CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 45 0000. ref SDS 44 0000.
040502 -
040503 -
040504 -
040506 -  ..
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 34 G68H, while Millie was
040903 - treated to recover from a very severe case of shingles infection,
040904 - reported earlier on 100104 1115. ref SDS 31 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 44 ER95
040915 -  ..
040916 - On 100218 1000 Millie had emergency meeting with Doctor Johnson,
040917 - primary care physician at Kaiser, after getting Neupogen treatment;
040918 - the doctor diagnosed relapse of shingles, and prescribed a 4th cycle
040919 - of treatment, but only with Acyclovir (Zovirax) 800 MG tablets,
040920 - ref SDS 44 0Y6O; the doctor also diagnosed Millie's 10 relapse of
040921 - cancer, and ordered switching treatment from Navelbine to Abraxane,
040922 - beginning on 100303. ref SDS 44 023N   The doctor further ordered a CT
040923 - test to evaluate rising pain. ref SDS 44 ES40
040925 -  ..
040926 - On 100218 1230 Millie had emergency CT test. ref SDS 44 PQ6R
040928 -  ..
040929 - On 100301 0005 letter to medical team reports improvement from CT test
040930 - on 100218, and increased energy may indicate Navelbine can continue
040931 - another cycle. ref SDS 45 ER95
040933 -  ..
040934 - On 100302 0830 meeting at Kaiser, ref SDS 46 ER95; Doctor Johnson
040935 - prescribed Abraxane for Millie starting treatment tomorrow for
040936 - recovering from 10th relapse of cancer. ref SDS 46 FB67  Blood counts
040937 - dropped significantly, ref SDS 46 IC4N; since Abraxane side effects
040938 - reduce blood counts this increases chances of shingles recurrence; the
040939 - doctor advised that treatment for cancer will be paused again, if
040940 - shingles recurs. ref SDS 46 FC68  Only way for Millie to get treatment
040941 - for shinges concurrent with cancer is to switch from Abraxane to a
040942 - "targeted" treatment for cancer that does not injure bone marrow
040943 - producing blood. ref SDS 46 IC85
040945 -  ..
040946 - On 100303 0730 Millie received 1st treatment 1st cycle Abraxane at
040947 - Kaiser Oncology Chemotherapy Clinic in Walnut Creek. ref SDS 47 625I
040949 -  ..
040950 - On 100304 2251 Millie notifies medical team that 1st treatment of 1st
040951 - cycle started with Abraxane to recover from 10th relapse of cancer.
040952 - ref SDS 0 ER95  Reports possible recurrence of shingles. ref SDS 0
040953 - OP6W  Millie asks Kaiser for written report on trade-offs for
040954 - prescribing agents "targeted" to treat her cancer that do no injure
040955 - the bone marrow producing new blood. ref SDS 0 OQ4Y
040956 -
040957 -
040959 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Millie's letter to medical team says...
041302 -
041303 -    1.  Subject : Treatment Started Cancer 10th Relapse Shingles Relapsing???
041304 -        Date: Thu, 04 Mar 2010 23:45:09 -0800
041317 -         ..
041318 -    2.  Excellent meeting on Tuesday.  You addressed 13 issues, and
041319 -        approved me for starting treatment with Abraxane to recover
041320 -        from the 10th relapse of cancer. ref SDS 46 ER95
041322 -         ..
041323 -    3.  I am concerned today that shingles may be recurring.  This
041324 -        evening I feel increased pressure on my right forehead, and the
041325 -        slight coloration which you saw on Tuesday, ref SDS 46 FU5F,
041326 -        may now be more intense, though I am not sure.  Thank goodness,
041327 -        I don't yet see any new bumps on my head, but this can happen
041328 -        quickly.
041329 -
041330 -            [On 100305 0822 Millie reports shingles seems well
041331 -            controlled, so there is hope of getting the 2nd treatment
041332 -            of the 1st cycle with Abraxane next Wednesday, and to
041333 -            recover from the 10th relapse of cancer ref SDS 48 0V6U
041335 -         ..
041336 -    4.  Good news is that I have needed less oxycodone the past few
041337 -        days to control pain.  Energy has been up, although I slept
041338 -        most of the day today.  That's normal for the day after chemo.
041340 -         ..
041341 -    5.  You mentioned during the meeting on Tuesday that Abraxane
041342 -        causes low blood counts that weaken the immune system, and this
041343 -        increases the risk of shingles recurring.  You were further
041344 -        concerned that since my blood counts from the test on Monday,
041345 -        100301, are already below Kaiser's published guidance for
041346 -        safely getting chemotherapy, Abraxane further lowering blood
041347 -        counts compounds the risk of shingles recurrence. ref SDS 46
041348 -        IC4N
041350 -         ..
041351 -    6.  I was very glad to hear that you will approve my treatment next
041352 -        Wednesday with Abraxane, even if blood counts fall further
041353 -        below safe levels, and would in that case consider adding more
041354 -        Neupogen treatments to maintain the immune system [reported
041355 -        on 100302 0830. ref SDS 46 FC5U
041356 -
041357 -            [On 100309 1643 Millie notifies medical team that lab
041358 -            reports test today shows Millie's blood counts rise
041359 -            significantly above level for safe chemotherapy to start
041360 -            2nd treatment with Abraxane. ref SDS 49 2O8W
041362 -         ..
041363 -    7.  Since the cancer marker has doubled in the past month with CA
041364 -        15-3 428 at the highest level in patient history [reported in
041365 -        the record yesterday, getting the 1st treatment with Abraxane,
041366 -        100303 0730, ref SDS 47 R59G], the urgent need is to maintain
041367 -        treatment [for gaining control of metastatic disease].  You
041368 -        seemed to say that if shingles recurs, treatment with Abraxane
041369 -        will have to be paused again until after another 10-day
041370 -        treatment for shingles. ref SDS 46 FC68
041371 -
041372 -            [On 100319 0843 cancer marker CA 15-3 360 dropped about 60
041373 -            points - aligns with evident reduction in IBC rash that
041374 -            signals some recovery achieved with first 2 treatments
041375 -            using Abraxane. ref SDS 51 1T4R
041377 -         ..
041378 -    8.  This presents a dilemma of balancing treatment for shingles
041379 -        concurrent with treating cancer, essential to recover from the
041380 -        10th relapse.  You explained on Tuesday that Kaiser can treat
041381 -        both my cancer and shingles concurrently only by prescribing
041382 -        agents "targeted" to cancer that do not injure my bone marrow.
041383 -        ref SDS 46 IC85
041385 -         ..
041386 -    9.  Please submit trade-offs for alternative agents that do not
041387 -        injure my bone marrow and so enable continuing treatment for my
041388 -        cancer while treating shingles concurrently [continuing prior
041389 -        requests shown in case study on 090725 2017. ref SDS 21 X66O].
041390 -        I am hopeful shingles does not recur, but today makes me
041391 -        worried, based on understandings from Tuesday that if shingles
041392 -        does recur, you will stop treatment with Abraxane.
041393 -
041394 -            [On 100305 0822 Millie asks medical team again to submit
041395 -            analysis of trade-offs for treatments "targeted" to
041396 -            Millie's patient profile that do not degrade bone marrow,
041397 -            and so reduce risk of shingles recurrence, and in any event
041398 -            can be given concurrently with treatment for shingles if
041399 -            this disease does recur. ref SDS 48 0W3W
041401 -         ..
041402 -   10.  I can come by tomorrow afternoon for a quick examination, like
041403 -        you did on 100218, when you resumed treatment for shingles.  I
041404 -        am worried that if shingles worsen on the weekend, what should
041405 -        I do?  The last time this happened, before I knew about
041406 -        shingles, it got really bad over the weekend, because nobody
041407 -        knew what to do.  At this time, I don't have any Acyclovir
041408 -        (Zovirax) on hand. Should I get this tomorrow from the pharmacy
041409 -        to be prepared?
041410 -
041411 -            [On 100305 0822 Millie reports shingles seems better
041412 -            controlled, ref SDS 48 ER95; she is more hopeful about
041413 -            getting through the 1st cycle without needing treatment for
041414 -            shingles, and so able to get 2nd treatment with Abraxane
041415 -            for recovering from 10th relapse of cancer. ref SDS 48 0W3Q
041416 -            Millie asks about prescription for treating shingles to
041417 -            have medication on hand to ensure timely recovery so that
041418 -            treatment for cancer is not interrupted. ref SDS 48 0W3T
041420 -             ..
041421 -            [On 100310 0730 Doctor Johnson visited with Millie in the
041422 -            Oncology Chemotherapy Infusion Clinic and made an
041423 -            examination.  The doctor concurred that shingles subsided,
041424 -            and that blood counts recovered to support getting Millie's
041425 -            2nd treatment with Abraxane, ref SDS 50 OR3H; the doctor
041426 -            did not prescribe treatment for shingles to maintain
041427 -            continuity of treatment for cancer. ref SDS 50 KE9I
041428 -
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041436 -
041437 -
041438 -
041439 -
041440 -
041441 -
0415 -