CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 37 0000. ref SDS 33 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie had a blood draw in Infusion Clinic this morning at 0800.
040902 - ref SDS 41 546N
040904 -  ..
040905 - The doctor was sick today.
040907 -  ..
040908 - Brigid displayed results of the blood test on the computer screen.
040910 -  ..
040911 - WBC was low again for the 2nd straight month.
040913 -  ..
040914 - This caused NEUTS to fall to 1.25, ref SDS 41 QY6H, significantly
040915 - below 1.5 standard for safe treatment.  Brigid approved treatment
040916 - today consistent with prior practice approving treatment with NEUTS as
040917 - low as 1.23, reported on 070301. ref SDS 19 P560
040919 -  ..
040920 - NEUTS 1.25 on the UCSF standard correlates to 1250 at Kaiser where
040921 - the standard for treatment is 1500.
040923 -  ..
040924 - Millie asked why Magnesium is not in the blood test this morning to
040925 - evaluate effectiveness of treatment, ref SDS 41 5K8H, ordered to
040926 - remedy low Magnesium the month before on 071213? ref SDS 38 HH5I
040928 -  ..
040929 - Brigid advised that Magnesium was not tested today, because UCSF
040930 - requires only occassional testing for this diagnostic.
040932 -  ..
040933 - Testing "occassionally" for Magnesium appears conflicting with the
040934 - Chemotherapy order reported on 070201, specifying a test for Magnesium
040935 - every 4 weeks to start a new cycle of treatment, ref SDS 18 5594, as
040936 - involved here.
040938 -  ..
040939 - Additionally, since Magnesium fell below requirements, testing should
040940 - continue to demonstrate recovery or that further treatment is needed.
040941 -
040942 -        [On 080117 Catherine submitted another report on the labs for
040943 -        080110 and it shows Magnesium was in fact tested with the Labs
040944 -        today, and was at the low end of the target range, indicating
040945 -        response to treatment with improvement today from the labs last
040946 -        month on 071213. ref SDS 42 4F9G
040948 -         ..
040949 -        [On 080313 prescription for cetuximab and Carboplatin specifies
040950 -        blood test for Magnesium every 4 weeks to start a new cycle of
040951 -        treatment. ref SDS 43 2N6N
040953 -  ..
040954 - Millie complained of mild stiff neck.  This has previously been
040955 - associated with lymphadenopathy, reported by biopsy on 040309.
040956 - ref SDS 1 0001
040958 -  ..
040959 - Brigid palpated the neck and noted no evident swelling that might
040960 - suggest lymphadenopathy.  At this time, stiff neck symptoms seem
040961 - likely attributable to sleeping awkwardly.
040963 -  ..
040964 - Brigid examined IBC rash.  She feels there may be some very slight
040965 - spreading of disease.  Intensity of inflammation seems to rise and
040966 - fall.  Today, inflammation of the rash seems quiet.  Nothing jumps out
040967 - at this time that is obviously significant spread of IBC, as has
040968 - occurred in years past, e.g., on 060806. ref SDS 10 0001  The feeling
040969 - is that continued treatment with cetuximab alone is justified by
040970 - examination and test diagnostics.
040972 -  ..
040973 - Jackie took pictures with Brigid holding a tape measure to assess
040974 - progression of disease.  Jackie indicated there may not be enough time
040975 - for UCSF to compare pictures today with conditions 3 and 6 months ago
040976 - for broader assessment of disease for annual review, as discussed in
040977 - the letter to UCSF yesterday on 080109. ref SDS 40 4P8N
040979 -  ..
040980 - Brigid advised that UCSF has never performed an annual review of
040981 - patient status.  She feels there is not enough time for UCSF to
040982 - prepare an annual review, and that the quality of medical care in this
040983 - case cannot be strengthened by investing time to write up patient
040984 - history and develop treatment planning and options, as further set out
040985 - in the letter to UCSF on 080109. ref SDS 40 4P9K
040987 -  ..
040988 - UCSF practice aligns with resistance at Kaiser to submitting a written
040989 - work up with treatment plans based on drugs available for treating
040990 - Millie, on grounds that written work plans are unnecessary, reported
040991 - on 041130. ref SDS 4 YR8F
040992 -
040993 -
040995 -  ..
040996 - Case Study Written 2nd Opinions Significant Factor Millie's Recovery
040997 -
040998 - We reviewed briefly that Millie's care has been greatly aided through
040999 - a process of periodic review, illustrated by 2nd opinions from...
041000 -
041001 -         UCSF Doctor Benz..................... 041018, ref SDS 2 0001
041002 -         Stanford Doctor Guardino............. 041019, ref SDS 3 0001
041003 -         Kaiser Doctor Shim................... 050826, ref SDS 5 0001
041004 -         Medical Offices Doctor Bailey........ 050909, ref SDS 6 0001
041005 -         Medical Offices Doctor Grissom....... 050912, ref SDS 7 0001
041006 -         UCSF Doctor Benz..................... 060821, ref SDS 11 0001
041008 -  ..
041009 - As seen in the record, in each case careful review of patient history
041010 - yielded critical insights that were applied effectively in Kaiser's
041011 - treatment plan.  Additionally, Doctor Rugo's review on 070130 has
041012 - proven helpful guiding work this past year. ref SDS 17 795I
041014 -  ..
041015 - This record suggests that while annual review may not be standard
041016 - practice for all patients nor even for any other patient, it has been
041017 - a strategic asset in management of this case.
041019 -  ..
041020 - Millie asked about scheduling additional work for the next 3 months.
041022 -  ..
041023 - Brigid looked at the schedule.  She gave Millie a document with
041024 - written instructions for the schedule managers at the front desk to
041025 - schedule Millie for more meetings with the medical team.
041026 -
041027 -
041028 -
041029 -
041030 -
041031 -
041032 -
041033 -
0411 -