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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 4 CH6X, ref SDS 3 YF5I.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie received a letter from Doctor Rugo late this afternoon...
040902 -
040903 -    1.  Subject: RE: Blood Counts Low Neupogen Treatment Today
040904 -        Date: Fri, 5 Dec 2008 19:12:15 -0800
040910 -         ..
040911 -    2.  You do not need neupogen for a ABC of 2.4 unless your
040912 -        neutrophils are low.  On this trial we have to be able to get
040913 -        differentials on a schedule and you cannot self medicate.  It
040914 -        is a problem on this trial.  Please do not schedule yourself
040915 -        for neupogen unless 1 you have a problem and Dr Johnson is
040916 -        involved, or 2 you discuss this with us first.
040917 -
040918 -            [...in another record today on 081205 Millie responded to
040919 -            UCSF. ref SDS 5 VM7K
040921 -             ..
040922 -            [On 081206 Millie submitted the complete lab to UCSF,
040923 -            ref SDS 6 WJ8K, which shows neutrophils are low.
040924 -            ref SDS 6 2K5U
040926 -             ..
040927 -            [On 081210 Glenna seemed to indicate in a call that UCSF
040928 -            relies on Kaiser's standards and practices for treating
040929 -            Millie with Neupogen when "neutrophils are low,"
040930 -            ref SDS 8 6S56, and further noted that UCSF supports Millie
040931 -            getting a follow up blood draw to test for neutrophils.
040932 -            ref SDS 8 633K
040934 -             ..
040935 -            [On 081210 Arlette ordered follow up blood test.
040936 -            ref SDS 9 616R
040938 -             ..
040939 -            [On 081210 Kaiser follow up lab, ref SDS 10 S65I, shows
040940 -            NEUTS 1.085. ref SDS 10 QY6H
040942 -             ..
040943 -            [On 081210 primary care physician called Millie and advised
040944 -            that ANC 1085 in blood test on 081210 does not require
040945 -            Neupogen under Kaiser standards and practices until ANC
040946 -            falls below 1000, ref SDS 11 J43V; doctor ordered follow up
040947 -            blood test to evaluate ANC below 1000 based on patient
040948 -            history indicating ANC falling 120+ points per day on
040949 -            sunitinib treatment protocol. ref SDS 11 H44M
040951 -  ..
040952 - The doctor responds to Millie's letter on 081202 asking about Neupogen
040953 - treatments, ref SDS 1 AT8U, and followed up this morning reporting
040954 - results of blood test ordered by Doctor Johnson at Kaiser. ref SDS 3
040955 - YF5I
040957 -  ..
040958 - Results of the blood test show...
040959 -
040960 -            ANC            L      624                    -> 1500
040961 -            Neutrophils    L       26      %         41  -  81
040962 -
040963 - ...below listed as "low" in Kaiser's report received today, 081205.
040964 - ref SDS 2 QY6H
040965 -
040966 -            [On 081206 Millie submitted the complete lab to UCSF,
040967 -            ref SDS 6 WJ8K, which shows neutrophils are low.
040968 -            ref SDS 6 2K5U
040970 -             ..
040971 -            [On 081206 Millie had a second Neupogen treatment at Kaiser
040972 -            due to low neutrophils, cited by Doctor Rugo today.
040973 -            ref SDS 7 UZ7K
040975 -  ..
040976 - Millie did not self-medicate.  She notified the medical team,
040977 - ref SDS 3 YF5I  When there was no response, she went to Kaiser for
040978 - guidance. ref SDS 4 V94M  Kaiser determined blood counts were low,
040979 - ref SDS 4 CH40, and gave treatment. ref SDS 4 CH6X
040981 -  ..
040982 - Reference to "ABC" likely means WBC 2.4 listed in the letter to the
040983 - medical team earlier this morning. ref SDS 3 TT8P
040985 -  ..
040986 - UCSF letter concludes...
040987 -
040988 -    3.  The platelet count [109] is mildly low but not worrisome.
040990 -  ..
040991 - Platelet 109 was reported in Kaiser's blood test on 081203, reviewed
040992 - today. ref SDS 2 RV5L  This responds to Millie's letter to the medical
040993 - team earlier today that cited low platelets. ref SDS 3 TT8P
040994 -
040995 -            [On 081210 follow up blood test shows platelets 67, about
040996 -            60% below the target range of 104. ref SDS 10 DM6J
040998 -             ..
040999 -            [On 081211 Millie letter to medical team asks about effects
041000 -            on health care with platelets falling below 60% of the
041001 -            target range. ref SDS 12 S28P
041003 -             ..
041004 -            [On 081218 labs at UCSF for examination starting 2nd cycle
041005 -            of sunitinib protocol show CBC blood counts again very low,
041006 -            ref SDS 13 075H, with platelets 67, ref SDS 13 7Z6N,
041007 -            attributed for causing new sunitinib side effect of
041008 -            nosebleed, ref SDS 14 GF4S, and NEUTS 0.74 have again
041009 -            fallen substantially, ref SDS 13 QY6H; as a result
041010 -            treatment regimen changed; all treatment was paused for 7
041011 -            days until 081226; Methotrexate ended entirely;
041012 -            consideration will be made to reduce dose for sunitinib.
041013 -            ref SDS 14 GF4V
041015 -  ..
041016 - This is good news.
041017 -
041026 -
041027 -
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0411 -