CONTACTS 

SUBJECTS
Labs Blood Tests INR Coaglulation Control  Cinic Case Management CA

3303 -
3303 -    ..
3304 - Summary/Objective
3305 -
330501 - Follow up ref SDS 23 0000. ref SDS 18 0000.
330502 -
330503 - Coordinate starting change to treatment adding Carboplatin to
330504 - cetuximab in clinical trial at UCSF. ref SDS 0 EX5H  INR can continue
330505 - to be tested once a month. ref SDS 0 RT8P  Initial response to
330506 - treatment wtih Proazc was feeling badly. ref SDS 0 RT8Y  Decided not
330507 - to take Prozac because emotionally feeling better now that
330508 - communication has improved between Kaiser and referral partner at
330509 - UCSF. ref SDS 0 RT4W  Millie has been able to resume exercise after
330510 - taking time off to recover from fall on 080125. ref SDS 0 RT5X
330511 - Results submitted to UCSF of Xray test on 080305 to evaluate
330512 - continuing pain from fall on 080125. ref SDS 0 RT6S  Continuing pain
330513 - in right arm from fall on 080125 seems to be declining, and so MRI
330514 - deferred at this time. ref SDS 0 RU3S  Cellulitis inflammation and
330515 - rash, and lymphedema swelling have fully subided in the left arm
330516 - responding to treatment with Keflex. ref SDS 0 RU4Q  IBC rash has also
330517 - declined even before starting increased treatment adding Carboplatin
330518 - to cetuximab in the clinical study. ref SDS 0 RU4U
330519 -
330520 -            [On 080313 CA 15-3 59 fell 4 points, the first decline in 6
330521 -            months, and occurred before starting Carboplatin.
330522 -            ref SDS 24 T25I
330523 -
330524 -
330525 -
330526 -
330527 -
330529 -  ..
3306 -
3307 -
3308 - Progress
3309 -
330901 - Labs Order Blood Tests Start New Cycle Cetuximab Carboplatin
330902 -
330903 - Follow up ref SDS 19 TN8W.
330904 -
330905 - Millie has not received response from Kaiser to a letter, ref DIP 2
330906 - 0001, on 080307 notifying of changes in medication, ref SDS 23 RW3T,
330907 - and from monthly to now weekly blood tests. ref SDS 23 RW7Q
330909 -  ..
330910 - Today, Millie submitted ref DIT 1 0001 to Jackie, the Clinical Trial
330911 - Coordinator at UCSF, with copies to the medical team, including Gloria
330912 - at the Coagulation Control Clinic, and saying...
330913 -
330914 -    1.  Tomorrow, I start treatment with cetuximab and Carboplatin as
330915 -        prescribed by Doctor Rugo during the meeting last week on
330916 -        080306. ref SDS 21 NW3N, ref DIT 1 0001
330918 -         ..
330919 -    2.  I sent a letter [dated 080307] to the coagulation control
330920 -        clinic notifying Kaiser of changes to medication for evaluation
330921 -        of Coumadin prescription.  I explained understandings that the
330922 -        protocol for the clinical trial using both cetuximab and
330923 -        Carboplatin requires weekly blood tests, which is a change from
330924 -        past practice getting monthly labs.  I asked Kaiser to advise
330925 -        if weekly labs should include INR tests in light of having been
330926 -        stable within the target range of 2.0 - 3.0 for the past year.
330927 -        ref SDS 23 RW7Q, ref DIT 1 6P6G
330929 -         ..
330930 -    3.  Kaiser has not notified that INR testing needs to be increased
330931 -        to weekly reports. ref DIT 1 6P7G
330933 -         ..
330934 -    4.  Therefore, weekly labs going forward may need INR and CA 15-3
330935 -        testing only for monthly labs to start each new cycle, rather
330936 -        than be included with weekly blood tests.  This will reduce
330937 -        costs and referral coordination efforts. ref DIT 1 6P7L
330938 -
330939 -            [On 080313 Jackie ordered the blood test in accordance with
330940 -            revised requirements for interim blood tests, as noed in
330941 -            the letter today, per above. ref SDS 24 W55I
330943 -             ..
330944 -            [On 080314 letter commends UCSF for timely work ordering
330945 -            blood tests in accordance with Kaiser requirements for
330946 -            Coagulation Control. ref SDS 26 EX5H
330947 -
330948 -
330949 -
330950 -
3310 -

SUBJECTS
Prozac 2 Pills Stopped Taking Caused Negative Physical Side Effects

5203 -
520401 -  ..
520402 - Prozac Treatment Paused Because Emotional Stress Depression Subside
520403 -
520404 - Follow up ref SDS 20 KT4J.
520405 -
520406 - Millie's letter to UCSF with copy to Kaiser continues...
520407 -
520408 -    5.  I began taking Prozac prescribed by Kaiser on 080305, and
520409 -        approved at UCSF the next day on 080306. ref SDS 21 NV5F,
520410 -        ref DIT 1 6P7R
520412 -         ..
520413 -    6.  Several friends mentioned that Prozac has a number of side
520414 -        effects. ref SDS 20 XP6H  The pharmacist at Kaiser told me to
520415 -        notify the doctor of any mood changes, including sadness and
520416 -        depression. ref SDS 20 GG5X  This led to further research on
520417 -        Prozac side effects, reported for convenience in the record on
520418 -        080305. ref SDS 20 GG7M, ref DIT 1 6P8O
520420 -         ..
520421 -    7.  Two (2) days ago, I felt quite strange physically in a way that
520422 -        is difficult to explain.  As a result, I stopped taking Prozac
520423 -        after two (2) pills. ref DIT 1 6P9N
520425 -         ..
520426 -    8.  I feel better emotionally now with the help of [the primary
520427 -        care physician - on 080305, ref SDS 20 KT4J, and Doctor Rugo
520428 -        explaining progression of my cancer that requires adding weekly
520429 -        chemotherapy [reported on 080306, ref SDS 21 NW3N].  I have
520430 -        been fearful (depressed) that we may have a hard time keeping
520431 -        blood counts up [also cited on 080305 during meeting at Kaiser,
520432 -        ref SDS 20 PC6M].  The most recent NEUTS rising to 2.75 seems
520433 -        like a good sign, though possibly just a one time spike from
520434 -        warding off Cellulitis, reported on 080306. ref SDS 21 033B
520435 -        ref DIT 1 6P9S
520437 -         ..
520438 -    9.  In any case, I have decided, subject to doctor's approval, to
520439 -        discontinue Prozac.
520440 -
520441 -            [On 080313 Millie reported to Kaiser further research with
520442 -            Wellness Community cancer support group revealed favorable
520443 -            results taking Prozac with minimal side effects.
520444 -            ref SDS 25 TA4U
520446 -             ..
520447 -            [On 080313 primary care physician requests confirmation on
520448 -            whether Millie is taking Prozac. ref SDS 25 UE5N
520450 -             ..
520451 -            [On 080403 meeting at UCSF Millie confirms she is not
520452 -            taking Prozac; emotional trauma subsides with improving
520453 -            health, better medical management and coordination,
520454 -            increased exercise. ref SDS 27 336H
520456 -             ..
520457 -            [On 080502 meeting at Kaiser Millie notified the doctor
520458 -            that she is not taking Prozac because issues causing former
520459 -            emotional stress have subsided, and exercise helps relieve
520460 -            routine stress. ref SDS 28 HH4I
520461 -
520462 -
520463 -
5205 -

SUBJECTS
Exercise Resumes Gym Hiking after Recovery from Fall Emotional Stres

7203 -
720401 -  ..
720402 - Exercise Resumes after Recovery from Fall Emotional Stress Relieved
720403 -
720404 - Follow up ref SDS 21 7V6M, ref SDS 17 1K9W.
720405 -
720406 -   10.  Good news, I have gotten back in the gym a couple of times, and
720407 -        finally have been out hiking twice, and again today, renewing
720408 -        exercise that was curtailed after my fall on 080125.
720409 -        ref DIT 1 6P4V
720411 -  ..
720412 - Millie reports high energy the day before getting the first treatment
720413 - with Carboplatin chemotherapy added to cetuximab, which typicall would
720414 - have adverse effects causing low energy, and generally feeling lousy,
720415 - reported on 080219. ref SDS 17 1K9W  Debilitating side effects of
720416 - chemotherapy are shown by case study on 050422. ref SDS 1 NT3I
720417 -
720418 -            [On 080314 day after 1st treatment with chemotherapy
720419 -            Carboplatin shows no loss of energy; but may reflect
720420 -            effects of steriods prescribed for pre-treatment
720421 -            medications. ref SDS 26 KO6Y
720422 -
720423 -
720424 -
7205 -

SUBJECTS
Xray 080305 Right Arm Fall Injury Negative Findings No Fracture Resu

9703 -
970401 -  ..
970402 - Xray Image Test Results Submitted to UCSF
970403 -
970404 - Follow up ref SDS 20 5M39.
970405 -
970406 -   11.  Here are results received on 080307 for the xray on 080305 of
970407 -        my right arm showing no findings of injury. ref SDS 23 IT8N,
970408 -        ref DIT 1 6P5R
970410 -         ..
970411 -   12.  By copy to Kaiser, I am requesting document identification to
970412 -        complete the record for the xray report, which was missing with
970413 -        the initial submission. ref DIT 1 6P5Y
970415 -  ..
970416 - The CT test on 080212 and received on 080315 illustrates the usual
970417 - test report identification. ref SDS 16 DA6Q
970419 -  ..
970420 - ID data includes...
970421 -
970422 -        Patient name and Kaiser number
970423 -        Personal physician
970424 -        Who ordered the test
970425 -        Where the test was performed
970427 -  ..
970428 - This is just standard stuff, but may be in a different screen from
970429 - what the doctor sees on the computer, and so difficult to transmit in
970430 - Kaiser's email system.
970431 -
970432 -
970433 -
970434 -
9705 -

SUBJECTS
Arm Right Discomfort Continues from Fall 080125 Condition Improves P

AG03 -
AG0401 -  ..
AG0402 - Arm Right Discomfort Continues from Fall 080125
AG0403 -
AG0404 - Follow up ref SDS 23 IT8N.
AG0405 -
AG0406 - Millie's letter to UCSF with copy to Kaiser continues...
AG0407 -
AG0408 -   13.  I continue to feel discomfort in the right arm, but it seems to
AG0409 -        be getting better [aligns with report on xray received from
AG0410 -        Kaiser on 080307, ref SDS 23 IT8N].  Slight pain occurs now
AG0411 -        only when I lift my right arm laterally to the full vertical
AG0412 -        position.  In the meeting with [the primary care physician at
AG0413 -        Kaiser] on 080305 there was consideration of ordering an MRI if
AG0414 -        the xray is negative and pain continues. ref SDS 20 5M39  My
AG0415 -        feeling is that evident improvement indicates MRI
AG0416 -        considerations can be deferred at this time. ref DIT 1 6P6T
AG0417 -
AG0418 -
AG0419 -
AG0420 -
AG05 -

SUBJECTS
Cellulitis Lymphedema Recovery Rash Swelling Subside Respond 10-day

B403 -
B40401 -  ..
B40402 - Cellulitis Lymphedema Recovered Rash Swelling Subside
B40403 -
B40404 - Follow up ref SDS 23 HS6W, ref SDS 20 RM6J.
B40405 -
B40406 -   14.  More good news, I think Cellulitis in my left arm has fully
B40407 -        subsided, including excessive swelling.  Catherine can check
B40408 -        this tomorrow. ref DIT 1 6Q3S
B40410 -  ..
B40411 - Tomorrow concludes 10-day treatment with Keflex begun on 080304, when
B40412 - Cellulitis was diagnosed. ref SDS 19 106G  This condition was examined
B40413 - at Kaiser the next day on 080305. ref SDS 20 RM6J
B40414 -
B40415 -            [On 080313 Millie completed 10-day treatment with Keflex
B40416 -            for Cellulitis; no visible inflammation or swelling that
B40417 -            signal Cellulitis and lymphedema. ref SDS 25 MQ4I
B40418 -
B40419 -
B40420 -
B405 -

SUBJECTS
IBC Rash Subsides Treatment Cetuximab Alone Before Starting Treatmen

BO03 -
BO0401 -  ..
BO0402 - IBC Rash Subsides Before Starting Treatment with Carboplatin
BO0403 -
BO0404 - Follow up ref SDS 21 NW3N, ref SDS 17 1K9W.
BO0405 -
BO0406 -   15.  More good news, my IBC seems much less intense today [improving
BO0407 -        conditions observed during examination at UCSF last week on
BO0408 -        080306, ref SDS 21 NW3N].  Will be interesting to see what the
BO0409 -        cancer marker shows for the test last week on 080306.
BO0410 -        ref SDS 22 A16M ref DIT 1 6Q3X
BO0412 -  ..
BO0413 - This report continues evidence of IBC responding to treatment with
BO0414 - cetuximab alone, reported to UCSF in a letter on 080219. ref SDS 17
BO0415 - 1K9W
BO0416 -
BO0417 -            [On 080313 CA 15-3 59 fell 4 points for labs on 080306, the
BO0418 -            first decline in 6 months, and occurred before starting
BO0419 -            Carboplatin. ref SDS 24 T25I
BO0421 -             ..
BO0422 -            [On 080314 letter to UCSF notes cancer marker falls prior
BO0423 -            to starting new treatment adding Carboplatin to cetuximab
BO0424 -            the day before on 080313. ref SDS 26 DE4N
BO0425 -
BO0426 -
BO0427 -
BO0428 -
BO05 -

SUBJECTS
Coordination Referral Kaiser UCSF  Fnctioning Team Collaboration Com

CQ03 -
CQ0401 -  ..
CQ0402 - Backup Medical Review Strengthens Health Care
CQ0403 - Referral Coordination Plan UCSF Relies Kaiser Backup Review
CQ0404 -
CQ0405 - Follow up ref SDS 23 HT3U. ref SDS 21 JT3L.
CQ0406 -
CQ0407 - Millie received ref DRT 1 0001 from the primary care physician at
CQ0408 - Kaiser responding to the letter sent to Kaiser on 080307 commending
CQ0409 - improved coordination on Kaiser's treatment referral with UCSF,
CQ0410 - ref SDS 23 HT3U, and citing UCSF comments the day before on 080307
CQ0411 - reporting reliance on Kaiser for backup 2nd opinion to improve quality
CQ0412 - of care for Millie...
CQ0414 -  ..
CQ0415 - The doctor says today...
CQ0416 -
CQ0417 -    1.  [Responding to your letter on March 7, 2008 noting improved
CQ0418 -        coordination between Kaiser and UCSF on referral treatment...],
CQ0419 -        ref SDS 23 HT3U
CQ0421 -         ..
CQ0422 -    2.  Glad we are functioning as a Team! ref DRT 1 0001
CQ0423 -
CQ0424 -            [On 080314 UCSF notified Kaiser recognizes effective
CQ0425 -            communication enables good coordination functioning as a
CQ0426 -            team. ref SDS 26 EX5H
CQ0427 -
CQ0428 -            [On 090213 1140 Doctor Johnson explains Millie's good
CQ0429 -            results surviving stage IV cancer 3 times longer than other
CQ0430 -            patients show benefits of synergy between Kaiser's
CQ0431 -            knowledge of patient history, and UCSF research have been
CQ0432 -            optimized through communication that integrates Kaiser's
CQ0433 -            team care model of case management with the UCSF practice
CQ0434 -            of comprehensive care. ref SDS 29 685I
CQ0435 -
CQ0436 -
CQ0437 -
CQ0438 -
CQ0439 -
CQ0440 -
CQ0441 -
CQ0442 -
CQ05 -