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: December 2, 2008 07:00 AM Tuesday; Rod Welch

Millie sunitinib #19 treatment IBC 5th relapse hiking 3 miles.

1...Summary/Objective
2...Sunitinib Metronomic Treatment Loading Dose Clinical Study UCSF
3...Sunitinib Cyclophosmaide Methotrexate Patient History
4...Side Effects Sunitinib Study with Cyclophosphamide Methotrexate
5...Exercise Hiking Maintain Fitness Strengthen Immune System
6...Case Study on Pateint History Exercising


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

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 85 0000. ref SDS 84 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Sunitinib Metronomic Treatment Loading Dose Clinical Study UCSF
040902 -
040903 - Follow up ref SDS 85 505G, ref SDS 84 505G.
040904 -
040905 - On 081113 Millie received sunitinib drugs from UCSF to treat the 5th
040906 - relapse of IBC.
040908 -  ..
040909 - Millie began the 14 day "charging" treatment on 081114. ref SDS 63
040910 - EK7I  After 14 treatments ending on 081127, ref SDS 80 6D63, Millie
040911 - tolerated sunitinib well at the prescribed dose.
040913 -  ..
040914 - During the meeting at UCSF on 081126, UCSF prescribed adding
040915 - chemotherapy treatment with cyclophosphamide each day with sunitinib,
040916 - and also adding 2 treatments of methotrexate twice a day for 2 days a
040917 - week as prescribed in the treatment protocol, reviewed on 081017.
040918 - ref SDS 49 004O
040920 -  ..
040921 - These supplemental treatments started on 081128. ref SDS 81 VR57
040923 -  ..
040924 - Millie continues with sunitinib and cyclophosphmaide; methotrexate
040925 - stops until next Friday on 081205.
040926 -
040928 -  ..
040929 - Sunitinib Cyclophosmaide Methotrexate Patient History
040930 -
040931 - Follow up ref SDS 85 OE6K, ref SDS 84 OE6K.
040932 -
040934 -        Cycle 1  begin 081128 after 14 treatmenst sunitinib alone
040935 -        Cohort: 3
040937 -        ..
040938 -                                          Cyclophos  Metho
040939 -                               Sunitinib   phamide   trexate
040940 -       Days  Date  Time  Cycle    37.5       50        5
040941 -       =======================================================
040942 -       Follow up ref SDS 85 PA8Y, ref SDS 84 PA8Y.
040943 -
040944 -        1.  081114 0700  Load    37.5        0        0 ... ref SDS 63 OE6K
040945 -        2.  081115 0700  Load    75.0        0        0 ... ref SDS 64 OE6K
040946 -        3.  081116 0700  Load   112.5        0        0 ... ref SDS 65 OE6K
040947 -        4.  081117 0700  Load   150.0        0        0 ... ref SDS 66 OE6K
040948 -        5.  081118 0700  Load   187.5        0        0 ... ref SDS 69 OE6K
040949 -        6.  081119 0700  Load   225.0        0        0 ... ref SDS 71 OE6K
040950 -        7.  081120 0700  Load   263.5        0        0 ... ref SDS 72 OE6K
040951 -        8.  081121 0700  Load   301.0        0        0 ... ref SDS 73 OE6K
040952 -        9.  081122 0700  Load   338.5        0        0 ... ref SDS 74 OE6K
040953 -       10.  081123 0700  Load   376.0        0        0 ... ref SDS 75 OE6K
040954 -       11.  081124 0700  Load   413.5        0        0 ... ref SDS 76 OE6K
040955 -       12.  081125 0700  Load   451.0        0        0 ... ref SDS 77 OE6K
040956 -       13.  081126 0700  Load   488.5        0        0 ... ref SDS 78 OE6K
040957 -       14.  081127 0700  Load   526.0        0        0 ... ref SDS 79 OE6K
040958 -       15.  081128 0700  1  1   563.5   1   50   1    5 ... ref SDS 81 OE6K
040959 -       16.  081129 0700  1  2   601.0   2  100   2   10 ... ref SDS 83 OE6K
040960 -       17.  081130 0700  1  3   638.5   3  150   2   10 ... ref SDS 84 OE6K
040961 -       18.  081201 0700  1  4   676.0   4  200   2   10 ... ref SDS 85 OE6K
040962 -       19.  081202 0700  1  5   713.5   5  250   2   10 ... ref SDS 0 OE6K
040963 -
040964 -
040965 -
040966 -
0410 -

SUBJECTS
Default Null Subject Account for Blank Record

0503 -
050401 -  ..
050402 - Side Effects Sunitinib Study with Cyclophosphamide Methotrexate
050403 -
050404 - Follow up ref SDS 85 LF8M, ref SDS 84 LF8M.
050405 -
050406 - Fatigue is a likely side effect of sunitinib with cyclophosphamide,
050407 - listed in the Consent document reviewed on 081017. ref SDS 49 4G7G
050409 -  ..
050410 - Energy improved today, but has declined the past few days shown by
050411 - declining exercise. ref SDS 0 X64F  After staying in bed on 081130,
050412 - Millie went hiking yesterday on 081201, and did well, but had severe
050413 - loss of energy at the end if the hike. ref SDS 85 3E4K  Millie
050414 - continues to work through this condition, going to the gym this
050415 - morning; she planned another hike at Lafayette, but was too tired
050416 - after working out in the gym. ref SDS 0 3E4K
050417 -
050418 -            [On 081202 Millie's letter to the medical team cites rising
050419 -            fatigue, ref SDS 86 AT8U, and asks about requirements for
050420 -            labs to evaluate blood counts, including NEUTS (ANC at
050421 -            Kaiser). ref SDS 86 AT8X
050423 -             ..
050424 -            [On 081203 blood draw ordered by Gloria for INR was
050425 -            expanded by primary care physician to test for broad
050426 -            response to treatment, including CBC that evaluates
050427 -            requirements for Neupogen to maintain immune system.
050428 -            ref SDS 87 TG8M
050430 -  ..
050431 - Vitals after getting up from bed, and before hiking was...
050432 -
050433 -          BP 141 77 Pulse 46
050435 -  ..
050436 - There was no report of heartburn nor upset stomach today.
050438 -  ..
050439 - Prilosec prescribed for heartburn has still not been taken.
050441 -  ..
050442 - Millie reports continued reduced taste from food, cited in study
050443 - consent documents, reviewed on 081017. ref SDS 49 6T5H
050444 -
050446 -     ..
050447 -                                   Date
050448 -    Description Adverse Event   Start  Stop     Medication
050449 -    ---------------------------------------------------------
050450 -    Follow up ref SDS 85 MV5H, ref SDS 84 MV5H.
050451 -
050452 -    Diarea                      081114 081114   Imodium........ ref SDS 63 LF8M
050453 -    Low pulse                   081120 081120   None........... ref SDS 72 LF8M
050454 -    Low pulse                   081121 081121   None........... ref SDS 73 7G8M
050455 -    BP 144 84 Pulse 48          081121 081121   Hiking......... ref SDS 73 LF8M
050456 -    Joint pain minor            081121 081121   Hiking......... ref SDS 73 LF8M
050457 -    Fatigue minor               081121 081121   Hiking......... ref SDS 73 LF8M
050458 -    Low pulse                   081122 081122   None........... ref SDS 74 7G8M
050459 -    Fatigue minor               081122 081122   Hiking......... ref SDS 74 LF8M
050460 -    Low pulse                   081123 081122   None........... ref SDS 75 7G8M
050461 -    BP 121 74 Pulse 53          081123 081123   Hiking......... ref SDS 75 LF8M
050462 -    Fatigue minor               081123 081122   Hiking......... ref SDS 75 LF8M
050463 -    Joint pain minor            081124 081124   Hiking......... ref SDS 76 LF8M
050464 -    Fatigue minor               081124 081124   Hiking......... ref SDS 76 LF8M
050465 -    Heartburn                   081124 081124   None........... ref SDS 76 HS9K
050466 -    BP 144 78 Pulse 52          081125 081125   Hiking......... ref SDS 77 LF8M
050467 -    Joint pain minor            081125 081125   Hiking......... ref SDS 77 LF8M
050468 -    Fatigue minor               081125 081125   Hiking......... ref SDS 77 LF8M
050469 -    Heartburn                   081125 081125   None........... ref SDS 77 HS9K
050470 -    Heartburn                   081126 081126   None........... ref SDS 78 HS9K
050471 -    Heartburn                   081127 081127   None........... ref SDS 80 HS9K
050472 -    BP 135 73 Pulse 48          081128 081128   Hiking......... ref SDS 81 5X6K
050473 -    Upset stomach               081128 081128   Hiking......... ref SDS 81 T76O
050474 -    BP 140 75 Pulse 50          081129 081129   Hiking......... ref SDS 83 5X6K
050475 -    Heartburn                   081129 081129   None........... ref SDS 83 HS9K
050476 -    Fatigue                     081129 081129   Rest........... ref SDS 83 LF8M
050477 -    Fatigue                     081130 081130   Rest........... ref SDS 84 LF8M
050478 -    BP 136 79 Pulse 46          081201 081201   Hiking......... ref SDS 85 5X6K
050479 -    Fatigue                     081201 081201   Rest........... ref SDS 85 LF8M
050480 -    Taste altered               081201 081201   Rest........... ref SDS 85 VP4G
050481 -    BP 141 77 Pulse 46          081202 081202   Aerobics gym... ref SDS 0 5X6K
050482 -    Fatigue                     081202 081202   Rest........... ref SDS 0 LF8M
050483 -    Taste altered               081202 081202   Rest........... ref SDS 0 VP4G
050484 -
050485 -
050486 -
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 85 3E4K, ref SDS 84 3E4K.
060405 -
060406 - Millie did not go hiking at Lafayette reservoir today.  She went to
060407 - the gym for an hour of aerobics.  Was too tired after the workout
060408 - today to go hiking.  Previously, Millie has gone hiking after the gym,
060409 - reported on Saturday 081130. ref SDS 83 3E4K  Reducing exercise
060410 - reflects rising side effects of fatigue from adding cyclophosphamide
060411 - to sunitinib, per above. ref SDS 0 LF8M
060413 -  ..
060414 - Millie complains of no leg pain, loss of breath, or similar ailment
060415 - that slows hiking and running.  Her general feeling is loss of energy.
060416 -
060417 -            [On 081203 blood draw ordered by Gloria for INR was
060418 -            expanded by primary care physician to test for broad
060419 -            response to treatment, including CBC that evaluates
060420 -            requirements for Neupogen to maintain blood counts for
060421 -            strong immune system. ref SDS 87 TG8M
060423 -  ..
060424 - Millie had her 19th treatment with sunitinib this morning at 0700.
060425 - ref SDS 85 PA8Y  This is the 5th day of the 1st cycle that includes
060426 - sunitinib and cyclophosphmaide.  Weekly treatment with methotrexate
060427 - ended Saturday.
060429 -  ..
060430 - On 081110, Millie complained about difficulty lifting herself from a
060431 - full squatting position. ref SDS 61 HX67  She has since been
060432 - exercising to strengthen legs, and arms.
060434 -  ..
060435 - This morning Millie did...
060436 -
060437 -        Arm presses 3 sets of 10 leaning against bannister.
060438 -        Squats 3 sets of 10 vary depth useing bannister for leverage
060439 -
060441 -  ..
060442 - Case Study on Pateint History Exercising
060443 -
060444 - Follow up ref SDS 85 X64F, ref SDS 84 X64F.
060445 -
060446 -                                              +- scm = Sunitinib Cyclophosphmaide Methotrexate
060447 -                                              +- sc  = Sunitinib Cyclophosphmaide
060448 -                           Time     Pulse     |
060449 -    Location        Miles Minutes  Avg Max  Chem  Neupo  Date
060450 -    ----------------------------------------------------------------
060451 -    Concord home (gym)                        sc        081202, ref SDS 0 3E4K
060452 -    Lafayette        5.50  102.3    95 122    sc        081201, ref SDS 85 3E4K
060453 -    Concord home                              sc        081130, ref SDS 84 3E4K
060454 -    Lafayette        2.75   56.7    90 115    scm       081129, ref SDS 83 3E4K
060455 -    Lafayette        2.75   46.5   100 128    scm       081128, ref SDS 81 3E4K
060456 -    Lafayette        5.50   93.3   100 122    s         081127, ref SDS 80 3E4K
060457 -    Concord home                              s         081126, ref SDS 78 3E4K
060458 -    Lafayette        4.00   73.7   105 127    s         081125, ref SDS 77 3E4K
060459 -    Lafayette        5.50   91.4   100 129    s         081124, ref SDS 76 3E4K
060460 -    Concord home                              s         081123, ref SDS 75 3E4K
060461 -    Lafayette        5.50   92.8    95 122    s         081122, ref SDS 74 3E4K
060462 -    Lafayette        5.50   94.4    85 112    s         081121, ref SDS 73 3E4K
060463 -    Lafayette        5.50   94.7    90 122    s         081120, ref SDS 72 3E4K
060464 -    San Francisco    1.00   60.0    65  75    s         081119, ref SDS 71 3E4K
060465 -    Lafayette        2.75   49.2    97 130    s         081118, ref SDS 70 3E4K
060466 -    Lafayette        5.50   93.6   115 138    s         081117, ref SDS 67 3E4K
060467 -    Concord home                              s         081116, ref SDS 65 Y68J
060468 -    Concord home                              s         081115, ref SDS 64 EK7I
060469 -    Concord home                              s         081114, ref SDS 63 XW6H
060470 -    Lafayette        5.50   94.2   115 138              081110, ref SDS 61 3E4K
060471 -    Lafayette        2.75   48.4   105 128              081109, ref SDS 60 3E4K
060472 -    Kaiser                                         x    081108, ref SDS 59 UZ7K
060473 -    Kaiser                                         x    081107, ref SDS 58 UZ7K
060474 -    Lafayette        5.50   90.2   120 143              081025, ref SDS 56 3E4K
060475 -    Kaiser                                         x    081025, ref SDS 56 UZ7K
060476 -    Kaiser                                         x    081024, ref SDS 55 UZ7K
060477 -    UCSF                                      c         081023, ref SDS 54 V94O
060478 -    Lafayette        5.50   90.6   115 141              081021, ref SDS 53 3E4K
060479 -    Lafayette        5.50   90.4   110 128              081020, ref SDS 52 3E4K
060480 -    Kaiser                                         x    081018, ref SDS 51 UZ7K
060481 -    Kaiser                                         x    081017, ref SDS 50 UZ7K
060482 -    UCSF                                      e         081016, ref SDS 48 V94O
060483 -    Lafayette        5.50   90.1   115 154              081014, ref SDS 47 3E4K
060484 -    Lafayette        5.50   92.7   115 138              081013, ref SDS 46 3E4K
060485 -    Lafayette        8.25  146.4   180 224              081012, ref SDS 45 3E4K
060486 -    Kaiser                                         x    081011, ref SDS 44 UZ7K
060487 -    Lafayette        5.50   93.3   116 138              081010, ref SDS 43 3E4K
060488 -    Kaiser                                         x    081010, ref SDS 43 UZ7K
060489 -    UCSF                                      e         081009, ref SDS 42 V94O
060490 -    Lafayette        5.50   92.1   113 137              081006, ref SDS 41 3E4K
060491 -    Lafayette        2.75   48.5   110 136         x    081004, ref SDS 40 3E4K
060492 -    Lafayette        5.50   98.2   117 136         x    081003, ref SDS 39 3E4K
060493 -    UCSF                                      c         081002, ref SDS 38 V94O
060494 -    Lafayette        5.50   94.7   115 142              080929, ref SDS 37 3E4K
060495 -    Lafayette        8.25  150.4   115 135              080928, ref SDS 37 3E4K
060496 -    Kaiser                                         x    080927, ref SDS 36 UZ7K
060497 -    Lafayette        5.50   90.2   120 140         x    080926, ref SDS 35 3E4K
060498 -    UCSF                                      c         080925, ref SDS 34 V94O
060499 -    Lafayette        5.50   92.3   116 138              080923, ref SDS 33 3E4K
060500 -    Lafayette        5.50   98.4   112 134              080922, ref SDS 33 3E4K
060501 -    Lafayette        5.50   98.2   114 137              080921, ref SDS 33 3E4K
060502 -    Lafayette        5.50  101.6   110 133         x    080920, ref SDS 32 3E4K
060503 -    Lafayette        5.50   89.3   115 144         x    080919, ref SDS 31 3E4K
060504 -    UCSF                                      c         080918, ref SDS 30 V94O
060505 -    Lafayette        2.75   46.2   117 139              080916, ref SDS 31 3E4K
060506 -    Lafayette        5.50   91.8   117 142              080915, ref SDS 29 3E4K
060507 -    Clayton Safeway  3.00   62.4    98 118              080914, ref SDS 28 3E4K
060508 -    Lafayette        8.25  129.7   123 147         x    080913, ref SDS 27 3E4K
060509 -    Lafayette        5.50   88.4   118 146         x    080912, ref SDS 26 3E4K
060510 -    UCSF                                      c         080911, ref SDS 25 V94O
060511 -    Lafayette        2.75   46.8   113 140              080909
060512 -    Lafayette        5.50   89.2   117 143              080908
060513 -    Lafayette        5.50   92.1   115 138              080907
060514 -    Lafayette        2.75   45.3   120 144         x    080906, ref SDS 24 3E4K
060515 -    Lafayette        2.75   56.8    93 120         x    080905, ref SDS 23 3E4K
060516 -    UCSF                                      c         080904, ref SDS 22 V94O
060517 -    Lafayette        8.25  140.4   116 131              080903
060518 -    Lafayette        5.50   94.9   115 134              080902
060519 -    Kaiser                                         x    080830
060520 -    Kaiser                                         x    080829
060521 -    UCSF                                      c         080828, ref SDS 21 V94O
060522 -    Lafayette        5.50   93.6   120 137              080826
060523 -    Lafayette        5.50   93.2   117 138              080825
060524 -    Lafayette        5.50   93.2   123 136         x    080823
060525 -    Lafayette        8.25  142.5   110 131         x    080822, ref SDS 20 3E4K
060526 -    UCSF                                      e         080821, ref SDS 19 V94O
060527 -    Lafayette        5.50   94.7   115 137              080820
060528 -    Lafayette        5.50   94.3   115 135              080819
060529 -    Lafayette        8.25  141.7   118 134              080815
060530 -    UCSF                                      e         080814, ref SDS 18 V94O
060531 -    Lafayette        5.50   93.8   120 136              080813
060532 -    Lafayette        5.50   94.4   116 139              080812
060533 -    Lafayette        5.50   94.2   119 133              080810
060534 -    Lafayette        8.25  143.6   114 132         x    080809, ref SDS 16 3E4K
060535 -    Lafayette        8.25  141.1   117 135         x    080808, ref SDS 15 3E4K
060536 -    UCSF                                      c         080807, ref SDS 14 V94O
060537 -    Lafayette        8.25  143.7   115 132              080805
060538 -    Concord          7.00  127.6   105 118              080804
060539 -    Lafayette        8.25  143.2   112 134              080802
060540 -    Lafayette        5.50   93.4   115 138              080801
060541 -    Lafayette        5.50   92.2   118 140              080729
060542 -    Lafayette        5.50   92.6   116 137              080728
060543 -    Lafayette        8.25  142.6   114 134              080727
060544 -    Lafayette        5.50   91.5   120 143              080726
060545 -    Lafayette        8.25  140.8   117 135              080725
060546 -    Lafayette        5.50   91.8   122 141              080723
060547 -    Lafayette        5.50   91.3   120 139              080722
060548 -    Lafayette        8.25  143.3   115 133              080720
060549 -    Lafayette        5.50   90.7   125 144              080719
060550 -    Lafayette        5.50   92.4   123 142              080716
060551 -    Lafayette        2.25   46.8   116 137              080715
060552 -    Lafayette        8.25  141.8   116 136              080712
060553 -    Lafayette        5.50   92.9   116 139              080711
060554 -    Lafayette        8.25  143.3   113 137              080704
060555 -    Lafayette        5.50   90.2   121 147              080630
060556 -    Lafayette        8.25  142.4   116 138              080628
060557 -    Lafayette        5.50   91.4   118 138              080625
060558 -    Lafayette        2.25   47.9   116 136              080623
060559 -    Lafayette        5.50   94.2   112 138              080622
060560 -    Lafayette        5.50   94.7   115 133              080621
060561 -    Lafayette        2.25   48.3   110 129              080620
060562 -    Mt Diablo        7.00  129.4   130 153              080616
060563 -    Lafayette        5.50   90.8   120 146              080615
060564 -    Lafayette        5.50   91.3   124 144              080614
060565 -    Lafayette        5.50   89.7   122 143              080613
060566 -    Lafayette        2.76   45.8   120 147              080611
060567 -    Lafayette        5.50   90.5   123 145              080609
060568 -    Lafayette        5.50   92.7   115 138              080607
060569 -    Lafayette        5.50   94.2   118 139              080602
060570 -    Lafayette        5.50   96.2   110 202              080507, ref SDS 5 WO8M
060571 -
060572 -
060573 -
060574 -
060575 -
060576 -
0606 -