CONTACTS 

SUBJECTS
Blood Counts Low NEUTS 0.95 Energy High Feel Well Fitness Good IBC T

3203 -
3203 -    ..
3204 - Summary/Objective
3205 -
320501 - Follow up ref SDS 12 PU6K, ref SDS 6 0000.
320502 -
320503 - Millie coordinates referral work at UCSF with Kaiser by reporting low
320504 - blood counts caused another missed chemotherapy treatment for cancer.
320505 - ref SDS 0 2V9K  Despite low blood counts, Millie's energy and fitness
320506 - have increased while getting treatment with cetuximab and adding
320507 - chemotherapy Carboplatin. ref SDS 0 4W5Y  Notifies medical team that
320508 - Millie went to the Kaiser Pharmacy and got more Neupogen treatments to
320509 - increase blood counts. ref SDS 0 4W7S  Millie asks how many Neupogen
320510 - treatments are prescribed? ref SDS 0 4W7X
320511 -
320512 -
320513 -
320515 -  ..
3206 -
3207 -
3208 - Progress
3209 -
320901 - Blood Counts Low Coordinate Neupogen Treatments Notify Medical Team
320902 - Treatments Missed 3 Due Low Blood Counts Ask Kaiser About Neupogen
320903 -
320904 - Follow up ref SDS 12 PU6K, ref SDS 6 TS5U.
320905 -
320906 - Millie's blood counts were very low today NEUTS 0.94, reported in the
320907 - labs performed during treatment at UCSF. ref SDS 12 PU6K  As a result,
320908 - Millie did not get treatment.  Catherine notfied the medical team, but
320909 - there were no instructions on Neupogen. ref SDS 12 KY4G
320911 -  ..
320912 - Concern about low blood counts getting chemotherapy Carboplatin
320913 - treatments was reported in Millie's letter to the medical team on
320914 - 080219, ref SDS 1 1K4P, and again on 080307. ref SDS 3 HS6R
320916 -  ..
320917 - Millie submitted ref DIT 1 0001 to primary care physician at Kaiser
320918 - with copies to the medical team, and asking about prescription for
320919 - Neupogen to increase blood counts...
320920 -
320921 -    1.  Blood counts were too low today for treatment with Carboplatin
320922 -        chemotherapy.  NEUTS .95 correlates to ANC 950 at Kaiser.
320923 -        ref SDS 12 PU6K  This is much lower than any prior status for
320924 -        this diagnostic in the past 6 years.  Note - CA 15-3 66 for the
320925 -        test on 080403 starting the current cycle, ref SDS 5 A16M,
320926 -        jumped unexpectedly from the 59 four weeks earlier [on March 6,
320927 -        2008], ref SDS 2 A16M, which reflects only 1 treatment with
320928 -        Carboplatin; 2 treatments were missed in the prior cycle due to
320929 -        difficulty holding blood counts.  Now today another treatment
320930 -        is missed. ref DIT 1 0001
320932 -             ..
320933 -            [On 080417 Brigid says Neupogen treatment not needed this
320934 -            week, because not Carboplatin chemothearpy next week for
320935 -            4th treatment in the cycle; discusses new treatment plan
320936 -            lowering dose of Carboplatin to achieve consistent
320937 -            treatments. ref SDS 13 MR3L
320939 -         ..
320940 -    2.  Last week on 080410 NEUTS 6.85 (ANC 6850) represents a much
320941 -        larger change over a 1-week period than any time previously in
320942 -        patient history. ref SDS 11 QY6H  The week before on 080403
320943 -        NEUTS 1.34, ref SDS 5 QY6H, led to UCSF prescribing Neupogen,
320944 -        ref SDS 4 XV4G, which you ordered the next day [on April 4,
320945 -        2008], ref SDS 7 JW6J, and was taken on Saturday 080405.
320946 -        ref SDS 8 7E5L  Subsequently, on 080409, the following
320947 -        Wednesday, I was treated in the ER for Cellulitis. ref SDS 10
320948 -        0R4H, ref DIT 1 LT6H
320950 -         ..
320951 -    3.  At that time, blood counts increased from resisting Cellulitis
320952 -        infection. ref SDS 10 439L, ref DIT 1 8G7G
320954 -         ..
320955 -    4.  Notice WBC 12.9 at Kaiser ER. ref SDS 10 075H  The next day [on
320956 -        080410] at UCSF WBC was still elevated at 9.0, ref SDS 11 075H,
320957 -        as a result, I received the 2nd treatment in the current cycle
320958 -        of Carboplatin in addition to cetuximab. ref SDS 11 EH5K,
320959 -        ref DIT 1 LT7L
320961 -         ..
320962 -    5.  Today, with NEUTS .95, I missed the 3rd treatment of
320963 -        Carboplatin and received treatment with cetuximab.  Catherine
320964 -        indicated she was coordinating with Brigid, and that initial
320965 -        thinking is to skip both today and next week, which is the
320966 -        normal bye week in the cycle. ref SDS 12 KY4G, ref DIT 1 LT8H
320967 -
320969 -  ..
320970 - Energy High Feeling Strong Well Good Conflicts with Low Blood Counts
320971 -
320972 -
320973 -    6.  Typically, when my blood counts are low I do not feel well,
320974 -        being very tired and sluggish.  This past week, including today
320975 -        I have felt good, very energetic, certainly much better than
320976 -        during prior chemotherapy treatments in 2002, and 2004 -6, when
320977 -        some days I could barely stand up.  Yesterday, I hiked about 4
320978 -        miles each of the past 3 days, and last Friday, I only did
320979 -        about 2.5 miles.  As it happens, I am tired today and will take
320980 -        a nap, but that is typical the day of treatment. ref DIT 1 LT8O
320981 -
320983 -  ..
320984 - Neupogen Treatment Received from Kaiser Pharmacy
320985 -
320986 -
320987 -    7.  Assuming the test is accurate, this afternoon I went to the
320988 -        Kaiser Park Shadelands pharmacy to get a refill for the
320989 -        Neupogen prescription you ordered on 080403. ref DIT 1 LT4K
320991 -  ..
320992 - Question How Many Neupogen Treatments Needed This Week??
320993 -
320994 -
320995 -    8.  Question:  should I take 1 Neupogen treatment, 2, 3???
320996 -        ref DIT 1 MR4L
320998 -         ..
320999 -    9.  The Neupogen plan in the meeting at UCSF on 080403 was to take
321000 -        1 shot, and see if that works. ref SDS 4 QX4I  Cellulitis
321001 -        disrupted the test data last week.  Since, Carboplatin is not
321002 -        scheduled for next week, my inclination would be to take 1
321003 -        treatment tomorrow, and check status with the blood test next
321004 -        week, and then adjust if needed. ref DIT 1 LT4S
321005 -
321006 -            [On 080418 Brigid says Neupogen treatment not needed this
321007 -            week, because not Carboplatin chemothearpy next week for
321008 -            4th treatment in the cycle; discusses new treatment plan
321009 -            lowering dose of Carboplatin to achieve consistent
321010 -            treatments. ref SDS 13 MR3L
321012 -             ..
321013 -            [On 080418 Millie drove back to Kaiser and cancelled the
321014 -            order for Neupogen, ref SDS 13 MJ6F; Millie notified UCSF
321015 -            that Neupogen prescription at Kaiser Pharmacy was
321016 -            cancelled. ref SDS 13 EM6G
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3211 -