THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: March 29, 2007 08:00 AM Thursday;
Millie meeting at UCSF begin 3rd cycle cetuximab treatment for IBC.
2...Agenda Develop Work Plan Stage IV Breast Cancer 15 Mos after Mastectomy
3...Complex Patient History Knowledge Management Dilemma Issues Grow 43
4...Vitals Show Stable Medical Condition
5...Coordination Plan Divided Responsibilities Kaiser UCSF Referral
6...Collaboration Primary Care at Kaiser with UCSF Clinical Study Cetuximab
7...Case Study Coordination Complex Communication Problems
8...Problems Coordination Communication Planning Feedback Follow Up
9...CA 15-3 Cancer Marker 33 Significant Improvement
10...CA 15-3 33 Cancer Marker Strong Response to Treatment Cetuximab
11...Axillary Left Arm No Lymphadenopathy Lymphedema Prominent
12...Lymphadenopathy Axillary Left Arm No Evidence Local Edema
13...Lymphedema Cellulitis Complications Left Arm Swelling
14...Swelling Left Arm Lymphedema Cellulitis Complications
15...Left Arm Lymphedema Cellulitis Complications Swelling Above Normal
16...Cellulitis Lymphedema Complications Left Arm Swelling Above Normal
17...IBC Left Arm Stable Subsiding Responds Treatment Cetuximab Drug Trial
18...Left Arm IBC Stable Subsiding Responds Treatment Cetuximab Drug Trial
19...Right Axillary Possible Involvement Red Rash Spreads Right Breast
20...IBC Right Arm New Minimal Red Rash Not Diagnosed IBC or Cellulitis
21...Right Breast Red Rash Spreads Possible Involvement Right Axillary
22...Red Rash Right Breast Spreads Possible Involvement Right Axillary
23...Right Chest Rash Not Visible Above Breast and Port Catheter
24...Rash Above Port Catheter on Right Upper Chest Not Visible Today
25...Left Supraclavicular Examination PET Test Report Finding SUV 4.5
26...Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
27...Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
28...2 Scenarios Conflict IBC Expanding Intensity Subsides
29...IBC Rash Left Breast Stomach and Back Seems to Be Subsiding
30...Examination IBC Rash Subsiding Responding to Treatment Cetuximab
31...Cetuximab Effective Treatment IBC Subsiding Left Breast Stomach Back
32...Stable Good for Treating Cancer as Chronic Disease Brigid's Rule
33...Prognosis Very Good IBC Stable Cetuximab Clinical Study
34...Stable Low Intensity IBC Rash Very Good Response to Treatment
35...Cetuximab Prognosis Good Chance IBC Rash 3rd Relapse Will Clear Up Again
36...Distant Metastasis No Evidence Patient History Examinations Tests
37...Local IBC Infection No Record Distant Metastasis Improves Chances
38...Prognosis Favorable No Lymphadenopathy 2006 No Distant Metastasis 5 Years
39...Wicked Problem Resolved Disease Subsides ANC Rises to Safe Level
40...ANC 1.81 Blood Counts Rise Above Safe Level for Treatment with Cetuximab
41...Measurable Disease IBC No New Sites No Expansion Intensity Declines
42...Photographs Record Measurable Disease IBC Tumor in Dermal Tissue
43...Measurable Disease IBC Observed with Tape Measure Photograph Pictures
44...CA 15-3 Diagnostic Measurable Disease IBC Not Measured by Image Testing
45...Lung Cancer Lymph Nodes Doctor's Progress Notes Medical Chart
46...Metastatic Cancer Lung Lymph Node Progress Notes Medical Chart
47...Biopsy Erratic Changes Rash Intensity Verify IBC Left Arm
48...CT Test 070326 No Findings Metastatic Disease
........Test History No Evidence Distant Metastasis
........Distant Metastasis No Evidence 5 Years Imaging Tests
....History Missing Context Pulmonary Embolism Enlarged Right Ventricle
....Comparison: 070131 061230 060930 Prior Related Tests Omitted
....CT Scan Failed Ignored Doctor's Order Test for Pulmonary Embolism
....Cancer No Findings Lymphadenopathy No Evidence Metastatic Disease
49...Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
50...Exercise Vigor Strength Engagement Ease Distress Living with Cancer
51...Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
52...Sleeping Difficulty Worry Cancer Health Issues Medical Management
53...Planning Case Management from Patient Profile Work Up
54...Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
55...Strategy Cetuximab Continued with Low ANC Expanding IBC Disease
56...Treatment 3rd Cycle Cetuximab Carboplatin 070329 10th Cycle 3rd Relapse
57...10th Cycle Treatment IBC 3rd Relapse 3rd Cycle Cetuximab Clinical Study
58...Cetuximab 3rd Cycle 1st Treatment IBC 3rd Relapse Clinical Study Drug Trial
59...Side Effects Cetuximab Similar Symptoms Pulmonary Embolism
60...Energy Strength Rising Minimal Side Effects Cetuximab Treatment
61...Facial Skin Dryness New Side Effect Cetuximab Curel Lotion Prescribed
62...Curel Lotion Prescribed Facial Skin Dryness New Side Effect Cetuximab
63...Clinical Study Cetuximab Treatment UCSF Begins 070201
64...UCSF Clinical Study Treatment Cetuximab Drug Trial Begins 070201
65...Drug Trials UCSF Has Other Clinical Study Treatments May Help Millie
66...Schedule Treatment Start Cetuximab Carboplatin 070201
67...Tired Breathing Difficulty Routine Activity Signals Pulmonary Emboli
68...Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
69...Pulmonary Emboli Hypercoagulable Work Up PET Scan Test Compare History
70...INR 2.4 Blood Test Patient Stable for Coumadin Treatments Pulmonary Emboli
71...Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
72...Cor Pulmonale Heart Disorder Enlarged Right Ventricle
73...Heart Examination Not Ordered Investigate Enlarged Right Ventricle
74...Enlarged Right Ventricle CT Test Aligns Patient Symptoms How Serious
Click here to comment!
1...Comparisons Kaiser made are needed in order to assess and implement
Meeting Examination Doctor 13th Review Start Treatment #16 After Mas
1403 - ..
1404 - Summary/Objective
140501 - Follow up ref SDS B1 0000. ref SDS A3 0000.
140503 - Examination today shows subsiding and stable IBC rash, with no new
140504 - sites since treatment started 070201 on the cetuximab clinical study.
140505 - ref SDS 0 LB5L Oncology practice seems to regard "stable" cancer as
140506 - favorable, while patients strive for no evidence of disease (NED).
140507 - ref SDS 0 M645 Results of blood tests today were not available in
140508 - time for the meeting. A few days later the report shows CA 15-3 33
140509 - dropped from 36 over the past 4 weeks. Declining biomarker indicates
140510 - response to treatment, aligned with clinical findings of subsiding IBC
140511 - rash. ref SDS 0 GJ5M CT test on 070326 shows no evidence of distant
140512 - metastasis. ref SDS 0 EY5O The doctor's order for a spiral CT scan to
140513 - test for pulmonary embolism and enlarged right ventricle was not
140514 - performed. ref SDS 0 0136 Rising energy and fewer symptoms suggest
140515 - recovery, but the actual condition is not known. ref SDS 0 E44L and
140516 - ref SDS 0 VJ4J Stable INR blood tests within the target range further
140517 - indicates effective treatment for pulmonary embolism. ref SDS 0 FE9I
140518 - Brigid modified the chemotherapy order to reduce the dose of Benadryl
140519 - in order to avoid side effects of "restless legs." ref SDS 0 MF6N ANC
140520 - blood counts rising above the target range indicate strengthening
140521 - immune system for safe chemotherapy treatments. ref SDS 0 VF5M Good
140522 - news today helps relieve emotional stress from doubt and worry about
140523 - the future. ref SDS 0 XU6M
140525 - [On 070330 examination at Kaiser by primary care physician finds
140526 - significantly increased intensity of rash on upper left arm,
140527 - ref SDS C9 N19J, and new rash above the right chest below the
140528 - colar bone; Keflex antibiotics was prescribed, ref SDS C9 474O;
140529 - about 3 hours later self-examination showed these erruptive rash
140530 - conditions had subsided, and so Keflex treatment was not
140531 - performed. ref SDS C9 KZ6L
140537 - ..
1408 - Progress
140901 - Agenda Develop Work Plan Stage IV Breast Cancer 15 Mos after Mastectomy
140903 - Follow up ref SDS B1 SM6M, ref SDS A5 SM6M.
140905 - ..
140906 - Millie met today with the medical team at UCSF starting the 3rd cycle
140907 - and 9th treatment of IBC with cetuximab, as planned in the launch
140908 - meeting on 070130. ref SDS A3 WM7G Treatment at UCSF is on referral
140909 - from Kaiser for participation in a clinical study drug trial ordered
140910 - by the primary care physician on 070105. ref SDS 98 PK68 This is the
140911 - 13th physician meeting scheduled to start the 10th chemotherapy cycle
140912 - since treatments began on 060711, ref SDS 77 SM6M, for the 3rd relapse
140913 - of IBC. ref SDS 77 8Y8I It is the 3rd meeting scheduled with Doctor
140914 - Rugo, and precedes a meeting with the primary care physician at Kaiser
140915 - tomorrow on 070330.
140917 - ..
140918 - Complete list of treatments for IBC 3rd relapse is reported in the
140919 - record of treatment following the meeting today. ref SDS C7 SG8I
140921 - ..
140922 - Agenda for meeting at UCSF on 070301 provides a structure for planning
140923 - the meeting today...
140925 - 1. Coordination plan.............................. ref SDS 0 RM4G
140926 - 2. CA 15-3 33 improvement......................... ref SDS 0 GJ5M
140927 - 3. Lymphedema restricts exercise.................. ref SDS 0 4Y93
140928 - 4. Breast exam IBC stable subsides................ ref SDS 0 025H
140929 - 5. Measurable disease declines.................... ref SDS 0 M652
140930 - 6. Side effects minimal........................... ref SDS 0 TQ6L
140931 - 7. CT no distant metastasis, no test for PE....... ref SDS 0 EY5O
140932 - 8. Patient work up continue strategy.............. ref SDS 0 K36G
140933 - 9. Treatment plan weekly clinical trial........... ref SDS 0 PF3O
140934 - 10. Pulmonary emboli how serious r ventricle....... ref SDS 0 CV5L
140936 - ..
140937 - Scheduled next meeting for Thursday 070426 0800, reported in the
140938 - record on 070315. ref SDS C0 159O
140940 - ..
140941 - The doctor could not support the meeting today; Millie met with two
140942 - (2) assistants...
140944 - 1. Brigid, Nurse Practitioner
140945 - 2. Jackie, Clinical Research Coordinator
Complex Patient History 43 Issues Overwhelms Span of Attention Drive
220401 - ..
220402 - Complex Patient History Knowledge Management Dilemma Issues Grow 43
220404 - Follow up ref SDS B1 LU3J, ref SDS A3 LU3J.
220406 - Sampling of issues patient history diagnosis and treatment...
220408 - 1. CA 15-3 monitors advance of cancer response to treatment
220409 - 2. Lymphedema complicated by mastectomy surgery
220410 - 3. Broken finger from minor fall complicates lymphedema
220411 - 4. Esophagitis reflux digestion issues
220412 - 5. Immune system chemotherapy increases risk of infection
220413 - Chemotherapy increase risk of infection
220414 - 6. Cat bites increase risk of infection complicates lymphedema
220415 - 7. Pneumonia chemotherapy increases risk of infection
220416 - 8. Metastatic cancer increases risk pulmonary embolism
220417 - 9. Lymphadenopathy left axilla local regional metastasis
220418 - 10. Lymphadenopathy right axilla distant metastasis
220419 - 11. Lymphadenopathy left supraclavicular diagnose metastatic cancer
220420 - 12. Breast cancer secondary IBC 3rd relapse left breast
220421 - 13. Cancer mutates slow response chemotherapy treatment
220422 - 14. Mastectomy surgery impact on treatment IBC relapse
220423 - 15. Blood vessels removed mastectomy slow chemotherapy treatments
220424 - 16. Treatment options, strategy, planning, schedule
220425 - 17. Drug trials increase declining pool chemotherapy agents
220426 - 18. UCSF Doctor Benz 2nd opinion apply diagnosis and treatment
220427 - 19. Pulmonary embolism blood clots in lungs
220428 - 20. INR weekly adjustments Coumadin treatment blood clots
220429 - 21. Enlarged right ventricle heart problem core pulmonale
220430 - 22. Dizziness symptom enlarged right ventricle cor pulmonale
220431 - 23. Fatigue shortness breath side effect chemotherapy loss fitness
220432 - 24. Fatigue shortness breath symptom pulmonary embolism
220433 - 25. Shortness breath fatigue dizzy symptoms pulmonary embolism
220434 - 26. Coagulapathy hypercoagulable state work up genetic risks
220435 - 27. Testing resolution of errors (see Benz 2nd opinion 060821)
220436 - 28. Testing distant metastatic disease
220437 - 29. Testing pulmonary embolism and heart disease
220438 - 30. Communication hectic schedule not enough time to manage details
220439 - 31. Emotional stress and well being
220440 - 32. Cellulitis inflammation temperature 102.6 on chemotherapy
220441 - 33. Urinary tract bladder infection
220442 - 34. IBC rash spreads to right breast
220443 - 35. Right breast rash may be "ring" infection, not cancer
220444 - 36. Lung cancer seems to be diagnosed in the Medical Chart
220445 - 37. IBC rash spreads to stomach and toward back
220446 - 38. IBC rash spreads to left arm
220447 - 39. Dry skin face chest arm
220448 - 40. Right arm evidence light red rash, may be IBC spreading
220449 - 41. Rash right upper right chest near port catheter
220450 - 42. Restless legs side effect Benadryl pre-treatment
220451 - 43. Sleeping difficulty side effect cetuximab
Vitals Submitted by Doctor UCSF Blood Pressure Pulse Normal Low Anxi
280401 - ..
280402 - Vitals Show Stable Medical Condition
280404 - Follow up ref SDS B1 KB5L, ref SDS A3 KB5L.
280406 - ..
280407 - Bld Prssr Pulse Temp Weight SaO2
280408 - ..
280409 - * 070329 0800............ [see treatment record, ref SDS C7 AW4L]
280410 - * 070301 1330............ [see treatment record, ref SDS B2 AW4L]
280411 - * 070130 1300............ 140 83 87 98
280412 - 070105 1040............
280413 - 061208 1226............ 152 90 76 97.8 147 99%
280414 - 061201 1430............ 123 76 76 97.5
280415 - 061110................. 136 83 73 97.0 150 98%
280416 - 061020 1534............ 140 79 67 99.8 151 97
280417 - 060929 1452............ 141 78 66 98.3
280418 - 060908 1335............ 139 79 73 98.1
280419 - 060814 1610............ 139 80 59 98.2
280420 - * 060808.................
280421 - 060711................. 172 87 54 97.5 147
280422 - 060623................. 141 87 71 98.0 147 99%
280423 - 060428................. 129 73 80 99.4 149 99%
280424 - 060217................. 153 81 61 98.6 150 99%
280426 - * For some reason, vitals not submitted.
280428 - ..
280429 - High blood pressure reflects pressure on patient about effectiveness
280430 - of new treatment and arrangements between UCSF and Kaiser for timely
280431 - care, discussed on 070130, ref SDS A3 Y642, and again last month on
280432 - 070301. ref SDS B1 Y642
280434 - ..
280435 - Today, Millie's vitals are normal, indicating reduced emotional strain
280436 - at this time, as discussed with Brigid on 070315, ref SDS C0 6A7J, and
280437 - reviewed again during the meeting today, per below. ref SDS 0 Y642
Coordination Plan Communication UCSF Kaiser Collaboration Object Dil
600401 - ..
600402 - Coordination Plan Divided Responsibilities Kaiser UCSF Referral
600403 - Collaboration Primary Care at Kaiser with UCSF Clinical Study Cetuximab
600405 - Follow up ref SDS B1 RM4G, ref SDS A3 RM4G.
600407 - Background on coordination plan to manage divided responsibilities
600408 - between Kaiser and referral to UCSF is reported on 070301. ref SDS B1
600409 - RM4G Case study on 070130 shows requirements for communication to
600410 - strengthen care. ref SDS A3 4T5N Scope of coordination requirements
600411 - is listed on 070222. ref SDS A9 KL5G
600413 - ..
600414 - On 070301 Brigid notified Millie that UCSF policy requires patients to
600415 - coordinate communications with Kaiser for comprehensive care.
600416 - ref SDS B1 O67N
600418 - ..
600419 - Coordination problems occurred on 070307 getting blood test results
600420 - from Kaiser on CA 15-3 cancer biomarker for review at UCSF.
600421 - ref SDS B7 Q65K Similar problems occurred the day before on 070306
600422 - getting feedback from Kaiser that blood test results at UCSF were
600423 - satisfactory to continue Coumadin treatments for pulmonary embolism.
600424 - ref SDS B5 UI5H On 070308 coordination scheduling blood tests was not
600425 - performed, ref SDS B8 1M6H; a week later on 070315 similar problems
600426 - occurred when treatment was not scheduled. ref SDS C0 1M6H Another
600427 - challenge was ordering a CT test for measurable disease required for
600428 - the clinical study. ref SDS B7 G56L Coordination further failed
600429 - today, when Kaiser could not submit results of the CT test on 070326
600430 - despite notice on 070326 to UCSF, ref SDS C2 FU6G, and notice to
600431 - Kaiser yesterday on 070328 that the report was needed in time for
600432 - meeting at 0800 today. ref SDS C5 VP5N ref SDS 0 EY5O
600434 - [On 070419 meeting with Doctor Rugo to review progress reports
600435 - improved coordination receiving test results from UCSF via
600436 - email. ref SDS D2 RM4G
600438 - ..
600439 - [On 070608 Kaiser urges patient to continue making extra
600440 - effort sending patient history to the doctor using
600441 - Kaiser's dedicated email system. ref SDS D8 6S3F
600443 - ..
600444 - Coordination to review side effects on the cetuximab clinical study
600445 - was facilitated this week with a letter to UCSF on 070326. ref SDS C2
600446 - 627X The letter submitted a comprehensive listing on 070322 from
600447 - meetings the past two (2) months in the Infusion Clinic. ref SDS C1
600448 - QU8K During the meeting today, Jackie disclosed that coordination was
600449 - not performed. Brigid did not get the list of pending side effects to
600450 - prepare for review with the patient today, per below. ref SDS 0 TQ6L
600452 - ..
600453 - Jackie seemed to cite "links" for withholding distribution of side
600454 - effects to prepare for meeting today. Rationale seems unclear.
600456 - [On 070419 Brigid made effort to improve coordination by using
600457 - precision access with links in email, ref SDS D2 DI8J; Jackie's
600458 - concerns about links was supported by Brigid's experience
600459 - showing need for orientation and initial assistance.
600460 - ref SDS D2 DI9F
600462 - ..
600463 - [On 070419 coordination submitting side effects via email with
600464 - precision access was not accessed during the meeting for
600465 - comprehensive review. ref SDS D2 DI4F
600467 - ..
600468 - Links strengthen coordination by efficiently connecting issues to
600469 - context with "precision access" to patient history, explained in NWO,
600470 - ref OF 5 PX6J Understanding context "augments intelligence" for good
600471 - management (see POIMS, ref OF 1 1X6G). There evidently was not enough
600472 - time for feedback to notify the patient that coordination was withheld
600473 - that prevented being prepared so that corrective action could be taken
600474 - to discuss issues comprehensively during the meeting today. Jackie
600475 - called a few days ago on 070327 and notified that blood tests were
600476 - ordered. ref SDS C4 407N This morning tests were performed, as
600477 - required, ref SDS C7 Q659, indicating benefits of timely notice, and
600478 - correcting previous problems on 070308. ref SDS B8 1M6H There was no
600479 - mention during the call on 070327 that coordination on side effects
600480 - did not occur. Resistance to feedback that refines accuracy of
600481 - knowledge for expediting work is explained in NWO. ref OF 5 2670
600483 - ..
600484 - Research on 040312 shows energy transferred through connections (i.e.,
600485 - links) yields the power of knowledge under the locality principle.
600486 - ref SDS 28 HS6O Earlier on 960205 published studies show people waste
600487 - 70% of the day in meetings that are unproductive because nobody
600488 - invests time to be prepared. ref SDS 2 5902 The UCSF coordinator role
600489 - helps solve the problem, reported on 070116. ref SDS A0 NK8F Tools
600490 - for electronic transfer with precision access greatly reduce the time
600491 - to coordinate and be prepared for working accurately, so that meetings
600492 - are productive. Roles and tools for working quickly and accurately
600493 - solve the weak link in management by being prepared for meetings that
600494 - makes communication effective, reported on 940114. ref SDS 1 2290
600496 - ..
600497 - Fearing the power of knowledge from connecting issues to context with
600498 - links in email, cited today, ref SDS 0 L55G, extends to antiquity, in
600499 - the Legend of Prometheus reviewed 991108. ref SDS 4 5810 In 400 BC,
600500 - Plato presented the tension between orality and literacy for accuracy,
600501 - in the Phaedrus dialogs, reviewed on 991209. ref SDS 5 5658 More
600502 - recently on 000503, research at SRI shows fear of knowledge remains
600503 - dominate in a world overwhelmed by first impressions from sensory
600504 - perception of information. ref SDS 6 5033
600506 - ..
600507 - Brigid commented that patient history in email is ignored, and that
600508 - UCSF relies on conversation from memories during emotional moments of
600509 - medical examinations rather than deliberation constructing writings
600510 - that yield comprehensive lists for comprehensive care. Resistance to
600511 - email seems conflicting with UCSF using email to review patient
600512 - history on 061230. ref SDS 95 OU5K UCSF used efficiencies of email
600513 - again on 070101 coordinating referral for Millie to get comprehensive
600514 - care at UCSF. ref SDS 96 YP8O On 070305 Brigid used email for timely
600515 - clarification of conflicting blood test standards. ref SDS B4 SN5O
600517 - [On 070406 UCSF made good progress learning to use email for
600518 - accurate communication via email to support the doctor patient
600519 - partnership with timely coordination and collaboration.
600520 - ref SDS D0 EQ6I
600522 - ..
600523 - [On 070418 Millie letter to UCSF thanks Brigid for taking time
600524 - to support doctor patient collaboration notifying good news of
600525 - continued decline in CA 15-3. ref SDS D1 EQ6I
600527 - ..
600528 - [On 070419 meeting with Doctor Rugo to review progress reports
600529 - improved coordination receiving test results from UCSF via
600530 - email. ref SDS D2 RM4G
600532 - ..
600533 - [On 070419 Brigid made effort to improve coordination by using
600534 - precision access with links in email, ref SDS D2 DI8J; Jackie's
600535 - concerns about links was supported by Brigid's experience
600536 - showing need for orientation and initial assistance.
600537 - ref SDS D2 DI9F
600539 - ..
600540 - [On 070501 letter from UCSF via email improves timely, accurate
600541 - communication. ref SDS D4 EQ6I
600543 - ..
600544 - [On 070509 Millie commended UCSF and recognized Brigid for
600545 - continued timely communication, coordination, and collaboration
600546 - via email supporting an effective doctor/patient partnership.
600547 - ref SDS D5 KR6K
600549 - ..
600550 - [On 070510 improved communication using email reduces stress by
600551 - relieving worry and doubt about medical mistakes. ref SDS D6
600552 - TK6J
600554 - ..
600555 - Timely, uniform distribution of "intelligence support" with email aids
600556 - comprehensive coordination. (see NWO, ref OF 5 A56M) Literacy
600557 - complements orality leveraged by intelligence with precision access to
600558 - patient history. Being prepared by reviewing patient history, in this
600559 - case side effects listed on 070322, ref SDS C1 QU8K, does not replace
600560 - discussion during meetings. Reviewing the record prior to meeting
600561 - expands span of attention to prevent critical details from slipping
600562 - through the cracks during conversation, as set out in POIMS.
600563 - ref OF 3 5106
600565 - [On 070419 Brigid made effort to improve coordination by using
600566 - precision access with links in email, ref SDS D2 DI8J; Jackie's
600567 - concerns about links was supported by Brigid's experience
600568 - showing need for orientation and initial assistance.
600569 - ref SDS D2 DI9F
Case Study Coordination Failure Perform Communication Planning Feedb
650401 - ..
650402 - Case Study Coordination Complex Communication Problems
650403 - Problems Coordination Communication Planning Feedback Follow Up
650405 - Coordination issues compound complexity case managemnet this cycle add
650406 - to the prior list on 070130, ref SDS A3 4T5N, and include...
650408 - 1. Communication with Kaiser blood
650409 - test results for prescribing
650410 - Coumadin to treat pulmonary
650411 - embolism, Coagulation Control
650412 - Clinic requests report by
650413 - conversation rather than
650414 - in writing.................... 070307, ref SDS B7 UH4M
650416 - ..
650417 - 2. Communication very difficult
650418 - coordinating getting results
650419 - on blood tests at Kaiser
650420 - for use at UCSF on
650421 - referral...................... 070307, ref SDS B7 Q65K
650423 - ..
650424 - 3. Coordination very difficult
650425 - reminding Kaiser to perform
650426 - CT test with correct
650427 - scope......................... 070307, ref SDS B7 G56L
650429 - ..
650430 - 4. Coordinating schedule for blood
650431 - test ordered to assess
650432 - treatment..................... 070308, ref SDS B8 1M6H
650434 - ..
650435 - 5. Coordinating schedule for
650436 - treatments.................... 070315, ref SDS C0 1M6H
650438 - ..
650439 - 6. Communication poor obtaining
650440 - CT test results from Kaiser
650441 - for review at
650442 - UCSF.......................... 070329, ref SDS 0 ZF4I
650444 - ..
650445 - 7. Communication failed to empower
650446 - being prepared to review side
650447 - effects during the meeting
650448 - today......................... 070329, ref SDS 0 945F
650450 - ..
650451 - 8. Kaiser Imaging department failed
650452 - to follow doctor's order for CT
650453 - scan to test for pulmonary
650454 - embolism...................... 070329, ref SDS 0 B74K
650456 - ..
650457 - 9. CT test report ignores patient
650458 - history of pulmonary embolism;
650459 - and lack of comparison drive
650460 - doubt and worry about
650461 - efficacy of
650462 - tests......................... 070329, ref SDS 0 GH5L
650464 - ..
650465 - 10. Collaboration failure referral coordination
650466 - blood test at UCSF on 080306 sent to Kaiser
650467 - on 080307 was not evaluated for emergency
650468 - care at Kaiser on 080409; Kaiser compared
650469 - blood test on 080409 with data on 071017
650470 - because nobody entered 6 months of test
650471 - data in Kaiser computer; if data is
650472 - not in the computer it does not
650473 - exist......................... 080409, ref SDS D9 439L
CA 15-3 33 Trend Falls through March Cetuximab Clinical Study Drug T
720401 - ..
720402 - CA 15-3 Cancer Marker 33 Significant Improvement
720404 - Follow up ref SDS B1 087J, ref SDS A3 087J.
720406 - Millie had a blood test this morning, and results were not reported
720407 - until 070403, and show continuing decline from 36 to 33, reported in
720408 - another record today. ref SDS C7 A16M
720410 - [On 070406 received letter from UCSF confirming CA 15-3 33.
720411 - ref SDS D0 EQ6I
720413 - ..
720414 - Test Date Date Received
720415 - 070329......... 33 H............. 070329, ref SDS C7 2N5J
720416 - 070301......... 36 H............. 070307, ref SDS B2 A16M
720417 - 070215......... 52 H............. 070307, ref SDS A7 ER5O
720418 - 070208......... 55 H............. 070307, ref SDS A7 ER5O
720419 - 070201.....cetuximab begins...... 070201, ref SDS A5 G68I
720420 - 070131......... 56 H............. 070202, ref SDS A6 087J
720421 - 070123......... 52 H............. 070202, ref SDS A6 087J
720422 - 070118......... 68 H............. 070123, ref SDS A2 GK5B
720423 - 070104......... 56 H............. 070110, ref SDS 99 087J
720424 - 061218......... 74 H............. 061227, ref SDS 93 6P9F
720425 - 061214......... 63 H............. 061227, ref SDS 93 6P9F
720426 - 061201....Pause treatments..... . 061201, ref SDS 90 GJ5M
720427 - 061130......... 67 H............. 061201, ref SDS 90 087J
720428 - 061116......... 66 H............. 061201, ref SDS 90 087J
720429 - 061110......... 56 H............. 061201, ref SDS 90 087J
720430 - 061109......... 61 H............. 061110, ref SDS 89 087J
720431 - 061026......... 57 H............. 061110, ref SDS 89 087J
720432 - 061019......... 56 H............. 061020, ref SDS 88 087J
720433 - 060928......... 51 H............. 060929, ref SDS 85 087J
720434 - 060907......... 68 H............. 060929, ref SDS 85 087J
720435 - 060813......... 73 H............. 060817, ref SDS 82 U24M
720436 - 060809......... 87 H............. 060810, ref SDS 81 2N5J
720437 - 060721..Taxotere capecitabine.... 060721, ref SDS 78 0001
720438 - 060708......... 71 H............. 060711, ref SDS 77 087J
720439 - 060616......... 63 H............. 060623, ref SDS 76 UQ5Q
720440 - 060522......... 59 H............. 060605, ref SDS 75 UQ5Q
720441 - 060501......... 49 H............. 060522, ref SDS 74 MC4F
720442 - 060421......... 44 H............. 060428, ref SDS 72 087J
720443 - 060330......... 40 H............. 060428, ref SDS 72 087J
720444 - 060303......... 36............... 060428, ref SDS 72 087J
720445 - 060210......... 33............... 060217, ref SDS 71 087J
720446 - 060109......... 34............... 060126, ref SDS 70 KV59
720447 - 051223......... 34............... 060106, ref SDS 69 087J
720448 - 051202......... 28............... 060106, ref SDS 69 087J
720449 - 051116......... 31............... 051121, ref SDS 68 087J
720450 - 051109......... 30............... 051121, ref SDS 68 087J
720451 - 051102......... 34............... 051121, ref SDS 68 087J
720452 - 051021..Mastectomy surgery....... 051021, ref SDS 67 0001
720453 - 050916...end treatment........... 050916, ref SDS 65 407N
720454 - 050909......... 45 H............. 051007, ref SDS 66 087J
720455 - 050826......... 45 H............. 050913, ref SDS 64 087J
720456 - 050819......... 45 H............. 050913, ref SDS 64 087J
720457 - 050812......... 39 .............. 050819, ref SDS 63 3K6L
720458 - 050729......... 45 H............. 050819, ref SDS 63 EA5G
720459 - 050708......... 46 H............. 050729, ref SDS 62 087J
720460 - 050701......... 37 .............. 050729, ref SDS 62 087J
720461 - 050617......... 45 H............. 050729, ref SDS 62 087J
720462 - 050527......... 56 H............. 050610, ref SDS 60 087J
720463 - 050512......... 67 H............. 050520, ref SDS 58 087J
720464 - 050506......... 80 H............. 050520, ref SDS 58 087J
720465 - ..
720466 - 050415.........105 H............. 050422, ref SDS 57 087J
720467 - 050415..Taxoter capecitabie begin 050415, ref SDS 56 407N
720468 - 050325.........100 H............. 050329, ref SDS 55 087J
720469 - 050318.........101 H............. 050325, ref SDS 54 2N5J
720470 - 050304......... 88 H............. 050311, ref SDS 52 087J
720471 - 050225......... 95 H............. 050308, ref SDS 51 0001
720472 - 050211......... 78 H............. 050214, ref SDS 50 02BB
720473 - 050128......... 67 H............. 050204, ref SDS 49 087J
720474 - 050104...AC start treatment...... 050104, ref SDS 48 407N
720475 - 041228......... 56 H............. 041230, ref SDS 47 087J
720476 - 041204......... 43 H............. 041210, ref SDS 46 087J
720477 - 041021...Taxol bevczmb ends...... 041021, ref SDS 44 0001
720478 - 041007......... 39............... 041104, ref SDS 45 087J
720479 - 040923......... 49 H............. 041005, ref SDS 43 087J
720480 - 040908......... 44 H............. 040909, ref SDS 42 087J
720481 - 040825......... 47 H............. 040909, ref SDS 42 087J
720482 - 040811......... 42 H............. 040812, ref SDS 41 087J
720483 - 040728......... 43 H............. 040729, ref SDS 39 2N5J
720484 - 040712......... 47 H............. 040713, ref SDS 38 087J
720485 - 040614......... 55 H............. 040615, ref SDS 37 PX6X
720486 - 040517......... 78 H............. 040601, ref SDS 35 2N5J
720487 - 040420...Taxol bevczmb starts.... 040420, ref SDS 33 9Z5J
720488 - 040311......... 70 H............. 040318, ref SDS 29 SM6M
720489 - 040205......... 60 H............. 040211, ref SDS 26 SM6M
720490 - 031201......... 62 H............. 031205, ref SDS 25 SM6M
720491 - 030912......... 66 H............. 030915, ref SDS 24 SM6M
720492 - 030708......... 68 H............. 030710, ref SDS 23 SM6M
720493 - 030503......... 54 H............. 030508, ref SDS 21 SM6M
720494 - 030403......... 45 H............. 030508, ref SDS 21 SM6M
720495 - 030215......... 46 H............. 030220, ref SDS 20 5E6L
720496 - 030106......... 37 H............. 030109, ref SDS 19 SM6M
720497 - 021204..Adjuvant chemo ends...... 021204, ref SDS 18 SQ5I
720498 - 021202......... 41 H?............ 021204, ref SDS 18 SP5G
720499 - 021111......... 36 H?............ 021113, ref SDS 17 Y65I
720500 - 021023......... 33 H?............ 021023, ref SDS 16 SQ5I
720501 - 020930......... 33 H?..39........ 021002, ref SDS 15 SQ5I
720502 - 020917......... 36 H?............ 020924, ref SDS 14 SQ5I
720503 - 020717......... 59 H?............ 020726, ref SDS 13 YN5K
720504 - 020629......... 75 H ............ 020705, ref SDS 12 UX6I
720505 - 020608........ 67 H ............ 020614, ref SDS 11 0001
720506 - 020603........ 108 H ............ 020607, ref SDS 10 X67F
720507 - 020511........ 117 H ............ 020603, ref SDS 9 PJ4J
720508 - 020419......... 81 H ............ 020430, ref SDS 8 7N5H
720509 - 020321......... 85 H ............ 020405, ref SDS 7 6T8K
720515 - ..
7208 - Analysis
720901 - CA 15-3 33 Cancer Marker Strong Response to Treatment Cetuximab
720903 - Follow up ref SDS B1 GJ5M, ref SDS A3 GJ5M.
720905 - Yesterday on 070328 the McNeil Lehrer television broadcast reported
720906 - research on biomarkers that identify cancer and guide treatment.
720907 - ref SDS C6 0001 Doctor Barker, Deputy Director NCI, and Doctor
720908 - Woodcock, Chief Medical Officer FDA explained goals and projects to
720909 - improve biomarkers for early detection of cancer, and timely, targeted
720910 - treatment. ref SDS C6 PK7G CA 15-3 cancer marker used in Millie's
720911 - case to assess response to treatment shows alignment with this
720912 - research. ref SDS 0 087J
720914 - ..
720915 - Background on Millie's patient history applying CA 15-3 is shown in a
720916 - case study on 030710. ref SDS 23 IA7H
720918 - ..
720919 - CA 15-3 for the blood test today was not available in time for the
720920 - meeting, as shown in another record reporting treatment at 0840 in the
720921 - Infusion Clinic. ref SDS C7 2N5J Subsequently, on 070403 Catherine
720922 - called and reported CA 15-3 was 33 for the test on 070329, as shown
720923 - above. ref SDS 0 087J
720925 - [On 070406 Millie received a letter from UCSF confirming CA
720926 - 15-3 33 for the blood test on 070329. ref SDS D0 EQ6I
720928 - ..
720929 - Continued dramatic decline of the cancer marker CA 15-3 33, per above,
720930 - ref SDS 0 087J, aligns with clinical findings today of IBC rash
720931 - subsiding, and that there has been no expansion of IBC since
720932 - examination OA 070130 despite expanding cancer for several months
720933 - while off treatment, shown below, ref SDS 0 LB5L. As noted, recent
720934 - research on 070328, ref SDS C6 0001 indicates that consistent decline
720935 - of cancer marker during the period of clinical trial so far in
720936 - Millie's case, and beginning on 070201, further aligns with Doctor
720937 - Rugo's assessment on 070301 finding response to treatment with
720938 - cetuximab. ref SDS B1 M68J
Lymphadenopathy Axillary No Findings Left Arm Patient No Complaint S
800401 - ..
800402 - Axillary Left Arm No Lymphadenopathy Lymphedema Prominent
800403 - Lymphadenopathy Axillary Left Arm No Evidence Local Edema
800405 - Follow up ref SDS B1 MW8J, ref SDS A3 MW8J.
800407 - Patient has a long history of IBC on the left breast and associated
800408 - lymphadenopathy symptoms in the left axillary, see case study on
800409 - 040517. ref SDS 34 OW3I
800411 - ..
800412 - Brigid examined the left axilla. Clinical palpation made no findings
800413 - of lumps or other indications of cancer, including swelled lymph nodes
800414 - that might indicate lymphadenopathy. The patient made no complaint of
800415 - lumps or discomfort from swelling under the left arm. CT test on
800416 - 070326 shows no findings of lymphadenopathy, reported below.
800417 - ref SDS 0 12GK There is no express finding that the analyst actually
800418 - looked at the left and right axillary.
Lymphedema Left Arm Swelling Increased No Evident Red Rash Inflammat
900401 - ..
900402 - Lymphedema Cellulitis Complications Left Arm Swelling
900403 - Swelling Left Arm Lymphedema Cellulitis Complications
900404 - Left Arm Lymphedema Cellulitis Complications Swelling Above Normal
900405 - Cellulitis Lymphedema Complications Left Arm Swelling Above Normal
900407 - Follow up ref SDS B1 4Y93.
900409 - Medical history of lymphedema in the left arm is reported in a case
900410 - study on 070130. ref SDS A3 VX6F
900412 - ..
900413 - The left arm today has continued swelling from lymphedema. Recent
900414 - measurement below the elbow was 11.5 inches, significantly increased
900415 - above previous norms reported in a study on 060509. ref SDS 73 HO7F
900417 - ..
900418 - There wasn't enough time today for discussing correlations between
900419 - exercise to strengthen the immune system that resists cancer, and
900420 - helps dissipate emotional stress, reviewed at UCSF on 070315,
900421 - ref SDS C0 6A7J, but may compound lymphedema with increased swelling,
900422 - and complications of Cellulitis, discussed at UCSF on 070222.
900423 - ref SDS A9 GG4H Lymphedema and Cellulitis in relation to side effects
900424 - on the cetuximab clinical study are shown below. ref SDS 0 M84I
900426 - [On 070330 examination at Kaiser by primary care physician finds
900427 - significantly increased intensity of rash on upper left arm,
900428 - ref SDS C9 N19J, and a similar new rash above the right breast and
900429 - below the colar bone; these dramatic changes in condition were
900430 - diagnosed without biopsy as complications of lymphedema causing
900431 - Cellulitis with elevated temperature, and possibly triggered by
900432 - patient's increased exercise that overtaxed the system.
900433 - ref SDS C9 583G Keflex antibiotics was prescribed, ref SDS C9
900434 - 474O; about 3 hours later self-examination showed these erruptive
900435 - rash conditions had subsided, and so Keflex treatment was not
900436 - performed. ref SDS C9 KZ6L
IBC Left Arm Examination Stable Subsides Rash Less Intense Responds
A40401 - ..
A40402 - IBC Left Arm Stable Subsiding Responds Treatment Cetuximab Drug Trial
A40403 - Left Arm IBC Stable Subsiding Responds Treatment Cetuximab Drug Trial
A40405 - Follow up ref SDS B1 527G.
A40407 - Examination of upper left arm indicates IBC rash area stable and
A40408 - intensity stable to subsiding, i.e., improving by responding to
A40409 - treatment.
A40411 - [On 070330 examination at Kaiser by primary care physician finds
A40412 - significantly increased intensity of rash on upper left arm,
A40413 - ref SDS C9 N19J, and a similar new rash above the right breast and
A40414 - below the colar bone; these dramatic changes in condition were
A40415 - diagnosed without biopsy as Cellulitis, possibly complications of
A40416 - lymphedema. ref SDS C9 583G Keflex antibiotic was prescribed,
A40417 - ref SDS C9 474O; about 3 hours later self-examination showed these
A40418 - erruptive rash conditions had subsided, and so Keflex treatment
A40419 - was not performed. ref SDS C9 KZ6L
A40421 - ..
A40422 - Aligns with declining measurable disease cancer marker CA 15-3, per
A40423 - above. ref SDS 0 UZ8N
A40425 - ..
A40426 - Jackie took photographs for measurable disease. Brigid held a
A40427 - measuring tape in several directions to record the spread of IBC
A40428 - inflammation in several directions, per below. ref SDS 0 EX8O
Right Axillary Lymphadenopathy No Findings Right Arm Patient No Comp
AC0401 - ..
AC0402 - Right Axillary Possible Involvement Red Rash Spreads Right Breast
AC0404 - Follow up ref SDS B1 3D6K, ref SDS A3 3D6K.
AC0406 - Background on patient history testing for lymphadenopathy in the right
AC0407 - axilla is reported in the record on 060929. ref SDS 85 3D6K
AC0409 - ..
AC0410 - Examination of the right axillary yielded same negative results
AC0411 - finding no evidence of lymphadenopathy, as occurred examining the left
AC0412 - axilla, per above. ref SDS 0 VU6O Also aligns with CT test on 070326,
AC0413 - reviewed below. ref SDS 0 12GK
Right Arm Examination Rash Slight Blemishes No Evidence IBC No Findi
AJ0401 - ..
AJ0402 - IBC Right Arm New Minimal Red Rash Not Diagnosed IBC or Cellulitis
AJ0404 - Follow up ref SDS B1 H15M.
AJ0406 - Background on slight red dots, rash or blemishes on the right arm is
AJ0407 - reported on 070301. ref SDS B1 H15M Examination at that time
AJ0408 - concluded the rash is not IBC. Further examination on 070315 reached
AJ0409 - the same conclusion, ref SDS C0 FO6H, supported by another review on
AJ0410 - 070322. ref SDS C1 LI4M
AJ0412 - ..
AJ0413 - There is the possibility this is IBC and is responding to treatment,
AJ0414 - as with IBC in other areas listed on 070301. ref SDS B1 4140
AJ0416 - ..
AJ0417 - Examination today yielded no change in analysis that IBC has not
AJ0418 - spread to the right arm, and Cellulitis has not occurred in the right
AJ0419 - arm.
AJ0421 - ..
AJ0422 - Similarly, there is no evidence of side effects in the right arm from
AJ0423 - cetuximab treatment for IBC, reported further below. ref SDS 0 MF6I
AJ0425 - ..
AJ0426 - This aligns with examination during treatment today in the Infusion
AJ0427 - Clinic. ref SDS C7 LI4M
IBC Right Breast Examination Stable Subsides Rash Less Intense Respo
AS0401 - ..
AS0402 - Right Breast Red Rash Spreads Possible Involvement Right Axillary
AS0403 - Red Rash Right Breast Spreads Possible Involvement Right Axillary
AS0405 - Follow up ref SDS B1 T99I.
AS0407 - ..
AS0408 - On 061204 IBC inflammation spread from the left chest area infected
AS0409 - with IBC across the sternum and slightly onto the right breast.
AS0410 - ref SDS 91 AE5I
AS0412 - ..
AS0413 - Examination of right breast shows reduced intensity of IBC rash, and
AS0414 - there is no spreading of the rash, suggesting favorable response to
AS0415 - treatment. At the time of examination today, CA 15-3 was not known.
AS0416 - Subsequently, report of testing this past month, including today
AS0417 - showing CA 15-3 has dropped to 36, ref SDS B1 GJ5M, seems to align
AS0418 - with observing that IBC on the right breast is subsiding.
AS0420 - ..
AS0421 - Jackie took photographs for measurable disease.
Rash Chest Right Side Above Breast Below Collar Bone Above Port Cath
B20401 - ..
B20402 - Right Chest Rash Not Visible Above Breast and Port Catheter
B20403 - Rash Above Port Catheter on Right Upper Chest Not Visible Today
B20405 - Follow up ref SDS C1 KU3L, ref SDS C0 KU3L.
B20407 - Background on 070315 Nurse's Notes for treatment in the Infusion
B20408 - Clinic report rash above the port catheter on the right side of the
B20409 - chest, and well above the right breast. This is a new condition not
B20410 - previously reported at Kaiser nor at UCSF. Following review of
B20411 - Nurse's Notes there was no evident rash observed by the patient.
B20412 - ref SDS C0 KU3L The following week, on 070322 Nurse's Notes for
B20413 - treatment report no continuing rash at this location. ref SDS C1 KU3L
B20415 - ..
B20416 - Case study on 070130 shows erratic changes in severity/intensity of
B20417 - IBC rash on left chest area, which led to referral to UCSF.
B20418 - ref SDS A3 5N6L
B20420 - ..
B20421 - Examination today observed no identifiable rash above the port
B20422 - catheter area on the right chest. Brigid noted a few blemishes and
B20423 - possibly one or two may have reddish coloration. These seem different
B20424 - from early observation of IBC on the left breast area, and on the
B20425 - stomach, and then the left arm, per patient history reported on
B20426 - 070301. ref SDS B1 H15M
B20428 - [On 070330 examination at Kaiser by primary care physician finds
B20429 - significantly increased intensity of rash on upper left arm,
B20430 - ref SDS C9 N19J, and a similar new rash above the right breast and
B20431 - below the colar bone; these dramatic changes in condition were
B20432 - diagnosed without biopsy as complications of lymphedema causing
B20433 - Cellulitis with elevated temperature, and possibly triggered by
B20434 - patient's increased exercise that overtaxed the system.
B20435 - ref SDS C9 583G Keflex antibiotics was prescribed, ref SDS C9
B20436 - 474O; about 3 hours later self-examination showed these erruptive
B20437 - rash conditions had subsided, and so Keflex treatment was not
B20438 - performed. ref SDS C9 KZ6L
B20440 - ..
B20441 - Discussion of side effects from cetuximab treatment for IBC is
B20442 - reported below. ref SDS 0 ID5M
Left Supraclavicular Examination Palpation Neck Lymphadenopathy No F
BA0401 - ..
BA0402 - Left Supraclavicular Examination PET Test Report Finding SUV 4.5
BA0403 - Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
BA0404 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
BA0406 - Follow up ref SDS B1 8R6M, ref SDS A3 8R6M.
BA0408 - During examination on 070130, Doctor Rugo asked about history of
BA0409 - radiation to the neck, and sequence of finding recurrence from Doctor
BA0410 - Laio's biopsy reported on 040309. ref SDS 27 0001 Background of image
BA0411 - testing, and consideration for radiation treatment of left
BA0412 - supraclavicular is reported on 060623. ref SDS 76 8R6M
BA0414 - ..
BA0415 - Like the left and right axillary locations, examination today for
BA0416 - cancer in left supraclavicular region found no evidence of lumps or
BA0417 - other indications of lymphadenopathy, as reported above. ref SDS 0
BA0418 - VU6O CT test on 070326 shows no findings of lymphadenopathy, reported
BA0419 - below. ref SDS 0 12GK There is no express finding that the analyst
BA0420 - actually looked at the left and right supraclavicular.
IBC Left Breast Examination 2 Scenarios End Stable Area No New Sites
BR0401 - ..
BR0402 - 2 Scenarios Conflict IBC Expanding Intensity Subsides
BR0403 - IBC Rash Left Breast Stomach and Back Seems to Be Subsiding
BR0404 - Examination IBC Rash Subsiding Responding to Treatment Cetuximab
BR0405 - Cetuximab Effective Treatment IBC Subsiding Left Breast Stomach Back
BR0407 - Follow up ref SDS B1 025H, ref SDS A3 025H.
BR0409 - Background of IBC recurrence on left breast beginning on 060623, and
BR0410 - treatment with Taxotere and capecitabine ending on 061201, with
BR0411 - subsequent progression of disease spreading to other areas is reported
BR0412 - on 070301. ref SDS B1 025H
BR0414 - ..
BR0415 - Case study on 070130 shows erratic changes in severity/intensity of
BR0416 - IBC rash on left chest area, which led to referral to UCSF.
BR0417 - ref SDS A3 5N6L All case studies are listed on 061018. ref SDS 87
BR0418 - 0001
BR0420 - ..
BR0421 - Cetuximab treatment started at UCSF on 070201. ref SDS A5 G68I
BR0423 - ..
BR0424 - Strategy for treating progression of disease was reviewed on 070301.
BR0425 - ref SDS B1 1T4O
BR0427 - ..
BR0428 - Examination today shows intensity of IBC rash seems to continue
BR0429 - subsiding or remains stable, and there is no evident expansion of IBC
BR0430 - rash areas, and further there are no new IBC rash sites, as listed on
BR0431 - 070301. ref SDS B1 4140 Since blemishes on the right arm have not
BR0432 - been diagnosed as IBC, per above, ref SDS 0 H15M; and, the same for
BR0433 - blemishes on the right chest, also, per above, ref SDS 0 583G, the
BR0434 - current condition today is...
BR0436 - left breast chest................. 060623, ref SDS 76 025H
BR0437 - right breast...................... 061204, ref SDS 91 AE5I
BR0438 - stomach........................... 070130, ref SDS A3 M68J
BR0439 - back.............................. 070130, ref SDS A3 M68J
BR0440 - left arm.......................... 070202, ref SDS A6 6Q5N
BR0442 - ..
BR0443 - IBC conditions of subsiding intensity and no new disease sites support
BR0444 - cancelling a meeting on 070308 to assess changing treatment protocol,
BR0445 - ref SDS B8 FO6H, possibly adding carboplatin, as part of a strategy
BR0446 - to improve effectiveness based on information available 070301.
BR0447 - ref SDS B1 T85J At this time, treatment with cetuximab alone seems
BR0448 - effective.
BR0450 - ..
BR0451 - At the time of examination today, CA 15-3 biomarker for the blood
BR0452 - test this morning was not known, similar to the meeting at UCSF on
BR0453 - 070301. see above. ref SDS 0 UZ8N On 070307 CA 15-3 36 was a dramatic
BR0454 - decline of the cancer marker that seems to align with visual findings
BR0455 - that disease likely expanded before starting treatment in the clinical
BR0456 - trial on 070201, ref SDS B7 U85L, and has yielded subsiding intensity,
BR0457 - and no evident expansion of IBC sites, as observed today. ref SDS 0
BR0458 - M68J
BR0460 - ..
BR0461 - On 070315 Millie submitted a report notifying the primary care
BR0462 - physician at Kaiser about progress with treatment for the 3rd relapse
BR0463 - of IBC with treatment starting on 070201 clinical study cetuximab at
BR0464 - UCSF. ref SDS B9 VP5N Millie meets tomorrow at Kaiser for review.
Prognosis Stable Low Intensity IBC Rash Very Good Response Treatment
BY0401 - ..
BY0402 - Stable Good for Treating Cancer as Chronic Disease Brigid's Rule
BY0403 - Prognosis Very Good IBC Stable Cetuximab Clinical Study
BY0404 - Stable Low Intensity IBC Rash Very Good Response to Treatment
BY0405 - Cetuximab Prognosis Good Chance IBC Rash 3rd Relapse Will Clear Up Again
BY0407 - Follow up ref SDS B1 M645, ref SDS A3 M645.
BY0409 - ..
BY0410 - Millie asked today about possible slowing subsidence of IBC rash
BY0411 - intensity? She cited rapid response to treatment during 2005, when
BY0412 - the expanding IBC rash was nearly completely gone after 4 weeks of
BY0413 - treatment with Taxotere and capecitabine (Xeloda), reported on 050520.
BY0414 - ref SDS 58 025H
BY0416 - ..
BY0417 - Brigid seemed to explain that for cancer, including this case of IBC,
BY0418 - "stable" conditions of low intensity rash is a "very good" response to
BY0419 - treatment for the patient, the medical team, and the clinical study.
BY0420 - There was comment that patients live for many years with disease
BY0421 - "stable." The goal is to prevent "progression of cancer," as found
BY0422 - today. ref SDS 0 M68J
BY0424 - ..
BY0425 - Laughed and credited Brigid with...
BY0427 - Brigid's rule: stable is good for treating cancer as a
BY0428 - chronic disease.
BY0430 - ..
BY0431 - Previously, on 070315 Brigid commented that one patient has been
BY0432 - treated for 10 months without progression of her breast cancer.
BY0433 - ref SDS C0 6A9H
BY0435 - [On 070510 the patient was subsequently moved to treatment with
BY0436 - Gemzar because disease began to progress. ref SDS D6 5P8J
BY0438 - ..
BY0439 - [On 091028 0830 applied Brigid's rule to continue Gemzar another
BY0440 - cycle, during meeting at Kaiser considering treatment plan for
BY0441 - Millie's 9th relapse. ref SDS E0 GN9H
Distant Metastasis No Evidence 6 Years Patient History Examinations
C60401 - ..
C60402 - Distant Metastasis No Evidence Patient History Examinations Tests
C60403 - Local IBC Infection No Record Distant Metastasis Improves Chances
C60404 - Prognosis Favorable No Lymphadenopathy 2006 No Distant Metastasis 5 Years
C60406 - Follow up ref SDS B1 FF4H, ref SDS A3 FF4H.
C60408 - There is no evidence of distant metastasis in internal organs,
C60409 - unchanged from the meeting at Kaiser on 070301, when CT test on 070131
C60410 - was reviewed. ref SDS A6 013T Results of recent CT testing this past
C60411 - Monday on 070326 were not available from Kaiser at the time of the
C60412 - meeting this morning. Subsequent review after the meeting indicate
C60413 - continuing favorable response to treatment with no findings of
C60414 - progression, shown below. ref SDS 0 EY5O
C60416 - ..
C60417 - IBC expanding during December and January, ref SDS B1 4140, presented
C60418 - grave concern, which now seems to be coming under control again.
Wicked Problem Resolved Disease Subsides Cetuximab Effective Treatme
CN0401 - ..
CN0402 - Wicked Problem Resolved Disease Subsides ANC Rises to Safe Level
CN0403 - ANC 1.81 Blood Counts Rise Above Safe Level for Treatment with Cetuximab
CN0405 - Follow up ref SDS B1 VF5M.
CN0407 - Millie had a blood test this morning at 0800 in the Infusion Clinic,
CN0408 - required to start a new 4-week treatment cycle with cetuximab,
CN0409 - reported in another record. ref SDS C7 Q659 Blood tests verify the
CN0410 - immune system is strong enough for chemotherapy. Millie is scheduled
CN0411 - to start cycle #3 today. Starting cycle #2 on 070301 presented a
CN0412 - wicked problem. Cancer was spreading which required increasing
CN0413 - chemotherapy; but, low blood counts prevented increasing treatment in
CN0414 - order to prevent cancer from cascading out of control. ref SDS B1 3K6H
CN0416 - ..
CN0417 - On 070301, Doctor Rugo devised a plan based on patient history to
CN0418 - continue treatments and increase testing. ref SDS B1 528F This was
CN0419 - successful. A week later on 070308, testing showed that blood counts
CN0420 - rose above the level for safe treatments, ref SDS B8 WX7I, and
CN0421 - continuing treatments improved Millie's cancer marker CA 15-3 to the
CN0422 - best level in over a year. ref SDS B8 B35O
CN0424 - ..
CN0425 - During the meeting this morning, blood test results were not
CN0426 - available. Brigid relied on the prior results for the test on 070308
CN0427 - showing rising ANC blood counts to approve continuing treatment for
CN0428 - the next cycle. Results for the test today were received a few hours
CN0429 - later during treatment in the Infusion Clinic and show continued
CN0430 - improvement in blood counts, ANC increased again to 1810. ref SDS C7
CN0431 - P560
CN0433 - ..
CN0434 - Rising blood counts, together with falling cancer marker, CA 15-3
CN0435 - resolves the prior wicked problem reported on 070301. ref SDS B1 VF6O
Measurable Disease IBC CA 15-3 33 Cancer Marker Improves Shows Respo
D20401 - ..
D20402 - Measurable Disease IBC No New Sites No Expansion Intensity Declines
D20403 - Photographs Record Measurable Disease IBC Tumor in Dermal Tissue
D20404 - Measurable Disease IBC Observed with Tape Measure Photograph Pictures
D20405 - CA 15-3 Diagnostic Measurable Disease IBC Not Measured by Image Testing
D20407 - Follow up ref SDS B1 M652, ref SDS A3 M652.
D20409 - Background on measurable disease for IBC using cancer biomarker CA
D20410 - 15-3 and photographic records showing spread of cancer is reported in
D20411 - a case study on 070101. ref SDS 96 4Q6K
D20413 - ..
D20414 - There wasn't enough time to get CA 15-3 results from the blood test
D20415 - this morning at 0800 to evaluate progression of disease, per above.
D20416 - ref SDS 0 GJ5M Subsequently, on 070403 CA 15-3 33 was reported, and
D20417 - continues the trend showing substantial response to treatment, which
D20418 - means cetuximab continues to be effective treating IBC, cited in the
D20419 - examination today, per above. ref SDS 0 M68J
D20421 - ..
D20422 - Procedures to assess measureable disease of IBC inflammation were
D20423 - developed and used for the previous two (2) cycles on 070301,
D20424 - ref SDS B1 EX8O, and earlier on 070201. ref SDS A5 6T6M
D20426 - ..
D20427 - Jackie and Brigid took pictures again today for the clinical study
D20428 - protocol to show measurable disease of IBC has not expanded, and that
D20429 - intensity of rash sites has subsided, since evaluation of the previous
D20430 - cycle on 070301, also, reported above. ref SDS 0 M68J Brigid held a
D20431 - tape measure in several directions at each IBC site. Measurements
D20432 - were entered in the Medical Chart. Jackie used a camera to take
D20433 - pictures with the tape measure in each position to clarify the
D20434 - meaning of the measurements, since IBC inflammation presents randomly
D20435 - with no consistent boundary.
D20437 - [On 070426 measurements were taken, and photographs to make sense
D20438 - of the data were not taken for some reason. ref SDS D3 F15J
D20440 - ..
D20441 - Jackie advised that pictures of IBC rash are not digitized, and so
D20442 - cannot be transmitted electronically. There is no written analysis of
D20443 - the photographic record to describe quantification of changes in
D20444 - measurable disease.
Lung Cancer No Discussion Metastatic Disease Nodes Doctor's Progress
DA0401 - ..
DA0402 - Lung Cancer Lymph Nodes Doctor's Progress Notes Medical Chart
DA0403 - Metastatic Cancer Lung Lymph Node Progress Notes Medical Chart
DA0405 - Follow up ref SDS B1 G25K, ref SDS A3 G25K.
DA0407 - Background is reported on 070130 in the record meeting with Doctor
DA0408 - Rugo at UCSF. ref SDS A3 G25K
DA0410 - ..
DA0411 - Findings for the CT test on 070326 (shown below, ref SDS 0 DA6Q)...
DA0413 - Lungs
DA0415 - The previously described 4 very small 2-3mm nodules are
DA0416 - all stable. No new lung nodules identified. no
DA0417 - interstitial disease. Scarring in the left apex is
DA0418 - stable. ref SDS 0 5S6L
DA0420 - ...do not support concern about lung cancer first reported in Kaiser's
DA0421 - Medical Chart on 061208, ref SDS 92 G25K, since there has been no
DA0422 - change for 5 years, noted in case study on patient history on 070117,
DA0423 - per above, ref SDS 0 5S6L,
DA0425 - ..
DA0426 - Finding no "interstitial disease" further indicates this side effect
DA0427 - of cetuximab treatment has not occurred in Millie's case so far.
DA0428 - ref SDS 0 5S6L Interstitial lung disease was listed in the clincial
DA0429 - study Consent documents received from UCSF on 070116. ref SDS A0 0256
DA0431 - [On 070330 primary care physician noted that Kaiser did not
DA0432 - perform thin slice spiral CT test ordered by the doctor to
DA0433 - evaluate pulmonary embolism in connection with related risks
DA0434 - of cetuximab treatment for IBC ordered on referral to UCSF.
DA0435 - ref SDS C9 NU55
DA0437 - ..
DA0438 - There was no discussion of this issue today, so that attention could
DA0439 - focus on assessing Millie's response to treatment for IBC.
Biopsy Left Right Breasts Left Arm Erratic Changes Intensity Rash In
DF0401 - ..
DF0402 - Biopsy Erratic Changes Rash Intensity Verify IBC Left Arm
DF0404 - Follow up ref SDS B1 KT7J, ref SDS A3 KT7J.
DF0406 - Background on biopsy to diagnose erratic rash on left and right chest
DF0407 - is reported in the record on 070130. ref SDS A3 KT7J On 070202 a new
DF0408 - rash was observed on the upper left arm, ref SDS A6 JP6F, which has
DF0409 - since been considered expanding IBC, reported on 070222. ref SDS A9
DF0410 - B643 This new rash on the left arm has not been verified by biopsy,
DF0411 - as reported on 070202. ref SDS A6 JP6L More recently consideration of
DF0412 - possible rash on right arm is reported on 070301. ref SDS B1 KT7J
DF0414 - ..
DF0415 - There was no discussion today of taking biopsies to verify diagnosis
DF0416 - of rash on the left arm. ref SDS B1 527G The rash on the right arm
DF0417 - was also not biopsied. ref SDS B1 H15M
CT Test Distant Metastasis No Findings Lymphadenopathy Cancer CT Sca
DK0401 - ..
DK0402 - CT Test 070326 No Findings Metastatic Disease
DK0404 - Follow up ref SDS B1 EY5O, ref SDS A3 EY5O.
DK0406 - Report on results for the CT test on 070326, ref SDS C3 VP5N, was
DK0407 - received today after the meeting. Findings of no metastatic disease,
DK0408 - ref SDS 0 LV57, aligns with patient history showing no evidence of
DK0409 - regional nor distant metastasis, reported previously on 070202.
DK0410 - ref SDS A6 GB8J
DK0412 - ..
DK0413 - Test History No Evidence Distant Metastasis
DK0414 - Distant Metastasis No Evidence 5 Years Imaging Tests
DK0416 - Follow up ref SDS A6 GB8J, ref SDS 97 1Y8G.
DK0418 - Type Date Received Source
DK0419 - CT 070326 reported on 070329........... ref SDS 0 DA6Q
DK0420 - CT 070131 reported on 070202........... ref SDS A6 1Y8G
DK0421 - PET/CT 061227 reported on 070102........... ref SDS 97 1Y8G
DK0422 - CT 060930 reported on 061012........... ref SDS 86 284J
DK0423 - MRI 060708 reported on 060711........... ref SDS 77 PT4K
DK0424 - Xray 060623 reported on 060711........... ref SDS 77 WJ6G
DK0425 - CT 060505 reported on 060523........... ref SDS 74 E355
DK0426 - PET 060414 reported on 060428........... ref SDS 72 WJ6G
DK0427 - PET 060120 reported on 060126........... ref SDS 70 WJ6G
DK0428 - PET/CT 051005 reported on 051007........... ref SDS 66 WJ6G
DK0429 - CT 050530 reported on 050610........... ref SDS 60 G75L
DK0430 - CT 050325 reported on 050422........... ref SDS 57 G75L
DK0431 - CT 041217 reported on 041230........... ref SDS 47 G75L
DK0432 - CT 041103 reported on 041104........... ref SDS 45 WV7H
DK0433 - CT 040921 reported on 041005........... ref SDS 43 NL4N
DK0434 - CT 040710 reported on 040811........... ref SDS 40 H85S
DK0435 - CT 040410 reported on 040416........... ref SDS 29 HX4K
DK0436 - CT 040307 reported on 040318........... ref SDS 29 LK5L
DK0437 - CT 031031 reported on 031205........... ref SDS 25 IG9K
DK0438 - CT 030626 reported on 030710........... ref SDS 23 AL6N
DK0439 - CT 030428 reported on 030508........... ref SDS 21 LK5L
DK0440 - PET 021218 reported on 030109........... ref SDS 19 LK5L
DK0441 - PET 020529 reported on 020603........... ref SDS 9 0001
DK0444 - ..
DK0445 - Patient Personal Physician 71/F Radiology Report
DK0449 - ..
DK0450 - CT Scan Chest, Abdomen and Pelvis with Contrast (Digital)
DK0453 - ..
DK0454 - Ordered on 03/26/2007 17:09 at WCR OUTPATIENT
CT Test 070326 History Identifies Breast Cancer Mistakes Testing Fai
DY0401 - ..
DY0402 - History Missing Context Pulmonary Embolism Enlarged Right Ventricle
DY0404 - Follow up ref SDS A6 0Z6O.
DY0406 - ..
DY0407 - HISTORY
DY0409 - Recurrent metastatic breast cancer. On clinical trial at
DY0410 - UCSF.
DY0412 - ..
DY0413 - This report repeats past practice on 070131 omitting context of
DY0414 - patient history on pulmonary embolism and Cor Pulmonale heart disorder
DY0415 - enlarged right ventricle, reported on 070202. ref SDS A6 0Z6O
DY0417 - ..
DY0418 - Background on the importance of context is also presented on 070202.
DY0419 - ref SDS A6 4I3N
DY0421 - ..
DY0422 - CT test report continues...
DY0424 - Methods
DY0426 - Scans were done through the chest, abdomen and pelvis in
DY0427 - the axial projection.
DY0429 - ..
DY0430 - IV contrast: Yes
DY0431 - Oral contrast: Yes
DY0432 - Reformations: No
CT Test 070326 Comparison Failed Perform Context Management Missing
EF0401 - ..
EF0402 - Comparison: 070131 061230 060930 Prior Related Tests Omitted
EF0404 - Follow up ref SDS A6 0136, ref SDS 97 AK9H.
EF0406 - ..
EF0407 - Comparison [omitted]
EF0409 - ..
EF0410 - On 070202 the doctor planned to order comparison with the CT test on
EF0411 - 060930 that diagnosed pulmonary embolism by performing another spiral
EF0412 - CT test for pulmonary embolism and enlarged left ventricle (Cor
EF0413 - Pulmonale) with the test for measurable disease required to assess
EF0414 - progression of disease on the clinical study at UCSF. At that time,
EF0415 - the doctor requested a one month reminder to order the test and
EF0416 - comparison for pulmonary embolism. ref SDS A6 P45O Millie notified
EF0417 - Kaiser on 070302 to order the thin slice spiral CT test along with
EF0418 - testing for the clinical trial at the end of the month. ref SDS B3
EF0419 - EZ6T On 070306 Millie asked Kaiser about progress ordering the CT
EF0420 - test. ref SDS B6 HS3X This was followed up the next day on 070307.
EF0421 - ref SDS B7 044V Kaiser submitted feedback later on 070307 affirming
EF0422 - the doctor was reminded to order the CT test, ref SDS B7 9Z9N, which
EF0423 - was subsequently scheduled for 070326, as planned on 070202.
EF0425 - ..
EF0426 - On 070326 Millie went to Kaiser for the test, and was advised by CT
EF0427 - technician that the Imaging Department at Kaiser failed to specify the
EF0428 - thin slice spiral CT scan ordered by the doctor to test for pulmonary
EF0429 - embolism and enlarged right ventricle (Cor Pulmonale). ref SDS C3 SK8L
EF0431 - ..
EF0432 - Kaiser's report received today for the CT test on 070326 does not have
EF0433 - a section for Comparison, unlike all the other CT test reports over
EF0434 - the past 6 years, shown above. ref SDS 0 DA8O This compounds mistakes
EF0435 - in the CT test on 070131, which made "comparison" with only a single
EF0436 - test on 060505, and even that incomplete comparison was incorrectly
EF0437 - presented, reported on 070202. ref SDS A6 1J41
EF0439 - ..
EF0440 - [On 070330 primary care physician at Kaiser seemed to
EF0441 - advise that reference to "interstitial disease" in
EF0442 - Kaiser's report on the CT test does not relate to
EF0443 - pulmonary embolism, and that there is no indication in
EF0444 - the report that Kaiser performed the test ordered by the
EF0445 - doctor for pulmonary embolism. ref SDS C9 B74K
EF0447 - ..
EF0448 - Failure to perform the doctor's order for evaluation to diagnose,
EF0449 - plan, and prescribe treatment in the context of patient history
EF0450 - continues prior problems reported in a study on 061012. ref SDS 86
EF0451 - A55J
EF0453 - ..
EF0454 - Numerous references to "stable" suggest the reader, ref SDS 0 1I69,
EF0455 - made comparisons with something, otherwise there is no basis for
EF0456 - findings of "stable."
EF0458 - ..
EF0459 - Comparisons Kaiser made are needed in order to assess and implement
EF0460 - findings of the CT test report.
EF0462 - ..
EF0463 - In particular, on 070307 the doctor ordered comparison with the CT
EF0464 - test on 060930 that found recurrence of pulmonary embolism,
EF0465 - ref SDS 86 294Q, and also found a new problem described as "enlarged
EF0466 - right ventricle". ref SDS 86 7E5L Research indicates this new problem
EF0467 - presents a heart disorder of Cor Pulmonale. ref SDS 86 IM5J The
EF0468 - purpose of comparison between the recent CT test on 070326, and the
EF0469 - test on 060930 is illustrated by comparison Kaiser made between tests
EF0470 - on 041217 and 041103, reported on 041230. ref SDS 47 WZ6H, and which
EF0471 - yielded findings that pulmonary embolism in a CT test on 041103 was no
EF0472 - longer visualized. ref SDS 47 PW3K
EF0474 - ..
EF0475 - Additionally, the doctor and patient need current findings on severity
EF0476 - of enlarged right ventricle, reported on 061012, ref SDS 86 7E6G, and
EF0477 - discussed with the doctor on 070105, ref SDS 98 VJ4J, and again on
EF0478 - 070202, ref SDS A6 P45O, leading to the current CT test on 070326,
EF0479 - which, as shown today, failed again to implement the doctor's order.
EF0480 - ref SDS 0 0136
CT Test 070326 Findings No Cancer Lymphadenopathy No Evidence Metast
EM0401 - ..
EM0402 - CT Scan Failed Ignored Doctor's Order Test for Pulmonary Embolism
EM0403 - Cancer No Findings Lymphadenopathy No Evidence Metastatic Disease
EM0405 - Follow up ref SDS A6 013T, ref SDS 97 RG4J.
EM0407 - ..
EM0408 - FINDINGS
EM0410 - ..
EM0411 - Chest CT:
EM0413 - Mediastinum: No abnormally enlarged lymph nodes.
EM0415 - Great Vessels stable.
EM0417 - ..
EM0418 - Heart: Normal
EM0420 - ..
EM0421 - Hila: No abnormally enlarged lymph nodes
EM0423 - ..
EM0424 - Lungs:
EM0426 - The previously described 4 very small 2-3mm nodules are
EM0427 - all stable. No new lung nodules identified. no
EM0428 - interstitial disease. Scarring in the left apex is
EM0429 - stable.
EM0431 - ..
EM0432 - Stable 4 2-3 mm nodules in the lungs, have been stable for 4 years,
EM0433 - reported in case study on 070117, ref SDS A1 RY6K, and so does not
EM0434 - seem to support diagnosis of lung cancer, also, reviewed on 070117,
EM0435 - ref SDS A1 NM6G, and citing original entry in the Medical Chart
EM0436 - reported on 061208. ref SDS 92 G25K
EM0438 - ..
EM0439 - "Interstitial disease" is listed as a side effect of cetuximab in the
EM0440 - clinical study constent documents received from UCSF on 070116.
EM0441 - Shortness of breath is the main symptom, ref SDS A0 0256
EM0443 - ..
EM0444 - Research on the Internet seems to associate pulmonary embolism and
EM0445 - "interstitial disease" which may indicate this test resolves prior
EM0446 - findings in the test on 060930, as reported on 061012. ref SDS 86 294Q
EM0447 - Lack of detail in this test, and failure to present comparison data
EM0448 - makes findings indeterminate on this issue. Failure to state
EM0449 - expressly that previous pulmonary embolism is no longer visualized as
EM0450 - reported on 041230, ref SDS 47 PW3K, adds to confusion interpreting
EM0451 - the test on 070326.
EM0453 - ..
EM0454 - On 070326 Millie was advised by CT technician that Imaging Department
EM0455 - failed to follow the doctor's order to test for pulmonary embolism
EM0456 - with spiral CT technology. ref SDS C3 SK8L
EM0458 - ..
EM0459 - The CT scan test report makes no findings on continuing, increased,
EM0460 - decreased, or resolved lung disorders of pulmonary embolism blood
EM0461 - clots, and hear disorders enlarged right ventricle Cor Pulmonale,
EM0462 - which aligns with the History section that fails to recognize these
EM0463 - disorders, ref SDS 0 GH5L; as well, there is no comparison with the
EM0464 - test on 060930 to show enable trend analysis, per above. ref SDS 0
EM0465 - 0136
EM0467 - ..
EM0468 - [On 070330 primary care physician at Kaiser seemed to
EM0469 - advised that reference to "interstitial disease" in
EM0470 - Kaiser's report on the CT test does not relate to
EM0471 - pulmonary embolism, and that there is no indication in
EM0472 - the report that Kaiser performed the test ordered by the
EM0473 - doctor for pulmonary embolism.
EM0475 - ..
EM0476 - CT Test Findings continue...
EM0478 - Pleura: Normal
EM0480 - ..
EM0481 - Effusions: None
EM0483 - ..
EM0484 - Bony thorax and soft tissues:
EM0486 - S/P left mastectomy. Portacath remains in right
EM0487 - anterior chest wall entering rt subclavian vein.
EM0489 - ..
EM0490 - ABDOMEN CT:
EM0492 - Liver: Normal size. Cyst in the dome unchanged.
EM0493 - Gallbladder and bile ducts: Normal
EM0495 - ..
EM0496 - Spleen:
EM0498 - Stable. Calcified granuloma and calcified splenic
EM0499 - artery aneurysm are stable.
EM0501 - ..
EM0502 - Pancreas: Normal
EM0503 - Right Kidney: Normal
EM0504 - Left Kidney: Normal
EM0505 - Adrenal glands: Normal
EM0506 - Aorta: Normal
EM0507 - Adenopathy: No abnormally enlarged lymph nodes.
EM0508 - Ascites: None
EM0510 - ..
EM0511 - Bowel and Mesentery:
EM0513 - Normal. Diverticuli in the sigmoid colon.
EM0515 - ..
EM0516 - Pelvis CT: Stable.
EM0519 - ..
EM0520 - IMPRESSION **:
EM0522 - Stable chest, abdomen and pelvis CT. No evidence of
EM0523 - metastatic disease.
EM0525 - ..
EM0528 - ..
EM0529 - DD: 03/27/2007 DT: 03/27/2007 CDS
Emotional Trauma Stress Moderate Pulse Normal Cancer Subsides Confid
EY0401 - ..
EY0402 - Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
EY0403 - Exercise Vigor Strength Engagement Ease Distress Living with Cancer
EY0404 - Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
EY0406 - Follow up ref SDS B1 Y642, ref SDS A3 Y642.
EY0408 - Medical issues create an emotional roller coaster explained on 070105,
EY0409 - ref SDS 98 Y642, and reviewed on 070301. ref SDS B1 Y642 Stress and
EY0410 - trauma are compounded with rising complexity of case history, listed
EY0411 - above. ref SDS 0 LU3J
EY0413 - ..
EY0414 - Millie's vitals are calmer today, e.g., pulse below 60, reported in
EY0415 - patient history for treatment today after examination by Brigid and
EY0416 - Jackie. ref SDS C7 AW4L
EY0418 - ..
EY0419 - Increased energy and fitness from reduced side effects, discussed
EY0420 - below, ref SDS 0 TQ6L, enables vigorous exercise that moderates
EY0421 - emotional swings and worry, reviewed previously on 070315. ref SDS C0
EY0422 - 6A7J
EY0424 - ..
EY0425 - Additionally....
EY0427 - 1. IBC stable and subsiding...... 070329, ref SDS 0 M68J
EY0429 - ..
EY0430 - 2. CA 15-3 33 continuing decline
EY0431 - to lowest level in over a
EY0432 - year.......................... 070329, ref SDS 0 087J
EY0434 - ..
EY0435 - 3. ANC 1810 (neuts 1.81) rising
EY0436 - to level for safe chemotherapy
EY0437 - treatment and reversing long
EY0438 - decline....................... 070329, ref SDS 0 VF5M
EY0440 - ..
EY0441 - 4. CT test showing no evidence
EY0442 - of distant metastasis.......... 070329, ref SDS 0 LV57
EY0444 - ...all significantly relieve stress and worry reported previously on
EY0445 - 070301, ref SDS B1 XU6M, and discussed with Brigid during the meeting
EY0446 - on 070315. ref SDS C0 6A7J
EY0448 - ..
EY0449 - Millie explained this morning that living with cancer brings continual
EY0450 - worry about progression of disease, and effectiveness of treatment,
EY0451 - including how life will change with decline from disease. As noted,
EY0452 - this moderates with good medical news the past month, ref SDS 0 XU6M,
EY0453 - but is always present since chronic metastatic disease has a natural
EY0454 - inevitability.
EY0456 - ..
EY0457 - Stress increases from communication difficulties described generally
EY0458 - on 070301, ref SDS B1 O24J, and reviewed again with the UCSF medical
EY0459 - team on 070315, ref SDS C0 OR5K, citing stress coordinating schedule
EY0460 - for the CT test on 070326, and shown by case study on 070307.
EY0461 - ref SDS B7 G56L Continuing communication issues compound emotional
EY0462 - stress, reviewed with coordination, above. ref SDS 0 S63K
EY0464 - [...below difficulty sleeping may reflect emotional
EY0465 - stress, and side effects of cetuximab treatment for IBC.
EY0466 - ref SDS 0 MR99
Sleeping Difficulty Worry Emotional Trauma Stress Prognosis Cetuxima
FA0401 - ..
FA0402 - Sleeping Difficulty Worry Cancer Health Issues Medical Management
FA0404 - Follow up ref SDS C1 NG3I.
FA0406 - Millie has not been sleeping well the past few weeks, and has trouble
FA0407 - falling asleep after going to the bathroom, a possible side effect of
FA0408 - cetuximab, along with worry about cancer, per above, ref SDS 0 IS8G,
FA0409 - and emotional stress coordinating complex communications. ref SDS 0
FA0410 - II7H Difficulty sleeping was previously reviewed last week on 070322.
FA0411 - ref SDS C1 NG3I
FA0413 - ..
FA0414 - Brigid indicated this morning that difficulty sleeping can be a side
FA0415 - effect of cetuximab, discussed further below. ref SDS 0 TQ6L Getting
FA0416 - 4.5 hours of continuous sleep is a target for good health.
FA0418 - ..
FA0419 - Millie feels she generally gets at least 4 5 hours of continuous
FA0420 - sleep. She has Atavin previously prescribed at Kaiser, which aids
FA0421 - getting to sleep when problems seem overwhelming, also, reported on
FA0422 - 070322, ref SDS C1 NG4N, citing work at Kaiser to cope with anxiety
FA0423 - from 3rd relapse of IBC, beginning on 060721. ref SDS 78 FZ5N
Strategy 3 Issues Resolved Sucessfully Work Plan Continue Weekly Tre
FM0401 - ..
FM0402 - Planning Case Management from Patient Profile Work Up
FM0403 - Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
FM0404 - Strategy Cetuximab Continued with Low ANC Expanding IBC Disease
FM0406 - Follow up ref SDS B1 K36G, ref SDS A3 K36G.
FM0408 - Background is reported on 070301. ref SDS B1 K36G Coordination issues
FM0409 - are presented above. ref SDS 0 RM4G
FM0411 - ..
FM0412 - Doctor Rugo's strategy was effective resolving issues on 070301,
FM0413 - ref SDS B1 1T4O, noted by examination today, per above. ref SDS 0 M68J
FM0415 - ..
FM0416 - Evident success of current treatment, including declining CA 15-3 33
FM0417 - to lowest level in over a year, and IBC rash subsiding significantly,
FM0418 - with no new sites, indicates successful strategy continuing weekly
FM0419 - treatments with cetuximab alone, and preserving additional treatment
FM0420 - by adding carboplatin when disease progresses, planned on 070130,
FM0421 - ref SDS A3 N13L, and discussed with the primary care physician at
FM0422 - Kaiser on 070202. ref SDS A6 QO6O
FM0424 - ..
FM0425 - Consideration of pulmonary embolism and Cor Pulmonale heart disorder
FM0426 - of enlarged right ventricle seem to require no change in treatment
FM0427 - strategy, since Millie has gained energy with reduction of former
FM0428 - shortness of breath, after ending treatment with Taxotere and
FM0429 - capecitabine on 061201.
Treatment IBC 10th Cycle 3rd Relapse 3rd Cycle 1st Treatment Chemoth
FT0401 - ..
FT0402 - Treatment 3rd Cycle Cetuximab Carboplatin 070329 10th Cycle 3rd Relapse
FT0403 - 10th Cycle Treatment IBC 3rd Relapse 3rd Cycle Cetuximab Clinical Study
FT0404 - Cetuximab 3rd Cycle 1st Treatment IBC 3rd Relapse Clinical Study Drug Trial
FT0406 - Follow up ref SDS B1 PF3O, ref SDS A3 PF3O.
FT0408 - Patient history of cetuximab treatments is listed in the record today
FT0409 - for working with the Infusion Clinic. ref SDS C7 7T3H
FT0411 - ..
FT0412 - Examination today supported approval for Millie to start cycle #3
FT0413 - treatment with cetuximab alone, in accordance with strategy, discussed
FT0414 - above. ref SDS 0 1R9H
FT0416 - ..
FT0417 - Brigid reviewed the UCSF Chemotherapy Order on 070201 that guides
FT0418 - Millie's treatment in the Infusion Clinic, ref SDS A5 IJ41, and which
FT0419 - was considered in the record for treatment last week on 070322.
FT0420 - ref SDS C1 WR4H
FT0422 - ..
FT0423 - Brigid reduced the prescription for pre-treatment Benadryl from 50 mg
FT0424 - to 25 mg in order to reduce side effects of "restless legs," discussed
FT0425 - below. ref SDS 0 MF6N There was no change to the prescription that
FT0426 - pre-treatment with Benadryl and Decadron should be given 30 - 60
FT0427 - minutes before treatment with cetuximab. ref SDS C1 IJ41
FT0429 - [On 070329 "restless legs" problem with Benadryl resolved with
FT0430 - Brigid's change in treatment dose. ref SDS C7 F77K
FT0432 - ..
FT0433 - Following the meeting with the doctor, treatment was given today at
FT0434 - 0900 in the Infusion Clinic, reported in another record, ref SDS C7
FT0435 - 1M6H Blood vials were drawn for drug trial research required for the
FT0436 - cetuximab clinical study, ref SDS C7 O56V, ordered by Jackie, reported
FT0437 - on 070328. ref SDS C4 5V6J
Side Effects Cetuximab Acne-like Rash Face Dry Skin Face Chest Arms
G70401 - ..
G70402 - Side Effects Cetuximab Similar Symptoms Pulmonary Embolism
G70403 - Energy Strength Rising Minimal Side Effects Cetuximab Treatment
G70404 - Facial Skin Dryness New Side Effect Cetuximab Curel Lotion Prescribed
G70405 - Curel Lotion Prescribed Facial Skin Dryness New Side Effect Cetuximab
G70407 - Follow up ref SDS B1 TQ6L.
G70409 - On 070326 Millie submitted a list of side effects for discussion
G70410 - today, ref SDS C2 627X, citing recent review on 070322, ref SDS C1
G70411 - QU8K, and prepared under the doctor/patient partnership model, set out
G70412 - in Kaiser's Healthwise Handbook, shown on 990625. ref SDS 3 4185
G70414 - ..
G70415 - Jackie disclosed this morning there was no coordination to prepare for
G70416 - discussing side effects today. ref SDS 0 945F Brigid did not get the
G70417 - list, also, above. ref SDS 0 W25L She asked Millie if she remembers
G70418 - any side effects?
G70420 - ..
G70421 - Millie advised that her energy seems restored, continuing favorable
G70422 - report on 070315, ref SDS C0 J18M, and presented in the list of side
G70423 - effects on 070322. ref SDS C1 CA4K
G70425 - ..
G70426 - Millie explained difficulty sleeping, which can be aided by Atavin,
G70427 - discussed above. ref SDS 0 MR99 This may be a side effect of
G70428 - cetuximab, and/or an emotional response coping with cancer, discussed
G70429 - above, ref SDS 0 IS8G, and further coping with complex communications
G70430 - required to coordinate effective treatment. ref SDS 0 II7H
G70432 - ..
G70433 - Brigid commented on how well Millie looks. Her skin seems soft and
G70434 - smooth, with little evidence of acne-like rash associated with
G70435 - cetuximab. Millie feels fortunate to have genetically avoided severe
G70436 - side effects of facial rash, and that treatment Brigid prescribed on
G70437 - 070222 has been effective. ref SDS A9 FO66
G70439 - [On 070330 primary care physician at Kaiser comments on how
G70440 - well Millie looks. ref SDS C9 N49K
G70442 - ..
G70443 - [On 070418 Millie writes to UCSF with copy to Kaiser advising
G70444 - she cannot remember feeling better. ref SDS D1 PY6W
G70446 - ..
G70447 - Millie reported having further followed Brigid's guidance on 070301 to
G70448 - use Curel lotion for reducing dry skin. ref SDS B1 5V73 Brigid
G70449 - recalled there was initial improvement reported during examination on
G70450 - 070315. ref SDS C0 6B8H Last week on 070322 treatment was
G70451 - supplemented with Aquaphor, recommended by the UCSF pharmacy.
G70452 - ref SDS C1 JS6M Skin dryness, including flaking and peeling on the
G70453 - chest and arms continue, but the combination of Curel and Aquaphor
G70454 - seem to help, as noted by Brigid this morning.
G70456 - ..
G70457 - That was all anyone could remember.
G70459 - ..
G70460 - Experience preparing the list of side effects yielded comments by the
G70461 - nurse in the Infusion Clinic on 070315 reporting a new rash on the
G70462 - right chest, and cited in the list on 070322. ref SDS C1 KU3L Whether
G70463 - this is a side effect of cetuximab, IBC, or something else is not
G70464 - known, per above. ref SDS 0 583G Brigid examined this area and noted
G70465 - no evidence of rash today, per above. ref SDS 0 BI5K
G70467 - ..
G70468 - Brigid examined Millie's right arm. She commented that various minor
G70469 - blemishes fit the model of normal skin, and show no evidence of rash,
G70470 - including IBC rash, as reported on 070322, ref SDS C1 LI4M, and
G70471 - discussed above. ref SDS 0 H15M
G70473 - ..
G70474 - The list on 070322 presents "restless legs." ref SDS C1 F77K Brigid
G70475 - seemed to comment that increasing the time from 10 to 20 minutes would
G70476 - not relieve "restless legs" problems. She changed the prescription in
G70477 - the Chemotherapy Order for pre-treatment with Benadryl from 50 mg to
G70478 - 25 mg, per above. ref SDS 0 WS3F
G70480 - ..
G70481 - There was no discussion of lymphedema and complications of Cellulitis
G70482 - which present problems that limit exercise to strengthen the immune
G70483 - system for resisting cancer, listed on 070322, ref SDS C1 SU6L, and
G70484 - shown above in connection with monitoring the left arm. ref SDS 0 4Y93
G70485 - Possible correlations and solutions with respect to side effects of
G70486 - treatment with cetuximab for IBC, were not considered because
G70487 - coordination was not supported to prepare for the meeting today, per
G70488 - above. ref SDS 0 945F
G70490 - [On 070330 examination at Kaiser by primary care physician finds
G70491 - significantly increased intensity of rash on upper left arm,
G70492 - ref SDS C9 N19J, and a similar new rash above the right breast and
G70493 - below the colar bone; these dramatic changes in condition were
G70494 - diagnosed without biopsy as complications of lymphedema causing
G70495 - Cellulitis with elevated temperature, and possibly triggered by
G70496 - patient's increased exercise that overtaxed the system.
G70497 - ref SDS C9 583G Keflex antibiotic was prescribed, ref SDS C9
G70498 - 474O; about 3 hours later self-examination showed these erruptive
G70499 - rash conditions had subsided, and so Keflex treatment was not
G70500 - performed. ref SDS C9 KZ6L
G70502 - [On 070607 recurrent cellulitis diagnosed during examination at
G70503 - UCSF for treatment of IBC with cetuximab, ref SDS D7 8H3I;
G70504 - condition worsened during treatment in the Infusion Clinic,
G70505 - temperature over 102, ref SDS D7 8J37; UCSF treated Millie with
G70506 - ceftriaxone antibiotics, ref SDS D7 8J9R, cellulitis seemed to
G70507 - subside, and temperature dropped to 101.4, UCSF released Millie
G70508 - to go home, ref SDS D7 8J5C; Kaiser prescribed outpatient
G70509 - ceftriaxone antibiotics for 5 days. ref SDS D7 8L46
Cetuximab Clinical Study UCSF Drug Trial Subsiding Stable IBC Metast
GF0401 - ..
GF0402 - Clinical Study Cetuximab Treatment UCSF Begins 070201
GF0403 - UCSF Clinical Study Treatment Cetuximab Drug Trial Begins 070201
GF0404 - Drug Trials UCSF Has Other Clinical Study Treatments May Help Millie
GF0406 - Follow up ref SDS B1 ZJ9N, ref SDS A3 ZJ9N.
GF0408 - Background on Kaiser referral to UCSF for treatment on clinical study
GF0409 - is reported on 070105. ref SDS 98 P256 Purpose of referral is to
GF0410 - improve patient care with new treatment. ref SDS 98 PK7L Case study
GF0411 - on Kaiser and UCSF collaborating to expedite treatment is listed on
GF0412 - 070130, ref SDS A3 4T5N, and reviewed again today, per above.
GF0413 - ref SDS 0 RM4G
GF0415 - ..
GF0416 - Consideration on 070301 to upgrade treatment by adding carboplatin for
GF0417 - better effectiveness than cetuximab alone, ref SDS B1 NY7N was
GF0418 - unnecessary, because Doctor Rugo's strategy was effective on 070308,
GF0419 - discussed further above. ref SDS 0 X68N
GF0421 - ..
GF0422 - Millie recovering with cetuximab treatment alone, and no
GF0423 - carboplatin...
GF0425 - 1. Clinical examination shows IBC inflammation subsiding.
GF0426 - ref SDS 0 M68J,
GF0428 - 2. CA 15-3 testing shows evidence of cancer falling.
GF0429 - ref SDS 0 087J
GF0431 - ..
GF0432 - 3. CT testing finds no evidence of metastatic disease.
GF0433 - ref SDS 0 LV57
GF0435 - ..
GF0436 - Jackie coordinated on 070327 to schedule blood draw for seven (7)
GF0437 - vials today, required to start the next cycle on the cetuximab study.
GF0438 - ref SDS C4 407N This was successful this morning with blood drawn in
GF0439 - the Infusion Clinic. ref SDS C7 Q659
Schedule Treatment Cetuximab 070329 Weekly Through 070524 Clinical S
GN0401 - ..
GN0402 - Schedule Treatment Start Cetuximab Carboplatin 070201
GN0404 - Follow up ref SDS B1 N96O, ref SDS A3 N96O.
GN0406 - Scheduling has proven a continuing challenge, listed above.
GN0407 - ref SDS 0 S63K
GN0409 - ..
GN0410 - On 070315 Nola in the Infusion Clinic scheduled Millie for weekly
GN0411 - treatments through May 24th. ref SDS C0 159O This aligns with
GN0412 - examination today showing current protocol has been effective, per
GN0413 - above. ref SDS 0 M68J and further fits the strategy. ref SDS 0 K36G
GN0415 - ..
GN0416 - Meetings and treatments continue on Thursdays, so the next treatment
GN0417 - at UCSF will be on 070405.
Pulmonary Embolism Blood Clots Lungs Enlarged Right Ventricle Heart
H00401 - ..
H00402 - Tired Breathing Difficulty Routine Activity Signals Pulmonary Emboli
H00403 - Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
H00404 - Pulmonary Emboli Hypercoagulable Work Up PET Scan Test Compare History
H00406 - Follow up ref SDS B1 CV5L, ref SDS A3 CV5L.
H00408 - Background on pulmonary embolism and correlation with IBC treatment at
H00409 - UCSF is reported in the record meeting at UCSF on 070130. ref SDS A3
H00410 - CV5L Doctor Rugo planned to avoid overlooking symptoms of pulmonary
H00411 - embolism that appear similar to side effects of chemotherapy
H00412 - treatment. ref SDS A3 MO7K The plan called for a CT test to evaluate
H00413 - cancer and to also check for pulmonary embolism. ref SDS A3 915J The
H00414 - CT test the next day on 070131, however, failed to do this, reported
H00415 - on 070202. ref SDS A6 TN6N At that time, on 070202 the primary care
H00416 - physician at Kaiser planned to correct the problem by ordering a
H00417 - spiral CT test for pulmonary embolism with Millie's next test for the
H00418 - clinical study at UCSF. ref SDS A6 T85K The doctor was reminded on
H00419 - 070307 to order a spiral CT test. ref SDS B7 9Z9N
H00421 - ..
H00422 - Kaiser performed a CT test on 070326, but failed to perform the thin
H00423 - slice spiral CT test ordered by the doctor to evaluate pulmonary
H00424 - embolism and enlarged right ventricle, reported above, ref SDS 0 0136,
H00425 - repeating past mistakes.
H00427 - ..
H00428 - At this time, status of pulmonary embolism remains unknown, which
H00429 - presents a risk to the patient getting treatment with cetuximab,
H00430 - since side effects can compound existing heart and lung problems,
H00431 - reported in research at....
H00433 - About Drug Finder
H00434 - Cetuximab
H00435 - Patient Education
H00437 - http://gsm.about.com/compact/showtext.asp?cpnum=2710&monotype=full&gname=Cetuximab&r=6078
H00439 - ..
H00440 - In a small number of patients, cetuximab has caused or
H00441 - worsened lung disease. If you notice difficulty breathing,
H00442 - increased shortness of breath, or other changes in your
H00443 - breathing, notify your health care provider.
H00445 - ..
H00446 - Millie's energy has improved, indicating reduced risk. She continues
H00447 - increased exercise at the gym. Recently Millie hiked the trail at
H00448 - Lafayette reservoir for the first time in about a year.
H00450 - ..
H00451 - Affirmative test evidence with a this slice spiral CT scan supports
H00452 - assumptions from absence of clinical symptoms, e.g., hear attack
H00453 - caused by highly lethal conditions like pulmonary embolism, reported
H00454 - on 060722. ref SDS 79 BI5J Activities like tennis that spikes the
H00455 - heart rate reported on 070218, ref SDS A8 N06R, must performed with a
H00456 - level of care that reduces benefits.
H00460 - ..
H00461 - INR 2.4 Blood Test Patient Stable for Coumadin Treatments Pulmonary Emboli
H00463 - Follow up ref SDS B1 FE9I.
H00465 - Brigid advised that the blood test this morning shows INR 2.4. This
H00466 - was confirmed an hour or so later, ref SDS C7 SE6N, when Diane
H00467 - submitted the blood test report, while Millie was getting treatment in
H00468 - the Infusion Clinic. ref SDS C7 A64L
H00470 - ..
H00471 - INR 2.4 today indicates Millie has stabilized conditions that reduce
H00472 - risks of pulmonary embolism with the current Coumadin treatment
H00473 - regimen. Favorable status supports relying on monthly blood tests
H00474 - currently scheduled at UCSF, reported on 070315, ref SDS C0 159O, and
H00475 - planned in the letter to Kaiser on 070302. ref SDS B3 X84G This
H00476 - schedule was discussed with Gloria a week later on 070307. ref SDS B7
H00477 - 723G
H00479 - ..
H00480 - These results need to be submitted to Gloria at Kaiser's Coagulation
H00481 - Control Clinic in Martinez, CA to prescribe Coumadin treatments for
H00482 - pulmonary embolism, as set out Millie's letter to UCSF on 070326,
H00483 - ref SDS C2 627T, and discussed with Jackie the next day on 070327.
H00484 - ref SDS C4 MT6Y
H00486 - [On 070330 letter to Kaiser notified Gloria of INR stable blood
H00487 - tests for past 2 months; continuing current Coumadin regimen.
H00488 - ref SDS C8 ZH4H
Examination Stethoscope No Findings Enlarged Right Ventricle Heart S
H80401 - ..
H80402 - Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
H80404 - Follow up ref SDS B1 Q35O, ref SDS A3 Q35O.
H80406 - Examination with a stethoscope today included multiple locations on
H80407 - Millie's back and chest. Brigid reported no findings of cardio
H80408 - pulmonary issues from the clinical examination. This method aligns
H80409 - with the practice at Kaiser, reported on 061020, ref SDS 88 PC6H,
H80410 - citing research on 061012 on monitoring heart disorder of enlarged
H80411 - right ventricle, Cor Pulmonale. ref SDS 86 IR5T
H80413 - ..
H80414 - SaO2 diagnostic for oxygenated blood cited at Kaiser, on 061208,
H80415 - ref SDS 92 1E5G, to indicate cardio-pulmonary functioning due to
H80416 - pulmonary embolism, including enlarged right ventricle, was tested
H80417 - three (3) times today during treatment after the examination, and was
H80418 - consistently above 98%, demonstrating no immediate danger. ref SDS C7
H80419 - AW4L
Enlarged Right Ventricle Heart Disorder Cor Pulmonale Related Pulmon
HI0401 - ..
HI0402 - Cor Pulmonale Heart Disorder Enlarged Right Ventricle
HI0403 - Heart Examination Not Ordered Investigate Enlarged Right Ventricle
HI0404 - Enlarged Right Ventricle CT Test Aligns Patient Symptoms How Serious
HI0406 - Follow up ref SDS B1 VJ4J, ref SDS A3 VJ4J.
HI0408 - Background on heart disorder Cor Pulmonale from enlarged right
HI0409 - ventricle, and plans for CT testing is reported on 070130. ref SDS A3
HI0410 - VJ4J Kaiser failed to perform the spiral CT test ordered by the
HI0411 - primary care physician to evaluate enlarged right ventricle, reported
HI0412 - above. ref SDS 0 0136
HI0414 - ..
HI0415 - This issue is closely related to pulmonary embolism, reported by the
HI0416 - primary care physician on 061228. ref SDS 94 JU7L Continued subsiding
HI0417 - of symptoms for pulmonary embolism reported on 070301, ref SDS B1
HI0418 - SX6N, and again today signal Cor Pulmonale, also, seems under control,
HI0419 - however, the actual status is unknown, per above. ref SDS 0 E44L
HI0421 - ..
HI0422 - During the meeting at Kaiser on 070202, the primary care physician did
HI0423 - not make referral for examination by a heart specialist, nor to get a
HI05 - dmill test, ref SDS A6 UN9F, discussed by Doctor Rugo during the