CONTACTS
SUBJECTS
1st Treatment 1st Cycle Taxotere Xeloda Capacitibine Chemotherapy Tr
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 49 0000. ref SDS 48 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - This begins a new treatment, changing to Taxotere and Capecitabine
040902 - (Xeloda) after 4 treatments of AC, which implements the doctor's
040903 - treatment plan on 050329, ref SDS 50 T58M, previously recommended by
040904 - Doctor Benz at UCSF in his 2nd opinion reported on 041117. ref SDS 42
040905 - OU6S
040907 - ..
040908 - [On 050502 marked improvement after 2 weeks of treatment with
040909 - Taxotere and capecitabine (Xeloda), IBC significantly subsides.
040910 - ref SDS 53 EO5J
040912 - ..
040913 - Toni is the nurse.
040914 -
040915 -
040916 -
040917 -
040918 -
0410 -
SUBJECTS
Blood Tests White Cell Count Good 2nd Cycle 1st Treatment Chemothera
Urine Tests No Evident Problems
Blood Test Results Pass for Treatment
0805 -
080601 - ..
080602 - Blood Counts Good Dose Chemotherapy Taxol Normal
080603 -
080604 - Follow up ref SDS 49 Q659, ref SDS 48 Q659.
080605 -
080606 - Millie had blood drawn this morning at 0635 by the Kaiser clinic in
080607 - Martinez.
080609 - ..
080610 - Millie requested report on blood test taken today?
080612 - ..
080613 - Barbara submitted the report showing...
080614 -
080615 - Patient Provider Category View FR Date To Date
080621 - ..
080622 - Procedure Results Reference Range
080624 - ..
080626 -
080627 - ** Martinez Medical Offices **
080629 - ..
080630 - @CBC
080631 - WBC x 10-3 L 3.3 K/uL 3.5 - 12.5
080632 - RBC x 10-6 3.71 M/uL 3.60 - 5.10
080633 - Hemoglobin 11.6 g/dL 11.5 - 15.0
080634 - Hematocrit 33.8 % 34.0 - 46.0
080635 - MCV 91 fL 80.0 - 100.0
080636 - RDW 13.9 % 11.9 - 14.3
080637 - Plt x10-3 348 K/uL 140 - 400
080638 - ..
080639 - Neutrophils L 39 % 50 - 70
080640 - Lymphocytes 41 % 20 - 50
080641 - Monocyte H 18 % 0 - 11
080642 - Eosinophils 1 % 1 - 5
080643 - Basophil 1% 0 - 2
080644 - Bands No Report % 0 - 5
080645 - Manual Diff? Chemo
080647 - ..
080648 - CA 15-3 Test Remote Collect -< - 39
080650 - ..
080651 - Seg Neutrophils No Report % 50 - 70
080653 - ..
080654 - DIFF Method Auto Dif
080655 - Anisocytosis No Report+
080656 - Macrocytes No Report+
080657 - Plt estimate Adequate
080659 - ..
080660 - Alkaline Phos 43 U/L 38 - 126
080661 - Bili, Tot Adult L 0.1 mg/dL 0.2 - 1.3
080662 - Creatinine 0.7 mg/dL 0.6 - 1.2
080663 - Phosphorus Test Remote Collect
080664 - Alt (SGPT) 45 U/L 11 - 66
080665 -
080666 -
080667 -
080668 -
080669 -
080670 -
080671 -
080672 -
080673 -
080674 -
0807 -
SUBJECTS
CA 15-3 78 Smaller Rise than 10 Points Reported on 040318
0903 -
090401 - ..
090402 - CA 15-3 Drops from 49 to Normal at 39, Lowest Reading Ever
090403 -
090404 - Follow up ref SDS 49 2N5J, ref SDS 48 2N5J.
090405 -
090406 -
090407 -
090408 -
090409 -
090410 -
090411 -
090412 -
090413 -
0905 -
SUBJECTS
Port Catheter Used for Chemotherapy Treatments on 040518
Prepare for Treatment Connect Equipment for Port Catheter Copazine B
Tagiment Dexatron Administered to Prevent Alergic Reaction to Taxol
Atavin Compazine Side Effect Reduces Effects Chemotherapy Nausea Anx
1306 -
1307 - 1410
130801 - ..
130802 - Preparation for Treatment Required One (1) Attempt to Connect Port
130803 -
130804 - Follow up ref SDS 49 EB7J, ref SDS 48 EB7J.
130805 -
130806 - Another nurse took admin with Toni to verify Millie's identification
130807 - and treatment.
130809 - ..
130810 - If no side effects then speed of treatment will be increased. The
130811 - total time is normally 60 minutes.
130813 - ..
130814 - Treatment plan calls for taking Decadron twice a day, beginning the
130815 - day before treatment with Taxotere, the day of treatment and the day
130816 - after treatment, which occurs every 3 weeks.
130817 -
130818 - [On 050506 Sheri advised that guidance requires taking two (2)
130819 - Decadron pills twice a day. ref SDS 54 OW5G
130821 - ..
130822 - Toni recommended taking second pill of decadron in early afternoon,
130823 - because some people get hyper and cannot sleep.
130825 - ..
130826 - Benedril will make you sleepy.
130828 - ..
130829 - Patient can ask for atavin to reduce nausea and aniexty; this could
130830 - also aid sleep.
130832 - ..
130833 - Decadron 10 Millie took this orally earlier today, per protocol.
130835 - ..
130836 - Toni gave Millie a pill for Compazine 10 prior to treatment that
130837 - reduces nausea rather than as a drip treatment to avoid allergic
130838 - reaction, as applied during the Taxol and Avastin treatment on the
130839 - trial protocol.
130841 - ..
130842 - Toni connected the port.
130844 - ..
130845 - Interlink System Vented Paclitaxel set
130846 -
130847 -
130848 -
130849 -
1309 -
SUBJECTS
Medication Prescription Mistake Avoided Doctor Patient Partnership C
2303 -
230401 - ..
230402 - Neupogen Prescribed by Doctor to Build Immune System Low Blood Counts
230403 -
230404 - Toni advised that the doctor has prescribed Neupogen to increase low
230405 - blood counts. This will be a 3 day treatment that raises WBC for
230406 - stronger immune system. ref SDS 0 0N7Q
230407 -
230408 - [...below, Pharmacist not aware Neupogen prescribed,
230409 - ref SDS 0 KW5N, checks with doctor, and corrects medical
230410 - mistake. ref SDS 0 KX49
230412 - ..
230413 - Xeloda can make patient tired and cause nausau.
230415 - ..
230416 - Neupogen will build energy, and reduce nausea.
230418 - ..
230419 - Toni explained that Millie will have to self-inject these treatments
230420 - with a disposable syrenge pre-loaded with Nuepogen, like the
230421 - treatments in 020520. ref SDS 3 RF4M
230422 -
230423 -
230424 -
230425 -
230427 - ..
2305 -
2306 -
2307 - 1422
2308 -
230801 - Benedryl started.
230802 -
230803 -
230804 -
230806 - ..
2309 -
2310 -
2311 - 1429
2312 -
231201 - Blaine took vitals.
231202 -
231203 - Blood preasure 121 73
231204 - Pulse 69
231205 - Temperature 98
231206 -
231207 -
231208 -
231209 -
231210 -
2313 -
SUBJECTS
Taxotere Full Dose Even though Blood Counts Below Targets
2403 -
2404 - 1442
240501 - ..
240502 - Taxotere Full Dose Even though Blood Counts Below Targets
240503 -
240504 - Follow up ref SDS 49 4N5M, ref SDS 48 4N5M.
240506 - ..
240507 - Taxotere started.
240509 - ..
240510 - Toni said Millie is getting a full dose of Taxotere, even though her
240511 - blood counts are very low.
240513 - ..
240514 - Millie asked about her history of low blood counts the past few months
240515 - that caused deferred treatments? (see case study on 060810 1330.
240516 - ref SDS 63 R33L). She related earlier history with Taxotere when low
240517 - blood counts caused deferred treatments, and subsequent relapse of
240518 - cancer possibly beginning on 021209...
240520 - ..
240521 - Millie asked if anything can be done to maintain a steady regimen of
240522 - treatment that increases the chance of favorable response, based on
240523 - experience showing that cancer returned when treatments were
240524 - interrupted, reported on 050318 1237. ref SDS 48 0001
240526 - ..
240527 - Toni said that the doctor has prescribed Neupogen to increase blood
240528 - counts for stronger immune system.
240529 -
240530 - [...below Zan, Manager of Oncology Pharmacy, recommends
240531 - patients keep a diary to assist medical team, ref SDS 0
240532 - XT5F, Zan refused to provide Neupogen, ref SDS 0 KW5N;
240533 - plans to track Millie's patient history of low blood counts
240534 - getting capecitabine to determine Millie's requirements for
240535 - Neupogen. ref SDS 0 XT61
240537 - ..
240538 - [...below Millie cite's Toni's report that the doctor has
240539 - already prescribed Neupogen; she asks Zan to investigate
240540 - avoiding interruption of cancer treatment caused by patient
240541 - history of low blood counts, as shown in Millie's diary.
240542 - ref SDS 0 KX49
240544 - ..
240545 - [...below Zan investigated and learned that Millie already
240546 - has history of low blood counts, so Neupogen prescribed to
240547 - maintain continuity of cancer treatments essential for
240548 - survival, ref SDS 0 649X; commended Millie's proactive
240549 - communication with Pharmacy Department through doctor
240550 - patient partnership reported in Millie's diary. ref SDS 0
240551 - XU8O
240552 -
240553 -
240554 -
240555 -
240556 -
2406 -
SUBJECTS
Taxotere Full Dose Even though Blood Counts Below Targets
2503 -
250401 - ..
250402 - Taxotere Test Patients Resistance to Side Effects
250403 -
250404 - Toni wants Millie to evaluate during 1st 15 minutes...
250405 -
250406 - Low back pain
250407 - Hot flashes
250408 - Shortness of breath
250410 - ..
250411 - This is a new procedure that was not used when Millie was treated with
250412 - Taxotere beginning on 020610. ref SDS 4 MR5I
250413 -
250414 -
250415 -
250416 -
250418 - ..
2505 -
2506 -
2507 - 1456
2508 -
250801 - Millie passed test without complaining of side effects.
250802 -
250803 - Toni started Millie on standard of treatment rate for Taxotere.
250804 -
250806 - ..
2509 -
2510 -
2511 - 1501
2512 -
251201 - Toni advised that Nadine will take over nursing for the rest of
251202 - Millie's treatment today.
251203 -
251204 -
251205 -
251206 -
251207 -
2513 -
SUBJECTS
Side Effects Instructions Chemotherapy with Taxotere and Xeloda Meet
2603 -
2604 - 1516
260501 - ..
260502 - Xeloda 2 Pills Twice Each Day
260503 - Pharmacist Gives Instructions for Xeloda
260504 - Side Effects Presented on Chemotherapy with Taxotere and Xeloda
260505 -
260506 - Follow up ref SDS 51 FP57.
260507 -
260508 - Zan, the pharmacist visited Millie during treatment.
260510 - ..
260511 - Zan asked if this is Millie's first time taking Xeloda (Capatibine),
260512 - and Mil advised she has not previously received this treatment.
260514 - ..
260515 - Zan confirmed written instructions for treatment with Xeloda...
260516 -
260517 - 1. 2 pills twice a day after breakfast and after dinner.
260518 -
260519 - Pills are taken after meals to reduce nausea.
260520 -
260521 - 2. Drink a full glass of water with taking the 2 pills.
260523 - ..
260524 - Sores in mouth, diarea, and worst case may be cracking of skin and
260525 - peeling with coloration change to redeness in extremeties, i.e., feet
260526 - and hands, cited by the doctor on 050329. ref SDS 51 FP57 Skin will
260527 - become sensitive to sun, so avoid prolonged exposure.
260529 - ..
260530 - Zan submitted documentation titled...
260532 - ..
260533 - Xeloda (capeditabine) Instruction Sheet
260534 -
260535 -
260536 - ...which says in part...
260537 -
260538 - It is very important that you tell your doctor if you are
260539 - taking warfarin, also known as Coumadin, which is a blood
260540 - thinner that alters the blood's ability to clot. Because
260541 - Xeloda can increase the effects of warfarin, your doctor will
260542 - need to check how fast yor blood clots on a more frequent
260543 - basis, so that your warfarin dosage can be adjusted as needed.
260545 - ..
260546 - During the meeting today, Zan said that he is aware Millie is taking
260547 - Coumadin from checking Millie's medical records, and from discussions
260548 - with the doctor. Zan advised that Kaiser will adjust the dosage of
260549 - Coumadin to fit the treatment with Xeloda, as set out in the
260550 - documentation. ref SDS 0 BU67
260552 - ..
260553 - Xeloda documentation continues...
260554 -
260555 - Important:
260557 - ..
260558 - Xeloda (capecitabine) like all chemotherapy treatments, has
260559 - certain side effects. For some persons, milder side effects
260560 - may suddenly become severe. These side effects are manageable
260561 - and can be reversed wen acted upon quickly.
260563 - ..
260564 - It is important that you stop your Xeloda and call your doctor
260565 - or nurse to report....
260566 -
260567 - a. If you have pain, redness, swelling or sores in your
260568 - mouth.
260570 - ..
260571 - b. If you have pain and swelling or redness of your hands or
260572 - feet that prevents normal activity.
260574 - ..
260575 - This was previously discussed with the doctor during a
260576 - meeting on 050329. ref SDS 51 NT3I
260578 - ..
260579 - [On 050510 Millie experienced pain hands and feet.
260580 - ref SDS 55 DX54
260582 - ..
260583 - [On 050513 side effects feet blistering cause pausing
260584 - treatment. ref SDS 57 AQ6G
260586 - ..
260587 - [On 050516 Xeloda has severe side effects apart from
260588 - published guidance. ref SDS 58 BD5L
260590 - ..
260591 - c. If you have more than 4 bowel movements each day or any
260592 - diarrhea at night.
260594 - ..
260595 - d. If you vomit more than once in a 24-hour period or if you
260596 - lose your appetite, and the amount of food you eat each day
260597 - is much less than normal.
260599 - ..
260600 - e. If you have a temperature of 100.5 F or greater or other
260601 - signs of infection.
260602 -
260604 - ..
260605 - Managing Side Effects...
260606 -
260607 - a. Mouth Sores
260608 -
260609 - Use Good dental hygiene.
260610 -
260611 - Swish and s;it with salt water and soda mouthwash 4 times
260612 - a day (1 tsp salt, 1 tsp baking soda dissolved in 1 quart
260613 - of water).
260615 - ..
260616 - b. Hand-Foot Syndrome
260617 -
260618 - 1. Avoid injury to feed and hands.
260619 -
260620 - Avoid tight-fitting shoes and repetitive rubbing,
260621 - pressure or prolonged heat to hands and feet.
260623 - ..
260624 - 2. Vitamin B6 (pyridoxine)
260626 - ..
260627 - 3. Balm
260628 -
260629 - [On 050729 Vivian, the pharmacist, suggested using
260630 - generous amounts of balm and wearing socks
260631 - overnight while sleeping to maximize treatment of
260632 - blisters on the feet. ref SDS 61 S23H
260633 -
260634 -
260635 -
260636 -
2607 -
SUBJECTS
Diary Journal Accurate Patient History Side Effects Taxotere Xeloda
2703 -
270401 - ..
270402 - Dose Chemotherapy Treatment Based on Side Effects Keep Diary
270403 - Side Effects Diary Assists Doctor Pharmacist Set Treatment Dosage
270404 - Treatment Dosage Diary of Side Effects Assists Doctor Pharmacist Set
270405 - Diary of Side Effects Assists Doctor Pharmacist Set Treatment Dosage
270406 -
270407 - Dosage can be adjusted to moderate side effects.
270409 - ..
270410 - Zan recommended keeping a diary to accurately track side effects for
270411 - evaluating adjustments to treatment protocol. Previously, accuracy in
270412 - medical treatment was illustrated at Stanford Cancer Center on 041019.
270413 - ref SDS 39 BV92
270414 -
270415 - [On 050422 the doctor asked Millie about the diary on side
270416 - effects; summary of diary reports reviewed with doctor.
270417 - ref SDS 52 VE68
270419 - ..
270420 - [On 060724 diary side effects for 2nd phase taking Taxotere
270421 - and capecitabine (Xeloda). ref SDS 62 QX8K
270422 -
270423 -
270424 -
270425 -
270426 -
2705 -
SUBJECTS
Prescription Xeloda Capecitabine 2 500 MG Pills Twice a Day
2803 -
280401 - ..
280402 - Prescription Xeloda Capecitabine 2 500 MG Pills Twice a Day
280403 - Capecitabine (Xeloda) Prescription 2 500 MG Pills Twice a Day
280404 -
280405 - The prescription for capecitabine (Xeloda) is to take 2 - 500 mg pills
280406 - twice a day (every 12 hours); Zan said the prescription will be
280407 - available for pickup after treatment today at the 2nd floor pharmacy.
280409 - ..
280410 - [On 050520 dramatic improvement after 2 cycles of treatment with
280411 - Taxotere and capecitabine (Xeloda), ref SDS 59 025H, despite
280412 - temporarily stopping treatments beginning on 050514 due to severe
280413 - side effects, ref SDS 57 RU9M; on 050520 treatment dose for
280414 - capecitabine (Xeloda) reduced to reduce side effects. ref SDS 59
280415 - NT3I
280417 - ..
280418 - [On 050610 recovery from IBC continues after 3 cycles of treatment
280419 - and with reduced dose of capecitabine (Xeloda). ref SDS 60 025H
280421 - ..
280422 - Millie asked if she can pickup Neupogen at the same time, per
280423 - discussion above? ref SDS 0 SQ4H
280425 - ..
280426 - Zan said that Neupogen is not prescribed.
280427 -
280428 -
280429 -
2805 -
SUBJECTS
Blood Counts Dose Xeloda Capecitabine Zan Pharmacist Draws Diagram S
2903 -
290401 - ..
290402 - Blood Counts Monitor Set Chemotherapy Treatment Dosage
290403 -
290404 - Zan drew a diagram on the back of a scrap of paper he had with him.
290405 - He marked a time line for the 21 days between each cycle of Taxotere
290406 - treatment.
290407 -
290408 - ------ Normal Range
290409 - --------/
290410 - /
290411 - 1 7 / 14 21
290412 - |------------\---------------\-----------|
290413 - \ /
290414 - c. /
290415 - \----------------/
290416 -
290418 - ..
290419 - Zan plotted a curve on the diagram showing blood counts fall during
290420 - the first 7 days after chemotherapy treatment, and then begin to rise
290421 - toward normal.
290423 - ..
290424 - Zan plans to monitor Millie's blood condition using the weekly blood
290425 - tests Millie gets for Coumadin. Zan advised that he may prescribe
290426 - Neupogen if blood counts are still too low after 14 days. He also
290427 - posed prospect of extending the treatment, giving Millie 2 weeks off
290428 - after the end of 2 weeks for Xeloda treatmet, rather than just 1 week
290429 - that is currently prescribed. Zan advised that he may reduce the
290430 - dosage of Taxotere as another way to maintain Millie's blood counts,
290431 - rather than use Neupogen.
290432 -
290433 -
290434 -
2905 -
SUBJECTS
Medication Prescription Mistake Avoided Doctor Patient Partnership C
08 02 04 02 AGMDN 050415cc 050415cc **Not Found**
4504 -
450501 - ..
450502 - Neupogen Prescribed by Doctor to Maintain Blood Counts
450503 - Medical Mistake Prescription Neupogen Corrected by Pharmacist
450504 - Mistakes Medical Prescription Neupogen Fixed Doctor Patient Partnerhip
450505 - Doctor Patient Partnerhip Avoids Medical Mistakes Prescribe Neupogen
450506 -
450507 - Millie asked Zan to further consider the Neupogen prescription issue
450508 - just discussed. ref SDS 0 KW5N
450510 - ..
450511 - Millie cited Toni's comment earlier today that the doctor has
450512 - prescribed Neupogen beginning with this first cycle to maintain blood
450513 - counts in the range that strengthens the immune system, per above.
450514 - ref SDS 0 4N5M Millie cited patient history of consistant low blood
450515 - counts that have previously delayed treatments, and asked if this
450516 - prior history could explain Toni's earlier comment that the doctor has
450517 - prescribed Neupogen in order to avoid prior problems?
450519 - ..
450520 - Zan said that Toni made a mistake because he plans to begin tracking
450521 - blood counts and will devise a plan for Neupogen, if needed.
450523 - ..
450524 - Millie explained keeping a diary of patient history the past 4 years,
450525 - as Zan recommends today, per above. ref SDS 0 2W6I This record seems
450526 - to support Toni's understanding today that the doctor has already
450527 - prescribed Neupogen. She asked Zan to check with the doctor, since
450528 - this is a life or death issue.
450530 - ..
450531 - Zan advised that he is manager of the Oncology Pharmacy Department,
450532 - and that the Pharmacy is tasked to assess requirements for Neupogen.
450533 - He feels certain the doctor expects the pharmacy to track Millie's
450534 - patient history for determining Millie's requirements for Neupogen, as
450535 - the Oncology Pharmacy does with other patients.
450537 - ..
450538 - Mil thanked Zan for taking time to discuss patient concerns.
450539 -
450540 -
450542 - ..
4506 -
4507 -
4508 - 1534
4509 -
450901 - An hour later, Zan returned and said he just talked to the doctor,
450902 - based on Millie's report on patient history showing persistant low
450903 - blood counts, per above. ref SDS 0 KX49
450905 - ..
450906 - Zan advised that the doctor prescribed three (3) days on Neupogen
450907 - after Millie completes two (2) weeks of capecitabine (Xeloda)
450908 - treatments, beginning in this 1st cycle. Zan apologized for not
450909 - having checked the record showing the history of low blood counts has
450910 - already been established in this case.
450911 -
450912 - [On 050502 Millie experienced pain in her spine; took Vicadin and
450913 - this seemed to help. ref SDS 53 AQ6G
450915 - ..
450916 - Zan thanked Millie for proactive communication explaining patient's
450917 - diary that aligns with the medical chart showing low blood counts, and
450918 - for mentioning Toni's understanding that Neupogen has already been
450919 - prescribed by the doctor. Zan said that the patient's notice today,
450920 - per above, ref SDS 0 KX49, prompted follow up inquiry with the doctor
450921 - that avoided a major mistake in treatment protocol, which aligns with
450922 - risks in medical practice and health care, reported in a study on
450923 - 990912. ref SDS 2 0001
450925 - ..
450926 - This scenario aligns with Kaiser's Healthwise Handbook calling for an
450927 - effective doctor-patient partnership through communication and
450928 - feedback that avoids mistakes, reviewed on 990625. ref SDS 1 4185
450929 -
450930 - [On 061020 Zan's colleague, Ross, in the Kaiser Pharmacy similar
450931 - experience avoiding error prescribing treatment through
450932 - collaboration team care, doctor patient partnership. ref SDS 64
450933 - UR6N
450935 - ..
450936 - It is not clear what would have occurred, if the doctor was not
450937 - available at the time Zan made inquiry. In that case, a significant
450938 - weight of social pressure and cognitive overhead typically resist
450939 - accurate communication, as set out in NWO. ref OF 13 OE5H
450941 - ..
450942 - For example, if, when Zan stopped by to visit the doctor on this
450943 - matter, the doctor was seeing a patient, attending a Tumor Board
450944 - hearing, making a presentation at a seminar on medical management, or,
450945 - if the doctor was on vacation, would clarification needed for an
450946 - accurate prescription today have taken place? If the doctor was not
450947 - available, do Kaiser's records enable Zan to review blood count
450948 - history in the time Zan can devote to making an assessment for one
450949 - patient, which he believed the doctor had already made? Would Zan
450950 - have asked another doctor to step in and assume responsibility for
450951 - reviewing the record and making a separate judgement? Would pressures
450952 - of social protocol in bureaucracy have prevented asking another doctor
450953 - to assume responsibility, reported on 040203? ref SDS 5 E44K Was
450954 - another doctor available, and if so, would that doctor be willing to
450955 - take responsibility, and, if so, would the doctor have taken time to
450956 - review the record and discover the history of persistant low blood
450957 - counts? Or, would the doctor have told Zan to wait until the primary
450958 - care physician is avilable, either after seeing a patient, after a
450959 - Tumor Board Hearing, after attending a seminar, or after returning
450960 - from vacation, as occurred previously on 041104. ref SDS 41 Q54O
450962 - ..
450963 - If Zan had to wait to consult with the doctor for any number of
450964 - reasons that frustrate taking immediate action, as noted in NWO
450965 - explaining the burden of cognitive overhead, ref OF 13 LH6K, would
450966 - there have been a controllable action item created to remind all
450967 - parties to investigate blood count history and make a determination in
450968 - time for effective action, once the current activity is replaced in
450969 - span of attention by other equally important matters for other
450970 - patients.
450971 -
450972 -
450973 -
450974 -
450975 -
450976 -
4510 -
SUBJECTS
1st Treatment 1st Cycle Taxotere Xeloda Capacitibine Chemotherapy Tr
4603 -
4604 - 1556
460501 - ..
460502 - Taxotere Chemotherapy Treatment Completed Today
460503 -
460504 - Taxotere completed.
460506 - ..
460507 - Saline flush was run for a few minutes.
460509 - ..
460510 - Nadine removed the drip treatment tube from the port, and applied
460511 - Hepren to reduce clotting, and avoid infection.
460512 -
460514 - ..
4606 -
4607 -
4608 - 1604
4609 -
460901 - Vitals taken by Nadine.
460902 -
460903 - Temperature......... 97.6
460904 - Pulse............... 145 77
460905 - Blood Pressure...... 57
460906 -
460907 -
460909 - ..
4610 -
4611 -
4612 - 1612
4613 -
461301 - We went to the Pharmacy and picked up the prescriptions for...
461302 -
461303 - Xeloda
461304 - Neupogen
461306 - ..
461307 - The co-payment on these drugs was approximatley $60. The full price
461308 - was about $1,300, saving $1,240.
461309 -
461310 -
461311 -
461312 -
461313 -
461314 -
461315 -
461316 -
4614 -
SUBJECTS
Tired Wobbly on Feet after Treatment In Asleep by 1900
Tired Wobbly on Feet after Treatment Asleep by 1900 Not Today After
4804 -
4805 - 1537
480601 - ..
480602 - Alert Energetic After Treatment Marked Change from Prior Treatments
480603 -
480604 - Follow up ref SDS 49 F54N, ref SDS 48 F54N.
480605 -
480606 - Millie seemed okay after treatment today. No immediate wobbliness.
480607 - She was okay to drive, and seemed alert the rest of the day.
480609 - ..
480610 - This seems unusual because Benedryal is part of the protocol for
480611 - Taxotere, per above. ref SDS 0 064F Previously, when treated with
480612 - Bendryl and Taxotere, Millie has been noticably wobbly and unsteady
480613 - on her feet, and retired early to bed, reported on
480614 -
480615 -
480616 -
480617 -
480618 -
480619 -
480620 -
480621 -
480622 -
4807 -