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 27 0000. ref SDS 25 0000.
080902 -
080903 -
080904 -
080905 -
080906 -
080908 -  ..
0810 -
0811 -
0812 - Progress
0813 - 1403
0814 -
081401 - Vicki is the nurse today.  She was the first nurse for the 2nd phase
081402 - of treatment begun on 040420. ref SDS 8 9Z5J
081404 -  ..
081405 - Millie had blood drawn here at the Chemotherapy Infusion clinic
081406 - yesterday.
081408 -  ..
081409 - Vicki asked Millie how she feels?
081411 -  ..
081412 - Mil advised that she feels so so, indicating the toll chemotherapy has
081413 - on lowering the energy level, discussed with Doctor Johnson last week.
081415 -  ..
081416 - Vicki said that chemotherapy makes patients very tired all the time.
081418 -  ..
081419 - Millie related that a memeber of her health club recently explained
081420 - that when she had chemotherapy treatments several years ago, she could
081421 - not work out at the gym, and felt like doing nothing but staying in
081422 - bed.
081424 -  ..
081425 - Millie has remained very active, but this is an increasing struggle,
081426 - per discussion with Doctor Johnson on 040812. ref SDS 26 0001
081427 -
081428 -
081429 -
081430 -
081431 -
081433 -  ..
0815 -
0816 -
0817 - 1749
0818 -
081801 - Rosalie called and asked for Millie.
081802 -
081803 - Mil is sleeping after treatments today.
081805 -  ..
081806 - Rosalie said she wanted to visit Millie in the clinic today, but did
081807 - not have enough time.  She asked how Millie is doing?
081809 -  ..
081810 - We reviewed comments to Vicki this afternoon at the hospital, per
081811 - above. ref SDS 0 KK4L
081812 -
081813 -
081814 -
081815 -
0819 -

SUBJECTS
Avastin Side Effect New Evidence Increased Risk Pulmonary Emboli Blo
Coumadin 1 MG Prescribed to Reduce Risk Blood Clots on Port Catheter

1704 -
170501 -  ..
170502 - Coumadin 1 MG Prescribed to Reduce Risk Blood Clots on Port Catheter
170503 - Blood Clots Pulmonary Emboli No Risk for Millie on Avastin Trial
170504 -
170505 - Follow up ref SDS 26 RZ4I.
170506 -
170507 - Since Rosalie is the protocol nurse for the Avastin trial, we
170508 - discussed recent reports by Genentec that some patients in the Avastin
170509 - trial have died who have a history of heart and blood clot problems in
170510 - the family, which was discussed with the doctor on 040812. ref SDS 26
170511 - RZ4I
170513 -  ..
170514 - We reviewed the discussion at Kaiser on 040812 reporting that Millie's
170515 - mother died of coronary thrombosis at the age of 40. ref SDS 26 MG5K
170517 -  ..
170518 - About a year ago, Millie's son, who is now 50, suffered blood clots in
170519 - his leg that travelled to his lungs, causing pulmonary edema.  He
170520 - collapsed walking up the stairs at home.  Ron Jr., was rushed to the
170521 - hospital.  He recovered and is now living normally, after treatment
170522 - with Coumadin to relieve blood clots.
170524 -  ..
170525 - During the meeting at Kaiser on 040517, Millie reported problems from
170526 - coughing, heavy chest, and shortness of breath. ref SDS 13 RZ4I  These
170527 - problems have continued with varying severity; cough medicine
170528 - prescibed by the doctor has been helpful, but symptoms persist, as
170529 - reported most recently to the doctor on 040812. ref SDS 26 RZ4I
170531 -         ..
170532 -        [On 041104 Doctor Kaufman reported that a blood clot is shown
170533 -        in at CT test taken on 041103; he diagnosed pulmonary embolism,
170534 -        which is a side effect of the Avastin trial, and this turn of
170535 -        events requires Millie to end participation in the Avastin
170536 -        trial, and to take Coumadin for life in 4 mg pills. ref SDS 28
170537 -        N43I
170539 -  ..
170540 - Rosalie indicated that Kaiser's practice of testing patient's blood
170541 - once a week prior to cancer treatments, under the Avastin trial
170542 - protocol generally discloses emerging problems in time to avoid harm.
170544 -  ..
170545 - Rosalie asked if Millie has any history of heart problems.
170547 -  ..
170548 - There is no record of a heart problem in Millie's personal medical
170549 - history.
170551 -  ..
170552 - Rosalie indicated her understanding that Genentec's new warning
170553 - pertains only to increased risk of blood clots for patients taking
170554 - Avastin who have a personal history of coronary problems.  She feels
170555 - that since Millie has not suffered these problems, history in her
170556 - family does not place Millie at higher risk for blood clots from
170557 - taking Avastin.  Therefore, precautions to avoid blood clots caused by
170558 - Avastin would be unnecessary overkill in Millie's case.
170559 -
170560 -        [On 041104 Doctor Kaufman reported that a blood clot is shown
170561 -        in at CT test taken on 041103; he diagnosed pulmonary embolism,
170562 -        which is a side effect of the Avastin trial, and this turn of
170563 -        events requires Millie to end participation in the Avastin
170564 -        trial, and to take Coumadin for life in 4 mg pills. ref SDS 28
170565 -        N43I
170567 -         ..
170568 -        [On 060714 oldest son hospitalized again with pulmonary emboli.
170569 -        ref SDS 29 8S6I
170571 -         ..
170572 -        [On 060722 oldes son reports doctors performed tests and found
170573 -        genetic cause of blood clots that will require continuing
170574 -        treatment. ref SDS 30 3D9T
170576 -  ..
170577 - Rosalie asked if Millie is taking Coumadin?
170579 -  ..
170580 - Millie's prescriptions are listed on Kaiser's computer, which the
170581 - doctor checks during examinations.  Coumadin does not sound familiar,
170582 - like something Millie is taking now, or during the past several years
170583 - of treatment for cancer.  Review of her medical history in the subject
170584 - index does not list Coumadin, so today is the first time this subject
170585 - appears in the record, begining on 020208, when Millie was first
170586 - examined for breast cancer. ref SDS 1 0001
170588 -  ..
170589 - Rosalie said that she feels Coumadin would be helpful for Millie to
170590 - avoid blood clots that occur with patients who have a port for
170591 - infusion treatments, which was installed for Millie during an
170592 - operation on 040419. ref SDS 7 0001  Rosalie plans to ask the doctor
170593 - to prescribe Coumadin to avoid blood clots caused by the port
170594 - catheter.
170596 -  ..
170597 - During the meeting on 040402, risk of blood clots clogging a port
170598 - catheter were discussed. ref SDS 3 6C6I  On 040409 Millie's letter
170599 - confirmed discussion when Rosalie advised that blood clots are not a
170600 - problem using Kaiser's system of port catheters, because Kaiser takes
170601 - a specific precaution to avoid blood clots by treating with heparin
170602 - each time the port catheter is used. ref SDS 4 7J96
170603 -
170604 -    [On 060714 oldest son hospitalized again with pulmonary emboli.
170605 -    ref SDS 29 8S6I
170607 -     ..
170608 -    [On 060722 oldes son reports doctors performed tests and found
170609 -    genetic cause of blood clots that will require continuing
170610 -    treatment. ref SDS 30 3D9T
170612 -  ..
170613 - It is unclear why Coumadin would be added to heparin to avoid blood
170614 - clots caused by port catheters.  In any case, additional protection
170615 - may help reduce the risk of blood clots from Avastin, as warned by
170616 - Genetech.
170617 -
170618 -
170619 -
170620 -
170622 -  ..
1707 -
1708 -
1709 - 1816
1710 -
171001 - Rosalie called back and talked to Millie, who woke up when the phone
171002 - rang.  Rosalie explained to Millie that she has now talked to the
171003 - doctor, and he has now prescribed Coumidin, which can be taken orally
171004 - once a day in 1 mg pills.  Millie can pick up the prescription
171005 - tomorrow, and will have to take this once a day for the remainder of
171006 - treatments to reduce the risk of blood clots.
171007 -
171008 -        [On 041104 Doctor Kaufman reported that a blood clot is shown
171009 -        in at CT test taken on 041103; he diagnosed pulmonary embolism,
171010 -        which is a side effect of the Avastin trial, and this turn of
171011 -        events requires Millie to end participation in the Avastin
171012 -        trial, and to take Coumadin for life in 4 mg pills. ref SDS 28
171013 -        N43I
171014 -
171015 -
171016 -
171017 -
171018 -
171019 -
1711 -

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

2105 -
210601 -  ..
210602 - Blood Counts Normal Dose Chemotherapy Taxol
210603 -
210604 - Follow up ref SDS 27 Q659, ref SDS 25 Q659.
210605 -
210606 - Millie requested report on blood test taken yesterday?
210608 -  ..
210609 - Diana later submitted the report showing...
210610 -
210611 -    Patient   Provider  Category   View      FR Date   To Date
210617 -     ..
210618 -    Procedure              Results             Reference Range
210620 -     ..
210621 -    Log#: 510422401504      040811 12:04 Outpa WCR Req: RA Johnson, MD
210622 -
210623 -                  ** Walnut Creek Medical Center **
210625 -     ..
210626 -    @CBC
210627 -    WBC x 10-3               3.9 K/uL           3.5   -     12.5
210628 -    RBC x 10-6              3.66 M/uL           3.60  -      5.10
210629 -    Hemoglobin              11.7 g/dL          11.5   -     15.0
210630 -    Hematocrit              34.8 %             34.0   -     46.0
210631 -    MCV                       95 fL            80.0   -    100.0
210632 -    RDW                     14.0 %             11.9   -     14.3
210633 -    Plt x10-3                218 K/uL         140     -    400
210634 -     ..
210635 -    Neutrophils   L           45 %             50     -     70
210636 -    Lymphocytes               43 %             20     -     50
210637 -    Monocyte                   3 %              0     -     11
210638 -    Eosinophils    H           9 %              1     -      5
210639 -    Basophil                   1%               0     -      2
210640 -    Bands                      1 %              0     -      5
210641 -    Manual Diff?         NOT REQ
210643 -     ..
210644 -    CA 15-3              NO TEST               -<     -     39
210645 -
210646 -
210647 -
210648 -
2107 -

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

2203 -
220401 -  ..
220402 - CA 15-3 Drops Again from 55 to 47
220403 -
220404 - Follow up ref SDS 27 2N5J, ref SDS 25 2N5J.
220405 -
220406 - No new test today, but received the CA 15-3 part of the report on
220407 - 040812. ref SDS 27 2N5J
220408 -
220409 -
220410 -
220411 -
220412 -
2205 -

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

2505 -
2506 - 1404
250701 -  ..
250702 - Preparation for Treatment Required One (1) Attempt to Connect Port
250703 -
250704 - Follow up ref SDS 27 EB7J, ref SDS 25 EB7J.
250705 -
250706 - Vicki was effective connecting the port to the equipment that links
250707 - to the infusion tubing.
250709 -       ..
250710 -      Interlink System Vented Paclitaxel set
250712 -  ..
250713 - Vicki brought Compazine pill for nausea.
250715 -  ..
250716 - Vicki flushed the port with Saline, but did not apply a saline flush
250717 - as has been done previously.  Vicki clarifies that saline flush is
250718 - not normally.
250720 -  ..
250721 - Skip saline flush.
250722 -
250724 -  ..
2508 -
2509 -
2510 - 1410
2511 -
251101 - Benadryl started.
251102 -
251103 -
251105 -  ..
2512 -
2513 -
2514 - 1420
2515 -
251501 - Benadryl completed alarm sounds.
251502 -
251503 - Julie was in the area and switched the treatment.
251504 -
251505 -
251507 -  ..
2516 -
2517 -
2518 - 1421
2519 -
251901 - Tagamet and Decadron administered prior to Taxol for prevention of
251902 - allergic reaction.
251903 -
251905 -  ..
2520 -
2521 -
2522 - 1434
2523 -
252301 - Alarm sounds Tagamet and Decadron complete.
252303 -  ..
252304 - Millie seems alert again today after Benadryl.  Not sleepy, no
252305 - slurred speech; she is reading, rather than sleeping.
252306 -
252307 -
252308 -
252309 -
2524 -

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

2603 -
2604 - 1438
260501 -  ..
260502 - Taxol Dosage Normal Because Blood Counts Above Targets
260503 -
260504 - Follow up ref SDS 27 4N5M, ref SDS 25 4N5M.
260505 -
260506 - Taxol is started by Diana.
260508 -  ..
260509 - Diana advised dosage is normal today, because blood counts are normal
260510 - again, per above, ref SDS 0 0N7Q, continuing conditions from treatment
260511 - on 040629. ref SDS 22 4N5M
260512 -
260513 -
260514 -
260516 -  ..
2606 -
2607 -
2608 - 1441
2609 -
260901 - Vitals taken by Diana....
260902 -
260903 -    Blood pressure:  163 81
260905 -     ..
260906 -    Pulse........... 65
260908 -     ..
260909 -    Temperature..... 96.9
260910 -
260912 -  ..
260913 - Speech a little slurred now, feeling effects of Benadryl; but, still
260914 - not sleepy nor cold.  Has not requested a blanket.
260915 -
260916 -
260917 -
260919 -  ..
2610 -
2611 -
2612 - 1501
2613 -
261301 - Vicki takes blood pressure and temperature again.
261302 -
261303 -    Blood pressure:  156 84
261305 -     ..
261306 -    Pulse........... 65
261308 -     ..
261309 -    Resperation.....
261311 -     ..
261312 -    Temperature..... not taken
261313 -
261314 -
261316 -  ..
2614 -
2615 -
2616 - 1528
2617 -
261701 - Alarm sounds.  Diana came by and noted the system is not plugged into
261702 - the power outlet.  The alarm indicates the battery is low on power.
261703 - Diana plugged the cable into the all outlet.
261704 -
261705 -
261707 -  ..
2618 -
2619 -
2620 - 1538
2621 -
262101 - Taxol completed alarm sounds.
262103 -  ..
262104 - Vitals taken again by Vicki...
262105 -
262106 -    Blood pressure:  157 81
262108 -     ..
262109 -    Pulse........... 66
262111 -     ..
262112 -    Temperature.....
262113 -
262114 -
262115 -
262116 -
262117 -
262118 -
2622 -

SUBJECTS
Avastin Treatment Without Blood Pressure Testing

2703 -
2704 - 1610
270501 -  ..
270502 - Avastin Treatment Without Blood Pressure Testing
270503 -
270504 - Follow up ref SDS 27 PV4H, ref SDS 25 PV4H.
270505 -
270506 - No Avastin today.
270507 -
270508 -
270509 -
270510 -
270511 -
2706 -

SUBJECTS
Tired Wobbly on Feet after Treatment In Asleep by 1900

2803 -
2804 - 1537
280501 -  ..
280502 - Alert Energetic After Treatment Marked Change from Prior Treatments
280503 -
280504 - Follow up ref SDS 27 F54N, ref SDS 25 F54N.
280505 -
280506 -
280507 -
280508 -
280509 -
280510 -
280511 -
2806 -