exhausted standard protocols.  You explained that
041000 -        Kaiser and UCSF have been so successful with my care that
041001 -        innovation is needed to continue treatment [reported on 090609
041002 -        0900, ref SDS 12 1P42].
041003 -
041004 -           [On 090610 2213 Millie notifies medical team that medical
041005 -           mistake which failed to treat IBC in breastbone area may
041006 -           have caused cancer spread into internal organs, which will
041007 -           be a new strategic inflection point for Millie's care.
041008 -           ref SDS 16 TA5O
041010 -         ..
041011 -    7.  You indicated the best approach at this time is to treat severe
041012 -        IBC in my breastbone area with systemic agents in consultation
041013 -        with Doctor Rugo and then you could radiate this location that
041014 -        was missed in the prior work. ["multi-modal treatment starting
041015 -        with MPA reported yesterday at UCSF on 090609 0900. ref SDS 12
041016 -        1P42]  I gathered from the meeting [yesterday] there is a
041017 -        concern about further radiation effects on my lungs, so you
041018 -        ordered a CT test for assessment developing the best treatment
041019 -        plan. ref SDS 12 1P3K
041021 -         ..
041022 -    8.  After the meeting, I called and explained your findings to
041023 -        Doctor Johnson at Kaiser.  He ordered the CT test for Sunday
041024 -        090614 1720 [reported on 090609 1427, ref SDS 14 PPVY].  Upon
041025 -        review, a Sunday test date conflicts with Kaiser's IS
041026 -        Department and Chemotherapy Infusion Clinic schedules.  They
041027 -        would have to provide overtime support, so Loretta changed the
041028 -        test to Friday 090612 [also reported on 090609 1514.
041029 -        ref SDS 15 1O99].
041031 -             ..
041032 -            [On 090609 1514 called Kaiser about scheduling accessing
041033 -            Millie's Power Port to get the CT test on Friday; Arlette,
041034 -            advised that the doctor ordered physical therapy for
041035 -            Millie. on 090611 1145. ref SDS 15 LA4J
041037 -         ..
041038 -    9.  To optimize UCSF treatment options, I signed the MPA consent
041039 -        documents today.
041041 -         ..
041042 -   10.  Kaiser has scheduled me to start Gemzar on Thursday, 090611
041043 -        1400.  Doctor Johnson advised Rod in a call today that if my
041044 -        blood counts don't hold up, which seems likely, then he will
041045 -        prescribe blood transfusions and other measures in order for me
041046 -        to get treatments.  I've never had a blood transfusion for
041047 -        getting chemotherapy treatment.  Typically, Kaiser has paused
041048 -        treatments, and changed treatments, but never given me blood
041049 -        transfusions.
041051 -         ..
041052 -   11.  I am afraid of suffering Gemzar side effects, and that Gemzar
041053 -        conflicts with Kaiser's published guidance for safely treating
041054 -        my patient profile.
041056 -         ..
041057 -   12.  Doctor Johnson also explained today that I can stop treatment,
041058 -        and Kaiser Hospice services will assist my transition shutting
041059 -        down.
041061 -         ..
041062 -   13.  My sense at this time is to defer Gemzar on 090611 and wait for
041063 -        results of the CT test the next day on Friday.  Then the
041064 -        medical team can develop a work plan to recover from this new
041065 -        situation of untreated IBC on my breastbone, and fluid on the
041066 -        lungs.
041068 -         ..
041069 -   14.  Is fluid on the lungs a big deal?  Does it require treatment
041070 -        separate from my cancer?
041072 -         ..
041073 -   15.  I realize this is a complex situation.  Just hope I don't slip
041074 -        through the cracks again.
041076 -         ..
041077 -   16.  Will treatment with Gemzar have any affect on the CT test the
041078 -        next day?
041080 -         ..
041081 -   17.  I am overwhelmed and afraid at the moment.
041082 -
041089 -
041090 -
041091 -
041092 -
041093 -
041094 -
041095 -
041096 -
041097 -
041098 -
041099 -
041100 -
041101 -
0412 -