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 - ëHU6K 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 -