CONTACTS 

SUBJECTS
Schedule Blood Test ANC INR CA 15-3 Examination Treatment 070426 Coo

1303 -
1303 -    ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS 33 0000. ref SDS 32 0000.
130502 -
130503 -
130504 -
130506 -  ..
1306 -
1307 -
1308 - Progress
1309 -
130901 - Schedule Starting Cetuximab 4th Cycle at UCSF on 070426
130902 - Coordination Blood Draw Exam Treatment Notify Kaiser on Blood Tests
130903 -
130904 - Follow up ref SDS 33 407N, ref SDS 32 407N.
130905 -
130906 - Millie submitted ref DIT 1 0001 to Jackie with a copy to Catherine
130907 - coordinating treatment on Thursday, 070426 0800, and following the
130908 - prior practice on 070329. ref SDS 36 Q659  Copy notifies Gloria INR
130909 - will be tested on Thursday to manage Coumadin treatments.  A copy to
130910 - Michele provides an opportunity to post blood test results to Kaiser's
130911 - medical chart, which were missing on 070330. ref SDS 38 128S
130913 -  ..
130914 - Millie says to Jackie at UCSF...
130915 -
130916 -    1.  Just a heads up to coordinate ordering blood tests for
130917 -        Thursday. ref DIT 1 0001
130919 -         ..
130920 -    2.  I got a call last night from UCSF to meet with you and Brigid
130921 -        on 070426 0800.  The earliest I can get a blood draw in the
130922 -        Infusion Clinic is 0800.  I will come down to the 2nd floor for
130923 -        our meeting in the Breast Care Center as soon as the blood draw
130924 -        is completed, probably about 0815, if everything goes smoothly.
130925 -        ref DIT 1 H45K
130927 -  ..
130928 - This plan follows prior practice on 070329 initiating blood testing as
130929 - early as possible, ref SDS 36 Q659, without Millie having to make a
130930 - special trip to get a blood drawn the day before treatment, and also
130931 - gives the medical team time to assess safety of treatments with
130932 - cetuximab that require NEUTS 1.50 (ANC 1500).
130934 -  ..
130935 - Subsequently, Millie considered that the blood test could be done
130936 - after meeting with the medical team, by relying on the interim blood
130937 - test done last week on 070419 that showed NEUTS rising to 1.87 (ANC
130938 - 1870). ref SDS 39 P560  As shown below, Millie called UCSF to revise
130939 - the schedule. ref SDS 0 1V3F
130940 -
130941 -            [On 070426 blood test results NEUTS 1.47 (ANC 1470) below
130942 -            Kaiser's standard of 1500, and well below UCSF requirements
130943 -            of 1800 for safe treatments with cetuximab. ref SDS 40 GV7L
130945 -  ..
130946 - Millie's letter continues...
130947 -
130948 -    3.  Please include INR and CA 15-3 in the scope of the lab slip.
130949 -        ref DIT 1 1G6G
130951 -         ..
130952 -    4.  By copy to Catherine, I am coordinating to alert the Infusion
130953 -        Clinic that a blood draw is needed at 0800, and further that
130954 -        since I am meeting with you and Brigid OA 0815, I will probably
130955 -        be a little late for treatment currently scheduled at 0830,
130956 -        maybe closer to 0900.  I think this fits Catherine's schedule.
130957 -        ref DIT 1 H46J
130959 -         ..
130960 -    5.  By copy to Gloria at Kaiser's Coagulation Control Clinic in
130961 -        Martinez, this confirms my letter on 070330, ref SDS 37 ZH4H,
130962 -        notifying that INR will be reported following the blood test at
130963 -        UCSF on 070426. ref DIT 1 H47H
130965 -         ..
130966 -    6.  By copy to Michele at Kaiser, this transmits results of the
130967 -        last blood test on 070329 for the Medical Chart. ref SDS 36
130968 -        A64L, ref DIT 1 H47N
130970 -         ..
130971 -    7.  Notice line 470940 in patient history shows "NEUTS" 1.81.
130972 -        Kaiser calls this "ANC."  Multiply the number by 1000 to get an
130973 -        equivalent value for Kaiser, so in this case ANC = 1810 by
130974 -        multiplying 1.81 x 1000. ref SDS 36 QY6H, ref DIT 1 H48K
130976 -         ..
130977 -    8.  Hope that's not too confusing. ref DIT 1 FE8O
130979 -         ..
130980 -    9.  [Primary care physician] reported in the Medical Chart for
130981 -        070330 that "Labs" are "at UCSF." ref SDS 38 128S  He usually
130982 -        uses "cut and paste" to log blood test results into the Medical
130983 -        Chart, including recent history on CA 15-3 listed in the record
130984 -        meeting at UCSF on 070329. ref SDS 35 087J, ref DIT 1 H49K
130986 -         ..
130987 -   10.  If helpful, you can also list the history on ANC (NEUTS).
130988 -        ref SDS 36 P560, ref DIT 1 TI4I
130990 -         ..
130991 -   11.  I will update blood test results on Friday or by Monday or so
130992 -        of next week. ref DIT 1 YJ4N
130993 -
130994 -
130996 -  ..
1310 -
1311 -
1312 - 1128
1313 -
131301 - Called UCSF Infusion Clinic.
131302 -
131303 - Talked to Adrian.
131305 -  ..
131306 - Adrian will pull Millie's chart and note coordination in Millie's
131307 - letter to Chatherine, per above. ref SDS 0 QF3F
131309 -  ..
131310 - Talked to Catherine.
131312 -  ..
131313 - She will put a note in Millie's chart that she needs blood draw at
131314 - 0800 on Thursday, and to include INR and CA 15-3, along with ANC, in
131315 - case Jackie does not have time to submit a lab slip.
131317 -  ..
131318 - Catherine's looking forward to treating Millie on Thursday OA 0900,
131319 - per letter to Jackie. ref SDS 0 MF6X
131320 -
131322 -  ..
1314 -
1315 -
1316 - 1234
1317 -
131701 - Letter to Mil notified of coordination.
131702 -
131704 -  ..
1318 -
1319 -
1320 - 1708
1321 -
132101 - Millie advised that she called Jackie this afternoon, and proposed
132102 - waiting to do blood tests until after starting treatment in the
132103 - Infusion Clinic, which occurs after meeting for examination to decide
132104 - on continuing treatment.
132106 -  ..
132107 - Normal standard of care for chemotherapy treatments called out in the
132108 - protocol for cetuximab Consent documents reviewed on 070116,
132109 - ref SDS 14 5U7Z, evaluates blood counts that show patients can safely
132110 - tolerate chemotherapy, reported on 070201. ref SDS 16 XR40  This was
132111 - illustrated on 060810 when Kaiser cancelled treatment because blood
132112 - tests showed ANC was too low. ref SDS 7 5K4F  More recently, on 070301
132113 - Doctor Rugo ordered extra blood tests to verify treatment could be
132114 - safely given, after Millie's ANC registered below the minimum level.
132115 - ref SDS 24 H93H
132117 -  ..
132118 - Ordering blood tests after examinations conflicts with patient
132119 - history, and cancer care requirements to provide diagnostic data for
132120 - the doctor to examine the patient and approve chemotherapy treatment.
132122 -  ..
132123 - Millie noticed that, since blood counts have been improving, the test
132124 - on Thursday will likely be okay. and so testing after examination
132125 - presents only a small risk of low blood counts weakening the immune
132126 - system and increasing exposure to infectious diseases.  How this
132127 - change in protocol affects UCSF standards for comprehensive cancer
132128 - care is the doctor's call.
132130 -  ..
132131 - If blood is drawn after examination, UCSF may order that treatment be
132132 - delayed an hour or so until test results are received from the Lab in
132133 - accordance with standard practice to verify patients can be treated
132134 - safely with chemotherapy.  Delay could be minimized by getting an
132135 - earlier blood draw at 0800, as occurred on 070329, ref SDS 36 0001,
132136 - and presented in the letter to UCSF earlier today, ref SDS 0 QF3F, and
132137 - also discussed with Catherine. ref SDS 0 GR3F
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1322 -