THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: June 27, 2008 12:00 PM Friday;
Millie meeting at Kaiser review progress UCSF clinical trial treat IBC.
2...Agenda Integrated Work Plan Kaiser UCSF
3...Arm Left Cellulitis Lymphedema Subsiding Continue Treatment
4...Cellulitis Inflammation Subsiding Lymphedema Swelling Reduced by Icing
5...Coordinate Medication Changes Between Kaiser and UCSF
6...Medication Current List Coordinate Kaiser UCSF Referral Care
7...Current Medications Comprehensive Care Coordinate Kaiser Referral UCSF
8...IBC Subsiding Demonstrates Response to Treatment 4th Relapse
9...Responding Treatment Despite Only 50% Prescribed Medication Dose
10...Kaiser Treat Millie with Cetuximab Carboplatin
11...Carboplatin 50% Prescribed Treatment Due to Low Blood Counts
12...Low Blood Counts Reduce Carboplatin to 50% of Prescribed Treatment
13...Neupogen Prescribed Increase Blood Counts Enable Complete Treatment
14...Black Box Knowledge Management Processing Kaiser Pharmacy
15...Neupogen Payment Inventory Problem Doctor Writing Letter to Resolve
16...CT Test 080718 Doctor Support Access Power Port Inject Contrast Media
17...Contrast Media Injection Trauma Power Port Surgery Controls CT Test
18...CT Test 080718 Doctor Support Access Power Port Inject Contrast Media
19...Prozac Not Needed Emotional Stress Relieved Favorable Results
20...Emotional Stress Subsides Health Care Referral Coordination Improve
21...Medical Chart Reports Examination Diagnosis Prescription Prognosis
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Meeting Examination Kaiser Backup Doctor Review Strategy Work Plan 3
1303 - ..
1304 - Summary/Objective
130501 - Follow up ref SDS 89 0000. ref SDS 71 0000.
130510 - ..
1308 - Progress
130901 - Agenda Integrated Work Plan Kaiser UCSF
130903 - Follow up ref SDS 89 QY5I.
130905 - Millie's vitals are normal today: BP 127 86 Pulse 78
130907 - Pulse normal about 60; so 63 indicates calm, minimal anxiety.
130909 - ..
130910 - Agenda for the meeting today...
130912 - 1. Cellulitis resolved............................ ref SDS 0 RM6J
130914 - ..
130915 - 2. IBC rash examination........................... ref SDS 0 NH4N
130917 - ..
130918 - 3. Emotional stress Prozac medication............. ref SDS 0 H26H
130920 - ..
130921 - 4. Nupeogen prescription.......................... ref SDS 0 NM3M
130923 - ..
130924 - 5. Neupogen correct mistake $2,000................ ref SDS 0 BT5J
130926 - ..
130927 - 6. Power Port surgery certificate................. ref SDS 0 7Y6I
130929 - ..
130930 - 7. CT test scheduled on 080718...
130932 - a. UCSF proposal advance date of test......... ref SDS 0 WX6I
130933 - b. Infusion Clinic Huber needle............... ref SDS 0 GO3G
Meeting Examination Kaiser Backup Doctor Review Strategy Work Plan 3
230401 - ..
230402 - Arm Left Cellulitis Lymphedema Subsiding Continue Treatment
230403 - Cellulitis Inflammation Subsiding Lymphedema Swelling Reduced by Icing
230405 - Follow up ref SDS 89 RM6J, ref SDS 71 RM6J.
230407 - Case study on Millie's patient history of Cellulitis and lymphedema
230408 - treatment with Keflex is shown in the record on 061203. ref SDS 16
230409 - YT4M Background on causation is in another case study on 070130.
230410 - ref SDS 22 VX6F
230412 - ..
230413 - Background on recent treatment for Cellulitis and lymphedema the past
230414 - few months is reported in the record on 080502. ref SDS 89 RM6J
230415 - Millie was treated in the ER on 080409, ref SDS 82 FY4L, and with
230416 - Keflex at home for 14 days. ref SDS 82 F142 Millie notified the
230417 - medical team in a letter on 080423 that treatment for Cellulitis and
230418 - lymphedema ended. ref SDS 84 TY9R On 080520 there was another
230419 - recurrence of Cellulitis without lymphedema. ref SDS 93 OU5J The
230420 - doctor prescribed 10 day treatment with Keflex. ref SDS 93 1K7H On
230421 - 080528 Millie reported to the medical team progress recovering from
230422 - Cellulitis. ref SDS 95 IJ5V This was completed on 080529, and
230423 - examination by the medical team at UCSF showed full recovery at that
230424 - time. ref SDS 96 KH6F
230426 - ..
230427 - Today, the doctor examined Millie's left arm and again observed no
230428 - evidence of Cellulitis nor lymphedema.
230430 - ..
230431 - Millie still has a 10-day prescription of Keflex on 080305 to treat
230432 - future recurrence, ref SDS 71 5M3F, after the 10-day treatment on
230433 - 080520. ref SDS 93 1K7H
230435 - ..
230436 - Millie related understandings from the surgeon during the meeting at
230437 - Kaiser on 080606, along the lines that remaining lymph nodes on
230438 - Millie's left chest, and under arm (axilla), which have not been
230439 - removed by surgery, may become more robust over time, and so better
230440 - able to handle exercise without causing Cellulitis and lymphedema.
230441 - ref SDS 97 4P7L This may account for Millie not suffering another
230442 - recurrence since 080520 while significantly increasing exercise.
230444 - ..
230445 - Helps reduce doubt, worry, and anxiety about maintaining vigorous
230446 - exercse that maintains blood counts, essential to get cheotherapy
230447 - treatment for cancer, and without getting Cellulitis and lymphedema
230448 - that require emergency treatment, cited below. ref SDS 0 H26H
Medications Coordinate Kaiser Coagulation Department Notify Changes
420401 - ..
420402 - Coordinate Medication Changes Between Kaiser and UCSF
420403 - Medication Current List Coordinate Kaiser UCSF Referral Care
420404 - Current Medications Comprehensive Care Coordinate Kaiser Referral UCSF
420406 - Follow up ref SDS 89 IE6M, ref SDS 71 IE6M.
420408 - Millie related discussion at UCSF yesterday on 080626 concerning
420409 - patient history of current medications, ref SDS A4 8A9G, and citing
420410 - Kaiser's listing received during the meeting on 080502, ref SDS 89
420411 - E43I, including review on frequency of use. ref SDS 89 N84O This
420412 - complemented the list in Kaiser's medical chart on 080502. ref SDS 89
420413 - 7Y6F
420415 - ..
420416 - Reliance on patient memory rather than the actual list of current
420417 - medications indicates slow progress on the referral coordination plan
420418 - discussed at UCSF on 070222. ref SDS 24 VK5N
420420 - ..
420421 - The list in the medical chart at Kaiser today, ref SDS 0 7Y6F, shows
420422 - closer alignment with the longer list of drugs received from the
420423 - doctor on 080502. ref SDS 89 NA6F
IBC Examination Expanding Cancer Disease Diagnose 4th Relapse Recomm
560401 - ..
560402 - IBC Subsiding Demonstrates Response to Treatment 4th Relapse
560403 - Responding Treatment Despite Only 50% Prescribed Medication Dose
560405 - Follow up ref SDS 89 N15G, ref SDS 71 N15G.
560407 - During the prior meeting on 080305 the doctor observed expanding IBC
560408 - rash. ref SDS 71 N15G The next day on 080306 Doctor Rugo at UCSF
560409 - concurred and determined Millie suffered progression of IBC disease.
560410 - After 13 months treatment with cetuximab alone. the 4th relapse of IBC
560411 - seems evident, ref SDS 72 NW3N, confirming prior findings in the
560412 - meeting on 080219. ref SDS 68 3J4I
560414 - ..
560415 - On 080312 Millie's letter to UCSF with copy to Kaiser reports IBC rash
560416 - seems to subside before starting new treatment with Carboplatin added
560417 - to existing treatment with cetuximab. ref SDS 75 RU4U
560419 - ..
560420 - During the meeting today, the doctor asked when Carboplatin was added
560421 - to weekly treatments at UCSF?
560423 - ..
560424 - Millie explained that her letter to the medical team at UCSF and
560425 - Kaiser on 080312 reported she would have the first treatment with
560426 - Carboplatin on 080313 to begin the 2nd arm of the clinical study.
560427 - ref SDS 75 BH5O The doctor recalled receiving Millie's letter and
560428 - asked if she actually had the treatment, since there have been
560429 - reports of continuing low blood counts?
560431 - ..
560432 - Millie advised that she had treatment on 080313, adding Carboplatin
560433 - chemotherapy to cetuximab, which Millie has been getting since 070201.
560434 - as reported in the record of patient history. ref SDS 76 TZ8I
560435 - Millie's letter the next day to the medical team on 080314 confirmed
560436 - have received this treatment, and being pleased to feel energetic the
560437 - following day. ref SDS 78 KO6Y Millie further commended Kaiser and
560438 - UCSF for improving communications coordinating her care. ref SDS 78
560439 - EX5H
560441 - ..
560442 - The doctor reported in the Medical Chart today that Carboplatin was
560443 - added on 080313, per below. ref SDS 89 NN8I
560445 - ..
560446 - On 080331 photographs support explanation of expanding disease.
560447 - ref SDS 80 9Q4I
560449 - ..
560450 - The doctor examined IBC on the left arm, chest, and lower stomach
560451 - areas. He was pleased again today to see reduced IBC inflammation and
560452 - rash, continuing findings from examination on 080502, ref SDS 89 NH4N,
560453 - that Millie has begun to improve from examination on 080305, prior to
560454 - starting expanded treatment with Carboplatin. ref SDS 71 N15G This
560455 - finding aligns with examination at UCSF yesterday on 080626 that
560456 - reported response to treatment.
560458 - [...below, Medical Chart reports negative palpation, and stable
560459 - IBC erythema. ref SDS 0 1Z6O
Default Null Subject Account for Blank Record
570401 - ..
570402 - Kaiser Treat Millie with Cetuximab Carboplatin
570403 - Carboplatin 50% Prescribed Treatment Due to Low Blood Counts
570404 - Low Blood Counts Reduce Carboplatin to 50% of Prescribed Treatment
570405 - Neupogen Prescribed Increase Blood Counts Enable Complete Treatment
570407 - Follow up ref SDS 89 NL9I.
570409 - The doctor had received Millie's letter on 080625 reporting concerns
570410 - about blood counts, Neupogen, ref SDS A3 IT5W, reduction of
570411 - Carboplatin treatment, ref SDS A3 IU9Y, and progression of IBC
570412 - disease. ref SDS A3 IU9S
570414 - ..
570415 - The doctor advised that Kaiser can now treat Millie with Cetuximab and
570416 - Carboplatin. This is a major change from the report on 070921 that
570417 - Kaiser cannot treat Millie with cetuximab. ref SDS 33 QY68
570419 - ..
570420 - Millie explained during the meeting today that treatment with Neupogen
570421 - at Kaiser Infusion Clinic ordered by the doctor on 080609, ref SDS 98
570422 - IL6I, yielded improving blood counts this week, reported at UCSF
570423 - yesterday on 080626. ref SDS A4 YY7U This enabled Millie to get
570424 - Carboplatin treatment for IBC yesterday as well. ref SDS A4 YY86
Default Null Subject Account for Blank Record
580401 - ..
580402 - Black Box Knowledge Management Processing Kaiser Pharmacy
580403 - Neupogen Payment Inventory Problem Doctor Writing Letter to Resolve
580405 - Follow up ref SDS 89 NM3M.
580407 - The doctor was very pleased that problems have now been resolved using
580408 - the computer to schedule Millie's Neupogen treatments so that she can
580409 - maintain blood counts to get the chemotherapy treatments for IBC in
580410 - the clinical study on referral to UCSF.
580412 - ..
580413 - The doctor received Millie's letter on 080625 notifying Kaiser that
580414 - the schedule for Neupogen treatments omitted treatment prescribed for
580415 - 080707. ref SDS A3 IT6W Confusion from July 4th being a holiday
580416 - caused a computer schedule problem because the computer could not
580417 - schedule consecutive treatments on July 4th and 5th. Therefore, the
580418 - computer could only schedule treatment on July 5th. Since the next
580419 - day is Sunday, and the Clinic is closed, the computer is not
580420 - programmed to schedule the 2nd treatment for the next available day on
580421 - Monday, 080707. To correct the mistake, during the meeting, the
580422 - doctor sent a follow up letter using the Kaiser computer system to ask
580423 - Zan in the Oncology Pharmacy about adding Millie's 2nd treatment to
580424 - the schedule for the Infusion Clinic on 080707.
580426 - ..
580427 - The doctor will also write a letter to resolve another Kaiser computer
580428 - problem reported to the medical team in Millie's letter on 080619,
580429 - ref SDS A1 YU9T The computer caused a conflict between drug inventory
580430 - control and patient quality care requirements in the Outpatient
580431 - Pharmacy on 080609. Millie was mischarged $2,000 for drugs she was
580432 - required to return, ref SDS 98 K270, due to a prescription mistake.
580433 - ref SDS 98 837J The doctor recalled this was also mentioned again in
580434 - Millie's letter on 080625. ref SDS A3 MV9K
580436 - ..
580437 - There was discussion that Kaiser is making progress using computers
580438 - for case management. Rolling out new technology requires continual
580439 - refinement from experience. The doctor feels feedback from patients
580440 - complements Kaiser's staff and medical professionals, but can be very
580441 - frustrating while people figure out how to configure automated systems
580442 - to properly handle the wide range of circumstances that arise treating
580443 - patients.
580445 - [On 080628 Kaiser protocol requires Millie get 2 injections of
580446 - 240 mcg for Neupogen prescribed by UCSF indicates confusion and
580447 - error by Outpatient Pharmacy providing treatment with a single
580448 - injection of 480 mcg. ref SDS A6 Q74G
580450 - ..
580451 - [On 080702 letter to medical team confirms planning for primary
580452 - care physician to write a letter correcting the mistake of
580453 - $2,000 mischarge for drugs which Millie was required to return.
580454 - ref SDS A7 EP4T
580456 - ..
580457 - [On 080707 Kaiser computer in Surgery Department did not
580458 - notify Coagulation Control Clinic to pause Coumadin
580459 - treatments required for surgery. ref SDS A8 JP7W
CT Test 080212 Findings Support Diagnosis IBC Progression Disease 4t
770401 - ..
770402 - CT Test 080718 Doctor Support Access Power Port Inject Contrast Media
770404 - Follow up ref SDS 89 N15O, ref SDS 71 N15O.
770406 - ..
770407 - The doctor did not have time today for considering Millie's report on
770408 - 080507 of a spike in heart beat (pulse) while laying down in bed; case
770409 - study shows occassional spike in pulse reported by heart monitor
770410 - during exercise, evaluated previously as defective equipment.
770411 - ref SDS 90 CK4K
CT Test 080425 Evaluate Diagnosis IBC Progression Disease 4th Relaps
960401 - ..
960402 - Contrast Media Injection Trauma Power Port Surgery Controls CT Test
960403 - CT Test 080718 Doctor Support Access Power Port Inject Contrast Media
960405 - Follow up ref SDS 89 WX6I, ref SDS 88 766K.
960407 - ..
960408 - Millie presented referral coordination with UCSF yesterday on
960409 - scheduling the next CT test. ref SDS A4 4F5S
960411 - ..
960412 - The doctor noted during the meeting that UCSF has important concerns
960413 - to perform tests according to clinical study protocol. Hospitals
960414 - doing clinical studies are audited by a state agency. Audit reports
960415 - that find failure to perform requirements can lead to loss of
960416 - certification as a clinical trial facility.
960418 - ..
960419 - The doctor indicated today that surgery at Kaiser to implant a Power
960420 - Port scheduled on 080708 controls the next CT test to assess Millie's
960421 - progress in the clinical trial at UCSF. On 080617 Kaiser scheduled
960422 - the CT test on 080718 in order to use the Power Port to inject
960423 - contrast medium for the CT test, ref SDS A0 DF55, which is required to
960424 - prevent injury to Millie, reported on 080425. ref SDS 85 FP6F He can
960425 - write a letter for UCSF to reconcile protocol adjustment in this case
960426 - based on patient health requirements determined by Kaiser.
960428 - ..
960429 - Millie explained Catherine's request for referral coordination
960430 - yesterday that Kaiser submit to UCSF for the Infusion Clinic a
960431 - certificate from the surgeon stating the Power Port has been correctly
960432 - implanted and tested for use. ref SDS A5 MZ9L
960434 - ..
960435 - The doctor said he is unfamiliar this form of documentation for a
960436 - surgical procedure. He asked why Millie's doctor at UCSF has not made
960437 - this request directly, which would provide opportunity to get
960438 - clarification? Millie related Doctor Rugo's concerns on 080403 that
960439 - referral coordination takes time and creates communication
960440 - frustrations that annoy busy health care professionals. ref SDS 81
960441 - SG7I
960443 - ..
960444 - The doctor sent a letter using Kaiser's computer email system
960445 - notifying the surgeon that UCSF requests a certificate on the Power
960446 - Port for suitability of use.
960448 - [On 080708 surgeon annoyed by coordination requirements between
960449 - Kaiser and UCSF on documentation to establish Power Port was
960450 - correctly implanted and certified for use. ref SDS A9 O65F
960452 - ..
960453 - [On 080708 Kaiser submitted a letter stating the Power Port was
960454 - tested successfully, and signed by the surgeon. ref SDS A9 O14F
960456 - ..
960457 - [On 080710 Millie submitted the doctor's letter to UCSF,
960458 - ref SDS A0 EE4O, the nurse advised that UCSF actually needs the
960459 - report on the xray performed showing placement of the Power
960460 - Port, ref SDS A9 UY3I; UCSF management called Kaiser; the
960461 - Surgery department coordinated submission of the xray report to
960462 - the Infusion Clinic at UCSF. ref SDS A0 TM5J
960464 - ..
960465 - Millie asked about Bella's concern on 080617 saying Kaiser needs to
960466 - assign someone in the Infusion Clinic to support the test on 080718
960467 - because using Power Port technology for injecting contrast medium is a
960468 - new procedure for the CT Department. ref SDS A0 OQ8L
960470 - ..
960471 - The doctor seemed annoyed by complications coordinating work between
960472 - the Infusion Clinic in the Oncology Department, and with the CT
960473 - Department for the test on 080718. The doctor left the examination
960474 - room to consult with Bella and staff in the Infusion Clinic.
960476 - ..
960477 - About 10 minutes later, the doctor returned.
960479 - ..
960480 - Following the meeting in the Infusion Clinic, the doctor seemed to
960481 - recognize coordination concerns about using Millie's Power Port for
960482 - the CT test on 080718, as related by Bella on 080617. ref SDS A0 OQ57
960484 - ..
960485 - The doctor asked Millie to call Kaiser the day before the CT test on
960486 - 080718, and let him know if nobody else has been assigned to support
960487 - the CT test for Millie on 080718, then he will personally go to the CT
960488 - Department and press the button on the CT test equipment to perform
960489 - the test. This planning is noted in the medical chart for today, per
960490 - below. ref SDS 0 CO3H
960492 - [On 080711 Ike in the CT Department indicated that the primary
960493 - care physician cannot support Millie's CT test by pushing the
960494 - button on the CT scan equipment. ref SDS B1 JQ87
960496 - ..
960497 - [On 080811 Paula at Kaiser Infusion Clinic investigating
960498 - solutions to support CT Department for Millie's next test
960499 - OA 080912; issue has been elevated, but no progress from
960500 - management reported at this time, ref SDS B3 LD3H; there
960501 - seems to be at least three (3) solutions. ref SDS B3 CW3O
960502 - Paula coordinating with primary care physician about
960503 - contacting Kaiser Oakland to perform Millie's next CT test.
960504 - ref SDS B3 DE79
Prozac Not Taken Current Medication Prescribed 080305 Patient Improv
AM0401 - ..
AM0402 - Prozac Not Needed Emotional Stress Relieved Favorable Results
AM0403 - Emotional Stress Subsides Health Care Referral Coordination Improve
AM0405 - Follow up ref SDS 89 KT4J, ref SDS 71 KT4J.
AM0407 - Background on emotional trauma from medical and case management issues
AM0408 - was reported on 080502, ref SDS 89 KT4J, explaining the doctor
AM0409 - prescribed Prozac on 080305 to relieve stress and anxiety. ref SDS 71
AM0410 - 5L5M
AM0412 - ..
AM0413 - On 080502 stress and anxiety increased emotional trauma from "black
AM0414 - box" experience ordering medication on Kaiser's computer. ref SDS 89
AM0415 - NM4J At that time, Kaiser charged for Neupogen treatment 500% higher,
AM0416 - without notice, and without recourse when something went "wrong" with
AM0417 - Kaiser's computer, causing medical mistakes getting prescribed drugs.
AM0418 - ref SDS 89 NM6J On 080609 confusion using Kaiser's computer ordering
AM0419 - additional medication again increased emotional trauma, ref SDS 98
AM0420 - 837J, and discussed further above. ref SDS 0 NM3M
AM0422 - ..
AM0423 - Continual recurrence of Cellulitis and lymphedema in the left arm with
AM0424 - only minimal exercise, causing treatment in the Emergency Department,
AM0425 - and shown by case study on 061203, ref SDS 16 YT4M, presents
AM0426 - significant emotional stress. Recent comments by the surgeon on
AM0427 - 080606 that Cellulitis and lymphedema may not occur as often due to
AM0428 - expanding capacity of existing lymphatics, helps reduce stress and
AM0429 - anxiety, per above. ref SDS 0 TU6L
AM0431 - ..
AM0432 - Case management and referral coordination problems, discussed with the
AM0433 - doctor today on scheduling surgery, ref SDS 0 WX6I, and the next CT
AM0434 - test, ref SDS 0 GO3G, and arranging for Neupogen treatments,
AM0435 - ref SDS 0 NM3M, present an unending cascade of communication problems
AM0436 - that increase emotional trauma, stress, and anxiety.
AM0438 - ..
AM0439 - Millie's exercise continues to increase, reported on 080616,
AM0440 - ref SDS 99 IZ5I, and a few days ago on 080622. ref SDS A2 IZ5I The
AM0441 - recent letter on 080625 shows a surprising and helpful increase in
AM0442 - energy, exercise, and fitness. This helps cope with emotional trauma
AM0443 - without Prozac medication.
AM0445 - [On 080702 Millie's letter to the medical team confirms
AM0446 - reports during examinations at UCSF and at Kaiser of
AM0447 - increased exercise and fitness. ref SDS A7 HO5O
CT Test 080212 Findings Support Diagnosis IBC Progression Disease 4t
B50401 - ..
B50402 - Medical Chart Reports Examination Diagnosis Prescription Prognosis
B50404 - Follow up ref SDS 89 YT5N, ref SDS 71 YT5N.
B50406 - Received the doctor's report in the medical chart for the meeting
B50407 - today...
B50409 - ..
B50410 - 1. Received: 6/27/08 1:06 PM
B50412 - ..
B50413 - 2. .... [patient] is a 72 Y female with a history of inflammatory
B50414 - cancer of left breast who was initially diagnosed 03/04/02.
B50415 - She had recurrent disease noted initially in the cervical LN's
B50416 - 03/03/04. On E2100 Study with Avastin, but she had a PE noted
B50417 - on CT 11/03/2004. Then, because of progression of disease, the
B50418 - patient was started on Taxotere and Xeloda 4/15/05. She had a
B50419 - total of 8 cycles ending 9/16/05. She had a palliative left
B50420 - mastectomy performed 10/21/05. Then her left chest lesions
B50421 - began expanding again. The patient started Taxotere and Xeloda
B50422 - again 07/21/06 for 7 cycles. She was started on a Clinical
B50423 - Trial 02/01/07 at UCSF and was randomized to the Erbitux only
B50424 - (no Carbo) Arm.
B50426 - ..
B50427 - She had weekly Carboplatin added 03/13/08 because of
B50428 - progression of disease. She has had to skip 3 treatments
B50429 - because off low counts. She has required Neupogen support and
B50430 - sometimes has to skip a week. She has no recent bouts of
B50431 - cellulitis.
B50433 - ..
B50434 - Doctor's comment might add explanation on response to treatment,
B50435 - reported during the meeting on 080502. ref SDS 89 SU49
B50437 - ..
B50438 - Medical Chart continues...
B50440 - 3. Current Medications
B50442 - PROCHLORPERAZINE 10MG....... Compazine. 080313, ref SDS 72 FA4H
B50443 - ONDANSETRON 8 MG TABLETS.... Zofran.... 080313, ref SDS 72 FA4H
B50444 - CEPHALEXIN 500 MG CAPSULES.. Keflex.... 080409, ref SDS 82 F142
B50445 - FLUOXETINE 20 MG CAPSULES... Prozac.... 080305, ref SDS 71 5L5M
B50446 - NEUPOGEN 480MCG/1.6ML.................. 080502, ref SDS 89 NL4M ,
B50447 - WARFARIN 4 MG TABLETS....... Coumadin.. 061002, ref SDS 13 MI5I
B50448 - TIMOLOL MALEATE 0.5% EYE.... Eye drops
B50449 - ACYCLOVIR 800MG............. Zoviraxe.. 070614 (no record prescribed by Doctor Rugo to treat cold sore on lip)
B50450 - LORAZEPAM 1 MG.............. Ativan.... 070921, ref SDS 33 3N8J
B50451 - Cetuximab................... Erbitux... 070201, ref SDS 23 4N5M
B50452 - Carboplatin............................ 080313, ref SDS 76 2N4N
B50454 - ..
B50455 - The medical chart still does not include contrast medium treatment for
B50456 - CT tests reported in Kaiser's list of medications received during the
B50457 - meeting on 080502. ref SDS 89 SY4M
B50459 - GASTROGRAFIN 66/10 SOLUTION............ 080617, ref SDS A0 DF64
B50461 - [On 080829 1200 medical chart omits contrast medium again,
B50462 - which Kaiser changed to Barrium Sulfate Suspension.
B50463 - ref SDS B6 554I
B50465 - ..
B50466 - The doctor added to the bottom of the list Cetuximab and Carboplatin
B50467 - prescribed by UCSF in Chemotherapy Orders, as noted for the meeting
B50468 - with the doctor on 080502, ref SDS 89 NA6F, and citing earlier
B50469 - listings of medications on 080307. UCSF. ref SDS 74 RW3T
B50471 - [On 080708 Kaiser surgery processing asks for Millie's
B50472 - current medications, per above, ref SDS 0 7Y6F, and
B50473 - cannot access patient medical chart; asks patient to
B50474 - verbally cite 14 medications.
B50476 - ..
B50477 - Kaiser should further add to the medical chart additional medications
B50478 - prescribed by UCSF for weekly treatments...
B50480 - Dexamethasone............... Decadron.. 080313, ref SDS 76 2N43
B50481 - Diphenhydramine............. Benedryl.. 080313, ref SDS 76 NX4N
B50483 - ..
B50484 - Medical Chart continues...
B50486 - 4. Physical Examination
B50488 - Performance Status: 0
B50489 - Lymph nodes: negative palpation
B50490 - Chest wall: erythema stable on lower left chest wall
B50491 - Ext: LUE edema decreased, erythema upper arm stable
B50493 - ..
B50494 - On 080502 the doctor explained that "Performance Status "0" means
B50495 - Millie has evident full mobility and demonstrates no loss of normal
B50496 - functioning. ref SDS 89 NP5M
B50498 - ..
B50499 - Stable erythema reported in the Medical Chart reflects examination
B50500 - today, per above, ref SDS 0 NH4N, and shows continuing improvement
B50501 - from examination on 080305 that found increasing IBC. ref SDS 71 1Z6O
B50503 - ..
B50504 - Medical Chart continues...
B50506 - Lab:
B50507 - Pending
B50509 - ..
B50510 - The doctor resolved the referral coordination problem reported for the
B50511 - examination on 080502, ref SDS 89 NP87,
B50513 - ..
B50514 - Millie's most recent labs are reported in the record on 080626 getting
B50515 - treatment at UCSF yesterday. ref SDS A5 439L
B50517 - ..
B50518 - Medical Chart continues...
B50520 - 5. Imaging
B50522 - 04/25/08 CT THORAX, ABDOMEN, PELVIS W CONTRAST - no change
B50523 - 04/09/08 CHEST, TWO VIEWS
B50524 - 03/05/08 HUMERUS 2+ VIEWS - normal
B50525 - 02/12/08 CT THORAX, ABDOMEN, PELVIS W CONTRAST - increased
B50526 - right axillary LN; infiltrate RML fissure
B50527 - 12/27/06 BASE SKULL TO MIDTHIGH PET/CT
B50528 - 07/08/06 MRI BRAIN WO/W CONTRAST(STD)- negative
B50530 - ..
B50531 - 6. Imp:
B50533 - 1. Metastatic breast cancer (IBC)lung, lymph node and chest wall
B50534 - 2. Recurrent leukopenia
B50535 - 3. Depression; stable, exercising more
B50536 - 4. Lymphedema; stable
B50538 - ..
B50539 - Good to see Kaiser noting correlation between managing depression and
B50540 - exercise.
B50542 - ..
B50543 - Stable nodules in the lungs were cited by the primary care physician
B50544 - at Kaiser in a letter on 070117 to explain the medical chart reporting
B50545 - lung cancer. ref SDS 20 TS8G
B50548 - ..
B50549 - Medical Chart continues...
B50551 - 7. Plan
B50553 - 1. Continue Clinical Trial on Erbitux with weekly Carbo
B50555 - ..
B50556 - 2. Repeat CT July 18th
B50558 - ..
B50559 - During the meeting today, the doctor determined that surgery for the
B50560 - Power Port controls doing the CT test to use the Power Port, per
B50561 - above. ref SDS 0 NF6H
B50563 - 3. Call my coordinator the day before CT is performed to
B50564 - identify licensed personal in Radiology who can push
B50565 - the dye into a central line
B50567 - ..
B50568 - Aligns with planning during the meeting when the doctor consulted with
B50569 - staff in the Infusion Clinic, per above. ref SDS 0 GO3G
B50571 - ..
B50572 - Medical chart continues...
B50574 - 4. Place Power Port
B50576 - ..
B50577 - During the meeting today, the doctor determined that surgery for the
B50578 - Power Port controls doing the CT test to use the Power Port, per
B50579 - above. ref SDS 0 NF6H
B50581 - ..
B50582 - Medical chart continues...
B50584 - 5. Continue Neupogen support, next July 7th
B50586 - 6. RTC 8 weeks
B50588 - ..
B50589 - The doctor submitted a paper to Millie showing the next meeting in 8
B50590 - weeks will be on August 22, 2008.
B50592 - ..
B50593 - After the meeting, Millie visited with the schedule clerk at the front
B50594 - desk.
B50596 - ..
B50597 - The schedule clerk said the doctor made a mistake about meeting in 8
B50598 - weeks, because the doctor will be on vacation at that time.
B50600 - ..
B50601 - Millie explained referral coordination in her case that has been
B50602 - effective with the doctor meeting to review progress the day after
B50603 - Millie meets with the doctor at UCSF to plan the another cycle. The
B50604 - clerk suggested scheduling the work at Kaiser at the next opportunity
B50605 - after the doctor returns from vacation, and explained this procedure
B50606 - will maintain continuity with past practice providing timely backup
B50607 - for Millie's referral care at UCSF.
B50609 - ..
B50610 - Millie agreed.
B50612 - ..
B50613 - The clerk said the next time the doctor can meet with Millie after his
B50614 - vacation will be 080829, 1 week later than ordered by the doctor
B50615 - during the meeting today.
B50617 - ..
B50618 - Millie suggested checking with the doctor about acceptability of this
B50619 - delay to the work plan set up by the doctor just 5 minutes ago, as
B50620 - shown in the medical chart, per above. ref SDS 0 PX5V
B50622 - ..
B50623 - The clerk said that doctor's don't like to be asked for clarification
B50624 - to resolve mistakes in patient care.
B50626 - ..
B50627 - The clerk proposed scheduling the work a week late on 080829, and
B50628 - then, if the doctor decides to come into the office a week earlier to
B50629 - comply with the initial work plan, Kaiser will notify Millie of the
B50630 - change.
B50632 - [On 080823 Hazel in the Infusion Clinic scheduled Millie
B50633 - for Neupogen treatment on 080905 because Millie explained
B50634 - there is a double schedule to meet with the doctor, and
B50635 - second one must be the mistake, because on 080627 the
B50636 - doctor ordered the next meeting on 080822, and the schedule
B50637 - clerk changed this to 080829. ref SDS B5 5T75
B50639 - ..
B50640 - Millie agreed.
B50642 - ..
B50643 - The clerk tried entering the schedule in the computer for Millie to
B50644 - meet with the doctor on 080829, but said there is a problem, and that
B50645 - something is wrong with the computer. After a few minutes, the clerk
B50646 - advised that while discussing the schedule with Millie, Kaiser's
B50647 - computer system now seems to be down, and so will not accept the
B50648 - schedule, similar to the problem Melanie had in the Pharmacy on
B50649 - 080609, when the computer would not correct another mistake ordering
B50650 - Neupogen. ref SDS 98 IS47
B50652 - [On 080809 Donna reported Kaiser's schedule omits Millie's
B50653 - treatment on 080823. ref SDS B2 C24J
B50655 - ..
B50656 - [On 080809 Donna reported Kaiser's schedule omits Millie's
B50657 - treatment on 080823. ref SDS B2 C24J
B50659 - ..
B50660 - [On 080822 Kaiser's schedule still omits Millie's treatment
B50661 - on 080823. ref SDS B4 GW73
B50663 - ..
B50664 - [On 080823 the next day, Hazel discovered the computer
B50665 - mysteriously changed the schedule received 080822, causing
B50666 - 2 new problems scheduling Millie's treatments. ref SDS B5
B50667 - 5T6N
B50669 - ..
B50670 - The clerk advised the meeting on 080829 can be placed in a
B50671 - holding directory that is part of the Kaiser case management system.
B50672 - When the computer comes back online, this directory will be
B50673 - automatically checked, and will schedule a meeting on 080829 between
B50674 - Millie and the doctor.
B50676 - ..
B50677 - Millie agreed.
B50679 - ..