CONTACTS 

SUBJECTS
Neupogen Mistake Treatment Not Needed  Cordination Referral Kaiser U

4303 -
4303 -    ..
4304 - Summary/Objective
4305 -
430501 - Follow up ref SDS 17 0000, ref SDS 16 0000,.
430502 -
430503 - UCSF advises that Neupogen not required to treat low blood counts,
430504 - because blood counts are expected to rise through natural processes
430505 - enough for Millie to safely get chemotherapy treatment next week on
430506 - 080424.  UCSF plans to consult with Millie on adjusting treatment by
430507 - increasing Neupogen and/or decreasing the dose of Carboplatin,
430508 - ref SDS 0 MR3L, so that Millie will have a better chance of
430509 - maintaining steady infusions with Carboplatin essential to treat IBC.
430510 - Millie went back to Kaiser and cancelled the order for Neupogen placed
430511 - yesterday, since this was a mistake. ref SDS 0 GR7U
430512 -
430513 -
430514 -
430515 -
430517 -  ..
4306 -
4307 -
4308 - Progress
4309 -
430901 - Neupogen Not Prescribed UCSF Discusses Treatment Plan Reduce Dose
430902 - Carboplatin Chemotherapy Increase Treatments by Lowering Dose
430903 - Carboplatin Lower Dose Discuss Possibility UCSF Propose Meeting 080501
430904 -
430905 - Follow up ref SDS 17 P45J, ref SDS 16 PU6K.
430906 -
430907 - Millie's blood counts were very low yesterday, NEUTS 0.94, reported in
430908 - the labs performed during treatment at UCSF. ref SDS 16 PU6K  As a
430909 - result, Millie did not get treatment.  Catherine notfied the medical
430910 - team, but there were no instructions on Neupogen. ref SDS 16 KY4G
430912 -  ..
430913 - Concern about low blood counts getting chemotherapy Carboplatin
430914 - treatments was reported in Millie's letter to the medical team on
430915 - 080219, ref SDS 4 1K4P, and again on 080307. ref SDS 7 HS6R  After
430916 - treatment yesterday, Millie sent a letter to the team reporting blood
430917 - count problems. ref SDS 17 2V9K
430919 -  ..
430920 - Today, Millie received ref DRT 1 0001 from Brigid at UCSF responding
430921 - to Millie's letter, ref DIP 1 0001 to primary care physician at Kaiser
430922 - with copies to the medical team, and asking about prescription for
430923 - Neupogen to increase blood counts. ref SDS 17 4W7S  Specifically,
430924 - Millie asked how much Neupogen to take. ref SDS 17 4W7X
430926 -  ..
430927 - Brigid's letter to Millie says...
430928 -
430929 -    1.  No need to take a neupogen shot this cycle as you did not
430930 -        receive chemotherapy.  You WBC and neuts will rise before the
430931 -        next cycle of Carbo that is due to start on May 1st and then we
430932 -        can work out a schedule of neupogen injections and also discuss
430933 -        possibly lowering dose of carbo.  Lowering the dose may ensure
430934 -        that we don't skip any doses in the future.  See you in May,
430935 -        ref DRT 1 0001
430937 -  ..
430938 - Millie was elated getting news today that the order for Neupogen
430939 - yesterday was a mistake and so she does not need treatment this week
430940 - for low blood counts reported yesterday at UCSF. ref SDS 16 PU6K
430942 -  ..
430943 - Brigid's comment that the doctor will discuss possibly lowering dose
430944 - of Carboplatin aligns with experience at Kaiser on 040525 when dose of
430945 - Taxol was lowered due to low blood counts, ref SDS 1 4N5M, and later
430946 - increased on 040615 after blood counts increased, and in order to
430947 - provide maximum medication treatment for the patient. ref SDS 3 4N5M
430948 - Strategies to balance blood counts and dose of chemotherapy to
430949 - optimize treatment for cancer were discussed at Kaiser on 040614.
430950 - ref SDS 2 9S9H
430952 -             ..
430953 -            [On 080423 Millie submits letter presenting consideration
430954 -            of reducing dose for chemotherapy Carboplatin on the 1st 2
430955 -            weeks of a cycle, and giving the full dose on the 3rd week,
430956 -            since there is an extra week to recover blood counts;
430957 -            equally Neupogen could be added to increase blood counts.
430958 -            ref SDS 18 OY7S
430960 -             ..
430961 -            [On 080423 Doctor Rugo submits a letter notifying Millie
430962 -            that if treatment with Carboplatin is reduced, it cannot
430963 -            later be increased to increase concentration and potency
430964 -            for better response to treatment. ref SDS 18 415F
430966 -             ..
430967 -            [On 080423 Millie's letter later notifies Doctor Rugo and
430968 -            the medical team, including the primary care physician at
430969 -            Kaiser to maintain the full dose of Carboplatin that
430970 -            optimizes chance for favorable response to treatment.
430971 -            ref SDS 18 XS6K
430973 -             ..
430974 -            [On 080501 0830 Millie's blood counts did not increase
430975 -            sufficient for getting chemotherapy treatment after
430976 -            skipping Neupogen treatments during the previous bye-week
430977 -            in the Carboplatin treatment cycle. ref SDS 19 4D5G
430979 -             ..
430980 -            [On 080501 0830 during the meeting with the medical team to
430981 -            start the next cycle, Millie confirmed that she wants to
430982 -            maintain the current treatment plan getting full dose of
430983 -            Carboplatin chemotherapy; UCSF revised the treatment plan
430984 -            to prevent skipping Carboplatin by maintaining blood counts
430985 -            from increasing Neupogen to 2 weekly treatments.
430986 -            ref SDS 19 CZ3N
430988 -             ..
430989 -            [On 080529 Chemotherapy Orders for Carboplatin show same
430990 -            dose 175 mg as today, ref SDS 22 PVUQ, but there is a
430991 -            handwritten mark that says "error," dated 080529 with
430992 -            initials mg. ref SDS 22 F55F
430994 -             ..
430995 -            [On 080529 review of Chemotherapy Orders for today, 080501,
430996 -            which were received from UCSF on 080515, ref SDS 21 E43I,
430997 -            and shown in this part of the record, ref SDS 22 MM9I,
430998 -            discovered UCSF evidently reduced the dose of Carboplatin
430999 -            and prescribed 2 weekly Neupogen treatments, per below,
431000 -            ref SDS 20 PVUQ, contrary to understandings with the
431001 -            medical team today, 080501, that Millie would get full dose
431002 -            of Carboplatin with 1 weekly Neupogen tratment this cycle.
431003 -            ref SDS 19 CZ3N
431005 -             ..
431006 -            [On 080625 Millie asks medical team about error in
431007 -            Chemotherapy Orders disclosed today by UCSF. ref SDS 24
431008 -            PQWV
431009 -
431010 -
431011 -
431012 -
431013 -
431014 -
4311 -

SUBJECTS
Neupogen Kaiser Pharmacy Cancelled Order Correct Mistake Patient Coo

9003 -
9004 - 0911
900501 -  ..
900502 - Neupogen Cancelled Order at Kaiser Pharmacy to Correct Mistake
900503 -
900504 - Millie submitted ref DIT 1 0001 to UCSF with copies to medical team,
900505 - ref DIT 1 00W3, and responding to Brigid's letter this morning, per
900506 - above. ref SDS 0 MR3L
900507 -
900508 -    1.  Thanks very much for timely response in your letter this
900509 -        morning saying to defer further Neupogen treatments to allow
900510 -        blood counts to recover normally, ref SDS 0 MR3L, over the next
900511 -        two (2) weeks (since next week is a bye in the treatment
900512 -        cycle). ref DIT 1 0001
900514 -         ..
900515 -    2.  I am going to the Kaiser Park Shadelands pharmacy and tell them
900516 -        to cancel the refill I requested yesterday, as noted in the
900517 -        letter on 080417. ref SDS 17 4W7S, ref DIT 1 SJ6F
900518 -
900519 -            [On 080609 Kaiser cancelled another order for Neupogen that
900520 -            was entered by mistake for $2,000 due
900521 -            to computer problems,
900522 -            pharmacy could not correct the mistake due to further
900523 -            computer problems, ref SDS 23 IS47, leaving Kaiser $2,000
900524 -            out of balance with inventory. ref SDS 23 K270
900526 -         ..
900527 -    3.  By copy to the medical team at Kaiser coordinating, as
900528 -        requested by Doctor Rugo on 080403, and implementing your
900529 -        comments on 080306 that UCSF is collaborating with Kaiser for
900530 -        backup in analysis, planning, and support for my care.
900531 -        ref SDS 5 JT3L
900532 -
900533 -            [On 090213 1140 Doctor Johnson explains Millie's good
900534 -            results surviving stage IV cancer 3 times longer than other
900535 -            patients show benefits of synergy between Kaiser's knowledge
900536 -            of patient history, and UCSF research have been optimized
900537 -            through communication that integrates Kaiser's team care
900538 -            model of case management with the UCSF practice of
900539 -            comprehensive care. ref SDS 25 685I
900541 -         ..
900542 -    4.  Thanks again for timely follow up.  It's a great relief to know
900543 -        that people are on the job so early (0703) and "listening."  I
900544 -        feel very good again this morning, so will be out hiking in a
900545 -        few hours.
900547 -  ..
900548 - Millie drove back to the Kaiser Pharmacy and cancelled the order
900549 - placed yesterday. ref SDS 17 4W7S
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