CONTACTS 

SUBJECTS
1st Treatment 1st Cycle Taxotere Xeloda Capacitibine Chemotherapy Tr

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 61 0000. ref SDS 58 0000.
040502 -
040503 - This is the final and 7th treatment with Taxotere and capecitabine
040504 - (Xeloda) scheduled by the primary care physician on 050729.
040505 - ref SDS 60 VP4N   The nurse brought Millie a teddy bear as a gift from
040506 - the Clinic staff to signify "graduation" from current treatment
040507 - regimine.  Good news CA 15-3 test last week on 050812 dropped back to
040508 - 39. ref SDS 0 3K6L
040509 -
040510 -
040511 -
040512 -
040514 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Barbara Smith is the nurse today.
040903 -  ..
040904 - Zan from the pharmacy visited Millie in the Chemotherapy Clinic.
040906 -  ..
040907 - Zan asked about side effects and whether the dose should be adjusted
040908 - again.
040910 -  ..
040911 - Millie related patient history in the diary on 050809, ref SDS 62
040912 - 0001, following guidance from Zan on 050415 to keep a diary.
040913 - ref SDS 49 2W6I
040914 -
040915 -       After meeting with Zan, Millie indicated she forgot to mention
040916 -       all of the side effects; this can be corrected by submitting the
040917 -       record.
040919 -  ..
040920 - Zan seemed to indicate that while Millie is experiencing some physical
040921 - and emotional trauma tolerating side effects of Taxotere and
040922 - capecitabine (Xeloda), her experience is at the low end of the scale
040923 - for suffering that most patients experience with these drugs.  Zan did
040924 - not present information on the number of patients Kaiser has treated
040925 - with Taxotere and capecitiabine.  This was prescribed in Millie's case
040926 - on 050329, ref SDS 47 FP57, after notice from UCSF received on 041117,
040927 - ref SDS 38 OU6S; capecitabine is not on the list of drugs Kaiser
040928 - prescribes, reported on 041130. ref SDS 39 FY5F
040930 -  ..
040931 - Zan said that Millie is fortunate that peeling and blisters on hands
040932 - and feet have been very moderate in her case after six (6) cycles of
040933 - treatment.  Zan feels the dose for the current treatment can therefore
040934 - remain the same.  This aligns with planning by the primary care
040935 - physician on 050729 to maintain the dose in order to avoid progress of
040936 - disease in the run up to a decision on surgery.  CA 15-3 falling back
040937 - to 39, as reported today, ref SDS 0 3K6L, may support the decision to
040938 - maintain drug strength for this current treatment.
040940 -  ..
040941 - Zan showed a pink or salmon colored hospital form, where he had jotted
040942 - some comments from the discussion just now, and indicated this will be
040943 - the report filed in the medical chart for the doctor to understand the
040944 - scope of patient side effects.  On 041014 review found handwritting in
040945 - the medical chart is illegible and difficult to interpret, because
040946 - context from situational awareness during verbal communication is not
040947 - entered in the medical chart due to limited time, and the perception
040948 - that accuracy and context are unnecessary overkill. ref SDS 35 W78K
040950 -  ..
040951 - As a result, Zan prepared a subscription for capecitabine (Xeloda)
040952 - that is the same dose as the prior treatments, since reducing the
040953 - dose by 25% on 050520.
040954 -
040955 -
040957 -  ..
040958 - Port Catheter Flush Scheduled When Patient Off Treatments
040959 -
040960 - Millie asked Barbara to schedule a meeting to flush the port catheter,
040961 - since today is her last chemo treatment, and Kaiser's guidance says
040962 - that a port needs to be flushed every 4 - 6 weeks when not getting
040963 - regular chemo treatments.
040965 -  ..
040966 - Barbara scheduled a meeting here at the Kaiser Walnut Creek
040967 - Chemotherapy Clinic for 050923 1000.
040968 -
040969 -
040970 -
040971 -
040972 -
040973 -
040974 -
040975 -
040976 -
040977 -
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 61 Q659, ref SDS 58 Q659.
080605 -
080606 - Millie had blood drawn this morning at 0600 by Kaiser in Martinez.
080608 -  ..
080609 - Barbara submitted the report showing...
080610 -
080611 -    Patient   Provider  Category   View      FR Date   To Date
080617 -     ..
080618 -    Procedure              Results             Reference Range
080620 -     ..
080622 -
080623 -                  ** Martinez Medical Offices **
080625 -     ..
080626 -    @CBC
080627 -    WBC x 10-3               7.8 K/uL           3.5   -     12.5
080628 -    RBC x 10-6    L         3.32 M/uL           3.60  -      5.10
080629 -    Hemoglobin    L         11.2 g/dL          11.5   -     15.0
080630 -    Hematocrit    L         32.8 %             34.0   -     46.0
080631 -    MCV                       99 fL            80.0   -    100.0
080632 -    RDW            H        18.7 %             11.9   -     14.3
080633 -    Plt x10-3              272   K/uL         140     -    400
080634 -     ..
080635 -    Neutrophils    H          83 %             50     -     70
080636 -    Lymphocytes               14 %             20     -     50
080637 -    Monocyte                   3 %              0     -     11
080638 -    Eosinophils                0 %              1     -      5
080639 -    Basophil                   0%               0     -      2
080640 -    Bands              No Report %              0     -      5
080641 -    Manual Diff?           Chemo
080643 -     ..
080644 -    CA 15-3        Test Remote Collect         -<     -     39
080646 -     ..
080647 -    Seg Neutrophils    No Report %             50     -     70
080649 -     ..
080650 -    DIFF Method         Auto Dif
080651 -    Anisocytosis       No Report+
080652 -    Macrocytes         No Report+
080653 -    Plt estimate         Adequate
080655 -     ..
080656 -    Alkaline Phos             45 U/L           38     -    126
080657 -    Bili, Tot Adult         <0.3 mg/dL        0.2     -    1.3
080658 -    Creatinine               0.7 mg/dL        0.6     -    1.2
080659 -    Phosphorus     Test Remote Collect
080660 -    Alt (SGPT)                29 U/L           11     -     66
080661 -    AST (SGOT)         No report U/L           11     -     66
080662 -    Glucose Random            93 mg/dL         60     -    159
080663 -
080665 -     ..
080666 -    Cuomdin (Anticoag Ther WARFARIN
080667 -    PT, Patient             22.3 Sec         9.2           11.6
080668 -    PT, INR                  2.1 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 39 Drops from 46 to Normal Again After 6th Treatment Cycle
090403 -
090404 - Follow up ref SDS 61 2N5J, ref SDS 58 2N5J.
090405 -
090406 - Results not available for CA 15-3 on the blood test today, per above.
090407 - ref SDS 0 5K6K
090409 -  ..
090410 - Barbara submitted results on the blood test for 050729...
090411 -
090414 -  ..
090415 - CA 15-3 dropped to 45, only one below 46 on the prior test, reported
090416 - during the meeting with the surgeon on 050727. ref SDS 59 YK6K  This
090417 - test was performed on blood drawn the morning before starting the 6th
090418 - cycle of treatment, and so does not reflect the 6th cycle.
090420 -  ..
090421 - A subsequent and most recent test on 050812 shows...
090422 -
090425 -  ..
090426 - Great news CA 15-3 dropped to 39 from 45; moving back from the bounce
090427 - reported on 050727, ref SDS 59 YK6K, and reflecting the 6th cycle of
090428 - treatment given on 050729.  The drop in CA 15-3 fits analysis on
090429 - 050729 that maintained dosage of treatment. ref SDS 60 GJ5M
090431 -  ..
090432 - Millie ordered another CA 15-3 test for the blood draw this morning,
090433 - and will get another next week before going on vacation.  Want to see
090434 - a pattern, per analysis by primary care physician on 040812.
090435 - ref SDS 27 CT9J
090436 -
090437 -
090438 -
090439 -
090440 -
090441 -
090442 -
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 - 1012
120701 -  ..
120702 - Preparation for Treatment Required One (1) Attempt to Connect Port
120703 -
120704 - Follow up ref SDS 61 EB7J, ref SDS 58 EB7J.
120705 -
120706 - Vitals taken by Tauna...
120707 -
120708 -    Blood preasure    128  75
120709 -    Pulse              70
120710 -    Temperature        97.6
120712 -  ..
120713 - Barbara took admin with Sheri to verify Millie's identification and
120714 - treatment protocol spec.
120716 -  ..
120717 - Millie explained having taken Decadron tablets according to the
120718 - prescription to take two tablets twice a day, per instructions on
120719 - 050415. ref SDS 49 8U4O
120721 -  ..
120722 - Barbara gave Millie a pill for Compazine 10 prior to treatment that
120723 - reduces nausea rather than as a drip treatment to avoid allergic
120724 - reaction.
120726 -  ..
120727 - Barbara made installation to the port....
120729 -       ..
120730 -      Interlink System Vented Paclitaxel set
120732 -  ..
120733 - Millie's blood counts are good, so there is no requirement to take
120734 - Nupigen again to strengthen the immune system.
120736 -  ..
120737 - Started saline flush.
120738 -
120739 -
120741 -  ..
1208 -
1209 -
1210 - 1008
1211 -
121101 - Benedryl started.
121102 -
121103 -
121105 -  ..
1212 -
1213 -
1214 - 1020
1215 -
121501 - Benedryl completed.
121502 -
121503 -
121504 -
121505 -
1216 -

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

1504 -
1505 - 1023
150601 -  ..
150602 - Taxotere Full Dose Even though Blood Counts Below Targets
150603 -
150604 - Follow up ref SDS 61 4N5M, ref SDS 58 4N5M.
150606 -  ..
150607 - Taxotere started.
150609 -  ..
150610 - Millie is getting a full dose of Taxotere because her blood counts are
150611 - very close to minimum. ref SDS 61 0N7Q
150612 -
150613 -
150614 -
150616 -  ..
1507 -
1508 - 1122
1509 -
150901 - Equipment beeped indicating treatment is over.
150902 -
150903 - Taxotere treatment completed.
150905 -  ..
150906 - Saline flush was run for a few minutes.
150908 -  ..
150909 - Babara removed the drip treatment tube from the port, and applied
150910 - Hepren to reduce clotting, and avoid infection.
150912 -  ..
150913 - Barbara did not get vitals at the end of treatment, as was done last
150914 - time.
150915 -
150916 -   Temperature.........
150917 -   Pulse...............
150918 -   Blood Pressure......
150919 -
150920 -
150921 -
150922 -
150924 -  ..
1510 -
1511 -
1512 - 1145
1513 -
151301 - We went to the Pharmacy and picked up the prescription for...
151302 -
151303 -            Xeloda
151304 -
151305 -
151306 -
151307 -
151308 -
151309 -
151310 -
151311 -
1514 -

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 - 1207
170601 -  ..
170602 - Alert Energetic After Treatment Marked Change from Prior Treatments
170603 -
170604 - Follow up ref SDS 61 F54N, ref SDS 58 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.
170609 -  ..
170610 - Millie drove us from Walnut Creek to the VA in Matinez, to pick up
170611 - some meds; we then drove to Clayton and split a hamburger for lunch.
170612 -
170614 -  ..
1707 -
1708 -
1709 - 1424
1710 -
171001 - Millie took a nap until about 1700.
171002 -
171004 -  ..
1711 -
1712 -
1713 - 1737
1714 -
171401 - Millie helped fix dinner; and after dinner she took her Xeloda pills.
171402 -
171403 -
171404 -
171405 -
171406 -
171407 -
171408 -
171409 -
171410 -
171411 -
1715 -