CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 12 0000, ref SDS 11 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040508 -
040510 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On Monday, 061002 the doctor left a telephone voice mail message that
040902 - tests show Millie has pulmonary emboli again, and so needs to resume
040903 - treatments. ref SDS 11 MI5I  The doctor requested a letter confirming
040904 - Millie received his notice and is following the doctor's instructions.
040905 - ref SDS 11 JK80  Later that day, Millie sent a letter to Kaiser
040906 - letting the doctor know that she got his message. ref SDS 11 V1DH  She
040907 - also went to the Kaiser pharmacy for medications ordered the doctor.
040908 - ref SDS 11 GO3J, however, at that time, on 061002, the pharmacist did
040909 - not provide instructions for taking Coumadin. ref SDS 11 9K7M
040911 -  ..
040912 - Millie expected that Gloria in the Kaiser Coagulation Treatment Clinic
040913 - in Martinez would call to schedule implementation of the doctor's
040914 - order on 061002 for treatment and testing of pulmonary emboli,
040915 - ref SDS 11 JK7J, as done previously in 2004 and 2005, shown by the
040916 - record on 051026, ref SDS 3 PO7J, and previously on 051006. when
040917 - Gloria requested support collaborating with the doctor. ref SDS 2 5F62
040919 -  ..
040920 - Since the Coagulation Treatment Clinic did not call yesterday, Millie
040921 - called the clinic after lunch today.  Gloria was out of the office.
040922 - The women who answered said that the clinic had not yet received an
040923 - order from the doctor.  She planned to contact the primary care
040924 - physician to expedite treatment for Millie.
040926 -  ..
040927 - After this call, Millie sent another letter to the doctor, following
040928 - up her letter on Monday, 061002, ref SDS 11 V1DH, and the doctor's
040929 - response yesterday, ref SDS 12 J04J, and asking for clarification of
040930 - treatment protocol with Coumadin, and saying...
040931 -
040934 -     Subject: Pulmonary Emboli - Anticoagulation Order
040935 -     Sent: 10/4/06 2:07 PM
040936 -
040940 -      ..
040941 -     I know I am to continue injecting the Lovenox for five
040942 -     days (twice a day) which I started last Monday in the
040943 -     PM. Am I to assume after the Lovenox I am to resume 4
040944 -     mg of coumadin a day from than on? I was under the
040945 -     impression I was to be contacted by the Anticoaulation
040946 -     Center for follow up. Please let me know what the
040947 -     procedure is.
040949 -      ..
040951 -
040953 -  ..
040954 - Millie's understanding in the letter to the doctor that treatment with
040955 - Lovenox preceeds treatment with Coumadin, aligns with the call from
040956 - the doctor on 061002, ref SDS 11 JK7J, with research on 060722,
040957 - ref SDS 7 HQ4N, and, also, with the protocol Kaiser followed when
040958 - Millie was first diagnosed with pulmonary emboli on 041104.
040959 - ref SDS 1 N455
040961 -  ..
040962 - This evening Millie explained getting a call back from the woman with
040963 - Kaiser's Coagulation Treatment Clinic, per above. ref SDS 0 XE95
040965 -  ..
040966 - Millie understood from this call that Kaiser is now prescribing
040967 - treatment with Coumadin immediately and concurrent with 5 days of
040968 - Lovenox treatment.
040970 -  ..
040971 - As a resut, this evening, Millie started taking Coumadin pills, along
040972 - with the shots for Lovenox.
040973 -
040974 -        [On 061006 Millie's letter to doctor confirms instructions to
040975 -        take Coumadin concurrent with Lovenox, despite conflicts with
040976 -        prior prior practice, and standard practice in published
040977 -        guidance. ref SDS 13 OP69
040979 -  ..
040980 - Taking Coumadin concurrent with Lovenox seems conflicting with the
040981 - call from the doctor on 061002, ref SDS 11 JK7J, with published
040982 - guidance reported in the record on 060722, ref SDS 7 HQ4N, and with
040983 - the protocol Kaiser supported for the original diagnosis on 041104.
040984 - ref SDS 1 N455
040986 -  ..
040987 - It would seem to increase risk of bleeding from increased thinning of
040988 - blood, but maybe standard practice has changed since 2004, or maybe
040989 - Millie's condition requires increased medication.
040990 -
040991 -        [On 061006 Millie's letter to doctor confirms instructions to
040992 -        take Coumadin concurrent with Lovenox, despite conflicts with
040993 -        prior prior practice, and standard practice in published
040994 -        guidance. ref SDS 13 OP69
040995 -
040996 -
040997 -
040998 -
040999 -
041000 -
041001 -
041002 -
041003 -
0411 -