CONTACTS
SUBJECTS
Case Management Communication SDS Record Accurate Meeting UCSF 07013
7503 -
7503 - ..
7504 - Summary/Objective
7505 -
750501 - Follow up ref SDS B6 0000. ref SDS B4 0000.
750502 -
750503 - Treatment today went smoothly. Brigid did another exam and asked more
750504 - questions about patient history, ref SDS 0 FO6H, with Jackie assisting
750505 - to take pictures for evaluating measurable disease on the cetuximab
750506 - drug trial. ref SDS 0 6T6M Millie was randomized to get only
750507 - cetuximab, which works out well, because it provides another "bite at
750508 - the apple," if disease progresses. Fortunately, at this time IBC
750509 - seems less severe than over the past few months, so starting with
750510 - minimum treatment is good strategy. ref SDS 0 XR3M Another advantage
750511 - is that cetuximab requires blood tests only every 4 weeks, which helps
750512 - reduce medical costs. UCSF can further save time for blood draws, by
750513 - performing the procedure on site an hour before starting treatment,
750514 - rather than Millie taking time off work to get blood drawn at Kaiser
750515 - the day before treatment. ref SDS 0 XR40 An action item is to clarify
750516 - how the Kaiser Coagulation Treatment Clinic will get notice of INR
750517 - results, and, also, clarify payment authority for blood tests
750518 - performed at UCSF. ref SDS 0 G55H Catherine in the Infusion Clinic on
750519 - the 5th floor was terrific. There was a small problem getting all 10
750520 - vials of blood drawn for the cetuximab study. This may relate to
750521 - Millie's blood draw the day before on 070131. ref SDS 0 H79H
750522 - Cetuximab treatment today was given over 2 hours to observe any
750523 - adverse reactions. Thankfully, there were none. Work was efficient
750524 - and professional in all respects. ref SDS 0 4N5M After treatment
750525 - Millie was more energetic than normal, possibly due to decadron.
750526 - ref SDS 0 F54N
750527 -
750528 - [On 070204 UCSF notified no initial side effects of treatment,
750529 - and energy has increased; planning for CT test to evaluate
750530 - pulmonary embolism. ref SDS D2 JJ7O
750532 - ..
750533 - [On 080313 Millie begins 16th cycle on clinical study; and 1st
750534 - cycle 1st treatment with cetuximab and carboplatin together
750535 - treating 4th relapse of IBC. ref SDS F7 TZ8I
750536 -
750537 -
750539 - ..
7506 -
7507 -
7508 - Progress
7509 -
750901 - Tape Recording SDS Record Accurate Comprehensive New Way of Working
750902 - Case Management Referral Coordination Plan Collaboration UCSF Kaiser
750903 -
750904 - Follow up ref SDS B6 407N, ref SDS B4 407N.
750905 -
750906 - Jackie said she received Millie's letter sent yesterday on 070131,
750907 - ref SDS C8 2P5M, transmitting the SDS record meeting with Doctor Rugo
750908 - and the medical team at UCSF the day before on 070130. ref SDS C7 0001
750909 - She forwarded a copy to Brigid, but did not forward to Doctor Rugo,
750910 - because the doctor depends on staff for accurate communications.
750912 - ..
750913 - Brigid said she has never seen reports on details of discussion in
750914 - meetings, shown in the SDS record for the meeting at UCSF on 070130.
750915 - ref SDS C7 1000 She did not realize Millie's patient history is so
750916 - complex. ref SDS C7 LU3J Brigid only had time to glance through the
750917 - record. Nothing jumped out inconsistent with her memory of the
750918 - meeting and medical examination on Tuesday, 070130. ref SDS C7 1000
750919 - She checked a few things that were a little hazy, and found alignment
750920 - with her notes in the medical chart. She added a few comments from
750921 - the SDS record that were not in the medical chart, but seemed possibly
750922 - important. Jackie said she read through the record last night just to
750923 - make sure everything is coordinated, and that Millie is getting
750924 - started on the "right foot" understanding treatment, and UCSF
750925 - procedures. She made a joke asking if Millie tape recorded the
750926 - meeting, because the narrative and background seems thorough and
750927 - accurate from her memory of the meeting.
750929 - ..
750930 - Brigid said that it is not necessary for patients to send this much
750931 - detail on meetings with the doctor for verification, because she is
750932 - very diligent making thorough notes in Millie's medical chart at UCSF.
750934 - ..
750935 - Millie asked for a copy of the medical chart to compare with patient
750936 - records.
750938 - ..
750939 - Brigid advised that UCSF never gives out the medical chart to
750940 - patients. She said it would take a lot of time, and there are a lot
750941 - of partial notes in short-hand that mean something to her, but not to
750942 - anyone else.
750944 - ..
750945 - Millie asked how the medical chart is checked for accuracy and
750946 - thorough reporting to provide comprehensive care which UCSF promises
750947 - in advertising for patients. This is shown outside on the wall of the
750948 - building.
750950 - ..
750951 - Brigid said UCSF does periodic audit reviews to verify everything is
750952 - in the medical chart.
750954 - ..
750955 - How does the auditor figure out notes that mean something to only one
750956 - person? What if something is missing? The doctor forgot to write it
750957 - down? What if something is entered incorrectly? How would the
750958 - auditor know?
750960 - ..
750961 - Brigid explained that sometimes things fall through the cracks, but
750962 - she is very careful writing everything down so the patient doesn't
750963 - have to worry.
750965 - ..
750966 - Discussed case management standards in Kaiser's Healthwise handbook
750967 - calling for "ping pong" practice of feedback for the doctor to verify
750968 - accuracy of communication with patients, reviewed on 990625.
750969 - ref SDS 4 3960 Kaiser's case management requires a well ordered
750970 - record to understand cause and effect in complex medical history.
750971 - Requirements for a well ordered record were reviewed on 890523.
750972 - ref SDS 1 TP8O Millie asked how the referral coordination plan for
750973 - Millie's treatment at UCSF applies Kaiser's case management practices?
750975 - ..
750976 - Brigid feels strongly there isn't enough time to perform Kaiser's
750977 - "ping pong" case management practice to verify verbal communications,
750978 - and to correlate alignment with the written reports, policy,
750979 - procedures, research, protocols, and correspondence, as shown in the
750980 - record meeting with Doctor Rugo on 070130. ref SDS C7 0001
750982 - ..
750983 - Jackie said it seemed strange reading understandings in the SDS record
750984 - of what she said, and did in the prior meeting on 070130, and further
750985 - how everything aligns with prior events. ref SDS C7 M882 Jackie noted
750986 - that busy people are not always aware of collateral effects, when
750987 - doing things in the moment, so placing everything in context is a
750988 - totally new experience.
750989 -
750990 - [On 090206 Doctor Stritter reported that Millie has survived
750991 - very aggressive cancer for a long time by performing complex
750992 - clinical, logistical, and financal case management. ref SDS G3
750993 - 7Q7J
750995 - ..
750996 - [On 090213 1140 primary care physician at Kaiser credits SDS
750997 - well ordered record for case management extends Millie's
750998 - survival much longer than expected for disease trajectory.
750999 - ref SDS G4 NY7L
751001 - ..
751002 - Jackie agreed with Brigid that there is not enough time for staff to
751003 - check accuracy of communications in the detail supported by SDS
751004 - records. She indicated that details on patient medical history are
751005 - critical to have available, because when there is a lot going on
751006 - people suffer memory lapse or get confused. That happens all the
751007 - time, because it is impossible to remember everything. But, she cited
751008 - a big dilemma. If people spend time writing everything down, and then
751009 - checking for accuracy, there is no time left to do any work. This
751010 - aligns with Ross' analysis on 890809. ref SDS 2 3S6H Jackie feels
751011 - that Doctor Rugo cannot invest time to provide feedback that refines
751012 - accuracy on just one patient. Doctor Rugo likes short letters which
751013 - go quickly to the point of what is needed, without context and links
751014 - presented in SDS records.
751016 - ..
751017 - On 061011 1746 Kaiser notified UCSF reduced their bill $200 because
751018 - Kaiser documents on doctor's progress notes, labs and radiology tests
751019 - submitted for 2nd opinion were organized by the patient into a well
751020 - ordered record that reduced time and expense for understanding patient
751021 - history. ref SDS A9 Z39O This shows benefits of doctor/patient
751022 - partnership leveraging medical training and experience with patient's
751023 - time to provide a well ordered record that saves lives, time and
751024 - money.
751026 - ..
751027 - There was brief discussion that Brigid's assurance patients don't have
751028 - to worry because she write's everything down, ref SDS 0 S571,
751029 - conflicts with Brigid's report there isn't enough time to correlate
751030 - daily work with the record. Seems like patient's with lots of time
751031 - should be helping doctor's and staff with limited time.
751033 - ..
751034 - [On 080403 0900 Doctor Rugo requested assistance using SDS
751035 - records of patient history to coordinate UCSF and Kaiser
751036 - medical services for Millie's care. ref SDS F8 4U9O
751038 - ..
751039 - [On 081017 0021 Doctor Rugo thanked Millie for coordinating a
751040 - very complex work plan involving shared responsibilities at
751041 - UCSF and Kaiser to start Millie's next treatment. ref SDS G0
751042 - RI6I
751044 - ..
751045 - [On 090121 1017 Glenna called and said Doctor Rugo requested
751046 - help finding chemotherapy agents and protocols discussed for
751047 - Millie's next systemic treatment, using the SDS well ordered
751048 - record of patient history, ref SDS G1 Y67L, and cited the "work
751049 - plan" on 081016 that guided complex work in progress to start
751050 - Millie's previous treatment. ref SDS F3 J36R
751052 - ..
751053 - [On 090203 1206 Doctor Al-Bussam advised that Millie's well
751054 - ordered record of complex medical history, ref SDS G1 NU5H,
751055 - enabled efficient review ref SDS G2 8488; and, that accurate
751056 - understanding enabled determining Millie can get treatment for
751057 - cancer in time to be effective. ref SDS G2 OE4F
751058 -
751060 - ..
751061 - Jackie advised that...
751062 -
751063 - Clinic phone... 415 353 7070
751064 -
751065 - ...is the primary contact between patients and UCSF for all issues
751066 - related to the study and requirements or medical questions, including
751067 - emergencies from complications and side effects of treatment.
751069 - ..
751070 - Case study on collaboration between UCSF and Kaiser during December
751071 - and January indicates need for coordination plan to facilitate
751072 - delivery of health care with multiple providers and divided
751073 - responsibilities. ref SDS C7 RM4G
751074 -
751075 - [On 070202 meeting at Kaiser with primary care physician cites
751076 - requirement for written coordination plan between Kaiser and
751077 - UCSF with respect to mediciation prescriptions and emergencies.
751078 - ref SDS D1 2O5H
751080 - ..
751081 - [On 070215 Millie notifies Kaiser of confusing whirl
751082 - coordinating between multiple providers. ref SDS D5 VW6U
751084 - ..
751085 - [On 070216 Jackie confirms patient should call UCSF for
751086 - emergencies. ref SDS D6 AM4N
751088 - ..
751089 - [On 070217 Millie requests clarification of coordination
751090 - planning on emergency treatment; notes that patient history
751091 - shows treatment at Kaiser Emergency does not require calling a
751092 - number, just show up; notes that driving to San Francisco for
751093 - emergency treatment at UCSF might enocunter fatal traffic
751094 - delays. ref SDS D7 4Q8O
751096 - ..
751097 - Jackie submitted the form for handicap parking signed by the doctor,
751098 - planned on 070130, and cited in the letter to UCSF yesterday on
751099 - 070131. ref SDS C8 FT6Q
751100 -
751101 - [...below, on 070201 0800 at 1705 on the way home, stopped at
751102 - DMV and obtained handicap parking permit. ref SDS 0 4R9I
751104 - ..
751105 - [On 110420 1538 received from DMV handicap parking permit
751106 - until June 2013. ref SDS G5 BZ5H
751107 -
751108 -
751109 -
7512 -
SUBJECTS
Examination Treatment Cetuximab 1st Treatment 1st Cycle Chemotherapy
Case Management Communication SDS Record Accurate Meeting 070130 at
7804 -
780501 - ..
780502 - Clinic Examination Orientation Starting Treatment Cetuximab
780503 -
780504 - Follow up ref SDS B6 407N, ref SDS B4 407N.
780505 -
780506 - Brigid made an examination.
780508 - ..
780509 - Doctor Rugo did not meet with Millie this morning. She was in the
780510 - hallway and waved good luck after the meeting when Millie was leaving
780511 - the clinic enroute with Jackie's escort for treatment on the 5th
780512 - floor. Jackie left the room to consult with the doctor on several
780513 - occassions during the course of the meeting with Brigid, and later
780514 - when starting treatment by the Infusion Clinic, reflecting plans on
780515 - 070130 for scheduling treatment today. ref SDS C7 M882
780517 - ..
780518 - On subsequent treatments, Millie will only be examined every 2nd
780519 - treatment, i.e., the 1st and 3rd treatments. Doctor Rugo will
780520 - normally meet with Millie once a month to make an examination and
780521 - assess progress to start each new cycle.
780522 -
780523 - [On 070412 examination for 3rd treatment moved to 4th treatment,
780524 - and Doctor Rugo's examination moved back a week to accomodate
780525 - traveling schedules. ref SDS E3 FO6H
780526 -
780527 -
780528 -
7806 -
SUBJECTS
Breast Examination Shows Improvement IBC Rash Left Right Breast Stom
8103 -
810401 - ..
810402 - Breast Examination Shows Improvement IBC Rash
810403 -
810404 - Follow up ref SDS C7 025H, ref SDS C1 025H.
810405 -
810406 - Brigid did another examination, following up the work by Doctor Rugo
810407 - on 070130, and made similar findings. Millie noted that the rash
810408 - seems less intense today than on 070130. ref SDS C7 M68J
810410 - ..
810411 - Brigid described presentation of IBC on left and right breast areas
810412 - similar to Doctor Rugo on 070130. ref SDS C7 M69K
810414 - ..
810415 - Brigid asked quetions about patient history, presented previously
810416 - during the meeting at UCSF on 070130, ref SDS C7 LC49, and listed in
810417 - case study on 060722 tracking progression of disease with 3rd relapse
810418 - IBC. ref SDS 94 JD5K
810420 - ..
810421 - Questions on fatigue, shortness of breath and other symptoms of
810422 - pulmonary embolism were referred to the meeting with Doctor Rugo on
810423 - 070130, ref SDS C7 CV5L, and citing patient history listed on 060722.
810424 - ref SDS 93 ZV41
810426 - ..
810427 - Millie qualified for clinical study on cetuximab drug trial because
810428 - she has had only 3 treatments, as discussed in correspondence between
810429 - Doctor Rugo and the primary care physician on 061230. ref SDS B9 PN5X
810430 - The doctor got approval from study management to waive Millie's
810431 - treatment with Taxol and bevecizumab (Avastin), because Millie was
810432 - removed from treatment due to PE and not because the treatment became
810433 - ineffective.
810434 -
810435 -
810436 -
8105 -
SUBJECTS
6 Patients Currently UCSF Cetuximab Carboplatin 100 Patients Clinica
8903 -
890401 - ..
890402 - 6 Patients Participating UCSF Cetuximab Carboplatin Clinical Study
890403 -
890404 - There are six (6) patients on the Cextuximab Carboplatin clinical
890405 - study at UCSF, clarifying Consent documentation that says there are 20
890406 - patients on study at UCSF. ref SDS C3 1H3O The small number of
890407 - patients being studied reflects limited availability of patients who
890408 - meet protocol requirements for triple negative and with fewer than 4
890409 - treatments, discussed between Doctor Rugo and the primary care
890410 - physician at Kaiser on 061230. ref SDS B9 PN5X
890411 -
890412 -
890413 -
890414 -
8905 -
SUBJECTS
Measureable Disease IBC Rash Photographs Tape Measure Evaluate Progr
9303 -
930401 - ..
930402 - Photographs Establish Baseline to Measure Progression of Disease
930403 - Measureable Disease Photographs IBC Rash Improving
930404 - IBC Rash Improved Measurable Disease Photographs Tape Measure
930405 -
930406 - Follow up ref SDS C7 M652, ref SDS C0 4Q6K.
930407 -
930408 - Jackie used a camera to take several pictures of infected tissue for
930409 - measurable disease.
930411 - ..
930412 - Brigid placed small round bandage-type identification stickers on the
930413 - skin and held a cloth-like tape measure in several directions so that
930414 - the photographs of skin infected with IBC can be disucssed in the
930415 - record with reference to specific locations and rash dimensions, as
930416 - developed by Doctor Rugo during the meeting on 070130. ref SDS C7 M652
930417 -
930418 - [On 080207 snafu caused loss of baseline photographs taken today;
930419 - may be able to use pictures from 070301. ref SDS F5 GH5H
930420 -
930421 -
930422 -
9305 -
SUBJECTS
Cetuximab Side Effects Face Rash Acne-like Mild Fatigue Weakness Sho
9603 -
960401 - ..
960402 - Side Effects Medicated After Weekly Examinations
960403 -
960404 - Follow up ref SDS C7 TQ6L, ref SDS C3 7Y4H.
960405 -
960406 - Side effects discussed during examination at UCSF on 070130 seem
960407 - similar to symptoms of pulmonary embolism. ref SDS C7 TQ6L
960409 - ..
960410 - Millie will be examined by Brigid before treatment next Thursday on
960411 - 070208 to evaluate side effects. At that time, UCSF will decide on
960412 - providing medication for acne-like rash, if it occurs, as discussed by
960413 - Doctor Rugo on 070130, ref SDS C7 IJ5L, and reviewed previously with
960414 - Jackie during the call on 070117. ref SDS C4 QM7I
960415 -
960416 - [On 070208 Millie requested treatment for the rash on her face
960417 - that is a side effect of cetuximab chemotherapy; this was deferred
960418 - for 2 weeks to the start of the next cycle on 070301. ref SDS D3
960419 - FO66
960420 -
960421 -
960422 -
9605 -
SUBJECTS
Randomized Cetuximab Drug Trial Cetuximab Carboplatin Clinical Study
9903 -
990401 - ..
990402 - Randomized Cetuximab Increases Treatment Options
990403 -
990404 - Jackie advised that Millie was randomized to get Cetuximab without
990405 - Carboplatin.
990407 - ..
990408 - This aligns with Millie's prior good luck getting randomized for
990409 - treatment with both Taxotere and bevacizumab (Avastin), reported on
990410 - 040416. ref SDS 18 8R6M Since there is a 50% chance in randomizing,
990411 - Millie was due this time to get only Cetuximab. Since IBC rash seems
990412 - to be improving, shown by examination the past few days, noted above,
990413 - ref SDS 0 FO6H, and since CA 15-3 seems relatively controlled,
990414 - reported on 070123, ref SDS C5 GK5B, then if the 2 tests now pending,
990415 - including yesterday, ref SDS C9 P56K, remain below 80, Millie seems to
990416 - have a good chance of improving with a single agent treatment at this
990417 - time. This preserves Carboplatin for additional treatment later, if
990418 - disease again progresses, as discussed with Doctor Rugo on 070130.
990419 - ref SDS C7 NI6K
990420 -
990421 - [On 070202 Millie notified Gloria at the Kaiser Coagulation
990422 - Treatment Clinic on scope of new treatment. ref SDS D0 PY6U
990424 - ..
990425 - [On 070202 primary care physician at Kaiser indicated starting
990426 - treatment with cetuximab gives Millie another treatment option in
990427 - the event that disease progresses. ref SDS D1 QO6O
990429 - ..
990430 - [On 070202 primary care physician notices new rash on upper left
990431 - arm, which is a symptom of cellulitis, ref SDS D1 JP6F but may
990432 - progression of IBC. ref SDS D1 JP6L
990434 - ..
990435 - [On 070222 examination at UCSF indicates new rash likely
990436 - progression of IBC. ref SDS D8 B64F
990438 - ..
990439 - [On 070419 IBC subsiding; Millie fortunate responding to treatment
990440 - with cetuximab alone, clinical study changes protocol eliminating
990441 - this option because not enough patients getting favorable response
990442 - with cetuximab alone. ref SDS E4 Q665
990443 -
990444 -
990445 -
990446 -
990447 -
9905 -
SUBJECTS
Blood Tests Cetuximab Monthly Clinical Study Drug Trial Performed at
A203 -
A20401 - ..
A20402 - Blood Tests 4 Week Cycle Cetuximab Performed at UCSF Saves Time Cost
A20403 -
A20404 - Brigid advised that Millie needs blood draws prior to examinations for
A20405 - approving chemotherapy with cetuximab only every 4 treatments, i.e.,
A20406 - once a month, rather than weekly, called out by the clinical study
A20407 - protocol, reviewed on 070116. ref SDS C3 5U7Z This change results
A20408 - from Millie being randomized in the study to get treatment only with
A20409 - cetuximab and not with Carboplatin. Since Cetuximab is designed to
A20410 - treat only cancer cells, there is less impact on the immune system
A20411 - than adding Carboplatin, which is a general chemotherapy drug more
A20412 - like capecitiabine and Taxotere that attack healthy cells along with
A20413 - cancer.
A20414 -
A20415 - [On 080306 Infusion Clinic medical chart shows incorrectly that
A20416 - Millie gets blood tests on 6-week cycle; causing confusion and
A20417 - delay despite excellent support by Infusion Clinic staff.
A20418 - ref SDS F6 NK5L
A20420 - ..
A20421 - On 030606 the primary care physician explained chemotherapy is a
A20422 - "poisen" that attacks everything, which reduces blood counts. This
A20423 - weakens the immune system, increasing risks of life threatening
A20424 - infection, e.g., pneumonia. Normal cancer care therefore requires
A20425 - blood tests to verify the immune system is strong enough for the
A20426 - patient to receive cheomtherapy. ref SDS 12 JP7G
A20428 - ..
A20429 - Previously, Kaiser would do blood tests the day before treatment to
A20430 - verify Millie could safely receive chemotherapy. If counts were too
A20431 - low, they would retest when Millie came in the day of treatment, and
A20432 - if counts had not increased enough, treatment would be delayed. For
A20433 - example, on 060810 Kaiser delayed Millie's treatment a week because
A20434 - blood counts were too low. ref SDS A0 5K4F Case study on patient
A20435 - history shows that sometimes, rather than delay treatment, Kaiser did
A20436 - another test the day of treatment to see if blood counts were at least
A20437 - rising, as effects of previous chemotherapy diminish. Treatment was
A20438 - often approved with blood counts below the target level, based on the
A20439 - doctor's judgement at the time of the patient's immediate condition
A20440 - shown by current blood work. ref SDS A0 HV45
A20441 -
A20442 - [On 070301 Doctor Rugo ordered an extra blood test because ANC was
A20443 - too low for treatment. ref SDS D9 H93H
A20445 - ..
A20446 - Jackie coordinated with Catherine on scheduling blood draws in the
A20447 - Infusion Clinic.
A20449 - ..
A20450 - Jackie will schedule Millie to get blood drawn at UCSF the same day as
A20451 - treatment, per below. ref SDS 0 QK6L Catherine said it takes about an
A20452 - hour to get results, so Millie can come in at 0800 to have blood
A20453 - drawn. During that hour, Doctor Rugo can do the monthly examination
A20454 - to start each new cycle.
A20456 - ..
A20457 - This solves blood draw problems discussed in the record on 070130.
A20458 - ref SDS C7 2Q4L Millie will not have to take time off the day before
A20459 - on Wednesdays to have blood drawn at Kaiser in Walnut Creek. She can
A20460 - have INR checked at the same time. If retesting is required to check
A20461 - ANC blood counts for safe treatment, this can done immediately without
A20462 - having to go back to Kaiser and delay treatment.
A20463 -
A20464 - [On 070301 testing at UCSF eliminates busy people having to
A20465 - account for differences in units of measures and standards
A20466 - between Kaiser and UCSF labs. ref SDS E0 HI6O
A20468 - ..
A20469 - CA 15-3 blood test is a diagnostic of measurable disease for IBC
A20470 - patients, since typically IBC does not register very well in image
A20471 - tests like PET and CT tests. The CA 15-3 cancer marker measures
A20472 - progression of disease, noted by the primary care physician in a
A20473 - letter to UCSF on 061230. ref SDS B9 PO3V CA 15-3 was initially
A20474 - reported to UCSF as the measurement of rising disease that required
A20475 - switching treatment in 2002, set out in Kaiser's letter to UCSF on
A20476 - 061228. ref SDS B8 D79P
A20477 -
A20478 - [On 070511 Millie ordered CA 15-3 at Kaiser to prepare for
A20479 - meeting with primary care physician scheduled on 070525, and to
A20480 - cross-check remarkable results reported by the UCSF Lab.
A20481 - ref SDS E5 B64J
A20483 - ..
A20484 - [On 070516 Kaiser reports CA 15-3 56 and describes this result
A20485 - as "stable," ref SDS E6 QN6M, which significantly conflicts
A20486 - with testing at UCSF. ref SDS E6 WV6L
A20488 - ..
A20489 - [On 070516 Millie asks Kaiser to verify accuracy of CA 15-3
A20490 - test on 070511, and to notify UCSF to be prepared for meeting
A20491 - with the patient on 070524. ref SDS E6 ZJ9N
A20493 - ..
A20494 - [On 070517 Kaiser advised that UCSF uses a different
A20495 - calibration method for CA 15-3 that cannot be compared to the
A20496 - Kaiser test results, like comparing apples and oranges.
A20497 - ref SDS D9 NT3O
A20499 - ..
A20500 - [On 070517 Nurse's Notes show nurse practitioner ordered
A20501 - another blood test to verify elevated CA 15-3 56 reported in
A20502 - Kaiser's test on 070511; but did not perform the test, and
A20503 - decided to wait another week to address the issue. ref SDS E7
A20504 - FG6H
A20506 - ..
A20507 - [On 070517 Brigid discloses that coordinating divided
A20508 - responsibilities on referral projects is difficult; and that
A20509 - UCSF recommends limiting laboratory work rather than empowering
A20510 - labs to cross-check tests for accuracy. ref SDS E8 466H
A20512 - ..
A20513 - [On 071017 problems ordering blood tests at Kaiser the day
A20514 - before treatment at UCSF - Jackie faxes request for blood draw
A20515 - to Arlette at Kaiser in Walnut Creek, Millie's main treatment
A20516 - location. ref SDS F0 Q45F Arlette is at lunch, delay finding
A20517 - out where to get blood drawn. ref SDS F0 4Q5M Arlette advises
A20518 - UCSF blood draw request was ordered by the doctor; tells
A20519 - customer to coordinate with Kaiser to schedule blood draws.
A20520 - ref SDS F0 4Q7G Kaiser in Walnut Creek cannot do blood draw
A20521 - until next week, ref SDS F0 YE9G; Millie goes to Kaiser in
A20522 - Martinez for the blood draw; finds the order is not entered in
A20523 - the computer, ref SDS F0 OS3F; blood draw performed using order
A20524 - found in the computer for prior blood draw from last January.
A20525 - ref SDS F0 OS5K
A20527 - ..
A20528 - [On 071018 blood test results were not available for review
A20529 - during examination, ref SDS F1 HL7O, treatment at UCSF was
A20530 - delayed for an hour or so until Kaiser submitted blood test
A20531 - results via fax. ref SDS F1 6N9F
A20533 - ..
A20534 - [On 071019 UCSF clinical trial staff confuses Neutrophils in
A20535 - Kaiser's blood test report on 071017, for NEUTS used by UCSF to
A20536 - assess patient safety for treatment. ref SDS F2 EU5U
A20538 - ..
A20539 - [On 071024 letter to UCSF proposes returning to performing
A20540 - blood tests at UCSF in order to avoid problems of confusion and
A20541 - delay, provided UCSF demonstrates there are no extra charges in
A20542 - billings. ref SDS F3 EP5W
A20544 - ..
A20545 - There may be some mechanics to work out so that Kaiser's records are
A20546 - maintained on patient history getting test reports from UCSF computers
A20547 - into Kaiser computers so that everybody is on the same page,
A20548 - especially managing Coumadin treatments based on INR reporting.
A20550 - ..
A20551 - Doing blood tests at UCSF will reduce costs to Kaiser from continual
A20552 - rework to correct mistakes. There were 3 blood tests and several CT
A20553 - tests at Kaiser before Millie got configured for treatment at UCSF.
A20554 -
A20555 -
A20556 -
A20558 - ..
A20559 - INR 1.6 Low Pulmonary Embolism Needs Increase Coumadin Treatment
A20560 - Pulmonary Embolism Treatment Coumadin Needs Increase Low INR 1.6
A20561 -
A20562 - Millie's INR is low again today, at 1.6, for the blood test yesterday.
A20563 - ref SDS C9 P56K, and as shown below. ref SDS 0 SE6N This will require
A20564 - increasing Coumadin. May reflect that Millie is no longer being
A20565 - treated with capecitabine. On 061020 Ross in the Kaiser Pharmacy said
A20566 - that capecitabine compounds effects of Coumadin. ref SDS B1 T650 This
A20567 - was supported by discussion with Kaiser Coagulation Treatment clinic
A20568 - on 061024. ref SDS B2 TZ4I
A20570 - ..
A20571 - Adjusting Coumadin has previously required continuing blood draws,
A20572 - sometimes for months with weekly blood draws. UCSF plans to perform
A20573 - blood tests on site the day of treatments provides an efficient
A20574 - procedure, per above. ref SDS 0 G59O
A20575 -
A20576 -
A20577 -
A20578 -
A206 -
SUBJECTS
Biopsies Cetuximab Clinical Study Not Medically Relevant Too High Ri
A903 -
A90401 - ..
A90402 - Biopsies Not Medically Relevant Too High Risk for Coumadin Patient
A90403 -
A90404 - Follow up ref SDS C7 KT7J, ref SDS C3 0348.
A90405 -
A90406 - Biopsies were discussed today in relation to UCSF letter yesterday,
A90407 - reported on 070131. ref SDS C9 YA6X
A90409 - ..
A90410 - Apparently biopsies for the study do not provide medically relevant
A90411 - pathology to assess, for example, IBC or status change, which would
A90412 - benefit the patient, reviewed in the record on 070130. ref SDS C7 KT7J
A90413 - Since there is no medical benefit for the patient to incur risk of
A90414 - bleeding, the study biopsies pose an unreasonable risk, as reported in
A90415 - Jackie's letter yesterday. ref SDS C9 YA6X
A90417 - ..
A90418 - In this case, Millie's negative "status" is an asset that qualifies
A90419 - for a powerful new treatment. Jackie clarified the study targets
A90420 - patients like Millie who are HER2, ER, PR (triple negative), reported
A90421 - on 020321. ref SDS 8 LA7O This aligns with the consent form received
A90422 - on 070116, but clarifies the meaning of "triple negative." ref SDS C3
A90423 - 0Q7I
A90425 - ..
A90426 - Jackie also noted that while status change does occur. She believes
A90427 - this is a rare event, maybe less than 1%?? Veronica made a similar
A90428 - point recommending investigation for status change in a 2nd opinion
A90429 - received on 050907, ref SDS 78 AE6P
A90430 -
A90431 -
A90432 -
A90433 -
A905 -
SUBJECTS
Cetuximab 1st Cycle 1st Treatment Chemotherapy 8th Cycle IBC 3rd Rel
AC03 -
AC04 - 0850
AC0501 - ..
AC0502 - Infusion Clinic for Cetuximab Treatent 1st Cycle 1st Treatment
AC0503 -
AC0504 - Follow up ref SDS B6 407N.
AC0505 -
AC0506 - Jackie accompanied Millie into the Infusion Clinic.
AC0508 - ..
AC0509 - Received treatment to begin 1st cycle with Cetuximab, and the 8th
AC0510 - treatment for 3rd relapse of IBC.
AC0511 -
AC0512 - [On 080313 Millie begins 16th cycle on clinical study; and
AC0513 - 1st cycle 1st treatment with cetuximab and carboplatin
AC0514 - together treating 4th relapse of IBC. ref SDS F7 TZ8I
AC0515 -
AC0516 - 1. Cycle 09 and 01 for relapse........ 060721, ref SDS 92 407N
AC0517 - 2. Cycle 10 and 02 for relapse........ 060814, ref SDS A1 LY6O
AC0518 - 3. Cycle 11 and 03 for relapse........ 060908, ref SDS A4 407N
AC0519 - 4. Cycle 12 and 04 for relapse........ 060929, ref SDS A6 407N
AC0520 - 5. Cycle 13 and 05 for relapse........ 061020, ref SDS B1 407N
AC0521 - 6. Cycle 14 and 06 for relapse........ 061110, ref SDS B4 407N
AC0522 - 7. Cycle 15 and 07 for relapse........ 061201, ref SDS B6 407N
AC0524 - ..
AC0525 - 8. Cycle 01 and 08 for relapse........ 070201, ref SDS 0 407N
AC0527 - ..
AC0528 - Nurses Notes...
AC0529 -
AC0537 -
AC0538 - [On 070301 visit number changed after 4 meetings.
AC0539 - ref SDS E0 QW4K
AC0541 - ..
AC0542 - UCSF Log Time...
AC0543 -
AC0544 - In....... 0945
AC0545 - Out...... 1330
AC0546 - Visit.... 3.75 Hours
AC0548 - ..
AC0549 - Pain Assessment...
AC0550 -
AC0551 - x
AC0552 - 0123456789 10
AC0554 - ..
AC0555 - Administration Site: Right Port Catheter
AC0556 - Needle Size: 20 G 1"
AC0557 - Blood Return Good: Yes
AC0559 - ..
AC0560 - Remind patient to call MD if temp > 101 F, Shaking Chills
AC0561 -
AC0562 - This protocol differs from Kaiser requirements, reported on
AC0563 - 041202. ref SDS 52 IX9N
AC0565 - ..
AC0566 - Jackie brought 10 blood vials for the clinical study research.
AC0568 - ..
AC0569 - Jackie also brought authorization documents for Millie to get
AC0570 - treatment on the study.
AC0572 - ..
AC0573 - The receptionist asked Millie for insurance or other payment card.
AC0575 - ..
AC0576 - Upon discussion, Millie gave her Medicare account card.
AC0578 - ..
AC0579 - Catherine is the nurse today.
AC0581 - ..
AC0582 - Millie had a blood draw yesterday afternoon, Wednesday, 070131.
AC0583 - ref SDS C9 P56K
AC0584 -
AC0585 -
AC0586 -
AC0587 -
AC06 -
SUBJECTS
Side Effects Infusion Clinic UCSF Consultation Starting New Treatmen
AL03 -
AL04 - 0911
AL0501 - ..
AL0502 - Side Effects Consultation Pharmacist Heavy Chest Difficult Breathing
AL0503 -
AL0504 - Follow up ref SDS B6 QU8K, ref SDS B4 QU8K.
AL0506 - ..
AL0507 - Need a new account for side effects beginning today on Cetuximab
AL0508 - clincial trial.
AL0510 - ..
AL0511 - Catherine asked Millie about past side effects for orientation of
AL0512 - future side effects on the new regimen.
AL0514 - ..
AL0515 - Side effects of treatment with Taxotere and capecitabine (Xeloda) are
AL0516 - listed in the record on 060724. ref SDS 95 QX8K
AL0518 - ..
AL0519 - Tired, fatigued - pulmonary emoblism...
AL0520 -
AL0521 - Millie's energy seems improved the past few weeks, as
AL0522 - reported to the doctor on 070130. ref SDS C7 RT6I
AL0524 - ..
AL0525 - Heavy chest - shortness of breathing
AL0526 -
AL0527 - This condition remains seems improved, as reported to
AL0528 - the doctor on 070130. ref SDS C7 RT6I
AL0530 - ..
AL0531 - Cough - clearing throat
AL0532 -
AL0533 - This condition remains seems improved, as reported to
AL0534 - the doctor on 070130. ref SDS C7 RT6I
AL0535 -
AL0537 - ..
AL0538 - Dry hands and feet...
AL0539 -
AL0540 - This condition seems much improved since ending
AL0541 - treatment with Taxotere and capecitiabine on 061201.
AL0542 -
AL0544 - ..
AL0545 - Eyes tearing
AL0546 -
AL0547 - This seems improved since ending treatment with Taxoter
AL0548 - and capecitabine on 061201.
AL0549 -
AL0551 - ..
AL0552 - Nausea
AL0553 -
AL0554 - Problem previously resolved, as reported on 061110.
AL0555 - ref SDS B4 D19M
AL0556 -
AL0558 - ..
AL0559 - Sores in mouth
AL0560 -
AL0561 - None yet, cleaning mouth carefully to avoid problem.
AL0562 -
AL0563 -
AL0564 -
AL0565 -
AL06 -
SUBJECTS
Schedule Treatment Weekly Thursday 0800 4 Week Cycles Clinical Study
AP03 -
AP0401 - ..
AP0402 - Schedule Weekly Treatments Continue on Thursdays
AP0403 -
AP0404 - Follow up ref SDS B6 QK6L, ref SDS B4 QK6L.
AP0406 - ..
AP0407 - Jackie advised that Millie's next treatment is scheduled for 070208
AP0408 - 0800.
AP0410 - ..
AP0411 - The next blood draw will be in 4 weeks. Jackie coordinated blood
AP0412 - draws for Millie at UCSF in the Infusion Clinic an hour before meeting
AP0413 - with Doctor Rugo to start each new cycle, discussed with Brigid and
AP0414 - Catherine, reported above. ref SDS 0 XR40
AP0415 -
AP0416 -
AP0417 -
AP0418 -
AP05 -
SUBJECTS
Blood Counts Good Test 070131 Enables Full Dose Treatment Cetuximab
AS03 -
AS0401 - ..
AS0402 - Blood Counts Good Dose Cetuximab Normal
AS0403 -
AS0404 - Follow up ref SDS B6 Q659, ref SDS B4 Q659.
AS0406 - ..
AS0407 - Catherine submitted the report on the blood test yesterday on 070131
AS0408 - showing...
AS0409 -
AS0410 - Patient Provider Category View FR Date To Date
AS0416 - ..
AS0417 - Procedure Results Reference Range
AS0418 -
AS0422 -
AS0423 - ** Marina Way South **
AS0425 - ..
AS0426 - Test Name Value Unit <-------- RANGE-------->
AS0427 - @CBC
AS0428 - WBC x 10-3 4.0 K/uL 3.5 - 12.5
AS0429 - RBC x 10-6 3.82 M/uL 3.60 - 5.70
AS0430 - Hemoglobin 12.6 g/dL 11.5 - 15.0
AS0431 - Hematocrit 36.6 % 34.0 - 46.0
AS0432 - MCV 96 fL 80.0 - 100.0
AS0433 - RDW H 14.5 % 11.9 - 14.3
AS0434 - Plt x10-3 236 K/uL 140 - 400
AS0435 - ..
AS0436 - Neutrophils 44 % 50 - 70
AS0437 - Lymphocytes 39 % 20 - 50
AS0438 - Monocyte 9 % 0 - 11
AS0439 - Eosinophils H 8 % 1 - 5
AS0440 - Basophil 1 % 0 - 2
AS0441 - Bands No Report % 0 - 5
AS0443 - ..
AS0444 - CA 15-3 No Report U/mL -< - 39
AS0446 - ..
AS0447 - Alkaline Phos 54 U/L 38 - 126
AS0449 - ..
AS0450 - Sodium 139 mEq/L 137 - 145
AS0451 - Potassium 4.5 mEq/L 3.5 - 5.3
AS0452 - BUN 13 ng/dL 7 - 17
AS0454 - ..
AS0455 - Creatinine 0.76 mg/dL 0.6 - 1.2
AS0456 - Calcium 9.5 mg/dL 8.4 - 10.2
AS0457 - Phosphorus 4.4 mg/dL 2.5 - 4.5
AS0458 - Magnesium 1.9 mg/dL 1.6 - 2.3
AS0459 - Protein, Total 7.1 g/dL 6.3 - 8.2
AS0460 - Albumin 4.3 g/dL 3.4 - 4.8
AS0462 - ..
AS0463 - Bili, Tot Adult 0.4 mg/dL 0.2 - 1.3
AS0464 - Bili, Unconj 0.6 mg/dL 0.1 - 1.1
AS0465 - Bili, Kunj 0.0 mg/dL 0.0 - 0.3
AS0466 - Bili, Direct 0.0 mg/dL 0.0 - 0.4
AS0467 - Bili, Direct 0.0 mg/dL 0.0 - 0.4
AS0469 - ..
AS0470 - ALT (SGPT) 37 U/L 11 - 66
AS0471 - AST (SGOT) 40 U/L
AS0473 - ..
AS0474 - RBC Morphology No Report
AS0475 - Poikilocytosis * No Report
AS0476 - Anisocytosis * No Report
AS0477 - Schistocytes * No Report
AS0478 - PLT Estimate No Report
AS0479 - PLT Morphology No Report
AS0480 -
AS0481 -
AS0482 -
AS0483 -
AS05 -
SUBJECTS
Anticoagulation Therapy Pulmonary Emboli INR Low 1.6 PT Patient High
AV03 -
AV0401 - ..
AV0402 - Anticoagulattion Therapy INR Low 1.6 PT Patient High 16.3
AV0403 -
AV0404 - Follow up ref SDS B6 SE6N, ref SDS B4 SE6N.
AV0405 -
AV0406 - PT, patient H 16.3 sec 8.9 - 11.1
AV0407 - PT INR L 1.6 sec 2 - 3
AV0409 - ..
AV0410 - Low INR may reflect that treatment with capecitabine (Xeloda) stopped
AV0411 - on 061201, and so compounding effect with Coumadin needs to be
AV0412 - reflected by adjusting level of Coumadin treatments, based on Gloria's
AV0413 - comments reported on 061024, ref SDS B2 TZ4I, and as further reported
AV0414 - above discussing blood draws at UCSF. ref SDS 0 6U5J
AV0416 - ..
AV0417 - Gloria called Millie at work and left a message to skip Coumadin on
AV0418 - Sunday in order to reduce INR to below 3.
AV0419 -
AV0420 - [On 070202 Millie called and left a message for Gloria, that
AV0421 - she got Gloria's message today on changing Coumadin protocol,
AV0422 - Millie notified Gloria that treatment with cetuximab was
AV0423 - delayed again from 070131 and actually started on 070201, and
AV0424 - further explained that her work schedule has changed, so she is
AV0425 - no longer at work on Thursday, since this is her new day for
AV0426 - treatments, ref SDS D0 PY5Q; Millie submitted a letter to
AV0427 - Kaiser confirming these understandings. ref SDS D0 428G
AV0429 - ..
AV0430 - [On 070202 Millie asked Kaiser to submit prescription
AV0431 - instructions in writing via email. ref SDS D0 PZ3T
AV0432 -
AV0433 -
AV0434 -
AV0435 -
AV0436 -
AV0437 -
AV0438 -
AV05 -
SUBJECTS
Absolute Neutrophils Count ANC 1760 Well Above 1500 Required for Tre
AY03 -
AY0401 - ..
AY0402 - ANC 1760 Well Above 1500 Criteria for Blood Counts Approve Treatment
AY0403 -
AY0404 - Follow up ref SDS B6 P560, ref SDS B4 P560.
AY0405 -
AY0406 - Millie has been worried lately that blood counts would not be high
AY0407 - enough for treatment, based on side effects reported to Kaiser this
AY0408 - afternoon, per above. ref SDS B6 SK9O Experience since 2002 has shown
AY0409 - a strong correlation between feeling tired, reported today,
AY0410 - ref SDS B4 FG3N, and having low blood counts.
AY0412 - ..
AY0413 - ANC seems to be dropping consistently, shown by reports...
AY0414 -
AY0415 - 6972................................ 060814, ref SDS A1 P560
AY0416 - 6390................................ 060908, ref SDS A4 P560
AY0417 - 5200................................ 060929, ref SDS A6 P560
AY0418 - 3869................................ 061020, ref SDS B1 P560
AY0419 - 2880................................ 061110, ref SDS B4 P560
AY0420 - 2888................................ 061201, ref SDS B6 P560
AY0421 - 1760................................ 070201, ref SDS 0 P560
AY0423 - ..
AY0424 - Formula for ANC, from record on 050128. ref SDS 55 TZ3N
AY0426 - ..
AY0427 - Calculation from 060908 yielded 6390. ref SDS A4 P560
AY0429 - ..
AY0430 - Note that bands are added to neutrophils, but both neutrophils and
AY0431 - bands have no report today.
AY0432 -
AY0433 - WBC = 4.0
AY0434 -
AY0435 - Neutrophils = .44
AY0436 - Bands = no report
AY0438 - ..
AY0439 - ANC = 4.0 x 1000 x .44 = 1760
AY0441 - ..
AY0442 - ANC calculation was not submitted by the nurse today.
AY0443 -
AY0444 -
AY0445 -
AY0446 -
AY05 -
SUBJECTS
CA 15-3 68 Rise from 56 Cancer Marker Current Blood Test Erratic For
B103 -
B10401 - ..
B10402 - CA 15-3 68 Rise from 56 Cancer Marker 2 Tests Pending
B10403 -
B10404 - Follow up ref SDS B6 2N5J, ref SDS B4 2N5J.
B10405 -
B10406 - The test on 070118 was received from Kaiser on 070123 showing 68,
B10407 - which increased 12 points after dropping nearly 20 points to 56
B10408 - reported on 070110. ref SDS C2 087J
B10410 - ..
B10411 - CA 15-3 for blood test yesterday was not available in the report
B10412 - today; there are two tests pending. Millie had CA 15-3 tested on
B10413 - 070123, ref SDS C5 AS6M, and again yesterday on 070113. ref SDS C9
B10414 - L96G
B10415 -
B10416 - [On 070202 CA 15-3 dropped to 52 and rose to 56 in next 2
B10417 - tests. ref SDS D1 087J
B10418 -
B10419 -
B10420 -
B10421 -
B10422 -
B105 -
SUBJECTS
Port Catheter IV Connection Prepare for Drip Treatment 1 Try Require
BA03 -
BA04 - 0907
BA0501 - ..
BA0502 - Preparation for Treatment Required One (1) Attempt to Connect Port
BA0503 -
BA0504 - Follow up ref SDS B6 EB7J, ref SDS B4 EB7J.
BA0506 - ..
BA0507 - UCSF did not follow Kaiser practice of using another nurse to assist
BA0508 - Catherine with verification that Millie is the correct patient, and is
BA0509 - getting the correct medication.
BA0511 - ..
BA0512 - Cetuximab does not require the patient to take Decadron for preparing
BA0513 - to get chemotherapy treatment, per instructions for Taxotere and
BA0514 - capecitabine reported on 050415, ref SDS 62 8U4O, and modified on
BA0515 - 050506. ref SDS 65 OW5G Decadron is given with IV after Benadryl.
BA0517 - ..
BA0518 - Catherine connected the IV tubes to the port....
BA0520 - ..
BA0521 - Interlink System Vented Paclitaxel set
BA0522 -
BA0524 - ..
BA0525 - Blood Flow Port Catheter Very Slow Difficult
BA0526 -
BA0527 - There was some initial problems getting blood to flow from the port
BA0528 - for the blood sample research vials. Catherine took several remedial
BA0529 - measures to eventually achieve sufficient flow to draw blood for the
BA0530 - the seven (7) vials required for the clinical study.
BA0532 - ..
BA0533 - This might have suggested the port was not well enough maintained.
BA0534 - When getting regular treatments, weekly, which will be the case for
BA0535 - Cetuximab, or every 3 weeks with Taxotere and capecitabine, there is
BA0536 - normally not a problem with maintenance of the port. Millie's last
BA0537 - treatment was 2 months ago on 061201. ref SDS B6 0001 Kaiser has a
BA0538 - port maintenance program to flush the port once a month, reported in
BA0539 - the record on 051121. ref SDS 85 SH5N This was done about a month
BA0540 - ago, so Millie is now borderline for needing the port flushed again.
BA0541 -
BA0542 - [On 070208 no initial problems getting blood to flow from the
BA0543 - port. ref SDS D3 DC5W
BA0545 - ..
BA0546 - [On 070222 sluggish blood removal from port again; reported to
BA0547 - doctor. ref SDS D8 DC5W
BA0549 - ..
BA0550 - [On 070301 problem experienced on 070222 did not occur drawing
BA0551 - blood from the port catheter. ref SDS E0 DC5W
BA0553 - ..
BA0554 - [On 070531 problem of no blood return on initial access
BA0555 - occurred again. ref SDS E9 DC5W
BA0557 - ..
BA0558 - Kaiser has not scheduled to have the port flushed, which may be an
BA0559 - error, since no one knew when treatment would wind up being started,
BA0560 - illustrated by the record on 070129. ref SDS C6 YF8U
BA0562 - ..
BA0563 - Catherine flushed the port with saline.
BA0564 -
BA0565 -
BA0566 -
BA0567 -
BA06 -
SUBJECTS
Blood Draws 10 Vials Clinical Study Research Cetuximab Drug Trial Bl
BE03 -
BE0401 - ..
BE0402 - Blood Draws 10 Vials for Clinical Study Research
BE0403 -
BE0404 - Catherine drew 10 vials of blood for the study, delivered by Jackie,
BE0405 - per above. ref SDS 0 1N46
BE0407 - ..
BE0408 - The first few vials were filled normally, then the rate of blood flow
BE0409 - dropped. Each successive vial took longer to fill. The last 2 blood
BE0410 - vials took much longer to fill. There was a joke about Millie
BE0411 - dropping for 10 push ups to pump up the heart rate and speed things
BE0412 - along.
BE0413 -
BE0414 - [On 070208 blood removal flowed normally. ref SDS D3 O56V
BE0416 - ..
BE0417 - [On 070222 blood removal sluggish again using port catheter.
BE0418 - ref SDS D8 DC5W
BE0420 - ..
BE0421 - [On 070301 problem experienced on 070222 did not occur the
BE0422 - following week. ref SDS E0 DC5W
BE0424 - ..
BE0425 - Possibly the blood draw yesterday for treatment today, may,
BE0426 - ref SDS C9 L96G, have contributed to slow blood supply today.
BE0428 - ..
BE0429 - When the blood vials were filled, Jackie took them to the Research
BE0430 - department.
BE0431 -
BE0432 -
BE0433 -
BE0434 -
BE0435 -
BE05 -
SUBJECTS
Benadryl Pre-treatment Prepares Patient for Cetuximab Chemotherapy A
BG03 -
BG04 - 0945
BG0501 - ..
BG0502 - Benadryl Reduce Side Effects Cetuximab Chemotherapy Treatment
BG0503 -
BG0504 - Follow up ref SDS B6 DC7J, ref SDS B4 DC7J.
BG0505 -
BG0506 - Benadryl (diphenhydramine) started. 50 MG....... ref SDS 0 IJ41
BG0508 - ..
BG0509 - Purpose reported on 060721. ref SDS 92 DC7J
BG0511 - ..
BG0512 - Chemotherpay order calls for Benadryl (diphenhydramine) pre-treatment
BG0513 - 30 - 60 minutes prior to cetuximab infusion, shown below. ref SDS 0
BG0514 - IJ41
BG0515 -
BG0516 -
BG0518 - ..
BG06 -
BG07 -
BG08 - 0955
BG09 -
BG0901 - Benedryl completed equipment beeps.
BG0902 -
BG0904 - ..
BG10 -
BG11 -
BG12 - 1000
BG13 -
BG1301 - Decadron (Dexamethasone) IV treatment started. 20 MG. ref SDS 0 FM4M
BG1302 -
BG1303 - Purpose reported on 060721. ref SDS 92 8G9G
BG1304 -
BG1306 - ..
BG14 -
BG15 -
BG16 - 1010
BG17 -
BG1701 - Decadron completed.
BG1702 -
BG1703 -
BG18 -
SUBJECTS
Cetuximab 1st Cycle 1st Treatment Clinical Study Drug Trial Treatmen
BI03 -
BI04 - 1015
BI0501 - ..
BI0502 - Cetuximab Loading Dose 684 MG 1st Treatment 2 Hours
BI0503 -
BI0504 - Follow up ref SDS B6 4N5M, ref SDS B4 4N5M.
BI0505 -
BI0506 - Cetuximab started....
BI0507 -
BI0508 - 684 MG loading dose. ref SDS 0 5555
BI0510 - ..
BI0511 - Study supply
BI0512 -
BI0514 - ..
BI0515 - This first treatment is given slowly over 2 hours. Subsequent weekly
BI0516 - treatments will take only 1 hour.
BI0518 - ..
BI0519 - Chemotherapy Orders...
BI0520 -
BI0521 - [On 080313 new chemotherapy order begins adding Carboplatin
BI0522 - chemotherapy to treatment with cetuximab. ref SDS F7 4E9N
BI0523 -
BI0529 - Auth# Stor BCC LOC
BI0530 - Visit: 12575738 DOS 20070201
BI0532 - ..
BI0533 - Date: 20070201
BI0535 - ..
BI0536 - Study Order for CC#05752: Phase II Trial of Cetuximab alone and
BI0537 - in combination with Carboplatin in ER-negative, PR-negative,
BI0538 - HER2-negative Nonoverexpressing Metastatic Breast Cancers
BI0540 - ..
BI0541 - Dates to be given: 070201
BI0542 - Arm 1:Cetuximab alone
BI0544 - ..
BI0545 - Diagnosis: breast cancer
BI0547 - ..
BI0548 - ICD-9 codes: 174.9
BI0549 - Allergies NKDA
BI0551 - ..
BI0552 - Pre-medications 30 - 60 minutes prior to cetuximab infusion
BI0554 - ..
BI0555 - x Diphenhydramine 50 mg IV or [illegible writing]
BI0556 -
BI0557 - Benadryl............... ref SDS 0 DC7J
BI0558 -
BI0559 - [On 070329 Brigid changed the Chemotherapy Order reducing
BI0560 - Diphenhydramine (Benadryl) from 50 mg to 25 mg in order to
BI0561 - reduce side effects of "restless legs." ref SDS E2 IJ44
BI0563 - ..
BI0564 - x Dexamethasone (??) 10 mg IB or 20 mg IV [handwritten ???]
BI0565 -
BI0566 - Further premed TBD [barely legible handwriting??]
BI0568 - ..
BI0569 - Medication: (plan to give weekly ********STUDY SUPPLY**********
BI0571 - ..
BI0572 - x Cetuximab (Erbitux) (loading dose)
BI0573 -
BI0574 - 400 mg/m [squared] = 684 mg IV over 120 minutes for
BI0575 - first dose x 1
BI0576 -
BI0577 - dose on date 20070201 Maximum infusion rate is 5 ml/minute
BI0578 - (concentration 2 mg/ml)
BI0580 - ..
BI0581 - x Cetuximab (Erbitux) (maintenance dose)
BI0582 -
BI0583 - 250 mg/m [squared] = 428 mg IV (or ____ mg/m[squared] =
BI0584 - ____mg) IV over 60 or ____ minutes.
BI0585 -
BI0586 - Maximum infusion rate is 5 ml/minute (concentration 2 mg/ml)
BI0587 - Infuse once weekly for 8 weeks. First dose to be given on date
BI0588 - 20070201.
BI0590 - ..
BI0591 - Cetuximab is administered undiluted through a low protien
BI0592 - binding 0.22 micro in-line filter. Use NS solution to flush the
BI0593 - line at the end of the infusion.
BI0595 - ..
BI0596 - ARM 2: Administer carboplatin if vital signs are unremarkable
BI0597 - one hour after cetuximab infusion.
BI0599 - ..
BI0600 - Vital signs at baseline, upon cetuximab completion and one hour
BI0601 - after cetuximab.
BI0602 -
BI0603 - ****please note start and stop times****
BI0605 - ..
BI0606 - Laboratory work:
BI0607 -
BI0608 - See carboplatin orders
BI0610 - ..
BI0611 - x Notify MD for dose modifications if patient has severe
BI0612 - acne in form of rash
BI0613 -
BI0614 - CBC with differential and platletes every 4 weeks
BI0615 - Creatinine and magnesium every 4 weeks
BI0616 - BUN AST Alk phos Alt Total bilrubin, electrolyes every 8
BI0617 - weeks. If levels are outside of normal laboratory values
BI0618 - notify Brigid NP (MD/RN) at 415 443 4730
BI0620 - ..
BI0621 - [On 080110 Magnesium not included in labs to start new 4
BI0622 - week cycle. ref SDS F4 HH5I
BI0624 - ..
BI0625 - [On 080313 order for 2nd arm of clinical study that
BI0626 - includes both cetuximab and Carboplatin specifies the same
BI0627 - laboratory blood testing scope. ref SDS F7 M866
BI0629 - ..
BI0630 - x Physician has discussed risks/benefits of therapy with the
BI0631 - patient. Signed consent obtained.
BI0632 -
BI0633 -
BI0634 - Yes No O2 by nasal cannula at 2 liters/min prn for chest
BI0635 - pain or SOB
BI0637 - ..
BI0638 - Yes No Diphenhydramine 50 mg IV prn x1 for urticaria
BI0639 - [barely legible], pruritis SOB
BI0641 - ..
BI0642 - Yes No Hydrocortizone 100 mg IV prn x1 for urticaria
BI0643 - [barely legible], pruritis SOB
BI0645 - ..
BI0646 - Yes No Albuterol inhaler 2-4 puffs prn SOB or chest
BI0647 - tightness
BI0649 - ..
BI0650 - Yes No Epinephrine 1x1000 (1 mg/ml) 0.3 mg IV prn
BI0651 - anaphylaxis
BI0653 - ..
BI0654 - Breast CC05752 Cetuximab doc 20061024
BI0655 - Approved 20060615
BI0656 -
BI0665 -
BI0667 - ..
BI07 -
BI08 -
BI09 - 1215
BI10 -
BI1001 - Cetuximab treatment completed.
BI1002 -
BI1003 - Millie had a 1 hour rest and observation period.
BI1004 -
BI1005 -
BI1007 - ..
BI11 -
BI12 -
BI13 - 1320
BI14 -
BI1401 - Line Flushing...
BI1402 -
BI1403 - Saline: 10 cc
BI1405 - ..
BI1406 - Catherine disconnected the IV tubes.
BI1408 - ..
BI1409 - She inserted Herceptin to flush the port.
BI1410 -
BI1411 - U100 Heparin 5 cc
BI1413 - ..
BI1414 - She then removed the needle from the port, and swabbed the needle
BI1415 - wound, and placed a temporary bandage.
BI1417 - ..
BI1418 - Port Access Removed........ Yes
BI1419 - Site Clear................. Yes
BI1420 - Infusion well tolerated.... Yes
BI1421 -
BI1422 -
BI1423 -
BI1424 -
BI1425 -
BI15 -
SUBJECTS
Vitals Blood Pressure Pulse Temperature Sa02 Weight Infusion Treatme
BL03 -
BL04 - 1310
BL0501 - ..
BL0502 - Vitals Show Patient Stable
BL0503 -
BL0504 - Follow up ref SDS B6 AW4L, ref SDS B4 AW4L.
BL0505 -
BL0506 - Catherine took vitals after starting Taxotere drip treatment...
BL0507 -
BL0508 - Blood
BL0509 - Date Time Pressure Pulse Temprtr Weight So2
BL0511 - ..
BL0512 - 070201 1330..... 136 74 66 148 94
BL0513 - 070201 1220..... 110 65 62 36.3c 148 96
BL0514 - 070201 1000..... 132 80 65 36.9c 148 99
BL0515 - 061201 1534..... 123 76 76 97.5 150
BL0516 - 061110 1534..... 136 83 73 97.0 150 98
BL0517 - 061020 1534..... 140 79 67 99.8 151 97
BL0518 - 060929 1452..... 141 78 66 98.3 149
BL0519 - 060908 1335..... 139 79 73 98.1 149
BL0520 - 060814 1610..... 139 80 59 98.2 151
BL0521 - 060722 1440..... 142 74 67 98.1 149
BL0522 - 060711.......... 172 87 54 97.5 147
BL0523 - 060623.......... 141 87 71 98.0 147
BL0524 - 060428.......... 129 73 80 99.4 149
BL0525 - 060217.......... 153 81 61 98.6 150
BL0526 - 050916.......... 120 80 80 98.5
BL0527 -
BL0528 -
BL0529 -
BL06 -
SUBJECTS
Energy Normal Stable Alert Drive Home After Treatment IBC 3rd Relaps
BO03 -
BO04 - 1705
BO0501 - ..
BO0502 - Energy Normal Stable After Treatment Taxotere Support Drugs
BO0503 -
BO0504 - Follow up ref SDS B6 F54N, ref SDS B4 F54N.
BO0506 - ..
BO0507 - On 060724 diary side effects for 2nd phase taking Taxotere and
BO0508 - capecitabine (Xeloda). ref SDS 95 YP4I
BO0510 - ..
BO0511 - Millie was alert after treatment today, and not wobbly nor
BO0512 - disoriented.
BO0514 - ..
BO0515 - She was able to drive home from San Francisco to Concord without
BO0516 - difficulty. Performed several tasks, including stopping at DMV to get
BO0517 - handicap parking permit by submitting the form received from Jacki
BO0518 - this morning, per above, ref SDS 0 YY3F, and which was approved by
BO0519 - Doctor Rugo at UCSF in the meeting on Tuesday, reported on 070130
BO0520 - 1300. ref SDS C7 JK4G
BO0521 -
BO0522 - [On 110420 1538 received from DMV handicap parking permit
BO0523 - until June 2013. ref SDS G5 BZ5H
BO0525 - ..
BO0526 - She went to the store.
BO0528 - ..
BO0529 - Millie had trouble sleeping last night. She was up about every hour.
BO0531 - ..
BO0532 - Her energy level the next day was normal to elevated.
BO0534 - ..
BO0535 - So far, no acne-like rash or other evident side effects.
BO0536 -
BO0537 -
BO0538 -
BO0539 -
BO0540 -
BO0541 -
BO0542 -
BO06 -