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1...Why is the visit number constant in Nurse's Notes, and yet seems to
CONTACTS
SUBJECTS
Treatment Cetuximab 4th Treatment 2nd Cycle Chemotherapy 10th Cycle
0603 -
0603 - ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 28 0000. ref SDS 26 0000.
060502 -
060503 - Millie received the 4th treatment today to complete the 2nd cycle with
060504 - cetuximab on a drug trial in a clinical study at UCSF under the
060505 - supervision of Doctor Rugo. ref SDS 0 7T3H Catherine was back at
060506 - work, and did an excellent job following the protocol, reviewing side
060507 - effects, ref SDS 0 QU8K, and providing professional care. ref SDS 0
060508 - 417F Millie reported expanding side effects problems of drying skin.
060509 - Catherine consulted the pharmacy. A new medication was prescirbed.
060510 - ref SDS 0 JS6M "Restless legs" was also presented today, caused by
060511 - Benadryl, and this was addressed by slowing the rate of drip treatment
060512 - infusion. ref SDS 0 F77K Millie reported that the "restless legs"
060513 - problem was reduced. The chemotherapy order calls for pre-treatment
060514 - 30 - 60 minutes prior to cetuximab infusion. This may provide
060515 - additional time to further moderate this problem, if needed.
060516 - ref SDS 0 DC7J
060517 -
060518 -
060519 -
060521 - ..
0606 -
0607 -
0608 - Progress
0609 -
060901 - Clinic Examination Orientation Starting Treatment Cetuximab
060902 -
060903 - Follow up ref SDS 28 407N, ref SDS 26 407N.
060905 - ..
060906 - Agenda...
060907 -
060908 - 1. Infusion Clinic........................... ref SDS 0 1M6H
060909 - 2. Side effects.............................. ref SDS 0 QU8K
060910 - 3. Vitals.................................... ref SDS 0 AW4L
060911 -
060912 -
060913 -
0610 -
SUBJECTS
Breast Examination Shows Improvement IBC Rash Intensity Subsides No
1103 -
110401 - ..
110402 - Breast Examination Likely IBC 2 Scenarios Spreading Intensity Declines
110403 -
110404 - Follow up ref SDS 28 FO6H, ref SDS 26 FO6H.
110405 -
110406 -
110407 -
110408 -
110409 -
1105 -
SUBJECTS
Emotional Stress Roller Coaster Endemic Cancer Treatment Erratic Cha
1603 -
160401 - ..
160402 - Emotional Roller Coaster Endemic Cancer Treatment and Coordination
160403 -
160404 - Follow up ref SDS 28 6A7J, ref SDS 22 Y642.
160405 -
160406 -
160407 -
160408 -
160409 -
1605 -
SUBJECTS
Cetuximab Prognosis IBC May Subside for 10 Months Before Progressing
1903 -
190401 - ..
190402 - Cetuximab Prognosis IBC May Subside for 10 Months Before Progressing
190403 - Prognosis Disease May Subside 10 Months or More Before Progression
190404 - Progresssion of Disease May be Delayed for 10 Months or More
190405 -
190406 - Follow up ref SDS 28 6A9H.
190407 -
190408 - No meeting with medical management team today.
190409 -
190410 -
190411 -
1905 -
SUBJECTS
Measureable Disease IBC Rash Tape Measure Evaluate Progression of Di
2203 -
220401 - ..
220402 - Measureable Disease Photographs IBC Rash Improving
220403 - IBC Rash Improved Measurable Disease Photographs Tape Measure
220404 -
220405 - Follow up ref SDS 28 6T6M, ref SDS 26 6T6M.
220406 -
220407 - No meeting with medical management team today.
220408 -
220409 -
220410 -
220411 -
220412 -
2205 -
SUBJECTS
Side Effects Infusion Clinic UCSF Consultation Treatment Cetuximab A
2703 -
270401 - ..
270402 - Side Effects Medicated After Weekly Examinations
270403 -
270404 - Follow up ref SDS 28 FO66, ref SDS 26 FO66.
270405 -
270406 - No meeting with medical management team today.
270407 -
270408 -
270409 -
2705 -
SUBJECTS
Blood Tests Cetuximab Monthly Clinical Study Drug Trial Performed at
3003 -
300401 - ..
300402 - Blood Tests 1 Per Month on Cetuximab Performed at UCSF Saves Time Cost
300403 -
300404 - Follow up ref SDS 28 XR40, ref SDS 26 XR40.
300405 -
300406 - The next blood test is scheduled for 070329.
300407 -
300408 -
300409 -
300410 -
3005 -
SUBJECTS
Cetuximab 2nd Cycle 4th Treatment 8th Total Treatment Chemotherapy 9
3303 -
3304 - 0845
330501 - ..
330502 - Infusion Clinic for Cetuximab Treatent
330503 -
330504 - Follow up ref SDS 28 1M6H, ref SDS 26 1M6H.
330505 -
330506 - Millie was scheduled last week for treatments through May. ref SDS 28
330507 - E29H Nola said she could enter the clinic immediately for treatment.
330509 - ..
330510 - Catherine was back at work today, and was very effective implementing
330511 - the drug trial protocol for cetuximab, including review of side
330512 - effects, taking vitals, and providing a high level of professional
330513 - care.
330515 - ..
330516 - Catherine discussed advantages of continuity of nurse staffing to
330517 - treat complex cases, shown by problems on 070301, ref SDS 23 GZ5I, the
330518 - following week on 070308, ref SDS 26 FF41, and again last week on
330519 - 070315. ref SDS 28 1M6H Using the same nurse as much as possible
330520 - reduces problems of overlooking side effects, recognizing new issues,
330521 - and understanding the protocol.
330522 -
330523 - [On 070809 Catherine not available; substitute had difficulty
330524 - understanding protocol; blood test performed out of sequence
330525 - because having others pay for an unnecessary test is faster and
330526 - easier for the staff than checking the record to verify accuracy
330527 - of treatment. ref SDS 34 7U7J
330528 -
330529 -
330530 -
330531 -
330533 - ..
3306 -
3307 -
3308 - 1033
3309 -
330901 - Millie received 8th overall and 4th treatment of 2nd cycle with
330902 - Cetuximab, starting from 070201, ref SDS 14 G68I, and the 15th
330903 - treatment for 3rd relapse of IBC, beginning on 060721. ref SDS 4 407N
330905 - ..
330906 - Taxotere Capecitabine
330907 -
330908 - Follow up ref SDS 28 PR8Q, ref SDS 26 PR8Q.
330909 -
330910 - Relapse Treatments
330911 -
330912 - 1. Cycle 09 and 01 ................... 060721, ref SDS 4 407N
330913 - 2. Cycle 10 and 02 ................... 060814, ref SDS 7 LY6O
330914 - 3. Cycle 11 and 03 ................... 060908, ref SDS 8 407N
330915 - 4. Cycle 12 and 04 ................... 060929, ref SDS 9 407N
330916 - 5. Cycle 13 and 05 ................... 061020, ref SDS 10 407N
330917 - 6. Cycle 14 and 06 ................... 061110, ref SDS 11 407N
330918 - 7. Cycle 15 and 07 ................... 061201, ref SDS 12 407N
330920 - ..
330921 - Cetuxiab Clinical Study
330922 -
330923 - Follow up ref SDS 28 7T3H, ref SDS 26 7T3H.
330924 -
330925 - Total Cetuximab
330926 - 8. Cycle 01 and 08 and 01 01.......... 070201, ref SDS 14 SG8I
330927 - 9. Cycle 01 and 08 and 02 02.......... 070208, ref SDS 16 7T3H
330928 - 10. Cycle 01 and 08 and 03 03.......... 070215, ref SDS 17 7T3H
330929 - 11. Cycle 01 and 08 and 04 04.......... 070222, ref SDS 20 7T3H
330930 - 12. Cycle 02 and 09 and 01 05.......... 070301, ref SDS 23 7T3H
330931 - 13. Cycle 02 and 09 and 02 06.......... 070308, ref SDS 26 7T3H
330932 - 14. Cycle 02 and 09 and 03 07.......... 070315, ref SDS 28 7T3H
330933 - 15. Cycle 02 and 09 and 04 08.......... 070322, ref SDS 0 7T3H
330935 - ..
330936 - Nurses Notes...
330947 - ..
330948 - Why is the visit number constant in Nurse's Notes, and yet seems to
330949 - vary in the schedule received from Nola last week? ref SDS 28 159O
330950 -
330952 - ..
330953 - UCSF Log Time...
330954 -
330955 - Blood
330956 - Test Infusion
330957 -
330958 - In....... 0830
330959 - Out...... 1100
330960 - Visit.... Min 2.5 Hours
330962 - ..
330963 - Pain Assessment...
330964 -
330965 - x
330966 - 0123456789 10
330967 -
330968 - <923k
330969 - Administration Site: Right Port Catheter
330970 - Needle Size: 20 G 1"
330971 - Blood Return Good: Yes
330973 - ..
330974 - Remind patient to call MD if temp > 101 F, Shaking Chills
330975 -
330976 - This protocol differs from Kaiser requirements, reported on
330977 - 041202. ref SDS 2 IX9N
330978 -
330979 -
330980 -
330981 -
3310 -
SUBJECTS
Side Effects Infusion Clinic UCSF Consultation Treatment Cetuximab A
4103 -
4104 - 0910
410501 - ..
410502 - Side Effects Consultation Pharmacist Heavy Chest Difficult Breathing
410503 -
410504 - Follow up ref SDS 28 QU8K, ref SDS 26 QU8K.
410506 - ..
410507 - Millie was asked about side effects today, which corrected the problem
410508 - on 070308. ref SDS 26 QG7K
410509 -
410510 - 1. Rash like acne
410511 -
410512 - Mild condition continues from 070208 around the nose,
410513 - ref SDS 16 QU8K; treatment effective with medication
410514 - prescribed on 070222. ref SDS 20 FO66
410516 - ..
410517 - 2. Dry skin face, chest arm...
410518 -
410519 - Millie notified UCSF in a letter on 070228 of sudden
410520 - extremely dry face. ref SDS 21 LR4S The next day, on
410521 - 070301, Brigid prescribed Curel lotion. ref SDS 22 5V73
410522 - Since that time, treatment with Curel has brought some
410523 - relief, per examination by Brigid prior to treatment
410524 - last week on 070315. ref SDS 28 6B8H Today, dryness has
410525 - spread to chest, and arms. Catherine called the
410526 - pharmacy. Recommended trying Aquaphor to relieve
410527 - chronic skin dryness. On the way home, Millie stopped
410528 - at Long's Drugs and purchased this treatment, described
410529 - on the bottle as "Advanced Therapy."
410530 -
410531 - [On 070329 Millie looks great, and feels fortunate to
410532 - have avoided severe skin rash side effects of
410533 - cetuximab by applying treatment prescribed by Brigid.
410534 - ref SDS 31 N49K
410536 - ..
410537 - 3. Rash on right chest
410538 -
410539 - Examination of upper right chest observes various
410540 - blemishes in the proximate area of the port catheter.
410541 - These are not identified in Nurses's Notes today as a
410542 - "rash," which clarifies reports of observations during
410543 - examination and treatment last week on 070315.
410544 - ref SDS 28 KU3L This issue is distinct from IBC rash
410545 - slighlty on the right breast, which is being tracked as
410546 - measurable disease by the examination team, reported on
410547 - 070315. ref SDS 28 FO6H
410549 - ..
410550 - [On 070330 examination at Kaiser by primary care
410551 - physician finds significantly increased intensity of
410552 - rash on upper left arm, ref SDS 33 N19J, and a
410553 - similar new rash above the right breast and below the
410554 - colar bone, ref SDS 33 583G; these dramatic changes
410555 - in condition were diagnosed without biopsy as
410556 - complications of lymphedema causing Cellulitis with
410557 - elevated temperature, and possibly triggered by
410558 - patient's increased exercise that overtaxed the
410559 - system. ref SDS 33 7C7F Keflex antibiotics was
410560 - prescribed, ref SDS 33 474O; about 3 hours later
410561 - self-examination showed these erruptive rash
410562 - conditions had subsided, and so Keflex treatment was
410563 - not performed. ref SDS 33 KZ6L
410565 - ..
410566 - 4. Rash right arm
410567 -
410568 - Millie discussed occassional red dots and blemishes that
410569 - occur on the right arm, examined by Brigid during last
410570 - week on 070315. ref SDS 28 FO6H There is a concern
410571 - about IBC spreading, or side effects of cetuximab
410572 - treatment. Today, Catherine seemed to indicate there is
410573 - no evidence of any distinct rash on the right arm.
410574 -
410576 - ..
410577 - 5. Restless legs
410578 -
410579 - Millie described "restless legs," reported in the record
410580 - following treatment last week on 070315. ref SDS 28 F77K
410581 - Catherine slowed the rate of Benadryl pre-treatment
410582 - medication, from 10 to 20 minutes. ref SDS 0 DC7J After
410583 - treatment today, Millie feels this change brought some
410584 - relief today. Maybe next week, Benadryl pre-treatment
410585 - can be given over 30 minutes, which seems to be
410586 - supported by the chemotherapy order. ref SDS 0 WR4H
410587 -
410588 - [On 070329 prescription for Benadryl changed from 50
410589 - mg to 25 mg. ref SDS 31 MF6N
410591 - ..
410592 - [On 070329 "restless legs" problem with Benadryl
410593 - resolved with Brigid's change in treatment dose.
410594 - ref SDS 32 F77K
410596 - ..
410597 - 6. Sleeping difficulty
410598 -
410599 - Over the past 2 -4 weeks, there has been gradually
410600 - increased difficulty sleeping. This occurs by staying
410601 - up later than 2000, until 2200 or in some cases later;
410602 - Millie has been rising earlier at 0430 or even 0300.
410603 - Sometimes after getting up to go to the bathroom, Millie
410604 - has difficulty falling to sleep. Normally, Millie gets
410605 - at least 8 hours sleep, and sleeps soundly. This makes
410606 - the change in sleep evident. The only previous report
410607 - of sleep issues was on 020726, which seemed related to
410608 - radiation treatments, but was not serious and did not
410609 - last. ref SDS 1 YX7O
410611 - ..
410612 - Last year on 060721, Ativan was prescribed by Kaiser to
410613 - aid sleep and relieve anxiety from the 3rd relapse of
410614 - IBC. ref SDS 4 FZ5N The current cause of difficulty
410615 - sleeping may be accumulating side effects to cetuximab,
410616 - and/or emotional trauma and anxiety, doubt, and worry
410617 - about effectiveness of treatment reported on 070301, and
410618 - shown by elevated vitals at that time. ref SDS 22 Y642
410619 - Last week on 070315, Brigid asked Millie about coping
410620 - with emotional swings from recent changes in prognosis
410621 - and treatments, consideration of changing treatment.
410622 - ref SDS 28 6A7J Another cause of anxiety that makes
410623 - sleep difficult is difficulty coordinating the work,
410624 - also, reviewed on 070315. ref SDS 28 OR5K Difficulty
410625 - sleeping may manifest anxiety, doubt, and worry that is
410626 - not evident from Millie's calm, measured demeanor
410627 - working with complex communications that delay and
410628 - frustrate getting things done. ref SDS 28 ES3K
410629 -
410630 - [On 070329 stress, anxiety, doubt, worry relieved by
410631 - good medical news, and increases by difficulty
410632 - managing communications. ref SDS 31 II7H
410634 - ..
410635 - 7. Lymphedema Cellulitis Complications
410636 -
410637 - Lymphedema continues relatively controlled. There is no
410638 - association with cetuximab treatments, since the
410639 - proximate cause was left breast mastectomy with removal
410640 - of lymph nodes in the left axillar, and is complicated
410641 - by exercise to strengthen the immune system for
410642 - resisting cancer, and by cat bites that flow from
410643 - engaging pets for qualify of life, reported in the case
410644 - study on 070130. ref SDS 13 VX6F
410645 -
410646 - [On 070330 examination at Kaiser by primary care
410647 - physician finds significantly increased intensity of
410648 - rash on upper left arm, ref SDS 33 N19J, and a
410649 - similar new rash above the right breast and below the
410650 - colar bone; these dramatic changes in condition were
410651 - diagnosed without biopsy as complications of
410652 - lymphedema causing Cellulitis with elevated
410653 - temperature, and possibly triggered by patient's
410654 - increased exercise that overtaxed the system.
410655 - ref SDS 33 583G Keflex antibiotics was prescribed,
410656 - ref SDS 33 474O; about 3 hours later self-examination
410657 - showed these erruptive rash conditions had subsided,
410658 - and so Keflex treatment was not performed.
410659 - ref SDS 33 KZ6L
410661 - ..
410662 - 8. Tired, fatigued - pulmonary emoblism...
410663 -
410664 - Fatigue, shortness of breath and other symptoms of
410665 - pulmonary embolism were presented during meeting on
410666 - 070130, ref SDS 13 CV5L, citing case study listed on
410667 - 060722. ref SDS 5 ZV41
410669 - ..
410670 - On 070218 Millie notified the primary care physician and
410671 - UCSF that energy continues to recover; she played tennis
410672 - and pulse reached 144. ref SDS 18 N05H
410674 - ..
410675 - Energy that seemed to be declining leading up to
410676 - treatment on 070301, ref SDS 23 CA4K, seems to be rising
410677 - back to normal the past few weeks, continuing trends
410678 - reported last week on 070315. ref SDS 28 CA4K Catherine
410679 - asked if Millie has played any more tennis? Millie has
410680 - not played tennis, but has worked out more in the gym,
410681 - including the stationary bike for several hours at a
410682 - time.
410683 -
410685 - ..
410686 - 9. Heavy chest - shortness of breathing
410687 -
410688 - Patient history was reported to UCSF on 070130.
410689 - ref SDS 13 RT6I
410690 -
410691 - Condition seems improved, as reported on 070204.
410692 - ref SDS 15 JJ7O No noticable increase, aligns with
410693 - continuing higher energy. ref SDS 0 CA4K
410694 -
410696 - ..
410697 - 10. Cough - clearing throat
410698 -
410699 - This condition seems improved, as reported to the doctor
410700 - on 070130. ref SDS 13 RT6I
410701 -
410703 - ..
410704 - 11. Dry hands and feet...
410705 -
410706 - Dry hands and feet seem much improved since ending
410707 - treatment with Taxotere and capecitiabine on 061201.
410708 -
410710 - ..
410711 - 12. Eyes tearing
410712 -
410713 - This seems improved since ending treatment with Taxoter
410714 - and capecitabine on 061201.
410715 -
410717 - ..
410718 - 13. Nausea and vomitting
410719 -
410720 - Problems with Taxotere and capecitabine reported on
410721 - 061110, ref SDS 11 D19M, did not occur this past week
410722 - after treatment with cetuximab. As a result, there was
410723 - no pre-treatment with Decadron today, per below.
410724 - ref SDS 0 G57I
410726 - ..
410727 - 14. Sores in mouth
410728 -
410729 - None yet, cleaning mouth carefully to avoid problem.
410730 -
410731 -
410732 -
410733 -
4108 -
SUBJECTS
Schedule Treatment Weekly Thursday 0800 4 Week Cycles Clinical Study
4403 -
440401 - ..
440402 - Schedule Weekly Treatments Continue on Thursdays
440403 -
440404 - Follow up ref SDS 28 QK6L, ref SDS 26 QK6L.
440406 - ..
440407 - Millie's next treatment is scheduled for 070329 0845, reported by Nola
440408 - on 070315. ref SDS 28 159O
440410 - ..
440411 - There are issues to work out in order to have the blood test done in
440412 - time for meeting with Doctor Rugo at 0800, since the Infusion Clinic
440413 - does not start work until 0830. On 070315, considered somone might
440414 - normally come in early in the Infusion Clinic, and could draw blood
440415 - and configure Millie with a port connection for treatment after
440416 - meeting with the doctor. ref SDS 28 WU6F
440417 -
440418 - [On 070326 presented scheduling plans to UCSF for getting blood
440419 - tests, examination, and treatment at the same time. ref SDS 29
440420 - 624X
440422 - ..
440423 - [On 070326 coordinated to schedule blood tests in advance of
440424 - normal hours. ref SDS 29 PP5Y
440426 - ..
440427 - [On 070327 Jackie submitting "lab slips" ordering blood tests for
440428 - Infusion Clinic to draw blood at 0800 on 070329. ref SDS 30 MT6Q
440430 - ..
440431 - [On 070329 blood tests, examination and treatment scheduling
440432 - issues were resolved. ref SDS 32 UZ4J
440433 -
440434 -
440435 -
440436 -
440437 -
440438 -
4405 -
SUBJECTS
Blood Counts ANC Normal 1.51 Test 070308 Safe for Cetuximab 2nd Trea
4703 -
4704 - 0840
470501 - ..
470502 - Blood Counts Normal Full Dose Cetuximab Ordered
470503 - Blood Test Not Scheduled Infusion Clinic Took Approprite Action
470504 -
470505 - Follow up ref SDS 28 Q659, ref SDS 26 Q659.
470506 -
470507 - The next blood test is scheduled for 070329.
470508 -
470509 -
470510 -
470511 -
4706 -
SUBJECTS
Coagulation Control Coumadin Treatment Pulmonary Embolism INR 2.5 PT
5403 -
540401 - ..
540402 - Coagulation Control INR High 2.5 PT 28 High
540403 -
540404 - Follow up ref SDS 28 SE6N, ref SDS 26 SE6N.
540405 -
540406 - Next blood test for INR is on 070426, per planning on 070308.
540407 - ref SDS 26 CS6J
540408 -
540409 -
540410 -
540411 -
5405 -
SUBJECTS
Absolute Neutrophils Count ANC 1510 Below 1800 UCSF Criteria But Abo
5703 -
570401 - ..
570402 - ANC 1510 Below 1800 Criteria for Blood Counts to Approve Treatment
570403 -
570404 - Follow up ref SDS 28 P560, ref SDS 26 P560.
570405 -
570406 - The next blood test is scheduled for 070329.
570407 -
570408 -
570409 -
570410 -
5705 -
SUBJECTS
Blood Tests CA 15-3 36 Test 070301 Results Submitted by UCSF CA 15-3
6203 -
620401 - ..
620402 - CA 15-3 36 Tests 2 From Kaiser 1 from UCSF Pending Submission
620403 -
620404 - Follow up ref SDS 28 2N5J, ref SDS 26 2N5J.
620405 -
620406 - The next blood test is scheduled for 070329.
620407 -
620408 -
620409 -
6205 -
SUBJECTS
Port Catheter IV Connection Prepare for Drip Treatment 1 Try Require
6503 -
6504 - 0835
650501 - ..
650502 - Preparation for Treatment Required One (1. Attempt to Connect Port
650503 -
650504 - Follow up ref SDS 28 EB7J, ref SDS 26 EB7J.
650506 - ..
650507 - The nurse connected the IV tubes to the port....
650509 - ..
650510 - Interlink System Vented Paclitaxel set
650512 - ..
650513 - Like last week and earlier on 070301, there were no problems getting
650514 - blood to flow from the port, ref SDS 23 EB7J, as occurred on 070222,
650515 - ref SDS 19 DC5W, and earlier on 070201. ref SDS 14 DC5W
650517 - ..
650518 - The nurse flushed the port with saline.
650519 -
650520 -
650521 -
650522 -
6506 -
SUBJECTS
Blood Draws 7 Vials Clinical Study Research Cetuximab Drug Trial Blo
6903 -
690401 - ..
690402 - Blood Draws 7 Vials for Clinical Study Research
690403 -
690404 - Follow up ref SDS 28 O56V, ref SDS 26 O56V.
690405 -
690406 - There were no blood draws today, because the study requires blood for
690407 - research only at the beginning of each cycle, and this is the 2nd
690408 - treatment in the 2nd cycle.
690409 -
690410 -
690411 -
690412 -
690413 -
6905 -
SUBJECTS
Benadryl Pre-treatment Prepares Patient for Cetuximab Chemotherapy A
7303 -
7304 - 0840
730501 - ..
730502 - Benadryl Reduce Side Effects Cetuximab Chemotherapy Treatment
730503 -
730504 - Follow up ref SDS 28 DC7J, ref SDS 26 DC7J.
730505 -
730506 - Benadryl (diphenhydramine) started. 50 MG....... ref SDS 0 IJ41
730507 -
730508 - Purpose reported on 060721. ref SDS 4 DC7J
730510 - ..
730511 - Chemotherpay order calls for Benadryl (diphenhydramine) pre-treatment
730512 - 30 - 60 minutes prior to cetuximab infusion, shown below. ref SDS 0
730513 - IJ41
730515 - ..
730516 - For some reason this requirement for Benadryl treatment has never been
730517 - implemented. The practice at Kaiser over the past 5 years, and this
730518 - year at UCSF, beginning on 070201, ref SDS 14 DC7J, has been to start
730519 - primary treatment immediately after 10 minutes of Benadryl infusion.
730520 - ref SDS 0 4N5M
730521 -
730522 - [On 070329 Chemotherapy Order reviewed during examination
730523 - and was not changed for pre-treatment 30 - 60 minutes prior
730524 - to cetuximab treatment. ref SDS 31 MF4N
730526 - ..
730527 - [On 070329 prescription for Benadryl changed from 50 mg to
730528 - 25 mg. ref SDS 31 MF6N
730530 - ..
730531 - Perhaps the Infusion Clinic has a standing order (i.e., policy) that
730532 - supports deviation from the chemotherapy order, or the order was
730533 - modified after 070201, and not submitted to the patient. Perhaps,
730534 - like Decadron, pre-treatment timing is adjusted according to patient
730535 - history, and up until recenlty, there has not been an issue.
730537 - ..
730538 - There may be some correlation between planning Benadryl treatment 30 -
730539 - 60 minutes prior to cetuximab, and the new problem of restless legs.
730540 - ref SDS 0 CC4I
730541 -
730542 - [On 070329 prescription for Benadryl changed from 50 mg to
730543 - 25 mg. ref SDS 31 MF6N
730544 -
730545 -
730547 - ..
7306 -
7307 -
7308 - 0900
7309 -
730901 - Benedryl completed equipment beeps.
730902 -
730903 - This took 20 minutes, rather than 10 minutes for previous treatments,
730904 - in order to reduce the effect of "restless legs," reported last week,
730905 - ref SDS 28 DC7J, and again today, per above. ref SDS 0 F77K
730907 - ..
730908 - After treatment, Millie reported that increasing the time for Benadryl
730909 - infusion today from 10 to 20 minutes seemed to reduce side effects of
730910 - "restless legs." Possibly this can be further improved within the
730911 - chemotherapy order for pre-treatments 30 - 60 minutes prior to
730912 - cetuximab. ref SDS 0 IJ41
730913 -
730914 - [On 070329 prescription for Benadryl changed from 50 mg to
730915 - 25 mg. ref SDS 31 MF6N
730916 -
730917 -
730919 - ..
7310 -
7311 -
7312 -
7313 -
731301 - Decadron (dexamethasone) IV pre-treatment........ ref SDS 0 FM4M
731302 -
731303 - On 070208 Decadron was not given because Millie did not experience
731304 - side effects of nausea and vomitting after treatment with cetuximab on
731305 - 070201. ref SDS 16 G57I Since this favorable condition continues, per
731306 - above, ref SDS 0 D19M, Decadron was not given again today.
731307 -
731308 - [On 070329 Chemotherapy Order reviewed during examination
731309 - and was not changed for pre-treatment 30 - 60 minutes prior
731310 - to cetuximab treatment. ref SDS 31 MF4N
731311 -
731313 - ..
7314 -
7315 -
7316 -
731601 - Decadron completed -- not reported.
731602 -
731603 -
731604 -
731605 -
7317 -
SUBJECTS
Cetuximab 2nd Cycle 4th Treatment Clinical Study Drug Trial Treatmen
7503 -
7504 - 0910
750501 - ..
750502 - Cetuximab Full Dose Blood Counts on Targets Treatment 1 Hour
750503 -
750504 - Follow up ref SDS 28 4N5M, ref SDS 26 4N5M.
750506 - ..
750507 - Cetuximab started.
750508 -
750509 - Verify chemotherapy order for 070208.
750511 - ..
750512 - Chemotherapy order calls for cetuximab to start 30 - 60 minutes after
750513 - Beyadryl pre-tretment. ref SDS 0 IJ41
750515 - ..
750516 - Chemotherapy Orders...
750517 -
750523 - Auth# Stor BCC LOC
750524 - Visit: 12575738 DOS 20070201
750526 - ..
750527 - Date: 20070201
750529 - ..
750530 - Study Order for CC#05752: Phase II Trial of Cetuximab alone and
750531 - in combination with Carboplatin in ER-negative, PR-negative,
750532 - HER2-negative Nonoverexpressing Metastatic Breast Cancers
750534 - ..
750535 - Dates to be given: 070201
750536 - Arm 1:Cetuximab alone
750538 - ..
750539 - Diagnosis: breast cancer
750541 - ..
750542 - ICD-9 codes: 174.9
750543 - Allergies NKDA
750545 - ..
750546 - Pre-medications 30 - 60 minutes prior to cetuximab infusion
750548 - ..
750549 - 4. Diphenhydramine 50 mg IV or [illegible writing]
750550 -
750551 - Benadryl........... ref SDS 0 DC7J
750552 -
750553 - [On 070329 Chemotherapy Order reviewed during examination
750554 - and was not changed for pre-treatment 30 - 60 minutes prior
750555 - to cetuximab treatment. ref SDS 31 MF4N
750557 - ..
750558 - [On 070329 prescription for Benadryl changed from 50 mg to
750559 - 25 mg. ref SDS 31 MF6N
750561 - ..
750562 - 5. Dexamethasone (??) 10 mg IB or 20 mg IV [handwritten ???]
750563 -
750564 - Further premed TBD [barely legible handwriting??]
750565 -
750566 - [On 070329 Chemotherapy Order reviewed during examination
750567 - and was not changed for pre-treatment 30 - 60 minutes prior
750568 - to cetuximab treatment. ref SDS 31 MF4N
750570 - ..
750571 - Medication: (plan to give weekly ********STUDY SUPPLY**********
750573 - ..
750574 - 6. Cetuximab (Erbitux) (loading dose)
750575 -
750576 - 400 mg/m [squared] = 684 mg IV over 120 minutes for
750577 - first dose x 1
750578 -
750579 - dose on dcte 20070201 Maximum infusion rate is 5 ml/minute
750580 - (concentration 2 mg/ml)
750582 - ..
750583 - 7. Cetuximab (Erbitux) (maintenance dose)
750584 -
750585 - 250 mg/m [squared] = 428 mg IV (or ____ mg/m[squared] =
750586 - ____mg) IV over 60 or ____ minutes.
750587 -
750588 - Maximum infusion rate is 5 ml/minute (concentration 2 mg/ml)
750589 - Infuse once weekly for 8 weeks. First dose to be given on date
750590 - 20070201.
750592 - ..
750593 - Cetuximab is administered undiluted through a low protien
750594 - binding 0.22 micro in-line filter. Use NS solution to flush the
750595 - line at the end of the infusion.
750597 - ..
750598 - ARM 2: Administer carboplatin of vital signs are unremarkable
750599 - one hour after cetuximab infusion.
750601 - ..
750602 - Vital signs at baseline, upon cetuximab completion and one hour
750603 - after cetuximab.
750604 -
750605 - ****please note start and stop times****
750607 - ..
750608 - Laboratory work:
750609 -
750610 - See carboplatin orders
750612 - ..
750613 - x Notify MD for dose modifications if patient has severe
750614 - acne in form rash
750615 -
750616 - CBC with differential and platletes every 4 weeks
750617 - Creatinine and magnesium every 4 weeks
750618 - BUN AST Alk phos Alt Total bilrubin, electrolyes every 8
750619 - weeks. If levels are outside of normal laboratory values
750620 - notify Brigid NP (MD/RN) at 415 443 4730
750622 - ..
750623 - x Physician has discussed risks/benefits of therapy with the
750624 - patient. Signed consent obtained.
750625 -
750626 -
750627 - Yes No O2 by nasal cannula at 2 liters/min prn for chest
750628 - pain or SOB
750630 - ..
750631 - Yes No Diphenhydramine 50 mg IV prn x1 for urticaria
750632 - [barely legible], pruritis SOB
750634 - ..
750635 - Yes No Hydrocortizone 100 mg IV prn x1 for urticaria
750636 - [barely legible], pruritis SOB
750638 - ..
750639 - Yes No Albuterol inhaler 2-4 puffs prn SOB or chest
750640 - tightness
750642 - ..
750643 - Yes No Epinephrine 1x1000 (1 mg/ml) 0.3 mg IV prn
750644 - anaphylaxis
750646 - ..
750647 - Breast CC05752 Cetuximab doc 20061024
750648 - Approved 20060615
750650 - ..
750651 - Physician signature [Hope Rugo]
750653 - ..
750654 - Provider# 35313
750656 - ..
750657 - Date: 20010131
750658 -
750660 - ..
7507 -
7508 -
7509 - 1010
7510 -
751001 - Cetuximab treatment completed.
751002 -
751003 - Millie had a 1 hour rest and observation period, required by the
751004 - protocol. ref SDS 0 G679
751005 -
751006 -
751007 -
751009 - ..
7511 -
7512 -
7513 - 1100
7514 -
751401 - Catherine disconnected the IV tubes.
751403 - ..
751404 - She inserted Herceptin to flush the port.
751406 - ..
751407 - She then removed the needle from the port, and swabbed the needle
751408 - wound, and placed a temporary bandage.
751409 -
751410 -
751411 -
751412 -
751413 -
7515 -
SUBJECTS
Vitals Blood Pressure Pulse Temperature Sa02 Weight Infusion Treatme
7803 -
7804 - 0900
780501 - ..
780502 - Vitals Show Patient Stable
780503 -
780504 - Follow up ref SDS 28 AW4L, ref SDS 26 AW4L.
780505 -
780506 - Blood
780507 - Date Time Pressure Pulse Temprtr Weight SaO2
780509 - ..
780510 - 070322 1055..... 118 71 55 37.0c 97
780511 - 070322 1015..... 120 69 57 37.1c 98
780512 - 070322 0900..... 130 70 56 36.0c 98
780513 - 070315 1300..... 119 75 58 36.2c 98
780514 - 070315 1150..... 137 73 52 36.5c 99
780515 - 070315 0945..... 143 85 60 36.4c 97
780516 - 070308 1100..... 144 87 70 36.0c 98
780517 - 070301 1645..... 125 62 90 * 36.4c
780518 - 070301 1505..... 112 69 86 * 36.6c 98
780519 - 070222 1145..... 115 73 58 36.3c 147 98
780520 - 070222 1045..... 100 60 56 36.6c 147 98
780521 - 070222 0930..... 117 63 68 36.2c 147 97
780522 - 070215 1200..... 106 66 61 37.0c 147 97
780523 - 070215 1055..... 96 61 64 37.0c 147 94
780524 - 070215 0930..... 100 64 66 36.7c 147 98
780525 - 070208 0920..... 143 70 59 36.5c 147 98
780526 - 070201 1330..... 136 74 66 148 94
780527 - 070201 1220..... 110 65 62 36.3c 148 96
780528 - 070201 1000..... 132 80 65 36.9c 148 99
780529 - 061201 1534..... 123 76 76 97.5 150
780530 - 061110 1534..... 136 83 73 97.0 150 98
780531 - 061020 1534..... 140 79 67 99.8 151 97
780532 - 060929 1452..... 141 78 66 98.3 149
780533 - 060908 1335..... 139 79 73 98.1 149
780534 - 060814 1610..... 139 80 59 98.2 151
780535 - 060722 1440..... 142 74 67 98.1 149
780536 - 060711.......... 172 87 54 97.5 147
780537 - 060623.......... 141 87 71 98.0 147
780538 - 060428.......... 129 73 80 99.4 149
780539 - 060217.......... 153 81 61 98.6 150
780540 - 050916.......... 120 80 80 98.5
780541 -
780542 - * Need vitals taken twice to verify atypical diagnostics.
780543 -
780544 -
780545 -
780546 -
7806 -
SUBJECTS
Energy Normal Stable Alert Drive Home After Treatment IBC 3rd Relaps
8103 -
8104 - 1110
810501 - ..
810502 - Energy Normal Stable After Treatment Cetuximab Support Drugs
810503 -
810504 - Follow up ref SDS 28 F54N, ref SDS 26 F54N.
810506 - ..
810507 - On 060724 diary side effects for cetuximab chemotherapy treatment on
810508 - clinical study drug trial. ref SDS 6 YP4I
810510 - ..
810511 - Millie was alert after treatment again today, and not wobbly nor
810512 - disoriented. She was able to drive home without side effects of
810513 - treatment.
810514 -
810515 -
810516 -
810517 -
810518 -
810519 -
810520 -
810521 -
810522 -
8106 -