CONTACTS 

SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 8 0000, ref SDS 5 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Background is reported on 081117, ref SDS 8 FQ5I, when Millie sent a
040902 - letter to Glenna asking about prescribing Millie's chemotherapy drugs
040903 - needed on Friday, 081128, because Thursday is a holiday. ref SDS 8
040904 - PR8U
040906 -  ..
040907 - On 081121 Millie submitted another letter to Glenna with a copy to the
040908 - medical team reminding again about prescribing drugs in time to start
040909 - treatment on 081128. ref SDS 10 0T6L  Millie has not received response
040910 - showing work has been done to accomplish procurement to start
040911 - treatment with cyclosphamide and Methotrexate, beginning on 081128.
040913 -  ..
040914 - This morning, Millie submitted another reminder to the medical team at
040915 - UCSF and Kaiser saying...
040916 -
040917 -   1.   Subject: Kaiser Order Chemo Drugs Prescribed by UCSF
040918 -        Date: Tue, 25 Nov 2008 10:38:56 -0800
040931 -         ..
040932 -    3.  Just another reminder that I am coming tomorrow a day early
040933 -        this week on Wednesday, instead of Thursday, due to the holiday
040934 -        season, as planned in the meeting on 081113.
040936 -         ..
040937 -    4.  My letter a few days ago on 081121 asked about coordinating
040938 -        with Kaiser to get medications in time to start the next phase
040939 -        of treatment on 081128, Friday. ref SDS 10 FQ5I
040941 -         ..
040942 -    5.  Patient history shows a variety of factors delay getting
040943 -        prescriptions at UCSF filled at Kaiser.  Placing orders early
040944 -        allows time to adjust for delays.  The holiday season compounds
040945 -        risks of delay.
040946 -
040947 -           [On 081126 Glenna could not attend meeting with medical
040948 -           team to review procurement of complementary drugs for
040949 -           sunitinib protocol.
040951 -            ..
040952 -           [On 081126 delays getting drugs at Kaiser for sunitinib
040953 -           protocol prescribed at UCSF. ref SDS 12 GM65
040955 -         ..
040956 -    6.  For some reason, I had the impression that Cyclophosphamide
040957 -        would be taken only twice a week with Methotrexate, and so
040958 -        timely procurement was less critical.  Recent review of the
040959 -        Consent documents indicates Cyclophosphamide actually is taken
040960 -        concurrent with daily treatment of sunitinib, shown on 081017.
040961 -        ref SDS 2 Q14K
040963 -         ..
040964 -    7.  This suggests Cyclophosphamide is needed on Friday, 081028.
040965 -        Accordingly, placing the order early reduces chances of
040966 -        slippage in the protocol schedule.  Alternatively, if starting
040967 -        Monday or Tuesday is not a big problem, then there is no need
040968 -        to rush on getting the drugs.
040969 -
040970 -           [On 081126 Kaiser prescribed taking cyclophosphamide and
040971 -           Methotrexate to be taken on Friday and Saturday; the
040972 -           prescription was submitted to Kaiser at Parkshadelands,
040973 -           ref SDS 12 GM65, who ordered the cyclophosphamide; Millie may
040974 -           get the drugs on Friday, Monday or Tuesday of next week.
040975 -           ref SDS 12 GM93
040977 -         ..
040978 -    8.  Good news.  Side effects at this time seem essentially zero.
040980 -         ..
040981 -    9.  Still not sure about response to treatment, but my sense is
040982 -        that advance of disease reported on 081121, ref SDS 10 5T4Q,
040983 -        seems to have slowed, stopped or been reversed??
040985 -  ..
040986 - This aligns with reports on 081018 that sunitinib metronomic and
040987 - multi-agent treatment with cyclophosphamide and methrotrexate in the
040988 - UCSF study will be effective for Millie. ref SDS 3 IT8V  Sunitinib
040989 - protocol Consent document explains theory of recovery using double
040990 - agent drugs, reviewed on 081017. ref SDS 2 006S
040991 -
040992 -            [On 090715 0224 Millie had similar experience with MPA
040993 -            protocol recovering from 7th relapse of cancer; IBC got
040994 -            much worse after starting treatment on 090616, and 3-weeks
040995 -            later began to improve, but still looked worse after
040996 -            4-weeks of treatment, than when treatment started on
040997 -            090616. ref SDS 16 BW8I
040999 -             ..
041000 -            [On 100111 1120 Millie had similar experience where
041001 -            shingles symptoms began to improve after 5 days of
041002 -            treatment, but after 2 days of recovery, still looked worse
041003 -            than when treatment began; this record indicates Millie
041004 -            should have full recovery in another 7 days. ref SDS 17
041005 -            ML7H
041007 -             ..
041008 -            [On 100112 0047 Millie reported to medical team shingles
041009 -            got worse, then improved following prior pattern of cancer
041010 -            disease trajectory. ref SDS 18 IS8U
041012 -  ..
041013 - Further aligns with analysis of primary care physician at Kaiser on
041014 - 081024 approving treatment with sunitinib metronomic protocol using
041015 - double agent drugs, based on experience at Kaiser with sunitinib.
041016 - ref SDS 4 XZ8W
041017 -
041018 -            [On 081202 letter to medical team reports findings from
041019 -            examination on 081126 of recovery from IBC; and days later
041020 -            there was significant increased recovery. ref SDS 13 AS6U
041022 -  ..
041023 - Letter to the medical team continues...
041024 -
041025 -   10.  How will adding chemo drugs to sunitinib relate to requirements
041026 -        for Neupogen to maintain blood counts?  Hoping this is not a
041027 -        factor.
041028 -
041029 -            [On 081126 blood counts decline slightly to NEUTS 1.50,
041030 -            which as that the low end of the range for safe
041031 -            chemotherapy treatments. ref SDS 11 PU6K
041033 -             ..
041034 -            [On 081202 Millie reported continuing fatigue and possible
041035 -            minor symptoms of a cold or other infection, which could
041036 -            signal low blood counts cited in the letter today,
041037 -            ref SDS 13 AT8U, and so asked again about evaluating need
041038 -            to get Neupogen treatments. ref SDS 13 AT8X
041040 -             ..
041041 -            [On 081202 Millie's patient history shows declining energy
041042 -            that reduces exercise, ref SDS 14 3E4K, due to side effects
041043 -            of sunitinib and cyclophosphamide daily treatments for
041044 -            cancer. ref SDS 14 LF8M
041046 -             ..
041047 -            [On 081203 blood draw ordered by Gloria for INR was
041048 -            expanded by primary care physician to test for broad
041049 -            response to treatment, including CBC that evaluates
041050 -            requirements for Neupogen to maintain blood counts for
041051 -            strong immune system. ref SDS 15 TG8M
041053 -         ..
041054 -   11.  By copy notifying Catherine and Diane in the Infusion Clinic
041055 -        that I will arrive OA 0800 tomorrow for blood draw.  Looking
041056 -        forward to seeing everyone.  Hope I park on the "right" side of
041057 -        the street, so I don't get another ticket (just a joke).
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0411 -