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: September 18, 2008 09:00 AM Thursday;
Rod Welch
Millie 1st treatment 8th cycle cetuximab Carboplatin 4th relapse IBC.
1...Summary/Objective
...Taxotere Capecitabine 2nd Relapse IBC Treatment After Mastectomy
...Cetuxiab Alone Clinical Study
...Cetuxiab 81 and Carboplatin 14 Treatments Clinical Study 2nd Arm
2...Schedule Weekly Treatments Continue on Thursdays
....Date Time Staff Sta Type Dept Loc Dur Number Cycl Trmnt
3...Labs Blood Test
4...Cancer Marker CA 15-3 95 Decreases Over 4 Weeks from 96
5...NEUTS 2.07 Increase 1st Week Chemotherapy Received
6...Chemotherapy Received Blood Counts Rise Significantly
7...Blood Counts Rise Significantly Chemotherapy Carboplatin Received
8...Neupogen Case Study Missed Carboplatin Treatments Low Blood Counts
9...Side Effects Neupogen Treatments Continue Mild Tolerance Acceptable
10...Coagulation Control INR 2.1 Normal Stable PT 26.2 High
11...Cetuximab Chemotherapy Order for 7th Cycle
12...Carboplatin Chemotherapy Orders
....Error Dates Treatment Should Include 3 Days
....Antimetics:
....Chemotherapy (plan to treat weekly for 3 out of 4 weeks).
....Carboplatin Dose Reduced May Aid Blood Counts Maintain Treatments
....Laboratory Work:
....Neupogen Prescribed in Chemotherapy Orders
..............
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CONTACTS
SUBJECTS
Cetuximab Carboplatin Clinical Study 2nd Arm 7th Cycle 1st Treatment
1003 -
1003 - ..
1004 - Summary/Objective
1005 -
100501 - Follow up ref SDS G8 0000. ref SDS G6 0000.
100502 -
100503 -
100504 -
100505 -
100507 - ..
1006 -
1007 -
1008 - Progress
1009 -
100901 - Background on Millie's treatment in the clinical study is reported on
100902 - 080508. ref SDS A0 TZ8I
100904 - ..
100905 - Taxotere Capecitabine 2nd Relapse IBC Treatment After Mastectomy
100906 -
100907 - Follow up ref SDS G8 X33O, ref SDS G6 X33O.
100908 -
100909 - Millie had left mastectomy on 051021. Biopsy at that time reported
100910 - no findings of cancer. Approximately 8 months later on 060707 the
100911 - doctor diagnosed IBC relapse and prescribed treatment with
100912 - capecitabine and Taxotere, which had been effective in 2005
100913 - completely eliminating signs of IBC disease. ref SDS 5 PF3O
100914 -
100915 - 1. Cycle 09 and 01 ................... 060721, ref SDS 6 407N
100916 - 2. Cycle 10 and 02 ................... 060814, ref SDS 8 LY6O
100917 - 3. Cycle 11 and 03 ................... 060908, ref SDS 8 407N
100918 - 4. Cycle 12 and 04 ................... 060929, ref SDS 8 407N
100919 - 5. Cycle 13 and 05 ................... 061020, ref SDS 9 407N
100920 - 6. Cycle 14 and 06 ................... 061110, ref SDS 10 407N
100921 - 7. Cycle 15 and 07 ................... 061201, ref SDS 11 407N
100923 - ..
100924 - Cetuxiab Alone Clinical Study
100925 -
100926 - Follow up ref SDS G8 356I, ref SDS G6 356I.
100927 -
100928 - After 7 cycles of treatment in 2006, the doctor diagnosed IBC
100929 - disease was progressing, and so made referral to UCSF for referral
100930 - in clinical study of Cetuximab and Carboplatin. Millie was
100931 - randominzed for treatment with Cetuximab alone, and began weekly
100932 - treatments at UCSF on 080201.
100934 - ..
100935 - Total Cetuximab
100936 - 8. Cycle 01 and 08 and 01 01.......... 070201, ref SDS 13 SG8I
100937 - 9. Cycle 01 and 08 and 02 02.......... 070208, ref SDS 14 SG8I
100938 - 10. Cycle 01 and 08 and 03 03.......... 070215, ref SDS 15 SG8I
100939 - 11. Cycle 01 and 08 and 04 04.......... 070222, ref SDS 16 SG8I
100940 - 12. Cycle 02 and 09 and 01 05.......... 070301, ref SDS 18 SG8I
100941 - 13. Cycle 02 and 09 and 02 06.......... 070308, ref SDS 20 7T3H
100942 - 14. Cycle 02 and 09 and 03 07.......... 070315, ref SDS 21 7T3H
100943 - 15. Cycle 02 and 09 and 04 08.......... 070322, ref SDS 22 7T3H
100944 - 16. Cycle 03 and 10 and 01 09.......... 070329, ref SDS 23 7T3H
100945 - 17. Cycle 03 and 10 and 02 10.......... 070405, ref SDS 24 7T3H
100946 - 18. Cycle 03 and 10 and 03 11.......... 070412, ref SDS 25 7T3H
100947 - 19. Cycle 03 and 10 and 04 12.......... 070419, ref SDS 26 7T3H
100948 - 20. Cycle 04 and 11 and 01 13.......... 070426, ref SDS 27 7T3H
100949 - 21. Cycle 04 and 11 and 02 14.......... 070503, ref SDS 28 7T3H
100950 - 22. Cycle 04 and 11 and 03 15.......... 070510, ref SDS 29 7T3H
100951 - 23. Cycle 04 and 11 and 04 16.......... 070517, ref SDS 30 7T3H
100952 - 24. Cycle 05 and 12 and 01 17.......... 070524, ref SDS 31 7T3H
100953 - 25. Cycle 05 and 12 and 02 18.......... 070531, ref SDS 32 7T3H
100954 - 26. Cycle 05 and 12 and 03 19.......... 070607, ref SDS 33 7T3H
100955 - 27. Cycle 05 and 12 and 04 20.......... 070614, ref SDS 34 0001
100956 - 28. Cycle 06 and 13 and 01 21.......... 070621, ref SDS 35 0001
100957 - 29. Cycle 06 and 13 and 02 22.......... 070628, ref SDS 36 0001
100958 - 30. Cycle 06 and 13 and 03 23.......... 070705, ref SDS 37 0001
100959 - 31. Cycle 06 and 13 and 04 24.......... 070712, ref SDS 37 0001
100960 - 32. Cycle 07 and 14 and 01 25.......... 070719, ref SDS 38 0001
100961 - 33. Cycle 07 and 14 and 02 26.......... 070726, ref SDS 36 0001
100962 - 34. Cycle 07 and 14 and 03 27.......... 070802, ref SDS 37 0001
100963 - 35. Cycle 07 and 14 and 04 28.......... 070809, ref SDS 39 0001
100964 - 36. Cycle 08 and 15 and 01 29.......... 070816, ref SDS 40 0001
100965 - 37. Cycle 08 and 15 and 02 30.......... 070823, ref SDS 41 0001
100966 - 38. Cycle 08 and 15 and 03 31.......... 070830, ref SDS 41 0001
100967 - 39. Cycle 08 and 15 and 04 32.......... 070906, ref SDS 42 0001
100968 - 40. Cycle 09 and 16 and 01 33.......... 070920, ref SDS 43 0001
100969 - 41. Cycle 09 and 16 and 02 34.......... 070927, ref SDS 44 0001
100970 - 42. Cycle 09 and 16 and 03 35.......... 071004, ref SDS 45 0001
100971 - 43. Cycle 09 and 16 and 04 36.......... 071011, ref SDS 46 0001
100972 - 44. Cycle 10 and 17 and 01 37.......... 071018, ref SDS 47 0001
100973 - 45. Cycle 10 and 17 and 02 38.......... 071025, ref SDS 48 0001
100974 - 46. Cycle 10 and 17 and 03 39.......... 071101, ref SDS 34 0001
100975 - 47. Cycle 10 and 17 and 04 40.......... 071108, ref SDS 49 0001
100976 - 48. Cycle 11 and 18 and 01 41.......... 071115, ref SDS 50 0001
100977 - 49. Cycle 11 and 18 and 02 42.......... 071122, ref SDS 36 0001
100978 - 50. Cycle 11 and 18 and 03 43.......... 071129, ref SDS 53 0001
100979 - 51. Cycle 11 and 18 and 04 44.......... 071206, ref SDS 54 0001
100980 - 52. Cycle 12 and 19 and 01 45.......... 071213, ref SDS 57 0001
100981 - 53. Cycle 12 and 19 and 02 46.......... 071220, ref SDS 60 0001
100982 - 54. Cycle 12 and 19 and 03 47.......... 071227, ref SDS 61 0001
100983 - 55. Cycle 12 and 19 and 04 48.......... 080103, ref SDS 62 0001
100984 - 56. Cycle 13 and 20 and 01 49.......... 080110, ref SDS 65 0001
100985 - 57. Cycle 13 and 20 and 02 50.......... 080117, ref SDS 66 0001
100986 - 58. Cycle 13 and 20 and 03 51.......... 080124, ref SDS 67 0001
100987 - 59. Cycle 13 and 20 and 04 52.......... 080131, ref SDS 69 0001
100988 - 60. Cycle 14 and 21 and 01 53.......... 080207, ref SDS 73 0001
100989 - 61. Cycle 14 and 21 and 02 54.......... 080214, ref SDS 74 0001
100990 - 62. Cycle 14 and 21 and 03 55.......... 080221, ref SDS 37 0001
100991 - 63. Cycle 14 and 21 and 04 56.......... 080228, ref SDS 79 0001
100992 - 64. Cycle 15 and 22 and 01 57 01 00... 080306, ref SDS 82 TZ8I
100994 - ..
100995 - Cetuxiab 81 and Carboplatin 14 Treatments Clinical Study 2nd Arm
100996 -
100997 - Follow up ref SDS G8 5B6J, ref SDS G6 5B6J.
100998 -
100999 - On 080207 doctor reports IBC may be spreading. ref SDS 72 GH5H
101000 - Follow up examination on 080219 Doctor Rugo diagnosed progression of
101001 - disease. ref SDS 94 3J4I Photographs show spread of IBC rash, UCSF
101002 - prescribed treatment under the 2nd Arm of the study so that Millie
101003 - now gets weekly treatment with cetuximab and with Carboplatin 3
101004 - weeks of each 4 week cycle.
101005 -
101006 - 2nd
101007 - Arm Cetuximab Carboplatin
101008 - 65. Cycle 01 15 and 22 and 02 58 02 01... 080313, ref SDS 84 TZ8I
101009 - 66. Cycle 01 15 and 22 and 03 59 03 01... 080320, ref SDS 85 TZ8I
101010 - 67. Cycle 01 15 and 22 and 04 60 04 01... 080327, ref SDS 86 TZ8I
101011 - 68. Cycle 02 16 and 23 and 01 61 05 02... 080403, ref SDS 87 TZ8I
101012 - 69. Cycle 02 16 and 23 and 02 62 06 03... 080410, ref SDS 90 TZ8I
101013 - 70. Cycle 02 16 and 23 and 03 63 07 03... 080417, ref SDS 92 TZ8I
101014 - 71. Cycle 02 16 and 23 and 04 64 08 03... 080424, ref SDS 95 TZ8I
101015 - 72. Cycle 03 17 and 24 and 01 65 09 04... 080501, ref SDS 98 5B6J
101016 - 73. Cycle 03 17 and 24 and 02 66 10 05... 080508, ref SDS A0 5B6J
101017 - 74. Cycle 03 17 and 24 and 03 67 11 05... 080515, ref SDS A1 5B6J
101018 - 75. Cycle 03 17 and 24 and 04 68 12 05... 080522, ref SDS A2 5B6J
101019 - 76. Cycle 04 18 and 25 and 01 69 13 06... 080529, ref SDS A5 5B6J
101020 - 77. Cycle 04 18 and 25 and 02 70 14 07... 080605, ref SDS A6 5B6J
101021 - 78. Cycle 04 18 and 25 and 03 71 15 08... 080612, ref SDS A9 5B6J
101022 - 79. Cycle 04 18 and 25 and 04 72 16 08... 080619, ref SDS B2 5B6J
101023 - 80. Cycle 05 19 and 26 and 01 73 17 09... 080626, ref SDS B7 5B6J
101024 - 81. Cycle 05 19 and 26 and 02 74 18 10... 080703, ref SDS C2 5B6J
101025 - 82. Cycle 05 19 and 26 and 03 75 19 11... 080710, ref SDS C5 5B6J
101026 - 83. Cycle 05 19 and 26 and 04 76 20 11... 080717, ref SDS D1 5B6J
101027 - 84. Cycle 06 20 and 27 and 01 77 21 12... 080724, ref SDS D8 5B6J
101028 - 85. Cycle 06 20 and 27 and 02 78 22 13... 080731, ref SDS E2 5B6J
101029 - 86. Cycle 06 20 and 27 and 03 79 23 14... 080807, ref SDS E8 5B6J
101030 - 87. Cycle 06 20 and 27 and 04 80 24 14... 080814, ref SDS F4 5B6J
101031 - 88. Cycle 07 21 and 28 and 01 81 25 14... 080821, ref SDS F6 5B6J
101032 - 89. Cycle 07 21 and 28 and 02 82 26 15... 080828, ref SDS G4 5B6J
101033 - 90. Cycle 07 21 and 28 and 03 83 27 16... 080904, ref SDS G6 5B6J
101034 - 91. Cycle 07 21 and 28 and 04 84 28 16... 080911, ref SDS G8 5B6J
101035 - 92. Cycle 08 22 and 29 and 01 85 29 17... 080918, ref SDS 0 5B6J
101037 - ..
101038 - Today is the 1st treatment of the 8th cycle with cetuximab and
101039 - Carboplatin together. This is the 29th treatment overall with
101040 - cetuximab on the 2nd arm of the clinical study, but is only the 17th
101041 - treatment with Carboplatin due to low blood counts.
101043 - ..
101044 - Catherine is the nurse today.
101045 -
101046 -
101047 -
1011 -
SUBJECTS
Default Null Subject Account for Blank Record
1703 -
170401 - ..
170402 - Schedule Weekly Treatments Continue on Thursdays
170403 -
170404 - Follow up ref SDS G8 1K7H. ref SDS G6 1K7H.
170405 -
170406 - Prior schedule is listed on 080904. ref SDS G6 PN6F
170407 -
170408 - The schedule for Neupogen is listed on 080905. ref SDS G7 WJ4O
170410 - ..
170411 - Nola submitted UCSF schedule for Millie's care over the next few
170412 - months, updating the plan received on 080904, ref SDS G6 HG57, and
170413 - implementing the schedule Brigid and Jill submitted during the meeting
170414 - with the medical team earlier this morning.
170416 - ..
170417 - Date Time Staff Sta Type Dept Loc Dur Number Cycl Trmnt
170418 -
170419 - 080925 0800 Catherine PEN AC1 CCINF INF 20 14821209 08 02
170420 - 080925 0900 Catherine PEN AC4 CCINF INF 60 14821201 08 02
170421 - 081002 0820 Catherine PEN AC1 CCINF INF 20 14821224 08 03
170422 - 081002 0900 Catherine PEN AC4 CCINF INF 60 14821217 08 03
170423 - 081009 0820 Catherine PEN AC1 CCINF INF 20 14821235 08 04
170424 - 081009 0900 Catherine PEN AC4 CCINF INF 60 14821231 08 04
170425 - ..
170426 - 081016 0800 Catherine PEN AC1 CCINF INF 20 14821257 09 01
170427 - * 081016 0830 Rugo PEN CHF BCC Z4F 30 14850513 09 01
170428 - Brigid
170429 - Megan
170430 - 081016 0900 Catherine PEN AC4 CCINF INF 60 14821243 09 01
170431 - 081023 0800 Catherine PEN AC1 CCINF INF 20 14881004 09 02
170432 - 081023 0900 Catherine PEN AC4 CCINF INF 60 14881004 09 02
170433 - ..
170434 - * 081030 09 03
170435 - ..
170436 - 081107 0800 Catherine PEN AC1 CCINF INF 20 14992142 09 04
170437 - 081107 0900 Catherine PEN AC4 CCINF INF 60 14881533 09 04
170438 - 081113 0800 Catherine PEN AC1 CCINF INF 20 14992153 10 01
170439 - 081113 0830 Rugo PEN CHF BCC Z4F 30 14820731 10 01
170440 - Lynn
170441 - Megan
170442 - 081113 0900 Catherine PEN AC4 CCINF INF 60 14992147 10 01
170443 - 081120 0800 Catherine PEN AC1 CCINF INF 20 14992160 10 02
170444 - 081120 0900 Catherine PEN AC4 CCINF INF 60 14992156 10 02
170445 - 081126 0800 Catherine PEN AC1 CCINF INF 20 15053793 10 03
170446 - 081126 0900 Catherine PEN AC4 CCINF INF 60 15053791 10 03
170447 - 081204 0800 Catherine PEN AC1 CCINF INF 20 15053793 10 04
170448 - 081204 0900 Catherine PEN AC4 CCINF INF 60 15053798 10 04
170449 - 081211 0800 Catherine PEN AC1 CCINF INF 20 15053813 11 01
170450 - 081211 0830 Rugo PEN CHF BCC Z4F 30 14820734 11 01
170451 - Lynn
170452 - Megan
170453 - 081211 0900 Catherine PEN AC4 CCINF INF 60 15053807 11 01
170454 - 081218 0800 Catherine PEN AC1 CCINF INF 20 15053823 11 02
170455 - 081218 0900 Catherine PEN AC4 CCINF INF 60 15053819 11 02
170456 - 081224 0800 Catherine PEN AC1 CCINF INF 20 15053832 11 03
170457 - 081224 0900 Catherine PEN AC4 CCINF INF 60 15053827 11 03
170458 - 090102 0800 Catherine PEN AC1 CCINF INF 20 15053845 11 04
170459 - 090102 0900 Catherine PEN AC4 CCINF INF 60 15053841 11 04
170460 - 090108 0800 Catherine PEN AC1 CCINF INF 20 15053853 12 01
170461 - * 090108 0830 Rugo PEN CHF BCC Z4F 30 14820734 12 01
170462 - Lynn
170463 - Megan
170464 - 090108 0900 Catherine PEN AC4 CCINF INF 60 15053851 12 01
170465 - 090115 0800 Catherine PEN AC1 CCINF INF 20 15053866 12 02
170466 - 090115 0900 Catherine PEN AC4 CCINF INF 60 15053858 12 02
170468 - ..
170469 - * Comment on schedule gaps...
170470 -
170471 - 1. Schedule received from Nola today still shows meeting with
170472 - the doctor on 081016 at 1130. This needs to be changed to
170473 - 0830, as Brigid did this morning for the meeting scheduled
170474 - at 1130 that she moved to 0830. ref SDS H1 GY3N
170476 - ..
170477 - 2. The schedule for treatment on 081030 was removed today by
170478 - Nola because Millie will be on vacation that week, per
170479 - review on 080905. ref SDS G6 HH93
170481 - ..
170482 - 3. Meeting with the doctor on 090108 has not yet been
170483 - scheduled.
170484 -
170485 -
170486 -
170487 -
170488 -
1705 -
SUBJECTS
Blood Tests Labs Infusion Clinic Evaluate Safe Chemotherapy 1st Trea
2503 -
2504 - 0750
250501 - ..
250502 - Labs Blood Test
250503 -
250504 - Follow up ref SDS G8 FW5N, ref SDS G6 FW5N.
250505 -
250506 - Adding Carboplatin to the treatment protocol now requires weekly blood
250507 - tests to determine if the immune system is strong enough for safe
250508 - chemotherapy treatment, reported on 070201, ref SDS 13 XR40, and
250509 - citing the clinical study protocol received from UCSF on 070116.
250510 - ref SDS 12 5U7Z
250512 - ..
250513 - Catherine performed the blood draw as shown in the schedule received
250514 - on 080904. ref SDS G6 SO8F
250516 - ..
250517 - The doctor's order for lab work, including 7 vials for the trial, was
250518 - ready in the Infusion Clinic today, implementing Millie's notice
250519 - yesterday on 080917 sent to Jill and the medical team. ref SDS H0 SG6T
250521 - ..
250522 - After the blood draw, Millie went to the Breast Care Clinic on 2nd
250523 - floor for a meeting with the medical team at 0830. ref SDS F5 YY3N
250524 -
250525 -
250526 -
250527 -
250529 - ..
2506 -
2507 -
2508 - 1010
2509 -
250901 - After examination on the 2nd floor, Millie returned to the Infusion
250902 - Clinic on the 5th floor for treatment by Catherine.
250904 - ..
250905 - During treatment, Catherine submitted results of the test starting the
250906 - 8th cycle. Scope is the same as for starting cycle 7 on 080821.
250907 - ref SDS F6 075H
250908 -
250923 - ..
250924 - Log#: 080918 08:15
250925 - <----------------------- U C S F -----------------------> <------------- Kaiser -------------->
250926 - Type Results Units Normal ACRO Type Units Normal
250927 - ..
250928 - CBC with DIFF & PLT CT CBCD
250929 - ..
250930 - WBC COUNT 4.3 x10E9/L 3.4 - 10 WBC WBC x10-3 K/uL 3.4 - 10.0
250931 - RBC COUNT L 3.76 x10E12/L 4 - 5.2 RBC RBC x10-6 M/uL 3.60 - 5.70
250932 - HEMOGLOBIN 13.1 g/dL 12 - 15.5 HGB Hemoglobin g/dL 11.5 - 15.0
250933 - HEMATOCRIT 37.3 PERCENT 36 - 46 HCT Hematocrit % 34.0 - 46.0
250934 - MCV 99 fL 80 - 100 MCV MCV fL 80.0 - 100.0
250935 - MCH H 34.8 pg 26 - 34 MCH
250936 - MCHC 35.1 g/dL 31 - 36 MCHC
250937 - PLATELETS 254 x10E9/L 140 - 450 PLT Plt x10-3 K/uL 140 - 400
250938 -
250939 - Performed at Mt Zion Clinic Lab, 1600 Divisadero, San
250940 - Francisco, CA 94115
250941 - ..
250942 - (posted 080925, ref SDS H2 VK6H)
250943 - CA 15-3 H* 95 U/mL < 33 CA153 CA 15-3 < 39
250944 -
250945 - Note new reference range [<33 changed from <31] and change in
250946 - methodology effective March 1, 2008. Performed using the
250947 - Siemens Centaur Chemiluminesence method. CA 15-3 result using
250948 - the Roche Elecsys assay is 75 U/mL. Ref range <31 U/mL. This
250949 - rebaseline value provided at no additional charge.
250951 - ..
250952 - This new note updates explanation of tests prior to 080301,
250953 - e.g., on 080207. ref SDS 73 A16M
250954 - ..
250955 - (NEUTS x 1000 = ANC for Kaiser)
250956 - NEUTS 2.07 x10E9/L 1.8 - 6.8 N-A ANC 1500
250957 - Neutrophils Not Reported Neutrophils % 50 - 70
250959 - ..
250960 - LYMPHS 1.69 x10E9/L 0.9 - 2.9 L-A Lymphocytes % 20 - 50
250961 - MONOS 0.25 x10E9/L 0.2 - 0.8 M-A Monocyte % 0 - 11
250962 - EOS 0.18 x10E9/L 0 - 0.4 E-A Esoinophils % 1 - 5
250963 - BASOS 0.07 x10E9/L 0 - 0.1 B-A Basophil % 0 - 2
250965 - ..
250966 - <----------------------- U C S F -----------------------> <------------- Kaiser -------------->
250967 - Type Results Units Normal ACRO Type Units Normal
250968 - PT H 24.0 s 12.0 - 14.1 PT PT, patient sec 8.9 - 11.1
250969 - INL NRM Ratio H 2.1 0.9 - 1.1 INR INR 2.0 - 3.0
250970 -
250971 - Performed at Mt Zion Clinic Lab, 1600 Divisadero, San
250972 - Francisco, CA 94115
250974 - ..
250975 - PARTIAL
250976 - THROMBOPLASTIN H 36.3 s 22.2 - 34.2 INR PTT
250977 -
250978 - Performed at Mt Zion Clinic Lab, 1600 Divisadero, San
250979 - Francisco, CA 94115
250981 - ..
250982 - FIBRINOGEN 326 mg/dL 202 - 430 FIB
250983 -
250984 - New test added today, 080818; Catherine says similar to INR.
250986 - ..
250987 - <----------------------- U C S F -----------------------> <------------- Kaiser -------------->
250988 - Type Results Units Normal ACRO Type Units Normal
250989 - ELECTROLYTE PANEL LYTE
250990 - SODIUM 138 mmol/L 134 - 143 NA Sodium mEq/L 137 - 145
250991 - POTASSIUM 3.9 mmol/L 3.4 - 4.9 K Potassium mEq/L 3.5 - 5.3
250992 - CHLORIDE 105 mmol/L 98 - 107 CL
250993 - CARBON DIOX TOTAL 24 mmol/L 23 - 32 CO2
250994 - ANION GAP 9 3 - 14 ANGA
250995 - ..
250996 - UREA NITROGEN 11 mg/dL 8 - 23 BUN BUN mg/dL 7 - 17
250997 - * GLUCOSE 145 mg/dL 70 - 199 GLU Glucose mg/dL ? - ?
250998 - AST H 42 U/L 16 - 41 AST AST (SGOT) U/L 14 - 36
250999 - ALT 33 U/L 11 - 54 ALT ALT (SGPT) U/L 11 - 66
251000 - BILIRUBIN, TOTAL 0.9 mg/dL 0.3 - 1.3 BILT Bili Total mg/dL 0.2 - 1.3
251001 - ALKALINE PHOSPHATASE 95 U/L 29 - 111 ALKP Alkaline Ph U/L 38 - 126
251002 - ..
251003 - * PROTEIN, TOTAL In Lab g/dL 5.8 - 8.0 TP Protine Total g/dL 6.3 - 8.2
251004 - * ALBUMIN In Lab g/dL 3.4 - 4.7 ALB Albumin g/dL 3.4 - 4.8
251005 - CALCIUM L 8.9 mg/dL 8.7 - 10.1 CA Calcium mg/dL 8.4 - 10.2
251006 - ..
251007 - MAGNESIUM 1.8 mg/dL 1.8 - 2.3 MG Magnesium mg/dL 1.6 - 2.3
251009 - ..
251010 - CREAT with eGFR
251011 - CREATININE 0.56 mg/dL 0.42 - 1.06 CR Creatinine mg/dL 0.6 - 1.2
251012 -
251013 - Note: Creatinine assay changed to IDMS standardization on
251014 - February 4, 2008 causing decrease in results of approximately
251015 - 0.09 mg/dL
251017 - ..
251018 - eGFR if Caucasian >60 mL/min GFRC
251019 - eGFR if African Amer >60 mL/min GFRA
251020 -
251021 - eGFR corrected for 1.73 sq meters of body surface area
251022 - Note: eGFR is only an estimation. Please see online Lab Manual
251023 - for potential limitations.
251024 - Performed at Mt Zion Clin Lab, 1600 Divisadero, San Francisco,
251025 - CA 94115
251027 - ..
251028 - * Labs today included following tests previously omitted...
251029 -
251030 - GLUCOSE.............................. ref SDS 0 SE9J
251031 - PROTEIN, TOTAL....................... ref SDS 0 GT9I
251032 - ALBUMIN
251034 - ..
251035 - Labs on 080821 omitted following tests...
251036 -
251037 - GLUCOSE.............................. ref SDS F6 SE9J
251038 - ALBUMIN.............................. ref SDS F6 GT9I
251039 - PROTEIN, TOTAL
251041 - ..
251042 - Labs on 080726 omitted following tests...
251043 -
251044 - GLUCOSE.............................. ref SDS D8 SE9J
251045 - ALBUMIN.............................. ref SDS D8 GT9I
251047 - ..
251048 - Labs on 080626 omitted following tests...
251049 -
251050 - GLUCOSE.............................. ref SDS B7 HS7I
251051 - PROTEIN, TOTAL
251052 - ALBUMIN
251053 - CALCIUM
251055 - ..
251056 - Case study on 080626 shows these four tests, which have been omitted
251057 - and included in various combinations the past 4 cycles, where
251058 - consistently included for the prevous 15 cycles. ref SDS B7 HS8F
251059 -
251060 -
2511 -
SUBJECTS
Default Null Subject Account for Blank Record
2603 -
260401 - ..
260402 - Cancer Marker CA 15-3 95 Decreases Over 4 Weeks from 96
260403 -
260404 - Follow up ref SDS F6 VK6H, ref SDS D8 TR4K.
260405 -
260406 - Results of the blood test today for the cancer marker were delayed for
260407 - several days. Received a week later on 080925, ref SDS H2 VK6H, the
260408 - CA 15-3 decreased from 96 on 080821, ref SDS F6 A16M, to CA 15-3 95
260409 - today, per above. ref SDS 0 A16M
260411 - ..
260412 - This decline from CA 15-3 96 to 95 shows at least a pause from sharp
260413 - increase the previous cycle ending on 080821. ref SDS F6 VK6H This is
260414 - similar to the change that occurred for cycle 6, when there was a 1
260415 - point decline from 72 to 71. ref SDS D8 TR4K
260417 - ..
260418 - Improvement in the Cancer Marker and in blood counts that enable
260419 - robust chemotherapy treatment, per below, ref SDS 0 PU6K, support the
260420 - recommendation on 080829 by the primary care physician that Millie's
260421 - health will be good enough for the vacation planned on 081027,
260422 - reported to the medical team also on 080829. ref SDS G5 RP7Y Good
260423 - numbers for medical diagnostics relieve emotional trauma, discussed
260424 - with the medical team today. ref SDS H1 MM5N
260426 - ..
260427 - Case study on patient history for the cancer marker reported in the
260428 - record meeting with the medical team today, ref SDS H1 GP3M, shows...
260430 - ..
260431 - The test at Kaiser on 080708 shows CA 15-3 141, but the sepcimen was
260432 - slightly hemolyzed, ref SDS C3 L74K, which can affect the result.
260433 - ref SDS C3 05YW As noted, labs at UCSF a few weeks later on 080724
260434 - yielded CA 15-3 71. The new test today seems to suggest that results
260435 - on 080708 were not indicative of a trend toward severe rising cancer
260436 - that requires changing treatment. This allows more time to make a
260437 - careful review with 2nd opinion analysis of treatment options.
260439 - ..
260440 - Findings during examination on 080821 of swelling in the left
260441 - supraclavicular area may align with rising cancer marker. ref SDS F5
260442 - 4C6O Brigid's examination today a month later did not report
260443 - continuing swelling, which may account for stabilizing the cancer
260444 - marker today.
260446 - ..
260447 - Case study on 080821 of rising neutropenia showing Millie has missed
260448 - over 20%, i.e., 4 of 18, prescribed chemotherapy treatments due to low
260449 - blood counts, ref SDS F6 EP7N, may suggest that if Carboplatin
260450 - treatments can be regularized with Neupogen in combination with
260451 - exercise, then the current regimen can slow or reverse possible
260452 - progression of disease.
260453 -
260454 -
260455 -
260456 -
260457 -
260458 -
2605 -
SUBJECTS
Absolute Neutrophils Count ANC 6850 Above 1500 NEUTS 6.85 Above 1.5
3503 -
350401 - ..
350402 - NEUTS 2.07 Increase 1st Week Chemotherapy Received
350403 - Chemotherapy Received Blood Counts Rise Significantly
350404 - Blood Counts Rise Significantly Chemotherapy Carboplatin Received
350405 -
350406 - Follow up ref SDS G8 PU6K, ref SDS G6 PU6K.
350407 -
350408 - Blood counts increased this week, shown by the Lab report today with
350409 - NEUTS 2.01, ref SDS 0 QY6H, compared with NEUTS 1.43 last week on
350410 - 080911, ref SDS G8 QY6H This is well above UCSF standard of 1.5 for
350411 - Millie to safely get chemotherapy treatment. Since today is the 1st
350412 - week in the new cycle, Millie had 2 Neupogen treatments last week at
350413 - Kaiser according to the regular schedule on 080905. ref SDS G7 6E8N
350415 - ..
350416 - Neutropenia causes a "roller coaster" above and below specified target
350417 - from week to week, while getting Neupogen treatments in recent months,
350418 - is shown in case study below. ref SDS 0 OK67
350420 - ..
350421 - Patient history getting cetuximab and Carboplatin is listed above.
350422 - ref SDS 0 5B6J
350424 - ..
350425 - Side effects of Neupogen is listed below. ref SDS 0 SB8I
350427 - ..
350428 - Fitness from hiking is listed in case study on 080915. ref SDS G9 KO6F
350429 -
350430 -
350431 -
350432 -
3505 -
SUBJECTS
Default Null Subject Account for Blank Record
3603 -
360401 - ..
360402 - Neupogen Case Study Missed Carboplatin Treatments Low Blood Counts
360403 -
360404 - Follow up ref SDS G8 8O7I, ref SDS G6 8O7I.
360405 -
360406 - Case study on 060809 shows Millie has often received chemotherapy when
360407 - blood counts are below the standard for safe treatments, and on some
360408 - occassions has received Neupogen to increase blood counts. ref SDS 7
360409 - HV45
360411 - ..
360412 - Research on neutropenia was reported on 070301, ref SDS 17 O59H, when
360413 - Doctor Rugo was concerned about holding blood counts with weekly
360414 - Carboplatin treatments. ref SDS 17 VF6O
360416 - ..
360417 - Millie has received 32 Neupogen treatments, and missed 4 chemotherapy
360418 - treatments due to rising neutropenia. Millie's letter to the medical
360419 - team on 080307 asked about solving low blood counts. ref SDS 83 HS6R
360420 - On 080423 Millie notified the medical team to maintain a full dose of
360421 - Carboplatin because these treatments yielded favorable response.
360422 - ref SDS 93 TY6Y On 080501 a mixup in communication reduced the dose
360423 - of Carboplatin with the aim of not missing treatments. Adding
360424 - Neupogen to avoid missing treatments might have enabled maintaining
360425 - full dose of Carboplatin to increase recovery. ref SDS 97 CZ3N
360427 - ..
360428 - Fitness from hiking is listed in case study on 080915. ref SDS G9 KO6F
360430 - ..
360431 - Reduced treatment may relate to rising cancer marker CA 15-3 96 on
360432 - 080821. ref SDS F6 A16M Millie has received only 17 of 21 total
360433 - treatments prescribed with Carboplatin, since starting the 2nd arm of
360434 - the clinical study on 080306...
360436 - ..
360437 - Neupogen Carboplatin
360438 - Date NEUTS Cur Totl Cycl Trm Rcvd Missed
360439 -
360440 - 080918 2.07 2 32 8 1 17.......... ref SDS 0 QY6H
360441 - 080911 1.43 2 30 7 4 16.......... ref SDS G8 QY6H
360442 - 080904 1.99 2 28 7 3 16.......... ref SDS G6 QY6H
360443 - 080828 3.09 2 26 7 2 15.......... ref SDS G4 QY6H
360444 - 080821 0.99 2 24 7 1 14 4... ref SDS F6 QY6H
360445 - 080814 1.37 0 22 6 4 14.......... ref SDS F4 QY6H
360446 - 080807 2.41 2 22 6 3 14.......... ref SDS E8 QY6H
360447 - 080731 1.92 2 20 6 2 13.......... ref SDS E2 QY6H
360448 - 080724 2.32 2 18 6 1 12.......... ref SDS D8 QY6H
360449 - 080717 2.47 1 16 5 4 11.......... ref SDS D1 QY6H
360450 - 080710 5.12 2 15 5 3 11.......... ref SDS C5 QY6H
360451 - 080703 2.90 2 13 5 2 10.......... ref SDS C2 QY6H
360452 - 080626 1.80 2 11 5 1 09.......... ref SDS B7 QY6H
360453 - 080619 0.74 1 9 4 4 08.......... ref SDS B2 QY6H
360454 - 080612 3.77 2 8 4 3 08.......... ref SDS A9 QY6H
360455 - 080605 1.55 2 6 4 2 07.......... ref SDS A6 QY6H
360456 - 080529 2.26 1 4 4 1 06.......... ref SDS A5 QY6H
360457 - 080522 0.96 0 3 4 05.......... ref SDS A2 QY6H
360458 - 080515 1.21 0 3 3 05 3... ref SDS A1 QY6H
360459 - 080508 5.41 1 3 3 2 05.......... ref SDS A0 QY6H
360460 - 080501 1.34 1 2 3 1 04.......... ref SDS 98 QY6H
360461 - 080424 1.34 0 2 4 03.......... ref SDS 95 QY6H
360462 - ..
360463 - 080417 0.95 0 2 3 03 2... ref SDS 92 QY6H
360464 - 080410 6.85 0 2 2 03.......... ref SDS 90 QY6H
360465 - 080403 1.34 1 1 2 1 02.......... ref SDS 87 QY6H
360466 - 080327 2.30 0 1 4 01.......... ref SDS 86 QY6H
360467 - 080320 1.28 0 1 3 01 1... ref SDS 85 QY6H
360468 - 080313 2.05 0 1 2 01.......... ref SDS 84 QY6H
360469 - 080306 1.75 0 1 1 00.......... ref SDS 82 QY6H
360470 -
360471 -
3605 -
SUBJECTS
Default Null Subject Account for Blank Record
3703 -
370401 - ..
370402 - Side Effects Neupogen Treatments Continue Mild Tolerance Acceptable
370403 -
370404 - Follow up ref SDS G8 SB8I, ref SDS G6 SB8I.
370405 -
370406 - Fitness from hiking is listed in case study on 080915. ref SDS G9 KO6F
370407 -
370408 - Side effects of Neupogen may be lessening, reported on...
370409 -
370410 - 080915................, ref SDS G9 9W9I
370411 - 080810................, ref SDS F2 9W9I
370412 - 080803................, ref SDS E3 9W9I
370413 - 080726................, ref SDS E0 9W9I
370414 - 080721................, ref SDS D5 9W9I
370415 - 080713................, ref SDS C8 RM94
370416 - 080629................, ref SDS C1 6Q5J
370417 - 080628................, ref SDS B9 6Q5J
370418 -
370419 - ...suggesting increased ability to tolerate 2 Neupogen treatments per
370420 - week.
370421 -
370422 -
370423 -
3705 -
SUBJECTS
Default Null Subject Account for Blank Record
5203 -
520401 - ..
520402 - Coagulation Control INR 2.1 Normal Stable PT 26.2 High
520403 -
520404 - Follow up ref SDS F6 K66J, ref SDS D8 K66J.
520405 -
520406 - The labs today show INR 2.1 at the low end of the scale, but still
520407 - continuing within the prescribed range. ref SDS 0 PU7Y
520409 - ..
520410 - On 080827 Millie reported INR results for the blood test on 080821 in
520411 - a letter to Gloria at Kaiser Coagulation Control Clinic in Martinez,
520412 - CA. ref SDS G0 504R Later that day on 080827, Kaiser notified Millie
520413 - that the report on INR was received, and advised Millie to continue
520414 - the same regimen for Coumadin to treat pulmonary embolism. ref SDS G3
520415 - VD7O
520417 - ..
520418 - [On 081015 Millie received a letter from Kaiser dated 081009
520419 - notifying that results of the blood test at UCSF today have not
520420 - been received, ref SDS H3 BB66; review shows the volume of work
520421 - during this period prevented submitting the report on INR to
520422 - Kaiser. ref SDS H3 S99J
520423 -
520424 -
520425 -
520426 -
520427 -
5205 -
SUBJECTS
Default Null Subject Account for Blank Record
5303 -
530401 - ..
530402 - Cetuximab Chemotherapy Order for 7th Cycle
530403 -
530404 - Follow up ref SDS F6 MM6N, ref SDS D8 MM6N.
530405 -
530406 - Chemotherapy Orders for cetuximab were not submitted today, because
530407 - the Chemotherapy Orders on 080821 are specified for 8 weeks.
530408 - ref SDS F6 YS86
530409 -
530410 -
530411 -
530412 -
530413 -
530414 -
5305 -
SUBJECTS
Default Null Subject Account for Blank Record
5403 -
540401 - ..
540402 - Carboplatin Chemotherapy Orders
540403 -
540404 - Follow up ref SDS F6 N54I, ref SDS D8 N54I.
540406 - ..
540407 - No evident difference between chemotherapy orders today and for last
540408 - month starting cycle 7 on 080821. ref SDS F6 N54I
540410 - ..
540416 - Auth# Stor BCC LOC
540417 - Visit: 14991467 DOS 20080918
540419 - ..
540420 - Date: 20080918
540422 - ..
540423 - Study Order for CC#05752: Phase II Trial of Cetuximab alone and
540424 - in combination with Carboplatin in ER-negative, PR-negative,
540425 - HER2-negative Nonoverexpressing Metastatic Breast Cancers.
540427 - ..
540428 - Arm: 2 - Cetuximab + Carboplatin
540430 - ..
540431 - Error Dates Treatment Should Include 3 Days
540432 -
540433 - Follow up ref SDS F6 PVQX.
540434 -
540435 - Dates to be given: 20080918
540436 - 20080925 *** omitted error ***, ref SDS 0 PN6F
540437 - 20081002 *** omitted error ***
540439 - ..
540440 - This may not be a real error, but just a different way of entering the
540441 - order by specifying the first day of treatment, and the next section
540442 - for "Days" to set subject dates. ref SDS 0 PVTP
540444 - ..
540445 - Chemotherapy Order Carboplatin continues...
540446 -
540447 - Allergies: NKDA
540449 - ..
540450 - Height: 62 inches
540452 - ..
540453 - Weight: 139 pounds
540455 - ..
540456 - There is handwriting that says...
540457 -
540458 - not 10% dose [delta symbol = "change"]
540460 - ..
540461 - Brigid prepared the Chemotherapy Order today during the meeting on
540462 - the 2nd floor with the medical team. She noted everything today is
540463 - the same except the weight is 139 rather than 140.
540465 - ..
540466 - She recalled that the clinical trial protocol says weight is only a
540467 - factor if there is a 10% change. In this case, the change of 1 pound
540468 - from 140 to 139 is less than 1%, and so should not require changing
540469 - the dose of Carboplatin.
540471 - ..
540472 - Brigid asked Jill to check the record during the meeting and
540473 - authenticate discussion about a 10% criteria for changing treatment
540474 - dose. Jill looked through Millie's medical chart. She could not find
540475 - authority for the 10% criteria. Brigid decided not to rely on
540476 - personal memory of a 10% criteria, and so did not change the dose, per
540477 - below. ref SDS 0 PVUQ
540479 - ..
540480 - Chemotherapy Order Carboplatin continues...
540481 -
540482 - Diagnosis: Metastatic breast cancer (IBC)
540484 - ..
540485 - ICD-9 codes: 174.9, 198.2
540487 - ..
540488 - This ICD-9 codes section conflicts with assignments in Chemotherapy
540489 - Order for the past 2 months (cycles)...
540490 -
540491 - 080821.....174.9, 198.5, 198.3, 196.2... ref SDS F6 PVSS
540492 - 080724.....174.9, 198.5, 196.2 ......... ref SDS D8 PVSS
540493 -
540494 - ...and is the same as cycle 5...
540495 -
540496 - 080626.....174.9, 198.2................. ref SDS B7 PVSS
540498 - ..
540499 - Chemotherapy Order Carboplatin continues...
540500 -
540501 - Cycle: 8
540503 - ..
540504 - Days: 1, 8, 15 (arm 2)
540506 - ..
540507 - This conflicts or complements with "Dates to be given" section shown
540508 - above. ref SDS 0 PVQX
540510 - ..
540511 - Chemotherapy Order Carboplatin continues...
540513 - ..
540514 - Antimetics:
540515 -
540516 - Follow up ref SDS F6 PVTT, ref SDS D8 PVTT.
540517 -
540518 - x Dexamethasone 10 mg IV (Decadron)
540519 - x Ondansetron 8 mg IV (Zofran)
540520 -
540522 - ..
540523 - Chemotherapy (plan to treat weekly for 3 out of 4 weeks).
540524 - Carboplatin Dose Reduced May Aid Blood Counts Maintain Treatments
540525 -
540526 - Follow up ref SDS F6 PVUQ, ref SDS D8 PVUQ.
540527 -
540528 - May administer Carboplatin if vital signs are unremarkable one
540529 - hour after cetuximab infusion..
540530 -
540531 - ** Please note start and stop times **
540533 - ..
540534 - Carboplatin (commercial supply) AUC 1.5 = 175 mg in D5W 250 ml
540536 - ..
540537 - Chemo orders today seem to show the same dose specified for cycle 4
540538 - started on 080529 and marked "error," ref SDS A5 PVUQ, reviewed on
540539 - 080626. ref SDS B6 2X5L At that time, the medical chart was
540540 - confusing, because Brigid could not find the Chemotherapy Order for
540541 - 080529 marked "error." ref SDS B6 RF4J UCSF planned to investigate
540542 - the error in the Chemotherapy Order. ref SDS B6 RF53
540544 - ..
540545 - On 080403 cycle 2 showed weight increase of 1 pound, less than 1% of
540546 - 139 pounds recorded for cycle 1 on 080313, and resulted in increasing
540547 - dose about 10%.
540549 - ..
540550 - Since Millie's weight decreased 1 pound from the prior cycle of 140
540551 - pounds to 139 pounds today, per above, ref SDS 0 PVRW, then comparable
540552 - analysis should reduce the dose today from 175 to about 150 mg.
540554 - ..
540555 - Chemotherapy Orders continue...
540556 -
540557 - IV over 30 minutes weekly x 3 doses followed by 1 week rest.
540559 - ..
540560 - [hand writting...]
540561 -
540562 - Carbo dose to remain the same unless CR > 1.3
540564 - ..
540565 - [...where CR = "Creatinine"]
540566 -
540567 - Carboplatin dose in mg = (desired AUC)(GFR+25)
540568 -
540569 - GFR (estimated) =
540570 -
540571 - (140-age in years)(weight in kg)(for females x 0.85)
540572 - ----------------------------------------------------
540573 - (Cr in mg/dL)(72)
540575 - ..
540576 - Unlike previous Chemotherapy Orders issued on 080403 which showed
540577 - handwritten values in the dosage formula, ref SDS 87 NV9H, there is
540578 - no similar handwriting on the Chemotherapy Orders received today from
540579 - UCSF.
540581 - ..
540582 - Chemotherapy Orders continues...
540584 - ..
540585 - Laboratory Work:
540586 -
540587 - Follow up ref SDS F6 PWPW, ref SDS D8 PWPW.
540588 -
540589 - x CBC with differential and platelets
540590 - x Creatinine, magnesium every 4 weeks
540591 - x BUN, AST, Alk phos, Alt, Total bilirubin, eletrolytes every 8 weeks
540593 - ..
540594 - Before meeting with the medical team this morning, Millie got a blood
540595 - draw in the Infusion Clinic, per above, ref SDS 0 439L, as planned in
540596 - Millie's letter to UCSF yesterday on 080917 submitting an agenda for
540597 - meeting with the medical team. ref SDS H0 SG6T
540599 - ..
540600 - Chemotherapy Orders continues...
540601 -
540602 - If ANC >= 1.5 x 1000/L, platelets >= 75 x 1000/L give 100% of dose
540604 - ..
540605 - If ANC < 1.5 x 1000/L, platelets < 75 x 1000/L....
540606 -
540609 - ..
540610 - x See cetuximab orders.
540612 - ..
540613 - The section checked to see cetuximab orders refers to the Chemotherapy
540614 - Order for cetuximab, per above. ref SDS F6 MM6N
540616 - ..
540617 - Chemotherapy Orders continue...
540618 -
540619 - Study tubes
540621 - ..
540622 - The "Study tubes" section today is not checked and is blank; however,
540623 - this morning Catherine reported that Jill or Megan, the new Clinical
540624 - Study Coordinator, delivered the 7 vials to the Infusion Clinic, per
540625 - above, ref SDS 0 LO4G, required for the trial protocol, and requested
540626 - in Millie's letter to the medical team this morning. ref SDS F5 6Y5K
540628 - ..
540629 - On 080724, the section on "Study tubes" was filled out, but showed
540630 - only three (3) study tubes were delivered. ref SDS D8 QD7H
540632 - ..
540633 - Chemotherapy Orders continue...
540635 - ..
540636 - Neupogen Prescribed in Chemotherapy Orders
540637 -
540638 - Follow up ref SDS F6 PWSY, ref SDS B6 PWSY.
540639 -
540640 - During the meeting with the medical team on the 2nd floor at 0800 this
540641 - morning, the doctor ordered continuing for the 8th cycle starting
540642 - today the same prescription issued for the 4th cycle shown in the
540643 - record on 080529, ref SDS A5 PWSY The Chemotherapy Orders for today
540644 - shows in handwriting...
540645 -
540646 - Neupogen 480 mcg SQ on D2 3
540648 - ..
540649 - This reflects handwritten prescription in the Chemotherapy Order for
540650 - Carboplatin received on 080821. ref SDS F6 PWSY
540652 - ..
540653 - Further reflects instructions that Neupogen is only given on the 3
540654 - days in the cycle when Millie gets Carboplatin, and so is skipped for
540655 - the 4th treatment in the cycle when Millie gets only cetuximab.
540657 - ..
540658 - Last month, this prescription failed. reported on 080821. ref SDS F5
540659 - HR6M The doctor therefore approved getting Neupogen for all four
540660 - weeks of the cycle, rather only on the 3 days getting Carboplatin.
540661 - ref SDS F5 ON5M
540663 - ..
540664 - On 080609 Zan in the Kaiser Oncology Pharmacy set up an account for
540665 - Millie to get Neupogen treatments in the Kaiser Infusion Clinic based
540666 - on Chemotherapy Orders showing the UCSF prescription. At that time,
540667 - Zan used the Chemotherapy Orders for 080529 which show a prescritpion
540668 - for 2 Neupogen treatments per week. ref SDS A8 L16I
540670 - ..
540671 - Brigid indicated today during the meeting with the medical team that
540672 - Neupogen on the bye week could be reduced to just 1 treatment, if
540673 - NEUTS seem high enough. The handwritten prescription reflects this
540674 - flexibility by omitting the 2nd criteria of only 3 treatments.
540675 - ref SDS 0 PWSY
540677 - ..
540678 - Chemotherapy Orders continue...
540680 - ..
540681 - x Physician has discussed risks/benefits of chemotherapy with the
540682 - patient. Consent, form obtained.
540683 -
540684 - x Yes O2 [oxygyn] by nasal cannula at 2 liters/min prn for chest pain or SOB
540686 - ..
540687 - x Yes Diphenhydramine 50 mg IV prn x 1 unticaria pruntis, SOB
540688 - (this is Benadryl)
540690 - ..
540691 - x Yes Hydrocrotisone 100 mg IV prn x 1 unticaria pruntis, SOB
540693 - ..
540694 - x Yes Aubterol inhaler 2 - 4 puffs prn SOB or chest tightness
540696 - ..
540697 - x Yes Epnephnna nhaler 2 - 4 puffs prn SOB or chest tightness
540699 - ..
540700 - Physician Signature
540701 -
540704 - Date: 080917
540706 - ..
540707 - Nurse Signature:
540708 -
540711 - Date: 080917
540713 - ..
540714 - No nurses signature is shown in the copy received from UCSF; may have
540715 - been entered and filed in UCSF records later.
540716 -
540717 -
540718 -
540719 -
540720 -
540721 -
540722 -
540723 -
5408 -