CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 16 0000. ref SDS 15 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Brad called at 1132 on 090601 for the Kaiser Oncology Pharmacy in
040902 - Walnut Creek, and he advised that Doctor Johnson prescribed Gemzar for
040903 - Millie, and it would start later this week. ref SDS 16 PQ7V
040905 -  ..
040906 - Brad further advised in the call on Monday that side effects of Gemzar
040907 - will be very difficult for Millie to tolerate, because of her patient
040908 - history having relapsed 8 times. ref SDS 16 8J8L
040910 -  ..
040911 - Brad was also concerned that Millie could not get prescribed
040912 - treatments with Gemzar needed to recover from cancer, because Gemzar
040913 - will cause compound problems shown in Millie's patient history of
040914 - chronic low blood counts cited in Doctor Johnson's medical chart.
040915 - ref SDS 16 FR4F  As a result, on Monday, Brad ordered a blood test for
040916 - Millie on Monday, 090601, in order to evaluate whether Millie can
040917 - safely get Gemzar. ref SDS 16 5K94
040919 -  ..
040920 - Sheree called later at 1153 and said Millie would start Gemzar on
040921 - Thursday or Friday. ref SDS 16 PQ51  She initially proposed Millie get
040922 - a blood test at that time, rather than today, because the clinic was
040923 - too busy, since several nurses had called in sick. ref SDS 16 HX63
040924 - Sheree then ordered a blood draw for Millie on 090602 at the Kaiser
040925 - Infusion Clinic in Martinez. ref SDS 16 LS7F
040927 -  ..
040928 - Millie went to Kaiser in Martinez on 090602 and got the blood test
040929 - ordered by Brad in the Pharmacy. ref SDS 17 VF6G  Results of the test
040930 - seem favorable for Millie to start Gemzar, because counts for ANC
040931 - 2756, ref SDS 17 B35J, suddenly doubled from the prior test on 090512.
040932 - ref SDS 7 B35J
040934 -  ..
040935 - Earlier today, Millie asked Kaiser when treatment with Gemzar will
040936 - start at Kaiser, reported on 090603 1128. ref SDS 18 07AD
040938 -  ..
040939 - Doctor Johnson reported in a letter received a few minutes ago, that
040940 - the Kaiser Pharmacy would call today and present Kaiser's schedule for
040941 - Millie to start Gemzar chemotherapy, reported on 090603 1507.
040942 - ref SDS 19 07AD
040944 -  ..
040945 - With this background, Queenie called today, also, from the Kaiser
040946 - Oncology Pharmacy in Walnut Creek.  She explained Gemzar treatment
040947 - Kaiser has scheduled for Millie next Thursday on 090611 1400.  Queenie
040948 - sais she did not know that Brad in the Oncology Pharmacy had called on
040949 - Monday with the same information explaining Gemzar is high risk for
040950 - Millie's patient profile. ref SDS 16 PQ7V
040951 -
040952 -        [On 090604 1114 Bella advised that Sheree made a mistake
040953 -        scheduling Millie's Gemzar treatment this week, and planning
040954 -        for same day lab work; Bella said to follow Queenie's schedule
040955 -        for treatment on 090611. ref SDS 22 ZF5S
040957 -  ..
040958 - Queenie talked for 30 to 40 minutes.
040960 -  ..
040961 - Queenie explained side effects of Gemzar are not that bad for most
040962 - patients.  She feels Millie will likely tolerate Gemzar well, because
040963 - Kaiser will treat Millie with Compazine to cope with adverse side
040964 - effects.  Qeenie was not aware that Brad called on Monay and seemed to
040965 - indicated difficulty Millie will likely experience tolerating side
040966 - effects of Gemzar. ref SDS 16 8J8L  Queenie will discuss with Brad
040967 - and send Millie a letter to clarify side effects.
040968 -
040969 -        [On 090603 1637 Millie letter to Kaiser thanks Doctor Johnson
040970 -        for Queenie's call indicating side effects of Gemzar are not
040971 -        that bad. ref SDS 20 UX9U
040973 -  ..
040974 - Queenie said that she will call Gloria, Millie's case manager at the
040975 - Kaiser Coagulation Control Clinic in Martinez, and mention that Millie
040976 - is going on Gemzar, so that Gloria can adjust Millie's Coumadin if
040977 - necessary.
040979 -  ..
040980 - Actually, Millie notified Gloria in a letter to the medical team on
040981 - 090601 confirming Doctor Johnson's prescription to treat Millie with
040982 - Gemzar.  At this time, Gloria nor anyone else has notified Millie to
040983 - change her Coumadin treatment, so evidently everything okay with the
040984 - current prescription for Coumadin taken with Gemzar.
040985 -
040986 -            [On 090605 1447 letter from Queenie does not say anything
040987 -            about contacting the Coagulation Control Center to adjust
040988 -            Millie's Coumadin, ref SDS 23 1J3L; however, Queenie
040989 -            submitted in her letter a link to Kaiser's published
040990 -            guidance on Gemzar and it says that blood thinners should
040991 -            be avoided while taking Gemzar, ref SDS 23 793G; and, this
040992 -            conflicts with Millie's prescription that requires taking
040993 -            Coumadin for life to treat pulmonary embolism.
040995 -  ..
040996 - Queenie also said that Millie will get Compazine prior to getting
040997 - Gemzar IV treatments, and this will help control Gemzar side effects
040998 - of nausea.  Queenie said she can order Compazine pills which Millie
040999 - can take at home as needed.
041001 -  ..
041002 - Millie said she has Compazine on hand already from prior chemotherapy.
041004 -  ..
041005 - Millie asked about criteria Kaiser will use to evaluate success and
041006 - failure of Gemzar treatments, that signals a new treatment is needed?
041007 - Will this be the cancer marker rising?  For example, on 090601 Brad
041008 - was worried Millie cannot hold blood counts required for safe
041009 - chemotherapy.  If Millie misses 1 treatments in 3, 2 in 4, 3 in 7, at
041010 - what point will Kaiser change treatments?  Will the spread of IBC rash
041011 - signal progression?  What measurements will be tracked, as Kaiser as
041012 - was done at UCSF?  What about rising adenopathy, for exmaple in the
041013 - neck?  How will CT tests be applied to assess progression in time to
041014 - start another treatment that can be effective?  Criteria for
041015 - evaluating progression of cancer was presented to Doctor Johnson in
041016 - Millie's letter earlier today on 090603 1128. ref SDS 18 028X  The
041017 - doctor's response to Millie's letter did not address this issue,
041018 - reported earlier on 090603 1507. ref SDS 19 07AD
041019 -
041020 -        [On 090604 1021 Millie's letter to medical team requests
041021 -        treatment plan on criteria for evaluating when treatment needs
041022 -        to be changed, and what treatments can continue Millie's
041023 -        recovery from the 8th relapse of cancer as a chronic disease.
041024 -        ref SDS 21 VM3T
041026 -  ..
041027 - Queenie said she will discuss these issues with the doctor.
041029 -  ..
041030 - Queenie will submit a letter presenting Kaiser's treatment plan for
041031 - Millie getting Gemzar, explaining risks and mitigation Kaiser will
041032 - perform for Millie's safety and recovery, and criteria for determining
041033 - treatment needs to be changed in time for a new treatment to be
041034 - effective, as Doctor Johnson has urged for the medical team since
041035 - 080829.
041037 -             ..
041038 -            [On 090603 1637 Millie notified Doctor Johnson that Queenie
041039 -            called as planned in the doctor's letter earlier today, and
041040 -            will submit a letter confirming Kaiser's guidance on
041041 -            patients getting Gemzar. ref SDS 20 UX4P
041043 -             ..
041044 -            [On 090605 1447 Millie received letter from Queenie with a
041045 -            link to the Internet listing Kaiser's guidance for Gemzar,
041046 -            ref SDS 23 BZ6K; and, which lists many significant risks
041047 -            not previously explained to Millie; most notably that says
041048 -            using Gemzar after having radiation treatments requires
041049 -            extreme caution, ref SDS 23 745O, and that patients should
041050 -            avoid taking blood thinners while getting Gemzar.
041051 -            ref SDS 23 793G
041052 -
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0411 -