CONTACTS 

SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 7 0000. ref SDS 6 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie notified the medical team about general results of labs at
040902 - Kaiser on 081203, indicating low blood counts. ref SDS 5 YF5I
040904 -  ..
040905 - Millie had Neupogen treatment at Kaiser at 1300 today. ref SDS 6 CH6X
040907 -  ..
040908 - This afternoon, Millie received a letter from UCSF explaining that
040909 - Neupogen treatment is needed with low neutrophils. ref SDS 7 JE5I
040911 -  ..
040912 - Millie sent a letter to Doctor Rugo explaining...
040913 -
040914 -    1.  Subject: Neupogen Treatment Tomorrow NEUTS 0.624 on Labs at Kaiser 081203
040915 -        Date: Fri, 05 Dec 2008 21:50:27 -0800
040925 -         ..
040926 -    2.  Thanks for guidance on Neupogen in your letter today,
040927 -        ref SDS 7 JE5I, responding to the letter to the team on 081202,
040928 -        ref SDS 2 AT8U, with follow up earlier today. ref SDS 5 YF5I
040930 -         ..
040931 -    3.  Doctor Johnson ordered labs on 081202 [responding to notice of
040932 -        chronic fatigue on 081202, and asking about Neupogen.
040933 -        ref SDS 2 AT8U]  Work was performed at Kaiser on 081203.
040934 -        ref SDS 3 TG8M  Results were posted on Kaiser's computer the
040935 -        next day, 081204.  Kaiser's labs do not present a calculation
040936 -        for ANC (NEUTS at UCSF).  As noted, I notified the medical team
040937 -        of partial results in a letter this morning, stating NEUTS were
040938 -        not available. ref SDS 5 YF5I
040940 -         ..
040941 -    4.  On 081126 Tara gave advice that Neupogen was not needed for
040942 -        NEUTS 1.50 in the test on 081126 at UCSF, and would be
040943 -        evaluated after the next lab at UCSF on 081218, implementing
040944 -        your instructions today. [reported in Millie's letter to the
040945 -        medical team on 081202. ref SDS 2 AT8U
040947 -         ..
040948 -    5.  I went to Kaiser this afternoon, as scheduled.  The nurse
040949 -        calculated NEUTS 0.624 (ANC 624 at Kaiser).  The nurse
040950 -        indicated this is low. ref SDS 6 CH40  Review of patient
040951 -        history on 081126 shows NEUTS 0.624 is lower than at any prior
040952 -        time. ref SDS 1 V19M
040954 -         ..
040955 -    6.  I don't know all of the elements for calculating NEUTS (ANC) at
040956 -        Kaiser.  The blood test on 081203 further shows Neutrophils 26%
040957 -        listed as below Kaiser's range of 41 - 81. ref SDS 4 QY6H
040959 -         ..
040960 -    7.  I will submit the full lab report later today, or early
040961 -        tomorrow. ref SDS 4 M85G
040962 -
040963 -            [On 081206 Millie submitted complete lab to UCSF.
040964 -            ref SDS 8 2K4U
040966 -         ..
040967 -    8.  Bonnie called for Doctor Johnson, my primary care physician.
040968 -        ref SDS 6 CH51
040970 -         ..
040971 -    9.  The doctor was not available until 081208.  Typically, a backup
040972 -        doctor can be consulted, but evidently no one was available.  I
040973 -        realize now I should have done more to contact you.  I have
040974 -        been very tired lately, not really thinking straight.  Things
040975 -        were hectic in the Infusion Clinic.  Driving home from Kaiser,
040976 -        I suddenly found myself in the wrong lane, but averted an
040977 -        accident [and did not crash into oncoming traffic].
040979 -         ..
040980 -   10.  Bonnie indicated NEUTS 0.624 might require treatment not only
040981 -        today and tomorrow, as already scheduled, but also a third
040982 -        treatment, ref SDS 6 X35F, which would require supplemental
040983 -        authorization from UCSF.  Bonnie further gave instructions on
040984 -        increased attention to avoid elevated risk of infection at this
040985 -        time of low blood counts.
040987 -         ..
040988 -   11.  Bonnie suggested asking UCSF about doing an interim blood test
040989 -        next week to evaluate NEUTS, in advance of my next test at UCSF
040990 -        scheduled 081218? ref SDS 6 YQ6L
040991 -
040992 -            [On 081206 Millie submitted Kaiser's report for the blood
040993 -            test on 081203, and asked UCSF again about doing a 3rd
040994 -            Neupogen treatment with another lab test to verify recovery
040995 -            from low blood counts. ref SDS 8 2K6P
040997 -             ..
040998 -            [On 081209 Millie sent a follow up letter to medical team
040999 -            asking about blood test to evaluate ANC. ref SDS 9 RL6Q
041001 -             ..
041002 -            [On 081210 Arlette ordered follow up blood test.
041003 -            ref SDS 10 616R
041005 -             ..
041006 -            [On 081210 Millie went to Kaiser and got laboratory work
041007 -            for a blood test. ref SDS 11 L84V
041009 -             ..
041010 -            [On 081210 blood test results show ANC 1085, below the
041011 -            target of 1500; letter to Kaiser asks primary care
041012 -            physician about getting 3rd Neupogent treatment on 081210,
041013 -            and 2 more regularly scheduled on 081212 and 081213?
041014 -            ref SDS 12 0Y4V
041016 -             ..
041017 -            [On 081210 primary care physician called Millie and advised
041018 -            that ANC 1085 in blood test on 081210 does not require
041019 -            Neupogen under Kaiser standards and practices until ANC
041020 -            falls below 1000, ref SDS 13 J43V; doctor ordered follow up
041021 -            blood test on 081212 to evaluate ANC below 1000 based on
041022 -            patient history indicating ANC falling 120+ points per day
041023 -            on sunitinib treatment protocol, which would cause ANC to
041024 -            drop below 500 without Neupogen until Millie's next
041025 -            scheduled lab at UCSF on 081218. ref SDS 13 H44M
041027 -         ..
041028 -   12.  Based on your letter today, by copy to Paula, the supervisor in
041029 -        Kaiser's Infusion clinic, I will cancel treatment tomorrow
041030 -        until approval from you.
041032 -         ..
041033 -   13.  Please let me know about getting an interim blood test next
041034 -        week, as well as Neupogen treatments, discussed at Kaiser
041035 -        today.
041036 -
041037 -            [On 081209 Millie letter asks medical team about
041038 -            recommendation today on 081205 for another blood test
041039 -            during week of 081208 - 081212 to evaluate further Neupogen
041040 -            treatments in advance of meeting at UCSF the following week
041041 -            on 081218. ref SDS 9 RL6W
041043 -             ..
041044 -            [On 081210 Arlette ordered follow up blood test.
041045 -            ref SDS 10 616R
041047 -             ..
041048 -            [On 081210 Millie went to Kaiser and got laboratory work
041049 -            for a blood test. ref SDS 11 L84V
041051 -             ..
041052 -            [On 081210 blood test results show ANC 1085, below the
041053 -            target of 1500; letter to Kaiser asks primary care
041054 -            physician about getting 3rd Neupogent treatment on 081210,
041055 -            and 2 more regularly scheduled on 081212 and 081213?
041056 -            ref SDS 12 0Y4V
041058 -             ..
041059 -            [On 081210 primary care physician called Millie and advised
041060 -            that ANC 1085 in blood test on 081210 does not require
041061 -            Neupogen under Kaiser standards and practices until ANC
041062 -            falls below 1000, ref SDS 13 J43V; doctor ordered follow up
041063 -            blood test on 081212 to evaluate ANC below 1000 based on
041064 -            patient history indicating ANC falling 120+ points per day
041065 -            on sunitinib treatment protocol, which would cause ANC to
041066 -            drop below 500 without Neupogen until Millie's next
041067 -            scheduled lab at UCSF on 081218. ref SDS 13 H44M
041069 -         ..
041070 -   14.  Thanks very much for support.
041072 -         ..
041073 -   15.  You may have heard that sunitinib treatment has recently
041074 -        yielded good response, and that side effects have begun to
041075 -        mount up.
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