CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 27 0000. ref SDS 21 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Background on Millie getting Neupogen treatment last week are reported
040902 - on 081207, ref SDS 18 673J, and citing Kaiser's recommendation for
040903 - Millie to get a 3rd Neupogen treatment this week, reported on 081205.
040904 - ref SDS 9 X35F  This was confirmed in Millie's letter to the medical
040905 - team on 081205. ref SDS 13 NN6P  Millie sent a follow up letter on
040906 - 081206 asking about a 3rd Neupogen treatment, and another blood test
040907 - this week. ref SDS 15 2K6P
040909 -  ..
040910 - Glenna coordinated with Doctor Rugo on Millie getting a follow up
040911 - blood test today; she tried discuss this with Arlette, but encountered
040912 - communication problems.  Arlette later ordered a blood test today to
040913 - evaluate Millie's need for further Neupogen treatment. coordinating
040914 - Millie's care getting a follow blood test to evaluate ref SDS 23 6131
040916 -  ..
040917 - Millie went to Kaiser and got the test.  Partial results indicate ANC
040918 - 1085 and show neutrophils are low, which is the criteria Doctor Rugo
040919 - presented in a letter from UCSF on 081205. ref SDS 10 JE5I  Millie sent
040920 - a letter to the medical team this afternoon reporting partial results
040921 - of the blood test, ref SDS 26 BT55, and asking if Millie needs
040922 - Neupogen treatment today, tomorrow, and/or on Friday and Saturyday,
040923 - previously scheduled. ref SDS 26 0Y4V
040925 -  ..
040926 - Arlette called about 1612 in the afternoon about Millie's letter sent
040927 - at 1607 to the medical team, ref SDS 27 U85B, on partial results of
040928 - the blood test today. ref SDS 26 BT55  She feels UCSF should submit a
040929 - specific number to Kaiser that aligns with Millie's sunitinib protocol
040930 - for giving Neupogen treatments.  Arlette planned to submit partial
040931 - results of the blood test via fax to Glenna at UCSF this afternoon.
040932 - ref SDS 27 SP4I  She wants Millie to notify UCSF that Kaiser needs a
040933 - specific level for ordering Neupogent treatments based on sunitinib
040934 - protocol requirements. ref SDS 27 OS6N
040936 -  ..
040937 - While preparing to notify UCSF of progress evaluating Millie's ANC
040938 - blood counts, and request specific guidance on Neupogen requested by
040939 - Arlette...
040941 -  ..
040942 - Doctor Johnson called to discuss Millie's letter to Kaiser earlier
040943 - this afternoon, ref SDS 26 BT55, asking about Neupogen treatments
040944 - based on ANC 1085 in the test today, ref SDS 25 QY6H, ordering a
040945 - following CBC test, ref SDS 26 0Y4Q, which was originally discussed by
040946 - Bonnie in the Infusion Clinic at Kaiser on 081205. ref SDS 8 X35F
040947 - Additionally, the letter today cited Millie's letter yesterday on
040948 - 081209 asking about ordering the CT test at the end of the month.
040949 - ref SDS 19 YL9I
040951 -  ..
040952 - The doctor advised that Millie does not need Neupogen today, based on
040953 - Kaiser standards and practice to give Neupogen when ANC falls below
040954 - 1000.  During the call, he related Arlette coming into his office and
040955 - he discussed this issue based on Millie's letter today explaining ANC
040956 - seems to be 1085 shown by partial results of the blood test this
040957 - afternoon at 1301, reported in an earlier record today. ref SDS 25
040958 - QY6H
040960 -         ..
040961 -        [On 081211 Millie's letter to medical team confirms
040962 -        understanding from telecon with primary care physician today
040963 -        about Kaiser's standards and practice for approving Neupogen
040964 -        treatments when ANC falls below 1000, and that with the current
040965 -        cancer sunitinib cancer treatment protocol, ANC blood counts
040966 -        are falling about 120 points per day. ref SDS 29 S27S
040968 -         ..
040969 -        [On 081223 Glenna called and advised that the medical team
040970 -        orders Neupogen treatment for Millie when blood counts fall
040971 -        below NEUTS 1.000 (ANC 1000), ref SDS 32 4P4K; Millie sent a
040972 -        letter confirming UCSF guidance on Neupogen. ref SDS 32 CV5K
040974 -  ..
040975 - The doctor considered deferring Neupogen and further blood tests until
040976 - Millie's next regularly scheduled test at UCSF on 081218 when Millie
040977 - starts the 2nd cycle, as set out in the letter today. ref SDS 26 0Y5R
040979 -  ..
040980 - Since Millie is getting daily chemotherapy with cyclophosphamide given
040981 - with sunitinib, and with Methotrexate twice a day on Fridays and
040982 - Saturdays, this may place blood counts at higher risk of degrading
040983 - Millie's immune system which in turn presents significant risk of
040984 - disease and infection prior to the next test at UCSF on 081218.
040986 -  ..
040987 - Patient history today on 081210 seems to show Millie's condition NEUTS
040988 - 1.50 (ANC 1500) on 081126. ref SDS 20 MK5G  After 7 days getting 263.5
040989 - mg sunitinib, 300 mg of cyclophosmaide, and 10 mg of methotrexate,
040990 - NEUTS fell to 624 on 081203.  Nominally that seems to average a
040991 - decline of about 120 points a day. ref SDS 20 RD6H
040993 -  ..
040994 - If ANC (NEUTS at UCSF) continues on this track for 7 days until
040995 - Millie's next lab at UCSF on 081218, then ANC blood counts could drop
040996 - to below 500.
040997 -
040998 -        [On 081211 Millie's letter to medical team confirms
040999 -        understanding from telecon with primary care physician today
041000 -        about Kaiser's standards and practice for approving Neupogen
041001 -        treatments when ANC falls below 1000, and that with the current
041002 -        cancer sunitinib cancer treatment protocol, ANC blood counts
041003 -        are falling about 120 points per day. ref SDS 29 S27S
041005 -  ..
041006 - Research on 070301 indicates ANC falling below 500 presents severe
041007 - risk of neuptropenia weakening the immune system, which causes disease
041008 - and infection. ref SDS 1 R13I
041010 -  ..
041011 - Doctor Johnson decided to do a follow up blood test in 2 days on
041012 - Friday, 081212.  If counts are still above 1000, then Neupogen
041013 - treatments scheduled for Friday and Saturday will be canceled, and
041014 - consideration of further Neupogen treatmnets will be deferred until
041015 - the blood test at UCSF on 081218.
041017 -  ..
041018 - There was discussion about doing the blood draw on 081212 in the
041019 - Infusion Clinic using the Power Port in order to avoid needle
041020 - punctures that cause injury and take extra time, reported on 080425.
041021 - ref SDS 3 FP6F
041023 -  ..
041024 - The doctor asked when Millie's next treatment is scheduled for
041025 - Neupogen in the Infusion Clinic?
041027 -  ..
041028 - The schedule on 081206 shows Millie's next Neupogen treatment is
041029 - scheduled on 081212 1300. ref SDS 16 HS5M
041031 -  ..
041032 - The doctor asked to hold the line while he finds Arlette.
041034 -  ..
041035 - About 2 minutes later, the doctor came on line, and reported she was
041036 - in his office.
041038 -  ..
041039 - The doctor coordinated with Arlette to schedule Millie for another
041040 - blood draw at the Kaiser Infusion Clinic in the late morning on Friday
041041 - 081212.  This enables using Millie's Power Port to avoid a needle
041042 - puncture.  Results will be available an hour or so later to evaluate
041043 - giving Neupogen, if needed, as scheduled at 1300.
041044 -
041045 -        [On 081211 Millie submitted a letter to the medical team
041046 -        explaining plans for another blood draw on Friday, 081212 to
041047 -        evaluate giving Millie another treatment of Neupogen.
041048 -        ref SDS 29 S27S
041050 -         ..
041051 -        [On 081211 Arlette called and left a message saying she has
041052 -        arranged for a blood draw to test for needing another Neupogen
041053 -        treatment will be performed using Millie's Power Port with
041054 -        access in the Infusion Clinic on 081212; and, further asked
041055 -        Millie to call the Infusion Clinic to schedule a time for the
041056 -        blood draw coordinated with Millie's Neupogen treatment
041057 -        previously scheduled for 081212 1300, ref SDS 30 6Z4F; call to
041058 -        the Infusion Clinic resulted in scheduling the blood draw at
041059 -        the time scheduled for Neupogen. ref SDS 30 IH6E
041061 -         ..
041062 -        [On 081211 Millie submitted a letter to Kaiser confirming the
041063 -        schedule for the blood draw in the Infusion Clinic on 081212
041064 -        1300. ref SDS 30 YQ6Q
041066 -         ..
041067 -        [On 081211 Arlette called again and changed the schedule for
041068 -        the blood draw testing blood counts to 081212 1100 instead of
041069 -        1300. ref SDS 30 4R5Q
041071 -         ..
041072 -        [On 081211 called Bella who explained confusion that caused
041073 -        scheduling Millie twice for the blood tests on 081212; Millie
041074 -        decided to get blood work at 1100. ref SDS 30 4R4X
041076 -  ..
041077 - Doctor Johnson asked about Millie's letter today on 081210 requesting
041078 - schedule for the next CT test at Kaiser. ref SDS 26 0Y5U  The doctor
041079 - could not find Millie's letter on 081209 referenced in the letter on
041080 - 081210 with requirements for the test, ref SDS 19 YL9I, citing the
041081 - letter from UCSF on 081203 requesting the test in time for review by
041082 - the medical team scheduled at UCSF on 090108. ref SDS 7 ZP4Y
041084 -  ..
041085 - Helped the doctor find the letter on 081209 that shows the scope of
041086 - work for the CT test. ref SDS 19 YL9I
041088 -  ..
041089 - Doctor Johnson advised that he can schedule Millie for a CT test on
041090 - 081230 so there is an extra day or so to complete analysis in time for
041091 - review to prepare for meeting with the medical team at UCSF on 090108,
041092 - as proposed in Millie's letter to the medical team on 081209.
041093 - ref SDS 19 YL9I and implementing Glenna's letter on 081203.
041094 - ref SDS 7 4P7N
041096 -  ..
041097 - The doctor explained the Kaiser computer shows the test can be done on
041098 - 081230 0730.
041100 -  ..
041101 - Upon discussion of requirements for accessing the port in the Oncology
041102 - Infusion Clinic, and considering the clinic begins work at 0800, and
041103 - further that Millie's CT test requires coordination with IS for
041104 - connecting the high pressure injection equipment to the Huber needle,
041105 - the doctor scheduled Millie's CT test for...
041106 -
041107 -                    081230 1020
041109 -  ..
041110 - The doctor ordered Barium Sulfate suspension for oral contrast medium,
041111 - which Millie can get at the Pharmacy tomorrow, or anytime prior to the
041112 - test, and will take the day of the test, as reported for the previous
041113 - test on 081107. ref SDS 4 BG4J
041114 -
041115 -        [On 081219 1140 Barrium Sulfate Suspension not in Kaiser's
041116 -        medical chart listing patient medications. ref SDS 31
041117 -        UF6L
041119 -         ..
041120 -        [On 081230 Barium Sulfate suspension contrast medium for CT
041121 -        test in combination with sunitinib treatment for cancer has
041122 -        severe side effects, ref SDS 33 FF4K; Millie considers changing
041123 -        back to Gastrografin. ref SDS 33 N66M
041125 -  ..
041126 - The doctor will submit the referral to the CT department citing
041127 - requirement to use Millie's Power Port, that coordination is required
041128 - with the Infusion Clinic, and with IS, and further that the test
041129 - should include the neck, as done for the prior test on 081107, noted
041130 - in the letter to the medical team on 081209, ref SDS 19 RL5X, and
041131 - cited in the follow up letter today. ref SDS 26 0Y5U
041133 -  ..
041134 - The doctor will further order findings consolidated into a single
041135 - report to solve the problem with the prior test on 081107, when
041136 - findings were issued in separate reports, shown in the record on
041137 - 081113. ref SDS 6 6V5I
041138 -
041139 -        [On 081211 Millie's letter to Kaiser with copies to the primary
041140 -        care physician in Oncology, the assistant Arlette, also in
041141 -        Oncology, and to the supervisor of the CT Department, Dennis,
041142 -        confirms doctor's order for the CT test on 081230 1020 to use
041143 -        Millie's Power Port, to coordinate with IS for power injection
041144 -        of contrast medium, and for the scope of the test to include
041145 -        the neck. ref SDS 30 PQ9P
041147 -         ..
041148 -        [On 081219 1140 Millie met with the primary care physician at
041149 -        Kaiser; review of Kaiser's computer shows the referral for the
041150 -        CT test on 081230 did not specify using the Power Port, and did
041151 -        not include the neck; the doctor edited the referral to conform
041152 -        with requirements. ref SDS 31 WP30
041154 -  ..
041155 - The doctor will submit a letter to Millie with a copy to the medical
041156 - team at UCSF confirming the date and time of the CT test.
041157 -
041158 -        [On 081210 Millie received a letter from the doctor confirming
041159 -        the CT test at Kaiser on 081230 1020. ref SDS 28 H48N
041161 -  ..
041162 - The doctor will ask Arlette to schedule the Infusion Clinic to access
041163 - Millie's Power Port in time for injecting contrast medium on 081230
041164 - 1020, ordered with the doctor's referral entered today in Kaiser's
041165 - computer, per above. ref SDS 0 SX9O
041167 -  ..
041168 - The doctor further advised that Arlette will notify IS to schedule
041169 - someone to support the CT test on 081230 at 1020, and in order to
041170 - avoid problems that occurred on 081107. ref SDS 4 1Q5O
041171 -
041172 -        [On 081211 Arlette called and left a message saying Millie is
041173 -        scheduled for port access in the Infusion Clinic on 081230 1000
041174 -        for Millie's test later in the CT Department at 1020.
041175 -        ref SDS 30 IG54
041177 -         ..
041178 -        [On 081211 Millie's letter to Kaiser confirms doctor's order
041179 -        today scheduling the CT test at Kaiser in Walnut Creek on
041180 -        081230 1020, and that Arlette arranged for Port Access in the
041181 -        Infusion Clinic on 081230 1000. ref SDS 30 PQ9P
041183 -  ..
041184 - Discussed the report for the CT test on 081107 presenting findings of
041185 - increased interstitional lung disease, reviewed on 081112. ref SDS 5
041186 - TS4J
041188 -  ..
041189 - Cited reporting the past few days that Millie does not look well, and
041190 - seems very tired. ref SDS 20 6E7G
041192 -  ..
041193 - The doctor seemed to indicate that Interstitional Lung Disease would
041194 - not typically relate to Millie's symptoms of chronic fatigue and not
041195 - looking well, nor feeling well.  The doctor further indicated that the
041196 - rate of progression reported by the CT test on 081107 in relation to
041197 - prior tests suggests very slow progression that would take 10 - 20
041198 - years to become a serious health issue for Millie.
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