CONTACTS 

SUBJECTS
9th Cycle 1st Treatment Taxotere Xeloda Capacitibine Chemotherapy Tr

0503 -
0503 -    ..
0504 - Summary/Objective
0505 -
050501 - Follow up ref SDS 71 0000. ref SDS 68 0000.
050502 -
050503 - Millie started chemotherapy again today to treat the 3rd relapse of
050504 - IBC.  Diana was the nurse.  It was nice to work with familiar people.
050505 - Everything went pretty well.  Diana scheduled the next treatment 1 day
050506 - ahead of regular cycle schedule in order to maintain the level of
050507 - chemtherapy for effectiveness. ref SDS 0 QK6L  Millie received a
050508 - number of support drugs, and felt the effects after treatment.
050509 - ref SDS 0 F54N  The Pharmacist ordered drugs, and gave instructions
050510 - that reflect prior practice. ref SDS 0 TZ4I
050511 -
050512 -    [On 060724 diary side effects for 2nd phase taking Taxotere and
050513 -    capecitabine (Xeloda). ref SDS 81 QX8K
050515 -     ..
050516 -    [On 060806 IBC progressing rapidly after 1st cycle Taxotere
050517 -    capecitabine treating recurrence. ref SDS 82 7Q95
050519 -     ..
050520 -    [On 060807 schedule emergency meeting to consider switching
050521 -    treatments for increasing effectiveness. ref SDS 83 423C
050523 -     ..
050524 -    [On 060808 examination shows improvement, IBC red rash delayed
050525 -    reaction to treatment, inflammation begins to wain. ref SDS 84
050526 -    VO6G
050527 -
050528 -
050529 -
050530 -
050532 -  ..
0506 -
0507 -
0508 - Progress
0509 -
050901 - This 9th cycle of treatment was ordered by the primary care physician
050902 - during the meeting on 060711. ref SDS 80 N96O  Begin treating 3rd
050903 - relapse of IBC, and first treatment since the 8th cycle on 050916.
050904 - ref SDS 71 407N  Millie had mastectomy surgery on 051021, which seemed
050905 - successful, ref SDS 74 E74F  She was NED until 060623, though with
050906 - rising CA 15-3.  At that time, on 060623 examination found a red rash
050907 - on the left breast. ref SDS 79 025H  After surgery, CA 15-3 cancer
050908 - marker fell from 45 down to 28, ref SDS 75 GJ5M, and then began a long
050909 - steady rise, and was 71 on 060711. ref SDS 80 087J  Image testing
050910 - continues to show no evidence of distant metastasis, also, reported on
050911 - 060711. ref SDS 80 EY5O
050913 -  ..
050914 - Millie had a blood draw on Monday, 060717. ref SDS 0 Q659
050915 -
050919 -  ..
050920 - Laurie stopped by and talked to Millie briefly, just exchanging
050921 - pleasantries.  Her daughter is now a PhD student in biology, attending
050922 - Oregon State University.
050923 -
050924 -
050925 -
0510 -

SUBJECTS
Schedule Treatment 1 Day Ahead of Regular 3-week Cycle on Thursday 0

0903 -
090401 -  ..
090402 - 1 Day Advance Treatment of Regular 3-week Cycle Accomodate Kaiser
090403 - Schedule Next Treatment Conflict Resolved Advance Chemo by 1 Day
090404 -
090405 - Diana said the Infusion Clinic is already booked on 060811, Friday,
090406 - which is the regular schedule for starting the next 3-week cycle with
090407 - drip treatment of Taxotere.  She booked Millie for the day before on
090408 - Thursday to accomodate Kaiser's work schedule.
090410 -  ..
090411 - Millie wants treatments on Friday to align with her work schedule.
090412 - The next day on Saturday, she will feel okay, based on patient
090413 - history.  Then the next 2 days she will feel ill effects of Taxotere
090414 - treatments.  By Tuesday when she is back at work, she will be starting
090415 - to feel better, and then by Thursday will be much better, even while
090416 - taking 2 weeks of capecitabine (Xeloda) oral chemotherapy.  This
090417 - scenario is supported by patient history of side effects, reported on
090418 - 050422. ref SDS 54 JY3N
090420 -  ..
090421 - Treatment on Thursday defeats patient's objectives to combine work
090422 - with treatment, as recommended by the primary care physician, on
090423 - 030606, ref SDS 4 LZ3L, and further in 2nd opinion from Stanford
090424 - Medical Center on 041019. ref SDS 40 NN6N
090426 -  ..
090427 - Patient history shows that treatment ahead of the regular 3-week cycle
090428 - risks blood counts falling below requirements.  Discussed setting the
090429 - schedule for following Monday rather than preceeding Thursday, since
090430 - Millie has both Friday and Monday off work.  Moving treatment ahead to
090431 - Thursday disrupts the patient's schedule, and may cause blood counts
090432 - to fall below Kaiser's standing orders on criteria for treatment.
090433 - Delaying treatment 2 more days provides more time for blood counts to
090434 - rise within criteria for treatment.
090436 -  ..
090437 - Diana said that treatment cannot be delayed until Monday in order to
090438 - accomodate patient work schedule because 3 days delay from Friday to
090439 - Monday dilutes concentration of treatment in the patient, which
090440 - reduces effectiveness of chemotherapy.
090441 -
090442 -     [On 060810 Kaiser delays treatment 7 days for blood counts to rise
090443 -     slightly, rather than apply past practice of maintaining
090444 -     chemotherapy levels for effective treatment. ref SDS 85 NH8T
090446 -  ..
090447 - Maintaining chemotherapy drug levels in the patient for effective
090448 - treatment was presented by the primary care physician on 040614,
090449 - ref SDS 23 6T7F, and previously on 030606. ref SDS 4 JP7G
090450 -
090451 -    [On 060810 case study shows pattern and practice of treatment when
090452 -    blood counts below standing orders due to patient's good health.
090453 -    ref SDS 85 HV45
090455 -  ..
090456 - Diana indicated that moving treatment ahead 1 day to solve Kaiser's
090457 - schedule problem is a better solution, even though it conflicts with
090458 - the customer's schedule, because Kaiser has flexibility applying blood
090459 - count criteria that gives priority to timely treatment, while also
090460 - avoiding undue risk to the immune system from low blood counts.  On
090461 - 040614 the primary care physician explained flexibility in Millie's
090462 - case arises from good health and fitness. ref SDS 23 356L  As a
090463 - result, Kaiser often waives standing orders on blood counts because on
090464 - the day of treatment counts will have risen since the date of the test
090465 - to within close range of 1500 used for treatment criteria.  An example
090466 - occurred on 020701, ref SDS 3 EN50, and again a few years later on
090467 - 050128. ref SDS 46 TZ3N
090469 -  ..
090470 - As a result, Diana submitted the following schedule...
090471 -
090472 -       060810 1330.... Chemotherapy Taxotere 10th Cycle
090473 -
090474 -
090475 -
090476 -
090477 -
0905 -

SUBJECTS
Blood Tests Chemotherapy White Cell Count Good 9th Cycle Taxotere Ca

1203 -
120401 -  ..
120402 - Blood Counts Good Dose Chemotherapy Taxol Normal
120403 -
120404 - Follow up ref SDS 71 Q659, ref SDS 68 Q659.
120406 -  ..
120407 - Diana submitted the report showing...
120408 -
120409 -    Patient   Provider  Category   View      FR Date   To Date
120415 -     ..
120416 -    Procedure              Results             Reference Range
120417 -
120420 -
120421 -                  ** Marina Way South **
120423 -     ..
120424 -    Test Name              Value Unit     <-------- RANGE-------->
120425 -    @CBC
120426 -    WBC x 10-3               4.8 K/uL           3.5   -     12.5
120427 -    RBC x 10-6              3.76 M/uL           3.60  -      5.70
120428 -    Hemoglobin              12.5 g/dL          11.5   -     15.0
120429 -    Hematocrit              34.9 %             34.0   -     46.0
120430 -    MCV                       93 fL            80.0   -    100.0
120431 -    RDW                     13.7 %             11.9   -     14.3
120432 -    Plt x10-3              212   K/uL         140     -    400
120433 -     ..
120434 -    Neutrophils    L          47 %             50     -     70
120435 -    Lymphocytes               41 %             20     -     50
120436 -    Monocyte                   9 %              0     -     11
120437 -    Eosinophils                3 %              1     -      5
120438 -    Basophil                   1%               0     -      2
120439 -    Bands              No Report %              0     -      5
120441 -     ..
120442 -    CA 15-3          No report                 -<     -     39
120443 -
120445 -  ..
120446 - This report aligns with the test on 060126 showing all tests normal
120447 - for first time in 4 years, ref SDS 76 YZ3N, except today, Neutrophils,
120448 - is slightly low.
120449 -
120450 -
120451 -
120452 -
120453 -
120454 -
1205 -

SUBJECTS
CA 15-3 71 No Change Not Tested with Current Blood Test for Chemo
CA 15-3 71 and 32 Above 39 Signals Relapse IBC Growing Red Rash and

1504 -
150501 -  ..
150502 - CA 15-3 71 No Change Not Tested with Current Blood Test for Chemo
150503 -
150504 - Follow up ref SDS 71 2N5J, ref SDS 68 2N5J.
150505 -
150506 - CA 15-3 was not ordered with the test on 060717, per above.
150507 - ref SDS 0 075H
150509 -  ..
150510 - Last test was reported on 060711. ref SDS 80 087J
150511 -
150512 -
150513 -
150514 -
150515 -
150516 -
1506 -

SUBJECTS
Port Connection Prepare for Treatment 1 Try Required Diana Excellent

1803 -
1804 - 1417
180501 -  ..
180502 - Preparation for Treatment Required One (1) Attempt to Connect Port
180503 - -----------------------------
180504 - Follow up ref SDS 71 EB7J, ref SDS 68 EB7J.
180506 -  ..
180507 - Julie did the administration with Diana to verify she is getting the
180508 - correct treatment.
180510 -  ..
180511 - Millie explained having taken Decadron tablets according to the
180512 - prescription to take two tablets twice a day, per instructions on
180513 - 050415. ref SDS 53 8U4O
180515 -  ..
180516 - Decadron was given by Diana again before treatment today, and Millie
180517 - will take another dose of Decadron tomorrow as part of chemotherapy
180518 - treatment today.
180519 -
180520 -        Generic name:  dexamethasone
180521 -
180522 -              http://www.tirgan.com/decadron.htm
180524 -         ..
180525 -        4 MG tablets.
180527 -         ..
180528 -        Decadron is a steroid given by intravenous as well as oral
180529 -        tablet methods.  Intravenous form gives immediate action and
180530 -        result and tablets are used to maintain the effect of Decadron.
180532 -         ..
180533 -        Decadron is used prior to chemotherapy to avoid nausea and
180534 -        vomiting.
180536 -  ..
180537 - Compazine - Diana gave Millie a pill prior to treatment that reduces
180538 - nausea rather than as a drip treatment to avoid allergic reaction.
180539 -
180540 -        Generic name:  Prochlorperazine
180542 -         ..
180543 -        Compazine is used to control severe nausea and vomiting.  It is
180544 -        also used to treat the mental disorder of schizophrenia, and is
180545 -        occasionally prescribed for anxiety.
180546 -
180547 -           [On 060929 Compazine and Atiman were not effective treating
180548 -           nausea and uneasy feeling in the stomache; treatment for
180549 -           this purpose discontinued; nausea relieved eating small
180550 -           amounts of food throughtout the day. ref SDS 86 D19M
180552 -  ..
180553 - Ativan - later during treatment, Millie was uncomfortable.  Diana gave
180554 - her an Ativan tablet.
180555 -
180556 -              http://www.drugs.com/ativan.html
180557 -
180558 -        Generic name:  benzodiazepines
180560 -         ..
180561 -        Ativan affects chemicals in the brain that may become
180562 -        unbalanced and cause anxiety, insomnia, and seizures.
180564 -         ..
180565 -        Ativan is used to relieve anxiety, nervousness, and tension
180566 -        associated with anxiety disorders. It is also used to treat
180567 -        certain types of seizure disorders and to relieve insomnia
180568 -        (induce sleep).
180569 -
180570 -           [On 060929 Compazine and Atiman were not effective treating
180571 -           nausea and uneasy feeling in the stomache; treatment for
180572 -           this purpose discontinued; nausea relieved eating small
180573 -           amounts of food throughtout the day. ref SDS 86 D19M
180574 -
180576 -  ..
180577 - Diana connected the IV tubes to the port....
180579 -       ..
180580 -      Interlink System Vented Paclitaxel set
180582 -  ..
180583 - This was done without incident, very professional and competent.
180584 -
180585 -
180586 -
180587 -
1806 -
1807 -
180701 -
1808 -

SUBJECTS
Benadryl Drip Treatment Prepares Patient for Chemotherapy Avoid Feve

2003 -
2004 - 1416
200501 -  ..
200502 - Benadryl started.
200503 -
200504 -              http://www.oncolink.org/treatment/article.cfm?c=2&s=10&id=150
200505 -
200506 -        Generic name:  diphenhydramine
200507 -
200508 -        Benadryl is given to treat side effects of fever and chills
200509 -        from cancer treatment with Taxotere and other chemotherapy
200510 -        agents.
200512 -         ..
200513 -        Fever and chills may occur during treatment, generally within
200514 -        30 minutes to 2 hours of beginning the first infusion.  This is
200515 -        less common after the first treatment.
200517 -         ..
200518 -        What to do:  Your doctor may give you diphenhydramine (Benadryl
200519 -        and acetaminophen (Tylenol r) before your treatment.  During
200520 -        the infusion, if you experience lightheadedness, fever, chills,
200521 -        or shakes inform your doctor or nurse immediately.  Additional
200522 -        medications may be given to alleviate your discomfort.  Your
200523 -        infusion may be slowed or temporarily stopped.
200525 -         ..
200526 -        Benadryl side effects...
200527 -
200528 -              Drugg.com
200529 -
200530 -              http://www.drugs.com/mtm/benadryl.html
200532 -         ..
200533 -        sleepiness, fatigue, or dizziness;
200535 -         ..
200536 -        headache;
200537 -
200538 -
200539 -
200541 -  ..
2006 -
2007 -
2008 - 1430
2009 -
200901 - Benedryl completed.
200902 -
200903 -
200904 -
200905 -
2010 -

SUBJECTS
Taxotere 102 MG Drip Treatment 9th Cycle Taxotere Capecitiabine (Xel

2303 -
2304 - 1436
230501 -  ..
230502 - Taxotere Full Dose Blood Counts on Targets
230503 -
230504 - Follow up ref SDS 71 4N5M, ref SDS 68 4N5M.
230506 -  ..
230507 - Taxotere started - 102 MG.
230509 -  ..
230510 - There was no patient evaulation process today, which fits the
230511 - procedure the first time Millie was treated with Taxotere on 020610,
230512 - ref SDS 2 MR5I; later, on 050415 Kaiser performed patient evaluation
230513 - of side effects for Taxotere treatment. ref SDS 53 4333
230514 -
230515 -
230516 -
230517 -
230518 -
230519 -
230520 -
2306 -

SUBJECTS
Vitals Blood Pressure Pulse Temperature Taxotere 102 MG Drip Treatme

2603 -
2604 - 1440
260501 -  ..
260502 - Vitals Show Patient Stable
260503 -
260504 - Diana took vitals after starting Taxotere drip treatment...
260505 -
260506 -                    Blood
260507 -    Date   Time     Pressure   Pulse  Temprtr  Weight
260509 -     ..
260510 -    060722 1440..... 142  74     67     98.1
260511 -    060711.......... 172  87     54     97.5    147
260512 -    060623.......... 141  87     71     98.0    147
260513 -    060428.......... 129  73     80     99.4    149
260514 -    060217.......... 153  81     61     98.6    150
260515 -    050916.......... 120  80     80     98.5
260516 -
260517 -
260518 -
260519 -
2606 -

SUBJECTS
Pharmacist Orders Capecitabine Decadron Instructions Dose Capecitabi

3103 -
3104 - 1516
310501 -  ..
310502 - Pharmacist Orders Capecitabine Decadron Instructions
310503 -
310504 - Follow up ref SDS 80 N96O.
310505 -
310506 - On 060711 Zan planned to visit with Millie today in the Infusion
310507 - Department and place an order for chemotherapy and decadron drugs.
310508 - Since the treatment is nearly complete, walked over to the Oncology
310509 - Pharmacy Department and found Zan.  We reviewed prior planning on
310510 - 060711. ref SDS 80 W64K
310512 -  ..
310513 - Zan asked for Millie's last name.
310515 -  ..
310516 - He checked the computer, and saw there is a pending task to prepare an
310517 - order for the pharmacy for Millie's cancer treatment drugs.  Zan said
310518 - he come and visit Millie shortly in the Infusion Department.
310519 -
310521 -  ..
3106 -
3107 -
3108 - 1533
3109 -
310901 - Zan visited Millie in the Infusion Department.
310902 -
310903 - He has placed the order for capecitabine (Xeloda) 500 MB tablets, and
310904 - for dexamethasone (Decadron) 4 MB tablets, and said that Millie can
310905 - pick up this prescription from the 2nd Floor Pharmacy (across the
310906 - lobby from the Infusion Department) after her treatment is completed
310907 - in a few minutes.
310909 -  ..
310910 - Zan reminded that Xeloda treatment is 1.5 500 MB tablets twice a day
310911 - for two weeks, and starting today after dinner.
310913 -  ..
310914 - This is the reduced dosage ordered by the doctor on 050520.
310915 - ref SDS 58 VP4N
310916 -
310918 -  ..
3110 -
3111 -
3112 - 1540
3113 -
311301 - Equipment beeped indicating treatment is over.
311302 -
311303 - Taxotere treatment completed.
311305 -  ..
311306 - Diana disconnected the IV tubes.
311308 -  ..
311309 - She inserted Herceptin to flush the port.
311311 -  ..
311312 - She then removed the needle from the port, and swabbed the needle
311313 - wound, and placed a temporary bandage.
311314 -
311315 -
311317 -  ..
3114 -
3115 -
3116 - 1550
3117 -
311701 - We went to the Pharmacy and picked up the prescription for Xeloda and
311702 - Decadron placed by Zan, per above. ref SDS 0 J48Q
311704 -  ..
311705 - After about 20 minutes, we noticed a message on the electronic board
311706 - that lists orders ready for pickup.  It said that if an order is not
311707 - ready in 15 minutes to ask an attendant at the counter.
311709 -  ..
311710 - We asked one of the pharmacists.  She checked Kaiser's computer and
311711 - said that the order has already been prepared, but it was sent to
311712 - another location in Livemore, or somewhere.  She left to try and
311713 - retrieve the order before it left the building.  After another 20
311714 - mintues without being called, another attendant was asked to check on
311715 - Millie's order.
311717 -  ..
311718 - The attendant said the order was ready.  She got it from one of many
311719 - bins behind the attendant's counter.
311720 -
311721 -
311722 -
311723 -
311724 -
3118 -

SUBJECTS
Tired Wobbly Asleep by 1800 Today after Treatment Decadron Compazine

3503 -
3504 - 1630
350501 -  ..
350502 - Tired Wobbly After Treatment Taxotere Support Drugs
350503 -
350504 - Follow up ref SDS 71 F54N, ref SDS 68 F54N.
350505 -
350506 - Millie was a little disoriented after treatment today, possibly due
350507 - Ativan and compazine. ref SDS 0 8G9G
350509 -  ..
350510 - She could not drive home.
350511 -
350512 -    [On 060724 diary side effects for 2nd phase taking Taxotere and
350513 -    capecitabine (Xeloda). ref SDS 81 QX8K
350514 -
350515 -
350517 -  ..
3506 -
3507 -
3508 - 1710
3509 -
350901 - Fixed a quick dinner, tuna casserole.  Millie ate, and was asleep by
350902 - 1750.
350903 -
350905 -  ..
3510 -
3511 -
3512 - 2023
3513 -
351301 - Millie woke up and took the 1.5 Xeloda tablets starting treatment
351302 - today, per Zan's instructions. ref SDS 0 J492
351303 -
351304 -
351305 -
351306 -
3514 -