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 7, 2008 09:47 PM Monday; Rod Welch

Kaiser called pre-op instructions Power Port surgery tomorrow.

1...Summary/Objective
2...Replace Port Catheter Right Side Cannot Implant on Primary Cancer Site


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CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 9 0000, ref SDS 9 0000.
040502 -
040503 - Pre-op review with Kaiser discussed issues, including that Millie has
040504 - paused Coumadin treatments, that she received a Neupogen treatment
040505 - today at Kaiser, and needs a certificate showing the Power Port was
040506 - successfully tested.   The doctor will personally make the IV
040507 - injection for anesthesia and to minimize pain finding a vein.  Kaiser
040508 - called back in the late PM and changed the time of surgery from 1345
040509 - to 0930, and that Millie should arrive at the hospital at 0630
040510 - tomorrow morning for surgery at 0930.
040511 -
040512 -     [On 080708 Millie gets surgery for Power Port. ref SDS 19 IT77
040513 -
040514 -
040515 -
040517 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Replace Port Catheter Right Side Cannot Implant on Primary Cancer Site
040902 -
040903 - Follow up ref SDS 9 IT77.
040904 -
040905 - Doctor Enis is the anesthesiologist.  He requested background on
040906 - Millie's surgery tomorrow.
040908 -  ..
040909 - Millie met with the surgeon on 080606 who approved surgery for Power
040910 - Port to replace the port catheter so that Millie can get injections of
040911 - contrast medium for CT tests through the port rather than IV needle
040912 - punctures in the right arm.  This will prevent further injury to
040913 - Millie' right arm.
040915 -  ..
040916 - The doctor advised on 080606 that the Kaiser Surgery Department would
040917 - notify the Coagulation Control Clinic to issue written instructions
040918 - for Millie to stop taking Coumadin 5 days prior to the date of
040919 - surgery.
040921 -  ..
040922 - On 080608 Millie sent a letter to the doctor confirming request to
040923 - coordinate date of surgery with next CT test planned for mid-July.
040924 - ref SDS 10 IT8V  On 080609 Millie received a letter from the surgeon
040925 - advising that coordination concerns for surgery prior to the next CT
040926 - test in mid-July were submitted to the surgery scheduling department.
040927 - ref SDS 11 MG5I
040929 -  ..
040930 - On 080617 Kaiser called and scheduled the surgery for 080708.
040931 - ref SDS 13 MG5I  There were instructions that Kaiser would notify
040932 - Millie about the time of the surgery a few days prior to 080708.
040933 - ref SDS 13 XF94  About a week ago, Millie received a call from Kaiser
040934 - setting the time of surgery at 1345, and Millie was to arrive for
040935 - pre-op administration 2 hours earlier at 1145.
040937 -  ..
040938 - On 080626 the primary care physician submitted a letter notifying the
040939 - surgeon, that UCSF needs a certificate that the Power Port has been
040940 - tested successfully so that Millie can get treatment using the new
040941 - port on 080710.
040943 -  ..
040944 - Millie has not received any instructions from Kaiser confirming when
040945 - to stop taking Neupogen.  She stopped Coumadin on 080703 based on the
040946 - 5-day verbal guidance from the doctor during the meeting on 080606.
040947 - ref SDS 0 AC8S
040949 -  ..
040950 - Millie's current medications are listed in the Kaiser's medical chart
040951 - received from Kaiser on 080627. ref SDS 18 7Y6F
040953 -  ..
040954 - Millie sent a letter to the medical team confirming discussion with
040955 - the doctor this morning on planning work tomorrow...
040956 -
040957 -    1.  Subject: Pre-op Guidance Planning Power Port Surgery tomorrow 080708
040958 -        Date: Mon, 07 Jul 2008 11:25:28 -0700
040966 -         ..
040967 -    3.  I received a call today at 1013 from Doctor Enis at Kaiser who
040968 -        will support anesthesia services for surgery tomorrow.
040970 -         ..
040971 -    4.  This confirms pre-op understandings on discussion with Doctor
040972 -        Enis...
040973 -
040974 -        1.  Nothing to eat after midnight.
040976 -             ..
040977 -        2.  Drink only clear liquids 4 hours prior to surgery.
040979 -             ..
040980 -        3.  Most recent prior surgery was on 051021 (October 21, 2005)
040981 -            left breast mastectomy.
040983 -             ..
040984 -        4.  Prior surgery was on 040419 to implant port catheter (being
040985 -            upgraded to Power Port with surgery tomorrow).
040987 -             ..
040988 -        5.  Original surgery left breast lumpectomy was on 020312, with
040989 -            reexcision on 020327.
040991 -             ..
040992 -        6.  Cancer changed and was diagnosed IBC on 040517 from biopsy
040993 -            on 040419.
040995 -             ..
040996 -        7.  Pulmonary embolism diagnosed 041104 shown by CT test on
040997 -            041103, treated with Coumadin until OA 051015 ; recurrence
040998 -            was diagnosed 061002 shown by CT test on 060930; treatment
040999 -            with Coumadin (Warfarin) resumed on 061002.
041000 -
041001 -                [On 080708 during surgery, the doctor used equipment to
041002 -                monitor and maintain pulmonary conditions in order to
041003 -                prevent blood clots. ref SDS 19 T29I
041005 -             ..
041006 -        8.  Currently treatment for IBC on referral by Kaiser to UCSF
041007 -            clinical study beginning on 070201.
041009 -             ..
041010 -        9.  Clinical study requires CT tests every 8 weeks; surgery
041011 -            tomorrow implants Power Port that will help prevent further
041012 -            damage to right arm from needle punctures injecting CT test
041013 -            contrast medium.
041015 -             ..
041016 -       10.  Neupogen treatment was received at 0900 this morning in
041017 -            the Infusion Clinic at Kaiser Walnut Creek, required for
041018 -            chemotherapy treatments at UCSF.
041020 -  ..
041021 - This was the second Neupogen treatment scheduled by the primary care
041022 - phyisician at Kaiser during the meeting on 080627, ref SDS 18 XK5K,
041023 - following treatment on Saturday, 080705, and applies planning in
041024 - Millie's letter to the medical team on 080625, ref SDS 15 IT6W, which
041025 - further implemented Brigid's instructions on 080626 to continue
041026 - getting 2 Neupogen treatments for the 5th cycle, ref SDS 16 QJ4H, even
041027 - though the Chemotherapy Order received from UCSF on 080626 does not
041028 - prescribe Neupogen treatments. ref SDS 17 PWSY
041029 -
041030 -               [On 080721 UCSF advises that Neupogen treatment was not
041031 -               needed to recover blood counts, ref SDS 21 YU7N, from
041032 -               the bleeding incident today on 080718, per above,
041033 -               ref SDS 20 IC6F, and in order to get chemotherapy next
041034 -               Thursday at UCSF.
041036 -                ..
041037 -               [On 080814 UCSF advises Neupogen was ordered for the
041038 -               Power Port matter. ref SDS 22 4Q5O which seems
041039 -               conflicting with the record on 080721. ref SDS 21 YU7N
041041 -  ..
041042 - Millie's letter to medical team continues...
041043 -
041044 -       11.  Doctor Riley-Paull planned on June 6 for Surgery [computer]
041045 -            to notify the Coagulation Control Clinic to pause Coumadin
041046 -            5 days prior to date of surgery.  Surgery was later
041047 -            scheduled for July 8. ref SDS 9 UQ4N  I have not received
041048 -            instructions from Kaiser, so I stopped taking Coumadin this
041049 -            past Thursday on 080703, and plan to resume treatments the
041050 -            day after surgery on 080709, subject to guidance from the
041051 -            doctor tomorrow.
041053 -  ..
041054 - Similar to problems ordering Neupogen; on 080502 doctor explained
041055 - confusion that makes prescribing medications like a "Black Box,"
041056 - ref SDS 7 NM3M,  On 080609 further confusion using Kaiser computer to
041057 - prescribe Neupogen. ref SDS 12 837J  Outpatient Pharmacy confused
041058 - using computer to correct mistake on prescription for Neupogen.
041059 - ref SDS 12 IS47  Case study on 061024 reports progress using computers
041060 - for health care case management. ref SDS 5 QJ4G
041061 -
041062 -               [On 080708 INR 1.1 blood test for surgery, well below
041063 -               target range INR 2.0 - 3.0 for pulmonary embolism case
041064 -               management; doctor describes INR 1.1 adequate and normal
041065 -               for patients not suffering pulmonary embolism, and
041066 -               within expected range when Coumadin is paused 5 days
041067 -               prior to surgery. ref SDS 19 MF4K
041069 -                ..
041070 -               [On 081105 Kaiser computer in Nuclear Medicine made
041071 -               another mistake, schedule for Muga test changed for 3rd
041072 -               time. ref SDS 23 N54H
041074 -  ..
041075 - Millie's letter to medical team continues...
041076 -
041077 -       12.  Reviewed requirements for anesthesia IV in right arm due
041078 -            to cancer and lymphedema on the left side.  Discussed
041079 -            patient history that IV needle punctures in the right arm
041080 -            are problematic.  Doctor Enis plans to personally perform
041081 -            the IV to minimize problems tomorrow.
041082 -
041083 -                [On 080708 Doctor Enis assigned a specialist to do the
041084 -                IV for anesthesia. ref SDS 19 T23S
041086 -             ..
041087 -       13.  Doctor Riley-Paull will access the port after surgery
041088 -            tomorrow, so that the Huber needle will be in place for
041089 -            treatment at UCSF on Thursday 080710.
041091 -             ..
041092 -       14.  Doctor Riley-Paull will provide a certificate showing the
041093 -            Power Port was tested successfully.  I will bring this to
041094 -            UCSF for treatment on Thursday.
041096 -         ..
041097 -    5.  Please submit these understandings to the surgery department.
041098 -
041106 -
041107 -
041109 -  ..
0412 -
0413 -
0414 - 1638
0415 -
041501 - Millie received another call from Kaiser.
041502 -
041503 - This person did not provide identification, except to indicate
041504 - representing Kaiser's Surgery Department.
041506 -  ..
041507 - Surgery tomorrow is advanced from 1345 to 0930.  Millie was asked to
041508 - arrive at the hospital 3 hours prior to surgery at 0630.
041510 -  ..
041511 - No reasons were given for changing the time of surgery.
041512 -
041513 -
041514 -
041515 -
041516 -
041517 -
041518 -
041519 -
041520 -
041521 -
041522 -
041523 -
041524 -
041525 -
041526 -
0416 -