CONTACTS 

SUBJECTS
Treatment Cetuximab 2nd Treatment 4th Cycle Chemotherapy 11th Cycle

1103 -
1103 -    ..
1104 - Summary/Objective
1105 -
110501 - Follow up ref SDS 49 0000. ref SDS 46 0000.
110502 -
110503 - Millie received 2nd treatment starting the 4th cycle of cetuximab
110504 - treatment on clinical study at UCSF. ref SDS 0 7T3H  Testing today
110505 - showed blood counts increased slightly, below safe levels for
110506 - treatment. ref SDS 0 P560  Catherine notified the medical team for
110507 - authorization of treatment, ref SDS 0 ME4H, which aligns with patient
110508 - history. ref SDS 0 V75F  Treatment was performed today after getting
110509 - results of blood tests, required by standard of care. ref SDS 0 EY7H
110510 -
110511 -
110512 -
110514 -  ..
1106 -
1107 -
1108 - Progress
1109 -
110901 - Clinic Examination Orientation Starting Treatment Cetuximab
110902 -
110903 - Follow up ref SDS 49 407N, ref SDS 46 407N.
110905 -  ..
110906 - Agenda...
110907 -
110908 -    1.  Breast examination........................ ref SDS 0 FO6H
110909 -    2.  Infusion Clinic........................... ref SDS 0 1M6H
110910 -    3.  Side effects.............................. ref SDS 0 QU8K
110911 -
110912 -
110913 -
110914 -
1110 -

SUBJECTS
Breast Examination Not Performed 2nd Treatment in Cycle Prior to Tre

1903 -
190401 -  ..
190402 - Breast Examination IBC Intensity Declines
190403 -
190404 - Follow up ref SDS 49 FO6H, ref SDS 46 FO6H.
190405 -
190406 - Breast examination not scheduled for 2nd treatment in cycle.
190407 -
190408 -
190409 -
1905 -

SUBJECTS
Emotional Health No Examination 2nd Treatment of Cycle in Breast Car

2603 -
260401 -  ..
260402 - Emotional Roller Coaster Endemic Cancer Treatment and Coordination
260403 -
260404 - Follow up ref SDS 49 6A7J, ref SDS 46 6A7J.
260405 -
260406 - Emotional health review not scheduled for 2nd treatment in cycle.
260407 -
260408 -
260409 -
2605 -

SUBJECTS
Prognosis Not Reviewed Breast Care Clinic Prior to 2nd Treatment of

3203 -
320401 -  ..
320402 - Cetuximab Prognosis IBC May Subside for 10 Months Before Progressing
320403 - Prognosis Disease May Subside 10 Months or More Before Progression
320404 - Progresssion of Disease May be Delayed for 10 Months or More
320405 -
320406 - Follow up ref SDS 49 6A9H, ref SDS 46 6A9H.
320407 -
320408 - Prognosis examination not scheduled for 2nd treatment in the cycle.
320409 -
320410 -
320411 -
3205 -

SUBJECTS
Measurable Disease Not Reviewed 2nd Treatment Cycle Examination Brea

3803 -
380401 -  ..
380402 - Measureable Disease Photographs IBC Rash Improving
380403 - IBC Rash Improved Measurable Disease Photographs Tape Measure
380404 -
380405 - Follow up ref SDS 49 6T6M, ref SDS 46 6T6M.
380406 -
380407 - Measurable disease not discussed with medical team during 2nd
380408 - treatment of the cycle.
380409 -
380410 -
380411 -
380412 -
380413 -
3805 -

SUBJECTS
Side Effects Not Reviewed in Breast Care Clinic Prior to 2nd Treatme

4403 -
440401 -  ..
440402 - Side Effects Medicated After Weekly Examinations
440403 -
440404 - Follow up ref SDS 49 FO66, ref SDS 46 FO66.
440405 -
440406 - Side Effects reviewed by Catherine in the Infusion Clinic, reported
440407 - below. ref SDS 0 QU8K
440408 -
440409 -
440410 -
440411 -
4405 -

SUBJECTS
Cetuximab 4th Cycle 2nd Treatment 14th Total Treatment Chemotherapy

5003 -
5004 - 0845
500501 -  ..
500502 - Infusion Clinic for Cetuximab Treatent
500503 -
500504 - Follow up ref SDS 49 1M6H, ref SDS 46 1M6H.
500506 -  ..
500507 - Millie received 14th overall and 2nd treatment of 4th cycle with
500508 - cetuximab, starting from 070201, ref SDS 19 G68I, and the 21th
500509 - treatment for 3rd relapse of IBC, beginning on 060721. ref SDS 7 407N
500511 -  ..
500512 - Catherine was the nurse today.
500514 -           ..
500515 -          Taxotere Capecitabine
500516 -
500517 -          Follow up ref SDS 49 PR8Q, ref SDS 46 PR8Q.
500518 -
500519 -                   Relapse Treatments
500520 -
500521 -      1.  Cycle 09 and 01 ................... 060721, ref SDS 7 407N
500522 -      2.  Cycle 10 and 02 ................... 060814, ref SDS 11 LY6O
500523 -      3.  Cycle 11 and 03 ................... 060908, ref SDS 12 407N
500524 -      4.  Cycle 12 and 04 ................... 060929, ref SDS 13 407N
500525 -      5.  Cycle 13 and 05 ................... 061020, ref SDS 14 407N
500526 -      6.  Cycle 14 and 06 ................... 061110, ref SDS 15 407N
500527 -      7.  Cycle 15 and 07 ................... 061201, ref SDS 16 407N
500529 -           ..
500530 -          Cetuxiab Clinical Study
500531 -
500532 -          Follow up ref SDS 49 7T3H, ref SDS 46 7T3H.
500533 -
500534 -                   Total    Cetuximab
500535 -      8.  Cycle 01 and 08 and 01 01.......... 070201, ref SDS 19 SG8I
500536 -      9.  Cycle 01 and 08 and 02 02.......... 070208, ref SDS 21 SG8I
500537 -     10.  Cycle 01 and 08 and 03 03.......... 070215, ref SDS 22 SG8I
500538 -     11.  Cycle 01 and 08 and 04 04.......... 070222, ref SDS 25 SG8I
500539 -     12.  Cycle 02 and 09 and 01 05.......... 070301, ref SDS 28 SG8I
500540 -     13.  Cycle 02 and 09 and 02 06.......... 070308, ref SDS 31 7T3H
500541 -     14.  Cycle 02 and 09 and 03 07.......... 070315, ref SDS 33 7T3H
500542 -     15.  Cycle 02 and 09 and 04 08.......... 070322, ref SDS 34 7T3H
500543 -     16.  Cycle 03 and 10 and 01 09.......... 070329, ref SDS 39 7T3H
500544 -     17.  Cycle 03 and 10 and 02 10.......... 070405, ref SDS 42 7T3H
500545 -     18.  Cycle 03 and 10 and 03 11.......... 070412, ref SDS 44 7T3H
500546 -     19.  Cycle 03 and 10 and 04 12.......... 070419, ref SDS 46 7T3H
500547 -     20.  Cycle 04 and 11 and 01 13.......... 070426, ref SDS 49 7T3H
500548 -     21.  Cycle 04 and 11 and 02 14.......... 070503, ref SDS 0 7T3H
500550 -  ..
500551 - Nurses Notes...
500562 -  ..
500563 - Why is the visit number constant in Nurse's Notes, and yet seems to
500564 - vary in the schedule received from Nola last week? ref SDS 33 159O
500566 -     ..
500567 -    UCSF Log Time...
500568 -
500569 -                   Blood
500570 -                    Test   Infusion
500571 -
500572 -          In.......          0830
500573 -          Out......          1130
500574 -          Visit....      Min  3.0  Hours  Total 3 Hours
500576 -      ..
500577 -     Pain Assessment...
500578 -
500579 -          x
500580 -          0123456789 10
500581 -
500582 -     <923k
500583 -     Administration Site:  Right Port Catheter
500584 -     Needle Size:          20 G 1"
500585 -     Blood Return Good:    Yes
500587 -      ..
500588 -     Remind patient to call MD if temp > 101 F, Shaking Chills
500589 -
500590 -            This protocol differs from Kaiser requirements, reported on
500591 -            041202. ref SDS 3 IX9N
500592 -
500593 -
500594 -
500595 -
5006 -

SUBJECTS
Side Effects Infusion Clinic UCSF Consultation Treatment Cetuximab A

6803 -
6804 - 0840
680501 -  ..
680502 - Side Effects Minimal...
680503 -
680504 - Follow up ref SDS 49 QU8K, ref SDS 46 QU8K.
680506 -  ..
680507 - Nurse's notes report side effects...
680509 -             ..
680510 -        1.  Rash acne-like
680511 -
680512 -            Follow up ref SDS 46 SK9O, ref SDS 49 958F.
680513 -
680514 -            Very mild facial rash continues from 070208 around the nose
680515 -            and chin. ref SDS 21 QU8K  Treatment effective prescribed
680516 -            on 070222. ref SDS 25 FO66
680517 -
680519 -             ..
680520 -        2.  Dry skin face, chest arm
680521 -
680522 -            Follow up ref SDS 46 JS6M, ref SDS 49 JS6M.
680523 -
680524 -            Background on notice and treatments prescribed reported on
680525 -            070322. ref SDS 34 JS6M  Medical team commented during
680526 -            examination on 070329, how well Millie looks. ref SDS 37
680527 -            N49K  The next day on 070330, the primary care physician at
680528 -            Kaiser commented similarly, during follow up examination.
680529 -            ref SDS 41 N49K  This indicates UCSF examinations by
680530 -            Catherine in the Infusion Clinic, and by Brigid in the
680531 -            Breast Care Center has been timely, thorough, and effective
680532 -            prescribing Curel on 070301, ref SDS 27 5V73, and later
680533 -            Aquaphor on 070322. ref SDS 34 JS6M
680534 -
680536 -             ..
680537 -        3.  Inflammation Port Catheter Resolved
680538 -
680539 -            Follow up ref SDS 46 RQ4O, ref SDS 49 RQ4O.
680540 -
680541 -            Nurses Notes report port catheter site much less red today
680542 -            and no tenderness.
680544 -                   ..
680545 -                  [On 070517 port catheter site red and tender again.
680546 -                  ref SDS 53 UD4K
680548 -             ..
680549 -        4.  Inflammation rash right chest
680550 -
680551 -            Follow up ref SDS 46 KU3L, ref SDS 49 KU3L.
680552 -
680553 -            Examination of right chest observes various blemishes.
680554 -            Patient reports no interim recurrent rash at this location.
680555 -            Aligns with declining CA 15-3 cancer marker from blood test
680556 -            last week on 070426, ref SDS 49 2N5J, and reviewed in the
680557 -            record meeting with the medical team at that time.
680558 -            ref SDS 48 GJ5M
680559 -
680560 -
680562 -             ..
680563 -        5.  Rash right arm
680564 -
680565 -            Follow up ref SDS 46 LI4M
680566 -
680567 -            Catherine does not comment on this issue in Nurse's Notes
680568 -            today.  Examination by the medical team on 070329 found no
680569 -            evidence of disease in the right arm. ref SDS 37 H15M
680570 -
680572 -             ..
680573 -        6.  Sleeping difficulty subsided
680574 -
680575 -            Follow up ref SDS 46 NG3I
680576 -
680577 -            This problem has subsided as worry and doubt have been
680578 -            reduced by continuing favorable reports showing response to
680579 -            treatment, discussed with the medical team during
680580 -            examination on 070426. ref SDS 48 Y642
680581 -
680583 -             ..
680584 -        7.  Lymphedema Cellulitis Complications
680585 -            Inflammation Erratic Upper Left Arm Side Effects Cetuximab
680586 -
680587 -            Follow up ref SDS 49 SU6L, ref SDS 46 SU6L.
680588 -
680589 -            Lymphedema continues relatively controlled with major
680590 -            swelling in the left reduced this morning to 11.25, cited
680591 -            in the study on 060509. ref SDS 5 HO7F  There is no evident
680592 -            association with cetuximab treatments.
680594 -             ..
680595 -            Intensity of rash on the upper left arm continues to rise
680596 -            and fall since the report at Kaiser on 070330. ref SDS 41
680597 -            N19J Causes of erratic inflammation are listed in the
680598 -            record for treatment last week on 070426. ref SDS 49 8B8Y
680600 -             ..
680601 -            Today, there is no evidence of increased inflammation on
680602 -            the upper left arm, continuing favorable report for
680603 -            examination by the medical team last week on 070426 in the
680604 -            Breast Care Center. ref SDS 48 115F
680605 -
680606 -
680608 -             ..
680609 -        8.  Tired, fatigued - pulmonary emoblism
680610 -
680611 -            Follow up ref SDS 49 FG3N, ref SDS 46 FG3N.
680612 -
680613 -            Fatigue, shortness of breath and other symptoms of
680614 -            pulmonary embolism were presented during meeting on 070130,
680615 -            ref SDS 18 CV5L, citing case study listed on 060722.
680616 -            ref SDS 8 ZV41  These are also side effects of cetuximab
680617 -            treatments, reported on 070116. ref SDS 17 O64M
680619 -             ..
680620 -            Energy has continued to rise back to normal despite effects
680621 -            of cetuximab, as reported last week on 070426. ref SDS 46
680622 -            FG3N
680624 -             ..
680625 -            Millie continues working out in the gym, and hiking trails
680626 -            of 3 - 5 miles several times a week, as reported to the
680627 -            medical team during examination on 070329. ref SDS 37 E44L
680628 -            Increased strength and stamina are shown by improved vitals
680629 -            reported today, per below. ref SDS 0 AW4L  Benefits of
680630 -            exercise to strengthen fitness builds the immune system
680631 -            that resists cancer and other diseases, presented during a
680632 -            meeting at Kaiser on 030606. ref SDS 1 JP7G  Published
680633 -            guidance emphasizes benefits of exercise, reviewed on
680634 -            050609. ref SDS 4 F88M
680636 -             ..
680637 -            Millie has been taking naps 2 - 3 hours after treatments
680638 -            the past month, beginning on 070405. ref SDS 42 BB7G  May
680639 -            indicate accumulating effects of cetuximab that make
680640 -            patients tired, listed as side effect in Consent documents
680641 -            reviewed on 070116. ref SDS 17 O64M
680642 -
680644 -             ..
680645 -        9.  Heavy chest - shortness of breathing
680646 -
680647 -            Follow up ref SDS 46 UL6L
680648 -
680649 -            Patient history was reported to UCSF on 070130. ref SDS 18
680650 -            RT6I
680652 -             ..
680653 -            Condition seems improved, tracking continuing higher
680654 -            energy, per above. ref SDS 0 CA4K
680655 -
680657 -             ..
680658 -       10.  Cough - clearing throat
680659 -
680660 -            Follow up ref SDS 46 8N4G
680661 -
680662 -            This condition occassionally increases noticably with
680663 -            episodes of mild, contined cough and clearing throat, as
680664 -            reported to the doctor on 070130. ref SDS 18 RT6I
680665 -
680667 -             ..
680668 -       11.  Dry hands and feet
680669 -
680670 -            Follow up ref SDS 46 UM32
680672 -             ..
680673 -            Dry hands and feet seem much improved since ending
680674 -            treatment with Taxotere and capecitiabine on 061201.
680675 -
680677 -             ..
680678 -       12.  Eyes tearing
680679 -
680680 -            Follow up ref SDS 46 HM9G
680681 -
680682 -            This seems improved since ending treatment with Taxoter
680683 -            and capecitabine on 061201.
680684 -
680686 -             ..
680687 -       13.  Nausea and vomitting
680688 -
680689 -            Follow up ref SDS 46 D19M
680691 -             ..
680692 -            Problems with Taxotere and capecitabine reported on 061110,
680693 -            ref SDS 15 D19M, did not occur this past week after
680694 -            treatment with cetuximab.  As a result, there was no
680695 -            pre-treatment with Decadron today, per below. ref SDS 34
680696 -            G57I
680698 -             ..
680699 -       14.  Sores in mouth
680700 -
680701 -            Follow up ref SDS 46 KW4R
680702 -
680703 -            None yet, cleaning mouth carefully to avoid problem.
680704 -
680705 -
680706 -
680707 -
6808 -

SUBJECTS
Schedule Treatment Weekly Thursday 0800 4 Week Cycles Clinical Study

7603 -
760401 -  ..
760402 - Schedule Weekly Treatments Continue on Thursdays
760403 -
760404 - Follow up ref SDS 49 QK6L, ref SDS 46 QK6L.
760406 -  ..
760407 - Millie's next treatment is scheduled for 070510 0830, reported by Nola
760408 - on 070315. ref SDS 33 159O
760409 -
760410 -
760411 -
760412 -
7605 -

SUBJECTS
Blood Tests Counts Low Received Before Treatment Evaluate Cetuximab

8303 -
8304 - 0830
830501 -  ..
830502 - Blood Test Counts Low Full Dose Cetuximab Approved after Testing
830503 -
830504 - Follow up ref SDS 49 R54J, ref SDS 46 R54J.
830505 -
830506 - Millie had another blood draw this morning to test safety for getting
830507 - treatment in light of sudden drop in blood counts from 1.87 on 070329
830508 - down to 1.47, below the target level of 1.80, reported last week
830509 - ref SDS 49 QY6H
830511 -  ..
830512 - Testing this morning prior to treatment corrects the problem last week
830513 - when test results did not arrive until after treatment and showed
830514 - blood counts too low for safe treatment. ref SDS 49 953O
830516 -  ..
830517 - Results showed blood counts starting to rise again, so treatment was
830518 - approved, per below. ref SDS 0 P560
830519 -
830521 -  ..
8306 -
8307 -
8308 - 1117
8309 -
830901 - During treatment, Catherine submitted results of the test.
830903 -     ..
830917 -     ..
830918 -    Log#:                   070503 09:20
830919 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
830920 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
830922 -     ..
830923 -    CBC with DIFF & PLT CT                                     CBCD
830924 -     ..
830925 -    WBC COUNT               4.3    x10E9/L     3.4  -   10     WBC   WBC x10-3        K/uL     3.4  -  10.0
830926 -    RBC COUNT               4.40   x10E12/L      4  -   5.2    RBC   RBC x10-6        M/uL    3.60  -  5.70
830927 -    HEMOGLOBIN             13.7    g/dL         12  -   15.5   HGB   Hemoglobin       g/dL    11.5  -  15.0
830928 -    HEMATOCRIT             40.3    PERCENT      36  -   46     HCT   Hematocrit       %       34.0  -  46.0
830929 -    MCV                    92      fL           80  -   100    MCV   MCV              fL      80.0  -  100.0
830930 -    MCH                    31.2    pg           26  -   34     MCH
830931 -    MCHC                   34.1    g/dL         31  -   36     MCHC
830932 -    PLATELETS             199      x10E9/L     140  -  450     PLT   Plt x10-3        K/uL     140  -  400
830934 -     ..
830935 -    CA 15-3        Not performed   U/mL             <  31    CA15-3  CA 15-3                        <  39
830936 -    ..
830937 -     (NEUTS x 1000 = ANC for Kaiser)
830938 -    NEUTS         L         1.54   x10E9/L     1.8  -  6.8     N-A   ANC                      1500
830939 -    Neutrophils    Not Reported                                      Neutrophils       %        50  -  70
830941 -     ..
830942 -    LYMPHS                  2.16   x10E9/L     0.9  -  2.9     L-A   Lymphocytes       %        20  -  50
830943 -    MONOS                   0.35   x10E9/L     0.1  -  0.6     M-A   Monocyte          %         0  -  11
830944 -    EOS                     0.21   x10E9/L       0  -  0.4     E-A   Esoinophils       %         1  -  5
830945 -    BASOS                   0.07   x10E9/L       0  -  0.1     B-A   Basophil          %         0  -  2
830946 -                                                                                                 0  -  5
830947 -
830948 -
8310 -

SUBJECTS
Absolute Neutrophils Count ANC 1540 Below 1800 Safe Level UCSF Requi

9103 -
910401 -  ..
910402 - ANC 1540 Below 1800 Criteria for Blood Counts to Approve Treatment
910403 -
910404 - Follow up ref SDS 49 P560, ref SDS 46 P560.
910405 -
910406 - Background on differences representing ANC in Kaiser and UCSF blood
910407 - testing is reported on 070301. ref SDS 28 U37I
910409 -  ..
910410 - ANC shown as "NUETS" in the UCSF blood test reported 1.54 for the test
910411 - today, per above. ref SDS 0 QY6H  This is equivalent to 1540 in
910412 - Kaiser's scheme.  Catherine noted NEUTS 1.54 is still well below UCSF
910413 - criteria of 1800 for safe treatment based on strength of the immune
910414 - system, but is going in the "right direction," i.e., rising, compared
910415 - to significant decline last week on 070426. ref SDS 49 GV7L  Other
910416 - authorities list 1.50 (ANC 1500) as a common level for safe
910417 - treatments, including cetuximab.
910418 -
910419 -     [On 070509 Millie's letter asks UCSF about follow up testing blood
910420 -     counts for safe treatment. ref SDS 51 3N5P
910422 -      ..
910423 -     [On 070510 UCSF does not order follow up test. ref SDS 52
910424 -     MZ3N
910426 -  ..
910427 - Nurse's Notes report treatment was performed today after getting blood
910428 - test results, and consulting with the medical team, per below.
910429 - ref SDS 0 EY7H
910431 -  ..
910432 - Millie's patient history supports approving treatment with low blood
910433 - counts.  The study on 060810 shows she has often been treated when
910434 - blood counts are too low, ref SDS 10 HV45, and so far there have been
910435 - no adverse consequences, which testing is designed to prevent.
910437 -  ..
910438 - ANC rises slightly...
910439 -
910440 -        6972................................ 060814, ref SDS 11 P560
910441 -        6390................................ 060908, ref SDS 12 P560
910442 -        5200................................ 060929, ref SDS 13 P560
910443 -        3869................................ 061020, ref SDS 14 P560
910444 -        2880................................ 061110, ref SDS 15 P560
910445 -        2888................................ 061201, ref SDS 16 P560
910446 -        1760................................ 070201, ref SDS 19 P560
910447 -        1230................................ 070301, ref SDS 28 P560
910448 -        1510................................ 070308, ref SDS 27 P560
910449 -        1810................................ 070329, ref SDS 39 P560
910450 -        1870................................ 070419, ref SDS 46 P560
910451 -        1470................................ 070426, ref SDS 49 P560
910452 -        1540................................ 070503, ref SDS 0 P560
910453 -
910454 -
910455 -
910456 -
9105 -

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

9903 -
9904 - 0845
990501 -  ..
990502 - Preparation for Treatment Required One (1) Attempt to Connect Port
990503 -
990504 - Follow up ref SDS 49 EB7J, ref SDS 46 EB7J.
990506 -  ..
990507 - The nurse connected the IV tubes to the port....
990509 -       ..
990510 -      Interlink System Vented Paclitaxel set
990512 -  ..
990513 - Like last week and earlier on 070301, there were no problems getting
990514 - blood to flow from the port, ref SDS 28 EB7J, as occurred on 070222,
990515 - ref SDS 24 DC5W, and earlier on 070201. ref SDS 19 DC5W
990517 -  ..
990518 - The nurse flushed the port with saline.
990520 -  ..
990521 - Prior inflammation above and at the port catheter penetration reported
990522 - on 070419, ref SDS 46 UJ4M, has improved, reported above. ref SDS 0
990523 - RQ4O
990524 -
990525 -
9906 -

SUBJECTS
Benadryl Pre-treatment Prepares Patient for Cetuximab Chemotherapy A

A603 -
A604 - 0920
A60501 -  ..
A60502 - Benadryl Reduce Side Effects Cetuximab Chemotherapy Treatment
A60503 -
A60504 - Follow up ref SDS 49 DC7J, ref SDS 46 DC7J.
A60505 -
A60506 - Benadryl (diphenhydramine) started.   25 MG....... ref SDS 49 IJ44
A60507 -
A60508 -        Purpose reported on 060721. ref SDS 6 DC7J
A60510 -  ..
A60511 - Chemotherpay order calls for Benadryl (diphenhydramine) pre-treatment
A60512 - 30 - 60 minutes prior to cetuximab infusion, shown below. ref SDS 49
A60513 - IJ41
A60515 -  ..
A60516 - UCSF waited today until results of the blood test were received at
A60517 - 0920, ref SDS 0 075H, and reviewed with the medical team prior to
A60518 - beginning Millie's infusion treatment today at 0920, per above.
A60519 - ref SDS 0 GV7L  This corrected problem last week discovering blood
A60520 - counts were too low for treatment after treatment was already given.
A60521 - ref SDS 49 MN6M
A60522 -
A60523 -
A60524 -
A60525 -
A60527 -  ..
A606 -
A607 -
A608 - 0940
A609 -
A60901 - Benedryl completed equipment beeps.
A60902 -
A60903 -
A60904 -
A60906 -  ..
A610 -
A611 -
A612 -
A613 -
A61301 - Decadron (dexamethasone) IV pre-treatment........ ref SDS 34 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 21 G57I  Since this favorable condition continues, per
A61306 - above, ref SDS 34 D19M, Decadron was not given again today.
A61307 -
A61309 -  ..
A614 -
A615 -
A616 -
A61601 - Decadron completed -- not reported.
A61602 -
A61603 -
A61604 -
A61605 -
A617 -

SUBJECTS
Cetuximab 4th Cycle 2nd Treatment Blood Counts Below Safe Levels Cli

AG03 -
AG04 - 0950
AG0501 -  ..
AG0502 - Cetuximab Full Dose Blood Counts Below Targets Treatment 1 Hour
AG0503 -
AG0504 - Follow up ref SDS 49 4N5M, ref SDS 46 4N5M.
AG0506 -  ..
AG0507 - Cetuximab started.
AG0508 -
AG0509 -           Verify chemotherapy order for 070208.
AG0511 -  ..
AG0512 - Chemotherapy order calls for cetuximab to start 30 - 60 minutes after
AG0513 - Beyadryl pre-tretment. ref SDS 49 IJ41
AG0515 -  ..
AG0516 - Millie received a full dose of cetuximab treatment, even though blood
AG0517 - counts from the test today were below the level for safe treatment,
AG0518 - discussed above, ref SDS 0 P560, citing the record showing Millie has
AG0519 - often has treatments with low blood counts. ref SDS 0 V75F
AG0521 -  ..
AG0522 - Chemotherapy Orders...
AG0523 -
AG0529 -    Auth#                                     Stor BCC LOC
AG0530 -    Visit:  12575738             DOS 20070201
AG0532 -     ..
AG0533 -    Date:  20070201
AG0535 -     ..
AG0536 -    Study Order for CC#05752:  Phase II Trial of Cetuximab alone and
AG0537 -    in combination with Carboplatin in ER-negative, PR-negative,
AG0538 -    HER2-negative Nonoverexpressing Metastatic Breast Cancers
AG0540 -     ..
AG0541 -    Dates to be given:  070201
AG0542 -    Arm 1:Cetuximab alone
AG0544 -     ..
AG0545 -    Diagnosis:  breast cancer
AG0547 -     ..
AG0548 -    ICD-9 codes: 174.9
AG0549 -    Allergies  NKDA
AG0551 -     ..
AG0552 -    Pre-medications 30 - 60 minutes prior to cetuximab infusion
AG0554 -     ..
AG0555 -    4. Diphenhydramine 25 mg IV or  [illegible writing]
AG0556 -
AG0557 -       Benadryl........... ref SDS 34 DC7J
AG0558 -
AG0559 -       On 070329 Brigid changed the Chemotherapy Order reducing
AG0560 -       Diphenhydramine (Benadryl) from 50 mg to 25 mg in order to
AG0561 -       reduce side effects of "restless legs." ref SDS 39 IJ44
AG0563 -        ..
AG0564 -       This was effective, reported above. ref SDS 39 7R6H
AG0566 -     ..
AG0567 -    5. Dexamethasone (??) 10 mg IB or 20 mg IV [handwritten ???]
AG0568 -
AG0569 -       Further premed TBD [barely legible handwriting??]
AG0571 -     ..
AG0572 -    Medication:  (plan to give weekly ********STUDY SUPPLY**********
AG0574 -     ..
AG0575 -    6. Cetuximab (Erbitux) (loading dose)
AG0576 -
AG0577 -              400 mg/m [squared] = 684 mg IV over 120 minutes for
AG0578 -              first dose x 1
AG0579 -
AG0580 -       dose on dcte 20070201   Maximum infusion rate is 5 ml/minute
AG0581 -       (concentration 2 mg/ml)
AG0583 -     ..
AG0584 -    7. Cetuximab (Erbitux) (maintenance dose)
AG0585 -
AG0586 -              250 mg/m [squared] = 428 mg IV (or ____ mg/m[squared] =
AG0587 -              ____mg) IV over 60 or ____ minutes.
AG0588 -
AG0589 -       Maximum infusion rate is 5 ml/minute (concentration 2 mg/ml)
AG0590 -       Infuse once weekly for 8 weeks.  First dose to be given on date
AG0591 -       20070201.
AG0593 -        ..
AG0594 -       Cetuximab is administered undiluted through a low protien
AG0595 -       binding 0.22 micro in-line filter.  Use NS solution to flush the
AG0596 -       line at the end of the infusion.
AG0598 -        ..
AG0599 -       ARM 2:  Administer carboplatin of vital signs are unremarkable
AG0600 -       one hour after cetuximab infusion.
AG0602 -        ..
AG0603 -       Vital signs at baseline, upon cetuximab completion and one hour
AG0604 -       after cetuximab.
AG0605 -
AG0606 -       ****please note start and stop times****
AG0608 -        ..
AG0609 -       Laboratory work:
AG0610 -
AG0611 -          See carboplatin orders
AG0613 -        ..
AG0614 -       x  Notify MD for dose modifications if patient has severe
AG0615 -          acne in form rash
AG0616 -
AG0617 -          CBC with differential and platletes every 4 weeks
AG0618 -          Creatinine and magnesium every 4 weeks
AG0619 -          BUN AST Alk phos Alt Total bilrubin, electrolyes every 8
AG0620 -          weeks.  If levels are outside of normal laboratory values
AG0621 -          notify Brigid NP  (MD/RN) at 415 443 4730
AG0623 -        ..
AG0624 -       x  Physician has discussed risks/benefits of therapy with the
AG0625 -          patient.  Signed consent obtained.
AG0626 -
AG0627 -
AG0628 -          Yes   5.  O2 by nasal cannula at 2 liters/min prn for chest
AG0629 -          pain or SOB
AG0631 -           ..
AG0632 -          Yes   6.  Diphenhydramine 50 mg IV prn x1 for urticaria
AG0633 -          [barely legible], pruritis SOB
AG0635 -           ..
AG0636 -          Yes   7.  Hydrocortizone 100 mg IV prn x1 for urticaria
AG0637 -          [barely legible], pruritis SOB
AG0639 -           ..
AG0640 -          Yes   8.  Albuterol inhaler 2-4 puffs prn SOB or chest
AG0641 -          tightness
AG0643 -           ..
AG0644 -          Yes   9.  Epinephrine 1x1000 (1 mg/ml) 0.3 mg IV prn
AG0645 -          anaphylaxis
AG0647 -           ..
AG0648 -          Breast CC05752 Cetuximab doc 20061024
AG0649 -          Approved 20060615
AG0651 -           ..
AG0652 -          Physician signature [Hope Rugo]
AG0654 -           ..
AG0655 -          Provider#  35313
AG0657 -           ..
AG0658 -          Date:  20010131
AG0659 -
AG0661 -  ..
AG07 -
AG08 -
AG09 - 1050
AG10 -
AG1001 - Cetuximab treatment completed.
AG1002 -
AG1003 - Millie had a 1 hour rest and observation period, required by the
AG1004 - protocol. ref SDS 34 G679
AG1005 -
AG1006 -
AG1007 -
AG1009 -  ..
AG11 -
AG12 -
AG13 - 1150
AG14 -
AG1401 - Nurse disconnected the IV tubes.
AG1403 -  ..
AG1404 - She inserted Herceptin to flush the port.
AG1406 -  ..
AG1407 - She then removed the needle from the port, and swabbed the needle
AG1408 - wound, and placed a temporary bandage.
AG1409 -
AG1410 -
AG1411 -
AG1412 -
AG1413 -
AG15 -

SUBJECTS
Vitals Blood Pressure Pulse Temperature Sa02 Weight Infusion Treatme

AN03 -
AN04 - 0900
AN0501 -  ..
AN0502 - Vitals Show Patient Stable
AN0503 -
AN0504 - Follow up ref SDS 49 AW4L, ref SDS 46 AW4L.
AN0505 -
AN0506 -                    Blood
AN0507 -    Date   Time     Pressure   Pulse  Temprtr  Weight   So2
AN0508 -    .
AN0509 -    070503 1150..... 113  67     59     36.8c            98
AN0510 -    070503 1055..... 125  72     54     36.1c           100
AN0511 -    070503 0915..... 127  70     60     36.9c            99
AN0512 -    070426 1130..... 119  70     57     36.3c            96
AN0513 -    070426 1030..... 141  73     67     36.4c            99
AN0514 -    070426 0900..... 130  78     52     36.5c            97
AN0515 -    070419 1230..... 133  79     57     36.3c            98
AN0516 -    070419 1130..... 141  78     56     37.6c **1        99
AN0517 -    070419 0930..... 153  80     53     36.1c           100
AN0518 -    070412 1120..... 114  65     53     36.6c            96
AN0519 -    070412 1020..... 130  66     57     36.8c            99
AN0520 -    070412 0900..... 116  69     65     36.8c            97
AN0521 -    070405 1130..... 133  75     55     36.2c            97
AN0522 -
AN0523 -            Consistently low pulse, does it reflect low blood pressure
AN0524 -            side effect of cetuximab, or improved fitness from working
AN0525 -            out that benefits emotional stress and immune system?
AN0527 -     ..
AN0528 -    070405 1030..... 114  69     57     36.4c            99
AN0529 -    070405 0900..... 128  78     54     36.5c           100
AN0530 -    070329 1140..... 125  74     53     36.8c            98
AN0531 -    070329 1045..... 125  72     53         c           100
AN0532 -    070329 0900..... 141  76     60     36.6c            99
AN0533 -    070322 1055..... 118  71     55     37.0c            97
AN0534 -    070322 1015..... 120  69     57     37.1c            98
AN0535 -    070322 0900..... 130  70     56     36.0c            98
AN0536 -    070315 1300..... 119  75     58     36.2c            98
AN0537 -    070315 1150..... 137  73     52     36.5c            99
AN0538 -    070315 0945..... 143  85     60     36.4c            97
AN0539 -    070308 1100..... 144  87     70     36.0c            98
AN0540 -    070301 1645..... 125  62     90 *   36.4c
AN0541 -    070301 1505..... 112  69     86 *   36.6c            98
AN0542 -    070222 1145..... 115  73     58     36.3c   147      98
AN0543 -    070222 1045..... 100  60     56     36.6c   147      98
AN0544 -    070222 0930..... 117  63     68     36.2c   147      97
AN0545 -    070215 1200..... 106  66     61     37.0c   147      97
AN0546 -    070215 1055.....  96  61     64     37.0c   147      94
AN0547 -    070215 0930..... 100  64     66     36.7c   147      98
AN0548 -    070208 0920..... 143  70     59     36.5c   147      98
AN0549 -    070201 1330..... 136  74     66             148      94
AN0550 -    070201 1220..... 110  65     62     36.3c   148      96
AN0551 -    070201 1000..... 132  80     65     36.9c   148      99
AN0552 -    061201 1534..... 123  76     76     97.5    150
AN0553 -    061110 1534..... 136  83     73     97.0    150      98
AN0554 -    061020 1534..... 140  79     67     99.8    151      97
AN0555 -    060929 1452..... 141  78     66     98.3    149
AN0556 -    060908 1335..... 139  79     73     98.1    149
AN0557 -    060814 1610..... 139  80     59     98.2    151
AN0558 -    060722 1440..... 142  74     67     98.1    149
AN0559 -    060711.......... 172  87     54     97.5    147
AN0560 -    060623.......... 141  87     71     98.0    147
AN0561 -    060428.......... 129  73     80     99.4    149
AN0562 -    060217.......... 153  81     61     98.6    150
AN0563 -    050916.......... 120  80     80     98.5
AN0564 -
AN0565 -  *    Need vitals taken twice to verify atypical diagnostics.
AN0566 -  **1  Nurses Notes seem to show 97.6 which is cellcius scale.
AN0567 -
AN0568 -
AN0569 -
AN06 -

SUBJECTS
Energy Normal Stable Alert Drive Home After Treatment Tired Sleep 2

B103 -
B104 - 1130
B10501 -  ..
B10502 - Energy Normal Stable After Treatment Cetuximab Support Drugs
B10503 -
B10504 - Follow up ref SDS 49 F54N, ref SDS 46 F54N.
B10506 -  ..
B10507 - On 060724 diary side effects for cetuximab chemotherapy treatment on
B10508 - clinical study drug trial. ref SDS 9 YP4I
B10510 -  ..
B10511 - Millie was alert after treatment again today, and not wobbly nor
B10512 - disoriented.  She was able to drive home without side effects of
B10513 - treatment.
B10515 -  ..
B10516 - Today, we experimented and drove through Oakland following signs for
B10517 - the detour because the bridge from the San Francisco - Oakland Bay
B10518 - bridge to get to Highway 24 on the way to Walnut Creek was exploded by
B10519 - a truck accident a few days ago.  This made the trip home about 50
B10520 - minutes instead of 40 minutes.
B10522 -  ..
B10523 - After arriving home about 1320, Millie took a nap from about 1320
B10524 - until about 1600.  Could relate to side effects from cetuximab
B10525 - treatments that cause fatigue, reported on 070116. ref SDS 17 O64M
B10526 -
B10527 -
B10528 -
B10529 -
B10530 -
B10531 -
B10532 -
B106 -