CONTACTS 

SUBJECTS
Staff Meeting Treatment Delay 080424 0900  USF Infusion Clinic Sched

0703 -
0703 -    ..
0704 - Summary/Objective
0705 -
070501 - Follow up ref SDS 19 0000. ref SDS 18 0000..
070502 -
070503 -
070504 -
070505 -
070506 -
070508 -  ..
0706 -
0707 -
0708 - Progress
0709 -
070901 - Treatment Tomorrow Delayed Until 0900 Coordinate Blood Draw Scope
070902 -
070903 - Follow up ref SDS 19 P45J, ref SDS 18 P45J.
070904 -
070905 - Millie received a call this morning from Nola at UCSF.  She reported
070906 - there is a staff meeting tomorrow at 0830.  Millie's treatment is
070907 - delayed from 0800 until 0900.
070909 -  ..
070910 - Millie submitted ref DIT 1 0001 to Catherine with copies to the
070911 - medical team at UCSF, including the doctor, Brigid, and Jackie.
070912 - ref DIT 1 00W3
070913 -
070914 -    1.  I received a call this morning from Nola advising you folks
070915 -        have a staff meeting at 0800 tomorrow.  As a result, our
070916 -        meeting at 0830 for treatment has been pushed back to 0900.
070917 -        ref DIT 1 0001
070919 -         ..
070920 -    2.  I will stop by, as usual, in the morning about 0745 to get a
070921 -        blood draw prior to the staff meeting.  The lab can then
070922 -        perform tests in time for treatment at 0900 after the staff
070923 -        meeting ends that starts at 0800. ref DIT 1 AW5O
070925 -         ..
070926 -    3.  If Diane, Steph, or others who typically draw blood for me
070927 -        prior to 0800 are not available, then we'll push everything
070928 -        back an hour to further accommodate the staff meeting.
070929 -        ref DIT 1 AW6K
070930 -
070931 -
070932 -
070933 -
070934 -
0710 -

SUBJECTS
Carboplatin Lower Dose Possibility Discuss Treatment Plan Neupogen E

3303 -
3304 - 0911
330501 -  ..
330502 - Chemotherapy Lower Dose to Increase Frequency of Treatments
330503 - Carboplatin Lower Dose Rather than Increase Neupogen Better Frequency
330504 - Carboplatin Lower Dose Discuss Possibility UCSF Propose Meeting 080501
330505 -
330506 - Follow up ref SDS 19 EM6G.
330507 -
330508 - Millie's letter to UCSF continues...
330510 -         ..
330511 -    4.  Please note Brigid's instructions on April 18th to forgo
330512 -        Neupogen treatment this past week to raise the blood counts
330513 -        (see below).  Since this week is a bye for Carboplatin, I have
330514 -        another week for blood counts to rise normally enough for
330515 -        getting the chemo with cetuximab next week.  Brigid further
330516 -        mentions [in UCSF letter on 080418] that Doctor Rugo plans to
330517 -        consider adjusting the dose of chemo to increase ability for
330518 -        maintaining blood counts week to week. ref SDS 19 MR3L,
330519 -        ref DIT 1 AW6Q
330521 -         ..
330522 -    5.  For example, we might try a reduced dose on weeks 1 and 2, and
330523 -        a full dose on week 3 when, like the current period, there will
330524 -        be 2 weeks to recover until the next treatment.  Equally, I am
330525 -        open to adding Neupogen to get full dose of chemo for a few
330526 -        cycles, so that hopefully the good start reducing IBC rash the
330527 -        past few weeks can be continued and even improved, since so far
330528 -        we have not yet achieved a level of chemo treatment called out
330529 -        by the protocol, i.e., three (3) weeks in a row. ref DIT 1 AW7P
330530 -
330531 -               [On 080821 patient history neutropenia shows Millie
330532 -               missed 50% of treatment with Carboplatin through
330533 -               treatment 6 of the clinical study 2nd arm. ref SDS 28
330534 -               XG6M
330536 -  ..
330537 - Lowering and increasing the dose of chemotherapy treatment according
330538 - to changing blood counts fits the practice of treatment at Kaiser,
330539 - reviewed on 080418. ref SDS 19 598J
330540 -
330541 -               [...below, Doctor Rugo discloses that if the dose level
330542 -               of Carboplatin chemotherapy medication is reduced in
330543 -               order to maintain blood counts so that the frequency of
330544 -               treatments is increased to achieve consistent level of
330545 -               drugs to treat cancer, then the dose cannot be increased
330546 -               in order to increase potency of the medication.
330547 -               ref SDS 0 415F
330549 -                ..
330550 -               [...below Millie's letter later today notifies the
330551 -               doctor and the medical team, including the primary care
330552 -               physician at Kaiser to maintain the full dose of
330553 -               Carboplatin that optimizes chance for favorable response
330554 -               to treatment. ref SDS 0 XS6K
330556 -                ..
330557 -               [On 080501 during the meeting with the medical team to
330558 -               start the next cycle, Millie confirmed that she wants to
330559 -               maintain the current treatment plan getting full dose of
330560 -               Carboplatin chemotherapy; UCSF revised the treatment
330561 -               plan to prevent skipping Carboplatin by maintaining
330562 -               blood counts from increasing Neupogen to 2 weekly
330563 -               treatments. ref SDS 20 CZ3N
330565 -  ..
330566 - Millie's letter to UCSF continues...
330567 -
330568 -    6.  I am very pleased with prospects for reducing IBC and minimal
330569 -        side effects so far with Carboplatin. ref DIT 1 AW8P
330570 -
330571 -
330572 -
330573 -
330574 -
330575 -
3306 -

SUBJECTS
Carboplatin Lower Dose Cannot Be Increased  t Improve Recovery Discu

6303 -
6304 - 2028
630501 -  ..
630502 - Chemotherapy Lower Dose Cannot Be Increased to Strengthen Recovery
630503 - Carboplatin Lower Dose Cannot Be Increased to Strengthen Recovery
630504 - Carboplatin Lower Dose Discuss Maintain Higher Dose Better Recovery
630505 -
630506 - Millie received ref DRT 1 0001 from Doctor Rugo with copies to the
630507 - medical team at UCSF, ref DRT 1 00W3, responding to the letter,
630508 - ref DIT 1 0001, which Millie submitted to Catherine this morning with
630509 - copies to the medical team, including Doctor Rugo, and proposing that
630510 - the medical team try reducing the dose of Carboplatin in 2 treatments
630511 - and then giving the full dose on the 3rd treatment in the cycle in
630512 - order to achieve greater concentration of treatment for cancer, per
630513 - above, ref SDS 0 OY7S, and which responded to Brigid's letter on
630514 - 080418 saying the medical team planned to discuss reducing the dose of
630515 - Carboplain at the next meeting on 080501 along with increasing
630516 - Neupogen for increasing blood counts to enable higher concentrations
630517 - of Carboplatin treatments. ref SDS 19 MR3L
630519 -  ..
630520 - Doctor Rugo responded today saying...
630521 -
630522 -    1.  Just so you know, if we reduce the dose, the dose stays
630523 -        reduced, we have to follow the study protocol.  We cannot vary
630524 -        the dose from visit to visit.
630526 -  ..
630527 - This appears to conflict with practice at Kaiser in 2004, reviewed
630528 - recently on 080418 considering Brigid's notice that the doctor plans
630529 - to discuss lowering the dose of Carboplatin. ref SDS 19 598J
630530 -
630531 -               [...below Millie's letter later today notifies the
630532 -               doctor and the medical team, including the primary care
630533 -               physician at Kaiser to maintain the full dose of
630534 -               Carboplatin that optimizes chance for favorable response
630535 -               to treatment. ref SDS 0 XS6K
630537 -                ..
630538 -               [On 080501 during the meeting with the medical team to
630539 -               start the next cycle, Millie confirmed that she wants to
630540 -               maintain the current treatment plan getting full dose of
630541 -               Carboplatin chemotherapy; UCSF revised the treatment
630542 -               plan to prevent skipping Carboplatin by maintaining
630543 -               blood counts from increasing Neupogen to 2 weekly
630544 -               treatments. ref SDS 20 CZ3N
630545 -
630546 -
630547 -
6306 -

SUBJECTS
Carboplatin Lower Dose Cannot Be Increased  Ptient Says Maintain Cur

9803 -
980401 -  ..
980402 - Treatment Plan Optimize Prospects for Response Maintain Full Dose
980403 - Full Dose Carboplatin Chemotherapy Patient Notifies UCSF
980404 -
980405 - Millie submitted ref DIT 1 0001 to Doctor Rugo with copies to the
980406 - medical team at UCSF, and including the primary care physician at
980407 - Kaiser...
980408 -
980409 -    1.  Thanks very much for clarifying in your letter today that
980410 -        reducing the dose of Carboplatin to increase chances of getting
980411 -        consistent treatments, i.e., 3 per cycle, will not permit
980412 -        increasing the dose later, ref SDS 0 415F, presented as a
980413 -        hypothetical in my letter earlier today. ref SDS 0 OY7S,
980414 -        ref DIT 2 0001
980416 -         ..
980417 -    2.  Since I am tolerating the current Carboplatin dose extremely
980418 -        well with respect to energy and vitality of daily life,
980419 -        compared with past experience taking other drugs, my sense
980420 -        would be to maintain the current dose in order to optimize
980421 -        effectiveness, and look to other means for controlling blood
980422 -        counts week-to-week, e.g., skipping treatments, as we have
980423 -        done, Neupogen, etc.  If we start off by reducing the dose and
980424 -        find that does not solve the blood count problem, we evidently
980425 -        cannot go back to the full dose, per your letter today.
980426 -        ref DIT 2 PU6G
980428 -  ..
980429 - Case study on 060810 lists patient history showing patients require a
980430 - steady dose level of chemotherapy in order for treatments to be
980431 - effective recovering from cancer. ref SDS 4 R33L
980433 -  ..
980434 - The study on 060810 cites the doctor's explanation on 030606,
980435 - ref SDS 1 JP7G, and later on 040614. ref SDS 2 6T7F  Kaiser
980436 - implemented the policy on 060721. ref SDS 3 KP6J
980437 -
980438 -               [On 080501 during the meeting with the medical team to
980439 -               start the next cycle, Millie confirmed that she wants to
980440 -               get the full dose of Carboplatin chemotherapy; UCSF
980441 -               revised the treatment plan to prevent skipping
980442 -               Carboplatin by maintaining blood counts with 1 weekly
980443 -               Neupogen treatment. ref SDS 20 CZ3N
980445 -                ..
980446 -               [On 080529 review of Chemotherapy Orders, ref SDS 23
980447 -               MM9I, for 080501, received from UCSF on 080515,
980448 -               ref SDS 22 E43I; and discovered on 080605, ref SDS 24
980449 -               JN38; UCSF evidently reduced the dose of Carboplatin and
980450 -               prescribed 2 weekly Neupogen treatments, ref SDS 21
980451 -               PVUQ, contrary to understandings with the medical team
980452 -               today, 080501, that Millie would get full dose of
980453 -               Carboplatin with 1 weekly Neupogen tratment this cycle.
980454 -               ref SDS 20 CZ3N
980456 -                ..
980457 -               [On 080529 Chemotherapy Orders for Carboplatin show same
980458 -               dose 175 mg as today, ref SDS 23 PVUQ, there is a
980459 -               handwritten mark that says "error," dated 080529 with
980460 -               initials mg. ref SDS 23 F55F
980462 -                ..
980463 -               [On 080625 Millie asks medical team about error in
980464 -               Chemotherapy Orders disclosed today by UCSF. ref SDS 25
980465 -               PQWV
980467 -                ..
980468 -               [On 080716 Millie letter to Kaiser asks about meeting to
980469 -               discuss CA 15-3 141 and progression of disease before
980470 -               scheduled meeting on 080829. ref SDS 26 VG7L
980472 -                ..
980473 -               [On 080821 lump on left supraclavicular and cancer
980474 -               marker rising from 71 to CA 15-3 96 may indicate 5th
980475 -               relapse of IBC under regimen of reduced dose and missing
980476 -               over 20% of Carboplatin due to neutropenia. ref SDS 27
980477 -               E34I
980479 -         ..
980480 -    3.  I am anxious to get your opinion and Brigid's assessment on
980481 -        response to treatment, when we meet next week.  I feel there
980482 -        has been good response, especially having missed 3 of 6
980483 -        prescribed treatments.If that awful rash goes a
980484 -        way, you will have the world's most grateful patient.  In any
980485 -        case, I would like your evaluation of response in relation to
980486 -        expectations based how others with IBC have responded at this
980487 -        stage of treatment. ref DIT 2 PU7G
980489 -         ..
980490 -    4.  The blood test tomorrow will provide interim status.
980491 -        Hopefully, the numbers will be back up, but if not, should
980492 -        consideration be given to getting a Neupogen treatment at
980493 -        Kaiser to ensure I will be ready for Carboplatin next week?
980494 -        ref DIT 2 PU7P
980496 -         ..
980497 -    5.  Yesterday, I completed the 14 day treatment for Cellulitis
980498 -        prescribed at the Kaiser ER on 080409.  The condition looks
980499 -        resolved, but is obviously sensitive.  On 080305 Doctor Johnson
980500 -        at Kaiser prescribed a 20-day reserve of Keflex so that I have
980501 -        medication on hand to resume treatment when needed. ref DIT 2
980502 -        PU8M
980504 -         ..
980505 -    6.  Should we do the same with Neupogen?  What is a safe amount to
980506 -        hold in reserve? ref DIT 2 PU9J
980507 -
980508 -
980509 -
980510 -
980511 -
980512 -
980513 -
980514 -
980515 -
9806 -