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: December 18, 2006 07:18 AM Monday; Rod Welch

Millie letters to doctor at Kaiser on pending issues.

1...Summary/Objective
2...Scope Letter to Kaiser on Progress Review Diagnosis Treatment
3...Diflucan Fluconazole Increased Risk Hemorraging INR Rises 6.4
4...INR 6.4 Coumadin Change Treatment Protocol Reduce Risk Hemorraging
........CA 15-3 Blood Test Request Submit Results
........Rash Seems Improved May Be Wax Wane Scenario #2
........2.Scenarios IBC Rash Wax Wane Infection May Respond Treatment
5...Doctor Advises Stop Taking Diflucan CA 15-3 Test Results Not Available
6...Drug Trials UCSF 2 Proposals Kaiser Review Pending Needs Support
7...UCSF 2 Drug Trial Proposals Kaiser Needs Support to Complete Review
8...Navelbine Compatibility Single Agent or Combined Taxotere Capecitabine
9...Navelbine Single Agent Combine Taxotere Capecitabine Conflict 2nd Opinions
10...Doctor Advises Kaiser Recommends Single Agent Treatment
11...Medical Mistakes Cursory Generalizations Prevent Communication
12...Patient Care Harmed Cursory Generalizations Prevent Communication
13...Case Study Double Agent Treatment Routinely Prescribed Patient History
14...Cor Pulmonale Heart Disorder Request Examination Heart Specialist
15...Heart Examination Enlarged Right Ventricle Request Heart Specialist
16...Enlarged Right Ventricle Examination Heart Specialist Patient Request
17...Doctor Says Enlarged Right Ventricle Not Life Threatening for Years
18...Cor Pulmonale Enlarged Right Ventricle Not Life Threatening for Years
19...Commend Primary Care Physician 5 Year Care Complex Cancer Case
20...IBC Expert Panel Tumor Board Productive Review Millie's Complex Case
21...Tumor Board Review on Changing Treatment Expansion of Disease
22...Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
23...Strategy Treatment Options Scenarios Planning Patient Work Up Deferred
24...Quarterly Review Patient History Access to Case Studies

ACTION ITEMS.................. Click here to comment!

1...Doctor does not respond to questions on Navelbine compatibility with

CONTACTS 

SUBJECTS
Kaiser Planning Issues Notify 5 Year Case Review

0503 -
0503 -    ..
0504 - Summary/Objective
0505 -
050501 - Follow up ref SDS 44 0000, ref SDS 42 0000.
050502 -
050503 - Millie wrote several letters today on pending issues, including
050504 - commending Kaiser and the doctor for good care the past 5 years.
050505 - ref SDS 0 K36G  Millie submitted the location of UCSF 2nd opinion that
050506 - proposes 2 drug trials Millie qualifies for participation. ref SDS 0
050507 - 086H   The doctor reported that results of CA 15-3 blood tests for
050508 - 0601214, and for today have not been posted yet. ref SDS 0 XT4K  Good
050509 - news hearing that heart disorder enlarged right ventricle takes many
050510 - years to become life threatening.  This is a good point to check with
050511 - heart specialist. ref SDS 0 VC4M
050512 -
050513 -
050514 -
050515 -
050517 -  ..
0506 -
0507 -
0508 - Progress
0509 -
050901 - Scope Letter to Kaiser on Progress Review Diagnosis Treatment
050902 -
050903 - Follow up ref SDS 44 5S84.
050904 -
050905 - Planning in the record on 061217 developed background on a number of
050906 - pending issues. ref SDS 44 5S84
050907 -
050908 -
050909 -
050910 -
050911 -
050912 -
0510 -

SUBJECTS
INR 6.4 Hemmoraging Risk Medication Mistakes Diflucan Conflicts with

3903 -
390401 -  ..
390402 - Diflucan Fluconazole Increased Risk Hemorraging INR Rises 6.4
390403 - INR 6.4 Coumadin Change Treatment Protocol Reduce Risk Hemorraging
390404 -
390405 - Follow up ref SDS 43 4O5H.
390406 -
390407 - Submitted ref DIT 1 0001 to the doctor saying...
390408 -
390409 -    1.  As we transition to a new treatment, possibly for
390410 -        expanding IBC to the right breast, there are a number of
390411 -        issues that need review. Kaiser's correspondence system
390412 -        limits clear, concise, and complete communications, so
390413 -        each issue will be submitted in a separate letter.
390414 -
390415 -           [On 061227 notified Kaiser technical folks about limitations
390416 -           of email system. ref SDS 48 OX5J
390418 -            ..
390419 -           [On 061227 Kaiser cited NWO analysis of Communication
390420 -           Metrics. ref SDS 48 OX5J
390422 -            ..
390423 -           [On 070115 Kaiser submitted issues with email productivity
390424 -           to technical and management teams. ref SDS 52 OX5J
390426 -  ..
390427 - This addresses issues listed on 061217. ref SDS 44 5S84
390429 -  ..
390430 - Problems with Kaiser's electronic communication system were reviewed
390431 - on 060106. ref SDS 24 1O8F
390433 -  ..
390434 - Letter to primary care physician continues...
390435 -
390436 -    2.  Last Thursday, on 061214 my INR jumped to 6.4 with Diflucan
390437 -        (fluconazole) beginning on 061208, ref DIT 1 L26F; conflict
390438 -        occurred which required changing Coumadin regimen. ref SDS 43
390439 -        4O5H
390441 -  ..
390442 - Citing issue in the list on 061217. ref SDS 44 MM6L
390443 -
390444 -            [...below, Doctor responds saying to stop taking Diflucan
390445 -            however, prescription has already expired. ref SDS 0 6P9F
390446 -
390447 -            [On 100202 0301 Millie's INR 5.8 2nd highest in patient
390448 -            history risks hemoraging and death, ref SDS 53 K069,
390449 -            slipped through the cracks again due to conflicts in
390450 -            medications that were overlooked. ref SDS 53 LH6T
390452 -  ..
390453 - Letter to primary care physician continues...
390454 -
390455 -    3.  This morning I went for another blood draw to check on the INR.
390456 -        ref DIT 1 L36N
390458 -  ..
390459 - Results of the blood draw reported later this morning show
390460 - significant improvement dropping from 6.4 to 3.3.
390461 -
390462 -            [On 061227 letter to doctor reports improvement INR test.
390463 -            ref SDS 47 4Q84
390465 -  ..
390466 - Treatments with Coumadin resumed at reduced level to bring INR within
390467 - 2.0 - 3.0.
390468 -
390469 -
390470 -
390471 -
390472 -
3905 -

SUBJECTS
Rash Seems Improved May Be Wax Wane Scenario #2 Infection May Respon

4503 -
450401 -         ..
450402 -        CA 15-3 Blood Test Request Submit Results
450403 -        Rash Seems Improved May Be Wax Wane Scenario #2
450404 -        2 Scenarios IBC Rash Wax Wane Infection May Respond Treatment
450405 -
450406 -        Follow up ref SDS 44 QT5K, ref SDS 42 KW45.
450407 -
450408 -    4.  Not sure if Diflucan has helped.  Patient history this morning
450409 -        indicates that rash seems improved, ref SDS 44 QT5K, however,
450410 -        this rash seems to wax and wane, ref DIT 1 L37H, as noted in
450411 -        Benz 2nd opinion received on 041117. ref SDS 14 OS6W
450412 -
450413 -            [On 061227 report rash seems worse. ref SDS 47 4Q73
450415 -             ..
450416 -            [On 070112 Millie notified doctor that improvement in CA
450417 -            15-3 aligns with IBC rash intensity subsiding. ref SDS 51
450418 -            1G3K
450420 -         ..
450421 -    5.  Please submit CA 15-3 for tests today, and on 061214.
450422 -        ref DIT 1 ON7K
450424 -  ..
450425 - This follows up work on 061214 when Millie had a blood test for
450426 - Coumadin (warfarin) treatment, and requested CA 15-3, following up the
450427 - meeting on 061208 when no blood test was reported. ref SDS 42 087J,
450428 - but results of the test on 061214 was not reported at that time.
450429 - ref SDS 43 4O5H
450430 -
450431 -            [On 061227 CA 15-3 74 significant rise aligns with rash
450432 -            getting worse, after small decline when rash improved
450433 -            slightly. ref SDS 47 UF3I
450435 -             ..
450436 -            [On 070110 CA 15-3 56 cancer marker drops dramatically
450437 -            significant improvement aligns with IBC rash intensity
450438 -            subsiding; continuing erratic changes. ref SDS 50 087J
450440 -             ..
450441 -            [On 070112 Millie notified doctor that improvement in CA
450442 -            15-3 aligns with IBC rash intensity subsiding. ref SDS 51
450443 -            1G3K
450444 -
450445 -
450446 -
4505 -

SUBJECTS
Diflucan Fluconazole INR 6.4 Medication Mistakes Conflicts with Coum

5703 -
5704 - 1231
570501 -  ..
570502 - Doctor Advises Stop Taking Diflucan CA 15-3 Test Results Not Available
570503 -
570504 - Millie received ref DRT 1 0001 from the doctor responding to the
570505 - letter earlier this morning, ref DIT 1 0001, reporting conflict with
570506 - Diflucan (fluconazole) and Coumadin (warfarin), and asking for
570507 - submission of results on CA 15-3 cancer marker tests, per above.
570508 - ref SDS 0 8U5L
570510 -  ..
570511 - Primary care physician says...
570512 -
570513 -        Labs still pending. OK to stop Diflucan if there has been no
570514 -        response by now.
570516 -  ..
570517 - The doctor's report that labs for CA 15-3 blood tests on 061214 are
570518 - still pending 4 days later on 061218, ref SDS 43 4O5H, conflicts with
570519 - patient history since often CA 15-3 is available the same day and most
570520 - often by the next day, shown by patient history on 061201. ref SDS 39
570521 - 2N5J
570523 -  ..
570524 - The doctor prescribed Diflucan (fluconazole) on 061208 for 10 days.
570525 - ref SDS 42 KW45  Since today is the 10th day the doctor proposes
570526 - stopping treatment on the date treatment was prescribed to end.
570527 -
570528 -
570529 -
570530 -
570531 -
570532 -
5706 -

SUBJECTS
Drug Trials Millie Submits Letter Notifying Kaiser Location in UCSF

6903 -
690401 -  ..
690402 - Drug Trials UCSF 2 Proposals Kaiser Review Pending Needs Support
690403 - UCSF 2 Drug Trial Proposals Kaiser Needs Support to Complete Review
690404 -
690405 - Follow up ref SDS 42 P256.
690406 -
690407 - Millie submitted ref DIT 2 0001 another letter to the primary care
690408 - physician, this one on drug trials, per note in the first letter
690409 - explaining limitations of Kaiser's correspondence system, per above.
690410 - ref SDS 0 8U5L
690412 -  ..
690413 - This letter implements planning yesterday on 061217. ref SDS 44 FP6G
690415 -  ..
690416 - Millie says to the primary care physician...
690417 -
690418 -    1.  During the meeting at Kaiser on 061208 you requested notice,
690419 -        ref SDS 42 D58F, of the location in the Benz 2nd opinion
690420 -        received from Kaiser on 060929, ref SDS 35 6L9O, and
690421 -        documenting an earlier consultation on 060821, that says UCSF
690422 -        has 2 studies which can help me. ref DIT 2 0001  Here is a link
690423 -        to the record reviewing the Benz opinion proposing the 2
690424 -        trials, and further links to the actual document. ref SDS 35
690425 -        UI9K
690427 -         ..
690428 -    2.  Please let me know if you need further support accessing the
690429 -        Benz report, and submit comments to assess the UCSF proposal.
690430 -        ref DIT 2 V86H
690431 -
690432 -           [On 061226 Kaiser performing due diligence collaborating
690433 -           with UCSF to consider drug trial potocols for Millie's
690434 -           patient profile. ref SDS 46 086H
690435 -
690436 -
690437 -
690438 -
690439 -
6905 -

SUBJECTS
Navelbine Vinorelbine Tartrate Side Effects Compatibility Protocol P

7303 -
730401 -  ..
730402 - Navelbine Compatibility Single Agent or Combined Taxotere Capecitabine
730403 -
730404 - Follow up ref SDS 42 3B4N.
730405 -
730406 - Millie submitted ref DIT 3 0001 another letter to the primary care
730407 - physician, this one on changing chemotherapy to Navelbine, and per
730408 - note in the first letter explaining limitations of Kaiser's
730409 - correspondence system, per above. ref SDS 0 8U5L
730411 -  ..
730412 - This letter implements planning yesterday on 061217. ref SDS 44 SU7H
730414 -  ..
730415 - Millie says to the primary care physician...
730416 -
730417 -    1.  I received a call last Thursday from Oncology pharmacy on
730418 -        changing treatment to Navelbine. ref DIT 3 0001  I requested a
730419 -        report on Kaiser's review of compatibility with patient
730420 -        history, including issues listed on 061208. ref SDS 42 LU3J
730422 -         ..
730423 -    2.  Past conflicts in medications with Avastin causing PE, reported
730424 -        on 041104, ref SDS 13 RZ4I, and recent experience with Diflucan,
730425 -        reported on 061214, ref SDS 43 XF77, and cited in another
730426 -        letter to Kaiser earlier today, per above, ref SDS 0 5M5Y,
730427 -        suggest this is a good time to check compatibility for changing
730428 -        treatment, particularly with respect to rising infection
730429 -        problems, and WBC, hemoglobin, etc., blood counts. ref DIT 3
730430 -        KJ6H
730432 -         ..
730433 -    3.  Since I have not heard back from the person who called about
730434 -        this, can you please follow up. ref DIT 3 BL6N
730435 -
730436 -            [On 061226 report to Kaiser that Brad called to follow up
730437 -            on the call from Oncology and gave an excellent explanation
730438 -            of research on Navelbine compatibility with patient
730439 -            history, and plans to confirm in a letter. ref SDS 46 EL4O
730441 -             ..
730442 -            [On 061227 Millie's letter to Kaiser commends Brad's work
730443 -            in the pharmacy assisting patients with carefully
730444 -            researched and lucid explanations of Navelbine chemotherapy
730445 -            compatibility issues. ref SDS 47 KN5X
730446 -
730448 -  ..
7305 -
7306 -
7307 - 1238
7308 -
730801 - Doctor's letter responding to Millie's letter today does not follow up
730802 - on conflicts between Navelbine and patient history; only addresses
730803 - Navelbine combining with other drugs, per below. ref SDS 0 U16H
730804 -
730805 -
730806 -
730807 -
730808 -
730809 -
7309 -

SUBJECTS
Navelbine Vinorelbine Tartrate Protocol Single Agent Combine Taxoter

AH03 -
AH0401 -  ..
AH0402 - Navelbine Single Agent Combine Taxotere Capecitabine Conflict 2nd Opinions
AH0403 -
AH0404 - Follow up ref SDS 42 Q74O. ref SDS 35 WR3Y.
AH0405 -
AH0406 -    4.  Navelbine was recommended in 2nd opinions.  Initially on
AH0407 -        041117, UCSF proposed single agent or combined with Taxotere.
AH0408 -        ref DIT 3 JN7H  However, recent opinion received on 060929 Benz
AH0409 -        proposes Navelbine and capecitabine. ref SDS 35 WR3Y
AH0411 -         ..
AH0412 -    5.  Please submit Kaiser's analysis on this issue. ref DIT 3 WO8F
AH0413 -
AH0414 -
AH0416 -  ..
AH05 -
AH06 -
AH07 - 1238
AH08 -
AH0801 - Doctor Advises Kaiser Recommends Single Agent Treatment
AH0802 - Medical Mistakes Cursory Generalizations Prevent Communication
AH0803 - Patient Care Harmed Cursory Generalizations Prevent Communication
AH0804 -
AH0805 - Millie received ref DRT 2 0001 from the doctor responding to the
AH0806 - letter earlier this morning, ref DIT 3 0001, asking about conflicts
AH0807 - between proposed treatment with Navelbine and patient profile, per
AH0808 - above, ref SDS 0 EB6J, and also about resolving conflict in Benz 2nd
AH0809 - opinions on Navelbine treatments, also, per above. ref SDS 0 Q74O
AH0811 -  ..
AH0812 - Primary care physician says...
AH0813 -
AH0814 -        At this time only single agent treatment would be recommended.
AH0815 -        Otherwise, all possibilities of treatment become rapidly
AH0816 -        exhausted.
AH0818 -  ..
AH0819 - Doctor does not respond to questions on Navelbine compatibility with
AH0820 - patient history, discussed with Oncology Pharmacy, per above.
AH0821 - ref SDS 0 427M
AH0823 -  ..
AH0824 - The doctor repeats past comments on 041130 that single agents are
AH0825 - recommended at this time to avoid exhausing all treatment
AH0826 - possibilities. ref SDS 15 5X4J  This was repeated a few weeks earlier
AH0827 - on 061208. ref SDS 42 Q74O
AH0829 -  ..
AH0830 - Cursory generalizations to avoid constructive response reduces doctor
AH0831 - patient partnership that relies on effective communication, called out
AH0832 - in Kaiser's Healthwise Handbood, reviewed on 990625. ref SDS 1 4185
AH0833 - Defeats purpose of timely correspondence delivery with Kaiser's
AH0834 - electronic mail system, reported on 051121. ref SDS 23 V25O
AH0836 -  ..
AH0837 - This response seems unsatisfying, similar to the letter on 060721,
AH0838 - ref SDS 29 O64U, which led to seeking 2nd opinion on 060725 for
AH0839 - reasoned, professional advice. ref SDS 31 QR6Y  Previously, on 061006
AH0840 - Millie was dissatisfied with poor quality of correspondence from
AH0841 - primary care physician, failing to answer patient questions, and
AH0842 - failing to explain reasoning and background in patient history that
AH0843 - supports diagnosis and treatment decisions. ref SDS 36 GW3J
AH0845 -  ..
AH0846 - Risk assessment on exhausting all treatment possibilities requires a
AH0847 - list of drugs available to treat IBC, requested on 041130, and again
AH0848 - on 060711.
AH0849 -
AH0850 -
AH0851 -
AH0852 -
AH09 -

SUBJECTS
Case Study Couplets Double-agent Chemotherapy Prescribed 6 Times Sin

AQ03 -
AQ0401 -  ..
AQ0402 - Case Study Double Agent Treatment Routinely Prescribed Patient History
AQ0403 -
AQ0404 - Millie's patient history shows most chemotherapy treatments have been
AQ0405 - double-agents (also "couplets")....
AQ0406 -
AQ0407 -        1.  Adriamycin Cytoxan prescribed
AQ0408 -            treatment......................... 020321, ref SDS 3 6SWS
AQ0410 -             ..
AQ0411 -        2.  Adriamycin Cytoxan treatment
AQ0412 -            started........................... 020423, ref SDS 4 0001
AQ0414 -             ..
AQ0415 -        3.  Taxotere prescribed, AC not
AQ0416 -            effective......................... 020603, ref SDS 5 WO4O
AQ0418 -             ..
AQ0419 -        4.  Bevacizumab (Avastin) combined
AQ0420 -            with Taxol treatment prescribed
AQ0421 -            as Millie's best course of
AQ0422 -            treatment......................... 040309, ref SDS 7 WG80
AQ0424 -             ..
AQ0425 -        5.  Bevacizumab (Avastin) combined
AQ0426 -            with Taxol treatment
AQ0427 -            started........................... 040420, ref SDS 8 9Z5J
AQ0429 -             ..
AQ0430 -        6.  Bevacizumab (Avastin) combined
AQ0431 -            with Taxol treatment ends due
AQ0432 -            to side effects pulmonary
AQ0433 -            embolism.......................... 041104, ref SDS 13 RZ4I
AQ0435 -             ..
AQ0436 -        7.  Patient asks about continuing
AQ0437 -            with single agent treatment using
AQ0438 -            Taxol that was effective and did
AQ0439 -            not cause blood clot problems,
AQ0440 -            doctor deferred until primary
AQ0441 -            care physician returns from
AQ0442 -            vacation.......................... 041104, ref SDS 13 Q59K
AQ0444 -             ..
AQ0445 -        8.  Doctor rejects double-agent treatment
AQ0446 -            with Taxotere and capecitabine
AQ0447 -            (Xeloda) recommended by Doctor Benz
AQ0448 -            at UCSF 2nd opinion; notes single
AQ0449 -            agent treatment preserves
AQ0450 -            limited options for
AQ0451 -            patient........................... 041130, ref SDS 15 5X4J
AQ0453 -             ..
AQ0454 -        9.  Primary care physician rejects
AQ0455 -            treatment with single agent Taxol
AQ0456 -            or Taxotere previously effective
AQ0457 -            for Millie........................ 041130, ref SDS 15 0293
AQ0459 -             ..
AQ0460 -       10.  Doctor proposes treatment with
AQ0461 -            couplet protocol combining
AQ0462 -            Novel Epothilones BMS-247550
AQ0463 -            with capeticatine................. 041210, ref SDS 16 CF9F
AQ0465 -             ..
AQ0466 -       11.  Patient asks about treatment
AQ0467 -            with single agent Taxol or
AQ0468 -            Taxotere.......................... 041230, ref SDS 17 2V85
AQ0470 -             ..
AQ0471 -       12.  Doctor prescribes 2 treatments with
AQ0472 -            double-agent chemtherapy Adriamycin
AQ0473 -            Cytoxan (AC) in order to qualify
AQ0474 -            patient for drug trial with double-
AQ0475 -            agent Novel Epothilones BMS-247550
AQ0476 -            combines with
AQ0477 -            capeticatine...................... 041230, ref SDS 17 XQ41
AQ0479 -             ..
AQ0480 -       13.  Doctor switches from AC to double-
AQ0481 -            agent chemtherapy combining Taxotere
AQ0482 -            with capecitabine
AQ0483 -            (Xeloda).......................... 050329, ref SDS 19 T58M
AQ0485 -             ..
AQ0486 -       14.  Doctor prescribes double-agent
AQ0487 -            chemotherapy treatment for 3rd
AQ0488 -            relapse of IBC combining
AQ0489 -            Taxotere with capecitabine
AQ0490 -            (Xeloda).......................... 060711, ref SDS 27 PF3O
AQ0491 -
AQ0492 -
AQ0493 -
AQ0494 -
AQ0495 -
AQ0496 -
AQ0497 -
AQ0498 -
AQ05 -

SUBJECTS
Enlarged Right Ventricle Cor Pulmonale Heart Disorder Patient Reques

BC03 -
BC0401 -  ..
BC0402 - Cor Pulmonale Heart Disorder Request Examination Heart Specialist
BC0403 - Heart Examination Enlarged Right Ventricle Request Heart Specialist
BC0404 - Enlarged Right Ventricle Examination Heart Specialist Patient Request
BC0405 -
BC0406 - Follow up ref SDS 42 VJ4J. ref SDS 40 VJ4J.
BC0407 -
BC0408 - Millie submitted ref DIT 4 0001 another letter to the primary care
BC0409 - physician, this one on getting a heart examination by a specialist,
BC0410 - and per note in the first letter explaining limitations of Kaiser's
BC0411 - correspondence system, per above. ref SDS 0 8U5L
BC0413 -  ..
BC0414 - This letter implements planning yesterday on 061217, ref SDS 44 0F9M,
BC0415 - to follow up Millie letter on 061027 requesting prognosis on when
BC0416 - exercise can be resumed in the gym to restore fitness. ref SDS 37 0C4I
BC0418 -  ..
BC0419 - Millie says to the primary care physician...
BC0420 -
BC0421 -    1.  In our meeting on 061208 you discussed findings in the PET test
BC0422 -        on 060930 that report enlarged right ventricle, and commented
BC0423 -        that examination with the stethoscope, ref DIT 4 0001, and Sa
BC0424 -        O2 99% indicate symptoms of Cor Pulmonale are not very severe
BC0425 -        yet. ref SDS 42 VJ4J
BC0427 -         ..
BC0428 -    2.  Hopefully, Coumadin treatments will manage this problem, and
BC0429 -        the PET/CT scan test scheduled for 061227, ref DIT 4 9Q6F, may
BC0430 -        shed more light on scope and requirements for treatment.
BC0431 -        ref SDS 42 1U4I
BC0433 -         ..
BC0434 -    3.  As we go forward, Kaiser's Team Care practice can provide
BC0435 -        review by a heart specialist to support initial impressions.
BC0436 -        ref DIT 4 HW7G  This would address my continuing symptoms of
BC0437 -        fatigue, shortness of breath, heavy chest, etc., with normal
BC0438 -        activity. ref SDS 42 CV5L
BC0440 -  ..
BC0441 - On 061208 Millie asked about examination by a heart specialist to
BC0442 - confirm clearance for resulming work outs in the gym to improve
BC0443 - physical fitness and relieve symptoms of pulmonary embolism.
BC0444 - ref SDS 42 HZ39
BC0445 -
BC0446 -
BC0448 -  ..
BC05 -
BC06 -
BC07 - 1244
BC08 -
BC0801 - Doctor Says Enlarged Right Ventricle Not Life Threatening for Years
BC0802 - Cor Pulmonale Enlarged Right Ventricle Not Life Threatening for Years
BC0803 -
BC0804 - Millie received ref DRT 3 0001 from the doctor responding to the
BC0805 - letter earlier this morning, ref DIT 4 0001, asking about examination
BC0806 - by heart specialist of Cor Pulmonale heart disorder due to enlarged
BC0807 - right ventricle, per above, ref SDS 0 VC4M, and also about resolving
BC0808 - conflict in Benz 2nd opinions on Navelbine treatments, also, per
BC0809 - above. ref SDS 0 Q74O
BC0811 -  ..
BC0812 - Primary care physician says...
BC0813 -
BC0814 -        This potential problem will most likely not become clinically
BC0815 -        relevant considering that it takes years to progress to a point
BC0816 -        where it becomes life threatening. ref DRT 3 0001
BC0818 -  ..
BC0819 - Feeling that something "most likely" will occur can be supported by
BC0820 - referral to specialist.
BC0821 -
BC0822 -            [On 061227 Millie letter notifies Kaiser of continuing
BC0823 -            symptoms pulmonary embolism and heart disorder Cor
BC0824 -            Pulmonale from enlarged right ventricle; proposes
BC0825 -            examination by heart specialist, ref SDS 47 645I, and
BC0826 -            suggests waiting to discuss during meeting on 070105 after
BC0827 -            results of PET/CT test on 061227 are reported. ref SDS 47
BC0828 -            B995
BC0829 -
BC0830 -
BC0831 -
BC0832 -
BC09 -

SUBJECTS
Commend Primary Care Physician Oncology Kaiser Team Care 5 Year Care

BI03 -
BI0401 -  ..
BI0402 - Commend Primary Care Physician 5 Year Care Complex Cancer Case
BI0403 -
BI0404 - Follow up ref SDS 42 K36G, ref SDS 40 K36G.
BI0406 -  ..
BI0407 - Millie submitted ref DIT 5 0001 another letter to the primary care
BI0408 - physician, this one commending care over past 5 years, and requesting
BI0409 - Tumor Board review, and per note in the first letter explaining
BI0410 - limitations of Kaiser's correspondence system, per above. ref SDS 0
BI0411 - 8U5L
BI0413 -  ..
BI0414 - This letter implements planning yesterday on 061217. ref SDS 44 GK5L
BI0416 -  ..
BI0417 - Millie says to the primary care physician...
BI0418 -
BI0419 -    1.  I want to take this occassion to commend your excellent work,
BI0420 -        and the entire Kaiser team for my care the past 5 years.
BI0421 -        Medical practice is a lot of hard work tracking countless
BI0422 -        details, far more complex than building a Boeing 747.  There
BI0423 -        are bound to be ups and downs.  Kaiser's commitment to
BI0424 -        excellence shines through in your work allocating time for
BI0425 -        review, analysis, and communications. ref DIT 5 0001
BI0427 -  ..
BI0428 - Level of effort required by Kaiser illustrated by complexity of 36
BI0429 - pending issues on 061208. ref SDS 42 LU3J  Progress eliminating errors
BI0430 - and omissions from the medical chart is presented on 061208.
BI0431 - ref SDS 42 FE4I
BI0432 -
BI0433 -
BI0434 -
BI0435 -
BI0436 -
BI0437 -
BI05 -

SUBJECTS
Strategy Treatment Plan IBC 3rd Relapse Tumor Board Review Major Cha

BV03 -
BV0401 -  ..
BV0402 - IBC Expert Panel Tumor Board Productive Review Millie's Complex Case
BV0403 - Tumor Board Review on Changing Treatment Expansion of Disease
BV0404 - Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
BV0405 - Strategy Treatment Options Scenarios Planning Patient Work Up Deferred
BV0406 -
BV0407 - Follow up ref SDS 42 K36G, ref SDS 40 K36G.
BV0408 -
BV0409 - Background on Tumor Board considerations is reported in another record
BV0410 - today. ref SDS 45 FW9K  Case study shows difficulty applying Kaiser's
BV0411 - Tumor Board capabilities. ref SDS 45 6W3X
BV0413 -  ..
BV0414 - Major change in patient status can be supported by Tumor Board
BV0415 - assistance reviewing patient history and proposing solutions.
BV0416 - Recently, on 061208 a major change occurred in Millie's case when the
BV0417 - doctor determined that effectiveness of treatment current has declined
BV0418 - with Taxotere and capecitiabine (Xeloda) chemotherapy. ref SDS 42 P69G
BV0420 -  ..
BV0421 - This letter implements planning yesterday on 061217. ref SDS 44 OA8O
BV0423 -  ..
BV0424 - Letter to primary care physician continues...
BV0425 -
BV0426 -    2.  Periodic review of case history offers timely notice of
BV0427 -        critical issues that inevitably get lost in the shuffle.  Can
BV0428 -        Kaiser assemble a panel for Tumor Board review of doctors with
BV0429 -        surgery and oncology expertise and with IBC experience more
BV0430 -        closely targeted to my patient profile: post-mastectomy, 3rd
BV0431 -        relapse secondary IBC, PE, Cellulitis, etc.? ref DIT 5 E46I
BV0433 -  ..
BV0434 - Implements discussion during meeting at Kaiser on 061208, ref SDS 42
BV0435 - P69G, citing Millie's letter to Kaiser on 061027 requesting review of
BV0436 - treatment strategy. ref SDS 37 KJ7K
BV0438 -  ..
BV0439 - Letter to primary care physician continues...
BV0440 -
BV0441 -    3.  A 5 year review with mounting issues seems like a good time to
BV0442 -        draw on Kaiser's vast resources for ideas on my care, and for
BV0443 -        lessons learned to help others. ref DIT 5 Q47H
BV0445 -         ..
BV0446 -    4.  Please let me know if Kaiser can do a Tumor Board review?
BV0447 -        ref DIT 5 M47M
BV0448 -
BV0449 -           [On 061227 letter to Doctor asks about progress arranging
BV0450 -           Tumor Board review. ref SDS 47 6L3F
BV0451 -
BV0452 -           [On 061228 doctor submits summary of patient history
BV0453 -           submitted to UCSF for participation in clincial drug trial
BV0454 -           as providing "5 year review" of complex patient history in
BV0455 -           place of Tumor Board support for analysis of diagnosis and
BV0456 -           treatment planning. ref SDS 49 NP8G
BV0457 -
BV0458 -
BV0459 -
BV0460 -
BV0461 -
BV0462 -
BV0463 -
BV05 -

SUBJECTS
Quarterly Review Patient History Precision Access to Case Studies Pi

CV03 -
CV0401 -  ..
CV0402 - Quarterly Review Patient History Access to Case Studies
CV0403 -
CV0404 - Follow up ref SDS 42 FE4I, ref SDS 9 0001.
CV0406 -  ..
CV0407 - Millie submitted ref DIT 6 0001 another letter to the primary care
CV0408 - physician, this one on reviewing the SDS record for feedback on doctor
CV0409 - patient partnership, and per note in the first letter explaining
CV0410 - limitations of Kaiser's correspondence system, per above. ref SDS 0
CV0411 - 8U5L
CV0413 -  ..
CV0414 - This letter implements planning yesterday on 061217. ref SDS 44 PK4L
CV0416 -  ..
CV0417 - Decided not to mention at this time opportunity to correct errors and
CV0418 - refine accuracy with feedback on Progress Notes in the Medical Chart,
CV0419 - listed on 061208, ref SDS 42 FE4I, including the evident error of
CV0420 - linking cancer with lung and lymph nodes. ref SDS 42 JP4L
CV0422 -  ..
CV0423 - Millie says to the primary care physician...
CV0424 -
CV0425 -    1.  Progress Notes from the Medical Chart have been very helpful.
CV0426 -        You seemed to indicate that feedback from the patient called
CV0427 -        out in Healthwise Handbook cannot be applied, because doctor's
CV0428 -        cannot enter clarifications. [on 061208, ref SDS 42 N54K]  This
CV0429 -        presents a dilemma of how to support doctor/patient
CV0430 -        partnership? ref DIT 6 0001
CV0432 -         ..
CV0433 -    2.  Possibly, quarterly review of a record for one meeting with
CV0434 -        access to case studies would be helpful without overburdening
CV0435 -        your time.  This would give you a chance to correct impressions
CV0436 -        by the patient that drift off course in communications, and
CV0437 -        also provide instructions that refine the practice in a way
CV0438 -        that supports your work. ref DIT 6 YU6G
CV0440 -         ..
CV0441 -    3.  For example, the record of our meeting on 061208 begins with a
CV0442 -        summary, ref DIT 6 JW7F, and has links to more details of
CV0443 -        various issues discussed. ref SDS 42 0001
CV0445 -         ..
CV0446 -    4.  This record will not be helpful for every doctor; not every
CV0447 -        patient can produce this work, but you might have ideas on how
CV0448 -        to make it useful. ref DIT 6 SW7K
CV0449 -
CV0450 -
CV0452 -  ..
CV05 -
CV06 -
CV07 - 1311
CV08 -
CV0801 - Millie received ref DRT 4 0001 from the doctor responding to the
CV0802 - letter earlier this morning, ref DIT 6 0001, asking about doctor
CV0803 - patient partnership to improve accuracy of Progress Notes in the
CV0804 - Medical Chart through feedback, per above, ref SDS 0 MF4I,
CV0806 -  ..
CV0807 - Primary care physician says...
CV0808 -
CV0809 -        We always are looking for ways to improve care and
CV0810 -        communication. ref DRT 4 0001
CV0812 -  ..
CV0813 - The doctor does not address the question in Millie's letter on
CV0814 - reviewing patient history, beginning with the record on 061208, and
CV0815 - determining the most constructive way to apply the record in the
CV0816 - doctor patient partnership to improve communication that avoids errors
CV0817 - and omissions in medical practice, cited as a major problem of health
CV0818 - care, reported on 990912. ref SDS 2 0001
CV0819 -
CV0820 -
CV0821 -
CV0822 -
CV0823 -
CV0824 -
CV0825 -
CV0826 -
CV0827 -
CV0828 -
CV0829 -
CV0830 -
CV09 -