THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: July 2, 2008 01:19 PM Wednesday; Rod Welch

Millie notifies medical team coordination meetings last week at UCSF and Kaiser.

1...Summary/Objective


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SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 4 0000, ref SDS 3 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie submitted a letter to the medical team saying...
040902 -
040903 -
040904 -
040905 -    1.  Subject: Meeting 080626 UCSF and with Kaiser on 080627, INR 2.5 Referral Coordination
040906 -        Date: Wed, 02 Jul 2008 13:30:46 -0700
040914 -         ..
040915 -    3.  This confirms understandings from meeting with the medical
040916 -        team, and treatment at UCSF on 080626, and the next day at
040917 -        Kaiser.
040919 -         ..
040920 -    4.  Blood tests at UCSF on 080626 show INR 2.5 continues steady...
040921 -
040922 -           http://www.welchco.com/sd/08/00101/02/08/06/26/090028.HTM#PU7Y
040923 -
040924 -        ...by copy, reporting to Gloria at Kaiser performing case
040925 -        management on pulmonary embolism.
040927 -         ..
040928 -    5.  Labs on 080626 may have omitted a series of tests that have
040929 -        been included on labs starting prior cycles....
040930 -
040931 -           http://www.welchco.com/sd/08/00101/02/08/06/26/090028.HTM#HS7I
040933 -         ..
040934 -    6.  Brigid found in examination on Thursday that IBC appears
040935 -        improved, responding to treatment, based on remembering
040936 -        conditions from examination on 080501.
040938 -         ..
040939 -    7.  Jackie took pictures for comparison.
040941 -         ..
040942 -    8.  I feel better about response to treatment now than a few days
040943 -        ago; and realize short term changes cause intensity of IBC rash
040944 -        to rise and fall.
040946 -         ..
040947 -    9.  I am very pleased to express appreciation again to the medical
040948 -        team for carefully managing my treatments with Carboplatin by
040949 -        prescribing Neupogen at levels that maintain blood counts,
040950 -        contain costs, and moderate side effects.  This is a complex
040951 -        process which UCSF and Kaiser have optimized.
040953 -         ..
040954 -   10.  I met with Doctor Johnson at Kaiser on Friday, 080627.  The
040955 -        doctor plans to write a letter to resolve the mix up in the
040956 -        Kaiser Pharmacy on my Neupogen treatments that occurred on
040957 -        080609...
040958 -
040959 -           http://www.welchco.com/sd/08/00101/02/08/06/09/233854.HTM#MG3I
040961 -         ..
040962 -   11.  This past week on Saturday and Sunday, I experienced for the
040963 -        first time bone pain, headache, and fatigue...
040964 -
040965 -           http://www.welchco.com/sd/08/00101/02/08/06/28/081739.HTM#6Q5J
040967 -         ..
040968 -   12.  With recurrent problems on Sunday I found an explanation of
040969 -        these symptoms can be side effects of Neupogen...
040970 -
040971 -           http://www.welchco.com/sd/08/00101/02/08/06/29/082943.HTM#RQ9I
040973 -         ..
040974 -   13.  At this time side effects seem manageable, again thanks to
040975 -        Brigid for tailoring treatment to precise requirements for my
040976 -        blood counts.
040978 -         ..
040979 -   14.  Exercise continues to increase doing longer distances at higher
040980 -        speed.
040982 -         ..
040983 -   15.  Doctor Johnson indicated on Friday that surgery for the Power
040984 -        Port on 080708 controls the CT test on 080718 in order to
040985 -        resolve injury to may arm from the previous CT test on 080425,
040986 -        found during examination at Kaiser on 080502...
040987 -
040988 -           http://www.welchco.com/sd/08/00101/02/08/05/02/120049.HTM#WX6I
040990 -         ..
040991 -   16.  The doctor explained concerns at UCSF for compliance with
040992 -        clinical study protocols, also, noted by Brigid at UCSF the day
040993 -        before on 080626.  Kaiser can submit a letter to UCSF
040994 -        documenting CT testing was scheduled to meet needs for patient
040995 -        care.  Going forward, better planning on my part will help meet
040996 -        study requirements.
040998 -         ..
040999 -   17.  Doctor Johnson further coordinated with Bella, the Charge
041000 -        Nurse, in the Infusion Clinic at Kaiser for him, or someone
041001 -        with a "certificate," to go to the Imaging Department on 080718
041002 -        to press the button on injecting contrast medium for the CT
041003 -        test through the Huber needle that will be placed by the nurse
041004 -        in the Infusion Clinic to access the Power Port. [confirms
041005 -        coordination in letter to medical team on 080619, ref SDS 2
041006 -        YU6X, on implementing scheduling performed on 080617 for CT
041007 -        test on 080718. ref SDS 1 OQ61]
041008 -
041009 -           [On 080715 Millie's letter notifies Kaiser that UCSF will
041010 -           leave the Huber needle accessing the Power Port for
041011 -           chemotherapy treatment on 080717 in place for the CT test
041012 -           the next day at Kaiser on 080718, so the schedule today for
041013 -           the Infusion Clinic at Kaiser to access the port is not
041014 -           needed. ref SDS 6 AW9S
041016 -            ..
041017 -           [On 080715 Arlette called and reported the doctor solved
041018 -           coordination problems by arranging for a nurse in radiology
041019 -           with certificate to support CT testing with Power Ports;
041020 -           Millie's CT test is good to go on 080718. ref SDS 6 RB4N
041022 -            ..
041023 -           [On 080715 Millie's letter notifies Kaiser that UCSF will
041024 -           leave the Huber needle accessing the Power Port for
041025 -           chemotherapy treatment on 080717 in place for the CT test
041026 -           the next day at Kaiser on 080718, so the schedule today for
041027 -           the Infusion Clinic at Kaiser to access the port is not
041028 -           needed. ref SDS 6 AW9S
041030 -         ..
041031 -   18.  Doctor Johnson also notified the surgeon that UCSF Infusion
041032 -        Clinic needs a certificate from Kaiser showing Power Port
041033 -        surgery on 080708 has been successfully tested, as requested by
041034 -        Catherine on 080626...
041035 -
041036 -           http://www.welchco.com/sd/08/00101/02/08/06/26/090028.HTM#MZ40
041038 -             ..
041039 -            [On 080708 Millie received letter from surgeon certifying
041040 -            new Power Port was implanted and tested successfully ready
041041 -            for use at UCSF. ref SDS 5 O14F
041043 -         ..
041044 -   19.  On Saturday, Laura in the Infusion Clinic at Kaiser requested
041045 -        the UCSF Chemotherapy Orders on 080626 starting cycle 5 to
041046 -        support Neupogen treatments...
041047 -
041048 -           http://www.welchco.com/sd/08/00101/02/08/06/28/090025.HTM#VO8I
041050 -         ..
041051 -   20.  Since the copy I received for Chemotherapy Orders on 080626 do
041052 -        not prescribe Neupogen treatments, Laura accepted the previous
041053 -        document for cycle 4 dated 080529, which prescribes 2 Neupogen
041054 -        treatments.  Not sure we need to do anything more on this,
041055 -        since on 080609 Zan relied on the Chemo Orders on 080529 to set
041056 -        up the Neupogen treatment account at Kaiser...
041057 -
041058 -           http://www.welchco.com/sd/08/00101/02/08/06/09/233854.HTM#L16I
041060 -         ..
041061 -   21.  During the meeting at Kaiser, also on 080627, Doctor Johnson
041062 -        corrected the scheduling problem that omitted Neupogen
041063 -        treatment on 080707.
041065 -         ..
041066 -   22.  Laura also explained that the prescription for Neupogen of 480
041067 -        mg in the UCSF prescription, requires 2 shots at Kaiser, having
041068 -        something to do with injury to the tissue from a large shot
041070 -         ..
041071 -   23.  I will check with Nola tomorrow on the schedule at UCSF which
041072 -        omits treatment on 080731.  It may have been just a printer
041073 -        problem.  I have penciled this date into the schedule...
041074 -
041075 -           http://www.welchco.com/sd/08/00101/02/08/06/26/090028.HTM#2F8G
041077 -         ..
041078 -   24.  Thanks again to all for excellent care.
041079 -
041087 -
041088 -
041089 -
041090 -
041091 -
041092 -
0411 -