CONTACTS 

SUBJECTS
Johnston, Lucille Medical
Lung cancer, Scope/Diagnosis
Participants, Patient Team
Impacts to Other Conditions
Delays Correction to Leg Artery Blockage

0707 -
0707 -    ..
0708 - Summary/Objective
0709 -
070901 - Follow up
070902 -
070903 - x0001 Sarah gave results of meeting today with Lucille's medical team.
070904 - Since it appears this matter is becoming a complex project (many
070905 - problems, options, people), recommended crafting a report of what
070906 - transpired today, and suggested other measures as explained below.
070908 -  ..
070909 - Submitted this record to Sarah via ref DIT 1.
070910 -
070912 -  ..
0710 -
0711 -
0712 - Discussion
0713 -
071301 - Sarah said she, Diane and Dee took Lucille (patient team - PT) to the
071302 - Doctor today for a report on their findings and treatment plan.  They
071303 - met with Lucille's Medical Team (MT).
071304 -
071306 -  ..
071307 - MT reported Lucille has a rare form of cancer, or it is rare for it to
071308 - occur in a non-smoker's lung (???).
071309 -
071310 -     The cancer is about the size of an egg, and it did not appear in
071311 -     her Xray taken a year ago.
071313 -         ..
071314 -        Comment
071315 -
071316 -        I would investigate whether typically a cancer of this size
071317 -        would be expected to appear in a formative stage within the
071318 -        period of Lucille's last Xray.
071319 -
071320 -        Ask the MT, and ask others.
071321 -
071323 -  ..
071324 - MT said the cancer is blocking a broncial tube, causing difficult
071325 - breathing.  Otherwise they feel Lucille is in good shape for 85.  This
071326 - condition raises exposure to contracting pneumonia if surgery is per-
071327 - formed to correct her leg problem (a bypass).
071328 -
071329 -
0714 -

SUBJECTS
Options; Surgery - Conventional
Laser Treatment
Radiation

1005 -
100601 -  ..
100602 - Medical team (MT) has concluded surgery is not a good solution for the
100603 - cancer on the lung.  I did not follow the reasoning for this position.
100604 - Sarah said the MT is considering laser surgery to remove the cancer
100605 - around the bronchial tube, in order to restore normal breathing.  Why
100606 - then not remove all or more of the cancer in the same way?
100608 -       ..
100609 -      Questions
100610 -
100611 -      What constrains the degree of removal under laser treatment?
100612 -
100613 -      If some can be done, why not all?  Might removal proceed in
100614 -      stages, if it is risky to remove all the cancer in a single
100615 -      procedure?
100617 -       ..
100618 -      What about a combination of removing most of the cancer with
100619 -      laser methods, and then use radiation to remove vestiges that may
100620 -      be too small to identify and remove.  Could this limit the amount
100621 -      of debilitating radiation treatment.
100623 -       ..
100624 -      Is the trauma of laser treatment greater than radiation or
100625 -      conventional surgery?  What constrains use of laser surgery?
100626 -
100628 -  ..
100629 - The medical team recommends radiation treatment (chemotheraty??), on
100630 - the grounds they have had success under similar circumstances with
100631 - this treatment (i.e. type of cancer, location, condition of patient,
100632 - age).
100634 -  ..
100635 - Inquiry on following might be considered...
100637 -           ..
100638 -          Questions
100639 -
100640 -          How many people have really been treated in the manner
100641 -          proposed for Lucille?
100642 -
100643 -          Over what period of time -- is Lucille's treatment in any way
100644 -          "experimental"?
100645 -
100646 -              Typically procedures evolve as people try the latest
100647 -              improvements.  A representation that a procedure has been
100648 -              used for 2 years, 5 years, etc, may turn out to mean a
100649 -              procedure of a particular class.  Whereas the procedure
100650 -              proposed for Lucille could have elements that have no or
100651 -              very limited experience to show adequacy and safety.
100653 -           ..
100654 -          With what equipment?
100656 -           ..
100657 -          Which practitioners?
100659 -           ..
100660 -          What results?
100662 -           ..
100663 -          How many were Lucille's age?
100665 -           ..
100666 -          How many negative results?
100668 -           ..
100669 -          If treatment fails, does the effort foreclose subsequent
100670 -          alternate treatments?
100672 -           ..
100673 -          If treatment succeeds, what is the risk Lucille's quality of
100674 -          life would be seriously impaired by side effects of the
100675 -          treatment?
100676 -
100677 -
1007 -

SUBJECTS
General, Policy
Procedures
Reports

1305 -
130601 -  ..
130602 - Unsupported verbal representations generally turn out to be ill
130603 - founded because there are so many details and inter-relationships,
130604 - that nuance and implications are lost in the heat of battle.  This
130605 - complexity in combination with imperatives of administrative routine,
130606 - causes mistakes.
130608 -  ..
130609 - Chances of success are greatly improved if the Medical Team (TM)
130610 - issues a statement of diagnosis, proposed treatment plan and schedule,
130611 - that can be reviewed by peers, Lucille's Patient Team (Sarah, Diane,
130612 - Dee), and other professionals consulted by the PT, prior to, and/or
130613 - concurrent with treatment.
130615 -  ..
130616 - Similarly, consideration should be given by the Patient Team to
130617 - crafting notes of the meeting today, to submit for confirmation of
130618 - understandings. Lucille is fortunate to have an excellent group of
130619 - family members helping her.  The benefits of serious questioning
130620 - mentioned in the discussion this evening, are greatly enhanced by
130621 - writing them out, so there is a baseline of information to measure
130622 - future action.  Submit- ting these understandings to MT helps it
130623 - proceed with care, but in a timely manner.
130625 -  ..
130626 - Requesting from MT a statement of diagnosis, treatment, plan and
130627 - schedule assists it in thinking through these key steps.  It is help-
130628 - ful and appropriate for PT to assist MT in preparing the schedule to
130629 - insure this critical step is accomplished.  One might propose a date
130630 - to meet on this matter, in submitting the notes of the just completed
130631 - meeting.
130632 -
130633 -
130634 -
1307 -

SUBJECTS
Brain Shadow
Testing

1404 -
1405 - Summary/Objective
140601 -  ..
140602 - Sarah said Lucille will have another brain scan on Monday to
140603 - investigate the report of a shadow at ref SDS 3 0001.
140604 -
140605 -
140606 -
140607 -
140608 -
140609 -
1407 -