THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com


S U M M A R Y


DIARY: December 13, 2007 09:00 AM Thursday; Rod Welch

Millie at UCSF 1st treatment 12th cycle cetuximab for 3rd relapse IBC.

1...Summary/Objective
2...Labs Blood Test
3...Magnesium Low Millie Treated with Magnesium IV


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CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0403 -    ..
0404 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040501 - Follow up ref SDS 6 0000. ref SDS 5 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040506 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040507 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040509 -  ..
0406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0408 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040901 - Labs Blood Test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040902 - 
040903 - Follow up ref SDS 3 MW7I, ref SDS 1 OB5H.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040904 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040905 - During treatment, Catherine submitted results of the test.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040906 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040921 -     ..
040922 -    Log#:                   071213 08:00                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040923 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
040924 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040926 -     ..
040927 -    CBC with DIFF & PLT CT                                     CBCD
040928 -     ..
040929 -    WBC COUNT    L*         3.3    x10E9/L     3.4  -   10     WBC   WBC x10-3        K/uL     3.4  -  10.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040930 -    RBC COUNT               4.57   x10E12/L      4  -   5.2    RBC   RBC x10-6        M/uL    3.60  -  5.70                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040931 -    HEMOGLOBIN             14.7    g/dL         12  -   15.5   HGB   Hemoglobin       g/dL    11.5  -  15.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040932 -    HEMATOCRIT             41.2    PERCENT      36  -   46     HCT   Hematocrit       %       34.0  -  46.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040933 -    MCV                    90      fL           80  -   100    MCV   MCV              fL      80.0  -  100.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040934 -    MCH                    32.2    pg           26  -   34     MCH                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040935 -    MCHC                   35.8    g/dL         31  -   36     MCHC                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040936 -    PLATELETS             226      x10E9/L     140  -  450     PLT   Plt x10-3        K/uL     140  -  400                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040937 -    ..
040938 -       (posted 070531, rex SDS 82 NQ6K)
040939 -    CA 15-3      H*        48      U/mL             <  31    CA15-3  CA 15-3                        <  39
040940 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040941 -         Note new reference range and change in methodology.  Performed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040942 -         using the Roche Elecsys 2010 ECLIA method.  Performed at UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040943 -         China Basin Lab, 185 Berry, San Francisco, CA  94107.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040944 -    ..
040945 -     (NEUTS x 1000 = ANC for Kaiser)
040946 -    NEUTS                   1.49   x10E9/L     1.8  -  6.8     N-A   ANC                      1500                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040947 -    Neutrophils    Not Reported                                      Neutrophils       %        50  -  70                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040949 -     ..
040950 -    LYMPHS                  1.30   x10E9/L     0.9  -  2.9     L-A   Lymphocytes       %        20  -  50                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040951 -    MONOS                   0.33   x10E9/L     0.1  -  0.6     M-A   Monocyte          %         0  -  11                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040952 -    EOS                     0.17   x10E9/L       0  -  0.4     E-A   Esoinophils       %         1  -  5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040953 -    BASOS                   0.05   x10E9/L       0  -  0.1     B-A   Basophil          %         0  -  2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040954 -                                                                                                 0  -  5
040955 -     ..
040956 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
040957 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
040958 -     ..
040959 -    PT              H      25.3    S          12.5  - 16.0     PT    PT, patient       sec     8.9  -  11.1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040960 -    INL NRM Ratio   H       2.3                0.9  -  1.2     INR   PT INR            sec     2.0  -  3.0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040961 -    PARTIAL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040962 -     THROMBOPLASTIN  Not Reported  S          22.4  - 33.3     PTT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040964 -     ..
040965 -    ELECTROLYTE PANEL                                          LYTE                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040966 -    SODIUM                135      mmol/L      134  -  143     NA    Sodium            mEq/L   137  -  145                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040967 -    POTASSIUM               4.1    mmol/L      3.4  -  4.9     K     Potassium         mEq/L   3.5  -  5.3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040968 -    CHLORIDE              103      mmol/L       98  -  107     CL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040969 -    CARBON DIOX TOTAL      23      mmol/L       23  -  32      CO2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040970 -    ANION GAP               9                    3  -  14      ANGA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040972 -     ..
040973 -    UREA NITROGEN          10      mg/dL         8  -  23      BUN   BUN               mg/dL     7  -  17                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040974 -    CALCIUM                 8.7    mg/dL       8.7  -  10.1    CA    Calcium           mg/dL   8.4  -  10.2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040975 -    MAGNESIUM      L*       1.7    mg/dL       1.8  -  2.3     MG    Magnesium         mg/dL   1.6  -  2.3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040977 -     ..
040978 -    CREATININE              0.7    mg/dL       0.6  -  1.2     CR    Creatinine        mg/dL   0.6  -  1.2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040979 -    GLUCOSE               139      mg/dL        70  -  199     GLU   Glucose           mg/dL     ?  -   ?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040980 -    AST            H*      48      U/L          16  -  41      AST   AST (SGOT)        U/L      14  -  36                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040981 -    ALT                    28      U/L          11  -  54      ALT   ALT (SGPT)        U/L      11  -  66                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040982 -    BILIRUBIN TOTAL         0.7    mg/dL       0.3  -  1.3     BILT  Bili Total        mg/dL   0.2  -  1.3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040983 -    ALKALINE PHOSPHATASE   63      U/L          29  -  111     ALKP  Alkaline Ph       U/L      38  -  126                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040984 -    PROTEIN TOTAL           6.0    g/dL        5.8  -  8.0     TP    Protein, Total    g/dL    6.3  -  8.2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040985 -    ALBUMIN                 4.2    g/dL        3.4  -  4.7     ALB   Albumin           g/dL    3.4  -  4.8                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040986 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040987 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040988 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040990 -  ..
040991 - Magnesium Low Millie Treated with Magnesium IV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040992 - 
040993 - Catherine called and notified Brigid that the blood test today shows                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040994 - low Magnesium 1.7, slightly below the target range of 1.8. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040995 - A14L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040997 -  ..
040998 - Decided to treat this with infusion of Magnesium through IV, and this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040999 - was done during the 1 hour rest period after treatment with cetuximab.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041000 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041001 -        [On 080110 initial lab report received from UCSF shows no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041002 -        report for magnesium to evaluate response to treatment today.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041003 -        ref SDS 8 JH6F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041005 -         ..
041006 -        [On 080118 Catherine submitted another report on the labs for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041007 -        080110; it shows Magnesium was in fact tested and was at the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041008 -        low end of the target range, indicating response to treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041009 -        today. ref SDS 9 4F9G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041011 -  ..
041012 - Research seems to indicate magnesium is a big part of bone                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041013 - development.  Low Magnesium contributes to anxiety, insomia, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041014 - fatigue.  Millie has experienced all of these somewhat lately.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041015 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041016 -        [On 080404 Magnesium again too low; UCSF orders treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041017 -        through Kaiser, because the report was delayed due to mistake                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041018 -        ordering blood tests on 080403. ref SDS 10 OQ36                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041020 -  ..
041021 - Fatigue is also associated with pulmonary embolism, and atelectasis,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041022 - which are further possibly associated with cor pulmonale (enlarged                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041023 - right ventricle), and possibly enlarged heart.  Atelectasis and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041024 - enlarged heart were both reported in the CT test on 071210, received                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041025 - today and reviewed with the medical team at UCSF this morning.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041026 - ref SDS 7 SR5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041027 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041028 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041029 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041030 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041031 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041032 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041033 -