CONTACTS 

SUBJECTS
CT Test Scheduled 080718 UCSF Requests Change 12 Weeks to 8 Weeks Ad

1003 -
1003 -    ..
1004 - Summary/Objective
1005 -
100501 - Follow up ref SDS 23 0000. ref SDS 21 0000.
100502 -
100503 -
100504 -
100505 -
100506 -
100507 -
100509 -  ..
1006 -
1007 -
1008 - Progress
1009 -
100901 - CT Test Scheduled 080718 After Surgery for Power Port
100902 -
100903 - Follow up ref SDS 23 DF55.
100904 -
100905 - Thomas called today for UCSF.  He is sitting in for Megan who is on
100906 - vacation.  This may relate to work on the Chemotherapy Order for
100907 - 080529 that was received on 080605. ref SDS 17 YD45
100909 -  ..
100910 - Thomas did not call to clarify prescription for Neupogen because
100911 - Millie's blood count today shows NEUTS 0.74, ref SDS 24 QY6H, the
100912 - lowest in 7 years of treatment, and only 1 Neupogen treatment was
100913 - prescribed at UCSF today.
100915 -  ..
100916 - Thomas said he talked to Jackie and Doctor Rugo today, and understands
100917 - that CT test scheduling was changed from 12 weeks, reported by Jackie
100918 - on 071009, ref SDS 6 985H, back to 8 weeks.
100920 -  ..
100921 - Thomas explained the 12 week schedule for the last CT test on 080425
100922 - (from the prior test on 080212), ref SDS 10 L86Y, was intended to be
100923 - an 8 week schedule starting from 080306, when Millie started the 2nd
100924 - arm of the clinical study. ref SDS 8 NW3N  Review of the record on
100925 - 080306 shows no mention of changing CT testing back to an 8 week
100926 - schedule.  During the meeting at UCSF on 080207 the doctor ordered the
100927 - next CT test expedited because prior tests seemed to contain errors
100928 - and omissions. ref SDS 8 YS8H, citing review on 071210. ref SDS 7 SR5P
100930 -  ..
100931 - Thomas advised that he is not aware of findings in the test on 080425
100932 - that justify expense of increased testing.  This was good news, and
100933 - aligns with review on 080428, ref SDS 11 EO8F, and with understandings
100934 - meeting with the medical team at UCSF on 080501. ref SDS 13 YF5K  The
100935 - next day at Kaiser, the primary care physician concurred with UCSF
100936 - assessment that the CT test on 080425 did not show evidence of disease
100937 - getting worse. ref SDS 14 N15O  Thomas noted that the study protocol
100938 - calls for 8 week testing, and so the doctor has resumed this schedule
100939 - as of 080306 when Millie began the 2nd arm of the study.
100941 -  ..
100942 - Thomas asked if Kaiser has scheduled the CT test?
100944 -  ..
100945 - A few days ago on 080617, Kaiser called and scheduled the next CT test
100946 - for 080718 at 1100. ref SDS 23 DF55
100948 -  ..
100949 - Millie then coordinated with the Infusion Department to access her new
100950 - port at 1030 on 080718 in time for the CT test at 1100. ref SDS 23
100951 - OQ61
100953 -  ..
100954 - Doing the CT test on 080718 provides a week to get the results in time
100955 - for review to prepare for meeting with the medical team to start the
100956 - next cycle in the clinical study on 080724, as discussed with the
100957 - medical team at UCSF on 080529. ref SDS 16 3F9O
100958 -
100959 -
100961 -  ..
100962 - UCSF Proposes Advancing Date of CT Test
100963 -
100964 - Thomas asked about coordinating with Kaiser to advance the test date?
100965 - He feels the doctor and staff at UCSF can expedite analysis of test
100966 - results.
100968 -  ..
100969 - We reviewed planning with UCSF on 080501 for Kaiser to change Millie's
100970 - port catherter to a Power Port for injecting CT test contrast medium.
100971 - ref SDS 13 766K  Work to upgrade the port was requested on 080502,
100972 - shown by the medical chart at Kaiser. ref SDS 14 VG5J  A few days ago
100973 - on 080617 Kaiser scheduled this work for 080708. ref SDS 23 DF8N  The
100974 - surgeon explained during a meeting at Kaiser on 080606 that she can
100975 - leave a Huber needle in the port the day of surgery, so a CT test
100976 - could done the next day, which would be a Wednesday, the day before
100977 - Millie gets treatment on Thursdays.  Doing a CT test on 080709 would
100978 - leave a gap of several weeks before staring the next cycle on 080724.
100980 -  ..
100981 - Thomas asked if the next CT test can be done with conventional IV
100982 - rather than wait for surgery on 080708 upgrading to a Power Port for
100983 - injecting CT test contrast medium to avoid inconvenience and
100984 - discomfort to the patient?
100986 -  ..
100987 - On 080425 shows Millie suffered severe injury using conventional IV
100988 - injection of contrast medium for the CT test. ref SDS 10 FP6F  On
100989 - 080502 the primary care physician examined Millie at Kaiser, and found
100990 - injury to the right arm that required a solution to prevent further
100991 - patient harm. ref SDS 14 WX6I  At that time, on 080502 the doctor
100992 - asked when the next CT test is needed.  Millie reported understandings
100993 - from meeting with the medical team the day before on 080501 that the
100994 - next CT test should be 12 weeks from the prior test, which would be on
100995 - 080718.  The doctor made a referral for surgery to implant a Power
100996 - Port that solves the problem in time for the CT test needed at UCSF.
100997 - ref SDS 14 AA8L
100999 -  ..
101000 - Later that day, Millie promptly sent a letter to the medical team on
101001 - 080502 notifying UCSF of findings from examination at Kaiser, and that
101002 - the doctor made referrral for Millie to get a Power Port in time for
101003 - the next CT test. ref SDS 15 GN8P  The letter to UCSF referenced the
101004 - record meeting at Kaiser planning for the next CT test on 080718,
101005 - ref SDS 14 AA8L, which was based on understandings meeting with UCSF
101006 - the day before on 080501.
101007 -
101009 -  ..
101010 - Millie will send a letter to Kaiser asking about advancing the CT
101011 - test, with a copy to the medical team at UCSF for coordinating on
101012 - changing the date of the next CT test.
101013 -
101014 -
101015 -
101016 -
1011 -

SUBJECTS
Neupogen 1 Treatment Prescribed NEUTS .74  Lwest 7 Years Patient Req

1703 -
170401 -  ..
170402 - Medical Team Notified Neupogen Treatments Scheduled at Kaiser
170403 -
170404 - Millie submitted ref DIT 1 0001 to UCSF with a copy to the medical
170405 - team, including Kaiser, ref DIT 1 00W3, for coordination...
170406 -
170407 -    1.  This confirms understanding during treatment today at UCSF and
170408 -        presents decision points on Neupogen treatments and CT tests.
170409 -        ref DIT 1 0001
170411 -         ..
170412 -    2.  Today is the 4th treatment in the [4th] cycle and so a bye week
170413 -        for Carboplatin.  As a result, I was treated with cetuximab
170414 -        alone, and received no chemotherapy today. ref DIT 1 DJ5O
170416 -         ..
170417 -    3.  The blood test today reported NEUTS .74 which is 740 on the
170418 -        Kaiser ANC scale.  This is markedly low in my patient history.
170419 -        Catherine advised that the doctor prescribed 1 treatment of
170420 -        Neupogen tomorrow or Saturday in order to increase blood counts
170421 -        so that I can get Carboplatin to start the new cycle next
170422 -        Thursday. ref DIT 1 DJ6K
170424 -         ..
170425 -    4.  On 080609 [the primary care physician] prescribed Neupogen
170426 -        treatments for me in the Infusion Clinic at Kaiser, Walnut
170427 -        Creek. ref SDS 22 IL6I, ref DIT 1 DJ7I
170429 -         ..
170430 -    5.  Zan in the Oncology Pharmacy at Kaiser called [also on 080609]
170431 -        and scheduled Neupogen treatments on 080620 and 080621 (Friday
170432 -        and Saturday after treatment on Thursday - today), ref SDS 22
170433 -        016S, since the UCSF Chemotherapy Orders issued on 080529
170434 -        prescribe 2 treatments on D2/D3. ref SDS 22 0165  I was
170435 -        hopeful, this treatment would not be needed, since there is no
170436 -        chemotherapy treatment today, but very low NEUTS .74 supports
170437 -        Neupogen treatment this week to be sure to get Carboplatin next
170438 -        week. ref DIT 1 DJ7N
170439 -
170440 -
170442 -  ..
170443 - Neupogen Standing Order for Treatment in Infusion Clinic
170444 -
170445 -
170446 -    6.  Zan seemed to indicate [in the call on 080609 that] I now have
170447 -        a standing order for Neupogen when needed at the Infusion
170448 -        Clinic. ref SDS 22 016S  This "standing order" planning needs
170449 -        to be confirmed by Kaiser. ref DIT 1 DJ8M
170450 -
170451 -               [On 080621 Millie received a letter from Kaiser
170452 -               confirming only 1 Neupogen treatment on 080627, which
170453 -               conflicts with the work plan for continuing treatments 2
170454 -               per week, ref SDS 25 YY6U, scheduled by Kaiser on
170455 -               080609, ref SDS 22 016S, implementing Chemotherapy
170456 -               Orders for the 4th cycle received from UCSF on 080529.
170457 -               ref SDS 17 JN38
170459 -                ..
170460 -               [On 080621 Kaiser submitted schedule showing Neupogen
170461 -               treatments scheduled through July, ref SDS 25 YY88; need
170462 -               treatment scheduled for 080707. ref SDS 25 YY50
170464 -         ..
170465 -    7.  Zan did not schedule a time for me to get treatment.
170466 -        Therefore, I assume I can come in any time and get treatment
170467 -        with Neupogen at the convenience of the Infusion Clinic staff.
170468 -        ref DIT 1 DJ8S
170469 -
170470 -
170472 -  ..
170473 - Patient Receives Prescribed Amount of Treatment 1st Time in 4 Cycles
170474 -
170475 -
170476 -    8.  This is my first cycle [out of 4 cycles so far] in the 2nd arm
170477 -        of the study getting all 3 prescribed treatments with
170478 -        Carboplatin.  Thanks to Doctor Rugo and Brigid for fine tuning
170479 -        my care to meet requirements, and to [the primary care
170480 -        physician] at Kaiser for expediting medication prescriptions in
170481 -        time to be effective. ref DIT 1 DJ9O
170483 -         ..
170484 -    9.  As a precaution, [I am] asking UCSF to verify prescription for
170485 -        1 Neupogen treatment in light of lowest NEUTS 0.74 [shown in my
170486 -        labs earlier today on 080619, ref SDS 24 QY6H, (ANC 740) in my
170487 -        7 year patient history.  If we need a second treatment, this is
170488 -        already prescribed at Kaiser, and if not, I can tell Kaiser
170489 -        tomorrow that we only need 1 treatment this week and can cancel
170490 -        the schedule for a second treatment on Saturday. ref DIT 1 DJ9V
170491 -
170492 -           [On 080620 UCSF confirmed prescription for only 1 Neupogen
170493 -           treatment this week, since Millie did not get Carboplating
170494 -           chemotherapy this week. ref SDS 25 YY5H
170495 -
170496 -
170498 -  ..
170499 - Neupogen Treatments Work Plan Schedule Infusion Clinic Avoid Mistakes
170500 - Confusing Computer Procedures $2,000 for 1 Treatment Order Cancelled
170501 -
170502 -
170503 -   10.  There have been problems setting up my Neupogen treatments.
170504 -        This was first prescribed as self-injection.  I reported
170505 -        treatment failed doing self-injection; my hand is shaking or
170506 -        just anxiety, but a treatment failed [reported on 080607].
170507 -        ref SDS 19 Q67I  The order was then changed [on 080609] to get
170508 -        the treatments in the Infusion Department. ref SDS 22 IL6I
170509 -        However, a computer mixup wound up with me paying $2,000 for
170510 -        six self-injection treatments in order to get 1 treatment of
170511 -        Neupogen prescribed last week [on 080609]. ref SDS 22 PR5U,
170512 -        ref DIT 1 DJ4T
170513 -
170514 -            [On 080627 primary care physician at Kaiser writing letter
170515 -            to explain Neupogen treatment protocol required for patient
170516 -            health. ref SDS 27 BT5J
170518 -             ..
170519 -            [On 080628 Kaiser protocol requires Millie get 2 shots of
170520 -            240 mg for Neupogen prescribed by UCSF indicates confusion
170521 -            and error by Outpatient Pharmacy providing treatment in 1
170522 -            shot of 480 mg. ref SDS 28 Q74G
170524 -         ..
170525 -   11.  Zan in the Oncology Pharmacy cancelled that order and I
170526 -        returned the vials of Neupogen to Kaiser, because Zan indicated
170527 -        that Kaiser quality control forbids patients to have double
170528 -        prescriptions.  Kaiser has the Neupogen vials and the $2000.
170529 -        The pharmacist said that because Zan cancelled the order in the
170530 -        computer 20 minutes before I could drive back to Kaiser and
170531 -        return the duplicate treatment vials, the computer won't
170532 -        process a refund.  Hopefully, this will all work out.
170533 -        ref DIT 1 X15K
170534 -
170535 -           [On 080625 Millie notifies medical team that computer
170536 -           mistake ordering treatments can be discussed during meeting
170537 -           with the primary care physician at Kaiser on 080627.
170538 -           ref SDS 26 MV9K
170540 -            ..
170541 -           [On 080627 primary care physician at Kaiser writing letter
170542 -           to resolve the mistake. ref SDS 27 NM3M
170544 -         ..
170545 -   12.  For our purposes, we now seem to be set up for orderly Neupogen
170546 -        treatments in the Infusion Clinic going forward.  My thanks to
170547 -        everyone. ref DIT 1 DJ6O
170548 -
170550 -  ..
170551 - Power Port Surgery Scheduled 080708 in Time for CT Test 070818
170552 -
170553 -
170554 -   13.  Good news.  Kaiser has scheduled surgery to upgrade my port
170555 -        catheter to a Power Port on 080708.  This will relieve problems
170556 -        discussed at UCSF on 080501 from CT test injections for
170557 -        contrast medium causing severe injuries to my arm.  At that
170558 -        time on 080501 Brigid explained the solution using a Power
170559 -        Port. ref SDS 13 766K, ref DIT 1 DJ6T
170561 -         ..
170562 -   14.  The next day on 080502 [the primary care physician] at Kaiser
170563 -        expedited work to upgrade the port by making a referral to
170564 -        surgery.  I met with the surgeon on 080606 and she approved.  A
170565 -        few days ago on 080617 Kaiser called and scheduled surgery for
170566 -        080708. ref SDS 23 MG5I, ref DIT 1 DK3S
170567 -
170568 -
170570 -  ..
170571 - CT Test Scheduled After Surgery Power Port Prevent Injury Millie's Arm
170572 -
170573 -
170574 -   15.  An hour or so later, Kaiser called and scheduled the next CT
170575 -        test for 080718 1100. ref SDS 23 DF55, ref DIT 1 DK4R
170577 -         ..
170578 -   16.  I also scheduled with the Infusion Clinic to install the Huber
170579 -        needle for connecting the CT test equipment to inject contrast
170580 -        medium.  This is set for 080718 1030, allowing half an hour to
170581 -        get from the clinic to the Imaging Department. ref SDS 23 OQ61,
170582 -        ref DIT 1 DK4Y
170583 -
170584 -           [On 080715 Millie's letter to Kaiser notifies she will leave
170585 -           the Huber needle accessing the Power Port for chemotherapy
170586 -           treatment on 080717 in place for the CT test the next day at
170587 -           Kaiser on 080718, so the schedule today for the Infusion
170588 -           Clinic at Kaiser to access the port is not needed.
170589 -           ref SDS 31 AW9S
170590 -
170592 -  ..
170593 - Kaiser Resolve Protocol Issue to Avoid Delay CT Test on 080718
170594 -
170595 -
170596 -   17.  There is a possible snag. ref DIT 1 SZ5J
170598 -         ..
170599 -   18.  Bella in the Infusion Clinic explained a labor dispute of some
170600 -        kind saying we need a doctor or nurse to go with me to the
170601 -        Imaging Department to supervise CT technicians using the Huber
170602 -        needle connection for injecting contrast medium.  She said this
170603 -        is a quality control safety issue. ref SDS 23 WM4M, ref DIT 1
170604 -        DK5Z
170606 -         ..
170607 -   19.  By copy to [the primary care physician], requesting guidance on
170608 -        resolving this matter over the next 4 weeks in time for the CT
170609 -        test on 080718 [as requested by Bella yesterday on 080617.
170610 -        ref SDS 23 OQ67], ref DIT 1 DK6Y
170611 -
170612 -           [On 080625 Millie's letter to medical team at Kaiser and
170613 -           UCSF confirms planning for CT test at Kaiser to use the
170614 -           Power Port for saving time and money that meets requirements
170615 -           cost containment. ref SDS 26 IU7R
170617 -            ..
170618 -           [On 080702 Millie's letter to medical team confirms that on
170619 -           080627 the primary care physician coordinated support by the
170620 -           Infusion Clinic to access the Power Port on 080718 in time
170621 -           for CT test at 1100; and further initiated planning that, if
170622 -           no one else is assigned, the primary care physician will
170623 -           personally press the button for the CT test using the Power
170624 -           Port on 080718. ref SDS 29 EQ3T
170626 -            ..
170627 -           [On 080711 Bella in the Infusion Clinic did not receive
170628 -           Millie's letter coordinating the work on 080709, ref SDS 30
170629 -           RW4R; Paula, Director of Infusion Clinic Services, disclosed
170630 -           that nobody has contacted the Infusion Clinic with
170631 -           assignments for Millie's CT test on 080718. ref SDS 30 RW42
170633 -            ..
170634 -           [On 080711 Ike in the CT Test Department did not receive
170635 -           Millie's letter on 080619 notifying Kaiser on coordinating
170636 -           today for the CT test on 080718 using the Power Port with a
170637 -           Huber needle, ref SDS 30 7K8I
170639 -            ..
170640 -           [On 080715 Arlette called and reported the doctor solved
170641 -           coordination problems by arranging for a nurse in radiology
170642 -           with certificate to support CT testing with Power Ports;
170643 -           Millie's CT test is good to go on 080718. ref SDS 31 RB4N
170645 -            ..
170646 -           [On 080715 Millie's letter notifies Kaiser that UCSF will
170647 -           leave the Huber needle accessing the Power Port for
170648 -           chemotherapy treatment on 080717 in place for the CT test
170649 -           the next day at Kaiser on 080718, so the schedule today for
170650 -           the Infusion Clinic at Kaiser to access the port is not
170651 -           needed. ref SDS 31 AW9S
170652 -
170653 -
170654 -
170656 -  ..
170657 - UCSF Notified CT Test Scheduled After Surgery Upgrade Port Catheter
170658 - CT Test Scheduled in Time to Prepare for Starting 6th Cycle Drug Trial
170659 -
170660 -
170661 -   20.  Thomas ******* with UCSF called today and talked to Rod.
170662 -        ref DIT 1 S77G
170664 -         ..
170665 -   21.  Thomas related Doctor Rugo's plan to change CT tests from 12
170666 -        weeks back to 8 weeks, as a result of starting on the 2nd arm
170667 -        of the clinical study. ref SDS 0 MG5I, ref DIT 1 DK7V
170669 -         ..
170670 -   22.  By copy to Doctor Rugo asking if we can stick with the current
170671 -        schedule for this test and return to an 8 week schedule for the
170672 -        next test, given the fact that the last test was on a 12 week
170673 -        schedule [reviewed during the call with Thomas today, per
170674 -        above, ref SDS 0 O394, citing the meeting with the medical team
170675 -        at UCSF on 080529, ref SDS 16 4F5S], and seemed to show no
170676 -        progression of disease, noted by Brigid [during the meeting at
170677 -        UCSF] on 080501. ref SDS 13 JJ3N, ref DIT 1 DK77
170678 -
170679 -            [On 080625 Thomas called again saying the doctor wants to
170680 -            advance the CT test. ref SDS 26 IU5X
170682 -             ..
170683 -            [On 080711 Kaiser CT Test Department asks about delaying
170684 -            the CT test scheduled for 080718 in order to have time for
170685 -            training and certifying staff to use the Power Port,
170686 -            ref SDS 30 JR35; alternatively, Kaiser proposes not using
170687 -            the Power Port and using a conventional IV that
170688 -            inconveniences the patient with pain and damage to the
170689 -            right are. ref SDS 30 JR40
170691 -         ..
170692 -   23.  If we need the CT test earlier, can it be the day after the
170693 -        surgeon upgrades my port on 080708, so I can use the Power
170694 -        Port, and provided Kaiser can accomplish that schedule?  The
170695 -        surgeon, Doctor Riley-Paul, said on 080606 that she would put a
170696 -        Huber needle in the port at the time of surgery and it can stay
170697 -        over night if the CT test is the next day on 080709.
170698 -        ref SDS 18 IT40
170699 -
170700 -
170702 -  ..
170703 - Surgery Power Port Huber Needle Access Port for Treatment at UCSF
170704 -
170705 -
170706 -   24.  Actually, the surgeon will have to access the port with a Huber
170707 -        needle, because I will get treatment at UCSF on 080710, and the
170708 -        doctor advised that the port cannot be accessed conventionally
170709 -        for 4 days after surgery, reported on 080606. ref SDS 18 IT40
170711 -         ..
170712 -   25.  This was discussed with Nosheen in the surgery scheduling
170713 -        department on 080617, so Kaiser is alerted. ref SDS 23 DF44
170715 -         ..
170716 -   26.  In sum, if we don't hear anything further I assume I need only
170717 -        1 Neupogen treatment this next week.  I will get it tomorrow,
170718 -        and will cancel the treatment scheduled for Saturday, and we
170719 -        will hold current planning for the CT test on 080718 after the
170720 -        port is upgraded on 080708.  The surgeon will implant a Huber
170721 -        needle for my treatment on 080710.
170723 -         ..
170724 -   27.  Hopefully, issues on payment for Neupogen, and the labor
170725 -        jurisdiction issue will be worked out over the next few weeks.
170726 -
170727 -
170728 -
170729 -
170730 -
170731 -
170732 -
170733 -
170734 -
170735 -
170736 -
170737 -
170738 -
170739 -
1708 -