Welch Company
San Francisco, CA
S U M M A R Y
DIARY: June 11, 2007 08:21 AM Monday;
Rod Welch
Millie Cellulitis IV treatment, coordination UCSF and Kaiser.
1...Summary/Objective
....UCSF Notified Cellulitis Improved Clarify Cellulitis Treatments
....Kaiser Request Clarification Cellulitis Treatments
2...Cellulitis 3rd Treatment Ceftriaxone IV 2gms Kaiser Martinez
....Port Catheter Avoided Nurse Substitutes Needle Penetration for IV
....IV Needle Penetration Mimimal Damage Substitute for Port Catheter
3...Reasons Not Presented Disagreement Treatment Cellulitis
4...UCSF Kaiser Communication Coordination Disagree on Treatment
5...070607 Chronology Time Line
6...070608 Chronology Time Line
7...Mental Maps Read What is Expected Not What is Written
8...Kaiser Proposes Oral Antibiotics That Have Not Been Prescribed
9...Clarification Prescription for Cellulitis Complete IV Treatment
10...Confirm UCSF Medical Team Coordinating with Kaiser on Patient Care
........Conflict Treatments Antibiotics with Cetuximab Coumadin
........Complete IV Treatments Unless Conflict Other Treatments
..............
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CONTACTS
SUBJECTS
Examination Treatment Cetuximab 3rd Treatment 4th Cycle Chemotherapy
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 85 0000. ref SDS 84 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Temperature 98.6.
040902 -
040903 - This continued no fever status from yesterday. ref SDS 85 UW5L
040905 - ..
040906 - No Tylenol since Saturday, as previously reported yesterday, 070610.
040907 - ref SDS 85 1V7K
040909 - ..
040910 - Arm shows no signs of worsening Cellulitis; improvement reported with
040911 - arm nearly normal seems stable today, with very slight inflammation
040912 - on upper inner arm, and lower arm. ref SDS 85 MV7N
040914 - ..
040915 - Energy seems back to normal now, thinking about getting things done.
040916 -
040918 - ..
040919 - UCSF Notified Cellulitis Improved Clarify Cellulitis Treatments
040920 -
040921 -
040922 - Millie sent a letter to UCSF...
040923 -
040924 - Subject: Cellulitis Seems Resolved
040926 - ..
040927 - Date: June 11, 2007 1108
040929 - ..
040933 - ..
040934 - I'm just leaving for Kaiser in Martinez to get the 3rd
040935 - treatment for Cellulitis.
040937 - ..
040938 - At this time, I seem to be mostly recovered, as shown in the
040939 - record yesterday. ref SDS 85 PR4W
040941 - ..
040942 - [The primary care physician] reported in a letter yesterday
040943 - that communication channels are now open between UCSF and
040944 - Kaiser on case management of my referral. ref SDS 85 OG7F
040946 - ..
040947 - Thanks for taking the initiative on this in your letter on
040948 - 070608. ref SDS 83 035H [this was actually a call from Brigid]
040950 - ..
040951 - As you can see, he also states in part that I should "now be
040952 - back on oral antibiotics," ref SDS 85 ST90, which seems to
040953 - conflict with the record on 070608 that IV antibiotics are
040954 - scheduled through Wednesday. ref SDS 83 AL39, Did you hear
040955 - anything different? Is the oral antibiotics Keflex, as Doctor
040956 - Rugo discussed on 060707? ref SDS 82 ZI35
040957 -
040958 - [...below, UCSF responds "great!!" ref SDS 0 3E4J
040960 - ..
040961 - [...below, Millie requests clarification from UCSF on
040962 - clarifying treatments. ref SDS 0 JQ6M
040964 - ..
040965 - [The primary care physician at Kaiser] advised in his letter
040966 - yesterday that you submitted results of the blood culture to
040967 - Kaiser, ref SDS 85 834N, which was performed at UCSF on 070607.
040968 - ref SDS 82 8J51 When time permits, please submit the record on
040969 - the blood culture to me. If you cannot easily send it with
040970 - email, I can get a copy from Catherine on Thursday. Just let
040971 - me know.
040973 - ..
040974 - Notice I have developed 3 cold sores on my lip, shown in the
040975 - record yesterday on 070610. ref SDS 85 LG4L Is this part of
040976 - Cellulitis, a side effect of cetuximab, or of the antibiotics
040977 - to treat Cellulitis, or is something else entirely?
040978 -
040979 - [...below, Millie requests comments on cold issue from
040980 - primary care physician. ref SDS 0 GJ5J
040982 - ..
040983 - [...below, UCSF responds "great!!" ref SDS 0 3E4J
040985 - ..
040986 - [...below, Millie requests clarification from UCSF on cold
040987 - sore issue. ref SDS 0 JQ8O
040988 -
040990 - ..
040991 - Thanks.
040992 -
040993 -
040995 - ..
040996 - Kaiser Request Clarification Cellulitis Treatments
040997 -
040998 - Follow up ref SDS 85 OG7F.
040999 -
041000 - Millie submitted a letter to Kaiser requesting clarification of the
041001 - doctor's letter yesterday saying to continue with oral antibiotics,
041002 - which conflicts with the record of IV antibiotics prescribed, and no
041003 - prescription for oral antibiotics at this time. ref SDS 85 OG9G
041004 -
041005 - Subject: Clarify Cellulitis Treatments
041007 - ..
041008 - Date: June 11, 2007 0904
041010 - ..
041011 - Please see the record yesterday reviewing your letter saying to
041012 - now be back on oral antibiotics. ref SDS 85 OG7F
041013 -
041014 - [On 070612 primary care physician at Kaiser clarifies
041015 - treatment plan to start Keflex oral antibiotics after
041016 - completing IV medications. ref SDS 86 QE4M
041018 - ..
041019 - I seem to be pretty much recovered from Cellulitis
041020 - inflammation, thanks very much. ref SDS 85 0T6K
041022 - ..
041023 - Also, I have 3 cold sores, any comments. ref SDS 85 LG4L
041024 -
041025 - [...see above Millie asks UCSF about correlations with
041026 - cetuximab treatments and cellulitis. ref SDS 0 JP3O
041028 - ..
041029 - Millie received an immediate response from Kaiser reporting that the
041030 - primary care physician is out of the office and cannot reply.
041031 -
041032 - [...see below primary care physician responds. ref SDS 0
041033 - QE5H
041034 -
041035 -
041036 -
041038 - ..
0411 -
0412 -
0413 - 0900
0414 -
041401 - Cellulitis 3rd Treatment Ceftriaxone IV 2gms Kaiser Martinez
041402 -
041403 - Millie went to Kaiser in Martinez to get the 3rd IV treatment of 5
041404 - total treatments for Cellulitis prescribed on 070607, ref SDS 82 8L46,
041405 - and scheduled the next day on 070608. ref SDS 83 AL39
041406 -
041408 - ..
041409 - Port Catheter Avoided Nurse Substitutes Needle Penetration for IV
041410 - IV Needle Penetration Mimimal Damage Substitute for Port Catheter
041411 -
041412 - Follow up ref SDS 83 VQ5L.
041413 -
041414 - Millie advised that the nurse was proactive this morning volunteering
041415 - to use the port catheter, and did this work very effectively. this
041416 - solved the problem that occurred last Friday on 070608, when Kaiser
041417 - insisted on giving treatment with conventional needle IV methods,
041418 - based on limited training. ref SDS 83 VQ5L Since the same nurse gave
041419 - treatment today with the port catheter, the previous problem was not a
041420 - training issue. May have related to limited time, and so, like
041421 - everyone, the nurse was trying to save time and money using
041422 - conventional methods that turned out to be harmful to the patient.
041423 -
041424 -
041425 -
041427 - ..
0415 -
0416 -
0417 - 1220
0418 -
041801 - Millie tired; taking a nap.
041802 -
041804 - ..
0419 -
0420 -
0421 - 1310
0422 -
042201 - Millie awake.
042202 -
042203 - Temperature 97.8.
042204 -
042206 - ..
0423 -
0424 -
0425 - 1429
0426 -
042601 - Brigid responded to Millie's letter this morning requesting
042602 - clarification of treatment for Cellulitis, ref SDS 0 JO6I, requesting
042603 - the report on blood cultures sent to Kaier, ref SDS 0 JP3G, and asking
042604 - if cold sores are side effects of cetuximab, Cellulits treatments,
042605 - etc., ref SDS 0 JP3O,
042607 - ..
042608 - The UCSF letter says...
042609 -
042610 - Subject: Cellulitis Seems Resolved
042611 -
042612 - Date: June 11, 2007 1259
042613 -
042614 - Great!!
042615 -
042617 - ..
042618 - Since this does not respond to issues in Millie's letter, per above.
042619 - ref SDS 0 VM9H; Millie sent a follow up saying...
042620 -
042621 - Subject: Cellulitis Seems Resolved
042622 -
042623 - Date: June 11, 2007 1438
042625 - ..
042628 - ..
042629 - Thanks for your letter earlier today on recovering from
042630 - Cellulitis. ref SDS 0 3E4J
042632 - ..
042633 - I also asked if UCSF and Kaiser have collaborated on my
042634 - treatment, as set out in [the primary care physician's] letter
042635 - yesterday, ref SDS 0 JO5J; and, is it your understanding I
042636 - should switch to oral antibiotic before completing 5 days of IV
042637 - treatment? ref SDS 0 JO6I I sent a letter to [the primary care
042638 - physician] this morning, ref SDS 0 OG7F, and got a reply that
042639 - he is out of town. Can you help clarify treatment based on
042640 - communications with Kaiser? ref SDS 85 IY3J
042642 - ..
042643 - Also, I requested a copy of the report on the blood culture,
042644 - ref SDS 0 JP3G, which the doctor reported UCSF submitted to
042645 - Kaiser. ref SDS 85 834N
042647 - ..
042648 - I also reported in my letter this morning that I have developed
042649 - 3 cold sores on my lip. ref SDS 85 LG4L, and asked if this new
042650 - condition is a side effect of cetuximab, or possibly
042651 - cellulitis related? Will the antibiotics clear it up or just
042652 - let nature takes its course? ref SDS 0 JP3O
042653 -
042655 - ..
0427 -
0428 -
0429 - 1613
0430 -
043001 - Millie received a call from Brigid responding to Millie's letter
043002 - earlier today, per above. ref SDS 0 JQ5H
043004 - ..
043005 - Brigid did not discuss the blood culture which Millie requested,
043006 - ref SDS 0 JQ8J, and, she did not discuss the new problem of cold
043007 - sores, also, raised in Millie's letter. ref SDS 0 JQ8O
043008 -
043009 -
043011 - ..
043012 - Reasons Not Presented Disagreement Treatment Cellulitis
043013 - UCSF Kaiser Communication Coordination Disagree on Treatment
043014 -
043015 - Brigid reported during the call today that last week she and Doctor
043016 - Rugo called and collaborated with the primary care physician at Kaiser
043017 - on the course of treatment that Millie should get for Cellulitis.
043018 - UCSF recommended to Kaiser that, following IV treatment with
043019 - Ceftriaxone at UCSF on 070607 at 1152, ref SDS 82 8J9R, Millie should
043020 - be treated only with Keflex pills, which Doctor Rugo had discussed
043021 - initially on 070607 at 0800, when Millie was examined and Doctor Rugo
043022 - diagnosed Cellulitis. ref SDS 82 ZI37 Millie gathered from Brigid's
043023 - explanation today, that Kaiser decided that treatment for recurrent
043024 - Cellulitis in this case should start using outpatient IV medication
043025 - with Ceftriaxone, and not with Keflex proposed by UCSF.
043027 - ..
043028 - Communication differences today reflect coordination challenges on
043029 - referral projects that occur in aligning test results between Kaiser
043030 - and UCSF, reported on 070511. ref SDS 81 T76M
043031 -
043039 - ..
043040 - Brigid did not present today in the call with Millie reasons UCSF
043041 - proposed only Keflex for continuing treatment of Cellulitis, nor any
043042 - reasons Kaiser presented for continuing treatment with Ceftriaxone.
043043 - On 041230 the primary care physician at Kaiser explained that reasons
043044 - for treatment prescriptions are important to patient care. ref SDS 10
043045 - XQ84 Importance of reasons for conflict and disagreement is presented
043046 - further in NWO. ref OF 2 PXWX
043048 - ..
043049 - Brigid did not say today, and the record is not clear when discussion
043050 - between Brigid, Doctor Rugo, and the primary care physician at Kaiser
043051 - occurred, either on 070607, or the next day on 070608. Review of
043052 - patient history indicates the call occurred on Friday, 070608 between
043053 - 1153 and 1743. ref SDS 0 QD6L
043054 -
043055 - [...below Millie received a letter from Kaiser; primary
043056 - care physician says to complete full course of oral
043057 - antibiotics, which conflicts with the record of no course
043058 - having been prescribed for oral antibiotics, and current
043059 - prescription for 5-days of IV anbiobiotics. ref SDS 0 QE5H
043061 - ..
043062 - [...below Millie requests clarification of treatment for
043063 - Cellulitis from Kaiser. ref SDS 0 QE4M
043065 - ..
043066 - [...below Millie responds to call from UCSF, ref SDS 0
043067 - VW4L, and notifies UCSF of decision to complete IV
043068 - treatment for Cellulitis. ref SDS 0 VW65
043070 - ..
043071 - [On 070612 Millie gets 4th IV treatment for Cellulitis at
043072 - Kaiser in Martinez. ref SDS 86 ZG84
043073 -
043075 - ..
043076 - 070607 Chronology Time Line
043077 -
043078 - Chronology of events on 070607 indicates there was likely no call
043079 - between the medical team at UCSF and the primary care physician at
043080 - Kaiser...
043081 -
043082 - 1. Diagnosis during examination at
043083 - UCSF; initial treatment
043084 - Keflex prescribed.................. 0800, ref SDS 82 ZI37
043086 - ..
043087 - 2. Millie treated in Infusion Clinic
043088 - UCSF with cetuximab for cancer;
043089 - Cellulitis condition worsens Vicodin
043090 - treatment given to relieve pain;
043091 - patient history of Cellulitis
043092 - reviewed........................... 0905, ref SDS 82 PSWS
043094 - ..
043095 - 3. Catherine sends email notifying
043096 - Brigid in Breast Care Clinic
043097 - that Millie's condition
043098 - worsens............................ 0930, ref SDS 82 8J33
043100 - ..
043101 - 4. Kaiser called independently via cell
043102 - phone by patient assistant; Arlette
043103 - notified Millie suffers recurrent
043104 - Cellulitis; UCSF medical team prescribes
043105 - outpatient oral antibiotics with
043106 - Keflex;, ref SDS 0 JR3H; Arlette
043107 - will discuss with primary care
043108 - physician and coordinate
043109 - with UCSF medical
043110 - team............................... 0930, ref SDS 82 GY41
043112 - ..
043113 - 5. Cellulitis worsens, temperature rises,
043114 - Millie in distress; Catherine notifies
043115 - Brigid in Breast Care Center again of
043116 - advancing disease; UCSF approves
043117 - treating Millie with ceftriaxone
043118 - IV 2gms, and take blood
043119 - culture............................ 1030, ref SDS 82 8J51
043121 - ..
043122 - 6. Kaiser called patient assistant at
043123 - UCSF on cell phone; Arlette advises that
043124 - primary care physician concurs with
043125 - UCSF initial prescription to treat
043126 - recurrent Cellulitis with Keflex
043127 - oral antibiotics................... 1048, ref SDS 82 0J70
043129 - ..
043130 - 7. Kaiser advised Millie's condition
043131 - worsened; UCSF changed prescription
043132 - and will treat recurrent Cellulitis
043133 - immediately at UCSF with IV antibiotics,
043134 - and take blood culture; Arlette will
043135 - notify primary care
043136 - physician.......................... 1048, ref SDS 82 8J80
043138 - ..
043139 - 8. UCSF begins treatment Cellulitis with
043140 - Ceftriaxone IV 2gms, after Millie
043141 - completes cetuximab IV treatment
043142 - for cancer......................... 1152, ref SDS 82 8J9R
043144 - ..
043145 - 9. Cellulitis IV treatment completed
043146 - Millie's temperature 101.4; UCSF
043147 - releases Millie to go
043148 - home............................... 1310, ref SDS 82 8J5C
043150 - ..
043151 - 10. Millie home from UCSF for treatment
043152 - on clinical study for cancer with
043153 - cetuximab, and after getting
043154 - exitent IV treatment for
043155 - Cellulitis at UCSF,
043156 - temperature 100.4.................. 1415, ref SDS 82 8L85
043158 - ..
043159 - 11. Kaiser called; Arlette asks for
043160 - name of IV treatment UCSF gave
043161 - this morning for Cellulitis;
043162 - Millie reports treatment listed
043163 - in UCSF Nurse's Notes is
043164 - Ceftriaxone........................ 1428, ref SDS 82 8L8H
043166 - ..
043167 - 12. Kaiser called; Arlette advises that
043168 - primary care physician at Kaiser
043169 - orders 5-days out-patient IV
043170 - treatment for Cellulitis at
043171 - Kaiser Martinez.................... 1503, ref SDS 82 8L46
043173 - ..
043174 - 13. Kaiser Martinez calls schedules
043175 - outpatient IV treatment tomorrow
043176 - 0900............................... 1526, ref SDS 82 8L8Q
043178 - ..
043179 - This record suggests that since Kaiser did not know the name of the IV
043180 - treatment at UCSF until this was requested from Millie at 1428, there
043181 - may have been a discussion between Kaiser and UCSF after 1428 and
043182 - before Kaiser entered a prescription for the same drug at 1503 on
043183 - 070607. ref SDS 0 SE52
043185 - ..
043186 - 070607 1430 would have been a good time for collaboration discussions
043187 - between Kaiser and UCSF to coordinate Millie's treatment.
043189 - ..
043190 - As well, there may have been no discussions between Kaiser and UCSF
043191 - on 070607.
043193 - ..
043194 - Late in the PM after work on 070607, Millie submitted the record of
043195 - work on 070607 to both UCSF and Kaiser. ref SDS 82 EF6J Possibly UCSF
043196 - reviewed the record the next day, and noticed that Kaiser prescribed
043197 - follow on IV treatment, ref SDS 82 8L8H, like UCSF gave earlier in the
043198 - morning. ref SDS 82 8J37
043200 - ..
043201 - If UCSF was too busy to review the record of work performed on 070607,
043202 - then their medical team may not been aware that Kaiser first
043203 - prescribed Keflex oral antibiotics, ref SDS 0 LR71, but later changed
043204 - and prescribed IV treatment, nstead of oral antibiotic, which UCSF
043205 - first proposed, when Cellulitis was diagnosed on 070607, ref SDS 82
043206 - ZI37, and says today was subsequently recommended to Kaiser.
043207 - ref SDS 0 JQ5G
043208 -
043210 - ..
043211 - 070608 Chronology Time Line
043212 -
043213 - On 070608 there were further opportunities for UCSF to learn that
043214 - Kaiser was treating Millie with Ceftriaxone IV 2gms...
043216 - ..
043217 - 1. Millie's letter to UCSF and Kaiser
043218 - reported she was leaving, and
043219 - following planning day before on
043220 - 070607 for 5-days IV treatment for
043221 - Cellulitis, ref SDS 82 8L46, to
043222 - get outpatient treatment at
043223 - Kaiser Martinez.................... 0814, ref SDS 83 AK59
043225 - ..
043226 - 2. Voice mail from Brigid requesting
043227 - contact information for primary care
043228 - physcian at Kaiser; Millie submits
043229 - to UCSF with copy to Arlette at
043230 - Kaiser for primary care physician,
043231 - and confirms Kaiser 5-day
043232 - treatment schedule with
043233 - Ceftriaxone........................ 1027, ref SDS 83 035H
043235 - ..
043236 - 3. Keflex, Millie asks if she should
043237 - take oral antibiotic on Sunday,
043238 - which Kaiser's schedule skips for
043239 - IV antibiotic...................... 1027, ref SDS 83 0R8F
043241 - ..
043242 - 4. Millie notifies primary care physician
043243 - with Kaiser's special email program
043244 - that UCSF seeks communication with
043245 - Kaiser to collaborate on Millie's
043246 - care, duplicating prior
043247 - coordination through
043248 - Arlette............................ 1153, ref SDS 83 6Q3N
043250 - ..
043251 - 5. Millie sends another letter to primary
043252 - care physician asking if UCSF and Kaiser
043253 - were communicating to coordinate
043254 - her care........................... 1743, ref SDS 83 Y75F
043256 - ..
043257 - This record suggests that since UCSF needed information for contacting
043258 - the primary care physician at Kaiser, there had been communication for
043259 - collaboration on coordinating Millie's care between UCSF and Kaiser
043260 - until some time after 070608 1027. ref SDS 0 JS5K
043262 - ..
043263 - 070608 1153 would have been a good time for collaboration discussions
043264 - between Kaiser and UCSF to coordinate Millie's treatment. ref SDS 0
043265 - W39Q
043267 - ..
043268 - There is no record of communications with the medical team on
043269 - Saturday, 070609.
043271 - ..
043272 - On Sunday 070610, the primary care physician responded to Millie's
043273 - letter on 070608 reporting that the "right channels of communication
043274 - were now open" between Kaiser to coordination Millies care on referral
043275 - to UCSF. ref SDS 85 OG7F This suggests that by this time the doctor
043276 - had communicated with UCSF
043278 - ..
043279 - The most likely scenario is that the doctors talked on 070608 sometime
043280 - after 1153 and before 1743, and to confer on Millie's treatment, as
043281 - related in Brigid's call today. ref SDS 0 JQ6F
043283 - ..
043284 - Evidently at that time, according to Brigid's call this afternoon,
043285 - UCSF proposed ending IV treatment prescribed by Kaiser on 070607, and
043286 - substituting Keflex, as Brigid's relates today, per above. ref SDS 0
043287 - JQ6F
043288 -
043289 -
043290 -
043292 - ..
0433 -
0434 -
0435 - 1644
0436 -
043601 - Mental Maps Read What is Expected Not What is Written
043602 - Kaiser Proposes Oral Antibiotics That Have Not Been Prescribed
043603 -
043604 - Millie received a letter from the primary care physician at Kaiser
043605 - responding to Millie's letter this morning requesting clarification of
043606 - treatment for Cellulitis, per above, ref SDS 0 OG7F, and following up
043607 - initial notice from Kaiser that the doctor was out of the office and
043608 - could not respond, per above. ref SDS 0 JP8I
043609 -
043610 - Subject: Clarify Cellulitis Treatments
043612 - ..
043613 - Date: June 11, 2007 1548
043615 - ..
043616 - You should complete the full course of oral antibiotics even
043617 - though your arm has improved. If the cold sores worsen, let me
043618 - know. Usually they disappear after a few days. If not, we may
043619 - need to treat you with acyclovir.
043620 -
043621 - [On 070612 primary care physician at Kaiser clarifies
043622 - treatment plan to start Keflex oral antibiotics after
043623 - completing IV medications. ref SDS 86 QE4M
043625 - ..
043626 - When this was first reviewed today, the word "oral" was overlooked,
043627 - and the rest of the construction appeared to endorse the current
043628 - treatment plan prescribed by Kaiser on 070607 calling for 5 days IV
043629 - treatment, ref SDS 82 8L46, and in accordance with the schedule
043630 - received from Kaiser the next day on 070608. ref SDS 83 AL39
043632 - ..
043633 - Further review entering the record brought into focus the doctor
043634 - submitted a construction...
043635 -
043636 - ...complete the full course of oral antibiotics...
043637 - ----
043639 - ..
043640 - "Oral" antibiotics was initially overlooked, i.e., read past by
043641 - mistake without recognition, because there is no prescription for oral
043642 - antibiotics in the record. On 070607 Millie was told Kaiser
043643 - prescribed 5-days of IV treatment at Martinez. Millie went to Kaiser
043644 - in Martinez on on 070608 and nurse gave her treatment called out in
043645 - Kaiser's computer, presumably entered by the doctor. ref SDS 83 AK6H
043646 - Since the only "course" currently scheduled is for IV antibiotics, and
043647 - since Millie asked if she should complete the course of IV treatments
043648 - scheduled, ref SDS 85 IY3J, a construction saying to complete the full
043649 - course caused the mind to overlook "oral".
043651 - ..
043652 - After situational awareness of "oral" occurred, Millie submitted
043653 - another letter for clarification of treatment for Cellulitis...
043654 -
043656 - ..
0437 -
0438 -
0439 - 2118
0440 -
044001 - Clarification Prescription for Cellulitis Complete IV Treatment
044002 -
044003 - Millie submitted a letter responding to the doctor's letter earlier
044004 - today saying to complete the full course of oral antibiotics.
044005 - ref SDS 0 QE5H
044006 -
044007 - Subject: Clarify Cellulitis Treatments
044009 - ..
044010 - Date: June 11, 2007 2120
044012 - ..
044013 - Your letter today says to complete the "full course of oral
044014 - antibiotics." ref SDS 0 QE5H Should this start tomorrow, or on
044015 - Thursday, after I complete the 5-day IV treatment at Martinez,
044016 - as reported on 070608. ref SDS 83 AL39
044017 -
044018 - [On 070612 nurse at Kaiser in Martinez suggests starting
044019 - Keflex in the evening after getting the final IV treatment.
044020 - ref SDS 86 RJ9G
044022 - ..
044023 - [On 070612 primary care physician at Kaiser clarifies
044024 - treatment plan to start Keflex oral antibiotics after
044025 - completing IV medications; does not specifiy whether this
044026 - should be same day, or the next day. ref SDS 86 QE4M
044028 - ..
044029 - By "full course" do you mean use pills in the bottle of Keflex
044030 - I have left over from the prescription last March? I don't
044031 - have a current prescription of Keflex, but assume the prior one
044032 - is still good.
044033 -
044034 - [On 070612 Kaiser does not clarify prescription for
044035 - medication to start after IV antibiotics. ref SDS 86 ZH59
044037 - ..
044038 - You can't imagine how relieved I am for that rash to go away.
044039 - It was a shock to see last Thursday, and a big dissapointment
044040 - with everything going so well. Now things look better.
044042 - ..
044043 - The Infusion Clinic did a great job using my port today, after
044044 - problems on Saturday trying to use a needle IV. The nurse left
044045 - the connection in place so I won't need continual punctures,
044046 - and it can also be used on Thursday for my treatment at UCSF.
044047 -
044048 -
044050 - ..
0441 -
0442 -
0443 - 2138
0444 -
044401 - Confirm UCSF Medical Team Coordinating with Kaiser on Patient Care
044402 -
044403 - Millie sent a letter to UCSF with feedback confirming understandings
044404 - in the telephone call from Brigid earlier today, per above.
044405 - ref SDS 0 JQ5G Feedback is a component of intelligence support,
044406 - explained in POIMS. ref OF 1 2200
044407 -
044408 - Subject: Cellulitis Treatment with Ceftriaxone
044410 - ..
044411 - Date: June 11, 2007 2141
044413 - ..
044419 - ..
044420 - Thanks for your call this afternoon, responding to my letter
044421 - asking for clarification of treatment for Cellulitis, and
044422 - explaining consultations between you and Doctor Rugo at UCSF,
044423 - and Doctor Johnson at Kaiser on this matter that occurred on
044424 - 070607. ref SDS 0 JQ5G
044425 -
044427 - ..
044428 - Conflict Treatments Antibiotics with Cetuximab Coumadin
044429 - Complete IV Treatments Unless Conflict Other Treatments
044430 -
044431 - Since Kaiser has prescribed 5-days of IV treatment with
044432 - ceftriaxone, and since 3 of the 5 treatments have been
044433 - completed, and so there are only 2 more to go, I am inclined to
044434 - complete the current regimen, unless there is a conflict with
044435 - cetuximab and or my Coumadin treatments. We have had issues in
044436 - the past at Kaiser with conflicts between treatments, so
044437 - naturally I am cautious.
044438 -
044439 - [On 070612 Millie gets 4th IV treatment for Cellulitis at
044440 - Kaiser in Martinez. ref SDS 86 ZG84
044442 - ..
044443 - By copy I am asking Gloria in the Coagulation Control Clinic at
044444 - Kaiser in Martinez about conflicts between Coumadin and
044445 - ceftriaxone. Further remind Gloria I have a blood test at UCSF
044446 - on Thursday, 070614, and will notify Kaiser of INR results for
044447 - evaluating Coumadin treatment adjustments.
044449 - ..
044450 - Thanks for your help.
044451 -
044453 - ..
044454 - Conflicts prescribing treatments have occurred several times in
044455 - patient history....
044456 -
044457 - 1. Cellulitis medication conflict
044458 - temperature 102+, Millie treated
044459 - Kaiser emergency.................. 041202, ref SDS 9 IX9N
044461 - ..
044462 - 2. Neupogen withheld by Pharmacy Department
044463 - resolved by reliance on patient history;
044464 - Zan appologized and thanked Millie for
044465 - keeping diary recommended by
044466 - Kaiser............................ 050415, ref SDS 11 KX49
044468 - ..
044469 - 3. Capecitabine treatment for Cancer
044470 - conflicts with Coumadin treatment
044471 - for pulmonary
044472 - embolism.......................... 061020, ref SDS 29 T650
044474 - ..
044475 - 4. Treatment conflicts created in part
044476 - by reliance on computers which staff
044477 - not trained to use but rely on using
044478 - only familiar parts of software
044479 - which prevents discovering
044480 - treatment conflicts............... 061024, ref SDS 31 NU5O,
044482 - ..
044483 - 5. Diflucan (fluconazole) treatment for
044484 - experiment assess spread IBC rash from
044485 - left to right breast conflicts with
044486 - Coumadin treatment for pulmonary
044487 - embolism; INR increases, risk
044488 - of death.......................... 061214, ref SDS 36 XF77
044489 -
044490 -
044491 -
044493 - ..
0445 -
0446 -
0447 - 2332
0448 -
044801 - Recognized writing up the record on the letter Millie sent to Brigid
044802 - confirming telecon, and with a copy to Gloria at Kaiser, that the
044803 - letter incorrectly represented Millie would have a blood test on
044804 - 070612, and that results would be submitted to Gloria for managing
044805 - Millie's Coumadin to treat pulmonary embolism, per above. ref SDS 0
044806 - VW8G
044808 - ..
044809 - Millie submitted a correction in a 2nd letter to Gloria, with a copy
044810 - to Brigid, and saying...
044811 -
044812 - Subject: INR Blood Test Schedule Correction
044813 - Cellulitis Treatment with Ceftriaxone
044815 - ..
044816 - Date: June 11, 2007 2339
044817 -
044824 - ..
044825 - I made a mistake in the letter earlier this evening indicating
044826 - I have a blood test on Thursday, 070614. ref SDS 0 VW8G My
044827 - blood tests at UCSF occur to start each new treatment cycle.
044828 - The next cycle (6th) starts a week later on 070621, as shown in
044829 - the schedule UCSF submitted on 060510. ref SDS 80 PT9H
044831 - ..
044832 - I will try to get INR results to Kaiser soon after the tests.
044833 - Doctor Johnson said in a letter yesterday on 070610 that
044834 - communication channels are now open between Kaiser and UCSF.
044835 - ref SDS 85 OG7F Brigid called this evening and seemed to
044836 - indicate coordination is still a work in progress, ref SDS 0
044837 - JQ6F, so I will try to fill in the gaps.
044839 - ..
044840 - Notice that treatment numbers are in the right hand column, and
044841 - dates are in the 1st column of the schedule.
044843 - ..
044844 - By copy to Brigid, there are a few questions on the schedule
044845 - beginning on line AP0445. ref SDS 80 0A6G These are minor,
044846 - just a heads up. Brigid planned to address schedule issues
044847 - when they come up.
044848 -
044849 -
044850 -
044851 -
044852 -
044853 -
044854 -
044855 -
0449 -