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: May 29, 2008 09:30 AM Thursday;
Rod Welch
Millie 1st treatment 4th cycle cetuximab Carboplatin 4th relapse IBC.
1...Summary/Objective
...Taxotere Capecitabine 2nd Relapse IBC Treatment After Mastectomy
...Cetuxiab Alone Clinical Study
...Cetuxiab with Carboplatin Clinical Study 2nd Arm
2...Schedule Weekly Treatments Continue on Thursdays
3...Labs Blood Test
4...CA 15-3 66 Cancer Marker Increases Presents Worsening Condition
5...NEUTS Improve UCSF Prescribed Neupogen Treatment on Sunday
6...Cetuximab Chemotherapy Orders Not Submitted
7...Carboplatin Chemotherapy Orders
....Antimetics:
....Error Carboplatin Treatment Reduced from 250 mg Down to 175 mg
....Chemotherapy (plan to treat weekly for 3 out of 4 weeks).
....Carboplatin Dose Reduced May Aid Blood Counts Maintain Treatments
....Laboratory work:
....Neupogen Prescribed 2 Treatments Conflicts Verbal Instruction for 1 Treatment
ACTION ITEMS..................
Click here to comment!
1...There is nothing checked in the Chemotherapy Orders for Laboratory
CONTACTS
SUBJECTS
Cetuximab 12th Cycle 3rd Treatment 18th Total Treatment Chemotherapy
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS A0 0000. ref SDS 99 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040508 -
040509 -
040511 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Background on Millie's treatment in the clinical study is reported on
040902 - 080508. ref SDS 98 TZ8I
040904 - ..
040905 - Taxotere Capecitabine 2nd Relapse IBC Treatment After Mastectomy
040906 -
040907 - Follow up ref SDS A0 X33O, ref SDS 99 X33O.
040908 -
040909 - Millie had left mastectomy on 051021. Biopsy at that time reported
040910 - no findings of cancer. Approximately 8 months later on 060707 the
040911 - doctor diagnosed IBC relapse and prescribed treatment. ref SDS 2
040912 - PF3O
040913 -
040914 - 1. Cycle 09 and 01 ................... 060721, ref SDS 3 407N
040915 - 2. Cycle 10 and 02 ................... 060814, ref SDS 5 LY6O
040916 - 3. Cycle 11 and 03 ................... 060908, ref SDS 5 407N
040917 - 4. Cycle 12 and 04 ................... 060929, ref SDS 5 407N
040918 - 5. Cycle 13 and 05 ................... 061020, ref SDS 6 407N
040919 - 6. Cycle 14 and 06 ................... 061110, ref SDS 7 407N
040920 - 7. Cycle 15 and 07 ................... 061201, ref SDS 8 407N
040922 - ..
040923 - Cetuxiab Alone Clinical Study
040924 -
040925 - Follow up ref SDS A0 356I, ref SDS 99 356I.
040926 -
040927 - Total Cetuximab
040928 - 8. Cycle 01 and 08 and 01 01.......... 070201, ref SDS 10 SG8I
040929 - 9. Cycle 01 and 08 and 02 02.......... 070208, ref SDS 11 SG8I
040930 - 10. Cycle 01 and 08 and 03 03.......... 070215, ref SDS 12 SG8I
040931 - 11. Cycle 01 and 08 and 04 04.......... 070222, ref SDS 13 SG8I
040932 - 12. Cycle 02 and 09 and 01 05.......... 070301, ref SDS 14 SG8I
040933 - 13. Cycle 02 and 09 and 02 06.......... 070308, ref SDS 16 7T3H
040934 - 14. Cycle 02 and 09 and 03 07.......... 070315, ref SDS 17 7T3H
040935 - 15. Cycle 02 and 09 and 04 08.......... 070322, ref SDS 18 7T3H
040936 - 16. Cycle 03 and 10 and 01 09.......... 070329, ref SDS 19 7T3H
040937 - 17. Cycle 03 and 10 and 02 10.......... 070405, ref SDS 20 7T3H
040938 - 18. Cycle 03 and 10 and 03 11.......... 070412, ref SDS 21 7T3H
040939 - 19. Cycle 03 and 10 and 04 12.......... 070419, ref SDS 22 7T3H
040940 - 20. Cycle 04 and 11 and 01 13.......... 070426, ref SDS 23 7T3H
040941 - 21. Cycle 04 and 11 and 02 14.......... 070503, ref SDS 24 7T3H
040942 - 22. Cycle 04 and 11 and 03 15.......... 070510, ref SDS 25 7T3H
040943 - 23. Cycle 04 and 11 and 04 16.......... 070517, ref SDS 26 7T3H
040944 - 24. Cycle 05 and 12 and 01 17.......... 070524, ref SDS 27 7T3H
040945 - 25. Cycle 05 and 12 and 02 18.......... 070531, ref SDS 28 7T3H
040946 - 26. Cycle 05 and 12 and 03 19.......... 070607, ref SDS 29 7T3H
040947 - 27. Cycle 05 and 12 and 04 20.......... 070614, ref SDS 30 0001
040948 - 28. Cycle 06 and 13 and 01 21.......... 070621, ref SDS 31 0001
040949 - 29. Cycle 06 and 13 and 02 22.......... 070628, ref SDS 32 0001
040950 - 30. Cycle 06 and 13 and 03 23.......... 070705, ref SDS 33 0001
040951 - 31. Cycle 06 and 13 and 04 24.......... 070712, ref SDS 34 0001
040952 - 32. Cycle 07 and 14 and 01 25.......... 070719, ref SDS 35 0001
040953 - 33. Cycle 07 and 14 and 02 26.......... 070726, ref SDS 36 0001
040954 - 34. Cycle 07 and 14 and 03 27.......... 070802, ref SDS 37 0001
040955 - 35. Cycle 07 and 14 and 04 28.......... 070809, ref SDS 38 0001
040956 - 36. Cycle 08 and 15 and 01 29.......... 070816, ref SDS 39 0001
040957 - 37. Cycle 08 and 15 and 02 30.......... 070823, ref SDS 40 0001
040958 - 38. Cycle 08 and 15 and 03 31.......... 070830, ref SDS 40 0001
040959 - 39. Cycle 08 and 15 and 04 32.......... 070906, ref SDS 41 0001
040960 - 40. Cycle 09 and 16 and 01 33.......... 070920, ref SDS 42 0001
040961 - 41. Cycle 09 and 16 and 02 34.......... 070927, ref SDS 43 0001
040962 - 42. Cycle 09 and 16 and 03 35.......... 071004, ref SDS 44 0001
040963 - 43. Cycle 09 and 16 and 04 36.......... 071011, ref SDS 45 0001
040964 - 44. Cycle 10 and 17 and 01 37.......... 071018, ref SDS 46 0001
040965 - 45. Cycle 10 and 17 and 02 38.......... 071025, ref SDS 47 0001
040966 - 46. Cycle 10 and 17 and 03 39.......... 071101, ref SDS 48 0001
040967 - 47. Cycle 10 and 17 and 04 40.......... 071108, ref SDS 49 0001
040968 - 48. Cycle 11 and 18 and 01 41.......... 071115, ref SDS 50 0001
040969 - 49. Cycle 11 and 18 and 02 42.......... 071122, ref SDS 36 0001
040970 - 50. Cycle 11 and 18 and 03 43.......... 071129, ref SDS 52 0001
040971 - 51. Cycle 11 and 18 and 04 44.......... 071206, ref SDS 53 0001
040972 - 52. Cycle 12 and 19 and 01 45.......... 071213, ref SDS 56 0001
040973 - 53. Cycle 12 and 19 and 02 46.......... 071220, ref SDS 59 0001
040974 - 54. Cycle 12 and 19 and 03 47.......... 071227, ref SDS 60 0001
040975 - 55. Cycle 12 and 19 and 04 48.......... 080103, ref SDS 61 0001
040976 - 56. Cycle 13 and 20 and 01 49.......... 080110, ref SDS 64 0001
040977 - 57. Cycle 13 and 20 and 02 50.......... 080117, ref SDS 65 0001
040978 - 58. Cycle 13 and 20 and 03 51.......... 080124, ref SDS 66 0001
040979 - 59. Cycle 13 and 20 and 04 52.......... 080131, ref SDS 68 0001
040980 - 60. Cycle 14 and 21 and 01 53.......... 080207, ref SDS 72 0001
040981 - 61. Cycle 14 and 21 and 02 54.......... 080214, ref SDS 73 0001
040982 - 62. Cycle 14 and 21 and 03 55.......... 080221, ref SDS 37 0001
040983 - 63. Cycle 14 and 21 and 04 56.......... 080228, ref SDS 79 0001
040984 - 64. Cycle 15 and 22 and 01 57 01 00... 080306, ref SDS 82 TZ8I
040985 -
040987 - ..
040988 - Cetuxiab with Carboplatin Clinical Study 2nd Arm
040989 -
040990 - Follow up ref SDS A0 5B6J, ref SDS 99 5B6J.
040991 -
040992 - On 080207 doctor reports IBC may be spreading. ref SDS 71 GH5H
040993 - Follow up examination on 080219 Doctor Rugo diagnosed progression of
040994 - disease. ref SDS 76 3J4I Photographs show spread of IBC rash,
040995 -
040996 - 2nd
040997 - Arm Cetuximab Carboplatin
040998 - 65. Cycle 01 15 and 22 and 02 58 02 01... 080313, ref SDS 83 TZ8I
040999 - 66. Cycle 01 15 and 22 and 03 59 03 01... 080320, ref SDS 84 TZ8I
041000 - 67. Cycle 01 15 and 22 and 04 60 04 01... 080327, ref SDS 85 TZ8I
041001 - 68. Cycle 02 16 and 23 and 01 61 05 02... 080403, ref SDS 86 TZ8I
041002 - 69. Cycle 02 16 and 23 and 02 62 06 03... 080410, ref SDS 89 TZ8I
041003 - 70. Cycle 02 16 and 23 and 03 63 07 03... 080417, ref SDS 91 TZ8I
041004 - 71. Cycle 02 16 and 23 and 04 64 08 03... 080424, ref SDS 94 TZ8I
041005 - 72. Cycle 03 17 and 24 and 01 65 09 04... 080501, ref SDS 96 5B6J
041006 - 73. Cycle 03 17 and 24 and 02 66 10 05... 080508, ref SDS 98 5B6J
041007 - 74. Cycle 03 17 and 24 and 03 67 11 05... 080515, ref SDS 99 5B6J
041008 - 75. Cycle 03 17 and 24 and 04 68 12 05... 080522, ref SDS A0 5B6J
041009 - 76. Cycle 04 18 and 25 and 01 69 13 06... 080529, ref SDS 0 5B6J
041011 - ..
041012 - Today is the 1st treatment of the 4th cycle with cetuximab and
041013 - Carboplatin together. This is the 13th treatment overall with
041014 - cetuximab on the 2nd arm of the clinical study, but is only the 6th
041015 - treatment with Carboplatin due to low blood counts.
041016 -
041017 -
041018 -
041019 -
0411 -
SUBJECTS
Schedule Treatment Cetuximab Carboplatin 080605 Weekly Through 08082
0903 -
090401 - ..
090402 - Schedule Weekly Treatments Continue on Thursdays
090403 -
090404 - Follow up ref SDS 65 QK6L, ref SDS 25 QK6L.
090405 -
090406 - This morning, Millie asked Nola about scheduling treatments for the
090407 - next few months, per discussions with the medical team earlier this
090408 - morning. Nola checked the computer and submitted an updated schedule
090409 - that also shows meetings with the doctor for examinations...
090410 -
090411 - Date Time Staff Sta Type Dept Loc Dur Number Cycl/Trmnt
090412 - -----------------------------------------------------------------
090413 - 080605 0800 Catherine PEN AC1 CCINF INF 20 14507964 04 02
090414 - 080605 0900 Rugo PEN CHF BCC Z4F 60 14507962 04 02
090415 - Brigid
090416 - Jackie
090417 - 080612 0800 Catherine PEN AC1 CCINF INF 20 14507966 04 03
090418 - 080612 0830 Catherine CAN P3H CCINF INF 180 14290033 04 03
090419 - 080612 0900 Catherine RSC AC3 CCINF INF 60 14507963 04 03
090420 - 080619 0800 Catherine PEN AC1 CCINF INF 20 14529515 04 04
090421 - 080619 0900 Catherine PEN AC4 CCINF INF 60 14529523 04 04
090422 - 080626 0800 Catherine PEN AC1 CCINF INF 20 14529529 05 01
090423 - 080626 0830 Rugo PEN CHF BCC Z4F 30 14348695 05 01
090424 - Brigid
090425 - Jackie
090426 - 080626 0900 Catherine PEN AC4 CCINF INF 60 14529546 05 01
090427 - 080703 0800 Catherine PEN AC4 CCINF INF 60 14529625 05 02
090428 - 080710 0800 Catherine PEN AC4 CCINF INF 60 14529626 05 03
090429 - 080717 0800 Catherine PEN AC4 CCINF INF 60 14529631 05 04
090430 - 080724 0800 Rugo PEN CHF B0G Z4F 30 14348723 06 01
090431 - Brigid
090432 - Jackie
090433 - 080724 0900 Catherine PEN AC4 CCINF INF 60 14529636 06 01
090435 - ..
090436 - 080821 0830 Rugo PEN CHF B0G Z4F 30 14348712 06 01
090437 - Brigid
090438 - Jackie
090439 -
090440 - [On 080609 Zan in Kaiser's Oncology Pharmacist used UCSF's
090441 - schedule for Millie's chemotherapy treatments to schedule her
090442 - Neupogen treatments at Kaiser. ref SDS A6 016S
090444 - ..
090445 - [On 080620 Kaiser's schedule for Millie's Neupogen treatments
090446 - correlate with UCSF's schedule for chemotherapy treatments.
090447 - ref SDS A8 YY88
090449 - ..
090450 - [On 080626 UCSF scheduled Millie's treatments through 080904,
090451 - ref SDS B0 IK7H; there is a gap on 080731 missing from the
090452 - schedule. ref SDS B0 2F8G
090453 -
090454 -
090455 -
090456 -
0905 -
SUBJECTS
Default Null Subject Account for Blank Record
1003 -
100401 - ..
100402 - Labs Blood Test
100403 -
100404 - Follow up ref SDS A0 FW5N, ref SDS 99 FW5N.
100405 -
100406 - Adding Carboplatin to the treatment protocol now requires weekly blood
100407 - tests to determine if the immune system is strong enough for safe
100408 - chemotherapy treatment, reported on 070201, ref SDS 10 XR40, and citing
100409 - the clinical study protocol received from UCSF on 070116. ref SDS 9
100410 - 5U7Z
100412 - ..
100413 - During treatment, Catherine submitted results of the test.
100414 -
100429 - ..
100430 - Log#: 080529 08:20
100431 - <----------------------- U C S F -----------------------> <------------- Kaiser -------------->
100432 - Type Results Units Normal ACRO Type Units Normal
100433 - ..
100434 - CBC with DIFF & PLT CT CBCD
100435 - ..
100436 - WBC COUNT 5.0 x10E9/L 3.4 - 10 WBC WBC x10-3 K/uL 3.4 - 10.0
100437 - RBC COUNT 4.06 x10E12/L 4 - 5.2 RBC RBC x10-6 M/uL 3.60 - 5.70
100438 - HEMOGLOBIN 13.4 g/dL 12 - 15.5 HGB Hemoglobin g/dL 11.5 - 15.0
100439 - HEMATOCRIT 38.9 PERCENT 36 - 46 HCT Hematocrit % 34.0 - 46.0
100440 - MCV 96 fL 80 - 100 MCV MCV fL 80.0 - 100.0
100441 - MCH 33.0 pg 26 - 34 MCH
100442 - MCHC 34.4 g/dL 31 - 36 MCHC
100443 - PLATELETS 217 x10E9/L 140 - 450 PLT Plt x10-3 K/uL 140 - 400
100444 -
100445 - Performed at Mt Zion Clinic Lab, 1600 Divisadero, San
100446 - Francisco, CA 94115
100447 - ..
100448 - (posted 080605, ref SDS A4 0N3L)
100449 - CA 15-3 H* 66 U/mL < 33 CA153 CA 15-3 < 39
100450 -
100451 - Note new reference range [<33 changed from <31] and change in
100452 - methodology effective March 1, 2008. Performed using the
100453 - Siemens Centaur Chemiluminesence method. CA 15-3 result using
100454 - the Roche Elecsys assay is 75 U/mL. Ref range <31 U/mL. This
100455 - rebaseline value provided at no additional charge.
100457 - ..
100458 - This new note updates explanation of tests prior to 080301,
100459 - e.g., on 080207. ref SDS 72 A16M
100460 - ..
100461 - (NEUTS x 1000 = ANC for Kaiser)
100462 - NEUTS L 2.26 x10E9/L 1.8 - 6.8 N-A ANC 1500
100463 - Neutrophils Not Reported Neutrophils % 50 - 70
100465 - ..
100466 - LYMPHS 1.98 x10E9/L 0.9 - 2.9 L-A Lymphocytes % 20 - 50
100467 - MONOS 0.49 x10E9/L 0.1 - 0.6 M-A Monocyte % 0 - 11
100468 - EOS 0.16 x10E9/L 0 - 0.4 E-A Esoinophils % 1 - 5
100469 - BASOS 0.09 x10E9/L 0 - 0.1 B-A Basophil % 0 - 2
100471 - ..
100472 - <----------------------- U C S F -----------------------> <------------- Kaiser -------------->
100473 - Type Results Units Normal ACRO Type Units Normal
100474 - PT H 22.4 s 12.0 - 14.1 PT PT, patient sec 8.9 - 11.1
100475 - INL NRM Ratio H 2.0 0.9 - 1.1 INR INR 2.0 - 3.0
100477 - ..
100478 - ELECTROLYTE PANEL LYTE
100479 - SODIUM L 130 mmol/L 134 - 143 NA Sodium mEq/L 137 - 145
100480 - POTASSIUM 3.9 mmol/L 3.4 - 4.9 K Potassium mEq/L 3.5 - 5.3
100481 - CHLORIDE L 96 mmol/L 98 - 107 CL
100482 - CARBON DIOX TOTAL L 18 mmol/L 23 - 32 CO2
100483 - ANION GAP H 16 3 - 14 ANGA
100484 - ..
100485 - UREA NITROGEN L 7 mg/dL 8 - 23 BUN BUN mg/dL 7 - 17
100486 - * GLUCOSE 133 mg/dL 70 - 199 GLU Glucose mg/dL ? - ?
100487 - AST H 49 U/L 16 - 41 AST AST (SGOT) U/L 14 - 36
100488 - ALT 29 U/L 11 - 54 ALT ALT (SGPT) U/L 11 - 66
100489 - BILIRUBIN, TOTAL 0.7 mg/dL 0.3 - 1.3 BILT Bili Total mg/dL 0.2 - 1.3
100490 - ALKALINE PHOSPHATASE 70 U/L 29 - 111 ALKP Alkaline Ph U/L 38 - 126
100491 - PROTEIN, TOTAL 6.2 g/dL 5.8 - 8.0 TP Protine Total g/dL 6.3 - 8.2
100492 - ALBUMIN 3.9 g/dL 3.4 - 4.7 ALB Albumin g/dL 3.4 - 4.8
100493 - CALCIUM 8.9 mg/dL 8.7 - 10.1 CA Calcium mg/dL 8.4 - 10.2
100494 - ..
100495 - MAGNESIUM L 1.7 mg/dL 1.8 - 2.3 MG Magnesium mg/dL 1.6 - 2.3
100497 - ..
100498 - CREAT with eGFR
100499 - CREATININE 0.51 mg/dL 0.42 - 1.06 CR Creatinine mg/dL 0.6 - 1.2
100500 -
100501 - Note: Creatinine assay changed to IDMS standardization on
100502 - February 4, 2008 causing decrease in results of approximately
100503 - 0.09 mg/dL
100505 - ..
100506 - eGFR if Caucasian >60 mL/min GFRC
100507 - eGFR if African Amer >60 mL/min GFRA
100508 -
100509 - eGFR corrected for 1.73 sq meters of body surface area
100510 - Note: eGFR is only an estimation. Please see online Lab Manual
100511 - for potential limitations.
100512 - Performed at Mt Zion Clin Lab, 1600 Divisadero, San Francisco,
100513 - CA 94115
100514 -
100515 -
100517 - ..
100518 - CA 15-3 66 Cancer Marker Increases Presents Worsening Condition
100519 -
100520 - Follow up ref SDS 96 U34O.
100521 -
100522 - Millie received results of lab today for CA 15-3 66, ref SDS 0 A16M,
100523 - cancer marker a week later on 080605, ref SDS A4 0N3L, and shows
100524 - worsening condition with increase from CA 15-3 59 on the previous
100525 - cycle on 080501. ref SDS 96 A16M
100526 -
100527 -
100529 - ..
100530 - NEUTS Improve UCSF Prescribed Neupogen Treatment on Sunday
100531 -
100533 - ..
100534 - During treatment today, Catherine confirmed Lynn's instructions
100535 - earlier this morning meeting with the medical team that, despite
100536 - improved NEUTS 2.26, per above, ref SDS 0 QY6H, Millie should get 1
100537 - treatment with Neupogen on Saturday in order to maintain blood counts
100538 - so that Millie can get chemotherapy treatment next Thursday on 080605.
100539 - After the meeting, and during treatment in the Infusion Clinic,
100540 - Catherine clarified that Neupogen treatment should be on Sunday,
100541 - 080601, rather than Saturday initially set by Lynn. ref SDS A2 4F42
100543 - ..
100544 - [On 080605 NEUTS 1.55 barely above minimum 1.50 target range
100545 - sufficient for safe chemotherapy treatment; nurse reports that
100546 - Chemotherapy Orders dated 080529 and marked received by the
100547 - Infusion Clinic on 080602 show prescription for 2 Neupogen
100548 - treatments each week of chemotherapy on day 2 and day 3, which
100549 - may mean Friday and Saturday, or Saturday and Sunday.
100550 - ref SDS A4 JN3K
100552 - ..
100553 - [...below, Chemotherapy Orders issued for the work today,
100554 - ref SDS 0 I66I, was received from UCSF a week later on 080605,
100555 - ref SDS A4 JN38, show UCSF prescribed 2 Neupogen treatments per
100556 - week, rather than 1, for this 4th cycle starting today.
100557 - ref SDS 0 PWSY
100559 - ..
100560 - [On 080612 NEUTS 3.77 blood counts rise significantly with 2
100561 - Neupogen treatments, as prescribed by UCSF. ref SDS A7 PU6K
100562 -
100564 - ..
100565 - Cetuximab Chemotherapy Orders Not Submitted
100566 -
100567 - Follow up ref SDS 96 MM6N, ref SDS 86 4E9N.
100568 -
100569 - On 080501 Millie received a Chemotherapy Order for cetuximab,
100570 - ref SDS 96 MM6N, together with another and separate Chemotherapy Order
100571 - for Carboplatin. ref SDS 96 I66I As noted on 080501, this was the
100572 - first time in Millie's patient history that UCSF submitted separate
100573 - Chemotherapy Orders for both drugs. ref SDS 96 IN5M
100574 -
100575 - [On 080626 Millie received a Chemotherapy Order for cetuximab,
100576 - unlike today, and received another and separate Chemotherapy
100577 - Order for Carboplatin. ref SDS B0 MM6N
100579 - ..
100580 - [On 080724 Millie received only 1 Chemotherapy Order for
100581 - Carboplatin, and did not receive a Chemotherapy Order for
100582 - cetuximab, as received today. ref SDS A1 MM6N
100583 -
100585 - ..
100586 - Carboplatin Chemotherapy Orders
100587 -
100588 - Follow up ref SDS 96 I66I, ref SDS 86 4E9N,.
100589 -
100590 - As noted in the record meeting with the medical team at 0830 on the
100591 - 2nd floor, Lynn did not submit the Chemotherapy Order and blood vials
100592 - for Millie to deliver to the Infusion Clinic today, ref SDS A2 TL4H,
100593 - as done for previous treatments the past 14 months, except for the
100594 - prior cycle on 080501, when Millie did not get the Chemo Order until a
100595 - weeks later on 080515. ref SDS 99 E43I
100597 - ..
100598 - The Chemotherapy Order for the prior cycle received on 080515 was
100599 - entered in the record on 080501 to correlate with the actual work,
100600 - ref SDS 96 4E9N; the document shows UCSF reduced the dose of
100601 - Carboplatin, and prescribed 2 treatments of Neupogen, contrary to
100602 - correspondence with the medical team on 080423, ref SDS 92 TY6Y, and
100603 - follow up discussion at UCSF on 080501 to maintain full dose with only
100604 - 1 weekly Neupogen treatment, ref SDS 95 CZ3N, confirmed by Millie's
100605 - letter to UCSF later that day after the meeting on 080501. ref SDS 97
100606 - MG3P Awareness that Chemotherapy Order dated 080501 reduced the dose
100607 - of Carboplatin did not occur until 080605, when Millie received the
100608 - Chemotherapy Order for 080529 and discovered there was an error marked
100609 - on the part that prescribes the dose for Carboplatin, and then
100610 - compared this with the Chemotherapy Order for 080501.
100612 - ..
100613 - [...below, Chemotherapy Orders issued for the work today, was
100614 - received from UCSF a week later on 080605, ref SDS A4 JN38;
100615 - shows reduced dose of Carboplatin, same as Chemotherapy Orders
100616 - on 080501, and is marked as "error," ref SDS 0 PVUQ; and UCSF
100617 - prescribed 2 Neupogen treatments. for this 4th cycle starting
100618 - today. ref SDS 0 PWSY
100620 - ..
100621 - [On 080605 Millie's letter to UCSF requests Chemotherapy Order
100622 - for 080529. ref SDS A5 JO9Q
100624 - ..
100625 - Megan may have delivered everything to the nurse on the 5th floor,
100626 - after the meeting on the 2nd floor, repeating the new practice from
100627 - the previous cycle on 080501. ref SDS 96 4E9N Millie did not get a
100628 - copy of the Chemotherapy Orders today.
100630 - ..
100631 - As well, starting this new cycle today, UCSF did not submit separate
100632 - Chemotherapy Orders for cetuximab, as was done last time on 080501.
100633 - ref SDS 96 IN5M Today, Chemotherapy Order was issued to Millie only
100634 - for Carboplatin, following prior practice.
100635 -
100636 - [On 080626 UCSF issued 2 Chemotherapy Orders again, one for
100637 - cetuximab and another for Carboplatin, following the practice
100638 - on 080501. ref SDS B0 1Y7N
100640 - ..
100641 - On 080605 Diane in the Infusion Clinic reported that Chemotherapy
100642 - Orders dated 080529 for the 4th cycle prescribe 2 Neupogen treatments.
100643 - ref SDS A4 JN38
100644 -
100645 - [On 080605 Millie's letter to UCSF requests copy of
100646 - Chemotherapy Order showing prescription of 2 Neupogen
100647 - treatments on 080529. ref SDS A5 JO9Q
100649 - ..
100650 - When treatment ended on 080605, Diane submitted a copy of Chemotherapy
100651 - Orders dated 080529 and marked received by the Infusion Clinic on
100652 - 080602. ref SDS A4 YD51
100654 - ..
100655 - No evident difference between chemotherapy orders today and for last
100656 - month on 080501. Carboplatin was decreased from 250 mg on 080403, to
100657 - 175 mg on 080501, ref SDS 96 PVUQ, and this continues with the new
100658 - order today. ref SDS 0 PVUY There is a notation on the Chemotherapy
100659 - Orders today that indicate the amount of Carboplatin specified for
100660 - treatment is an "error." ref SDS 0 F55F
100661 -
100663 - ..
100669 - Auth# Stor BCC LOC
100670 - Visit: 14289699 DOS 20080529
100672 - ..
100673 - Date: 20080529
100675 - ..
100676 - There is a "Received" stamp and the date "800602" is entered.
100678 - ..
100679 - Evidently, UCSF issued at least 2 versions of the Chemotherapy Orders,
100680 - because one has the received date of 080602, and the other does not.
100682 - ..
100683 - Chemotherapy Orders continue...
100684 -
100685 - Study Order for CC#05752: Phase II Trial of Cetuximab alone and
100686 - in combination with Carboplatin in ER-negative, PR-negative,
100687 - HER2-negative Nonoverexpressing Metastatic Breast Cancers.
100689 - ..
100690 - Arm: 2 - Cetuximab + Carboplatin
100692 - ..
100693 - Dates to be given: 20080529
100695 - ..
100696 - Allergies: NKDA
100698 - ..
100699 - Height: 62 inches
100701 - ..
100702 - Weight: 140 pounds
100704 - ..
100705 - Diagnosis: Metastatic breast cancer (IBC)
100707 - ..
100708 - ICD-9 codes: 174.4/198.5/198.3/196.2
100710 - ..
100711 - This ICD-9 codes conflicts with assignments in Chemotherapy Order for
100712 - cycle 3 on 080501. ref SDS 96 PVSS
100713 -
100714 - [On 080626 codes assigned to Chemotherapy Order for the
100715 - next cycle is much different from codes assigned today.
100716 - ref SDS B0 PVSS
100718 - ..
100719 - Chemotherapy Order for Carboplatin continues...
100720 -
100721 - Cycle: 4
100723 - ..
100724 - Days: 1, 8, 15 (arm 2)
100725 -
100727 - ..
100728 - Antimetics:
100729 -
100730 - Follow up ref SDS 96 PVTT, ref SDS 86 2N43.
100731 -
100732 - x Dexamethasone 10 mg IV (Decadron)
100733 - x Ondansetron 8 mg IV (Zofran)
100734 -
100736 - ..
100737 - Error Carboplatin Treatment Reduced from 250 mg Down to 175 mg
100738 - Chemotherapy (plan to treat weekly for 3 out of 4 weeks).
100739 - Carboplatin Dose Reduced May Aid Blood Counts Maintain Treatments
100740 -
100741 - Follow up ref SDS 96 PVUQ, ref SDS 86 2N4N.
100742 -
100743 - May administer Carboplatin if vital signs are unremarkable one
100744 - hour after cetuximab infusion..
100745 -
100746 - ** Please note start and stop times **
100748 - ..
100749 - Carboplatin (commercial supply) AUC 1.5 = 175 mg in D5W 250 ml
100751 - ..
100752 - Chemo orders today seem to show the same dose of Carboplatin and
100753 - Neupogen, per below, ref SDS 0 PWSY, specified for the previous cycle
100754 - (3) started on 080501, ref SDS 96 PVUQ, which was not recognized until
100755 - 5 weeks later on 080605, because the Chemotherapy Orders for 080501
100756 - were received from UCSF on 080515, ref SDS 99 E43I, and were not
100757 - reviewed until 080605, because the Chemotherapy Orders for today were
100758 - not received until a week later on 080605, ref SDS A4 YD51, and only
100759 - at that time could a comparison be made that revealed changes in
100760 - treatment in the Chemotherapy Orders that seem conflicting with
100761 - understandings from meetings with the medical team.
100763 - ..
100764 - There is a handwritten notation with a line drawn through the amount
100765 - "175," indicating this is an error. Above the lined out entry, is
100766 - written "175" the same as the amount line out. There is further
100767 - handwritten notation saying...
100768 -
100769 - error mg
100770 -
100771 - ...and with the date 080529. The "error" notation on the amount of
100772 - Carboplatin that reduced the dose, aligns with planning while meeting
100773 - with the medical team on 080501 for Millie to continue getting the
100774 - full dose of Carboplatin. ref SDS 95 CZ3N This was confirmed in
100775 - Millie's letter to UCSF later that day on 080501. ref SDS 97 MG3P
100776 - Feedback from Brigid in a letter responding to Millie's letter, and
100777 - saying to ignore the Chemotherapy Order and go with 1 Neupogen
100778 - treatment per week, seemed to further confirm an error occurred in the
100779 - Chemotherapy Order for 080501.
100780 -
100781 - [On 080605 Millie's letter to UCSF requests Chemotherapy Order
100782 - for 080529. ref SDS A5 JO9Q
100784 - ..
100785 - [On 080625 Millie asks medical team about error in Chemotherapy
100786 - Orders disclosed today by UCSF. ref SDS A9 PQWV
100788 - ..
100789 - [On 080716 Millie letter to Kaiser asks about meeting to
100790 - discuss CA 15-3 142 and progression of disease before
100791 - scheduled meeting on 080829. ref SDS B1 IT77
100793 - ..
100794 - This handwriting may relate to Lynn's work this morning meeting with
100795 - the medical team on the 2nd floor. At that time, Megan assisted Lynn
100796 - in correcting errors in UCSF documentation on Millie's medical chart,
100797 - but did not explain what was wrong or what was corrected. ref SDS A2
100798 - NW89
100800 - ..
100801 - Chemotherapy Orders continue...
100802 -
100803 - IV over 30 minutes weekly x 3 doses followed by 1 week rest.
100805 - ..
100806 - [hand writting...]
100807 -
100808 - Carbo dose to remain the same unless CR >= 1.3
100810 - ..
100811 - [...where CR = "Creatinine"]
100812 -
100813 - Carboplatin dose in mg = (desired AUC)(GFR+25)
100814 -
100815 - GFR (estimated) =
100816 -
100817 - (140-age in years)(weight in kg)(for females x 0.85)
100818 - ----------------------------------------------------
100819 - (Cr in mg/dL)(72)
100821 - ..
100822 - Unlike previous Chemotherapy Orders issued on 080403 which showed
100823 - handwritten values in the dosage formula, ref SDS 84 NV9H, there is
100824 - no similar handwriting on the Chemotherapy Orders received today from
100825 - UCSF.
100827 - ..
100828 - Chemotherapy Orders continues...
100830 - ..
100831 - Laboratory work:
100832 -
100833 - Follow up ref SDS 96 PWPW, ref SDS 86 2N6N.
100834 -
100835 - CBC with differential and platelets
100836 - Creatinine, magnesium every 4 weeks
100837 - BUN, AST, Alk phos, Alt, Total bilirubin, eletrolytes every 8 weeks
100839 - ..
100840 - There is nothing checked in the Chemotherapy Orders for Laboratory
100841 - Work today. This conflicts with practice in all previous Chemotherapy
100842 - Orders specifying laboratory blood tests required for treatment in the
100843 - Infusion Clinic, illustrated by the record on 080501. ref SDS 96 PWPW
100844 -
100845 - [On 080626 Chemotherapy Order for Carboplatin again did not
100846 - check off the scope of blood tests, similar to the order for
100847 - today; Catherine marked the Chemotherapy Order on 080626 to
100848 - show the scope of labs actually performed. ref SDS B0 PWPW
100850 - ..
100851 - Before meeting with the medical team this morning, Millie got a blood
100852 - draw in the Infusion Clinic, as planned in Millie's letter to UCSF
100853 - yesterday on 080528. ref SDS A1 U45H There was a mixup though. The
100854 - nurse did not get the order for the blood draw. She used the scope in
100855 - the Chemotherapy Orders issued for blood draws last month on 080501,
100856 - for the blood test today, per above. ref SDS 0 439L
100858 - ..
100859 - On 070201 chemotherapy order for cetuximab alone appears identical to
100860 - requirements for laboratory blood tests. ref SDS 9 5594
100862 - ..
100863 - Chemotherapy Orders continues...
100864 -
100865 - If ANC >= 1.5 x 1000/L, platelets >= 75 x 1000/L give 100% of dose
100867 - ..
100868 - If ANC < 1.5 x 1000/L, platelets < 75 x 1000/L....
100869 -
100872 - ..
100873 - See cetuximab orders. received on 080501. ref SDS 96 MM6N
100875 - ..
100876 - For some reason this instruction is not selected again today,
100877 - repeating the omission in Chemotherapy Orders for the previous cycle
100878 - on 080501. ref SDS 96 PWSR
100880 - ..
100881 - This conflicts with the record on 080313 for the initial order,
100882 - ref SDS 81 4F92, and further conflicts with the record today showing
100883 - UCSF issued new Chemotherapy Orders for cetuximab, per above.
100884 - ref SDS 0 MM6N
100886 - ..
100887 - Chemotherapy Orders continue...
100888 -
100890 - ..
100891 - Neupogen Prescribed 2 Treatments Conflicts Verbal Instruction for 1 Treatment
100892 -
100893 - Follow up ref SDS 96 PWTR.
100895 - ..
100896 - Handwriting says at this point near the bottom of the Chemotherapy
100897 - Orders form...
100898 -
100899 - Neupogen 480 mcg SQ on D2 + 3
100901 - ..
100902 - This writing appears to prescribe 2 Neupogen treatments for each
100903 - weekly treatment of Carboplatin during this cycle, which repeats the
100904 - prescription in the Chemotherapy Orders for the prior cycle shown on
100905 - 080501. ref SDS 96 PWTR
100907 - ..
100908 - This morning, Lynn indicated that even though Millie's blood counts
100909 - increased substantially this past week, UCSF has prescribed only 1
100910 - Neupogen treatment on Saturday. ref SDS A2 4F42 After the meeting,
100911 - the Infusion Clinic nurse consulted by telephone with the medical team
100912 - on the 2nd floor, and confirmed that Millie should take 1 Neupogen
100913 - treatment, except on Sunday, 080601, per above. ref SDS 0 TE6N Taking
100914 - 1 Neupogen treatment even though Chemotherapy Orders prescribe 2
100915 - treatments, aligns with UCSF letter on 080501 that changed the
100916 - prescription from 2 treatments in the Chemotherapy Orders to only 1
100917 - Neupogen treatment. ref SDS 95 M658
100919 - ..
100920 - [On 080605 NEUTS 1.55 barely above minimum 1.50 target
100921 - range sufficient for safe chemotherapy treatment,
100922 - ref SDS A4 JN3K; nurse reports Chemotherapy Orders dated
100923 - 080529 and marked received by the Infusion Clinic on 080602
100924 - do not prescribe just 1 Neupogen treatment; but actually
100925 - show 2 Neupogen treatments are prescribed for each week of
100926 - chemotherapy on day 2 and on day 3, which may mean Friday
100927 - and Saturday, or Saturday and Sunday. ref SDS A4 JN38
100929 - ..
100930 - [On 080605 Millie's letter to UCSF requests copy of
100931 - Chemotherapy Order showing prescription of 2 Neupogen
100932 - treatments on 080529. ref SDS A5 JO9Q
100934 - ..
100935 - [On 080605 Millie received Chemotherapy Order dated 080529
100936 - and marked received 080602. ref SDS A4 YD51
100938 - ..
100939 - [On 080609 Zan in the Kaiser Oncology Pharmacy fills order
100940 - issued by primary care physician for Millie to get Neupogen
100941 - treatments in the Kaiser Infusion Clinic in order to avoid
100942 - further errors in treatment. ref SDS A6 IL6I
100944 - ..
100945 - Chemotherapy Orders continue...
100947 - ..
100948 - x Physician has discussed risks/benefits of chemotherapy with the
100949 - patient. Consent, form obtained.
100950 -
100951 - x Yes O2 [oxygyn] by nasal cannula at 2 liters/min prn for chest pain or SOB
100953 - ..
100954 - x Yes Diphenhydramine 50 mg IV prn x 1 unticaria pruntis, SOB
100955 - (this is Benadryl)
100957 - ..
100958 - x Yes Hydrocrotisone 100 mg IV prn x 1 unticaria pruntis, SOB
100960 - ..
100961 - x Yes Aubterol inhaler 2 - 4 puffs prn SOB or chest tightness
100963 - ..
100964 - x Yes Epnephnna nhaler 2 - 4 puffs prn SOB or chest tightness
100966 - ..
100967 - Physician Signature
100968 -
100971 - Date: 080306
100973 - ..
100974 - Nurse Signature:
100975 -
100978 - Date: 080313
100980 - ..
100981 - No nurses signature is shown in the copy received from UCSF; may have
100982 - been entered and filed in UCSF records later.
100983 -
100984 -
100985 -
100986 -
100987 -
100988 -
100989 -
100990 -
100991 -
100992 -
100993 -
100994 -
100995 -
1010 -