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: May 18, 2004 12:01 PM Tuesday; Rod Welch

Millie chemo treatment with Taxol and Avastin.

1...Summary/Objective
2...Blood and Other Tests Within Target Range
3...Preparation for Treatment Required Three (3) Attempts to Connect Port
4...Taxol Treatment Delayed Because Taxol Not Prepared by Lab
5...Avastin Treatment Without Blood Pressure Testing
6...Tired and Wobbly Today After Treatments

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1...Blood pressure and tempearture equipment is not configured, so these

CONTACTS 

SUBJECTS
Chemotherapy Taxol Avastin Bevacizamub VEGF Treatments Begin Today 2
Blood Tests Cause Big Welt on Right Forearm Difficulty Finding Vein
Difficulty Finding Vein Blood Tests Cause Big Welt on Right Forearm
Port Catheter Not Used Blood Tests Difficulty Finding Vein Cause Big
Blood Tests Cause Big Welt on Right Forearm Difficulty Finding Vein

0907 -
0907 -    ..
0908 - Summary/Objective
0909 -
090901 - Follow up ref SDS 9 0000. ref SDS 7 0000.
090902 -
090903 - Today, Millie begins 2nd 3-week cycle of Taxol and Avastin.
090905 -  ..
090906 - Mary is the nurse.
090908 -  ..
090909 - Mary notices a the big welt on Millie's right forearm; and, Millie
090910 - explains swelling has gone down from icing the area yesterday, after a
090911 - technician had difficulty in the lab finding a vein for drawing blood.
090913 -  ..
090914 - Millie asks Mary to schedule drawing blood for the fluid tests, here
090915 - in the Chemotherapy Clinic, for treatment next week, so that the port
090916 - catheter can be used, rather than from a vein, which caused a problem
090917 - yesterday.
090919 -  ..
090920 - Mary returned later with a document showing a meeting at the
090921 - Chemotherapy Infusion Clinic on 040524 1430, the day before treatment
090922 - in the clinic on 040525 1200.
090924 -  ..
090925 - Mary, also, handed Millie another document with the title...
090926 -
090927 -                     Laboratory Requisition
090928 -
090929 - ...that shows the scope of the tests to be performed on 040524 at the
090930 - Chemotherapy Infusion Clinic.  The requisition shows...
090932 -         ..
090933 -        Chemestry
090934 -
090935 -          Creatine                  CREAT
090936 -          Total Billirubin          BILIT
090937 -          Alk Phos                  ALKP
090938 -          Alt SGPT                  ALT
090940 -         ..
090941 -        Hematology
090942 -
090943 -          CBC with Differential     CBCD
090945 -  ..
090946 - Millie explained the scope of the Lab Requisition for the blood tests
090947 - on 040524 appears to be incorrect.
090949 -  ..
090950 - Previously, on 040419 Rosalie submitted Laboratory Requisitions for
090951 - each of the 3 weeks of treatment in each cycle.  Blood tests for each
090952 - week are markedly different, and none fit the scope in the requisition
090953 - submitted by Mary today, per above. ref SDS 0 9T90
090955 -  ..
090956 - The next treatment will be the 2nd week of the Avastin trial cycle,
090957 - and the protocol is for only getting Taxol treatment - Avastin is not
090958 - administered for the 2nd week in the cycle.  The Laboratory
090959 - Requisitions for week two (2) submitted previously by Rosalie show
090960 - that for week two (2) there is only a single test to be performed...
090961 -
090962 -        Hematology
090964 -           ..
090965 -          CBC with Differential     CBCD
090967 -  ..
090968 - This may not be terribly important in terms of patient impact, but
090969 - might impact the trial data.
090970 -
090971 -
090972 -
090973 -
090974 -
090975 -
0910 -

SUBJECTS
Blood Tests White Cell Count Good 2nd Cycle 1st Treatment Chemothera
Urine Tests No Evident Problems
Blood Test Results Pass for Treatment

1305 -
130601 -  ..
130602 - Blood and Other Tests Within Target Range
130603 -
130604 - Millie asked about results of the blood test taken yesterday.
130606 -  ..
130607 - Mary said the white cell count and other criteria are good today, and
130608 - submitted the report showing...
130609 -
130610 -    Patient   Provider  Category   View      FR Date   To Date
130616 -     ..
130617 -    Procedure              Results             Reference Range
130619 -     ..
130620 -    Log#: 510413802000      040517 15:08 Outpa WCR Req: RA Johnson, MD
130621 -
130622 -                  ** Walnut Creek Medical Center **
130624 -     ..
130625 -    Urinalysis
130627 -     ..
130628 -    Culture Per?           Not Req
130629 -    Microscopic?           Not Ind
130630 -    pH                     5.0                 4.5     -    8.0
130631 -    Sp. Gravity            1.010               1.001   -    1.035
130632 -    Glucose                Negative            Negative
130633 -    Blood                  Negative            Negative
130634 -    Nitirtes               Negative            Negative
130635 -    Ketones                Negative            Negative
130636 -    Leuk Esterase          Negative            Negative
130637 -    Protein                Negative            Negative
130638 -    Bilirubin              Negative            Negative
130639 -    Urobilinogen           < 1 EU/dL           =< 2.0
130640 -    Urine Source           Clean
130642 -     ..
130643 -    LAB.RES <Shift F9> For complete Lab Results    WCRM9H  040518 1229
130644 -
130645 -
130647 -     ..
130648 -    Patient   Provider  Category   View      FR Date   To Date
130655 -     ..
130656 -    Procedure              Results             Reference Range
130658 -     ..
130659 -    Log#: 510413801998      040517 13:15 Outpa WCR Req: RA Johnson, MD
130660 -                  ** Walnut Creek Medical Center **
130662 -     ..
130663 -    Alkaline Phos             60 U/L           38     -    126
130664 -    Bili, Tot Adult          0.3 mb/dL          0.2   -      1.3
130665 -    Creatinie                0.7 mb/dL          0.6   -      1.2
130666 -    CA 15-3             TEST IN LAB
130667 -    AST (SGOT)                37 U/L           14     -     36
130668 -    ALT (SGPT)                31 U/L           11     -     66
130669 -
130670 -        [On 040601 received CA 15-3 results, up to 78.
130672 -     ..
130673 -    Log#: 510413801999 COL  040517 13:15 Outpa WCR Req: RA Johnson, MD
130674 -                  ** Walnut Creek Medical Center **
130676 -     ..
130677 -    @CBC
130678 -    WBC x 10-3               4.8 K/uL           3.5   -     12.5
130679 -    RBC x 10-6              3.73 M/uL           3.6   -      5.10
130680 -    Hemoglobin              12.2 g/dL          11.5   -     15.0
130681 -    Hematocrit              34.7 %             34.0   -     46.0
130682 -    MCV                       93 fL            80.0   -    100.0
130684 -     ..
130685 -    LAB.RES <Shift F9> For complete Lab Results    WCRM9H  040518 1230
130686 -
130687 -
130689 -     ..
130690 -    Patient   Provider  Category   View      FR Date   To Date
130697 -     ..
130698 -    Procedure              Results             Reference Range
130700 -     ..
130701 -    Log#: 510413801999      040517 13:15 Outpa WCR Req: RA Johnson, MD
130702 -                  ** Walnut Creek Medical Center **
130704 -     ..
130705 -    RDW                     13.9 %             11.9   -     14.3
130706 -    Plt x10-3                233 K/uL         140     -    400
130707 -    Neutrophils   L           42 %             50     -     70
130708 -    Lymphocytes               43 %             20     -     50
130709 -    Monocyte                  10 %              0     -     11
130710 -    Eosinophil    H            5 %              0     -      4
130711 -    Basophil                   1 %              0     -      2
130712 -    Manual Diff?            CHEMO
130714 -     ..
130715 -    @MDIF
130716 -    Diff Method          Auto Dif
130718 -     ..
130719 -    Log#: 500412402708 COL  040503 17:20 Outpa WCR Req: RA Johnson, MD
130720 -                  ** Walnut Creek Medical Center **
130722 -     ..
130723 -    CBC
130724 -    WBC x 10-3               4.7 K/uL           3.5   -     12.5
130726 -     ..
130727 -    LAB.RES <Shift F9> For complete Lab Results    WCRM9H  040518 1230
130728 -
130729 -
130730 -
130731 -
130732 -
1308 -

SUBJECTS
Prepare for Treatment Connect Equipment for Port Catheter
Tagiment Dexatron Administered to Prevent Alergic Reaction to Taxol
Port Catheter Required 3 Tried to Connect Infusion Equipment Prepare

1605 -
160601 -  ..
160602 - Preparation for Treatment Required Three (3) Attempts to Connect Port
160603 -
160604 - There is a set of equipment the nurse uses to connect the port
160605 - catheter to the tubes that deliver the intravenous treatements.
160607 -  ..
160608 - Mary apologized for discomfort from taking three (3) tries to connect
160609 - the port to the equipment that links to the infusion tubing.  On prior
160610 - treatments, this was accomplished on the first try, without any pain
160611 - or incident.
160613 -  ..
160614 - The nurse administered compazine pill for nausea, as was done last
160615 - week.
160616 -
160617 -
160619 -  ..
1607 -
1608 -
1609 - 1216
1610 -
161001 - Benedrill was administered again for allergic reaction.
161002 -
161003 -    It has a side effect of making the patient sleepy, reported on
161004 -    040427, ref SDS 7 Q675, however, unlike the last treatment, Millie
161005 -    did not sleep during the treatment today.
161007 -     ..
161008 -    Note - below, Millie was less wobbly after the treatment today.
161009 -    ref SDS 0 F54N
161010 -
161011 -
161013 -  ..
1611 -
1612 -
1613 - 1227
1614 -
161401 - Alarm sounded indicating Benedril treatment was completed.  A nurse,
161402 - Diana, attending to another patient next to Millie explained that the
161403 - monitoring system was reporting an air buble in the plastic tube that
161404 - impeded flow of Benedril.  Diana made an adjustment to the tube that
161405 - is fed through the monitoring equiment.  About 4 minutes later, she
161406 - made another adjustment, even though another alarm did not sound.
161408 -  ..
161409 - Mary came a few minutes later and checked the equipment and said
161410 - everything seems to be working correctly now.
161411 -
161412 -
161413 -
161415 -  ..
1615 -
1616 -
1617 - 1239
1618 -
161801 - Tagimint and dexatron are administered prior to Taxol for prevention
161802 - of allergic reaction.
161803 -
161804 -
161806 -  ..
1619 -
1620 -
1621 - 1250
1622 -
162201 - Alarm sounds.  A new nurse, Anne, checks and advises there is a small
162202 - amount of material still in the container.  She reset the alarm so
162203 - that the remaining medicine is received by Millie.
162204 -
162205 -
162206 -
162207 -
1623 -

SUBJECTS
Taxol Treatment Delayed 30 Minutes Because Lab Has Not Prepared Trea

1703 -
1704 - 1254
170501 -  ..
170502 - Taxol Treatment Delayed Because Taxol Not Prepared by Lab
170503 -
170504 - Alarm sounds.  Another nurse, Kathy, checks and notes Tagimint and
170505 - Dexatron treatment is completed.  She leaves to look for Mary to start
170506 - treatment with Taxol.
170507 -
170508 -
170510 -  ..
1706 -
1707 -
1708 - 1257
1709 -
170901 - Mary is busy with paperwork at the nurses workstation, possibly
170902 - investigating Millie's treatment plan.
170904 -  ..
170905 - Mary leaves the workstation to attend other matters.
170906 -
170908 -  ..
1710 -
1711 -
1712 - 1301
1713 -
171301 - Mary reports that Taxol is being prepared in the lab, and is not
171302 - ready yet.  She expects the Taxol will be available shortly.
171303 -
171304 -
171305 -
171307 -  ..
1714 -
1715 -
1716 - 1327
1717 -
171701 - Taxol is started.
171703 -  ..
171704 - Millie is not hooked up again for continuous blood pressure tests,
171705 - about every 15 minutes.  Unlike the last two (2) treatments, today
171706 - they are not taking Millie's temperature every 15 minutes.
171707 -
171709 -  ..
1718 -
1719 -
1720 - 1422
1721 -
172101 - Taxol completed.
172102 -
172103 -
172104 -
172105 -
1722 -

SUBJECTS
Avastin Treatment Without Blood Pressure Testing

1803 -
180401 -  ..
180402 - Avastin Treatment Without Blood Pressure Testing
180403 -
180404 - Avastin treatment not yet ready; seems to be another backup in the
180405 - lab, as occurred with Taxol. ref SDS 0 PQ5V
180407 -  ..
180408 - Mary starts to hook up the equipment to take continuous blood pressure
180409 - and temperature diagnostics, as on prior treatments, but since Avastin
180410 - is not yet available, blood pressure equipment is not configured.
180411 -
180412 -
180414 -  ..
1805 -
1806 -
1807 - 1435
1808 -
180801 - Avastin treatment now available.  Nurse, Shiree, gets equipment and
180802 - starts treatment.
180804 -  ..
180805 - Shiree asks how many times Millie has had Avastin?
180807 -  ..
180808 - Millie advised that she has had two (2) prior treatments so this is
180809 - the 3rd with Avastin.
180811 -  ..
180812 - Shiree explained that this 3rd treatment will, therefore, be set for
180813 - 30 minutes.  The first was 90 minutes; the 2nd was 60 minutes, and the
180814 - rest will be 30 minutes.
180816 -  ..
180817 - Blood pressure and tempearture equipment is not configured, so these
180818 - diagnostics are not captured on this visit.
180819 -
180820 -
180822 -  ..
1809 -
1810 -
1811 - 1506
1812 -
181201 - Treatment ends.
181202 -
181204 -  ..
181205 - Got home about 1535.
181206 -
181207 -
181208 -
181209 -
1813 -

SUBJECTS
Tired Wobbly on Feet after Treatment In Asleep by 1900

1903 -
1904 - 1621
190501 -  ..
190502 - Tired and Wobbly Today After Treatments
190503 -
190504 - Follow up ref SDS 9 F54N, ref SDS 7 F54N.
190505 -
190506 - Millie seemed less tired today.
190507 -
190508 - We got home about 1535 -- traffic was light.  Millie felt like she
190509 - could drive, but decided I would drive this trip, and maybe Millie
190510 - will drive home next time.
190512 -  ..
190513 - At home, we fixed an early dinner.  Millie seemed more energetic, and
190514 - worked on preparing a meal.
190516 -  ..
190517 - She watched television, and was in bed by about 2000.
190518 -
190519 -
190520 -
190521 -
190522 -
1906 -