CONTACTS 

SUBJECTS
Examination Treatment Cetuximab 4th Treatment 1st Cycle Chemotherapy

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS D3 0000. ref SDS D0 0000.
060502 -
060503 - Examination of rash on upper left arm indicates more likely IBC rather
060504 - than cellulitis. ref SDS 0 B64F  Treatment for cellulitis was
060505 - continued as unharmful, if disease turns out to be IBC. ref SDS 0 IS5K
060506 - Jackie took photographs to get a baseline condition for measurable
060507 - disease to evaluate progression of IBC on the left arm. ref SDS 0 6T6M
060508 - Brigid verified that Millie plays tennis right handed in order to
060509 - avoid causing complications of lymphedema in the left arm causing
060510 - cellulitis. ref SDS 0 457F  Brigid wrote a prescription to treat
060511 - facial rash that is a side effect of cetuximab treatment for IBC.
060512 - ref SDS 0 FO66  After examination, went to Infusion Clinic and got the
060513 - 4th treatment of the 1st cycle on the clinical study for cetuximab.
060514 - ref SDS 0 1M6H
060515 -
060516 -
060517 -
060518 -
060520 -  ..
0606 -
0607 -
0608 - Progress
0609 -
060901 - Clinic Examination Orientation Starting Treatment Cetuximab
060902 -
060903 - Follow up ref SDS D3 407N, ref SDS D0 407N.
060904 -
060905 - Agenda...
060906 -
060907 -    1.  Breast examination IBC left arm........... ref SDS 0 FO6H
060908 -    2.  Measurable disease photographs............ ref SDS 0 6T6M
060909 -    3.  Side effects prescribe for face rash...... ref SDS 0 FO66
060910 -    4.  Infusion Clinic........................... ref SDS 0 1M6H
060911 -    5.  Side effects review....................... ref SDS 0 QU8K
060912 -
060913 -
060914 -
0610 -

SUBJECTS
Breast Examination Shows Improvement IBC Rash Left Right Breast Stom

1203 -
120401 -  ..
120402 - IBC Spreads Left Arm IBC Intensity Subsides Conflicting Evidence
120403 - Breast Examination Likely IBC Progression Spreading Upper Left Arm
120404 -
120405 - Follow up ref SDS D3 FO6H, ref SDS D0 FO6H.
120406 -
120407 - No examination was scheduled today, as planned on 070208 under the
120408 - clinical study protocol. ref SDS D0 IU5M
120410 -  ..
120411 - During examination at Kaiser on 070202 the primary care physician
120412 - observed a rash on Millie's upper left arm. ref SDS C8 6Q5N  On 070214
120413 - Millie notifed the doctor that the rash persisted, and asked about
120414 - renewal of prescription for treating cellulitis recurrence.
120415 - ref SDS D2 R66P  On 070215 Millie submitted a follow up notice to
120416 - Kaiser with a copy to UCSF. ref SDS D4 VW4R
120418 -  ..
120419 - Jackie notified Millie on 070216 that UCSF would examine the new rash
120420 - on the upper left during the meeting today. ref SDS D5 VE3K  The next
120421 - day, on 070217 Millie responded noting concern that new rash on the
120422 - arm could be expanding IBC, and asking for coordination to notify the
120423 - Infusion Clinic that treatment would be delayed today for an exigent
120424 - examination. ref SDS D6 BD6P
120426 -  ..
120427 - Today, Brigid examined the rash on the upper left arm.  This is a
120428 - solid, continuous rash with medium intensity, and irregular shape,
120429 - unlike cellulitis that covers the entire arm, reported on 061027.
120430 - ref SDS B1 WO6N
120432 -  ..
120433 - Brigid indicated that the rash looks and feels more like IBC, than
120434 - cellulitis.  This indicates that since 061204 cancer has spread
120435 - to...
120436 -
120437 -            right breast...................... 061204, ref SDS B7 AE5I
120438 -            stomach........................... 070130, ref SDS C5 M68J
120439 -            back.............................. 070130, ref SDS C5 M68J
120440 -            left arm.......................... 070202, ref SDS C8 6Q5N
120442 -  ..
120443 - IBC occurring on the left arm presents a major progression of disease
120444 - that may signal treatment with cetuximab alone is failing.  May relate
120445 - to Millie suffering severe Cellulitus treated in the Emergency Room at
120446 - Kaiser on 061027.  At that time, swelled lymphatics were observed
120447 - running from the area of IBC on the left chest up to the left
120448 - shoulder, perhaps providing a path for IBC infection. ref SDS B1 V79M
120450 -  ..
120451 - On the positive side, intensity of the IBC rash seems to be subsiding
120452 - on the left chest, and new areas of IBC seem relatively quiet.  UCSF
120453 - needs results for CA 15-3 tests in order to assess changing treatment
120454 - to increase effectiveness, per below. ref SDS 0 ER5O
120455 -
120456 -     [On 070228 Millie's letter to UCSF requests coordination with
120457 -     Kaiser to get 2 CA 15-3 cancer tests for evaluating rate of
120458 -     progression that determines when to change treatments to prevent
120459 -     disease from cascading out of control. ref SDS D9 LQ5X
120461 -      ..
120462 -     [On 070301 IBC progression to left arm, evident rise CA 15-3
120463 -     cancer marker presents prognosis of failed response to treatment,
120464 -     requiring increasing prescription from cetuximab alone to add
120465 -     carboplatin. ref SDS E0 OL5M
120467 -      ..
120468 -     [On 070524 CA 15-3 37 cancer marker rises 30% signals
120469 -     effectiveness of treatment with cetuximab alone may be
120470 -     ending; since IBC continues to subside, and CT tests
120471 -     shown no progression of disease, decided to continue
120472 -     with cetuximab alone now. ref SDS E8 357I
120473 -
120474 -
120475 -
120476 -
120477 -
1205 -

SUBJECTS
Coordination Plan Facilitate Collaboration UCSF Kaiser Medical Care

2203 -
220401 -  ..
220402 - Coordination Plan Facilitate Collaboration UCSF Kaiser Common Care
220403 -
220404 - Follow up ref SDS C8 RM4G, ref SDS C5 RM4G.
220405 -
220406 - Jackie commented that UCSF needs a coordination plan to collaborate
220407 - with Kaiser on dividing responsibilities for comprehensive care of the
220408 - many issues in Millie's case.  Complex patient history listed on
220409 - 070202 increases risk of overlooking problems and mistaking symptoms.
220410 - ref SDS C8 LU3J  The case study on 070130 showed requirements for
220411 - better coordination. ref SDS C5 4T5N
220413 -  ..
220414 - After the examination today, Millie went to the Infusion Clinic for
220415 - treatment.  Jackie took a few minutes to examine the record on
220416 - coordination.  She explained that access to the Internet is fast and
220417 - easy on the UCSF wireless network.  However, we were unable to make a
220418 - connection, so we used data on c15 to review scope. ref SDS 0 KL5G
220420 -               ..
220421 -              [On 070228 letter to UCSF requests draft of coordination
220422 -              plan for review during meeting on 070301. ref SDS D9 LQ6R
220424 -               ..
220425 -              [On 070301 there wasn't enough time to review draft
220426 -              coordination plan. ref SDS E0 HH7H
220428 -               ..
220429 -              [On 070301 UCSF asks patient to coordinate communications
220430 -              with Kaiser on integrated care and divided
220431 -              responsibilities. ref SDS E0 O67N
220433 -               ..
220434 -              [On 070308 coordination planning presents complex
220435 -              challenges that resist communication. ref SDS E0 O24J
220437 -               ..
220438 -              [On 070309 Arlette reports her schedule has changed, and
220439 -              she can no longer support coordination as done
220440 -              previously. ref SDS E5 VP4P
220442 -               ..
220443 -              [On 070517 Brigid discloses that coordinating divided
220444 -              responsibilities on referral projects is difficult; and
220445 -              that UCSF recommends limiting laboratory work rather than
220446 -              empowering labs to cross-check tests for accuracy.
220447 -              ref SDS E7 466H
220449 -               ..
220450 -              [On 070610 primary care physician advises channels of
220451 -              communication now established with UCSF for referral case
220452 -              management. ref SDS F2 GV9G
220454 -               ..
220455 -              [On 070719 got help for connecting to the UCSF wireless
220456 -              network to access the Internet and email. ref SDS F3 HT6F
220458 -               ..
220459 -              [On 080305 problems transmitting laboratory blood tests
220460 -              from UCSF and entering into Kaiser medical chart
220461 -              continues for the entire year. ref SDS F7 LS6O
220463 -               ..
220464 -              [On 080306 UCSF reports reliance on Kaiser for backup
220465 -              analysis to strengthen care for patient with complex
220466 -              patient history of compound medical problems. ref SDS F8
220467 -              JT3L
220468 -
220470 -  ..
220471 - Pending action items support Jackie's proposal for Kaiser and UCSF to
220472 - develop a referral coordination plan, per above, ref SDS 0 VK5N,
220473 - include...
220474 -
220475 -        1.  Kaiser primary care physician backup medical opinion for
220476 -            comprehensive cancer care by UCSF; and UCSF complements
220477 -            Kaiser team care case management of total patient care.
220478 -            How is progress and assessment at Kaiser on the full range
220479 -            of patient issues entered into UCSF medical chart for
220480 -            integrated analysis; similarly, how will UCSF focus on
220481 -            cancer treatment in the clinical trial be entered into
220482 -            Kaiser medical chart for consideration of implications on
220483 -            total patient care?
220485 -               ..
220486 -              [On 080305 primary care physician at Kaiser reported that
220487 -              new correspondence procedures at UCSF for secure email
220488 -              prevent timely efficient distribution of the record.  He
220489 -              could not figure out what buttons to press in order to
220490 -              accomplish anything.  Very frustrating, which discourages
220491 -              busy people from communicating. ref SDS F7 US6I
220493 -               ..
220494 -              [On 080306 UCSF reports reliance on Kaiser primary care
220495 -              physician for backup medical opinion. ref SDS F8 JT3L
220497 -             ..
220498 -        2.  Emergency treatment
220499 -
220500 -            On 070201 Jackie advised Millie to call UCSF for emergency
220501 -            treatment. ref SDS C7 407N
220503 -             ..
220504 -            On 070215 confusion coordination medications. ref SDS D4
220505 -            VW6U
220507 -             ..
220508 -            On 070216 Jackie confirmed Millie should call UCSF for
220509 -            emergency treatment. ref SDS D5 AM4N
220510 -
220511 -              [On 070228 scope coordination plan includes Emergency
220512 -              Care procedures at Kaiser. ref SDS D9 LR3V
220513 -
220514 -              [On 070607 questions on Emergency treatment occurred in
220515 -              connection with recurrent Cellulitis diagnosed at UCSF.
220516 -              ref SDS F0 8J5C
220518 -               ..
220519 -              [On 070608 Brigid initiated coordination with Kaiser by
220520 -              requesting contact information for communications.
220521 -              ref SDS F1 035H
220523 -               ..
220524 -              [On 070610 primary care physician at Kaiser reports
220525 -              communication channels are now open with UCSF, signaling
220526 -              progress toward coordination planning on referral
220527 -              projects. ref SDS F2 OG7F
220529 -             ..
220530 -            On 070217 Millie requested clarification of emergency
220531 -            procedures; presents issues to be addressed, ref SDS D6
220532 -            AM4N; notes emergencies cannot afforc complex procedures.
220533 -            ref SDS D6 BD8T
220535 -             ..
220536 -        3.  IBC expands to left arm. ref SDS 0 B64F
220538 -             ..
220539 -        4.  Lymphedema left arm may be at risk tennis. ref SDS 0 IS5K
220541 -             ..
220542 -        5.  CT test notify Kaiser when to order the test in time for
220543 -            UCSF requirements on the study; on 070202 primary care
220544 -            physician at Kaiser requested 1 month notice to order CT
220545 -            test that also checks for pulmonary embolism.
220547 -             ..
220548 -        6.  Current medications to avoid conflicts; for example today
220549 -            medication was prescribed for face rash side effects
220550 -            cetuximab clinical study drug trial requires assessment to
220551 -            avoid conflicts, ref SDS 0 FO66  Medication was also added
220552 -            to treat facial dryness cited today in side effects.
220553 -            ref SDS 0 UM32
220555 -             ..
220556 -        7.  Blood test results and converting to common standards for
220557 -            accurate diagnosis and treatment, ref SDS 0 XR40; e.g., INR
220558 -            for Coumadin treatment of pulmonary embolism. ref SDS 0
220559 -            6U5J
220560 -
220561 -              [On 080305 continuing problems getting UCSF blood test
220562 -              reports entered into Kaiser's medical chart. ref SDS F7
220563 -              417N
220565 -               ..
220566 -              [On 080307 report for laboratory blood test at UCSF was
220567 -              submitted to primary care physician at Kaiser for
220568 -              addition to the medical chart that provides current,
220569 -              accurate data that enables comprehensive assessment to
220570 -              backup UCSF medical opinion on patient care. ref SDS F9
220571 -              ZX4K
220573 -             ..
220574 -        8.  Billings and payments should not require coordination since
220575 -            the doctor advised in correspondence on 061230 that Kaiser
220576 -            would pay for all costs for standard of care not paid for
220577 -            the clinical trial component. ref SDS B9 3X6K
220578 -
220579 -              [On 070228 scope coordination plan includes blood test
220580 -              report procedures. ref SDS D9 LQ6W
220582 -               ..
220583 -              [On 070329 coordination failed, side effects were not
220584 -              reviewed to prepare for discussion with the patient
220585 -              during a meeting at UCSF. ref SDS E6 945F
220587 -               ..
220588 -              [On 070329 UCSF objects to timely distribution of patient
220589 -              history for being prepared to make meetings productive
220590 -              with comprehensive review of side effects on cetuximab
220591 -              clinical study. ref SDS E6 W25L
220593 -               ..
220594 -              [On 070823 Millie receives nearly 100 documents from
220595 -              Kaiser and UCSF with conflicting invoices, Kaiser
220596 -              refusing payments and UCSF claiming recovery from Millie,
220597 -              ref SDS F4 X16N, which conflicts with the bargain entered
220598 -              into on 070119. ref SDS B9 3X6K
220600 -               ..
220601 -              [On 070830 Millie gets "big bill" of over $10K claimed by
220602 -              UCSF because Kaiser and UCSF failed to complete
220603 -              coordination for referral. ref SDS F5 W05N
220605 -             ..
220606 -        9.  Communciation balancing timeliness and accuracy enabled by
220607 -            email to save lives, time, and money balanced against ITT
220608 -            departments requiring busy professionals to remember how to
220609 -            use multiple systems that encourages greater reliance on
220610 -            conversation that seems fast and easy, and degrades
220611 -            productivity to zero.
220613 -               ..
220614 -              [On 08304 UCSF proposes reliance on conversation for
220615 -              critical medical advice, and resists confirmation in
220616 -              writing. ref SDS F6 6T41
220618 -               ..
220619 -              [On 080304 UCSF adopts new communication procedure using
220620 -              a separate email system that requires remembering new
220621 -              passwords and "hints," ref SDS F6 0T8F and ref SDS F6
220622 -              KV6M, that complicate and delay communications.
220623 -              ref SDS F6 SG8I
220625 -               ..
220626 -              [On 080304 UCSF correspondence conflicts with
220627 -              understanding from conversation. ref SDS F6 B18J
220629 -               ..
220630 -              [On 080305 primary care physician at Kaiser had
220631 -              difficulty using new email procedures at UCSF.
220632 -              ref SDS F7 US6I
220634 -               ..
220635 -              [On 080306 during the meeting at UCSF, the medical team
220636 -              disclosed that UCSF management has mandated using a UCSF
220637 -              email channel for secure communication, rather than
220638 -              provide timely, accurate communication requested by the
220639 -              patient. ref SDS F8 JT66
220641 -               ..
220642 -              [On 080719 Kaiser Infusion Clinic prepared report on work
220643 -              to maintain Power Port after failure of CT test at Kaiser
220644 -              the day before on 080718, so that UCSF notified port can
220645 -              be safely used for blood draws and treatments.
220646 -              ref SDS G1 LL4H
220648 -             ..
220649 -       10.  Neupogen treatments at Kaiser require Chemotherpay Orders
220650 -            showing work at Kaiser aligns with the doctor's
220651 -            prescription at UCSF.
220653 -               ..
220654 -              [On 080609 Zan in the Kaiser Oncology Pharmacy asked for
220655 -              copies of UCSF Chemotherapy Orders prescribing Neupogen
220656 -              treatments at Kaiser Infusion Clinic. ref SDS G0 XN8N
220657 -
220658 -
220659 -
220660 -
220661 -
2207 -

SUBJECTS
Lymphedema Complications Cellulitis Tennis Risk Management Right Han

2603 -
260401 -  ..
260402 - Lymphedema Cellulitis Complications Playing Tennis
260403 -
260404 - Follow up
260405 -
260406 - Brigid suggested continuing Keflex antibiotic treatment just in case
260407 - the rash is actually Cellulitis.  Treatment was received from the
260408 - pharmacy at Kaiser on 070218, ref SDS D7 N069, as shown in Millie's
260409 - letter to Kaiser on 070217. ref SDS D6 9C6J
260411 -  ..
260412 - Patient history on lymphedema and complications of cellulitis are
260413 - reported in a case study on 070130. ref SDS C5 VX6F
260415 -  ..
260416 - Brigid asked Millie if she plays tennis right handed, following up
260417 - Millie's letter on 070218 reporting increased energy enabled playing
260418 - tennis for the first time in 6 years. ref SDS D7 N05H  There is
260419 - concern that extended strain on the left arm from exercise like tennis
260420 - can increase side effects of lymphedema with complications of
260421 - cellulitis, which can become very serious, shown by Millie's treatment
260422 - in the hospital for 5 days on 061027. ref SDS B1 Q265  Since Millie is
260423 - right handed, this seems like a manageable risk in order to maintain
260424 - fitness that strengthens the immune system to resist cancer.
260426 -  ..
260427 - How will considerations for lymphedema and cellulitis be submitted to
260428 - Kaiser, including the physical therapyst, Mary, who treated Millie
260429 - last year,e.g., on 060710, ref SDS 88 Q05H, for opportunity to
260430 - contribute on shaping procedures in this matter?
260431 -
260432 -
260433 -
260434 -
260435 -
2605 -

SUBJECTS
Measureable Disease IBC Rash Photographs Tape Measure Evaluate Progr

2903 -
290401 -  ..
290402 - Measureable Disease Photographs IBC Rash Improving
290403 - IBC Rash Improved Measurable Disease Photographs Tape Measure
290404 -
290405 - Follow up ref SDS D3 6T6M, ref SDS D0 6T6M.
290406 -
290407 - Brigid used the procedure on 070201. ref SDS C7 6T6M  She placed
290408 - identification stickers on the arm, and held a cloth-like tape measure
290409 - in several directions on Millie's upper left arm.  Jackie took
290410 - photographs using the same camera to record scope of initial condition
290411 - observed today, which seems about the same as seen earlier on 070202.
290412 -
290413 -
290414 -
290415 -
290416 -
2905 -

SUBJECTS
Side Effects Infusion Clinic UCSF Consultation Treatment Cetuximab A

3503 -
350401 -  ..
350402 - Side Effects Medicated After Weekly Examinations
350403 -
350404 - Follow up ref SDS D3 FO66, ref SDS D0 FO66.
350405 -
350406 - Brigid wrote a prescription to treat facial rash requested on 070208,
350407 - ref SDS D0 FO66, and later prescribed by the pharmacy doctor during
350408 - the meeting for treatment on 070215. ref SDS D3 QU8K
350410 -             ..
350411 -            Benza Clin Clindamycin benzoyl peroxide gel
350412 -
350413 -            NDC 0066-0494-24
350414 -            25 g jar
350416 -  ..
350417 - How does coordination occur to notify Kaiser of current medications,
350418 - and who is checking to verify there are no conflicts, as occurred on
350419 - 061020, ref SDS A9 YQ7L, and again on 061214? ref SDS B8 XF77
350420 -
350421 -     [On 070329 Millie looks great, and feels fortunate to have avoided
350422 -     severe skin rash side effects of cetuximab by applying treatment
350423 -     prescribed by Brigid. ref SDS E6 N49K
350424 -
350425 -
350426 -
350427 -
350428 -
3505 -

SUBJECTS
Blood Tests Cetuximab Monthly Clinical Study Drug Trial Performed at

3803 -
380401 -  ..
380402 - Blood Tests 1 Per Month on Cetuximab Performed at UCSF Saves Time Cost
380403 -
380404 - Follow up ref SDS D3 XR40, ref SDS D0 XR40.
380405 -
380406 - No blood test today for cetuximab treatment; Jackie has scheduled the
380407 - next blood test for the clinical study on 070301, per planning on
380408 - 070208. ref SDS D0 XR40
380410 -  ..
380411 - How will coordination occur with Kaiser to submit blood test reports,
380412 - so that Kaiser has a complete record of patient history in their
380413 - computer for the medical chart?
380414 -
380415 -        [On 070301 UCSF blood test diagnostics vary significantly from
380416 -        Kaiser procedures, requiring coordination for common assessment
380417 -        of patient history. ref SDS E1 Q659
380419 -         ..
380420 -        [On 070305 Kaiser notified of differences with UCSF blood test
380421 -        diagnostics. ref SDS E3 K14H
380422 -
380424 -  ..
380425 - INR 2.5 Pulmonary Embolism Coumadin Treatment Stable
380426 - Pulmonary Embolism Treatment Coumadin Stable INR 2.5
380427 -
380428 - Follow up ref SDS D3 6U5J, ref SDS D0 6U5J.
380429 -
380430 - No test for INR today, because on 070215 INR tested at 2.5 within the
380431 - range of 2.0 - 3.0. ref SDS D3 IC9O
380433 -  ..
380434 - How will Gloria at Kaiser's Coagulation Control Clinic in Martinez be
380435 - notified of INR diagnostic results for the blood test scheduled for
380436 - next week on 070301, in order to make adjustments in Coumadin
380437 - treatments for pulmonary embolism?
380438 -
380439 -        [...below issues followed up with Kaiser. ref SDS 0 SE6N
380440 -
380441 -
380442 -
3805 -

SUBJECTS
Cetuximab 1st Cycle 4th Treatment Chemotherapy 8th Cycle IBC 3rd Rel

4103 -
4104 - 0850
410501 -  ..
410502 - Infusion Clinic for Cetuximab Treatent
410503 -
410504 - Follow up ref SDS D3 1M6H, ref SDS D0 1M6H.
410505 -
410506 - Treatment was delayed an hour today due to unplanned, exigent
410507 - examination for IBC on upper left arm, per above. ref SDS 0 FO6H
410509 -  ..
410510 - Catherine is the nurse today.  She had a family matter, and so some of
410511 - the work was performed by a trainee, Rachael (??), who was assisted by
410512 - an experienced infusion treatment nurse, Pauline.
410514 -  ..
410515 - Millie received 4th treatment of 1st cycle with Cetuximab, and the
410516 - 11th treatment for 3rd relapse of IBC.
410518 -           ..
410519 -          Taxotere Capecitabine
410520 -
410521 -          Follow up ref SDS D3 PR8Q, ref SDS D0 PR8Q.
410522 -
410523 -                   Relapse Treatments
410524 -
410525 -      1.  Cycle 09 and 01 ................... 060721, ref SDS 90 407N
410526 -      2.  Cycle 10 and 02 ................... 060814, ref SDS 99 LY6O
410527 -      3.  Cycle 11 and 03 ................... 060908, ref SDS A2 407N
410528 -      4.  Cycle 12 and 04 ................... 060929, ref SDS A4 407N
410529 -      5.  Cycle 13 and 05 ................... 061020, ref SDS A8 407N
410530 -      6.  Cycle 14 and 06 ................... 061110, ref SDS B3 407N
410531 -      7.  Cycle 15 and 07 ................... 061201, ref SDS B5 407N
410533 -           ..
410534 -          Cetuxiab Clinical Study
410535 -
410536 -          Follow up ref SDS D3 7T3H, ref SDS D0 7T3H.
410537 -
410538 -                   Total    Cetuximab
410539 -      8.  Cycle 01 and 08 and 01............. 070201, ref SDS C7 SG8I
410540 -      9.  Cycle 01 and 08 and 02............. 070208, ref SDS D0 SG8I
410541 -     10.  Cycle 01 and 08 and 03............. 070215, ref SDS D3 SG8I
410542 -     11.  Cycle 01 and 08 and 04............. 070222, ref SDS 0 SG8I
410544 -  ..
410545 - Nurses Notes...
410556 -     ..
410557 -    UCSF Log Time...
410558 -
410559 -          In....... 0915
410560 -          Out...... 1145
410561 -          Visit.... 2.5  Hours
410563 -      ..
410564 -     Pain Assessment...
410565 -
410566 -          x
410567 -          0123456789 10
410568 -
410569 -     <923k
410570 -     Administration Site:  Right Port Catheter
410571 -     Needle Size:          20 G 1"
410572 -     Blood Return Good:    Yes
410574 -      ..
410575 -     Remind patient to call MD if temp > 101 F, Shaking Chills
410576 -
410577 -            This protocol differs from Kaiser requirements, reported on
410578 -            041202. ref SDS 49 IX9N
410579 -
410580 -
410581 -
410582 -
4106 -

SUBJECTS
Side Effects Infusion Clinic UCSF Consultation Treatment Cetuximab A

5003 -
5004 - 0910
500501 -  ..
500502 - Side Effects Consultation Pharmacist Heavy Chest Difficult Breathing
500503 -
500504 - Follow up ref SDS D3 QU8K, ref SDS D0 QU8K.
500506 -  ..
500507 - Catherine asked Millie about side effects...
500508 -
500509 -            Rash like acne
500510 -
500511 -               Mild condition continues from 070208 around the nose,
500512 -               ref SDS D0 QU8K, observed by Catherine again on 070215.
500513 -               At that time, the pharmacy doctor prescribed treatment
500514 -               for rash. ref SDS D3 QU8K  This morning rash continues;
500515 -               Brigid prescribed treatment, per above. ref SDS 0 FO66
500516 -
500518 -             ..
500519 -            Lymphedema Cellulitis Complications
500520 -
500521 -               Treatment continues begun on 070217, ref SDS D7 N069,
500522 -               though at this time the rash now looks like IBC rather
500523 -               than recurrence of cellulitis, per above. ref SDS 0 FO66
500524 -
500526 -             ..
500527 -            Tired, fatigued - pulmonary emoblism...
500528 -
500529 -               Fatigue, shortness of breath and other symptoms of
500530 -               pulmonary embolism were presented during meeting on
500531 -               070130, ref SDS C5 CV5L, citing case study listed on
500532 -               060722. ref SDS 91 ZV41
500534 -                ..
500535 -               On 070204 UCSF notified no initial side effects of
500536 -               treatment, and energy has increased; planning for CT
500537 -               test to evaluate pulmonary embolism. ref SDS C9 JJ7O
500539 -                ..
500540 -               On 070218 Millie notified the primary care physician and
500541 -               UCSF that energy continues to recover; she played tennis
500542 -               and pulse reached 144. ref SDS D7 N05H
500544 -                ..
500545 -               Energy at this time remains elevated compared past 6
500546 -               months during treatment with Taxotere and capecitabine,
500547 -               and after suffering pulmonary embolism, ref SDS A7 M36G,
500548 -               and enlarged right ventricle, reported on 061012.
500549 -               ref SDS A7 7E5L
500550 -
500552 -             ..
500553 -            Heavy chest - shortness of breathing
500554 -
500555 -               Patient history was reported to UCSF on 070130.
500556 -               ref SDS C5 RT6I
500557 -
500558 -               Condition seems improved, as reported on 070204.
500559 -               ref SDS C9 JJ7O  No noticable increase, aligns with
500560 -               continuing higher energy. ref SDS 0 CA4K
500561 -
500563 -             ..
500564 -            Cough - clearing throat
500565 -
500566 -               This condition seems improved, as reported to the doctor
500567 -               on 070130. ref SDS C5 RT6I
500568 -
500570 -             ..
500571 -            Dry face, hands and feet...
500572 -
500573 -               Dry hands and feet seem much improved since ending
500574 -               treatment with Taxotere and capecitiabine on 061201.
500575 -
500576 -               Face now seems increasingly dry; need remedy.
500577 -
500578 -                   [On 070228 Millie notified UCSF about increasing
500579 -                   problem of facial dryness. ref SDS D9 LR4S
500581 -                    ..
500582 -                   [On 070301 UCSF prescribed Curel lotion to treat
500583 -                   rising facial dryness caused by cetuximab treatments
500584 -                   for IBC. ref SDS E0 5V73
500585 -
500587 -             ..
500588 -            Eyes tearing
500589 -
500590 -               This seems improved since ending treatment with Taxoter
500591 -               and capecitabine on 061201.
500592 -
500594 -             ..
500595 -            Nausea and vomitting
500596 -
500597 -               Problems with Taxotere and capecitabine reported on
500598 -               061110, ref SDS B3 D19M, did not occur this past week
500599 -               after treatment with cetuximab.  As a result, there was
500600 -               no pre-treatment with Decadron today, per below.
500601 -               ref SDS 0 G57I
500602 -
500604 -             ..
500605 -            Sores in mouth
500606 -
500607 -               None yet, cleaning mouth carefully to avoid problem.
500608 -
500609 -
500610 -
500611 -
5007 -

SUBJECTS
Schedule Treatment Weekly Thursday 0800 4 Week Cycles Clinical Study

5303 -
530401 -  ..
530402 - Schedule Weekly Treatments Continue on Thursdays
530403 -
530404 - Follow up ref SDS D3 QK6L, ref SDS D0 QK6L.
530406 -  ..
530407 - Today, Millie's next treatment is scheduled for 070301 1430.
530409 -  ..
530410 - Blood draw will be needed next week on 070301 to start a new cycle,
530411 - per discusison with Brigid, reported on 070201. ref SDS C7 XR40
530412 -
530413 -
530414 -
530415 -
5305 -

SUBJECTS
Blood Counts Good Test 070131 Blood Removal Port Catheter Sluggish D

5603 -
560401 -  ..
560402 - Blood Counts Good Dose Cetuximab Normal
560403 -
560404 - Follow up ref SDS D3 Q659, ref SDS D0 Q659.
560406 -  ..
560407 - There was no blood test today.  The next test is scheduled for 070301
560408 - 1145 to start the next cycle.
560409 -
560410 -
560411 -
560412 -
560413 -
5605 -

SUBJECTS
Anticoagulation Therapy Pulmonary Emboli INR Perfect 2.5 PT Patient

5903 -
590401 -     ..
590402 -    Anticoagulattion Therapy INR Low 2.5 PT Patient
590403 -
590404 -    Follow up ref SDS D3 SE6N, ref SDS D0 SE6N.
590405 -
590406 -    PT, patient    H        ??.? sec           8.9    -     11.1
590407 -    PT INR         L         2.5 sec           2      -      3
590409 -  ..
590410 - Millie skipped getting blood test for INR today, per planning on
590411 - 070215 for evaluating Coumadin to control pulmonary embolism.
590412 - ref SDS D3 6U5J
590413 -
590414 -        [On 070301 significant differences between blood test
590415 -        diagnostic reporting shows requirements for coordination
590416 -        plan. ref SDS E1 OX6L  INR 2.5 is a perfect test result
590417 -        under Kaiser's methods and practices, indicating Coumadin
590418 -        treatment for pulmonary embolism is adequate; INR 2.5 is
590419 -        too high by UCSF standards, requiring changing Coumadin
590420 -        treatment protocol. ref SDS E1 SE6N
590422 -         ..
590423 -        [On 070302 Gloria at the Kaiser Coagulation Control Clinic
590424 -        in Martinez, CA called and left a message saying that since
590425 -        Kaiser did not receive results of the blood test at UCSF
590426 -        the day before on 070301, Millie should get a blood test
590427 -        for INR the following week on 070308 to evaluate Coumadin
590428 -        treatments for pulmonary embolism. ref SDS E2 U24Y
590430 -         ..
590431 -        [On 070302 Millie called back and left a message for Gloria at
590432 -        the Kaiser Coagulation Control Clinic in Martinez, CA, and
590433 -        Millie sent a letter to Arlette in the doctor's office at
590434 -        Kaiser's oncology clinic in Walnut Creek; copies were sent to
590435 -        Gloria, and to Jackie, the Clinical Research Coordinator at
590436 -        UCSF confirming the telephone message to Gloria that reported
590437 -        the blood test on 070301 shows INR 2.5, ref SDS E2 K14H, and so
590438 -        testing for INR would occur with the next blood test on 070329
590439 -        for the next cycle of cetuximab treatment for IBC. ref SDS E2
590440 -        X84G
590442 -         ..
590443 -        [On 070305 Millie requested that Gloria coordinate directly
590444 -        with UCSF on interpreting the UCSF blood test report for
590445 -        prescribing Coumadin to treat pulmonary embolism, and
590446 -        reminded that UCSF has ordered another blood test on
590447 -        070308, so that INR can be tested again if needed.
590448 -        ref SDS E3 3A6S
590449 -
590450 -
590451 -
590452 -
590453 -
590454 -
590455 -
5905 -

SUBJECTS
Absolute Neutrophils Count ANC 1760 Well Above 1500 Required for Tre

6203 -
620401 -  ..
620402 - ANC 1760 Well Above 1500 Criteria for Blood Counts Approve Treatment
620403 -
620404 - Follow up ref SDS D3 P560, ref SDS D0 P560.
620405 -
620406 - No blood test for treatment today.
620407 -
620408 -
620409 -
6205 -

SUBJECTS
CA 15-3 67 Rise from 61 Cancer Marker Current Blood Test Reversing P

6503 -
650401 -  ..
650402 - CA 15-3 56 Fall from 68 Cancer Marker Test Pending
650403 -
650404 - Follow up ref SDS D3 2N5J, ref SDS D0 2N5J.
650405 -
650406 - On 070202 CA 15-3 dropped to 52 and rose to 56 in 2 tests. ref SDS C8
650407 - 087J
650409 -  ..
650410 - CA 15-3 presents a diagnostic of measurable disease in Millie's case,
650411 - noted in the record for the meeting at UCSF on 070130. ref SDS C5 M652
650413 -  ..
650414 - There are now two (2) CA 15-3 tests pending report from Kaiser.
650415 - Jackie said during the meeting with Brigid that UCSF has not received
650416 - anything from Kaiser on these two tests.  She explained the doctor
650417 - uses CA 15-3 to supplement visual examination for evaluating
650418 - progression of disease, and effectiveness of treatment for deciding on
650419 - changing treatment.  Since there is clear evidence of expanding IBC
650420 - reported above, ref SDS 0 B64F, CA 15-3 is the only other criteria in
650421 - this case.
650423 -  ..
650424 - CA 15-3 for blood test on 070208 taken to determine INR diagnostic to
650425 - evaluate pulmonary embolism, was reported by Arlette in a telephone
650426 - call to be about 56, and has not been formally submitted.  CA 15-3 for
650427 - the test this morning, per above, ref SDS D3 L59G, has not been
650428 - submitted.
650429 -
650430 -     [On 070228 Millie letter to UCSF requests coordination with Kaiser
650431 -     to get 2 CA 15-3 cancer tests for evaluating rate of progression
650432 -     that determines when to change treatments to prevent disease from
650433 -     cascading out of control. ref SDS D9 LQ5X
650434 -
650435 -
650436 -
650437 -
650438 -
650439 -
650440 -
6505 -

SUBJECTS
Port Catheter IV Connection Prepare for Drip Treatment 1 Try Require

7403 -
7404 - 0917
740501 -  ..
740502 - Preparation for Treatment Required One (1. Attempt to Connect Port
740503 -
740504 - Follow up ref SDS D3 EB7J, ref SDS D0 EB7J.
740506 -  ..
740507 - Catherine connected the IV tubes to the port....
740509 -       ..
740510 -      Interlink System Vented Paclitaxel set
740512 -  ..
740513 - Catherine flushed the port with saline.
740515 -  ..
740516 - Catherine reports in Nurse's Notes sluggish blood removal from the
740517 - port for starting treatment today, similar to problems reported on
740518 - 070201. ref SDS C7 DC5W and ref SDS C7 O56V
740520 -  ..
740521 - A doctor was notified.  The record is not clear on which doctor was
740522 - contacted, and what instructions the doctor gave.
740523 -
740524 -        [On 070301 problem experienced on 070222 did not occur the
740525 -        following week. ref SDS E1 DC5W
740526 -
740527 -        [On 070531 problem of no blood return on initial access
740528 -        occurred again. ref SDS E9 DC5W
740530 -  ..
740531 - There is a note that looks like...
740532 -
740533 -        TPA instituted a D/C
740535 -  ..
740536 - Medications say...
740537 -
740538 -        1145 TPA    2 mg   IV push
740539 -
740540 - ...so this may be what the doctor prescribed.
740541 -
740543 -  ..
740544 - Blood Draws 7 Vials for Clinical Study Research
740545 -
740546 - Follow up ref SDS D3 O56V, ref SDS D0 O56V.
740547 -
740548 - Blood draw for cetuximab clinical study research not required today,
740549 - after 10 vials were taken on 070201, ref SDS C7 O56V, and another 10
740550 - vials were drawn again on 070208. ref SDS D0 O56V
740551 -
740552 -
740553 -
740554 -
740555 -
7406 -

SUBJECTS
Benadryl Pre-treatment Prepares Patient for Cetuximab Chemotherapy A

7603 -
7604 - 0920
760501 -  ..
760502 - Benedryl Reduce Side Effects Cetuximab Chemotherapy Treatment
760503 -
760504 - Follow up ref SDS D3 DC7J, ref SDS D0 DC7J.
760505 -
760506 - Benadryl (diphenhydramine) started.   50 MG....... ref SDS 0 IJ41
760507 -
760508 -        Purpose reported on 060721. ref SDS 89 DC7J
760510 -  ..
760511 - Chemotherpay order calls for Benadryl (diphenhydramine) pre-treatment
760512 - 30 - 60 minutes prior to cetuximab infusion, shown below. ref SDS 0
760513 - IJ41
760514 -
760516 -  ..
7606 -
7607 -
7608 - 0930
7609 -
760901 - Benedryl completed equipment beeps.
760902 -
760903 -
760905 -  ..
7610 -
7611 -
7612 -
7613 -
761301 - Decadron (dexamethasone) IV pre-treatment........ ref SDS 0 FM4M
761302 -
761303 - On 070208 Decadron was not given, because Millie did not experience
761304 - side effects of nausea and vomitting after treatment with cetuximab on
761305 - 070201. ref SDS D0 G57I  Since this favorable condition continues, per
761306 - above, ref SDS 0 D19M, Decadron was not given again today.
761307 -
761309 -  ..
7614 -
7615 -
7616 -
7617 -
761701 - Decadron completed -- not reported.
761702 -
761703 -
761704 -
761705 -
7618 -

SUBJECTS
Cetuximab 1st Cycle 4th Treatment Clinical Study Drug Trial Treatmen

7803 -
7804 - 0945
780501 -  ..
780502 - Cetuximab Full Dose Blood Counts on Targets Treatment 1 Hour
780503 -
780504 - Follow up ref SDS D3 4N5M, ref SDS D0 4N5M.
780505 -
780506 - Cetuximab started.
780507 -
780508 -           Verify chemotherapy order for 070208.
780510 -  ..
780511 - Chemotherapy Orders...
780512 -
780518 -    Auth#                                     Stor BCC LOC
780519 -    Visit:  12575738             DOS 20070201
780521 -     ..
780522 -    Date:  20070201
780524 -     ..
780525 -    Study Order for CC#05752:  Phase II Trial of Cetuximab alone and
780526 -    in combination with Carboplatin in ER-negative, PR-negative,
780527 -    HER2-negative Nonoverexpressing Metastatic Breast Cancers
780529 -     ..
780530 -    Dates to be given:  070201
780531 -    Arm 1:Cetuximab alone
780533 -     ..
780534 -    Diagnosis:  breast cancer
780536 -     ..
780537 -    ICD-9 codes: 174.9
780538 -    Allergies  NKDA
780540 -     ..
780541 -    Pre-medications 30 - 60 minutes prior to cetuximab infusion
780543 -     ..
780544 -    6. Diphenhydramine 50 mg IV or  [illegible writing]
780546 -     ..
780547 -    7. Dexamethasone (??) 10 mg IB or 20 mg IV [handwritten ???]
780548 -
780549 -       Further premed TBD [barely legible handwriting??]
780551 -     ..
780552 -    Medication:  (plan to give weekly ********STUDY SUPPLY**********
780554 -     ..
780555 -    8. Cetuximab (Erbitux) (loading dose)
780556 -
780557 -              400 mg/m [squared] = 684 mg IV over 120 minutes for
780558 -              first dose x 1
780559 -
780560 -       dose on dcte 20070201   Maximum infusion rate is 5 ml/minute
780561 -       (concentration 2 mg/ml)
780563 -     ..
780564 -    9. Cetuximab (Erbitux) (maintenance dose)
780565 -
780566 -              250 mg/m [squared] = 428 mg IV (or ____ mg/m[squared] =
780567 -              ____mg) IV over 60 or ____ minutes.
780568 -
780569 -       Maximum infusion rate is 5 ml/minute (concentration 2 mg/ml)
780570 -       Infuse once weekly for 8 weeks.  First dose to be given on date
780571 -       20070201.
780573 -        ..
780574 -       Cetuximab is administered undiluted through a low protien
780575 -       binding 0.22 micro in-line filter.  Use NS solution to flush the
780576 -       line at the end of the infusion.
780578 -        ..
780579 -       ARM 2:  Administer carboplatin of vital sighs are unremarkable
780580 -       one hour after cetuximab infusion.
780582 -        ..
780583 -       Vital signs at baseline, upon cetuximab completion and one hour
780584 -       after cetuximab.
780585 -
780586 -       ****please note start and stop times****
780588 -        ..
780589 -       Laboratory work:
780590 -
780591 -          See carboplatin orders
780593 -        ..
780594 -       x  Notify MD for dose modifications if patient has severe
780595 -          acneinform rash
780596 -
780597 -          CBC with differential and platletes every 4 weeks
780598 -          Creatinine and magnesium every 4 weeks
780599 -          BUN AST Alk phos Alt Total bilrubin, electrolyes every 8
780600 -          weeks.  If levels are outside of normal laboratory values
780601 -          notify Brigid NP  (MD/RN) at 415 443 4730
780603 -        ..
780604 -       x  Physician has discussed risks/benefits of therapy with the
780605 -          patient.  Signed consent obtained.
780606 -
780607 -
780608 -          Yes  No   O2 by nasal cannula at 2 liters/min prn for chest
780609 -          pain or SOB
780611 -           ..
780612 -          Yes  No   Diphenhydramine 50 mg IV prn x1 for urticaria
780613 -          [barely legible], pruritis SOB
780615 -           ..
780616 -          Yes  No   Hydrocortizone 100 mg IV prn x1 for urticaria
780617 -          [barely legible], pruritis SOB
780619 -           ..
780620 -          Yes  No   Albuterol inhaler 2-4 puffs prn SOB or chest
780621 -          tightness
780623 -           ..
780624 -          Yes  No   Epinephrine 1x1000 (1 mg/ml) 0.3 mg IV prn
780625 -          anaphylaxis
780627 -           ..
780628 -          Breast CC05752 Cetuximab doc 20061024
780629 -          Approved 20060615
780631 -           ..
780632 -          Physician signature [Hope Rugo]
780634 -           ..
780635 -          Provider#  35313
780637 -           ..
780638 -          Date:  20010131
780639 -
780641 -  ..
7807 -
7808 -
7809 - 1020
7810 -
781001 - Cetuximab treatment completed.
781002 -
781003 - Millie had a 1 hour rest and observation period.
781004 -
781005 -
781007 -  ..
7811 -
7812 -
7813 - 1145
7814 -
781401 - Catherine disconnected the IV tubes.
781403 -  ..
781404 - She inserted Herceptin to flush the port.
781406 -  ..
781407 - She then removed the needle from the port, and swabbed the needle
781408 - wound, and placed a temporary bandage.
781409 -
781410 -
781411 -
781412 -
781413 -
7815 -

SUBJECTS
Vitals Blood Pressure Pulse Temperature Sa02 Weight Infusion Treatme

8103 -
8104 - 0930
810501 -  ..
810502 - Vitals Show Patient Stable
810503 -
810504 - Follow up ref SDS D3 AW4L, ref SDS D0 AW4L.
810505 -
810506 - Catherine took vitals after starting Taxotere drip treatment...
810507 -
810508 -                    Blood
810509 -    Date   Time     Pressure   Pulse  Temprtr  Weight   So2
810511 -     ..
810512 -    070222 1145..... 115  73     58     36.3c   147      98
810513 -    070222 1045..... 100  60     56     36.6c   147      98
810514 -    070222 0930..... 117  63     68     36.2c   147      97
810515 -    070215 1200..... 106  66     61     37.0c   147      97
810516 -    070215 1055.....  96  61     64     37.0c   147      94
810517 -    070215 0930..... 100  64     66     36.7c   147      98
810518 -    070208 0920..... 143  70     59     36.5c   147      98
810519 -    070201 1330..... 136  74     66             148      94
810520 -    070201 1220..... 110  65     62     36.3c   148      96
810521 -    070201 1000..... 132  80     65     36.9c   148      99
810522 -    061201 1534..... 123  76     76     97.5    150
810523 -    061110 1534..... 136  83     73     97.0    150      98
810524 -    061020 1534..... 140  79     67     99.8    151      97
810525 -    060929 1452..... 141  78     66     98.3    149
810526 -    060908 1335..... 139  79     73     98.1    149
810527 -    060814 1610..... 139  80     59     98.2    151
810528 -    060722 1440..... 142  74     67     98.1    149
810529 -    060711.......... 172  87     54     97.5    147
810530 -    060623.......... 141  87     71     98.0    147
810531 -    060428.......... 129  73     80     99.4    149
810532 -    060217.......... 153  81     61     98.6    150
810533 -    050916.......... 120  80     80     98.5
810534 -
810535 -  *  Need vitals taken today, maybe twice.
810536 -
810537 -
810538 -
810539 -
8106 -

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

8403 -
8404 - 1145
840501 -  ..
840502 - Energy Normal Stable After Treatment Cetuximab Support Drugs
840503 -
840504 - Follow up ref SDS D3 F54N, ref SDS D0 F54N.
840506 -  ..
840507 - On 060724 diary side effects for cetuximab chemotherapy treatment on
840508 - clinical study drug trial. ref SDS 93 YP4I
840510 -  ..
840511 - On 070204 Millie reported to Kaiser and to UCSF increased energy,
840512 - working out in the gym. ref SDS C9 HF5H
840514 -  ..
840515 - Millie was alert after treatment again today, and not wobbly nor
840516 - disoriented.  She was able to drive home without side effects of
840517 - treatment.
840518 -
840519 -
840520 -
840521 -
840522 -
840523 -
840524 -
8406 -