THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: November 10, 2006 03:40 PM Friday;
Millie meeting at Kaiser to evaluate start 6th IBC treatment cycle.
2...Agenda Develop Work Plan Stage IV Breast Cancer 8 Mos after Mastectomy
3...Complex Patient History Knowledge Management Dilemma Issues Grow 34
4...Vitals Show Stable Medical Condition
5...CA 15-3 Cancer Marker 56 Rises Slightly from Prior Test on 060928
6...CA 15-3 61 Cancer Marker Test Tomorrow Influence Treatment Decision
7...Digestion Problems Increasing Relatively Infrequent Mild
8...Esophagitis Not Compared in Current PET Test with Prior Report
9...Cellulitis Complications Lymphedema Cleared Treatment Ends
10...Left Axillary No Evidence Lymphadenopathy Cellulitis Treatment Ends
11...Lymphedema Left Arm Lump Under Arm Diagnosis Not Cancer
12...Post Operation Localized Edema Left Axillary Swelling Reduced
13...Right Axillary FDG SUV 2.5 Lump Discomfort Not Reported by Patient
14...Left Supraclavicular Examination PET Test Report Finding SUV 4.5
15...Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
16...Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
17...IBC Red Rash Left Breast Stable Not Responding to Treatment
18...Red Rash Stable Left Breast Rising CA 15-3 No Response to Treatment
19...Examination Left Breast IBC Inflammation Red Rash Seems Stable Rising
20...Blood Vessels Removed Mastectomy Create Pockets that Resist Treatment
21...Slow Response to Treatment Mastectomy Removed Blood Vessels
22...Expectations Recovery Rate Reduced Mastectomy Remove Blood Vessels
23...Alternate Treatment Method Blood Vessels Cannot Deliver Chemotherapy
24...Treatment Options Expand Pool of Drugs Biopsy Test for Status Change
25...Biopsy to Determine Biology of IBC and Guide Choice of Treatment
26...Status Change Did Not Occur Retest Biopsy 040419 Treatment Options
27...PET CT Image Testing Distant Metastasis Risks Secondary Cancer
28...IBC Test Distant Metastasis Discouraged Avoid Risk Secondary Cancer
29...Radiation Image Tests PET CT Limit to Reduce Risk Secondary Cancer
30...Risk Secondary Cancer Exposure Radiation Image Testing CT PET Scan
31...Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
32...Exercise Vigor Strength Engagement Ease Distress Living with Cancer
33...Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
34...Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
35...Strategy Treatment Options Scenarios Planning Patient Work Up Deferred
36...Treatment Continue 6th Cycle Taxotere and Capecitabine (Xeloda)
37...6th Cycle Taxotere and Capecitabine (Xeloda) Treatment Continue
38...Taxotere and Capecitabine (Xeloda) 6th-Cycle Treatment Continue
39...Schedule Treatment Continue Prescription Taxotere Capecitabine Xeloda
40...Procrit Prescribe to Treat Symptoms Pulmonary Embolism Fatigue
41...Tired Breathing Difficulty Routine Activity Signals Pulmonary Emboli
42...Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
43...Pulmonary Emboli Genetic Cause Hypercoagulable Work Up Family History
44...Comparison CT Test 060930 with Test 041103 Original Diagnosis
45...Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
46...Heart Examination Not Ordered Investigate Enlarged Right Ventricle
47...Enlarged Right Ventricle CT Test Aligns Patient Symptoms How Serious
48...Coagulapathy Report Family Genetic Disposition Pulmonary Emboli
49...Hypercoagulable State Work Up Risk Assessment Treatment Guidance
....What is antiphospholipid syndrome (APS)?
50...Work Plan Received Communications Doctor/Patient Partnership
51...Communications Doctor Submits Work Plan Doctor/Patient Partnership
52...Doctor/Patient Partnership Communications Doctor Submits Work Plan
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Meeting Doctor Examination 5th Review Prepare for Treatment #5 After
1903 - ..
1904 - Summary/Objective
190501 - Follow up ref SDS F1 0000. ref SDS E4 0000.
190503 - Continuing rise of CA 15-3 cancer marker, ref SDS 0 GJ5M, aligns with
190504 - examination showing stable to worsening areas of IBC rash on left
190505 - breast. ref SDS 0 025H Treatment strategy and plan for changing
190506 - protocol can consider the doctor previously proposed surgery to remove
190507 - "pockets of resistance" to chemotherapy. ref SDS 0 K36G Rising
190508 - indigestion remains mild and infrequent. Investigation of image
190509 - testing diagnosing "likely esophagitis" not scheduled. ref SDS 0 JP6K
190510 - Millie suffered sudden elevated temperature while on chemotherapy.
190511 - Hospitalized for 5 days to treat Cellulitis that presents complication
190512 - of lymphedema in left arm due to loss of lymphatics from surgery, and
190513 - triggered by broken finger a month earlier. Treatment ended today,
190514 - and examination indicates arm seems clear of symptoms. ref SDS 0 A68L
190515 - Hectic schedule prevented consideration of pending issues, e.g.,
190516 - impaired delivery of systemic treatment agents due to blood vessels
190517 - removed by surgery, ref SDS 0 H544, study opportunity for biopsy to
190518 - establish measurable disease and expand treatment options for mutated
190519 - cancer, ref SDS 0 KT7J, to compare CT tests for trend analysis on
190520 - pulmonary embolism. ref SDS 0 QQ4N Patient reports continuing
190521 - symptoms pulmonary embolism after 3 weeks treatment with Coumadin.
190522 - Fatigue, shortness of breath, heavy chest occur with normal activity.
190523 - ref SDS 0 CV5L Procrit prescribed based on low hemoglobin blood count
190524 - to treat anemia symptoms of continuing fatigue. ref SDS 0 OY4H
190525 - Examination by stethoscope indicates enlarged right ventricle may not
190526 - present serious condition. ref SDS 0 Q35O The doctor feels the
190527 - coagulapathy report on a family member does not suggest increased risk
190528 - for Millie that requires change diagnosis, treatment, nor further
190529 - investigation. ref SDS 0 626L Kaiser support for Knowledge Management
190530 - demonstrates opportunities to strengthen medical practice. ref SDS 0
190531 - FE4I
190533 - [On 061201 primary care physician took immediate action to correct
190534 - schedule mistake so that examination occurs on schedule, allowing
190535 - timely consideration of changing treatment. ref SDS G4 N96O
190540 - ..
1908 - Progress
190901 - Agenda Develop Work Plan Stage IV Breast Cancer 8 Mos after Mastectomy
190903 - Follow up ref SDS F1 SM6M, ref SDS E4 SM6M.
190905 - This is the 6th review meeting for 14th overall, and 6th chemotherapy
190906 - cycle, reported in another record today, ref SDS G1 407N, following
190907 - start of treatments on 060711 for 3rd relapse of IBC. ref SDS B8 SM6M
190908 - The doctor had a hectic schedule today, and so the meeting scheduled
190909 - for 1540 actually started at 1710.
190911 - ..
190912 - Millie submitted ref DIT 1 0001 with an agenda to guide discussions,
190913 - and provided background, ref DIT 1 F26L, to support the doctor in
190914 - preparing for the meeting, as follows...
190916 - 1. CA 15-3 review seems negative.................. ref SDS 0 GJ5M
190917 - 2. Lymphedema/Cellulitis treatment effective...... ref SDS 0 MW8J
190918 - 3. Breast exam IBC biopsy measurable disease...... ref SDS 0 025H
190919 - 4. Treatment plan strategy........................ ref SDS 0 K36G
190920 - 5. Pulmonary emboli how serious r ventricle....... ref SDS 0 VJ4J
190921 - 6. PE symptoms cough clearing throat fatigue...... ref SDS 0 CV5L
190922 - 7. Hypercoagulable state work up.................. ref SDS 0 626L
190923 - 8. Coagulapathy report Millie's son............... ref SDS 0 626L
190924 - 9. Esophagitis, heart burn........................ ref SDS 0 JP6K
190926 - ..
190927 - Today, rather than Millie list the agenda on the marking board, the
190928 - doctor worked from list transferred from Millie's letter into the
190929 - electronic Medical Chart, shown below, ref SDS 0 684G as was done last
190930 - month on 061020. ref SDS F1 K84N The doctor displayed the agenda on
190931 - the computer screen showing the Medical Chart in the examination room.
190933 - [On 061208 hectic schedule not enough time to work from
190934 - agenda in the Medical Chart. ref SDS G7 K84N
190936 - ..
190937 - Scheduled next meeting in about 3 weeks to start the 8th cycle, and
190938 - assess progress on December 1, 2006
Complex Patient History 34 Issues Overwhelms Span of Attention Drive
200401 - ..
200402 - Complex Patient History Knowledge Management Dilemma Issues Grow 34
200404 - Follow up ref SDS F1 MO4K.
200406 - Sampling of issues patient history diagnosis and treatment...
200408 - 1. CA 15-3 monitors advance of cancer response to treatment
200409 - 2. Lymphedema complicated by mastectomy surgery
200410 - 3. Broken finger from minor fall complicates lymphedema
200411 - 4. Esophagitis reflux digestion issues
200412 - 5. Immune system chemotherapy increases risk of infection
200413 - 6. Chemotherapy increase risk of infection
200414 - 7. Cat bites increase risk of infection complicates lymphedema
200415 - 8. Pneumonia chemotherapy increases risk of infection
200416 - 9. Metastatic cancer increases risk pulmonary embolism
200417 - 10. Lymphadenopathy left axilla local regional metastasis
200418 - 11. Lymphadenopathy right axilla distant metastasis
200419 - 12. Lymphadenopathy left supraclavicular diagnose metastatic cancer
200420 - 13. Mastectomy surgery impact on cancer treatment and lymphedema
200421 - 14. Breast cancer secondary IBC 3rd relapse
200422 - 15. Cancer mutates slow response chemotherapy treatment
200423 - 16. Blood vessels removed mastectomy slow chemotherapy treatments
200424 - 17. Treatment options, strategy, planning, schedule
200425 - 18. Drug trials increase declining pool chemotherapy agents
200426 - 19. UCSF Doctor Benz 2nd opinion apply diagnosis and treatment
200427 - 20. Pulmonary embolism blood clots in lungs
200428 - 21. INR weekly adjustments Coumadin treatment blood clots
200429 - 22. Enlarged right ventricle heart problem core pulmonale
200430 - 23. Dizziness symptom enlarged right ventricle cor pulmonale
200431 - 24. Fatigue shortness breath side effect chemotheapy loss fitness
200432 - 25. Fatigue shortness breath symptom pulmonary embolism
200433 - 26. Shortness breath fatigue dizzy symptoms pulmonary embolism
200434 - 27. Coagulapathy hypercoagulable state work up genetic risks
200435 - 28. Testing resolution of errors (see Benz 2nd opinions)
200436 - 29. Testing distant metastatic disease
200437 - 30. Testing resolution pulmonary emoblism and heart disease
200438 - 31. Communication hectic schedule not enough time to manage details
200439 - 32. Emotional stress and well being
200441 - ..
200442 - Issues added today...
200444 - 33. Cellulitis inflammation temperature 102.6 on chemotherapy
200445 - 34. Urinary tract bladder infection
Vitals Obtain from Infusion Clinic Progress Note Meeting Doctor John
220401 - ..
220402 - Vitals Show Stable Medical Condition
220404 - Follow up ref SDS F1 KB5L, ref SDS E4 KB5L.
220406 - ..
220407 - Bld Prssr Pulse Temp Weight SaO2
220408 - ..
220409 - 061110................. 136 83 73 97.0 150 98%
220410 - 061020 1534............ 140 79 67 99.8 151 97
220411 - 060929 1452............ 141 78 66 98.3
220412 - 060908 1335............ 139 79 73 98.1
220413 - 060814 1610............ 139 80 59 98.2
220414 - * 060808.................
220415 - 060711................. 172 87 54 97.5 147
220416 - 060623................. 141 87 71 98.0 147 99%
220417 - 060428................. 129 73 80 99.4 149 99%
220418 - 060217................. 153 81 61 98.6 150 99%
220420 - ...per Doctor's report, shown below, vitals were obtained from the
220421 - record on treatment today in the Infusion Clinic. ref SDS 0 JQ4J
CA 15-3 61 Rise from 56 Continues Increase Indicates Slow Response T
320401 - ..
320402 - CA 15-3 Cancer Marker 56 Rises Slightly from Prior Test on 060928
320404 - Follow up ref SDS F1 087J, ref SDS E4 087J.
320406 - The test yesterday shows CA 15-3 cancer marker at 61 has ticked up
320407 - again the past 3 weeks during cycle 4. ref SDS G1 2N5J An interim
320408 - test on 061026 was up only 1 tick at 57...
320410 - ..
320411 - Test Date Date Received
320412 - 061109......... 61 H............. 061110, ref SDS 0 087J
320413 - 061026......... 57 H............. 061110, ref SDS 0 087J
320414 - 061019......... 56 H............. 061020, ref SDS F1 087J
320415 - 060928......... 51 H............. 060929, ref SDS E4 087J
320416 - 060907......... 68 H............. 060929, ref SDS E4 087J
320417 - 060813......... 73 H............. 060817, ref SDS D9 U24M
320418 - 060809......... 87 H............. 060810, ref SDS D7 2N5J
320419 - 060708......... 71 H............. 060711, ref SDS B8 087J
320420 - 060616......... 63 H............. 060623, ref SDS B6 UQ5Q
320421 - 060522......... 59 H............. 060605, ref SDS B1 UQ5Q
320422 - 060501......... 49 H............. 060522, ref SDS A8 MC4F
320423 - 060421......... 44 H............. 060428, ref SDS A1 087J
320424 - 060330......... 40 H............. 060428, ref SDS A1 087J
320425 - 060303......... 36............... 060428, ref SDS A1 087J
320426 - 060210......... 33............... 060217, ref SDS 91 087J
320427 - 060109......... 34............... 060126, ref SDS 90 KV59
320428 - 051223......... 34............... 060106, ref SDS 89 087J
320429 - 051202......... 28............... 060106, ref SDS 89 087J
320430 - 051116......... 31............... 051121, ref SDS 87 087J
320431 - 051109......... 30............... 051121, ref SDS 87 087J
320432 - 051102......... 34............... 051121, ref SDS 87 087J
320433 - 050909......... 45 H............. 051007, ref SDS 81 087J
320434 - 050826......... 45 H............. 050913, ref SDS 75 087J
320435 - 050819......... 45 H............. 050913, ref SDS 75 087J
320436 - 050812......... 39 .............. 050819, ref SDS 68 3K6L
320437 - 050729......... 45 H............. 050819, ref SDS 68 EA5G
320438 - 050708......... 46 H............. 050729, ref SDS 67 087J
320439 - 050701......... 37 .............. 050729, ref SDS 67 087J
320440 - 050617......... 45 H............. 050729, ref SDS 67 087J
320441 - 050527......... 56 H............. 050610, ref SDS 64 087J
320442 - 050512......... 67 H............. 050520, ref SDS 62 087J
320443 - 050506......... 80 H............. 050520, ref SDS 62 087J
320444 - ..
320445 - 050415.........105 H............. 050422, ref SDS 59 087J
320446 - 050325.........100 H............. 050329, ref SDS 57 087J
320447 - 050318.........101 H............. 050325, ref SDS 56 2N5J
320448 - 050304......... 88 H............. 050311, ref SDS 54 087J
320449 - 050225......... 95 H............. 050308, ref SDS 53 0001
320450 - 050211......... 78 H............. 050214, ref SDS 52 02BB
320451 - 050128......... 67 H............. 050204, ref SDS 51 087J
320452 - 041228......... 56 H............. 041230, ref SDS 50 087J
320453 - 041204......... 43 H............. 041210, ref SDS 49 087J
320454 - 041007......... 39............... 041104, ref SDS 45 087J
320455 - 040923......... 49 H............. 041005, ref SDS 43 087J
320456 - 040908......... 44 H............. 040909, ref SDS 42 087J
320457 - 040825......... 47 H............. 040909, ref SDS 42 087J
320458 - 040811......... 42 H............. 040812, ref SDS 41 087J
320459 - 040728......... 43 H............. 040729, ref SDS 39 2N5J
320460 - 040712......... 47 H............. 040713, ref SDS 38 087J
320461 - 040614......... 55 H............. 040615, ref SDS 37 PX6X
320462 - 040517......... 78 H............. 040601, ref SDS 35 2N5J
320463 - 040311......... 70 H............. 040318, ref SDS 28 SM6M
320464 - 040205......... 60 H............. 040211, ref SDS 26 SM6M
320465 - 031201......... 62 H............. 031205, ref SDS 25 SM6M
320466 - 030912......... 66 H............. 030915, ref SDS 24 SM6M
320467 - 030708......... 68 H............. 030710, ref SDS 23 SM6M
320468 - 030503......... 54 H............. 030508, ref SDS 21 SM6M
320469 - 030403......... 45 H............. 030508, ref SDS 21 SM6M
320470 - 030215......... 46 H............. 030220, ref SDS 20 5E6L
320471 - 030106......... 37 H............. 030109, ref SDS 19 SM6M
320472 - 021202......... 41 H?............ 021204, ref SDS 18 SP5G
320473 - 021111......... 36 H?............ 021113, ref SDS 17 Y65I
320474 - 021023......... 33 H?............ 021023, ref SDS 16 SQ5I
320475 - 020930......... 33 H?..39........ 021002, ref SDS 15 SQ5I
320476 - 020917......... 36 H?............ 020924, ref SDS 14 SQ5I
320477 - 020717......... 59 H?............ 020726, ref SDS 13 YN5K
320478 - 020629......... 75 H ............ 020705, ref SDS 11 UX6I
320479 - 020608........ 67 H ............ 020614, ref SDS 9 0001
320480 - 020603........ 108 H ............ 020607, ref SDS 8 X67F
320481 - 020511........ 117 H ............ 020603, ref SDS 7 PJ4J
320482 - 020419......... 81 H ............ 020430, ref SDS 5 7N5H
320483 - 020321......... 85 H ............ 020405, ref SDS 4 6T8K
320489 - ..
3207 - Analysis
320801 - CA 15-3 61 Cancer Marker Test Tomorrow Influence Treatment Decision
320803 - Follow up ref SDS F1 GJ5M, ref SDS E4 GJ5M.
320805 - Consecutive rise of CA 15-3 cancer marker from 56 to 61 and a total
320806 - rise of 20% from 51 to 61 during the current treatment cycle aligns
320807 - with the doctor's examination today finding that IBC red rash has been
320808 - stable, showing no response to treatment. ref SDS 0 025H Rising
320809 - symptoms may indicate scenario #2 developed on 060808, ref SDS D4
320810 - HT5K, where effectiveness of treatment protocol has fallen, and/or
320811 - that treatment is not being delivered to infected tissue because
320812 - mastectomy surgery created "pockets of resistance" by removing blood
320813 - vessels that were not replaced with reconstructive surgery, as related
320814 - in the record for the meeting on 061020, ref SDS F1 KU4L, and
320815 - discussed further below. ref SDS 0 P66G
Digestion Problems Increasing Relatively Infrequent Mild Esophagitis
360401 - ..
360402 - Digestion Problems Increasing Relatively Infrequent Mild
360403 - Esophagitis Not Compared in Current PET Test with Prior Report
360405 - Follow up ref SDS F1 JP6K, ref SDS E4 JP6K.
360407 - Millie reported increasing, though still relatively infrequent, 4 - 5
360408 - times a month, episodes of discomfort from indigestion.
360410 - ..
360411 - The doctor reviewed background on diagnosis of "likely esophagitis"
360412 - reported in PET scan test performed on 060120, and received on 060126.
360413 - ref SDS 90 DH4O Follow up on 060623, ref SDS B6 DH4O, reviewed
360414 - contrast CT study on 060505. Pathology findings reported nodes within
360415 - the right paratracheal that might relate to the earlier findings, as
360416 - shown on 060523. ref SDS A8 4O8P At about the same time, attending
360417 - physicians who treated Millie for pneumonia in the Emergency Room on
360418 - 060607 reported Kaiser diagnosed Millie with esophagitis. ref SDS B2
360419 - K66E Research indicates possible correlations with pneumonia.
360420 - ref SDS B2 HX7L At the time on 060623, consideration of esophagitis
360421 - was deferred due to computer access issues and limited time.
360422 - ref SDS B6 463H
360424 - ..
360425 - On 060711 the doctor determined that infrequent episodes of symptoms
360426 - do not support diagnosis of esophagitis and prescribed continued over
360427 - the counter treatment. ref SDS B8 4R6K
360429 - ..
360430 - The doctor indicated today that the CT test on 060505 finding nodes
360431 - within the right paratracheal, reviewed on 060523, ref SDS A8 4O8P,
360432 - likely do not support the earlier PET scan test findings of likely
360433 - esophagitis, because the locations are different.
360435 - ..
360436 - The doctor commented that rising indigestion reported today may relate
360437 - to esophagitis, but symptoms remain too mild for diagnosis, except to
360438 - continue treatment with Tums. Doctor's progress notes reflect these
360439 - understandings, noting GERD stable with Tums. ref SDS 0 1248
Left Axillary Lymphadenopathy Patient No Complaint of Swelling Disco
530401 - ..
530402 - Cellulitis Complications Lymphedema Cleared Treatment Ends
530403 - Left Axillary No Evidence Lymphadenopathy Cellulitis Treatment Ends
530404 - Lymphedema Left Arm Lump Under Arm Diagnosis Not Cancer
530405 - Post Operation Localized Edema Left Axillary Swelling Reduced
530407 - Follow up ref SDS F1 MW8J, ref SDS E4 MW8J.
530409 - ..
530410 - Patient history of left axillary lymphadenopathy and lymphedema is
530411 - reported on 060106. ref SDS 89 S164
530413 - ..
530414 - There was no examination today for cancer in left axilla. The patient
530415 - made no complaint of lumps or discomfort from swelling under the left
530416 - arm.
530418 - ..
530419 - On 060914 Millie fell and injured the middle index finger on her left
530420 - hand; complications of lymphedema increased causing the left arm to
530421 - swell. ref SDS E5 ZQ5I Over the next week, swelling increased. On
530422 - 060922 Millie notified Kaiser of this new problem. ref SDS E6 0D5Y On
530423 - 060929 the primary care physician examined the left arm and injured
530424 - finger. Physical therapy was prescribed for continuing treatment of
530425 - lymphedema. ref SDS E4 IW9J
530427 - ..
530428 - On 061016 swelling and pain in the left finger, and running up her arm
530429 - led to further examination. Xrays at Kaiser showed the finger was
530430 - broken. This was treated with a soft-cast for 5 days. On 061020 the
530431 - primary care physician examined Millie's arm and hand. Continuing
530432 - treatment with physical therapy was prescribed. ref SDS F1 153G
530434 - ..
530435 - On 061027 Millie was treated in the Emergency Room and hospitalized
530436 - with a temperature of 102.6. Her left arm was severely swelled and
530437 - inflamed. ref SDS F4 Q265 Doctors diagnosed Cellulitis complications
530438 - of lymphedema, and the broken finger, ref SDS F4 V759, suffered on
530439 - 060914. She was treated with antibiotics for 5 days, and released on
530440 - 061101 after the inflammation and swelling subsided. ref SDS F7 JR9N
530442 - ..
530443 - Bladder (urinary tract) infection was also diagnosed on 061027, and
530444 - this was treated with antibiotics. ref SDS F4 V76H
530446 - ..
530447 - Millie was treated with Nupigen for 5 days to increase blood counts,
530448 - and, also, with antibiotics to treat Cellulitis for the next 10 days,
530449 - which ends today.
530451 - ..
530452 - Examination today shows the left arm appears still completely cleared
530453 - of Cellulitis inflammation, and that lymphedema swelling continues, as
530454 - shown in doctor progress notes. ref SDS 0 1248 Treatment for
530455 - lymphedema is under direction of the physical therapy department,
530456 - reported on 061020. ref SDS F1 EP7P
530458 - ..
530459 - Below left elbow measures 11.25" continued improvement shown in case
530460 - study on 060509. ref SDS A6 HO7F
530463 - [On 061112 patient relapses, ref SDS G2 HP52, examined by Doctor
530464 - Seier at Internal Medicine Clinic, Kaiser in Walnut Creek.
530465 - ref SDS G2 FP67
530467 - ..
530468 - [On 061112 doctor orders prescription for antibiotics for another
530469 - 10 days; recommends patient examination by primary care physician.
530470 - ref SDS G2 BX4G
530472 - ..
530473 - [On 061203 patient relapses, ref SDS G5 MF9H, very slight
530474 - temperature; notify primary care physician. ref SDS G5 5X3N
Right Axillary Clinical Examination Finds No Lump Patient Complains
580401 - ..
580402 - Right Axillary FDG SUV 2.5 Lump Discomfort Not Reported by Patient
580404 - Follow up ref SDS F1 3D6K, ref SDS E4 3D6K.
580406 - Background on patient history of testing for lymphedanopathy in the
580407 - right axilla is reported in the record on 060929. ref SDS E4 3D6K
580409 - ..
580410 - There was no examination today for cancer in right axilla. The
580411 - patient made no complaint of lumps or discomfort from swelling under
580412 - the right arm. This work aligns with CT test on 060930 that found no
580413 - evidence of disease in the right axillary, reported on 061020.
580414 - ref SDS F1 8T4S
Left Supraclavicular Neck CT Test Contrast Study on 060505 Finds No
660401 - ..
660402 - Left Supraclavicular Examination PET Test Report Finding SUV 4.5
660403 - Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
660404 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
660406 - Follow up ref SDS F1 8R6M, ref SDS E4 8R6M.
660408 - Background of image testing, and consideration for radiation treatment
660409 - of left supraclavicular is reported on 060623. ref SDS B6 8R6M
660411 - ..
660412 - Like the left and right axillary locations, there was no examination
660413 - today for cancer in left supraclavicular region. The patient made no
660414 - complaint of lumps or discomfort from swelling in this area. This
660415 - work aligns with CT test on 060930 that found no evidence of disease
660416 - in the left supraclavicular location, reported on 061020. ref SDS F1
660417 - LP5G
Examination IBC Red Rash Left Breast Stable Unchanged to Worse After
810401 - ..
810402 - IBC Red Rash Left Breast Stable Not Responding to Treatment
810403 - Red Rash Stable Left Breast Rising CA 15-3 No Response to Treatment
810404 - Examination Left Breast IBC Inflammation Red Rash Seems Stable Rising
810406 - Follow up ref SDS F1 025H, ref SDS E4 025H.
810408 - Background on prior relapse examinations is listed on 060711.
810409 - ref SDS B8 8Y7O
810411 - ..
810412 - Millie's letter, ref DIP 1 ZL6L, to Kaiser on 061027 asks for review
810413 - of treatment strategy to address slow response to treatment.
810414 - ref SDS F3 KJ7K
810416 - ..
810417 - The doctor looked briefly at the left breast. Examination today shows
810418 - IBC red rash seems stable to worsening, as indicated might be
810419 - occurring during the examination on 061020. ref SDS F1 XO5L The
810420 - doctor's progress notes describe "stable lesions." ref SDS 0 ZL5W
810422 - ..
810423 - Observation again shows "pockets" of red rash above and below the
810424 - surgery incision line for mastectomy performed on 051021, as seen
810425 - previously on 061020. ref SDS F1 YP6F
810427 - ..
810428 - One location above the incision line about 1" left of the sternum area
810429 - and approximately .5" diameter, shows rising intensity. Previously,
810430 - on 060808 the area of greatest intensity was nearer to the sternum.
810431 - ref SDS D4 NS5J The sternum region now seems less intense, possibly
810432 - responding to treatment, perhaps getting chemotherapy agent from
810433 - capillaries in the right breast.
810435 - ..
810436 - Overall there seems to be more red rash above and below the incision
810437 - line than observed on 060711, ref SDS B8 8Z8G, again on 060808, after
810438 - report of slight reduction in IBC rash. ref SDS D4 8Z8G More
810439 - importantly, IBC rash seems stable to worse today after 6 cycles of
810440 - chemotherapy than on 061020 after the 5th cycle. ref SDS F1 XO5L
810442 - ..
810443 - Stable to worsening IBC rash aligns with rising CA 15-3 cancer marker,
810444 - reported above. ref SDS 0 GJ5M
810446 - ..
810447 - IBC may not be responding to systemic treatment under scenario #2
810448 - presented in the record on 060808. ref SDS D4 HT5K On 050311 the
810449 - doctor described this condition as presenting "pockets" of cancer that
810450 - resist treatment with chemotherapy. ref SDS 54 PA4N This may be
810451 - occurring due to cancer mutating, and compounded by mastectomy surgery
810452 - that removed blood vessels which normally deliver treatment to
810453 - infected tissue, discussed further below. ref SDS 0 EH3F
810455 - ..
810456 - Kaiser continues to avoid measurements, photographs, and biopsy to
810457 - assess measurable disease, as presented in the UCSF 2nd opinion
810458 - submitted by Doctor Benz, and reviewed with the primary care physician
810459 - on 061020. ref SDS F1 JQ3J
Mastectomy Removes Blood Vessels Prevents Delivery Chemotherapy Trea
870401 - ..
870402 - Blood Vessels Removed Mastectomy Create Pockets that Resist Treatment
870403 - Slow Response to Treatment Mastectomy Removed Blood Vessels
870404 - Expectations Recovery Rate Reduced Mastectomy Remove Blood Vessels
870405 - Alternate Treatment Method Blood Vessels Cannot Deliver Chemotherapy
870407 - Follow up ref SDS F1 EH3F, ref SDS E4 EH3F.
870409 - Background on slow response to treatment and impending progression of
870410 - disease due to mastectomy surgery on 051021 was reviewed in the record
870411 - for the meeting on 061020. ref SDS F1 EH3F
870413 - ..
870414 - Millie's letter to Kaiser, ref DIP 1 ZL6L, on 051027 asks about slow
870415 - recovery from IBC caused by mastectomy surgery removing blood vessels
870416 - needed to deliver treatment. ref SDS F3 MS3Y
870418 - ..
870419 - Review on 061012 of CT test on 060930 shows no findings of local,
870420 - regional, nor distant metastasis. ref SDS E8 2967 Findings were
870421 - discussed with the primary care physician during the previous meeting
870422 - on 061020. ref SDS F1 EY5O
870424 - ..
870425 - Examination today shows no improvement and either stable, or
870426 - progression of disease, per above. ref SDS 0 RU6J
870428 - ..
870429 - This recent evidence may indicate the patient is being treated with
870430 - chemotherapy that has harsh side effects, including increased risk for
870431 - pulmonary embolism, ref SDS C4 KN5L, and with no evidence of
870432 - metastatic disease, except at a location on the left chest breast area
870433 - that cannot be treated effectively with chemotherapy due to mastectomy
870434 - surgery that removed blood vessels, or possibly with the current
870435 - protocol due to mutation of disease, or some combination of both
870436 - factors.
870438 - ..
870439 - If treatment cannot be delivered through a conventional method using
870440 - the blood system, then alternatives need to be investigated, such as
870441 - direct application to infected tissue or further surgery.
870443 - ..
870444 - If the disease has mutated in the normal course, then consideration
870445 - for changing chemotherapy agents seems required.
870447 - ..
870448 - Hectic schedule today, ref SDS 0 SM6M, the doctor did not have enough
870449 - time to consider these issues.
Biopsy Left Breast Investigate for Mutated Cancer IBC Red Rash Statu
930401 - ..
930402 - Treatment Options Expand Pool of Drugs Biopsy Test for Status Change
930403 - Biopsy to Determine Biology of IBC and Guide Choice of Treatment
930404 - Status Change Did Not Occur Retest Biopsy 040419 Treatment Options
930406 - Follow up ref SDS F1 KT7J, ref SDS E4 KT7J.
930408 - Can a biopsy contribute to patient work up for developing a strategy
930409 - and treatment plan, discussed on 060711, ref SDS B8 K36G, and more
930410 - recently on 061020? ref SDS F1 KH6H
930412 - ..
930413 - If cancer has mutated, shown by no response to treatment that was
930414 - previously effective, per examination above, ref SDS 0 025H, this
930415 - change in biology of the cancer, may yield a status change??
930417 - ..
930418 - Tissue from the biopsy on 051021 and from current tissue may be
930419 - conducive to investigation, although the pathology analysis received
930420 - on 051027 for the biopsy on 051021 reported finding no evidence of
930421 - cancer, except for DCIS. ref SDS 86 616P Nominally, status change
930422 - requires testing tissue infected with cancer. This may require a skin
930423 - scrapping of the red rash on on the left breast area.
930425 - ..
930426 - With a hectic schedule today, ref SDS 0 SM6M, the primary care
930427 - physician did not have time to review this issue.
CT Scan Test 060930 Pulmonary Embolism Analyst Failed Perform Doctor
A20401 - ..
A20402 - PET CT Image Testing Distant Metastasis Risks Secondary Cancer
A20403 - IBC Test Distant Metastasis Discouraged Avoid Risk Secondary Cancer
A20404 - Radiation Image Tests PET CT Limit to Reduce Risk Secondary Cancer
A20405 - Risk Secondary Cancer Exposure Radiation Image Testing CT PET Scan
A20407 - Follow up ref SDS F1 EY5O, ref SDS E4 EY5O.
A20409 - Kaiser ordered a CT scan on 060929 to test for pulmonary embolism
A20410 - following notice of rising symptoms. ref SDS E4 B56N The test was
A20411 - performed on an expedited basis the next day on 060930. ref SDS E6
A20412 - MI5I The doctor called on 061002 and reported the test was positive
A20413 - for pulmonary embolism recurrence, and prescribed treatments to
A20414 - resume, ref SDS E7 MI5I, which were previously stopped on 061007.
A20415 - ref SDS 81 GC6K
A20417 - ..
A20418 - Review on 061012 shows the imaging department did not compare and
A20419 - assess differences between pathology for recurrent and original
A20420 - pulmonary embolism. ref SDS E8 2935 The patient's letter on 061013
A20421 - asks the doctor about making the comparison? During the meeting on
A20422 - 061020 the doctor had a hectic schedule so there was not enough time
A20423 - to review this issue. ref SDS F1 UQ5G, noted as well in the section on
A20424 - image tests shown on 061020. ref SDS F1 N96N
A20426 - [On 061208 doctor ordered PET scan test to set new baseline for
A20427 - changing chemotherapy to treat IBC; and added to the order request
A20428 - for analysis of pulmonary embolism, and enlarged right ventricle
A20429 - by comparing and contrasting with prior CT tests on 041103 and on
A20430 - 060930, even though CT scan tests are a better diagnostic for this
A20431 - comparison. ref SDS G7 ZY5L
A20433 - ..
A20434 - The doctor's schedule was hectic again today, ref SDS 0 SM6M, and so
A20435 - did not have time to discuss Kaiser's progress and findings on making
A20436 - the comparison.
A20438 - ..
A20439 - The doctor commented today that the technical method of the CT scan on
A20440 - 060930 to test for pulmonary embolism recurrence provides a better,
A20441 - more rigorous test for metastatic disease than is normally performed
A20442 - for cancer. This aligns with the report on 061020 that the test for
A20443 - pulmonary embolism is different from testing for cancer, ref SDS F1
A20444 - S56G; today, this is clarified as also being "better" for evaluating
A20445 - cancer than the test normally done to evaluate response to treatment
A20446 - for cancer.
Emotional Trauma Rises Abrupt Changes IBC Worsening Spreading Red Ra
A70401 - ..
A70402 - Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
A70403 - Exercise Vigor Strength Engagement Ease Distress Living with Cancer
A70404 - Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
A70406 - Follow up ref SDS F1 Y642, ref SDS E4 Y642.
A70408 - Emotional roller coaster of good news mixed with concern from mounting
A70409 - medical issues listed on 061020, ref SDS F1 PB3H, increases stress
A70410 - because limited time due to a hectic schedule prevents timely
A70411 - consideration, noted again today with the meeting starting 90 minutes
A70412 - late. ref SDS 0 SM6M The gap between problems listed on 061020,
A70413 - ref SDS F1 R24G, and time for professional review increases trauma
A70414 - from emotional stress.
A70416 - ..
A70417 - Relief from physical exercise discussed in the letter on 061013 has
A70418 - not yet been addressed by Kaiser, per below, reviewing new matter of
A70419 - pulmonary embolism. ref SDS 0 CR5N
Strategy Treatment Plan IBC 3rd Relapse Scope Chemotherapy Drug Agen
AD0401 - ..
AD0402 - Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
AD0403 - Strategy Treatment Options Scenarios Planning Patient Work Up Deferred
AD0405 - Follow up ref SDS F1 K36G, ref SDS E4 K36G.
AD0407 - Background on requirements and challenge performing requirements for
AD0408 - planning and proactive management in time for action to be effective
AD0409 - is reported on 060825. ref SDS E1 K36G
AD0411 - ..
AD0412 - During the meeting on 041210, the primary care physician proposed
AD0413 - surgery to treat worsening IBC. ref SDS 49 ZV5J Case study on surgery
AD0414 - for IBC was developed at that time on 041210. ref SDS 49 657F When
AD0415 - IBC spread during treatment with chemotherapy the doctor again
AD0416 - recommended surgery on 050311 to remove "pockets of resistance" that
AD0417 - failed to respond to treatment, ref SDS 54 PA4N, as observed by
AD0418 - examination on the left breast area the past several months, noted
AD0419 - above. ref SDS 0 025H
AD0421 - ..
AD0422 - The prospect that mastectomy surgery may have removed blood vessels
AD0423 - which normally deliver treatment to infected tissue, but now create
AD0424 - pockets of resistance to chemotherapy, reviewed above, ref SDS 0 J39O,
AD0425 - requires review of treatment strategy, including prospects of for
AD0426 - further surgery, as recommended by the primary care physician on
AD0427 - 050311 to treat pockets of resistance to chemotherapy. ref SDS 54 AU9G
AD0428 - On 050913 the doctor strongly favored a surgical solution even after
AD0429 - IBC red rash had subsided. ref SDS 75 5T5N This raises the question
AD0430 - about ideas and stratagems for corrective surgery.
AD0432 - ..
AD0433 - With a hectic schedule today, ref SDS 0 SM6M, the primary care
AD0434 - physician did not have time to review this issue.
Treatment IBC 6th Cycle for 3rd Relapse Continue Chemotherapy Agents
AI0401 - ..
AI0402 - Treatment Continue 6th Cycle Taxotere and Capecitabine (Xeloda)
AI0403 - 6th Cycle Taxotere and Capecitabine (Xeloda) Treatment Continue
AI0404 - Taxotere and Capecitabine (Xeloda) 6th-Cycle Treatment Continue
AI0406 - Follow up ref SDS F1 PF3O, ref SDS E4 PF3O.
AI0408 - The doctor proposed continuing current treatment with Taxotere and
AI0409 - capecitabine (Xeloda) for the 6th cycle of treatment given in the
AI0410 - Infusion Clinic today. ref SDS G1 407N
AI0412 - ..
AI0413 - With a hectic schedule there was not enough time for presentation of
AI0414 - ideas, research, and strategy, as noted above, ref SDS 0 K36G, to
AI0415 - improve the rate of recovery for IBC on the left breast, which has
AI0416 - shown no improvement for several cycles, per above, ref SDS 0 025H,
AI0417 - and as noted in the doctor's treatment plan that continues current
AI0418 - chemotherapy, see below. ref SDS 0 125V
Schedule Treatment 061201 on Friday for 7th Cycle Taxotere Capecitab
AK0401 - ..
AK0402 - Schedule Treatment Continue Prescription Taxotere Capecitabine Xeloda
AK0404 - Follow up ref SDS F1 N96O, ref SDS E4 N96O.
AK0406 - The doctor scheduled the next meeting for 061201 prior to chemotherapy
AK0407 - treatment in the afternoon. This will provide an opportunity to
AK0408 - assess changing the treatment plan to redress slow response the past
AK0409 - several cycles, per above showing cancer seems to be increasing.
AK0410 - ref SDS 0 025H
AK0412 - [On 061201 primary care physician took immediate action to correct
AK0413 - schedule mistake so that examination occurs on schedule, allowing
AK0414 - timely consideration of changing treatment. ref SDS G4 N96O
Pulmonary Emboli Blood Clots Lungs Symptoms Continue Fatigue Shortne
AV0401 - ..
AV0402 - Procrit Prescribe to Treat Symptoms Pulmonary Embolism Fatigue
AV0403 - Tired Breathing Difficulty Routine Activity Signals Pulmonary Emboli
AV0404 - Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
AV0405 - Pulmonary Emboli Genetic Cause Hypercoagulable Work Up Family History
AV0407 - Follow up ref SDS F1 CV5L, ref SDS E4 CV5L.
AV0409 - Background on discovering and treating pulmonary embolism recurrence
AV0410 - is reported for the meeting on 061020. ref SDS F1 CV5L
AV0412 - ..
AV0413 - Millie's patient history reported recently on 061108, ref SDS G0 VR6F,
AV0414 - confirms her letter to Kaiser on 061027 reporting slow recovery from
AV0415 - pulmonary embolism. ref SDS F3 MS5P, She continues to tire quickly and
AV0416 - suffers fatigue, weakness, shortness of breath with normal exertion
AV0417 - walking up stairs at home, at BART, walking a few blocks to work, or
AV0418 - shopping. There is also noticable cough, and clearing of her throat
AV0419 - concurrent with treatments for pulmonary embolism beginning on 061002,
AV0420 - as reported to the nurse and pharmacist in the Infusion Clinic again
AV0421 - today, while getting chemotherapy treatment. ref SDS G1 SK9O
AV0423 - ..
AV0424 - The doctor advised that prescription today for Procrit may improve
AV0425 - Millie's fatigue and low energy problem, since it treats low blood
AV0426 - counts for hemoglobin shown in the blood test yesterday, and presented
AV0427 - during treatment in the Infusion Clinic today, ref SDS G1 0N7Q, as
AV0428 - explained by the pharmacist, Masha. ref SDS G1 6Z8J
AV0430 - ..
AV0431 - The doctor's notes describe Procrit treats anemia, shown below.
AV0432 - ref SDS 0 1248
AV0434 - ..
AV0435 - There wasn't enough time today for the doctor to review patient
AV0436 - history of fairly frequent low hemoglobin, which did not result in
AV0437 - prescription for Procrit, and explain how the current condition
AV0438 - differs in sufficient degree to require treatment? ref SDS G1 DT7O
AV0440 - ..
AV0441 - With a hectic schedule today, ref SDS 0 SM6M, the doctor did not have
AV0442 - time to present treatment plans and estimate on when Millie will
AV0443 - recover enough for working out in the gym to restore fitness that
AV0444 - strengthens immune system, as requested in her letter to Kaiser on
AV0445 - 061027 advising that pulmonary embolism symptoms continue with
AV0446 - fatigue, shortness of breath. ref SDS F3 MS5P
AV0449 - ..
AV0450 - Comparison CT Test 060930 with Test 041103 Original Diagnosis
AV0452 - Follow up ref SDS F1 UQ5G.
AV0454 - As noted earlier, per above, ref SDS 0 LZ3M, Kaiser has not performed
AV0455 - the comparison ordered by the doctor on 060929 with the earlier CT
AV0456 - test on 041103 to assess trends in pulmonary embolism findings, as
AV0457 - reported on 061012. ref SDS E8 2935
AV0459 - ..
AV0460 - The doctor's hectic schedule did not have enough time again, as on
AV0461 - 061020, ref SDS F1 UQ5M, to review the patient's preliminary analysis
AV0462 - on 061012, and comment on significance of several differences between
AV0463 - the two tests, ref SDS E8 7E7G, including a new heart disorder caused
AV0464 - by an enlarged right ventricle, ref SDS E8 IM5J, discussed briefly
AV0465 - with the doctor during the meeting on 061020. ref SDS F1 VJ4J
Examination Clinical Findings Correlate with Research Stethoscope No
B70401 - ..
B70402 - Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
B70404 - Follow up ref SDS F1 PC6H.
B70406 - The doctor examined Millie with a stethoscope again today. This
B70407 - included multiple locations on her her back, and on her chest. He
B70408 - reported finding no evidence of cardio pulmonary issues from clinical
B70409 - examination.
Enlarged Right Ventricle Heart Examination Not Ordered Kaiser Not En
BS0401 - ..
BS0402 - Heart Examination Not Ordered Investigate Enlarged Right Ventricle
BS0403 - Enlarged Right Ventricle CT Test Aligns Patient Symptoms How Serious
BS0405 - Follow up ref SDS F1 VJ4J. ref SDS E8 7E5L.
BS0407 - The doctor feels that enlarged right ventricle reported in the CT test
BS0408 - on 060930, and reviewed on 061012, ref SDS E8 T95G, has been carefully
BS0409 - analyzed in diagnosis and treatment protocols following the meeting on
BS0410 - 061020, when this matter was first discussed. ref SDS F1 3Q9H
BS0412 - ..
BS0413 - As noted above citing continuing infirmities from pulmonary embolism,
BS0414 - ref SDS 0 VD4G, Kaiser has had not time to answer the patient's letter
BS0415 - on 061027, ref SDS 0 P15N, asking when cardio-pulmonary condition will
BS0416 - recover to resume working out in the gym. ref SDS F3 MS5P Exercise is
BS0417 - a major part of patient commitment to physical fitness strengthening
BS0418 - the immune system, and builds emotional stability, reviewed above,
BS0419 - ref SDS 0 Y642, and discussed previously with the doctor during the
BS0420 - meeting on 061020. ref SDS F1 VJ4J
BS0422 - ..
BS0423 - Kaiser has not had enough time to determine how severely the right
BS0424 - ventricle is enlarged, as discussed, also, on 061020. ref SDS F1 VJ4J
BS0426 - ..
BS0427 - The doctor seemed satisfied that examination today by stethoscope, as
BS0428 - called out in research for clinical assessment, reported 061012.
BS0429 - ref SDS E8 IR5T, and discussed earlier, ref SDS 0 Q35O, indicates
BS0430 - enlarged right ventricle does not present a serious enough problem to
BS0431 - consider directed treatment, nor require further investigation,
BS0432 - including referral to a heart specialist, and that continuing with
BS0433 - Coumadin is the best course.
BS0435 - ..
BS0436 - The doctor cited vitals that show So2 test result of 98%, reported
BS0437 - during treatment in the Infusion Clinic earlier today, ref SDS G1
BS0438 - AW4L. He explained that 98% shows high oxygen content, indicating
BS0439 - effective cardio pulmonary functioning, rather than diminished
BS0440 - capacity that would signal significant impact of enlarged right
BS0441 - ventricle. (see also doctor's progress notes in the Medical Chart
BS0442 - citing O2 Sat 98%. ref SDS 0 ZL5W)
Coagulapathy Report Family Genetic Disposition Pulmonary Emboli Hype
C10401 - ..
C10402 - Coagulapathy Report Family Genetic Disposition Pulmonary Emboli
C10403 - Hypercoagulable State Work Up Risk Assessment Treatment Guidance
C10405 - Follow up ref SDS F1 626L.
C10407 - The doctor received the coagulapathy report on first-degree family
C10408 - member with recurrent pulmonary embolism, first reported to Kaiser on
C10409 - 060714. ref SDS B9 0001 Millie's letter, ref DIP 2 0001, submitted to
C10410 - Kaiser on 061103, ref SDS F9 VR6F, responded to the doctor's request
C10411 - on 060929, ref SDS E4 QT6N, and repeated a few weeks ago during
C10412 - another meeting at Kaiser on 061020. ref SDS F1 ES3I
C10414 - ..
C10415 - The doctor highlighted the paragraph in Millie's transmittal letter to
C10416 - Kaiser that says...
C10418 - Hypercoagulable state work up of family member who recently
C10419 - suffered recurrent pulmonary emboli indicates factor V and
C10420 - prothrombin G20210A mutations are negative. Test results are,
C10421 - however, consistent with a Lupus Anticoagulant (an
C10422 - antiphospholipid antibody). Cardiolipin AB IGM tested at 23,
C10423 - well above the target range of 15 that signals positive
C10424 - results. The number "23" is circled in handwriting, indicating
C10425 - heightened interest. There is no analysis nor summary
C10426 - explanation expressly stating genetic risk for thrombosis,
C10427 - including pulmonary emboli. Prior research seems to suggest
C10428 - these findings demonstrate genetic disposition for PE in the
C10429 - family member. and further that patients with family history of
C10430 - blood clot problems together with recurrent thrombosis present
C10431 - as "strongly thrombophilic" and should get extensive evaluation
C10432 - for thrombophilias to guide diagnosis and treatment.
C10433 - ref SDS F9 N18S
C10435 - ..
C10436 - The coagulapathy report is reviewed in the record of patient history
C10437 - on 061102. ref SDS F8 0001
C10439 - ..
C10440 - During the meeting today, the doctor discussed coagulapathy results in
C10441 - the report that show...
C10443 - 1. Factor V tested negative, ref SDS F8 TK3V, further at
C10444 - ref SDS F8 ME6X, and
C10446 - 2. Prothrombin G20210A mutation, also, tested negative.
C10447 - ref SDS F8 PRXX
C10449 - ..
C10450 - 3. Lupus Anticoagulant (an antiphospholipid antibody) test
C10451 - consistent with this criteria. ref SDS F8 6E5M
C10453 - ..
C10454 - 4. Cardiolipin AB IGM shows results of 23, which is above the
C10455 - target range of 15, and is circled in handwriting, likely
C10456 - indicating focus on positive finding. ref SDS F8 6F49
C10458 - ..
C10459 - The doctor interprets these results to show positive findings for DNA
C10460 - risk of pulmonary embolism, as cited in the record on 061102,
C10461 - ref SDS F8 4N55 The doctor describes findings as "acquired" rather
C10462 - than inherited genetic risk for pulmonary embolism, based on researh
C10463 - submitted today, as shown below. ref SDS 0 PD69 The doctor further
C10464 - noted that test results of "23" represent only a "weak" risk, rather
C10465 - than strongly positive.
C10467 - [On 061113 Millie commends doctor's analysis of
C10468 - coagulapathy report. ref SDS G3 0F5H
C10470 - ..
C10471 - The doctor advised that the report will be retained in Millie's
C10472 - medical chart, and that findings of "acquired" rather than inherited
C10473 - condition signals no increased risk of blood clot problems for Millie,
C10474 - does not require hypercoagulable state work up, nor other measures to
C10475 - evaluate patient profile, and requires no adjustments in diagnosis and
C10476 - treatment, addressing issue presented in Millie's letter to Kaiser on
C10477 - 061103. ref SDS F9 N18S
C10479 - ..
C10480 - [...below, progress notes in medical chart make no mention
C10481 - of performing this work on the coagulapathy report -
C10482 - nothing in the narrative reporting that documents requested
C10483 - last month were received today, no narrative on research of
C10484 - significance, nothing is mentioned summarizing extensive
C10485 - guidance to customer (patient), ref SDS 0 279I, no
C10486 - impression on findings, ref SDS 0 1248, and no plan to
C10487 - follow up by for example filing the coagulapathy report in
C10488 - the medical report. ref SDS 0 125V
C10490 - ..
C10491 - The doctor submitted research in an article...
C10493 - Medic8 GeneticDisorders
C10495 - ..
C10496 - Antiphospholipid Syndrome
C10497 - What is antiphospholipid syndrome (APS)?
C10500 - ..
C10501 - Article is dated: September 1, 2006
C10503 - http://www.medic8.com/genetics/antiphosolipid-syndrome.htm
C10505 - ..
C10506 - APS is explained in the article as associated with lupus anticoagulant
C10507 - antibody, ref OF 3 2X5H, which was reported in the coagulapathy test
C10508 - reviewed in Millie's family history on 060722. ref SDS F8 KJ3H
C10510 - ..
C10511 - The doctor highlighted the paragraph that says...
C10513 - Is APS inherited?
C10515 - Although APS has been reported to occur in multiple members of
C10516 - the same family, no clear inheritance pattern has been
C10517 - identified and no gene has been found to be the sole cause of
C10518 - this condition. One report in 1999 studied families with more
C10519 - than one affected member, examined possible modes of
C10520 - inheritance, and examined links with certain genes. In seven
C10521 - families, 30 out of 101 family members met diagnostic criteria
C10522 - for the syndrome. The data were fitted best by either a
C10523 - dominant (one copy of the altered gene inherited from one
C10524 - parent causes the condition) or codominant (features related to
C10525 - the condition from both parents are observed) model.
C10526 - ref OF 3 0L3G
C10528 - ..
C10529 - The doctor also highlighted and discussed the sentence...
C10531 - ...no clear inheritance pattern has been identified and no gene
C10532 - has been found to be the sole cause of this condition.
Work Plan Doctor Submits Doctor/Patient Partnership Communications I
CS0401 - ..
CS0402 - Work Plan Received Communications Doctor/Patient Partnership
CS0403 - Communications Doctor Submits Work Plan Doctor/Patient Partnership
CS0404 - Doctor/Patient Partnership Communications Doctor Submits Work Plan
CS0406 - Follow up ref SDS F1 FE4I, ref SDS E4 FE4I.
CS0412 - ..
CS0413 - Issues from Kaiser's Progress Notes...
CS0415 - 1. Narrative near the end, says
CS0417 - The patient is here for cycle #5.
CS0419 - ..
CS0420 - This repeats language from the prior report that should be
CS0421 - edited to reflect an update. Consideration should be given to
CS0422 - say "cycle #6," consistent with the Plan section. ref SDS 0
CS0423 - 125V
CS0425 - ..
CS0426 - 2. Cellulitis - patient hospitalized 5 days complications of
CS0427 - lymphedema, not mentioned anywhere in the doctor's report.
CS0428 - ref SDS 0 M75J
CS0430 - ..
CS0431 - 3. Coagulapathy report received and discussed with patient,
CS0432 - including submission of research to the patient on issues in
CS0433 - the report - consideration might be given to reporting these
CS0434 - results, which are an action item in the doctor's report for
CS0435 - the prior period. ref SDS 0 YH6K
CS0437 - ..
CS0438 - 4. Current medications - this might be updated to list Taxotere
CS0439 - for cancer, antibiotics treatment for Cellulitis, Coumadin for
CS0440 - pulmonary emboli, and Procrit to increase hemoglobin blood
CS0441 - count for better energy. Additionally, during the reporting
CS0442 - period, Lovenox was prescribed, and the patient is taking Tums
CS0443 - for emerging digestion problems. ref SDS 0 SE86
CS0445 - ..
CS0446 - 5. Impression section might mention resolution of coagulapathy
CS0447 - report review. ref SDS 0 1248
CS0449 - ..
CS0450 - Reporting on lymphedema which repeats expression from prior
CS0451 - report on 061020, might be updated to report complication of
CS0452 - Cellulitis. ref SDS 0 1P8H
CS0454 - ..
CS0455 - Doctor's initiative today transferring the agenda from Millie's letter
CS0456 - into Kaiser's electronic Medical Chart, per above, ref SDS 0 NO6O, and
CS0457 - using the list to guide the meeting, per below, ref SDS 0 684G, shows
CS0458 - progress applying the doctor patient partnership model presented in
CS0459 - Kaiser's Healthwise Handbook, reviewed on 990625, ref SDS 2 4185, and,
CS0460 - also, for timely review of patient history, further called out in the
CS0461 - Handbook, 990625, ref SDS 2 TD5S, and reported on 060106. ref SDS 89
CS0462 - FE4I
CS0464 - ..
CS0465 - [On 061208 hectic schedule not enough time to work from
CS0466 - agenda in the Medical Chart. ref SDS G7 K84N
CS0468 - 1. 11/10/2006 03:40 PM
CS0470 - Wcr-ONnc2 > Main Campus
CS0473 - ..
CS0474 - 2. Your primary care clinician is listed as...