CONTACTS 

SUBJECTS
Chemotherapy Taxol Avastin Bevacizamub VEGF Treatments Begin Today 2
Blood Tests Cause Big Welt on Right Forearm Difficulty Finding Vein
Blood Test Results Pass for Treatment
Flue Shot at Kaiser While Waiting for Blood Draw to Get Chemotherapy

0906 -
0906 -    ..
0907 - Summary/Objective
0908 -
090801 - Follow up ref SDS 37 0000. ref SDS 34 0000.
090802 -
090803 - Today, Millie completed the 2nd of two (2) treatments with Adriamycin
090804 - Cytoxan (AC), which was schedule on 041230 in order for Millie to
090805 - qualify for a new drug trial. ref SDS 35 XQ41
090806 -
090807 -
090808 -
090810 -  ..
0909 -
0910 -
0911 - Progress
0912 -
091201 - The nurse submitted a printed schedule at the request of the doctor.
091202 -
091203 - The list shows that a meeting scheduled with the doctor for today was
091204 - deferred until next week.
091206 -  ..
091207 - Millie's schedule now calls for...
091208 -
091209 -        Meeting with the doctor.................. 050204
091210 -        Meeting with the doctor.................. 050218
091211 -        Chemotherapy treatment................... 050311
091213 -  ..
091214 - During the meeting next week on 050204 will review need for meeting
091215 - again on 050218.
091217 -  ..
091218 - Barbara is the nurse today.  She had called and left a message
091219 - yesterday reminding Millie to get blood drawn today in the Walnut
091220 - Creek hospital before getting chemotherapy treatment.
091222 -  ..
091223 - After all of the patients had begun treatment, Millie was the only
091224 - patient still in the waiting area outside the clinic.  While calling
091225 - another patient, a nurse, who works in the infusion department, saw
091226 - Millie about 1020 and explained there seems to be some confusion in
091227 - the schedule for the clinic to draw blood from Millie for tests prior
091228 - to getting chemotherapy treatment.  Millie explained a mixup evidently
091229 - occurred, because she had blood drawn from the Kaiser hospital in
091230 - Martinez early this morning, in accordance with the schedule prepared
091231 - by Kaiser during the last chemotherapy treatment on 050104, and so she
091232 - does not need blood drawn again in order to get treatment.
091234 -  ..
091235 - About 10 minutes later, at 1030, Sherrie was calling another patient,
091236 - and she asked Millie if she had been called yet.  Millie explained
091237 - that no one has called, possibly due to a mixup in Kaiser's records on
091238 - blood testing today.  Sherie asked Millie to come into the clinic and
091239 - find Barbara, who will be Millie's nurse today, and explain that the
091240 - blood tests have been done, so she is ready for treatment.
091242 -  ..
091243 - Rosalie passed by while Millie was waiting to get treatment in the
091244 - patient area outside the clinic.  Rosalie did not report results of
091245 - research she planned to perform on qualifications for a new trial
091246 - treatment chemotherapy protocol, which she further planned to discuss
091247 - with the primary care physician, following the meeting in the clinic
091248 - on 050104. ref SDS 37 NT5G
091250 -  ..
091251 - We walked into the clinic treatment area.  Barbara was in the corner
091252 - of the adjacent, narrow patient treatment area talking to a patient,
091253 - So we waited about 5 minutes.  Barbara eventually saw Millie and
091254 - indicated any of the open treatment stations could be used.
091256 -  ..
091257 - Barbara and another nurse performed a cross check, like double entry
091258 - bookkeeping, with one nurse reading through a due diligence checklist
091259 - for proactive risk management to avoid mistakes.  They verified that
091260 - Millie is the correct patient, and that chemotherapy medicines and
091261 - application instructions delivered by the pharmacy for treatment today
091262 - align with prescription requirements made by the doctor.  After both
091263 - agreed that everything on the checklist was correctly performed,
091264 - Barbara then connected Millie with an IV for delivering the
091265 - chemotherapy treatment.
091266 -
091267 -     [On 050913 primary care physician objects that Time Out for second
091268 -     opinions for due diligence to verify diagnosis and present
091269 -     treatment options delays implementing the doctors prescription.
091270 -     ref SDS 38 5T4J
091271 -
091272 -
091273 -
091274 -
091275 -
091276 -
0913 -

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

1305 -
130601 -  ..
130602 - Blood Counts Good Dose Chemotherapy Taxol Normal
130603 -
130604 - Follow up ref SDS 37 Q659, ref SDS 34 Q659.
130605 -
130606 - Millie had blood drawn this morning at 0635 by the Kaiser clinic in
130607 - Martinez.
130609 -  ..
130610 - Millie requested report on blood test taken today?
130612 -  ..
130613 - Barbara submitted the report showing...
130614 -
130615 -    Patient   Provider  Category   View      FR Date   To Date
130621 -     ..
130622 -    Procedure              Results             Reference Range
130624 -     ..
130625 -    Log#: 540502800013      050128 06:36 Outpa WCR Req: RA Johnson, MD
130626 -    Log#: 540502800014      050128 06:36 Outpa WCR Req: RA Johnson, MD
130627 -
130628 -                  ** Martinez Medical Offices **
130630 -     ..
130631 -    @CBC
130632 -    WBC x 10-3               3.7 K/uL           3.5   -     12.5
130633 -    RBC x 10-6              4.08 M/uL           3.60  -      5.10
130634 -    Hemoglobin              12.2 g/dL          11.5   -     15.0
130635 -    Hematocrit              36.7 %             34.0   -     46.0
130636 -    MCV                       90 fL            80.0   -    100.0
130637 -    RDW                     13.9 %             11.9   -     14.3
130638 -    Plt x10-3                348 K/uL         140     -    400
130639 -     ..
130640 -    Neutrophils    L          39 %             50     -     70
130641 -    Lymphocytes               41 %             20     -     50
130642 -    Monocyte       H          18 %              0     -     11
130643 -    Eosinophils                1 %              1     -      5
130644 -    Basophil                   1%               0     -      2
130645 -    Bands              No Report %              0     -      5
130646 -    Manual Diff?           Chemo
130648 -     ..
130649 -    CA 15-3        Test Remote Collect         -<     -     39
130651 -     ..
130652 -    Seg Neutrophils    No Report %             50     -     70
130654 -     ..
130655 -    DIFF Method         Auto Dif
130656 -    Anisocytosis       No Report+
130657 -    Macrocytes         No Report+
130658 -    Plt estimate         Adequate
130660 -     ..
130661 -    Alkaline Phos             43 U/L           38     -    126
130662 -    Bili, Tot Adult  L       0.1 mg/dL        0.2     -    1.3
130663 -    Creatinine               0.7 mg/dL        0.6     -    1.2
130664 -    Phosphorus     Test Remote Collect
130665 -    Alt (SGPT)                45 U/L           11     -     66
130666 -
130667 -
130668 -
130669 -
1307 -

SUBJECTS
Absolute Neutrophils Count ANC Composite Blood Test Count Criteria R

1503 -
150401 -  ..
150402 - Absolute Neutrophils Count ANC Composite Criteria Ready Chemotherapy
150403 -
150404 - Barbara explained that Kaiser calculates a composite number for...
150405 -
150406 -            ANC = Absolute Neutrophils Count
150407 -
150408 - ...as follows....
150409 -
150410 -          ANC = WBC x 1000 x Neutrophils
150411 -
150412 -              = 3.7 x 1000 x .39
150414 -               ..
150415 -              = 1443
150417 -        ..
150418 -       [On 060810 formula calculating ANC includes bands. ref SDS 40
150419 -       GL4M
150421 -        ..
150422 -       [On 060814 Diana clarified the formula to calcualte ANC includes
150423 -       bands. ref SDS 41 P563
150425 -        ..
150426 -       [On 070301 research on neutropenia explains calcualtion of ANC
150427 -       at Kaiser and NEUTS at UCSF. ref SDS 42 516G
150429 -  ..
150430 - Barbara said they need at least 1500 to perform treatment without
150431 - written authorization from the doctor.
150433 -  ..
150434 - Millie asked if the mixup tracking down the blood test this morning,
150435 - per above, ref SDS 0 KV52, has delayed getting treatment.
150437 -  ..
150438 - Barbara said that since ANC composite caluclation today is somewhat
150439 - below 1500, she met with the primary care physician this morning at
150440 - about 0800 prior to him attending a Tumor Board hearing.  At that
150441 - time, the doctor signed authorization for Millie to get chemothearpy
150442 - treatment today rather than incur delay that dilutes concentration and
150443 - effectiveness of treatment.  She said the doctor feels the count is
150444 - close enough to permit safe treatment today that avoids the harm of
150445 - delaying treatment.
150446 -
150447 -     [On 050916 treatment authorized with ANC 1271. ref SDS 39 7N4M
150449 -      ..
150450 -     [On 060810 treatment deferred with ANC 1408, one day before
150451 -     scheduled date of treatment. ref SDS 40 UK7M
150452 -
150453 -
150454 -
150455 -
150456 -
150457 -
150458 -
1505 -

SUBJECTS
CA 15-3 78 Smaller Rise than 10 Points Reported on 040318

1603 -
160401 -  ..
160402 - CA 15-3 Drops from 49 to Normal at 39, Lowest Reading Ever
160403 -
160404 - Follow up ref SDS 37 2N5J, ref SDS 34 2N5J.
160405 -
160406 - No test today.
160407 -
160408 -
160409 -
160410 -
160411 -
1605 -

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

1905 -
1906 - 1107
190701 -  ..
190702 - Preparation for Treatment Required One (1) Attempt to Connect Port
190703 -
190704 - Follow up ref SDS 37 EB7J, ref SDS 34 EB7J.
190705 -
190706 - Barbara delivered...
190708 -  ..
190709 - Decadron 10, compazine, 10, anzimet 100 MG given in pill form prior to
190710 - treatment for avoiding nausea rather than as a drip treatment to avoid
190711 - allergic reaction, as applied during the Taxol and Avastin treatment
190712 - on the trial protocol.
190714 -       ..
190715 -      Interlink System Vented Paclitaxel set
190716 -
190717 -
190718 -
190719 -
190720 -
190721 -
1908 -

SUBJECTS
Taxol Treatment Delayed 30 Minutes Because Lab Has Not Prepared Trea
AC Adriamycin Cytoxin Treatment Begun Today on New Regimine Replacin
AC Adriamycin Cytoxin Treatment Begun Today on New Regimine Replacin

2205 -
2206 - 1044
220701 -  ..
220702 - AC Andria and Cytoxin Full Dose Because Blook Counts Above Targets
220703 -
220704 - Follow up ref SDS 37 4N5M, ref SDS 34 4N5M.
220705 -
220706 - Barbara advised that Millie's blood count was low today, but Doctor
220707 - Johnson cleared Millie to get treatment.
220709 -  ..
220710 - Andrimiacin started.
220712 -  ..
220713 - Dose on AC 98 and Cytoxin is 984 MG.
220715 -  ..
220716 - Urine will be red or orange.  White cell count can drop, which places
220717 - patient at risk.
220719 -  ..
220720 - If temperature goes over 100.5, call Kaiser
220721 -
220723 -  ..
2208 -
2209 -
2210 - 1052
2211 -
221101 - Cytoxin started.
221102 -
221104 -  ..
221105 - Millie has prescription for Anzemet to complement treatment today, but
221106 - will need to extend the prescription if there is a 3rd and 4th
221107 - treatment.
221109 -  ..
221110 - Decadron can cause restlessness, difficult to sleep.
221111 -
221113 -  ..
2212 -
2213 -
2214 - 1056
2215 -
221501 - Vitals
221502 -
221503 -   Temperature......... 98.0
221504 -   Pulse............... 153 79
221505 -   Blood Pressure...... 55
221506 -
221507 -
221508 -
221510 -  ..
2216 -
2217 -
2218 - 1153
2219 -
221901 - Cytoxin completed.
221902 -
221903 - Saline flush was run for a few minutes.
221904 -
221905 -
221906 -
221907 -
2220 -

SUBJECTS
Tired Wobbly on Feet after Treatment In Asleep by 1900

2303 -
2304 - 1537
230501 -  ..
230502 - Alert Energetic After Treatment Marked Change from Prior Treatments
230503 -
230504 - Follow up ref SDS 37 F54N, ref SDS 34 F54N.
230505 -
230506 - Millie seemed okay after treatment today.  No immediate wobbliness.
230507 - She was okay to drive, and seemed alert the rest of the day.
230509 -  ..
230510 - We drove to Dublin and picked up a wig she had ordered a few days ago.
230511 - Then drove to Costco in Concord, and did some grocery shopping.  At
230512 - home, she helped store the groceries, then prepared herself a grilled
230513 - cheese sandwich for lunch.  No evident side effects of treatment.
230514 -
230515 -
230516 -
230517 -
230518 -
230519 -
230520 -
2306 -