CONTACTS 

SUBJECTS
Submit Meeting Notes Confirm Understandings Examination 070301 UCSF

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 8 0000, ref SDS 7 0000.
060502 -
060503 -
060504 -
060505 -
060507 -  ..
0606 -
0607 -
0608 - Progress
0609 -
060901 - Millie submitted ref DIT 1 0001 to Arlette at Kaiser and a copy was
060902 - submitted to Jackie at UCSF confirming understandings meeting at UCSF
060903 - yesterday.
060904 -
060905 -    1.  I met with Doctor Rugo and her team at UCSF yesterday at 2:45p.
060906 -        ref DIT 1 0001
060908 -         ..
060909 -    2.  Doctor Rugo concurred with Brigid's initial assessment on
060910 -        070222, ref SDS 6 B64F, that the rash on the upper left arm,
060911 -        which [the primary care physician] cited at Kaiser on 070202,
060912 -        ref SDS 5 JP6F, is spreading IBC. ref SDS 8 527G ref DIT 1 4S48
060913 -
060914 -           [On 070315 Millie submitted to primary care physician at
060915 -           Kaiser progress report on recovering from IBC 3rd relapse
060916 -           with treatment starting on 070201 clinical study cetuximab
060917 -           at UCSF. ref SDS 15 VP5N
060919 -         ..
060920 -    3.  There was consideration during the meeting to increase the
060921 -        scope of treatment by adding carboplatin either yesterday or in
060922 -        the next treatment on 070308, ref SDS 8 1T4O, as planned on
060923 -        070130 for responding to progression of disease. ref SDS 4
060924 -        NI6K, ref DIT 1 4S49
060926 -         ..
060927 -    4.  Doctor Rugo's examination indicated that intensity of IBC rash
060928 -        seems less on the chest area, and stable to improved on the
060929 -        stomach and the left arm. ref SDS 8 4140  Photographs were
060930 -        taken to memorialize observations and assess measurable disease
060931 -        for IBC, ref SDS 8 EX8O, called out in the protocol.
060932 -        ref DIT 1 4S55
060934 -         ..
060935 -    5.  Jackie indicated there wasn't enough time to get CA 15-3
060936 -        diagnostics for the 2 tests at Kaiser on 070208 and on 070215
060937 -        in time to assess progression of disease during the meeting
060938 -        yesterday, ref SDS 8 MP58, as discussed in the letter to Kaiser
060939 -        on 070228. ref SDS 7 ED5H  As well, CA 15-3 results for the
060940 -        test today were not available, since this usually takes a few
060941 -        days. ref DIT 1 4S56
060942 -
060943 -             [On 070306 Millie asks Kaiser for CA 15-3 test results for
060944 -             blood work on 070208 and 070215. ref SDS 12 MI7J
060946 -         ..
060947 -    6.  ANC was reported for the blood test today identified under my
060948 -        name and 477238-1.  ANC is listed in UCSF blood tests as
060949 -        "NEUTS" and shows 1.23, ref SDS 9 P560, which corresponds to
060950 -        1230 under Kaiser's scheme , reported on 060810. ref SDS 3
060951 -        MP5I, ref DIT 1 4S57
060953 -         ..
060954 -    7.  WBC shows 4.1, which is not low, so other factors must have
060955 -        been quite low (but are not clear to me in the report).
060956 -        ref SDS 9 075H  We are working with Jackie on coordinating
060957 -        distribution of diagnostics.  Brigid mentioned in the meeting
060958 -        that patients hand carry data to their primary care doctor.
060959 -        ref SDS 8 O67N  That seems problematic, as reported by AHRQ
060960 -        study reported on 041125. ref SDS 1 SD6N, ref DIT 1 4S63
060962 -         ..
060963 -    8.  Doctor Rugo approved treatment today, despite low ANC.
060964 -        ref SDS 8 T85J and under reasoning previously applied at
060965 -        Kaiser, reported on 060810. ref SDS 3 HV45  There was
060966 -        discussion that switching to both cetuximab and carboplatin
060967 -        would likely further impact ANC, causing delayed treatment
060968 -        and/or measures to elevate ANC, as done previously at Kaiser,
060969 -        e.g., neupogen on 050415. ref SDS 2 KX49, ref DIT 1 4S66
060971 -         ..
060972 -    9.  Doctor Rugo decided that, since discovery of IBC on the left
060973 -        arm was near to the time that treatment with cetuximab was
060974 -        started on 070201, and since clinical evaluation indicates
060975 -        possible improvement on the study, since CA 15-3 dropped from
060976 -        68 to 56 reported on 070202, ref SDS 5 087J, that treatment
060977 -        will be started on the next cycle beginning today with
060978 -        cetuximab only. ref SDS 8 NY7N, ref DIT 1 4S69
060980 -         ..
060981 -   10.  Since blood counts were low in the test yesterday, on 070301,
060982 -        ref SDS 0 EY6T, the doctor ordered another test prior to
060983 -        treatment next Thursday on 070308.  Jackie is coordinating this
060984 -        task. ref SDS 8 528F, ref DIT 1 4S75
060985 -
060986 -            [On 070308 for some reason the blood test was not ordered,
060987 -            but was given anyway; ANC increased from 1.23 to 1.51 that
060988 -            meets requirements for cetuximab treatments. ref SDS 14
060989 -            Q659
060991 -         ..
060992 -   11.  During the meeting, Jackie reminded that [the primary care
060993 -        physician at Kaiser] requested a month notice for the next CT
060994 -        test required for the clinical study, ref SDS 8 5Z6L, so there
060995 -        is time to order the test at Kaiser and specify scope to test
060996 -        for pulmonary embolism, and enlarged right ventricle to compare
060997 -        with the test on 060930 that diagnosed recurrence.  Brigid
060998 -        prepared a UCSF
061000 -              ..
061001 -             Department of Radiology Outpatient Request
061002 -
061003 -        ...form dated 070301, and requesting a test on or before 070328
061004 -        in order to get a report in time for the next meeting with
061005 -        Doctor Rugo to start the next cycle on 070329. ref SDS 8 UR9J
061006 -        My sense is that the test should be done at least a few days
061007 -        earlier, if possible, so there is time for analysis, and to
061008 -        make distribution in time for review to prepare for meeting
061009 -        with the doctor on 070329.
061010 -
061011 -            [On 070306 follow up letter to Kaiser reminding to order CT
061012 -            test in time for starting next cycle on 070329, and to
061013 -            order test for pulmonary embolism. ref SDS 12 HS3X
061015 -         ..
061016 -   12.  Arlette, please let me know if you need a copy of the UCSF
061017 -        request.  I can mail it or drive over to Kaiser after work next
061018 -        week, just let me know.  How late are you open for this type of
061019 -        coordination?
061021 -         ..
061022 -   13.  The goal is to get a CT test report, like the prior report on
061023 -        041218 that said at that time the prior PE visualized in the CT
061024 -        test on 041103 is no longer visualized.  Or, if it is still
061025 -        there, then is it bigger, smaller, what's going on??
061027 -         ..
061028 -   14.  Please let me know the date of the test.
061029 -
061030 -
061031 -
061032 -
0611 -

SUBJECTS
INR 2.5 Blood Test 070301 Notify Kaiser Coagulation Control Clinic B

1103 -
110401 -  ..
110402 - INR 2.5 Stable Normal Notify Kaiser Coagulation Control Clinic
110403 -
110404 - Follow up ref SDS 9 SE6N.
110405 -
110406 - Millie submitted ref DIT 2 0001 supplementing the letter earlier,
110407 - shown above, ref SDS 0 WT5L, and sent to Arlette with copies to Gloria
110408 - at the Kaiser Coagulation Control Clinic in Martinez, and to Jackie at
110409 - UCSF, saying...
110410 -
110411 -    1.  Further to my letter earlier today, ref DIT 1 0001, Jackie
110412 -        asked me [during the meeting at UCSF on 070301, ref SDS 8 0U8K
110413 -        O67N, to coordinate with Kaiser, and] report INR in the blood
110414 -        test yesterday on 070301 was 2.5, same as two weeks ago on
110415 -        070215; PT appears to be 31.7. ref SDS 9 SE6N  Jackie might
110416 -        clarify, if I am mistaken on interpreting the report.  I can
110417 -        deliver UCSF papers to Kaiser, or maybe Jackie can fax it or
110418 -        something.  Evidently, there is a problem sending data
110419 -        electronically to ensure accuracy.  I could also hand carry the
110420 -        report on the blood test yesterday to Gloria at Kaiser in
110421 -        Martinez, if that helps to manage the record.  Just let me
110422 -        know. ref DIT 2 0001
110423 -
110424 -           [On 070305 entering results of the blood test on 070301
110425 -           showed a big difference in the way UCSF and Kaiser set the
110426 -           "normal" range for INR, ref SDS 9 SE6N, Millie wrote a
110427 -           letter notifying Jackie at UCSF with copies to Arlette and
110428 -           Gloria at Kaiser, ref SDS 10 XG5H; and asking UCSF for
110429 -           clarification to facilitate managing Millie's Coumadin
110430 -           treatments for pulmonary embolism. ref SDS 10 3A4Y
110431 -
110433 -  ..
110434 - Gloria Requests Another Blood Test Next Week to on INR to Assess Coumadin Treatments
110435 -
110436 -
110437 -    2.  When I got home from errands today, Gloria, at Kaiser's
110438 -        Coagulation Control Clinic in Martinez, had left a telephone
110439 -        message asking about blood tests to assess changes in Coumadin
110440 -        treatment for pulmonary embolism.  Gloria proposed in her
110441 -        message getting INR tested next week. ref DIT 2 XO6J
110443 -         ..
110444 -    3.  I called Gloria back this afternoon and left a message on these
110445 -        understandings from UCSF documents received yesterday.  This
110446 -        letter confirms that message. ref DIT 2 XO7G
110448 -         ..
110449 -    4.  We have previously discussed that, when INR stabilizes,
110450 -        indicated by 2.5 for the past 2 weeks, this could permit
110451 -        skipping the next weekly test.  However, since Doctor Rugo
110452 -        ordered a blood test for next week on 070308 to check ANC in
110453 -        connection with cetuximab treatment for cancer, then INR can be
110454 -        checked again as well, as Gloria discussed in her phone message
110455 -        today.  If INR is still stable, then we might consider waiting
110456 -        to test INR again until UCSF needs to test for starting cycle
110457 -        on the clinical study, currently scheduled for 070329.
110458 -        ref DIT 2 XO7L
110460 -             ..
110461 -            [On 070305 Millie requested that Gloria coordinate directly
110462 -            with UCSF on interpreting the UCSF blood test report for
110463 -            prescribing Coumadin to treat pulmonary embolism, and
110464 -            reminded that UCSF has ordered another blood test on
110465 -            070308, so that INR can be tested again if needed.
110466 -            ref SDS 10 3A6S
110468 -             ..
110469 -            [On 070305 Brigid advised INR 2 - 3 is the correct range
110470 -            for prescribing Coumadin to treat Millie for pulmonary
110471 -            embolism, despite being 100% over the normal range in the
110472 -            report for the UCSF blood test on 070301. ref SDS 10 SN5O
110474 -             ..
110475 -            [On 070305 UCSF did not make distribution to coorindate
110476 -            communciations with Kaiser; Millie sent a letter thanking
110477 -            Brigid for timely response to INR question, and sent copies
110478 -            thanking Jackie for timely coordination, and also copies to
110479 -            Arlette at Kaiser in Walnut Creek, and to Gloria in
110480 -            Kaiser's Coagulation Control Clinic in Martinez, CA for
110481 -            managing Coumadin that treats Millie's pulmonary embolism.
110482 -            ref SDS 10 B18H
110484 -             ..
110485 -            [On 070306 Millie requests feedback from Gloria to verify
110486 -            accuracy of understandings that Kaiser is satisfied with
110487 -            UCSF blood test on INR for prescribing Coumadin to treat
110488 -            pulmonary embolism, and advises current regimen will
110489 -            continue until further notice. ref SDS 11 FJ9K
110491 -             ..
110492 -            [On 070307 Gloria called and confirmed Millie's current
110493 -            Coumadin treatment should be continued based on UCSF blood
110494 -            test reporting, ref SDS 13 UH4M, and further indicated that
110495 -            since blood tests over the past month indicate Millie's INR
110496 -            condition has stabalized between the target range of 2.0 -
110497 -            3.0 then further testing can follow the UCSF schedule for
110498 -            monthly blood tests on the clinical study for treating
110499 -            Millie's cancer. ref SDS 13 723G
110500 -
110501 -
110502 -
110503 -
110504 -
110505 -
110506 -
110507 -
1106 -