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 5, 2008 07:00 AM Friday;
Rod Welch
Millie sunitinib #22 treatment IBC 5th relapse recovering well.
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...Blood Test Kaiser on 081203 Report NEUTS 0.624 Very Low
6...Neupogen Case Study Low Blood Counts Sunitinib Cyclophosphamide Protocol
7...Patient history of NEUTS (ANC) Kaiser....
8...Exercise Hiking Maintain Fitness Strengthen Immune System
9...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 B9 0000. ref SDS B8 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Sunitinib Metronomic Treatment Loading Dose Clinical Study UCSF
040902 -
040903 - Follow up ref SDS B9 505G, ref SDS B8 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 91
040910 - EK7I After 14 treatments ending on 081127, ref SDS A9 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 75 004O
040920 - ..
040921 - These supplemental treatments started on 081128. ref SDS B0 VR57
040923 - ..
040924 - Millie continues with sunitinib and cyclophosphmaide; methotrexate
040925 - is taken twice today and tomorrow.
040926 -
040928 - ..
040929 - Sunitinib Cyclophosmaide Methotrexate Patient History
040930 -
040931 - Follow up ref SDS B9 OE6K, ref SDS B8 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 B9 PA8Y, ref SDS B8 PA8Y.
040943 -
040944 - 1. 081114 0700 Load 37.5 0 0 ... ref SDS 91 OE6K
040945 - 2. 081115 0700 Load 75.0 0 0 ... ref SDS 92 OE6K
040946 - 3. 081116 0700 Load 112.5 0 0 ... ref SDS 93 OE6K
040947 - 4. 081117 0700 Load 150.0 0 0 ... ref SDS 94 OE6K
040948 - 5. 081118 0700 Load 187.5 0 0 ... ref SDS 97 OE6K
040949 - 6. 081119 0700 Load 225.0 0 0 ... ref SDS 99 OE6K
040950 - 7. 081120 0700 Load 263.5 0 0 ... ref SDS A0 OE6K
040951 - 8. 081121 0700 Load 301.0 0 0 ... ref SDS A1 OE6K
040952 - 9. 081122 0700 Load 338.5 0 0 ... ref SDS A2 OE6K
040953 - 10. 081123 0700 Load 376.0 0 0 ... ref SDS A3 OE6K
040954 - 11. 081124 0700 Load 413.5 0 0 ... ref SDS A4 OE6K
040955 - 12. 081125 0700 Load 451.0 0 0 ... ref SDS A5 OE6K
040956 - 13. 081126 0700 Load 488.5 0 0 ... ref SDS A6 OE6K
040957 - 081126 0820 NEUTS....... 1.50................. ref SDS A7 PU6K
040958 - 14. 081127 0700 Load 526.0 0 0 ... ref SDS A8 OE6K
040959 - 15. 081128 0700 1 1 563.5 1 50 1 5 ... ref SDS B0 OE6K
040960 - 16. 081129 0700 1 2 601.0 2 100 2 10 ... ref SDS B2 OE6K
040961 - 17. 081130 0700 1 3 638.5 3 150 2 10 ... ref SDS B3 OE6K
040962 - 18. 081201 0700 1 4 676.0 4 200 2 10 ... ref SDS B4 OE6K
040963 - 19. 081202 0700 1 5 713.5 5 250 2 10 ... ref SDS B6 OE6K
040964 - 20. 081203 0700 1 6 751.0 6 300 2 10 ... ref SDS B8 OE6K
040965 - 081203 0735 NEUTS....... 0.624................ ref SDS B7 RN5G
040966 - 21. 081204 0700 1 7 788.5 7 350 2 10 ... ref SDS B9 OE6K
040967 - ..
040968 - 22. 081205 0700 1 8 826.0 8 400 3 15 ... ref SDS 0 OE6K
040969 - 081205 1300 Neupogen...... 480 mcg............ ref SDS C1 KV84
040970 -
040971 -
040972 -
040973 -
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 B9 LF8M, ref SDS B8 LF8M.
050405 -
050406 - Fatigue is a likely side effect of sunitinib with cyclophosphamide,
050407 - listed in the Consent document reviewed on 081017. ref SDS 75 4G7G
050409 - ..
050410 - NEUTs blood tests show patient[history neutropenia from chemotherapy
050411 - everyday with cyclophosphamide reported in case study on 081205.
050412 - ref SDS 0 EC5N
050414 - ..
050415 - Energy improved a little yesterday, but has declined the past week,
050416 - shown by declining exercise. ref SDS B9 X64F After staying in bed on
050417 - 081130, Millie went hiking on 081201, and did well, but had severe
050418 - loss of energy at the end if the hike. ref SDS B4 3E4K On 081202,
050419 - Millie did aerobics in the gym, but was too tired for hiking.
050420 - ref SDS B6 3E4K Yesterday, on 081203 she did one lap very slow.
050421 - ref SDS B8 AG3J
050423 - ..
050424 - On 081202 Millie's letter to the medical team cites rising fatigue,
050425 - ref SDS B5 AT8U, and asks about requirements for labs to evaluate
050426 - blood counts, including NEUTS (ANC at Kaiser). ref SDS B5 AT8X
050428 - ..
050429 - Glenna reported in a telephone call yesterday, responding to Millie's
050430 - letter on 081202, that other patients treated with the sunitinib
050431 - protocol also experience fatigue. ref SDS B8 XN43
050433 - ..
050434 - On 081203 blood draw ordered by Gloria for INR was expanded by primary
050435 - care physician to test for broad response to treatment, including CBC
050436 - that evaluates requirements for Neupogen to maintain immune system
050437 - while getting daily treatments with sunitinib and chemotherapy with
050438 - cyclophosphamide. ref SDS B7 TG8M
050440 - ..
050441 - Vitals after getting up from bed, and before hiking was...
050442 -
050443 - BP 138 76 Pulse 49
050445 - ..
050446 - Millie had higher blood pressure later today at Kaiser for Neupogen
050447 - treatment. ref SDS C1 4C4F
050449 - ..
050450 - Millie reported minor heartburn today, and no upset stomach.
050452 - ..
050453 - Prilosec prescribed for heartburn has still not been taken.
050455 - ..
050456 - Diarrhea occurred again today after taking all three pills starting
050457 - the 2nd week of the 1st cycle. This is the first episode since
050458 - starting on the new treatment on 081114. She took Imodium treatment,
050459 - also reported on 081114. ref SDS 91 LF8M
050461 - ..
050462 - Millie reports improved taste from some foods today (e.g., soup),
050463 - cited in study consent documents, reviewed on 081017. ref SDS 75 6T5H
050464 -
050466 - ..
050467 - Date
050468 - Description Adverse Event Start Stop Medication
050469 - ---------------------------------------------------------
050470 - Follow up ref SDS B9 MV5H, ref SDS B8 MV5H.
050471 -
050472 - Diarrhea 081114 081114 Imodium........ ref SDS 91 LF8M
050473 - Low pulse 081120 081120 None........... ref SDS A0 LF8M
050474 - Low pulse 081121 081121 None........... ref SDS A1 7G8M
050475 - BP 144 84 Pulse 48 081121 081121 Hiking......... ref SDS A1 LF8M
050476 - Joint pain minor 081121 081121 Hiking......... ref SDS A1 LF8M
050477 - Fatigue minor 081121 081121 Hiking......... ref SDS A1 LF8M
050478 - Low pulse 081122 081122 None........... ref SDS A2 7G8M
050479 - Fatigue minor 081122 081122 Hiking......... ref SDS A2 LF8M
050480 - Low pulse 081123 081122 None........... ref SDS A3 7G8M
050481 - BP 121 74 Pulse 53 081123 081123 Hiking......... ref SDS A3 LF8M
050482 - Fatigue minor 081123 081122 Hiking......... ref SDS A3 LF8M
050483 - Joint pain minor 081124 081124 Hiking......... ref SDS A4 LF8M
050484 - Fatigue minor 081124 081124 Hiking......... ref SDS A4 LF8M
050485 - Heartburn 081124 081124 None........... ref SDS A4 HS9K
050486 - BP 144 78 Pulse 52 081125 081125 Hiking......... ref SDS A5 LF8M
050487 - Joint pain minor 081125 081125 Hiking......... ref SDS A5 LF8M
050488 - Fatigue minor 081125 081125 Hiking......... ref SDS A5 LF8M
050489 - Heartburn 081125 081125 None........... ref SDS A5 HS9K
050490 - Heartburn 081126 081126 None........... ref SDS A6 HS9K
050491 - Heartburn 081127 081127 None........... ref SDS A9 HS9K
050492 - BP 135 73 Pulse 48 081128 081128 Hiking......... ref SDS B0 5X6K
050493 - Upset stomach 081128 081128 Hiking......... ref SDS B0 T76O
050494 - BP 140 75 Pulse 50 081129 081129 Hiking......... ref SDS B2 5X6K
050495 - Heartburn 081129 081129 None........... ref SDS B2 HS9K
050496 - Fatigue 081129 081129 Rest........... ref SDS B2 LF8M
050497 - Fatigue 081130 081130 Rest........... ref SDS B3 LF8M
050498 - BP 136 79 Pulse 46 081201 081201 Hiking......... ref SDS B4 5X6K
050499 - Fatigue 081201 081201 Rest........... ref SDS B4 LF8M
050500 - Taste altered 081201 081201 Rest........... ref SDS B4 VP4G
050501 - BP 141 77 Pulse 46 081202 081202 Aerobics gym... ref SDS B6 5X6K
050502 - Fatigue 081202 081202 Rest........... ref SDS B6 LF8M
050503 - Taste altered 081202 081202 Rest........... ref SDS B6 VP4G
050504 - BP 138 77 Pulse 48 081203 081203 Hiking......... ref SDS B8 5X6K
050505 - Fatigue 081203 081203 Rest........... ref SDS B8 LF8M
050506 - Taste altered 081203 081203 Rest........... ref SDS B8 VP4G
050507 - NEUTS (ANC) 0.624 081203 081203 Neupogen.......
050508 - BP 133 72 Pulse 45 081204 081204 Rest........... ref SDS B9 5X6K
050509 - Fatigue 081204 081204 Rest........... ref SDS B9 LF8M
050510 - Taste altered 081204 081204 Rest........... ref SDS B9 VP4G
050511 - BP 138 76 Pulse 49 081205 081205 Rest........... ref SDS 0 5X6K
050512 - Diarrhea 081205 081114 Imodium........ ref SDS 0 LF8M
050513 - Fatigue 081205 081205 Rest........... ref SDS 0 LF8M
050514 - Taste altered 081205 081205 Rest........... ref SDS 0 VP4G
050515 -
050516 -
050517 -
050518 -
0506 -
SUBJECTS
Default Null Subject Account for Blank Record
0603 -
060401 - ..
060402 - Blood Test Kaiser on 081203 Report NEUTS 0.624 Very Low
060403 -
060404 - Follow up ref SDS B7 TG8M, ref SDS B5 AT8U.
060405 -
060406 - Millie received results of the blood test from Kaiser today while
060407 - getting a Neupogen treatment, reported in another record.
060409 - ..
060410 - The test was performed at Kaiser on 081203 implementing orders by
060411 - primary care physician, ref SDS B7 TG8M, responding to Millie's letter
060412 - to the Medical team on 081202. ref SDS B5 AT8U
060413 -
060414 - [On 081206 Millie submitted the complete lab to UCSF.
060415 - ref SDS C4 2K4U
060417 - ..
060418 - The previous lab at UCSF was on 081126. ref SDS A7 075H
060419 -
060420 - [On 081210 Kaiser follow up lab, ref SDS C8 S65I, shows
060421 - NEUTS 1.085. ref SDS C8 QY6H
060423 - ..
060424 - The previous lab performed at Kaiser was on 080708, when Millie had
060425 - minor surgery to upgrade port catheter to a Power Port for CT tests.
060426 - ref SDS 31 075H Results of the test on 080708 are listed without
060427 - attribution in the medical chart for the meeting with the primary
060428 - care physician on 081024.
060430 - ..
060431 - The report from Kaiser today showing prior lab from "081105" must be
060432 - incorrect, because Millie was traveling on a ship at sea in the
060433 - Carribean on 081105, shown by her itenary, reported on 081026,
060434 - ref SDS 83 JN4M, and did not return home until the next day on 081106.
060435 - ref SDS 84 F75H
060436 -
060438 - ..
060439 - Patient Provider Category View FR Date To Date
060453 - ..
060454 - 72/F Lab Results Summary
060456 - ..
060457 - Log#: 540833800002 081203 07:35
060458 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
060459 - Type Results Units Normal Type Units Normal ACRO
060460 - ..
060461 - CBC with DIFF & PLT CT CBCD
060462 - ..
060463 - WBC L 2.4 K/uL 3.4 - 10.0 WBC x10-3 x10E9/L 3.4 - 10 WBC
060464 - RBC L 3.51 M/uL 3.60 - 5.70 RBC x10-6 x10E12/L 4 - 5.2 RBC
060465 - Hemoglobin 11.8 g/dL 11.5 - 15.0 Hemoglobin g/dL 12 - 15.5 HGB
060466 - Hematocrit L 34.7 % 34.0 - 46.0 Hematocrit PERCENT 36 - 46 HCT
060467 - MCV 99 fL 80.0 - 100.0 MCV fL 80 - 100 MCV
060468 - RDW, RBC H 14.5 % 11.9 - 14.3 [Not Reported at UCSF]
060469 - MCH [Not Reported] MCH pg 26 - 34 MCH
060470 - MCHC [Not Reported] MCHC g/dL 31 - 36 MCHC
060471 - ..
060472 - Platelets L 109 K/uL 140 - 400 Plt x10-3 x10E9/L 140 - 450 PLT
060473 -
060474 - [On 081205 Millie letter to medical team advises platelets
060475 - 109 well below target range. ref SDS C0 TT8P
060476 -
060477 - [On 081210 follow up blood test shows platelets 67, about
060478 - 60% below the target range of 104. ref SDS C8 DM6J
060479 - ..
060480 - (calculated by Bonnie at Kaiser 081205. ref SDS C1 CH40)
060481 - ANC L 624 -> 1500 NEUTS x10E9/L 1.8 - 6.8 N-A
060482 - Neutrophils L 26 % 41 - 81 Neutrophils
060484 - ..
060485 - [On 081210 Kaiser follow up lab, ref SDS C8 S65I, shows
060486 - NEUTS 1.085. ref SDS C8 QY6H
060488 - ..
060489 - Lymphocytes H 55 % 13 - 46 LYMPHS x10E9/L 0.9 - 2.9 L-A
060490 - Monocyte 5 % 4 - 12 MONOS x10E9/L 0.2 - 0.8 M-A
060491 - Esoinophils H 14 % 0 - 4 EOS x10E9/L 0.0 - 0.4 E-A
060492 - Basophil 1 % 0 - 1 BASOS x10E9/L 0.0 - 0.1 B-A
060494 - ..
060495 - Log#: 540833800002 081203 07:35
060496 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
060497 - Type Results Units Normal Type Units Normal ACRO
060498 - PT, Patient H 28.0 sec 8.2 - 10.6 PT s 12.0 - 14.1 PT
060499 - PT INR H 2.7 INL NRM Ratio 0.9 - 1.1 INR
060501 - ..
060502 - Log#: 540833800002 081203 07:35
060503 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
060504 - Type Results Units Normal Type Units Normal ACRO
060505 - ELECTROLYTE PANEL
060506 - Sodium 139 mEq/L 133 - 145 SODIUM mmol/L 134 - 143 NA
060507 - Potassium 4.9 mEq/L 3.5 - 5.3 POTASSIUM mmol/L 3.4 - 4.9 K
060508 - Chloride 107 mEq/L 100 - 111 CHLORIDE mmol/L 98 - 107 CL
060509 - CO2 24 mEq/L 24 - 33 CARBON DIOX TOTAL mmol/L 23 - 32 CO2
060510 - ANION GAP [No Report] ANION GAP 3 - 14 ANGA
060511 - ..
060512 - BUN 13 mg/dL 10 - 20 UREA NITROGEN mg/dL 8 - 23 BUN
060513 - AST (SGOT) H 48 U/L 10 - 40 AST U/L 16 - 41 AST
060514 - ALT (SGPT) 24 U/L -< 36 ALT U/L 11 - 54 ALT
060515 - Bili, Tot Adult 0.6 mg/dL 0.2 - 1.2 BILIRUBIN, TOTAL mg/dL 0.3 - 1.3 BILT
060516 - Alkaline Phos 71 U/L 37 - 117 ALKALINE PHOSPHATASE U/L 29 - 111 ALKP
060517 - ..
060518 - Total Protein [No Report] g/dL 6.0 - 7,7 PROTEIN, TOTAL g/dL 5.8 - 8.0 TP
060519 - ALBUMIN [No Report] ALBUMIN g/dL 3.4 - 4.7 ALB
060520 - Calcium 9.1 mg/dL 8.5 - 10.3 CALCIUM mg/dL 8.7 - 10.1 CA
060521 - ..
060522 - Magnesium 2.0 mg/dL 1.7 - 2.3 MAGNESIUM mg/dL 1.8 - 2.3 MG
060524 - ..
060525 - Log#: 540833800002 081203 07:35
060526 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
060527 - Type Results Units Normal Type Units Normal ACRO
060528 - RBC Morphology
060529 - Platelets, Bld, QL,
060530 - MAN CT DECREASE
060531 - Polychromasia 1+
060532 - Macrocytes 1+
060533 - Ovalocytes Bld, QL,
060534 - Light Microscopy 1+
060535 - Dacrocytes Bld, QL, [also called "Teardrop"??]
060536 - Light Microscopy 1+
060538 - ..
060539 - Log#: 540833800002 081203 07:35
060540 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
060541 - Type Results Units Normal Type Units Normal ACRO
060542 - Creat with GFR
060543 - Creatinine 0.69 mg/dL -< 1.11 CREATININE mg/dL 0.42 - 1.06 CR
060544 -
060545 - Note: Creatinine assay changed to IDMS standardization on
060546 - February 4, 2008 causing decrease in results of approximately
060547 - 0.09 mg/dL
060549 - ..
060550 - GFR Non-Afr Am >60 mL/min > 60 - eGFR if Caucasian >60 mL/min GFRC
060551 - GFR African AM >60 mL/min > 60 eGFR if African Amer >60 mL/min GFRA
060552 - GFR Note **
060553 -
060554 - [On 081210 Kaiser follow up lab, ref SDS C8 S65I, shows
060555 - NEUTS 1.085. ref SDS C8 QY6H
060556 -
060557 -
060558 -
060559 -
0606 -
SUBJECTS
Default Null Subject Account for Blank Record
0703 -
070401 - ..
070402 - Neupogen Case Study Low Blood Counts Sunitinib Cyclophosphamide Protocol
070403 -
070404 - Follow up ref SDS A7 EP7N. ref SDS 85 EP7N.
070405 -
070406 - Case study on 060809 shows Millie has often received chemotherapy when
070407 - blood counts are below the standard for safe treatments, and on some
070408 - occassions has received Neupogen to increase blood counts. ref SDS 1
070409 - HV45
070411 - ..
070412 - Research on neutropenia was reported on 070301, ref SDS 2 O59H, when
070413 - Doctor Rugo was concerned about holding blood counts with weekly
070414 - Carboplatin treatments. ref SDS 2 VF6O
070416 - ..
070417 - Background on Neupogen treatments is reported in the record today
070418 - shown below on 081205. ref SDS 0 EC5N
070420 - ..
070421 - On 081126 UCSF advised that NEUTS decreasing to 1.50 after several
070422 - weeks of no chemotherapy, and several weeks with sunitinib did not
070423 - require Neupogen until after review of laboratory work for starting
070424 - the next cycle on 081218.
070426 - ..
070427 - Millie's letter to the medical team on 081202 reported symptoms of
070428 - chronic fatigue and sniffles that could relate to low immune system.
070429 - ref SDS B5 AT8U The primary care physician at Kaiser responded by
070430 - ordering blood work. On 081203 Kaiser performed labs. Results
070431 - reported today show NEUTS 0.624. ref SDS 0 QY6H
070433 - ..
070434 - Glenna reported in a telephone call on 081203 that other patients
070435 - treated with the sunitinib protocol also experience fatigue.
070436 - ref SDS B8 XN43
070437 -
070438 - [On 081219 1140 primary care physician concurs with UCSF order
070439 - to pause treatments, ref SDS D5 JK7H; diagnoses cytopenia,
070440 - including pancytopenia from expanded low blood counts that
070441 - risks fatal infection, and cause chronic fatigue, muscle
070442 - weakness, and loss of vitality and vigor associated with
070443 - chemotherapy. ref SDS D5 LS6K
070445 - ..
070446 - [On 090122 0925 Millie suffers fall during aerobics
070447 - exercise at the gym due to fatigue and muscle weankess
070448 - caused by low blood counts, ref SDS E7 CW6J; suffered
070449 - severe pain, ref SDS E7 WS7T, and treated for dislocated
070450 - shoulder at Emergency Room Department, ref SDS E7 W05P
070452 - ..
070453 - [On 090213 1140 Doctor Johnson explains risks of cytopenia and
070454 - pancytopenia that reduce energy, fitness, and muscle strength
070455 - contribute to Millie's fall and dislocated shoulder.
070456 - ref SDS E8 PQTX
070458 - ..
070459 - In another record today, Millie had a Neupogen treatment ordered at
070460 - Kaiser due to low blood counts. ref SDS C1 CH40 She was treated with
070461 - 480 mcg Neupogen. ref SDS C1 KV84 The nurse recommended notifying
070462 - UCSF to consider adding a 3rd Neupogen treatment for next week, and
070463 - checking blood counts next week, in advance of the meeting at UCSF on
070464 - 081218. ref SDS C1 X35F
070466 - ..
070467 - Millie received a letter late this evening from Doctor Rugo, and after
070468 - Millie was treated with Neupogen at Kaiser, reported in another
070469 - record. ref SDS C1 CH6X The doctor advised that Neupogen is needed
070470 - with neutrophils low. ref SDS C2 JE5I The blood test on 081203 shows
070471 - neutrophils 26% which is well below the normal range of 41 - 81.
070472 - ref SDS 0 QY6H Millie sent a letter reporting neutrophils were low.
070473 - ref SDS C3 NN4S
070474 -
070475 - [On 081206 Millie submitted Kaiser's report for the lab on
070476 - 081203 to UCSF, ref SDS C4 WJ8K showing neutrophils are
070477 - low. ref SDS C4 2K5U
070479 - ..
070480 - [On 081210 Glenna seemed to indicate in a call that UCSF
070481 - relies on Kaiser's standards and practices for treating
070482 - Millie with Neupogen when "neutrophils are low,"
070483 - ref SDS C6 6S56, and further noted that UCSF supports
070484 - Millie getting a follow up blood draw to test for
070485 - neutrophils. ref SDS C6 633K
070487 - ..
070488 - [On 081210 Arlette ordered follow up blood test.
070489 - ref SDS C7 616R
070491 - ..
070492 - [On 081210 Kaiser follow up lab, ref SDS C8 S65I, shows
070493 - NEUTS 1.085. ref SDS C8 QY6H
070495 - ..
070496 - [On 081210 primary care physician called Millie and advised
070497 - that ANC 1085 in blood test on 081210 does not require
070498 - Neupogen under Kaiser standards and practices until ANC
070499 - falls below 1000, ref SDS C0 J43V; doctor ordered follow up
070500 - blood test on 081212 to evaluate ANC below 1000 based on
070501 - patient history indicating ANC falling 120+ points per day
070502 - on sunitinib treatment protocol, which would cause ANC to
070503 - drop below 500 without Neupogen until Millie's next
070504 - scheduled lab at UCSF on 081218. ref SDS C0 H44M
070505 -
070506 -
070508 - ..
070509 - Patient history of NEUTS (ANC) Kaiser....
070510 -
070511 - Cycloph Metho
070512 - Neupogen Sunitinib osphamide trexate, ref SDS 0 ES4F
070513 - Date NEUTS Cur MCG # MG # MG # MG
070514 - 090116 57 2135.5..paused................. ref SDS E5 V14O
070515 - 090116 1.768............................................ ref SDS E6 QY6H
070516 - 090110 51 1910.5..paused................. ref SDS E3 UV5H
070517 - 090110 6 2880.................................... ref SDS E4 P73J
070518 - 090109 50 1875.0..paused................. ref SDS E1 6C4J
070519 - 090109 5 2400.................................... ref SDS E2 P73J
070520 - 090108 49 1837.5 35 1750.............. ref SDS D9 9F9I
070521 - 090108 0.870............................................ ref SDS E0 QY6H
070522 - 081226 36 1350.0 22 1100.............. ref SDS D7 9I6T
070523 - 081226 1.710............................................ ref SDS D8 QY6H
070524 - 081220 4 1920 2 missed 2 missed............. ref SDS D6 UZ7K
070525 - 081219 1 missed 1 missed ended..... ref SDS D4 UZ7K
070526 - 081219 3 1440.................................... ref SDS D4 UZ7K
070527 - 081218 0.740 35 1312.5 21 1050 6 30 ... ref SDS D3 QY6H and ref SDS D2 MF5H
070528 - 081212 1.054 29 1087.5 15 750 5 25 ... ref SDS D1 5G4J
070529 - 081210 1.085 27 1013.5 13 650 4 20 ... ref SDS C5 X59G
070530 - 081206 2 960 23 863.5 9 450 4 20 ... ref SDS C5 2Q6V
070531 - 081205 0.624 1 480 22 826.0 8 400 3 15 ... ref SDS 0 QY6H
070532 - 081126 1.50 0 13 488.5 ....................... ref SDS A7 QY6H
070533 - ..
070534 - Neupogen Carboplatin
070535 - Date NEUTS Cur Totl Cycl Trm Rcvd Missed
070536 - 081107 1.67 2 44 9 2 21.......... ref SDS 85 QY6H
070537 - 081023 1.65 2 42 9 2 21.......... ref SDS 80 QY6H
070538 - 081016 2.55 2 40 9 1 20.......... ref SDS 74 QY6H
070539 - 081009 1.98 2 38 8 4 19.......... ref SDS 68 QY6H
070540 - 081002 1.93 2 36 8 3 19.......... ref SDS 64 QY6H
070541 - 080925 3.82 2 34 8 2 18.......... ref SDS 60 QY6H
070542 - 080918 2.07 2 32 8 1 17.......... ref SDS 56 QY6H
070543 - 080911 1.43 2 30 7 4 16.......... ref SDS 51 QY6H
070544 - 080904 1.99 2 28 7 3 16.......... ref SDS 48 QY6H
070545 - 080828 3.09 2 26 7 2 15.......... ref SDS 47 QY6H
070546 - 080821 0.99 2 24 7 1 14 4... ref SDS 45 QY6H
070547 - 080814 1.37 0 22 6 4 14.......... ref SDS 44 QY6H
070548 - 080807 2.41 2 22 6 3 14.......... ref SDS 40 QY6H
070549 - 080731 1.92 2 20 6 2 13.......... ref SDS 38 QY6H
070550 - 080724 2.32 2 18 6 1 12.......... ref SDS 36 QY6H
070551 - 080717 2.47 1 16 5 4 11.......... ref SDS B2 QY6H
070552 - 080710 5.12 2 15 5 3 11.......... ref SDS B3 QY6H
070553 - 080703 2.90 2 13 5 2 10.......... ref SDS B4 QY6H
070554 - 080626 1.80 2 11 5 1 09.......... ref SDS B5 QY6H
070555 - 080619 0.74 1 9 4 4 08.......... ref SDS B6 QY6H
070556 - 080612 3.77 2 8 4 3 08.......... ref SDS B7 QY6H
070557 - 080605 1.55 2 6 4 2 07.......... ref SDS B8 QY6H
070558 - 080529 2.26 1 4 4 1 06.......... ref SDS B9 QY6H
070559 - 080522 0.96 0 3 4 05.......... ref SDS 38 QY6H
070560 - 080515 1.21 0 3 3 05 3... ref SDS 36 QY6H
070561 - 080508 5.41 1 3 3 2 05.......... ref SDS B2 QY6H
070562 - 080501 1.34 1 2 3 1 04.......... ref SDS B3 QY6H
070563 - 080424 1.34 0 2 4 03.......... ref SDS B4 QY6H
070564 - ..
070565 - 080417 0.95 0 2 3 03 2... ref SDS B5 QY6H
070566 - 080410 6.85 0 2 2 03.......... ref SDS B6 QY6H
070567 - 080403 1.34 1 1 2 1 02.......... ref SDS B7 QY6H
070568 - 080327 2.30 0 1 4 01.......... ref SDS B8 QY6H
070569 - 080320 1.28 0 1 3 01 1... ref SDS B9 QY6H
070570 - 080313 2.05 0 1 2 01.......... ref SDS 38 QY6H
070571 - 080306 1.75 0 1 1 00.......... ref SDS 36 QY6H
070572 -
070573 -
070574 -
070575 -
070576 -
0706 -
SUBJECTS
Default Null Subject Account for Blank Record
0803 -
080401 - ..
080402 - Exercise Hiking Maintain Fitness Strengthen Immune System
080403 -
080404 - Follow up ref SDS B9 3E4K, ref SDS B8 3E4K.
080405 -
080406 - Millie did no go hiking today due to rising fatigue.
080408 - ..
080409 - Reducing exercise reflects rising side effects of fatigue from adding
080410 - cyclophosphamide to sunitinib, per above. ref SDS B8 LF8M
080412 - ..
080413 - Her general feeling is loss of energy, reflected by low blood counts
080414 - reported today, per above. ref SDS 0 QY6H, for the blood test on
080415 - 081203. ref SDS B7 TG8M
080417 - ..
080418 - Glenna reported in a telephone call on 081203 that other patients
080419 - treated with the sunitinib protocol also experience fatigue.
080420 - ref SDS B8 XN43
080422 - ..
080423 - Millie had her 21st treatment with sunitinib this morning at 0700.
080424 - ref SDS B9 PA8Y This is the 7th day of the 1st cycle that includes
080425 - sunitinib and cyclophosphmaide. Weekly treatment with methotrexate
080426 - start again tomorrow.
080428 - ..
080429 - On 081110, Millie complained about difficulty lifting herself from a
080430 - full squatting position. ref SDS 89 HX67 She has since been
080431 - exercising to strengthen legs, and arms.
080433 - ..
080434 - This morning Millie did...
080435 -
080436 - Arm presses 3 sets of 10 leaning against bannister.
080437 - Squats 3 sets of 10 vary depth useing bannister for leverage
080438 -
080440 - ..
080441 - Case Study on Pateint History Exercising
080442 -
080443 - Follow up ref SDS B9 X64F, ref SDS B8 X64F.
080444 -
080445 - +- scm = Sunitinib Cyclophosphmaide Methotrexate
080446 - +- sc = Sunitinib Cyclophosphmaide
080447 - Time Pulse |
080448 - Location Miles Minutes Avg Max Chem Neupo Date
080449 - ----------------------------------------------------------------
080450 - Concord home scm 081205, ref SDS 0 3E4K
080451 - Concord home sc 081204, ref SDS B9 3E4K
080452 - Lafayette 2.75 62.7 90 117 sc 081203, ref SDS B8 3E4K
080453 - Concord home (gym) sc 081202, ref SDS B6 3E4K
080454 - Lafayette 5.50 102.3 95 122 sc 081201, ref SDS B4 3E4K
080455 - Concord home sc 081130, ref SDS B3 3E4K
080456 - Lafayette 2.75 56.7 90 115 scm 081129, ref SDS B2 3E4K
080457 - Lafayette 2.75 46.5 100 128 scm 081128, ref SDS B0 3E4K
080458 - Lafayette 5.50 93.3 100 122 s 081127, ref SDS A9 3E4K
080459 - Concord home s 081126, ref SDS A6 3E4K
080460 - Lafayette 4.00 73.7 105 127 s 081125, ref SDS A5 3E4K
080461 - Lafayette 5.50 91.4 100 129 s 081124, ref SDS A4 3E4K
080462 - Concord home s 081123, ref SDS A3 3E4K
080463 - Lafayette 5.50 92.8 95 122 s 081122, ref SDS A2 3E4K
080464 - Lafayette 5.50 94.4 85 112 s 081121, ref SDS A1 3E4K
080465 - Lafayette 5.50 94.7 90 122 s 081120, ref SDS A0 3E4K
080466 - San Francisco 1.00 60.0 65 75 s 081119, ref SDS 99 3E4K
080467 - Lafayette 2.75 49.2 97 130 s 081118, ref SDS 98 3E4K
080468 - Lafayette 5.50 93.6 115 138 s 081117, ref SDS 95 3E4K
080469 - Concord home s 081116, ref SDS 93 Y68J
080470 - Concord home s 081115, ref SDS 92 EK7I
080471 - Concord home s 081114, ref SDS 91 XW6H
080472 - Lafayette 5.50 94.2 115 138 081110, ref SDS 89 3E4K
080473 - Lafayette 2.75 48.4 105 128 081109, ref SDS 88 3E4K
080474 - Kaiser x 081108, ref SDS 87 UZ7K
080475 - Kaiser x 081107, ref SDS 86 UZ7K
080476 - Lafayette 5.50 90.2 120 143 081025, ref SDS 82 3E4K
080477 - Kaiser x 081025, ref SDS 82 UZ7K
080478 - Kaiser x 081024, ref SDS 81 UZ7K
080479 - UCSF c 081023, ref SDS 80 V94O
080480 - Lafayette 5.50 90.6 115 141 081021, ref SDS 79 3E4K
080481 - Lafayette 5.50 90.4 110 128 081020, ref SDS 78 3E4K
080482 - Kaiser x 081018, ref SDS 77 UZ7K
080483 - Kaiser x 081017, ref SDS 76 UZ7K
080484 - UCSF e 081016, ref SDS 74 V94O
080485 - Lafayette 5.50 90.1 115 154 081014, ref SDS 73 3E4K
080486 - Lafayette 5.50 92.7 115 138 081013, ref SDS 72 3E4K
080487 - Lafayette 8.25 146.4 180 224 081012, ref SDS 71 3E4K
080488 - Kaiser x 081011, ref SDS 70 UZ7K
080489 - Lafayette 5.50 93.3 116 138 081010, ref SDS 69 3E4K
080490 - Kaiser x 081010, ref SDS 69 UZ7K
080491 - UCSF e 081009, ref SDS 68 V94O
080492 - Lafayette 5.50 92.1 113 137 081006, ref SDS 67 3E4K
080493 - Lafayette 2.75 48.5 110 136 x 081004, ref SDS 66 3E4K
080494 - Lafayette 5.50 98.2 117 136 x 081003, ref SDS 65 3E4K
080495 - UCSF c 081002, ref SDS 64 V94O
080496 - Lafayette 5.50 94.7 115 142 080929, ref SDS 63 3E4K
080497 - Lafayette 8.25 150.4 115 135 080928, ref SDS 63 3E4K
080498 - Kaiser x 080927, ref SDS 62 UZ7K
080499 - Lafayette 5.50 90.2 120 140 x 080926, ref SDS 61 3E4K
080500 - UCSF c 080925, ref SDS 60 V94O
080501 - Lafayette 5.50 92.3 116 138 080923, ref SDS 59 3E4K
080502 - Lafayette 5.50 98.4 112 134 080922, ref SDS 59 3E4K
080503 - Lafayette 5.50 98.2 114 137 080921, ref SDS 59 3E4K
080504 - Lafayette 5.50 101.6 110 133 x 080920, ref SDS 58 3E4K
080505 - Lafayette 5.50 89.3 115 144 x 080919, ref SDS 57 3E4K
080506 - UCSF c 080918, ref SDS 56 V94O
080507 - Lafayette 2.75 46.2 117 139 080916, ref SDS 57 3E4K
080508 - Lafayette 5.50 91.8 117 142 080915, ref SDS 55 3E4K
080509 - Clayton Safeway 3.00 62.4 98 118 080914, ref SDS 54 3E4K
080510 - Lafayette 8.25 129.7 123 147 x 080913, ref SDS 53 3E4K
080511 - Lafayette 5.50 88.4 118 146 x 080912, ref SDS 52 3E4K
080512 - UCSF c 080911, ref SDS 51 V94O
080513 - Lafayette 2.75 46.8 113 140 080909
080514 - Lafayette 5.50 89.2 117 143 080908
080515 - Lafayette 5.50 92.1 115 138 080907
080516 - Lafayette 2.75 45.3 120 144 x 080906, ref SDS 50 3E4K
080517 - Lafayette 2.75 56.8 93 120 x 080905, ref SDS 49 3E4K
080518 - UCSF c 080904, ref SDS 48 V94O
080519 - Lafayette 8.25 140.4 116 131 080903
080520 - Lafayette 5.50 94.9 115 134 080902
080521 - Kaiser x 080830
080522 - Kaiser x 080829
080523 - UCSF c 080828, ref SDS 47 V94O
080524 - Lafayette 5.50 93.6 120 137 080826
080525 - Lafayette 5.50 93.2 117 138 080825
080526 - Lafayette 5.50 93.2 123 136 x 080823
080527 - Lafayette 8.25 142.5 110 131 x 080822, ref SDS 46 3E4K
080528 - UCSF e 080821, ref SDS 45 V94O
080529 - Lafayette 5.50 94.7 115 137 080820
080530 - Lafayette 5.50 94.3 115 135 080819
080531 - Lafayette 8.25 141.7 118 134 080815
080532 - UCSF e 080814, ref SDS 44 V94O
080533 - Lafayette 5.50 93.8 120 136 080813
080534 - Lafayette 5.50 94.4 116 139 080812
080535 - Lafayette 5.50 94.2 119 133 080810
080536 - Lafayette 8.25 143.6 114 132 x 080809, ref SDS 42 3E4K
080537 - Lafayette 8.25 141.1 117 135 x 080808, ref SDS 41 3E4K
080538 - UCSF c 080807, ref SDS 40 V94O
080539 - Lafayette 8.25 143.7 115 132 080805
080540 - Concord 7.00 127.6 105 118 080804
080541 - Lafayette 8.25 143.2 112 134 080802
080542 - Lafayette 5.50 93.4 115 138 080801
080543 - Lafayette 5.50 92.2 118 140 080729
080544 - Lafayette 5.50 92.6 116 137 080728
080545 - Lafayette 8.25 142.6 114 134 080727
080546 - Lafayette 5.50 91.5 120 143 080726
080547 - Lafayette 8.25 140.8 117 135 080725
080548 - Lafayette 5.50 91.8 122 141 080723
080549 - Lafayette 5.50 91.3 120 139 080722
080550 - Lafayette 8.25 143.3 115 133 080720
080551 - Lafayette 5.50 90.7 125 144 080719
080552 - Lafayette 5.50 92.4 123 142 080716
080553 - Lafayette 2.25 46.8 116 137 080715
080554 - Lafayette 8.25 141.8 116 136 080712
080555 - Lafayette 5.50 92.9 116 139 080711
080556 - Lafayette 8.25 143.3 113 137 080704
080557 - Lafayette 5.50 90.2 121 147 080630
080558 - Lafayette 8.25 142.4 116 138 080628
080559 - Lafayette 5.50 91.4 118 138 080625
080560 - Lafayette 2.25 47.9 116 136 080623
080561 - Lafayette 5.50 94.2 112 138 080622
080562 - Lafayette 5.50 94.7 115 133 080621
080563 - Lafayette 2.25 48.3 110 129 080620
080564 - Mt Diablo 7.00 129.4 130 153 080616
080565 - Lafayette 5.50 90.8 120 146 080615
080566 - Lafayette 5.50 91.3 124 144 080614
080567 - Lafayette 5.50 89.7 122 143 080613
080568 - Lafayette 2.76 45.8 120 147 080611
080569 - Lafayette 5.50 90.5 123 145 080609
080570 - Lafayette 5.50 92.7 115 138 080607
080571 - Lafayette 5.50 94.2 118 139 080602
080572 - Lafayette 5.50 96.2 110 202 080507, ref SDS 18 WO8M
080573 -
080574 -
080575 -
080576 -
080577 -
080578 -
0806 -