CONTACTS 

SUBJECTS
Anticoagulation Therapy Pulmonary Emboli INR Low 1.8 PT Patient No R

1203 -
1203 -    ..
1204 - Summary/Objective
1205 -
120501 - Follow up ref SDS 7 0000. ref SDS 4 0000.
120502 -
120503 -
120504 -
120505 -
120506 -
120508 -  ..
1206 -
1207 -
1208 - Progress
1209 -
120901 - Millie had a blood test on 070131. ref SDS 5 L96G  The report received
120902 - during treatment at Kaiser on 070201 showed INR 1.6. ref SDS 6 SE6N
120903 - At that time, Gloria adjusted Millie's Coumadin and ordered another
120904 - blood test today.  After treatment at UCSF this morning, on the way
120905 - home, Millie stopped at Kaiser in Walnut Creek and had another blood
120906 - draw in the laboratory on the 1st floor.
120908 -  ..
120909 - Gloria called and left a message at the house, with results of the
120910 - blood draw, as Millie requested in her letter to Kaiser on 070202.
120911 - ref SDS 7 PY5U
120913 -  ..
120914 - Millie also received ref DRT 1 0001 from Gloria confirming the
120915 - telephone message, as further requested in Millie's letter on 070202.
120916 - ref SDS 7 PZ3T
120917 -
120918 -    1.  Here are your Protime blood test results:
120919 -
120920 -            Your INR result: INR 1.8   02/08/2007, ref DRT 1 0001
120922 -             ..
120923 -            Your Target INR range: INR Low Range: 2  - INR High Range:
120924 -            3
120925 -
120926 -               [On 070215 blood test INR 2.5, so can skip blood test
120927 -               for INR the following week. ref SDS 9 IC9O
120929 -         ..
120930 -    2.  Please take your Warfarin as described on the calendar below
120931 -        and continue with your regular blood tests. ref DRT 1 BK6H
120933 -         ..
120934 -    3.  Your New Warfarin Schedule is as follows:
120936 -             ..
120937 -            NEW Dosing Instructions:  Using Warfarin 4MG Tablet (BLUE
120938 -            in color):  Take 6MG (1 & 1/2 tabs) every Thursday; take
120939 -            4MG ( 1 tab) all other days of the week. ref DRT 1 TK6L
120941 -         ..
120942 -    4.  OR:, ref DRT 1 DL7I
120943 -
120944 -            Sunday      4 MG
120945 -            Monday      4 MG
120946 -            Tuesday     4 MG
120947 -            Wednesday   4 MG
120948 -            Thursday    6 MG
120949 -            Friday      4 MG
120950 -            Saturday    4 MG
120952 -         ..
120953 -    5.  Please have your next protime blood test on Follow up date:
120954 -        2/15/07 If possible, do not have your INR labs done on Fridays
120955 -        or weekends.  For same day results, go to the lab before 11am.
120956 -        ref DRT 1 OU86
120957 -
120958 -               [On 070215 blood test INR 2.5, so can skip blood test
120959 -               for INR the following week. ref SDS 9 6U5J
120961 -  ..
120962 - Millie's next blood draw will on 070301 at UCSF, per meeting today at
120963 - UCSF with Brigid and Jackie, and in connection with planning Millie's
120964 - blood draws for treatment on the cetuximab clinical trial. ref SDS 8
120965 - XR40
120967 -  ..
120968 - On 061201, Millie ended treatment with capecitabine (Xeloda), which
120969 - causes erratic Coumadin requirements, reported by Gloria on 061024.
120970 - ref SDS 1 0M5J  The past few Coumadin treatments reflect this with low
120971 - counts.  Since Gloria's prescription is raising Millie's INR count
120972 - from 1.6 to 1.8 toward the target range of 2 - 3, ref SDS 0 8Y3V, and
120973 - since there is no evidence that the new treatment with cetuximab
120974 - affects Coumadin (warfarin) treatments, as capecitabine did, then
120975 - there is minimal risk of losing control of pulmonary embolism blood
120976 - thining treatments by switching to monthly blood tests, with the next
120977 - test on 070301, per above. ref SDS 0 626J
120979 -  ..
120980 - Gloria's letter to Millie continues...
120981 -
120982 -    6.  Please contact us at (925) 372-1628 or Fax (925) 372-1229.
120983 -        ref DRT 1 OU8G
120984 -
120985 -        •  If your warfarin dose is different than what is written on
120986 -           this letter.
120988 -            ..
120989 -        •  If you do not receive a call or a letter in 4 or 5 days
120990 -           after your lab work. ref DRT 1 OU89
120992 -            ..
120993 -        •  If you have any unusual bruises or bleeding. ref DRT 1 OU93
120995 -            ..
120996 -        •  If there are changes in your medications, vitamin k intake
120997 -           in your diet, vitamins, herbal products, or alcohol use.
120998 -           ref DRT 1 VN4F
121000 -            ..
121001 -        •  If you become ill or have decreased appetite, diarrhea,
121002 -           vomiting. ref DRT 1 OU98
121004 -            ..
121005 -        •  Also call us if you are planning to have surgical or dental
121006 -           procedure. ref DRT 1 OU97
121007 -
121008 -
121009 -
121010 -
1211 -

SUBJECTS
Blood Test Schedule Pulmonary Embolism Coumadin Treatments Propose N

2103 -
2104 - 1717
210501 -  ..
210502 - Coordinate Blood Tests Pulmonary Embolism Cetuximab Clinical Study
210503 -
210504 - Millie submitted ref DIT 1 0001 to Gloria with a copy to Jackie at
210505 - UCSF, responding to Kaiser's letter, ref DRT 1 0001, received earlier
210506 - today, per above. ref SDS 0 MY3K
210507 -
210508 -    1.  Thanks very much for your letter today, ref SDS 0 5L9M, and
210509 -        confirming your telephone message which I received when I got
210510 -        home from San Francisco today. ref SDS 0 E99J  I am
210511 -        implementing your new instructions for Coumadin. ref SDS 0
210512 -        8Y4R, ref DIT 1 0001
210514 -         ..
210515 -    2.  Your instruction to get a blood test before 1100 on Thursday
210516 -        presents a coordination problem. ref SDS 0 MY3K  I am copying
210517 -        Jackie at UCSF, who is coordinating my new treatments for
210518 -        cancer. ref DIT 1 QU5M
210520 -         ..
210521 -    3.  UCSF can draw blood on Thursday before 1100 because I can get
210522 -        up at 0500 and drive to the City before traffic becomes a
210523 -        nightmare, and then get treatment after results are available.
210524 -        Jackie has put this schedule into place, ref SDS 8 XR40,
210525 -        however, they only need one test every 4 weeks.  My next
210526 -        treatment is next Thursday at 0830.  I cannot get back to
210527 -        Concord until about 1200, as we did today.  The test after that
210528 -        on 070301 will draw blood at 1145, because I have a meeting
210529 -        with Doctor Rugo at 1330 before getting another treatment.
210530 -        Should I draw blood twice, or can INR be tested in the same
210531 -        blood draw?  I am happy to move the test ahead to before 1100,
210532 -        as you request. ref DIT 1 QU6I
210534 -         ..
210535 -    4.  How critical is the interim blood test for next week?  Could we
210536 -        possibly squeeze by and test the following week to avoid
210537 -        conflicts with treatment at UCSF? ref DIT 1 QU7K
210538 -
210539 -               [On 070215 blood test INR 2.5, so can skip blood test
210540 -               for INR the following week. ref SDS 9 6U5J
210542 -         ..
210543 -    5.  Whatever happens, I greatly appreciate your stewardship of my
210544 -        treatments for pulmonary embolism. ref DIT 1 QU7Q
210545 -
210546 -
210547 -
210548 -
2106 -

SUBJECTS
Blood Test Schedule Pulmonary Embolism Coumadin Treatments Approve S

3403 -
3404 - 1903
340501 -  ..
340502 - Skip Next Treatment Approved
340503 -
340504 - Millie received ref DRT 2 0001 from Gloria responding to Millie's
340505 - letter earlier today ref DIT 1 0001, reported above. ref SDS 0 CS8O
340507 -  ..
340508 - Gloria says to Millie...
340509 -
340510 -    1.  Yes, we can skip next week if you can not make it to the lab:
340511 -        however, the timing (before 11am) is not necessary unless you
340512 -        want results the same day.
340513 -
340514 -    2.  Otherwise you can test at any time of the day.
340515 -
340516 -               [On 070215 blood test INR 2.5, so can skip blood test
340517 -               for INR the following week. ref SDS 9 6U5J
340519 -         ..
340520 -    3.  Hope this helps
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3406 -