THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: January 10, 2008 09:00 AM Thursday; Rod Welch

Millie at UCSF 1st treatment 13th cycle cetuximab for 3rd relapse IBC.

1...Summary/Objective
2...Labs Blood Test
3...Magnesium Low End of Target Range No Treatment


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CONTACTS 

SUBJECTS
Cetuximab 12th Cycle 3rd Treatment 18th Total Treatment Chemotherapy

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 14 0000. ref SDS 13 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie had a blood draw in Infusion Clinic this morning at 0800.
040902 -
040903 - Diane did the work and was a delight to work with as usual.
040905 -  ..
040906 - There was a slight problem today getting blood to flow to collect all
040907 - of the test vials.   About 75% through the draw, blood seemed to flow
040908 - normally.
040909 -
040911 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Labs Blood Test
041302 -
041303 - Follow up ref SDS 9 BD6I, ref SDS 4 MW7I.
041304 -
041305 - During treatment, Catherine submitted results of the test.
041306 -
041307 -           [On 080131 Millie had an interim blood test to evaluate
041308 -           effects of fall on 080125, ref SDS 17 CX9O, and it showed no
041309 -           ill effects. ref SDS 17 QY6H
041310 -
041325 -     ..
041326 -    Log#:                   080110 08:15
041327 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
041328 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
041330 -     ..
041331 -    CBC with DIFF & PLT CT                                     CBCD
041332 -     ..
041333 -    WBC COUNT    L*         3.8    x10E9/L     3.4  -   10     WBC   WBC x10-3        K/uL     3.4  -  10.0
041334 -    RBC COUNT               4.34   x10E12/L      4  -   5.2    RBC   RBC x10-6        M/uL    3.60  -  5.70
041335 -    HEMOGLOBIN             13.9    g/dL         12  -   15.5   HGB   Hemoglobin       g/dL    11.5  -  15.0
041336 -    HEMATOCRIT             39.6    PERCENT      36  -   46     HCT   Hematocrit       %       34.0  -  46.0
041337 -    MCV                    91      fL           80  -   100    MCV   MCV              fL      80.0  -  100.0
041338 -    MCH                    32.1    pg           26  -   34     MCH
041339 -    MCHC                   35.1    g/dL         31  -   36     MCHC
041340 -    PLATELETS             201      x10E9/L     140  -  450     PLT   Plt x10-3        K/uL     140  -  400
041341 -    ..
041342 -     (received 080117, ref SDS 16 KW8I)
041343 -    CA 15-3      H*        51      U/mL             <  31    CA15-3  CA 15-3                        <  39
041344 -
041345 -         Note new reference range and change in methodology.  Performed
041346 -         using the Roche Elecsys 2010 ECLIA method.  Performed at UCSF
041347 -         China Basin Lab, 185 Berry, San Francisco, CA  94107.
041348 -
041349 -         51 is an increase of 3 from 48 reported for the blood test on
041350 -         071213. ref SDS 9 A16M
041351 -    ..
041352 -     (NEUTS x 1000 = ANC for Kaiser)
041353 -    NEUTS                   1.25   x10E9/L     1.8  -  6.8     N-A   ANC                      1500
041354 -    Neutrophils    Not Reported                                      Neutrophils       %        50  -  70
041355 -
041356 -             [On 080131 interim test NEUTS 1.61 rises to safe level for
041357 -             treatment. ref SDS 17 OW7O
041359 -     ..
041360 -    LYMPHS                  1.82   x10E9/L     0.9  -  2.9     L-A   Lymphocytes       %        20  -  50
041361 -    MONOS                   0.48   x10E9/L     0.1  -  0.6     M-A   Monocyte          %         0  -  11
041362 -    EOS                     0.21   x10E9/L       0  -  0.4     E-A   Esoinophils       %         1  -  5
041363 -    BASOS                   0.06   x10E9/L       0  -  0.1     B-A   Basophil          %         0  -  2
041364 -                                                                                                 0  -  5
041365 -     ..
041366 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
041367 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
041368 -     ..
041369 -    PT              H      25.8    S          12.5  - 16.0     PT    PT, patient       sec     8.9  -  11.1
041370 -    INL NRM Ratio   H       2.3                0.9  -  1.2     INR   PT INR            sec     2.0  -  3.0
041371 -
041372 -         Performed at Mt Zion Clinic Lab, 1600 Divisadero, San
041373 -         Francisco, CA  94115
041375 -     ..
041376 -    PARTIAL
041377 -     THROMBOPLASTIN  Not Reported  S          22.4  - 33.3     PTT
041379 -     ..
041380 -    ELECTROLYTE PANEL                                          LYTE
041381 -    SODIUM                138      mmol/L      134  -  143     NA    Sodium            mEq/L   137  -  145
041382 -    POTASSIUM               4.3    mmol/L      3.4  -  4.9     K     Potassium         mEq/L   3.5  -  5.3
041383 -    CHLORIDE              106      mmol/L       98  -  107     CL
041384 -    CARBON DIOX TOTAL      25      mmol/L       23  -  32      CO2
041385 -    ANION GAP               7                    3  -  14      ANGA
041387 -     ..
041388 -    UREA NITROGEN          10      mg/dL         8  -  23      BUN   BUN               mg/dL     7  -  17
041389 -    CALCIUM                 8.8    mg/dL       8.7  -  10.1    CA    Calcium           mg/dL   8.4  -  10.2
041390 -     ..
041391 -    MAGNESIUM               1.8    mg/dL       1.8  -  2.3     MG    Magnesium         mg/dL   1.6  -  2.3
041392 -
041393 -         There was no report for magnesium today, per below.
041394 -         ref SDS 0 HH5I  Later it turned that Magnesium was added to
041395 -         the scope of testing, and so results were reported here to
041396 -         have comprehensive listing.
041397 -
041398 -            [On 080118 Catherine submitted another report on the labs
041399 -            for 080110 (today), and it shows Magnesium was in fact
041400 -            tested today, and was at the low end of the target range,
041401 -            indicating response to treatment with improvement today
041402 -            from the labs last month on 071213. ref SDS 16 4F9G
041404 -     ..
041405 -    CREATININE              0.8    mg/dL       0.6  -  1.2     CR    Creatinine        mg/dL   0.6  -  1.2
041406 -    GLUCOSE               102      mg/dL        70  -  199     GLU   Glucose           mg/dL     ?  -   ?
041407 -    AST            H*      48      U/L          16  -  41      AST   AST (SGOT)        U/L      14  -  36
041408 -    ALT                    27      U/L          11  -  54      ALT   ALT (SGPT)        U/L      11  -  66
041409 -    BILIRUBIN TOTAL         1.0    mg/dL       0.3  -  1.3     BILT  Bili Total        mg/dL   0.2  -  1.3
041410 -    ALKALINE PHOSPHATASE   53      U/L          29  -  111     ALKP  Alkaline Ph       U/L      38  -  126
041411 -    PROTEIN TOTAL           6.3    g/dL        5.8  -  8.0     TP    Protein, Total    g/dL    6.3  -  8.2
041412 -    ALBUMIN                 4.0    g/dL        3.4  -  4.7     ALB   Albumin           g/dL    3.4  -  4.8
041413 -
041414 -
041415 -
041417 -  ..
041418 - Magnesium Low End of Target Range No Treatment
041419 -
041420 - Follow up ref SDS 9 HH5I.
041421 -
041422 - The Chemotherapy order issued on 070201 for Millie's treatment in the
041423 - clinical study for cetuximab shows Magnesium should be tested every 4
041424 - weeks to align with starting a new cycle of treatment, ref SDS 2 5594,
041425 - as involved here.
041427 -  ..
041428 - During the meeting this morning with the medical team, Brigid advised
041429 - that magnesium was not tested today, per above, ref SDS 0 5K8H,
041430 - because there is no reason to test this diagnostic every month.
041431 - ref SDS 15 JH6F
041433 -  ..
041434 - Discussion centered on advisability of testing until recovery is
041435 - demonstrated. ref SDS 15 JA3G
041436 -
041437 -        [On 080118 Catherine submitted another report on the labs for
041438 -        080110 (today), and it shows Magnesium was in fact tested
041439 -        today, and was at the low end of the target range, indicating
041440 -        response to treatment with improvement today from the labs last
041441 -        month on 071213. ref SDS 16 4F9G
041442 -
041443 -
041444 -
041445 -
041446 -
041447 -
041448 -
041449 -
041450 -
0415 -