CONTACTS 

SUBJECTS
Cellulitis Left Arm Lymphedema Swelling Moderate Temperature 101.9 R

1403 -
1403 -    ..
1404 - Summary/Objective
1405 -
140501 - Follow up ref SDS 38 0000. ref SDS 31 0000.
140502 -
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
140569 -
140570 -
140571 -
140572 -
140573 -
140575 -  ..
1406 -
1407 -
1408 - Progress
1409 -
140901 - Cellulitis Recurrence Moderate to Severe Swelling Inflammation
140902 - Delayed Reaction Fall 080125 Aligns Prior Cellulitis on 061027
140903 -
140904 - Follow up ref SDS 38 V45J.
140905 -
140906 - Millie returned from meeting at the Wellness Community today.  She
140907 - was not feeling well...
140908 -
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.
140918 -
140919 -        [...below Cellulitis increases 70% left arm. ref SDS 0 FU87
140920 -
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
140931 -
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
140955 -
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
140980 -
140981 -
140982 -
1410 -

SUBJECTS
Temperature 101.9 Cellulitis Recurrence Lymphedema Requires Treatmen

2403 -
2404 - 1248
240501 -  ..
240502 - Temperature 101.9 Requires Emergency Treatment Well Above 100.5
240503 -
240504 - Follow up ref SDS 38 0P96.
240505 -
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
240513 -
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
240535 -
240536 -
240537 -
240538 -
2406 -

SUBJECTS
Cellulitis Symptoms Temperature Chills Shakes Bones Hurt Arm Pain Ho

3403 -
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
340405 -
340406 - Follow up ref SDS 38 0P44.
340407 -
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.
340423 -
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.
340452 -
340453 -
340454 -
340455 -
340456 -
3405 -

SUBJECTS
Keflex Cellulitis Treatment Cephalexin Tylenol Ice Reduce Temperatur

4503 -
450401 -  ..
450402 - Treatment Keflex Tylenol Ice Reduce Temperature Swelling Inflammation
450403 -
450404 - Follow up ref SDS 38 106G.
450405 -
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.
450428 -
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.
450439 -
450440 -
450441 -
4505 -

SUBJECTS
Emergency Room Temperature 101.7 Cellulitis Left Arm Severe Red Rash

5603 -
5604 - 1328
560501 -  ..
560502 - Temperature Monitor Patient Progress
560503 -
560504 - Follow up ref SDS 38 H18Q.
560505 -
560506 - Temperature 101.2
560507 -
560509 -  ..
5606 -
5607 -
5608 - 1333
5609 -
560901 - Kaiser Emergency Treatment
560902 -
560903 - Temperature climbed back to 101.6.
560904 -
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
560908 -
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
560912 -
560914 -  ..
5610 -
5611 -
5612 - 1348
5613 -
561301 - Arrived Kaiser Emergency, and checked in.
561302 -
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.
561316 -
561317 -
561318 -
561320 -  ..
5614 -
5615 -
5616 - 1421
5617 -
561701 - Emergency Examination Temperature 101.7 Cellulitis Spreading
561702 -
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.
561716 -
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.
561746 -
561748 -  ..
5618 -
5619 -
5620 - 1443
5621 -
562101 - Waiting Room until a room is available.
562102 -
562104 -  ..
5622 -
5623 -
5624 - 1454
5625 -
562501 - Millie taken to examination and treatment room.  Waiting for doctor
562502 - to arrive.
562503 -
562504 -
562505 -
5626 -

SUBJECTS
Examination Room Care Cellulitis Worsening Nurse Practitioner Reques

6703 -
6704 - 1503
670501 -  ..
670502 - Patient History Reviewed Again Cellulitis Advancing
670503 -
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
670511 -
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.
670524 -
670526 -  ..
670527 - Causation Cellulitis Exercise Discounted Likely Infection Cut Scratch
670528 -
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
670539 -
670540 -
670542 -  ..
6706 -
6707 -
6708 - 1512
6709 -
670901 - Doctor Provda arrives.
670902 -
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
670911 -
670912 -
670914 -  ..
670915 - Labs Blood Culture Xray EKG Diagnostics Ordered for Assessment
670916 -
670917 - Doctor Provda orders...
670918 -
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
670933 -
670934 -
670935 -
670936 -
6710 -

SUBJECTS
Blood Draw Failed Wrong Needle Used Laboratory Tests Medical Mistake

7903 -
7904 - 1520
790501 -  ..
790502 - Blood Draw Problem Using Wrong Needle
790503 -
790504 - Follow up ref SDS 11 ZP43.
790505 -
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.
790529 -
790531 -  ..
7906 -
7907 -
7908 - 1534
7909 -
790901 - Christina returns with a 1" needle for the port catheter.
790902 -
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
790911 -
790913 -  ..
7910 -
7911 -
7912 - 1535
7913 -
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.
791312 -
791314 -  ..
7914 -
7915 -
7916 - 1540
7917 -
791701 - Blood draw completed for 4 vials.
791702 -
791703 - Lian assists Millie sign admission documents.
791705 -  ..
791706 - Lian takes Millie's credit card, and promises not to go to Macy's.
791707 -
791708 -
791710 -  ..
7918 -
7919 -
7920 - 1542
7921 -
792101 - Urine sample.  Christina helps Millie get up from the gurney, so she
792102 - can go to the rest room.
792103 -
792104 -
792105 -
792106 -
7922 -

SUBJECTS
Payment Processing for Emergency Care Handled Professionaly

9003 -
9004 - 1546
900501 -  ..
900502 - Payment Processing for Emergency Care
900503 -
900504 - Lian returns with payment approval documents to sign, and to return
900505 - Mil's credit card.  Millie is still in the rest room.
900506 -
900508 -  ..
9006 -
9007 -
9008 - 1546
9009 -
900901 - Millie returns mission accomplished.
900902 -
900904 -  ..
9010 -
9011 -
9012 - 1550
9013 -
901301 - Lian returns.  She has a receipt for payment, and returns credit
901302 - card.
901303 -
901305 -  ..
9014 -
9015 -
9016 - 1552
9017 -
901701 - Malissa arrives to do an EKG.
901702 -
901703 - She has a cough.  Coughs several times during the 5 minute procedure.
901704 -
901705 -
901706 -
9018 -

SUBJECTS
Xray EKG Testing Negative Findings Cellulitis Lymphedema Emergency C

A303 -
A304 - 1558
A30501 -  ..
A30502 - EKG Xray Testing Negative Findings
A30503 -
A30504 - EKG completed.
A30505 -
A30507 -  ..
A306 -
A307 -
A308 - 1603
A309 -
A30901 - Millie taken for xray.
A30902 -
A30904 -  ..
A310 -
A311 -
A312 - 1614
A313 -
A31301 - Millie returns xray completed.
A31302 -
A31303 - Waiting for results of testing...
A31304 -
A31305 -
A31306 -
A314 -

SUBJECTS
Cefazolin Antibiotic Treatment Cellulitis Lymphedema Temperature Alr

AF03 -
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
AF0506 -
AF0507 - Cristina returns.  She has not seen results of blood tests.
AF0508 -
AF0509 - She starts Millie with saline.
AF0511 -  ..
AF0512 - Connects antibiotic treatment.
AF0513 -
AF0514 -                   Cefazolin inj 1 g (ANCEF/KEFZOL)
AF0515 -
AF0516 -     Start 080409 1530 to 080410 0329
AF0518 -  ..
AF0519 - Vitals....
AF0520 -
AF0521 -                 BP       Pulse   Temperature
AF0522 -
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
AF0529 -
AF0530 -
AF0531 -
AF06 -

SUBJECTS
Laboratory Tests Blood Counts Very High WBC Immune System Fighting I

CM03 -
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
CM0504 -
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.
CM0524 -
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...
CM0563 -
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
CM0586 -
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
CM0650 -
CM0651 -
CM0653 -  ..
CM0654 - Blood Culture Test Results Pending
CM0655 -
CM0656 - Christina said blood cultures will not be available for a few days.
CM0657 -
CM0658 -
CM0659 -
CM0660 -
CM07 -

SUBJECTS
Admission Hospital Recovery Cellulitis Pending Room Availability Pat

CX03 -
CX04 - 1733
CX0501 -  ..
CX0502 - Admission Hospital Recovery Cellulitis Pending Room Availability
CX0503 -
CX0504 - Christina confirms that Doctor Provda wants Millie admitted.
CX0505 -
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.
CX0517 -
CX0519 -  ..
CX06 -
CX07 -
CX08 - 1804
CX09 -
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
CX0912 -
CX0914 -  ..
CX10 -
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.
CX1220 -
CX1222 -  ..
CX13 -
CX14 -
CX15 - 1909
CX16 -
CX1601 - Left hospital with Millie watching television.
CX1602 -
CX1604 -  ..
CX17 -
CX18 -
CX19 - 1932
CX20 -
CX2001 - Arrived home.
CX2002 -
CX2003 -
CX2004 -
CX21 -

SUBJECTS
Doctor Not Enough Time Review Patient History Relies Foggy Memory En

E703 -
E704 - 1944
E70501 -  ..
E70502 - Patient History Accurate Memory Saves Time Money Health Care
E70503 - Admission Doctor Examination Patient History Effects Hospitilization
E70504 -
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...
E70594 -
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.
E70600 -
E70601 -
E70603 -  ..
E707 -
E708 -
E709 - 1955
E710 -
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.
E71010 -
E71011 -
E71013 -  ..
E711 -
E712 -
E713 - 2030
E714 -
E71401 - Millie Ready to Go Home Waiting for Discharge Document Processing
E71402 -
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.
E71417 -
E71418 -
E71419 -
E715 -

SUBJECTS
Discharge Documentation Waived Keflex 14-day Home Care Prescribed Em

F003 -
F004 - 2043
F00501 -  ..
F00502 - Discharge Documentation Waived Millie Goes Home to Avoid Infection
F00503 -
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
F00533 -
F00534 -
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
F00540 -
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
F00569 -
F00570 -
F00571 -
F006 -

SUBJECTS
UCSF Treatment Cetuximab Carboplatin Chemotherapy on Clinical Study

FG03 -
FG0401 -  ..
FG0402 - UCSF Treatment on Clinical Study Tomorrow Based on Local Evaluation
FG0403 -
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.
FG0420 -
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
FG0433 -
FG0434 -
FG0435 -
FG0437 -  ..
FG05 -
FG06 -
FG07 - 2057
FG08 -
FG0801 - Visit Discharge Pharmacy.
FG0802 -
FG0803 - Millie 14-day prescription for Keflex was ready.
FG0804 -
FG0806 -  ..
FG09 -
FG10 -
FG11 - 2127
FG12 -
FG1201 - Temperature Normal at Home Begin Oral Keflex Treatments
FG1202 -
FG1203 - Millie arrives home.
FG1204 -
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.
FG1218 -
FG1220 -  ..
FG13 -
FG14 -
FG15 - 2300
FG16 -
FG1601 - Millie takes Keflex.  Next treatment at 0500 tomorrow.
FG1602 -
FG1603 -
FG1604 -
FG1605 -
FG1606 -
FG17 -

SUBJECTS
Notify Medical Team UCSF Kaiser Cellulitis  Lmphedema Recurrence Lef

FQ03 -
FQ0401 -  ..
FQ0402 - Notify Medical Team of Cellulitis Request Guidance
FQ0403 -
FQ0404 - Follow up ref SDS 38 AP5J, ref SDS 28 NF4G.
FQ0405 -
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
FQ0408 -
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.
FQ0423 -
FQ0424 -            [...above, called Arlette in Oncology Department at Kaiser
FQ0425 -            who advised the doctor is on vacation. ref SDS 0 FU6G
FQ0426 -
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
FQ0463 -
FQ0464 -
FQ0465 -
FQ0466 -
FQ0467 -
FQ0468 -
FQ0469 -
FQ0470 -
FQ0471 -
FQ0472 -
FQ0473 -
FQ0474 -
FQ0475 -
FQ05 -