CONTACTS 

SUBJECTS
Chemotherapy Taxol Avastin Bevacizamub VEGF Treatments Begin Today 2
Blood Tests Cause Big Welt on Right Forearm Difficulty Finding Vein
Difficulty Finding Vein Blood Tests Cause Big Welt on Right Forearm
Port Catheter Not Used Blood Tests Difficulty Finding Vein Cause Big
Blood Tests Cause Big Welt on Right Forearm Difficulty Finding Vein

0807 -
0807 -    ..
0808 - Summary/Objective
0809 -
080901 - Follow up ref SDS 14 0000. ref SDS 13 0000.
080902 -
080903 - Good news -- CA 15-3 shows largest drop in all the years Millie has
080904 - been tested, complementing clinical indicators reviewed with Doctor
080905 - Johnson on Monday.  Blood counts are finally normal, ref SDS 0 Q659,
080906 - after many months of being too low for normal dosage of chemotharapy
080907 - treatments. ref SDS 0 4N5M  As a result, the doctor's plan, reported by
080908 - Rosalie, last week, for Millie to meet with the pharmacist during
080909 - treatment today to receive another pill or other treatment to increase
080910 - the blood counts, was cancelled today. ref SDS 0 3P5O  This suggests
080911 - Millie's system may be getting stronger to enable the bone marrow to
080912 - replenish blood at a rate fast enough to keep up with chemotherapy
080913 - using Taxol and Avastin.  Finally, Millie did not get weak and wobbly
080914 - from treatments today. She did not sleep, and she was able to drive
080915 - home.  She did not sleep when we got home. ref SDS 0 F54N  This may
080916 - reflect weaker Benadryl or a stronger steriod to make her hyper.
080917 -
080918 -
080919 -
080920 -
080921 -
080922 -
080924 -  ..
0810 -
0811 -
0812 - Progress
0813 -
081301 - Diana is the nurse today.
081303 -  ..
081304 - Millie had blood drawn at the Chemotherapy clinic again yesterday,
081305 - after the meeting with Doctor Johnson, so they could use the port
081306 - catheter.
081307 -
081308 -
081310 -  ..
0814 -
0815 -
0816 - 1211
0817 -
081701 - Diana advises the lab has not provided a report on urinalysis.
081702 -
081703 - She calls the lab and orders missing information needed to administer
081704 - the Avastin treatment.
081706 -  ..
081707 - Diana advises that the lab said Millie is good to go for Avastin.
081709 -  ..
081710 - Diana brought a big bag with the equipment and treatments for Millie.
081711 - She said they have everything ready today except the Avastin, which
081712 - she will order after starting the Taxol, now that the lab says the
081713 - urinalysis report is favorable.
081715 -  ..
081716 - Blood counts are normal today.  Good news (report is shown below,
081717 - ref SDS 0 0N7Q)  As a result, Taxol treatment is increased to normal
081718 - dose, ref SDS 0 4N5M, changing prior practice reported on 040601
081719 - disclosing that chemotherapy treatments have been continuously
081720 - lowered. ref SDS 14 Q659)
081722 -  ..
081723 - Cough medication prescribed by Doctor Johnson yesterday seems to have
081724 - been effective.  Coughing reported on 040517 has been greatly reduced.
081725 - ref SDS 11 RZ4I
081726 -
081727 -
081728 -
081729 -
081730 -
0818 -

SUBJECTS
Blood Tests White Cell Count Good 2nd Cycle 1st Treatment Chemothera
Urine Tests No Evident Problems
Blood Test Results Pass for Treatment

1205 -
120601 -  ..
120602 - Blood Counts Rise to Normal Dose Chemotherapy Taxol Adjusted Lower
120603 -
120604 - Follow up ref SDS 14 Q659, ref SDS 13 Q659.
120605 -
120606 - Millie asked about results of the blood test taken yesterday?
120608 -  ..
120609 - Diana said the blood counts are all good today, so Millie gets full
120610 - dose of chemotherapy treatment, as planned on 040525, ref SDS 13 4N5M,
120611 - and discussed with the primary care physician yesterday on 040614.
120612 - ref SDS 17 6T74
120614 -  ..
120615 - Diana later submitted the report showing...
120616 -
120617 -    Patient   Provider  Category   View      FR Date   To Date
120623 -     ..
120624 -    Procedure              Results             Reference Range
120626 -     ..
120627 -    Log#: 510416602056      040614 14:38 Outpa WCR Req: RA Johnson, MD
120628 -
120629 -                  ** Walnut Creek Medical Center **
120631 -     ..
120632 -    @CBC
120633 -    WBC x 10-3               4.4 K/uL           3.5   -     12.5
120634 -    RBC x 10-6              3.91 M/uL           3.60  -      5.10
120635 -    Hemoglobin              12.6 g/dL          11.5   -     15.0
120636 -    Hematocrit              37.0 %             34.0   -     46.0
120637 -    MCV                       94 fL            80.0   -    100.0
120638 -    RDW                     15.3 %             11.9   -     14.3
120639 -    Plt x10-3                233 K/uL         140     -    400
120640 -     ..
120641 -    Seg Neutrophils L         49 %             50     -     70
120642 -    Lymphocytes               30 %             20     -     50
120643 -    Monocyte                   8 %              0     -     11
120644 -    Eosinophil    H            7 %              0     -      4
120645 -    Basophil             NOT REPORTED           0     -      2
120646 -    Manual Diff?         NOT REQ
120648 -     ..
120649 -    @MDIF
120650 -    Diff Method         Auto Dif
120652 -     ..
120653 -    LAB.RES <Shift F9> For complete Lab Results    WCRDXL  040615 1229
120655 -  ..
120656 - Sharee later submitted a supplemental blood test report.
120658 -     ..
120659 -    Log#: 510416602055      040614 14:20 Outpa WCR Req: RA Johnson, MD
120660 -
120661 -             ** TPMG Regional Lab, Berkeley   **
120663 -     ..
120664 -    Ferritin      H        177   ng/mL         10     -    170
120665 -
120666 -             ** TPMG Regional Laboratory, MWS **
120668 -     ..
120669 -    IRON/TIBC
120670 -    UIBC                   244   ug/dL         92     -    365
120671 -    Transf. % Sat.          27   %             15     -     55
120672 -    TIBC                   336   ug/dL        228     -    428
120673 -    Iron                    92   ug/dL         35     -    160
120674 -     ..
120675 -             ** TPMG Regional Lab, Berkeley   **
120677 -     ..
120678 -    CA 15-3       H         55   U/mL                 -<    39
120679 -
120680 -             ** WALNUT CREEK MEDICAL CENTER **
120682 -     ..
120683 -    AST (SGOT)    H         45   U/L           14     -     36
120684 -    ALT (SGPT)              35   U/L           11     -     66
120686 -     ..
120687 -    LAB.RES <Shift F9> For complete Lab Results    WCRSDE  040615 1304
120688 -
120689 -
120690 -
120692 -  ..
120693 - Urinalisys
120694 -
120695 -    Patient   Provider  Category   View      FR Date   To Date
120697 -
120698 -    Patient             Personal Physician:  Robert A. Johnson, MD
120701 -     ..
120702 -    Procedure              Results             Reference Range
120704 -     ..
120705 -    Log#: 510416602056      040614 14:38 Outpa WCR Req: RA Johnson, MD
120706 -
120707 -                  ** Walnut Creek Medical Center **
120709 -     ..
120710 -    Urinalysis
120712 -     ..
120713 -    Culture Per?           Not Ind
120714 -    Microscopic?           Not Ind
120715 -    pH                     5.0                 4.5     -    8.0
120716 -    Sp. Gravity            1.015               1.001   -    1.035
120717 -    Glucose                Negative            Negative
120718 -    Blood                  Negative            Negative
120719 -    Nitirtes               Negative            Negative
120720 -    Ketones                Negative            Negative
120721 -    Leuk Esterase          Negative            Negative
120722 -    Protein                Negative            Negative
120723 -    Bilirubin              Negative            Negative
120724 -    Urobilinogen           < 1 EU/dL           =< 2.0
120725 -    Urine Source           Clean
120727 -     ..
120728 -    LAB.RES <Shift F9> For complete Lab Results    WCRM9H  040601 1216
120729 -
120730 -
120731 -
120732 -
1208 -

SUBJECTS
CA 15-3 55 28 Point Drop from 78 on Prior Report Reversing Prior Tre

1303 -
130401 -  ..
130402 - CA 15-3 Drops from 78 to 55, Reversing Prior Trend.
130403 -
130404 - Follow up ref SDS 14 2N5J, ref SDS 11 087J.
130406 -  ..
130407 - Report on blood lab does not have notice of CA 15-3 ordered yesterday,
130408 - per above. ref SDS 0 0N7Q
130410 -  ..
130411 - Sharee will investigate.
130412 -
130414 -  ..
1305 -
1306 -
1307 - 1314
1308 -
130801 - Sharee submits supplemental blood test report, per above. ref SDS 0
130802 - 0255
130804 -  ..
130805 - CA 15-3 drops significantly to 55 from 78 a month ago, reversing the
130806 - trend the past 4 months, reported on 040517. ref SDS 17 087J
130807 -
130808 -     [On 040713 CA 15-3 rose to 54 up from 47. ref SDS 19 2N5J
130809 -
130810 -     [On 040729 CA 15-3 drops to 43 down from 54. ref SDS 20 2N5J
130812 -  ..
130813 - Seems to align with report yesterday that lumps in neck have gotten
130814 - smaller, ref SDS 17 8R6M, and redness of left breast has further
130815 - declined. ref SDS 17 735H
130816 -
130817 -
130818 -
130819 -
130820 -
1309 -

SUBJECTS
Prepare for Treatment Connect Equipment for Port Catheter
Tagiment Dexatron Administered to Prevent Alergic Reaction to Taxol
Port Catheter Required 3 Tried to Connect Infusion Equipment Prepare

1605 -
1606 - 1145
160701 -  ..
160702 - Preparation for Treatment Required One (1) Attempt to Connect Port
160703 -
160704 - Follow up ref SDS 14 EB7J, ref SDS 13 EB7J.
160705 -
160706 - Diana was effective connecting the port to the equipment that links to
160707 - the infusion tubing.
160709 -  ..
160710 - Diana asks how many treatments Millie has received in order to set
160711 - the control for the rate.  Millie explains this is the 3rd cycle 1st
160712 - treatment, so Diana sets the rate at 30 minutes.
160714 -  ..
160715 - Diana asks for the order of the treatment.  Is Avastin first, or does
160716 - it follow the Taxol.
160718 -  ..
160719 - Millie explains the order of past treatments has been Taxol and then
160720 - Avastin.
160722 -  ..
160723 - Benadryl started.
160724 -
160725 -
160727 -  ..
1608 -
1609 -
1610 - 1156
1611 -
161101 - Remind Diana about Compazine.
161102 -
161103 - Diana brought Compazine pill for nausea.
161105 -  ..
161106 - Vital signs taken
161107 -
161108 -    Blood pressure    150 90
161109 -
161110 -    Pulse             62
161111 -
161112 -
161114 -  ..
1612 -
1613 -
1614 - 1145
1615 -
161501 - Alarm sounds ending Benadryl.
161502 -
161503 - Benadryl completed.
161504 -
161506 -  ..
1616 -
1617 -
1618 - 1202
1619 -
161901 - Diana starts Tagamet and Decadron administered prior to Taxol for
161902 - prevention of allergic reaction.
161903 -
161904 -
161906 -  ..
1620 -
1621 -
1622 - 1206
1623 -
162301 - Alarm sounds indicating problem with equipment.  Diana adjusts
162302 - equipment and infusion continues for Tagamet and Decadron.
162303 -
162304 -
162306 -  ..
1624 -
1625 -
1626 - 1216
1627 -
162701 - Alarm sounds indicating Tagamet and Decadron is complete, ready for
162702 - Taxol treatment.
162704 -  ..
162705 - Another nurse comes by and turns off the machine.  She notifies
162706 - Diana.
162707 -
162708 -
162709 -
162710 -
162711 -
162712 -
1628 -

SUBJECTS
Taxol Treatment Delayed 30 Minutes Because Lab Has Not Prepared Trea

1703 -
1704 - 1217
170501 -  ..
170502 - Taxol Dosage Increased to Normal Due to Blood Counts Rise to Normal
170503 -
170504 - Follow up ref SDS 14 4N5M, ref SDS 13 4N5M.
170505 -
170506 - Taxol is started by Diana.
170508 -  ..
170509 - Dosage was increased to normal today, because blood count was normal,
170510 - per above, ref SDS 0 Q659, and reversing the prior procedure of giving
170511 - reduced chemothrapy treatment, because of low blood counts, reported
170512 - on 040525. ref SDS 13 4N5M
170514 -  ..
170515 - Diana sets timer for notice to perform continuous blood pressure
170516 - tests, as on prior treatments;
170517 -
170519 -  ..
1706 -
1707 -
1708 - 1228
1709 -
170901 - Alarm on timer sounds for next vital sign testing.
170902 -
170903 - Diana comes by and says the alarm is for the patient next to Millie.
170905 -  ..
170906 - Dianna introduces Sharee to continue support for Millie, because
170907 - Diana is attending chemotherapy training.
170908 -
170909 -
170911 -  ..
1710 -
1711 -
1712 - 1238
1713 -
171301 - Diana takes blood pressure and temperature again.
171302 -
171303 -    Blood pressure:  159 88
171305 -     ..
171306 -    Pulse........... 58
171308 -     ..
171309 -    Resperation..... 18
171310 -
171311 -
171313 -  ..
1714 -
1715 -
1716 - 1243
1717 -
171701 - Sharee takes vitals again.
171702 -
171703 - Seems to be some confusion in the record.  Millie explains Diana just
171704 - took vitals a few minutes ago.
171706 -  ..
171707 - Sharee says need to take again to correct the record.
171708 -
171709 -    Blood pressure:  160 83
171711 -     ..
171712 -    Pulse........... 59
171714 -     ..
171715 -    Resperation..... 18
171716 -
171717 -
171719 -  ..
1718 -
1719 -
1720 - 1253
1721 -
172101 - Alarm on timer sounds for next vital sign testing.
172102 -
172103 - Sharee takes vitals.
172104 -
172105 -    Blood pressure:  154 80
172107 -     ..
172108 -    Pulse........... 56
172110 -     ..
172111 -    Resperation..... 18
172112 -
172113 -
172115 -  ..
1722 -
1723 -
1724 - 1324
1725 -
172501 - Alarm on timer sounds for next vital sign testing.
172502 -
172503 - Sharee takes vitals.
172504 -
172505 -    Blood pressure:  181 76
172507 -     ..
172508 -    Pulse........... 59
172510 -     ..
172511 -    Resperation..... 18
172512 -
172513 -
172514 -
172516 -  ..
1726 -
1727 -
1728 - 1325
1729 -
172901 - Taxol completed.
172902 -
172903 -
172904 -
172905 -
172906 -
1730 -

SUBJECTS
Avastin Treatment Without Blood Pressure Testing

1803 -
1804 - 1326
180501 -  ..
180502 - Avastin Treatment Without Blood Pressure Testing
180503 -
180504 - Follow up ref SDS 14 PV4H, ref SDS 13 PV4H.
180505 -
180506 - Avastin started.
180507 -
180508 - Sharee asks Millie assume she is taking Avastin over 30 minutes.
180510 -  ..
180511 - Millie is alert today and says yes.
180512 -
180513 -
180515 -  ..
1806 -
1807 -
1808 - 1356
1809 -
180901 - Avastin treatment ends.
180902 -
180903 -
180904 -
180905 -
1810 -

SUBJECTS
Blood Counts Normal Today Taxol Normal Dose Chemotherapy Pharmacist
Treatment Chemotherapy Masectomy Radiation How Inflammatory Breast C
Blood Counts Normal Today Taxol Normal Dose Chemotherapy Pharmacist

2105 -
2106 - 1621
210701 -  ..
210702 - Procrit Neupogen Not Administered Because Blood Counts Normal Today
210703 - Alert Energetic After Treatment Marked Change from Prior Treatments
210704 -
210705 - Follow up ref SDS 14 F54N, ref SDS 13 F54N.
210706 -
210707 - After treatment, we stopped in the pharmacy area of the chemotherapy
210708 - clinic and asked for a pharmacist.  This is located near the entrance
210709 - to the Clinic.  A man, who did not give his name, explained that he
210710 - planned to visit Millie in the clinic during her treatment today and
210711 - administer procrit and Neupogen to raise her blood counts so that
210712 - Millie can get a normal dose of Taxol.
210714 -  ..
210715 - Since Millie's blood counts are normal today, ref SDS 0 0N7Q, the
210716 - doctor decided to increase Taxol treatment to a normal dose,
210717 - ref SDS 0 4N5M, without, also, treating with procrit and Neupogen.
210718 - That is why he did not visit Millie in the clinic, as planned during a
210719 - call from Rosalie last week, following submission on 040610 of the
210720 - record meeting with Doctor Johnson on 040517, ref SDS 16 OH4S, which
210721 - reported patients with IBC are commonly treated with a high dose of
210722 - Taxol, but Millie had been receiving a low dose.  The doctor discussed
210723 - this issue again yesterday, explaining strategies for optimizing
210724 - treatment wtih chemotherapy to increase recovery from cancer.
210725 - ref SDS 17 6T7F
210726 -
210727 -        [On 080418 UCSF plans to discuss treatment strategy to reduce
210728 -        dose of Carboplatin chemotherapy and increasing Neupogen to
210729 -        maintain blood counts high enough to avoid skipping Carboplatin
210730 -        treatments. ref SDS 21 MR3L
210732 -         ..
210733 -        [On 080423 Millie's letter to UCSF discusses using Neupogen to
210734 -        increase blood counts that maintain full dose of Carboplatin
210735 -        chemotherapy, rather than reduce the dose of Carboplatin to
210736 -        maintain blood counts. ref SDS 22 OY7S
210738 -         ..
210739 -        [On 080423 Doctor Rugo submits a letter notifying Millie
210740 -        that if treatment with Carboplatin is reduced, it cannot
210741 -        later be increased to increase concentration and potency
210742 -        for better response to treatment. ref SDS 22 415F
210744 -         ..
210745 -        [On 080423 Millie's letter notifies Doctor Rugo and the medical
210746 -        team, including the primary care physician at Kaiser to
210747 -        maintain the full dose of Carboplatin that optimizes chance for
210748 -        favorable response to treatment. ref SDS 22 XS6K
210750 -         ..
210751 -        [On 080501 during the meeting with the medical team to start
210752 -        the next cycle, Millie confirmed that she wants to maintain the
210753 -        current treatment plan getting full dose of Carboplatin
210754 -        chemotherapy; UCSF revised the treatment plan to prevent
210755 -        skipping Carboplatin by maintaining blood counts from
210756 -        increasing Neupogen to 2 weekly treatments. ref SDS 23 CZ3N
210757 -
210758 -
210759 -
210760 -
210761 -
2108 -

SUBJECTS
Tired Wobbly on Feet after Treatment In Asleep by 1900

2203 -
2204 - 1629
220501 -  ..
220502 - Alert Energetic After Treatment Marked Change from Prior Treatments
220503 -
220504 - Follow up ref SDS 14 F54N, ref SDS 13 F54N.
220505 -
220506 - After treatment, Millie was not tired, nor wobbly.  She was alert and
220507 - felt strong, and so drove home today.
220509 -  ..
220510 - This is a marked change from last week, and other prior treatments.
220512 -  ..
220513 - Mil stopped at a grocery store to pickup some things for dinner.
220515 -  ..
220516 - We got home about 1450.
220518 -  ..
220519 - Millie was alert the rest of the day.  She worked in the garden, and
220520 - then watched television.
220522 -  ..
220523 - About 1730 she fixed dinner; after dinner, she did some reading,
220524 - watched television and retired about 2100, which is her normal bed
220525 - time to get up at 0500 for work.
220527 -  ..
220528 - This is a marked change from prior treatments, illustrated by the
220529 - record last week. ref SDS 14 RX94
220530 -
220531 -
220532 -
220533 -
220534 -
220535 -
220536 -
220537 -
220538 -
2206 -