Welch Company
San Francisco, CA


S U M M A R Y


DIARY: April 15, 2005 02:00 PM Friday; Rod Welch

Millie 1st treatment 1st cycle Taxotere with Xeloda at Kaiser.

1...Summary/Objective
2...Blood Counts Good Dose Chemotherapy Taxol Normal
3...CA 15-3 Drops from 49 to Normal at 39, Lowest Reading Ever
4...Preparation for Treatment Required One (1) Attempt to Connect Port
5...Neupogen Prescribed by Doctor to Build Immune System Low Blood Counts
6...Taxotere Full Dose Even though Blood Counts Below Targets
7...Taxotere Test Patients Resistance to Side Effects
8...Xeloda 2 Pills Twice Each Day
9...Pharmacist Gives Instructions for Xeloda
10...Side Effects Presented on Chemotherapy with Taxotere and Xeloda
........Xeloda (capeditabine) Instruction Sheet
11...Dose Chemotherapy Treatment Based on Side Effects Keep Diary
12...Side Effects Diary Assists Doctor Pharmacist Set Treatment Dosage
13...Treatment Dosage Diary of Side Effects Assists Doctor Pharmacist Set
14...Diary of Side Effects Assists Doctor Pharmacist Set Treatment Dosage
15...Prescription Xeloda Capecitabine 2 500 MG Pills Twice a Day
16...Capecitabine (Xeloda) Prescription 2 500 MG Pills Twice a Day
17...Blood Counts Monitor Set Chemotherapy Treatment Dosage
18...Neupogen Prescribed by Doctor to Maintain Blood Counts
19...Medical Mistake Prescription Neupogen Corrected by Pharmacist
20...Mistakes Medical Prescription Neupogen Fixed Doctor Patient Partnerhip
21...Doctor Patient Partnerhip Avoids Medical Mistakes Prescribe Neupogen
22...Taxotere Chemotherapy Treatment Completed Today
23...Alert Energetic After Treatment Marked Change from Prior Treatments


..............
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CONTACTS 
SUBJECTS
1st Treatment 1st Cycle Taxotere Xeloda Capacitibine Chemotherapy Tr                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0403 -    ..
0404 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040501 - Follow up ref SDS 49 0000. ref SDS 48 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040507 -  ..
0406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0408 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040901 - This begins a new treatment, changing to Taxotere and Capecitabine                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040902 - (Xeloda) after 4 treatments of AC, which implements the doctor's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040903 - treatment plan on 050329, ref SDS 50 T58M, previously recommended by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040904 - Doctor Benz at UCSF in his 2nd opinion reported on 041117. ref SDS 42                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040905 - OU6S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040907 -         ..
040908 -        [On 050502 marked improvement after 2 weeks of treatment with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040909 -        Taxotere and capecitabine (Xeloda), IBC significantly subsides.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040910 -        ref SDS 53 EO5J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040912 -  ..
040913 - Toni is the nurse.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040914 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040915 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040916 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040917 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040918 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0410 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Blood Tests White Cell Count Good 2nd Cycle 1st Treatment Chemothera                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
Urine Tests No Evident Problems                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
Blood Test Results Pass for Treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0805 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080601 -  ..
080602 - Blood Counts Good Dose Chemotherapy Taxol Normal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
080603 - 
080604 - Follow up ref SDS 49 Q659, ref SDS 48 Q659.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
080605 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080606 - Millie had blood drawn this morning at 0635 by the Kaiser clinic in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
080607 - Martinez.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
080609 -  ..
080610 - Millie requested report on blood test taken today?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
080612 -  ..
080613 - Barbara submitted the report showing...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
080614 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080615 -    Patient   Provider  Category   View      FR Date   To Date                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080621 -     ..
080622 -    Procedure              Results             Reference Range                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080624 -     ..
080626 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080627 -                  ** Martinez Medical Offices **                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080629 -     ..
080630 -    @CBC                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
080631 -    WBC x 10-3     L         3.3 K/uL           3.5   -     12.5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080632 -    RBC x 10-6              3.71 M/uL           3.60  -      5.10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
080633 -    Hemoglobin              11.6 g/dL          11.5   -     15.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080634 -    Hematocrit              33.8 %             34.0   -     46.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080635 -    MCV                       91 fL            80.0   -    100.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080636 -    RDW                     13.9 %             11.9   -     14.3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080637 -    Plt x10-3                348 K/uL         140     -    400
080638 -     ..
080639 -    Neutrophils    L          39 %             50     -     70                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080640 -    Lymphocytes               41 %             20     -     50                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080641 -    Monocyte       H          18 %              0     -     11                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080642 -    Eosinophils                1 %              1     -      5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080643 -    Basophil                   1%               0     -      2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080644 -    Bands              No Report %              0     -      5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080645 -    Manual Diff?           Chemo                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080647 -     ..
080648 -    CA 15-3        Test Remote Collect         -<     -     39
080650 -     ..
080651 -    Seg Neutrophils    No Report %             50     -     70                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080653 -     ..
080654 -    DIFF Method         Auto Dif                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080655 -    Anisocytosis       No Report+                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
080656 -    Macrocytes         No Report+                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
080657 -    Plt estimate         Adequate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
080659 -     ..
080660 -    Alkaline Phos             43 U/L           38     -    126                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080661 -    Bili, Tot Adult  L       0.1 mg/dL        0.2     -    1.3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080662 -    Creatinine               0.7 mg/dL        0.6     -    1.2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080663 -    Phosphorus     Test Remote Collect                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
080664 -    Alt (SGPT)                45 U/L           11     -     66                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
080665 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080666 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080667 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080668 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080669 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080670 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080671 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080672 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080673 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
080674 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0807 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
CA 15-3 78 Smaller Rise than 10 Points Reported on 040318                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0903 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090401 -  ..
090402 - CA 15-3 Drops from 49 to Normal at 39, Lowest Reading Ever                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
090403 - 
090404 - Follow up ref SDS 49 2N5J, ref SDS 48 2N5J.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090408 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090410 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090412 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090413 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0905 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Port Catheter Used for Chemotherapy Treatments on 040518                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
Prepare for Treatment Connect Equipment for Port Catheter Copazine B                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
Tagiment Dexatron Administered to Prevent Alergic Reaction to Taxol                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
Atavin Compazine Side Effect Reduces Effects Chemotherapy Nausea Anx                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
1306 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1307 - 1410                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
130801 -  ..
130802 - Preparation for Treatment Required One (1) Attempt to Connect Port                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
130803 - 
130804 - Follow up ref SDS 49 EB7J, ref SDS 48 EB7J.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
130805 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130806 - Another nurse took admin with Toni to verify Millie's identification                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
130807 - and treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
130809 -  ..
130810 - If no side effects then speed of treatment will be increased.  The                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
130811 - total time is normally 60 minutes.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
130813 -  ..
130814 - Treatment plan calls for taking Decadron twice a day, beginning the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
130815 - day before treatment with Taxotere, the day of treatment and the day                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
130816 - after treatment, which occurs every 3 weeks.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
130817 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130818 -     [On 050506 Sheri advised that guidance requires taking two (2)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
130819 -     Decadron pills twice a day. ref SDS 54 OW5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
130821 -  ..
130822 - Toni recommended taking second pill of decadron in early afternoon,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
130823 - because some people get hyper and cannot sleep.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130825 -  ..
130826 - Benedril will make you sleepy.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
130828 -  ..
130829 - Patient can ask for atavin to reduce nausea and aniexty; this could                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
130830 - also aid sleep.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130832 -  ..
130833 - Decadron 10 Millie took this orally earlier today, per protocol.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
130835 -  ..
130836 - Toni gave Millie a pill for Compazine 10 prior to treatment that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
130837 - reduces nausea rather than as a drip treatment to avoid allergic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
130838 - reaction, as applied during the Taxol and Avastin treatment on the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
130839 - trial protocol.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130841 -  ..
130842 - Toni connected the port.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
130844 -       ..
130845 -      Interlink System Vented Paclitaxel set                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
130846 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130847 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130848 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
130849 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
1309 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Medication Prescription Mistake Avoided Doctor Patient Partnership C                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2303 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
230401 -  ..
230402 - Neupogen Prescribed by Doctor to Build Immune System Low Blood Counts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
230403 - 
230404 - Toni advised that the doctor has prescribed Neupogen to increase low                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
230405 - blood counts.  This will be a 3 day treatment that raises WBC for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
230406 - stronger immune system. ref SDS 0 0N7Q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
230407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
230408 -        [...below, Pharmacist not aware Neupogen prescribed,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
230409 -        ref SDS 0 KW5N, checks with doctor, and corrects medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
230410 -        mistake. ref SDS 0 KX49                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
230412 -  ..
230413 - Xeloda can make patient tired and cause nausau.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
230415 -  ..
230416 - Neupogen will build energy, and reduce nausea.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
230418 -  ..
230419 - Toni explained that Millie will have to self-inject these treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
230420 - with a disposable syrenge pre-loaded with Nuepogen, like the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
230421 - treatments in 020520. ref SDS 3 RF4M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
230422 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
230423 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
230424 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
230425 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
230427 -  ..
2305 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2306 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2307 - 1422                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
2308 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
230801 - Benedryl started.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
230802 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
230803 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
230804 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
230806 -  ..
2309 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2310 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2311 - 1429                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
2312 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
231201 - Blaine took vitals.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
231202 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
231203 -    Blood preasure    121  73                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
231204 -    Pulse              69                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
231205 -    Temperature        98                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
231206 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
231207 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
231208 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
231209 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
231210 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2313 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Taxotere Full Dose Even though Blood Counts Below Targets                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2404 - 1442                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
240501 -  ..
240502 - Taxotere Full Dose Even though Blood Counts Below Targets                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
240503 - 
240504 - Follow up ref SDS 49 4N5M, ref SDS 48 4N5M.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
240506 -  ..
240507 - Taxotere started.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
240509 -  ..
240510 - Toni said Millie is getting a full dose of Taxotere, even though her                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
240511 - blood counts are very low.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
240513 -  ..
240514 - Millie asked about her history of low blood counts the past few months                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
240515 - that caused deferred treatments? (see case study on 060810 1330.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
240516 - ref SDS 63 R33L).  She related earlier history with Taxotere when low                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
240517 - blood counts caused deferred treatments, and subsequent relapse of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
240518 - cancer possibly beginning on 021209...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
240520 -  ..
240521 - Millie asked if anything can be done to maintain a steady regimen of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
240522 - treatment that increases the chance of favorable response, based on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
240523 - experience showing that cancer returned when treatments were                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
240524 - interrupted, reported on 050318 1237. ref SDS 48 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
240526 -  ..
240527 - Toni said that the doctor has prescribed Neupogen to increase blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
240528 - counts for stronger immune system.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
240529 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240530 -            [...below Zan, Manager of Oncology Pharmacy, recommends                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
240531 -            patients keep a diary to assist medical team, ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
240532 -            XT5F, Zan refused to provide Neupogen, ref SDS 0 KW5N;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
240533 -            plans to track Millie's patient history of low blood counts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
240534 -            getting capecitabine to determine Millie's requirements for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
240535 -            Neupogen. ref SDS 0 XT61                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
240537 -             ..
240538 -            [...below Millie cite's Toni's report that the doctor has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
240539 -            already prescribed Neupogen; she asks Zan to investigate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
240540 -            avoiding interruption of cancer treatment caused by patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
240541 -            history of low blood counts, as shown in Millie's diary.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
240542 -            ref SDS 0 KX49                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
240544 -             ..
240545 -            [...below Zan investigated and learned that Millie already                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
240546 -            has history of low blood counts, so Neupogen prescribed to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
240547 -            maintain continuity of cancer treatments essential for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
240548 -            survival, ref SDS 0 649X; commended Millie's proactive                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
240549 -            communication with Pharmacy Department through doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
240550 -            patient partnership reported in Millie's diary. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
240551 -            XU8O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240552 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240553 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240554 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240555 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
240556 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Taxotere Full Dose Even though Blood Counts Below Targets                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
250401 -  ..
250402 - Taxotere Test Patients Resistance to Side Effects                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
250403 - 
250404 - Toni wants Millie to evaluate during 1st 15 minutes...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
250405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
250406 -          Low back pain                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
250407 -          Hot flashes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
250408 -          Shortness of breath                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
250410 -  ..
250411 - This is a new procedure that was not used when Millie was treated with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
250412 - Taxotere beginning on 020610. ref SDS 4 MR5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
250413 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
250414 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
250415 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
250416 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
250418 -  ..
2505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2506 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2507 - 1456                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
2508 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
250801 - Millie passed test without complaining of side effects.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
250802 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
250803 - Toni started Millie on standard of treatment rate for Taxotere.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
250804 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
250806 -  ..
2509 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2510 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2511 - 1501                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
2512 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
251201 - Toni advised that Nadine will take over nursing for the rest of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
251202 - Millie's treatment today.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
251203 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
251204 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
251205 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
251206 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
251207 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2513 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Side Effects Instructions Chemotherapy with Taxotere and Xeloda Meet                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2603 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2604 - 1516                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
260501 -  ..
260502 - Xeloda 2 Pills Twice Each Day                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
260503 - Pharmacist Gives Instructions for Xeloda                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
260504 - Side Effects Presented on Chemotherapy with Taxotere and Xeloda                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
260505 - 
260506 - Follow up ref SDS 51 FP57.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
260507 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260508 - Zan, the pharmacist visited Millie during treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
260510 -  ..
260511 - Zan asked if this is Millie's first time taking Xeloda (Capatibine),                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
260512 - and Mil advised she has not previously received this treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260514 -  ..
260515 - Zan confirmed written instructions for treatment with Xeloda...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260516 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260517 -        1.  2 pills twice a day after breakfast and after dinner.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
260518 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260519 -            Pills are taken after meals to reduce nausea.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
260520 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260521 -        2.  Drink a full glass of water with taking the 2 pills.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260523 -  ..
260524 - Sores in mouth, diarea, and worst case may be cracking of skin and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
260525 - peeling with coloration change to redeness in extremeties, i.e., feet                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
260526 - and hands, cited by the doctor on 050329. ref SDS 51 FP57  Skin will                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
260527 - become sensitive to sun, so avoid prolonged exposure.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
260529 -  ..
260530 - Zan submitted documentation titled...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
260532 -         ..
260533 -        Xeloda (capeditabine) Instruction Sheet                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260534 -        
260535 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260536 - ...which says in part...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
260537 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260538 -        It is very important that you tell your doctor if you are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
260539 -        taking warfarin, also known as Coumadin, which is a blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
260540 -        thinner that alters the blood's ability to clot.  Because                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
260541 -        Xeloda can increase the effects of warfarin, your doctor will                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
260542 -        need to check how fast yor blood clots on a more frequent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
260543 -        basis, so that your warfarin dosage can be adjusted as needed.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
260545 -  ..
260546 - During the meeting today, Zan said that he is aware Millie is taking                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
260547 - Coumadin from checking Millie's medical records, and from discussions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
260548 - with the doctor.  Zan advised that Kaiser will adjust the dosage of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
260549 - Coumadin to fit the treatment with Xeloda, as set out in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
260550 - documentation. ref SDS 0 BU67                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
260552 -  ..
260553 - Xeloda documentation continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
260554 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260555 -        Important:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
260557 -         ..
260558 -        Xeloda (capecitabine) like all chemotherapy treatments, has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
260559 -        certain side effects.  For some persons, milder side effects                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
260560 -        may suddenly become severe.  These side effects are manageable                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
260561 -        and can be reversed wen acted upon quickly.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
260563 -         ..
260564 -        It is important that you stop your Xeloda and call your doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
260565 -        or nurse to report....                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
260566 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260567 -        a.  If you have pain, redness, swelling or sores in your                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260568 -            mouth.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
260570 -             ..
260571 -        b.  If you have pain and swelling or redness of your hands or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
260572 -            feet that prevents normal activity.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
260574 -             ..
260575 -            This was previously discussed with the doctor during a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
260576 -            meeting on 050329. ref SDS 51 NT3I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
260578 -                 ..
260579 -                [On 050510 Millie experienced pain hands and feet.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
260580 -                ref SDS 55 DX54                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
260582 -                 ..
260583 -                [On 050513 side effects feet blistering cause pausing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
260584 -                treatment. ref SDS 57 AQ6G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260586 -                 ..
260587 -                [On 050516 Xeloda has severe side effects apart from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
260588 -                published guidance. ref SDS 58 BD5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
260590 -             ..
260591 -        c.  If you have more than 4 bowel movements each day or any                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
260592 -            diarrhea at night.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
260594 -             ..
260595 -        d.  If you vomit more than once in a 24-hour period or if you                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
260596 -            lose your appetite, and the amount of food you eat each day                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
260597 -            is much less than normal.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
260599 -             ..
260600 -        e.  If you have a temperature of 100.5 F or greater or other                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
260601 -            signs of infection.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
260602 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260604 -         ..
260605 -        Managing Side Effects...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260606 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260607 -        a.  Mouth Sores                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
260608 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260609 -            Use Good dental hygiene.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
260610 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260611 -            Swish and s;it with salt water and soda mouthwash 4 times                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
260612 -            a day (1 tsp salt, 1 tsp baking soda dissolved in 1 quart                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
260613 -            of water).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
260615 -             ..
260616 -        b.  Hand-Foot Syndrome                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
260617 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260618 -            1.  Avoid injury to feed and hands.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
260619 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260620 -                Avoid tight-fitting shoes and repetitive rubbing,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
260621 -                pressure or prolonged heat to hands and feet.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
260623 -                 ..
260624 -            2.  Vitamin B6 (pyridoxine)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
260626 -                 ..
260627 -            3.  Balm                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
260628 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260629 -                    [On 050729 Vivian, the pharmacist, suggested using                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
260630 -                    generous amounts of balm and wearing socks                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
260631 -                    overnight while sleeping to maximize treatment of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
260632 -                    blisters on the feet. ref SDS 61 S23H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
260633 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260634 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260635 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
260636 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2607 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Diary Journal Accurate Patient History Side Effects Taxotere Xeloda                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2703 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
270401 -  ..
270402 - Dose Chemotherapy Treatment Based on Side Effects Keep Diary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
270403 - Side Effects Diary Assists Doctor Pharmacist Set Treatment Dosage                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
270404 - Treatment Dosage Diary of Side Effects Assists Doctor Pharmacist Set                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
270405 - Diary of Side Effects Assists Doctor Pharmacist Set Treatment Dosage                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
270406 - 
270407 - Dosage can be adjusted to moderate side effects.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
270409 -  ..
270410 - Zan recommended keeping a diary to accurately track side effects for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270411 - evaluating adjustments to treatment protocol.  Previously, accuracy in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
270412 - medical treatment was illustrated at Stanford Cancer Center on 041019.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
270413 - ref SDS 39 BV92                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
270414 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270415 -     [On 050422 the doctor asked Millie about the diary on side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
270416 -     effects; summary of diary reports reviewed with doctor.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
270417 -     ref SDS 52 VE68                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
270419 -      ..
270420 -     [On 060724 diary side effects for 2nd phase taking Taxotere                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
270421 -     and capecitabine (Xeloda). ref SDS 62 QX8K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270422 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270423 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270424 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270425 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270426 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2705 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Prescription Xeloda Capecitabine 2 500 MG Pills Twice a Day                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2803 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
280401 -  ..
280402 - Prescription Xeloda Capecitabine 2 500 MG Pills Twice a Day                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
280403 - Capecitabine (Xeloda) Prescription 2 500 MG Pills Twice a Day                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
280404 - 
280405 - The prescription for capecitabine (Xeloda) is to take 2 - 500 mg pills                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
280406 - twice a day (every 12 hours); Zan said the prescription will be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
280407 - available for pickup after treatment today at the 2nd floor pharmacy.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
280409 -      ..
280410 -     [On 050520 dramatic improvement after 2 cycles of treatment with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
280411 -     Taxotere and capecitabine (Xeloda), ref SDS 59 025H, despite                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
280412 -     temporarily stopping treatments beginning on 050514 due to severe                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
280413 -     side effects, ref SDS 57 RU9M; on 050520 treatment dose for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
280414 -     capecitabine (Xeloda) reduced to reduce side effects. ref SDS 59                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
280415 -     NT3I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
280417 -      ..
280418 -     [On 050610 recovery from IBC continues after 3 cycles of treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
280419 -     and with reduced dose of capecitabine (Xeloda). ref SDS 60 025H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
280421 -  ..
280422 - Millie asked if she can pickup Neupogen at the same time, per                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
280423 - discussion above? ref SDS 0 SQ4H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
280425 -  ..
280426 - Zan said that Neupogen is not prescribed.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
280427 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
280428 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
280429 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2805 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Blood Counts Dose Xeloda Capecitabine Zan Pharmacist Draws Diagram S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2903 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
290401 -  ..
290402 - Blood Counts Monitor Set Chemotherapy Treatment Dosage                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
290403 - 
290404 - Zan drew a diagram on the back of a scrap of paper he had with him.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
290405 - He marked a time line for the 21 days between each cycle of Taxotere                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
290406 - treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
290407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
290408 -                                         ------  Normal Range                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
290409 -                                --------/                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
290410 -                               /                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
290411 -      1            7          /   14          21                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
290412 -      |------------\---------------\-----------|                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
290413 -       \                    /                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
290414 -        c.                 /                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
290415 -         \----------------/                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
290416 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
290418 -  ..
290419 - Zan plotted a curve on the diagram showing blood counts fall during                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
290420 - the first 7 days after chemotherapy treatment, and then begin to rise                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
290421 - toward normal.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
290423 -  ..
290424 - Zan plans to monitor Millie's blood condition using the weekly blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
290425 - tests Millie gets for Coumadin.  Zan advised that he may prescribe                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
290426 - Neupogen if blood counts are still too low after 14 days.  He also                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
290427 - posed prospect of extending the treatment, giving Millie 2 weeks off                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
290428 - after the end of 2 weeks for Xeloda treatmet, rather than just 1 week                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
290429 - that is currently prescribed.  Zan advised that he may reduce the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
290430 - dosage of Taxotere as another way to maintain Millie's blood counts,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
290431 - rather than use Neupogen.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
290432 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
290433 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
290434 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
2905 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Medication Prescription Mistake Avoided Doctor Patient Partnership C                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
08 02 04 02 AGMDN 050415cc 050415cc          **Not Found**                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
4504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
450501 -  ..
450502 - Neupogen Prescribed by Doctor to Maintain Blood Counts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
450503 - Medical Mistake Prescription Neupogen Corrected by Pharmacist                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
450504 - Mistakes Medical Prescription Neupogen Fixed Doctor Patient Partnerhip                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
450505 - Doctor Patient Partnerhip Avoids Medical Mistakes Prescribe Neupogen                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450506 - 
450507 - Millie asked Zan to further consider the Neupogen prescription issue                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450508 - just discussed. ref SDS 0 KW5N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
450510 -  ..
450511 - Millie cited Toni's comment earlier today that the doctor has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
450512 - prescribed Neupogen beginning with this first cycle to maintain blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450513 - counts in the range that strengthens the immune system, per above.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450514 - ref SDS 0 4N5M  Millie cited patient history of consistant low blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450515 - counts that have previously delayed treatments, and asked if this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
450516 - prior history could explain Toni's earlier comment that the doctor has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450517 - prescribed Neupogen in order to avoid prior problems?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450519 -  ..
450520 - Zan said that Toni made a mistake because he plans to begin tracking                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450521 - blood counts and will devise a plan for Neupogen, if needed.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
450523 -  ..
450524 - Millie explained keeping a diary of patient history the past 4 years,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450525 - as Zan recommends today, per above. ref SDS 0 2W6I  This record seems                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450526 - to support Toni's understanding today that the doctor has already                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
450527 - prescribed Neupogen.  She asked Zan to check with the doctor, since                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450528 - this is a life or death issue.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
450530 -  ..
450531 - Zan advised that he is manager of the Oncology Pharmacy Department,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450532 - and that the Pharmacy is tasked to assess requirements for Neupogen.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450533 - He feels certain the doctor expects the pharmacy to track Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450534 - patient history for determining Millie's requirements for Neupogen, as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450535 - the Oncology Pharmacy does with other patients.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450537 -  ..
450538 - Mil thanked Zan for taking time to discuss patient concerns.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
450539 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450540 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450542 -  ..
4506 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
4507 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
4508 - 1534                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
4509 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
450901 - An hour later, Zan returned and said he just talked to the doctor,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450902 - based on Millie's report on patient history showing persistant low                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450903 - blood counts, per above. ref SDS 0 KX49                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
450905 -  ..
450906 - Zan advised that the doctor prescribed three (3) days on Neupogen                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
450907 - after Millie completes two (2) weeks of capecitabine (Xeloda)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
450908 - treatments, beginning in this 1st cycle.  Zan apologized for not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
450909 - having checked the record showing the history of low blood counts has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450910 - already been established in this case.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450911 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450912 -     [On 050502 Millie experienced pain in her spine; took Vicadin and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
450913 -     this seemed to help. ref SDS 53 AQ6G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
450915 -  ..
450916 - Zan thanked Millie for proactive communication explaining patient's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450917 - diary that aligns with the medical chart showing low blood counts, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450918 - for mentioning Toni's understanding that Neupogen has already been                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450919 - prescribed by the doctor.  Zan said that the patient's notice today,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450920 - per above, ref SDS 0 KX49, prompted follow up inquiry with the doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450921 - that avoided a major mistake in treatment protocol, which aligns with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450922 - risks in medical practice and health care, reported in a study on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
450923 - 990912. ref SDS 2 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
450925 -  ..
450926 - This scenario aligns with Kaiser's Healthwise Handbook calling for an                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450927 - effective doctor-patient partnership through communication and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
450928 - feedback that avoids mistakes, reviewed on 990625. ref SDS 1 4185                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
450929 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450930 -     [On 061020 Zan's colleague, Ross, in the Kaiser Pharmacy similar                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
450931 -     experience avoiding error prescribing treatment through                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
450932 -     collaboration team care, doctor patient partnership. ref SDS 64                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
450933 -     UR6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
450935 -  ..
450936 - It is not clear what would have occurred, if the doctor was not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450937 - available at the time Zan made inquiry.  In that case, a significant                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450938 - weight of social pressure and cognitive overhead typically resist                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
450939 - accurate communication, as set out in NWO. ref OF 13 OE5H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450941 -  ..
450942 - For example, if, when Zan stopped by to visit the doctor on this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
450943 - matter, the doctor was seeing a patient, attending a Tumor Board                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
450944 - hearing, making a presentation at a seminar on medical management, or,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450945 - if the doctor was on vacation, would clarification needed for an                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
450946 - accurate prescription today have taken place?  If the doctor was not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450947 - available, do Kaiser's records enable Zan to review blood count                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450948 - history in the time Zan can devote to making an assessment for one                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450949 - patient, which he believed the doctor had already made?  Would Zan                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450950 - have asked another doctor to step in and assume responsibility for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450951 - reviewing the record and making a separate judgement?  Would pressures                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450952 - of social protocol in bureaucracy have prevented asking another doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450953 - to assume responsibility, reported on 040203? ref SDS 5 E44K  Was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
450954 - another doctor available, and if so, would that doctor be willing to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450955 - take responsibility, and, if so, would the doctor have taken time to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450956 - review the record and discover the history of persistant low blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450957 - counts?  Or, would the doctor have told Zan to wait until the primary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450958 - care physician is avilable, either after seeing a patient, after a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450959 - Tumor Board Hearing, after attending a seminar, or after returning                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450960 - from vacation, as occurred previously on 041104. ref SDS 41 Q54O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450962 -  ..
450963 - If Zan had to wait to consult with the doctor for any number of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450964 - reasons that frustrate taking immediate action, as noted in NWO                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450965 - explaining the burden of cognitive overhead, ref OF 13 LH6K, would                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
450966 - there have been a controllable action item created to remind all                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
450967 - parties to investigate blood count history and make a determination in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450968 - time for effective action, once the current activity is replaced in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450969 - span of attention by other equally important matters for other                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
450970 - patients.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
450971 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450972 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450973 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450974 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450975 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450976 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
4510 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
1st Treatment 1st Cycle Taxotere Xeloda Capacitibine Chemotherapy Tr                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
4603 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
4604 - 1556                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
460501 -  ..
460502 - Taxotere Chemotherapy Treatment Completed Today                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
460503 - 
460504 - Taxotere completed.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
460506 -  ..
460507 - Saline flush was run for a few minutes.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
460509 -  ..
460510 - Nadine removed the drip treatment tube from the port, and applied                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
460511 - Hepren to reduce clotting, and avoid infection.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
460512 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
460514 -  ..
4606 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
4607 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
4608 - 1604                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
4609 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
460901 - Vitals taken by Nadine.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
460902 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
460903 -   Temperature......... 97.6                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
460904 -   Pulse............... 145 77                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
460905 -   Blood Pressure...... 57                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
460906 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
460907 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
460909 -  ..
4610 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
4611 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
4612 - 1612                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
4613 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
461301 - We went to the Pharmacy and picked up the prescriptions for...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
461302 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
461303 -            Xeloda                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
461304 -            Neupogen                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
461306 -  ..
461307 - The co-payment on these drugs was approximatley $60.  The full price                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
461308 - was about $1,300, saving $1,240.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
461309 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
461310 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
461311 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
461312 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
461313 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
461314 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
461315 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
461316 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
4614 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Tired Wobbly on Feet after Treatment In Asleep by 1900                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
Tired Wobbly on Feet after Treatment Asleep by 1900 Not Today After                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
4804 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
4805 - 1537                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
480601 -  ..
480602 - Alert Energetic After Treatment Marked Change from Prior Treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
480603 - 
480604 - Follow up ref SDS 49 F54N, ref SDS 48 F54N.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
480605 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480606 - Millie seemed okay after treatment today.  No immediate wobbliness.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
480607 - She was okay to drive, and seemed alert the rest of the day.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
480609 -  ..
480610 - This seems unusual because Benedryal is part of the protocol for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
480611 - Taxotere, per above. ref SDS 0 064F  Previously, when treated with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
480612 - Bendryl and Taxotere, Millie has been noticably wobbly and unsteady                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
480613 - on her feet, and retired early to bed, reported on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
480614 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480615 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480616 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480617 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480618 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480619 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480620 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480621 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480622 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
4807 -