CONTACTS 

SUBJECTS
Neupogen Side Effects Bone Pain Fatigue No Headache Suffered Today A

1503 -
1503 -    ..
1504 - Summary/Objective
1505 -
150501 - Follow up ref SDS 66 0000. ref SDS 61 0000.
150502 -
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150504 -
150505 -
150506 -
150508 -  ..
1506 -
1507 -
1508 - Progress
1509 -
150901 - Millie's labs at UCSF today for the 4th treatment in the 7th cycle of
150902 - the clinical study showed blood counts NEUTS 1.37.  This is below
150903 - below requirements for safe chemotherpay treatment, shown in another
150904 - record today, 080814. ref SDS 67 QY6H
150906 -  ..
150907 - Typically, Millie does not get Neupogen treatment during the 4th week
150908 - of the treatment cycle, because the body's natural bone marrow system
150909 - replenishes blood and is not restrained by chemotherapy Carboplatin,
150910 - because the 4th week is a bye in the clinical study treatment cycle.
150912 -  ..
150913 - Case study on 080814 shows UCSF has occassionally ordered Neupogen on
150914 - the 4th week in the cycle when blood counts are very low.  When Millie
150915 - returned home today from treatment, she recalled blood counts were
150916 - 1.75.  Since UCSF sets 1.80 as the standard for giving treatment, and
150917 - Kaiser uses 1.50, blood counts 1.75 seem to require no medical
150918 - treatment to increase counts for treatment next week, since the body's
150919 - systems should be sufficient.  However, as noted, the lab report
150920 - actually shows NEUTS 1.37, ref SDS 67 QY6H, which is well below the
150921 - UCSF standard, and still below the Kaiser standard.
150923 -  ..
150924 - Millie submitted a letter to UCSF asking...
150925 -
150926 -    1.  Subject: Neupogen Treatments Canceled This Week
150927 -        Date: Thu, 14 Aug 2008 16:01:52 -0700
150932 -         ..
150933 -    2.  Dear Brigid,
150935 -         ..
150936 -    3.  Blood counts for NEUTS 1.37 (ANC 1370 Kaiser) were a little low
150937 -        today.  Since today is the 4th week in the cycle, I did not get
150938 -        Carboplatin, so I assume we can skip Neupogen treatments at
150939 -        Kaiser on Friday and Saturday.
150941 -         ..
150942 -    4.  By copy I am asking Paula to notify the Infusion Clinic of this
150943 -        change in the schedule.  I talked to Bonnie last week at
150944 -        Kaiser, and she said to wait until today to cancel Neupogen
150945 -        treatments for this week, so I am following that advice today.
150947 -         ..
150948 -    5.  Patient history shows that previously, when counts were very
150949 -        low NEUTS 0.74 the doctor prescribed 1 Neupogen treatment on
150950 -        the 4th week to make sure counts would be good to start the
150951 -        next cycle, see case study in the record today. ref SDS 67
150952 -        6S8H. and citing the record on 080619. ref SDS 35 QY6H
150954 -         ..
150955 -    6.  If you feel I should go ahead and get a Neupogen treatment as a
150956 -        precaution [because NEUTS 1.37 are again well below the safe
150957 -        level needed for safe chemotherapy next week], as was done on
150958 -        080717 [actually, on 080719, ref SDS 52 SR37], please let me
150959 -        know.  Otherwise I assume we can follow the Chemo Orders on
150960 -        080724 saying to get Neupogen only when I get Carbo.
150961 -        ref SDS 57 PWSY
150962 -
150963 -               [...below, UCSF says policy is to skip Neupogen on bye
150964 -               week for chemotherapy. ref SDS 0 UK3K
150966 -                ..
150967 -               [On 080821 blood counts fell without Neupogen; Millie
150968 -               could not get chemotherapy, ref SDS 69 HR6M; doctor
150969 -               considers skipping Neupogen again according to UCSF
150970 -               policy; and decides to prescribe Neupogen based on
150971 -               patient history of difficulty increasing blood counts in
150972 -               time for treating cancer. ref SDS 69 RV93
150974 -                ..
150975 -               [On 080918 case study shows 2 Neupogen treatments on
150976 -               each of all 4-weeks in the chemotherapy cycle avoids
150977 -               missing chemotherapy treatments. ref SDS 70 OK67
150979 -         ..
150980 -    7.  Have a great weekend.
150981 -
150988 -         ..
150989 -   10.  PS.  I don't have contact information on the new study
150990 -        coordinator; I assume Jackie has left for school.
150991 -
150992 -
150994 -  ..
1510 -
1511 -
1512 - 1644
1513 -
151301 - Millie received a response from Brigid at UCSF...
151302 -
151303 -    1.  Subject:  Neupogen Treatments Canceled This Week
151304 -        Date: Thu, 14 Aug 2008 16:05:29 -0700
151308 -         ..
151309 -    2.  We usually don't give any neupogen if you don't receive the
151310 -        Carbo, now we did last time as prep for the port placement.
151312 -  ..
151313 - UCSF indicating today that Neupogen was given "as prep for the port
151314 - placement" seems conflicting with patient history.  Surgery for the
151315 - Power Port was performed on Tuesday, 080708. ref SDS 43 IT6K  Millie
151316 - had treatment at UCSF the week before on 080703.  This was the 2nd
151317 - week in the 5th cycle, and so 2 Neupogen treatments were required by
151318 - Brigid's instructions during the meeting on 080626, ref SDS 38 QJ4H,
151319 - even though the Chemotherapy Order received from UCSF on 080626 did
151320 - not specify Neupogen treatments. ref SDS 39 PWSY  Millie's letter to
151321 - the medical team on 080707 reported getting the 2 Neupogen treatments
151322 - at Kaiser on 080705 and on 080707. ref SDS 42 JP7T  This record does
151323 - not show UCSF ordered Neupogen treatment to "prep for the port
151324 - placement."
151326 -  ..
151327 - More recently on 080718, UCSF was asked for guidance on getting
151328 - Nupogen, ref SDS 51 I46Q, after using the port for the CT test failed,
151329 - and caused bleeding from the port surgical wound, and required
151330 - emergency measures. ref SDS 51 IC6F  UCSF did not respond.  The next
151331 - day on 080719 Millie received Neupogen treatmentat Kaiser. ref SDS 52
151332 - SR37, to recover from side effects of bleeding during failed attempts
151333 - at Kaiser on 080718 to use the Power Port for injecting contrast
151334 - medium. ref SDS 51 A370
151336 -  ..
151337 - Several days later on 080721 UCSF reported that bleeding during the
151338 - Power Port problem on 080718 did not require Neupogen treatment.
151339 - ref SDS 53 A13G
151341 -  ..
151342 - UCSF letter continues...
151343 -
151344 -        I don't think we will know for sure if you would need it until
151345 -        we give it another chance to check the NEUTS after the week
151346 -        break.
151348 -         ..
151349 -        There is always a chance that the neuts might not be high
151350 -        enough but I think we should not get the neupogen and see next
151351 -        week, this plan OK???
151352 -
151353 -               [On 080821 blood counts fell without Neupogen; Millie
151354 -               could not get chemotherapy, ref SDS 69 HR6M; doctor
151355 -               considers skipping Neupogen again according to UCSF
151356 -               policy; and decides to prescribe Neupogen based on
151357 -               patient history of difficulty increasing blood counts in
151358 -               time for treating cancer. ref SDS 69 RV93
151360 -                ..
151361 -               [On 080918 case study shows 2 Neupogen treatments on
151362 -               each of all 4-weeks in the chemotherapy cycle avoids
151363 -               missing chemotherapy treatments. ref SDS 70 OK67
151364 -
151381 -  ..
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1515 -
1516 - 1657
1517 -
151701 - Millie submitted a response confirming understandings that UCSF does
151702 - not prescribe Neupogen treatments for this week...
151703 -
151704 -    1.  Subject: Neupogen Treatments Canceled This Week at Kaiser Confirmed
151705 -        Date: Thu, 14 Aug 2008 17:04:16 -0700
151713 -         ..
151714 -    3.  Thanks for timely response confirming in your letter today,
151715 -        that we can skip Neupogen treatments at Kaiser this week on
151716 -        Friday and Saturday. ref SDS 0 4Q5O, By copy to Paula, confirm
151717 -        UCSF guidance.
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