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: June 26, 2008 09:00 AM Thursday;
Rod Welch
Millie 1st treatment 5th 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 72 Slight Increase Past 4 Weeks Cycle
5...NEUTS Improve UCSF Prescribed Neupogen Treatment on Sunday
6...Chemotherapy Orders Received Medical Team Delivered to Infusion Clinic
7...Cetuximab Chemotherapy Orders
....Medication: (plan to give weekly)
....Laboratory work:
8...Carboplatin Chemotherapy Orders
....Antimetics:
....Chemotherapy (plan to treat weekly for 3 out of 4 weeks).
....Carboplatin Dose Reduced May Aid Blood Counts Maintain Treatments
....Laboratory Work:
....Neupogen Not Prescribed in Chemotherapy Orders
9...Power Port Surgery Certification Required Kaiser Submit to UCSF
ACTION ITEMS..................
Click here to comment!
1...* Labs today seem to omit following tests...
2...No laboratory work is specified, including the choice to "See
CONTACTS
SUBJECTS
Cetuximab 12th Cycle 3rd Treatment 18th Total Treatment Chemotherapy
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS A8 0000. ref SDS A5 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040508 -
040509 -
040510 -
040511 -
040513 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Background on Millie's treatment in the clinical study is reported on
040902 - 080508. ref SDS 96 TZ8I
040904 - ..
040905 - Taxotere Capecitabine 2nd Relapse IBC Treatment After Mastectomy
040906 -
040907 - Follow up ref SDS A8 X33O, ref SDS A5 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 3
040912 - PF3O
040913 -
040914 - 1. Cycle 09 and 01 ................... 060721, ref SDS 4 407N
040915 - 2. Cycle 10 and 02 ................... 060814, ref SDS 6 LY6O
040916 - 3. Cycle 11 and 03 ................... 060908, ref SDS 6 407N
040917 - 4. Cycle 12 and 04 ................... 060929, ref SDS 6 407N
040918 - 5. Cycle 13 and 05 ................... 061020, ref SDS 7 407N
040919 - 6. Cycle 14 and 06 ................... 061110, ref SDS 8 407N
040920 - 7. Cycle 15 and 07 ................... 061201, ref SDS 9 407N
040922 - ..
040923 - Cetuxiab Alone Clinical Study
040924 -
040925 - Follow up ref SDS A8 356I, ref SDS A5 356I.
040926 -
040927 - Total Cetuximab
040928 - 8. Cycle 01 and 08 and 01 01.......... 070201, ref SDS 11 SG8I
040929 - 9. Cycle 01 and 08 and 02 02.......... 070208, ref SDS 12 SG8I
040930 - 10. Cycle 01 and 08 and 03 03.......... 070215, ref SDS 13 SG8I
040931 - 11. Cycle 01 and 08 and 04 04.......... 070222, ref SDS 14 SG8I
040932 - 12. Cycle 02 and 09 and 01 05.......... 070301, ref SDS 15 SG8I
040933 - 13. Cycle 02 and 09 and 02 06.......... 070308, ref SDS 17 7T3H
040934 - 14. Cycle 02 and 09 and 03 07.......... 070315, ref SDS 18 7T3H
040935 - 15. Cycle 02 and 09 and 04 08.......... 070322, ref SDS 19 7T3H
040936 - 16. Cycle 03 and 10 and 01 09.......... 070329, ref SDS 20 7T3H
040937 - 17. Cycle 03 and 10 and 02 10.......... 070405, ref SDS 21 7T3H
040938 - 18. Cycle 03 and 10 and 03 11.......... 070412, ref SDS 22 7T3H
040939 - 19. Cycle 03 and 10 and 04 12.......... 070419, ref SDS 23 7T3H
040940 - 20. Cycle 04 and 11 and 01 13.......... 070426, ref SDS 24 7T3H
040941 - 21. Cycle 04 and 11 and 02 14.......... 070503, ref SDS 25 7T3H
040942 - 22. Cycle 04 and 11 and 03 15.......... 070510, ref SDS 26 7T3H
040943 - 23. Cycle 04 and 11 and 04 16.......... 070517, ref SDS 27 7T3H
040944 - 24. Cycle 05 and 12 and 01 17.......... 070524, ref SDS 28 7T3H
040945 - 25. Cycle 05 and 12 and 02 18.......... 070531, ref SDS 29 7T3H
040946 - 26. Cycle 05 and 12 and 03 19.......... 070607, ref SDS 30 7T3H
040947 - 27. Cycle 05 and 12 and 04 20.......... 070614, ref SDS 31 0001
040948 - 28. Cycle 06 and 13 and 01 21.......... 070621, ref SDS 32 0001
040949 - 29. Cycle 06 and 13 and 02 22.......... 070628, ref SDS 33 0001
040950 - 30. Cycle 06 and 13 and 03 23.......... 070705, ref SDS 34 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 33 0001
040954 - 34. Cycle 07 and 14 and 03 27.......... 070802, ref SDS 34 0001
040955 - 35. Cycle 07 and 14 and 04 28.......... 070809, ref SDS 36 0001
040956 - 36. Cycle 08 and 15 and 01 29.......... 070816, ref SDS 37 0001
040957 - 37. Cycle 08 and 15 and 02 30.......... 070823, ref SDS 38 0001
040958 - 38. Cycle 08 and 15 and 03 31.......... 070830, ref SDS 38 0001
040959 - 39. Cycle 08 and 15 and 04 32.......... 070906, ref SDS 39 0001
040960 - 40. Cycle 09 and 16 and 01 33.......... 070920, ref SDS 40 0001
040961 - 41. Cycle 09 and 16 and 02 34.......... 070927, ref SDS 41 0001
040962 - 42. Cycle 09 and 16 and 03 35.......... 071004, ref SDS 42 0001
040963 - 43. Cycle 09 and 16 and 04 36.......... 071011, ref SDS 43 0001
040964 - 44. Cycle 10 and 17 and 01 37.......... 071018, ref SDS 44 0001
040965 - 45. Cycle 10 and 17 and 02 38.......... 071025, ref SDS 45 0001
040966 - 46. Cycle 10 and 17 and 03 39.......... 071101, ref SDS 31 0001
040967 - 47. Cycle 10 and 17 and 04 40.......... 071108, ref SDS 46 0001
040968 - 48. Cycle 11 and 18 and 01 41.......... 071115, ref SDS 47 0001
040969 - 49. Cycle 11 and 18 and 02 42.......... 071122, ref SDS 33 0001
040970 - 50. Cycle 11 and 18 and 03 43.......... 071129, ref SDS 49 0001
040971 - 51. Cycle 11 and 18 and 04 44.......... 071206, ref SDS 50 0001
040972 - 52. Cycle 12 and 19 and 01 45.......... 071213, ref SDS 53 0001
040973 - 53. Cycle 12 and 19 and 02 46.......... 071220, ref SDS 56 0001
040974 - 54. Cycle 12 and 19 and 03 47.......... 071227, ref SDS 57 0001
040975 - 55. Cycle 12 and 19 and 04 48.......... 080103, ref SDS 58 0001
040976 - 56. Cycle 13 and 20 and 01 49.......... 080110, ref SDS 61 0001
040977 - 57. Cycle 13 and 20 and 02 50.......... 080117, ref SDS 62 0001
040978 - 58. Cycle 13 and 20 and 03 51.......... 080124, ref SDS 63 0001
040979 - 59. Cycle 13 and 20 and 04 52.......... 080131, ref SDS 65 0001
040980 - 60. Cycle 14 and 21 and 01 53.......... 080207, ref SDS 69 0001
040981 - 61. Cycle 14 and 21 and 02 54.......... 080214, ref SDS 70 0001
040982 - 62. Cycle 14 and 21 and 03 55.......... 080221, ref SDS 34 0001
040983 - 63. Cycle 14 and 21 and 04 56.......... 080228, ref SDS 75 0001
040984 - 64. Cycle 15 and 22 and 01 57 01 00... 080306, ref SDS 78 TZ8I
040985 -
040987 - ..
040988 - Cetuxiab with Carboplatin Clinical Study 2nd Arm
040989 -
040990 - Follow up ref SDS A8 5B6J, ref SDS A5 5B6J.
040991 -
040992 - On 080207 doctor reports IBC may be spreading. ref SDS 68 GH5H
040993 - Follow up examination on 080219 Doctor Rugo diagnosed progression of
040994 - disease. ref SDS 89 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 79 TZ8I
040999 - 66. Cycle 01 15 and 22 and 03 59 03 01... 080320, ref SDS 80 TZ8I
041000 - 67. Cycle 01 15 and 22 and 04 60 04 01... 080327, ref SDS 81 TZ8I
041001 - 68. Cycle 02 16 and 23 and 01 61 05 02... 080403, ref SDS 82 TZ8I
041002 - 69. Cycle 02 16 and 23 and 02 62 06 03... 080410, ref SDS 85 TZ8I
041003 - 70. Cycle 02 16 and 23 and 03 63 07 03... 080417, ref SDS 87 TZ8I
041004 - 71. Cycle 02 16 and 23 and 04 64 08 03... 080424, ref SDS 90 TZ8I
041005 - 72. Cycle 03 17 and 24 and 01 65 09 04... 080501, ref SDS 93 5B6J
041006 - 73. Cycle 03 17 and 24 and 02 66 10 05... 080508, ref SDS 96 5B6J
041007 - 74. Cycle 03 17 and 24 and 03 67 11 05... 080515, ref SDS 97 5B6J
041008 - 75. Cycle 03 17 and 24 and 04 68 12 05... 080522, ref SDS 98 5B6J
041009 - 76. Cycle 04 18 and 25 and 01 69 13 06... 080529, ref SDS A1 5B6J
041010 - 77. Cycle 04 18 and 25 and 02 70 14 07... 080605, ref SDS A2 5B6J
041011 - 78. Cycle 04 18 and 25 and 03 71 15 08... 080612, ref SDS A5 5B6J
041012 - 79. Cycle 04 18 and 25 and 04 72 16 08... 080619, ref SDS A8 5B6J
041013 - 80. Cycle 05 19 and 26 and 01 73 17 09... 080626, ref SDS 0 5B6J
041015 - ..
041016 - Today is the 1st treatment of the 5th cycle with cetuximab and
041017 - Carboplatin together. This is the 17th treatment overall with
041018 - cetuximab on the 2nd arm of the clinical study, but is only the 9th
041019 - treatment with Carboplatin due to low blood counts.
041021 - ..
041022 - Catherine was Millie's nurse today, because she is coming in early now
041023 - at 0800.
041024 -
041025 -
041026 -
041027 -
0411 -
SUBJECTS
Default Null Subject Account for Blank Record
0903 -
090401 - ..
090402 - Schedule Weekly Treatments Continue on Thursdays
090403 -
090404 - Follow up ref SDS A1 IK7H, ref SDS 62 QK6L.
090405 -
090406 - Nola submitted UCSF schedule for Millie's care over the next few
090407 - months, updating the schedule received on 080529. ref SDS A1 IK7H
090408 -
090409 - Date Time Staff Sta Type Dept Loc Dur Number Cycl/Trmnt
090410 - -----------------------------------------------------------------
090411 - 080703 0800 Catherine PEN AC4 CCINF INF 60 14529625 05 02
090412 - 080710 0800 Catherine PEN AC4 CCINF INF 60 14529626 05 03
090413 - 080717 0800 Catherine PEN AC4 CCINF INF 60 14529631 05 05
090414 - 080724 0800 Rugo PEN CHF BCC Z4F 30 14348723 06 01
090415 - Brigid
090416 - Jackie
090417 - 080724 0800 Catherine PEN AC4 CCINF INF 60 14529636 06 01
090418 - ..
090419 - * 080731 Catherine PEN AC4 CCINF INF 60 06 02
090420 -
090421 - 080807 0820 Catherine PEN AC1 CCINF INF 20 14587572 06 03
090422 - 080807 0900 Catherine PEN AC4 CCINF INF 60 14587582 06 03
090423 - 080814 0800 Catherine PEN AC1 CCINF INF 20 14587586 06 04
090424 - 080814 0900 Catherine PEN AC4 CCINF INF 60 14587609 06 04
090425 - 080821 0800 Catherine PEN AC1 CCINF INF 20 14587612 07 01
090426 - 080821 0830 Rugo PEN CHF BCC Z4F 30 14348712 07 01
090427 - Brigid
090428 - Jackie
090429 - 080821 0900 Catherine PEN AC4 CCINF INF 60 14587616 07 01
090430 - 080828 0800 Catherine PEN AC1 CCINF INF 20 14587621 07 02
090431 - 080828 0900 Catherine PEN AC4 CCINF INF 60 14587630 07 02
090432 - 080904 0800 Catherine PEN AC1 CCINF INF 20 14647227 07 03
090433 - 080904 0900 Catherine PEN AC4 CCINF INF 60 14647245 07 03
090435 - ..
090436 - There seems to be a gap in the UCSF schedule for treatments in the
090437 - Infusion Clinic on 080731. ref SDS 0 2F8G
090438 -
090439 - [On 080703 Nola submitted the schedule for Millie's treatment on
090440 - 080707. ref SDS B7 IK7H
090441 -
090442 - [On 080711 Zan extended the schedule for Millie's treatment with
090443 - Neupogen at Kaiser based on UCSF's schedule received today.
090444 - ref SDS C0 RW3F
090445 -
090446 -
090447 -
090448 -
090449 -
0905 -
SUBJECTS
Default Null Subject Account for Blank Record
1003 -
1004 - 0800
100501 - ..
100502 - Labs Blood Test
100503 -
100504 - Follow up ref SDS A8 FW5N, ref SDS A5 FW5N.
100505 -
100506 - Adding Carboplatin to the treatment protocol now requires weekly blood
100507 - tests to determine if the immune system is strong enough for safe
100508 - chemotherapy treatment, reported on 070201, ref SDS 11 XR40, and citing
100509 - the clinical study protocol received from UCSF on 070116. ref SDS 10
100510 - 5U7Z
100512 - ..
100513 - Millie went to the Infusion Clinic on the 5th floor at 0800 for the
100514 - blood draw, as planned in the letter to UCSF yesterday. ref SDS B1
100515 - IU3Y
100517 - ..
100518 - Catherine advised that there is no order on file this morning from the
100519 - medical team for Millie's blood draw. This conflicts the letter
100520 - yesterday on 080625 asking the medical team to submit the order for
100521 - labs to the Infusion Clinic. ref SDS B1 IU3Y
100523 - ..
100524 - Catherine did a blood draw using the scope for the prior test on
100525 - 080529, ref SDS A1 075H, as planned in the letter yesterday for
100526 - working around snags, so that the medical team is prepared for the
100527 - meeting at 0830.
100528 -
100529 - [...in another record, Thomas explained during the meeting
100530 - with medical team at 0830 that there wasn't enough time to
100531 - submit the order for the blood draw to the Infusion Clinic
100532 - this morning; and, so planned to deliver it after the
100533 - meeting as a record to document the work.
100535 - ..
100536 - During treatment, Catherine submitted results of the test.
100537 -
100552 - ..
100553 - Log#: 080626 08:10
100554 - <----------------------- U C S F -----------------------> <------------- Kaiser -------------->
100555 - Type Results Units Normal ACRO Type Units Normal
100556 - ..
100557 - CBC with DIFF & PLT CT CBCD
100558 - ..
100559 - WBC COUNT 3.9 x10E9/L 3.4 - 10 WBC WBC x10-3 K/uL 3.4 - 10.0
100560 - RBC COUNT L 3.83 x10E12/L 4 - 5.2 RBC RBC x10-6 M/uL 3.60 - 5.70
100561 - HEMOGLOBIN 12.7 g/dL 12 - 15.5 HGB Hemoglobin g/dL 11.5 - 15.0
100562 - HEMATOCRIT 37.7 PERCENT 36 - 46 HCT Hematocrit % 34.0 - 46.0
100563 - MCV 98 fL 80 - 100 MCV MCV fL 80.0 - 100.0
100564 - MCH 33.1 pg 26 - 34 MCH
100565 - MCHC 33.6 g/dL 31 - 36 MCHC
100566 - PLATELETS 206 x10E9/L 140 - 450 PLT Plt x10-3 K/uL 140 - 400
100567 -
100568 - Performed at Mt Zion Clinic Lab, 1600 Divisadero, San
100569 - Francisco, CA 94115
100570 - ..
100571 - (posted 080703, ref SDS B7 Q49H)
100572 - CA 15-3 H* 72 U/mL < 33 CA153 CA 15-3 < 39
100573 -
100574 - Note new reference range [<33 changed from <31] and change in
100575 - methodology effective March 1, 2008. Performed using the
100576 - Siemens Centaur Chemiluminesence method. CA 15-3 result using
100577 - the Roche Elecsys assay is 75 U/mL. Ref range <31 U/mL. This
100578 - rebaseline value provided at no additional charge.
100580 - ..
100581 - This new note updates explanation of tests prior to 080301,
100582 - e.g., on 080207. ref SDS 71 A16M
100583 - ..
100584 - (NEUTS x 1000 = ANC for Kaiser)
100585 - NEUTS L 1.80 x10E9/L 1.8 - 6.8 N-A ANC 1500
100586 - Neutrophils Not Reported Neutrophils % 50 - 70
100588 - ..
100589 - LYMPHS 1.55 x10E9/L 0.9 - 2.9 L-A Lymphocytes % 20 - 50
100590 - MONOS 0.24 x10E9/L 0.1 - 0.6 M-A Monocyte % 0 - 11
100591 - EOS 0.20 x10E9/L 0 - 0.4 E-A Esoinophils % 1 - 5
100592 - BASOS 0.10 x10E9/L 0 - 0.1 B-A Basophil % 0 - 2
100594 - ..
100595 - <----------------------- U C S F -----------------------> <------------- Kaiser -------------->
100596 - Type Results Units Normal ACRO Type Units Normal
100597 - PT H 27.3 s 12.0 - 14.1 PT PT, patient sec 8.9 - 11.1
100598 - INL NRM Ratio H 2.5 0.9 - 1.1 INR INR 2.0 - 3.0
100599 -
100600 - Performed at Mt Zion Clinic Lab, 1600 Divisadero, San
100601 - Francisco, CA 94115
100603 - ..
100604 - PARTIAL
100605 - THROMBOPLASTIN H 35.9 s 22.2 - 34.2 INR PTT
100606 -
100607 - Performed at Mt Zion Clinic Lab, 1600 Divisadero, San
100608 - Francisco, CA 94115
100610 - ..
100611 - <----------------------- U C S F -----------------------> <------------- Kaiser -------------->
100612 - Type Results Units Normal ACRO Type Units Normal
100613 - ELECTROLYTE PANEL LYTE
100614 - SODIUM 140 mmol/L 134 - 143 NA Sodium mEq/L 137 - 145
100615 - POTASSIUM 3.9 mmol/L 3.4 - 4.9 K Potassium mEq/L 3.5 - 5.3
100616 - CHLORIDE 104 mmol/L 98 - 107 CL
100617 - CARBON DIOX TOTAL 23 mmol/L 23 - 32 CO2
100618 - ANION GAP 13 3 - 14 ANGA
100619 - ..
100620 - UREA NITROGEN 10 mg/dL 8 - 23 BUN BUN mg/dL 7 - 17
100621 - * GLUCOSE mg/dL 70 - 199 GLU Glucose mg/dL ? - ?
100622 - AST H 47 U/L 16 - 41 AST AST (SGOT) U/L 14 - 36
100623 - ALT 28 U/L 11 - 54 ALT ALT (SGPT) U/L 11 - 66
100624 - BILIRUBIN, TOTAL 0.9 mg/dL 0.3 - 1.3 BILT Bili Total mg/dL 0.2 - 1.3
100625 - ALKALINE PHOSPHATASE 75 U/L 29 - 111 ALKP Alkaline Ph U/L 38 - 126
100626 - * PROTEIN, TOTAL g/dL 5.8 - 8.0 TP Protine Total g/dL 6.3 - 8.2
100627 - * ALBUMIN g/dL 3.4 - 4.7 ALB Albumin g/dL 3.4 - 4.8
100628 - * CALCIUM mg/dL 8.7 - 10.1 CA Calcium mg/dL 8.4 - 10.2
100629 - ..
100630 - MAGNESIUM L 1.6 mg/dL 1.8 - 2.3 MG Magnesium mg/dL 1.6 - 2.3
100632 - ..
100633 - CREAT with eGFR
100634 - CREATININE 0.46 mg/dL 0.42 - 1.06 CR Creatinine mg/dL 0.6 - 1.2
100635 -
100636 - Note: Creatinine assay changed to IDMS standardization on
100637 - February 4, 2008 causing decrease in results of approximately
100638 - 0.09 mg/dL
100640 - ..
100641 - eGFR if Caucasian >60 mL/min GFRC
100642 - eGFR if African Amer >60 mL/min GFRA
100643 -
100644 - eGFR corrected for 1.73 sq meters of body surface area
100645 - Note: eGFR is only an estimation. Please see online Lab Manual
100646 - for potential limitations.
100647 - Performed at Mt Zion Clin Lab, 1600 Divisadero, San Francisco,
100648 - CA 94115
100649 -
100651 - ..
100652 - * Labs today seem to omit following tests...
100653 -
100654 - GLUCOSE.............................. ref SDS 0 SE9J
100655 - PROTEIN, TOTAL
100656 - ALBUMIN
100657 - CALCIUM
100659 - ..
100660 - Labs on these tests may have been performed and not submitted, or were
100661 - printed on a separate paper, and misplaced by the patient.
100663 - ..
100664 - On 080423 UCSF requested support from doctor patient partnership on
100665 - scope of blood tests. ref SDS 88 P45J Patient cites Chemotherapy
100666 - orders. ref SDS 88 798Q
100667 -
100668 - [On 080702 Millie notified the medical team about
100669 - questions on the scope of blood tests. ref SDS B6 EP8W
100671 - ..
100672 - [On 080703 review seemed to indicate that blood tests
100673 - missing from laboratory work today are not specified in
100674 - Chemotherapy Orders. ref SDS B7 TW3O
100676 - ..
100677 - [On 080724 labs starting cycle 6 included Protein Total
100678 - and Calcium, ref SDS C2 GT9I, which were missing from
100679 - lab starting cycle 5 today, ref SDS 0 SE9J, and
100680 - continue to omit Glucose and Albumin, ref SDS C2 PT5X,
100681 - also, omitted for the lab today. ref SDS 0 HS7I
100683 - ..
100684 - These tests have been performed on all prior labs starting a
100685 - new cycle for the past 15 cycles...
100686 -
100687 - 1. 080529....................... ref SDS A1 SE9J
100688 - 2. 080501....................... ref SDS 93 SE9J
100689 - 3. 080403....................... ref SDS 82 SE9J
100690 - 4. 080306....................... ref SDS 78 VG8R
100691 - 5. 080207....................... ref SDS 69 VG8R
100692 - 6. 080110....................... ref SDS 60 4B5G
100693 - 7. 071213....................... ref SDS 52 4B5G
100694 - 8. 071115....................... ref SDS 47 4B5G
100695 - 9. 071018....................... ref SDS 44 L63J
100696 - 10. 070920....................... ref SDS 40 4B5G
100697 - 11. 070816....................... ref SDS 37 4B5G
100698 - 12. 070719....................... ref SDS 35 4B5G
100699 - 13. 070621....................... ref SDS 32 4B5G
100700 - 14. 070524....................... ref SDS 28 4B5G
100701 - 15. 070426....................... ref SDS 24 4B5G
100702 -
100703 -
100705 - ..
100706 - CA 15-3 72 Slight Increase Past 4 Weeks Cycle
100707 -
100708 - Follow up ref SDS A1 IJ8L, ref SDS 93 U34O.
100709 -
100710 - Millie received results of lab today for CA 15-3 72, ref SDS 0 A16M,
100711 - cancer marker a week later on 080703, ref SDS B7 Q49H, and shows
100712 - worsening condition with increase from CA 15-3 66 from the previous
100713 - cycle on 080529. ref SDS A1 IJ8L
100714 -
100715 - [On 080708 CA 15-3 141 cancer marker for labs at Kaiser to
100716 - support surgery seem conflicting with clinical examination
100717 - findings today; raise major concern of advancing disease; tests
100718 - may have been compromised, so CT test and follow up labs at
100719 - UCSF will guide assessment. ref SDS B8 L74K
100720 -
100721 -
100723 - ..
100724 - NEUTS Improve UCSF Prescribed Neupogen Treatment on Sunday
100725 -
100726 - Follow up ref SDS A8 PU6K, ref SDS A5 PU6K.
100727 -
100728 - Blood counts increased significantly this week shown by the report
100729 - today with NEUTS 1.80, ref SDS 0 QY6H, compared with NEUTS 0.74 last
100730 - week on 080619, ref SDS A8 QY6H Significant rise in blood counts
100731 - today reflects getting no Carboplatin treatment last week on 080619,
100732 - which was a bye week for chemotherapy, while also getting Neupogen
100733 - treatment, which follows UCSF guidance submitted in Brigid's letter on
100734 - 080620. ref SDS B0 YY5H
100736 - ..
100737 - Catherine notified the medical team about Millie's low blood counts
100738 - today for Magnesium. ref SDS 0 CP6J
100740 - ..
100741 - The doctor prescribed Magnesium.
100743 - ..
100744 - Millie received Magnesium treatment through the IV port during the
100745 - rest period between cetuximab and Carboplatin.
100746 -
100747 - [On 080703 no follow up test for low Magnesium. ref SDS B7 TW7F
100748 -
100749 -
100751 - ..
100752 - Chemotherapy Orders Received Medical Team Delivered to Infusion Clinic
100753 -
100754 - Follow up ref SDS A1 I66I, ref SDS 93 I66I.
100755 -
100756 - As noted in the record meeting with the medical team at 0830 on the
100757 - 2nd floor, Brigid submitted Chemotherapy Orders and blood vials to
100758 - Millie today for delivery to the Infusion Clinic today, as done for
100759 - previous treatments the past 14 months, until 080501, ref SDS 93 4E9N,
100760 - and again starting the prior cycle on 080529. ref SDS A1 I66I
100762 - ..
100763 - This cycle UCSF submitted separate Chemotherapy Orders for cetuximab,
100764 - as was done for the first time on 080501, ref SDS 93 IN5M, and not
100765 - done starting the previous cycle on 080529. ref SDS A1 1Y7N
100767 - ..
100768 - This is the 2nd time in patient history Millie has received 2 separate
100769 - orders.
100770 -
100771 -
100772 -
1008 -
SUBJECTS
Default Null Subject Account for Blank Record
1103 -
110401 - ..
110402 - Cetuximab Chemotherapy Orders
110403 -
110404 - Follow up ref SDS 93 MM6N.
110405 -
110411 - Auth# Stor BCC LOC
110412 - Visit: 14507962 DOS 20080626
110413 -
110414 - [On 080724 Millie received only 1 Chemotherapy Order for
110415 - Carboplatin, and did not receive a Chemotherapy Order for
110416 - cetuximab, as received today. ref SDS C2 MM6N
110418 - ..
110419 - Date: 20080626
110421 - ..
110422 - Study Order for CC#05752: Phase II Trial of Cetuximab alone and
110423 - in combination with Carboplatin in ER-negative, PR-negative,
110424 - HER2-negative Nonoverexpressing Metastatic Breast Cancers.
110426 - ..
110427 - Arm: 2 - Cetuximab + Carboplatin
110429 - ..
110430 - Dates to be given: 20080626
110432 - ..
110433 - Allergies: NKDA
110435 - ..
110436 - Height: 62 inches
110438 - ..
110439 - Weight: 140 pounds
110441 - ..
110442 - Diagnosis: Breast Cancer (IBC)
110444 - ..
110445 - ICD-9 codes: 174.9/198.2
110447 - ..
110448 - Chemotherapy Order on cetuximab on 080501 shows ICD-9 codes 174.4 and
110449 - 198.2, rather than 174.9 and 198.2 in the cetuximab order today.
110450 - ref SDS 93 SH6H
110452 - ..
110453 - Chemotherapy Order for Cetuximab continues...
110454 -
110455 - Cycle: 5
110457 - ..
110458 - Pre-medications 30 - 60 minutes prior to cetuximab infusion
110460 - ..
110461 - x Diphenhydramine 25 mg IV
110462 -
110463 - Benadryl............... explained on 070201. ref SDS 11 DC7J
110465 - ..
110466 - Medication: (plan to give weekly)
110467 -
110468 - x Cetuximab - Erbitux - (study supply) (maintenance)
110469 -
110470 - 250 mg/m*m = 428 mg
110472 - ..
110473 - Maximum infusion rate is 5 ml/minute. (concentration 2 mg/ml)
110475 - ..
110476 - Infuse once weekly for 8 weeks. First dose is to be given on date
110477 - 080626 [for some reason the date is blank on the form]
110479 - ..
110480 - Cetuximab is administered undiluted through a low protein binding
110481 - 0.22 micro in-line filter. Use NS soution to flush the line at
110482 - the end of the Infusion.
110484 - ..
110485 - Arm 2: Administer carboplatin if vital signs are unremarkable one
110486 - hour after cetuximab infusion.
110488 - ..
110489 - Vital signs at baseline, upon cetuximab completion and one hour
110490 - after cetuximab.
110491 -
110492 - **** please not start and stop times ****
110493 -
110495 - ..
110496 - Laboratory work:
110497 -
110498 - See carboplatin orders.
110499 - Notify MD for dose modifications if patient has severe acne
110500 - form rash
110501 - CBC with differential and plateletes every 4 weeks
110502 - Creatinine and magnesium every 4 weeks
110503 - BUN, AST, Alk Phos, ALT, total bilrubin, electrolytes every
110504 - 8 weeks
110506 - ..
110507 - No laboratory work is specified, including the choice to "See
110508 - Carboplatin orders.
110510 - ..
110511 - Typically, Lab work for Cetuximab is the same as for Carboplatin, see
110512 - below. ref SDS 0 PWPW
110514 - ..
110515 - Chemotherapy Order Cetuximab continue...
110516 -
110517 - If levels are outside of normal laboratory values notify
110518 -
110521 - ..
110522 - Chemotherapy Order Cetuximab continue...
110524 - ..
110525 - x Physician has discussed risks/benefits of chemotherapy with the
110526 - patient. Consent, form obtained.
110527 -
110528 - x Yes O2 [oxygyn] by nasal cannula at 2 liters/min prn for chest pain or SOB
110530 - ..
110531 - x Yes Diphenhydramine 50 mg IV prn x 1 unticaria pruntis, SOB
110532 - (this is Benadryl)
110534 - ..
110535 - x Yes Hydrocrotisone 100 mg IV prn x 1 unticaria pruntis, SOB
110537 - ..
110538 - x Yes Aubterol inhaler 2 - 4 puffs prn SOB or chest tightness
110540 - ..
110541 - x Yes Epnephnna nhaler 2 - 4 puffs prn SOB or chest tightness
110543 - ..
110544 - Physician Signature
110545 -
110548 - Date: 080624
110550 - ..
110551 - Nurse Signature:
110552 -
110555 - Date: 080313
110557 - ..
110558 - No nurses signature is shown in the copy received from UCSF; may have
110559 - been entered and filed in UCSF records later.
110560 -
110561 -
110562 -
1106 -
SUBJECTS
Default Null Subject Account for Blank Record
1203 -
120401 - ..
120402 - Carboplatin Chemotherapy Orders
120403 -
120404 - Follow up ref SDS A1 I66I, ref SDS 93 I66I.
120406 - ..
120407 - No evident difference between chemotherapy orders today and for last
120408 - month on 080529, except the order today does not list the prescription
120409 - for Neupogen, which was given verbally during the meeting before
120410 - treatment today with medical team, per below. ref SDS 0 PWSY
120412 - ..
120413 - Carboplatin was decreased from 250 mg on 080403, to 175 mg on 080501,
120414 - ref SDS 96 PVUQ; this was continued in the Chemotherapy Order issued
120415 - for the previous cycle (#4) on 080529, however, there is a notation
120416 - that indicates the amount of Carboplatin specified was an "error,"
120417 - ref SDS A1 F55F, because planning during the meeting on 080501 was for
120418 - Millie to get the full dose of Carboplatin, ref SDS 92 CZ3N, further
120419 - shown in Millie's letter to UCSF later that day on 080501. ref SDS 94
120420 - MG3P Yesterday, on 080625 Millie asked in a letter to the medical
120421 - team about the error in Chemotherapy Orders discovered on 080605.
120422 - ref SDS B1 PQWV During the meeting today on the 2nd floor, starting
120423 - cycle 5, the Chemotherapy Order showing "error" for dose of
120424 - Carboplatin in prior Chemotherapy Orders was missing from the medical
120425 - chart. Brigid requested a copy. ref SDS B2 RF3N
120426 -
120427 - [On 080724 medical team has not had time to review the
120428 - error in the Chemotherapy Order on 080529, ref SDS C1 PW6G,
120429 - the new Chemotherapy Order for 080724 shows same dose
120430 - marked "error" in the work on 080529. ref SDS C2 PVVR
120432 - ..
120433 - After meeting on the 2nd floor, Millie went for treatment in the
120434 - Infusion Clinic on the 5th floor. Catherine showed a copy of the
120435 - Chemotherapy Order for 080501 and 080529 on file in the Infusion
120436 - Clinic. They both show the dose for Carboplatin was reduced, and the
120437 - orders for 080529 note the dose prescription is an "error."
120438 - ref SDS A1 PVUQ
120440 - ..
120441 - Millie received the Chemotherapy Order for today 080626...
120443 - ..
120449 - Auth# Stor BCC LOC
120450 - Visit: DOS
120452 - ..
120453 - As shown, visit # and date of service (DOS) are missing from the
120454 - Chemotherapy Order for Carboplatin today.
120456 - ..
120457 - Since today, UCSF issued a separate Chemotherapy Order for Cetuximab,
120458 - possibly, the visit # and DOS fields, shown above, ref SDS 0 MM6N, are
120459 - intended to apply for the Chemotherapy Order on Carboplatin.
120461 - ..
120462 - Chemotherapy Order Carboplatin continue...
120463 -
120464 - Date: 20080626
120466 - ..
120467 - Study Order for CC#05752: Phase II Trial of Cetuximab alone and
120468 - in combination with Carboplatin in ER-negative, PR-negative,
120469 - HER2-negative Nonoverexpressing Metastatic Breast Cancers.
120471 - ..
120472 - Arm: 2 - Cetuximab + Carboplatin
120474 - ..
120475 - Dates to be given: 20080626
120477 - ..
120478 - Allergies: NKDA
120480 - ..
120481 - Height: 62 inches
120483 - ..
120484 - Weight: 140 pounds
120486 - ..
120487 - Diagnosis: Metastatic breast cancer (IBC)
120489 - ..
120490 - ICD-9 codes: 174.9/198.2
120492 - ..
120493 - This ICD-9 codes section conflicts with assignments in Chemotherapy
120494 - Order for 080529. ref SDS A1 PVSS
120495 -
120496 - [On 080724 codes assigned to Chemotherapy Order for the
120497 - next cycle is much different from codes assigned today.
120498 - ref SDS C2 PVSS
120500 - ..
120501 - These codes are the same shown in the Chemotherapy Order today for
120502 - cetuximab, per above. ref SDS 0 SH6H They may have been copied to
120503 - reflect common accounting, or there may have been a mistake copying
120504 - from the wrong document.
120506 - ..
120507 - Chemotherapy Order Carboplatin continue...
120508 -
120509 - Cycle: 5
120511 - ..
120512 - Days: 1, 8, 15 (arm 2)
120513 -
120515 - ..
120516 - Antimetics:
120517 -
120518 - Follow up ref SDS A1 PVTT, ref SDS 93 PVTT.
120519 -
120520 - x Dexamethasone 10 mg IV (Decadron)
120521 - x Ondansetron 8 mg IV (Zofran)
120522 -
120524 - ..
120525 - Chemotherapy (plan to treat weekly for 3 out of 4 weeks).
120526 - Carboplatin Dose Reduced May Aid Blood Counts Maintain Treatments
120527 -
120528 - Follow up ref SDS A1 PVUQ, ref SDS 93 PVUQ.
120529 -
120530 - May administer Carboplatin if vital signs are unremarkable one
120531 - hour after cetuximab infusion..
120532 -
120533 - ** Please note start and stop times **
120535 - ..
120536 - Carboplatin (commercial supply) AUC 1.5 = 175 mg in D5W 250 ml
120538 - ..
120539 - Chemo orders today seem to show the same dose specified for the
120540 - previous cycle (4) started on 080529 and marked "error," ref SDS A1
120541 - PVUQ
120543 - ..
120544 - Chemotherapy Orders continue...
120545 -
120546 - IV over 30 minutes weekly x 3 doses followed by 1 week rest.
120548 - ..
120549 - [hand writting...]
120550 -
120551 - Carbo dose to remain the same unless CR >= 1.3
120553 - ..
120554 - [...where CR = "Creatinine"]
120555 -
120556 - Carboplatin dose in mg = (desired AUC)(GFR+25)
120557 -
120558 - GFR (estimated) =
120559 -
120560 - (140-age in years)(weight in kg)(for females x 0.85)
120561 - ----------------------------------------------------
120562 - (Cr in mg/dL)(72)
120564 - ..
120565 - Unlike previous Chemotherapy Orders issued on 080403 which showed
120566 - handwritten values in the dosage formula, ref SDS 82 NV9H, there is
120567 - no similar handwriting on the Chemotherapy Orders received today from
120568 - UCSF.
120570 - ..
120571 - Chemotherapy Orders continues...
120573 - ..
120574 - Laboratory Work:
120575 -
120576 - Follow up ref SDS A1 PWPW, ref SDS 93 PWPW.
120577 -
120578 - x CBC with differential and platelets
120579 - x Creatinine, magnesium every 4 weeks
120580 - x BUN, AST, Alk phos, Alt, Total bilirubin, eletrolytes every 8 weeks
120582 - ..
120583 - Before meeting with the medical team this morning, Millie got a blood
120584 - draw in the Infusion Clinic, as planned in Millie's letter to UCSF
120585 - yesterday on 080625. ref SDS B1 IU3Y
120587 - ..
120588 - There was another a mixup today. As occurred on 080529, ref SDS A1
120589 - OK6N, the nurse did not get the order for the blood draw. Catherine
120590 - checked Chemotherapy Orders for starting the previous cycle 4 on
120591 - 080529. It does not show any Laboratory Work checked; ref SDS A1
120592 - PWPW; so she used the scope of tests that were actually performed on
120593 - 080529, ref SDS A1 075H, to determine what tests to draw blood for
120594 - this morning, as shown in blood tests listed above. ref SDS 0 439L
120596 - ..
120597 - Chemotherapy Orders continues...
120598 -
120599 - If ANC >= 1.5 x 1000/L, platelets >= 75 x 1000/L give 100% of dose
120601 - ..
120602 - If ANC < 1.5 x 1000/L, platelets < 75 x 1000/L....
120603 -
120606 - ..
120607 - x See cetuximab orders. received today on 080626. ref SDS 0 MM6N
120609 - ..
120610 - This aligns with Chemotherapy Orders for the 3rd cycle on 080501,
120611 - ref SDS 96 PWSR, and conflicts with Chemotherapy Orders for prior 4th
120612 - cycle on 080529. ref SDS A1 PWPW
120614 - ..
120615 - Chemotherapy Orders continue...
120616 -
120617 - x Study tubes 3 purple top, 1 cell saver
120619 - ..
120620 - Not sure about handwriting on "cell saver"
120622 - ..
120623 - Chemotherapy Orders continue...
120625 - ..
120626 - Neupogen Not Prescribed in Chemotherapy Orders
120627 -
120628 - Follow up ref SDS A1 PWSY, ref SDS 93 PWTR.
120629 -
120630 - During the meeting with the medical team on the 2nd floor at 0830 this
120631 - morning, Brigid advised that the doctor continues for the 5th cycle
120632 - the same prescription, ref SDS B2 QJ4H issued for the 4th cycle of
120633 -
120634 - Neupogen 480 mcg SQ on D2 + 3,
120635 -
120636 - ...as shown in the record on 080529, ref SDS A1 PWSY
120638 - ..
120639 - The actual Chemotherapy Order for today shows no handwritten entry
120640 - for Neupogen.
120641 -
120642 - [On 080628 Laura in the Kaiser Infusion Clinic asked about
120643 - Chemotherapy Orders that prescribe Neupogen treatments.
120644 - ref SDS B5 VO8I
120646 - ..
120647 - On 080609 Zan in the Kaiser Oncology Pharmacy set up an account for
120648 - Millie to get Neupogen treatments in the Kaiser Infusion Clinic. At
120649 - that time, Zan used the Chemotherapy Order for 080529, ref SDS A4
120650 - L16I, which also shows a prescritpion for 2 Neupogen treatments per
120651 - week. ref SDS A1 PWSY
120653 - ..
120654 - Chemotherapy Orders continue...
120656 - ..
120657 - x Physician has discussed risks/benefits of chemotherapy with the
120658 - patient. Consent, form obtained.
120659 -
120660 - x Yes O2 [oxygyn] by nasal cannula at 2 liters/min prn for chest pain or SOB
120662 - ..
120663 - x Yes Diphenhydramine 50 mg IV prn x 1 unticaria pruntis, SOB
120664 - (this is Benadryl)
120666 - ..
120667 - x Yes Hydrocrotisone 100 mg IV prn x 1 unticaria pruntis, SOB
120669 - ..
120670 - x Yes Aubterol inhaler 2 - 4 puffs prn SOB or chest tightness
120672 - ..
120673 - x Yes Epnephnna nhaler 2 - 4 puffs prn SOB or chest tightness
120675 - ..
120676 - Physician Signature
120677 -
120680 - Date: 080626
120682 - ..
120683 - Nurse Signature:
120684 -
120687 - Date: 080313
120689 - ..
120690 - No nurses signature is shown in the copy received from UCSF; may have
120691 - been entered and filed in UCSF records later.
120692 -
120693 -
120694 -
1207 -
SUBJECTS
Default Null Subject Account for Blank Record
1303 -
130401 - ..
130402 - Power Port Surgery Certification Required Kaiser Submit to UCSF
130403 -
130404 - Millie advised Catherine today that on 080619 Kaiser scheduled surgery
130405 - for 080708 to upgrade the port catheter to a Power Port. ref SDS A7
130406 - MG5I Catherine was very pleasd to hear Kaiser is solving problems
130407 - injecting contrast medium for CT tests by accessing the port rather
130408 - than continue using IV needle punctures in the arm, which caused
130409 - severe injury during the last CT test on 080425, ref SDS 91 FP6F, and
130410 - shown by bruising observed during treatment a week later on 080501.
130411 - ref SDS 93 DT3M
130413 - ..
130414 - Catherine asked if Kaiser will permit UCSF to access the port so soon
130415 - after surgery on 080708 for Millie's treatment on 080710?
130417 - ..
130418 - Millie explained the doctor's instruction on 080606 that the new port
130419 - cannot be accessed for 4 days after surgery. The surgeon plans to
130420 - access the port on the day of surgery, 080708, with a Huber needle so
130421 - that Catherine can use this access to the port for treatment on
130422 - 080710. ref SDS A3 IT40
130424 - ..
130425 - Catherine requested that Kaiser submit a copy of the certificate
130426 - showing the new Power Port is ready for use.
130428 - ..
130429 - Millie asked what the certificate should say. Is this a standard
130430 - medical form of some kind?
130432 - ..
130433 - Catherine clarified that UCSF needs a letter from Kaiser saying the
130434 - Power Port was successfully tested after surgery on 080708. UCSF
130435 - needs this on file to verify safe treatment on 080710. The surgeon
130436 - reported on 040419 that the original port was successfully tested
130437 - after surgery. ref SDS 2 WQ7I Millie can follow up during the meeting
130438 - at Kaiser tomorrow, so the suergon is notified that UCSF needs a copy
130439 - of the certificate.
130440 -
130441 - [On 080627 primary care physician at Kaiser sent a letter to
130442 - the surgeon requesting a certificate for UCSF that the Power
130443 - Port was successfully tested for use. ref SDS B4 7Y6I
130445 - ..
130446 - [On 080702 letter to medical team confirms surgeon notified to
130447 - submit certificate that Power Port was successfully tested for
130448 - use at UCSF. ref SDS B6 EQ3W
130450 - ..
130451 - [On 080628 Laura at Kaiser requested Chemotherapy Orders
130452 - documenting UCSF prescription for Neupogen treatments at
130453 - Kaiser. ref SDS B5 QQ9I
130455 - ..
130456 - [On 080708 Power Port was implanted by surgery to replace the
130457 - port catheter, ref SDS B8 WD9J; surgeon not familiar with a
130458 - "certificate" on results of surgery nor for implanting port
130459 - catheter devices. ref SDS B8 O65F
130461 - ..
130462 - [On 080708 Kaiser submitted a letter stating the Power Port was
130463 - tested successfully, and signed by the surgeon. ref SDS B8 O14F
130465 - ..
130466 - [On 080710 Millie submitted the doctor's letter to UCSF,
130467 - ref SDS B9 EE4O, the nurse advised that UCSF actually needs the
130468 - report on the xray performed showing placement of the Power
130469 - Port, ref SDS B8 UY3I; UCSF management called Kaiser; the
130470 - Surgery department coordinated submission of the xray report to
130471 - the Infusion Clinic at UCSF. ref SDS B9 TM5J
130473 - ..
130474 - Millie asked Catherine about Bella's concern on 080617 that Kaiser
130475 - cannot use the Power Port to inject CT test contrast medium unless a
130476 - doctor or other professional with a certificate assists the technician
130477 - during the process of pressing the button the the test equipment that
130478 - injects the contrast medium through the Power Port. ref SDS A7 ER5K
130480 - ..
130481 - Catherine said this issue has never come up at UCSF. Patients
130482 - routinely get port access in the Infusion Clinic with a Huber needle
130483 - in a Power Port, and then go to the testing department where a
130484 - technician connects to the Huber needle for injecting CT contrast
130485 - medium. Catherine said that connecting to an IV for injecting
130486 - contrast medium is identical to connecting to a Huber needle accessing
130487 - a Power Port.
130488 -
130489 - [On 080708 surgery blood test shows INR 1.1 well below target
130490 - range INR 2.0 - 3.0 for pulmonary embolism case management;
130491 - doctor describes INR 1.1 adequate and normal for patients not
130492 - suffering pulmonary embolism, and within expected range when
130493 - Coumadin is paused 5 days prior to surgery. ref SDS B8 MF4K
130494 -
130495 -
130496 -
130497 -
130498 -
130499 -
130500 -
130501 -
1306 -