CONTACTS 

SUBJECTS
Treatment Cetuximab 1st Treatment 2nd Cycle Chemotherapy 10th Cycle

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS D8 0000. ref SDS D2 0000.
060502 -
060503 - Started 2nd cycle cetuximab treatment for IBC on clinical study.
060504 - Looks like problem reported last week drawing blood for study protocol
060505 - did not occur today.
060506 -
060507 -
060508 -
060510 -  ..
0606 -
0607 -
0608 - Progress
0609 -
060901 - Clinic Examination Orientation Starting Treatment Cetuximab
060902 -
060903 - Follow up ref SDS D8 407N, ref SDS D2 407N.
060904 -
060905 - Agenda...
060906 -
060907 -    1.  Side effects.............................. ref SDS 0 QU8K
060908 -    2.  Infusion Clinic........................... ref SDS 0 1M6H
060909 -
060910 -
060911 -
0610 -

SUBJECTS
Breast Examination Shows Improvement IBC Rash Left Right Breast Stom

1003 -
100401 -  ..
100402 - Breast Examination Likely IBC Progression Spreading Upper Left Arm
100403 -
100404 - Follow up ref SDS D8 FO6H, ref SDS D2 FO6H.
100405 -
100406 - Examination was performed prior to treatment in the Oncology Clinic
100407 - under supervision of Doctor Rugo.
100408 -
100409 -
100410 -
1005 -

SUBJECTS
Measureable Disease IBC Rash Photographs Tape Measure Evaluate Progr

1303 -
130401 -  ..
130402 - Measureable Disease Photographs IBC Rash Improving
130403 - IBC Rash Improved Measurable Disease Photographs Tape Measure
130404 -
130405 - Follow up ref SDS D8 6T6M, ref SDS D2 6T6M.
130406 -
130407 -
130408 -
130409 -
1305 -

SUBJECTS
Cetuximab Side Effects Mild Face Rash Acne-like Medication Prescript

1903 -
190401 -  ..
190402 - Side Effects Medicated After Weekly Examinations
190403 -
190404 - Follow up ref SDS D8 FO66, ref SDS D2 FO66.
190405 -
190406 -
190407 -
190408 -
1905 -

SUBJECTS
Blood Tests Cetuximab Monthly Clinical Study Drug Trial Performed at

2203 -
220401 -  ..
220402 - Blood Tests 1 Per Month on Cetuximab Performed at UCSF Saves Time Cost
220403 -
220404 - Follow up ref SDS D8 XR40, ref SDS D2 XR40.
220405 -
220406 - Blood test today, results reported below. ref SDS 0 Q659
220407 -
220409 -  ..
220410 - INR 2.5 Low Pulmonary Embolism Needs Increase Coumadin Treatment
220411 - Pulmonary Embolism Treatment Coumadin Needs Increase Low INR 2.5
220412 -
220413 - Follow up ref SDS D8 6U5J, ref SDS D2 6U5J.
220414 -
220415 -
220416 -
220417 -
220418 -
2205 -

SUBJECTS
Cetuximab 2nd Cycle 1st Treatment Chemotherapy 8th Cycle IBC 3rd Rel

2503 -
2504 - 1500
250501 -  ..
250502 - Infusion Clinic for Cetuximab Treatent
250503 -
250504 - Follow up ref SDS D8 1M6H, ref SDS D2 1M6H.
250505 -
250506 - Treatment was given after meeting with Doctor Rugo in the Oncology
250507 - Clinic, which was delayed from 1330 until OA 1415. ref SDS E0 0001
250509 -  ..
250510 - Catherine is the nurse today.  She had a family matter, and so some of
250511 - the work was performed by a trainee, Carrie (??), who was assisted by
250512 - an experienced infusion treatment nurse, Pauline Cassidy.
250514 -  ..
250515 - Millie feels after treatment today that Carrie deserves credit for
250516 - being a fast learner, and Pauline was very helpful supporting the work
250517 - on short notice, similar to last week on 070222. ref SDS D7 GZ5I
250518 - Millie further noted that Catherine's knowledge of patient history
250519 - strengthens work operations.
250521 -  ..
250522 - Millie received 5th overall and 1st treatment of 2nd cycle with
250523 - Cetuximab, starting from 070201, ref SDS C6 G68I, and the 12th
250524 - treatment for 3rd relapse of IBC, beginning on 060721. ref SDS 89 407N
250526 -           ..
250527 -          Taxotere Capecitabine
250528 -
250529 -          Follow up ref SDS D8 PR8Q, ref SDS D2 PR8Q.
250530 -
250531 -                   Relapse Treatments
250532 -
250533 -      1.  Cycle 09 and 01 ................... 060721, ref SDS 89 407N
250534 -      2.  Cycle 10 and 02 ................... 060814, ref SDS 98 LY6O
250535 -      3.  Cycle 11 and 03 ................... 060908, ref SDS A1 407N
250536 -      4.  Cycle 12 and 04 ................... 060929, ref SDS A3 407N
250537 -      5.  Cycle 13 and 05 ................... 061020, ref SDS A8 407N
250538 -      6.  Cycle 14 and 06 ................... 061110, ref SDS B2 407N
250539 -      7.  Cycle 15 and 07 ................... 061201, ref SDS B4 407N
250541 -           ..
250542 -          Cetuxiab Clinical Study
250543 -
250544 -          Follow up ref SDS D8 7T3H, ref SDS D2 7T3H.
250545 -
250546 -                   Total    Cetuximab
250547 -      8.  Cycle 01 and 08 and 01 01.......... 070201, ref SDS C6 SG8I
250548 -      9.  Cycle 01 and 08 and 02 02.......... 070208, ref SDS C9 SG8I
250549 -     10.  Cycle 01 and 08 and 03 03.......... 070215, ref SDS D2 SG8I
250550 -     11.  Cycle 01 and 08 and 04 04.......... 070222, ref SDS D8 SG8I
250551 -     12.  Cycle 02 and 09 and 01 05.......... 070301, ref SDS 0 SG8I
250553 -  ..
250554 - Nurses Notes...
250565 -  ..
250566 - This is the first change in the "Visit" number since the meeting on
250567 - 070201. ref SDS C6 R35G
250569 -     ..
250570 -    UCSF Log Time...
250571 -
250572 -          In....... 1500
250573 -          Out...... 1730
250574 -          Visit.... 2.5  Hours
250576 -      ..
250577 -     Pain Assessment...
250578 -
250579 -          x
250580 -          0123456789 10
250581 -
250582 -     <923k
250583 -     Administration Site:  Right Port Catheter
250584 -     Needle Size:          20 G 1"
250585 -     Blood Return Good:    Yes
250587 -      ..
250588 -     Remind patient to call MD if temp > 101 F, Shaking Chills
250589 -
250590 -            This protocol differs from Kaiser requirements, reported on
250591 -            041202. ref SDS 49 IX9N
250592 -
250593 -
250594 -
250595 -
2506 -

SUBJECTS
Side Effects Infusion Clinic UCSF Consultation Treatment Cetuximab A

3503 -
3504 - 0910
350501 -  ..
350502 - Side Effects Consultation Pharmacist Heavy Chest Difficult Breathing
350503 -
350504 - Follow up ref SDS D8 QU8K, ref SDS D2 QU8K.
350506 -  ..
350507 - Catherine asked Millie about side effects...
350508 -
350509 -            Rash like acne
350510 -
350511 -               Mild condition continues from 070208 around the nose,
350512 -               ref SDS C9 QU8K; treatment effective with medication
350513 -               prescribed on 070222. ref SDS D8 FO66
350515 -             ..
350516 -            Face very dry...
350517 -
350518 -               Millie notified UCSF in a letter on 070228 of sudden
350519 -               extremely dry fact, a new side effect of cetuximab; and
350520 -               requested treatment. ref SDS D9 LR4S  Brigid prescribed
350521 -               a face cream.
350522 -
350524 -             ..
350525 -            Lymphedema Cellulitis Complications
350526 -
350527 -               Treatment for cellulitis begun on 070217, ref SDS D6
350528 -               N069, was completed on 070228; rash diagnosed on 070222
350529 -               as IBC, ref SDS D8 FO66, and discussed again with
350530 -               Doctor Rugo during cyclical examination today.
350531 -
350533 -             ..
350534 -            Tired, fatigued - pulmonary emoblism...
350535 -
350536 -               Fatigue, shortness of breath and other symptoms of
350537 -               pulmonary embolism were presented during meeting on
350538 -               070130, ref SDS C4 CV5L, citing case study listed on
350539 -               060722. ref SDS 90 ZV41
350541 -                ..
350542 -               On 070218 Millie notified the primary care physician and
350543 -               UCSF that energy continues to recover; she played tennis
350544 -               and pulse reached 144. ref SDS D6 N05H
350546 -                ..
350547 -               Energy has begun to decline with increasing treatments
350548 -               of cetuximab, ref SDS 0 7T3H, but sill elevated compared
350549 -               to condition on ending 6 months of treatment with
350550 -               Taxotere and capecitabine, and after suffering pulmonary
350551 -               embolism, ref SDS A6 M36G, and enlarged right ventricle,
350552 -               reported on 061012. ref SDS A6 7E5L
350553 -
350554 -                   [On 070308 energy seems to be rising again back to
350555 -                   normal. ref SDS E7 CA4K
350556 -
350558 -             ..
350559 -            Heavy chest - shortness of breathing
350560 -
350561 -               Patient history was reported to UCSF on 070130.
350562 -               ref SDS C4 RT6I
350563 -
350564 -               Condition seems improved, as reported on 070204.
350565 -               ref SDS C8 JJ7O  No noticable increase, aligns with
350566 -               continuing higher energy. ref SDS D8 CA4K
350567 -
350569 -             ..
350570 -            Cough - clearing throat
350571 -
350572 -               This condition seems improved, as reported to the doctor
350573 -               on 070130. ref SDS C4 RT6I
350574 -
350576 -             ..
350577 -            Dry hands and feet...
350578 -
350579 -               Dry hands and feet seem much improved since ending
350580 -               treatment with Taxotere and capecitiabine on 061201.
350581 -
350583 -             ..
350584 -            Eyes tearing
350585 -
350586 -               This seems improved since ending treatment with Taxoter
350587 -               and capecitabine on 061201.
350588 -
350590 -             ..
350591 -            Nausea and vomitting
350592 -
350593 -               Problems with Taxotere and capecitabine reported on
350594 -               061110, ref SDS B2 D19M, did not occur this past week
350595 -               after treatment with cetuximab.  As a result, there was
350596 -               no pre-treatment with Decadron today, per below.
350597 -               ref SDS 0 G57I
350599 -             ..
350600 -            Sores in mouth
350601 -
350602 -               None yet, cleaning mouth carefully to avoid problem.
350603 -
350604 -
350605 -
350606 -
3507 -

SUBJECTS
Schedule Treatment Weekly Thursday 0800 4 Week Cycles Clinical Study

3803 -
380401 -  ..
380402 - Schedule Weekly Treatments Continue on Thursdays
380403 -
380404 - Follow up ref SDS D8 QK6L, ref SDS D2 QK6L.
380406 -  ..
380407 - Millie's next treatment is scheduled for 070308 0900.
380409 -  ..
380410 - Blood draw will be needed next week on 070308 0800 to check ANC,
380411 - because the ANC diagnositc is low today, 1230, ordered by Doctor Rugo
380412 - during the meeting today.
380413 -
380414 -
380415 -
380416 -
3805 -

SUBJECTS
Blood Counts Low Test 070301 Blood Removal Port Catheter Okay Correc

7503 -
7504 - 1200
750501 -  ..
750502 - Blood Counts Low Full Dose Cetuximab Ordered
750503 -
750504 - Follow up ref SDS D8 Q659, ref SDS D2 Q659.
750505 -
750506 - Millie had a blood test today at 1200 (noon) in the UCSF Infusion
750507 - Clinic; previous test was on 070301, and reported in the record on
750508 - 070201. ref SDS C6 Q659
750510 -  ..
750511 - Catherine submitted the report on the blood test, shown below.
750512 - ref SDS 0 075H
750514 -  ..
750515 - Over the next few days, there was time to correlate UCSF blood test
750516 - standards, with Kaiser, based on patient history.
750518 -  ..
750519 - Case study indicates many differences from Kaiser's blood testing
750520 - diagnotics with respect to scope, units and ranges, further suggesting
750521 - substantive differences in test measurement protocols that effect
750522 - application to diagnosis and treatment, e.g, INR. ref SDS 0 SE6N
750523 -
750524 -        [On 070305 Millie discovered differences between the way UCSF
750525 -        and Kaiser set the normal range for INR, ref SDS E3 K14H; she
750526 -        wrote a letter to Jackie at UCSF with a copy to Arlette and to
750527 -        Gloria, and asking for clarification from UCSF to facilitate
750528 -        Gloria's work managing Millie's Coumadin treatments for
750529 -        pulmonary embolism. ref SDS E3 3A4Y
750531 -         ..
750532 -        [On 090420 1451 case study shows labs enable effective care
750533 -        when performed locally because blood counts are dynamic in
750534 -        realtime with treatment decisions. ref SDS F3 HT9K
750536 -  ..
750537 - This presents significant risk of mistakes distinguishing differences
750538 - large and small interpreting blood test results for diagnosis and
750539 - treatment decisions, e.g., INR, discussed below. ref SDS 0 SE6N
750541 -  ..
750542 - ISO may have a standard for converting multiple providers to a common
750543 - standard to avoid mistakes.
750545 -  ..
750546 - Case studies for managing patient history are listed on 061018.
750547 - ref SDS A7 0001
750549 -  ..
750550 - Millie's letter on 070228 to UCSF with copy to Kaiser requested review
750551 - today of a draft coordination plan to manage blood test reporting.
750552 - ref SDS D9 LQ6W
750553 -
750554 -            [On 070330 coordination failing, medical chart at Kaiser
750555 -            shows lab at UCSF, rather than entering the blood test
750556 -            report to aid patient care. ref SDS E8 128S
750558 -     ..
750572 -     ..
750573 -    Log#:                   070301 12:00
750574 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
750575 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
750577 -     ..
750578 -    PARN CBC with DIFF & PLT CT                               CBCD
750579 -     ..
750580 -    WBC COUNT               4.1    x10E9/L     3.4  -   10     WBC   WBC x10-3        K/uL     3.4  -  10.0
750581 -    RBC COUNT               4.23   x10E12/L      4  -   5.2    RBC   RBC x10-6        M/uL    3.60  -  5.70
750582 -    HEMOGLOBIN             13.8    g/dL         12  -   15.5   HGB   Hemoglobin       g/dL    11.5  -  15.0
750583 -    HEMATOCRIT             39.8    PERCENT      36  -   46     HCT   Hematocrit       %       34.0  -  46.0
750584 -    MCV                    94      fL           80  -   100    MCV   MCV              fL      80.0  -  100.0
750585 -                                                                     RDW              %       11.9  -  14.3
750586 -    MCH                    32.6    pg           26  -   34     MCH
750587 -    MCHC                   34.7    g/dL         31  -   36     MCHC
750588 -    PLATELETS             230      x10E9/L     140  -  450     PLT   Plt x10-3        K/uL     140  -  400
750589 -    ..
750590 -       (posted 070307)
750591 -    CA 15-3                36      U/mL             <  31    CA15-3  CA 15-3                        <  39
750593 -     ..
750594 -    NEUTS           L       1.23   x10E9/L     1.8  -  6.8     N-A   ANC                      1500
750595 -    Neutrophils    Not Reported                                      Neutrophils       %        50  -  70
750597 -     ..
750598 -    LYMPHS                  2.10   x10E9/L     0.9  -  2.9     L-A   Lymphocytes       %        20  -  50
750599 -    MONOS                   0.36   x10E9/L     0.1  -  0.6     M-A   Monocyte          %         0  -  11
750600 -    EOS                     0.30   x10E9/L       0  -  0.4     E-A   Esoinophils       %         1  -  5
750601 -    BASOS                   0.08   x10E9/L       0  -  0.1     B-A   Basophil          %         0  -  2
750602 -                                                                     Bands             %         0  -  5
750604 -     ..
750605 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
750606 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
750608 -     ..
750609 -    PT              H      28.0    S          12.5  - 16.0     PT    PT, patient       sec     8.9  -  11.1
750610 -    INL Nrm Ratio   H       2.5                0.9  -  1.2     INR   PT INR            sec     2.0  -  3.0
750611 -    PARTIAL
750612 -     THROMBOPLASTIN        31.7    S          22.4  - 33.3     PTT
750614 -     ..
750615 -    ELECTROLYTE PANEL                                          LYTE
750616 -    SODIUM                140      mmol/L      134  -  143     NA    Sodium            mEq/L   137  -  145
750617 -    POTASSIUM               4.0    mmol/L      3.4  -  4.9     K     Potassium         mEq/L   3.5  -  5.3
750618 -    CHLORIDE              105      mmol/L       98  -  107     CL
750619 -    CARBON DIOX TOTAL      27      mmol/L       23  -  32      CO2
750620 -    ANION GAP               8                    3  -  14      ANGA
750622 -     ..
750623 -    UREA NITROGEN          12      mg/dL         8  -  23      BUN   BUN               mg/dL     7  -  17
750624 -    CALCIUM                 9.4    mg/dL       8.7  -  10.1    CA    Calcium           mg/dL   8.4  -  10.2
750625 -    MAGNESIUM               2.0    mg/dL       1.8  -  2.3     MG    Magnesium         mg/dL   1.6  -  2.3
750627 -     ..
750628 -    CREATININE              0.7    mg/dL       0.6  -  1.2     CR    Creatinine        mg/dL   0.6  -  1.2
750629 -    AST                    36      U/L          16  -  41      AST   AST (SGOT)        U/L      14  -  36
750630 -    ALT                    24      U/L          11  -  54      ALT   ALT (SGPT)        U/L      11  -  66
750631 -    BILIRUBIN TOTAL         0.7    mg/dL       0.3  -  1.3     BILT  Bili Total        mg/dL   0.2  -  1.3
750632 -    ALKALINE PHOSPHATASE   53      U/L          29  -  111     ALKP  Alkaline Ph       U/L      38  -  126
750633 -    PROTEIN TOTAL           6.2    g/dL        5.8  -  8.0     TP    Protein, Total    g/dL    6.3  -  8.2
750634 -    ALBUMIN                 4.0    g/dL        3.4  -  4.7     ALB   Albumin           g/dL    3.4  -  4.8
750635 -
750636 -
750637 -
750638 -
7507 -

SUBJECTS
Coagulation Control Coumadin Treatment Pulmonary Embolism INR 2.5 PT

9603 -
960401 -     ..
960402 -    Coagulation Control INR High 2.5 PT 28 High
960403 -
960404 -    Follow up ref SDS D8 SE6N, ref SDS D2 SE6N.
960405 -
960406 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
960407 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
960409 -     ..
960410 -    PT              H      28.0    S          12.5  - 16.0     PT    PT, patient       sec     8.9  -  11.1
960411 -    INL Nrm Ratio   H       2.5                0.9  -  1.2     INR   PT INR            sec     2.0  -  3.0
960412 -    PARTIAL
960413 -     THROMBOPLASTIN        31.7    S          22.4  - 33.3     PTT
960415 -  ..
960416 - UCSF and Kaiser appear to calculate INR much differently.  In Kaiser's
960417 - scheme, 2.5 is a perfect result in the middle of the target range 2.0
960418 - - 3.0; yet 2.5 is high in UCSF diagnostics that use a normative scale
960419 - of 0.9 - 1.2 (see comparative blood test report above, ref SDS 0 PU7Y,
960420 - and therefore would require adjusting Coumadin treatments for
960421 - pulmonary embolism.
960423 -  ..
960424 - Since 2.5 is more than double the high range of 1.2 on the UCSF scale,
960425 - it therefore seems to correlate to more than INR 6 in the Kaiser
960426 - scheme.  On 061214, Gloria, at Kaiser's Coagulation Control Clinic in
960427 - Martinez, CA, notified Millie that a conflict overlooked in prescribed
960428 - medications caused INR to jump to 6.4.  This required ending
960429 - conflicting treatment, and further required immediate change in the
960430 - Coumadin protocol to reduce risk of hemorraging. ref SDS B7 0001
960432 -  ..
960433 - Differences in blood test standards presents a very high risk for
960434 - error, cited above. ref SDS 0 HI6O  When busy people look at a blood
960435 - test report, or ask someone for a diagnostic, or remember a diagnostic
960436 - from a telephone call, meeting, etc., and are told or observe or
960437 - simply recall that INR is 2.5, there will be a very great tendency to
960438 - overlook if this is a Kaiser test or UCSF test.
960440 -  ..
960441 - Millie skipped getting blood tested on 070222 for INR, per planning on
960442 - 070215 for evaluating Coumadin to control pulmonary embolism.
960443 - ref SDS D2 6U5J  This saves time, money, and avoids needle
960444 - penetrations that cause trauma to the right arm, reported on 040318,
960445 - ref SDS 11 CO3G, because getting blood drawn through the port, other
960446 - than on treatment days, has proven difficult to coordinate.
960448 -  ..
960449 - Planning on 070215 was to test for INR with UCSF blood tests for
960450 - cancer treatment. ref SDS D2 IC9O
960452 -  ..
960453 - However, if INR reported by UCSF in the test today is actually high,
960454 - as shown in the report, ref SDS 0 SE6N, then Gloria will want to
960455 - consider adjusting Coumadin treatments this week.
960457 -  ..
960458 - The difference between being perfect and being 100% too high requires
960459 - investigation.  On 070222 Jackie talked about developing a
960460 - coordination plan to facilitate collaboration between Kaiser and UCSF
960461 - in Millie's care. ref SDS D7 VK5N  Differences in blood test
960462 - diagnostics should be normalized, ref SDS D7 WY6J, with particular
960463 - attention to INR assessment, cited in Millie's letter to UCSF on
960464 - 070228. ref SDS D9 LQ6W
960465 -
960466 -        [On 070302 Gloria at the Kaiser Coagulation Control Clinic
960467 -        in Martinez, CA called and left a message saying that since
960468 -        Kaiser did not receive results of the blood test at UCSF
960469 -        the day before on 070301, Millie should get a blood test
960470 -        for INR the following week on 070308 to evaluate Coumadin
960471 -        treatments for pulmonary embolism. ref SDS E2 U24Y
960473 -         ..
960474 -        [On 070302 Millie called back and left a message for Gloria at
960475 -        the Kaiser Coagulation Control Clinic in Martinez, CA, and
960476 -        Millie sent a letter to Arlette in the doctor's office at
960477 -        Kaiser's oncology clinic in Walnut Creek; copies were sent to
960478 -        Gloria, and to Jackie, the Clinical Research Coordinator at
960479 -        UCSF confirming the telephone message to Gloria that reported
960480 -        the blood test on 070301 shows INR 2.5, ref SDS E2 K14H, and so
960481 -        testing for INR would occur with the next blood test on 070329
960482 -        for the next cycle of cetuximab treatment for IBC. ref SDS E2
960483 -        X84G
960485 -         ..
960486 -        [On 070305 entering results of the blood test on 070301 showed
960487 -        a big difference in the way UCSF and Kaiser set the "normal"
960488 -        range for INR, ref SDS E1 SE6N, Millie wrote a letter notifying
960489 -        Jackie at UCSF with copies to Arlette and Gloria at Kaiser,
960490 -        ref SDS E3 XG5H; and asking UCSF for clarification to
960491 -        facilitate managing Millie's Coumadin treatments for pulmonary
960492 -        embolism. ref SDS E3 3A4Y
960494 -         ..
960495 -        [On 070305 Millie requested that Gloria coordinate directly
960496 -        with UCSF on interpreting the UCSF blood test report for
960497 -        prescribing Coumadin to treat pulmonary embolism, and
960498 -        reminded that UCSF has ordered another blood test on
960499 -        070308, so that INR can be tested again if needed.
960500 -        ref SDS E3 3A6S
960502 -         ..
960503 -        [On 070305 Brigid advised INR 2 - 3 is the correct range for
960504 -        prescribing Coumadin to treat Millie for pulmonary embolism,
960505 -        despite being 100% over the normal range in the report for the
960506 -        UCSF blood test on 070301. ref SDS E3 SN5O
960508 -         ..
960509 -        [On 070305 UCSF did not make distribution to coorindate
960510 -        communciations with Kaiser; Millie sent a letter thanking
960511 -        Brigid for timely response to INR question, and sent copies
960512 -        thanking Jackie for timely coordination, and also copies to
960513 -        Arlette at Kaiser in Walnut Creek, and to Gloria in
960514 -        Kaiser's Coagulation Control Clinic in Martinez, CA for
960515 -        managing Coumadin that treats Millie's pulmonary embolism.
960516 -        ref SDS E3 B18H
960518 -         ..
960519 -        [On 070306 Millie requests feedback from Gloria to verify
960520 -        accuracy of understandings that Kaiser is satisfied with
960521 -        UCSF blood test on INR for prescribing Coumadin to treat
960522 -        pulmonary embolism, and advises current regimen will
960523 -        continue until further notice. ref SDS E4 FJ9K
960525 -         ..
960526 -        [On 070307 Gloria confirmed Millie's current Coumadin
960527 -        treatment should be continued based on UCSF blood test
960528 -        reporting, ref SDS E6 UH4M, and advised there is not enough
960529 -        time to confirm with written instructions that verify
960530 -        accuracy. ref SDS E6 UH6L
960531 -
960532 -
960533 -
960534 -
9606 -

SUBJECTS
Absolute Neutrophils Count ANC 1230 Well Below 1800 Required for Tre

AB03 -
AB0401 -  ..
AB0402 - ANC 1230 Well Below 1800 Criteria for Blood Counts to Approve Treatment
AB0403 -
AB0404 - Follow up ref SDS D8 P560, ref SDS D2 P560.
AB0405 -
AB0406 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
AB0407 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
AB0409 -     ..
AB0410 -    NEUTS           L       1.23   x10E9/L     1.8  -  6.8     N-A   ANC                      1500
AB0411 -    Neutrophils    Not Reported                                      Neutrophils       %        50  -  70
AB0413 -  ..
AB0414 - During the meeting with Doctor Rugo this afternoon prior to treatment,
AB0415 - Brigid explained today that NEUTS = 1.23 listed in the UCSF blood test
AB0416 - report today, per above, ref SDS 0 QY6H, corresponds to ANC listed in
AB0417 - Kaiser's report. ref SDS E0 VF5M  This reflects Nurses's Notes for
AB0418 - treatment today showing ANC 1.23.
AB0420 -  ..
AB0421 - Additionally, UCSF does not multiply the calculation by 1000, as
AB0422 - Kaiser does, reported on 060810. ref SDS 97 GL4M, so the number 1.23
AB0423 - correspondes to ANC 1230 in Kaiser's scheme.  UCSF may calculate ANC
AB0424 - differently, because Kaiser uses 1500 for the low check point, also,
AB0425 - reported on 060810, ref SDS 97 5K4F, rather than 1800 (1.8), indicated
AB0426 - in UCSF test report. ref SDS 0 QY6H
AB0428 -  ..
AB0429 - ANC continues falling...
AB0430 -
AB0431 -        6972................................ 060814, ref SDS 98 P560
AB0432 -        6390................................ 060908, ref SDS A1 P560
AB0433 -        5200................................ 060929, ref SDS A3 P560
AB0434 -        3869................................ 061020, ref SDS A8 P560
AB0435 -        2880................................ 061110, ref SDS B2 P560
AB0436 -        2888................................ 061201, ref SDS B4 P560
AB0437 -        1760................................ 070201, ref SDS C6 P560
AB0438 -        1230................................ 070301, ref SDS 0 P560
AB0440 -  ..
AB0441 - Since the calculation at UCSF for ANC seems different from Kaiser,
AB0442 - direct comparisons in the above table may be misleading.
AB0443 -
AB0444 -            [On 070301 research on low blood counts indicates so far
AB0445 -            Millie has "mild" neutropenia. ref SDS E0 R13I
AB0447 -  ..
AB0448 - Doctor Rugo approved treatment today with low ANC.  This aligns with
AB0449 - patient history for treatment with ANC in range today, reported in
AB0450 - case study on 060810, ref SDS 97 5V7M, citing work at Kaiser on
AB0451 - 050916. ref SDS 78 4N5M
AB0452 -
AB0453 -            [On 070308 ANC increased to 1.51 within the normal range
AB0454 -            for cetuximab treatments. ref SDS E7 P560
AB0455 -
AB0456 -
AB0457 -
AB0458 -
AB0459 -
AB05 -

SUBJECTS
CA 15-3 Test 070208 and 070215 Results Still Pending Submission by K

AF03 -
AF0401 -  ..
AF0402 - CA 15-3 36 Tests 2 From Kaiser 1 from UCSF Pending Submission
AF0403 -
AF0404 - Follow up ref SDS D8 2N5J, ref SDS D2 2N5J.
AF0406 -  ..
AF0407 - CA 15-3 for the blood test this morning was not provided with results
AF0408 - reported today.  Subsequently, on 070307 Catherine called and advised
AF0409 - the result for the test today is 36. ref SDS E6 U85L   Later on 070307
AF0410 - Arlette at Kaiser reported CA 15-3 was 55 on 070208, and a week later
AF0411 - dropped again to 52 on 070315.  This record of consistently falling
AF0412 - cancer marker since starting treatment with cetuximab on 070201 seems
AF0413 - to indicate response to treatment. ref SDS 0 A16M
AF0415 -  ..
AF0416 - CA 15-3 36 is the best cancer marker condition for Millie in over a
AF0417 - year, shown in the record meeting with the doctor today. ref SDS E0
AF0418 - 087J
AF0420 -  ..
AF0421 - CA 15-3 presents a diagnostic of measurable disease in Millie's case,
AF0422 - noted in the record for the meeting at UCSF on 070130. ref SDS C4 M652
AF0423 -
AF0424 -      [On 070302 letter to Kaiser requests results of CA 15-3 tests on
AF0425 -      070208 and 070215. ref SDS E2 EY5W
AF0426 -
AF0427 -      [On 070306 Millie asks Kaiser for CA 15-3 test results for
AF0428 -      blood work on 070208 and 070215. ref SDS E5 MI7J
AF0430 -       ..
AF0431 -      [On 070511 Millie ordered CA 15-3 at Kaiser to prepare for
AF0432 -      meeting with primary care physician scheduled on 070525, and to
AF0433 -      cross-check remarkable results reported by the UCSF Lab.
AF0434 -      ref SDS E9 B64J
AF0436 -       ..
AF0437 -      [On 070516 Kaiser reports CA 15-3 56 and describes this result as
AF0438 -      "stable," ref SDS F0 QN6M, which significantly conflicts with
AF0439 -      testing at UCSF. ref SDS F0 WV6L
AF0441 -       ..
AF0442 -      [On 070516 Millie asks Kaiser to verify accuracy of CA 15-3 test
AF0443 -      on 070511, and to notify UCSF to be prepared for meeting with the
AF0444 -      patient on 070524. ref SDS F0 ZJ9N
AF0446 -       ..
AF0447 -      [On 070517 Kaiser advised that UCSF uses a different calibration
AF0448 -      method for CA 15-3 that cannot be compared to the Kaiser test
AF0449 -      results, like comparing apples and oranges. ref SDS E0 NT3O
AF0451 -       ..
AF0452 -      [On 070517 Nurse's Notes show nurse practitioner ordered another
AF0453 -      blood test to verify elevated CA 15-3 56 reported in Kaiser's
AF0454 -      test on 070511; but did not perform the test, and decided to wait
AF0455 -      another week to address the issue. ref SDS F1 FG6H
AF0457 -       ..
AF0458 -      [On 070517 Brigid discloses that coordinating divided
AF0459 -      responsibilities on referral projects is difficult; and that UCSF
AF0460 -      recommends limiting laboratory work rather than empowering labs
AF0461 -      to cross-check tests for accuracy. ref SDS F2 466H
AF0462 -
AF0463 -
AF0464 -
AF0465 -
AF0466 -
AF05 -

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

AJ03 -
AJ04 - 1500
AJ0501 -  ..
AJ0502 - Preparation for Treatment Required One (1. Attempt to Connect Port
AJ0503 -
AJ0504 - Follow up ref SDS D8 EB7J, ref SDS D2 EB7J.
AJ0506 -  ..
AJ0507 - Catherine connected the IV tubes to the port....
AJ0509 -       ..
AJ0510 -      Interlink System Vented Paclitaxel set
AJ0512 -  ..
AJ0513 - There were no problems getting blood to flow from the port for the
AJ0514 - blood sample research vials, as occurred last week on 070222,
AJ0515 - ref SDS D7 DC5W, and earlier on 070201. ref SDS C6 DC5W
AJ0517 -  ..
AJ0518 - Pauline flushed the port with saline.
AJ0519 -
AJ0520 -
AJ0521 -
AJ0522 -
AJ06 -

SUBJECTS
Blood Draws 7 Vials Clinical Study Research Cetuximab Drug Trial Blo

AN03 -
AN0401 -  ..
AN0402 - Blood Draws 7 Vials for Clinical Study Research
AN0403 -
AN0404 - Follow up ref SDS D8 O56V, ref SDS D2 O56V.
AN0405 -
AN0406 - Blood draw for cetuximab clinical study research required today.
AN0407 - Seven (7) vials were drawn, adding to 10 vials on 070201, ref SDS C6
AN0408 - O56V, and another 7 vials drawn on 070208. ref SDS C9 O56V
AN0410 -  ..
AN0411 - Blood blood normally.  Problems reported drawing the last few vials on
AN0412 - 070201, ref SDS C6 O56V, did not occur today.
AN0413 -
AN0414 -
AN0415 -
AN0416 -
AN0417 -
AN0418 -
AN05 -

SUBJECTS
Benadryl Pre-treatment Prepares Patient for Cetuximab Chemotherapy A

AP03 -
AP04 - 1530
AP0501 -  ..
AP0502 - Benedryl Reduce Side Effects Cetuximab Chemotherapy Treatment
AP0503 -
AP0504 - Follow up ref SDS D8 DC7J, ref SDS D2 DC7J.
AP0505 -
AP0506 - Benadryl (diphenhydramine) started.   50 MG....... ref SDS 0 IJ41
AP0507 -
AP0508 -        Purpose reported on 060721. ref SDS 89 DC7J
AP0510 -  ..
AP0511 - Chemotherpay order calls for Benadryl (diphenhydramine) pre-treatment
AP0512 - 30 - 60 minutes prior to cetuximab infusion, shown below. ref SDS 0
AP0513 - IJ41
AP0514 -
AP0516 -  ..
AP06 -
AP07 -
AP08 - 1540
AP09 -
AP0901 - Benedryl completed equipment beeps.
AP0902 -
AP0903 -
AP0905 -  ..
AP10 -
AP11 -
AP12 -
AP13 -
AP1301 - Decadron (dexamethasone) IV pre-treatment........ ref SDS 0 FM4M
AP1302 -
AP1303 - On 070208 Decadron was not given because Millie did not experience
AP1304 - side effects of nausea and vomitting after treatment with cetuximab on
AP1305 - 070201. ref SDS C9 G57I  Since this favorable condition continues, per
AP1306 - above, ref SDS 0 D19M, Decadron was not given again today.
AP1307 -
AP1308 -
AP1309 -
AP1310 -
AP1311 -
AP1313 -  ..
AP14 -
AP15 -
AP16 -
AP17 -
AP1701 - Decadron completed -- not reported.
AP1702 -
AP1703 -
AP1704 -
AP1705 -
AP18 -

SUBJECTS
Cetuximab 2nd Cycle 1st Treatment Clinical Study Drug Trial Treatmen

AR03 -
AR04 - 1545
AR0501 -  ..
AR0502 - Cetuximab Full Dose Blood Counts on Targets Treatment 1 Hour
AR0503 -
AR0504 - Follow up ref SDS D8 4N5M, ref SDS D2 4N5M.
AR0505 -
AR0506 - Cetuximab started.
AR0507 -
AR0508 -           Verify chemotherapy order for 070208.
AR0510 -  ..
AR0511 - Chemotherapy Orders...
AR0512 -
AR0518 -    Auth#                                     Stor BCC LOC
AR0519 -    Visit:  12575738             DOS 20070201
AR0521 -     ..
AR0522 -    Date:  20070201
AR0524 -     ..
AR0525 -    Study Order for CC#05752:  Phase II Trial of Cetuximab alone and
AR0526 -    in combination with Carboplatin in ER-negative, PR-negative,
AR0527 -    HER2-negative Nonoverexpressing Metastatic Breast Cancers
AR0529 -     ..
AR0530 -    Dates to be given:  070201
AR0531 -    Arm 1:Cetuximab alone
AR0533 -     ..
AR0534 -    Diagnosis:  breast cancer
AR0536 -     ..
AR0537 -    ICD-9 codes: 174.9
AR0538 -    Allergies  NKDA
AR0540 -     ..
AR0541 -    Pre-medications 30 - 60 minutes prior to cetuximab infusion
AR0543 -     ..
AR0544 -    3. Diphenhydramine 50 mg IV or  [illegible writing]
AR0546 -     ..
AR0547 -    4. Dexamethasone (??) 10 mg IB or 20 mg IV [handwritten ???]
AR0548 -
AR0549 -       Further premed TBD [barely legible handwriting??]
AR0551 -     ..
AR0552 -    Medication:  (plan to give weekly ********STUDY SUPPLY**********
AR0554 -     ..
AR0555 -    5. Cetuximab (Erbitux) (loading dose)
AR0556 -
AR0557 -              400 mg/m [squared] = 684 mg IV over 120 minutes for
AR0558 -              first dose x 1
AR0559 -
AR0560 -       dose on dcte 20070201   Maximum infusion rate is 5 ml/minute
AR0561 -       (concentration 2 mg/ml)
AR0563 -     ..
AR0564 -    6. Cetuximab (Erbitux) (maintenance dose)
AR0565 -
AR0566 -              250 mg/m [squared] = 428 mg IV (or ____ mg/m[squared] =
AR0567 -              ____mg) IV over 60 or ____ minutes.
AR0568 -
AR0569 -       Maximum infusion rate is 5 ml/minute (concentration 2 mg/ml)
AR0570 -       Infuse once weekly for 8 weeks.  First dose to be given on date
AR0571 -       20070201.
AR0573 -        ..
AR0574 -       Cetuximab is administered undiluted through a low protien
AR0575 -       binding 0.22 micro in-line filter.  Use NS solution to flush the
AR0576 -       line at the end of the infusion.
AR0578 -        ..
AR0579 -       ARM 2:  Administer carboplatin of vital sighs are unremarkable
AR0580 -       one hour after cetuximab infusion.
AR0582 -        ..
AR0583 -       Vital signs at baseline, upon cetuximab completion and one hour
AR0584 -       after cetuximab.
AR0585 -
AR0586 -       ****please note start and stop times****
AR0588 -        ..
AR0589 -       Laboratory work:
AR0590 -
AR0591 -          See carboplatin orders
AR0593 -        ..
AR0594 -       x  Notify MD for dose modifications if patient has severe
AR0595 -          acneinform rash
AR0596 -
AR0597 -          CBC with differential and platletes every 4 weeks
AR0598 -          Creatinine and magnesium every 4 weeks
AR0599 -          BUN AST Alk phos Alt Total bilrubin, electrolyes every 8
AR0600 -          weeks.  If levels are outside of normal laboratory values
AR0601 -          notify Brigid NP  (MD/RN) at 415 443 4730
AR0603 -        ..
AR0604 -       x  Physician has discussed risks/benefits of therapy with the
AR0605 -          patient.  Signed consent obtained.
AR0606 -
AR0607 -
AR0608 -          Yes  No   O2 by nasal cannula at 2 liters/min prn for chest
AR0609 -          pain or SOB
AR0611 -           ..
AR0612 -          Yes  No   Diphenhydramine 50 mg IV prn x1 for urticaria
AR0613 -          [barely legible], pruritis SOB
AR0615 -           ..
AR0616 -          Yes  No   Hydrocortizone 100 mg IV prn x1 for urticaria
AR0617 -          [barely legible], pruritis SOB
AR0619 -           ..
AR0620 -          Yes  No   Albuterol inhaler 2-4 puffs prn SOB or chest
AR0621 -          tightness
AR0623 -           ..
AR0624 -          Yes  No   Epinephrine 1x1000 (1 mg/ml) 0.3 mg IV prn
AR0625 -          anaphylaxis
AR0627 -           ..
AR0628 -          Breast CC05752 Cetuximab doc 20061024
AR0629 -          Approved 20060615
AR0631 -           ..
AR0632 -          Physician signature [Hope Rugo]
AR0634 -           ..
AR0635 -          Provider#  35313
AR0637 -           ..
AR0638 -          Date:  20010131
AR0639 -
AR0641 -  ..
AR07 -
AR08 -
AR09 - 1645
AR10 -
AR1001 - Cetuximab treatment completed.
AR1002 -
AR1003 - Millie had a 1 hour rest and observation period.
AR1004 -
AR1005 -
AR1007 -  ..
AR11 -
AR12 -
AR13 - 1730
AR14 -
AR1401 - Pauline disconnected the IV tubes.
AR1403 -  ..
AR1404 - She inserted Herceptin to flush the port.
AR1406 -  ..
AR1407 - She then removed the needle from the port, and swabbed the needle
AR1408 - wound, and placed a temporary bandage.
AR1409 -
AR1410 -
AR1411 -
AR1412 -
AR1413 -
AR15 -

SUBJECTS
Vitals Blood Pressure Pulse Temperature Sa02 Weight Infusion Treatme

AU03 -
AU04 - 0930
AU0501 -  ..
AU0502 - Vitals Show Patient Stable
AU0503 -
AU0504 - Follow up ref SDS D8 AW4L, ref SDS D2 AW4L.
AU0505 -
AU0506 - Catherine took vitals after starting Taxotere drip treatment...
AU0507 -
AU0508 -                    Blood
AU0509 -    Date   Time     Pressure   Pulse  Temprtr  Weight   So2
AU0511 -     ..
AU0512 -    070301 1645..... 125  62     90 *   36.4c
AU0513 -    070301 1505..... 112  69     86 *   36.6c            98
AU0514 -    070222 1145..... 115  73     58     36.3c   147      98
AU0515 -    070222 1045..... 100  60     56     36.6c   147      98
AU0516 -    070222 0930..... 117  63     68     36.2c   147      97
AU0517 -    070215 1200..... 106  66     61     37.0c   147      97
AU0518 -    070215 1055.....  96  61     64     37.0c   147      94
AU0519 -    070215 0930..... 100  64     66     36.7c   147      98
AU0520 -    070208 0920..... 143  70     59     36.5c   147      98
AU0521 -    070201 1330..... 136  74     66             148      94
AU0522 -    070201 1220..... 110  65     62     36.3c   148      96
AU0523 -    070201 1000..... 132  80     65     36.9c   148      99
AU0524 -    061201 1534..... 123  76     76     97.5    150
AU0525 -    061110 1534..... 136  83     73     97.0    150      98
AU0526 -    061020 1534..... 140  79     67     99.8    151      97
AU0527 -    060929 1452..... 141  78     66     98.3    149
AU0528 -    060908 1335..... 139  79     73     98.1    149
AU0529 -    060814 1610..... 139  80     59     98.2    151
AU0530 -    060722 1440..... 142  74     67     98.1    149
AU0531 -    060711.......... 172  87     54     97.5    147
AU0532 -    060623.......... 141  87     71     98.0    147
AU0533 -    060428.......... 129  73     80     99.4    149
AU0534 -    060217.......... 153  81     61     98.6    150
AU0535 -    050916.......... 120  80     80     98.5
AU0536 -
AU0537 -  *  Need vitals taken twice to verify atypical diagnostics.
AU0538 -
AU0539 -
AU0540 -
AU0541 -
AU06 -

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

AX03 -
AX04 - 1730
AX0501 -  ..
AX0502 - Energy Normal Stable After Treatment Cetuximab Support Drugs
AX0503 -
AX0504 - Follow up ref SDS D8 F54N, ref SDS D2 F54N.
AX0506 -  ..
AX0507 - On 060724 diary side effects for cetuximab chemotherapy treatment on
AX0508 - clinical study drug trial. ref SDS 92 YP4I
AX0510 -  ..
AX0511 - Millie reported side effects today lower energy. ref SDS 0 FG3N
AX0513 -  ..
AX0514 - Millie was alert after treatment again today, and not wobbly nor
AX0515 - disoriented.  She was able to drive home without side effects of
AX0516 - treatment.
AX0517 -
AX0518 -
AX0519 -
AX0520 -
AX0521 -
AX0522 -
AX0523 -
AX0524 -
AX0525 -
AX06 -