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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 47 0000. ref SDS 40 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On 090108 Millie's blood counts were very low at UCSF. ref SDS 48
040902 - YN8O
040904 -  ..
040905 - Examination on 090108 showed that substantial recovery from IBC
040906 - symptoms observed at UCSF on 081218, ref SDS 43 VD4F, and the next day
040907 - at Kaiser on 081219. ref SDS 45 3L9L, did not continue after Millie
040908 - resumed treatment on 081226, following a one week pause to recover
040909 - from rising side effects, also reported on 081218. ref SDS 43 QW7H  On
040910 - 090108 IBC in the breastbone area was stable to worse; other sites IBC
040911 - seems improved to stable.  Recovery has been slowed or possibly
040912 - reversed, except the CT test on 081230, reported the lymph node in the
040913 - left supraclavicular was no longer visible, showing substantial
040914 - recovery from enlarged node palpated at UCSF on 081016, ref SDS 11
040915 - J34X, and identified in the CT test on 081107 as very large, reported
040916 - on 081113. ref SDS 16 5O6N
040918 -  ..
040919 - On 090108 the doctor changed Millie's treatment plan and prescribed a
040920 - blood test today to guide treatments beginning today, as reported in
040921 - Millie's letter to the medical team on 090109. ref SDS 49 UF3Q  At
040922 - thta time, on 090109 the primary care physician's assistant, ordered
040923 - blood test for Millie at Kaiser to accomplish care prescribed by UCSF.
040924 - ref SDS 50 BF5N
040925 -
040927 -  ..
040928 - Lab Blood Test CBC to Evaluate Neupogen and Cancer Treatment Plan
040929 -
040930 - Follow up ref SDS 47 6Z4F, ref SDS 40 6Z4F.
040931 -
040932 - This morning, Millie went to the Infusion Clinic at Kaiser in Walnut
040933 - Creek, CA.
040935 -  ..
040936 - Debbie is Millie's nurse today.
040938 -  ..
040939 - While Debbie was drawing blood for the test, walked down the hall and
040940 - visited briefly with the primary care physician in his personal office
040941 - within the Oncology Department.  Arlette was with the doctor, and he
040942 - had a telephone call.  He had just returned from a Tumor Board
040943 - hearing, which occurs on Fridays at 0800 to 1000.
040945 -  ..
040946 - Since the doctor was very busy, walked back to the Infusion Clinic and
040947 - visited with Bella.  She will change the schedule for Millie's
040948 - Neupogen treatment on 090213 from 0830 to 1140 to correlate with
040949 - meeting the doctor at 1140.
040951 -  ..
040952 - Millie left the Infusion Clinic and went to the cafeteria to wait for
040953 - results of the blood test today.  Debbie took Millie's cell phone
040954 - number to call when the lab submits the report in about an hour or so.
040955 - If ANC is below 1000, Millie will return to the clinic for Neupogen
040956 - treatment, if needed.
040958 -  ..
040959 - Millie is walking very slowly due to pain in her toes from peripheral
040960 - neuropathy which may be causedby sunitinib, reported in patient
040961 - history today. ref SDS 51 HY8M
040962 -
040963 -
040965 -  ..
0410 -
0411 -
0412 - 1315
041301 -  ..
041302 - After 3 hours Millie had won four rounds of dominos.  She felt tired
041303 - and so stayed in the cafeteria while results of the blood test were
041304 - investigated.  Since Kaiser refuses to answer customer telephone calls
041305 - until 1330, walked to the Oncology Department on the 2nd floor.
041307 -  ..
041308 - The attendant at the Oncology customer counter said that Arlette is at
041309 - lunch.  She said that Debbie who did the blood draw, ref SDS 0 VF6G,
041310 - is at lunch, and so are Florida, Bella, Laura, Hazel, Sheree, and
041311 - Diana, who are all familiar with Millie's case management.  Seemed
041312 - everyone was at lunch.  Asked for Cisi.  The attendant called the
041313 - Infusion Clinic and talked to Cisi.  The attendant said she made a
041314 - mistake.  Debbie is available and will bring results of the blood test
041315 - this morning to the Infusion Clinic customer lobby.
041317 -  ..
041318 - About 10 minutes later Debbie submittted results of the test.
041320 -  ..
041321 - Since ANC shows 1768 Debbie will cancel Neupogen treatment today and
041322 - tomorrow.
041323 -
041324 -
041326 -  ..
041327 - Laboratory Blood Test Results Posted Kaiser's Computer
041328 -
041329 - Follow up ref SDS 47 S65I, ref SDS 42 FW5N.
041330 -
041331 - Previous lab at UCSF on 090108, ref SDS 48 FW5N, and 2 weeks earlier
041332 - at Kaiser on 081226. ref SDS 47 S65I
041333 -
041334 -        [On 090118 Millie submits complete report to the medical team.
041335 -        ref SDS 53 PZ3P
041337 -     ..
041338 -    Patient   Provider  Category   View      FR Date   To Date
041352 -     ..
041353 -    72/F Lab Results Summary
041355 -     ..
041356 -    Log#: 510901602277       090116 11:00
041357 -    <------------------- KAISER -----------------------><-----------------  UCSF --------------------->
041358 -    Type                 Results   Units        Normal        Type                  Units         Normal       ACRO
041359 -     ..
041360 -    CBC with DIFF & PLT CT                                                                                    CBCD
041361 -     ..
041362 -    WBC                     5.2    K/uL     3.4  -  10.0      WBC x10-3             x10E9/L     3.4  -  10      WBC
041363 -    RBC            L        3.19   M/uL    3.60  -  5.70      RBC x10-6             x10E12/L      4  -  5.2     RBC
041364 -    Hemoglobin     L       10.6    g/dL    11.5  -  15.0      Hemoglobin            g/dL         12  -  15.5    HGB
041365 -    Hematocrit     L       31.9    %       34.0  -  46.0      Hematocrit            PERCENT      36  -  46      HCT
041366 -    MCV                   100      fL      80.0  -  100.0     MCV                   fL           80  -  100     MCV
041367 -    RDW, RBC       H       16.7    %       11.9  -  14.3      [Not Reported at UCSF]
041368 -    MCH                [Not Reported]                         MCH                   pg           26  -  34      MCH
041369 -    MCHC               [Not Reported]                         MCHC                  g/dL         31  -  36      MCHC
041370 -    Lymphocytes            31      %         13  -  46        LYMPHS                x10E9/L     0.9  -  2.9     L-A
041371 -    Monocyte                8      %          4  -  12        MONOS                 x10E9/L     0.2  -  0.8     M-A
041372 -     ..
041373 -    Eosinophils      H     27      %          0  -  4         EOS                   x10E9/L     0.0  -  0.4     E-A
041374 -
041375 -          [On 090118 Millie letter to medical team asks about
041376 -          eosinophils 700% high. ref SDS 53 PZ4Q
041378 -     ..
041379 -    Basophil                1      %          0  -  1         BASOS                 x10E9/L     0.0  -  0.1     B-A
041380 -     ..
041381 -    Platelets             145      K/uL     140  -  400       Plt x10-3             x10E9/L     140  -  450     PLT
041383 -  ..
041384 - On 081218 UCSF instructed Millie to call for guidance on adjusting
041385 - dose of cancer treatments, if the blood test on 081226 reported
041386 - platelets below 75, ref SDS 43 TY8O, confirmed in Millie's letter to
041387 - the medical team on 081218.
041389 -  ..
041390 - Since platelets are again above 75, Millie did not contact UCSF for
041391 - guidance on changing the dose of treatment today.
041393 -  ..
041394 - CBC blood test continues...
041395 -
041396 -    Log#: 510901602276       080116 11:00
041397 -    <------------------- KAISER -----------------------><-----------------  UCSF --------------------->
041398 -    Type                 Results   Units        Normal        Type                  Units         Normal       ACRO
041399 -       (posted 090122, ref SDS 56 FJ8W)
041400 -    CA 15-3      H*       303      U/mL             <  39     CA 15-3               U/mL              <  33     CA153
041402 -  ..
041403 - 100 points seems like a big increase from the prior test 3 weeks ago
041404 - on 081226. ref SDS 47 PQTQ   CA 15-3 303 is 3 times higher than Millie
041405 - has suffered in her 8 years of treatments.
041406 -
041407 -            [On 090121 1017 reported to Glenna that cancer marker CA
041408 -            15-3 significantly elevated in past few weeks. ref SDS 54
041409 -            N95K
041411 -             ..
041412 -            [On 090323 analysis indicates huge drop in cancer marker
041413 -            following completion of radiation and hyperthermia,
041414 -            ref SDS 57 NR4H, and supported by case study showing full
041415 -            history of CA 15-3 mapped agains all treatment history.
041416 -            ref SDS 57 J13O
041417 -
041419 -  ..
041420 - CBC blood test continues...
041421 -
041422 -    Log#: 510901602277       090116 11:00
041423 -    <------------------- KAISER -----------------------><-----------------  UCSF --------------------->
041424 -    Type                 Results   Units        Normal        Type                  Units         Normal       ACRO
041425 -    (calculated with formula on 081205. ref SDS 23 JG6F)
041426 -    ANC                  1768                    -> 1500      NEUTS                 x10E9/L     1.8  -  6.8     N-A
041427 -    Neutrophils    L       34      %         41  -  81        Neutrophils
041428 -
041429 -              ANC = WBC x 1000 x (Neutrophils + Bands)
041430 -
041431 -                    5.2 x 1000 x (.34 + 0) = 1768
041433 -  ..
041434 - CBC blood test continues...
041435 -
041436 -    Log#: 510901602275       090116 11:00
041437 -    <------------------- KAISER -----------------------><-----------------  UCSF --------------------->
041438 -    Type                 Results   Units        Normal        Type                  Units         Normal       ACRO
041439 -    PT, Patient   H        30.3    sec      8.2  -  10.6      PT                    s          12.0  -  14.1    PT
041440 -    PT INR        H         3.1                               INL NRM Ratio                     0.9  -  1.1     INR
041442 -  ..
041443 - INR slightly above the target range may reflect pausing
041444 - cyclophosphamide for the past 7 days, similar to analysis for the test
041445 - last week on 090108, ref SDS 48 PU7Y, and presented in Millie's letter
041446 - to the medical team on 090109. ref SDS 49 UF4S
041447 -
041448 -        [On 090116 Millie letter notified Gloria in Coagulation
041449 -        Control Clinic that INR 3.1 and context with plans to
041450 -        continue current dose. ref SDS 52 IT8X
041452 -         ..
041453 -        [On 090122 INR 3.7 for lab at Kaiser treating Millie in
041454 -        Emergency Department for separated shoulder; Doctor orders
041455 -        Coumadin paused for 2 days, and to contact Coagulation
041456 -        Control Clinic for instructions. ref SDS 55 F56L
041457 -
041459 -  ..
041460 - Eosinophils 700% High Concentration White Blood Cells Fights Infection
041461 -
041462 - Not sure if EOS at UCSF is the same as Eosinophils at Kaiser.  The
041463 - past 4 months indicate EOS has been steady and within range.  The past
041464 - month, Kaiser reports Eosinophils have increased significantly to now
041465 - 700% above the target range...
041466 -
041467 -          [On 090118 Millie letter to medical team asks about
041468 -          eosinophils 700% high. ref SDS 53 PZ4Q
041470 -         ..
041471 -        Kaiser......H.....27      %          0  -  4...... 090116, ref SDS 0 0255,
041472 -        UCSF........h..... 0.42  x10E9/L   0.0  -  0.4.... 090108, ref SDS 48 PU7S
041473 -        Kaiser......H.....10      %          0  -  4...... 081226, ref SDS 47 PU7S
041474 -        UCSF.............. 0.24  x10E9/L   0.0  -  0.4.... 081218, ref SDS 42 PU7S
041475 -        Kaiser......H.....10      %          0  -  4...... 081212, ref SDS 40 PU7S
041476 -        Kaiser......H..... 8      %          0  -  4...... 081210, ref SDS 33 PU7S
041477 -        Kaiser......H.....14      %          0  -  4...... 081203
041478 -            reported in the record on..................... 081205, ref SDS 22 PU7S
041479 -        UCSF.............. 0.22  x10E9/L   0.0  -  0.4.... 081126, ref SDS 17 PU7S
041480 -        UCSF.............. 0.17  x10E9/L   0.0  -  0.4.... 081107, ref SDS 13 PU7S
041481 -        UCSF.............. 0.20  x10E9/L   0.0  -  0.4.... 081023, ref SDS 12 PU7S
041482 -        UCSF.............. 0.25  x10E9/L   0.0  -  0.4.... 081016, ref SDS 10 PU7S
041483 -        UCSF.............. 0.10  x10E9/L   0.0  -  0.4.... 081009, ref SDS 9 PU7S
041484 -        UCSF.............. 0.15  x10E9/L   0.0  -  0.4.... 081002, ref SDS 8 PU7S
041485 -        UCSF.............. 0.14  x10E9/L   0.0  -  0.4.... 080925, ref SDS 7 PU7S
041486 -        UCSF.............. 0.18  x10E9/L   0.0  -  0.4.... 080918, ref SDS 6 PU7S
041487 -        UCSF.............. 0.11  x10E9/L   0.0  -  0.4.... 080911, ref SDS 5 PU7S,
041488 -        UCSF.............. 0.18  x10E9/L   0.0  -  0.4.... 080904, ref SDS 4 PU7S,
041489 -        UCSF.............. 0.21  x10E9/L   0.0  -  0.4.... 080828, ref SDS 3 PU7S,
041490 -
041492 -     ..
041493 -    Research indicates...
041494 -
041495 -    Netdoctor_co.uk
041496 -
041497 -    Eosinophilia
041498 -
041499 -              http://www.netdoctor.co.uk/diseases/facts/eosinophilia.htm
041501 -     ..
041502 -    An eosinophil is a type of white blood cell.
041504 -  ..
041505 - Eosinophils 700% above the target range, may account for WBC rising to
041506 - 5.2 in the test today. ref SDS 0 075H
041508 -  ..
041509 - Could abnormally high eosinophils cause misleading WBC and ANC in the
041510 - blood test today, since actual neutrophils 34% are about 30% below the
041511 - minimum target range? ref SDS 0 QY6H
041512 -
041513 -            [On 090118 Millie's letter asks medical team about
041514 -            implications of eosinophils 700% high? ref SDS 53 PZ4Q
041516 -  ..
041517 - Research Netdoctor_co_uk continues...
041518 -
041519 -    Eosinophils are produced in the bone marrow and are normally found
041520 -    in the bloodstream and the gut lining.  They contain proteins that
041521 -    help the body to fight infection from parasitic organisms, such as
041522 -    worms.  But in certain diseases these proteins can damage the body.
041524 -     ..
041525 -    What is eosinophilia?
041527 -     ..
041528 -    The term eosinophilia refers to conditions in which abnormally
041529 -    high amounts of eosinophils are found in either the blood or in
041530 -    body tissues.
041532 -     ..
041533 -    When does eosinophilia occur?
041535 -     ..
041536 -    Eosinophilia occurs in a wide range of conditions.  Its commonest
041537 -    causes in the UK are allergic diseases such as asthma and hay
041538 -    fever, whereas worldwide the main cause is parasitic infection.  It
041539 -    can also occur in relation to common skin diseases, medicine
041540 -    reactions, and parasitic infections. Other rarer causes include:
041542 -     ..
041543 -    How does eosinophilia occur?
041545 -     ..
041546 -    Increased numbers of eosinophils are produced to fight off allergic
041547 -    disease or parasitic infections.  This is helpful in combating
041548 -    parasitic infections but not in cases of allergic diseases as they
041549 -    accumulate in tissues and cause damage.  For example, in asthma,
041550 -    eosinophilia causes damage to the airways of the lung.
041552 -  ..
041553 - Could this be occurring to resist IBC?  The paper goes on to list skin
041554 - infections and disease as a reason for the bone marrow to increase
041555 - production of eosinophils. ref SDS 0 VD4N
041556 -
041557 -            [On 090118 Millie's letter asks medical team about
041558 -            implications of eosinophils 700% high? ref SDS 53 PZ4Q
041560 -  ..
041561 - Research Netdoctor_co_uk continues...
041562 -
041563 -     What are the symptoms of eosinophilia?
041564 -
041565 -     The symptoms of eosinophilia are those of the underlying
041566 -     condition. For example, eosinophilia due to asthma is marked by
041567 -     symptoms such as wheezing and breathlessness, whereas parasitic
041568 -     infections may lead to abdominal pain, diarrhoea, fever, or cough
041569 -     and rashes.
041571 -      ..
041572 -     Medicine reactions often give rise to skin rashes, and they often
041573 -     occur after taking a new drug.
041575 -  ..
041576 - Millie started sunitinib on 081114, and added cyclophosphamide, and
041577 - Methotrexate on 081128. ref SDS 18 OE6K
041578 -
041579 -            [On 090118 Millie's letter asks medical team about
041580 -            implications of eosinophils 700% high? ref SDS 53 PZ4Q
041582 -  ..
041583 - Research Netdoctor_co_uk continues...
041584 -
041585 -     Rarer symptoms of eosinophilia can include weight loss, night
041586 -     sweats, lymph node enlargement, other skin rashes, and numbness
041587 -     and tingling due to nerve damage.
041589 -  ..
041590 - Millie has reported rising pain toes within the past month, cited in
041591 - patient history today.
041592 -
041593 -
041594 -
041595 -
041596 -
041597 -
041598 -
041599 -
041600 -
041601 -
0417 -