CONTACTS 

SUBJECTS
CA 15-3 56 Blood Tests 070511 at Kaiser  Cncer Marker Suddenly Rises

2903 -
2903 -    ..
2904 - Summary/Objective
2905 -
290501 - Follow up ref SDS 22 0000. ref SDS 21 0000.
290502 -
290503 - Kaiser reported the blood test on 070511 shows cancer marker CA 15-3
290504 - 59.  This is a big increase compared to testing at UCSF just 2 weeks
290505 - ago on 070426 that found CA 15-3 29. ref SDS 0 RH9H  Kaiser describing
290506 - a big increase as "stable," indicates gaps in coordination between
290507 - Kaiser and UCSF on referral work. ref SDS 0 WV6L  Millie asked Kaiser
290508 - to verify accuracy of the test report, ref SDS 0 ZJ9N, and to notify
290509 - UCSF so that their medical team can prepare for meeting with Millie on
290510 - 070517, and consider changing treatments in time to be effective.
290511 - ref SDS 0 UH3R  Millie sent a letter to UCSF on coordinating to change
290512 - the date of the next CT test to align with requirements of the clnical
290513 - study, ref SDS 0 EF9M; and, further explaining initial understandings
290514 - of major change in cancer marker, with considerations for changing
290515 - treatments. ref SDS 0 J55T  Millie notified Kaiser she feels well with
290516 - rising fitness from increased exercise, training hard in the gym.
290517 - ref SDS 0 UH4S  Kaiser disclosed that all CT scans now use thin slice
290518 - spiral technology required to test for pulmonary embolism and enlarged
290519 - right ventricle. ref SDS 0 GP3L  Millie coordinated with Kaiser to
290520 - order the CT test scheduled for 070520 to evaluate pulmonary embolism
290521 - and enlarged right ventricle by comparing with prior tests on 060930
290522 - and on 041103, and which diangosed pulmonary embolism and enlarged
290523 - right ventricle. ref SDS 0 Y76G
290524 -
290525 -
290526 -
290527 -
290528 -
290530 -  ..
2906 -
2907 -
2908 - Progress
2909 -
290901 - CA 15-3 Cancer Marker Cross-check UCSF Support Kaiser Primary Care
290902 -
290903 - Kaiser called Millie on 070511, and asked her to get another blood
290904 - test for a CT test Kaiser scheduled as part of Millie's treatment on
290905 - referral at UCSF. ref SDS 22 T76M
290907 -  ..
290908 - Millie went to Kaiser Park Shadelands in Walnut Creek for the blood
290909 - test.  AT that time, Millie ordered an additional test for CA 15-3 to
290910 - support the meeting scheduled for 070525 with the primary care
290911 - physician at Kaiser.  Testing the cancer marker, CA 15-3 at Kaiser
290912 - provides a cross-check for testing at UCSF, which has shown
290913 - substantial improvement, most recently on 070426 when CA 15-3 29
290914 - reached the lowest level in many years on systemic treatment.
290915 - ref SDS 19 2N5J
290916 -
290918 -  ..
290919 - Kaiser's Email System Doctor Cannot Find Critical Details
290920 - Medical Mistakes CA 15-3 Substantial Rise Reported Stable
290921 - CA 15-3 56 Significant Increase Kaiser Describes Stable Condition
290922 -
290923 - Follow up ref SDS 23 IN5P.
290924 -
290925 - On 070514 Millie sent a letter, ref DIP 1 MS7K, to Kaiser asking for
290926 - results of the blood test on CA 15-3 that was performed at Kaiser on
290927 - 070511. ref SDS 23 IN5P
290929 -  ..
290930 - Today, Millie received ref DRT 1 0001 from the doctor reporting
290931 - results of the blood test on 070511 shows CA 15-3 56...
290933 -         ..
290934 -        Received 070516 1534
290936 -         ..
290937 -        Seems to be remaining stable. ref DRT 1 0001
290938 -
290939 -            | CA 15-3
290940 -            DATE TIME |
290941 -            ---------------+-----------
290942 -            05/11/07 08:56 | 56 H
290943 -            02/15/07 07:06 | 52 H
290944 -            02/08/07 12:43 | 55 H
290945 -            01/31/07 16:05 | 56 H
290946 -            01/23/07 06:42 | 52 H
290947 -            01/18/07 06:42 | 68 H
290948 -            01/04/07 06:36 | 56 H
290949 -            12/18/06 06:40 | 74 H
290951 -  ..
290952 - Kaiser reporting that cancer marker CA 15-3 seems "stable" conflicts
290953 - with the record using Kaiser's patient email system notifying...
290955 -             ..
290956 -            Letter notified Kaiser cancer
290957 -            marker for test on 070301
290958 -            dropped CA 15-3 to
290959 -            36................................ 070315, ref SDS 14 HR9G
290961 -             ..
290962 -            Letter to Kaiser requests results
290963 -            of test at Kaiser on 070511, and
290964 -            reported test on 070426 at UCSF
290965 -            CA 15-3 was down to
290966 -            29................................ 070514, ref SDS 23 IN5P
290967 -
290968 -               [...below, Millie requests verification. ref SDS 0 ZJ9N
290970 -                ..
290971 -               [...below Millie asks Kaiser to notify UCSF of major
290972 -               change in CA 15-3 56 cancer biomarker. ref SDS 0 ZJ9N
290974 -                ..
290975 -               [...below Millie notifies UCSF. ref SDS 0 J55T
290977 -                ..
290978 -               [On 070517 Nurse's Notes at Kaiser report elevated CA
290979 -               15-3; nurse practitioner orders retest; but, no blood
290980 -               test was actually performed. ref SDS 24 FG5N
290982 -                ..
290983 -               [On 070524 CA 15-3 37 makes dramatic reversal and begins
290984 -               to rise in the UCSF test method, ref SDS 26 EU4I;
290985 -               examination seems to show IBC at all sites continues to
290986 -               subside. ref SDS 26 EU6O
290988 -                ..
290989 -               [On 070531 UCSF not concerned results of blood test
290990 -               today show CA 15-3 37 rising 30% from the prior report
290991 -               on 070426, because CT scans show no metastatic cancer,
290992 -               and IBC inflammation appears to be subsiding.
290993 -               ref SDS 28 NQ6K
290995 -                ..
290996 -               [On 070608 Kaiser urges patient to continue making extra
290997 -               effort sending patient history to the doctor using
290998 -               Kaiser's dedicated email system. ref SDS 30 6S3F
291000 -  ..
291001 - This record suggests Kaiser cannot manage patient history nor organize
291002 - documents for finding critical details, even when expressly provided
291003 - with Kaiser's email system.  No one is assigned to capture critical
291004 - details from correspondence in Kaiser's computer email system, and
291005 - enter data with annotatations on source, date, and time into the
291006 - appropriate section of Kaiser's electronic Medical Chart program to
291007 - the section that reports CA 15-3 test results.
291009 -  ..
291010 - In this case, it appears the doctor looked on his computer, and
291011 - because the computer did not list results from UCSF, these results
291012 - were beyond consideration, ref SDS 0 AN4O, despite having been
291013 - submitted only 2 days earlier.
291014 -
291015 -        [On 070525 Kaiser's medical chart seems misleading because test
291016 -        results from UCSF are missing. ref SDS 27 128S
291018 -         ..
291019 -        [On 070610 Kaiser reports coordination improved by opening
291020 -        right communication channels with UCSF. ref SDS 31 GV9G
291022 -         ..
291023 -        [On 080409 same problem of test data submitted to Kaiser
291024 -        missing from Kaiser's computer, so health care professional
291025 -        relied on computer which is missing 6 months of data.
291026 -        ref SDS 32 439L
291028 -  ..
291029 - The problem seems similar to INR blood test management for Coumadin
291030 - treatment of pulmonary embolims.  On 061024 Kaiser reported that
291031 - treatment with Coumadin was not adjusted when the doctor added
291032 - treatment for cancer with capecitabine, because even though this is
291033 - entered in Kaiser's computer, it is located at a different part of the
291034 - computer program from the part that is examined routinely to prescribe
291035 - Coumadin. ref SDS 7 TZ4I
291037 -  ..
291038 - Coordination of referrals appear problematic because Kaiser and UCSF
291039 - cannot transmit and enter patient history routinely.
291041 -  ..
291042 - Doctor patient partnership through communication called out in
291043 - Kaiser's Healthwise Handbook, reviewed on 990625, ref SDS 1 4185, has
291044 - not been effective in this case.
291046 -  ..
291047 - Case study on computer access failures reported on 061024. ref SDS 7
291048 - NU5O
291050 -  ..
291051 - Case study on medical mistakes reported on 040416. ref SDS 3 GN7J
291053 -  ..
291054 - This has the effect of Kaiser ignoring communications from the
291055 - patient.
291056 -
291057 -
291058 -
291059 -
2911 -

SUBJECTS
CT Tests Thin Slice Spiral All Kaiser Scans 1 MM Improved 5 MM Compa

4603 -
460401 -  ..
460402 - CT Scans Kaiser Walnut Creek All Thin Slice Spiral Technology
460403 -
460404 - Follow up ref SDS 23 405I.
460406 -  ..
460407 - Doctor's letter to Millie concludes...
460408 -
460409 -        All CT's are thin sliced now (helical) with 1 mm cuts vs the
460410 -        old 5 mm cuts.  They are just read at different intervals.
460411 -        ref DRT 1 QO7F
460413 -  ..
460414 - The doctor responds to Millie's letter on 070514 asking that the test
460415 - on 070520 use technology for evaluating pulmonary embolism and Cor
460416 - Pulmonale. ref SDS 23 IN4V
460418 -  ..
460419 - Representing that all CTs are thin sliced spiral that can evaluate
460420 - pulmonary embolism and Cor Pulmonale, noted in the doctor's letter
460421 - today, conflicts with the report on 061020, when the doctor advised
460422 - that previous CT scans did not find pulmonary embolism, because this
460423 - requires special thin slice spiral technology. ref SDS 6 S56G
460424 -
460425 -     [...below Millie coordinates with Kaiser to order next CT test to
460426 -     make comparison with prior test on 060930 that diagnosed pulmonary
460427 -     embolism and enlarged right ventricle. ref SDS 0 Y76G
460429 -  ..
460430 - Possibly, at that time on 061020 Kaiser was performing different
460431 - tests, and now all are the same.
460433 -  ..
460434 - On 061227 Millie had a follow up PET/CT test at Kaiser in Walnut
460435 - Creek; review on 070102 showed...
460436 -
460437 -            History cites only cancer, and
460438 -            nothing on pulmonary embolism
460439 -            and enlarged right
460440 -            ventricle......................... 070102, ref SDS 8 9X7X
460442 -             ..
460443 -            Comparison for trend analysis ordered
460444 -            by the doctor was not performed; only
460445 -            compared with prior test on 060414
460446 -            and not with recent test on 070929
460447 -            that found pulmonary embolism
460448 -            and enlarged right ventricle,
460449 -            indicating the test did not
460450 -            use thin slice spiral CT
460451 -            technology........................ 070102, ref SDS 8 AK9H
460453 -             ..
460454 -            Primary care physician ordered
460455 -            comparison of test on 061227 with
460456 -            prior test on 060930 that diagnosed
460457 -            pulmonary embolis and enlarged
460458 -            right ventricle; and noted test
460459 -            results do not report
460460 -            comparison for trend
460461 -            analysis.......................... 070105, ref SDS 9 HB3K
460463 -  ..
460464 - Millie had another CT test at Kaiser in Pleasenton on 070131, and was
460465 - reviewed at Kaiser on 070202 showing...
460466 -
460467 -            History cites only cancer, and
460468 -            nothing on pulmonary embolism
460469 -            and enlarged right
460470 -            ventricle......................... 070202, ref SDS 12 0Z6O
460472 -             ..
460473 -            Comparison for trend analysis on
460474 -            pulmonary embolism and enlarged
460475 -            right ventricle not performed for
460476 -            prior tests on 061227 and 060930;
460477 -            only compared with single prior
460478 -            test on 060505 which was of little
460479 -            medical value; no indication test
460480 -            used thin slice spiral CT
460481 -            technology........................ 070202, ref SDS 12 0136
460483 -  ..
460484 - CT test at Kaiser in Walnut Creek on 070326 was reviewed at UCSF on
460485 - 070329 showing...
460486 -
460487 -            History cites only cancer, and
460488 -            nothing on pulmonary embolism
460489 -            and enlarged right
460490 -            ventricle......................... 070329, ref SDS 15 GH5L
460492 -             ..
460493 -            Comparison for trend analysis
460494 -            omitted entirely; test was
460495 -            compared with
460496 -            nothing........................... 070329, ref SDS 15 0136
460498 -  ..
460499 - On 070131 Millie had another CT test and was told by the technician
460500 - that the order did not specify thin slice spiral CT scans, and so this
460501 - was not done. ref SDS 10 KM7L  She reported this in a letter to the
460502 - primary care physician at Kaiser. ref SDS 10 KM8Y
460504 -  ..
460505 - Possibly, at that time on 070131 Kaiser was performing different
460506 - tests, and now all are the same.
460508 -  ..
460509 - Since Kaiser has data to assess pulmonary embolism, and Cor Pulmonale,
460510 - it is not clear why there would not be a review at least quarterly, or
460511 - bi-annually, annually..., to assess trends in order to guide health
460512 - care decisions.
460513 -
460514 -
460515 -
460516 -
460517 -
4606 -

SUBJECTS
CA 15-3 56 Blood Tests 070511 at Kaiser  Cncer Marker Verify Accurac

5303 -
5304 - 1653
530501 -  ..
530502 - Verify Medical Test Data Not Mistake on CA 15-3 56 Cancer Marker
530503 - Coordination Kaiser Notify UCSF Prepare for Meeting Patient
530504 - CA 15-3 56 Verify Sudden Increase After Months of Decline Not Mistake
530505 -
530507 -  ..
530508 - Millie submitted ref DIT 1 0001 responding to the doctor's letter
530509 - received today, and notifying results of blood test on 070511, per
530510 - above. ref SDS 0 QN6M
530512 -  ..
530513 - Millie says to Kaiser...
530514 -
530515 -    1.  Gosh, I hope CA 15-3 56 is a mistake?  Jumping from 29 to 56
530516 -        [as shown in Kaiser's letter today per above, ref SDS 0 QN6M,
530517 -        in 2 weeks seems significant, shown by patient history meeting
530518 -        at UCSF on 070426. ref SDS 18 087J, ref DIT 1 0001
530520 -         ..
530521 -    2.  Please verify this data, and submit to Doctor Rugo so she can
530522 -        prepare for meeting on 070524.  I will get another blood test
530523 -        at that time, but results take 4 or 5 days.  At the last
530524 -        meeting [on 070510] UCSF advised that all of the other patients
530525 -        (there are only 6, reported on 070201, ref SDS 11 X44L) in the
530526 -        study were switched to cetuximab and carboplatin within a few
530527 -        weeks. ref SDS 21 6A9H  If CA 15-3 is rising rapidly UCSF will
530528 -        want to consider changing my treatment, as well.  This was
530529 -        raised on 070301, but then "the dots" shaped up favorably.
530530 -        ref SDS 13 NY7N, ref DIT 1 LA5O
530531 -
530532 -            [...below, Millie notifies UCSF of preliminary report from
530533 -            Kaiser, and that Kaiser may notify UCSF of this change in
530534 -            CA 15-3 diagnotics, after verifying their data. ref SDS 0
530535 -            J55T
530537 -             ..
530538 -            [On 070517 Nurse's Notes show nurse practitioner ordered
530539 -            another blood test to verify elevated CA 15-3 56 reported
530540 -            in Kaiser's test on 070511; but did not perform the test,
530541 -            and decided to wait another week to address the issue.
530542 -            ref SDS 24 2N5J
530544 -             ..
530545 -            [On 070517 Kaiser advises that CA 15-3 calculation method
530546 -            different from UCSF so test results cannot be compared,
530547 -            like apples and oranges. ref SDS 25 NT3O
530549 -             ..
530550 -            [On 070517 Millie submits patient history on CA 15-3 to
530551 -            assist Kaiser evaluate response to treatment at UCSF on
530552 -            cetuxiab clinical study. ref SDS 25 KU4H
530554 -             ..
530555 -            [On 070524 CA 15-3 37 makes dramatic reversal and begins
530556 -            to rise in the UCSF test method, ref SDS 26 EU4I;
530557 -            examination seems to show IBC at all sites continues to
530558 -            subside. ref SDS 26 EU6O
530560 -             ..
530561 -            [On 070531 UCSF not concerned results of blood test today
530562 -            show CA 15-3 37 rising 30% from the prior report on 070426,
530563 -            because CT scans show no metastatic cancer, and IBC
530564 -            inflammation appears to be subsiding. ref SDS 28 NQ6K
530566 -             ..
530567 -            [On 070610 primary care physician reports right channels
530568 -            for communication finally open between Kaiser and UCSF for
530569 -            coordination on Millie's referral treatment. ref SDS 31
530570 -            ST90
530571 -
530572 -
530573 -
530574 -
5306 -

SUBJECTS
Fitness Improves Working Out Training Hard in Gym Strengthens Immune

6003 -
600401 -     ..
600402 -    Fitness Increasing Working Out Training Hard in Gym
600403 -
600404 -
600405 -    3.  I feel great, training hard, the rash is still subsiding, so
600406 -        the biomarker suddenly rising dramatically seems annomolous.
600407 -        ref DIT 1 IA7F
600409 -  ..
600410 - This follows up Millie's letter to UCSF with copy to Kaiser on 070418
600411 - that she could not remember feeling better. ref SDS 17 PY6W
600413 -  ..
600414 - Training hard in the gym is a goal Millie discussed with the doctor at
600415 - Kaiser during a meeting on 070105. ref SDS 9 WR4J  Fitness was
600416 - associated with resisting and recovering from cancer and other
600417 - diseases, during a meeting at Kaiser on 030606. ref SDS 2 JP7G  The
600418 - doctor cited lack of fitness on 050729 for symptoms similar to
600419 - pulmonary embolism. ref SDS 4 RZ4I
600421 -             ..
600422 -            [On 070607 Millie suffers recurrence Cellulitis
600423 -            inflammation envelopes left arm trauma complications
600424 -            lymphedema, high fever possibly from working out and
600425 -            training too hard in the gym. ref SDS 29 ZH6I
600426 -
600427 -
600428 -
600429 -
6005 -

SUBJECTS
CT Test Scheduled 070520 Comparison Test  00930 Lung Heart Disorders

9803 -
9804 - 1721
980501 -  ..
980502 - CT Test 070520 Compare Test 060930 Lung Heart Disorders
980503 -
980505 -  ..
980506 - Millie submitted ref DIT 3 0001 responding to Kaiser's letter received
980507 - today saying all CT tests use thin slice spiral CT technology...
980508 -
980509 -    1.  Your letter today comments that all CT scans at Kaiser are thin
980510 -        slice spiral CT tests, ref SDS 0 GP3L, that can assess
980511 -        pulmonary embolism and enlarged right ventricle, which were
980512 -        diagnosed in the test on 060930 [see review on 061012,
980513 -        ref SDS 5 294Q]  Please ask the imaging department to compare
980514 -        the current test on 070521 with the test on 060930 and report
980515 -        on changes in PE and enlarged right ventricle observed in the
980516 -        current test.  Comparison was missing from the report on the
980517 -        last CT test on 070326, reviewed at UCSF on 070329, ref SDS 15
980518 -        0136, and noted by you in the meeting at Kaiser on 070330.
980519 -        ref SDS 16 0136, ref DIT 3 0001
980520 -
980521 -            [On 070517 Kaiser advises of new policy to review 20% of
980522 -            test data and avoid comparisons to assess progression of
980523 -            lung and heart disorders saves time and money for helping
980524 -            other patients. ref SDS 25 HM4K
980525 -
980526 -
980527 -
980528 -
980529 -
9806 -

SUBJECTS
CT Test Notify UCSF Schedule Changed 070520  Aign Requirements Cetux

A903 -
A904 - 1748
A90501 -  ..
A90502 - CT Test Scheduled 070520 Notify UCSF for Clinical Study
A90503 -
A90504 - Follow up ref SDS 22 T77M.
A90505 -
A90506 - Millie submitted, ref DIT 2 0001, notifying Brigid and Jackie at UCSF
A90507 - that the CT test scheduled for 070514 has been changed to 070520,
A90508 - reported on 070511, ref SDS 22 T77M, to more closely align with
A90509 - requirements of the clinical study testing on 8-week intervals, as
A90510 - discussed during the meeting at UCSF on 070510. ref SDS 21 V36R
A90512 -  ..
A90513 - Millie's letter to UCSF says...
A90514 -
A90515 -    1.  I have scheduled the next CT test for 070521, as you and Jackie
A90516 -        suggested in the meeting last week at UCSF on 070510.
A90517 -        ref SDS 21 V36R  Kaiser called me the next day on 070511 and
A90518 -        said I needed a blood test for creatinine to prepare for the CT
A90519 -        test. ref SDS 22 T76M  It was unclear in this call why the test
A90520 -        at UCSF on 070426, ref SDS 19 4B5G, was not adequate.  I went
A90521 -        to Kaiser on 070511 and got the test, and at that time
A90522 -        requested a CA 15-3 study. ref SDS 22 B64J, ref DIT 2 0001
A90523 -
A90524 -
A90525 -
A90526 -
A906 -

SUBJECTS
CA 15-3 56 Substantial Rise Blood Tests 070511 at Kaiser Alert Notif

AI03 -
AI0401 -  ..
AI0402 - Cancer Relapse IBC #4 CA 15-3 56 Rises Significantly
AI0403 - CA 15-3 56 Test at Kaiser Indicates Significant Rise
AI0404 -
AI0405 -
AI0406 - Millie's letter to UCSF continues...
AI0407 -
AI0408 -    2.  Today, ...Kaiser reported results of this test show CA 15-3 56.
AI0409 -        ref SDS 0 QN6M  By Kaiser's data this is "stable," ref SDS 0
AI0410 -        QN6M, but in fact it is a major change. ref SDS 0 WV6L  I have
AI0411 -        written to the doctor requesting verification, and that Kaiser
AI0412 -        notify Doctor Rugo of this change, as shown in my letter.
AI0413 -        ref SDS 0 ZJ9N  We will get another reading next week when we
AI0414 -        start the next cycle. ref DIT 2 MW69
AI0416 -         ..
AI0417 -    3.  I will be in the Infusion Clinic for treatment tomorrow.
AI0418 -        Please let me know if we need to take timely action.
AI0419 -        ref DIT 2 MW77
AI0420 -
AI0421 -            [On 070517 Nurse's Notes show nurse practitioner ordered
AI0422 -            another blood test to verify elevated CA 15-3 56 reported
AI0423 -            in Kaiser's test on 070511; but did not perform the test,
AI0424 -            and decided to wait another week to address the issue.
AI0425 -            ref SDS 24 FG6H
AI0427 -             ..
AI0428 -            [On 070517 Brigid discloses that coordinating divided
AI0429 -            responsibilities on referral projects is difficult; and
AI0430 -            that UCSF recommends limiting laboratory work rather than
AI0431 -            empowering labs to cross-check tests for accuracy.
AI0432 -            ref SDS 25 466H
AI0434 -             ..
AI0435 -            [On 070524 CA 15-3 37 makes dramatic reversal and begins
AI0436 -            to rise in the UCSF test method, ref SDS 26 EU4I;
AI0437 -            examination seems to show IBC at all sites continues to
AI0438 -            subside. ref SDS 26 EU6O
AI0440 -             ..
AI0441 -            [On 070531 UCSF not concerned results of blood test today
AI0442 -            show CA 15-3 37 rising 30% from the prior report on 070426,
AI0443 -            because CT scans show no metastatic cancer, and IBC
AI0444 -            inflammation appears to be subsiding. ref SDS 28 NQ6K
AI0445 -
AI0446 -
AI0447 -
AI0448 -
AI0449 -
AI0450 -
AI0451 -
AI05 -
AI06 -