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: October 12, 2008 10:16 AM Sunday;
Rod Welch
Millie hiking at Lafayette reservoir erratic pulse again.
1...Summary/Objective
2...Exercise Hiking Maintain Fitness Strengthen Immune System
3...Pulse Elevated 60% Near 200 2 Laps Returned to Normal Third Lap
..............
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
2203 -
2203 - ..
2204 - Summary/Objective
2205 -
220501 - Follow up ref SDS 92 0000, ref SDS 88 0000.
220502 -
220503 -
220504 -
220506 - ..
2206 -
2207 -
2208 - Progress
2209 -
220901 - Exercise Hiking Maintain Fitness Strengthen Immune System
220902 - Pulse Elevated 60% Near 200 2 Laps Returned to Normal Third Lap
220903 -
220904 - Follow up ref SDS 95 3E4K, ref SDS 94 3E4K.
220905 -
220906 - Millie went hiking at Lafayette reservoir and did 3 laps, about 8.25
220907 - miles. Time was pretty good, 146.4 minutes.
220909 - ..
220910 - Research on Neupogen side effects was reported on 080629. ref SDS 42
220911 - RQ9I Case study on Neupogen side effects listed on 081011.
220912 - ref SDS 95 SB8I
220914 - ..
220915 - Side effects reported yesterday on 081011 of bone pain and headaches
220916 - have dissipated today. ref SDS 95 FL4H
220918 - ..
220919 - Pulse spiked significantly for the first 2 laps. Millie reported
220920 - pulse was 202 just starting out. Normally, this would be 55 - 70, and
220921 - going up to 85 hiking for .25 miles on flat terrain. Kept close watch
220922 - with observations about every 5 minutes, mostly climbing hills, and
220923 - checking to see the pulse drop normally with decline of effort.
220924 -
220925 - [On 081013 next day pulse was normal, averaging 115, and
220926 - maximum was 138 despite increased speed compared with today.
220927 - ref SDS 96 3E4K
220929 - ..
220930 - First lap was slow about 50 minutes, compared to 46 - 47 minutes
220931 - normally, and in order to closely monitor for adverse effects of
220932 - exercising at elevated pulse.
220933 -
220934 - [On 081016 INR 4.2 increases above target range on UCSF blood
220935 - test. ref SDS 97 5260
220937 - ..
220938 - [On 081016 notified Gloria at Kaiser Coagulation Control Clinic
220939 - in Martinez, that did not take Coumadin. ref SDS 98 J37J
220941 - ..
220942 - [On 081019 Millie notified Gloria that Coumadin treatment
220943 - was resumed the next day on Friday, 081017. ref SDS 99 TH7T
220945 - ..
220946 - [On 081105 primary care physician orders Muga test for heart
220947 - damage prior to starting sunitinib clinical study that has some
220948 - heart related side effects. ref SDS 90 WO72
220950 - ..
220951 - Millie's normal pulse on this hike is about 115, even when the pace is
220952 - at 45 minutes for a lap. It can elevate to 135 - 145, when running up
220953 - a hill, and can drop to below 100 on flat sections, and going slow.
220955 - ..
220956 - Today, on the first 2 laps the pulse averaged about 180. It got to
220957 - 224 once, and was over 200 on 5 - 10 occassions. It might have
220958 - dropped into the 120s maybe once or twice. Curiously, it went up
220959 - after climbing a hill, and starting down the other side, or on flat
220960 - tereain, whereas normally pulse rises while going up hill, and then
220961 - drops quickly. Today, Millie experience very unusual big increases
220962 - and decreases in pulse that seemed unrelated to climing hills.
220964 - ..
220965 - There was concern the equipment might not be reporting accurately.
220966 - The patient assistant used the equipment for about half a mile, and it
220967 - reported consistent with past history.
220969 - ..
220970 - Naturally, there was concern about consequences of vigorous exercise
220971 - with reports of elevated pulse in relation to patient history of
220972 - pulmnary embolism, and recently findings on 080723 of Interstitional
220973 - lung disease from the CT test on 080718, ref SDS 54 TS4J, and which
220974 - occurs from side effects of cetuximab treatments. ref SDS 54 PF5H
220976 - ..
220977 - Today, Millie did not report any symptoms. No dizziness, weakness, no
220978 - difficulty breathing, no increased perspiration, nothing that signaled
220979 - increase stress cardio-pulmonary activity, except elevated pulse.
220980 - Diet has been normal: soup, fish, rice, broccoli, spinich, asparagas,
220981 - tomatoes, eggs, pancakes - normal. She had a glass of wine the day
220982 - before with dinner.
220984 - ..
220985 - Decided to try a 3rd lap. On this lap the pulse returned to normal
220986 - averaging about 118 even while hiking faster. Maximum on 2 occassions
220987 - during the 3rd lap was 136, and these occurred as expected while
220988 - climbing the most difficult hills. Pulse dropped into the 120s and
220989 - then to between 110 - 119 after starting down the other side, and on
220990 - flat terrain.
220992 - ..
220993 - Millie reported today that she has experienced additional pulse spikes
220994 - the past several weeks, but none lasted for even one lap, and most
220995 - returned to normal after a few minutes, similar to the report several
220996 - months ago on 080507. ref SDS 29 PQ5L Occassional elevated pulse was
220997 - reported to the medical team in a letter on 080520. ref SDS 31 TV7P
220998 - This was reported again to the medical team in a follow up letter on
220999 - 080528. ref SDS 33 IK5P Due to a change in personnel, and difficult
221000 - coordination that impeded communication elevated pulse was not
221001 - discussed with the medical team during the meeting at UCSF on 080529.
221002 - ref SDS 34 4F53 Similarly, during the meeting at Kaiser on 080627 the
221003 - doctor did not have time to discuss the spike in pulse that occurred
221004 - on 080507. ref SDS 40 J54I On 080829 the doctor did not have time to
221005 - review Millie's report on 080507 of spike in pulse. ref SDS 70 J54I
221006 - At that time, on 080829 Millie notified the medical team about
221007 - increased exercise, and that there have been no further episodes of
221008 - elevated pulse since the report on 080507.
221010 - ..
221011 - Elevated pulse is listed in the medical chart for the meeting at
221012 - Kaiser on 080829. ref SDS 70 2W4I
221014 - ..
221015 - Hiking was interrupted last week with side effects of chemotherapy and
221016 - Neupogen treatments, going out only 3 days. This week hiking was
221017 - interrupted yesterday with a social event.
221018 -
221019 - +- c = Carboplatin
221020 - +- e = Erbatex cetuximab
221021 - Time Pulse |
221022 - Location Miles Minutes Avg Max Chem Neupo Date
221023 - ----------------------------------------------------------------
221024 - Lafayette 8.25 146.4 180 224 081012, ref SDS 0 3E4K
221025 - Kaiser x 081011, ref SDS 95 3E4K
221026 - Lafayette 5.50 93.3 116 138 x 081010, ref SDS 94 3E4K
221027 - UCSF e 081009, ref SDS 93 V94O
221028 - Lafayette 5.50 92.1 113 137 081006, ref SDS 92 3E4K
221029 - Lafayette 2.75 48.5 110 136 x 081004, ref SDS 91 3E4K
221030 - Lafayette 5.50 98.2 117 136 x 081003, ref SDS 90 3E4K
221031 - UCSF c 081002, ref SDS 89 V94O
221032 - Lafayette 5.50 94.7 115 142 080929, ref SDS 88 3E4K
221033 - Lafayette 8.25 150.4 115 135 080928, ref SDS 88 3E4K
221034 - Kaiser x 080927, ref SDS 87 UZ7K
221035 - Lafayette 5.50 90.2 120 140 x 080926, ref SDS 86 3E4K
221036 - UCSF c 080925, ref SDS 85 V94O
221037 - Lafayette 5.50 92.3 116 138 080923, ref SDS 84 3E4K
221038 - Lafayette 5.50 98.4 112 134 080922, ref SDS 84 3E4K
221039 - Lafayette 5.50 98.2 114 137 080921, ref SDS 84 3E4K
221040 - Lafayette 5.50 101.6 110 133 x 080920, ref SDS 83 3E4K
221041 - Lafayette 5.50 89.3 115 144 x 080919, ref SDS 82 3E4K
221042 - UCSF c 080918, ref SDS 81 V94O
221043 - Lafayette 2.75 46.2 117 139 080916, ref SDS 82 3E4K
221044 - Lafayette 5.50 91.8 117 142 080915, ref SDS 80 3E4K
221045 - Clayton Safeway 3.00 62.4 98 118 080914, ref SDS 79 3E4K
221046 - Lafayette 8.25 129.7 123 147 x 080913, ref SDS 78 3E4K
221047 - Lafayette 5.50 88.4 118 146 x 080912, ref SDS 77 3E4K
221048 - UCSF c 080911, ref SDS 76 V94O
221049 - Lafayette 2.75 46.8 113 140 080909
221050 - Lafayette 5.50 89.2 117 143 080908
221051 - Lafayette 5.50 92.1 115 138 080907
221052 - Lafayette 2.75 45.3 120 144 x 080906, ref SDS 75 3E4K
221053 - Lafayette 2.75 56.8 93 120 x 080905, ref SDS 74 3E4K
221054 - UCSF c 080904, ref SDS 73 V94O
221055 - Lafayette 8.25 140.4 116 131 080903
221056 - Lafayette 5.50 94.9 115 134 080902
221057 - Kaiser x 080830
221058 - Kaiser x 080829
221059 - UCSF c 080828, ref SDS 69 V94O
221060 - Lafayette 5.50 93.6 120 137 080826
221061 - Lafayette 5.50 93.2 117 138 080825
221062 - Lafayette 5.50 93.2 123 136 x 080823
221063 - Lafayette 8.25 142.5 110 131 x 080822, ref SDS 67 3E4K
221064 - UCSF e 080821, ref SDS 66 V94O
221065 - Lafayette 5.50 94.7 115 137 080820
221066 - Lafayette 5.50 94.3 115 135 080819
221067 - Lafayette 8.25 141.7 118 134 080815
221068 - UCSF e 080814, ref SDS 64 V94O
221069 - Lafayette 5.50 93.8 120 136 080813
221070 - Lafayette 5.50 94.4 116 139 080812
221071 - Lafayette 5.50 94.2 119 133 080810
221072 - Lafayette 8.25 143.6 114 132 x 080809, ref SDS 62 3E4K
221073 - Lafayette 8.25 141.1 117 135 x 080808, ref SDS 61 3E4K
221074 - UCSF c 080807, ref SDS 60 V94O
221075 - Lafayette 8.25 143.7 115 132 080805
221076 - Concord 7.00 127.6 105 118 080804
221077 - Lafayette 8.25 143.2 112 134 080802
221078 - Lafayette 5.50 93.4 115 138 080801
221079 - Lafayette 5.50 92.2 118 140 080729
221080 - Lafayette 5.50 92.6 116 137 080728
221081 - Lafayette 8.25 142.6 114 134 080727
221082 - Lafayette 5.50 91.5 120 143 080726
221083 - Lafayette 8.25 140.8 117 135 080725
221084 - Lafayette 5.50 91.8 122 141 080723
221085 - Lafayette 5.50 91.3 120 139 080722
221086 - Lafayette 8.25 143.3 115 133 080720
221087 - Lafayette 5.50 90.7 125 144 080719
221088 - Lafayette 5.50 92.4 123 142 080716
221089 - Lafayette 2.25 46.8 116 137 080715
221090 - Lafayette 8.25 141.8 116 136 080712
221091 - Lafayette 5.50 92.9 116 139 080711
221092 - Lafayette 8.25 143.3 113 137 080704
221093 - Lafayette 5.50 90.2 121 147 080630
221094 - Lafayette 8.25 142.4 116 138 080628
221095 - Lafayette 5.50 91.4 118 138 080625
221096 - Lafayette 2.25 47.9 116 136 080623
221097 - Lafayette 5.50 94.2 112 138 080622
221098 - Lafayette 5.50 94.7 115 133 080621
221099 - Lafayette 2.25 48.3 110 129 080620
221100 - Mt Diablo 7.00 129.4 130 153 080616
221101 - Lafayette 5.50 90.8 120 146 080615
221102 - Lafayette 5.50 91.3 124 144 080614
221103 - Lafayette 5.50 89.7 122 143 080613
221104 - Lafayette 2.76 45.8 120 147 080611
221105 - Lafayette 5.50 90.5 123 145 080609
221106 - Lafayette 5.50 92.7 115 138 080607
221107 - Lafayette 5.50 94.2 118 139 080602
221108 - Lafayette 5.50 96.2 110 202 080507, ref SDS 29 WO8M
221109 -
221110 -
221111 -
221112 -
221113 -
221114 -
2212 -