CONTACTS 

SUBJECTS
1st Treatment 1st Cycle Taxotere Xeloda Capacitibine Chemotherapy Tr

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 63 0000. ref SDS 61 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - This 8th cycle of treatment was ordered by the primary care physician
040902 - during the meeting on 050913 per 2nd opinion recommendations of Doctor
040903 - Bailey to maintain Mil's favorable condition while evaluating and
040904 - planning mastectomy surgery. ref SDS 64 T642
040905 -
040906 -    [On 051021 Millie had mastectomy surgery, ref SDS 68 0001, and then
040907 -    continued on "treatment holiday" from today, 050916, due to
040908 -    favorable test diagnostics.
040910 -     ..
040911 -    [On 060428 PET scan test findings show mild FDG uptake right
040912 -    axillary SUV 2.6; and FDG uptake left supraclavicular SUV 4.5; CA
040913 -    15-3 rose to 44, above the cancer signal of 39, treatment holiday
040914 -    continued. ref SDS 70 0001
040916 -     ..
040917 -    [On 060523 CT test findings show no evidence of disease,
040918 -    ref SDS 71 4R82; question on whether CT findings in right axillary
040919 -    represent rising or stable conditions? ref SDS 71 4O8P
040921 -     ..
040922 -    [On 060721 Millie begins 9th cycle chemotherapy treatment for 3rd
040923 -    IBC relapse. ref SDS 72 0001
040925 -  ..
040926 - Yesterday, Millie had a blood draw, and the pathology report showed
040927 - her counts are still too low for treatment.  This is a little alarming
040928 - because ordinarily blood counts climb after time elapses from the
040929 - prior treatment.  The last Taxotere treatment was on 050819.  There
040930 - are 2 weeks of treatment with capecitabine (Xeloda).  Most often,
040931 - Mil's blood counts climb to normal during the 1 week of time off from
040932 - treatment between the end of treatments with capecitabine (Xeloda) and
040933 - the start of the next drip treatment with Taxotere.  There have been a
040934 - few occasions since April when blood counts have been slightly low,
040935 - but she has been treated, because the counts were rising.  What is
040936 - troubling today is that Millie has had an extra week off which should
040937 - have caused blood counts to rise.  For example, when the 7th cycle was
040938 - started on 050819, her counts were very high, indicating a strong
040939 - immune system.
040941 -  ..
040942 - Hazel Luciano is the nurse today.
040944 -  ..
040945 - Hazel said that the primary care physician ordered a follow up blood
040946 - test this morning.  They think the critical blood counts will go up,
040947 - because certain of the counts were high, which indicates that the
040948 - others are in the process of rising.
040950 -  ..
040951 - Ross walked through the clinic, and Millie talked with him briefly
040952 - about ordering the capecitabine (Xeloda).  Ross said he saw the order
040953 - from the primary care physician for Millie to get another treatment
040954 - today.  Ross asked about dosage.  Millie said the the doctor did not
040955 - change the treatment.  Ross said he will prepare Taxotere for full
040956 - dose, and will tell the other pharmacist, who prepares the Xeloda
040957 - prescription to maintain the prior dosage, and to order the
040958 - prescription for Millie to pickup up in the 2nd floor pharmacy, based
040959 - on the patient's memory of meeting with the doctor three (3) days ago
040960 - when the doctor did not discuss dosage.
040961 -
040962 -    [...below, primary care physician came into the clinic and visited
040963 -    with Millie; he confirmed intent for treatment today with prior
040964 -    dose prescription. ref SDS 0 HC6G
040965 -
040966 -
040967 -
040969 -  ..
040970 - Port Catheter Flush Scheduled When Patient Off Treatments
040971 -
040972 - Follow up ref SDS 63 LA3O.
040973 -
040974 - Cancel meeting to flush port catheter, because Millie's treatment
040975 - today eliminates requirement for the flushing operation, which was
040976 - scheduled for 050923 1000, during the meeting on 050819. ref SDS 63
040977 - LA3O
040979 -  ..
040980 - Hazel scheduled the meeting to flush the port 051028 0830 on a
040981 - Friday.
040982 -
040983 -     [On 051021 Millie's surgery used the port, so flush scheduled
040984 -     today for 051028 is not required. ref SDS 68 QW3M
040985 -
040986 -
040987 -
040988 -
040989 -
040990 -
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 63 Q659, ref SDS 61 Q659.
080605 -
080606 - Millie had blood drawn yesterday at 0600 by Kaiser in Martinez.  This
080607 - report listed below shows WBC too low, ref SDS 0 0N7Q, so another lab
080608 - test was performed with blood drawn here in the clinic this morning.
080609 - These results showed Millie's blood counts rose significantly to
080610 - permit getting treatment.
080611 -
080612 -     [On 051021 received report on blood lab report done today,
080613 -     ref SDS 68 4L4K, and it aligns with figures in notes by the
080614 -     primary care physician for the meeting on 051007, and received
080615 -     from the doctor on 051011. ref SDS 67 WB3R
080616 -
080618 -  ..
080619 - Hazel submitted the report showing...
080620 -
080621 -    Patient   Provider  Category   View      FR Date   To Date
080627 -     ..
080628 -    Procedure              Results             Reference Range
080630 -     ..
080632 -
080633 -                  ** Martinez Medical Offices **
080635 -     ..
080636 -    @CBC
080637 -    WBC x 10-3    L          3.1 K/uL           3.5   -     12.5
080638 -    RBC x 10-6    L         3.30 M/uL           3.60  -      5.10
080639 -    Hemoglobin    L         10.9 g/dL          11.5   -     15.0
080640 -    Hematocrit    L         32.8 %             34.0   -     46.0
080641 -    MCV                       99 fL            80.0   -    100.0
080642 -    RDW            H        16.3 %             11.9   -     14.3
080643 -    Plt x10-3              262   K/uL         140     -    400
080644 -     ..
080645 -    Neutrophils    L          41 %             50     -     70
080646 -    Lymphocytes               38 %             20     -     50
080647 -    Monocyte       H          15 %              0     -     11
080648 -    Eosinophils    H           6 %              1     -      5
080649 -    Basophil                   0%               0     -      2
080650 -    Bands              No Report %              0     -      5
080651 -    Manual Diff?           Chemo
080653 -     ..
080654 -    CA 15-3          No report                 -<     -     39
080656 -     ..
080657 -    Seg Neutrophils    No Report %             50     -     70
080659 -     ..
080660 -    DIFF Method         Auto Dif
080661 -    Anisocytosis       No Report+
080662 -    Macrocytes         No Report+
080663 -    Plt estimate         Adequate
080665 -     ..
080666 -    Alkaline Phos             45 U/L           38     -    126
080667 -    Bili, Tot Adult         <0.4 mg/dL        0.2     -    1.3
080668 -    Creatinine               0.8 mg/dL        0.6     -    1.2
080669 -    Phosphorus     Test Remote Collect
080670 -    Alt (SGPT)                23 U/L           11     -     66
080671 -    AST (SGOT)         No report U/L           11     -     66
080672 -    Glucose Random            93 mg/dL         60     -    159
080673 -
080675 -     ..
080676 -    Cuomdin (Anticoag Ther WARFARIN
080677 -    PT, Patient        No report Sec         9.2           11.6
080678 -    PT, INR            No report Ratio         2              3
080679 -
080680 -        [...below, ACN composite calculation 1271, below target level
080681 -        1500; primary care physician approves treatment. ref SDS 0 BN7J
080683 -         ..
080684 -        [On 060126 blood test report shows all tests normal for first
080685 -        time in 4 years. ref SDS 69 YZ3N
080686 -
080687 -
080688 -
080689 -
080690 -
080691 -
0807 -

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

0903 -
090401 -  ..
090402 - CA 15-3 45 Current No Test for Recent Blood Test
090403 -
090404 - Follow up ref SDS 63 2N5J, ref SDS 61 2N5J.
090405 -
090406 - CA 15-3 was not ordered yesterday.
090407 -
090408 -
090409 -
090410 -
0905 -

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

1205 -
1206 - 1012
120701 -  ..
120702 - Preparation for Treatment Required One (1) Attempt to Connect Port
120703 - -----------------------------
120704 - Follow up ref SDS 63 EB7J, ref SDS 61 EB7J.
120706 -  ..
120707 - Hazel Smith did the administration with Hazel to verify she is
120708 - getting the correct treatment.
120710 -  ..
120711 - Millie explained having taken Decadron tablets according to the
120712 - prescription to take two tablets twice a day, per instructions on
120713 - 050415. ref SDS 49 8U4O
120715 -  ..
120716 - Hazel gave Millie a pill for Compazine 10 prior to treatment that
120717 - reduces nausea rather than as a drip treatment to avoid allergic
120718 - reaction.
120720 -  ..
120721 - Hazel made installation to the port....
120723 -       ..
120724 -      Interlink System Vented Paclitaxel set
120726 -  ..
120727 - Millie's blood counts were low, so they will use the blood drawn from
120728 - the port to do another test.
120729 -
120730 -
120732 -  ..
120733 - Started saline flush.
120734 -
120735 -
120737 -  ..
1208 -
1209 -
1210 - 0824
1211 -
121101 - Benedryl started.
121102 -
121103 - Vitals taken by Hazel...
121104 -
121105 -    Blood preasure    107  63         120 80
121106 -    Pulse              70              80
121107 -    Temperature        97.1            98.5
121108 -
121109 -
121110 -
121111 -
121113 -  ..
1212 -
1213 -
1214 - 0830
1215 -
121501 - Benedryl completed.
121502 -
121503 -
121504 -
121505 -
1216 -

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

1504 -
1505 - 1023
150601 -  ..
150602 - Taxotere Full Dose Even though Blood Counts Below Targets
150603 -
150604 - Follow up ref SDS 63 4N5M, ref SDS 61 4N5M.
150606 -  ..
150607 - Taxotere started.
150609 -  ..
150610 - Calculation of ANC composite blood count criteria based on formula
150611 - submitted by Kaiser on 050128. ref SDS 42 TZ3N
150612 -
150613 -            ANC = WBC x 1000 x Neutrophils......... ref SDS 0 0N7Q
150614 -
150615 -                = 3.1 x 1000 x .41
150617 -                 ..
150618 -                = 1271
150620 -  ..
150621 - ANC = 1271 calculated today, is well below 1500 reported as requiring
150622 - primary care physician's signed authorization for treatment, reported
150623 - on 050128. ref SDS 42 HZ47
150625 -  ..
150626 - Millie is getting a full dose of chemotherapy treatment today, because
150627 - the doctor authorized the treatment, per below. ref SDS 0 HC6G
150628 -
150629 -    [On 060810 treatment deferred with ANC 1408, one day before
150630 -    scheduled date of treatment. ref SDS 73 UK7M
150631 -
150632 -    [On 070301 treatment at UCSF approved with ANC 1230; correlation to
150633 -    calculation of ANC at Kaiser is not clear in the record.
150634 -    ref SDS 74 P560
150636 -  ..
150637 - Per conversation with Ross, above, ref SDS 0 FB5F, he prepared full
150638 - dose based on conversation with Millie remembering understandings from
150639 - the doctor during the meeting on 050913.
150640 -
150642 -  ..
1507 -
1508 -
1509 - 0839
1510 -
151001 - Ross came by and discussed side effects again.
151002 -
151003 - Millie asked about remedy for the fingernail problem.  Ross
151004 - coordinated with Hazel, because the nurses are better at reviewing
151005 - symptoms and suggesting remedies.
151007 -  ..
151008 - If Hazel has ideas about remedies for fingernails, she will
151009 - coordinate with primary care physician for a prescription.
151010 -
151012 -  ..
1511 -
1512 -
1513 - 0916
1514 -
151401 - The primary care physician came through the clinic and spoke with
151402 - Millie briefly.  Millie related earlier discussion with Ross about the
151403 - dose for treatment, per above. ref SDS 0 FB5F  The doctor confirmed
151404 - there was no change in the prescribed dosage based on calculation of
151405 - blood count at 1271, even though this is well below Kaiser criteria of
151406 - 1500, per above. ref SDS 0 R43M
151407 -
151408 -    [On 060810 treatment deferred with ANC 1408, one day before
151409 -    scheduled date of treatment. ref SDS 73 UK7M
151411 -  ..
151412 - Millie further reviewed discussion about 40 minutes ago on side
151413 - effects with the pharmacist, per above. ref SDS 0 TZ4I
151415 -  ..
151416 - The doctor suggests soaking fingers in alchohol to keep them clean and
151417 - sanitary.  There is no published guidance on reducing this side
151418 - effect.
151420 -  ..
151421 - The doctor advised that he has met with the surgeon on Millie's case,
151422 - and so collaboration has now occurred, as discussed during the meeting
151423 - on 050913. ref SDS 64 T646  He did not relate what was discussed in
151424 - relation to preliminary notice of 2nd opinions submitted to the doctor
151425 - during the meeting on 050913. ref SDS 64 TS5E
151426 -
151427 -      [On 050923 the surgeon reported on meeting with the primary care
151428 -      physician in the hallway for a brief discussion. ref SDS 66 LP6H
151429 -
151430 -
151431 -
151433 -  ..
1515 -
1516 - 0938
1517 -
151701 - Equipment beeped indicating treatment is over.
151702 -
151703 - Taxotere treatment completed.
151705 -  ..
151706 - Barbara Smith came by and did the saline flush run for a few
151707 - minutes.
151709 -  ..
151710 - Babara removed the drip treatment tube from the port, and applied
151711 - Hepren to reduce clotting, and avoid infection.
151713 -  ..
151714 - Hazel did not get vitals at the end of treatment, as was done last
151715 - time.
151716 -
151717 -   Temperature.........
151718 -   Pulse...............
151719 -   Blood Pressure......
151720 -
151721 -
151723 -  ..
1518 -
1519 -
1520 - 0958
1521 -
152101 - We went to the Pharmacy and picked up the prescription for...
152102 -
152103 -            Xeloda
152104 -
152105 -
152107 -  ..
1522 -
1523 -
1524 - 1032
1525 -
152501 - After getting Millie's Xeloda drugs at the pharmacy, we walked over to
152502 - the Pathology Department and delivered the plastic container with a
152503 - biopsy slide, which was missing from delivery on 050913. ref SDS 65
152504 - NP92
152505 -
152506 -
152507 -
152508 -
152509 -
152510 -
152511 -
1526 -

SUBJECTS
Tired Wobbly on Feet after Treatment In Asleep by 1900

1703 -
1704 - 1030
170501 -  ..
170502 - Alert Energetic After Treatment Marked Change from Prior Treatments
170503 -
170504 - Follow up ref SDS 63 F54N, ref SDS 61 F54N.
170505 -
170506 - Millie seemed okay after treatment today.  No immediate wobbliness.
170507 - She was okay to drive, and seemed alert the rest of the day.
170509 -  ..
170510 - Millie drove us from Walnut Creek to the VA in Matinez, to pick up
170511 - some meds; we then drove to Clayton and split a hamburger for lunch.
170512 -
170514 -  ..
1706 -
1707 -
1708 - 1424
1709 -
170901 - Millie took a nap until about 1700.
170902 -
170904 -  ..
1710 -
1711 -
1712 - 1737
1713 -
171301 - Millie helped fix dinner; and after dinner she took her Xeloda pills.
171302 -
171303 -
171304 -
171305 -
171306 -
171307 -
171308 -
171309 -
171310 -
171311 -
1714 -