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: November 21, 2008 07:00 AM Friday; Rod Welch

Millie sunitinib #8 IBC 5th relapse hiking6 miles.

1...Summary/Objective
........Patient History Sunitinib Loading Dose 14 Days
2...Side Effects Sunitinib Study
3...Exercise Hiking Maintain Fitness Strengthen Immune System
4...Case Study on Pateint History Exercising
5...Side Effects Neupogen Treatments Increase May Be Chemotherapy


..............
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CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 72 0000. ref SDS 71 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On 081113 Millie received sunitinib drugs from UCSF to treat the 5th
040902 - relapse of IBC.
040904 -  ..
040905 - Millie began the 14 day "charging" treatment on 081114. ref SDS 63
040906 - EK7I After 14 treatments, if Millie tolerates sunitinib at the
040907 - prescribed dose, then she begins adding 2 chemotherapy drugs once a
040908 - day for 2 days a week as prescribed in the treatment protocol,
040909 - reviewed on 081017. ref SDS 49 004O
040911 -  ..
040912 - After a week of 8 treatments, including today, ref SDS 0 PA8Y, there
040913 - is no evident response to treatment.  IBC rash seems more intense on
040914 - the lower left abodmen, i.e., filling in previously scattered patches,
040915 - and is wrapping more toward the back.  Previously, after starting
040916 - cetuximab on 070201, a month later on 070301 there was similar concern
040917 - about advancing disease, because IBC occurred for the first time on
040918 - the left arm. ref SDS 1 4140  At that time, the doctor scheduled an
040919 - emergency meeting on 070308 to evaluate CA 15-3 and decide on adding
040920 - Carboplatin. ref SDS 1 Q57O  A week later CA 15-3 had declined
040921 - substantially, and so the meeting scheduled for 070308 was cancelled,
040922 - because Millie continued with cetuximab alone. ref SDS 2 FO6H
040924 -  ..
040925 - A difference between the March 2007 scenario, and today is that on
040926 - 070301, despite spread of IBC to the left arm, IBC elsewhere seemed to
040927 - be subsiding in intensity, creating mixed signals on response to
040928 - treatment. ref SDS 1 Q76L   Today, there is marked increased intensity
040929 - of IBC, and no recent CA 15-3 testing to cross-check analysis.
040931 -  ..
040932 - Millie sent a letter to the medical team today on initial response to
040933 - treatment, citing mild side effects, and reminded about coordinating
040934 - the prescription at UCSF for Kaiser to order chemo drugs needed to
040935 - start the full regimen after 081128. ref SDS 72 ID7I
040936 -
040938 -         ..
040939 -        Patient History Sunitinib Loading Dose 14 Days
040940 -
040941 -        Follow up ref SDS 72 OE6K, ref SDS 71 OE6K.
040942 -
040944 -        Cycle 1
040945 -        Cohort: 3
040947 -   ..
040948 -                             Sunitinib MG      Cyclophos    Metho
040949 -                         Amount  Today   Cum    phamide     trexate
040950 -  Days  Date  Time Cycle 25 12.5 Total  Total   Amnt Total Amnt Total
040951 -  --------------------------------------------------------------------
040952 -  Follow up ref SDS 72 PA8Y, ref SDS 71 PA8Y.
040953 -
040954 -    1.  081114 0700   1   1   1  37.5    37.5    0     0    0     0 ..... ref SDS 61 OE6K
040955 -    2.  081115 0700   1   1   1  37.5    75.0    0     0    0     0 ..... ref SDS 62 OE6K
040956 -    3.  081116 0700   1   1   1  37.5   112.5    0     0    0     0 ..... ref SDS 63 OE6K
040957 -    4.  081117 0700   1   1   1  37.5   150.0    0     0    0     0 ..... ref SDS 64 OE6K
040958 -    5.  081118 0700   1   1   1  37.5   187.5    0     0    0     0 ..... ref SDS 67 OE6K
040959 -    6.  081119 0700   1   1   1  37.5   225.0    0     0    0     0 ..... ref SDS 69 OE6K
040960 -    7.  081120 0700   1   1   1  37.5   263.5    0     0    0     0 ..... ref SDS 70 OE6K
040961 -    8.  081121 0700   1   1   1  37.5   301.0    0     0    0     0 ..... ref SDS 0 OE6K
040962 -
040963 -
040964 -
040965 -
040966 -
040967 -
0410 -

SUBJECTS
Default Null Subject Account for Blank Record

0503 -
050401 -  ..
050402 - Side Effects Sunitinib Study
050403 -
050404 - Follow up ref SDS 72 LF8M, ref SDS 71 LF8M.
050405 -
050406 - Sunitinib side effects are listed in the study Consent document,
050407 - reviewed on 081017. ref SDS 49 4G7G
050409 -  ..
050410 - Today, Millie reports minor joint pain, ref SDS 49 U18H, and fatigue,
050411 - side effects listed for sunitinib on 081017. ref SDS 49 4G7G
050413 -  ..
050414 - Millie's record of exercising shows correlation between treatments and
050415 - exercise that indicates mild effects so far. ref SDS 0 X64F  She plans
050416 - continued hiking to work through side effects.
050418 -  ..
050419 - Mil feels blood pressure 144 84 and pulse 48 this morning, may reflect
050420 - sunitinib side effects of high blood pressure, also listed on 081017.
050421 - ref SDS 49 C78M  Yesterday, there was evident marked decrease in pulse
050422 - while hiking. ref SDS 72 7G8M   This occurred again today, showing
050423 - generally a 30 point drop in patient profile for pulse while hiking.
050424 - ref SDS 0 X64F
050425 -
050426 -            [On 081122 possible body system correction with blood
050427 -            pressure rising. ref SDS 73 3E4K
050429 -             ..
050430 -            [On 081122 followed up. ref SDS 73 499N
050432 -  ..
050433 - Millie also has side effects from Neupogen; but nothing for several
050434 - weeks since she stopped treatments pending evaluation with new
050435 - sunitinib treatments, reported today. ref SDS 72 XQ4L
050437 -     ..
050438 -                                   Date
050439 -    Description Adverse Event   Start  Stop     Medication
050440 -    ---------------------------------------------------------
050441 -    Follow up ref SDS 72 LF8M, ref SDS 71 LF8M.
050442 -
050443 -    Diarea                      081114 081114   Imodium........ ref SDS 63 LF8M
050444 -    Low pulse                   081120 081120   None........... ref SDS 72 LF8M
050445 -    Low pulse                   081121 081121   None........... ref SDS 0 7G8M
050446 -    BP 144 84 Pules 48          081121 081121   Hiking......... ref SDS 0 LF8M
050447 -    Joint pain minor            081121 081121   Hiking......... ref SDS 0 LF8M
050448 -    Fatigue minor               081121 081121   Hiking......... ref SDS 0 LF8M
050449 -
050450 -
050451 -
050452 -
050453 -
050454 -
0505 -

SUBJECTS
Default Null Subject Account for Blank Record

0603 -
060401 -  ..
060402 - Exercise Hiking Maintain Fitness Strengthen Immune System
060403 -
060404 - Follow up ref SDS 72 3E4K, ref SDS 71 3E4K.
060405 -
060406 - Millie went hiking at Lafayette reservoir, and did 2 laps about 5.5
060407 - miles in 94.7 minutes, which is a good time for her without running.
060408 - ref SDS 72 X64F
060410 -  ..
060411 - Millie has not had another attack of Cellulitis and lymphedema since
060412 - going to the emergency care unit on 080409. ref SDS 4 0001  There was
060413 - a slight flare up on 080520. ref SDS 6 OU5J
060415 -  ..
060416 - Millie had her 8th treatment with sunitinib this morning at 0700.
060417 - ref SDS 0 PA8Y
060419 -  ..
060420 - This morning Millie feels well rested; she slept well.
060422 -  ..
060423 - On 081110, Millie complained about diffiuclty lifting herself from a
060424 - full squatting position. ref SDS 61 HX67  She has since been
060425 - exercising to strengthen her legs, and arms.
060427 -  ..
060428 - This morning Millie did...
060429 -
060430 -        Arm presses 3 sets of 10 leaning against bannister.
060431 -        Squats 3 sets of 10 vary depth useing bannister for leverage
060433 -  ..
060434 - There have been no indications of Cellulitis nor lymphedema that has
060435 - occurred previously with exercising the left arm, reported on 070607.
060436 - ref SDS 3 ZH6I
060437 -
060439 -  ..
060440 - Case Study on Pateint History Exercising
060441 -
060442 - Follow up ref SDS 72 X64F, ref SDS 71 X64F.
060443 -
060444 -                                          +- s = Sunitinib
060445 -                                          +- c = Carboplatin
060446 -                                          +- e = Erbatex cetuximab
060447 -                           Time     Pulse |
060448 -    Location        Miles Minutes  Avg Max  Chem Neupo  Date
060449 -    ----------------------------------------------------------------
060450 -    Lafayette        5.50   94.4    85 112    s         081121, ref SDS 0 3E4K
060451 -    Lafayette        5.50   94.7    90 122    s         081120, ref SDS 72 3E4K
060452 -    San Francisco    1.00   60.0    65  75    s         081119, ref SDS 71 3E4K
060453 -    Lafayette        2.75   49.2    97 130    s         081118, ref SDS 70 3E4K
060454 -    Lafayette        5.50   93.6   115 138    s         081117, ref SDS 67 3E4K
060455 -    Concord home                              s         081116, ref SDS 65 Y68J
060456 -    Concord home                              s         081115, ref SDS 64 EK7I
060457 -    Concord home                              s         081114, ref SDS 63 XW6H
060458 -    Lafayette        5.50   94.2   115 138              081110, ref SDS 61 3E4K
060459 -    Lafayette        2.75   48.4   105 128              081109, ref SDS 60 3E4K
060460 -    Kaiser                                         x    081108, ref SDS 59 UZ7K
060461 -    Kaiser                                         x    081107, ref SDS 58 UZ7K
060462 -    Lafayette        5.50   90.2   120 143              081025, ref SDS 56 3E4K
060463 -    Kaiser                                         x    081025, ref SDS 56 UZ7K
060464 -    Kaiser                                         x    081024, ref SDS 55 UZ7K
060465 -    UCSF                                     c          081023, ref SDS 54 V94O
060466 -    Lafayette        5.50   90.6   115 141              081021, ref SDS 53 3E4K
060467 -    Lafayette        5.50   90.4   110 128              081020, ref SDS 52 3E4K
060468 -    Kaiser                                         x    081018, ref SDS 51 UZ7K
060469 -    Kaiser                                         x    081017, ref SDS 50 UZ7K
060470 -    UCSF                                     e          081016, ref SDS 48 V94O
060471 -    Lafayette        5.50   90.1   115 154              081014, ref SDS 47 3E4K
060472 -    Lafayette        5.50   92.7   115 138              081013, ref SDS 46 3E4K
060473 -    Lafayette        8.25  146.4   180 224              081012, ref SDS 45 3E4K
060474 -    Kaiser                                         x    081011, ref SDS 44 UZ7K
060475 -    Lafayette        5.50   93.3   116 138              081010, ref SDS 43 3E4K
060476 -    Kaiser                                         x    081010, ref SDS 43 UZ7K
060477 -    UCSF                                      e         081009, ref SDS 42 V94O
060478 -    Lafayette        5.50   92.1   113 137              081006, ref SDS 41 3E4K
060479 -    Lafayette        2.75   48.5   110 136         x    081004, ref SDS 40 3E4K
060480 -    Lafayette        5.50   98.2   117 136         x    081003, ref SDS 39 3E4K
060481 -    UCSF                                      c         081002, ref SDS 38 V94O
060482 -    Lafayette        5.50   94.7   115 142              080929, ref SDS 37 3E4K
060483 -    Lafayette        8.25  150.4   115 135              080928, ref SDS 37 3E4K
060484 -    Kaiser                                         x    080927, ref SDS 36 UZ7K
060485 -    Lafayette        5.50   90.2   120 140         x    080926, ref SDS 35 3E4K
060486 -    UCSF                                      c         080925, ref SDS 34 V94O
060487 -    Lafayette        5.50   92.3   116 138              080923, ref SDS 33 3E4K
060488 -    Lafayette        5.50   98.4   112 134              080922, ref SDS 33 3E4K
060489 -    Lafayette        5.50   98.2   114 137              080921, ref SDS 33 3E4K
060490 -    Lafayette        5.50  101.6   110 133         x    080920, ref SDS 32 3E4K
060491 -    Lafayette        5.50   89.3   115 144         x    080919, ref SDS 31 3E4K
060492 -    UCSF                                      c         080918, ref SDS 30 V94O
060493 -    Lafayette        2.75   46.2   117 139              080916, ref SDS 31 3E4K
060494 -    Lafayette        5.50   91.8   117 142              080915, ref SDS 29 3E4K
060495 -    Clayton Safeway  3.00   62.4    98 118              080914, ref SDS 28 3E4K
060496 -    Lafayette        8.25  129.7   123 147         x    080913, ref SDS 27 3E4K
060497 -    Lafayette        5.50   88.4   118 146         x    080912, ref SDS 26 3E4K
060498 -    UCSF                                      c         080911, ref SDS 25 V94O
060499 -    Lafayette        2.75   46.8   113 140              080909
060500 -    Lafayette        5.50   89.2   117 143              080908
060501 -    Lafayette        5.50   92.1   115 138              080907
060502 -    Lafayette        2.75   45.3   120 144         x    080906, ref SDS 24 3E4K
060503 -    Lafayette        2.75   56.8    93 120         x    080905, ref SDS 23 3E4K
060504 -    UCSF                                      c         080904, ref SDS 22 V94O
060505 -    Lafayette        8.25  140.4   116 131              080903
060506 -    Lafayette        5.50   94.9   115 134              080902
060507 -    Kaiser                                         x    080830
060508 -    Kaiser                                         x    080829
060509 -    UCSF                                      c         080828, ref SDS 21 V94O
060510 -    Lafayette        5.50   93.6   120 137              080826
060511 -    Lafayette        5.50   93.2   117 138              080825
060512 -    Lafayette        5.50   93.2   123 136         x    080823
060513 -    Lafayette        8.25  142.5   110 131         x    080822, ref SDS 20 3E4K
060514 -    UCSF                                      e         080821, ref SDS 19 V94O
060515 -    Lafayette        5.50   94.7   115 137              080820
060516 -    Lafayette        5.50   94.3   115 135              080819
060517 -    Lafayette        8.25  141.7   118 134              080815
060518 -    UCSF                                      e         080814, ref SDS 18 V94O
060519 -    Lafayette        5.50   93.8   120 136              080813
060520 -    Lafayette        5.50   94.4   116 139              080812
060521 -    Lafayette        5.50   94.2   119 133              080810
060522 -    Lafayette        8.25  143.6   114 132         x    080809, ref SDS 16 3E4K
060523 -    Lafayette        8.25  141.1   117 135         x    080808, ref SDS 15 3E4K
060524 -    UCSF                                      c         080807, ref SDS 14 V94O
060525 -    Lafayette        8.25  143.7   115 132              080805
060526 -    Concord          7.00  127.6   105 118              080804
060527 -    Lafayette        8.25  143.2   112 134              080802
060528 -    Lafayette        5.50   93.4   115 138              080801
060529 -    Lafayette        5.50   92.2   118 140              080729
060530 -    Lafayette        5.50   92.6   116 137              080728
060531 -    Lafayette        8.25  142.6   114 134              080727
060532 -    Lafayette        5.50   91.5   120 143              080726
060533 -    Lafayette        8.25  140.8   117 135              080725
060534 -    Lafayette        5.50   91.8   122 141              080723
060535 -    Lafayette        5.50   91.3   120 139              080722
060536 -    Lafayette        8.25  143.3   115 133              080720
060537 -    Lafayette        5.50   90.7   125 144              080719
060538 -    Lafayette        5.50   92.4   123 142              080716
060539 -    Lafayette        2.25   46.8   116 137              080715
060540 -    Lafayette        8.25  141.8   116 136              080712
060541 -    Lafayette        5.50   92.9   116 139              080711
060542 -    Lafayette        8.25  143.3   113 137              080704
060543 -    Lafayette        5.50   90.2   121 147              080630
060544 -    Lafayette        8.25  142.4   116 138              080628
060545 -    Lafayette        5.50   91.4   118 138              080625
060546 -    Lafayette        2.25   47.9   116 136              080623
060547 -    Lafayette        5.50   94.2   112 138              080622
060548 -    Lafayette        5.50   94.7   115 133              080621
060549 -    Lafayette        2.25   48.3   110 129              080620
060550 -    Mt Diablo        7.00  129.4   130 153              080616
060551 -    Lafayette        5.50   90.8   120 146              080615
060552 -    Lafayette        5.50   91.3   124 144              080614
060553 -    Lafayette        5.50   89.7   122 143              080613
060554 -    Lafayette        2.76   45.8   120 147              080611
060555 -    Lafayette        5.50   90.5   123 145              080609
060556 -    Lafayette        5.50   92.7   115 138              080607
060557 -    Lafayette        5.50   94.2   118 139              080602
060558 -    Lafayette        5.50   96.2   110 202              080507, ref SDS 5 WO8M
060559 -
060560 -
060561 -
0606 -

SUBJECTS
Default Null Subject Account for Blank Record

0703 -
070401 -  ..
070402 - Side Effects Neupogen Treatments Increase May Be Chemotherapy
070403 -
070404 - Follow up ref SDS 72 SB8I, ref SDS 71 SB8I.
070405 -
070406 - Research on Neupogen side effects was reported on 080629. ref SDS 9
070407 - RQ9I  Previous case study on Neupogen side effects listed on 081002.
070408 - ref SDS 35 SB8I
070410 -  ..
070411 - Millie last reported side effects of Neupogen on 081109 experiencing
070412 - bone pain, headache, and fatigue associated with Neupogen and
070413 - chemotherapy. ref SDS 60 9V4H
070415 -  ..
070416 - Millie may not need Neupogen for the sunitinib treatment begun on
070417 - 081114. ref SDS 63 505G
070419 -  ..
070420 - Today, she called today and left a message for the Infusion Clinic to
070421 - cancel treatment on 081121 and 081122.
070423 -  ..
070424 - Side effects of Neupogen should cease, because she has not had a
070425 - treatment since 081108, ref SDS 59 UZ7K, citing background for getting
070426 - Neupogen treatment reported in the record on 081107. ref SDS 58 1M9O
070427 -
070428 -               081109................, ref SDS 60 SB8I
070429 -               081018................, ref SDS 51 Y17L
070430 -               081011................, ref SDS 44 FL4H
070431 -               081010................, ref SDS 43 SB8I
070432 -               081006................, ref SDS 41 3E4K
070433 -               081004................, ref SDS 40 Y17L
070434 -               081002................, ref SDS 38 Y17L
070435 -               080930................, ref SDS 37 Y17L
070436 -               080923................, ref SDS 33 K16F
070437 -               080915................, ref SDS 29 9W9I
070438 -               080810................, ref SDS 17 9W9I
070439 -               080803................, ref SDS 13 9W9I
070440 -               080726................, ref SDS 12 9W9I
070441 -               080721................, ref SDS 11 9W9I
070442 -               080713................, ref SDS 10 RM94
070443 -               080629................, ref SDS 8 6Q5J
070444 -               080628................, ref SDS 7 6Q5J
070445 -
070446 -
070447 -
070448 -
070449 -
070450 -
070451 -
070452 -
0705 -