THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: October 2, 2006 01:41 PM Monday; Rod Welch

Kaiser Millie's doctor advised of findings for pulmonary emboli.

1...Summary/Objective


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CONTACTS 

SUBJECTS
Pulmonary Emboli Blood Clots Lungs Diagnosed Recurrence Treatment Pr

0903 -
0903 -    ..
0904 - Summary/Objective
0905 -
090501 - Follow up ref SDS 9 0000, ref SDS 8 0000.
090502 -
090503 - Millie diagnosed with pulmonary embolism recurrence, based on CT test
090504 - this past Saturday. ref SDS 0 MI5I  Doctor prescribed immediate
090505 - treatment, ref SDS 0 JK7J, and requested a letter confirming patient
090506 - performing instructions. ref SDS 0 JK80  Letter to Kaiser thanks
090507 - doctor for taking timely action to resume treatment. ref SDS 0 V1DH
090508 - Millie went to Kaiser for prescription, and started treatment this
090509 - evening. ref SDS 0 GO3J
090510 -
090511 -
090512 -
090513 -
090514 -
090515 -
090517 -  ..
0906 -
0907 -
0908 - Progress
0909 -
090901 - Primary care physician left a telephone message today saying the
090902 - emergency CT test on Saturday, 060930, ref SDS 9 MI66, shows Millie
090903 - has pulmonary embolism again.
090905 -  ..
090906 - Testing was ordered during a meeting on Friday, 060929. ref SDS 8 DY5M
090907 - At that time, Millie explained symptoms, ref SDS 8 B56N, and she
090908 - reviewed reports on 060722 of family genetics for pulmonary emboli,
090909 - ref SDS 6 3D9T, previously submitted to Kaiser on 060724. ref SDS 7
090910 - NL5Q  Research on 060722 shows Millie is high risk for recurrence of
090911 - pulmonary emboli, ref SDS 6 6G6O, and further that 45% of patients who
090912 - suffer recurrence for pulmonary embolism die, making prompt, accurate
090913 - treatment a very critical issue. ref SDS 6 BI5J
090915 -         ..
090916 -        [...below, Millie requests the CT test report. ref SDS 0 JM42
090918 -         ..
090919 -        [061003 Doctor advised in a reply that the analyst's report is
090920 -        not yet available. ref SDS 10 RI6L
090922 -         ..
090923 -        [On 061006 Millie asks about CT test report again.
090924 -        ref SDS 12 QQ5P
090926 -         ..
090927 -        [On 061012 review CT test shows pulmonary embolism recurrence,
090928 -        ref SDS 14 N26L; current conditions seems less severe than on
090929 -        041103, ref SDS 14 7E7G, except new finding of enlarged right
090930 -        ventricle presents new problem of heart disorder. ref SDS 14
090931 -        7E5L
090933 -         ..
090934 -        [On 061020 primary care physician advised that CT tests for
090935 -        pulmonary embolism are different from CT tests for cancer, and
090936 -        so have to be expressly requested with the order for the test.
090937 -        ref SDS 16 S56G
090939 -         ..
090940 -        [On 061027 Millie letter advises Kaiser that pulmonary embolism
090941 -        symptoms continue fatigue, shortness of breath; Millie asks
090942 -        about prognosis for getting back in the gym to improve fitness,
090943 -        which previously were attributed to symptoms for pulmonary
090944 -        embolism. ref SDS 17 K24K
090946 -         ..
090947 -        [On 061208 doctor ordered CT test to evaluate pulmonary
090948 -        embolism because symptoms continue 2 months after treatent.
090949 -        ref SDS 19 Q93H
090951 -         ..
090952 -        [On 070102 received report for CT test performed on 061227;
090953 -        Kaiser failed to compare with CT test on 060930 that diagnosed
090954 -        pulmonary embolism, and enlarged right ventricle. ref SDS 21
090955 -        AK9H
090957 -  ..
090958 - The doctor prescribed a 5-day treatment with Lovenox to prevent
090959 - further blood clots, and with the aim for existing clotting to clear.
090960 - Millie can get medication ordered by the doctor at the Pharmacy today.
090962 -  ..
090963 - After the 5-day treatment with Lovenox, Millie will resume treatments
090964 - with Coumadin, which were stopped on 051007. ref SDS 2 GC6K  Coumadin
090965 - treatment prevents recurrence of pulmonary emboli, reported in
090966 - research on 060722. ref SDS 6 HQ4N  This was the original protocol
090967 - Kaiser prescribed on 041104 when Millie was first diagnosed with
090968 - pulmonary emboli. ref SDS 1 N455
090969 -
090970 -     [On 061004 Millie received verbal instructions from Coagulation
090971 -     Treatment Clinic to take Coumadin concurrently with Lovenox, which
090972 -     appears conflicting with pior instructions for Coumadin to follow
090973 -     treatment with Lovenox. ref SDS 11 0G59
090975 -      ..
090976 -     [On 061006 Lovenox prescription increased another 5-day cycle,
090977 -     call from Advice Nurse relaying instructions from the doctor.
090978 -     ref SDS 12 VI43
090980 -      ..
090981 -     [On 061006 Millie's letter to doctor confirms instructions to take
090982 -     Coumadin concurrent with Lovenox, despite conflicts with prior
090983 -     prior practice, and standard practice in published guidance.
090984 -     ref SDS 12 OP69
090986 -  ..
090987 - The doctor requested feedback with an email to confirm Millie is
090988 - moving forward with treatment for pulmonary emboli.
090989 -
090990 -     [...below, Millie submitted feedback to verify accuracy of
090991 -     understandings being implemented. ref SDS 0 JM48
090992 -
090993 -     [On 061020 Ross in the Oncology Pharmacy Department did not know
090994 -     Millie was being treated with Coumadin for pulmonary emboli; and
090995 -     cautioned that the dose for Coumadin and Xeloda have to be
090996 -     balanced. ref SDS 15 T650
090998 -      ..
090999 -     [On 061108 Millie cough, clearing throat PE symptoms more
091000 -     prominent; chronic fatigue continues. ref SDS 18 VR6F
091002 -      ..
091003 -     [On 061214 Gloria requested feedback from Millie to authenticate
091004 -     accuracy of communication on changing Coumadin treatment for
091005 -     pulmonary embolism in order to avoid hemorrging due to erroneous
091006 -     conflict in medication prescription. ref SDS 20 XF6M
091008 -      ..
091009 -     [On 070307 Gloria indicated that feedback is an important
091010 -     process to authenticate accuracy of communications at
091011 -     Kaiser. ref SDS 22 ML3H
091012 -
091013 -
091015 -  ..
0911 -
0912 -
0913 - HU6K 1357
0914 -
091401 - Millie sent a letter...
091402 -
091405 -        Subject: PE Treatment Plan
091406 -        Sent: 10/2/06 2:03 PM
091408 -         ..
091411 -         ..
091412 -        Got your message on findings of pulmonary emboli. ref SDS 0
091413 -        MI5I Thanks for staying on top of this.  I feel better that we
091414 -        can do something now so I am not so tired.
091416 -         ..
091417 -        Please send me the analyst's report.
091418 -
091419 -            [061003 Doctor advised in a reply that the analyst's
091420 -            report is not yet available. ref SDS 10 J05V
091421 -
091422 -            [On 061004 Millie requests clarification of treatment
091423 -            protocol for pulmonary emboli, which conflicts with prior
091424 -            practice and published guidance. ref SDS 11 XE9G
091426 -             ..
091427 -            [On 061006 Millie asks about CT test report again.
091428 -            ref SDS 12 QQ5P
091430 -             ..
091431 -            [On 061011 Millie asks advice nurse to submit the report on
091432 -            the CT test. ref SDS 13 UR7K
091434 -             ..
091435 -            [On 061012 CT test report received. ref SDS 14 PT4K from
091436 -            both the advice nurse, ref SDS 14 UE4J, and from the
091437 -            doctor. ref SDS 14 EW4H
091439 -  ..
091440 - Millie's letter continues...
091441 -
091442 -        Do you still need diagnostics on my son's condition?
091444 -  ..
091445 - This was discussed in the meeting on Friday, 060929, per above.
091446 - ref SDS 0 EM8I
091448 -  ..
091449 - Millie's letter continues...
091450 -
091451 -        I will pickup meds from the pharmacy shortly, and get
091452 -        started on preparation for Coumadin (Warfarin)
091453 -        treatments.
091455 -  ..
091456 - Millie provides feedback requested in the doctor's message to verify
091457 - instructions are being accurately implemented, per above. ref SDS 0
091458 - JK80
091460 -  ..
091461 - Millie's letter continues...
091462 -
091463 -        I plan to coordinate blood tests for PE with tests using
091464 -        my port for IBC treatments. This will reduce needle
091465 -        trauma. You may recall my arm swelled up like a
091466 -        balloon, but the port has solved the problem.
091467 -
091468 -            [On 061004 Millie received verbal instructions from
091469 -            Coagulation Treatment Clinic to take Coumadin concurrently
091470 -            with Lovenox, which appears conflicting with pior
091471 -            instructions for Coumadin to follow treatment with Lovenox.
091472 -            ref SDS 11 0G59
091474 -             ..
091475 -            [On 061006 Millie's letter to doctor confirms instructions
091476 -            to take Coumadin concurrent with Lovenox, despite conflicts
091477 -            with prior prior practice, and standard practice in
091478 -            published guidance. ref SDS 12 OP69
091480 -             ..
091481 -            [On 061020 Ross in the Oncology Pharmacy Department did not
091482 -            know Millie was being treated with Coumadin for pulmonary
091483 -            emboli; and cautioned that the dose for Coumadin and Xeloda
091484 -            have to be balanced. ref SDS 15 T650
091486 -         ..
091487 -        When time permits, please send me by email sections from
091488 -        the medical chart on our meeting last Friday on 060929,
091489 -        and for the previous meeting on 060825 covering
091491 -         ..
091492 -        Vitals
091493 -        Orders Placed During This Visit
091495 -         ..
091496 -        These were in your earlier reports, but not the last
091497 -        two; just want a consistent record.
091498 -
091499 -
091501 -  ..
0916 -
0917 -
0918 - 1404
0919 -
091901 - Millie drove to Kaiser in Walnut Creek and purchased medication for
091902 - treating pulmonary emboli.
091904 -  ..
091905 - She still has Coumadin pills from treatments in 2005.  The pharmacist
091906 - said they can be used because the bottles have yet been opened, even
091907 - the expriation date was in 2005.
091909 -  ..
091910 - The pharmacist did not submit written instructions, nor offer verbal
091911 - guidance as occurs with other prescriptions.  The pharmacist asked
091912 - Millie if she is familiar with Lovenox and Coumadin procedures?
091914 -  ..
091915 - Millie explained having done this in 2004 and 2005, and that she
091916 - expected to get a call from Gloria in Kaiser's Coagulation Treatment
091917 - Clinic in Martinez later today or tomorrow with instructions to
091918 - implement the doctor's prescription today on resuming treatment for
091919 - pulmonary emboli, per above, ref SDS 0 JK7J,
091920 -
091921 -        [On 061006 Millie's letter to doctor confirms instructions to
091922 -        take Coumadin concurrent with Lovenox, despite conflicts with
091923 -        prior prior practice, and standard practice in published
091924 -        guidance. ref SDS 12 OP69
091925 -
091926 -
091927 -
091929 -  ..
0920 -
0921 -
0922 - 1830
0923 -
092301 - Millie begins treatment with...
092302 -
092303 -        Lovenox
092305 -         ..
092306 -        80 mg 0.8 mL
092308 -         ..
092309 -        10 0.8 mg syringes
092311 -         ..
092312 -        Self-administered shots subcutaneous injections
092314 -         ..
092317 -         ..
092318 -        NDC 0075 0622 80
092320 -         ..
092321 -        For:  Enoxaparin sodium
092323 -         ..
092324 -        Aventis Pharma
092325 -        Boulevard Industrial
092326 -        76580 Le Trait
092327 -        France
092329 -         ..
092330 -        Aventis Pharmeceuticals Inc
092331 -        Bridgewater, NJ  08807
092332 -
092333 -                http://www.aventis.us.com
092335 -         ..
092336 -        50069520
092337 -
092338 -
092339 -
092340 -
092341 -
092342 -
092343 -
092344 -
092345 -
092346 -
092347 -
0924 -