CONTACTS 

SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 34 0000. ref SDS 33 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On 081218 Millie's blood counts were very low at UCSF, ref SDS 36
040902 - YN8O,
040904 -  ..
040905 - Examination on 081218 showed Millie made substantial recovery with IBC
040906 - symptoms subsiding. ref SDS 37 VD4F  There had also been significant
040907 - increase inside effects. ref SDS 37 QW7H  As a result, the doctor
040908 - changed Millie's treatment plan and ordered a blood test today to get
040909 - results that guide treatments beginning today. ref SDS 37 BQ8F
040911 -  ..
040912 - The next day, the test was ordered by the primary care physician at
040913 - Kaiser on 081219, shown by Millie's letter to the medical team on
040914 - 081223. ref SDS 39 BV5P
040915 -
040916 -
040918 -  ..
040919 - Lab Blood Test CBC to Evaluate Neupogen and Cancer Treatment Plan
040920 -
040921 - Follow up ref SDS 34 6Z4F, ref SDS 33 6Z4F.
040922 -
040923 - This morning, Millie went to the Infusion Clinic.
040925 -  ..
040926 - Luke is Millie's nurse.
040928 -  ..
040929 - Luke is new on the job in the Chemotherapy Infusion Clinic.  Explained
040930 - prior experience in the Intensive Care Unit (ICU).
040932 -  ..
040933 - Millie asked about Luke's experience accessing Power Port technology?
040935 -  ..
040936 - Luke seemed familiar with the purple color and triagular shape of the
040937 - Bard Power Port.
040939 -  ..
040940 - After inserting the Huger needle into the Power Port, there was no
040941 - blood flow.  Luke pressed on Millie's chest, and tried other measures,
040942 - but nothing succeeded.
040944 -  ..
040945 - Luke asked Hazel for assistance, similar Diane completing a blood draw
040946 - at UCSF on 080821, when Heather had problems like Luke today at
040947 - Kaiser. ref SDS 2 LO5F
040949 -  ..
040950 - Hazel was working on the computer at a work station across from
040951 - Millie's chemotherapy chair.  She investigated the Huber needle access
040952 - which Luke had done.  Hazel decided to start over.  She removed the
040953 - Huber needle and disposed of all related paraphanalia.  Hazel brought
040954 - a new Huber needle kit.  In aobut 2 minutes she access the port, and
040955 - verified adequate blood flow.  Luke then dreq blood for each of the
040956 - tests ordered.
040958 -  ..
040959 - Millie left the Infusion Clinic to wait for results of the blood test
040960 - today.  Luke will call Millie's cell phone number when the lab submits
040961 - the report in about an hour or so.  If ANC is below 1000, Millie will
040962 - return to the clinic for Neupogen treatment.
040964 -  ..
040965 - After leaving the Infusion clinic on the 2nd floor, Millie stopped at
040966 - the Pharmacy on the first floor to order refill for cyclophosphamide,
040967 - because there are only enough pills for 9-days of cancer treatments,
040968 - and the current work plan requires 14-days of treatment, reported at
040969 - UCSF on 081218. ref SDS 37 PR6U  Millie also ordered refill for
040970 - prilosec to prevent heartburn.
040972 -  ..
040973 - Millie placed the order for the medications, and then went to the
040974 - cafeteria for breakfast.
040976 -  ..
040977 - After breakfast, winning several rounds of dominos, Luke called.  He
040978 - advised that ANC 1710 was reported by the lab, and platelets 187.
040979 - These are very good blood counts, compared to the lab at UCSF on
040980 - 081218.
040982 -  ..
040983 - Millie advised Luke that Neupogen is cancelled today and tomorrow.
040984 -
040985 -
040987 -  ..
040988 - Laboratory Blood Test Results Posted Kaiser's Computer
040989 -
040990 - Follow up ref SDS 36 FW5N, ref SDS 34 S65I,
040991 -
040992 - Previous lab at UCSF on 081218, ref SDS 36 FW5N, and a week earlier at
040993 - Kaiser on 081212. ref SDS 34 S65I
040995 -     ..
040996 -    Patient   Provider  Category   View      FR Date   To Date
041010 -     ..
041011 -    72/F Lab Results Summary
041013 -     ..
041014 -    Log#: 510836100798       081226 10:30
041015 -    <------------------- KAISER -----------------------><-----------------  UCSF --------------------->
041016 -    Type                 Results   Units        Normal        Type                  Units         Normal       ACRO
041017 -     ..
041018 -    CBC with DIFF & PLT CT                                                                                    CBCD
041019 -     ..
041020 -    WBC                     3.8    K/uL     3.4  -  10.0      WBC x10-3             x10E9/L     3.4  -  10      WBC
041021 -    RBC            L        2.93   M/uL    3.60  -  5.70      RBC x10-6             x10E12/L      4  -  5.2     RBC
041022 -    Hemoglobin     L       10.0    g/dL    11.5  -  15.0      Hemoglobin            g/dL         12  -  15.5    HGB
041023 -    Hematocrit     L       29.9    %       34.0  -  46.0      Hematocrit            PERCENT      36  -  46      HCT
041024 -    MCV            H      102      fL      80.0  -  100.0     MCV                   fL           80  -  100     MCV
041025 -    RDW, RBC       H       18.1    %       11.9  -  14.3      [Not Reported at UCSF]
041026 -    MCH                [Not Reported]                         MCH                   pg           26  -  34      MCH
041027 -    MCHC               [Not Reported]                         MCHC                  g/dL         31  -  36      MCHC
041028 -     ..
041029 -    Platelets             187      K/uL     140  -  400       Plt x10-3             x10E9/L     140  -  450     PLT
041031 -  ..
041032 - On 081218 UCSF instructed Millie to call for guidance on adjusting
041033 - dose of cancer treatments, if the blood test today reported platelets
041034 - below 75, ref SDS 37 TY8O, confirmed in Millie's letter to the
041035 - medical team on 081218.
041037 -  ..
041038 - Since platelets are above 75, Millie did not contact UCSF for
041039 - guidance on changing the dose of treatment today.
041040 -
041041 -            [On 090310 1500 platelets 245 again well within normal
041042 -            range. ref SDS 41 8T6M
041044 -  ..
041045 - CBC blood test continues...
041046 -
041047 -    Log#: 510836100798       081226 10:30
041048 -    <------------------- KAISER -----------------------><-----------------  UCSF --------------------->
041049 -    Type                 Results   Units        Normal        Type                  Units         Normal       ACRO
041050 -       (posted 081212,
041051 -    CA 15-3      H*       202      U/mL             <  39     CA 15-3               U/mL              <  33     CA153
041053 -  ..
041054 - Called UCSF Infusion Clinic this morning.  The nurse reported cancer
041055 - marker CA 15-3 95 for Millie's blood test last week on 081218.
041056 - ref SDS 36 A16M, which shows substantial improvement compared to the
041057 - prior test at Kaiser on 081210 that showed the highest ever cancer
041058 - marker, doubling any prior test report in Millie's 7 year patient
041059 - history. ref SDS 27 PQTQ
041060 -
041061 -        [On 090116 1030 CA 15-3 303 jumps 100 points in 3 weeks.
041062 -        ref SDS 40 RQ9H
041064 -  ..
041065 - CBC blood test continues...
041066 -
041067 -    Log#: 510836100798       081226 10:30
041068 -    <------------------- KAISER -----------------------><-----------------  UCSF --------------------->
041069 -    Type                 Results   Units        Normal        Type                  Units         Normal       ACRO
041070 -    (calculated with formula on 081205. ref SDS 10 JG6F)
041071 -    ANC            L     1710                    -> 1500      NEUTS                 x10E9/L     1.8  -  6.8     N-A
041072 -    Neutrophils    L       45      %         41  -  81        Neutrophils
041073 -
041074 -              ANC = WBC x 1000 x (Neutrophils + Bands)
041075 -
041076 -                    3.8 x 1000 x (.45 + 0) = 1710
041078 -  ..
041079 - On 081218 there was discussion at UCSF about reducing the dose of
041080 - sunitinib from 37.5 to 25 mg per day, if the blood counts for the lab
041081 - at Kaiser today on 081226 were less than NEUTS 1.250. ref SDS 37 BQ8F
041082 - This was confirmed in a letter to the medical team on 081218.
041083 - ref SDS 38 GF5X  This plan was disucssed at Kaiser the next day on
041084 - 081219. ref SDS 39 BV6R
041086 -  ..
041087 - CBC blood test continues...
041088 -
041089 -    Log#: 510836100798       081226 10:30
041090 -    <------------------- KAISER -----------------------><-----------------  UCSF --------------------->
041091 -    Type                 Results   Units        Normal        Type                  Units         Normal       ACRO
041092 -    Lymphocytes            31      %         13  -  46        LYMPHS                x10E9/L     0.9  -  2.9     L-A
041093 -    Monocyte         H     14      %          4  -  12        MONOS                 x10E9/L     0.2  -  0.8     M-A
041094 -    Esoinophils      H     10      %          0  -  4         EOS                   x10E9/L     0.0  -  0.4     E-A
041095 -    Basophil                1      %          0  -  1         BASOS                 x10E9/L     0.0  -  0.1     B-A
041096 -
041098 -     ..
041099 -    Log#: 510836100798       081226 10:30
041100 -    <------------------- KAISER -----------------------><-----------------  UCSF --------------------->
041101 -    Type                 Results   Units        Normal        Type                  Units         Normal       ACRO
041102 -    LIPID Panel
041103 -    Cholosterol           182      mg/dL         -< 239
041104 -    Triglycerides         143      mg/dL         -< 199
041105 -    Cholosterol L          34      mg/dL         >  45
041106 -    LDL Calculated        119      mg/dL         -< 129
041107 -
041109 -  ..
041110 - Research on the Internet show....
041111 -
041112 -       WebMD
041113 -
041114 -       Cholesterol Management Health Center
041115 -       Lipid Panel - Topic Overview
041116 -
041117 -              http://www.webmd.com/cholesterol-management/tc/lipid-panel-topic-overview
041119 -        ..
041120 -       A lipid panel is a blood test that measures lipids-fats and
041121 -       fatty substances used as a source of energy by your body.
041122 -       Lipids include cholesterol, triglycerides, high-density
041123 -       lipoprotein (HDL), and low-density lipoprotein (LDL).
041125 -         ..
041126 -        This panel measures:
041127 -
041128 -        •  Total cholesterol level.
041129 -        •  Triglyceride level.
041130 -        •  HDL cholesterol level. This is the "good"
041131 -           cholesterol.
041132 -        •  LDL cholesterol level. This is the "bad"
041133 -           cholesterol.
041135 -         ..
041136 -        Other measurements that may be done for a lipid panel include:
041137 -
041138 -        •  Very-low-density lipoprotein (VLDL) cholesterol
041139 -           level.
041140 -        •  The ratio of total cholesterol to HDL.
041141 -        •  The ratio of LDL to HDL.
041143 -         ..
041144 -        Lipids are found in your blood and are stored in tissues.  They
041145 -        are an important part of cells, and they help keep your body
041146 -        working normally.  Lipid disorders, such as high cholesterol,
041147 -        may lead to life-threatening illnesses, such as coronary artery
041148 -        disease (CAD), heart attack, or stroke.
041149 -
041151 -         ..
041152 -        Mayoclinic.com
041154 -         ..
041155 -        Cholesterol
041156 -
041157 -              http://www.mayoclinic.com/health/cholesterol-test/CL00033
041159 -         ..
041160 -        Cholesterol test: Sorting out the lipids
041162 -         ..
041163 -        Learn how this common blood test, sometimes called a lipid
041164 -        panel or lipid profile, is done, how to prepare and what the
041165 -        results mean.
041167 -         ..
041168 -        A complete cholesterol test - more accurately referred to as a
041169 -        lipid panel or lipid profile - includes a group of blood tests
041170 -        used to measure the amount of cholesterol and triglycerides in
041171 -        your blood.  Cholesterol tests are done to help assess your
041172 -        risk of coronary artery disease or risk of vascular disease in
041173 -        other parts of your body.
041175 -         ..
041176 -        Cholesterol and triglycerides are types of fats called lipids
041177 -        that naturally circulate in your blood.  Although lipids are
041178 -        necessary for your body to function normally, too much fat in
041179 -        your blood increases your risk of heart or vascular disease.
041181 -         ..
041182 -        If your cholesterol levels are abnormal, you probably won't
041183 -        have any signs or symptoms, so a cholesterol test is an
041184 -        important risk assessment tool.  Many studies have shown that
041185 -        elevated cholesterol levels are a significant risk factor for
041186 -        heart disease, which is the No. 1 killer of both men and women.
041188 -         ..
041189 -        What types of cholesterol are measured?
041191 -         ..
041192 -        A complete cholesterol test, referred to as a lipid panel or
041193 -        lipid profile, includes the measurement of four types of fats
041194 -        (lipids) in your blood:
041195 -
041196 -        1.  Low-density lipoprotein (LDL) cholesterol. This is
041197 -            sometimes called the "bad" cholesterol.  Too much of it in
041198 -            your blood causes the accumulation of fatty deposits
041199 -            (plaques) in your arteries (atherosclerosis), which reduces
041200 -            blood flow.  These plaques sometimes rupture and lead to
041201 -            major heart and vascular problems.  In addition, in people
041202 -            with diabetes and in people who are at high risk of heart
041203 -            disease, LDL cholesterol particles tend to be smaller and
041204 -            denser.  These smaller, denser particles can cause greater
041205 -            damage to blood vessels than can the cholesterol particles
041206 -            found in people at lower risk of heart disease and in those
041207 -            without diabetes.
041209 -             ..
041210 -        2.  High-density lipoprotein (HDL) cholesterol. This is
041211 -            sometimes called the "good" cholesterol because it helps
041212 -            carry away LDL cholesterol, thus keeping arteries open and
041213 -            your blood flowing more freely.
041215 -             ..
041216 -        3.  Triglycerides.  Triglycerides are another type of fat in
041217 -            the blood.  When you eat, your body converts any calories
041218 -            it doesn't need to use right away into triglycerides, which
041219 -            are stored in fat cells and released later for energy.
041220 -            High triglyceride levels usually mean you regularly eat
041221 -            more calories than you burn.  High levels are also seen in
041222 -            overweight people, in those consuming too many sweets or
041223 -            too much alcohol, and in people with diabetes who have
041224 -            elevated blood sugar levels.
041226 -             ..
041227 -        4.  Total cholesterol. This is a sum of your blood's
041228 -            cholesterol content.
041230 -         ..
041231 -        Together, the four numbers can provide clues about your risk
041232 -        of heart attack, stroke or other blood vessel damage (vascular
041233 -        disease). Results of a lipid panel cholesterol test are listed
041234 -        as a set of numbers in milligrams per deciliter (mg/dL).
041236 -         ..
041237 -        It's possible to measure only total cholesterol. However, this
041238 -        single test isn't used as much anymore, because knowing only
041239 -        your total cholesterol level doesn't provide your doctor with
041240 -        as much useful information as the more complete lipid panel.
041242 -         ..
041243 -        In 2001, a group of national experts known as the National
041244 -        Cholesterol Education Program Expert Panel recommended that the
041245 -        ideal cholesterol test measure the four types of fats (lipids)
041246 -        in your blood that are included in a lipid panel or lipid
041247 -        profile.
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