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1...What supports the 14k+ figure? Are these different parameters or
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SUBJECTS
Treatment Trial Zilog Epothilone BMS 247550 Plus Capecitabine Protoc
Red Breast Left Side Rash Worsen Covers More Area Darker Coloration
IBC Red Breast Rash Left Side Recedes from Covering More of Breast B
Emergency Kaiser Temperature 102 IBC Red Breast Rash Left Side Reced
0706 -
0706 - ..
0707 - Summary/Objective
0708 -
070801 - Follow up ref SDS 18 0000.
070802 -
070803 - IBC symptoms increased significantly today, and cost $50 to discover
070804 - this was expected side effects of prescribed treatment. ref SDS 0 0148
070805 - The rash on the left breast widened. Coloration declined in some
070806 - areas, but is much worse under the arm. The appearance was alarming.
070807 - Millie's temperature was elevated above 101, and her left arm had a
070808 - slight ache. ref SDS 0 S96L Called Kaiser to report new conditions.
070809 - Guidance from Oncology said to get treatment at the Emergency Room
070810 - when temperature rises above 100.5. ref SDS 0 IX9N Examination in the
070811 - Emergency Room showed temperature dropped to 99.9. ref SDS 0 016E
070812 - Doctor Parsley indicated cause of increased IBC symptoms is expected
070813 - part of recovery using medication ordered by the primary care
070814 - physician a few days ago to treat a wound to the left breast.
070815 - ref SDS 0 RC92 Cellulitus was diagnosed, and existing treatment with
070816 - antibiotics was supported. Good news blood tests showed WBC count is
070817 - very high, which supports diagnosis that increased IBC symptoms are
070818 - attributed to cellulitus, and not to an increase in cancer activity.
070819 - ref SDS 0 W47N Follow up in 2 days at ER or with primary care
070820 - physician if symptoms do not improve. ref SDS 0 MW5L Millie's letter
070821 - confirm's understandings, and notices excellent work in ER.
070822 - ref SDS 0 0Q3Q
070823 -
070824 - [On 041210 punch biopsy wound follow up examination, recovery
070825 - slow, antibiotics prescription renewed.
070827 - ..
070828 - [On 050212 Millie treated in emergency room for severe reaction to
070829 - cat bite. ref SDS 25 0001
070830 -
070831 -
070832 -
070833 -
070834 -
070835 -
070837 - ..
0709 -
0710 -
0711 - Progress
0712 -
071201 - IBC Symptoms Increase Temperature Elevated Above 101
071202 -
071203 - After Millie got dressed for work, and with the house warmed by the
071204 - heating system, she still felt chilled.
071206 - ..
071207 - She took her temperature several times, and it shows 100.2.
071209 - ..
071210 - The rash on the left breast, which was reported to the doctor
071211 - yesterday, ref SDS 18 RO7Q, has spread to under the arm, and feels
071212 - warm to the touch. The left arm has a slight ache. Coloration on the
071213 - breast area seems less intense, however, the area from the breast to
071214 - under the arm is very intense, like the breast yesterday.
071216 - ..
071217 - Coloration and scope of red rash is significantly increased compared
071218 - to examination a few days ago by the doctor on 0411130. ref SDS 17
071219 - 025H For example, on 041019 Doctor Guardino at Stanford observed very
071220 - light coloraton to only part of the left breast. ref SDS 14 TX93 The
071221 - day before on 041018 Doctor Benz made the same observation, shown in
071222 - the report received on 041117 that describes "areas of peau d'orange"
071223 - on the left breast. ref SDS 16 OU5T
071225 - ..
071226 - Abrupt worsening of IBC symptoms that now engulf well beyond the
071227 - entire breast, in combination with rising temperature, is alarming.
071229 - ..
071230 - As a result, Millie decided to stay home from work.
071231 -
071232 -
071234 - ..
0713 -
0714 -
0715 - 0640
0716 -
071601 - Millie's temperature climbed above 101.
071602 -
071603 - Called Kaiser Advice Nurse at the Oncology clinic...
071604 -
071605 - 680 295 4030
071607 - ..
071608 - Oncology clinic is closed. The voice message said that if temperature
071609 - of cancer patient rises above 100.5, go to emergency for immediate
071610 - treatment.
071612 - ..
071613 - Decided to take Millie to Emergency room at Kaiser in Walunt Creek.
071614 -
071615 - [...see below cost to patient for visiting Emergency is $50 above
071616 - payment by insurance. ref SDS 0 0148
071617 -
071618 - [On 070216 instructions call UCSF for emergency high fever
071619 - spreading rash IBC cellulitis; conflicts with Kaiser instructions.
071620 - ref SDS 29 UW9I
071622 - ..
071623 - [On 070201 UCSF protocol for emergency contacting doctor when
071624 - temperature > 101. ref SDS 28 DN4F
071625 -
071626 -
071627 -
071628 -
071630 - ..
0717 -
0718 -
0719 - 0713
0720 -
072001 - Notify Primary Care Physician of New Events
072002 - Consent to New Treatment Planning to Sign
072003 -
072004 - Submitted ref DIT 1 0001 to Rosalie reporting progress reviewing the
072005 - new consent form, and advising about rise of temperature, and about
072006 - change in spread of rash, per above.. ref SDS 0 H96L
072008 - ..
072009 - Millie proposes signing the consent forms today, if Rosalie has time.
072010 - ref DIT 1 00W2
072011 -
072012 -
072013 -
072014 -
072016 - ..
0721 -
0722 -
0723 - 0720
0724 -
072401 - Notify Millie Out of the Office Today
072402 -
072403 - Millie sent a letter, ref DIT 2 0001, to Donna, Director of Human
072404 - Resources, advising she will not be in the office today, and asking
072405 - her check with HR on resolving SDI issue discussed yesterday.
072407 - ..
072408 - Millie says to Donna...
072409 -
072410 - 1. I have a temperature of 101 this morning, and so will have to
072411 - go into the hospital for examination, treatment, etc.
072413 - ..
072414 - 2. PS. Can you discuss the long term disability situation with
072415 - HR, per our discussion yesterday. Thanks (you're a life saver)
072416 -
072417 -
072418 -
072419 -
072421 - ..
0725 -
0726 -
0727 - 0732
0728 -
072801 - Emergency Room Visit Examine Rising IBC Symptoms Temperature 99.9
072802 -
072803 - Drove to Kaiser Hospital in Walnut Creek and visited Emergency
072804 - department.
072806 - ..
072807 - Traffic was not too bad for the morning commute.
072808 -
072809 -
072811 - ..
0729 -
0730 -
0731 - 0803
0732 -
073201 - Arrive at Emergency Kaiser Hospital.
073203 - ..
073204 - Talked to Nico.
073206 - ..
073207 - Millie's temperature has dropped to 99.9. He decided to do further
073208 - tests. Millie was admitted for examination.
073209 -
073210 -
073211 -
073213 - ..
0733 -
0734 -
0735 - 0930
0736 -
073601 - Maria prepared patient admission documents for getting emergency
073602 - treatment.
073603 -
073604 -
073605 -
073607 - ..
0737 -
0738 -
0739 - 0940
0740 -
074001 - Millie in emergency examination room.
074002 -
074003 - Nurse discloses that patient must pay $50 for Emergency services
074004 - ordered by Kaiser's Oncology voice mail system, per above. ref SDS 0
074005 - IX9N
074007 - ..
074008 - [...see below, symptoms that caused visit to Emergency Room
074009 - were expected for the treatment prescribed by Kaiser.
074010 - ref SDS 0 4Q40
074011 -
074012 -
074013 -
074015 - ..
0741 -
0742 -
0743 - 0947
0744 -
074401 - Treatment Wound Initially Increases IBC Symptoms Rash Temperature
074402 - Tissue Sample Lab Test Cellulitus Antibiotic Treatment Appropriate
074403 -
074404 - Follow up ref SDS 17 6T5G.
074405 -
074406 - Doctor Parsley examined Millie.
074408 - ..
074409 - The redness has spread considerably, even beyond the breast toward the
074410 - neck, and beneath the arm pit.
074412 - ..
074413 - Millie explains intensity of inflammation (redness) seems today to
074414 - have reduced somewhat around the breast, but has increased under the
074415 - arm, relative to conditions yesterday, that were reported to the
074416 - doctor on 041201. ref SDS 18 RO7Q
074418 - ..
074419 - Doctor Parsley reviewed Kaiser's computer and found the pathology
074420 - report on tissue taken from the punch biopsy wound still festering on
074421 - the left breast after 7 months, which the primary care physician in
074422 - Oncology ordered on 041130. ref SDS 17 JU6N Doctor Parlsey indicated
074423 - lab results and case history indicates that elevated IBC symptoms
074424 - actually identify cellulitus, rather than worsening IBC. This was
074425 - great news.
074427 - ..
074428 - There was no explanation that worsening IBC can cause cellulitus in a
074429 - wound surrounded by IBC tissue, and which occurred from a punch biopsy
074430 - on 040419 that originally was diagnosed as IBC, reported on 040517.
074431 - ref SDS 12 6T5G
074433 - ..
074434 - Cellulitus pathology was researched on 030109, ref SDS 8 TE4P, when
074435 - Millie was firs diagnosed with this disease on her left breast.
074436 - ref SDS 8 0T6N
074437 -
074438 - [On 061027 cellulitus diagnosed again when Millie taken to
074439 - Emergency Room with temprature 102.4; continuing trauma from
074440 - fall that broke her finger on 060914, caused complications of
074441 - lymphedema in the left arm. ref SDS 27 WS7N
074443 - ..
074444 - This presents a "wicked problem" of diagnosis and treatment where
074445 - compound problems present ovelapping symptoms.
074446 -
074447 - [...see below, Doctor Parsley examination notes submitted to
074448 - patient confirms diagnosis of cellulitus. ref SDS 0 LQ3R
074450 - ..
074451 - [...see below, Patient Instructions seem to have "cellulitus"
074452 - written out in long hand. ref SDS 0 AY3T
074454 - ..
074455 - [On 060722 "wicked problems" occurred diagnosing pulmonary
074456 - emboli. ref SDS 26 346F
074458 - ..
074459 - Doctor Parsley feels the medication prescribed is appropriate for the
074460 - infection identified by the lab, and that there is no conflict with
074461 - Millie's other medications, including cuomadin and her cough medicine.
074462 -
074463 - [On 041230 elevated CA 15-3, spreading rash, and new cancer
074464 - sores on left breast indicate IBC symptoms advancing; treatment
074465 - was scheduled to begin on 050104. ref SDS 23 XQ6I
074467 - ..
074468 - Doctor Parsley asked for the date of the last chemotherapy. The
074469 - record on 041021 shows the last chemotherapy treatment. ref SDS 15
074470 - 407N
074472 - ..
074473 - The doctor advised that Millie's report today that the degree of
074474 - redness in the left breast has declined somewhat from yesterday is
074475 - consistent with how the prescribed medication works to treat the type
074476 - of infection reported by the lab on the breast biopsy sore. He said
074477 - typically there are initial side effects that increase IBC symptoms
074478 - for rising temperature, and spread of the rash, then symptoms begin to
074479 - clear up. Accordingly, Millie's experience has been consistent with
074480 - the expected recovery cycle for treating the problem caused by the
074481 - breast wound.
074482 -
074483 - [...see above, patient required to pay $50 to learn about side
074484 - effects of prescribed treatment. ref SDS 0 0148
074486 - ..
074487 - [On 041210 meeting with primary care physician did not discuss
074488 - procedures to notify patients about ominous treatment side
074489 - effects. ref SDS 20 BI6J
074490 -
074491 -
074493 - ..
074494 - Surgeon Examination of Breast Wound Ordered
074495 -
074496 - Doctor Parsley asked when the biopsy was taken that caused the wound
074497 - to the left breast? We reviewed the record showing a punch biopsy was
074498 - performed on 040419. ref SDS 10 1572
074500 - ..
074501 - Doctor Parsley asked when the surgeon examined the wound? On O40429
074502 - the surgeon examined the patient, and planned for follow up based on
074503 - coordinating with primary care physician in Oncology. ref SDS 11 SD7F
074505 - ..
074506 - Doctor Parsley plans to order review by the surgeon for input on
074507 - treating the wound that has caused current problems. He advised that
074508 - Millie will receive a notice in the mail on when examination by the
074509 - surgeon will occur.
074510 -
074511 - [...see below letter to Millie on scope of service today, does not
074512 - mention examination by surgeon. ref SDS 0 BI5P
074514 - ..
074515 - [...see below, Patient Instruction form does not seem to mention
074516 - examination by surgery. ref SDS 0 AX6K
074518 - ..
074519 - [...see below letter to Doctor Johnson discloses notice to surgery
074520 - on examination of wound. ref SDS 0 BI4Y
074522 - ..
074523 - [On 050107 examination by the surgeon resulted in plans to
074524 - continue new chemotherapy treatment toward evaluation of surgery.
074525 - ref SDS 24 IS5N
074526 -
074527 -
074529 - ..
074530 - Immune System Evaluated with WBC Test
074531 - Blood Test WBC Ordered Identify Cause Increased Symptoms IBC
074532 -
074533 - Doctor Parsley ordered a blood test primarily to check the white blood
074534 - cell count for evaluating the strength of the immune system,
074535 - essential for Millie to recover from IBC.
074537 - ..
074538 - The doctor related that he expects the WBC test will confirm his
074539 - impression that recovery from elevated IBC symptoms is now underway,
074540 - after hitting a high point of negative symptoms early this morning.
074541 - The doctor explained that since the last chemotherapy treatment was
074542 - over 4 weeks ago on 041027, then if the white blood cell count is
074543 - still low it will not be due to chemotherapy, but rather could
074544 - indicate a new problem that requires treatment.
074545 -
074546 - [...see below, Doctor Parsley reports that blood test showed white
074547 - blood cell count is 10.6, which confirms first impression that
074548 - recovery is occurring under the current treatment plan.
074549 - ref SDS 0 W47N
074551 - ..
074552 - Doctor Parsley added CA 15-3 to the order for blood tests, per
074553 - approval by primary care physician on 041130. ref SDS 17 GJ5M Doctor
074554 - Parsley was not familiar with CA 15-3, so this was explained by the
074555 - patient, as one of many indicators for breast cancer, to assist in
074556 - preparing the order for blood tests needed today, which will, also, be
074557 - reviewed with the primary care physician on 041210 to plan treatment.
074558 -
074559 - [On 041210 CA 15-3 rises to 43 after 6 weeks without treatment,
074560 - ref SDS 20 GJ5M, cited in planning to schedule treatment as soon
074561 - as possible. ref SDS 20 028N
074562 -
074563 -
074565 - ..
074566 - Oncology Notified Patient in Emergency Room for Elevated Temperature
074567 -
074568 - Follow up ref SDS 17 6T5G.
074569 -
074570 - Doctor Parsley sent an email to notify the primary care physician in
074571 - the Oncology Department that Millie is in the emergency room today, so
074572 - if he wants to examine the change in condition of the breast from the
074573 - examination on Tuesday, he can ask Millie to stop by Oncology after
074574 - release from the Emergency Department, or the doctor can visit Millie
074575 - in Emergency.
074576 -
074577 - [...see below, Doctor Parsely notifies primary care physician
074578 - about results of examination. ref SDS 0 PT5Q
074579 -
074581 - ..
074582 - Kaiser Computers Access Internet
074583 -
074584 - Doctor Parsley advised that he can access the Internet from his
074585 - computer here in the hospital. In this case, he was using a computer
074586 - in the common administration area where there about five (5) or so
074587 - work stations.
074588 -
074589 -
074590 -
074592 - ..
0746 -
0747 -
0748 - 0959
0749 -
074901 - Blood Test to Verify Diagnosis and Recovery Prognosis
074902 -
074903 - Kristie drew blood. We discussed using the port to draw blood.
074904 -
074905 - Kristie says the emergency room is not set up for using a port, so she
074906 - wants to first try using a vein with a butterfly needle system. If
074907 - she is not successful on the first try, Kristie will go get a
074908 - professional certified to draw blood from the port catheter.
074910 - ..
074911 - Kristie was very thorough examining Millie's arm. She found a vein
074912 - which she thought would be conducive to a blood draw. This was
074913 - successful on the first try. Millie was not discomforted in any way
074914 - by the procedure, as usually occurs because of having so many blood
074915 - draws. As a result, it was not necessary to use the port.
074916 -
074917 - [Letter to Kaiser commends ER staff. ref SDS 0 0Q3Q
074918 -
074919 -
074920 -
074921 -
074923 - ..
0750 -
0751 -
0752 - 1102
0753 -
075301 - Good News Blood Tests WBC 10.6 Indicates Recovery on Track
075302 -
075303 - Doctor Parsley reports on results of blood tests show good news.
075304 -
075305 - Report shows white blood cell count is 10.6 with 79% neutrafils, which
075306 - is effective for fighting Millie's condition, and so confirms initial
075307 - impression during the examination earlier, per above. ref SDS 0 4Q49
075308 -
075309 - [...see below, Doctor Parsley's letter to Doctor Johnson has a
075310 - figure of 14K+, which seems conflicting, if this is the same
075311 - parameter. ref SDS 0 XG5H
075313 - ..
075314 - Doctor Parsley explained a lot of details on cellulitus, and other
075315 - factors, which supports the prescription on Tuesday for curing the
075316 - sore on the left breast with penicillin. Doctor Parsley expects
075317 - Millie will show continued improvement in reduction of symptoms that
075318 - involve the rash, temperature, and soreness of the left arm by
075319 - continuing the current prescription of antibiotics.
075320 -
075321 - [...see below, Doctor Parsley examination notes submitted to
075322 - patient confirms diagnosis of cellulitus. ref SDS 0 LQ3R
075324 - ..
075325 - [...see below, Patient Instructions seem to have "cellulitus"
075326 - written out in long hand. ref SDS 0 AY3T
075328 - ..
075329 - Cellulitus was diagnosed previously on....
075330 -
075331 - 030109................................ ref SDS 8 0T6N
075332 - 040318................................ ref SDS 9 IM6J
075334 - ..
075335 - Biopsy taken on................... 040419, ref SDS 10 1572
075337 - ..
075338 - Pathology report says biopsy
075339 - found IBC......................... 040517, ref SDS 12 6T5G
075341 - ..
075342 - IBC diagnosed on.................. 040614, ref SDS 13 6T5G
075344 - ..
075345 - Current findings evidently supported by lab report of tissue sample
075346 - taken by the doctor during the examination on 041130. ref SDS 17 HT7G
075348 - ..
075349 - Are we confident IBC is not "waxing" again, per 2nd opinion submitted
075350 - by Doctor Benz at UCSF, received on 041117? ref SDS 16 OS6W
075351 -
075352 - [see below, letter to Kaiser cites this issue. ref SDS 0 TE7X
075353 -
075354 -
075356 - ..
075357 - Follow Up Examination If No Improvement in 2 Days
075358 -
075359 - If there is no or minimal improvement over the next 2 days, then
075360 - Millie should return to the hospital for further examination,
075361 - diagnosis, and prescription, either to the Emergency Room, or to the
075362 - primary care physician in Oncology. Doctor Parsley will notify the
075363 - surgeon to examine the sore on the left breast, for corrective
075364 - measures on prior work performed 040419.
075365 -
075366 - [...below, Doctor Parsley's report to Millie confirms this
075367 - instruction.
075369 - ..
075370 - [...below, Doctor Parsley's "Instructions" form has illegible
075371 - handwriting that appears to support understandings for follow
075372 - up in 2 days with ER or with Doctor Johnson, if no
075373 - improvement. ref SDS 0 AY3T
075375 - ..
075376 - [...below, Doctor Parsley's letter to Doctor Johnson expressly
075377 - calls for follow up visit in 2 days if no improvement.
075378 - ref SDS 0 BJ35
075380 - ..
075381 - [On 041230 primary care physician in Oncology advised that
075382 - surgery has become critical task in treatment plan; asks when
075383 - the meeting is schedule for the surgeon to examine the patient.
075384 - ref SDS 22 CW6J
075385 -
075386 -
075387 -
075388 -
075389 -
075391 - ..
0754 -
0755 -
0756 - 1113
0757 -
075701 - ER Report Clarifies Complex Verbal Diagnosis and Follow Up Planning
075702 - Email Timely Accurate Communication Patient and Professional Staff
075703 -
075704 - At the conclusion of the meeting, Doctor Parsley began an explanation
075705 - of findings and prescriptions. The patient asked for a written
075706 - report. The doctor offered to provide a written report.
075708 - ..
075709 - About 10 minutes later, Doctor Parsley submitted a printed report
075710 - confirming diagnosis and prescription, ref DRT 1 000, which was then
075711 - discussed with the patient.
075713 - ..
075714 - Millie asked the doctor to submit the report via email in order to
075715 - reduce the time for managing the record by orders of magnitude. The
075716 - doctor advised that his computer here at the hospital can access the
075717 - Internet, and agreed to communicate with the patient via email; this
075718 - aligns with prior experience working with Kaiser....
075719 -
075720 - Doctor Racah.................. 000218, ref SDS 5 VM68
075721 - Doctor Yamamoto............... 000206, ref SDS 4 0001
075722 - Doctor Boulris................ 991018, ref SDS 3 0001
075723 - Doctor Zipperstein............ 940728, ref SDS 1 0001
075725 - ..
075726 - This has not been supported in all cases....
075727 -
075728 - Primary care physician........ 990625, ref SDS 2 1978
075729 - Nurse primary care
075730 - physician..................... 020402, ref SDS 6 C24N
075731 - Radiologist................... 020708, ref SDS 7 EY9N
075732 - Primary care physician........ 040614, ref SDS 13 NO6O
075733 -
075734 - [On 041212 Gary notices SDS is attractive to some
075735 - doctors, and not to others. ref SDS 21 XN7P
075737 - ..
075738 - The doctor sent the report via email that says...
075740 - ..
075741 - [...below, Millie thanks Kaiser for good work in ER.
075742 - ref SDS 0 0Q3Q
075743 -
075744 - 1. Diagnosis: There are no coded diagnoses, ref DRT 1 XP6L
075746 - ..
075747 - 2. Procedures; There are no coded procedures, ref DRT 1 MP6O
075749 - ..
075750 - 3. Encounter Notes:
075752 - ..
075753 - 4. 68 YO F with breast CA, has chronic small draining wound of L
075754 - breast, developed larger area of redness and pain 3 days ago,
075755 - rx Diclox for this 11/30. Redness and pain has increased in
075756 - area, but decreased in intensity by today. Had temp this AM
075757 - 101.2. ref DRT 1 1Q7H
075759 - ..
075760 - Clarification - patient chronology and intent to convey that increased
075761 - redness began yesterday, as reported to Doctor Johnson on 041201.
075762 - ref SDS 18 RO7Q
075763 -
075764 - [see below, letter to Kaiser cites this issue. ref SDS 0 TE7Q
075766 - ..
075767 - Problem seemed worse today, with respect to the area of rash spread,
075768 - and moderated in some areas on intensity of coloration. Rise in
075769 - temperature, and slight ache in left arm were new events, and seemed
075770 - to fit criteria for emergency room visits, per above. ref SDS 0 IX9N
075772 - ..
075773 - This clarification does not seem to impact diagnosis and treatment.
075775 - ..
075776 - Doctor Notes continue...
075777 -
075778 - 5. Last chemo over 1 month ago, no problem with WBC. ref DRT 1
075779 - AQ8F
075781 - ..
075782 - 6. PE: Alert, not toxic, L breast difuse and mottled erythema
075783 - overall, max in inferior half. Redness extends in mottled
075784 - areas to L axilla and across front side of L shoulder.
075785 - Minimally tender. No abscess palpated. Small pinpoint area of
075786 - drainage mid lower breast area. ref DRT 1 OQ8I
075788 - ..
075789 - 7. Imp: Cellulitis of L breast. Breast CA, wtih chronic open
075790 - wound. ref DRT 1 JQ8O
075792 - ..
075793 - This confirms understandings from the meeting, per above. ref SDS 0
075794 - RC92
075795 -
075796 - [...see below, Patient Instructions seem to have "cellulitus"
075797 - written out in long hand. ref SDS 0 AY3T
075799 - ..
075800 - Doctor Parsley continues...
075801 -
075802 - 8. WBC OK at 10.6 with 79% neut. ref DRT 1 5R9H
075804 - ..
075805 - 9. Appears to be improving, with decreased pain and decreased
075806 - intensity of erythema, in spite of some spread of area during
075807 - rx. Would not change abx at this time. Continue as planned,
075808 - f/u as planned. ref DRT 1 DR9K
075810 - ..
075811 - 10. Recheck in ER for any change or worsenign, f/u regular MD,
075812 - ref DRT 1 NR4F
075814 - ..
075815 - "Recheck in ER..." is clarified by Doctor Parsley's verbal guidance
075816 - for follow up examination in 2 days if no improvement. ref SDS 0 MW5L
075817 -
075818 - [...below, Doctor Parsley's "Instructions" form has illegible
075819 - handwriting that appears to support understandings for follow
075820 - up in 2 days with ER or with Doctor Johnson, if no
075821 - improvement. ref SDS 0 AY3T
075823 - ..
075824 - [...below, Doctor Parsley's letter to Doctor Johnson expressly
075825 - calls for follow up visit in 2 days if no improvement.
075826 - ref SDS 0 BJ35
075828 - ..
075829 - This report seems to omit requirement for examination by surgeon for
075830 - input on healing the wound to the left breast that seems to be the
075831 - cause of the problems today, per above. ref SDS 0 BG98 Doctor
075832 - Parsley's letter to Doctor Johnson advises of notice to Doctor
075833 - Riley-Paull to examine the wound to the left breast. ref SDS 0 BI4Y
075835 - ..
075836 - Doctor Parsely's report to Millie concludes...
075837 -
075838 - 11. See progress in medical record. ref DRT 1 NR4I
075839 -
075840 -
075841 -
075843 - ..
075844 - Patient Instruction Form Calls to Follow Up in 2 Days
075845 -
075846 - Doctor Parsley also gave Millie a copy of Kaiser's form with follow up
075847 - instructions.
075849 - ..
075850 - There is illegible handwriting in the section under...
075851 -
075852 - Other Instructions...
075854 - ..
075855 - The best interpretation is that the form shows...
075856 -
075857 - Cellulitis.
075859 - ..
075860 - Cellulitis was discussed with patient, per above. ref SDS 0 4Q94
075861 -
075862 - [...see above, Doctor Parsley examination notes submitted to
075863 - patient confirms diagnosis of cellulitus. ref SDS 0 LQ3R
075865 - ..
075866 - Patient Instructions continue...
075867 -
075868 - Continue [assume current treatment is shown, but not clear]
075869 -
075870 - Ret in 1 - 2 days and
075872 - ..
075873 - not later.
075875 - ..
075876 - This aligns with understanding of verbal instructions, per above.
075877 - ref SDS 0 MW5L
075878 -
075879 - [...below, Doctor Parsley's letter to Doctor Johnson expressly
075880 - calls for follow up visit in 2 days if no improvement.
075881 - ref SDS 0 BJ35
075882 -
075883 -
075884 -
075885 -
075886 -
075888 - ..
0759 -
0760 -
0761 - 1255
0762 -
076201 - Coordination between Emergency and Oncology on Progress and Follow Up
076202 -
076203 - When we returned from lunch, after release from the hospital, there
076204 - was a letter from Doctor Parsley notifying the primary care physician
076205 - about results of the visit today....
076206 -
076207 - Ms B*** was in ER today with fever and signs of cellulitis of L
076208 - breast, for which you started Diclox 11/30. Her temp was
076209 - improving, and the redness was becoming apparently less intense
076210 - and more mottled, suggesting a turn for the better. ref DRT 2
076211 - 0001
076213 - ..
076214 - Her WBC was 14k+ with left shift, so that was not a problem.
076215 - ref DRT 2 RS6J
076217 - ..
076218 - This seems conflicting with the verbal report to the patient at 1102,
076219 - that WBC was 10.6, per above. ref SDS 0 W47N Doctor Parsley's report
076220 - to the patient also shows 10.6 for WBC. ref SDS 0 LQ3R
076222 - ..
076223 - What supports the 14k+ figure? Are these different parameters or
076224 - different measuring units?
076226 - ..
076227 - Doctor Parsley continues to Doctor Johnson...
076228 -
076229 - I chose to stay the course with Diclox PO, and advised her to
076230 - contact you or us in ER if not improved further in next 2 days.
076231 - ref DRT 2 PS6M
076233 - ..
076234 - This aligns with understandings from meeting with the doctor, per
076235 - above. ref SDS 0 MW5L It also seems to fit the handwriting in the
076236 - Patient Instruction form. ref SDS 0 AX6Y
076238 - ..
076239 - Doctor Parsley continues to promary care physician....
076240 -
076241 - I also sent an eConsult to Surgery requesting an appt to
076242 - consider the non-healing bx site. ref DRT 2 ET7G
076244 - ..
076245 - This aligns with Doctor Parsley's discussion with Millie during the
076246 - examination, per above. ref SDS 0 BG98
076247 -
076248 - [On 041230 primary care physician in Oncology advised that
076249 - surgery has become critical task in treatment plan; asks
076250 - when the meeting is schedule for the surgeon to examine the
076251 - patient. ref SDS 22 CW6J
076252 -
076253 -
076254 -
076256 - ..
0763 -
0764 -
0765 - 2137
0766 -
076601 - Confirmed Understandings with Letter to Kaiser
076602 -
076603 - Millie submitted ref DIT 3 0001 transmitting this record to Kaiser.
076604 - Thanked Doctor Parsley for the work today, and ask about pending
076605 - action items.
076606 -
076607 - 1. Thanks very much for a timely report, per above, ref SDS 0
076608 - 426W, on the work today at the Kaiser ER in Walnut Creek.
076609 - ref DIT 3 0001
076611 - ..
076612 - 2. There is a slight correction on the period of time symptoms
076613 - were experienced. ref DIT 3 N85M I don't think it warrants
076614 - changing the record, but you can decide. ref SDS 0 LP5W
076616 - ..
076617 - 3. There is also a question on diagnosis of cellulitus,
076618 - ref DIT 3 N96K, based on case history. ref SDS 0 4256
076620 - ..
076621 - 4. My understanding is that current findings rely on lab reports
076622 - that convey confidence. The plan to follow up in 2 days based
076623 - on reduction in symptoms provides further risk management.
076624 - ref DIT 3 557G
076626 - ..
076627 - 5. Greatly appreciated your work, and the ER staff. Everyone was
076628 - professional, timely, and encouraging. ref DIT 3 H57L
076630 - ..
076631 - Example of staff work was Kristie. ref SDS 0 EQ5U Doctor Prasely
076632 - submitted several reports that together created a good record.
076633 - ref SDS 0 426W and ref SDS 0 PT5Q
076635 - ..
076636 - Letter to Doctor Prasely concludes...
076637 -
076638 - 6. No need to respond unless there is a material change to the
076639 - record. ref DIT 3 M58F
076640 -
076641 -
076642 -
076643 -
076644 -
076645 -
076646 -
076647 -
076648 -
076649 -
076650 -
076651 -
076652 -
0767 -