CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 29 0000. ref SDS 28 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Background on 081210 the primary care physician ordered follow up
040902 - blood test for Millie tomorrow on 081212 to evaluate getting more
040903 - Neupogen on 081212 and 081213. ref SDS 26 H46J  The doctor asked
040904 - Arlette to arrange for the blood draw in the Infusion Clinic
040905 - coordinated with previously scheduled Neupogen treatment at 1300.
040906 - ref SDS 26 HJ7J  This was confirmed in Millie's letter to the medical
040907 - team submitted this morning OA 0400. ref SDS 28 S27S
040909 -  ..
040910 - Arlette scheduled the test today at 1100. ref SDS 29 4R5Q
040911 -
040912 -
040914 -  ..
040915 - Schedule Blood Draw for CBC Test to Evaluate Neupogen 081212
040916 -
040917 - Follow up ref SDS 29 6Z4F, ref SDS 23 S65I.
040918 -
040919 - Millie went to the Infusion Section, which is accessed from the
040920 - Oncology patient lobby, rather than through the locked door to the
040921 - Infusion Clinic.
040923 -  ..
040924 - Cheryl is Millie's nurse.
040926 -  ..
040927 - Recieved from the nurse today, and posted complete results for the
040928 - test on 081210, ref SDS 23 S65I, including CA 15-3 197. ref SDS 23
040929 - A16M
040931 -  ..
040932 - Need comment from the doctor on effects of low blood counts generally,
040933 - and platelets 67, reported on 081210, ref SDS 23 DM6J, both cited in
040934 - Millie's letter to the medical team on 081211. ref SDS 28 S28P
040935 -
040937 -  ..
0410 -
0411 -
0412 - 1204
0413 -
041301 - Talked to Arlette at the front desk about getting results of the
041302 - blood test.
041304 -  ..
041305 - Arlette will call the lab to expedite processing Millie's blood draw.
041306 - Arlette will print a report which Millie can get at the Oncology front
041307 - desk.  She will call Millie on the cell phone when results have been
041308 - posted.
041310 -  ..
041311 - Arlette will ask Doctor Johnson about implications of falling
041312 - plateletts, and other blood counts that are outside target range.
041313 -
041315 -  ..
0414 -
0415 -
0416 - 1235
0417 -
041701 - Arlette called.
041702 -
041703 - She said results of the blood test today have been posted.  ANC 1054
041704 - shows Millie's counts now seem to be holding.  Doctor Johnson approved
041705 - Millie to not need Neupogen this weekend, so she can go home, rather
041706 - than get treatment.
041708 -  ..
041709 - The doctor recommends Millie ask Doctor Rugo at UCSF about effects of
041710 - low blood counts generally, and platelets 67, reported on 081210,
041711 - ref SDS 23 DM6J, both cited in Millie's letter to the medical team on
041712 - 081211. ref SDS 28 S28P
041713 -
041714 -        [On 081217 1422 Millie's letter to medical team notifies that
041715 -        Kaiser expects UCSF to address low blood counts problem.
041716 -        ref SDS 31 YJ4S
041718 -         ..
041719 -        [On 081217 1422 Millie's letter to medical team submits agenda
041720 -        for meeting at UCSF on 081218 and includes review of low blood
041721 -        counts that cause severe fatigue and muscle weakness that has
041722 -        reduced exerercise to zero. ref SDS 31 YJ6R
041724 -         ..
041725 -        [On 081218 labs at UCSF for examination starting 2nd cycle
041726 -        of sunitinib protocol show CBC blood counts again very low,
041727 -        ref SDS 32 075H, with platelets 67, ref SDS 32 7Z6N,
041728 -        attributed for causing new sunitinib side effect of
041729 -        nosebleed, ref SDS 33 GF4S, and NEUTS 0.74 have again fallen
041730 -        substantially, ref SDS 32 QY6H; as a result treatment
041731 -        regimen changed; all treatment was paused for 7 days until
041732 -        081226; Methotrexate ended entirely; consideration will be
041733 -        made to reduce dose for sunitinib. ref SDS 33 GF4V
041735 -         ..
041736 -        [On 081219 1140 primary care physician concurs UCSF order
041737 -        to pause treatments, ref SDS 34 JK7H, due to rising
041738 -        cytopenia, including pancytopenia from expanded low blood
041739 -        counts that risks fatal infection. ref SDS 34 LS6K
041741 -  ..
041742 - Went upstairs and got the report from the front desk.
041744 -  ..
041745 - Called the Infusion Clinic.  Diana assigned to give Millie Neupogen
041746 - treatment today came out to the Oncology waiting lobby.  She will
041747 - cancel treatment today and tomorrow, based on Doctor Johnson's
041748 - guidance on applying results of the blood test today.
041749 -
041750 -        [...in another record today on 081212, Kaiser cancelled
041751 -        Neupogen treatments schedule today and tomorrow. ref SDS 30
041752 -        UZ7K
041753 -
041754 -
041756 -  ..
041757 - Laboratory Blood Test Results Posted Kaiser's Computer
041758 -
041759 - Follow up ref SDS 23 S65I. ref SDS 8 M85G.
041760 -
041761 - Previous lab at Kaiser two days ago on 081210, ref SDS 23 075H, and
041762 - prior lab a week ago on 081203, reported in the record on 081205.
041763 - ref SDS 8 075H
041765 -  ..
041766 - On 081210 primary care physician called Millie and advised that ANC
041767 - 1085 in blood test on 081210 does not require Neupogen under Kaiser
041768 - standards and practices until ANC falls below 1000, ref SDS 18 J43V;
041769 - doctor ordered follow up blood test on 081212 to evaluate ANC below
041770 - 1000 based on patient history indicating ANC falling 120+ points per
041771 - day on sunitinib treatment protocol, which would cause ANC to drop
041772 - below 500 without Neupogen until Millie's next scheduled lab at UCSF
041773 - on 081218. ref SDS 18 H44M
041774 -
041776 -     ..
041777 -    Patient   Provider  Category   View      FR Date   To Date
041791 -     ..
041792 -    72/F Lab Results Summary
041794 -     ..
041795 -    Log#: 510834702083       081212 11:15
041796 -    <------------------- KAISER -----------------------><-----------------  UCSF --------------------->
041797 -    Type                 Results   Units        Normal        Type                  Units         Normal       ACRO
041798 -     ..
041799 -    CBC with DIFF & PLT CT                                                                                    CBCD
041800 -     ..
041801 -    WBC            L        3.1    K/uL     3.4  -  10.0      WBC x10-3             x10E9/L     3.4  -  10      WBC
041802 -    RBC            L        2.90   M/uL    3.60  -  5.70      RBC x10-6             x10E12/L      4  -  5.2     RBC
041803 -    Hemoglobin     L        9.6    g/dL    11.5  -  15.0      Hemoglobin            g/dL         12  -  15.5    HGB
041804 -    Hematocrit     L       29.0    %       34.0  -  46.0      Hematocrit            PERCENT      36  -  46      HCT
041805 -    MCV                   100      fL      80.0  -  100.0     MCV                   fL           80  -  100     MCV
041806 -    RDW, RBC       H       15.9    %       11.9  -  14.3      [Not Reported at UCSF]
041807 -    MCH                [Not Reported]                         MCH                   pg           26  -  34      MCH
041808 -    MCHC               [Not Reported]                         MCHC                  g/dL         31  -  36      MCHC
041809 -     ..
041810 -    Platelets      L       64      K/uL     140  -  400       Plt x10-3             x10E9/L     140  -  450     PLT
041812 -  ..
041813 - On 081205 UCSF advised that blood test on 081203 showing platelets 109
041814 - is not worrisome. ref SDS 10 GF8Q
041816 -  ..
041817 - On 081211 Millie letter to medical team asks about effects on health
041818 - care with platelets 67 falling below 60% of the target range.
041819 - ref SDS 28 S28P
041821 -  ..
041822 - Per telecon with Arlette, Kaiser defers to UCSF. ref SDS 0 KQ66
041824 -  ..
041825 - CBC blood test continues...
041826 -
041827 -    Log#: 510834702083       081212 11:15
041828 -    <------------------- KAISER -----------------------><-----------------  UCSF --------------------->
041829 -    Type                 Results   Units        Normal        Type                  Units         Normal       ACRO
041830 -    (calculated with formula on 081205. ref SDS 9 JG6F)
041831 -    ANC            L     1054                    -> 1500      NEUTS                 x10E9/L     1.8  -  6.8     N-A
041832 -    Neutrophils    L       34      %         41  -  81        Neutrophils
041833 -
041834 -              ANC = WBC x 1000 x (Neutrophils + Bands)
041835 -
041836 -                    3.1 x 1000 x (.34 + 0) = 1054
041837 -
041839 -     ..
041840 -    Log#: 510834702083       081212 11:15
041841 -    <------------------- KAISER -----------------------><-----------------  UCSF --------------------->
041842 -    Type                 Results   Units        Normal        Type                  Units         Normal       ACRO
041843 -    Lymphocytes      H     51      %         13  -  46        LYMPHS                x10E9/L     0.9  -  2.9     L-A
041844 -    Monocyte                4      %          4  -  12        MONOS                 x10E9/L     0.2  -  0.8     M-A
041845 -    Esoinophils      H     10      %          0  -  4         EOS                   x10E9/L     0.0  -  0.4     E-A
041846 -    Basophil                0      %          0  -  1         BASOS                 x10E9/L     0.0  -  0.1     B-A
041847 -
041848 -
041849 -
041850 -
041851 -
041852 -
041853 -
041854 -
041855 -
041856 -
0419 -