Re: Mrs. Nailya Pazletdinova Re: Chemotherapy Regimen

Date: ЗО"" January, 2019 Dear Doctor,
Re: Mrs. Nailya Pazletdinova " Re: Chemotherapy Regimen:
Who is a patient of ours has been diagnosed with Carcinoma Ovary Treatment history:
i would suggest to give her treatment as per the schedule written below:
The patient has been explained about the prognosis, nature of treatment, outcome, response, cost, duration and toxicity of the treatment. Patient planned for 3 cycles of chemotherapy with Paclitaxel + Carboplatin Dl, D8 & D15 (in total of 9 doses) out of which she already underwent 1^' cycle of chemotherapy Day 1 under my care at Max Cancer Center, Saket. On 28.01.19. Patient wishes to take the chemotherapy treatment under your care at local place. Please give her more 8 doses of chemotherapy as per given schedule.
Chemotherapy dates are due on :- 4.02.19, 11.02.19, 25.02.19, 4.03.19, 11.03.19, 25.03.19,1.04.19,8.04.19
Premedication
•:♦ Inj. Palnox250 meg + Inj. Avil 1 amp + Inj. Rantac 50 mg + Inj. Dexa 8 mg 100 ml NS
IV over 30 minutes >
Chemotherapy administration
•:• Inj. Paclitaxel 130 mg in 500 ml NS IV over 2 hours
♦ Inj. Carboplatin (AUC 2) 160 mg in 500 ml NS IV over 2 hours,
'> Flush with 100ml NS.

Chemotherapy Regimen; '-■--■][:.-"^::.'-:_■■;■-:■:.■■::.i.^:-:..[: r:-: ,■■ ■;■■ CBC, LFT, RFT, before each session of each cycle.
Discharge Medications and Instructions:
♦ Tab. Domstal 10 mg 2tabs thrice daily before meals x 3 days then if
for nausea / vomiting
♦ Tab. Pantocid 40 mg once daily (before breakfast)
♦:• Tab. Ultracet Itab as and when required for pain
•:♦ . Tab. CalcQome 100 mg Itab twice daily
<• Cap. A to Z once daily
♦ Xerostene mouth was thrice daily
♦:• Syp. Looz 30ml at bed time for constipation
For Vomiting: Kindly mark the ones to be prescribed

• 
  1, Tab. Emeset 04/08/16/32 mg PO IDS ,■ " ,
  
• 
  2. Tab. Domstal 10/20 mg PO TDS ■■ ..
  
• 
  3. Tab Aprecap 80 mg PO Daily X 2 days.
  
• 
  4. Tab. Grainsetron 1 mg PO TWICE DAILY ■
  
• 
  5. Tab. Dexona 02/04/08 mg twice daily x 3 days
  

For Indigestion: Kindly mark the ones to be prescribed

• 
  1. Tab. Pantocid 40mg PO daily 30mins before meals '''"•
  
• 
  2, Syp. Digene 2tsf PO every Shouriy •
  
• 
  3. Tab. Rantac 150/300mg PO twice daily I I 4. Tab. Razo 20mg twice daily
  

For Fever: Kindly mark the ones to be prescribed

• 
  1. Tab. Calpol/ crocin 500 mg stat and do a CBC (Complete Blood Count)
  
• 
  2. Tab. Ciprofloxacin 500mg BD X 5 days CZl 3. Cap. Augmentin Duo 625mg BDX5 days
  
• 
  4, Tab. Cefixime (200mg) BDX 5 days • . : . .. .
  

• 
  5. Tab. Acyclovir (200 mg) ODX days
  
• 
  6. Tab. Bactrim DS
  

In case of loose motions: Kindly mark the ones to be prescribed

• 
  1. Cap. Imodium/Tab, Lomotil one stat and then one every 5 hrs.
  
• 
  2. Tab Redotil lOOmg Po TDS ^._,,,
  
• 
  3. Plenty of oral fluids ' ■;; I I -4. O.R.S. / Electral powder (I satchet dissolved in 1 Litre )
  

In case of Constipation: Kindly mark the ones to be prescribed
I I 1. Syp. Cremaffin plus 2 tsf PO at night

• 
  2. Syp. Duphalac 2 tsf PO at night
  
• 
  3. Tab. Dulcolax 2 tab Po at night -For Pain: Kindly mark the ones to be prescribed
  

I I 1. Cap. Prooxyvon 1 cap SOS

• 
  2. Tab. Crocin 500mg PO Three times a day
  
• 
  3. Tab. Tramadol 50 mg PO BD
  

For Oral Ulcers: Kindly mark the ones to be prescribed
□ 1, Tab. Forcan lOOmg PO BD For 5 days
I I 2. Chlorhexidine/ Betadine gargles twice daily
□ 3. Dologel for local application three times a day
I I 4. Mucalne Gel 2 tsf three times a day
I I 5. Boroglycerine with Tab Dexona 4 mg crushed and mixed together to be applied In mouth Three times a day. Following blood tests to be done 1-2 days before chemo, reports to be verified before administering chemotherapy. Kindly mark the ones to be prescribed

• 
  1, CBC
  

• 
  2. KFT
  
• 
  3. LPT
  

CBC, KFT and if indicated LFT's to be repeated before every chemoihcrap) trcaimcni, CBC to be done in between two chemotherapy cycles for safe monitoring, approximately 7-10 days after treatment.
Growth factors / colony stimulating factors to be used as per the clinical indications and
need. ' ■, . ,
It should be noted that this letter is only recommendatory in nature and is being written because the patient does not wish to take further treatment at this hospital under our direct supervision. The chemotherapy regimen mentioned above should be undertaken by a doctor who is trained and experienced in handling chemotherapy drugs. The treating doctor should exercise his / her judgment at all times including modiflcalion / termination of the regimen if required. The responsibility for the appropriate conduct of the above mentioned regimen, including management of any side effects, shall lie with the treating doctor. Please repeat the CBC, KFT & LFT before every cycle. The next cycle should be started only if the WBC count is > 3500/mm^ and the platlet count is > ЮОООО/тт"* In case the patient develops fever at anytime the CBC should be repeated at the time and treated accordingly.
The patient should follow up with me after completion of chemotherapy.