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1...This record indicates the nurse did not submit the full report. The
CONTACTS
SUBJECTS
12th Cycle Treatment Taxotere Xeloda Capacitibine Chemotherapy 4th C
0503 -
0503 - ..
0504 - Summary/Objective
0505 -
050501 - Follow up ref SDS 91 0000. ref SDS 88 0000.
050502 -
050503 - Millie was surprised that blood counts are very good again today for
050504 - treatment. ref SDS 0 P560 There are a number of "no report" entries,
050505 - indicating that Kaiser may not have submitted the full report.
050506 - ref SDS 0 0N7Q She has been more tired throughout the past treatment
050507 - cycle. Failing to recover energy usually indicates low blood counts.
050508 - Being tired, and heavy chest, difficulty breathing also reported today
050509 - may indicate recurrence of pulmonary emboli. ref SDS 0 QU8K After
050510 - starting Taxotere drip treatment, the nurse helped Millie move the
050511 - mobile treatment aparatus and walk to the Oncology Clinic, so that the
050512 - doctor could have a meeting concurrent with getting treatment.
050513 - ref SDS 0 4N5M Just before meeting with the doctor, the pharmacist
050514 - came into the examination room and consulted with Millie on ordering
050515 - chemotherapy drugs for the the next cycle of treatment starting today.
050516 - ref SDS 0 TZ4I Vitals show patient stable. ref SDS 91 AW4L Patient
050517 - alert and energy level good treatment. ref SDS 91 F54N Nadine and the
050518 - Kaiser Infusion Clinic team did an excellent job today.
050519 -
050520 -
050521 -
050522 -
050523 -
050525 - ..
0506 -
0507 -
0508 - Progress
0509 -
050901 - Treatment Regular 3 Week Schedule Steady Level Chemotherapy Agent
050902 -
050903 - Follow up ref SDS 91 407N, ref SDS 88 407N.
050904 -
050905 - Received treatment to begin 12th cycle overall of chemotherapy with
050906 - Taxotere and capecitabine (Xeloda), and the 4th treatment for 3rd
050907 - relapse of IBC. Scheduling and treatment were reviewed by the primary
050908 - care physician on 060825. ref SDS 90 025H There was another review
050909 - meeting with the doctor today during treatment. Treatments have been
050910 - irregular so far, with slow response, reported on 060922. ref SDS 92
050911 - 0D4T Treatment today is on schedule, keeping a steady level of
050912 - chemotherapy agent treating cancer.
050913 -
050917 - ..
050918 - Millie had a blood draw yesterday afternoon, Thursday, 060928.
050920 - ..
050921 - Angela said the blood counts are good today. This was confirmed by
050922 - the report showing counts are well above requirements for treatment.
050923 - ref SDS 0 P560
050925 - ..
050926 - There was an innovation today with the primary care physician meeting
050927 - with the patient during treatment. This reduced the overall time at
050928 - the Kaiser facility by about 50%, from 4 hours to 2.
050929 -
050930 -
050931 -
050932 -
0510 -
SUBJECTS
Side Effects Consultation Pharmacist Tired Heavy Chest Difficult Bre
1403 -
140401 - ..
140402 - Breathing Difficulty Heavy Chest Pulmonary Emboli Side Effects
140403 - Side Effects Consultation Pharmacist Heavy Chest Difficult Breathing
140404 -
140405 - Follow up ref SDS 91 QU8K.
140406 -
140407 - On 060724 diary showing history of side effects for 2nd phase taking
140408 - Taxotere and capecitabine (Xeloda). ref SDS 82 QX8K
140410 - ..
140411 - Millie met with the pharmacist briefly in the examination room, per
140412 - below, and notified Kaiser of new side effects. ref SDS 0 819O Other
140413 - side effects remain moderate, possibly reflecting reduced levels of
140414 - chemotherapy agent, compared to 2005, as reported on 060922.
140415 - ref SDS 92 9F35
140417 - ..
140418 - Tired, fatigued..
140419 -
140420 - New problem; ordinarily after the 1st week of a new
140421 - treatment cycle, energy level rises to normal by the
140422 - middle of the 2nd week of treatment. The 3rd week that
140423 - is off treatment is typically normal energy.
140425 - ..
140426 - This cycle Millie has been continuously tired through
140427 - the 3rd week, including today, and so was surprised to
140428 - learn her blood counts are still very strong, per below.
140429 - ref SDS 0 P560
140431 - ..
140432 - Heavy chest - difficult breathing
140433 -
140434 - Millie described being out of breath after walking up
140435 - the stairs at home, and at the BART station.
140436 -
140437 - On 060724 patient notified Kaiser of possible finding
140438 - pulmonary emboli family genetics, ref SDS 83 NL5Q, from
140439 - report a few days earlier on 060722 of oldest son
140440 - relapse pulmonary emboli. ref SDS 81 3D9T
140442 - ..
140443 - Dry hands.
140444 -
140445 - Lotion received from Kaiser on 060809 is somewhat
140446 - effective. ref SDS 91 KW45 Other lotion has fully
140447 - relieved the problem to manageable levels.
140449 - ..
140450 - Loose bowels -- no diarrhea
140451 -
140452 - Problem has cleared without treatment.
140454 - ..
140455 - Nausea
140456 -
140457 - Uneasy, queazy feeling in stomache taking compasize,
140458 - prescribes Anzemet were not effective. Eating small
140459 - amounts of food thorughout the day relieves problem.
140461 - ..
140462 - sores in mouth
140463 -
140464 - None yet, cleaning mouth carefully to avoid problem.
140465 -
140466 -
140467 -
140468 -
140469 -
140470 -
140471 -
1405 -
SUBJECTS
Schedule Treatment Regular 3-week Cycle on Friday 061020 Angela Meye
1703 -
170401 - ..
170402 - Schedule Next Treatment Continue Fridays
170403 -
170404 - Follow up ref SDS 91 QK6L, ref SDS 88 QK6L.
170406 - ..
170407 - Today, Millie's next treatment is scheduled for 061020 1430.
170409 - ..
170410 - Blood draw is schedued forthe day before on 061019 1500.
170412 - ..
170413 - Meeting with the doctor also scheduled for 061020. Not sure about
170414 - the time, because we can do it before or during treatment.
170415 -
170416 -
170417 -
170418 -
1705 -
SUBJECTS
Blood Tests Chemotherapy White Cell Count Good 12th Cycle Taxotere C
2003 -
200401 - ..
200402 - Blood Counts Good Dose Chemotherapy Taxol Normal
200403 -
200404 - Follow up ref SDS 91 Q659, ref SDS 88 Q659.
200406 - ..
200407 - Angela submitted the report showing...
200408 -
200409 - Patient Provider Category View FR Date To Date
200415 - ..
200416 - Procedure Results Reference Range
200417 -
200421 -
200422 - ** Marina Way South **
200424 - ..
200425 - Test Name Value Unit <-------- RANGE-------->
200426 - @CBC
200427 - WBC x 10-3 5.2 K/uL 3.5 - 12.5
200428 - RBC x 10-6 3.71 M/uL 3.60 - 5.70
200429 - Hemoglobin 12.1 g/dL 11.5 - 15.0
200430 - Hematocrit 35.8 % 34.0 - 46.0
200431 - MCV 97 fL 80.0 - 100.0
200432 - RDW H 16.1 % 11.9 - 14.3
200433 - Plt x10-3 249 K/uL 140 - 400
200434 - ..
200435 - Neutrophils No Report % 50 - 70
200436 - Lymphocytes No Report % 20 - 50
200437 - Monocyte No Report % 0 - 11
200438 - Eosinophils No Report % 1 - 5
200439 - Basophil No Report % 0 - 2
200440 - Bands No Report % 0 - 5
200442 - ..
200443 - CA 15-3 H 51 U/mL -< - 39
200445 - ..
200446 - Alkaline Phos No Report U/L 38 - 126
200447 - Bili, Tot Adult 0.6 mg/dL 0.2 - 1.3
200448 - Creatinine 0.6 mg/dL 0.6 - 1.2
200449 - ALT (SGPT) 22 U/L 14 - 36
200450 - AST (SGOT) No Report U/L 11 - 66
200452 - ..
200453 - RBC Morphology No Report
200454 - Poikilocytosis * No Report
200455 - Anisocytosis * No Report
200456 - Schistocytes * No Report
200457 - PLT Estimate No Report
200458 - PLT Morphology No Report
200460 - ..
200461 - This record indicates the nurse did not submit the full report. The
200462 - document says page 1 of 4, and we only got page 1.
200463 -
200464 -
200465 -
200466 -
200467 -
200468 -
2005 -
SUBJECTS
Absolute Neutrophils Count ANC 5200 Well Above 1500 Required for Tre
2303 -
230401 - ..
230402 - ACN 5200 Well Above 1500 Criteria for Blood Counts Approve Treatment
230403 -
230404 - Follow up ref SDS 91 P560, ref SDS 88 P560.
230405 -
230406 - Millie was surprised that blood counts reported today are very strong,
230407 - per above. ref SDS 0 0N7Q Experience since 2002 has shown a strong
230408 - correlation between feeling tired, reported today, ref SDS 0 FG3N, and
230409 - having low blood counts.
230411 - ..
230412 - Formula for ANC, from record on 050128. ref SDS 45 TZ3N
230414 - ..
230415 - Calculation from 060908 yielded 6390. ref SDS 91 P560
230417 - ..
230418 - Note that bands are added to neutrophils, but both neutrophils and
230419 - bands have no report today.
230420 -
230421 - WBC = 5.2
230422 -
230423 - Neutrophils = no report
230424 - Bands = no report
230426 - ..
230427 - ANC = 5.2 x 1000 x = 5200
230429 - ..
230430 - ANC calculation was not submitted by the nurse today, possibly
230431 - indicating that since WBC is high enough, there is no need to make
230432 - the calculation.
230433 -
230434 -
230435 -
230436 -
230437 -
230438 -
2305 -
SUBJECTS
CA 15-3 51 Dramatic Drop from 68 Cancer Marker Current Blood Test
2503 -
250401 - ..
250402 - CA 15-3 51 Dramatic Drop from 68 Cancer Marker Current Blood Test
250403 -
250404 - Follow up ref SDS 91 2N5J, ref SDS 88 2N5J.
250406 - ..
250407 - Test today showing CA 15-3 51, ref SDS 0 5K6K, was another big drop
250408 - from 68 reported following the last treatment on 060908, and received
250409 - last week on 060922. ref SDS 92 MG6F
250410 -
250411 -
250412 -
250413 -
250414 -
2505 -
SUBJECTS
Port Connection Prepare for Treatment 1 Try Required Angela Excellent 2
2803 -
2804 - 1417
280501 - ..
280502 - Preparation for Treatment Required One (1) Attempt to Connect Port
280503 -
280504 - Follow up ref SDS 91 EB7J, ref SDS 88 EB7J.
280506 - ..
280507 - Bonnie did the administration with Angela to verify Millie gets the
280508 - correct treatment.
280510 - ..
280511 - Millie explained having taken Decadron tablets according to the
280512 - prescription to take two tablets twice a day, per instructions on
280513 - 050415. ref SDS 52 8U4O
280515 - ..
280516 - Decadron was not given by Angela again before treatment today, because
280517 - Millie took the pills this morning with her meal, as prescribed; and
280518 - Millie will take another treatment of Decadron tomorrow as part of
280519 - chemotherapy treatment with Taxotere today.
280520 -
280521 - Generic name: dexamethasone
280522 -
280523 - http://www.tirgan.com/decadron.htm
280525 - ..
280526 - Description and purpose of Decadron is reported in the record
280527 - on 060721. ref SDS 80 4I4Q
280529 - ..
280530 - Compazine - Angela gave Millie a pill prior to treatment. Millie took
280531 - this with a cup of water, as she has for the past 5 years. Angela
280532 - said this was a mistake. She apologized for not alerting the patient
280533 - should wait to take Compazine treatment until after verification of
280534 - treatment protocol, per above. ref SDS 0 EB7J
280536 - ..
280537 - Ativan - was not part of treatment today, previously given on 060721.
280538 - ref SDS 80 FZ5M
280539 -
280540 - Generic name: benzodiazepines
280541 -
280542 - Purpose of Atiman reported on 060721. ref SDS 80 NF6K
280544 - ..
280545 - Anzemet
280546 -
280547 - Generic name: dolasetron mesylate
280548 -
280549 - http://www.anzemet.com
280551 - ..
280552 - Millie advised that she tried Anzemet once, and found it did not
280553 - relieve side effects of nausea, reported on 060908, ref SDS 91 O64I,
280554 - and per above, ref SDS 0 D19M, and so she has not taken this again,
280555 - also, reported to the pharmacist, per below. ref SDS 0 NT3J
280556 -
280557 -
280558 -
280560 - ..
2806 -
2807 -
2808 - 1441
2809 -
280901 - Angela connected the IV tubes to the port....
280903 - ..
280904 - Interlink System Vented Paclitaxel set
280906 - ..
280907 - This was done without incident, very professional and competent.
280908 -
280909 -
280910 -
2810 -
SUBJECTS
Benedryl Reduce Side Effects Taxotere Chemotherapy Treatment Meyer A
3103 -
3104 - 1446
310501 - ..
310502 - Benedryl Reduce Side Effects Taxotere Chemotherapy Treatment
310503 -
310504 - Follow up ref SDS 91 DC7J.
310505 -
310506 - Benadryl started.
310508 - ..
310509 - Purpose reported on 060721. ref SDS 80 DC7J
310510 -
310511 -
310513 - ..
3106 -
3107 -
3108 - 1456
3109 -
310901 - Benedryl completed.
310902 -
310903 -
310904 -
310905 -
3110 -
SUBJECTS
Taxotere 102 MG Drip Treatment 12th Cycle Taxotere Capecitiabine (Xe
3403 -
3404 - 1458
340501 - ..
340502 - Taxotere Full Dose Blood Counts on Targets
340503 -
340504 - Follow up ref SDS 91 4N5M, ref SDS 88 4N5M.
340506 - ..
340507 - Taxotere started - 102 MG.
340509 - ..
340510 - There was no patient evaulation process today, which fits the
340511 - procedure the first time Millie was treated with Taxotere on 020610,
340512 - ref SDS 2 MR5I; later, on 050415 Kaiser performed patient evaluation
340513 - of side effects for Taxotere treatment. ref SDS 52 4333
340515 - ..
340516 - While connecting Taxotere treatment, Angela commented that she hoped
340517 - Millie doesn't mind her saying that she noticed Millie's age from
340518 - Kaiser's computer records, and initially thought there was a mistake,
340519 - because Millie looks so young and strong for a 70 year old. She said
340520 - that Millie looks younger than her mom who is only 52.
340521 -
340522 - [....in another record today, Doctor Benz at UCSF mentions in a
340523 - 2nd opinion letter that Millie looks younger than her age.
340524 - ref SDS 93 WQ6S
340526 - ..
340527 - Millie thanked Angela for generous comments, and for doing a good job
340528 - assisting with her treatment today. She confirmed that she is 70,
340529 - and feels fortunate to that Kaiser is taking good care of her.
340530 -
340531 -
340532 -
340534 - ..
3406 -
3407 -
3408 - 1602
3409 -
340901 - Equipment beeped indicating treatment is over, while were still
340902 - meeting with the primary care physician.
340904 - ..
340905 - Angela knocked on the examination room door, and the doctor said we
340906 - are about finished.
340908 - ..
340909 - About 5 minutes later, the meeting ended. The doctor opened the door,
340910 - and Angela assisted Millie back to the Infusion Clinic while still
340911 - connected to the IV treatment equipment.
340913 - ..
340914 - Angela disconnected the IV tubes.
340916 - ..
340917 - She inserted Herceptin to flush the port.
340919 - ..
340920 - She then removed the needle from the port, and swabbed the needle
340921 - wound, and placed a temporary bandage.
340922 -
340923 -
340924 -
340925 -
340926 -
3410 -
SUBJECTS
Vitals Blood Pressure Pulse Temperature Taxotere 102 MG Drip Treatme
3703 -
3704 - 1452
370501 - ..
370502 - Vitals Show Patient Stable
370503 -
370504 - Follow up ref SDS 91 AW4L, ref SDS 88 AW4L.
370505 -
370506 - Angela took vitals before starting Benedryl drip treatment...
370507 -
370508 - Blood
370509 - Date Time Pressure Pulse Temprtr Weight
370511 - ..
370512 - 060929 1452..... 141 78 66 98.3
370513 - 060908 1335..... 139 79 73 98.1
370514 - 060814 1610..... 139 80 59 98.2
370515 - 060722 1440..... 142 74 67 98.1
370516 - 060711.......... 172 87 54 97.5 147
370517 - 060623.......... 141 87 71 98.0 147
370518 - 060428.......... 129 73 80 99.4 149
370519 - 060217.......... 153 81 61 98.6 150
370520 - 050916.......... 120 80 80 98.5
370521 -
370522 -
370523 -
370524 -
3706 -
SUBJECTS
Pharmacist Orders Capecitabine (Xeloda) 12th Cycle Decadron Doctor's
4203 -
4204 - 1513
420501 - ..
420502 - Pharmacist Orders Capecitabine Decadron Instructions
420503 -
420504 - Follow up ref SDS 91 TZ4I, ref SDS 88 TZ4I.
420505 -
420506 - After Angela assisted Millie moving from the Infusion Clinic into the
420507 - examination for meeting with the primary care physician, and before
420508 - the doctor came into the room, a young woman came and introduced
420509 - herself as a pharmacist.
420511 - ..
420512 - She has placed an order on the 2nd floor pharmacay for Millie to get
420513 - another treatment of capecitabine (Xeloda), and this includes
420514 - Decadron, required for Taxotere that is the other part chemotherapy
420515 - treatment prescribed for Millie.
420517 - ..
420518 - The pharmacist asked Millie to explain the protocol for capecitabine,
420519 - and Millie related taking 1.5 pills twice a day for 2 weeks. The
420520 - pharmacist explained that Millie passed Kaiser's quality control
420521 - efforts to verify patient is taking the prescribed amount of
420522 - treatment, following up Millie's letter to the doctor on 060922
420523 - reporting an error in taking capecitabine (Xeloda) one day.
420524 - ref SDS 92 0D5R
420526 - ..
420527 - There was discussion of side effects, per above. ref SDS 0 QU8K
420529 - ..
420530 - Millie explained recent resumption of previous side effects of
420531 - chemotherapy treatment that causes difficulty breathing with a heavy
420532 - chest, ref SDS 0 UL6L, which was due to blood clots and pulmonary
420533 - emboli reported on 041104. ref SDS 40 N43I
420535 - ..
420536 - The pharmacist was unaware of blood clots or shortness of breath
420537 - being associated with either Taxotere or capecitabine (Xeloda).
420539 - ..
420540 - On 060711 another pharmacist, Zan, discussed adjusting the dose of
420541 - chemotherapy agent based on the patient not receiving treatment with
420542 - Coumadin for pulmonary emboli. ref SDS 79 S33L This however seems a
420543 - different issue from whether Taxotere and/or capecitabine may have
420544 - side effects of blood clots. If the patient has recurrence of
420545 - pulmonary emboli, this may require adjusting chemotherapy treatments,
420546 - as Zan related on 060711. ref SDS 79 S34N
420548 - ..
420549 - The pharmacist asked Millie if she needs refill for Anzemet,
420550 - prescribed on 060908 for nausea? ref SDS 91 D19M Millie advised that
420551 - she tried this once, and found this was not effective, so she does not
420552 - need a refill. Per above, Millie advised that eating small amounts of
420553 - food through the day keeps her stomache from feeling nausious.
420554 - ref SDS 0 QU8K
420555 -
420556 -
420557 -
420558 -
420559 -
4206 -
SUBJECTS
Energy Normal Stable Alert Drive Home After Treatment IBC 3rd Relaps
4603 -
4604 - 1733
460501 - ..
460502 - Energy Normal Stable After Treatment Taxotere Support Drugs
460503 -
460504 - Follow up ref SDS 91 F54N, ref SDS 88 F54N.
460505 -
460506 - Millie was a little tired after treatment today, but was not wobbly
460507 - nor disoriented. She was alert enough to drive home.
460509 - ..
460510 - On 060724 diary side effects for 2nd phase taking Taxotere and
460511 - capecitabine (Xeloda). ref SDS 82 QX8K
460512 -
460513 -
460514 -
460515 -
460516 -
460517 -
460518 -
4606 -