CONTACTS 

SUBJECTS
Meeting Examination Doctor Review Strategy Work Plan 3rd Cycle 1st T

1503 -
1503 -    ..
1504 - Summary/Objective
1505 -
150501 - Follow up ref SDS A4 0000. ref SDS 94 0000.
150502 -
150503 -
150504 -
150505 -
150506 -
150507 -
150508 -
150510 -  ..
1506 -
1507 -
1508 - Progress
1509 -
150901 - Agenda for the meeting today was submitted with Millie's letter to the
150902 - medical team yesterday on 080430. ref SDS D4 1H6Y
150903 -
150904 -
150905 -
150906 -
1510 -

SUBJECTS
Work Plan Carboplatin Full Dose Optimize Recovery NEUTS 1.34 Blood C

4003 -
400401 -  ..
400402 - Work Plan Continue Carboplatin Full Dose Optimize Recovery Prospects
400403 - Neupogen Increase Blood Counts Enable Full Dose Carboplatin Treatment
400404 - NEUTS 1.34 Blood Counts Low Treatment Approved with Neupogen Treatments
400405 -
400406 - Millie had a blood draw in the Infusion Clinic this morning at 0800.
400407 - ref SDS D6 DT3M
400409 -  ..
400410 - During the meeting today in the Breast Care Clinic, Brigid introduced
400411 - Megan who is taking over for Jackie as Clinical Research Coordinator
400412 - for Millie's treatment.  Jackie is going to law school, after working
400413 - the past 15 months, as Clinical Research Coordinator for Doctor Rugo
400414 - on Millie's case.
400416 -  ..
400417 - Brigid displayed results of the blood test on the computer in the
400418 - examination room.  Brigid was disappointed that NEUTS 1.34 are still
400419 - below the safe level for chemotherapy today, ref SDS D6 QY6H, despite
400420 - not getting chemotherapy during the "bye-week" in the 4-week cycle for
400421 - Carboplatin, implementing Brigid's instructions in UCSF's letter on
400422 - 080418. ref SDS C9 MR3L
400424 -  ..
400425 - As proposed in Brigid's letter on 080418 saying to skip Neupogen
400426 - during the bye-week for Carboplatin, discussed today treatment plans
400427 - to solve problem of low blood counts that have forced Millie to skip
400428 - treatments with Carboplatin chemotherapy, most recently on 080410.
400429 - ref SDS C8 PU6K
400431 -  ..
400432 - At that time on 080418, Brigid reported the doctor would discuss today
400433 - possibly lowering the dose of Carboplatin hoping to reduce effects on
400434 - blood counts so that Millie will not have to skip treatments.
400435 - ref SDS C9 MR3L  Millie responded on 080423 with a possible treatment
400436 - plan to reduce the dose of Carboplatin for 1st or 2nd weekly
400437 - treatment, and then give the full dose for 2nd or 3rd treatment in the
400438 - cycle, since the 4th week in the cycle already skips Carboplatin under
400439 - the protocol. ref SDS D0 OY7S  Doctor Rugo said in a reply letter that
400440 - the dose for Carboplatin cannot be increased to improve care, after
400441 - once being decreased to avoid low blood counts. ref SDS D0 I49N
400443 -  ..
400444 - Today, during the meeting, Millie confirmed notice in her letter to
400445 - UCSF on 080423 that she wants to continue getting the full dose of
400446 - Carboplatin in order to increase chances of continued improvement
400447 - treating IBC, ref SDS D0 TY6Y, noted today by Brigid during
400448 - examination, per below. ref SDS 0 JJ3N  Millie wants to first try
400449 - maintaining blood counts to get the full dose of Carboplatin by adding
400450 - treatment with Neupogen.
400452 -  ..
400453 - Since Doctor Rugo is out of town today, Brigid will advise Clinical
400454 - study management that Millie wants to optimize recovery from cancer
400455 - with 1 Neupogen treatment for every week in the cycle, rather than
400456 - skip Neupogen during the bye-week, and in order to maintain blood
400457 - counts for getting the full dose of Carboplatin, since this
400458 - prescription was ordered by the doctor starting the previous cycle on
400459 - 080403, ref SDS C1 6Y9K  Getting the full dose of Carboplatin has been
400460 - very effective reducing IBC symptoms, and getting 1 Neupogen treatment
400461 - per week was very effective increasing NEUTS 6.85, about 400% above
400462 - the target level of 1.8, reported on 080410. ref SDS C7 QY6H
400464 -  ..
400465 - After meeting with the medical team on the 2nd floor, Megan did not
400466 - submit the Chemotherapy Orders and blood vials for delivery by Millie
400467 - to the nurse in the Infusion Clinic on the 5th floor.
400468 -
400469 -        [On 080529 review of Chemotherapy Orders for today, 080501,
400470 -        which were received from UCSF on 080515, ref SDS E1 E43I, and
400471 -        shown in this part of the record, ref SDS E7 MM9I, discovered
400472 -        UCSF evidently reduced the dose of Carboplatin and prescribed 2
400473 -        weekly Neupogen treatments, per below, ref SDS D6 PVUQ,
400474 -        contrary to understandings with the medical team today, 080501,
400475 -        that Millie would get full dose of Carboplatin with 1 weekly
400476 -        Neupogen tratment this cycle. ref SDS D5 CZ3N
400478 -         ..
400479 -        [On 080529 Chemotherapy Orders for Carboplatin show same dose
400480 -        175 mg as today, ref SDS E7 PVUQ, but there is a handwritten
400481 -        mark that says "error," dated 080529 with initials mg.
400482 -        ref SDS E7 F55F
400484 -         ..
400485 -        [On 080625 Millie asks medical team about error in Chemotherapy
400486 -        Orders discovered on 080605. ref SDS F4 PQWV
400488 -         ..
400489 -        [On 080716 Millie letter to Kaiser asks about meeting to
400490 -        discuss CA 15-3 141 and progression of disease before
400491 -        scheduled meeting on 080829. ref SDS F6 VG7L
400493 -  ..
400494 - Later, Megan visited Millie and the nurse in the Infusion Clinic on
400495 - the 5th floor. ref SDS D6 4E9N  She confirmed that the Clinical Study
400496 - people approved Millie to get Carboplatin chemotherapy today despite
400497 - NEUTS 1.34, below the 1.50 standard that signals safe treatment.  She,
400498 - also, submitted Chemotherapy Orders today for both cetuximab,
400499 - ref SDS D6 MM6N, and Carboplatin. ref SDS D6 I66I  This is the first
400500 - time in patient history, since starting the 2nd Arm of the clinical
400501 - study on 080313 that UCSF has submitted Chemotherapy Orders for both
400502 - drugs. ref SDS D6 4E9N
400503 -
400505 -  ..
400506 - Neupogen 2 Treatments Prescribed by Clinical Study Changed to 1 by UCSF
400507 -
400508 - Megan submitted the Chemotherapy Orders for today to the nurse showing
400509 - the clinical study management recommended 2 treatments with Neupogen
400510 - this cycle for each weekly treatment with Carboplatin. ref SDS D6 PWSY
400511 - Megan explained that increasing Neupogen from 1 to 2 treatments per
400512 - week this cycle will increase and maintain blood counts at or above a
400513 - level showing the immune system is strong enough for safe treatment
400514 - with the full dose of Carboplatin chemotherapy, discussed during the
400515 - meeting with Brigid this morning, per above. ref SDS 0 CZ3N
400517 -  ..
400518 - Millie did not receive the Chemotherapy Orders today.  Understandings
400519 - were based on conversations with Megan and the nurse. ref SDS D6 4E9N
400521 -  ..
400522 - Before getting information about the 2 treatments with Neupogen a
400523 - letter to UCSF and with a copy to Kaiser confirmed understandings in
400524 - the meeting with the medical team that Millie will continue getting a
400525 - full dose of Carboplatin to provide the best chance of recovery from
400526 - IBC, and this will supplemented with 1 treatment per week of Neupogen
400527 - that maintains the immune system with blood counts at a safe level for
400528 - chemotherapy treatments.
400529 -
400530 -        [...in another record, after the meeting Millie sent a letter
400531 -        to the medical team confirming understandings the doctor
400532 -        ordered a full dose of Carboplatin chemotherapy, and ordered 1
400533 -        treatment of Neupogen to maintain blood counts. ref SDS D7 MG3P
400535 -  ..
400536 - Subsequently, Brigid wrote a letter to Millie explaining that review
400537 - of patient history shows Millie's blood counts increased dramatically
400538 - from 1.34 to over 6.00, reported 080410, ref SDS C7 QY6H, with just 1
400539 - Neupogen treatment prescribed on 080403. ref SDS C1 6Y9K  As a result,
400540 - UCSF changed the prescription from 2 to just 1 Neupogen treatment per
400541 - week for this new cycle starting today, which, it turned out,
400542 - conformed with the letter sent to UCSF shortly after the meeting.
400543 - ref SDS D7 MG3P  Brigid does not relate in her letter that UCSF
400544 - considered unusual contextual effects of Millie suffering Cellulitis
400545 - recurrence during the week when blood counts increased, and the
400546 - possibility that much of the rise was due to that factor, as related
400547 - in Millie's letter to UCSF on 080410. ref SDS C6 F85X
400548 -
400549 -        [On 080502 health care cost containment saves patient $500 by
400550 -        checking the record to discover only 1 Neupogen treatment
400551 -        needed. ref SDS D9 OV8J
400553 -         ..
400554 -        [On 080529 blood counts improve, ref SDS E6 4F38, medical team
400555 -        prescribes 1 treatment with Neupogen starting the 4th cycle.
400556 -        ref SDS E6 4F42; during treatment in the Infusion Clinic after
400557 -        meeting with medical team, nurse confirms guidance for 1
400558 -        treatment with Neupogen. ref SDS E7 TE6N
400560 -         ..
400561 -        [On 080609 Kaiser prescribed Neupogen treatment in Infusion
400562 -        Clinic for quality care that avoids confusion and mistakes.
400563 -        ref SDS F1 IL6I
400565 -  ..
400566 - In any case, starting with 1 Neupogen treatment might work, and
400567 - reduces wear and tear, including emotional capital on the patient.
400568 -
400569 -
400570 -
4006 -

SUBJECTS
Cellulitis Lymphedema Research Reduce Recurrence UCSF No Ideas Advic

6003 -
600401 -  ..
600402 - Cellulitis Lymphedema Research Reduce Recurrence
600403 -
600404 - Millie asked for advice and referral to UCSF for research on
600405 - Cellulitis and lymphedema which increase health care costs and take a
600406 - lot of time for providers and the patient to recover?  Case study on
600407 - patient history in the record for 061203 shows Millie has suffered
600408 - recurrence some 41 times since 2003, ref SDS 47 YT4M, most recently on
600409 - 080409. ref SDS C5 0001  Causes of Cellulitis and lymphedema are shown
600410 - in case study on 070130. ref SDS 60 VX6F  Affects of exercise causing
600411 - recurrence of Cellulitis and lymphedema are tracked in a third study
600412 - on 070218. ref SDS 66 K55K
600414 -  ..
600415 - Brigid seemed to indicate today that UCSF has no advice nor remedies
600416 - to reduce risks of Cellulitis and lymphedema on Millie's left arm.
600417 -
600418 -        [On 080606 surgeon advises that when lymph nodes are removed,
600419 -        remaining lymphatic system eventually grows more robust and
600420 -        reduces recurrence of lymphedema and Cellulitis from increased
600421 -        exercise. ref SDS E8 4P6L
600422 -
600423 -
600424 -
6005 -

SUBJECTS
Examination IBC Stable to Improved Condition Full Dose Carboplatin C

7603 -
760401 -  ..
760402 - Examination Finds Substantially Reduced IBC Rash Response to Treatment
760403 -
760404 - Follow up ref SDS C1 S55F. ref SDS B7 NW3N.
760406 -  ..
760407 - Brigid made an examination.  She received Millie's letter on 080423
760408 - asking for UCSF opinion on evident good response to treatment with
760409 - reduced IBC rash after starting 2nd arm of clinical study that added
760410 - treatment with Carboplatin chemotherapy. ref SDS D0 TY7X
760412 -  ..
760413 - Brigid reported today IBC disease shows favorable response to
760414 - treatment improving findings on 080403. ref SDS C1 SA5J  There is now
760415 - substantially less IBC rash with Millie getting full dose of
760416 - Carboplatin (230 mg) prescribed for each treatment, beginning with
760417 - cycle 1 on 080313. ref SDS B9 2N4N  Brigid indicated this is good
760418 - recovery from cancer relapse diagnosed by the doctor on 080219,
760419 - ref SDS B5 QY5I, and despite Millie getting only 50% of Carboplatin
760420 - chemotherapy treatments.  Low blood counts required skipping
760421 - treatments on 080320, ref SDS C0 SE5R, and again most recently on
760422 - 080417. ref SDS C8 PU6K
760424 -         ..
760425 -        [On 080502 examination by primary care physician at Kaiser
760426 -        finds favorable response to treatment, ref SDS D8 NH4N, despite
760427 -        getting only 50% of prescribed Carboplatin chemotherapy,
760428 -        ref SDS D8 NH4N, which Millie has tolerated well shown by
760429 -        significantly increased exercise. ref SDS D8 ZD9O
760431 -         ..
760432 -        [On 080520 Millie reported in a letter to the Medical team
760433 -        again further increased energy and exercise showing
760434 -        continued tolerance of chemotherapy Carboplatin treatments
760435 -        at UCSF. ref SDS E2 TV6U
760436 -
760437 -
760438 -
7605 -

SUBJECTS
CT Test 080425 Findings Cancer Stable Align with Examination Reverse

A203 -
A20401 -  ..
A20402 - CT Test Findings Cancer Stable Align with Examination
A20403 -
A20404 - Brigid seemed to indicate findings from the CT test on 080425 show
A20405 - response to treatment increased on 080313 adding Carboplatin to
A20406 - cetuximab.  Rising adenopathy reported in the prior test on 080212,
A20407 - and reviewed on 080215 seems to have ended based on the recent CT
A20408 - test.  This aligns with review on 080428, ref SDS D2 EO8F, and further
A20409 - reflects examination today showing IBC disease subsiding. ref SDS 0
A20410 - NW3N
A20411 -
A20412 -
A20413 -
A205 -

SUBJECTS
Exercise Fitness Increase Good Tolerance Carboplatin Chemotherapy Hi

AS03 -
AS0401 -  ..
AS0402 - Exercise Increases Good Tolerance Carboplatin Chemotherapy
AS0403 -
AS0404 - Brigid noted Millie's letter on 080409 citing very good tolerance of
AS0405 - Carboplatin chemotherapy added to cetuximab for the 2nd arm of the
AS0406 - study. ref SDS C4 W14X  Millie reported today significantly increased
AS0407 - exercise in the gym and hiking at Lafayette Reservoir adding distance
AS0408 - and increasing the pace of workouts.  Increases quality of life,
AS0409 - vigor, interest and ability to get things done.
AS0411 -  ..
AS0412 - Previously, exercise was cited on 030606 at Kaiser for helping
AS0413 - patients maintain fitness for aggressive chemotherapy to recover from
AS0414 - cancer. ref SDS 5 NE57
AS0415 -
AS0416 -        [On 080502 examination by primary care physician at Kaiser
AS0417 -        finds favorable response to treatment, ref SDS D8 NH4N,
AS0418 -        despite getting only 50% of prescribed Carboplatin
AS0419 -        chemotherapy, ref SDS D8 NH4N, which Millie has tolerated
AS0420 -        well shown by significantly increased exercise. ref SDS D8
AS0421 -        ZD9O
AS0423 -         ..
AS0424 -        [On 080520 Millie reported in a letter to the Medical team
AS0425 -        again further increased energy and exercise showing
AS0426 -        continued tolerance of chemotherapy Carboplatin treatments
AS0427 -        at UCSF. ref SDS E2 TV6U
AS0429 -         ..
AS0430 -        [On 080528 Millie sent another letter to the medical team
AS0431 -        reporting rising energy and exercise. ref SDS E5 XY9J
AS0433 -  ..
AS0434 - On 050609 article reports study found exercise repairs some of the
AS0435 - cumulative damage chemotherapy causes to the immune system; this
AS0436 - prolings effectiveness of chemotherapy treatment to aid recovery from
AS0437 - breast cancer, ref SDS 21 F88M; quality of life from strength and
AS0438 - range of motion are obvious benefits of exercise. ref SDS 21 F93X
AS0439 -
AS0440 -
AS0441 -
AS05 -

SUBJECTS
Current Medications New UCSF Case Management System Relies Patient P

BB03 -
BB0401 -  ..
BB0402 - Current Medications Case Management Referral Coordination with Kaiser
BB0403 -
BB0404 - Follow up ref SDS B6 7Y6F.
BB0405 -
BB0406 - Brigid took down a list of current medications, which is a new quality
BB0407 - control procedure being tried at UCSF.  Maintaining a list of current
BB0408 - medications is listed in referral coordination planning proposed on
BB0409 - 070222. ref SDS 67 V16F  On 080307 Millie notified Kaiser Coagulation
BB0410 - Control Department, and the Oncology Department to update list of
BB0411 - current medications, ref SDS B8 RW3T, based on Kaiser's medical chart
BB0412 - for Millie from meeting with the primary care physician on 080305,
BB0413 - ref SDS B6 7Y6F, including discussion of Prosac and Keflex at that
BB0414 - time on 080305. ref SDS B6 IE6M  Today, UCSF did not have the list,
BB0415 - and so asked Millie to construct another list from personal memory.
BB0417 -  ..
BB0418 - Brigid seemed to present a future procedure of UCSF using the list
BB0419 - prepared by hand writing today to construct a printed report which the
BB0420 - patient will examin on subsequent meetings, and continually update,
BB0421 - including sign to authenticate accuracy of the report, so that UCSF
BB0422 - can maintain a list of current medications.
BB0423 -
BB0424 -     [On 080529 Lynn asked Millie if the UCSF front desk staff in the
BB0425 -     breast care clinic submitted the printed list of current
BB0426 -     medications for review, update, and signature; this was not done
BB0427 -     for the meeting on 080529. ref SDS E6 8A9G
BB0428 -
BB0429 -
BB0430 -
BB05 -

SUBJECTS
Magnesium Low Blood Counts 1.6 Below 1.8 Requirement Labs UCSF Magne

C203 -
C20401 -  ..
C20402 - Magnesium Low Treatment Prescribed
C20403 -
C20404 - Magnesium 1.6 was low again today, so Brigid prescribed treatment with
C20405 - magnesium during infusion treatment today, as was done previously on
C20406 - 080404, ref SDS C3 O059, for the blood test the day before on 080403.
C20407 - ref SDS C2 CP6J
C20409 -  ..
C20410 - Sodium is also low in the blood test today.  Brigid noted this is only
C20411 - very slightly low, as is carbon, and so these conditions do not
C20412 - require treatment.
C20413 -
C20414 -
C20415 -
C205 -

SUBJECTS
Power Port Huber Needle Solution UCSF Mistakes CT Test Injury 4 Need

CM03 -
CM0401 -  ..
CM0402 - CT Test Huber Needle Power Port Inject Contrast Medium
CM0403 - Power Port Huber Needle CT Test New Method Avoid Needle Punctures
CM0404 -
CM0405 - Brigid noted during the meeting today that she received Millie's
CM0406 - letter submitted yesterday on 080430 requesting UCSF comment on
CM0407 - Kaiser's letter the day before on 080429, ref SDS D4 W64T, which
CM0408 - advised that Millie's primary care physician is investigating the use
CM0409 - of a "Huber" needle with Millie's current port catheter for CT tests.
CM0410 - ref SDS D3 1H6Y  Using a port avoids injury, pain, and suffering which
CM0411 - have escalated with recent CT tests using conventional IV needle
CM0412 - punctures into Millie's right arm to inject test contrast medium,
CM0413 - reported last week on 080425. ref SDS D1 FP6F
CM0415 -  ..
CM0416 - Brigid advised that last June in 2007, UCSF adopted a policy of
CM0417 - implanting only Power Port catheters for IV transfusions and drawing
CM0418 - blood.  She explained that UCSF experienced problems using standard
CM0419 - port catheters for injecting CT test contrast medium.  These
CM0420 - injections create greater pressures on the port mechanism than occurs
CM0421 - from blood draws and IV injections of chemotherapy treatment drugs,
CM0422 - e.g., Taxotere, Bevacizumab, Carboplatin, and this can cause the port
CM0423 - to fail, with significant problems for patients.  Brigid said the new
CM0424 - Power Port catheters are designed to withstand the higher pressures
CM0425 - that occur with CT test injections.  This solves problems of patient
CM0426 - safety that occurred with the earlier technology for port catheters.
CM0427 - Brigid was unaware of any patient safety issues using the new Power
CM0428 - Ports for injecting CT test contrast medium.
CM0430 -  ..
CM0431 - Millie asked how the Power Port can be used in her case?
CM0433 -  ..
CM0434 - Brigid feels the Power Port has to be implanted through another
CM0435 - surgery at the same location as the current port.  She said the port
CM0436 - should not be installed on the left side where IBC disease has been
CM0437 - active.  This aligns with procedures explained at Kaiser on 040318.
CM0438 - ref SDS 10 OF7H  Nor can the port be installed on a leg, or below the
CM0439 - chest area.  Brigid seemed to say the only way Millie can use a Power
CM0440 - Port catheter is to remove and replace the existing port.
CM0442 -  ..
CM0443 - Surgery to upgrade Millie's port catheter to a Power Port is needed in
CM0444 - time for the next CT test.  The recent test on 080425 was on the 12
CM0445 - week schedule the doctor implemented on 071009, ref SDS B2 985H; the
CM0446 - previous test on 080212 was expedited by the doctor on 080207 to
CM0447 - evaluate progression of disease. ref SDS B4 GH5M  The 12 week schedule
CM0448 - calculates to 080718 for the next CT test.
CM0449 -
CM0450 -     [On 080502 Millie met with the primary care physician at Kaiser;
CM0451 -     the doctor made findings of injury to Millie's right arm caused by
CM0452 -     needle punctures to inject contrast medium; ref SDS D8 WX6I; he
CM0453 -     considered UCSF experience using Power Ports to inject CT test
CM0454 -     contrast medium which avoids trauma from conventional IV needle
CM0455 -     punctures, ref SDS D8 J13G; during the meeting, the doctor sent a
CM0456 -     referral letter to the surgeon to replace the port catheter with a
CM0457 -     Power Port for injecting contrast medium on future CT tests.
CM0458 -     ref SDS D8 VG5J
CM0460 -      ..
CM0461 -     [On 080502 Millie sent a letter coordinating the medical team on
CM0462 -     work at Kaiser to implant a Power Port in time for doing the next
CM0463 -     CT test with a Power Port. ref SDS D9 GN8P
CM0465 -      ..
CM0466 -     [On 080508 Millie asks primary care physician about progress
CM0467 -     scheduling surgery to upgrade the port catheter to a Power Port
CM0468 -     for injecting contrast medium in time for the next CT test.
CM0469 -     ref SDS E0 GO8G
CM0471 -      ..
CM0472 -     [On 080520 Kaiser did not respond; Millie sent followed up letter
CM0473 -     asking Kaiser to coordinate with the Surgery department on
CM0474 -     expediting Power Port surgery, ref SDS E2 GS8K, in time for next
CM0475 -     CT test expected in 4 weeks. ref SDS E2 TV4S
CM0477 -      ..
CM0478 -     [On 080523 Millie received a letter from Kaiser advising
CM0479 -     that the surgeon reports Kaiser can upgrade Millie's port
CM0480 -     catheter to a Power Port, and he made a referral for this
CM0481 -     work to be performed, ref SDS E3 MG6F; this will solve the
CM0482 -     problems reported on 080425 injecting contrast medium for CT
CM0483 -     tests. ref SDS D1 FP6F
CM0485 -      ..
CM0486 -     [On 080528 Millie's letter to the medical team coordinated
CM0487 -     planning required for surgery to implant a Power Port,
CM0488 -     ref SDS E5 IJ6W, and for CT test department to use the Power
CM0489 -     Port for Millie's next test. ref SDS E5 IK4Q
CM0491 -      ..
CM0492 -     [On 080606 Millie met with the surgeon at Kaiser on planning to
CM0493 -     upgrade port catheter to Power Port implements direction from UCSF
CM0494 -     to do the work on the right side opposite from the primary
CM0495 -     location of Millie's cancer on the left side. ref SDS E8 IT77
CM0497 -      ..
CM0498 -     [On 080608 Millie sent a letter to the surgeon using Kaiser's
CM0499 -     internal email system, because the doctor is not included in
CM0500 -     distribution for referral coordination with the medical team at
CM0501 -     Kaiser and UCSF; and notifying the surgeon of requirements to
CM0502 -     coordinate surgery to implant the Power Port and to access the new
CM0503 -     port with a Huber needle to enable CT testing within the next few
CM0504 -     days after surgery. ref SDS E9 XS4S
CM0506 -      ..
CM0507 -     [On 080609 Kaiser Surgery Department notified the patient that
CM0508 -     requirements for coordination of Power Port surgery in time for
CM0509 -     the next CT test were presented to the Schedule Department.
CM0510 -     ref SDS F0 MG5I
CM0512 -      ..
CM0513 -     [On 080617 Power Port surgery scheduled on 080708. ref SDS F2
CM0514 -     3C7N; CT test using Power Port scheduled 10 days later on 080718
CM0515 -     1100. ref SDS F2 DF55
CM0517 -      ..
CM0518 -     [On 080619 Millie notified medical team at Kaiser and UCSF that CT
CM0519 -     test is scheduled to use the Power Port on 080718, ref SDS F3
CM0520 -     YU6X; cites requirements to resolve protocol and certification
CM0521 -     issues over next 4 weeks. ref SDS F3 YV4R
CM0523 -      ..
CM0524 -     [On 080625 Millie's letter to medical team at Kaiser and UCSF
CM0525 -     confirms planning for CT test at Kaiser to use the Power Port for
CM0526 -     saving time and money that meets requirements cost containment.
CM0527 -     ref SDS F4 IU7R
CM0529 -      ..
CM0530 -     [On 080702 Millie's letter to medical team confirms that on 080627
CM0531 -     the primary care physician coordinated support by the Infusion
CM0532 -     Clinic to access the Power Port on 080718 in time for CT test at
CM0533 -     1100; and further initiated planning that, if no one else is
CM0534 -     assigned, the primary care physician will personally press the
CM0535 -     button for the CT test using the Power Port on 080718. ref SDS F5
CM0536 -     EQ3T
CM0538 -  ..
CM0539 - Brigid further indicated that surgery to remove and replace the
CM0540 - existing port with a Power Port presents high risks of surgery.  She
CM0541 - commented that risks Millie faces from trauma to her arm, experienced
CM0542 - recently on 080425, ref SDS D1 9W9I, are likely less than risks from
CM0543 - surgery to upgrade the port that will avoid trauma to the arm from
CM0544 - future CT test injections.
CM0545 -
CM0546 -     [On 080606 Kaiser surgeon schedules work to upgrade port catheter
CM0547 -     to a Power Port; reports experience shows this work can be done
CM0548 -     with risks comparable to the original surgery classified as
CM0549 -     minimal. ref SDS E8 IT6M
CM0551 -  ..
CM0552 - UCSF analysis today seems conflicting with Rosalie's explanation at
CM0553 - Kaiser on 040402 that outpatient minor surgery to implant port
CM0554 - catheter equipment is a common solution to avoid injury from continued
CM0555 - needle penetrations. ref SDS 11 V750  At that time, Kaiser did not
CM0556 - present risks of surgery as criteria for avoiding this solution, and
CM0557 - in fact scheduled the surgery.  The work was performed on 04019.
CM0558 - Kaiser post operation report described successful surgery, the whole
CM0559 - thing took about 20 minutes, ref SDS 13 PPSW
CM0561 -  ..
CM0562 - Kaiser's post-operation report has proven accurate, since the port
CM0563 - catheter has been effective for the past 4 years eliminating needle
CM0564 - punctures except for injecting CT test contrast medium.  Since this
CM0565 - latter issue CT test injectins has now become extremely problematic it
CM0566 - is unclear why upgrading the port should present greater risks than
CM0567 - existed originally, and which Kaiser has demonstrated ability to
CM0568 - manage successfully.
CM0570 -  ..
CM0571 - Brigid further explained that UCSF approves using a standard port
CM0572 - catheter, like Millie now has, to inject CT contrast medium for
CM0573 - patients who have severe injury from needle penetrations, as Millie
CM0574 - suffered on 080425. ref SDS D1 FP6F  Brigid indicated this procedure
CM0575 - requires slowing the rate of injecting CT contrast medium in order to
CM0576 - avoid damaging the port catheter, and so involves risks of failure.
CM0578 -  ..
CM0579 - This seems to suggest a strategy of trying Millie's current port on
CM0580 - the next CT test, and if it is damaged, then schedule replacement for
CM0581 - the test after that.  Brigid indicated that some CT test professionals
CM0582 - avoid accessing a port catheter for injecting contrast medium.  Millie
CM0583 - recalled asking the CT test technician at Kaiser on 080425 about using
CM0584 - her port catheter, and he was adament Kaiser would not approve this
CM0585 - procedure. ref SDS D1 2I4F
CM0587 -  ..
CM0588 - Since Kaiser policy prevents using a port catheter, Millie needs
CM0589 - surgery to upgrade to a Power Port as explained by Brigid today, per
CM0590 - above. ref SDS 0 TQ6F  Surgery should occur befor the next CT test.
CM0591 - The recent test on 080425 was 12 weeks after the prior test on 080212.
CM0592 - This allows 2 - 3 months for the surgery in time for the next CT test
CM0593 - in mid-July.
CM0594 -
CM0595 -        [On 080502 primary care physician sent a letter to surgeon at
CM0596 -        Kaiser investigating follow up surgery to upgrade Millie's port
CM0597 -        catheter implanted on 040419 to a "Power Port" for injecting CT
CM0598 -        test contrast medium in order to avoid further injury, pain,
CM0599 -        and suffering, ref SDS B3 VG5J; there is also consideration of
CM0600 -        using the existing port catheter by slowing the rate of
CM0601 -        injecting contrast medium for CT tests (point 2), if that is
CM0602 -        possible, which reduces risk of damaging the port from high
CM0603 -        pressure that occurs from CT test injections. ref SDS B3 847I
CM0605 -         ..
CM0606 -        [On 080508 Millie asks primary care physician about
CM0607 -        progress scheduling surgery to upgrade the port catheter
CM0608 -        to a Power Port for injecting contrast medium in time
CM0609 -        for the next CT test. ref SDS D1 GO8G
CM0610 -
CM0611 -
CM0612 -
CM0613 -
CM0614 -
CM0615 -
CM0616 -
CM07 -