CONTACTS 

SUBJECTS
Examination Treatment Cetuximab 3rd Treatment 4th Cycle Chemotherapy

1103 -
1103 -    ..
1104 - Summary/Objective
1105 -
110501 - Follow up ref SDS 75 0000. ref SDS 73 0000.
110502 -
110503 - Millie received the 3rd treatment starting the 4th cycle of cetuximab
110504 - chemotherapy on clinical study at UCSF. ref SDS 0 7T3H  Examination
110505 - shows continuing improvement with IBC rash subsiding. ref SDS 0 FO6H
110506 - Side effects remain mild. ref SDS 0 QU8K  UCSF scheduled meetings and
110507 - treatment for the next 2 cycles through 070802. ref SDS 0 3E8L  UCSF
110508 - decided testing blood counts for safe treatment was unnecessary.
110509 - ref SDS 0 MZ3N  UCSF took the initiative to schedule the next CT test
110510 - for the clinical study. ref SDS 0 DT8I  Somehow the test was scheduled
110511 - sooner than the 8 week interval specified by UCSF.  This was left
110512 - uncorrected. ref SDS 0 V36R  UCSF explained that previous thin slice
110513 - spiral CT test methods that discovered lung and heart disorders are
110514 - not needed to assess interim effect of treatment on preconditions.
110515 - ref SDS 0 VP4H  Patient emotional condition stabalized by favorable
110516 - response to treatment. ref SDS 0 6A7J  Millie has been treated with
110517 - cetuximab alone longer than other patients, further indicating strong
110518 - response and favorable prognosis. ref SDS 0 6A9H
110519 -
110520 -
110521 -
110523 -  ..
1106 -
1107 -
1108 - Progress
1109 -
110901 - Clinic Examination Orientation Starting Treatment Cetuximab
110902 -
110903 - Follow up ref SDS 75 407N, ref SDS 73 407N.
110905 -  ..
110906 - Agenda...
110907 -
110908 -    1.  Schedule meetings......................... ref SDS 0 9L9N
110909 -    2.  Breast examination........................ ref SDS 0 FO6H
110910 -    3.  Test blood counts NEUTS 1.54.............. ref SDS 0 MZ3N
110911 -    4.  CT test schedule 8 week intervals......... ref SDS 0 DT8I
110912 -    5.  Emotional coping with cancer.............. ref SDS 0 6A7J
110913 -    6.  Prognosis good............................ ref SDS 0 6A9H
110914 -    7.  Infusion Clinic........................... ref SDS 0 1M6H
110915 -    8.  Side effects.............................. ref SDS 0 QU8K
110916 -    9.  Schedule treatments....................... ref SDS 0 QK6L
110917 -   10.  Treatment cetuximab....................... ref SDS 0 4N5M
110918 -   11.  Vitals.................................... ref SDS 0 AW4L
110919 -   12.  Energy after treatment.................... ref SDS 0 F54N
110920 -
110921 -
110923 -  ..
110924 - Schedule 8 Weeks Treatments for Next 2 Cycles Cetuximab Clinical Study
110925 -
110926 - Follow up ref SDS 57 MQ3M.
110927 -
110928 - Millie asked about scheduling meetings for the next few months.  The
110929 - last treatment currently scheduled is in 2 weeks on 070524, shown in
110930 - the record on 070315. ref SDS 57 NM4M   At that time, Jackie explained
110931 - a new procedure for patients to work with scheduling assistants, who
110932 - then contact the doctors and nurses to plan the schedule and enter
110933 - everything in the computer. ref SDS 57 MQ3M
110935 -  ..
110936 - Brigid said the next few months will be difficult scheduling.  The
110937 - doctor's schedule is hectic.  Brigid will be on leave during June for
110938 - military reserve duty.  She checked the computer, and noted that
110939 - everyone's schedule seems full.  She explained that UCSF can schedule
110940 - meetings to fit Millie's weekly treatment cycle, explained on 070201,
110941 - ref SDS 38 DQ3F, and UCSF will assign someone to perform examinations
110942 - when they occur.  Brigid filled out a document.  After the meeting,
110943 - Millie met with the scheduling assistant at the front desk in the
110944 - lobby and submitted Bridig's order for scheduling treatment covering
110945 - the 8-week period after 070524.
110947 -  ..
110948 - The attendant reviewed Brigid's document and checked the computer.
110949 - She left the area for about 15 minutes to consult with Brigid and
110950 - others on the schedule.  She returned and said there are problems with
110951 - the schedule, but that UCSF will schedule meetings without knowing at
110952 - this time who will meet with Millie.
110954 -  ..
110955 - The new schedule for meetings is listed below, integrated with the
110956 - schedule from the Infusion Clinic for additional treatments.
110957 - ref SDS 0 QK6L
110958 -
110959 -
110960 -
110961 -
110962 -
110963 -
1110 -

SUBJECTS
Breast Examination Shows Improvement IBC Rash Intensity Subsides No

1903 -
190401 -  ..
190402 - Breast Examination IBC Intensity Declines
190403 -
190404 - Follow up ref SDS 75 FO6H, ref SDS 73 FO6H.
190405 -
190406 - Examination today shows continuing favorable recovery from 3rd relapse
190407 - of IBC with treatment using cetuximab alone, reported on 070426.
190408 - ref SDS 72 LB5L
190409 -
190410 -
190411 -
190412 -
190413 -
1905 -

SUBJECTS
Blood Tests Schedule Evaluate Blood Counts ANC NEUTS High Enough Saf

3303 -
330401 -  ..
330402 - NEUTS Blood Counts 1.54 Requires No Follow Up Test for Safe Treatment
330403 -
330404 - Brigid said that UCSF received Millie's letter, ref DIP 1 TV4H,
330405 - submitted yesterday on 070509, ref SDS 76 3N4W, and asking about
330406 - follow up tests on blood counts that dropped dramatically 2 weeks ago
330407 - on 070426, ref SDS 73 P560, and then rose slightly last week on
330408 - 070503, but are still well below the level UCSF lists for safe
330409 - treatments. ref SDS 75 P560
330410 -
330411 -
330412 -
330413 -
3305 -

SUBJECTS
CT Scan Test Scheduled 070514 Not Enough Time Respond Patient Reques

4503 -
450401 -  ..
450402 - CT Test Schedule on 8 Week Interval Test for Lung Heart Disorders
450403 -
450404 - Follow up ref SDS 76 3M6V, ref SDS 62 DA8O.
450405 -
450406 - Brigid discussed Millie's letter, ref DIP 1 T76N, yesterday on 070509,
450407 - and reporting notice that Kaiser has scheduled a CT test on 070514.
450408 - ref SDS 76 3M6V
450410 -  ..
450411 - Jackie advised that she coordinated with Kaiser to schedule a CT test
450412 - required by the clincial study protocol.
450413 -
450414 -        [On 070610 primary care physician advises channels of
450415 -        communication now established with UCSF for referral case
450416 -        management. ref SDS 83 GV9G
450418 -  ..
450419 - UCSF performing case management is a big help to Millie, discussed
450420 - further below on relieving patient stress. ref SDS 0 M29K
450422 -  ..
450423 - Discussion on 070301 indicated UCSF saves time relying on patients to
450424 - coordinate work with referring physicians. ref SDS 46 O67N  At that
450425 - time, on 070301, Brigid suggested that Millie schedule a CT test at
450426 - Kaiser. ref SDS 46 CI9L  Millie coordinated on 070307, ref SDS 51
450427 - 9Z9N, and on 070309, Kaiser scheduled a CT test for 070328.
450428 - ref SDS 55 VP5N  Kaiser's schedule conflicted with Brigid's order for
450429 - testing to accomodate Doctor Rugo's schedule.  Millie followed up to
450430 - align Kaiser's work with UCSF requirements, reported in a letter on
450431 - 070314. ref SDS 56 DT4I  Case study on 070307 shows coordination took
450432 - a lot of work, ref SDS 51 G56L, discussed with the medical team at
450433 - UCSF on 070315. ref SDS 57 OG6G
450435 -  ..
450436 - Jackie noted irony of Kaiser scheduling the prior test too late, and
450437 - now scheduling the next CT test on 070514, about 2 weeks earlier than
450438 - requirements of the cetuximab clinical study to test every 8 weeks.
450440 -  ..
450441 - There wasn't enough time during the meeting today for UCSF to submit
450442 - requirements for 8 week testing, discussed in Millie's letter
450443 - yesterday on 070509. ref SDS 76 3N3V
450445 -  ..
450446 - Brigid explained that trauma to the patient from frequent CT tests
450447 - noted in Millie's letter yesterday, ref SDS 76 3N3V, is hard to
450448 - relieve in this case.  Since Kaiser has already scheduled the test on
450449 - 070514, getting this changed to align with UCSF requirements takes a
450450 - lot of work, shown by case study on 070307 presenting Millie's
450451 - experience coordinating work at Kaiser. ref SDS 51 G56L
450452 -
450453 -     [On 070511 Kaiser called Millie to advise that additional blood
450454 -     tests needed for the CT test; Millie explained requirements of the
450455 -     cetuximab clinical study for CT testing on 8 week cycles; Kaiser
450456 -     changed the test date from 070514 to 070520 to better align with
450457 -     UCSF requirements. ref SDS 77 T77M
450459 -      ..
450460 -     [On 070516 Millie notified UCSF schedule changed to meet
450461 -     requirements of clinical study, and reduce trauma to patient from
450462 -     frequent testing. ref SDS 79 EF9M
450463 -
450464 -
450465 -
450466 -
450467 -
4505 -

SUBJECTS
CT Test Scope Schedule 4th Cycle UCSF Clinical Study Cetuximab Asses

6103 -
610401 -  ..
610402 - CT Test Scope Discover Severity Pulmonary Embolism Unnecessary
610403 -
610404 - Follow up ref SDS 76 XR6G.
610405 -
610406 - Brigid discussed evaluation of Millie's pulmonary embolism and Cor
610407 - Pulmonale using thin slice spiral CT technology, which was omitted
610408 - from the last test on 070326, as reported in the record meeting at
610409 - UCSF on 070329, ref SDS 61 0136, and presented in Millie's letter
610410 - yesterday. ref SDS 76 EQ9O
610412 -  ..
610413 - Brigid indicated that UCSF standard of care on the cetuximab clinical
610414 - study does not require notifying Kaiser to use thin slice spiral CT
610415 - technology for the test scheduled for 070517, and in order to increase
610416 - scrutiney 500% from 5 mm scans to 1 mm scans for evaluating presence
610417 - of lung and heart disorders.  This issue was discussed during the
610418 - meeting with Doctor Rugo on 070130.  At that time, UCSF planned
610419 - vigorous testing to manage risks of complications and compounding
610420 - preconditions. ref SDS 36 RS9O  Thin slice spiral CT testing had been
610421 - effective in Millie's case. ref SDS 36 E17H
610423 -  ..
610424 - Today, Brigid seemed to indicate that until pulmonary embolism and Cor
610425 - Pulmonale advance to a point of visibility in CT tests without thin
610426 - slice spiral CT technology the patient has nothing to worry about, and
610427 - can safely continue on the cetuximab clincial study drug trial with
610428 - documented cases of pulmonary embolism and heart disorders, reported
610429 - in the Consent documents received from UCSF on 070116. ref SDS 35 I75I
610430 - Brigid noted UCSF is not worried about Millie being at risk, because,
610431 - so far, standard of care without thin slice spiral CT technology has
610432 - been effective treating other patients at UCSF on the cetuximab
610433 - carbopltin clincial study.
610435 -  ..
610436 - On 070201 UCSF advised there are six (6) patients in the cetuximab
610437 - carboplatin clincial study at UCSF. ref SDS 38 G68L  Millie's patient
610438 - history may be different, illustrated by Jackie's report this morning
610439 - that Millie has responded well to treatment with cetuximab alone
610440 - longer than other patients in the study, per below. ref SDS 0 YF74
610442 -  ..
610443 - Case study on 060722 shows Millie had many CT tests in 2004 in the
610444 - form UCSF proposes today.  None showed pulmonary embolism; yet,
610445 - symptoms increased over many months. ref SDS 18 6G6O  Like today at
610446 - UCSF, ref SDS 0 KD5I, on 041005 Kaiser told Millie not to worry about
610447 - continuing treatment with the Taxol and bevacizumab (Avastin) clinical
610448 - trial, ref SDS 7 RZ4I, which, like cetuximab and carboplatin, reported
610449 - on 070116, ref SDS 35 I75I, had a few cases of death from pulmonary
610450 - embolism, reported on 040812. ref SDS 6 MG4G  At that time, Kaiser
610451 - presented Millie with a dilemma of rising symptoms without explanation
610452 - by testing nor resolution with treatment, and continuing treatment for
610453 - cancer, which, like cetuximab, was effective, but presented risks of
610454 - lung and heart disorders.
610455 -
610456 -     [On 070517 patient history showing only thin slice spiral CT
610457 -     testing has identified lung and heart disorders in Millie's case
610458 -     shows specifying testing that has been effective for Millie does
610459 -     not require the same level of investigation for patients with
610460 -     different patient history. ref SDS 80 WX91
610462 -  ..
610463 - Millie resolved the dilemma by getting a 2nd opinion from UCSF, also,
610464 - reported on 041005. ref SDS 7 OG5L  On 041018 Millie presented the
610465 - issue to Doctor Benz. ref SDS 8 LX96  The doctor explained that
610466 - serious cardiopulmonary disorders can form which busy analysts
610467 - overlook using conventional imaging technology. ref SDS 8 588O  Two
610468 - weeks later, Kaiser scheduled an exigent test on 041103.  The next day
610469 - on 041104 the doctor advised that Millie was diagnosed with pulmonary
610470 - embolism.  Millie was removed from treatment with Taxol bevacizumab
610471 - (Avastin) drug trial. ref SDS 9 RZ4I  Kaiser advised on 041104 that
610472 - blood clots on the lungs, overlooked in previous CT tests, were
610473 - causing symptoms for 6 months, which, if not relieved by immediate
610474 - action, could cause death, ref SDS 9 N43I, and therefore, would
610475 - require disruptive monitoring and treatment for the rest of Millie's
610476 - life. ref SDS 9 4Y9G  Discussion today, seems to indicate this was
610477 - unnecessary overkill because problems discovered on 041103 were not
610478 - identified using CT tests without thin slice spiral CT technology.
610479 - ref SDS 0 KD5I
610481 -  ..
610482 - Millie had another thin slice spiral CT test on 041217.  Kaiser
610483 - reported on 041230 that the test showed the prior condition found on
610484 - 041103 was resolved by treatment. ref SDS 12 PW3K  A year later, after
610485 - many additional tests showed no findings of pulmonary embolism, on
610486 - 051007 Kaiser ended Millie's treatment for pulmonary embolism.
610487 - ref SDS 14 RZ4I  Another year later, after continuing CT tests
610488 - reported no findings of pulmonary embolism, on 060929 Millie
610489 - complained of symptoms. ref SDS 24 B56N  Kaiser performed an exigent
610490 - test the next day on 060930. ref SDS 26 MI5I  On 061002 the doctor
610491 - called and reported the test diagnosed recurrance of pulmonary
610492 - embolism. ref SDS 27 MI5I  Immediate same day treatment was prescribed
610493 - for Millie. ref SDS 27 JK7J
610495 -  ..
610496 - On 061012 Kaiser's report on the test presented findings of enlarged
610497 - right ventricle, ref SDS 28 7E5L, which was not noted in the doctor's
610498 - call on 061002.  Research on 061012 indicates Cor Pulmonale describes
610499 - enlarged right ventricle, and can be caused by pulmonary embolism,
610500 - leading to death. ref SDS 28 L35J  Kaiser's letter submitted by the
610501 - primary care physician on 061228 noted that Millie's Cor Pulmonale may
610502 - have been caused by pulmonary embolism. ref SDS 34 0M6O
610504 -  ..
610505 - On 061020 Kaiser disclosed that CT tests for pulmonary embolism on
610506 - 041103, the follow up on 041218, and the recent test that reported
610507 - recurrence used thin slice spiral technology, ref SDS 30 S56G, which
610508 - is more comprehensive than the other CT tests Millie had which did not
610509 - show lung and heart disorders.
610511 -  ..
610512 - Brigid noted that Millie has no evident symptoms, as occurred with
610513 - prior testing for pulmonary embolism in 2004, and 2006.  Why should
610514 - UCSF recommend Kaiser investigate again with thin slice spiral CT
610515 - testing, as discussed with Doctor Benz on 041018, when currently there
610516 - are no symptoms?  Millie seems healthy today, and has been playing
610517 - tennis, hiking, working out in the gym.  This makes testing for
610518 - cardiopulmonary disorders seem like unnecessary overkill.
610520 -  ..
610521 - Research on 060722 indicated 45% of people who suffer recurrent
610522 - pulmonary embolism suddenly die without any symptoms. ref SDS 18 BI5J
610523 - Research on 061012 further notes that often there are no symptoms of
610524 - Cor Pulmonale until the patient dies. ref SDS 28 LG9L
610526 -  ..
610527 - An example occurred recently while hiking at Lafayette Park.  About 2
610528 - miles along the trail, several emergency vehicles were assembled with
610529 - lights flashing, and attendants conferring.  This was extremely
610530 - alarming, because the trail is quite narrow and remote.  Manuevering
610531 - ambulances, Fire Trucks, and other vehicles bringing assistance was
610532 - difficult and disrupting.  Inquiry among hikers, who saw the incident,
610533 - revealed that an elderly couple were going up one of the steeper
610534 - hills, and the man, perhaps younger than Millie, simply keeled over,
610535 - totally without warning or complaining of symptoms, as noted in
610536 - research. ref SDS 0 AL3K  This person's medical history, and
610537 - disposition are not known.  However, Millie's patient history and
610538 - family history of cardiopulmonary disorders is well known.  Managing
610539 - Millie's disposition requires testing to guide action based on her
610540 - history.
610542 -  ..
610543 - Since cetuximab places Millie at increased risk, per above,
610544 - ref SDS 0 KD5I, this requires increased review.  Since other methods
610545 - have proven ineffective, and since thin slice spiral CT tests have
610546 - proven effective identifying cardiopulmonary disease in Millie's case,
610547 - this method should be proposed by UCSF to meet study requirements.
610549 -  ..
610550 - UCSF's analysis today that lung and heart disease are not serious
610551 - enough for action until disease rises to a level identified by CT
610552 - testing without thin slice spiral CT technology suggests that Doctor
610553 - Benz recommendations in 2004 for Kaiser to investigate were erroneous,
610554 - since Kaiser had already performed such tests and found nothing.
610555 - ref SDS 0 HW5I  Under the UCSF criteria today, findings on 041104
610556 - should have been ignored; Millie should have continued treatment on
610557 - the drug trial for Taxol and bevacizumab (Avastin), and proactive case
610558 - management involving years of treatment for pulmonary embolism have
610559 - been a wasteful mistake, i.e., unnecessary overkill.
610561 -  ..
610562 - Brigid explained that getting Kaiser to align work with requirements
610563 - takes extra time, is difficult and stressful, shown by case study of
610564 - prodigious efforts by Doctor Rugo, Jackie, and others to get Millie
610565 - treated on referral from Kaiser. ref SDS 37 RM4G  It's a lot faster
610566 - and easier to interpret requirements as suggestions that are
610567 - unnecessary overkill, discussed above. ref SDS 0 VP4H
610568 -
610569 -     [On 070514 Millie coordinated with Kaiser to align CT testing with
610570 -     requirements for evaluating preconditions pulmonary embolism and
610571 -     Cor Pulmonale that can become complications from treatments on the
610572 -     cetuximab clinical study. ref SDS 78 IM9O
610574 -  ..
610575 - NASA reported to Congress on 030826 that small problems compound into
610576 - conflict and calamity, because people interpret requirements as
610577 - suggestions, which can be ignored in order to avoid performing work,
610578 - ref SDS 4 8K4G, that can sometimes seem unpleasant and stressful, like
610579 - writing a letter explaining requirements for further investigation, as
610580 - UCSF did on 041018, ref SDS 0 KD84, and which resulted in changing
610581 - the course of care to align with patient history.
610582 -
610583 -     [On 070516 Kaiser discloses all CT scans are thin slice spiral
610584 -     technology; Kaiser chooses to review and analyse test data at
610585 -     different intervals; and since 061030, Kaiser has refused to
610586 -     assess Millie's lung and heart disorders. ref SDS 79 SE4L
610588 -      ..
610589 -     [On 070516 Millie coordinated with Kaiser to perform requirements
610590 -     of clincial study for monitoring lung and heart preconditions by
610591 -     comparing next CT test on 070520 with prior testing that diagnosed
610592 -     pulmonary embolism and enlarged right ventricle (Cor Pulmonale)
610593 -     for trend analysis. ref SDS 79 Y76G
610595 -      ..
610596 -     [On 070517 Kaiser discloses that costs do not justify benefits of
610597 -     performing clincial study requirements to monitor Millie's
610598 -     preconditions of lung and heart disorders in order to guide
610599 -     treatment decisions on saving lives, time, and money. ref SDS 80
610600 -     OS5G
610601 -
610602 -
610603 -
610604 -
6107 -

SUBJECTS
Emotional Trauma Stress Moderate Pulse Normal Cancer Subsides Reliev

7003 -
700401 -  ..
700402 - Emotional Roller Coaster Endemic Cancer Treatment and Coordination
700403 -
700404 - Follow up ref SDS 75 6A7J, ref SDS 73 6A7J.
700405 -
700406 - Brigid asked about coping emotionally with cancer and demands of
700407 - getting treatments on the clinical study, following up discussions on
700408 - 070315? ref SDS 57 6A7J  This issue was discussed more recently on
700409 - 070426 citing improved prognosis. ref SDS 72 Y642
700411 -  ..
700412 - UCSF recent practice providing timely, accurate communication with
700413 - email on evolving medical conditions, shown by Brigid's letter on
700414 - 070501, ref SDS 74 EQ6I, strengthens coordination through team care
700415 - discussed previously on 070301. ref SDS 46 O67N  The doctor patient
700416 - partnership model increases health care effectivness, called out in
700417 - the Kaiser Healthwise Handbook, reviewed on 990625. ref SDS 1 4185
700418 - Better communication helps reduce stress by relieving worry and doubt
700419 - about medical mistakes, reviewed on 990912. ref SDS 2 0001  Using
700420 - email for timely, accurate communication on 070501 may therefore help
700421 - correct problems on 070329 ignoring patient history on side effects.
700422 - ref SDS 61 W25L
700423 -
700424 -        [On 070524 rising cancer marker, and new communication problems
700425 -        preventing collaboration between Kaiser and UCSF increase
700426 -        emotional stress. ref SDS 81 Y642
700428 -         ..
700429 -        [On 070607 sudden attack of Lymphedema compounded by Cellulitis
700430 -        require emergency care cause emotional stress to accelerate
700431 -        like a roller coaster. ref SDS 82 6A7J
700433 -  ..
700434 - Good news of medical improvement reported two (2) weeks ago on 070426,
700435 - ref SDS 72 Y642, relieves stress.  Brigid's letter on 070501 with
700436 - favorable test results for CA 15-3 29, ref SDS 74 EQ6I, cited in the
700437 - letter to UCSF yesterday on 070509, ref SDS 76 KR6K, helps relieve
700438 - stress from worry and doubt about the future.
700440 -  ..
700441 - Good news today that Millie has responded longer with cetuximab alone
700442 - than other patients relieves stress with hope of a longer, productive
700443 - life, per below. ref SDS 0 6A9H
700445 -  ..
700446 - UCSF taking the initiative to coordinate with Kaiser scheduling the
700447 - next CT test relieves a great deal of stress, per above. ref SDS 0
700448 - DT8I  Increasing frequency of testing to six weeks well in advance of
700449 - study requirements increases stress contemplating physical trauma
700450 - enduring the test process, as noted in Millie letter to UCSF
700451 - yesterday. ref SDS 76 3N3V  UCSF avoiding time, effort, and stress
700452 - correcting Kaiser scheduling mistakes to align with requirements,
700453 - ref SDS 0 V36R, increases patient stress performing case management to
700454 - align Kaiser's work with requirements.
700456 -  ..
700457 - Relief from emotional trauma is tempered by rising stress from complex
700458 - communications coordinating referral illustrated by examples listed on
700459 - 070315. ref SDS 57 OR5K  Difficulty getting good people to use good
700460 - management performing test study requirements that align with patient
700461 - history, discussed above, ref SDS 0 TK8H, increases worry and doubt
700462 - about the future, also, illustrated by example presented above.
700463 - ref SDS 0 AL3K
700464 -
700465 -
700466 -
7005 -

SUBJECTS
Prognosis Stable Low Intensity IBC Rash Remarkable Response Treatmen

7903 -
790401 -  ..
790402 - Cetuximab Prognosis IBC May Subside for 10 Months Before Progressing
790403 - Prognosis Disease May Subside 10 Months or More Before Progression
790404 - Progresssion of Disease May be Delayed for 10 Months or More
790405 - 10 Months or More Before Progresssion of Disease Switch to Gemzar
790406 -
790407 - Follow up ref SDS 75 6A9H, ref SDS 73 6A9H.
790409 -  ..
790410 - Brigid seemed to indicate Millie's favorable response to treatment
790411 - with cetuximab alone is remarkable and unexpected in relation to
790412 - experience on the clinical study.
790414 -  ..
790415 - Jackie reported that Millie has been treated with cetuximab longer
790416 - than other patients in the clinical trial.  Usually after a few weeks
790417 - or months, disease progresses, requiring UCSF to upgrade treatment by
790418 - adding carboplatin.  This was considered in Millie's case on 070301,
790419 - but a week later on 070308 falling cancer marker supported impression
790420 - from examinations that IBC rash is subsiding.  This resulted in
790421 - continuing treatment with cetuximab alone. ref SDS 52 YA6O
790423 -  ..
790424 - Favorable response to treatment naturally relieves stress, reported
790425 - above. ref SDS 0 TL3M  Differences responding to treatment in Millie's
790426 - case supports consideration for testing that aligns with patient
790427 - history, also discussed above. ref SDS 0 AL48
790428 -
790429 -
790430 -
790431 -
7905 -

SUBJECTS
Cetuximab Prognosis IBC Subside 10 Months Before Progressing Woman S

8703 -
870401 -  ..
870402 - Gemzar Switched from Cetuximab Carboplatin 10 Months Progression
870403 -
870404 - Millie asked how the woman is doing who was treated for 10 months on
870405 - cetuximab and carboplatin, reported on 070315? ref SDS 57 6A40
870407 -  ..
870408 - Brigid advised that this patient later suffered progression of
870409 - disease, and is now being treated with Gemzar.  On 061201 Kaiser
870410 - proposed switching Millie to Gemzar or Navelbine, ref SDS 33 ZZ9N.
870411 - Gemzar in combination with Taxotere was presented in a 2nd opinion
870412 - received from Doctor Benz on 041117, ref SDS 10 OU6S, following
870413 - consultation at UCSF on 041018.  Later, in a follow up 2nd opinion
870414 - received on 060929 Doctor Benz discussed Navelbine and Gemzar in
870415 - combination with capeticabine. ref SDS 25 WR3Y
870416 -
870417 -
8705 -

SUBJECTS
Side Effects Cetuximab Acne-like Rash Face Dry Skin Face Chest Arms

9303 -
930401 -  ..
930402 - Side Effects Medicated After Weekly Examinations
930403 -
930404 - Follow up ref SDS 75 FO66, ref SDS 73 FO66.
930405 -
930406 - Side Effects were considered carefully by Brigid during examination
930407 - this morning, and again during treatment in the Infusion Clinic,
930408 - reported below. ref SDS 0 QU8K
930409 -
930410 -
930411 -
930412 -
9305 -

SUBJECTS
Cetuximab 4th Cycle 3rd Treatment 15th Total Treatment Chemotherapy

9903 -
9904 - 0845
990501 -  ..
990502 - Infusion Clinic for Cetuximab Treatent
990503 -
990504 - Follow up ref SDS 75 1M6H, ref SDS 73 1M6H.
990506 -  ..
990507 - Millie received 15th overall and 3rd treatment of 4th cycle with
990508 - cetuximab, starting from 070201, ref SDS 38 G68I, and the 22nd
990509 - treatment for 3rd relapse of IBC, beginning on 060721. ref SDS 17 407N
990511 -  ..
990512 - Catherine was the nurse today.
990514 -           ..
990515 -          Taxotere Capecitabine
990516 -
990517 -          Follow up ref SDS 75 PR8Q, ref SDS 73 PR8Q.
990518 -
990519 -                   Relapse Treatments
990520 -
990521 -      1.  Cycle 09 and 01 ................... 060721, ref SDS 17 407N
990522 -      2.  Cycle 10 and 02 ................... 060814, ref SDS 21 LY6O
990523 -      3.  Cycle 11 and 03 ................... 060908, ref SDS 22 407N
990524 -      4.  Cycle 12 and 04 ................... 060929, ref SDS 23 407N
990525 -      5.  Cycle 13 and 05 ................... 061020, ref SDS 29 407N
990526 -      6.  Cycle 14 and 06 ................... 061110, ref SDS 31 407N
990527 -      7.  Cycle 15 and 07 ................... 061201, ref SDS 32 407N
990529 -           ..
990530 -          Cetuxiab Clinical Study
990531 -
990532 -          Follow up ref SDS 75 7T3H, ref SDS 73 7T3H.
990533 -
990534 -                   Total    Cetuximab
990535 -      8.  Cycle 01 and 08 and 01 01.......... 070201, ref SDS 38 SG8I
990536 -      9.  Cycle 01 and 08 and 02 02.......... 070208, ref SDS 40 SG8I
990537 -     10.  Cycle 01 and 08 and 03 03.......... 070215, ref SDS 41 SG8I
990538 -     11.  Cycle 01 and 08 and 04 04.......... 070222, ref SDS 44 SG8I
990539 -     12.  Cycle 02 and 09 and 01 05.......... 070301, ref SDS 49 SG8I
990540 -     13.  Cycle 02 and 09 and 02 06.......... 070308, ref SDS 52 7T3H
990541 -     14.  Cycle 02 and 09 and 03 07.......... 070315, ref SDS 57 7T3H
990542 -     15.  Cycle 02 and 09 and 04 08.......... 070322, ref SDS 58 7T3H
990543 -     16.  Cycle 03 and 10 and 01 09.......... 070329, ref SDS 63 7T3H
990544 -     17.  Cycle 03 and 10 and 02 10.......... 070405, ref SDS 66 7T3H
990545 -     18.  Cycle 03 and 10 and 03 11.......... 070412, ref SDS 68 7T3H
990546 -     19.  Cycle 03 and 10 and 04 12.......... 070419, ref SDS 70 7T3H
990547 -     20.  Cycle 04 and 11 and 01 13.......... 070426, ref SDS 73 7T3H
990548 -     21.  Cycle 04 and 11 and 02 14.......... 070503, ref SDS 75 7T3H
990549 -     22.  Cycle 04 and 11 and 03 15.......... 070510, ref SDS 0 7T3H
990551 -  ..
990552 - Nurses Notes...
990563 -  ..
990564 - Why is the visit number constant in Nurse's Notes, and yet seems to
990565 - vary in the schedule received from Nola last week? ref SDS 57 159O
990567 -     ..
990568 -    UCSF Log Time...
990569 -
990570 -                   Blood
990571 -                    Test   Infusion
990572 -
990573 -          In.......          0830
990574 -          Out......          1130
990575 -          Visit....      Min  3.0  Hours  Total 3 Hours
990577 -      ..
990578 -     Pain Assessment...
990579 -
990580 -          x
990581 -          0123456789 10
990582 -
990583 -     <923k
990584 -     Administration Site:  Right Port Catheter
990585 -     Needle Size:          20 G 1"
990586 -     Blood Return Good:    Yes
990588 -      ..
990589 -     Remind patient to call MD if temp > 101 F, Shaking Chills
990590 -
990591 -            This protocol differs from Kaiser requirements, reported on
990592 -            041202. ref SDS 11 IX9N
990593 -
990594 -
990595 -
990596 -
9906 -

SUBJECTS
Side Effects Infusion Clinic UCSF Consultation Treatment Cetuximab A

AH03 -
AH04 - 0840
AH0501 -  ..
AH0502 - Side Effects Minimal...
AH0503 -
AH0504 - Follow up ref SDS 75 QU8K, ref SDS 73 QU8K.
AH0506 -  ..
AH0507 - Nurse's notes report side effects...
AH0509 -             ..
AH0510 -        1.  Rash acne-like
AH0511 -
AH0512 -            Follow up ref SDS 75 SK9O, ref SDS 73 SK9O.
AH0513 -
AH0514 -            Very mild facial rash continues from 070208 around the nose
AH0515 -            and chin. ref SDS 40 QU8K  Treatment effective prescribed
AH0516 -            on 070222. ref SDS 44 FO66
AH0517 -
AH0519 -             ..
AH0520 -        2.  Dry skin face, chest arm
AH0521 -
AH0522 -            Follow up ref SDS 75 JS6M, ref SDS 73 JS6M.
AH0523 -
AH0524 -            Background reported on 070503. ref SDS 70 JS6M  Condition
AH0525 -            continues controlled with Curel treatment prescribe on
AH0526 -            070301, ref SDS 46 5V73, and later Aquaphor on 070322.
AH0527 -            ref SDS 58 JS6M
AH0528 -
AH0530 -             ..
AH0531 -        3.  Lymphedema Cellulitis Complications
AH0532 -            Inflammation Erratic Upper Left Arm Side Effects Cetuximab
AH0533 -
AH0534 -            Follow up ref SDS 75 SU6L, ref SDS 73 SU6L.
AH0535 -
AH0536 -            Lymphedema continues relatively controlled with major
AH0537 -            swelling in the left reduced this morning to 10.75, cited
AH0538 -            in the study on 060509. ref SDS 15 HO7F  There is no evident
AH0539 -            association with cetuximab treatments.
AH0541 -             ..
AH0542 -            Intensity of rash on the upper left arm continues to rise
AH0543 -            and fall since the report at Kaiser on 070330. ref SDS 65
AH0544 -            N19J Causes of erratic inflammation are listed in the
AH0545 -            record for treatment last week on 070426. ref SDS 73 8B8Y
AH0547 -             ..
AH0548 -            Today, there is no evidence of increased inflammation on
AH0549 -            the upper left arm, continuing favorable report for
AH0550 -            examination last week on 070503, ref SDS 75 8B8I, and
AH0551 -            previously by the medical team on 070426. ref SDS 72 115F
AH0552 -
AH0554 -             ..
AH0555 -        4.  Tired, fatigued - pulmonary emoblism
AH0556 -
AH0557 -            Follow up ref SDS 75 FG3N, ref SDS 73 FG3N.
AH0558 -
AH0559 -            Fatigue, shortness of breath and other symptoms of
AH0560 -            pulmonary embolism were presented during meeting on 070130,
AH0561 -            ref SDS 36 CV5L, citing case study listed on 060722.
AH0562 -            ref SDS 18 ZV41  These are also side effects of cetuximab
AH0563 -            treatments, reported on 070116. ref SDS 35 O64M  Planning
AH0564 -            was discussed this morning with the medical team for thin
AH0565 -            slice spiral CT test to assess pulmonary embolism and Cor
AH0566 -            Pulmonale (enlarged right ventricle), per above.
AH0567 -            ref SDS 0 VP4H
AH0569 -             ..
AH0570 -            Energy and exercise remain active, reported on 070503.
AH0571 -            ref SDS 75 CA4K
AH0573 -             ..
AH0574 -            Millie has been taking naps 2 - 3 hours after treatments
AH0575 -            the past month, beginning on 070405. ref SDS 66 BB7G  May
AH0576 -            indicate accumulating effects of cetuximab that make
AH0577 -            patients tired, listed as side effect in Consent documents
AH0578 -            reviewed on 070116. ref SDS 35 O64M
AH0579 -
AH0581 -             ..
AH0582 -        5.  Heavy chest - shortness of breathing
AH0583 -
AH0584 -            Follow up ref SDS 70 UL6L
AH0585 -
AH0586 -            Patient history was reported to UCSF on 070130. ref SDS 36
AH0587 -            RT6I
AH0589 -             ..
AH0590 -            Condition seems improved, tracking continuing higher
AH0591 -            energy, per above. ref SDS 0 CA4K
AH0592 -
AH0594 -             ..
AH0595 -        6.  Cough - clearing throat
AH0596 -
AH0597 -            Follow up ref SDS 70 8N4G
AH0598 -
AH0599 -            Condition seems less evident lately.
AH0600 -
AH0601 -
AH0602 -
AH0603 -
AH07 -

SUBJECTS
Schedule Treatment Weekly Thursday 0830 4 Week Cycles Clinical Study

AP03 -
AP0401 -  ..
AP0402 - Schedule Weekly Treatments Continue on Thursdays
AP0403 -
AP0404 - Follow up ref SDS 75 QK6L, ref SDS 73 QK6L.
AP0406 -  ..
AP0407 - Millie's next treatment is scheduled for 070517 0830, reported by Nola
AP0408 - on 070315. ref SDS 57 159O
AP0410 -  ..
AP0411 - This morning, Millie asked Nola about scheduling treatments for the
AP0412 - next few months, per discussions with the medical team reported above.
AP0413 - ref SDS 0 9L9N  Nola checked the computer and submitted an updated
AP0414 - schedule that also shows meetings with the doctor for examinations...
AP0416 -     ..
AP0417 -    Date  Time  Staff      Sta Type Dept  Loc  Dur Number Cycl/Trmnt
AP0418 -    -----------------------------------------------------------------
AP0419 -    070531 0830  Catherine    PEN  P1H  CCINF  INF  60            05  02
AP0420 - ?  070607 0800  Brigid       PEN  CHF  BCC    Z4F  30  12997853  05  03
AP0421 -                 Jackie
AP0422 -    070607 0830  Catherine    PEN  P1H  CCINF  INF  60  12997886  05  03
AP0423 -    070614 0830  Catherine    PEN  P1H  CCINF  INF  60  12997890  05  04
AP0424 -    070621 0800  Doctor Rugo  PEN  CHF  BBC    Z4F  30  12997859  06  01
AP0425 -                 Mary Lou
AP0426 -                 Jackie
AP0427 -    070621 0830  Catherine    PEN  P1H  CCINF  INF  60  12997893  06  01
AP0428 -    070628 0830  Catherine    PEN  P1H  CCINF  INF  60  12997897  06  02
AP0429 - ?  070705 0800  Doctor Rugo  PEN  CHF  BCC    Z4F  30            06  03
AP0430 -                 Brigid
AP0431 -                 Jackie
AP0432 -    070705 0830  Catherine    PEN  P1H  CCINF  INF  60  12997900  06  03
AP0433 -    070712 0830  Catherine    PEN  P1H  CCINF  INF  60  12997902  06  04
AP0434 -    070719 0800  Doctor Rugo  PEN  CHF  BBC    Z4F  30  12997805  07  01
AP0435 -                 Brigid
AP0436 -                 Jackie
AP0437 -    070719 0830  Catherine    PEN  P1H  CCINF  INF  60  12997914  07  01
AP0438 -    070726 0830  Catherine    PEN  P1H  CCINF  INF  60  12997916  07  02
AP0439 - ?  070802 0830  Doctor Rugo  PEN  CHF  BCC    Z4F  30  12997818  07  03
AP0440 -                 Brigid (military duty)
AP0441 -                 Jackie
AP0442 -    070802 0900  Catherine    PEN  P1H  CCINF  INF  60  12997919  07  03
AP0444 -  ..
AP0445 - ?? Questions on the Schedule...
AP0446 -
AP0447 -        1.  Doctor Rugo is listed for meeting with Millie on 070607
AP0448 -            which is the 3rd treatment of the 5th cycle.
AP0449 -
AP0450 -            Normally, Doctor Rugo sees Millie only on the 1st
AP0451 -            treatment to start each new cycle.
AP0453 -             ..
AP0454 -        2.  No meeting is schedule for 070705 which is the 3rd
AP0455 -            treatment of the 6th cycle.
AP0457 -             ..
AP0458 -            UCSF has been meeting regularly with Millie for the 3rd
AP0459 -            cycle of treatments, as planned during the meeting on
AP0460 -            070201. ref SDS 38 DQ3F
AP0462 -             ..
AP0463 -        3.  Doctor Rugo is listed for meeting with Millie on 070802
AP0464 -            which is the 3rd treatment of the 7th cycle.
AP0466 -             ..
AP0467 -            Normally, Doctor Rugo sees Millie only on the 1st
AP0468 -            treatment to start each new cycle.
AP0469 -
AP0470 -
AP0471 -
AP0472 -
AP05 -

SUBJECTS
Port Catheter IV Connection Prepare for Drip Treatment 1 Try Require

AX03 -
AX04 - 0845
AX0501 -  ..
AX0502 - Preparation for Treatment Required One (1. Attempt to Connect Port
AX0503 -
AX0504 - Follow up ref SDS 75 EB7J, ref SDS 73 EB7J.
AX0506 -  ..
AX0507 - The nurse connected the IV tubes to the port....
AX0509 -       ..
AX0510 -      Interlink System Vented Paclitaxel set
AX0512 -  ..
AX0513 - Like last week and earlier on 070301, there were no problems getting
AX0514 - blood to flow from the port, ref SDS 49 EB7J, as occurred on 070222,
AX0515 - ref SDS 43 DC5W, and earlier on 070201. ref SDS 38 DC5W
AX0517 -  ..
AX0518 - The nurse flushed the port with saline.
AX0520 -  ..
AX0521 - Prior inflammation above and at the port catheter penetration reported
AX0522 - on 070419, ref SDS 70 UJ4M, has improved, reported on 070503.
AX0523 - ref SDS 75 RQ4O
AX0524 -
AX0525 -
AX06 -

SUBJECTS
Benadryl Pre-treatment Prepares Patient for Cetuximab Chemotherapy A

B403 -
B404 - 0900
B40501 -  ..
B40502 - Benadryl Reduce Side Effects Cetuximab Chemotherapy Treatment
B40503 -
B40504 - Follow up ref SDS 75 DC7J, ref SDS 73 DC7J.
B40505 -
B40506 - Benadryl (diphenhydramine) started.   25 MG....... ref SDS 73 IJ44
B40507 -
B40508 -        Purpose reported on 060721. ref SDS 16 DC7J
B40510 -  ..
B40511 - Chemotherpay order calls for Benadryl (diphenhydramine) pre-treatment
B40512 - 30 - 60 minutes prior to cetuximab infusion, shown below. ref SDS 0
B40513 - IJ41
B40514 -
B40515 -
B40517 -  ..
B406 -
B407 -
B408 - 0920
B409 -
B40901 - Benedryl completed equipment beeps.
B40902 -
B40903 -
B40904 -
B40906 -  ..
B410 -
B411 -
B412 -
B413 -
B41301 - Decadron (dexamethasone) IV pre-treatment........ ref SDS 58 FM4M
B41302 -
B41303 - On 070208 Decadron was not given because Millie did not experience
B41304 - side effects of nausea and vomitting after treatment with cetuximab on
B41305 - 070201. ref SDS 40 G57I  Since this favorable condition continues, per
B41306 - above, ref SDS 58 D19M, Decadron was not given again today.
B41307 -
B41309 -  ..
B414 -
B415 -
B416 -
B41601 - Decadron completed -- not reported.
B41602 -
B41603 -
B41604 -
B41605 -
B417 -

SUBJECTS
Cetuximab 4th Cycle 3rd Treatment Blood Counts Below Safe Levels Cli

BE03 -
BE04 - 0940
BE0501 -  ..
BE0502 - Cetuximab Full Dose Blood Counts Below Targets Treatment 1 Hour
BE0503 -
BE0504 - Follow up ref SDS 75 4N5M, ref SDS 73 4N5M.
BE0506 -  ..
BE0507 - Cetuximab started.
BE0508 -
BE0509 -           Verify chemotherapy order for 070208.
BE0511 -  ..
BE0512 - Chemotherapy order calls for cetuximab to start 30 - 60 minutes after
BE0513 - Beyadryl pre-tretment. ref SDS 73 IJ41
BE0515 -  ..
BE0516 - Millie received a full dose of cetuximab treatment, even though blood
BE0517 - counts from the test last week on 070503 were below the level for safe
BE0518 - treatment, discussed above, ref SDS 0 MZ3N, and prior review on
BE0519 - 070503, ref SDS 75 P560, citing the record showing Millie has often
BE0520 - has treatments with low blood counts. ref SDS 75 V75F
BE0522 -  ..
BE0523 - Chemotherapy Orders...
BE0524 -
BE0530 -    Auth#                                     Stor BCC LOC
BE0531 -    Visit:  12575738             DOS 20070201
BE0533 -     ..
BE0534 -    Date:  20070201
BE0536 -     ..
BE0537 -    Study Order for CC#05752:  Phase II Trial of Cetuximab alone and
BE0538 -    in combination with Carboplatin in ER-negative, PR-negative,
BE0539 -    HER2-negative Nonoverexpressing Metastatic Breast Cancers
BE0541 -     ..
BE0542 -    Dates to be given:  070201
BE0543 -    Arm 1:Cetuximab alone
BE0545 -     ..
BE0546 -    Diagnosis:  breast cancer
BE0548 -     ..
BE0549 -    ICD-9 codes: 174.9
BE0550 -    Allergies  NKDA
BE0552 -     ..
BE0553 -    Pre-medications 30 - 60 minutes prior to cetuximab infusion
BE0555 -     ..
BE0556 -    4. Diphenhydramine 25 mg IV or  [illegible writing]
BE0557 -
BE0558 -       Benadryl........... ref SDS 58 DC7J
BE0559 -
BE0560 -       On 070329 Brigid changed the Chemotherapy Order reducing
BE0561 -       Diphenhydramine (Benadryl) from 50 mg to 25 mg in order to
BE0562 -       reduce side effects of "restless legs." ref SDS 63 IJ44
BE0564 -        ..
BE0565 -       This was effective, reported above. ref SDS 63 7R6H
BE0567 -     ..
BE0568 -    5. Dexamethasone (??) 10 mg IB or 20 mg IV [handwritten ???]
BE0569 -
BE0570 -       Further premed TBD [barely legible handwriting??]
BE0572 -     ..
BE0573 -    Medication:  (plan to give weekly ********STUDY SUPPLY**********
BE0575 -     ..
BE0576 -    6. Cetuximab (Erbitux) (loading dose)
BE0577 -
BE0578 -              400 mg/m [squared] = 684 mg IV over 120 minutes for
BE0579 -              first dose x 1
BE0580 -
BE0581 -       dose on dcte 20070201   Maximum infusion rate is 5 ml/minute
BE0582 -       (concentration 2 mg/ml)
BE0584 -     ..
BE0585 -    7. Cetuximab (Erbitux) (maintenance dose)
BE0586 -
BE0587 -              250 mg/m [squared] = 428 mg IV (or ____ mg/m[squared] =
BE0588 -              ____mg) IV over 60 or ____ minutes.
BE0589 -
BE0590 -       Maximum infusion rate is 5 ml/minute (concentration 2 mg/ml)
BE0591 -       Infuse once weekly for 8 weeks.  First dose to be given on date
BE0592 -       20070201.
BE0594 -        ..
BE0595 -       Cetuximab is administered undiluted through a low protien
BE0596 -       binding 0.22 micro in-line filter.  Use NS solution to flush the
BE0597 -       line at the end of the infusion.
BE0599 -        ..
BE0600 -       ARM 2:  Administer carboplatin of vital signs are unremarkable
BE0601 -       one hour after cetuximab infusion.
BE0603 -        ..
BE0604 -       Vital signs at baseline, upon cetuximab completion and one hour
BE0605 -       after cetuximab.
BE0606 -
BE0607 -       ****please note start and stop times****
BE0609 -        ..
BE0610 -       Laboratory work:
BE0611 -
BE0612 -          See carboplatin orders
BE0614 -        ..
BE0615 -       x  Notify MD for dose modifications if patient has severe
BE0616 -          acne in form rash
BE0617 -
BE0618 -          CBC with differential and platletes every 4 weeks
BE0619 -          Creatinine and magnesium every 4 weeks
BE0620 -          BUN AST Alk phos Alt Total bilrubin, electrolyes every 8
BE0621 -          weeks.  If levels are outside of normal laboratory values
BE0622 -          notify Brigid NP  (MD/RN) at 415 443 4730
BE0624 -        ..
BE0625 -       x  Physician has discussed risks/benefits of therapy with the
BE0626 -          patient.  Signed consent obtained.
BE0627 -
BE0628 -
BE0629 -          Yes   5.  O2 by nasal cannula at 2 liters/min prn for chest
BE0630 -          pain or SOB
BE0632 -           ..
BE0633 -          Yes   6.  Diphenhydramine 50 mg IV prn x1 for urticaria
BE0634 -          [barely legible], pruritis SOB
BE0636 -           ..
BE0637 -          Yes   7.  Hydrocortizone 100 mg IV prn x1 for urticaria
BE0638 -          [barely legible], pruritis SOB
BE0640 -           ..
BE0641 -          Yes   8.  Albuterol inhaler 2-4 puffs prn SOB or chest
BE0642 -          tightness
BE0644 -           ..
BE0645 -          Yes   9.  Epinephrine 1x1000 (1 mg/ml) 0.3 mg IV prn
BE0646 -          anaphylaxis
BE0648 -           ..
BE0649 -          Breast CC05752 Cetuximab doc 20061024
BE0650 -          Approved 20060615
BE0652 -           ..
BE0653 -          Physician signature [Hope Rugo]
BE0655 -           ..
BE0656 -          Provider#  35313
BE0658 -           ..
BE0659 -          Date:  20010131
BE0660 -
BE0662 -  ..
BE07 -
BE08 -
BE09 - 1045
BE10 -
BE1001 - Cetuximab treatment completed.
BE1002 -
BE1003 - Millie had a 1 hour rest and observation period, required by the
BE1004 - protocol. ref SDS 0 G679
BE1005 -
BE1006 -
BE1007 -
BE1009 -  ..
BE11 -
BE12 -
BE13 - 1145
BE14 -
BE1401 - Nurse disconnected the IV tubes.
BE1403 -  ..
BE1404 - She inserted Herceptin to flush the port.
BE1406 -  ..
BE1407 - She then removed the needle from the port, and swabbed the needle
BE1408 - wound, and placed a temporary bandage.
BE1409 -
BE1410 -
BE1411 -
BE1412 -
BE1413 -
BE15 -

SUBJECTS
Vitals Blood Pressure Pulse Temperature Sa02 Weight Infusion Treatme

BL03 -
BL04 - 0900
BL0501 -  ..
BL0502 - Vitals Show Patient Stable
BL0503 -
BL0504 - Follow up ref SDS 75 AW4L, ref SDS 73 AW4L.
BL0505 -
BL0506 -                    Blood
BL0507 -    Date   Time     Pressure   Pulse  Temprtr  Weight   So2
BL0508 -    .
BL0509 -    070510 1145..... 145  86     54     35.9c           100
BL0510 -    070510 1045..... 149  82     69     37.0c            97
BL0511 -    070510 0900..... 132  75     62     36.8c            99
BL0512 -    070503 1150..... 113  67     59     36.8c            98
BL0513 -    070503 1055..... 125  72     54     36.1c           100
BL0514 -    070503 0915..... 127  70     60     36.9c            99
BL0515 -    070426 1130..... 119  70     57     36.3c            96
BL0516 -    070426 1030..... 141  73     67     36.4c            99
BL0517 -    070426 0900..... 130  78     52     36.5c            97
BL0518 -    070419 1230..... 133  79     57     36.3c            98
BL0519 -    070419 1130..... 141  78     56     37.6c **1        99
BL0520 -    070419 0930..... 153  80     53     36.1c           100
BL0521 -    070412 1120..... 114  65     53     36.6c            96
BL0522 -    070412 1020..... 130  66     57     36.8c            99
BL0523 -    070412 0900..... 116  69     65     36.8c            97
BL0524 -    070405 1130..... 133  75     55     36.2c            97
BL0525 -
BL0526 -            Consistently low pulse, does it reflect low blood pressure
BL0527 -            side effect of cetuximab, or improved fitness from working
BL0528 -            out that benefits emotional stress and immune system?
BL0530 -     ..
BL0531 -    070405 1030..... 114  69     57     36.4c            99
BL0532 -    070405 0900..... 128  78     54     36.5c           100
BL0533 -    070329 1140..... 125  74     53     36.8c            98
BL0534 -    070329 1045..... 125  72     53         c           100
BL0535 -    070329 0900..... 141  76     60     36.6c            99
BL0536 -    070322 1055..... 118  71     55     37.0c            97
BL0537 -    070322 1015..... 120  69     57     37.1c            98
BL0538 -    070322 0900..... 130  70     56     36.0c            98
BL0539 -    070315 1300..... 119  75     58     36.2c            98
BL0540 -    070315 1150..... 137  73     52     36.5c            99
BL0541 -    070315 0945..... 143  85     60     36.4c            97
BL0542 -    070308 1100..... 144  87     70     36.0c            98
BL0543 -    070301 1645..... 125  62     90 *   36.4c
BL0544 -    070301 1505..... 112  69     86 *   36.6c            98
BL0545 -    070222 1145..... 115  73     58     36.3c   147      98
BL0546 -    070222 1045..... 100  60     56     36.6c   147      98
BL0547 -    070222 0930..... 117  63     68     36.2c   147      97
BL0548 -    070215 1200..... 106  66     61     37.0c   147      97
BL0549 -    070215 1055.....  96  61     64     37.0c   147      94
BL0550 -    070215 0930..... 100  64     66     36.7c   147      98
BL0551 -    070208 0920..... 143  70     59     36.5c   147      98
BL0552 -    070201 1330..... 136  74     66             148      94
BL0553 -    070201 1220..... 110  65     62     36.3c   148      96
BL0554 -    070201 1000..... 132  80     65     36.9c   148      99
BL0555 -    061201 1534..... 123  76     76     97.5    150
BL0556 -    061110 1534..... 136  83     73     97.0    150      98
BL0557 -    061020 1534..... 140  79     67     99.8    151      97
BL0558 -    060929 1452..... 141  78     66     98.3    149
BL0559 -    060908 1335..... 139  79     73     98.1    149
BL0560 -    060814 1610..... 139  80     59     98.2    151
BL0561 -    060722 1440..... 142  74     67     98.1    149
BL0562 -    060711.......... 172  87     54     97.5    147
BL0563 -    060623.......... 141  87     71     98.0    147
BL0564 -    060428.......... 129  73     80     99.4    149
BL0565 -    060217.......... 153  81     61     98.6    150
BL0566 -    050916.......... 120  80     80     98.5
BL0567 -
BL0568 -  *    Need vitals taken twice to verify atypical diagnostics.
BL0569 -  **1  Nurses Notes seem to show 97.6 which is cellcius scale.
BL0570 -
BL0571 -
BL0572 -
BL06 -

SUBJECTS
Energy Normal Stable Alert Drive Home After Treatment Tired Sleep 2

BZ03 -
BZ04 - 1130
BZ0501 -  ..
BZ0502 - Energy Normal Stable After Treatment Cetuximab Support Drugs
BZ0503 -
BZ0504 - Follow up ref SDS 75 F54N, ref SDS 73 F54N.
BZ0506 -  ..
BZ0507 - On 060724 diary side effects for cetuximab chemotherapy treatment on
BZ0508 - clinical study drug trial. ref SDS 19 YP4I
BZ0510 -  ..
BZ0511 - Millie was alert after treatment again today, and not wobbly nor
BZ0512 - disoriented.  She was able to drive home without side effects of
BZ0513 - treatment.
BZ0515 -  ..
BZ0516 - Today, we experimented again and drove South on highway 17 toward San
BZ0517 - Jose.  We were able to turn around before getting to Hegenberger road,
BZ0518 - and go North back to Oakland and then taking Highway 24 to Concord,
BZ0519 - because the bridge from the San Francisco - Oakland Bay bridge to get
BZ0520 - to Highway 24 on the way to Walnut Creek was exploded by a truck
BZ0521 - accident a few days ago.  This made the trip home about 50 minutes
BZ0522 - instead of 40 minutes.
BZ0524 -  ..
BZ0525 - After arriving home about 1300, Millie took a nap from about 1410
BZ0526 - until about 1600.  Could relate to side effects from cetuximab
BZ0527 - treatments that cause fatigue, reported on 070116. ref SDS 35 O64M
BZ0528 -
BZ0529 -
BZ0530 -
BZ0531 -
BZ0532 -
BZ0533 -
BZ0534 -
BZ06 -