CONTACTS 

SUBJECTS
Examination Treatment Cetuximab 3rd Treatment 5th Cycle Chemotherapy

1103 -
1103 -    ..
1104 - Summary/Objective
1105 -
110501 - Follow up ref SDS 92 0000, ref SDS 90 0000.
110502 -
110503 - IBC rash continues to subside.  Millie received another treatment with
110504 - cetuximab. ref SDS 0 FO6H  Cellulitis recurred in the left arm,
110505 - causing severe inflammation and fever.  Initial prescription was to
110506 - take Keflex at home. ref SDS 0 ZH6I  After examination in the Breast
110507 - Care Center, Millie's condition worsened with chills, shakes, and
110508 - fever during treatment with cetuximab for IBC in the Infusion Clinic.
110509 - Catherine took immediate action to relieve pain; she reviewed patient
110510 - history last year on previous treatment for Cellulitis at Kaiser.
110511 - ref SDS 0 TU6J  Brigid and Catherine consulted, ref SDS 0 8J33, and
110512 - Millie was treated with IV antibiotics. ref SDS 0 8J51  She was
110513 - released in the early afternoon with temperature of 101.4. ref SDS 0
110514 - GY41  Arlette coordinated review at Kaiser. ref SDS 0 0J70  At home,
110515 - temperature came down, fluctuating below 100.5, so did not go to
110516 - Emergency. ref SDS 0 8L85  Arlette notified that the primary care
110517 - physician decided to treat Millie for 5 days with outpatient IV
110518 - antibiotices, ref SDS 0 8L8H, starting tomorrow at 0900. ref SDS 0
110519 - 8L8Q  By 1030p temperature falls to 99.5. ref SDS 0 PL6W  Medical team
110520 - was notified of understandings on events today, and asked for
110521 - comments. ref SDS 0 EF6J  By midnight, temeprature rises again -
110522 - 100.2.  Persistent fever may indicate complications. ref SDS 0 JN6N
110523 -
110524 -        [On 070608 fever rises 100.3 at 0500; by 0700 temperature back
110525 -        to normal; Cellulitis inflammation seems improved. ref SDS 93
110526 -        AK6I
110528 -         ..
110529 -        [On 070608 UCSF requests progress reports on fever status;
110530 -        Millie submits current record of improvement. ref SDS 93 PQUW
110532 -         ..
110533 -        [On 070608 Millie begins outpatient IV treatment for Cellulitis
110534 -        at Kaiser in Martinez; receives 5 day schedule. ref SDS 93 AK6H
110535 -        difficulty applying patient profile to use port catheter to
110536 -        avoid trauma to right arm; nurse prefers to use needle IV due
110537 -        to lack of training. ref SDS 93 VQ5L
110539 -         ..
110540 -        [On 070608 UCSF requests contact information to improve
110541 -        coordination with Kaiser on managing divided responsibilities
110542 -        for referral project. ref SDS 93 035H
110544 -         ..
110545 -        [On 070608 Millie notifies UCSF of treatment schedule at Kaiser
110546 -        for Cellulitis, ref SDS 93 AN6N; she submits contact
110547 -        information for primary care physician requested by UCSF.
110548 -        ref SDS 93 0R9T
110550 -         ..
110551 -        [On 070608 fever returns in the afternoon, temperature 99.5,
110552 -        taking Tylenol; Millie notified medical team of change in
110553 -        condition. ref SDS 93 04BE
110555 -         ..
110556 -        [On 070608 fever ends late afternoon, temperature 98.6.
110557 -        ref SDS 93 WQ3I
110559 -         ..
110560 -        [On 070608 fever returns early evening, temperature 99.7,
110561 -        taking 2 Tylenol. ref SDS 93 S44N
110563 -         ..
110564 -        [On 070608 fever ends late evening, temperature 98.5.
110565 -        ref SDS 93 F49G
110567 -         ..
110568 -        [On 070609 temperature continues normal overnight and in early
110569 -        AM; Cellulitis inflammation seems to have subsided somewhat;
110570 -        Millie goes to Kaiser in Walnut Creek for IV treatment in the
110571 -        Infusion Department; nurse uses port catheter to avoid trauma
110572 -        on right arm. ref SDS 94 AK6I
110574 -         ..
110575 -        [On 070609 after treatment at Kaiser in Walnut Creek, Millie
110576 -        shopping at the mall; very tired after getting home; takes a
110577 -        nap; more shopping at Costco. ref SDS 94 JL97
110579 -         ..
110580 -        [On 070609 fever returns late afternoon, temperature 99.2,
110581 -        takes Tylenol. ref SDS 94 PR4Y
110583 -         ..
110584 -        [On 070608 fever ends late evening, temperature 98.3.
110585 -        ref SDS 94 2Q7H
110587 -         ..
110588 -        [On 070610 temperature remains normal all day; Cellulitis
110589 -        inflammation and rash much improved in AM, ref SDS 95 AK6I, has
110590 -        developed 3 cold sores, ref SDS 95 NL5N, and by evening the arm
110591 -        looks normal again, except for swelling. ref SDS 95 UW5L
110593 -         ..
110594 -        [On 070610 Kaiser reports right communication channels now open
110595 -        for coordination with UCSF on referral project. ref SDS 95 OG7F
110597 -         ..
110598 -        [On 070611 UCSF reports collaboration with Kaiser on treatment
110599 -        plan for recovering from Cellulitis. ref SDS 96 JQ6F
110600 -
110601 -
110603 -  ..
1107 -
1108 -
1109 - Progress
1110 -
111001 - Clinic Examination Progress Treatment Cetuximab Drug Trial
111002 -
111003 - Follow up ref SDS 84 407N, ref SDS 82 407N.
111005 -  ..
111006 - Agenda...
111007 -
111008 -    1.  Breast examination........................ ref SDS 0 FO6H
111009 -    2.  Emotional coping with cancer.............. ref SDS 0 6A7J
111010 -    3.  Prognosis good............................ ref SDS 0 6A9H
111011 -    4.  Infusion Clinic........................... ref SDS 0 1M6H
111012 -    5.  Side effects.............................. ref SDS 0 QU8K
111013 -    6.  Schedule treatments....................... ref SDS 0 QK6L
111014 -    7.  Treatment cetuximab....................... ref SDS 0 4N5M
111015 -    8.  Vitals.................................... ref SDS 0 AW4L
111016 -    9.  Energy after treatment.................... ref SDS 0 F54N
111017 -
111018 -
111019 -
111020 -
111021 -
1111 -

SUBJECTS
Breast Examination Shows Improvement IBC Rash Intensity Subsides No

1903 -
190401 -  ..
190402 - Breast Examination IBC Intensity Declines
190403 -
190404 - Follow up ref SDS 84 FO6H, ref SDS 82 FO6H.
190405 -
190406 - Examination today shows continuing favorable recovery from 3rd relapse
190407 - of IBC with treatment using cetuximab alone, reported on 070524.
190408 - ref SDS 89 M68J
190410 -  ..
190411 - Doctor Rugo noted that IBC continuing to subside at all sites supports
190412 - work plan and treatment strategy reviewed on 070524, ref SDS 89 K36G,
190413 - to continue with cetuximab alone despite sudden increase in the cancer
190414 - marker, CA 15-3 37, also reported on 070324. ref SDS 89 087J
190415 -
190416 -
190417 -
190418 -
1905 -

SUBJECTS
Breast Examination Shows Improvement Prognosis IBC Rash Intensity Su

2803 -
280401 -  ..
280402 - Cetuximab Prognosis IBC May Subside for 10 Months Before Progressing
280403 - Prognosis Disease May Subside 10 Months or More Before Progression
280404 - Progresssion of Disease May be Delayed for 10 Months or More
280405 - 10 Months or More Before Progresssion of Disease Switch to Gemzar
280406 -
280407 - Follow up ref SDS 89 M645, ref SDS 84 6A9H.
280408 -
280409 - Doctor Rugo indicated this morning that prognosis remains very
280410 - favorable for treatment with cetuximab alone, as noted previously on
280411 - 070324, ref SDS 89 M645, and based on examination today showing IBC
280412 - continues to subside, per above. ref SDS 0 FO6H
280413 -
280414 -
280415 -
2805 -

SUBJECTS
Waiver Patient Sign Continue Clinical Study Cetuximab Only Protocol

3503 -
350401 -  ..
350402 - Waiver Continue Clinical Study Cetuximab Only
350403 -
350404 - UCSF advised this morning that Millie has to sign a waiver to continue
350405 - on the study getting cetuximab alone, since she seems to be doing well
350406 - with this treatment, per examination above, ref SDS 0 6A9H, and the
350407 - study recently changed the protocol to treat patients only with
350408 - cetuximab and carboplatin.
350410 -  ..
350411 - During the meeting on 070419, Jackie reported this change in the
350412 - protocol to only treat patients with both cetuximab and carboplatin.
350413 - ref SDS 75 Q65N
350415 -  ..
350416 - Since Millie is doing well with cetuximab alone, she is entitled under
350417 - terms of the clinical study to continue this treatment until there is
350418 - evidence that IBC has begun to progress, reported on 070116 reviewing
350419 - the study protocol. ref SDS 41 NL7I
350420 -
350421 -
3505 -

SUBJECTS
Side Effects Cetuximab Acne-like Rash Face Dry Skin Face Chest Arms

4503 -
450401 -  ..
450402 - Side Effects Medicated After Weekly Examinations
450403 -
450404 - Follow up ref SDS 89 TQ6L, ref SDS 84 FO66.
450405 -
450406 - Side effects of cetuximab treatment are listed in the record receiving
450407 - treatment today in the Infusion Clinic, ref SDS 0 QU8K, and were
450408 - presented in the Clinical Study Consent form received from UCSF on
450409 - 070116. ref SDS 41 O64M
450411 -  ..
450412 - Side Effects were minimally considered today during the meeting with
450413 - Brigid this morning due to requirements focusing on recurrence of
450414 - Cellulitis and lymphedema; similarly side effects were reviewed
450415 - minimally during treatment in the Infusion Clinic, reported below.
450416 - ref SDS 0 QU8K
450417 -
450418 -
450419 -
450420 -
4505 -

SUBJECTS
Lymphadema Cellulitis Recurrence Severe Inflammation Entire Left Arm

5903 -
590401 -  ..
590402 - Lymphadema Escalates into Cellulitis on Left Arm
590403 - Keflex Prescribed Cellulitis Inflammation Entire Left Arm
590404 - Cellulitis Recurs Inflammation Entire Left Arm Keflex Prescribed
590405 - Knowledge Management Dilemma Exercise Resists Cancer Causes Cellulitis
590406 -
590407 - Follow up ref SDS 71 4Y93, ref SDS 48 N069.
590408 -
590409 - Millie suffered a setback today.  She has been working out in the gym
590410 - to restore fitness, reported in a letter to Kaiser on 070516.
590411 - ref SDS 86 UH4S  On Tuesday, this included lifting 3 pound weights
590412 - with each hand.  Exercising with weights restores strength that has
590413 - declined the past few years during treatment with capecitabine that
590414 - saps energy, and so prevented exercise.  Reducing exercise has caused
590415 - fitness to suffer, along with weakening the immune system needed to
590416 - resist cancer, as related by the primary care physician at Kaiser on
590417 - 030606. ref SDS 1 O44J  Since ending capecitabine treatments on
590418 - 061201, energy gradually increased, allowing exercise to improve
590419 - fitness, even after starting new treatments at UCSF on 070201, because
590420 - cetuximab does not sap energy to the severe degree exerienced with
590421 - capecitabine, reported for example on 050520. ref SDS 13 VP3N
590422 - Strengthening the immune system with exercise has helped stop advance
590423 - of cancer.  IBC symptoms have declined substantially during the past 4
590424 - months, as reported above. ref SDS 0 FO6H  Lifting weights may,
590425 - however, have overextended Millie's left arm, causing cellultis
590426 - complications of lymphedema, as a result of removing additional lymph
590427 - nodes during mastectomy surger on 051021. ref SDS 18 EG5L  May need
590428 - research on limits of activity in relation to lymphedema and risks of
590429 - Cellulitis, reviewed most recently at Kaiser on 070330. ref SDS 71
590430 - 4Y93
590432 -         ..
590433 -        [On 080409 nurse advises of opinion that exercise cannot cause
590434 -        Cellulitis. ref SDS 98 TG4L
590436 -  ..
590437 - Yesterday, Millie hiked about 3 miles at Lafayette Park.  Not clear
590438 - that hiking would affect Cellulitis.  Millie also cut her left hand
590439 - slightly within the past few weeks.
590440 -
590441 -        [On 070612 Millie suffered another cat bite. ref SDS 97 6G6H
590443 -  ..
590444 - This morning, Millie was initially concerned when her temperature
590445 - taken prior to examination was elevated at about 99.4.  When she
590446 - undressed for the examination, her left arm was enveloped with
590447 - inflammation and swelling.  This was shocking, similar to cellulitis
590448 - on 061027, ref SDS 36 WO6N, because only a few hours earlier after
590449 - showering to get ready for driving to San Francisco, her arm was
590450 - completely clear, except for very slight IBC rash on the upper left
590451 - arm.  The speed of advancing redness in just a few hours was
590452 - unnerving.
590454 -  ..
590455 - Previously, extensive exercise seemed associated with Cellulitis
590456 - during examination at Kaiser on 070330. ref SDS 71 7C7F  Earlier, on
590457 - 070218 similar experience from playing tennis. ref SDS 48 N069
590459 -  ..
590460 - When Brigid saw Millie's condition she consulted with Doctor Rugo.
590462 -  ..
590463 - The doctor examined Millie and diagnosed Cellulitis.
590465 -  ..
590466 - The doctor prescribed Keflex treatment, which the primary care
590467 - physician at Kaiser ordered on 070330, when less severe inflammation
590468 - on the upper left arm was diagnosed as Cellulitis. ref SDS 71 T87G
590469 - Millie did not take the medication on 070330, because after the
590470 - examination, inflammation subsided. ref SDS 71 N75M
590472 -  ..
590473 - Treatment prescribed today is for Millie to take Keflex on hand at
590474 - home, after treatment at UCSF with cetuximab.
590475 -
590476 -        [...below primary care physician at Kaiser notified;,
590477 -        ref SDS 0 GY41; concurs outpatient treatment with Keflex oral
590478 -        antibiotics. ref SDS 0 0J70
590480 -         ..
590481 -        [...Millie's condition worsens; treated with IV antibiotics.
590482 -        ref SDS 0 8J37
590484 -         ..
590485 -        [...primary care physician at Kaiser prescribes outpatint IV
590486 -        treatment with Ceftriaxone 2gms for 5 days, rather than Keflex,
590487 -        so this treatment remains on hand from prior prescription on
590488 -        070330. ref SDS 0 8L46
590489 -
590490 -
590491 -
590492 -
5905 -

SUBJECTS
Emotional Roller Coaster Cellulits Lymphedema Recurrence Increases E

7903 -
790401 -  ..
790402 - Emotional Roller Coaster Endemic Cancer Treatment and Coordination
790403 -
790404 - Follow up ref SDS 84 6A7J, ref SDS 82 6A7J.
790406 -  ..
790407 - Last month, on 070510 Brigid asked Millie how she was coping
790408 - emotionally with continuing changes in medical problems. ref SDS 84
790409 - 6A7J  At that time, improved communications had helped relieve worry,
790410 - doubt, and anxiety about the future. ref SDS 84 TK6J  A few weeks
790411 - later, emotional health was again reviewed, ref SDS 89 Y642, showing
790412 - rise of cancer marker, and new communication problems have increased
790413 - depression about how to enable collaboration between UCSF and Kaiser
790414 - that strengthens patient care. ref SDS 89 X74O
790416 -  ..
790417 - Today, new crisis of acute lymphedema and Cellulitis recurrence with
790418 - rising temperature did not leave enough time for Brigid to investigate
790419 - emotional stress, as done previously on 070510. ref SDS 84 6A7J
790421 -  ..
790422 - After the examination, Millie was very emotional about recurrence of
790423 - cellulitis.  She's worried that strong advocacy on 050913 promoting
790424 - mastectomy surgery and lack of time investigating side effects,
790425 - ref SDS 15 5T4J, as well on 050923, ref SDS 16 G49M, and later
790426 - reported on 061027, ref SDS 36 714I, has created a chronic condition
790427 - where hard work to restore fitness, called out by Kaiser in the
790428 - meeting on 030606, ref SDS 1 O44J, discussed again at Kaiser on
790429 - 040614, ref SDS 4 6T7F, and reported in research on 050609,
790430 - ref SDS 14 F88M, may have been turned against her with rising
790431 - Cellulitis, per above. ref SDS 0 ZH6I
790433 -  ..
790434 - When Millie arrived at the Infusion Clinic on the 5th floor she did
790435 - not feel well, was anxious and uncomfortable physically.
790437 -  ..
790438 - There was a note at the front desk that the nurses were in a staff
790439 - meeting, and that treatments would begin at 0900, rather than the
790440 - usual time of 0830.
790442 -  ..
790443 - All of the chairs were taken.  Millie did not feel well, and seemed to
790444 - be getting worse.  We went to the lobby on the 1st floor, and waited
790445 - in chairs there.
790447 -  ..
790448 - Millie called her daughter, Pam at work, and got information on
790449 - possible opportunity to play bridge, which Pam called about last
790450 - night, while Millie was sleeping.  Millie told Pam about recurrence of
790451 - cellulitis.  Pam has a medical procedure this morning.
790453 -  ..
790454 - After the call, Millie seemed to get worse.  She had chills.  Her hand
790455 - was shaking.  She advised that her left arm afflicted with Cellulitis
790456 - hurt when touched, less so at rest.  Her condition seemed similar to
790457 - 061027, when she was treated in the Emergency at Kaiser and
790458 - hospitalized for 5 days. ref SDS 36 124J
790460 -  ..
790461 - Millie was emotional about this set back, after doing so well
790462 - working out in the gym Tuesday, and again yesterday hiking the trails
790463 - at Lafayette Park.
790465 -  ..
790466 - We went upstairs to get medical assistance.
790467 -
790468 -
790469 -
790470 -
7905 -

SUBJECTS
Cetuximab 5th Cycle 3rd Treatment 19th Total Treatment Chemotherapy

8503 -
8504 - 0830
850501 -  ..
850502 - Infusion Clinic for Cetuximab Treatent
850503 -
850504 - Follow up ref SDS 92 1M6H, ref SDS 90 1M6H.
850505 -
850506 - Millie received 19th overall and 3rd treatment of 5th cycle with
850507 - cetuximab, starting from 070201, ref SDS 44 G68I, and the 26th
850508 - treatment for 3rd relapse of IBC, beginning on 060721. ref SDS 22 407N
850510 -  ..
850511 - Catherine was the nurse today.
850513 -         ..
850514 -        Taxotere Capecitabine
850515 -
850516 -        Follow up ref SDS 92 PR8Q, ref SDS 90 PR8Q.
850517 -
850518 -    1.  Cycle 09 and 01 ................... 060721, ref SDS 22 407N
850519 -    2.  Cycle 10 and 02 ................... 060814, ref SDS 28 LY6O
850520 -    3.  Cycle 11 and 03 ................... 060908, ref SDS 28 407N
850521 -    4.  Cycle 12 and 04 ................... 060929, ref SDS 28 407N
850522 -    5.  Cycle 13 and 05 ................... 061020, ref SDS 34 407N
850523 -    6.  Cycle 14 and 06 ................... 061110, ref SDS 37 407N
850524 -    7.  Cycle 15 and 07 ................... 061201, ref SDS 38 407N
850526 -         ..
850527 -        Cetuxiab Clinical Study
850528 -
850529 -        Follow up ref SDS 92 7T3H, ref SDS 90 7T3H.
850530 -
850531 -                   Total    Cetuximab
850532 -    8.  Cycle 01 and 08 and 01 01.......... 070201, ref SDS 44 SG8I
850533 -    9.  Cycle 01 and 08 and 02 02.......... 070208, ref SDS 46 SG8I
850534 -   10.  Cycle 01 and 08 and 03 03.......... 070215, ref SDS 47 SG8I
850535 -   11.  Cycle 01 and 08 and 04 04.......... 070222, ref SDS 50 SG8I
850536 -   12.  Cycle 02 and 09 and 01 05.......... 070301, ref SDS 55 SG8I
850537 -   13.  Cycle 02 and 09 and 02 06.......... 070308, ref SDS 58 7T3H
850538 -   14.  Cycle 02 and 09 and 03 07.......... 070315, ref SDS 63 7T3H
850539 -   15.  Cycle 02 and 09 and 04 08.......... 070322, ref SDS 64 7T3H
850540 -   16.  Cycle 03 and 10 and 01 09.......... 070329, ref SDS 69 7T3H
850541 -   17.  Cycle 03 and 10 and 02 10.......... 070405, ref SDS 72 7T3H
850542 -   18.  Cycle 03 and 10 and 03 11.......... 070412, ref SDS 74 7T3H
850543 -   19.  Cycle 03 and 10 and 04 12.......... 070419, ref SDS 76 7T3H
850544 -   20.  Cycle 04 and 11 and 01 13.......... 070426, ref SDS 79 7T3H
850545 -   21.  Cycle 04 and 11 and 02 14.......... 070503, ref SDS 82 7T3H
850546 -   22.  Cycle 04 and 11 and 03 15.......... 070510, ref SDS 84 7T3H
850547 -   23.  Cycle 04 and 11 and 04 16.......... 070517, ref SDS 87 7T3H
850548 -   24.  Cycle 05 and 12 and 01 17.......... 070524, ref SDS 90 7T3H
850549 -   25.  Cycle 05 and 12 and 02 18.......... 070531, ref SDS 92 7T3H
850550 -   26.  Cycle 05 and 12 and 03 19.......... 070607, ref SDS 0 7T3H
850551 -
850552 -
850553 -
8506 -

SUBJECTS
Cellulitis Lymphedema Temperature Rise Patient Suffering Chills Shak

A403 -
A404 - 0855
A40501 -  ..
A40502 - Staff Meeting Cannot be Interrupted to Assist Patient Rising Symptoms
A40503 - Patient Suffering Rising Symptoms Pain Chills Staff Meeting Priority
A40504 - Cellulitis Lymphedema Temperature Rise Require Emergency Treatment
A40505 -
A40506 - We went upstairs a little before 0900.  The staff meeting was still
A40507 - underway.  Millie seemed worse.  She needs immediate medical
A40508 - assistance.
A40510 -  ..
A40511 - The receptionist at the front desk said that Millie looked well enough
A40512 - that she does not need immediate assistance.  She said that everyone
A40513 - is still in a staff meeting that could not be interrupted, and she was
A40514 - afraid of suffering reprisals for asking someone in the meeting to
A40515 - help a patient before the meeting ends.
A40517 -  ..
A40518 - The attendant did not know where Millie could go for immediate
A40519 - assistance.
A40521 -  ..
A40522 - UCSF assistance for patient requiring immediate help conflicts with
A40523 - standard of care at Kaiser Emergency Room in Walnut Creek CA.  On
A40524 - 061027 Millie suffered recurrence of Cellulitis and lymphedema with
A40525 - elevated temperature.  Like today, at that time Millie was being
A40526 - treated with chemotherapy. ref SDS 36 0001  Like UCSF, Kaiser staff
A40527 - was very busy, and asked Millie to wait for treatment. ref SDS 36 Z23J
A40528 - Like today, while waiting on 061027 Millie's condition got worse, so
A40529 - the ER attendant arranged for Millie to lie down on a gurney, until
A40530 - someone could see her. ref SDS 36 ZO9N  Kaiser staff investigated and
A40531 - discovered Millie's temperature was rising, and arranged timely care.
A40532 - ref SDS 36 ZP6L
A40534 -  ..
A40535 - Today, about 10 minutes later, a nurse opened the door and said
A40536 - everyone could come into the clinic.  The staff meeting was still
A40537 - underway in the room where Millie normally gets treatment.  Nola
A40538 - suggested that Millie take a chair in an adjacent room until the
A40539 - meeting ends.  Nola got a blanket to wrap around Millie's shoulders as
A40540 - a first step to treat chills and shakes.
A40541 -
A40543 -  ..
A406 -
A407 -
A408 - 0905
A409 -
A40901 - The staff meeting ended, so Flora, who takes vitals, and knows Millie
A40902 - well, suggested that Millie take her usual chair in the treatment room
A40903 - where the meeting was held.  Millie asked for another blanket for her
A40904 - legs.  She does not look well.
A40906 -  ..
A40907 - Flora took Millie's temperature and seemed to indicate it had climbed
A40908 - to over 100.  After she completed other vitals, Flora took Millie's
A40909 - temperature again, and indicated it dropped back to below 99, closer
A40910 - to normal, a great relief. (see vitals. ref SDS 0 AW4L)
A40912 -  ..
A40913 - Millie asked for pineapple juice.  Got this from the common area
A40914 - refrigerator where UCSF keeps beverages for patients.
A40915 -
A40917 -  ..
A40918 - Millie is very uncomfortable.
A40920 -  ..
A40921 - Catherine attended Millie.
A40923 -  ..
A40924 - Catherine gave Millie Vicodin to control pain, noted earlier, per
A40925 - above. ref SDS 0 8I80
A40927 -  ..
A40928 - Reported diagnosis of Cellulitis this morning, per above, ref SDS 0
A40929 - ZI35  Reviewed patient history of severe Cellulitis on 061027, when
A40930 - Millie was treated with IV antibiotics and hospitalized for 5 days.
A40931 - ref SDS 36 V65J  A few months ago, on 070330, the primary care
A40932 - physician at Kaiser diagnosed very mild recurrence of Cellulitis, and
A40933 - prescribed treatment at home with Keflex. ref SDS 71 T87G  Within a
A40934 - few hours after the examination on 070330 Millie's condition improved
A40935 - without taking Keflex treatments. ref SDS 71 N75M
A40936 -
A40938 -  ..
A410 -
A411 -
A412 - 0930
A413 -
A41301 - Catherine sent a letter to Brigid via email for consultation.  Brigid
A41302 - confirmed initial plan for Millie to take Keflex at home for 10 days,
A41303 - according to the prescription on 070330, and as discussed earlier this
A41304 - morning. ref SDS 0 ZI37  There seemed to be concern about payment for
A41305 - treatment that is not part of the clinical study.
A41307 -  ..
A41308 - Called Kaiser and talked to Arlette...
A41309 -
A41310 -                925 295 4030
A41312 -  ..
A41313 - Presented current Cellulitis issue, and reviewed patient history
A41314 - treating this condition, per above. ref SDS 0 8I6U
A41316 -  ..
A41317 - Arlette will notify primary care physician.
A41318 -
A41319 -
A41320 -
A41321 -
A414 -

SUBJECTS
Default Null Subject Account for Blank Record

AT03 -
AT0401 -  ..
AT0402 - Side Effects Minimal...
AT0403 -
AT0404 - Follow up ref SDS 92 QU8K. ref SDS 91 QU8K.
AT0405 -
AT0406 - Nurse's notes report side effects...
AT0408 -  ..
AT0409 - Focus today was entirely dominated by treating Cellulitis and
AT0410 - lymphedema, and bring Millie's temperature under control, per above.
AT0411 - ref SDS 0 TU6J
AT0412 -
AT0413 -
AT0414 -
AT05 -

SUBJECTS
Default Null Subject Account for Blank Record

B103 -
B10401 -  ..
B10402 - Schedule Weekly Treatments Continue on Thursdays
B10403 -
B10404 - Follow up ref SDS 92 QK6L. ref SDS 91 QK6L.
B10405 -
B10406 - Millie's next treatment is scheduled for 070614 0830, as reported by
B10407 - Nola on 070510. ref SDS 84 3E8L
B10408 -
B10409 -
B10410 -
B105 -

SUBJECTS
Default Null Subject Account for Blank Record

BH03 -
BH0401 -  ..
BH0402 - Preparation for Treatment Required One (1. Attempt to Connect Port
BH0403 -
BH0404 - Follow up ref SDS 92 EB7J. ref SDS 91 EB7J.
BH0405 -
BH0406 - The nurse connected the IV tubes to the port....
BH0407 -
BH0408 -        Interlink System Vented Paclitaxel set
BH0410 -  ..
BH0411 - There were no problems getting blood to flow from the port catheter,
BH0412 - unlike last week on 080531. ref SDS 92 DC5W
BH0414 -  ..
BH0415 - The nurse flushed the port with saline.
BH0416 -
BH0417 -
BH0418 -
BH0419 -
BH05 -

SUBJECTS
Default Null Subject Account for Blank Record

BQ03 -
BQ0401 -  ..
BQ0402 - Benadryl Reduce Side Effects Cetuximab Chemotherapy Treatment
BQ0403 -
BQ0404 - Follow up ref SDS 92 DC7J. ref SDS 91 DC7J.
BQ0405 -
BQ0406 - Benadryl (diphenhydramine) started.   25 MG....... ref SDS 80 IJ44
BQ0407 -
BQ0408 -       Purpose reported on 060721. ref SDS 22 DC7J
BQ0410 -  ..
BQ0411 - Chemotherpay order calls for Benadryl (diphenhydramine) pre-treatment
BQ0412 - 30 - 60 minutes prior to cetuximab infusion, shown below. ref SDS 92
BQ0413 - IJ41
BQ0414 -
BQ0415 -
BQ0416 -
BQ0417 -
BQ0418 -
BQ05 -

SUBJECTS
Default Null Subject Account for Blank Record

BR03 -
BR04 - 1030
BR0501 -  ..
BR0502 - Cellulitis Lymphedema Worsens Emergency Treatment Approved
BR0503 -
BR0504 - Millie's condition worsens.  Temperature rises above 102. ref SDS 0
BR0505 - AW4L
BR0507 -  ..
BR0508 - Reviewed background that when Millie's temperature is over 100.5 she
BR0509 - is taken to Emergency at Kaiser for treatment and monitoring.  Would
BR0510 - like to get her temperature down before leaving UCSF today.
BR0512 -  ..
BR0513 - Catherine contacted Brigid again.  UCSF approved treating Millie with
BR0514 - IV antibiotics and ordered blood culture.
BR0515 -
BR0516 -        [...below, Catherine starts Millie on ceftriaxone IV 2gms
BR0517 -        antibiotic to treat fever and Cellulitis. ref SDS 0 8J40
BR0518 -
BR0519 -        [On 070610 primary care physician reports Kaiser received
BR0520 -        results of blood culture. ref SDS 95 834N
BR0522 -         ..
BR0523 -        [On 070611 Millie requests copy of report on results of the
BR0524 -        blood culture from UCSF. ref SDS 96 JP3G
BR0525 -
BR0526 -
BR0528 -  ..
BR06 -
BR07 -
BR08 - 1048
BR09 -
BR0901 - Arlette called back from Kaiser.
BR0902 -
BR0903 - The primary care physician wants Millie to start taking Keflex at home
BR0904 - this afternoon, as proposed initially by UCSF medical team this
BR0905 - morning at 0800, per above, ref SDS 0 ZI37, and call to report results
BR0906 - tomorrow.
BR0908 -  ..
BR0909 - Explained Millie's condition has worsened.  UCSF will treat Millie
BR0910 - here with intravenous antibiotics rather than wait to try Keflex at
BR0911 - home.
BR0913 -  ..
BR0914 - Arlette will notify the doctor about these changes.
BR0915 -
BR0916 -
BR0918 -  ..
BR10 -
BR11 -
BR12 - 1058
BR13 -
BR1301 - Called Kathy at N&P and let her know that Millie cannot have lunch
BR1302 - today, as planned earlier.   Kathy will let the others know.  They
BR1303 - evidently had planned this event for a few weeks.
BR1304 -
BR1305 -
BR1307 -  ..
BR14 -
BR15 -
BR16 - 1152
BR17 -
BR1701 - Millie completes treatment with cetuximab.  She is moved to a private
BR1702 - room where she can lie down in bed.
BR1704 -  ..
BR1705 - Catherine has started Millie on IV antibiotics ordered by Brigid, per
BR1706 - above. ref SDS 0 8J51  She said that Millie has another hour to go on
BR1707 - this supplemental treatment for Cellulitis listed in Nurse's Notes...
BR1708 -
BR1709 -                ceftriaxone IV 2gms
BR1710 -
BR1711 -       [...below, ask medical team for name of antibiotic. ref SDS 0
BR1712 -       688K
BR1714 -        ..
BR1715 -       [On 070608 Brigid submits name of antibiotic. ref SDS 93 KQ44
BR1717 -        ..
BR1718 -       [On 070608 Millie received schedule on 5 days of IV treatment
BR1719 -       with ceftriaxone for Cellulitis. ref SDS 93 AL39
BR1721 -  ..
BR1722 - Cellulitis inflammation on Millie's arm is now much worse, but there
BR1723 - is no pain because Catherine gave her Vicodin medication that is
BR1724 - compatible with Millie's Coumadin treatments for pulmonary embolism.
BR1725 - Rising inflammation fits the cycle of Cellulitis infection on 061027.
BR1726 - ref SDS 36 WO6N
BR1728 -  ..
BR1729 - Millie's temperature remains elevated above 101, but may be coming
BR1730 - down.
BR1732 -  ..
BR1733 - Catherine will consult with Brigid and Doctor Rugo about coordinating
BR1734 - with the primary care physician at Kaiser on whether to keep Millie at
BR1735 - UCSF, or take her to Kaiser in Walnut Creek, and in that case whether
BR1736 - Millie can drive in her own car, or needs transportation in an
BR1737 - ambulance.
BR1738 -
BR1740 -  ..
BR18 -
BR19 -
BR20 - 1310
BR21 -
BR2101 - Catherine advises that Millie has improved.  Inflammation in the arm
BR2102 - seems to be down.  Millie wants to go home.
BR2104 -  ..
BR2105 - Catherine reports that Millie's temperature has dropped to 101.4.
BR2106 - ref SDS 0 AW4L  There is some question about conversion from Celsius
BR2107 - to Farhenheit.
BR2109 -  ..
BR2110 - UCSF has released Millie to go home for treatment with Keflex
BR2111 - beginning tomorrow, since the IV antibiotic will be effective until
BR2112 - tomorrow.
BR2113 -
BR2114 -        [...below, Kaiser prescribes 5-day IV treatment for cellulitis.
BR2115 -        ref SDS 0 8L46
BR2117 -         ..
BR2118 -        [On 070608 Millie begins 5-day IV treatment at Kaiser in
BR2119 -        Martinez for Cellulitis. ref SDS 93 AK6H
BR2121 -         ..
BR2122 -        [On 070610 primary care physician at Kaiser seems to indicate
BR2123 -        IV medications completed after only 2 treatments, and Millie
BR2124 -        should start oral antibiotics. ref SDS 95 OG7F
BR2126 -         ..
BR2127 -        [On 070611 Millie requested clarification of treatment for
BR2128 -        Cellulitis from primary care physician at Kaiser.
BR2129 -        ref SDS 96 OG7F
BR2131 -         ..
BR2132 -        [On 070612 primary care physician at Kaiser clarifies
BR2133 -        treatment plan to start Keflex oral antibiotics after
BR2134 -        completing IV medications. ref SDS 97 QE4M
BR2135 -
BR2136 -
BR2138 -  ..
BR2139 - Emergency Treatment Temperature 100.5+ Case Study
BR2140 - Temperature 100.5+ Emergency Treatment Patient History
BR2141 -
BR2142 - Reviewed again Millie's history of going to Emergency at Kaiser when
BR2143 - her temperature reaches 100.5, see reports on...
BR2144 -
BR2145 -            Temperature 101+
BR2146 -            Cellulitis
BR2147 -            medication conflict.............. 041202, ref SDS 10 IX9N
BR2149 -             ..
BR2150 -            Temperature 101.9
BR2151 -            cat bite......................... 050212, ref SDS 12 5V8J
BR2153 -             ..
BR2154 -            Temperature 102.4
BR2155 -            pneumonia........................ 060607, ref SDS 20 O46O
BR2157 -             ..
BR2158 -            Temperature 101.5
BR2159 -            Cellulitis....................... 061027, ref SDS 36 EX4P
BR2161 -             ..
BR2162 -            Temperature 101.9
BR2163 -            Cellulitis....................... 080409, ref SDS 98 0001
BR2165 -  ..
BR2166 - Catherine related understandings with the medical team in the Breast
BR2167 - Care Center that Millie has been treated previously in Kaiser's
BR2168 - Emergency for Cellulitis.  She indicated that UCSF makes no
BR2169 - recommendations on this issue, and expects that Millie will consult
BR2170 - with Kaiser for follow on treatment of Cellulitis.
BR2171 -
BR2173 -  ..
BR2174 - Emergency treatment is part of the scope for coordination planning,
BR2175 - ref SDS 49 KL5G, which Jackie recommended on 070222. ref SDS 49 VK5N
BR2176 - Up until now, there has been enough time to develop an actual plan,
BR2177 - so decisions are ad hoc.
BR2178 -
BR2179 -      [On 070608 Brigid initiated coordination with Kaiser by
BR2180 -      requesting contact information for communications. ref SDS 93
BR2181 -      035H
BR2183 -       ..
BR2184 -      [On 070610 primary care physician at Kaiser reports communication
BR2185 -      channels are now open with UCSF, signalling progress toward
BR2186 -      coordination planning on referral projects. ref SDS 95 OG7F
BR2187 -
BR2188 -
BR2189 -
BR2190 -
BR2191 -
BR2192 -
BR2193 -
BR22 -

SUBJECTS
Vitals Blood Pressure Pulse Temperature Sa02 Weight Infusion Treatme

BY03 -
BY04 - 0900
BY0501 -  ..
BY0502 - Vitals Show Patient Stable
BY0503 -
BY0504 - Follow up ref SDS 84 AW4L, ref SDS 82 AW4L.
BY0505 -
BY0506 -                     Blood
BY0507 -    Date   Time   Pressure  Pulse  Temperture  Weight So2
BY0508 -    .
BY0509 -    070607 1230..... 112  68     86   38.6c 101.48f         98
BY0510 -    070607 1120..... 140  68     85   38.2c 100.76f         96
BY0511 -    070607 1025..... 142  58     80   38.9c 102.02f         98
BY0512 -    070607 1015.....                  38.6c 101.48f
BY0513 -    070607 0910..... 146  73     70   36.4c  97.52f         97
BY0514 -    070510 1145..... 145  86     54   35.9c                100
BY0515 -    070510 1045..... 149  82     69   37.0c                 97
BY0516 -    070510 0900..... 132  75     62   36.8c                 99
BY0517 -    070503 1150..... 113  67     59   36.8c                 98
BY0518 -    070503 1055..... 125  72     54   36.1c                100
BY0519 -    070503 0915..... 127  70     60   36.9c                 99
BY0520 -    070426 1130..... 119  70     57   36.3c                 96
BY0521 -    070426 1030..... 141  73     67   36.4c                 99
BY0522 -    070426 0900..... 130  78     52   36.5c                 97
BY0523 -
BY0524 -
BY0525 -
BY06 -

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

CC03 -
CC04 - 1320
CC0501 -  ..
CC0502 - Energy Low Unstable After Cetuximab Treatment and for Cellulitis
CC0503 -
CC0504 - Follow up ref SDS 84 F54N, ref SDS 82 F54N.
CC0506 -  ..
CC0507 - On 060724 diary side effects for cetuximab chemotherapy treatment on
CC0508 - clinical study drug trial. ref SDS 24 YP4I
CC0510 -  ..
CC0511 - Millie was generally alert after treatment today, but wobbly and a
CC0512 - little disoriented.  She was not able to drive home.
CC0514 -  ..
CC06 -
CC07 -
CC08 - 1415
CC09 -
CC0901 - Millie had some yogurt and pineapple for lunch.
CC0902 -
CC0903 - Temperature 100,4 down slightly from leaving the hospital, per above.
CC0904 - ref SDS 0 AW4L
CC0906 -  ..
CC0907 - This is slightly below 100.5 which Kaiser calls for Emergency care,
CC0908 - per study on patient history above. ref SDS 0 1N3X
CC0910 -  ..
CC0911 - Millie takes Tylenol medication on hand to control temperature and
CC0912 - relieve pain.
CC0913 -
CC0914 -                  Kaiser
CC0915 -                  Regular strength
CC0916 -                  APAP
CC0917 -                  Acetaminophen............ 325 mg
CC0919 -  ..
CC0920 - Cellulitis inflammation seems slightly reduced, but this is
CC0921 - subjective.  The upper tricep seems like the worst area of rash, and
CC0922 - has subsided a little.
CC0923 -
CC0924 -
CC0925 -
CC0927 -  ..
CC10 -
CC11 -
CC12 - 1428
CC13 -
CC1301 - Arlette called.
CC1302 -
CC1303 - Millie explained release from UCSF with temperature 101.4 at about
CC1304 - 1300; current temperature 100.4; Cellulitis still very severe, but
CC1305 - slightly improved from this morning, per above. ref SDS 0 8L85
CC1307 -  ..
CC1308 - Arlette says the doctor needs the the name of the antibiotic given at
CC1309 - UCSF this morning. ref SDS 0 8J40  Millie reads handwritten Nurse's
CC1310 - Notes something like...
CC1311 -
CC1312 -                Ceftriaxone IV 2gms
CC1313 -
CC1314 -
CC1316 -  ..
CC14 -
CC15 -
CC16 - 1503
CC17 -
CC1701 - Arlette calls back.
CC1702 -
CC1703 - Doctor ordered outpatient IV treatment with Ceftriaxone 2gms for 5
CC1704 - days at Kaiser in Martinez, rather than Keflex, as earlier discussed.
CC1705 - ref SDS 0 7V4R
CC1706 -
CC1707 -     [On 070608 Millie received schedule on 5 days of IV treatment
CC1708 -     with ceftriaxone for Cellulitis. ref SDS 93 AL39
CC1710 -      ..
CC1711 -     [On 070610 primary care physician letter notifies Millie to
CC1712 -     begin taking oral antibiotics, ref SDS 95 OG9G, after 2nd
CC1713 -     IV treatment, and before completing work plan for 5-IV
CC1714 -     treatments presented today. ref SDS 93 AL39
CC1715 -
CC1716 -
CC1717 -
CC1719 -  ..
CC18 -
CC19 -
CC20 - 1515
CC21 -
CC2101 - Temperature 99.7.
CC2102 -
CC2104 -  ..
CC22 -
CC23 -
CC24 - 1526
CC25 -
CC2501 - Kaiser at Martinez called and scheduled Millie for IV treatment at
CC2502 - 0900 tomorrow.
CC2503 -
CC2505 -  ..
CC26 -
CC27 -
CC28 - 1530
CC29 -
CC2901 - Millie asleep.
CC2902 -
CC2904 -  ..
CC30 -
CC31 -
CC32 - 1810
CC33 -
CC3301 - Millie awake.
CC3302 -
CC3303 - Temperature increased to 100.3
CC3305 -  ..
CC3306 - Millie takes medication to control temperature.
CC3308 -  ..
CC3309 - Prepared light meal... rice, slice beef, and asparagus.
CC3311 -  ..
CC3312 - Discuss going to Emergency if temperature continues to increase.
CC3313 -
CC3315 -  ..
CC34 -
CC35 -
CC36 - 1919
CC37 -
CC3701 - Temperature 99.9
CC3702 -
CC3703 - Millie asleep.
CC3704 -
CC3706 -  ..
CC38 -
CC39 -
CC40 - 2245
CC41 -
CC4101 - Temperature 99.5.
CC4102 -
CC4103 - Millie takes another Tylonel.
CC4105 -  ..
CC4106 - Cellulitis inflammation seems slightly better, less intense and
CC4107 - swelling has subsided somewhat.
CC4108 -
CC4109 -
CC4111 -  ..
CC42 -
CC43 -
CC44 - 2323
CC45 -
CC4501 - Millie notifies medical team of coordinated actions today, per
CC4502 - above...
CC4503 -
CC4504 -        Subject:  Cellulitis Recurrence Coordination UCSF Kaiser
CC4506 -         ..
CC4507 -        Date:  June 7, 2007 2326
CC4509 -         ..
CC4510 -        Thanks for coordinating my treatment today.  Thanks, also, to
CC4511 -        Brigid for timely support, and especially to Catherine for
CC4512 -        taking immediate action at UCSF to get me through a crisis.
CC4513 -        Here are my understandings of the record today, which is
CC4514 -        fragmentary and hurried.  Please let me know of any additions
CC4515 -        and corrections. ref SDS 0 0001
CC4517 -         ..
CC4518 -        I would like to get the name of the antibiotic IV treatment.
CC4519 -        ref SDS 0 8J40
CC4521 -         ..
CC4522 -        Thanks to all.
CC4523 -
CC4524 -            [On 070608 Arlette says to send the record to the primary
CC4525 -            care physician so communications will be in Kaiser's
CC4526 -            electronic medical chart. ref SDS 93 6R6F
CC4527 -
CC4528 -
CC4529 -
CC4531 -  ..
CC46 -
CC47 -
CC48 - 0023
CC49 -
CC4901 - Temperature 100.2
CC4902 -
CC4903 - Millie took another Tylenol.
CC4905 -  ..
CC4906 - Persistant elevated temperature today appears conflicting with prior
CC4907 - recovery from Cellulitis on 061027, when IV antibiotics restored
CC4908 - Millie's temperature within a few hours. ref SDS 36 V78N
CC4909 -
CC4910 -
CC4911 -
CC4912 -
CC4913 -
CC4914 -
CC4915 -
CC4916 -
CC4917 -
CC50 -