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: September 29, 2006 02:30 PM Friday; Rod Welch

Millie at Kaiser 12th cycle Xeloda Taxotere IBC relapse.

1...Summary/Objective
2...Treatment Regular 3 Week Schedule Steady Level Chemotherapy Agent
3...Breathing Difficulty Heavy Chest Pulmonary Emboli Side Effects
4...Side Effects Consultation Pharmacist Heavy Chest Difficult Breathing
5...Schedule Next Treatment Continue Fridays
6...Blood Counts Good Dose Chemotherapy Taxol Normal
7...ACN 5200 Well Above 1500 Criteria for Blood Counts Approve Treatment
8...CA 15-3 51 Dramatic Drop from 68 Cancer Marker Current Blood Test
9...Preparation for Treatment Required One (1) Attempt to Connect Port
10...Benedryl Reduce Side Effects Taxotere Chemotherapy Treatment
11...Taxotere Full Dose Blood Counts on Targets
12...Vitals Show Patient Stable
13...Pharmacist Orders Capecitabine Decadron Instructions
14...Energy Normal Stable After Treatment Taxotere Support Drugs

ACTION ITEMS.................. Click here to comment!

1...This record indicates the nurse did not submit the full report. The

CONTACTS 

SUBJECTS
12th Cycle Treatment Taxotere Xeloda Capacitibine Chemotherapy 4th C

0503 -
0503 -    ..
0504 - Summary/Objective
0505 -
050501 - Follow up ref SDS 91 0000. ref SDS 88 0000.
050502 -
050503 - Millie was surprised that blood counts are very good again today for
050504 - treatment. ref SDS 0 P560  There are a number of "no report" entries,
050505 - indicating that Kaiser may not have submitted the full report.
050506 - ref SDS 0 0N7Q  She has been more tired throughout the past treatment
050507 - cycle.  Failing to recover energy usually indicates low blood counts.
050508 - Being tired, and heavy chest, difficulty breathing also reported today
050509 - may indicate recurrence of pulmonary emboli. ref SDS 0 QU8K  After
050510 - starting Taxotere drip treatment, the nurse helped Millie move the
050511 - mobile treatment aparatus and walk to the Oncology Clinic, so that the
050512 - doctor could have a meeting concurrent with getting treatment.
050513 - ref SDS 0 4N5M  Just before meeting with the doctor, the pharmacist
050514 - came into the examination room and consulted with Millie on ordering
050515 - chemotherapy drugs for the the next cycle of treatment starting today.
050516 - ref SDS 0 TZ4I  Vitals show patient stable. ref SDS 91 AW4L  Patient
050517 - alert and energy level good treatment. ref SDS 91 F54N  Nadine and the
050518 - Kaiser Infusion Clinic team did an excellent job today.
050519 -
050520 -
050521 -
050522 -
050523 -
050525 -  ..
0506 -
0507 -
0508 - Progress
0509 -
050901 - Treatment Regular 3 Week Schedule Steady Level Chemotherapy Agent
050902 -
050903 - Follow up ref SDS 91 407N, ref SDS 88 407N.
050904 -
050905 - Received treatment to begin 12th cycle overall of chemotherapy with
050906 - Taxotere and capecitabine (Xeloda), and the 4th treatment for 3rd
050907 - relapse of IBC.  Scheduling and treatment were reviewed by the primary
050908 - care physician on 060825. ref SDS 90 025H  There was another review
050909 - meeting with the doctor today during treatment.  Treatments have been
050910 - irregular so far, with slow response, reported on 060922. ref SDS 92
050911 - 0D4T  Treatment today is on schedule, keeping a steady level of
050912 - chemotherapy agent treating cancer.
050913 -
050917 -  ..
050918 - Millie had a blood draw yesterday afternoon, Thursday, 060928.
050920 -  ..
050921 - Angela said the blood counts are good today.  This was confirmed by
050922 - the report showing counts are well above requirements for treatment.
050923 - ref SDS 0 P560
050925 -  ..
050926 - There was an innovation today with the primary care physician meeting
050927 - with the patient during treatment.  This reduced the overall time at
050928 - the Kaiser facility by about 50%, from 4 hours to 2.
050929 -
050930 -
050931 -
050932 -
0510 -

SUBJECTS
Side Effects Consultation Pharmacist Tired Heavy Chest Difficult Bre

1403 -
140401 -  ..
140402 - Breathing Difficulty Heavy Chest Pulmonary Emboli Side Effects
140403 - Side Effects Consultation Pharmacist Heavy Chest Difficult Breathing
140404 -
140405 - Follow up ref SDS 91 QU8K.
140406 -
140407 - On 060724 diary showing history of side effects for 2nd phase taking
140408 - Taxotere and capecitabine (Xeloda). ref SDS 82 QX8K
140410 -  ..
140411 - Millie met with the pharmacist briefly in the examination room, per
140412 - below, and notified Kaiser of new side effects. ref SDS 0 819O  Other
140413 - side effects remain moderate, possibly reflecting reduced levels of
140414 - chemotherapy agent, compared to 2005, as reported on 060922.
140415 - ref SDS 92 9F35
140417 -             ..
140418 -            Tired, fatigued..
140419 -
140420 -               New problem; ordinarily after the 1st week of a new
140421 -               treatment cycle, energy level rises to normal by the
140422 -               middle of the 2nd week of treatment.  The 3rd week that
140423 -               is off treatment is typically normal energy.
140425 -                ..
140426 -               This cycle Millie has been continuously tired through
140427 -               the 3rd week, including today, and so was surprised to
140428 -               learn her blood counts are still very strong, per below.
140429 -               ref SDS 0 P560
140431 -             ..
140432 -            Heavy chest - difficult breathing
140433 -
140434 -               Millie described being out of breath after walking up
140435 -               the stairs at home, and at the BART station.
140436 -
140437 -               On 060724 patient notified Kaiser of possible finding
140438 -               pulmonary emboli family genetics, ref SDS 83 NL5Q, from
140439 -               report a few days earlier on 060722 of oldest son
140440 -               relapse pulmonary emboli. ref SDS 81 3D9T
140442 -             ..
140443 -            Dry hands.
140444 -
140445 -               Lotion received from Kaiser on 060809 is somewhat
140446 -               effective. ref SDS 91 KW45  Other lotion has fully
140447 -               relieved the problem to manageable levels.
140449 -             ..
140450 -            Loose bowels -- no diarrhea
140451 -
140452 -               Problem has cleared without treatment.
140454 -             ..
140455 -            Nausea
140456 -
140457 -               Uneasy, queazy feeling in stomache taking compasize,
140458 -               prescribes Anzemet were not effective.  Eating small
140459 -               amounts of food thorughout the day relieves problem.
140461 -             ..
140462 -            sores in mouth
140463 -
140464 -               None yet, cleaning mouth carefully to avoid problem.
140465 -
140466 -
140467 -
140468 -
140469 -
140470 -
140471 -
1405 -

SUBJECTS
Schedule Treatment Regular 3-week Cycle on Friday 061020 Angela Meye

1703 -
170401 -  ..
170402 - Schedule Next Treatment Continue Fridays
170403 -
170404 - Follow up ref SDS 91 QK6L, ref SDS 88 QK6L.
170406 -  ..
170407 - Today, Millie's next treatment is scheduled for 061020 1430.
170409 -  ..
170410 - Blood draw is schedued forthe day before on 061019 1500.
170412 -  ..
170413 - Meeting with the doctor also scheduled for 061020.  Not sure about
170414 - the time, because we can do it before or during treatment.
170415 -
170416 -
170417 -
170418 -
1705 -

SUBJECTS
Blood Tests Chemotherapy White Cell Count Good 12th Cycle Taxotere C

2003 -
200401 -  ..
200402 - Blood Counts Good Dose Chemotherapy Taxol Normal
200403 -
200404 - Follow up ref SDS 91 Q659, ref SDS 88 Q659.
200406 -  ..
200407 - Angela submitted the report showing...
200408 -
200409 -    Patient   Provider  Category   View      FR Date   To Date
200415 -     ..
200416 -    Procedure              Results             Reference Range
200417 -
200421 -
200422 -                  ** Marina Way South **
200424 -     ..
200425 -    Test Name            Value Unit     <-------- RANGE-------->
200426 -    @CBC
200427 -    WBC x 10-3               5.2 K/uL           3.5   -     12.5
200428 -    RBC x 10-6              3.71 M/uL           3.60  -      5.70
200429 -    Hemoglobin              12.1 g/dL          11.5   -     15.0
200430 -    Hematocrit              35.8 %             34.0   -     46.0
200431 -    MCV                       97 fL            80.0   -    100.0
200432 -    RDW             H       16.1 %             11.9   -     14.3
200433 -    Plt x10-3              249   K/uL         140     -    400
200434 -     ..
200435 -    Neutrophils       No Report  %             50     -     70
200436 -    Lymphocytes       No Report  %             20     -     50
200437 -    Monocyte          No Report  %              0     -     11
200438 -    Eosinophils       No Report  %              1     -      5
200439 -    Basophil          No Report  %              0     -      2
200440 -    Bands             No Report  %              0     -      5
200442 -     ..
200443 -    CA 15-3         H         51 U/mL          -<     -     39
200445 -     ..
200446 -    Alkaline Phos     No Report  U/L           38     -    126
200447 -    Bili, Tot Adult          0.6 mg/dL        0.2     -    1.3
200448 -    Creatinine               0.6 mg/dL        0.6     -    1.2
200449 -    ALT (SGPT)                22 U/L           14     -     36
200450 -    AST (SGOT)        No Report  U/L           11     -     66
200452 -     ..
200453 -    RBC Morphology    No Report
200454 -    Poikilocytosis  * No Report
200455 -    Anisocytosis    * No Report
200456 -    Schistocytes    * No Report
200457 -    PLT Estimate      No Report
200458 -    PLT Morphology    No Report
200460 -  ..
200461 - This record indicates the nurse did not submit the full report.  The
200462 - document says page 1 of 4, and we only got page 1.
200463 -
200464 -
200465 -
200466 -
200467 -
200468 -
2005 -

SUBJECTS
Absolute Neutrophils Count ANC 5200 Well Above 1500 Required for Tre

2303 -
230401 -  ..
230402 - ACN 5200 Well Above 1500 Criteria for Blood Counts Approve Treatment
230403 -
230404 - Follow up ref SDS 91 P560, ref SDS 88 P560.
230405 -
230406 - Millie was surprised that blood counts reported today are very strong,
230407 - per above. ref SDS 0 0N7Q  Experience since 2002 has shown a strong
230408 - correlation between feeling tired, reported today, ref SDS 0 FG3N, and
230409 - having low blood counts.
230411 -  ..
230412 - Formula for ANC, from record on 050128. ref SDS 45 TZ3N
230414 -  ..
230415 - Calculation from 060908 yielded 6390. ref SDS 91 P560
230417 -  ..
230418 - Note that bands are added to neutrophils, but both neutrophils and
230419 - bands have no report today.
230420 -
230421 -                  WBC               =   5.2
230422 -
230423 -                  Neutrophils       =    no report
230424 -                  Bands             =    no report
230426 -             ..
230427 -            ANC = 5.2 x 1000 x      = 5200
230429 -  ..
230430 - ANC calculation was not submitted by the nurse today, possibly
230431 - indicating that since WBC is high enough, there is no need to make
230432 - the calculation.
230433 -
230434 -
230435 -
230436 -
230437 -
230438 -
2305 -

SUBJECTS
CA 15-3 51 Dramatic Drop from 68 Cancer Marker Current Blood Test

2503 -
250401 -  ..
250402 - CA 15-3 51 Dramatic Drop from 68 Cancer Marker Current Blood Test
250403 -
250404 - Follow up ref SDS 91 2N5J, ref SDS 88 2N5J.
250406 -  ..
250407 - Test today showing CA 15-3 51, ref SDS 0 5K6K, was another big drop
250408 - from 68 reported following the last treatment on 060908, and received
250409 - last week on 060922. ref SDS 92 MG6F
250410 -
250411 -
250412 -
250413 -
250414 -
2505 -

SUBJECTS
Port Connection Prepare for Treatment 1 Try Required Angela Excellent    2

2803 -
2804 - 1417
280501 -  ..
280502 - Preparation for Treatment Required One (1) Attempt to Connect Port
280503 -
280504 - Follow up ref SDS 91 EB7J, ref SDS 88 EB7J.
280506 -  ..
280507 - Bonnie did the administration with Angela to verify Millie gets the
280508 - correct treatment.
280510 -  ..
280511 - Millie explained having taken Decadron tablets according to the
280512 - prescription to take two tablets twice a day, per instructions on
280513 - 050415. ref SDS 52 8U4O
280515 -  ..
280516 - Decadron was not given by Angela again before treatment today, because
280517 - Millie took the pills this morning with her meal, as prescribed; and
280518 - Millie will take another treatment of Decadron tomorrow as part of
280519 - chemotherapy treatment with Taxotere today.
280520 -
280521 -        Generic name:  dexamethasone
280522 -
280523 -              http://www.tirgan.com/decadron.htm
280525 -         ..
280526 -        Description and purpose of Decadron is reported in the record
280527 -        on 060721. ref SDS 80 4I4Q
280529 -  ..
280530 - Compazine - Angela gave Millie a pill prior to treatment.  Millie took
280531 - this with a cup of water, as she has for the past 5 years.  Angela
280532 - said this was a mistake.  She apologized for not alerting the patient
280533 - should wait to take Compazine treatment until after verification of
280534 - treatment protocol, per above. ref SDS 0 EB7J
280536 -  ..
280537 - Ativan - was not part of treatment today, previously given on 060721.
280538 - ref SDS 80 FZ5M
280539 -
280540 -        Generic name:  benzodiazepines
280541 -
280542 -        Purpose of Atiman reported on 060721. ref SDS 80 NF6K
280544 -  ..
280545 - Anzemet
280546 -
280547 -        Generic name:  dolasetron mesylate
280548 -
280549 -               http://www.anzemet.com
280551 -  ..
280552 - Millie advised that she tried Anzemet once, and found it did not
280553 - relieve side effects of nausea, reported on 060908, ref SDS 91 O64I,
280554 - and per above, ref SDS 0 D19M, and so she has not taken this again,
280555 - also, reported to the pharmacist, per below. ref SDS 0 NT3J
280556 -
280557 -
280558 -
280560 -  ..
2806 -
2807 -
2808 - 1441
2809 -
280901 - Angela connected the IV tubes to the port....
280903 -       ..
280904 -      Interlink System Vented Paclitaxel set
280906 -  ..
280907 - This was done without incident, very professional and competent.
280908 -
280909 -
280910 -
2810 -

SUBJECTS
Benedryl Reduce Side Effects Taxotere Chemotherapy Treatment Meyer A

3103 -
3104 - 1446
310501 -  ..
310502 - Benedryl Reduce Side Effects Taxotere Chemotherapy Treatment
310503 -
310504 - Follow up ref SDS 91 DC7J.
310505 -
310506 - Benadryl started.
310508 -         ..
310509 -        Purpose reported on 060721. ref SDS 80 DC7J
310510 -
310511 -
310513 -  ..
3106 -
3107 -
3108 - 1456
3109 -
310901 - Benedryl completed.
310902 -
310903 -
310904 -
310905 -
3110 -

SUBJECTS
Taxotere 102 MG Drip Treatment 12th Cycle Taxotere Capecitiabine (Xe

3403 -
3404 - 1458
340501 -  ..
340502 - Taxotere Full Dose Blood Counts on Targets
340503 -
340504 - Follow up ref SDS 91 4N5M, ref SDS 88 4N5M.
340506 -  ..
340507 - Taxotere started - 102 MG.
340509 -  ..
340510 - There was no patient evaulation process today, which fits the
340511 - procedure the first time Millie was treated with Taxotere on 020610,
340512 - ref SDS 2 MR5I; later, on 050415 Kaiser performed patient evaluation
340513 - of side effects for Taxotere treatment. ref SDS 52 4333
340515 -  ..
340516 - While connecting Taxotere treatment, Angela commented that she hoped
340517 - Millie doesn't mind her saying that she noticed Millie's age from
340518 - Kaiser's computer records, and initially thought there was a mistake,
340519 - because Millie looks so young and strong for a 70 year old.  She said
340520 - that Millie looks younger than her mom who is only 52.
340521 -
340522 -        [....in another record today, Doctor Benz at UCSF mentions in a
340523 -        2nd opinion letter that Millie looks younger than her age.
340524 -        ref SDS 93 WQ6S
340526 -  ..
340527 - Millie thanked Angela for generous comments, and for doing a good job
340528 - assisting with her treatment today.  She confirmed that she is 70,
340529 - and feels fortunate to that Kaiser is taking good care of her.
340530 -
340531 -
340532 -
340534 -  ..
3406 -
3407 -
3408 - 1602
3409 -
340901 - Equipment beeped indicating treatment is over, while were still
340902 - meeting with the primary care physician.
340904 -  ..
340905 - Angela knocked on the examination room door, and the doctor said we
340906 - are about finished.
340908 -  ..
340909 - About 5 minutes later, the meeting ended.  The doctor opened the door,
340910 - and Angela assisted Millie back to the Infusion Clinic while still
340911 - connected to the IV treatment equipment.
340913 -  ..
340914 - Angela disconnected the IV tubes.
340916 -  ..
340917 - She inserted Herceptin to flush the port.
340919 -  ..
340920 - She then removed the needle from the port, and swabbed the needle
340921 - wound, and placed a temporary bandage.
340922 -
340923 -
340924 -
340925 -
340926 -
3410 -

SUBJECTS
Vitals Blood Pressure Pulse Temperature Taxotere 102 MG Drip Treatme

3703 -
3704 - 1452
370501 -  ..
370502 - Vitals Show Patient Stable
370503 -
370504 - Follow up ref SDS 91 AW4L, ref SDS 88 AW4L.
370505 -
370506 - Angela took vitals before starting Benedryl drip treatment...
370507 -
370508 -                    Blood
370509 -    Date   Time     Pressure   Pulse  Temprtr  Weight
370511 -     ..
370512 -    060929 1452..... 141  78     66     98.3
370513 -    060908 1335..... 139  79     73     98.1
370514 -    060814 1610..... 139  80     59     98.2
370515 -    060722 1440..... 142  74     67     98.1
370516 -    060711.......... 172  87     54     97.5    147
370517 -    060623.......... 141  87     71     98.0    147
370518 -    060428.......... 129  73     80     99.4    149
370519 -    060217.......... 153  81     61     98.6    150
370520 -    050916.......... 120  80     80     98.5
370521 -
370522 -
370523 -
370524 -
3706 -

SUBJECTS
Pharmacist Orders Capecitabine (Xeloda) 12th Cycle Decadron Doctor's

4203 -
4204 - 1513
420501 -  ..
420502 - Pharmacist Orders Capecitabine Decadron Instructions
420503 -
420504 - Follow up ref SDS 91 TZ4I, ref SDS 88 TZ4I.
420505 -
420506 - After Angela assisted Millie moving from the Infusion Clinic into the
420507 - examination for meeting with the primary care physician, and before
420508 - the doctor came into the room, a young woman came and introduced
420509 - herself as a pharmacist.
420511 -  ..
420512 - She has placed an order on the 2nd floor pharmacay for Millie to get
420513 - another treatment of capecitabine (Xeloda), and this includes
420514 - Decadron, required for Taxotere that is the other part chemotherapy
420515 - treatment prescribed for Millie.
420517 -  ..
420518 - The pharmacist asked Millie to explain the protocol for capecitabine,
420519 - and Millie related taking 1.5 pills twice a day for 2 weeks.  The
420520 - pharmacist explained that Millie passed Kaiser's quality control
420521 - efforts to verify patient is taking the prescribed amount of
420522 - treatment, following up Millie's letter to the doctor on 060922
420523 - reporting an error in taking capecitabine (Xeloda) one day.
420524 - ref SDS 92 0D5R
420526 -  ..
420527 - There was discussion of side effects, per above. ref SDS 0 QU8K
420529 -  ..
420530 - Millie explained recent resumption of previous side effects of
420531 - chemotherapy treatment that causes difficulty breathing with a heavy
420532 - chest, ref SDS 0 UL6L, which was due to blood clots and pulmonary
420533 - emboli reported on 041104. ref SDS 40 N43I
420535 -  ..
420536 - The pharmacist was unaware of blood clots or shortness of breath
420537 - being associated with either Taxotere or capecitabine (Xeloda).
420539 -  ..
420540 - On 060711 another pharmacist, Zan, discussed adjusting the dose of
420541 - chemotherapy agent based on the patient not receiving treatment with
420542 - Coumadin for pulmonary emboli. ref SDS 79 S33L  This however seems a
420543 - different issue from whether Taxotere and/or capecitabine may have
420544 - side effects of blood clots.  If the patient has recurrence of
420545 - pulmonary emboli, this may require adjusting chemotherapy treatments,
420546 - as Zan related on 060711. ref SDS 79 S34N
420548 -  ..
420549 - The pharmacist asked Millie if she needs refill for Anzemet,
420550 - prescribed on 060908 for nausea? ref SDS 91 D19M  Millie advised that
420551 - she tried this once, and found this was not effective, so she does not
420552 - need a refill.  Per above, Millie advised that eating small amounts of
420553 - food through the day keeps her stomache from feeling nausious.
420554 - ref SDS 0 QU8K
420555 -
420556 -
420557 -
420558 -
420559 -
4206 -

SUBJECTS
Energy Normal Stable Alert Drive Home After Treatment IBC 3rd Relaps

4603 -
4604 - 1733
460501 -  ..
460502 - Energy Normal Stable After Treatment Taxotere Support Drugs
460503 -
460504 - Follow up ref SDS 91 F54N, ref SDS 88 F54N.
460505 -
460506 - Millie was a little tired after treatment today, but was not wobbly
460507 - nor disoriented.  She was alert enough to drive home.
460509 -  ..
460510 - On 060724 diary side effects for 2nd phase taking Taxotere and
460511 - capecitabine (Xeloda). ref SDS 82 QX8K
460512 -
460513 -
460514 -
460515 -
460516 -
460517 -
460518 -
4606 -