THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: April 9, 2008 12:43 PM Wednesday;
Millie suffers recurrence of Cellulitis, temperature 101.9.
2...Cellulitis Recurrence Moderate to Severe Swelling Inflammation
3...Delayed Reaction Fall 080125 Aligns Prior Cellulitis on 061027
4...Temperature 101.9 Requires Emergency Treatment Well Above 100.5
5...Over-heated Temperature 101.9 Chills Shakes Symptoms Cellulitis
6...General Ill Feeling Beginning Today While at Wellness Community
7...Cellulitis Symptoms Temperature Chills Shakes Bones Hurt Arm Pain
8...Treatment Keflex Tylenol Ice Reduce Temperature Swelling Inflammation
9...Temperature Monitor Patient Progress
10...Kaiser Emergency Treatment
11...Emergency Examination Temperature 101.7 Cellulitis Spreading
12...Patient History Reviewed Again Cellulitis Advancing
13...Causation Cellulitis Exercise Discounted Likely Infection Cut Scratch
14...Labs Blood Culture Xray EKG Diagnostics Ordered for Assessment
15...Blood Draw Problem Using Wrong Needle
16...Payment Processing for Emergency Care
17...EKG Xray Testing Negative Findings
18...Cefazolin Antibiotic Treatment Begins Temperature Already Dropping
19...Antibiotic Cefazolin Treatment Begins Temperature Already Dropping
20...Treatment Cefazolin Antibiotic Begins Temperature Already Dropping
21...Temperature Already Dropping Treatment Cefazolin Antibiotic Begins
22...Test Data Trend Analysis Incomplete Omits 6 Blood Tests at UCSF
23...Labs Blood Tests Show Immune System Fighting Infection WBC Very High
24...Blood Culture Test Results Pending
25...Admission Hospital Recovery Cellulitis Pending Room Availability
26...Patient History Accurate Memory Saves Time Money Health Care
27...Admission Doctor Examination Patient History Effects Hospitilization
28...Millie Ready to Go Home Waiting for Discharge Document Processing
29...Discharge Documentation Waived Millie Goes Home to Avoid Infection
30...Keflex Oral Antibiotic 14-day Home Treatment Prescribed
31...Hospital Care Increases Risk of Getting Sick Millie Not Admitted
32...Chemotherapy Patients High Risk for Disease from Infection in Hospital
33...UCSF Treatment on Clinical Study Tomorrow Based on Local Evaluation
34...Temperature Normal at Home Begin Oral Keflex Treatments
35...Notify Medical Team of Cellulitis Request Guidance
Click here to comment!
Cellulitis Left Arm Lymphedema Swelling Moderate Temperature 101.9 R
1403 - ..
1404 - Summary/Objective
140501 - Follow up ref SDS 38 0000. ref SDS 31 0000.
140503 - Millie had another recurrence of Cellulitis at about 1300, more severe
140504 - this time than on 080304 because of temperature 101.9, and bones in
140505 - the hips hurt. ref SDS 0 V45J Started Keflex treatment with icing,
140506 - used for prior episode. ref SDS 0 106G Temperature seemed to fall to
140507 - 101.2, but then rose back to 101.6 over the span of 30 minutes, so at
140508 - 1333 Millie notified the medical team, ref SDS 0 AP5J, and went to the
140509 - Emergency at Kaiser. ref SDS 0 H18Q Millie's temperature increased to
140510 - 101.7, and Cellulitis rash rising; she is admitted for emergency care.
140511 - ref SDS 0 0U69 Millie seen by nurse to begin care in Emergency
140512 - Examination room at 1500, only about an hour after arriving at
140513 - hospital. Cellulitis spreads on left arm. ref SDS 0 PV3R Doctor
140514 - makes examination and orders blood work; expects Millie will be
140515 - admitted for extended care. ref SDS 0 F44W The nurse has problems
140516 - getting blood to flow from the port. Change to 1" needle corrects the
140517 - problem. ref SDS 0 IG6S EKG performed with no results reported, but
140518 - evidently negative. ref SDS 0 PH8R Xray also performed, no results
140519 - reported. ref SDS 0 IH5H About 1700 (5pm) nurse connects treatment
140520 - with Cefazolin antibiotics to treat Cellulitis. There is no treatment
140521 - with ice on the left arm to reduce swelling and inflammation.
140522 - ref SDS 0 FY4L Report on labs shows WBC significantly elevated, as
140523 - expected from Neupogen treatment last Friday, and body's reaction to
140524 - fight Cellulitis today. ref SDS 0 075H Kaiser does not have a room
140525 - available, ref SDS 0 08BH, so Millie is taken to the Yellow holding
140526 - department to wait for someone to be discharged and make room for
140527 - admitting Millie. ref SDS 0 FZ8A Admitting doctor discussed Millie's
140528 - case with oncology consultant. Decide not to admit Millie to the
140529 - hospital in order to reduce risk of getting infection from hospital
140530 - environment. ref SDS 0 M49N Millie will have 14-day treatment at
140531 - home with Keflex. ref SDS 0 F149 At home about 2130, temperature
140532 - drops to 98.7. ref SDS 0 M46X Ice left arm. Millie takes first
140533 - Keflex at 2300 (11p). ref SDS 0 M539
140535 - ..
140536 - [On 080410 Millie notifies UCSF that Kaiser ER released
140537 - patient for treatment chemotherapy clinical study based on
140538 - assessment by UCSF. ref SDS 51 WS5G
140540 - ..
140541 - [On 080410 Millie asks UCSF for research on causes of
140542 - Cellulitis how can recurrence be voided? ref SDS 52 PJ5Q
140544 - ..
140545 - [On 080410 Millie gets treatment on referral at UCSF for
140546 - IBC with cetuximab and chemotherapy Carboplatin, because
140547 - blood counts rise to highest ever. ref SDS 53 2N5F
140549 - ..
140550 - [On 080410 Millie examination in evening shows Cellulitis
140551 - rash and inflammation from lymphedema have substantially
140552 - subsided. ref SDS 54 V45J
140554 - ..
140555 - [On 080411 in the morning evidence of rash increasing on
140556 - the upper left arm, and on the chest IBC areas, initially
140557 - attributed to cetuximab side effects, because Millie has no
140558 - temperature, 97.2. ref SDS 55 V45J Late in afternoon rash
140559 - subsides, but not yet completely. ref SDS 55 HE4Q
140561 - ..
140562 - [On 080520 Millie suffers recurrence Cellulitis left arm,
140563 - begins 10 day treatment with Keflex. ref SDS 57 OU5J
140565 - ..
140566 - [On 090122 Millie dislocated shoulder and fracture suffered
140567 - from accident falling during exercise treated in Emergency
140568 - Department Kaiser Walnut Creek CA. ref SDS 60 WS5K
140575 - ..
1408 - Progress
140901 - Cellulitis Recurrence Moderate to Severe Swelling Inflammation
140902 - Delayed Reaction Fall 080125 Aligns Prior Cellulitis on 061027
140904 - Follow up ref SDS 38 V45J.
140906 - Millie returned from meeting at the Wellness Community today. She
140907 - was not feeling well...
140909 - 1. Bones ache
140910 - 2. Hips especially hurt
140911 - 3. Left arm hurts
140912 - 4. Temperature 101.9
140914 - ..
140915 - Examined left arm. Cellulitis rash approximately 50% which is
140916 - moderate, but likley increasing. There is no significant swelling
140917 - that usually occurs with Cellulitis.
140919 - [...below Cellulitis increases 70% left arm. ref SDS 0 FU87
140921 - [On 080629 bone pain, headache are side effects of Neupogen
140922 - treatments, ref SDS 59 TR5L, which the doctor prescribed on
140923 - 080403, ref SDS 46 6Y9K, Millie got the treatment with
140924 - self-injection on 080405. ref SDS 49 RU6I
140926 - ..
140927 - This recurrence follows prior events on 080304, ref SDS 38 0001, and
140928 - previously on 071214. ref SDS 28 V45J On 080313 Millie completed
140929 - 10-day treatment with Keflex for Cellulitis; no visible inflammation
140930 - or swelling that signal Cellulitis and lymphedema. ref SDS 44 MQ4I
140932 - [On 080410 Millie asks UCSF for research on causes of
140933 - Cellulitis how can recurrence be voided? ref SDS 52 PJ5Q
140935 - ..
140936 - [On 080520 Millie suffered recurrence Cellulitis and lymphedema
140937 - treatment with Keflex, ref SDS 57 OU5J; reported Cellulitis
140938 - recurrence to medical team, ref SDS 57 VN4O; primary care
140939 - physician at Kaiser prescribed 10 day treatment. ref SDS 57
140940 - 1K7H
140942 - ..
140943 - [On 080606 surgeon indicated diminished lymphatic system from
140944 - removing cancerous lymph nodes may eventually strengthen
140945 - because remaining lymph nodes become more robust, which reduces
140946 - occurance of lymphadema and Cellulitis. ref SDS 58 4P7L
140948 - ..
140949 - Main difference today is a temperature of 101.9. Previously, on
140950 - 080304 there was no temperature. ref SDS 38 0P96
140952 - ..
140953 - Prior Cellulitis and lymphedema are shown in case study on 061203.
140954 - ref SDS 15 YT4M
140956 - [...below Emergency Care Admissions nurse asks Millie about
140957 - scope of the problem, and patient history; does not have time
140958 - to review the record. ref SDS 0 0U69
140960 - ..
140961 - [...below Emergency Room nurse asks Millie about scope of
140962 - problem, and patient history; does not have time to review the
140963 - record. ref SDS 0 KF8F
140965 - ..
140966 - [...below Emergency Room Doctor asks Millie about scope of
140967 - problem, and patient history; does not have time to review the
140968 - record. ref SDS 0 F44W
140970 - ..
140971 - [...below, Admissions Doctor asks Millie about scope of
140972 - problem, and patient history again; does not have time to
140973 - review the record. ref SDS 0 PXPW
140975 - ..
140976 - Patient history shows Millie treated at Kaiser ER for Cellulitis when
140977 - temperature rises above 100.5, e.g., on 041202. ref SDS 5 IX9N On
140978 - 070607 Millie was treated with intravenous drugs at UCSF because
140979 - temparature increased above 102. ref SDS 21 8J37
Temperature 101.9 Cellulitis Recurrence Lymphedema Requires Treatmen
2404 - 1248
240501 - ..
240502 - Temperature 101.9 Requires Emergency Treatment Well Above 100.5
240504 - Follow up ref SDS 38 0P96.
240506 - Took her temperature at 1248 and got a reading of 101.9f.
240508 - ..
240509 - Patient history shows Millie treated at Kaiser ER for Cellulitis when
240510 - temperature rises above 100.5, e.g., on 041202. ref SDS 5 IX9N On
240511 - 070607 Millie was treated with intravenous drugs at UCSF because
240512 - temparature increased above 102. ref SDS 21 8J37
240514 - [...below, temperature falls to 101.2. ref SDS 0 H18Q
240516 - ..
240517 - [...below, temperature rises to 101.6; Millie goes to Kaiser
240518 - Emergency. ref SDS 0 0R4H
240520 - ..
240521 - [...below, notify primary care physician, and medical team at
240522 - UCSF Millie treated at Kaiser ER for Cellulitis with
240523 - temperature 101.9. ref SDS 0 AP5J
240525 - ..
240526 - [...below, temperature 101.7 at Kaiser Emergency. ref SDS 0
240527 - 0U69
240529 - ..
240530 - [...below, temperature drops to 100.5 at 1700. ref SDS 0 FY5X
240532 - ..
240533 - [...below, temperature drops to normal 98.7 at 2130.
240534 - ref SDS 0 M46X
Cellulitis Symptoms Temperature Chills Shakes Bones Hurt Arm Pain Ho
340401 - ..
340402 - Over-heated Temperature 101.9 Chills Shakes Symptoms Cellulitis
340403 - General Ill Feeling Beginning Today While at Wellness Community
340404 - Cellulitis Symptoms Temperature Chills Shakes Bones Hurt Arm Pain
340406 - Follow up ref SDS 38 0P44.
340408 - Cellulitis today may be delayed reaction to working out in the gym
340409 - yesterday, and increasing pace of hiking on Monday, when the route was
340410 - done in 45 minutes, considerably better than prior best time of 47
340411 - minutes.
340413 - ..
340414 - Millie said the exercise at the gym yesterday included one routine
340415 - that lifting the right and left arms alternatively to music. This was
340416 - done vigorously and numerous times, as with any physical work out to
340417 - build strength and range of motion, i.e., flexibility. After the
340418 - workout yesterday, she was perspiring heavily, and even more so the
340419 - day before on Monday, because of hiking fast over hills with high
340420 - temperature and humidity. Possibly, the perspiring process on the
340421 - left arm over-taxed the lymphatics on the left side, leading to trauma
340422 - that caused lymphedema, and then Cellulitis.
340424 - [...in another record earlier today, Millie reported to the
340425 - medical team increased exercise the past few weeks, since starting
340426 - on the 2nd arm of the clinical study that added Carboplatin
340427 - chemotherapy. ref SDS 50 W14X
340429 - ..
340430 - [...below Christina, RN, feels Cellulitis cannot be caused by over
340431 - exercising, which is good news. ref SDS 0 TG4L
340433 - ..
340434 - Cellulitis on 080304 was speculated as possibly delayed reaction to
340435 - severe fall on 080125. ref SDS 38 H132
340437 - ..
340438 - Millie has not suffered any evident scratches from the cat or
340439 - otherwise that might have caused infection. Possibly she was
340440 - scratched slightly by the cat, working in the garden, or the kitchen,
340441 - and it seemed so minor and incidental to other things that she has
340442 - forgotten.
340444 - ..
340445 - While at the Wellness Community support group meeting, Millie
340446 - suddently began feeling badly about 1030. AT first, her hips hurt
340447 - from sitting. Then she noticed pain in her left arm.
340449 - ..
340450 - She stayed for the entire meeting. Her condition got worse, including
340451 - feelings of being overheated (temperature), then chills, and shakes.
Keflex Cellulitis Treatment Cephalexin Tylenol Ice Reduce Temperatur
450401 - ..
450402 - Treatment Keflex Tylenol Ice Reduce Temperature Swelling Inflammation
450404 - Follow up ref SDS 38 106G.
450406 - Millie has Keflex for 2 10-day treatments previously prescribed on
450407 - 080305, ref SDS 39 5M3F, for medication in case Cellulitis and
450408 - lymphedema swelling occur again, as today. Since Cellulitis has
450409 - occurred today, per above, ref SDS 0 V45J, this treatment was started
450410 - immediately.
450412 - ..
450413 - The prescription on 080305 calls for 4 pills a day, i.e., every 6
450414 - hours, and for 10 days. ref SDS 23 IZ71
450416 - ..
450417 - Millie used 1 of the 2 10-day treatments for the prescription on
450418 - 080305, reported completed on 080313. ref SDS 44 V45J There was
450419 - concern on 080314 that Cellulitis occurred again, so Millie began
450420 - another 10-day treatment, ref SDS 45 V45J but this turned out to be
450421 - inflammation from treatment with cetuximab for cancer, and so
450422 - treatment was stopped. ref SDS 45 8U6K She therefore has Keflex still
450423 - on hand to start treatment today.
450425 - ..
450426 - Starting Keflex with the last bottle of pills, suggests we need
450427 - another prescription for 2 more bottles to treat future episodes.
450429 - [...below, Kaiser prescribes another 14-day treatment with
450430 - Keflex, ref SDS 0 F149, so Millie retains the reserve
450431 - prescription issued on 080305, per above. ref SDS 0 106G
450433 - ..
450434 - Icing left arm was also started, as previously done on 080304.
450435 - ref SDS 38 010G
450437 - ..
450438 - Tylonol 325 mg, took two for temperature.
Emergency Room Temperature 101.7 Cellulitis Left Arm Severe Red Rash
5604 - 1328
560501 - ..
560502 - Temperature Monitor Patient Progress
560504 - Follow up ref SDS 38 H18Q.
560506 - Temperature 101.2
560509 - ..
5608 - 1333
560901 - Kaiser Emergency Treatment
560903 - Temperature climbed back to 101.6.
560905 - Drove to emergency at Kaiser in Walunt Creek. This implements UCSF
560906 - guidance on 080304 for Millie to be examined by a doctor when
560907 - Cellulitis occurs. ref SDS 38 6S7I
560909 - [...below, notify primary care physician, and medical team at
560910 - UCSF Millie treated at Kaiser ER for Cellulitis with
560911 - temperature 101.9. ref SDS 0 AP5J
560914 - ..
5612 - 1348
561301 - Arrived Kaiser Emergency, and checked in.
561303 - Called Arlette while waiting in the lobby to see initial screening
561304 - task.
561306 - ..
561307 - Doctor Johnson is on vacation this week.
561309 - ..
561310 - Arlette got the first letter today when Millie reported good response
561311 - to treatment with Carboplatin last week. She has not yet seen the 2nd
561312 - letter notifying of Cellulitis relapse. Arlette will notify the
561313 - doctor if he checks in. She feels Emergency treatment is the best
561314 - course under Kaiser guidance when patients getting chemotherapy have
561315 - a temperature above 100.5. Wishes Millie good luck.
561320 - ..
5616 - 1421
561701 - Emergency Examination Temperature 101.7 Cellulitis Spreading
561703 - Millie examined by Oliver Naca, RN. Excellent job asking about
561704 - current problems and patient history.
561706 - ..
561707 - Temperature 101.7.
561709 - ..
561710 - Reviewed current problem of Cellulitis, per above, ref SDS 0 V45J, and
561711 - prior episode reported on 080304. ref SDS 38 V45J
561713 - ..
561714 - Oliver created a narrative in Kaiser's computer to explain patient
561715 - history of current emergency, and background.
561717 - [...below Emergency Room nurse asks Millie about scope of
561718 - problem, and patient history; does not have time to review the
561719 - record. ref SDS 0 KF8F
561721 - ..
561722 - [...below, Admissions Doctor asks Millie about scope of
561723 - problem, and patient history again. ref SDS 0 PXPW
561725 - ..
561726 - Examination of left arm shows advancing Cellulitis now approximately
561727 - 70% of left arm, compared to 50% at 1248 per above. ref SDS 0 OG7L
561729 - ..
561730 - Patient in clinical study for cetuximab and Carboplatin on referral
561731 - from Kaiser to UCSF.
561733 - ..
561734 - Patient on chemotherapy Carboplatin. Has received 2 treatments
561735 - beginning on 080313. ref SDS 43 TZ8I Second treatment with
561736 - Carboplatin was this past Thursday, 080403. ref SDS 47 TZ8I
561738 - ..
561739 - Millie has had approximately 65 weekly treatments with cetuximab
561740 - beginning on 070201. ref SDS 18 G68I
561742 - ..
561743 - Oliver noted in the record for blood draws from Millie's port to
561744 - perform lab testing rather than use a conventional needle that causes
561745 - Millie's arm to swell.
561748 - ..
5620 - 1443
562101 - Waiting Room until a room is available.
562104 - ..
5624 - 1454
562501 - Millie taken to examination and treatment room. Waiting for doctor
562502 - to arrive.
Examination Room Care Cellulitis Worsening Nurse Practitioner Reques
6704 - 1503
670501 - ..
670502 - Patient History Reviewed Again Cellulitis Advancing
670504 - Christina Jee, RN arives. She asks for explanation of problem; has
670505 - not had time to read Oliver's report, per above. ref SDS 0 W99H
670507 - ..
670508 - Review patient history of current problem, per above discussion with
670509 - Oliver, which he entered into the computer, ref SDS 0 FU80, and citing
670510 - the initial record reported above. ref SDS 0 V45J
670512 - [...below Emergency Room Doctor asks Millie about scope of
670513 - problem, and patient history; does not have time to review the
670514 - record. ref SDS 0 F44W
670516 - ..
670517 - [...below, Admissions Doctor asks Millie about scope of problem
670518 - and patient history again. ref SDS 0 PXPW
670520 - ..
670521 - Examination now shows Cellulitis increased to entire left arm,
670522 - increased from 70%, 30 minutes ago, per above. ref SDS 0 FU87 Still
670523 - minimal swelling.
670526 - ..
670527 - Causation Cellulitis Exercise Discounted Likely Infection Cut Scratch
670529 - Christina seems to indicate that Cellulitis cannot be caused by trauma
670530 - from over exercising, as speculated when Cellulitis occurred last year
670531 - while at UCSF on 070607. ref SDS 21 ZH6I The year before, on 061027
670532 - the attending physician presented analysis the Cellulitis was caused
670533 - by a fall at BART. ref SDS 11 714I She feels Millie may have picked up
670534 - an infection from a "table," or a scratch working in the garden.
670535 - Millie has been scratched by the cat and gotten Cellulitis, reported
670536 - on 050212. ref SDS 6 0001 There is no record such an event in this
670537 - case. Millie has increased exercise in the past few weeks, per above.
670538 - ref SDS 0 0P44
670542 - ..
6708 - 1512
670901 - Doctor Provda arrives.
670903 - Asks Millie about patient history. Doctor Provda did not have enough
670904 - time to review the record, submitted earlier to Kaiser, per above.
670905 - ref SDS 0 V45J
670907 - ..
670908 - Millie explains again events of the day, per discussions above with
670909 - Christina, ref SDS 0 PV3R, and with Oliver, also above, ref SDS 0
670910 - FU80, citing patient history, per above. ref SDS 0 OG81
670914 - ..
670915 - Labs Blood Culture Xray EKG Diagnostics Ordered for Assessment
670917 - Doctor Provda orders...
670919 - 1. laboratory blood work................ ref SDS 0 439L
670920 - 2. blood cultures....................... ref SDS 0 3Y6L
670921 - 3. xray................................. ref SDS 0 IH5H
670922 - 4. EKG diagnostics...................... ref SDS 0 PH8R
670924 - ..
670925 - The doctor ordered Tylonol, but cancelled the prescription because
670926 - patient history shows that Millie took Tylonol at 1300, per above.
670927 - ref SDS 0 IF3G
670929 - ..
670930 - The doctor feels Millie will have to be admitted today in order to
670931 - treat advancing Cellulitis and high temperature, noted above.
670932 - ref SDS 0 1E4G, and during Admissions for ER care. ref SDS 0 0U69
Blood Draw Failed Wrong Needle Used Laboratory Tests Medical Mistake
7904 - 1520
790501 - ..
790502 - Blood Draw Problem Using Wrong Needle
790504 - Follow up ref SDS 11 ZP43.
790506 - Christina draws blood for lab testing. She used the port, per
790507 - Oliver's planning above. ref SDS 0 FU40
790509 - ..
790510 - A saline flush was not used on this occassion.
790512 - ..
790513 - Blood flow was very slow. Christina asked Millie to sit up; she asked
790514 - her to cough, and then raise her right arm up and down. This did not
790515 - solve the problem.
790517 - ..
790518 - Saline flush was tried.
790520 - ..
790521 - Blood then flowed normally. However, this only worked for 1 vial.
790523 - ..
790524 - Christina decided to try a longer needle, a 1" instead .75" initially
790525 - tried and which is failing.
790527 - ..
790528 - Another nurse borrows Christina's scissors.
790531 - ..
7908 - 1534
790901 - Christina returns with a 1" needle for the port catheter.
790903 - This solved the problem.
790905 - ..
790906 - Millie explained how to secure the needle with gause and paper tape.
790908 - ..
790909 - Reflects problems using Huber needle with port catheter in Emergency
790910 - Room on 061027. ref SDS 11 HD5I
790913 - ..
7912 - 1535
791301 - Lian Fong Liu arrives for Millie to sign documents to pay for
791302 - Emergency care. She waits while Christina completes drawing blood.
791304 - ..
791305 - Lian offers to get Millie more ice water. Nice improvement from prior
791306 - experience with payment ops in the Emergency Room, e.g., report on
791307 - 050212. ref SDS 6 JV8J
791309 - ..
791310 - Christina needs her scissors. Lian goes and finds the nurse who
791311 - borrowed the scissors.
791314 - ..
7916 - 1540
791701 - Blood draw completed for 4 vials.
791703 - Lian assists Millie sign admission documents.
791705 - ..
791706 - Lian takes Millie's credit card, and promises not to go to Macy's.
791710 - ..
7920 - 1542
792101 - Urine sample. Christina helps Millie get up from the gurney, so she
792102 - can go to the rest room.
Payment Processing for Emergency Care Handled Professionaly
9004 - 1546
900501 - ..
900502 - Payment Processing for Emergency Care
900504 - Lian returns with payment approval documents to sign, and to return
900505 - Mil's credit card. Millie is still in the rest room.
900508 - ..
9008 - 1546
900901 - Millie returns mission accomplished.
900904 - ..
9012 - 1550
901301 - Lian returns. She has a receipt for payment, and returns credit
901302 - card.
901305 - ..
9016 - 1552
901701 - Malissa arrives to do an EKG.
901703 - She has a cough. Coughs several times during the 5 minute procedure.
Xray EKG Testing Negative Findings Cellulitis Lymphedema Emergency C
A304 - 1558
A30501 - ..
A30502 - EKG Xray Testing Negative Findings
A30504 - EKG completed.
A30507 - ..
A308 - 1603
A30901 - Millie taken for xray.
A30904 - ..
A312 - 1614
A31301 - Millie returns xray completed.
A31303 - Waiting for results of testing...
Cefazolin Antibiotic Treatment Cellulitis Lymphedema Temperature Alr
AF04 - 1653
AF0501 - ..
AF0502 - Cefazolin Antibiotic Treatment Begins Temperature Already Dropping
AF0503 - Antibiotic Cefazolin Treatment Begins Temperature Already Dropping
AF0504 - Treatment Cefazolin Antibiotic Begins Temperature Already Dropping
AF0505 - Temperature Already Dropping Treatment Cefazolin Antibiotic Begins
AF0507 - Cristina returns. She has not seen results of blood tests.
AF0509 - She starts Millie with saline.
AF0511 - ..
AF0512 - Connects antibiotic treatment.
AF0514 - Cefazolin inj 1 g (ANCEF/KEFZOL)
AF0516 - Start 080409 1530 to 080410 0329
AF0518 - ..
AF0519 - Vitals....
AF0521 - BP Pulse Temperature
AF0523 - 1659 113 65 76 100.5
AF0524 - 1705 113 61 73
AF0526 - ..
AF0527 - Temperature 100.5 shows marked improvement from 101.7 at time of
AF0528 - admission 3 hours ago. ref SDS 0 0U69
Laboratory Tests Blood Counts Very High WBC Immune System Fighting I
CM04 - 1716
CM0501 - ..
CM0502 - Test Data Trend Analysis Incomplete Omits 6 Blood Tests at UCSF
CM0503 - Labs Blood Tests Show Immune System Fighting Infection WBC Very High
CM0505 - During treatment, Christina submitted results of the test.
CM0507 - ..
CM0508 - Christina checked Kaiser's computer and noted that tests for WBC and
CM0509 - other ANC criteria are very high compared to prior tests at Kaiser
CM0510 - last year in October on 071017, which is shown in the record for the
CM0511 - examination by the primary care physician on 071116, ref SDS 25 U55Y,
CM0512 - and most recently cited still unchanged in the medical chart during
CM0513 - examination at Kaiser on 080305. ref SDS 39 417N
CM0515 - ..
CM0516 - Mille reported that she had Neupogen treatment on 080405, ref SDS 49
CM0517 - RU6I, which increases blood counts for chemotherapy treatments at
CM0518 - UCSF, prescribed by UCSF on 080403. ref SDS 46 6Y9K
CM0520 - ..
CM0521 - Christina explained that unusually high WBC blood counts are expected
CM0522 - today because the immune system activates to resist Cellulitis
CM0523 - infection. There is a compound effect with Neupogen.
CM0525 - [On 080501 UCSF cites rise in blood counts yesterday, after
CM0526 - 1 Neupogen treatment, to change prescription from 2 to 1
CM0527 - weekly treatments with Neupogen for enabling continuous
CM0528 - chemotherapy treatments; there is no evident consideration
CM0529 - that blood counts may have increased in part due to
CM0530 - resisting Cellulitis infection. ref SDS 56 M658
CM0532 - ..
CM0533 - Christina said everything else in the blood test is "stable" compared
CM0534 - to results from 6 months ago last October at Kaiser on 071017.
CM0535 - ref SDS 24 OS5K
CM0537 - ..
CM0538 - Millie asked about comparing the test today with results from blood
CM0539 - testing at UCSF last month on 080306, which was subitted to Kaiser the
CM0540 - next day on 080307, ref SDS 42 JY5K, and for the purpose of accurate
CM0541 - patient history, as Christina notes today is critical to Emergency
CM0542 - care?
CM0544 - ..
CM0545 - Christina said there is no indication in the computer of any blood
CM0546 - tests between today and 071017. Millie advised that she has been
CM0547 - tested about six (6) times since last October, i.e., every 4 weeks at
CM0548 - UCSF. On 070610 the primary care physician reported that the right
CM0549 - communication channels were working for Millie's comprehensive care on
CM0550 - referral to UCSF from Kaiser. ref SDS 22 OG7F
CM0552 - ..
CM0553 - Christina said Kaiser can only consider data that somebody enters in
CM0554 - the computer. This aligns with patient history, for example working
CM0555 - with the primary care physician on 070516, ref SDS 20 RH9H, and
CM0556 - further shown in case study on 061024 showing reliance on computer
CM0557 - data innoculates health care providers from knowledge of patient
CM0558 - history, ref SDS 10 9W4O, due to failure coordinating referral care,
CM0559 - reported in case study on 070130. ref SDS 17 RM4G
CM0561 - ..
CM0562 - Christina submitted results for the blood test today...
CM0578 - ..
CM0579 - Log#: 080409 14:25
CM0580 - <----------------------- K a i s e r ------------------->
CM0581 - Type Results Units Normal ACRO
CM0582 - ..
CM0583 - CBC with DIFF & PLT CT CBCD
CM0584 - ..
CM0585 - WBC COUNT H* 12.9 K/uL 3.4 - 10 WBC
CM0587 - Note: WBC 12.9 very high signals immune system active to
CM0588 - resist Cellulitis, per Christina, above. ref SDS 0 BS8H
CM0590 - ..
CM0591 - RBC COUNT 4.19 M/uL 3.60 - 5.70 RBC
CM0592 - RDW, RBC H* 14.4 % 11.9 - 14.3 RBC
CM0593 - HEMOGLOBIN 13.4 g/dL 11.5 - 15.0 HGB
CM0594 - HEMATOCRIT 37.9 % 34 - 46 HCT
CM0595 - MCV 91 fL 80 - 100 MCV
CM0596 - MCH No Report pg 26 - 34 MCH
CM0597 - MCHC No Report g/dL 31 - 36 MCHC
CM0598 - PLATELETS x10-3 L* 136 K/uL 140 - 400 PLT
CM0600 - ..
CM0601 - Neutrophils 83 % 50 - 70
CM0603 - ..
CM0604 - Lymphocytes L* 8 % 20 - 50 L-A
CM0605 - MONOS 8 % 0 - 11 M-A
CM0606 - Eosinophils 1 % 1 - 5 E-A
CM0607 - Basophil 0 % 0 - 2 B-A
CM0609 - ..
CM0610 - <----------------------- K a i s e r ------------------->
CM0611 - Type Results Units Normal ACRO Type
CM0613 - ..
CM0614 - ELECTROLYTE PANEL LYTE
CM0615 - SODIUM L* 134 mEq/L 137 - 145 NA
CM0616 - POTASSIUM 3.5 mEq/L 3.5 - 5.3 K
CM0617 - CHLORIDE 100 mmol/L 98 - 107 CL
CM0618 - Bicarb 24 mmol/L 23 - 32 CO2
CM0619 - ANION GAP 10 3 - 14 ANGA
CM0620 - ..
CM0621 - BUN 10 mg/dL 8 - 23 BUN
CM0622 - GlUCOSE 117 mg/dL 70 - 199 GLU
CM0624 - ..
CM0625 - CREAT with eGFR
CM0626 - CREATININE 0.45 mg/dL 0.60 - 1.20 CR
CM0627 - ..
CM0628 - eGFR if Caucasian >60 mL/min GFRC
CM0629 - eGFR if African Amer >60 mL/min GFRA
CM0631 - ..
CM0632 - Comment, glomerular filtration rate **
CM0633 - Lactate, ser/plas 1.5
CM0634 - Differential panel Auto Dif
CM0636 - ..
CM0637 - Urine Analysis
CM0638 - Specimen source Clean
CM0639 - Microscopic Exam, urin Indicatd
CM0640 - Glucose UA Negative
CM0641 - Bilirubin, UA Negative
CM0642 - Ketones, UA Negative
CM0643 - Specific gravity UA 1.010
CM0644 - Hemoglobin, ur, ql Small (A)
CM0645 - pH, UA 6.0
CM0646 - Protein, UA Negative
CM0647 - Urobilinogen, UA <1mg/dL
CM0648 - Nitrite, UA Negative
CM0649 - Leukocyte Esterase, UA Negative
CM0653 - ..
CM0654 - Blood Culture Test Results Pending
CM0656 - Christina said blood cultures will not be available for a few days.
Admission Hospital Recovery Cellulitis Pending Room Availability Pat
CX04 - 1733
CX0501 - ..
CX0502 - Admission Hospital Recovery Cellulitis Pending Room Availability
CX0504 - Christina confirms that Doctor Provda wants Millie admitted.
CX0506 - They do not have a room available yet, so Millie will be moved to a
CX0507 - holding area "yellow." An admitting doctor will then make another
CX0508 - examination and execute orders for Millie to be taken upstairs to the
CX0509 - hosital.
CX0511 - ..
CX0512 - Millie asked about getting something to eat.
CX0514 - ..
CX0515 - Christina said she will order dinner for Millie, and this will be
CX0516 - served after Millie is moved to the Yellow Department.
CX0519 - ..
CX08 - 1804
CX0901 - Christina takes Millie to the yellow department to wait for a room
CX0902 - assignment in the hospital.
CX0904 - ..
CX0905 - Jennifer is the new nurse.
CX0907 - ..
CX0908 - Jennifer said that Millie's room assignment in the hospital might not
CX0909 - be available until tomorrow. Millie may stay in the Emergency Yellow
CX0910 - Department over night, as occurred previously on 060709. ref SDS 11
CX0911 - OM6J
CX0914 - ..
CX11 - 1827
CX1201 - ..
CX1202 - Millie is still hungery. Christina's plan an hour ago to order dinner
CX1203 - for Millie has not worked. ref SDS 0 R87L Millie wants soup for
CX1204 - dinner. Went to the cafeteria and bought a small bowl of splitpea
CX1205 - soup, and a bowl of vegetable soup with rice. Took this back to Mil's
CX1206 - room #5 in the Yellow transfer section of the Emergency Department.
CX1208 - ..
CX1209 - She likes both soups, and the bread and butter, but does not eat very
CX1210 - much.
CX1212 - ..
CX1213 - Millie is still waiting for the admitting doctor to pay a visit.
CX1215 - ..
CX1216 - Talk to Jennifer in the Medical Control Center.
CX1218 - ..
CX1219 - Jennifer has no information on the schedule.
CX1222 - ..
CX15 - 1909
CX1601 - Left hospital with Millie watching television.
CX1604 - ..
CX19 - 1932
CX2001 - Arrived home.
Doctor Not Enough Time Review Patient History Relies Foggy Memory En
E704 - 1944
E70501 - ..
E70502 - Patient History Accurate Memory Saves Time Money Health Care
E70503 - Admission Doctor Examination Patient History Effects Hospitilization
E70505 - Millie called.
E70507 - ..
E70508 - She has been examined by the Emergency Care Admissions Physician,
E70509 - Doctor Lisa Pujol, MD. The doctor did not have time to review the
E70510 - record, and so asks Millie about background of current problem?
E70512 - ..
E70513 - Millie explains again report to Nurse Oliver, which was written up in
E70514 - Kaiser's computer, per above, ref SDS 0 FU80, explained again to Nurse
E70515 - Practitioner Christina, ref SDS 0 PV3R, and again to Doctor Provda.
E70516 - ref SDS 0 F44W So far, no one has time to review the record submitted
E70517 - to Kaiser for accurate understanding of patient history relevant to
E70518 - the current emergency, per above. ref SDS 0 V45J
E70520 - ..
E70521 - Doctor Pujol asks about history of prior Cellulitis and lymphedema?
E70523 - ..
E70524 - Millie asks about Kaiser's records on prior care for Cellulitis?
E70526 - ..
E70527 - The doctor said it takes a long time to look up patient history on
E70528 - Kaiser's comnputer; talking to the patient seems fast and easy. This
E70529 - practice aligns with case study on 061024 showing difficulty finding
E70530 - patient history on Kaiser's computer in time to be effective treating
E70531 - the patient. ref SDS 10 NU5O
E70533 - ..
E70534 - Kaiser's health care practice aligns with trends in Knowledge
E70535 - Managment to work by conversation, reported on 010114. ref SDS 3 EK3I
E70536 - On 011102 professional paper proposes conversation for storytelling to
E70537 - learn implicit knowledge from memory of experience, citing examples
E70538 - fixing plumbing problems with conversation rather than checking the
E70539 - plans and specifications, ref SDS 4 H461; similarly copy machines are
E70540 - repaired with conversation because talking is faster and easier than
E70541 - finding and reading product specifications. ref SDS 4 HD8M
E70543 - ..
E70544 - Millie explains case study on patient history beginning on 030109
E70545 - treating recurrent Cellulitis and lymphedema reported in the record
E70546 - for 061203, ref SDS 15 YT4M, which was submitted to Kaiser earlier
E70547 - this afternoon to assist the medical team, per above. ref SDS 0 J83G
E70548 - Mastectomy surgery on 051021 increased risk of lymphedema, ref SDS 8
E70549 - QU5I, which in turn increases recurrence of Cellulitis by preventing
E70550 - normal functioning of the left arm, reported on 060417 ref SDS 9 2Z9M
E70552 - ..
E70553 - Recent Cellulitis occurred last month on 080304, and before that on
E70554 - 071214, both treated at home with Keflex for 10-days, per above.
E70555 - ref SDS 0 OG81
E70557 - ..
E70558 - The doctor advised that she cannot find any record of Millie's care
E70559 - for IBC during the past year in Kaiser's computer.
E70561 - ..
E70562 - Millie relates treatment for IBC since 040517, reported in case study
E70563 - of patient history on 050812. ref SDS 7 FS6K
E70565 - ..
E70566 - Millie explained treatment with cetuximab and Carboplatin in clinical
E70567 - study at UCSF on referral from Kaiser, reported on 070105. ref SDS 16
E70568 - PK68 Treatment with cetuximab alone began on 070201. ref SDS 18 G68I
E70569 - Treatment with chemotherapy was ordered on 080306, ref SDS 40 459G;
E70570 - the first treatment with Carboplatin was on 080313. ref SDS 43 TZ8I
E70571 - As a result of low blood counts, the 2nd treatment with Carboplatin
E70572 - was delayed until just last week on 080403. ref SDS 47 TZ8I
E70574 - ..
E70575 - Doctor Pujol commends Millie's memory and clarity presenting patient
E70576 - history, despite advancing age of 72 years, and despite weakened
E70577 - condition from debilitating effects of current illness. The doctor
E70578 - feels that accurate understanding of patient history enables better
E70579 - health care decisions. This aligns with reporting on 990912
E70580 - explaining the high cost of medical mistakes occurs primarily from
E70581 - failed communication that prevents understanding critical details in
E70582 - time to take effective action. ref SDS 2 0001
E70584 - ..
E70585 - The doctor indicated that since Millie's temperture has started to
E70586 - come down with treatment, per above, ref SDS 0 JZ5K, Millie may be
E70587 - able to go home today, rather than be admitted to the hospital. She
E70588 - feels Millie's patient history of successful care for Cellulitis at
E70589 - home shows this may be a viable solution that will save a lot of time
E70590 - and money involved with hospital care.
E70592 - ..
E70593 - Doctor Pujol has an Internet address...
E70595 - http:\\www.permanente.net/doctor/lisapujol
E70597 - ..
E70598 - The doctor plans to collaborate with oncology consultant for Emergency
E70599 - Department to further evaluate Millie's case based on patient history.
E70603 - ..
E709 - 1955
E71001 - Millie called. Doctor Pujol has decided not to admit Millie to the
E71002 - hospital. She can come home and continue treatment with oral Keflex.
E71004 - ..
E71005 - Millie said nobody has checked her temperature since 1700. ref SDS 0
E71006 - FY4L She still feels warm.
E71008 - ..
E71009 - There has been no discussion about getting treatment at UCSF tomorrow.
E71013 - ..
E713 - 2030
E71401 - Millie Ready to Go Home Waiting for Discharge Document Processing
E71403 - Arrived at hospital. Millie is dressed and waiting for discharge
E71404 - documentation. There is no progress on processing. No one seems to
E71405 - be working on discharge ops.
E71407 - ..
E71408 - Discussed discharge processing with Jennifer at the Control Center
E71409 - counter.
E71411 - ..
E71412 - Jennifer said that Doctor Pujol has to prepare forms on the computer
E71413 - for discharging Millie, including a home care instructions, and
E71414 - narrative with explanation of reasoning for discharge, e.g.,
E71415 - tempearture normal, Cellulitis rash subsiding, no signs of problems
E71416 - from blood work and other testing, etc.
Discharge Documentation Waived Keflex 14-day Home Care Prescribed Em
F004 - 2043
F00501 - ..
F00502 - Discharge Documentation Waived Millie Goes Home to Avoid Infection
F00504 - Doctor Pujol stops by to visit Millie. She explains difficulty
F00505 - preparing discharge documentation because her computer skills are for
F00506 - admitting patients. The doctor does not know how to use the computer
F00507 - for discharge ops; there evidently is no one available to assist with
F00508 - the process. Difficulty getting things done when everything is on the
F00509 - computer is a common problem shown by case study on 061024.
F00510 - ref SDS 10 NU5O This will improve as the work force gains experience
F00511 - using techynology for traditional knowledge work.
F00513 - ..
F00514 - Kaiser's practice providing support for oncology consultation, per
F00515 - above, ref SDS 0 T44F, can be extended to provide support for using
F00516 - the computer to make preparing discharge documentation fast and easy,
F00517 - so the patient has feedback on planning, instructions, and
F00518 - expectations without relying entirerly on assumptions from memory of
F00519 - hurried conversations.
F00521 - ..
F00522 - Jennifer decides that since Doctor Pujol has not admitted Millie to
F00523 - the hospital, then Kaiser does not need to give Millie discharge
F00524 - documentation, per earlier planning above, ref SDS 0 F16P, explaining
F00525 - disposition of the transaction today, and reasons for release and
F00526 - instructions for patient home care.
F00528 - ..
F00529 - The doctor said Millie can go home. She does not have to wait for
F00530 - discharge documents, but can rely on verbal instructions. This aligns
F00531 - with UCSF practices prescribing Magnesium replacement last week on
F00532 - 080403. ref SDS 48 O76G
F00536 - ..
F00537 - Keflex Oral Antibiotic 14-day Home Treatment Prescribed
F00538 - Hospital Care Increases Risk of Getting Sick Millie Not Admitted
F00539 - Chemotherapy Patients High Risk for Disease from Infection in Hospital
F00541 - Doctor Pujol says she consulted with the on-call oncology doctor, per
F00542 - planning related earlier, shown above. ref SDS 0 T44F
F00544 - ..
F00545 - They decided not to admit Millie to the hospital because Millie is
F00546 - being treated with chemotherapy for cancer. This status presents high
F00547 - risk for disease caused by infection. They feel staying in the
F00548 - hospital increases exposure to a lot of infection, and so Millie's
F00549 - best course is to get home treatment, since her temperature is coming
F00550 - down.
F00552 - ..
F00553 - The doctor has prescribed another 14 days of Keflex. The prescription
F00554 - has already been entered in the computer, and so should be ready in
F00555 - the Discharge Pharmacy. She wants Millie to take Keflex for 14 days.
F00556 - The 20 day Keflex prescription prescribed on 080305 by the primary
F00557 - care physician, ref SDS 39 5M3F, can remain in reserve for future
F00558 - recurrence, illustrated by the emergency earlier this morning, per
F00559 - above. ref SDS 0 106G
F00561 - ..
F00562 - As long as Millie's temperature is not elevated to create a greater
F00563 - risk of infection as a chemotherapy patient, than getting sick in the
F00564 - hospital, then home care aligns with patient history shown in the case
F00565 - study on 061203, ref SDS 15 YT4M, of recent episodes, beginning on
F00566 - 071214, ref SDS 28 V45J, and most recently last month on 080304.
F00567 - ref SDS 38 V45J In both cases, home care with 10-day treatments of
F00568 - Keflex were effective, reported on 080313. ref SDS 44 V45J
UCSF Treatment Cetuximab Carboplatin Chemotherapy on Clinical Study
FG0401 - ..
FG0402 - UCSF Treatment on Clinical Study Tomorrow Based on Local Evaluation
FG0404 - Doctor Pujol indicated that Kaiser's oncology consultant recommends
FG0405 - Millie go to UCSF tomorrow for regularly scheduled treatment on
FG0406 - Thursday. UCSF can make an assessment of readiness for treatment with
FG0407 - cetuximab and Carboplatin, or with cetuximab alone. Since the blood
FG0408 - counts are high today, reflecting Neupogen treatment prescribed on
FG0409 - 080403, ref SDS 47 QY6H, and taken the next day on 080404, and further
FG0410 - elevated today by the immune system activating to resist Cellulitis,
FG0411 - per above, ref SDS 0 075H, this may be sufficient to support treatment
FG0412 - at UCSF tomorrow.
FG0414 - ..
FG0415 - The doctor explained having marked on Millie's left arm the current
FG0416 - spread of Cellulitis. She said not to get this area wet in a shower
FG0417 - tomorrow. UCSF can use the markings tomorrow to assess Cellulitis
FG0418 - subsiding or advancing for consideration in giving treatment for
FG0419 - cancer.
FG0421 - [On 080410 Millie notifies UCSF that Kaiser ER released patient
FG0422 - for treatment chemotherapy clinical study based on assessment
FG0423 - by UCSF. ref SDS 51 WS5G
FG0425 - ..
FG0426 - [On 080410 examination at UCSF about 0800 shows slight
FG0427 - expanding disease beyond lines drawn today showing spread of
FG0428 - Cellulitis. ref SDS 53 3R4H
FG0430 - ..
FG0431 - [On 080410 examination at home about 1700 shows arm nearly
FG0432 - normal, no signs of Cellulitis rash. ref SDS 54 V45J
FG0437 - ..
FG07 - 2057
FG0801 - Visit Discharge Pharmacy.
FG0803 - Millie 14-day prescription for Keflex was ready.
FG0806 - ..
FG11 - 2127
FG1201 - Temperature Normal at Home Begin Oral Keflex Treatments
FG1203 - Millie arrives home.
FG1205 - Temperature 98.7.
FG1207 - ..
FG1208 - This is further decline from 100.5 at 1653, per above, ref SDS 0 FY4L,
FG1209 - continuing decline from 101.9 at 1248 this afternoon, per above.
FG1210 - ref SDS 0 0P96
FG1212 - ..
FG1213 - Millie had some yogurt with canned peaches.
FG1215 - ..
FG1216 - She is in bed. Fixed ice packs on left arm again,
FG1217 - per above.
FG1220 - ..
FG15 - 2300
FG1601 - Millie takes Keflex. Next treatment at 0500 tomorrow.
Notify Medical Team UCSF Kaiser Cellulitis Lmphedema Recurrence Lef
FQ0401 - ..
FQ0402 - Notify Medical Team of Cellulitis Request Guidance
FQ0404 - Follow up ref SDS 38 AP5J, ref SDS 28 NF4G.
FQ0406 - Millie submitted ref DIT 1 0001 to the primary care physician at
FQ0407 - Kaiser with copies to the medical team at UCSF. ref DIT 1 00W3
FQ0409 - 1. Please see the record today reporting Cellulitis recurrence.
FQ0410 - ref SDS 0 V45J
FQ0412 - ..
FQ0413 - 2. Note temperature has fallen from 101.9 to 101.2 over 20 minutes
FQ0414 - with starting Keflex and icing the arm. ref SDS 0 H18Q
FQ0416 - ..
FQ0417 - 3. Standing guidance is for Emergency Room care when temperature
FQ0418 - is above 100.5, reported on 041202. ref SDS 5 IX9N
FQ0420 - ..
FQ0421 - 4. I am leaving for Kaiser ER, and can coordinate further from
FQ0422 - there.
FQ0424 - [...above, called Arlette in Oncology Department at Kaiser
FQ0425 - who advised the doctor is on vacation. ref SDS 0 FU6G
FQ0427 - [...above, Millie gets IV treatment for Cellulitis;
FQ0428 - temperature drops to 100.5. ref SDS 0 FY4L
FQ0430 - ..
FQ0431 - [...above, doctor plans to admit Millie to treat
FQ0432 - Cellulitis. ref SDS 0 08BH
FQ0434 - ..
FQ0435 - [...above, doctor considering sending Millie home, because
FQ0436 - temperature has come down. ref SDS 0 BU4G
FQ0438 - ..
FQ0439 - [...above, doctor releases Millie for 14-day home care with
FQ0440 - Keflex, because risk of getting disease is greater in the
FQ0441 - hospital. ref SDS 0 F142
FQ0443 - ..
FQ0444 - [On 080410 Millie notifies UCSF that Kaiser ER released
FQ0445 - patient for treatment chemotherapy clinical study based on
FQ0446 - assessment by UCSF. ref SDS 51 WS5G
FQ0448 - ..
FQ0449 - [On 080410 Millie gets treatment on referral at UCSF for
FQ0450 - IBC with cetuximab and chemotherapy Carboplatin, because
FQ0451 - blood counts rise to highest ever. ref SDS 53 2N5F
FQ0453 - ..
FQ0454 - [On 080410 Millie examination in evening shows Cellulitis
FQ0455 - rash and inflammation from lymphedema have substantially
FQ0456 - subsided. ref SDS 54 V45J
FQ0458 - ..
FQ0459 - [On 080411 in the morning evidence of rash increasing on
FQ0460 - the upper left arm, and on the chest IBC areas, initially
FQ0461 - attributed to cetuximab side effects, because Millie has no
FQ0462 - temperature, 97.2. ref SDS 55 V45J