CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 49 0000. ref SDS 46 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 100203, Millie resumed treatment after a 3-week pause ordered by
040902 - Doctor Johnson, on 100112 0830, ref SDS 35 G68H, while Millie was
040903 - treated to recover from a very severe case of shingles infection,
040904 - reported earlier on 100104 1115. ref SDS 32 0P9S
040906 -  ..
040907 - On 100217 0730 Millie got the 3rd treatment of the 3rd cycle with
040908 - Navelbine for Millie to recover from the 9th relaspe of cancer.
040910 -  ..
040911 - On 100218 1000 Millie got Neupogen treatment at Kaiser to maintain
040912 - blood counts essential for getting Navelbine chemotherapy treatment
040913 - for cancer. ref SDS 45 ER95
040915 -  ..
040916 - On 100218 1000 Millie had emergency meeting with Doctor Johnson,
040917 - primary care physician at Kaiser, after getting Neupogen treatment;
040918 - the doctor diagnosed relapse of shingles, and prescribed a 4th cycle
040919 - of treatment, but only with Acyclovir (Zovirax) 800 MG tablets,
040920 - ref SDS 45 0Y6O; the doctor also diagnosed Millie's 10 relapse of
040921 - cancer, and ordered switching treatment from Navelbine to Abraxane,
040922 - beginning on 100303. ref SDS 45 023N   The doctor further ordered a CT
040923 - test to evaluate rising pain. ref SDS 45 ES40
040925 -  ..
040926 - On 100218 1230 Millie had emergency CT test. ref SDS 45 PQ6R
040928 -  ..
040929 - On 100301 0005 letter to medical team reports improvement from CT test
040930 - on 100218, and increased energy may indicate Navelbine can continue
040931 - another cycle. ref SDS 46 ER95
040933 -  ..
040934 - On 100302 0830 meeting at Kaiser, ref SDS 47 ER95; Doctor Johnson
040935 - prescribed Abraxane for Millie starting treatment tomorrow for
040936 - recovering from 10th relapse of cancer. ref SDS 47 FB67  Blood counts
040937 - dropped significantly, ref SDS 47 IC4N; since Abraxane side effects
040938 - reduce blood counts this increases chances of shingles recurrence; the
040939 - doctor advised that treatment for cancer will be paused again, if
040940 - shingles recurs. ref SDS 47 FC68  Only way for Millie to get treatment
040941 - for shinges concurrent with cancer is to switch from Abraxane to a
040942 - "targeted" treatment for cancer that does not injure bone marrow
040943 - producing blood. ref SDS 47 IC85
040945 -  ..
040946 - On 100303 0730 Millie received 1st treatment 1st cycle Abraxane at
040947 - Kaiser Oncology Chemotherapy Clinic in Walnut Creek. ref SDS 48 625I
040949 -  ..
040950 - On 100304 2251 Millie notifies medical team that 1st treatment of 1st
040951 - cycle started with Abraxane to recover from 10th relapse of cancer.
040952 - ref SDS 49 ER95  Reports possible recurrence of shingles. ref SDS 49
040953 - OP6W  Millie asks Kaiser for written report on trade-offs for
040954 - prescribing agents "targeted" to treat her cancer that do no injure
040955 - the bone marrow producing new blood. ref SDS 49 OQ4Y
040957 -  ..
040958 - On 100305 0822 Millie notifies medical team that shingles seems to
040959 - have subsided again, so that treatment with Abraxane can continue.
040960 - ref SDS 0 ER95  Millie requests prescription for medication to have
040961 - available in time to treat shingles recurrence so that treatment for
040962 - cancer can continue. ref SDS 0 0W3T  Millie further requests that the
040963 - medical team submit analysis of trade-offs for alternative oncologic
040964 - treatments. ref SDS 0 0W3W
040965 -
040966 -
040968 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Millie's letter to medical team says...
041302 -
041303 -    1.  Subject:  Shingles Seems Okay Abraxane Side Effects Minimal
041304 -        Date:  Fri, 05 Mar 2010 08:40:38 -0800
041317 -         ..
041318 -    2.  Just a quick adjunct to report last night feeling shingles was
041319 -        recurring. ref SDS 49 OP6W
041321 -         ..
041322 -    3.  This morning I am relieved that shingles seems still well
041323 -        controlled, and I have had minimal side effects from Abraxane.
041324 -        Yesterday, I was tired and so slept most of the day, but that's
041325 -        normal the first few days after chemo.  Today I have more
041326 -        energy, and so thinking about going for a hike.
041328 -         ..
041329 -    4.  Accordingly, I am hopeful this morning about getting through to
041330 -        next Wednesday for the 2nd treatment with Abraxane, before
041331 -        shingles recurs [possibly reducing need for meeting today at
041332 -        Kaiser requested in Millie's letter to the medical team
041333 -        yesterday on 100304 2251. ref SDS 49 OQ5W  We still have the
041334 -        blood count problem to assess on Tuesday.
041335 -
041336 -           [On 100309 1643 Millie notifies medical team that lab
041337 -           reports test shows Millie's blood counts rise significantly
041338 -           above level for safe chemotherapy to start 2nd treatment
041339 -           with Abraxane. ref SDS 51 2O8W
041341 -         ..
041342 -    5.  Would it be possible to have treatment on-hand for shingles, so
041343 -        if my forehead swells up on the weekend I can treat it for a
041344 -        few days to perhaps get us through to the next treatment on
041345 -        Wednesday [and in order to manage risks from dilemma balancing
041346 -        concurrent treatments for both shingles and cancer, presented
041347 -        by Doctor Johnson during the meeting at Kaiser on 100302 0830.
041348 -        ref SDS 47 FC68].  Again, right now I feel symptoms of shingles
041349 -        recurrence I reported last night have subsided this morning.
041350 -
041351 -            [On 100310 0730 Doctor Johnson visited with Millie in the
041352 -            Oncology Chemotherapy Infusion Clinic and made an
041353 -            examination.  The doctor concurred that shingles subsided,
041354 -            and that blood counts recovered to support getting Millie's
041355 -            2nd treatment with Abraxane, ref SDS 52 OR3H; the doctor
041356 -            did not prescribe treatment for shingles to maintain
041357 -            continuity of treatment for cancer. ref SDS 52 KE9I
041359 -             ..
041360 -            [On 100330 0830 Doctor Johnson examination at Kaiser finds
041361 -            no evidence of shingles recurrence, makes no assessment of
041362 -            the cause for increased pain on the forehead, head, neck,
041363 -            and across the upper back, ref SDS 55 FU5F; and, which was
041364 -            reported to the medical team the day before on 100329,
041365 -            ref SDS 54 WA8Y; the doctor does not extend prescription
041366 -            for Acyclovir (Zovirax) medication to be prepared for
041367 -            recovering from shingles recurrence, ref SDS 55 4E48, which
041368 -            Millie requested on 100305, ref SDS 50 0W3T, and in order
041369 -            to recover from shingles with enough time to maintain
041370 -            continuity of treatment to avoid death by recovering from
041371 -            cancer; instead, additional pain medication was prescribed
041372 -            with morphine. ref SDS 55 FB55
041374 -         ..
041375 -    6.  Still need trade-offs for cancer treatments that do not degrade
041376 -        bone marrow production of new blood, which you indicated during
041377 -        the meeting at Kaiser on 100302, would permit concurrent
041378 -        treatment for shingles. ref SDS 47 FC68  Thankfully, we are not
041379 -        in an emergency mode at the moment, so Kaiser and UCSF have
041380 -        time to investigate and develop a work plan [since the doctor
041381 -        has not yet had time to perform due process explained in the
041382 -        record meeting with Doctor Johnson at Kaiser on 100302 0830.
041383 -        ref SDS 47 ZV4N, and required by Kaiser's policy to provide
041384 -        evidenced-based health care, reported on 090520 1153.
041385 -        ref SDS 18 4M9G, which calls for the doctor to determine
041386 -        trade-offs of alternative treaments evaluating effectiveness,
041387 -        side effects, and cost, reported on 090725 2017. ref SDS 22
041388 -        T58U; Millie has requested trade-offs many times, shown in case
041389 -        study on 090725 2017. ref SDS 22 X66O]
041390 -
041391 -            [On 100319 0843 Millie's letter to medical team reports
041392 -            initial recovery from 10th relapse after 2 treatments with
041393 -            Abraxane gives time to complete review and compare
041394 -            trade-offs for alternative oncology treatments in time for
041395 -            Millie to recover from the 11th relapse by treating
041396 -            Millie's cancer as a chronic disease. ref SDS 53 1T5V
041397 -
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0415 -