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 -