CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - During the meeting with the medical team this morning at UCSF, Tara
040902 - had recommended notifying Kaiser that INR had increased above the
040903 - target range of 3.0, and if Kaiser did not respond, then Millie should
040904 - skip Coumadin treatment today, as was done 6 weeks ago on 081016, when
040905 - INR increased above 4. ref SDS 1 K66J  At that time, the increase
040906 - seemed like a one time event caused by anomolies performing the blood
040907 - draw that may have contaminated the specimen. ref SDS 1 X68G
040909 -  ..
040910 - As recommended by Tara, Millie called Gloria at the Kaiser Coagulation
040911 - Control Clinic in Martinez.  She left a message reporting changes to
040912 - treatment from cetuximab and Carboplatin to sunitinib,
040913 - cyclophosphamide and Methotreaxate, and that the blood test this
040914 - morning shows INR climbed to 3.4. ref SDS 2 K66J
040915 -
040917 -  ..
0410 -
0411 -
0412 - 1218
0413 -
041301 - Gloria called back.
041302 -
041303 - She said there is no reporting in her Kaiser data base showing that
041304 - sunitinib has any affects on, or conflicts with, warfarin (Coumadin),
041305 - but this is a fairly new treatment, and so there may not be enough
041306 - history to have developed guidance.
041308 -  ..
041309 - Gloria further advised there is history on effects of cyclophosphamide
041310 - and methotrexate taking supports guidance for adjusting warfarin
041311 - (Coumadin) to treat pulmonary embolism, but there is no history on the
041312 - particular combination with sunitinib prescribed by UCSF for Millie in
041313 - this case.  She feels getting an effective adjustment will require
041314 - trial and errot to find the right level of Coumadin.
041316 -  ..
041317 - Gloria will submit a letter today explaining changes in Millie's daily
041318 - Coumadin treatments to experiment toward stabalizing INR blood counts
041319 - again between 2.0 and 3.0.
041321 -  ..
041322 - She wants Millie to get another blood test for INR next week at Kaiser
041323 - to verify the dose change.
041324 -
041325 -        [On 081126 Millie received a letter from Gloria, Kaiser's case
041326 -        manager for Millie's Coumadin treatments for pulmonary
041327 -        embolism, and confirming changes to the dose of Coumadin
041328 -        required to manage Millie's chronic pulmonary embolism
041329 -        condition, ref SDS 3 VQ8V; Kaiser further ordered an interim
041330 -        blood draw on 081203 to evaluate effectiveness of changes to
041331 -        Coumadin taken with Millie's daily treatments with sunitinib
041332 -        and cyclophosphamide. ref SDS 3 VQ9W
041334 -         ..
041335 -        [On 081201 Millie notified medical team of plans to get blood
041336 -        draw at Kaiser on 081204 to test INR for evaluating Coumadin
041337 -        treatments for pulmonary embolism. ref SDS 4 AT7W
041339 -         ..
041340 -        [On 081203 Millie had her blood drawn at the Kaiser Coagulation
041341 -        Control Clinic in Martinez CA for evaluating stability of INR
041342 -        blood counts that signal effectiveness of daily Coumadin
041343 -        treatments for pulmonary embolism, taken with daily sunitinib
041344 -        and cyclophosphamide treatments for cancer. ref SDS 5 7N82
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0414 -