THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: March 12, 2008 09:53 AM Wednesday;
Millie coordinates medical planning UCSF and Kaiser to start Carboplat
2...Labs Order Blood Tests Start New Cycle Cetuximab Carboplatin
3...Prozac Treatment Paused Because Emotional Stress Depression Subside
4...Exercise Resumes after Recovery from Fall Emotional Stress Relieved
5...Xray Image Test Results Submitted to UCSF
6...Arm Right Discomfort Continues from Fall 080125
7...Cellulitis Lymphedema Recovered Rash Swelling Subside
8...IBC Rash Subsides Before Starting Treatment with Carboplatin
9...Backup Medical Review Strengthens Health Care
10...Referral Coordination Plan UCSF Relies Kaiser Backup Review
Click here to comment!
Labs Blood Tests INR Coaglulation Control Cinic Case Management CA
3303 - ..
3304 - Summary/Objective
330501 - Follow up ref SDS 23 0000. ref SDS 18 0000.
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
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
330529 - ..
3308 - Progress
330901 - Labs Order Blood Tests Start New Cycle Cetuximab Carboplatin
330903 - Follow up ref SDS 19 TN8W.
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...
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
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
Prozac 2 Pills Stopped Taking Caused Negative Physical Side Effects
520401 - ..
520402 - Prozac Treatment Paused Because Emotional Stress Depression Subside
520404 - Follow up ref SDS 20 KT4J.
520406 - Millie's letter to UCSF with copy to Kaiser continues...
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.
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
Exercise Resumes Gym Hiking after Recovery from Fall Emotional Stres
720401 - ..
720402 - Exercise Resumes after Recovery from Fall Emotional Stress Relieved
720404 - Follow up ref SDS 21 7V6M, ref SDS 17 1K9W.
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
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
Xray 080305 Right Arm Fall Injury Negative Findings No Fracture Resu
970401 - ..
970402 - Xray Image Test Results Submitted to UCSF
970404 - Follow up ref SDS 20 5M39.
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...
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.
Arm Right Discomfort Continues from Fall 080125 Condition Improves P
AG0401 - ..
AG0402 - Arm Right Discomfort Continues from Fall 080125
AG0404 - Follow up ref SDS 23 IT8N.
AG0406 - Millie's letter to UCSF with copy to Kaiser continues...
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
Cellulitis Lymphedema Recovery Rash Swelling Subside Respond 10-day
B40401 - ..
B40402 - Cellulitis Lymphedema Recovered Rash Swelling Subside
B40404 - Follow up ref SDS 23 HS6W, ref SDS 20 RM6J.
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
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
IBC Rash Subsides Treatment Cetuximab Alone Before Starting Treatmen
BO0401 - ..
BO0402 - IBC Rash Subsides Before Starting Treatment with Carboplatin
BO0404 - Follow up ref SDS 21 NW3N, ref SDS 17 1K9W.
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
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
Coordination Referral Kaiser UCSF Fnctioning Team Collaboration Com
CQ0401 - ..
CQ0402 - Backup Medical Review Strengthens Health Care
CQ0403 - Referral Coordination Plan UCSF Relies Kaiser Backup Review
CQ0405 - Follow up ref SDS 23 HT3U. ref SDS 21 JT3L.
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...
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
CQ0424 - [On 080314 UCSF notified Kaiser recognizes effective
CQ0425 - communication enables good coordination functioning as a
CQ0426 - team. ref SDS 26 EX5H
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