CONTACTS 

SUBJECTS
10th Cycle Treatment Taxotere Xeloda Capacitibine Chemotherapy Treat

0503 -
0503 -    ..
0504 - Summary/Objective
0505 -
050501 - Follow up ref SDS 84 0000, ref SDS 79 0000.
050502 -
050503 - Millie's blood count was well above criteria for treatment.
050504 - ref SDS 0 P560  For some reason Kaiser did not perform CA 15-3 needed
050505 - to assess changing treatment protocol based on trend analysis.  Diana
050506 - ordered the test, which can be performed sometime this week.
050507 - ref SDS 0 2N5J
050508 -
050509 -    [On 060817 CA 15-3 73 dramatic improvement, reversing 6 month rise
050510 -    of cancer marker, now falling back below critical 80 level,
050511 -    ref SDS 85 TS5O; supports observation impression on 060808 that IBC
050512 -    red rash subsiding and breaking up, ref SDS 83 VO6G, further
050513 -    reported on 060817, ref SDS 85 NU6L, evidence patient experiencing
050514 -    delayed response to treatment under scenario #1, developed on
050515 -    060808. ref SDS 83 J16O
050516 -
050517 -
050518 -
050520 -  ..
0506 -
0507 -
0508 - Progress
0509 -
050901 - When Millie registered at the counter today for treatment in the
050902 - Oncology Department, the attendant handed her an envelope with the
050903 - packet of documents that Arlette printed from Kaiser's records.  This
050904 - follows up planning on 060810, when Arlette offered to prepare
050905 - documents for 2nd opinion review. ref SDS 84 U76O
050906 -
050907 -     [On 060819 organize Kaiser's documents to facilitate 2nd opinion
050908 -     review by UCSF. ref SDS 86 LK4M
050910 -      ..
050911 -     [On 061011 commend Kaiser and Arlette for extra work providing a
050912 -     packet of documents to facilitate 2nd opinion review by UCSF,
050913 -     reducing the cost by 30%, which saved the customer $200.
050914 -     ref SDS 87 QY4I
050916 -  ..
050917 - Received treatment to begin 10th cycle overall of chemotherapy with
050918 - Taxotere and Xeloda, and 2nd cycle of treatment for 3rd relapse of
050919 - IBC, planned by the primary care physician on 060711. ref SDS 78 PF3O
050920 - Scheduling and treatment were reviewed by the backup doctor on 060808
050921 - due to rising IBC symptoms after 1st cycle, and decision was made to
050922 - continue treatment plan with Taxotere and Xeloda. ref SDS 83 N96O  The
050923 - 1st cycle (9th overall) was performed on regular schedule at Kaiser on
050924 - 060721. ref SDS 79 407N  Work today was deferred from the regular
050925 - schedule for the 2nd cycle to treat relapse due to low blood counts on
050926 - 060810. ref SDS 84 5K4F
050928 -  ..
050929 - Diana said the blood counts are good today.  This was confirmed by the
050930 - report showing counts are well above requirements for treatment.
050931 - ref SDS 0 P560
050933 -  ..
050934 - Millie had a blood draw on Sunday, 060813, per planning on 060810.
050935 - ref SDS 84 CN7I
050936 -
050939 -
050940 -
050941 -
050942 -
050943 -
0510 -

SUBJECTS
Schedule Treatment Regular 3-week Cycle on Monday 060904 Labor Day E

0803 -
080401 -  ..
080402 - Schedule Next Treatment Change to Mondays Side Effects Experiment
080403 -
080404 - Follow up ref SDS 79 QK6L.
080405 -
080406 - The original plan was for treatments on Friday, to fit Millie's
080407 - schedule of having Friday and Monday off-work, which gives time to
080408 - recover from ill feelings caused by Taxotere, reported on 060721,
080409 - ref SDS 79 QK6L, and citing case study on side effects reported on
080410 - 050422. ref SDS 52 JY3N
080411 -
080412 -     [On 060817 followed up. ref SDS 85 7Q8H
080414 -  ..
080415 - Diana said that she cannot change the schedule back to Friday, because
080416 - that day is already booked.  Extra effort would be needed to support
080417 - patient requirements.  The nurse was also concerned that advancing
080418 - treatment 3 days from Monday to Friday would not be enough time for
080419 - blood counts to recover, as occurred on 060810, ref SDS 84 5K4F, and
080420 - this would require getting approval of the doctor or cause another
080421 - delay.  She said that delaying the next treatment to the following
080422 - Friday would, also, require the nursing staff to get approval of the
080423 - doctor for allowing chemotherapy to be diluted across a greater time
080424 - span which reduces theraputic benefits to the patient.  These choices
080425 - to support the patient are stressful for the nursing staff, as
080426 - explained on 060810, ref SDS 84 NW9K
080428 -  ..
080429 - Diana proposed that Millie experiment and try treatments on Monday,
080430 - and indicted that if this turns out to be inconvenient, then another
080431 - nurse can consider making the effort to adjust the schedule to fit the
080432 - patient's requirements by switching back to Friday.
080434 -  ..
080435 - Millie agreed.
080437 -  ..
080438 - As a result, Diana submitted the following schedule...
080439 -
080440 -       060903 1330.... Blood Draw
080441 -       060904 1330.... Chemotherapy Taxotere 11th Cycle
080443 -  ..
080444 - Actually, this is Labor Day, a holiday.  Sounded like Diana went
080445 - ahead and scheduled the work on this day to align with treatment on
080446 - Mondays, and further scheduled Millie to get a blood draw the day
080447 - before on 060903 to evaluate ready for treatment.
080448 -
080449 -
080450 -
080451 -
080452 -
080453 -
080454 -
0805 -

SUBJECTS
Blood Tests Chemotherapy White Cell Count Good 10th Cycle Taxotere C

1203 -
120401 -  ..
120402 - Blood Counts Good Dose Chemotherapy Taxol Normal
120403 -
120404 - Follow up ref SDS 84 Q659, ref SDS 79 Q659.
120406 -  ..
120407 - Diana submitted the report showing...
120408 -
120409 -    Patient   Provider  Category   View      FR Date   To Date
120415 -     ..
120416 -    Procedure              Results             Reference Range
120417 -
120420 -
120421 -                  ** Marina Way South **
120423 -     ..
120424 -    Test Name            Value Unit     <-------- RANGE-------->
120425 -    @CBC
120426 -    WBC x 10-3               8.4 K/uL           3.5   -     12.5
120427 -    RBC x 10-6              4.08 M/uL           3.60  -      5.70
120428 -    Hemoglobin              13.2 g/dL          11.5   -     15.0
120429 -    Hematocrit              38.2 %             34.0   -     46.0
120430 -    MCV                       94 fL            80.0   -    100.0
120431 -    RDW                     14.3 %             11.9   -     14.3
120432 -    Plt x10-3              248   K/uL         140     -    400
120433 -     ..
120434 -    Neutrophils               83 %             50     -     70
120435 -    Lymphocytes     L         16 %             20     -     50
120436 -    Monocyte                   0 %              0     -     11
120437 -    Eosinophils                0 %              1     -      5
120438 -    Basophil                   0 %              0     -      2
120439 -     ..
120440 -    Bands             No Report  %              0     -      5
120442 -     ..
120443 -    CA 15-3           No Report  U/mL          -<     -     39
120445 -     ..
120446 -    Alkaline Phos     No Report  U/L           38     -    126
120447 -    Bili, Tot Adult   No Report  mg/dL        0.2     -    1.3
120448 -    Creatinine        No Report  mg/dL        0.6     -    1.2
120449 -    AST (SGOT       H No Report  U/L           14     -     36
120450 -    ALT (SGPT         No Report  U/L           11     -     66
120452 -     ..
120453 -    RBC Morphology    No Report
120454 -    Poikilocytosis  * No Report
120455 -    Anisocytosis    * No Report
120456 -    Schistocytes    * No Report
120457 -    PLT Estimate      No Report
120458 -    PLT Morphology    No Report
120459 -
120460 -
120461 -
120462 -
1205 -

SUBJECTS
Absolute Neutrophils Count ANC Formula Clarified Composite Blood Tes

1503 -
150401 -  ..
150402 - ACN 6972 Well Above 1500 Criteria for Blood Counts Approve Treatment
150403 - ANC Blood Count Formula Clarified Patient Meets Test for Treatment
150404 -
150405 - Formula for ANC, from record on 050128. ref SDS 44 TZ3N
150407 -  ..
150408 - Calculation from 060810 yielded 1376. ref SDS 84 9C5N
150410 -  ..
150411 - Diana clarified the formula for ANC
150413 -  ..
150414 - She said bands are added to neutrophis to get the total number for
150415 - calculating with WBC.
150416 -
150417 -                  WBC               =   8.4........ ref SDS 0 0N7Q
150418 -                  Neutrophils       =   0.83....... ref SDS 0 8W7S
150419 -                  Bands             -   0.......... ref SDS 0 2Q5O
150421 -             ..
150422 -            ANC = 8.4 x 1000 x (0.83 + 0) = 6972
150423 -
150424 -               [On 070301 research on neutropenia explains
150425 -               calcualtion of ANC at Kaiser and NEUTS at UCSF.
150426 -               ref SDS 88 516G
150427 -
150428 -
150429 -
150430 -
1505 -

SUBJECTS
CA 15-3 87 No Change Not Tested with Current Blood Test for Chemo

1703 -
170401 -  ..
170402 - CA 15-3 87 No Change Not Tested with Current Blood Test for Chemo
170403 -
170404 - Follow up ref SDS 84 2N5J, ref SDS 79 2N5J.
170406 -  ..
170407 - Last test was reported on 060810. ref SDS 84 2N5J
170409 -  ..
170410 - For some reason CA 15-3 was not performed for this blood test.
170411 - ref SDS 84 564H
170413 -  ..
170414 - Diana ordered another CA 15-3 test which Millie can get tomorrow to
170415 - assess efficacy of treatment, reported on 060810. ref SDS 84 5T9J
170416 - This test will support review on 060821 by Doctor Benz at UCSF.
170417 -
170418 -    [On 060817 CA 15-3 73 dramatic improvement, reversing 6 month rise
170419 -    of cancer marker, now falling back below critical 80 level,
170420 -    ref SDS 85 TS5O; supports observation impression on 060808 that IBC
170421 -    red rash subsiding and breaking up, ref SDS 83 VO6G, further
170422 -    reported on 060817, ref SDS 85 NU6L, evidence patient experiencing
170423 -    delayed response to treatment under scenario #1, developed on
170424 -    060808. ref SDS 83 J16O
170425 -
170426 -
170427 -
170428 -
1705 -

SUBJECTS
Port Connection Prepare for Treatment 1 Try Required Diana Excellent

2003 -
2004 - 1417
200501 -  ..
200502 - Preparation for Treatment Required One (1) Attempt to Connect Port
200503 - -----------------------------
200504 - Follow up ref SDS 79 EB7J, ref SDS 69 EB7J.
200506 -  ..
200507 - Julie did the administration again with Diana to verify Millie gets
200508 - the correct treatment.
200510 -  ..
200511 - Millie explained having taken Decadron tablets according to the
200512 - prescription to take two tablets twice a day, per instructions on
200513 - 050415. ref SDS 51 8U4O
200515 -  ..
200516 - Decadron was given by Diana again before treatment today, and Millie
200517 - will take another dose of Decadron tomorrow as part of chemotherapy
200518 - treatment today.
200519 -
200520 -        Generic name:  dexamethasone
200521 -
200522 -              http://www.tirgan.com/decadron.htm
200524 -         ..
200525 -        Description and purpose of Decadron is reported in the record
200526 -        on 060721. ref SDS 79 4I4Q
200528 -  ..
200529 - Compazine - Diana gave Millie a pill prior to treatment that reduces
200530 - nausea rather than as a drip treatment to avoid allergic reaction.
200531 -
200532 -        Generic name:  Prochlorperazine
200533 -
200534 -        Purpose of Compazine is reported on 060721. ref SDS 79 WD4M
200536 -  ..
200537 - Ativan - was not part of treatment today, previously given on 060721.
200538 - ref SDS 79 FZ5M
200539 -
200540 -        Generic name:  benzodiazepines
200541 -
200542 -        Purpose of Atiman reported on 060721. ref SDS 79 NF6K
200543 -
200544 -
200545 -
200547 -  ..
2006 -
2007 -
2008 - 1609
2009 -
200901 - Diana connected the IV tubes to the port....
200903 -       ..
200904 -      Interlink System Vented Paclitaxel set
200906 -  ..
200907 - This was done without incident, very professional and competent.
200908 -
200909 -
200910 -
2010 -

SUBJECTS
Benadryl Drip Treatment Prepares Patient for Chemotherapy Avoid Feve

2203 -
2204 - 1416
220501 -  ..
220502 - Benadryl started.
220503 -
220504 -              http://www.oncolink.org/treatment/article.cfm?c=2&s=10&id=150
220505 -
220506 -        Generic name:  diphenhydramine
220507 -
220508 -        Purpose reported on 060721. ref SDS 79 DC7J
220509 -
220510 -
220512 -  ..
2206 -
2207 -
2208 - 1629
2209 -
220901 - Benedryl completed.
220902 -
220903 -
220904 -
220905 -
2210 -

SUBJECTS
Taxotere 102 MG Drip Treatment 10th Cycle Taxotere Capecitiabine (Xe

2503 -
2504 - 1633
250501 -  ..
250502 - Taxotere Full Dose Blood Counts on Targets
250503 -
250504 - Follow up ref SDS 79 4N5M, ref SDS 69 4N5M.
250506 -  ..
250507 - Taxotere started - 102 MG.
250509 -  ..
250510 - There was no patient evaulation process today, which fits the
250511 - procedure the first time Millie was treated with Taxotere on 020610,
250512 - ref SDS 2 MR5I; later, on 050415 Kaiser performed patient evaluation
250513 - of side effects for Taxotere treatment. ref SDS 51 4333
250514 -
250515 -
250516 -
250518 -  ..
2506 -
2507 -
2508 - 1732
2509 -
250901 - Equipment beeped indicating treatment is over.
250902 -
250903 - Taxotere treatment completed.
250905 -  ..
250906 - Diana disconnected the IV tubes.
250908 -  ..
250909 - She inserted Herceptin to flush the port.
250911 -  ..
250912 - She then removed the needle from the port, and swabbed the needle
250913 - wound, and placed a temporary bandage.
250914 -
250915 -
250916 -
250917 -
250918 -
2510 -

SUBJECTS
Vitals Blood Pressure Pulse Temperature Taxotere 102 MG Drip Treatme

2803 -
2804 - 1440
280501 -  ..
280502 - Vitals Show Patient Stable
280503 -
280504 - Follow up ref SDS 79 AW4L.
280505 -
280506 - Diana took vitals before starting Benedryl drip treatment...
280507 -
280508 -                    Blood
280509 -    Date   Time     Pressure   Pulse  Temprtr  Weight
280511 -     ..
280512 -    060814 1610..... 139  80     59     98.2
280513 -    060722 1440..... 142  74     67     98.1
280514 -    060711.......... 172  87     54     97.5    147
280515 -    060623.......... 141  87     71     98.0    147
280516 -    060428.......... 129  73     80     99.4    149
280517 -    060217.......... 153  81     61     98.6    150
280518 -    050916.......... 120  80     80     98.5
280519 -
280520 -
280521 -
280522 -
2806 -

SUBJECTS
Pharmacist Orders Capecitabine Decadron Instructions Dose Capecitabi

3303 -
3304 - 1420
330501 -  ..
330502 - Pharmacist Orders Capecitabine Decadron Instructions
330503 -
330504 - Follow up ref SDS 79 TZ4I, ref SDS 78 N96O.
330505 -
330506 - Zan called Millie at home, and advised that he has placed an order
330507 - for Millie's medication.
330508 -
330510 -  ..
3306 -
3307 -
3308 - 1522
3309 -
330901 - Arrived at hospial.  Millie went to the pharmacy on the 2nd floor and
330902 - purchased the drugs ordered by Zan earlier today.
330903 -
330904 -
330905 -
330906 -
330907 -
3310 -

SUBJECTS
Tired Wobbly Alert to Drive Home Asleep by 1910 Today after Treatmen

3703 -
3704 - 1733
370501 -  ..
370502 - Tired Wobbly After Treatment Taxotere Support Drugs
370503 -
370504 - Follow up ref SDS 79 F54N, ref SDS 69 F54N.
370505 -
370506 - Millie was a little disoriented after treatment today.  She was not
370507 - treated with Ativan, as was done on 060721, ref SDS 79 F54N, and so
370508 - Mil was alert enough to drive home.
370510 -  ..
370511 - On 060724 diary side effects for 2nd phase taking Taxotere and
370512 - capecitabine (Xeloda). ref SDS 80 QX8K
370513 -
370514 -
370516 -  ..
3706 -
3707 -
3708 - 1802
3709 -
370901 - Fixed a salad for Millie.  Millie ate, and was asleep by 1830.
370902 -
370904 -  ..
3710 -
3711 -
3712 - 1910
3713 -
371301 - Woke Millie up and she took the 1.5 Xeloda tablets starting treatment
371302 - today, per Zan's instructions on 060721. ref SDS 79 J492
371303 -
371304 -
371305 -
371306 -
3714 -