ONCOLOGY FOLLOWUP NOTE

DIAGNOSES:
1. Diffuse large B-cell lymphoma, stage III-A.
2. Anemia, chronic disease.
3. Chemotherapy-related neutropenia.
4. Dysphagia.
5. Hypokalemia.
6. Coronary artery disease.

SUBJECTIVE: The patient returns to clinic today for continued evaluation of

his lymphoma. He is unfortunately not due for chemotherapy until this
Friday, and it is unclear why he was scheduled this day. In the past few
weeks, he has needed to be taken by ambulance to XXXX Hospital. He was
apparently significantly hypokalemic, although we do not have records, and
although it appears that he only received replacement with oral potassium
rather than intravenous potassium. He was also told that he had “a touch
of pneumonia,” and apparently got a z-pack; he has improved. Apparently,
he had rigors. The patient never takes his temperature at home, so we do
not know if he had a fever. Today, he is feeling fairly good. His major
complaint today, besides the dysphagia which has improved, is numbness in
his left hand, greater than his right hand.

OBJECTIVE: TEMPERATURE: 97.9 degrees Fahrenheit; BLOOD PRESSURE: 154/69;

PULSE: 85; WEIGHT: 159 pounds. On examination today he still has a mass in
the retropharyngeal space.

LABORATORY DATA: From today, chemistries and liver function tests are
normal, other than a glucose of 116. His potassium is normal at 4.5. CBC:
White count 7.6; hemoglobin 15.5; hematocrit 46.8; platelet count is 266.
Differential is 68.6% neutrophils; 15.8% lymphocytes.

ASSESSMENT: A XX-year-old gentleman with diffuse large B-cell lymphoma who

will be due for chemotherapy on Friday, and I will write his orders
today. Unfortunately, he did not receive enough Neupogen. It is unclear
if he was neutropenic at the time that he had pneumonia, and for this
cycle, he will get 6 doses of Neupogen. In addition, because of his
neuropathy, I will cut is vincristine dose to 1 mg.

PLAN:
1. Cancel chemotherapy nurse today.
2. Chemotherapy nurse to be scheduled on Friday.
3. Premedication with ondansetron 8 mg and dexamethasone 12 mg IV
piggyback.
4. Cytoxan, 1,400 mg IV push.
5. Vincristine, 1 mg IV push.
6. Prednisone, 100 mg p.o. q. day x5 days.
7. Rituximab, 700 mg IV.
8. Neupogen 300 mcg, subcutaneous q. day x6 days beginning 1 day
following chemotherapy.
9. Return on August 2, 2005 for post-chemotherapy check.

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