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: June 29, 2004 12:25 PM Tuesday; Rod Welch

Millie chemo 3rd cycle 3rd treatment with Taxol and Avastin

1...Summary/Objective
2...Blood Counts Normal Dose Chemotherapy Taxol Adjusted Lower
3...CA 15-3 Rises from 70 to 78, Reduction from 10 Point Rise on 040318
4...Preparation for Treatment Required One (1) Attempt to Connect Port
5...Taxol Dosage Normal Because Blood Counts Low but Close to Targets
6...Avastin Treatment Without Blood Pressure Testing
7...Alert Energetic After Treatment Marked Change from Prior Treatments


..............
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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

0807 -
0807 -    ..
0808 - Summary/Objective
0809 -
080901 - Follow up ref SDS 19 0000. ref SDS 18 0000.
080902 -
080903 -
080904 -
080905 -
080907 -  ..
0810 -
0811 -
0812 - Progress
0813 -
081301 - Barbara is the nurse today.
081303 -  ..
081304 - Millie had blood drawn at the Chemotherapy clinic again yesterday.
081306 -  ..
081307 - A nurse in the ocologogy clinic called Millie yesterday and said that
081308 - her blood counts were low, and so Kaiser's Infusion team wants Millie
081309 - to come in this morning to do another "lab," which means draw blood
081310 - again, to see if the counts have increased so that a normal treatment
081311 - can be given.  There was a suggestion that if the counts did not rise
081312 - in the follow up blood test, then treatment would be postponed.
081314 -  ..
081315 - Millie explained to the person who called that she is on a trial, and
081316 - that rather than delay treatment, Doctor Johnson has been reducing
081317 - the dosage.  Millie asked the person who called to contact Rosalie
081318 - and/or Stephanie Aguilar to clarfify the schedule.  The person who
081319 - called said that Doctor Johnson would be contacted.
081321 -  ..
081322 - Millie called back and talked to Debra, who is the doctor's secretary.
081324 -  ..
081325 - Millie advised Debra that the primary care physician asked Millie to
081326 - call him at the conclusion of treatment with antibiotics for the sore
081327 - on her breast from the biopsy taken on 040419, which the doctor
081328 - prescribed during the meeting on 0404615.  Millie reported that the
081329 - sore seems be somewhat improved, but not healed.  There is still
081330 - seepage and tenderness.
081332 -  ..
081333 - Millie explained the call earlier from someone at the hospital who
081334 - reported low blood counts and that treatment would be postponed.
081336 -  ..
081337 - Debra advised that she will investigate.
081339 -  ..
081340 - This morning, Stephanie Aguilar called and advied that Millie's blood
081341 - counts are okay for normal treatment.  She asked who called Millie
081342 - about postponing treatment today?
081344 -  ..
081345 - Millie said the person did not give their name.
081347 -  ..
081348 - This afternoon, Millie asked Barbara to change the time for meetings
081349 - on Thursdays from 1000 to 1200 or 1300 in order to coordinate with
081350 - exercise.
081352 -  ..
081353 - Barbara advised that next treatment Millie gets, cannot be changed,
081354 - because there is a meeting on that date, which limits flexibility for
081355 - schedule adjustments, but the treatments after that will be changed
081356 - per Millie's request.
081358 -  ..
081359 - Barbara later changed the schedule for Millie to get treatments at
081360 - 1300.
081362 -  ..
081363 - Millie noticed an elderly man getting treatment in an adjacent chair
081364 - had a copy of the book...
081365 -
081366 -                     The Purpose Driven Life
081367 -                     What on Earth am I Here For?
081368 -                     Rick Warren
081369 -                     Zonedervan Publishing
081371 -  ..
081372 - The patient left a short time after we arrived, but we talked briefly
081373 - explaining how Patty had give us this book just a few weeks ago, on
081374 - 040613. ref SDS 16 C64M  The patient commented how much he has enjoyed
081375 - reading the book, because the experience has brought comfort and
081376 - strength in meeting the challenge of cancer with purpose driven by
081377 - resolve and confidence.
081378 -
081379 -
081380 -
081381 -
081382 -
081383 -
081384 -
0814 -

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

1205 -
120601 -  ..
120602 - Blood Counts Normal Dose Chemotherapy Taxol Adjusted Lower
120603 -
120604 - Follow up ref SDS 19 Q659, ref SDS 18 Q659.
120605 -
120606 - Millie requested report on blood test taken yesterday?
120608 -  ..
120609 - Barbara later submitted the report showing...
120610 -
120611 -    Patient   Provider  Category   View      FR Date   To Date
120617 -     ..
120618 -    Procedure              Results             Reference Range
120620 -     ..
120621 -    Log#: 510418002089      040628 18:06 Outpa WCR Req: RA Johnson, MD
120623 -     ..
120624 -    Ferritin             TEST CANCELLED
120625 -    IRON/TIBC            TEST CANCELLED
120626 -    CA 15-3              TEST CANCELLED
120627 -
120629 -     ..
120630 -    Log#: 510418002090      040628 18:07 Outpa WCR Req: RA Johnson, MD
120632 -     ..
120633 -    Ferritin       TEST IN LAB                    92  -     365
120635 -     ..
120636 -    IRON/TIBC
120637 -
120638 -      UIBC                   217 ug/dL            92  -     365
120639 -      Transf. % Sat.          26 %                15  -      55
120640 -      TIBC                   294 ug/dL           228  -     428
120641 -      Iron                    77 ug/dL            35  -     160
120643 -     ..
120644 -    CA 15-3        TEST IN LAB   U/mL                 -<    39
120645 -
120647 -     ..
120648 -    Log#: 510418002090      040628 13:27 Outpa WCR Req: RA Johnson, MD
120649 -
120650 -                  ** Walnut Creek Medical Center **
120652 -     ..
120653 -    @CBC
120654 -    WBC x 10-3    L          3.3 K/uL           3.5   -     12.5
120655 -    RBC x 10-6    L         3.27 M/uL           3.60  -      5.10
120656 -    Hemoglobin    L         10.7 g/dL          11.5   -     15.0
120657 -    Hematocrit    L         30.8 %             34.0   -     46.0
120658 -    MCV                       94 fL            80.0   -    100.0
120659 -    RDW           H         15.0 %             11.9   -     14.3
120660 -    Plt x10-3                207 K/uL         140     -    400
120661 -     ..
120662 -    Neutrophils   L           46 %             50     -     70
120663 -    Lymphocytes               48 %             20     -     50
120664 -    Monocyte                   3 %              0     -     11
120665 -    Eosinophil                 3 %              0     -      4
120666 -    Basophil                   1 %              0     -      2
120667 -    Manual Diff?         NOT REQ
120669 -     ..
120670 -    @MDIF
120671 -    Diff Method         Auto Dif
120672 -
120674 -     ..
120675 -    Log#: 510418002089      040628 13:27 Outpa WCR Req: RA Johnson, MD
120676 -
120677 -
120678 -
120679 -
120680 -
1207 -

SUBJECTS
CA 15-3 78 Smaller Rise than 10 Points Reported on 040318

1303 -
130401 -  ..
130402 - CA 15-3 Rises from 70 to 78, Reduction from 10 Point Rise on 040318
130403 -
130404 - Follow up ref SDS 19 2N5J, ref SDS 18 2N5J.
130405 -
130406 - CA 15-3 not reported in this blood test.  Millie said she ordered CA
130407 - 15-3 yesterday.  This occurred previously on 040615. ref SDS 18 2N5J
130408 -
130410 -  ..
1305 -
1306 -
1307 - 1350
1308 -
130801 - Millie asks Barbara about report on CA 15-3?  Barbara will
130802 - investigate.
130803 -
130804 -     Barbara brings revised blood test report that shows CA 15-3 was
130805 -     cancelled, along with several other tests; Barbara points out that
130806 -     the cancellation was rescinded and test was performed, but is
130807 -     pending results from the lab, per above. ref SDS 0 MY5W
130808 -
130809 -
130810 -
130811 -
130812 -
130813 -
1309 -

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 -
1606 - 1250
160701 -  ..
160702 - Preparation for Treatment Required One (1) Attempt to Connect Port
160703 -
160704 - Follow up ref SDS 19 EB7J, ref SDS 18 EB7J.
160705 -
160706 - Barbara was effective connecting the port to the equipment that links
160707 - to the infusion tubing.
160709 -  ..
160710 - Barbara brought Compazine pill for nausea.
160711 -
160712 -
160714 -  ..
1608 -
1609 -
1610 - 1253
1611 -
161101 - Saline started.
161102 -
161104 -  ..
1612 -
1613 -
1614 - 1258
1615 -
161501 - Benadryl started.
161502 -
161504 -  ..
1616 -
1617 -
1618 - 1303
1619 -
161901 - Warning alarm sounds.  Sharee was near Millie, so she inspected the
161902 - equipment and advised a defect of some kind occurred.  She made
161903 - adjustments and treatment continued.
161904 -
161905 -
161906 -
161908 -  ..
1620 -
1621 -
1622 - 1312
1623 -
162301 - Benadryl completed.
162302 -
162303 - Barbara starts Tagamet and Decadron administered prior to Taxol for
162304 - prevention of allergic reaction.
162306 -  ..
162307 - Millie says she is not feeling the Benadryl today.
162309 -  ..
162310 - Speech is not slurred.
162312 -  ..
162313 - Seems different from last week.
162314 -
162316 -  ..
1624 -
1625 -
1626 - 1317
1627 -
162701 - Vital
162702 -
162703 -    Blood pressure:  164 74
162705 -     ..
162706 -    Pulse........... 53
162708 -     ..
162709 -    Resperation..... 18
162710 -
162711 -
162712 -
162713 -
162715 -  ..
1628 -
1629 -
1630 - 1328
1631 -
163101 - Alarm sounds indicating Tagamet and Decadron is complete, ready for
163102 - Taxol treatment.
163104 -  ..
163105 - Mary comes by and turns off the machine.
163106 -
163107 -
163108 -
163109 -
1632 -

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

1703 -
1704 - 1330
170501 -  ..
170502 - Taxol Dosage Normal Because Blood Counts Low but Close to Targets
170503 -
170504 - Follow up ref SDS 19 4N5M, ref SDS 18 4N5M.
170505 -
170506 - Taxol is started by Mary.
170508 -  ..
170509 - Barbara will investigate whether dosage is normal today, because blood
170510 - counts are close to normal again, per above, ref SDS 0 0N7Q,
170511 - continuing change from last week, on 040615. ref SDS 18 4N5M
170512 -
170513 -      Barbara later reported that dosage is normal today.
170514 -
170516 -  ..
170517 - Vital
170518 -
170519 -    Blood pressure:  169 82
170521 -     ..
170522 -    Pulse........... 56
170524 -     ..
170525 -    Resperation..... 18
170526 -
170527 -
170529 -  ..
170530 - Millie says starting to feel the Benadryl now.
170532 -  ..
170533 - Speech is a little slurred again.
170535 -  ..
170536 - Seems similar to last week.
170537 -
170539 -  ..
1706 -
1707 -
1708 - 1333
1709 -
170901 - Barbara takes blood pressure and temperature again.
170902 -
170903 -    Blood pressure:  162 88
170905 -     ..
170906 -    Pulse........... 58
170908 -     ..
170909 -    Resperation..... 18
170910 -
170911 -
170913 -  ..
1710 -
1711 -
1712 - 1348
1713 -
171301 - Barbara takes vitals again.
171302 -
171303 - Machine has difficulty.
171304 -
171305 -    Blood pressure:  148 75
171307 -     ..
171308 -    Pulse........... 50
171310 -     ..
171311 -    Resperation..... 18
171312 -
171314 -  ..
1714 -
1715 -
1716 - 1351
1717 -
171701 - Millie notices that Taxol is not dripping.
171702 -
171703 - Vickey investigates and finds the equipment is not set for Taxol.
171704 - She changes settings, and Taxol infusion begins.
171705 -
171706 -
171708 -  ..
1718 -
1719 -
1720 - 1409
1721 -
172101 - Barbara takes vitals again.
172102 -
172103 - Machine has difficulty.
172104 -
172105 -    Blood pressure:  176 75
172107 -     ..
172108 -    Pulse........... 56
172109 -
172110 -
172111 -
172112 -
172114 -  ..
1722 -
1723 -
1724 - 1456
1725 -
172501 - Taxol completed alarm sounds.
172502 -
172503 -
172504 -
172505 -
1726 -

SUBJECTS
Avastin Treatment Without Blood Pressure Testing

1803 -
1804 - 1458
180501 -  ..
180502 - Avastin Treatment Without Blood Pressure Testing
180503 -
180504 - Follow up ref SDS 19 PV4H, ref SDS 18 PV4H.
180505 -
180506 - Barbara starts Avastin.
180507 -
180509 -  ..
180510 - Barbara takes vitals again.
180512 -  ..
180513 - Machine has difficulty.
180514 -
180515 -    Blood pressure:  145 75
180517 -     ..
180518 -    Pulse........... 58
180519 -
180520 -
180522 -  ..
1806 -
1807 -
1808 - 1528
1809 -
180901 - Alarm sounds Avastin treatment ends.
180902 -
180903 - Mary disconnects the equipment.
180904 -
180905 -
180906 -
180907 -
180908 -
1810 -

SUBJECTS
Tired Wobbly on Feet after Treatment In Asleep by 1900

1903 -
1904 - 1531
190501 -  ..
190502 - Alert Energetic After Treatment Marked Change from Prior Treatments
190503 -
190504 - Follow up ref SDS 19 F54N, ref SDS 18 F54N.
190505 -
190506 - After treatment, Millie seems to be recovering faster.  She drives
190507 - home again, and today we took the freeway.
190509 -  ..
190510 - Mil talked about going to Costco to buy a chicken for dinner.  Decided
190511 - not to make a bid deal our of dinner.  We drove to Safeway, which is
190512 - on not far from the house, and bought a loaf of french bread.
190514 -  ..
190515 - We got home about 1620.
190517 -  ..
190518 - Millie had some messages on the answering machine.  She called and
190519 - talked to Yanna for about 20 minutes or so.  She watched television
190520 - for awhile until dinner about 1720.  Don't think she slepted before
190521 - dinner.  I fixed some left-overs.
190523 -  ..
190524 - Millie slept after dinner from about 1800 to about 2200.  She got up
190525 - briefly to check on the cats, then went back to sleep.
190526 -
190527 -
190528 -
190529 -
190530 -
190531 -
190532 -
190533 -
190534 -
190535 -
1906 -