CONTACTS 

SUBJECTS
Treatment Cetuximab 1st Treatment 3rd Cycle Chemotherapy 10th Cycle

1103 -
1103 -    ..
1104 - Summary/Objective
1105 -
110501 - Follow up ref SDS 29 0000. ref SDS 28 0000.
110502 -
110503 - Blood tests were performed at 0800 in the Infusion Clinic on the 5th
110504 - floor, ref SDS 0 Q659, without conflicting with examination scheduled
110505 - at the same time in the Breast Care Center on the 2nd floor.
110506 - ref SDS 0 UZ4J  Treatment was performed at 0900, after meeting with
110507 - the medical team at 0815. ref SDS 0 SG8I  "Restless legs" side effects
110508 - from Benadryl pre-treatments were avoided today after Brigid reduced
110509 - the dose in the Chemotherapy Order. ref SDS 0 F77K  Blood tests show
110510 - good results. ref SDS 0 A64L  INR coagulation tests have been stable
110511 - for several months enabling stable Coumadin treatments for pulmonary
110512 - embolism. ref SDS 0 SE6N  Rising ANC blood counts show immune system
110513 - continues to recover, enabling scheduled treatments, ref SDS 0 P560,
110514 - and resolving concerns last month. ref SDS 0 C56G  Improving CA 15-3
110515 - cancer biomarker further demonstrate response to treatment that aligns
110516 - with clinical examination today. ref SDS 0 2N5J  Improved energy
110517 - underscores benefits of treatment at UCSF on the cetuximab clinical
110518 - study. ref SDS 0 2N5J
110519 -
110520 -
110521 -
110522 -
110524 -  ..
1106 -
1107 -
1108 - Progress
1109 -
110901 - Clinic Examination Orientation Starting Treatment Cetuximab
110902 -
110903 - Follow up ref SDS 29 407N, ref SDS 28 407N.
110905 -  ..
110906 - Agenda...
110907 -
110908 -    1.  Infusion Clinic........................... ref SDS 0 1M6H
110909 -    2.  Side effects.............................. ref SDS 0 QU8K
110910 -    3.  Blood tests............................... ref SDS 0 Q659
110911 -
110912 -
110913 -
110914 -
1110 -

SUBJECTS
Breast Examination Performed in Breast Care Clinic Prior to Treatmen

1803 -
180401 -  ..
180402 - Breast Examination Likely IBC 2 Scenarios Spreading Intensity Declines
180403 -
180404 - Follow up ref SDS 29 FO6H, ref SDS 28 FO6H.
180405 -
180406 - Breast examination performed in Breast Care clinic. ref SDS 32 025H
180407 -
180408 -
180409 -
1805 -

SUBJECTS
Emotional Health Reviewed Examination Breast Care Clinic Prior to Tr

2303 -
230401 -  ..
230402 - Emotional Roller Coaster Endemic Cancer Treatment and Coordination
230403 -
230404 - Follow up ref SDS 29 6A7J, ref SDS 28 6A7J.
230405 -
230406 - Emotional health reviewed during examination performed in Breast Care
230407 - clinic. ref SDS 32 Y642
230408 -
230409 -
230410 -
230411 -
230412 -
2305 -

SUBJECTS
Prognosis Reviewed During Examination Breast Care Clinic Prior to Tr

2703 -
270401 -  ..
270402 - Cetuximab Prognosis IBC May Subside for 10 Months Before Progressing
270403 - Prognosis Disease May Subside 10 Months or More Before Progression
270404 - Progresssion of Disease May be Delayed for 10 Months or More
270405 -
270406 - Follow up ref SDS 29 6A9H, ref SDS 28 6A9H.
270407 -
270408 - Prognosis reviewed with medical team during examination in the Breast
270409 - Care Clinic. ref SDS 32 M645
270410 -
270411 -
270412 -
270413 -
2705 -

SUBJECTS
Measurable Disease Reviewed During Examination Breast Care Clinic Pr

3103 -
310401 -  ..
310402 - Measureable Disease Photographs IBC Rash Improving
310403 - IBC Rash Improved Measurable Disease Photographs Tape Measure
310404 -
310405 - Follow up ref SDS 29 6T6M, ref SDS 28 6T6M.
310406 -
310407 - Measurable disease reviewed with medical team during examination in
310408 - the Breast Care Clinic. ref SDS 32 M652
310409 -
310410 -
310411 -
310412 -
310413 -
3105 -

SUBJECTS
Side Effects Reviewed During Examination Breast Care Clinic Prior to

3503 -
350401 -  ..
350402 - Side Effects Medicated After Weekly Examinations
350403 -
350404 - Follow up ref SDS 29 FO66, ref SDS 28 FO66.
350405 -
350406 - Side Effects reviewed with medical team during examination in the
350407 - Breast Care Clinic. ref SDS 32 TQ6L
350408 -
350409 -
350410 -
3505 -

SUBJECTS
Cetuximab 3rd Cycle 1st Treatment 9th Total Treatment Chemotherapy 1

4003 -
4004 - 0800
400501 -  ..
400502 - Infusion Clinic for Cetuximab Treatent
400503 -
400504 - Follow up ref SDS 29 1M6H, ref SDS 28 1M6H.
400506 -  ..
400507 - Millie arrived a little before 0800 to get a blood draw as soon as
400508 - possible, planned on 070326, ref SDS 30 PP5Y, and confirmed in the
400509 - letter to UCSF on 070327. ref SDS 31 MT6Q
400510 -
400511 -
400513 -  ..
4006 -
4007 -
4008 - 0910
4009 -
400901 - Millie received 9th overall and 1st treatment of 3rd cycle with
400902 - Cetuximab, starting from 070201, ref SDS 14 G68I, and the 16th
400903 - treatment for 3rd relapse of IBC, beginning on 060721. ref SDS 4 407N
400905 -  ..
400906 - Catherine was working today, busy with other patients, so there wasn't
400907 - enough time to assist Millie.
400912 -  ..
400913 - Diane did a terrific job without benefit of experience on patient
400914 - history in this case.
400916 -           ..
400917 -          Taxotere Capecitabine
400918 -
400919 -          Follow up ref SDS 29 PR8Q, ref SDS 28 PR8Q.
400920 -
400921 -                   Relapse Treatments
400922 -
400923 -      1.  Cycle 09 and 01 ................... 060721, ref SDS 4 407N
400924 -      2.  Cycle 10 and 02 ................... 060814, ref SDS 7 LY6O
400925 -      3.  Cycle 11 and 03 ................... 060908, ref SDS 8 407N
400926 -      4.  Cycle 12 and 04 ................... 060929, ref SDS 9 407N
400927 -      5.  Cycle 13 and 05 ................... 061020, ref SDS 10 407N
400928 -      6.  Cycle 14 and 06 ................... 061110, ref SDS 11 407N
400929 -      7.  Cycle 15 and 07 ................... 061201, ref SDS 12 407N
400931 -           ..
400932 -          Cetuxiab Clinical Study
400933 -
400934 -          Follow up ref SDS 29 7T3H, ref SDS 28 7T3H.
400935 -
400936 -                   Total    Cetuximab
400937 -      8.  Cycle 01 and 08 and 01 01.......... 070201, ref SDS 14 SG8I
400938 -      9.  Cycle 01 and 08 and 02 02.......... 070208, ref SDS 16 SG8I
400939 -     10.  Cycle 01 and 08 and 03 03.......... 070215, ref SDS 17 7T3H
400940 -     11.  Cycle 01 and 08 and 04 04.......... 070222, ref SDS 20 7T3H
400941 -     12.  Cycle 02 and 09 and 01 05.......... 070301, ref SDS 23 7T3H
400942 -     13.  Cycle 02 and 09 and 02 06.......... 070308, ref SDS 26 7T3H
400943 -     14.  Cycle 02 and 09 and 03 07.......... 070315, ref SDS 28 7T3H
400944 -     15.  Cycle 02 and 09 and 04 08.......... 070322, ref SDS 29 7T3H
400945 -     16.  Cycle 03 and 10 and 01 09.......... 070329, ref SDS 0 7T3H
400947 -  ..
400948 - Nurses Notes...
400959 -  ..
400960 - Why is the visit number constant in Nurse's Notes, and yet seems to
400961 - vary in the schedule received from Nola last week? ref SDS 28 159O
400962 -
400964 -     ..
400965 -    UCSF Log Time...
400966 -
400967 -                   Blood
400968 -                    Test   Infusion
400969 -
400970 -          In....... 0800     0910
400971 -          Out...... 0815     1140
400972 -          Visit....      Min  2.5  Hours  Total 3 Hrs 40 Min
400974 -      ..
400975 -     Pain Assessment...
400976 -
400977 -          x
400978 -          0123456789 10
400979 -
400980 -     <923k
400981 -     Administration Site:  Right Port Catheter
400982 -     Needle Size:          20 G 1"
400983 -     Blood Return Good:    Yes
400985 -      ..
400986 -     Remind patient to call MD if temp > 101 F, Shaking Chills
400987 -
400988 -            This protocol differs from Kaiser requirements, reported on
400989 -            041202. ref SDS 1 IX9N
400990 -
400991 -
400992 -
400993 -
4010 -

SUBJECTS
Side Effects Infusion Clinic UCSF Consultation Treatment Cetuximab A

5703 -
5704 - 0910
570501 -  ..
570502 - Side Effects Minimal...
570503 -
570504 - Follow up ref SDS 29 QU8K, ref SDS 28 QU8K.
570506 -  ..
570507 - Nurse's notes report side effects...
570508 -
570509 -        1.  Rash acne-like...... ref SDS 29 SK9O
570510 -
570511 -               Minimal facial rash continues from 070208 around the
570512 -               nose and chin, ref SDS 16 QU8K; treatment effective with
570513 -               medication prescribed on 070222. ref SDS 20 FO66
570515 -             ..
570516 -        2.  Dry skin face, chest, arms, back...... ref SDS 29 JS6M
570517 -
570518 -               Background on notice and treatments prescribed reported
570519 -               on 070322. ref SDS 29 JS6M  Medical team commented
570520 -               during examination this morning, how well Millie looks.
570521 -               ref SDS 32 N49K  The next day, the primary care
570522 -               physician at Kaiser made similar comment during follow
570523 -               up examination. ref SDS 34 N49K  This indicates Curel
570524 -               suggested on 070301, ref SDS 22 5V73, and Aquaphor
570525 -               prescribed by the pharmacy on 070322, ref SDS 29 JS6M,
570526 -               have been effective.
570528 -             ..
570529 -        3.  Rash on right chest....... ref SDS 29 KU3L
570530 -
570531 -               Examination of right chest observes various blemishes.
570532 -               Nurses's Notes today say no rash noted above the port,
570533 -               continuing observation reported last week on 070322.
570534 -               ref SDS 29 KU3L  This updates Nurse's Notes on 070315
570535 -               that reported a new rash on the right side above the
570536 -               port. ref SDS 28 KU3L  Similarly, examination by the
570537 -               medical team in the Breast Care Clinic this morning,
570538 -               observed no rash at this location. ref SDS 32 BI5K
570540 -                   ..
570541 -                  [On 070330 examination at Kaiser by primary care
570542 -                  physician finds significantly increased intensity of
570543 -                  rash on upper left arm, ref SDS 34 N19J, and a
570544 -                  similar new rash above the right breast and below the
570545 -                  colar bone, ref SDS 34 583G; these dramatic changes
570546 -                  in condition were diagnosed without biopsy as
570547 -                  complications of lymphedema causing Cellulitis with
570548 -                  elevated temperature, and possibly triggered by
570549 -                  patient's increased exercise that overtaxed the
570550 -                  system. ref SDS 34 7C7F  Keflex antibiotics was
570551 -                  prescribed, ref SDS 34 474O; about 3 hours later
570552 -                  self-examination showed these erruptive rash
570553 -                  conditions had subsided, and so Keflex treatment was
570554 -                  not performed. ref SDS 34 KZ6L
570556 -             ..
570557 -        4.  Rash right arm............... ref SDS 29 LI4M
570558 -
570559 -               Diane does not comment on this issue in Nurse's Notes.
570560 -               Examination by the medical team this morning reported
570561 -               finding no evidence of disease in the right arm.
570562 -               ref SDS 32 5Y6M
570564 -             ..
570565 -        5.  Restless legs side effect Benedryl...... ref SDS 29 F77K
570566 -
570567 -               Millie reported "restless legs," following treatment on
570568 -               070315. ref SDS 28 F77K  This morning, before treatment,
570569 -               Brigid changed the Chemotherapy Order to reduce the dose
570570 -               of Benadryl. ref SDS 32 MF4N  Reducing Benadryl
570571 -               pre-treatment, per below, ref SDS 0 DC7J, eliminated
570572 -               "restless legs" problem today, per below. ref SDS 0 7R6H
570574 -             ..
570575 -        6.  Sleeping difficulty................. ref SDS 29 NG3I
570576 -
570577 -               This problem was reported last week on 070322.  Review
570578 -               with the medical team this morning indicates 4.5 hours
570579 -               continuous sleep is adequate and being achieved.  Atavin
570580 -               previously prescribed by Kaiser helps cope with anxiety,
570581 -               ref SDS 32 V63F, worrying about prognosis living with
570582 -               cancer, and complex communications that impact diagnosis
570583 -               and treatment. ref SDS 32 MR99
570585 -             ..
570586 -        7.  Lymphedema Cellulitis Complications...... ref SDS 29 SU6L
570587 -
570588 -               Lymphedema continues relatively controlled with major
570589 -               swelling in the left arm, reported in examination by the
570590 -               medical team earlier this morning, ref SDS 32 4Y93, and
570591 -               citing study on 060509. ref SDS 2 HO7F  There is no
570592 -               evident association with cetuximab treatments.
570593 -               Proximate cause was left breast mastectomy with removal
570594 -               of lymph nodes in the left axillary, complicated by
570595 -               exercise to strengthen the immune system for resisting
570596 -               cancer, and by cat bites that flow from engaging pets
570597 -               for qualify of life, reported in the case study on
570598 -               070130. ref SDS 13 VX6F
570600 -                   ..
570601 -                  [On 070330 examination at Kaiser by primary care
570602 -                  physician finds significantly increased intensity of
570603 -                  rash on upper left arm, ref SDS 34 N19J, and a
570604 -                  similar new rash above the right breast and below the
570605 -                  colar bone, ref SDS 34 583G; these dramatic changes
570606 -                  in condition were diagnosed without biopsy as
570607 -                  complications of lymphedema causing Cellulitis with
570608 -                  elevated temperature, and possibly triggered by
570609 -                  patient's increased exercise that overtaxed the
570610 -                  system. ref SDS 34 7C7F  Keflex antibiotics was
570611 -                  prescribed, ref SDS 34 474O; about 3 hours later
570612 -                  self-examination showed these erruptive rash
570613 -                  conditions had subsided, and so Keflex treatment was
570614 -                  not performed. ref SDS 34 KZ6L
570615 -
570617 -             ..
570618 -        8.  Tired, fatigued - pulmonary emoblism... ref SDS 29 FG3N
570619 -
570620 -               Fatigue, shortness of breath and other symptoms of
570621 -               pulmonary embolism were presented during meeting on
570622 -               070130, ref SDS 13 CV5L, citing case study listed on
570623 -               060722. ref SDS 5 ZV41
570625 -                ..
570626 -               Energy that seemed to be declining leading up to
570627 -               treatment on 070301, ref SDS 23 CA4K, has continued to
570628 -               rise back to normal, as reported last week on 070322.
570629 -               ref SDS 29 CA4K  Millie continues working out in the
570630 -               gym, and has started hiking the trail at Lafayette
570631 -               Reservoir again, as reported to the medical team during
570632 -               examination this morning. ref SDS 32 E44L
570634 -             ..
570635 -        9.  Heavy chest - shortness of breathing..... ref SDS 29 UL6L
570636 -
570637 -               Patient history was reported to UCSF on 070130.
570638 -               ref SDS 13 RT6I
570639 -
570640 -               Condition seems improved, tracking continuing higher
570641 -               energy, per above. ref SDS 0 CA4K
570642 -
570644 -             ..
570645 -       10.  Cough - clearing throat............... ref SDS 29 8N4G
570646 -
570647 -               This condition seems improved, as reported to the doctor
570648 -               on 070130. ref SDS 13 RT6I
570649 -
570651 -             ..
570652 -       11.  Dry hands and feet................ ref SDS 29 UM32
570653 -
570654 -               Dry hands and feet seem much improved since ending
570655 -               treatment with Taxotere and capecitiabine on 061201.
570656 -
570658 -             ..
570659 -       12.  Eyes tearing...................... ref SDS 29 HM9G
570660 -
570661 -               This seems improved since ending treatment with Taxoter
570662 -               and capecitabine on 061201.
570663 -
570665 -             ..
570666 -       13.  Nausea and vomitting................. ref SDS 29 D19M
570667 -
570668 -               Problems with Taxotere and capecitabine reported on
570669 -               061110, ref SDS 11 D19M, did not occur this past week
570670 -               after treatment with cetuximab.  As a result, there was
570671 -               no pre-treatment with Decadron today, per below.
570672 -               ref SDS 29 G57I
570674 -             ..
570675 -       14.  Sores in mouth................... ref SDS 29 KW4R
570676 -
570677 -               None yet, cleaning mouth carefully to avoid problem.
570678 -
570679 -
570680 -
570681 -
5707 -

SUBJECTS
Schedule Treatment Weekly Thursday 0800 4 Week Cycles Clinical Study

6203 -
620401 -  ..
620402 - Schedule Weekly Treatments Continue on Thursdays
620403 -
620404 - Follow up ref SDS 29 QK6L, ref SDS 28 QK6L.
620406 -  ..
620407 - Millie's next treatment is scheduled for 070405 0830, reported by Nola
620408 - on 070315. ref SDS 28 159O
620410 -  ..
620411 - Scheduling conflict problems getting blood tests, examination, and
620412 - treatment cited last week on 070322, ref SDS 29 UZ4J, and previously
620413 - on 070315, ref SDS 28 F14O, were worked out with planning on 070326,
620414 - ref SDS 30 625T, and subsequent coordination with the Infusion Clinic
620415 - staff. ref SDS 30 PP5Y  This was facilitated by Jackie submitting lab
620416 - slips, reported on 070327, ref SDS 31 MT6Q, for getting a blood test
620417 - this morning at 0800.
620418 -
620419 -
620420 -
620421 -
620422 -
620423 -
6205 -

SUBJECTS
Blood Tests Counts Normal Evaluate Start Cetuximab Treatment 1st Tre

6703 -
6704 - 0800
670501 -  ..
670502 - Blood Test Counts Normal Full Dose Cetuximab Ordered
670503 -
670504 - Follow up ref SDS 29 Q659, ref SDS 28 Q659.
670505 -
670506 - Millie had a blood draw this morning at 0800 in the Infusion Lab where
670507 - the work can be performed using the port catheter that reduces trauma
670508 - to Millie's arm from needle penetrations, and before meeting with the
670509 - medical team for examination to start a new cycle of treatment on the
670510 - cetuximab clinical study.  This schedule allows Millie to avoid a
670511 - separate trip to the hospital for blood draws a day before treatment;
670512 - it also gives the medical team time to perform the protocol assessing
670513 - safety of cetuximab treatments that require NEUTS 1.50 (ANC 1500).
670514 - The test was ordered by Jackie on 060327, ref SDS 31 407N, following
670515 - up coordination on 070326. ref SDS 30 625X  This corrects the problem
670516 - scheduling blood tests on 070308. ref SDS 26 1M6H
670518 -        ..
670519 -       [...improved coordination on blood tests reported during meeting
670520 -       to start new cycle of treatment; continuing challenges
670521 -       coordinating review of side effects to be prepared for
670522 -       examinations. ref SDS 32 945F
670523 -
670525 -  ..
6706 -
6707 -
6708 - 1020
6709 -
670901 - During treatment, Diane submitted results of the test.
670903 -     ..
670917 -     ..
670918 -    Log#:                   070329 08:15
670919 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
670920 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
670922 -     ..
670923 -    PARN CBC with DIFF & PLT CT                               CBCD
670924 -     ..
670925 -    WBC COUNT               4.6    x10E9/L     3.4  -   10     WBC   WBC x10-3        K/uL     3.4  -  10.0
670926 -    RBC COUNT               4.37   x10E12/L      4  -   5.2    RBC   RBC x10-6        M/uL    3.60  -  5.70
670927 -    HEMOGLOBIN             13.9    g/dL         12  -   15.5   HGB   Hemoglobin       g/dL    11.5  -  15.0
670928 -    HEMATOCRIT             40.6    PERCENT      36  -   46     HCT   Hematocrit       %       34.0  -  46.0
670929 -    MCV                    93      fL           80  -   100    MCV   MCV              fL      80.0  -  100.0
670930 -    MCH                    31.7    pg           26  -   34     MCH
670931 -    MCHC                   34.3    g/dL         31  -   36     MCHC
670932 -    PLATELETS             223      x10E9/L     140  -  450     PLT   Plt x10-3        K/uL     140  -  400
670933 -    ..
670934 -       (posted 070403)
670935 -    CA 15-3         H       33     U/mL             <  31    CA15-3  CA 15-3                        <  39
670936 -
670937 -        [On 070406 received letter from UCSF confirming CA 15-3 33.
670938 -        ref SDS 35 EQ6I
670939 -    ..
670940 -     (NEUTS x 1000 = ANC for Kaiser)
670941 -    NEUTS           L       1.81   x10E9/L     1.8  -  6.8     N-A   ANC                      1500
670942 -    Neutrophils    Not Reported                                      Neutrophils       %        50  -  70
670944 -     ..
670945 -    LYMPHS                  1.97   x10E9/L     0.9  -  2.9     L-A   Lymphocytes       %        20  -  50
670946 -    MONOS                   0.45   x10E9/L     0.1  -  0.6     M-A   Monocyte          %         0  -  11
670947 -    EOS                     0.24   x10E9/L       0  -  0.4     E-A   Esoinophils       %         1  -  5
670948 -    BASOS                   0.09   x10E9/L       0  -  0.1     B-A   Basophil          %         0  -  2
670949 -                                                                                                 0  -  5
670950 -     ..
670951 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
670952 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
670953 -     ..
670954 -    PT              H      26.8    S          12.5  - 16.0     PT    PT, patient       sec     8.9  -  11.1
670955 -    INL Nrm Ratio   H       2.4                0.9  -  1.2     INR   PT INR            sec     2.0  -  3.0
670956 -    PARTIAL
670957 -     THROMBOPLASTIN        31.7    S          22.4  - 33.3     PTT
670959 -     ..
670960 -    ELECTROLYTE PANEL                                          LYTE
670961 -    SODIUM                130      mmol/L      134  -  143     NA    Sodium            mEq/L   137  -  145
670962 -    POTASSIUM               4.1    mmol/L      3.4  -  4.9     K     Potassium         mEq/L   3.5  -  5.3
670963 -    CHLORIDE              107      mmol/L       98  -  107     CL
670964 -    CARBON DIOX TOTAL      26      mmol/L       23  -  32      CO2
670965 -    ANION GAP               6                    3  -  14      ANGA
670967 -     ..
670968 -    UREA NITROGEN           9      mg/dL         8  -  23      BUN   BUN               mg/dL     7  -  17
670969 -    CALCIUM                 8.9    mg/dL       8.7  -  10.1    CA    Calcium           mg/dL   8.4  -  10.2
670970 -    MAGNESIUM               1.9    mg/dL       1.8  -  2.3     MG    Magnesium         mg/dL   1.6  -  2.3
670972 -     ..
670973 -    CREATININE              0.9    mg/dL       0.6  -  1.2     CR    Creatinine        mg/dL   0.6  -  1.2
670974 -    AST             H      42      U/L          16  -  41      AST   AST (SGOT)        U/L      14  -  36
670975 -    ALT                    24      U/L          11  -  54      ALT   ALT (SGPT)        U/L      11  -  66
670976 -    BILIRUBIN TOTAL         0.8    mg/dL       0.3  -  1.3     BILT  Bili Total        mg/dL   0.2  -  1.3
670977 -    ALKALINE PHOSPHATASE   55      U/L          29  -  111     ALKP  Alkaline Ph       U/L      38  -  126
670978 -    PROTEIN TOTAL           6.4    g/dL        5.8  -  8.0     TP    Protein, Total    g/dL    6.3  -  8.2
670979 -    ALBUMIN                 3.9    g/dL        3.4  -  4.7     ALB   Albumin           g/dL    3.4  -  4.8
670980 -
670981 -
670982 -
670983 -
6710 -

SUBJECTS
INR 2.4 Coagulation Control Coumadin Treatment Pulmonary Embolism PT

7503 -
750401 -  ..
750402 - Coagulation Control INR 2.4 Normal Stable PT 26.8 High
750403 -
750404 - Follow up ref SDS 29 SE6N, ref SDS 28 SE6N.
750405 -
750406 - The test today shows PT 26.8 and INR 2.4, per above. ref SDS 0 PU7Y
750408 -  ..
750409 - This has been stable for several months at 2.5 and 2.4, indicating the
750410 - current regimen is effective, and may support continuing blood test
750411 - regimen once a month, per planning on 070308, ref SDS 26 CS6J, and
750412 - communication with Gloria the day before on 070307. ref SDS 25 IY6I
750413 -
750414 -     [On 070330 letter to Kaiser notified Gloria of INR stable blood
750415 -     tests for past 2 months; continuing current Coumadin regimen.
750416 -     ref SDS 33 ZH4H
750417 -
750418 -
750419 -
750420 -
7505 -

SUBJECTS
Absolute Neutrophils Count ANC 1810 Above 1800 UCSF Requirement for

8103 -
810401 -  ..
810402 - ANC 1810 Above 1800 Criteria for Blood Counts to Approve Treatment
810403 -
810404 - Follow up ref SDS 29 P560, ref SDS 28 P560.
810405 -
810406 - Background on differences representing ANC in Kaiser and UCSF blood
810407 - testing is reported on 070301. ref SDS 23 U37I
810409 -  ..
810410 - ANC reported as "NUETS" in the UCSF blood test reported as 1.81, per
810411 - above. ref SDS 0 QY6H  This is equivalent to 1810 in Kaiser's scheme.
810413 -  ..
810414 - ANC continues rising...
810415 -
810416 -        6972................................ 060814, ref SDS 7 P560
810417 -        6390................................ 060908, ref SDS 8 P560
810418 -        5200................................ 060929, ref SDS 9 P560
810419 -        3869................................ 061020, ref SDS 10 P560
810420 -        2880................................ 061110, ref SDS 11 P560
810421 -        2888................................ 061201, ref SDS 12 P560
810422 -        1760................................ 070201, ref SDS 14 P560
810423 -        1230................................ 070301, ref SDS 23 P560
810424 -        1510................................ 070308, ref SDS 22 P560
810425 -        1810................................ 070329, ref SDS 0 P560
810427 -  ..
810428 - Blood counts for ANC rising shows strengthening immune system that
810429 - reverses prior trend over the past 6 months, which threatened to delay
810430 - or impede schedule weekly treatments, especially of the doctor added
810431 - carboplatin to increase effectiveness of treatments, as reported last
810432 - month on 070301. ref SDS 23 AZ4G  ANC rising over the past month
810433 - validates UCSF treatment plan.
810434 -
810435 -
810436 -
810437 -
810438 -
8105 -

SUBJECTS
CA 15-3 33 Blood Tests 070329 Results Submitted by UCSF Cancer Marke

8603 -
860401 -  ..
860402 - CA 15-3 33 Tests 2 From Kaiser 1 from UCSF Pending Submission
860403 -
860404 - Follow up ref SDS 29 2N5J, ref SDS 28 2N5J.
860405 -
860406 - CA 15-3 was not available from the blood test today.  On 070403
860407 - results show the marker declined again dropping from 36 down to 33,
860408 - per above. ref SDS 0 A16M  Continued decline in the cancer marker
860409 - shows continuing response to treatment on the cetuximab clinical
860410 - study.
860412 -  ..
860413 - Patient history of CA 15-3 is reported in the record on examination
860414 - today, 070329. ref SDS 32 087J
860415 -
860416 -        [On 070406 received letter from UCSF confirming CA 15-3 33.
860417 -        ref SDS 35 EQ6I
860419 -  ..
860420 - Cancer marker CA 15-3 dropping toward normal aligns with observations
860421 - of IBC rash subsiding at all locations, and no new IBC sites occurring
860422 - during the past 4-week treatment cycle, reported in another record
860423 - today. ref SDS 32 M68J
860424 -
860425 -        [On 070330 examination at Kaiser by primary care physician
860426 -        finds significantly increased intensity of rash on upper left
860427 -        arm, ref SDS 34 N19J, and a similar new rash above the right
860428 -        breast and below the colar bone; these dramatic changes do not
860429 -        seem to represent rising cancer in light of declinding CA 15-3
860430 -        biomarker, and so were diagnosed without biopsy as Cellulitis.
860431 -        ref SDS 34 7C7G  Keflex antibiotic was prescribed, ref SDS 34
860432 -        474O; about 3 hours later self-examination showed these
860433 -        erruptive rash conditions had subsided, and so Keflex treatment
860434 -        was not performed. ref SDS 34 KZ6L
860435 -
860436 -
860437 -
860438 -
860439 -
860440 -
860441 -
860442 -
8605 -

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

9203 -
9204 - 0835
920501 -  ..
920502 - Preparation for Treatment Required One (1) Attempt to Connect Port
920503 -
920504 - Follow up ref SDS 29 EB7J, ref SDS 28 EB7J.
920506 -  ..
920507 - The nurse connected the IV tubes to the port....
920509 -       ..
920510 -      Interlink System Vented Paclitaxel set
920512 -  ..
920513 - Like last week and earlier on 070301, there were no problems getting
920514 - blood to flow from the port, ref SDS 23 EB7J, as occurred on 070222,
920515 - ref SDS 19 DC5W, and earlier on 070201. ref SDS 14 DC5W
920517 -  ..
920518 - The nurse flushed the port with saline.
920519 -
920520 -
920521 -
920522 -
9206 -

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

9803 -
9804 - 0800
980501 -  ..
980502 - Blood Draws 7 Vials for Clinical Study Research
980503 -
980504 - Follow up ref SDS 29 O56V, ref SDS 28 O56V.
980505 -
980506 - The nurse drew seven (7) vials of blood today for research on the
980507 - cetuximab clincial trial, and required to start each cycle.  Today is
980508 - the 1st treatment for the 3rd cycle. ref SDS 0 7T3H
980509 -
980510 -
980511 -
980512 -
980513 -
9806 -

SUBJECTS
Benadryl Pre-treatment Prepares Patient for Cetuximab Chemotherapy A

A603 -
A604 - 0910
A60501 -  ..
A60502 - Benadryl Reduce Side Effects Cetuximab Chemotherapy Treatment
A60503 -
A60504 - Follow up ref SDS 29 DC7J, ref SDS 28 DC7J.
A60505 -
A60506 - Benadryl (diphenhydramine) started.   50 MG....... ref SDS 29 IJ41
A60507 -
A60508 -        Purpose reported on 060721. ref SDS 4 DC7J
A60510 -  ..
A60511 - Chemotherpay order calls for Benadryl (diphenhydramine) pre-treatment
A60512 - 30 - 60 minutes prior to cetuximab infusion, shown below. ref SDS 0
A60513 - IJ41
A60515 -  ..
A60516 - Millie advised Diane that Brigid changed the Chemotherapy Order this
A60517 - morning to reduce side effects of "restless legs," per above.
A60518 - ref SDS 0 F77K
A60520 -  ..
A60521 - Diane thanked Millie for the heads up.  She explained that Benadryl
A60522 - treatments are so routine, that practitioners often do not check this
A60523 - part of Chemotherapy Orders which are filled with a lot of details.
A60525 -  ..
A60526 - Diane checked the Chemotherapy Order and implemented changing Benadryl
A60527 - pre-treatment from 50 mg to only 25 mg, per below. ref SDS 0 IJ44
A60528 -
A60529 -
A60531 -  ..
A606 -
A607 -
A608 - 0930
A609 -
A60901 - Benedryl completed equipment beeps.
A60903 -  ..
A60904 - Millie reported that decreasing the dose of Benadryl pre-treatment to
A60905 - 25 mg completely eliminated previous problems of "restless legs," per
A60906 - above. ref SDS 0 F77K
A60907 -
A60908 -
A60910 -  ..
A610 -
A611 -
A612 -
A613 -
A61301 - Decadron (dexamethasone) IV pre-treatment........ ref SDS 29 FM4M
A61302 -
A61303 - On 070208 Decadron was not given because Millie did not experience
A61304 - side effects of nausea and vomitting after treatment with cetuximab on
A61305 - 070201. ref SDS 16 G57I  Since this favorable condition continues, per
A61306 - above, ref SDS 29 D19M, Decadron was not given again today.
A61307 -
A61309 -  ..
A614 -
A615 -
A616 -
A61601 - Decadron completed -- not reported.
A61602 -
A61603 -
A61604 -
A61605 -
A617 -

SUBJECTS
Cetuximab 3rd Cycle 1st Treatment Clinical Study Drug Trial Treatmen

AE03 -
AE04 - 0930
AE0501 -  ..
AE0502 - Cetuximab Full Dose Blood Counts on Targets Treatment 1 Hour
AE0503 -
AE0504 - Follow up ref SDS 29 4N5M, ref SDS 28 4N5M.
AE0506 -  ..
AE0507 - Cetuximab started.
AE0508 -
AE0509 -           Verify chemotherapy order for 070208.
AE0511 -  ..
AE0512 - Chemotherapy order calls for cetuximab to start 30 - 60 minutes after
AE0513 - Beyadryl pre-tretment. ref SDS 29 IJ41
AE0515 -  ..
AE0516 - Chemotherapy Orders...
AE0517 -
AE0523 -    Auth#                                     Stor BCC LOC
AE0524 -    Visit:  12575738             DOS 20070201
AE0526 -     ..
AE0527 -    Date:  20070201
AE0529 -     ..
AE0530 -    Study Order for CC#05752:  Phase II Trial of Cetuximab alone and
AE0531 -    in combination with Carboplatin in ER-negative, PR-negative,
AE0532 -    HER2-negative Nonoverexpressing Metastatic Breast Cancers
AE0534 -     ..
AE0535 -    Dates to be given:  070201
AE0536 -    Arm 1:Cetuximab alone
AE0538 -     ..
AE0539 -    Diagnosis:  breast cancer
AE0541 -     ..
AE0542 -    ICD-9 codes: 174.9
AE0543 -    Allergies  NKDA
AE0545 -     ..
AE0546 -    Pre-medications 30 - 60 minutes prior to cetuximab infusion
AE0548 -     ..
AE0549 -    4. Diphenhydramine 25 mg IV or  [illegible writing]
AE0550 -
AE0551 -       Benadryl........... ref SDS 29 DC7J
AE0552 -
AE0553 -       Earlier this morning, Brigid changed the Chemotherapy Order
AE0554 -       reducing Diphenhydramine (Benadryl) from 50 mg to 25 mg in order
AE0555 -       to reduce side effects of "restless legs," per above.
AE0556 -       ref SDS 0 F77K
AE0558 -        ..
AE0559 -       This was effective, reported above. ref SDS 0 7R6H
AE0561 -     ..
AE0562 -    5. Dexamethasone (??) 10 mg IB or 20 mg IV [handwritten ???]
AE0563 -
AE0564 -       Further premed TBD [barely legible handwriting??]
AE0566 -     ..
AE0567 -    Medication:  (plan to give weekly ********STUDY SUPPLY**********
AE0569 -     ..
AE0570 -    6. Cetuximab (Erbitux) (loading dose)
AE0571 -
AE0572 -              400 mg/m [squared] = 684 mg IV over 120 minutes for
AE0573 -              first dose x 1
AE0574 -
AE0575 -       dose on dcte 20070201   Maximum infusion rate is 5 ml/minute
AE0576 -       (concentration 2 mg/ml)
AE0578 -     ..
AE0579 -    7. Cetuximab (Erbitux) (maintenance dose)
AE0580 -
AE0581 -              250 mg/m [squared] = 428 mg IV (or ____ mg/m[squared] =
AE0582 -              ____mg) IV over 60 or ____ minutes.
AE0583 -
AE0584 -       Maximum infusion rate is 5 ml/minute (concentration 2 mg/ml)
AE0585 -       Infuse once weekly for 8 weeks.  First dose to be given on date
AE0586 -       20070201.
AE0588 -        ..
AE0589 -       Cetuximab is administered undiluted through a low protien
AE0590 -       binding 0.22 micro in-line filter.  Use NS solution to flush the
AE0591 -       line at the end of the infusion.
AE0593 -        ..
AE0594 -       ARM 2:  Administer carboplatin of vital signs are unremarkable
AE0595 -       one hour after cetuximab infusion.
AE0597 -        ..
AE0598 -       Vital signs at baseline, upon cetuximab completion and one hour
AE0599 -       after cetuximab.
AE0600 -
AE0601 -       ****please note start and stop times****
AE0603 -        ..
AE0604 -       Laboratory work:
AE0605 -
AE0606 -          See carboplatin orders
AE0608 -        ..
AE0609 -       x  Notify MD for dose modifications if patient has severe
AE0610 -          acne in form rash
AE0611 -
AE0612 -          CBC with differential and platletes every 4 weeks
AE0613 -          Creatinine and magnesium every 4 weeks
AE0614 -          BUN AST Alk phos Alt Total bilrubin, electrolyes every 8
AE0615 -          weeks.  If levels are outside of normal laboratory values
AE0616 -          notify Brigid NP  (MD/RN) at 415 443 4730
AE0618 -        ..
AE0619 -       x  Physician has discussed risks/benefits of therapy with the
AE0620 -          patient.  Signed consent obtained.
AE0621 -
AE0622 -
AE0623 -          Yes  No   O2 by nasal cannula at 2 liters/min prn for chest
AE0624 -          pain or SOB
AE0626 -           ..
AE0627 -          Yes  No   Diphenhydramine 50 mg IV prn x1 for urticaria
AE0628 -          [barely legible], pruritis SOB
AE0630 -           ..
AE0631 -          Yes  No   Hydrocortizone 100 mg IV prn x1 for urticaria
AE0632 -          [barely legible], pruritis SOB
AE0634 -           ..
AE0635 -          Yes  No   Albuterol inhaler 2-4 puffs prn SOB or chest
AE0636 -          tightness
AE0638 -           ..
AE0639 -          Yes  No   Epinephrine 1x1000 (1 mg/ml) 0.3 mg IV prn
AE0640 -          anaphylaxis
AE0642 -           ..
AE0643 -          Breast CC05752 Cetuximab doc 20061024
AE0644 -          Approved 20060615
AE0646 -           ..
AE0647 -          Physician signature [Hope Rugo]
AE0649 -           ..
AE0650 -          Provider#  35313
AE0652 -           ..
AE0653 -          Date:  20010131
AE0654 -
AE0656 -  ..
AE07 -
AE08 -
AE09 - 1040
AE10 -
AE1001 - Cetuximab treatment completed.
AE1002 -
AE1003 - Millie had a 1 hour rest and observation period, required by the
AE1004 - protocol. ref SDS 29 G679
AE1005 -
AE1006 -
AE1007 -
AE1009 -  ..
AE11 -
AE12 -
AE13 - 1140
AE14 -
AE1401 - Diane disconnected the IV tubes.
AE1403 -  ..
AE1404 - She inserted Herceptin to flush the port.
AE1406 -  ..
AE1407 - She then removed the needle from the port, and swabbed the needle
AE1408 - wound, and placed a temporary bandage.
AE1409 -
AE1410 -
AE1411 -
AE1412 -
AE1413 -
AE15 -

SUBJECTS
Vitals Blood Pressure Pulse Temperature Sa02 Weight Infusion Treatme

AK03 -
AK04 - 0900
AK0501 -  ..
AK0502 - Vitals Show Patient Stable
AK0503 -
AK0504 - Follow up ref SDS 29 AW4L, ref SDS 28 AW4L.
AK0505 -
AK0506 -                    Blood
AK0507 -    Date   Time     Pressure   Pulse  Temprtr  Weight   So2
AK0508 -
AK0509 -        [On 070329 followed up. ref SDS 32 XU6M
AK0511 -     ..
AK0512 -    070329 1140..... 125  74     53     36.8c            98
AK0513 -    070329 1045..... 125  72     53         c           100
AK0514 -    070329 0900..... 141  76     60     36.6c            99
AK0515 -    070322 1055..... 118  71     55     37.0c            97
AK0516 -    070322 1015..... 120  69     57     37.1c            98
AK0517 -    070322 0900..... 130  70     56     36.0c            98
AK0518 -    070315 1300..... 119  75     58     36.2c            98
AK0519 -    070315 1150..... 137  73     52     36.5c            99
AK0520 -    070315 0945..... 143  85     60     36.4c            97
AK0521 -    070308 1100..... 144  87     70     36.0c            98
AK0522 -    070301 1645..... 125  62     90 *   36.4c
AK0523 -    070301 1505..... 112  69     86 *   36.6c            98
AK0524 -    070222 1145..... 115  73     58     36.3c   147      98
AK0525 -    070222 1045..... 100  60     56     36.6c   147      98
AK0526 -    070222 0930..... 117  63     68     36.2c   147      97
AK0527 -    070215 1200..... 106  66     61     37.0c   147      97
AK0528 -    070215 1055.....  96  61     64     37.0c   147      94
AK0529 -    070215 0930..... 100  64     66     36.7c   147      98
AK0530 -    070208 0920..... 143  70     59     36.5c   147      98
AK0531 -    070201 1330..... 136  74     66             148      94
AK0532 -    070201 1220..... 110  65     62     36.3c   148      96
AK0533 -    070201 1000..... 132  80     65     36.9c   148      99
AK0534 -    061201 1534..... 123  76     76     97.5    150
AK0535 -    061110 1534..... 136  83     73     97.0    150      98
AK0536 -    061020 1534..... 140  79     67     99.8    151      97
AK0537 -    060929 1452..... 141  78     66     98.3    149
AK0538 -    060908 1335..... 139  79     73     98.1    149
AK0539 -    060814 1610..... 139  80     59     98.2    151
AK0540 -    060722 1440..... 142  74     67     98.1    149
AK0541 -    060711.......... 172  87     54     97.5    147
AK0542 -    060623.......... 141  87     71     98.0    147
AK0543 -    060428.......... 129  73     80     99.4    149
AK0544 -    060217.......... 153  81     61     98.6    150
AK0545 -    050916.......... 120  80     80     98.5
AK0546 -
AK0547 -  *  Need vitals taken twice to verify atypical diagnostics.
AK0548 -
AK0549 -
AK0550 -
AK0551 -
AK06 -

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

AS03 -
AS04 - 1110
AS0501 -  ..
AS0502 - Energy Normal Stable After Treatment Cetuximab Support Drugs
AS0503 -
AS0504 - Follow up ref SDS 29 F54N, ref SDS 28 F54N.
AS0506 -  ..
AS0507 - On 060724 diary side effects for cetuximab chemotherapy treatment on
AS0508 - clinical study drug trial. ref SDS 6 YP4I
AS0510 -  ..
AS0511 - Millie was alert after treatment again today, and not wobbly nor
AS0512 - disoriented.  She was able to drive home without side effects of
AS0513 - treatment.
AS0514 -
AS0515 -
AS0516 -
AS0517 -
AS0518 -
AS0519 -
AS0520 -
AS0521 -
AS0522 -
AS06 -