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 3, 2008 07:00 AM Wednesday; Rod Welch

Millie sunitinib #20 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 87 0000. ref SDS 85 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 87 505G, ref SDS 85 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 87 OE6K, ref SDS 85 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 87 PA8Y, ref SDS 85 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 87 OE6K
040963 -       20.  081203 0700  1  6   751.0   6  300   2   10 ... ref SDS 0 OE6K
040964 -
040965 -
040966 -
040967 -
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 87 LF8M, ref SDS 85 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 87 X64F  After staying in bed on 081130,
050412 - Millie went hiking on 081201, and did well, but had severe loss of
050413 - energy at the end if the hike. ref SDS 85 3E4K  Yesterday, Millie did
050414 - aerobics in the gym, but was too tired for hiking. ref SDS 87 3E4K
050416 -  ..
050417 - Today, she went hiking and did 1 lap, after spending a few hours at a
050418 - cancer support group meeting. ref SDS 0 X64F
050420 -  ..
050421 - On 081202 Millie's letter to the medical team cites rising fatigue,
050422 - ref SDS 86 AT8U, and asks about requirements for labs to evaluate
050423 - blood counts, including NEUTS (ANC at Kaiser). ref SDS 86 AT8X
050425 -  ..
050426 - Glenna reported in a telephone call today, responding to Millie's
050427 - letter on 081202, that other patients treated with the sunitinib
050428 - protocol also experience fatigue.
050430 -             ..
050431 -            [On 081203 blood draw ordered by Gloria for INR was
050432 -            expanded by primary care physician to test for broad
050433 -            response to treatment, including CBC that evaluates
050434 -            requirements for Neupogen to maintain immune system while
050435 -            getting daily treatments with sunitinib and chemotherapy
050436 -            with cyclophosphamide. ref SDS 88 TG8M
050438 -             ..
050439 -            [On 081205 results of blood test today, show NEUTS 0.624 at
050440 -            the lowest level in patient history. ref SDS 89 3Q4K
050442 -             ..
050443 -            [On 081218 labs at UCSF for examination starting 2nd cycle
050444 -            of sunitinib protocol show CBC blood counts again very low,
050445 -            ref SDS 90 075H, with platelets 67, ref SDS 90 7Z6N,
050446 -            attributed for causing new sunitinib side effect of
050447 -            nosebleed, ref SDS 91 GF4S, and NEUTS 0.74 have again
050448 -            fallen substantially, ref SDS 90 QY6H; as a result
050449 -            treatment regimen changed; all treatment was paused for 7
050450 -            days until 081226; Methotrexate ended entirely;
050451 -            consideration will be made to reduce dose for sunitinib.
050452 -            ref SDS 91 GF4V
050454 -             ..
050455 -            [On 081219 1140 primary care physician concurs with UCSF
050456 -            order to pause treatments, ref SDS 92 JK7H; diagnoses
050457 -            cytopenia, including pancytopenia from expanded low blood
050458 -            counts that risks fatal infection, and cause chronic
050459 -            fatigue, muscle weakness, and loss of vitality and vigor
050460 -            associated with chemotherapy. ref SDS 92 LS6K
050462 -             ..
050463 -            [On 090122 0925 Millie suffers fall during aerobics
050464 -            exercise at the gym due to fatigue and muscle weankess
050465 -            caused by low blood counts, ref SDS 93 CW6J; suffered
050466 -            severe pain, ref SDS 93 WS7T, and treated for dislocated
050467 -            shoulder at Emergency Room Department, ref SDS 93 W05P
050468 -                                                                        M
050469 -             ..
050470 -            [On 090213 1140 Doctor Johnson explains risks of cytopenia
050471 -            and pancytopenia that reduce energy, fitness, and muscle
050472 -            strength contribute to Millie's fall and dislocated
050473 -            shoulder. ref SDS 94 PQTX
050475 -  ..
050476 - Vitals after getting up from bed, and before hiking was...
050477 -
050478 -          BP 138 77 Pulse 48
050480 -  ..
050481 - There was no report of heartburn nor upset stomach today.
050483 -  ..
050484 - Millie tried spagetti again for dinner.  Had less sauce to reduce
050485 - heartburn.
050487 -  ..
050488 - Prilosec prescribed for heartburn has still not been taken.
050490 -  ..
050491 - Millie reports continued reduced taste from food, cited in study
050492 - consent documents, reviewed on 081017. ref SDS 49 6T5H  Some
050493 - improvement occurred today; Millie reported oatmeal breakfast was
050494 - "tasty" this morning.
050495 -
050497 -     ..
050498 -                                   Date
050499 -    Description Adverse Event   Start  Stop     Medication
050500 -    ---------------------------------------------------------
050501 -    Follow up ref SDS 87 MV5H, ref SDS 85 MV5H.
050502 -
050503 -    Diarea                      081114 081114   Imodium........ ref SDS 63 LF8M
050504 -    Low pulse                   081120 081120   None........... ref SDS 72 LF8M
050505 -    Low pulse                   081121 081121   None........... ref SDS 73 7G8M
050506 -    BP 144 84 Pulse 48          081121 081121   Hiking......... ref SDS 73 LF8M
050507 -    Joint pain minor            081121 081121   Hiking......... ref SDS 73 LF8M
050508 -    Fatigue minor               081121 081121   Hiking......... ref SDS 73 LF8M
050509 -    Low pulse                   081122 081122   None........... ref SDS 74 7G8M
050510 -    Fatigue minor               081122 081122   Hiking......... ref SDS 74 LF8M
050511 -    Low pulse                   081123 081122   None........... ref SDS 75 7G8M
050512 -    BP 121 74 Pulse 53          081123 081123   Hiking......... ref SDS 75 LF8M
050513 -    Fatigue minor               081123 081122   Hiking......... ref SDS 75 LF8M
050514 -    Joint pain minor            081124 081124   Hiking......... ref SDS 76 LF8M
050515 -    Fatigue minor               081124 081124   Hiking......... ref SDS 76 LF8M
050516 -    Heartburn                   081124 081124   None........... ref SDS 76 HS9K
050517 -    BP 144 78 Pulse 52          081125 081125   Hiking......... ref SDS 77 LF8M
050518 -    Joint pain minor            081125 081125   Hiking......... ref SDS 77 LF8M
050519 -    Fatigue minor               081125 081125   Hiking......... ref SDS 77 LF8M
050520 -    Heartburn                   081125 081125   None........... ref SDS 77 HS9K
050521 -    Heartburn                   081126 081126   None........... ref SDS 78 HS9K
050522 -    Heartburn                   081127 081127   None........... ref SDS 80 HS9K
050523 -    BP 135 73 Pulse 48          081128 081128   Hiking......... ref SDS 81 5X6K
050524 -    Upset stomach               081128 081128   Hiking......... ref SDS 81 T76O
050525 -    BP 140 75 Pulse 50          081129 081129   Hiking......... ref SDS 83 5X6K
050526 -    Heartburn                   081129 081129   None........... ref SDS 83 HS9K
050527 -    Fatigue                     081129 081129   Rest........... ref SDS 83 LF8M
050528 -    Fatigue                     081130 081130   Rest........... ref SDS 84 LF8M
050529 -    BP 136 79 Pulse 46          081201 081201   Hiking......... ref SDS 85 5X6K
050530 -    Fatigue                     081201 081201   Rest........... ref SDS 85 LF8M
050531 -    Taste altered               081201 081201   Rest........... ref SDS 85 VP4G
050532 -    BP 141 76 Pulse 46          081202 081202   Aerobics gym... ref SDS 87 5X6K
050533 -    Fatigue                     081202 081202   Rest........... ref SDS 87 LF8M
050534 -    Taste altered               081202 081202   Rest........... ref SDS 87 VP4G
050535 -    BP 138 77 Pulse 48          081203 081203   Hiking......... ref SDS 0 5X6K
050536 -    Fatigue                     081203 081203   Rest........... ref SDS 0 LF8M
050537 -    Taste altered               081203 081203   Rest........... ref SDS 0 VP4G
050538 -
050539 -
050540 -
0506 -

SUBJECTS
Default Null Subject Account for Blank Record

0603 -
060401 -  ..
060402 - Exercise Hiking Maintain Fitness Strengthen Immune System
060403 -
060404 - Follow up ref SDS 87 3E4K, ref SDS 85 3E4K.
060405 -
060406 - Millie went hiking at Lafayette reservoir, and did 1 lap, about 2.75
060407 - miles in  62.7 minutes. ref SDS 0 X64F  The first 1.5 miles was a good
060408 - time.  The last mile fatigue caused very slow pace to complete the
060409 - hike.  Slower time reflects rising side effects of fatigue from adding
060410 - cyclophosphamide to sunitinib, per above. ref SDS 85 LF8M
060412 -  ..
060413 - Reducing exercise reflects rising side effects of fatigue from adding
060414 - cyclophosphamide to sunitinib, per above. ref SDS 0 LF8M
060416 -  ..
060417 - Her general feeling is loss of energy.
060419 -  ..
060420 - Glenna reported in a telephone call that other patients treated with
060421 - the sunitinib protocol also experience fatigue.
060423 -  ..
060424 - Millie had her 20th treatment with sunitinib this morning at 0700.
060425 - ref SDS 0 PA8Y  This is the 6th 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 87 X64F, ref SDS 85 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 -    Lafayette        2.75   62.7    90 117    sc        081203, ref SDS 0 3E4K
060452 -    Concord home (gym)                        sc        081202, ref SDS 87 3E4K
060453 -    Lafayette        5.50  102.3    95 122    sc        081201, ref SDS 85 3E4K
060454 -    Concord home                              sc        081130, ref SDS 84 3E4K
060455 -    Lafayette        2.75   56.7    90 115    scm       081129, ref SDS 83 3E4K
060456 -    Lafayette        2.75   46.5   100 128    scm       081128, ref SDS 81 3E4K
060457 -    Lafayette        5.50   93.3   100 122    s         081127, ref SDS 80 3E4K
060458 -    Concord home                              s         081126, ref SDS 78 3E4K
060459 -    Lafayette        4.00   73.7   105 127    s         081125, ref SDS 77 3E4K
060460 -    Lafayette        5.50   91.4   100 129    s         081124, ref SDS 76 3E4K
060461 -    Concord home                              s         081123, ref SDS 75 3E4K
060462 -    Lafayette        5.50   92.8    95 122    s         081122, ref SDS 74 3E4K
060463 -    Lafayette        5.50   94.4    85 112    s         081121, ref SDS 73 3E4K
060464 -    Lafayette        5.50   94.7    90 122    s         081120, ref SDS 72 3E4K
060465 -    San Francisco    1.00   60.0    65  75    s         081119, ref SDS 71 3E4K
060466 -    Lafayette        2.75   49.2    97 130    s         081118, ref SDS 70 3E4K
060467 -    Lafayette        5.50   93.6   115 138    s         081117, ref SDS 67 3E4K
060468 -    Concord home                              s         081116, ref SDS 65 Y68J
060469 -    Concord home                              s         081115, ref SDS 64 EK7I
060470 -    Concord home                              s         081114, ref SDS 63 XW6H
060471 -    Lafayette        5.50   94.2   115 138              081110, ref SDS 61 3E4K
060472 -    Lafayette        2.75   48.4   105 128              081109, ref SDS 60 3E4K
060473 -    Kaiser                                         x    081108, ref SDS 59 UZ7K
060474 -    Kaiser                                         x    081107, ref SDS 58 UZ7K
060475 -    Lafayette        5.50   90.2   120 143              081025, ref SDS 56 3E4K
060476 -    Kaiser                                         x    081025, ref SDS 56 UZ7K
060477 -    Kaiser                                         x    081024, ref SDS 55 UZ7K
060478 -    UCSF                                      c         081023, ref SDS 54 V94O
060479 -    Lafayette        5.50   90.6   115 141              081021, ref SDS 53 3E4K
060480 -    Lafayette        5.50   90.4   110 128              081020, ref SDS 52 3E4K
060481 -    Kaiser                                         x    081018, ref SDS 51 UZ7K
060482 -    Kaiser                                         x    081017, ref SDS 50 UZ7K
060483 -    UCSF                                      e         081016, ref SDS 48 V94O
060484 -    Lafayette        5.50   90.1   115 154              081014, ref SDS 47 3E4K
060485 -    Lafayette        5.50   92.7   115 138              081013, ref SDS 46 3E4K
060486 -    Lafayette        8.25  146.4   180 224              081012, ref SDS 45 3E4K
060487 -    Kaiser                                         x    081011, ref SDS 44 UZ7K
060488 -    Lafayette        5.50   93.3   116 138              081010, ref SDS 43 3E4K
060489 -    Kaiser                                         x    081010, ref SDS 43 UZ7K
060490 -    UCSF                                      e         081009, ref SDS 42 V94O
060491 -    Lafayette        5.50   92.1   113 137              081006, ref SDS 41 3E4K
060492 -    Lafayette        2.75   48.5   110 136         x    081004, ref SDS 40 3E4K
060493 -    Lafayette        5.50   98.2   117 136         x    081003, ref SDS 39 3E4K
060494 -    UCSF                                      c         081002, ref SDS 38 V94O
060495 -    Lafayette        5.50   94.7   115 142              080929, ref SDS 37 3E4K
060496 -    Lafayette        8.25  150.4   115 135              080928, ref SDS 37 3E4K
060497 -    Kaiser                                         x    080927, ref SDS 36 UZ7K
060498 -    Lafayette        5.50   90.2   120 140         x    080926, ref SDS 35 3E4K
060499 -    UCSF                                      c         080925, ref SDS 34 V94O
060500 -    Lafayette        5.50   92.3   116 138              080923, ref SDS 33 3E4K
060501 -    Lafayette        5.50   98.4   112 134              080922, ref SDS 33 3E4K
060502 -    Lafayette        5.50   98.2   114 137              080921, ref SDS 33 3E4K
060503 -    Lafayette        5.50  101.6   110 133         x    080920, ref SDS 32 3E4K
060504 -    Lafayette        5.50   89.3   115 144         x    080919, ref SDS 31 3E4K
060505 -    UCSF                                      c         080918, ref SDS 30 V94O
060506 -    Lafayette        2.75   46.2   117 139              080916, ref SDS 31 3E4K
060507 -    Lafayette        5.50   91.8   117 142              080915, ref SDS 29 3E4K
060508 -    Clayton Safeway  3.00   62.4    98 118              080914, ref SDS 28 3E4K
060509 -    Lafayette        8.25  129.7   123 147         x    080913, ref SDS 27 3E4K
060510 -    Lafayette        5.50   88.4   118 146         x    080912, ref SDS 26 3E4K
060511 -    UCSF                                      c         080911, ref SDS 25 V94O
060512 -    Lafayette        2.75   46.8   113 140              080909
060513 -    Lafayette        5.50   89.2   117 143              080908
060514 -    Lafayette        5.50   92.1   115 138              080907
060515 -    Lafayette        2.75   45.3   120 144         x    080906, ref SDS 24 3E4K
060516 -    Lafayette        2.75   56.8    93 120         x    080905, ref SDS 23 3E4K
060517 -    UCSF                                      c         080904, ref SDS 22 V94O
060518 -    Lafayette        8.25  140.4   116 131              080903
060519 -    Lafayette        5.50   94.9   115 134              080902
060520 -    Kaiser                                         x    080830
060521 -    Kaiser                                         x    080829
060522 -    UCSF                                      c         080828, ref SDS 21 V94O
060523 -    Lafayette        5.50   93.6   120 137              080826
060524 -    Lafayette        5.50   93.2   117 138              080825
060525 -    Lafayette        5.50   93.2   123 136         x    080823
060526 -    Lafayette        8.25  142.5   110 131         x    080822, ref SDS 20 3E4K
060527 -    UCSF                                      e         080821, ref SDS 19 V94O
060528 -    Lafayette        5.50   94.7   115 137              080820
060529 -    Lafayette        5.50   94.3   115 135              080819
060530 -    Lafayette        8.25  141.7   118 134              080815
060531 -    UCSF                                      e         080814, ref SDS 18 V94O
060532 -    Lafayette        5.50   93.8   120 136              080813
060533 -    Lafayette        5.50   94.4   116 139              080812
060534 -    Lafayette        5.50   94.2   119 133              080810
060535 -    Lafayette        8.25  143.6   114 132         x    080809, ref SDS 16 3E4K
060536 -    Lafayette        8.25  141.1   117 135         x    080808, ref SDS 15 3E4K
060537 -    UCSF                                      c         080807, ref SDS 14 V94O
060538 -    Lafayette        8.25  143.7   115 132              080805
060539 -    Concord          7.00  127.6   105 118              080804
060540 -    Lafayette        8.25  143.2   112 134              080802
060541 -    Lafayette        5.50   93.4   115 138              080801
060542 -    Lafayette        5.50   92.2   118 140              080729
060543 -    Lafayette        5.50   92.6   116 137              080728
060544 -    Lafayette        8.25  142.6   114 134              080727
060545 -    Lafayette        5.50   91.5   120 143              080726
060546 -    Lafayette        8.25  140.8   117 135              080725
060547 -    Lafayette        5.50   91.8   122 141              080723
060548 -    Lafayette        5.50   91.3   120 139              080722
060549 -    Lafayette        8.25  143.3   115 133              080720
060550 -    Lafayette        5.50   90.7   125 144              080719
060551 -    Lafayette        5.50   92.4   123 142              080716
060552 -    Lafayette        2.25   46.8   116 137              080715
060553 -    Lafayette        8.25  141.8   116 136              080712
060554 -    Lafayette        5.50   92.9   116 139              080711
060555 -    Lafayette        8.25  143.3   113 137              080704
060556 -    Lafayette        5.50   90.2   121 147              080630
060557 -    Lafayette        8.25  142.4   116 138              080628
060558 -    Lafayette        5.50   91.4   118 138              080625
060559 -    Lafayette        2.25   47.9   116 136              080623
060560 -    Lafayette        5.50   94.2   112 138              080622
060561 -    Lafayette        5.50   94.7   115 133              080621
060562 -    Lafayette        2.25   48.3   110 129              080620
060563 -    Mt Diablo        7.00  129.4   130 153              080616
060564 -    Lafayette        5.50   90.8   120 146              080615
060565 -    Lafayette        5.50   91.3   124 144              080614
060566 -    Lafayette        5.50   89.7   122 143              080613
060567 -    Lafayette        2.76   45.8   120 147              080611
060568 -    Lafayette        5.50   90.5   123 145              080609
060569 -    Lafayette        5.50   92.7   115 138              080607
060570 -    Lafayette        5.50   94.2   118 139              080602
060571 -    Lafayette        5.50   96.2   110 202              080507, ref SDS 5 WO8M
060572 -
060573 -
060574 -
060575 -
060576 -
060577 -
0606 -