CONTACTS 

SUBJECTS
CA 15-3 Dramatic Fall from 105 to 65 Shows Favorable Response to Tre
Meeting Doctor Examine Recovery and Side Effects Response to Xeloda
CA 15-3 Dramatic Fall from 105 to 65 Shows Favorable Response to Tre

0705 -
0705 -    ..
0706 - Summary/Objective
0707 -
070701 - Follow up ref SDS 28 0000. ref SDS 24 0000.
070702 -
070703 -
070704 -
070706 -  ..
0708 -
0709 -
0710 - Progress
0711 -
071101 - Agenda...
071103 -  ..
071104 - CA 15-3 Cancer Marker Falls Dramatically
071105 -
071106 -
071107 -          1.  CA 15-3
071108 -
071109 -              Since the last meeting, CA 15-3 has dropped twice,
071110 -              reflecting clinical improvement in breast.  There was an
071111 -              interim drop from 105 on 050422, ref SDS 28 554O, to 87
071112 -              several weeks ago, and another drop to 65 shown in the
071113 -              test last week.
071114 -               ..
071115 -              This demonstrates favorable response to treatment that
071116 -              aligns with clinical observation of significantly
071117 -              reduction of inflammation and redness of the breast,
071118 -              discussed below. ref SDS 0 887P
071119 -
071120 -
071121 -
0712 -

SUBJECTS
CT Test Ordered to Assess Progress of Recovery Based on Reduced CA 1

0903 -
090401 -  ..
090402 - CT Test Ordered Evaluate Progress on Recovery
090403 -
090404 - Follow up ref SDS 28 886M.
090405 -
090406 -          2.  CT Test results
090407 -
090408 -              The doctor ordered another CT test for the week between
090409 -              the end of the 3rd cycle, and beginning the 4th cycle.
090410 -
090411 -
090412 -
090413 -
0905 -

SUBJECTS
Examination Shows Breast Recovery Inflammation Greatly Reduced Size

1003 -
100401 -  ..
100402 - Examination Shows Breast Recovery Inflammation Greatly Reduced
100403 -
100404 -
100405 -          3.  Breast examination
100406 -
100407 -              The doctor examined the left breast and concurred there
100408 -              has been dramatic improvement with Taxotere and
100409 -              capecitabine (Xeloda), and that this supports continued
100410 -              efforts to find a treatment level that the patient can
100411 -              tolerate, discussed below. ref SDS 0 887S
100413 -               ..
100414 -              The expanding area of inflammation observed by the
100415 -              surgeon on 050324, ref SDS 21 906K, and earlier during
100416 -              the examination by the doctor on 050311, ref SDS 20 887P,
100417 -              has now receded.
100419 -               ..
100420 -              Cancerous bumps and sores that began appearing two (2)
100421 -              months ago, and reported in the meeting on 050311,
100422 -              ref SDS 20 UA8N, have now fully dried up.
100423 -
100424 -                 [On 050610 CT scan test shows no evidence of IBC,
100425 -                 ref SDS 36 B58M; doctor proposes consideration of
100426 -                 surgery. ref SDS 36 XQ41
100428 -                  ..
100429 -                 [On 051007 PET scan test report favorable no findings
100430 -                 of local, regional nor distant metastatic disease,
100431 -                 ref SDS 38 NL4N, impression prior abnormalities
100432 -                 resolved. ref SDS 38 L66M
100434 -               ..
100435 -              These observations reflect improvement reported beginning
100436 -              on 050502, ref SDS 29 EO5J, and again on 050510.
100437 -              ref SDS 30 EO5J
100439 -               ..
100440 -              Under the Arm
100441 -
100442 -                  Right side no evident swelled lymph nodes left
100443 -                  axillary.  Patient reports no discomfort.
100444 -
100445 -
100446 -
100447 -
100448 -
100449 -
1005 -

SUBJECTS
Default Null Subject Account for Blank Record

1103 -
110401 -               ..
110402 -          4.  Treatment plan...
110404 -               ..
110405 -              Capecitabine (Xeloda)
110406 -
110407 -                  Side effects
110408 -
110409 -                     Feet exam.
110410 -
110411 -                     The doctor examined the right foot, and observed
110412 -                     evidence of blistering, which has significantly
110413 -                     receded after Xeloda treatment was stopped on
110414 -                     050514. ref SDS 31 QC8M
110416 -                   ..
110417 -                  Dosage adjustment
110418 -
110419 -                     Planning on dosage adjustments are shown in the
110420 -                     record on 050516. ref SDS 32 BD4G
110421 -
110422 -                     Doctor reduces dosage by 25% in order to maintain
110423 -                     treatment that has proven effective. ref SDS 0
110424 -                     887P
110425 -                         [On 050527 Ross called and advised a
110426 -                         prescription is ready at the Kaiser Pharmacy
110427 -                         for Milli's next treatment cycle. ref SDS 35
110428 -                         DH43
110429 -                      ..
110430 -                     This is experimental to search for a level of
110431 -                     treatment that is effective without causing severe
110432 -                     side effects.  Previously, on 041104 Kaiser
110433 -                     stopped treatment with Taxol and Avastin, which,
110434 -                     like Taxotere and Xeloda, had proven effective,
110435 -                     rather than reduce the dose of Avastin in order to
110436 -                     reduce the severity of side effects. ref SDS 7
110437 -                     Q59K
110438 -                          ..
110439 -                         [On 050613 Millie feeling strong durng
110440 -                         treatment cycles; hiked 3 miles. ref SDS 37
110441 -                         QJ7M
110442 -
110443 -
110444 -
110445 -
110446 -
110447 -
110448 -
1105 -

SUBJECTS
Default Null Subject Account for Blank Record

1203 -
120401 -               ..
120402 -              Clinical trial option
120403 -
120404 -                  Millie asked about a new trial announced at UCSF in
120405 -                  the Summer edition of the...
120406 -
120407 -                     Carol Franc Buck
120408 -                     Breast Care Center
120409 -                     Newsletter
120410 -
120411 -                  ...which says in part on page 7...
120413 -                   ..
120414 -                  AG 013736 in Combination with Codetaxel versus
120415 -                  Docetaxel Alone in Patients wtih Metastatic Breast
120416 -                  Cancer
120418 -                   ..
120419 -                  Doctor Hope Rugo and her team are conducting a
120420 -                  research study to evaluate the safety and
120421 -                  effectiveness of an oxperimental drug called AG
120422 -                  013736, which is manufactured by Pfizer, together
120423 -                  with an approved cancer drug, docetaxel (Taxotere),
120424 -                  as a therapy to treat metastatic breast cancer.  The
120425 -                  main purpose of this part of the study is to
120426 -                  determine if giving docetaxel and AG 013736 is better
120427 -                  than giving docetaxol by itself, and to see whether
120428 -                  this combination controls metastatic cancer for
120429 -                  longer than the chemotherapy alone.
120431 -                   ..
120432 -                  For more information..., please contact Mary O'Rouke
120433 -                  at 415 353 9612
120435 -               ..
120436 -              The doctor today indicated Millie may not qualify for
120437 -              this trial because of already being treated with Taxol,
120438 -              or for some other reason.
120440 -               ..
120441 -              There was discussion of contacting Doctor Benz who
120442 -              examined Millie at UCSF on 041018, ref SDS 6 0001, and a
120443 -              month later on 041117 submitted an opinion, ref SDS 8
120444 -              6L9O, which recommended treatment with capecitabine,
120445 -              ref SDS 8 OU5V, including the current treatment of
120446 -              couplets capecitabene-Taxotere, which is the current
120447 -              treatment begun on 050415. ref SDS 25 407N
120449 -               ..
120450 -              No other options for treatment were discussed today.
120451 -
120452 -
120453 -
1205 -

SUBJECTS
Default Null Subject Account for Blank Record

1303 -
130401 -               ..
130402 -          5.  Bladder infection
130403 -
130404 -              Millie reported a new problem of bladder infection,
130405 -              beginning yesterday.  Today, seems improved, but still
130406 -              discomfort urniating.
130408 -               ..
130409 -              Temperature was elevated to 100.4 today, when the nurse
130410 -              took vitals to begin the meeting.  This was startling
130411 -              because guidance for chemotherapy patients is to visit
130412 -              the emergency room when the temperature reaches 100.5,
130413 -              based on prior experience with the cat bite problem,
130414 -              reported on 041202. ref SDS 11 IX9N
130416 -               ..
130417 -              Millie is planning a trip tomorrow taking a train to
130418 -              Grand Junction, Colorado visiting her sister's family.
130420 -               ..
130421 -              Doctor ordered urnialysis which requires a lab sample
130422 -              after the meeting.
130423 -
130424 -                  [...see below visited lab. ref SDS 0 JP9F
130426 -               ..
130427 -              Doctor prescribed Keflex for 10 days, and advised that if
130428 -              the temperature comes down by tomorrow, there is no
130429 -              problem for Millie to take the train ride for a 4 day
130430 -              vactaion to Colorado.
130431 -
130432 -                  [On 050521 after taking prescribed Keflex,
130433 -                  temperature drops to 98.9; so, Millie left on the
130434 -                  trip to Colorado. ref SDS 34 6H6O
130435 -
130436 -
130437 -
130438 -
130439 -
1305 -

SUBJECTS
Default Null Subject Account for Blank Record

1403 -
140401 -               ..
140402 -          6.  Dental Care
140403 -
140404 -              Reviewed discussions on 050518 with the dentist noting
140405 -              that regular dental cleaning is recommended for cancer
140406 -              patients to reduce the chance of infection. ref SDS 33
140407 -              F779  The dentist advised Millie this past October that
140408 -              she needs work to repair a bridge.
140410 -               ..
140411 -              The doctor indicated today that routine dental cleaning
140412 -              is a good idea.
140414 -               ..
140415 -              He further indicated that undergoing more extensive
140416 -              "surgical" dental work to eliminate infection, also,
140417 -              reported on 050518, ref SDS 33 FB7Y, is not a common
140418 -              practice for chemotherapy patients, because the bigger
140419 -              risk is dental care causing infection due to reduced
140420 -              immune strength.  Routine cleaning often includes
140421 -              examination with xray imaging, which will disclose
140422 -              whether there is a pre-existing problem of infection that
140423 -              needs attention.  The current regimine of chemotherapy
140424 -              treatments will be ending in about 6 weeks.  That may
140425 -              provide a window of opportunity for dental work, if
140426 -              needed.
140427 -
140428 -
140429 -
140430 -
140431 -
140432 -
140433 -
1405 -

SUBJECTS
Default Null Subject Account for Blank Record

1503 -
150401 -               ..
150402 -          7.  Meeting with the doctor scheduled for next 4 weeks.
150403 -
150404 -
150405 -
150406 -
150407 -
1505 -

SUBJECTS
Proven Template Inventory KM Classes Technology and Methods, John Ma
Communication Problems Solution Planned Technology Improvements Plan
New Way Working Care About Accuracy When within Reach Attitudes Chan
Steady Exposure to SDS Records Applies Theory of Transformation in B
Culture Change Resisted Overcome by Relentless Pressure Converts Res
SDS Time Period Transformation 2 - 6 Months Using SDS for 8 Steps Co
Intelligence Attitudes Change Care About Organizational Memory SDS R
Lesson Learned 3-layer Architecture Deployment Transformation Learn
Attitudes Change Care About Accuracy Feedback Refines Accuracy Recor
Medical Chart Legible Meeting Minutes Contemporaneous Record Meeting
Examination Shows Breast Recovery Inflammation Greatly Reduced Size

4813 -
481401 -               ..
481402 -              Continual Exposure Good Management Drives Transformation
481403 -
481404 -          8.  Contemporaneous record improves communication and
481405 -              analysis for diagnosis and treatment planning.
481407 -               ..
481408 -              During the meeting today, the doctor invested time
481409 -              entering a record of discussion with the patient, the
481410 -              examination, diagnosis and treatment planning.  He did
481411 -              considerable cross checking of sources, and editing to
481412 -              refine understandings, which fits the model of quality
481413 -              control discussed in POIMS for thinking through writing.
481414 -              ref OF 7 3742  This editing led to further discussion and
481415 -              examination that clarified understandings to correct
481416 -              initial error from spontaneous first impressions, similar
481417 -              to Morris' first experience using SDS on 910520.
481418 -              ref SDS 1 655O
481420 -               ..
481421 -              Capturing personal and organizational memory invests
481422 -              intellectual capital (see POIMS, ref OF 5 1101) that pays
481423 -              off in better diagnosis and treatment from avoiding
481424 -              continual mistakes (see NWO, ref OF 13 0742), which is
481425 -              especially common in the complex practice of health care,
481426 -              reported on 990912, ref SDS 2 0001, and illustrated by
481427 -              work on 041230 when the doctor asked why chemotherapy
481428 -              treatments with Adriamycin and Cytoxin had been stopped
481429 -              two (2) years earlier, ref SDS 16 XQ84, which was
481430 -              critical to prescribing this treatment, as recommended a
481431 -              few weeks earlier in a 2nd opinion by the Stanford Cancer
481432 -              Center in a letter received on 041209. ref SDS 12 SN88
481434 -               ..
481435 -              The doctor commented on a recent demonstration of a new
481436 -              work station which Kaiser plans to deploy that will give
481437 -              doctors more efficient use of technology with an
481438 -              ergonomic design.  The current configuration of the
481439 -              doctor's computer in the examination room is awkward,
481440 -              which slows productivity and discourages use, reflecting
481441 -              the report on 000307 that good management using
481442 -              traditional methods is a lot of hard work. ref SDS 3 5182
481443 -              Therefore, effort today capturing a greater share of the
481444 -              record in real-time took considerable motivation.  The
481445 -              record on 910520 illustrates how ergonomics play a big
481446 -              role in software design to increase productivity.
481447 -              ref SDS 1 JE6M
481449 -               ..
481450 -              Additionally, the doctor was careful to check the agenda
481451 -              listed by the patient on the marking board to ensure
481452 -              comprehensive consideration of all pending and new
481453 -              matters.
481455 -               ..
481456 -              This shows progress from continual support for good
481457 -              management the past several years, beginning on 020321.
481458 -              ref SDS 4 0001  It may reflect experience at the last
481459 -              meeting on 050422, when another patient asked the doctor
481460 -              about a record she found on the Internet with patient
481461 -              history. ref SDS 28 9V8M  Seeing how good work history
481462 -              aids understanding for diagnosis and treatment planning
481463 -              may have contributed to the doctor's effort today.  After
481464 -              the meeting, Millie remarked that today seemed to
481465 -              demonstrate a marked change in performance using good
481466 -              management to capture a contemporaneous record, and to
481467 -              edit the record while talking to the patient in order
481468 -              refine accuracy understanding events, correlations,
481469 -              implications and nuance.  This change in conduct reflects
481470 -              how attitudes change.  People care about accuracy when
481471 -              improvement is within reach.
481472 -
481473 -
481474 -
481475 -
481476 -
481477 -
481479 -  ..
4815 -
4816 -
4817 - 1120
4818 -
481801 - Visited Pharmacy on 2nd Floor after meeting with the doctor.
481802 -
481803 - Received prescription for Keflex....
481804 -
481805 -    Cephalexin 250 MG capsules
481807 -     ..
481808 -    Rx #512 988685
481810 -     ..
481811 -    Take 1 capsule only 3 times a day.
481812 -
481813 -
481815 -  ..
4819 -
4820 -
4821 - 1139
4822 -
482201 - Visited the Lab on the 1st Floor.
482202 -
482203 - Millie gave a urine sample for the urinalysis ordered by the doctor to
482204 - assess new report today of a bladder problem. ref SDS 0 YQ6K
482205 -
482206 -
482208 -  ..
4823 -
4824 -
4825 - 1523
4826 -
482601 - This afternoon, Millie said she is not feeling well.
482602 -
482603 - At 1500 she took a Keslex pill for the bladder infection.
482605 -  ..
482606 - She reported feeling chilled, and so put on a robe over her clothing,
482607 - even though the temperature in the house is about 73 degrees, because
482608 - the weather has warmed up to about 78 outside today.
482610 -  ..
482611 - Her temperature is still 100.4.
482612 -
482614 -  ..
4827 -
4828 -
4829 - 1817
4830 -
483001 - This evening, Millie did not eat much dinner.  We had spagetti, which
483002 - she likes, so loss of appetitie is a concern.
483003 -
483004 -
483006 -  ..
4831 -
4832 -
4833 - 2200
4834 -
483401 - Millie took another Keflex pill for the bladder infection problem.
483402 - ref SDS 0 JJ5J
483403 -
483404 -
483405 -
483406 -
483407 -
483408 -
483409 -
483410 -
483411 -
483412 -
4835 -