CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 35 0000. ref SDS 34 0000.
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040505 -
040507 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 100203, Millie resumed treatment after a 3-week pause ordered by
040902 - Doctor Johnson, on 100112 0830, ref SDS 27 G68H, while Millie was
040903 - treated to recover from a very severe case of shingles infection,
040904 - reported earlier on 100104 1115. ref SDS 25 0P9S
040906 -  ..
040907 - On 100217 0730 Millie got the 3rd treatment of the 3rd cycle with
040908 - Navelbine for Millie to recover from the 9th relaspe of cancer.
040910 -  ..
040911 - On 100218 1000 Millie got Neupogen treatment at Kaiser to maintain
040912 - blood counts essential for getting Navelbine chemotherapy treatment
040913 - for cancer. ref SDS 35 ER95   After getting Neupogen, Millie has
040914 - emergency meeting with Doctor Johnson; shingles recurrence diagnosed,
040915 - treatment resumed. ref SDS 35 PP5Y  Doctor Johnson diagnosed
040916 - progression of cancer after 3 week delay treating cancer with
040917 - chemotherapy, while Millie was treated for shingles. ref SDS 35 MD4H
040918 - Millie very discouraged about delays treating her cancer with
040919 - chemotherapy rather than providing targeted treatment that works
040920 - concurrently with treating shingles. ref SDS 35 XE6I
040922 -  ..
040923 - On 100219 1453 Zan called and sent a letter confirming that Abraxane
040924 - chemotherapy will have severe side effects and will likely not be
040925 - effective for Millie to recover from cancer. ref SDS 0 ER95
040926 -
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040930 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Zan, the chief pharmacist for the Oncology Pharmacy at Kasier in
041302 - Walnut Creek, called earlier today.
041304 -  ..
041305 - Zan advised that Doctor Johnson prescribed Abraxane for Millie
041306 - starting on 100303, to recover from the 10th relapse of cancer.  This
041307 - confirms Doctor Johnson's work plan yesterday to end treatment with
041308 - Navelbine and start Abraxane, reported on 100218 1000. ref SDS 35 023N
041310 -  ..
041311 - Zan explained that Millie's patient profile relapsing 10 times since
041312 - she was first diagnosed in 2002, shown in the record on 090213,
041313 - ref SDS 4 AC6G, has caused her cancer to mutate to resist chemotherapy
041314 - with Abraxane.  This aligns with Doctor Benz's 2nd opinion received
041315 - from Kaiser on 060929, saying that Abraxane will not effective for
041316 - Millie because her cancer has progressed with taxanes. ref SDS 1 SX3J
041318 -  ..
041319 - Zan also said that chemotherapy has severe side effects for Millie's
041320 - history of low blood counts.  He cited Doctor Johnson's order
041321 - yesterday to extend Millie's treatment for shingles infection, caused
041322 - by chemotherapy weakening Millie's immune system.  Zan indicated that
041323 - recurrence of shingles or getting some other infection could be fatal.
041324 -
041325 -            [On 100601 0830 Doctor Johnson diagnosed Phlebitis, which
041326 -            can be fatal causing blood clots; he ordered treatment with
041327 -            Relafen for 2 weeks, ref SDS 49 OP4G; this is the 2nd major
041328 -            infection from treating Millie with chemotherapy that
041329 -            conflicts with patient profile, reported on 090601 0818.
041330 -            ref SDS 8 FR8L
041332 -  ..
041333 - These problems were presented by Zan's colleague, Brad, when he called
041334 - on 090601, and cautioned Millie about getting Gemzar chemotherapy that
041335 - Docor Johnson prescribed at time time. ref SDS 8 8J8L  Brad also
041336 - disclosed that chemotherapy treatment risked getting fatal infection.
041337 - ref SDS 8 FR8L
041339 -  ..
041340 - Zan asked what happened?
041342 -  ..
041343 - Explained that Millie got a letter few days later from Queenie, in
041344 - Zan's office.  Queenie submitted Kaiser's guidance on Gemzar, which
041345 - required extreme caution for Millie's history of radiation, and to
041346 - entirely avoid Gemzar because Millie must take warfarin blood thinner,
041347 - reported on 090605 1447. ref SDS 9 V34K
041349 -  ..
041350 - Later that day, a letter was submitted on 100605, asking Doctor
041351 - Johnson to provide written assurance that Millie is somehow protected
041352 - from risks of Gemzar. ref SDS 10 LF7S  In the morning on 090609, UCSF
041353 - discovered they made medical mistakes giving Millie radiation on
041354 - referral from Kaiser, and planned for Millie to recover getting MPA, a
041355 - targeted cancer agent. ref SDS 11 W65W  In the afternoon on 090609,
041356 - Doctor Johnson called and insisted on Millie getting Gemzar, and he
041357 - refused to provide written assurance that Millie can ignore Kaiser's
041358 - published guidance for Gemzar. ref SDS 12 OT6G
041360 -  ..
041361 - Then a few days later, UCSF called and told Millie to come in and
041362 - start treatment with MPA, rather than Gemazr.  Millie went to UCSF on
041363 - 090616, and Doctor Rugo said everybody at Kaiser and UCSF is on board
041364 - to treat Millie with MPA, and then with PARP. ref SDS 13 KD6L
041366 -  ..
041367 - Zan said he is glad everything finally got worked out.  He asked why
041368 - Kaiser is ordering more chemotherapy, rather than UCSF treating Millie
041369 - with targeted agents?  Advised that nobody seems to know.  Somehow,
041370 - Kaiser has been treating Millie with chemo for 6 months, and this has
041371 - been very difficult for her.
041373 -  ..
041374 - Zan said he is sending a letter to make sure everybody chemotherapy
041375 - with Abraxane is risky for Millie, like Gemzar was.
041377 -  ..
041378 - A few mintues later, received Zan's letter...
041379 -
041380 -    1.  Subject:  ABRAXANE, chemotherapy
041381 -        Received: 2/19/10 12:28 PM
041388 -         ..
041389 -    2.  Abraxane will be usually given over 30 minutes of infusion once
041390 -        a week for 3 weeks followed by one week off.
041392 -         ..
041393 -    3.  Some of the common side effects are: Infections due to low
041394 -        white blood cell count (neutropenia), hair loss, Numbness,
041395 -        tingling, or burning of hands and feet (sensory neuropathy),
041396 -        Fatigue and weakness (asthenia), Joint and muscle pain, Mouth
041397 -        or lip sores (mucositis), Upset stomach and diarrhea,
041398 -        Irritation at the injection site, and Low blood pressure
041399 -        (hypotension).  We also have you on Neupogen the day after each
041400 -        treatment.  Plan is to start treatment on Wednesday March 3rd.
041402 -  ..
041403 - Risk of infection due to low blood counts with Abraxane, aligns with
041404 - Brad's report on 090601, that Gemzar chemotherapy was high risk of
041405 - fatal infections for Millie's patient profile. ref SDS 8 FR8L
041406 -
041407 -            [On 100601 0830 Doctor Johnson diagnosed Phlebitis, which
041408 -            can be fatal causing blood clots; he ordered treatment with
041409 -            Relafen for 2 weeks, ref SDS 49 OP4G; this is the 2nd major
041410 -            infection from treating Millie with chemotherapy that
041411 -            conflicts with patient profile, reported on 090601 0818.
041412 -            ref SDS 8 FR8L
041414 -  ..
041415 - Zan's letter from Kaiser concludes...
041416 -
041417 -    4.  Thanks
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