THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: July 8, 2005 01:30 PM Friday; Rod Welch

Millie Taxotere treatment begin 5th cycle with Xeloda at Kaiser.

1...Summary/Objective
2...Blood Counts Good Dose Chemotherapy Taxol Normal
3...CA 15-3 Drops to 37 Lowest Reading Ever
4...Preparation for Treatment Required One (1) Attempt to Connect Port
5...Taxotere Full Dose Even Blood Counts Within Targets
6...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 55 0000. ref SDS 53 0000.
040502 -
040503 - Millie received a fifth (5th) treatment of Taxotere today, and begins
040504 - the 5th cycle of treatment with capecitabine (Xeloda).
040505 -
040506 -
040507 -
040509 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Toni is the nurse.
040902 -
040903 - On 050329 Millie was scheduled to receive four (4) cycles of Taxotere
040904 - and Xeloda (capecitabine). ref SDS 47 FP57  The fourth cycle was
040905 - completed on 050617. ref SDS 55 407N  Millie met with the doctor on
040906 - 050610.  There was dramatic improvement recovering from IBC.  At that
040907 - time the doctor made plans for examination to perform surgery after
040908 - completing the 4th cycle of Taxoter and Xeloda. ref SDS 54 VF3M
040910 -  ..
040911 - Subsequently, on 050617 Millie was notifed that meeting with the
040912 - surgeon was delayed from the 1st week in July to the end of July.  She
040913 - notified the doctor in a letter using a Kaiser Oncology Department
040914 - form that this delay conflicts with planning by the doctor to exploit
040915 - a window of opportunity for advancing recovery planned on 050610.
040916 - ref SDS 54 6N5M  Millie later received a call from an assistant at the
040917 - Hospital who represented that the doctor was unable to reschedule the
040918 - meeting with the surgeon to the original time table planned on 050610
040919 - to the first week of July, and that the doctor further scheduled
040920 - Millie to receive additional treatments of Taxotere and Xeloda.  As a
040921 - result, Millie is getting a 5th cycle of chemotherapy treatment today.
040922 - There have been studies submitted showing effectiveness of treatment
040923 - relative to side effects reported in another record today. ref SDS 56
040924 - 0001
040926 -  ..
040927 - We visited with a woman from the pharmacy, Vivian.
040929 -  ..
040930 - Vivian reported that the doctor has ordered two (2) more treatments of
040931 - Taxotere and Xeloda.
040933 -  ..
040934 - Vivian asked about side effects and whether the dose should be
040935 - adjusted again, following the change to the treatment protocol that
040936 - reduced the dose of capecitabine (Xeloda) by 25%, reported on 050520?
040937 - ref SDS 52 VP3N
040939 -  ..
040940 - Millie reported that side effects of blistering and peeling feet have
040941 - lessened.  New side effects of tearing eyes and swelled feet have
040942 - appeared the past few days, in addition to low energy.
040944 -  ..
040945 - The pharmacist, and the nurse, Toni, both commented that tearing eyes,
040946 - and swelling in feet, ankles, and abdomen are common side effects of
040947 - Taxotere that causes the system to retain water, and this is generally
040948 - considered a mild side effect.
040950 -  ..
040951 - Millie said that today swelled feet, ankles, abdomen, and tearing eyes
040952 - have not occurred, possibly because she has been busy on her feet most
040953 - of the morning, before treatment.
040955 -  ..
040956 - Toni said that activity like occassional walking reduces water
040957 - retention side effects of Taxotere.  She also suggested using a foot
040958 - stool to elevate Millie's feet at her desk.  Taking an occassional
040959 - walk for a minute or two helps reduce this problem.
040960 -
040961 -     [On 050809 seems to be less problems from swelling, possibly
040962 -     following guidance today. ref SDS 58 T89H
040964 -  ..
040965 - Millie recalled that this swelling problem did not occur with Taxotere
040966 - treatments in 2002.  On 020603 the doctor changed the prescription
040967 - from AC to Taxotere. ref SDS 2 WO4O  After two treatments, she began
040968 - radiation treatment on 020708. ref SDS 3 TV4I
040970 -  ..
040971 - Toni commented that side effects tend to accumulate.  Back in 2002
040972 - Millie have still been pretty active, and so did not notice gradual
040973 - build up of side effects from Taxotere, especially given the break
040974 - from chemo for radiation.
040976 -  ..
040977 - Millie remembered that she was still going to exercise class 4 - 5
040978 - times a week and doing a lot of hiking at that time in 2002.
040980 -  ..
040981 - Vivian said that Millie now has a lot more Taxotere in her system from
040982 - the prior treatments, and now four more consecutive treatments with
040983 - two potent drugs, so this may account for noticing new side effects
040984 - that previously were not impacting her life.
040986 -  ..
040987 - Millie was expecting to get back to regular exercise after ending
040988 - treatents with Taxotere and capecitabine (Xeloda) with the 4th cycle,
040989 - and was surprised when Hazel submitted a schedule during the treatment
040990 - here in the clinic for the 4th cycle on 050617 that showed the doctor
040991 - had scheduled more treatments without notice to the patient.
040992 - ref SDS 55 407N
040994 -  ..
040995 - Millie needs a note from the doctor to establish entitlement for
040996 - extending her membership to a health clinic using prior payment for
040997 - six (6) months or so that could not be used because of medical
040998 - incapacitaties.  On 041130 she reported to the doctor difficulty
040999 - walking, especially getting up and down stairs. ref SDS 39 GN8K  On
041000 - 041210 an xray showed spurring in the knee joint that accounts for
041001 - difficult mobility.  This was subsequently treated successfully with
041002 - Glucosimine and Chondroitin.  Patient history on side effects from
041003 - cancer treatments that prevent normal activity are reported on 050422.
041004 - ref SDS 49 NT3I
041006 -         ..
041007 -        [On 050729 doctor supports patient planning to resume organized
041008 -        exercise. ref SDS 57 Y86K
041009 -
041010 -
041011 -
041012 -
041013 -
041014 -
0411 -

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 55 Q659, ref SDS 53 Q659.
080605 -
080606 - Millie had blood drawn this morning at 1100 by the Kaiser Chemotherapy
080607 - Clinic.  They left the connection to the port so that treatment this
080608 - afternoon is faster and easier.
080610 -  ..
080611 - Kathy submitted the report showing...
080612 -
080613 -    Patient   Provider  Category   View      FR Date   To Date
080619 -     ..
080620 -    Procedure              Results             Reference Range
080622 -     ..
080623 -    Log#: 510518901767      050708 11:15 Outpa WCR Req: RA Johnson, MD
080624 -
080625 -                  ** Martinez Medical Offices **
080627 -     ..
080628 -    @CBC
080629 -    WBC x 10-3               3.8 K/uL           3.5   -     12.5
080630 -    RBC x 10-6    L         3.46 M/uL           3.60  -      5.10
080631 -    Hemoglobin    L         11.0 g/dL          11.5   -     15.0
080632 -    Hematocrit    L         31.1 %             34.0   -     46.0
080633 -    MCV                       95 fL            80.0   -    100.0
080634 -    RDW            H        21.4 %             11.9   -     14.3
080635 -    Plt x10-3            No test K/uL         140     -    400
080636 -     ..
080637 -    Neutrophils    H          78 %             50     -     70
080638 -    Lymphocytes               20 %             20     -     50
080639 -    Monocyte                   1 %              0     -     11
080640 -    Eosinophils                0 %              1     -      5
080641 -    Basophil                   1%               0     -      2
080642 -    Bands              No Report %              0     -      5
080643 -    Manual Diff?           Chemo
080645 -     ..
080646 -    CA 15-3        Test Remote Collect         -<     -     39
080648 -     ..
080649 -    Seg Neutrophils    No Report %             50     -     70
080651 -     ..
080652 -    DIFF Method         Auto Dif
080653 -    Anisocytosis       No Report+
080654 -    Macrocytes         No Report+
080655 -    Plt estimate         Adequate
080657 -     ..
080658 -    Alkaline Phos             45 U/L           38     -    126
080659 -    Bili, Tot Adult         <0.7 mg/dL        0.2     -    1.3
080660 -    Creatinine               0.6 mg/dL        0.6     -    1.2
080661 -    Phosphorus     Test Remote Collect
080662 -    Alt (SGPT)                27 U/L           11     -     66
080663 -    AST (SGOT)           No test U/L           11     -     66
080665 -     ..
080666 -    Cuomdin (Anticoag Ther WARFARIN
080667 -    PT, Patient          No test Sec         9.2           11.6
080668 -    PT, INR              No test Ratio         2              3
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 to 37 Lowest Reading Ever
090403 -
090404 - Follow up ref SDS 55 2N5J, ref SDS 53 2N5J.
090405 -
090406 - Results are not available for CA 15-3 on the blood test today.
090407 - ref SDS 0 5K6K
090409 -  ..
090410 - Toni submitted results on the blood test for last week on 050701...
090411 -
090412 -    Log#: 540518200022      050701 06:43 Outpa WCR Req: RA Johnson, MD
090414 -  ..
090415 - Good news CA 15-3 has dropped to 37, two points below 39, and down
090416 - dramatically from 54 reported on 050611. ref SDS 54 554O  This is the
090417 - best reading Millie has ever had on this particular test in 4 years of
090418 - treatment.  She had a 39 on the test last year on 041007, ref SDS 36
090419 - 2N5J, but today is better.  This indicates significant change in
090420 - direction from the long climb that read 105 on 050329. ref SDS 47 PPRX
090421 -
090422 -      [On 050729 CA 15-3 46 significant rise again above normal.
090423 -      ref SDS 57 087J
090424 -
090425 -
090426 -
090427 -
090428 -
090429 -
0905 -

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

1205 -
1206 - 1349
120701 -  ..
120702 - Preparation for Treatment Required One (1) Attempt to Connect Port
120703 -
120704 - Follow up ref SDS 55 EB7J, ref SDS 53 EB7J.
120705 -
120706 - Vitals taken by Shannon...
120707 -
120708 -    Blood preasure    131  73
120709 -    Pulse              84
120710 -    Temperature        98.5
120712 -  ..
120713 - Another nurse took admin with Toni to verify Millie's identification
120714 - and treatment.
120716 -  ..
120717 - Millie explained having taken only 2 Decadron tablets yesterday in the
120718 - evening, and missed taking the 2 tablets in the morning, which
120719 - conflicts to take two tablets twice a day, per instructions on 050415.
120720 - ref SDS 48 8U4O
120722 -  ..
120723 - Toni gave Millie a pill for Compazine 10 prior to treatment that
120724 - reduces nausea rather than as a drip treatment to avoid allergic
120725 - reaction.
120726 -
120728 -  ..
1208 -
1209 -
1210 - 1355
1211 -
121101 - Toni was pleased that the port was previously connected, so she did
121102 - not make this installation, per above. ref SDS 0 Q659
121104 -       ..
121105 -      Interlink System Vented Paclitaxel set
121107 -  ..
121108 - Millie's blood counts are good, so there is no requirement to take
121109 - Nupigen again to strengthen the immune system.
121110 -
121111 -
121113 -  ..
1212 -
1213 -
1214 - 1351
1215 -
121501 - Benedryl started.
121502 -
121503 -
121505 -  ..
1216 -
1217 -
1218 - 1402
1219 -
121901 - Benedryl completed.
121902 -
121903 -
121904 -
121905 -
121906 -
121907 -
121908 -
121909 -
1220 -

SUBJECTS
Taxol Treatment Delayed 30 Minutes Because Lab Has Not Prepared Trea
AC Adriamycin Cytoxin Treatment Begun Today on New Regimine Replacin

1504 -
1505 - 1402
150601 -  ..
150602 - Taxotere Full Dose Even Blood Counts Within Targets
150603 -
150604 - Follow up ref SDS 55 4N5M, ref SDS 53 4N5M.
150606 -  ..
150607 - Taxotere started.
150608 -
150609 -
150610 -
150611 -
150612 -
150614 -  ..
1507 -
1508 - 1502
1509 -
150901 - Equipment beeped indicating treatment is over.  Nurse checked and
150902 - noticed there is a bit more to drip, so she started the drip again.
150903 -
150905 -  ..
1510 -
1511 -
1512 - 1505
1513 -
151301 - Taxotere treatment completed.
151302 -
151303 - Saline flush was run for a few minutes.
151305 -  ..
151306 - Toni did not remove the drip treatment tube from the port, and
151307 - apply Hepren to reduce clotting, and avoid infection, because this
151308 - was done earlier today when Millie got blood drawn in the lab.
151310 -  ..
151311 - Toni did not vitals at the end of treatment, as was done last time.
151312 -
151313 -   Temperature......... 97.6
151314 -   Pulse............... 145 77
151315 -   Blood Pressure...... 57
151316 -
151317 -
151318 -
151319 -
151321 -  ..
1514 -
1515 -
1516 - 1542
1517 -
151701 - We went to the Pharmacy and picked up the prescriptions for...
151702 -
151703 -            Xeloda
151705 -  ..
151706 - The co-payment on these drugs was approximatley $60.  The full price
151707 - was about $1,300, saving $1,240.
151708 -
151709 -
151710 -
151711 -
151712 -
151713 -
151714 -
151715 -
1518 -

SUBJECTS
Tired Wobbly on Feet after Treatment In Asleep by 1900
Tired Wobbly on Feet after Treatment Asleep by 1900 Not Today After

1704 -
1705 - 1537
170601 -  ..
170602 - Alert Energetic After Treatment Marked Change from Prior Treatments
170603 -
170604 - Follow up ref SDS 55 F54N, ref SDS 53 F54N.
170605 -
170606 - Millie seemed okay after treatment today.  No immediate wobbliness.
170607 - She was okay to drive, and seemed alert the rest of the day.
170608 -
170609 -
170610 -
170611 -
170612 -
170613 -
1707 -




































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