CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 28 0000. ref SDS 27 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Background on 081202 Millie submitted a letter to the medical team
040902 - asking about blood tests and Neupogen treatments, ref SDS 4 AT8U, and
040903 - further requesting a schedule for the next CT test in time for review
040904 - at UCSF to start the 2nd cycle. ref SDS 4 AT7T  Millie asked about
040905 - doing the test a week before the meeting at UCSF on 090108.
040906 - ref SDS 4 AT9T
040908 -  ..
040909 - On 081203 Glenna called about scheduling the next CT test as set out
040910 - in the letter on 081202. ref SDS 6 YZ5I  Glenna submitted a letter
040911 - notifying the medical team that the next CT test is needed for the
040912 - meeting at UCSF on 090108. ref SDS 6 4P7N  On 081209 Millie letter to
040913 - medical team requesting coordinating schedule for CT test on 081230,
040914 - 081231, or 090102 in time for meeting with medical team at UCSF on
040915 - 090108. ref SDS 18 YL9I  Millie sent a follow up earlier today citing
040916 - the letter on 081209. ref SDS 25 0Y5U
040918 -  ..
040919 - Additionally, on 081203 the doctor ordered a blood test to evaluate
040920 - blood counts with respect to getting Neupogen treatments. ref SDS 5
040921 - 7N82  Results of the test on 081203 were reported on 081205, showing
040922 - NEUTS 0.624, about 60% below the target range of 1.50. ref SDS 7 CH40
040923 - Kaiser gave Millie Neupogen treatment on 081205, ref SDS 7 CH6X, and
040924 - Millie got a second treatment on 081206. ref SDS 15 BI4J  Millie's
040925 - letter to the medical team on 081209 asked about doing a follow up
040926 - blood test to evaluate need for more Neupogen. ref SDS 18 RL6Q
040928 -  ..
040929 - Arlette scheduled the blood test yesterday on 081210, ref SDS 23 DK6J,
040930 - which yielded results later on 081210 showing ANC 1085. ref SDS 24
040931 - QY6H
040933 -  ..
040934 - Doctor Johnson called late this afternoon, ref SDS 27 J43I, responding
040935 - to Millie's letter on 081209, ref SDS 18 YL9I, and scheduled the CT
040936 - test for 081230 1020.  After the call from the doctor, Millie received
040937 - a letter confirming understandings on scheduling the CT test.
040938 - ref SDS 28 LE5I
040940 -  ..
040941 - During the doctor's call yesterday, the doctor further explained that
040942 - Neupogen is not needed when ANC is above 1000, and so Neupogen was not
040943 - scheduled for yesterday or today. ref SDS 27 J43V  The doctor
040944 - scheduled Millie for another blood test on 081212 to determine if
040945 - blood counts remain above 1000, and of not then Kaiser will treat with
040946 - Neupogen on Friday and maybe on Saturday. ref SDS 27 H46X
040948 -  ..
040949 - Millie submitted a letter to the medical team confirming these
040950 - understandings...
040951 -
040952 -    1.  Subject: Blood Test Dec 12 Evaluate Need for Neupogen
040953 -        Date: Thu, 11 Dec 2008 04:10:28 -0800
040962 -         ..
040963 -    2.  Thanks very much for calling late yesterday afternoon on
040964 -        081210, ref SDS 27 H36O, responding to the letter to the
040965 -        medical team on 081209, and the follow up yesterday requesting
040966 -        guidance on Neupogen treatments, based on the blood test today
040967 -        that evidently shows ANC 1085 (would like confirmation from
040968 -        Kaiser on this calculation shown from partial results of the
040969 -        blood test today. ref SDS 25 0Y3X
040971 -         ..
040972 -    3.  In an earlier call, Arlette advised that partial results of the
040973 -        blood test today were submitted via fax to Glenna at UCSF.
040974 -        ref SDS 26 RL40
040976 -         ..
040977 -    4.  You seemed to indicate that ANC 1085 (NEUTS 1.085 at UCSF) does
040978 -        not require Neupogen treatment, until ANC falls below 1000.
040979 -        ref SDS 27 J43V  You further indicated that since I am getting
040980 -        daily chemotherapy treatments (low dose) and patient history in
040981 -        the record on 081210. ref SDS 19 OE6K indicates average 120+
040982 -        point decline per day in ANC under this regimen, ref SDS 19
040983 -        NR5J, you therefor ordered a follow up blood test on Friday
040984 -        081212. ref SDS 27 H46X  If I continue to respond to Neupogen
040985 -        treatments given at Kaiser last week, with ANC remaining above
040986 -        1000, then Neupogen will be deferred until the following
040987 -        Thursday when I will be tested at UCSF on 081218.  If the test
040988 -        on this Friday, 081212, shows ANC below 1000, then
040989 -        consideration will be made to give Neupogen on Friday and
040990 -        Saturday (081212 and 081213). ref SDS 27 H46X
040992 -         ..
040993 -    5.  Doctor Rugo mentioned in her letter on 081205 that platelets
040994 -        109 was mildly low but not worrisome. ref SDS 9 GF8Q
040996 -         ..
040997 -    6.  The blood test yesterday shows platelets 67 about 60% below the
040998 -        range of 140 - 400. ref SDS 24 DM6J
041000 -         ..
041001 -    7.  Please let me know of any implications for my [health] care
041002 -        with falling platelets.
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 29 075H, with platelets 67, ref SDS 29 7Z6N,
041007 -           attributed for causing new sunitinib side effect of
041008 -           nosebleed, ref SDS 30 GF4S, and NEUTS 0.74 have again fallen
041009 -           substantially, ref SDS 29 QY6H; as a result treatment
041010 -           regimen changed; all treatment was paused for 7 days until
041011 -           081226; Methotrexate ended entirely; consideration will be
041012 -           made to reduce dose for sunitinib. ref SDS 30 GF4V
041014 -         ..
041015 -    8.  Note as well, that most of the CBC diagnostics are low and a
041016 -        few are high, which is a big change from patient history
041017 -        showing most counts typically within range. ref SDS 24 075H
041018 -
041019 -           [On 081218 labs at UCSF for examination starting 2nd cycle
041020 -           of sunitinib protocol show CBC blood counts again very low,
041021 -           ref SDS 29 075H, with platelets 67, ref SDS 29 7Z6N,
041022 -           attributed for causing new sunitinib side effect of
041023 -           nosebleed, ref SDS 30 GF4S, and NEUTS 0.74 have again fallen
041024 -           substantially, ref SDS 29 QY6H; as a result treatment
041025 -           regimen changed; all treatment was paused for 7 days until
041026 -           081226; Methotrexate ended entirely; consideration will be
041027 -           made to reduce dose for sunitinib. ref SDS 30 GF4V
041029 -            ..
041030 -           [On 081219 1140 primary care physician concurs with UCSF
041031 -           order to pause treatments, ref SDS 31 JK7H; diagnoses
041032 -           cytopenia, including pancytopenia from expanded low blood
041033 -           counts that risks fatal infection, and cause chronic
041034 -           fatigue, muscle weakness, and loss of vitality and vigor
041035 -           associated with chemotherapy. ref SDS 31 LS6K
041037 -            ..
041038 -           [On 090122 0925 Millie suffers fall during aerobics
041039 -           exercise at the gym due to fatigue and muscle weankess
041040 -           caused by low blood counts, ref SDS 32 CW6J; suffered
041041 -           severe pain, ref SDS 32 WS7T, and treated for dislocated
041042 -           shoulder at Emergency Room Department, ref SDS 32 W05P
041044 -            ..
041045 -           [On 090213 1140 Doctor Johnson explains risks of cytopenia and
041046 -           pancytopenia that reduce energy, fitness, and muscle strength
041047 -           contribute to Millie's fall and dislocated shoulder.
041048 -           ref SDS 33 PQTX
041050 -         ..
041051 -    9.  Thanks for scheduling the next CT test on 081230 1020, and for
041052 -        coordinating with UCSF showing progress on this requirement, as
041053 -        set out in your letter yesterday on 081210. ref SDS 28 LE5I
041054 -        This schedule aligns with Glenna's letter at UCSF on 081203,
041055 -        ref SDS 6 4P7N, requesting the test in time for review at UCSF
041056 -        on 090108.
041058 -         ..
041059 -   10.  You indicated the scope includes the neck to correlate with the
041060 -        prior test on 081107 reporting many findings of adenopathy in
041061 -        the right supraclavicular never previously reported in 7 years
041062 -        of patient history, and not identified by examination at UCSF
041063 -        nor by you at Kaiser.
041065 -         ..
041066 -   11.  Thanks again to Glenna and to Arlette for coordinating complex
041067 -        test results and considerations for Neupogen.
041069 -         ..
041070 -   12.  This resolves all of the issues in the letter to the medical
041071 -        team on 081209, and the follow up yesterday on 081210.
041072 -
041079 -
041080 -
041081 -
041082 -
041083 -
041084 -
041085 -
0411 -