CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 4 PQ7V.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie received a call on Wedensday, 090603 1524, from Queenie in the
040902 - Oncology Pharmacy for Kaiser in Walunt Creek. ref SDS 6 6W9H  This
040903 - followed up the call from Brad on 090601 advising that Doctor Johnson
040904 - prescribed Gemzar for Millie. ref SDS 4 PQ7V
040906 -  ..
040907 - At that time on Wednesday, Queenie talked to Millie for 30 - 40
040908 - minutes telling her to be sure and do various things to prepare for
040909 - getting Gemzar, and efforts Kaiser is taking to mitigate side effects
040910 - of treatment. ref SDS 6 7J9L
040912 -  ..
040913 - Queenie was asked to send a letter to Millie confirming the long
040914 - complex discussion explaining how Kaiser's general guidance relates to
040915 - Millie's patient history. ref SDS 6 7J4P
040917 -  ..
040918 - Today, Millie received the following letter that only mentions plans
040919 - to treat neausa with compazine, and ignores many extreme risks getting
040920 - Gemzar that cause death or infirmity for Millie's patient profile...
040921 -
040922 -    1.  Subject:  Chemotherapy info
040923 -        Received: 6/5/09 10:06 AM
040930 -         ..
040931 -    3.  Per our discussion 2 days ago, here is the website that
040932 -        provides you with written information for the chemotherapy,
040933 -        Gemzar:
040934 -
040935 -           http://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=11338
040937 -  ..
040938 - This letter does not accomplish requirements for Kaiser to confirm
040939 - what was said in Queenie's telecon with Millie on 090603, that
040940 - explained how general guidance on Gemzar relates to Millie's patient
040941 - profile.
040942 -
040943 -            [On 090605 2215 letter to Zoe in Kaiser's Quality Care
040944 -            Office reports Queenie's letter requires quality care
040945 -            review of Kaiser's prescription to treat Millie with Gemzar
040946 -            on 090611 1400. ref SDS 8 L55T
040947 -
040949 -  ..
040950 - Extreme Caution Gemzar after Radiation Treatment
040951 -
040952 - Kaiser's letter today changes dramatically planning for Millie to
040953 - start Gemzar treatment on 090611.  In the call from Zoe earlier today
040954 - at 1230, the work plan called for Kaiser to prepare a treatment plan
040955 - after Millie gets Gemzar. ref SDS 7 7S54  Kaiser's guidance today
040956 - presents quality care issues that now appear to prevent Millie getting
040957 - Gemzar to recover from her 8th relapse of cancer.
040959 -  ..
040960 - Kaiser's website says in part...
040961 -
040962 -            MEDICATION INFO SHEET
040963 -            GEMCITABINE
040964 -            (Jem-SITE-a-been)
040965 -
040966 -            Precautions:
040967 -
040968 -            1.  Gemcitabine should be used with extreme caution if you
040969 -                have just received radiation therapy.
040971 -  ..
040972 - Kaiser's warning in published guidance for Gemzar aligns with Kaiser's
040973 - Pharmacist, Brad, who warned on 090601 that Gemzar is high risk for
040974 - Millie's patient profile, but did not say that Millie's radiation
040975 - treatments require extreme caution. ref SDS 4 8J8L
040977 -  ..
040978 - Kaiser's warning received today aligns with research on the Internet
040979 - that getting Gemzar concurrent or consecutively with radiation can be
040980 - life-threatening based on the amount of radiation the patient received
040981 - and the time interval between effects of radiation and starting
040982 - Gemzar.
040984 -  ..
040985 - Millie received massive radiation accumulating from treatment at UCSF
040986 - 4 days a week for 4 weeks in a row from 090219 to 090317, reported in
040987 - Doctor Hsu's treatment plan, received on 090226. ref SDS 1 D452
040989 -  ..
040990 - Doctor Hsu warned on 090312 that radiation continues to be effective
040991 - for months after ending treatment. ref SDS 2 VL4O  Today, Millie has
040992 - open sores bleeding on her chest recovering from radiation, and her
040993 - cancer marker is still going down, reported for the labs on 090602.
040994 - ref SDS 5 PQTQ, further signaling radiation is still affecting her
040995 - system.
040997 -  ..
040998 - Kaiser's published guidance for gemcitabine continues...
040999 -
041000 -            2.  Rarely, gemcitabine may increase your chance of
041001 -                bleeding.  Because of this, you should avoid using
041002 -                blood thinners, or drugs that also affect bleeding...
041004 -             ..
041005 -            Side Effects...
041006 -
041007 -            More Common > 10%
041008 -
041009 -            3.  Rash, itchy skin ( mainly on arms and legs)
041010 -            4.  Swollen arms and legs
041011 -            5.  Joint /muscle pain
041013 -             ..
041014 -            Less Common <10%
041015 -
041016 -            6.  Low white blood counts, fever and chills, infections
041017 -            7.  Difficulty breathing, cough
041019 -  ..
041020 - Kaiser's published guidance received late today presents significant
041021 - risks that have not been explained by Doctor Johnson, by Brad in his
041022 - call on 090601 from the Kaiser Oncology Pharmacy, ref SDS 4 PQ7V, nor
041023 - by Queenie on 090603, also, calling from the Oncology Pharmacy.
041024 - ref SDS 6 6W9H
041026 -  ..
041027 - Brad mentioned concerns that Millie's blood counts might be too low to
041028 - get chemotherapy, and he schedueld a blood test to evaluate the
041029 - problem. ref SDS 4 JH4K  Queenie mentioned in her call only that
041030 - Millie would get compazine for nausea.
041032 -  ..
041033 - Kaiser's instructions on giving patients Gemzar lists many other risks
041034 - for Millie's patient profile, including low blood counts, and injury
041035 - to her shoulder because Gemzar increases joint and muscle pain.
041036 -
041037 -            [On 090605 Millie wrote a letter to Zoe in Kaiser's Quality
041038 -            Care Department to request thorough review on viability of
041039 -            prescribing Gemzar for Millie's patient profile.
041040 -            ref SDS 8 LE4Q
041042 -             ..
041043 -            [On 090607 Millie letter to medical team reports continuing
041044 -            bleeding from open sores from radiation treatment, and asks
041045 -            about getting examination to start treating with Vitamin E
041046 -            plus pentoxifylline (Trental), planned on 090312,
041047 -            ref SDS 2 6P8K; Millie's letter further asks for Doctor
041048 -            Hsu's comments on Kaiser prescribing Gemzar.
041050 -  ..
041051 - Kaiser's guidance also says Millie should not be on blood thinners
041052 - while getting Gemzar, per above. ref SDS 0 793G  Since Millie is
041053 - required to take Coumadin for Pulmonary Embolism, this alone seems to
041054 - eliminate Gemzar as a viable treatment.  Queenie seemed to discuss
041055 - this issue during the telecon with Millie on 090603 1524, ref SDS 6
041056 - SN3F, but her letter today on 090605 says nothing about this major
041057 - issue.
041059 -  ..
041060 - Letter from Queenie continues...
041061 -
041062 -    4.  Also for nausea at home after chemotherapy, take
041063 -        Prochlorperazine (Compazine) 10mg orally every 8 hours AS
041064 -        NEEDED for nausea/vomiting. (I did not send this to pharmacy as
041065 -        you have the medication at home, but let one of us know later
041066 -        if you need a refill)
041068 -  ..
041069 - Queenie's comments about compazine confirm telecon quidance she gave
041070 - to Millie on 090603 1524. ref SDS 6 SN4I
041072 -  ..
041073 - Letter from Queenie concludes...
041074 -
041075 -    5.  Take care!
041076 -
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0411 -