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 9, 2008 05:34 PM Wednesday;
Rod Welch
Millie notified medical team of successful surgery on Power Port.
1...Summary/Objective
2...Power Port Surgery 080707 Successful Follow Up Requirements
..............
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CONTACTS
SUBJECTS
Power Port Notify Medical Team Surgery Successful Follow Up Tasks Re
2503 -
2503 - ..
2504 - Summary/Objective
2505 -
250501 - Follow up ref SDS 19 0000. ref SDS 18 0000.
250502 -
250503 -
250504 -
250505 -
250506 -
250507 -
250508 -
250510 - ..
2506 -
2507 -
2508 - Progress
2509 -
250901 - Power Port Surgery 080707 Successful Follow Up Requirements
250902 -
250903 - Follow up ref SDS 19 IT77, ref SDS 18 IT77.
250904 -
250905 - Yesterday on 080708 Millie had surgery to implant a Power Port for use
250906 - in drawing blood needed to perform tests, for injecting chemotherapy
250907 - to treat cancer, and for injecting contrast medium to perform CT
250908 - tests. The day before on 080707 Millie submitted a letter to the
250909 - medical team coordinating the surgery. ref SDS 18 AC59
250911 - ..
250912 - Millie submitted ref DIT 1 0001 to the primary care physician at
250913 - Kaiser with copies to the medical team, ref DIT 1 00W3, and asking for
250914 - distribution to the surgeon.
250915 -
250916 - 1. Surgery yesterday on 080708 implanting a Power Port device was
250917 - successful; my deep appreciation to Doctor Riley-Paull, and her
250918 - team at Kaiser for getting this done. ref SDS 19 0001,
250919 - ref DIT 1 0001
250920 -
250921 - [On 080710 Catherine at UCSF received Millie's letter today
250922 - on implementing the Power Port for infusion treatments and
250923 - blood draws. ref SDS 21 TZ8I
250925 - ..
250926 - [On 080717 Millie separate letter to Kaiser commending the
250927 - surgeon on successful Power Port surgery and accessing the
250928 - Power Port for Millie's treatment at UCSF 2 days later,
250929 - because the surgery department does not support
250930 - communication coordinating with the medical team.
250931 - ref SDS 26 EF5I
250933 - ..
250934 - 2. I felt a slight pain late last night from the surgery, but
250935 - nothing today, so we seem to have a good result. ref SDS 19
250936 - TL4O, ref DIT 1 WP6F
250938 - ..
250939 - 3. Asking [the primary care physician] or Arlette to submit
250940 - results of the blood test yesterday. ref SDS 19 6F4I and shown
250941 - later in the same record, ref SDS 19 MF4K
250942 - ref DIT 1 WP6K
250943 -
250944 - [On 080712 letter to medical team reports CA 15-3 142
250945 - results of labs at Kaiser on 080708 for surgery to implant
250946 - the Power Port. ref SDS 23 K14R
250948 - ..
250949 - 4. The surgeon submitted a letter certifying the Power Port was
250950 - tested for blood draw and injection, and is ready for use at
250951 - UCSF tomorrow. ref SDS 19 BF4K, ref DIT 1 WP6O
250953 - ..
250954 - [On 080710 Power Port with Huber needle pre-configured was
250955 - used at UCSF for Millie's treatment; worked perfectly.
250956 - ref SDS 21 TZ8I
250958 - ..
250959 - 5. Tomorrow, I will bring the surgeon's original letter for UCSF
250960 - files, as requested by the Infusion Clinic. ref DIT 1 WP7L
250961 -
250962 - [On 080710 Millie submitted the doctor's letter to UCSF,
250963 - ref SDS 21 EE4O, the nurse advised that UCSF actually needs
250964 - the report on the xray performed showing placement of the
250965 - Power Port, see below, ref SDS 19 UY3I, UCSF management
250966 - called Kaiser; the Surgery department coordinated
250967 - submission of the xray report to the Infusion Clinic at
250968 - UCSF. ref SDS 21 TM5J
250970 - ..
250971 - 6. The surgeon used stitches to maintain the Huber needle in
250972 - place, and indicated that UCSF nurses or a doctor can remove
250973 - the stitches to remove the Huber needle after treatment
250974 - tomorrow. ref SDS 19 LI5K, ref DIT 1 WP7Q
250975 -
250976 - [On 080710 after treatment, nurse in the Infusion Clinic
250977 - removed stitches easily with no discomfort to Millie, after
250978 - treatment. ref SDS 21 6A6H
250980 - ..
250981 - 7. Gloria submitted a new treatment plan for Coumadin to increase
250982 - INR 1.1 back to the target range of 2.0 - 3.0 required for case
250983 - management of pulmonary embolism. ref SDS 19 PSPS, ref DIT 1
250984 - WP8O
250986 - ..
250987 - 8. Gloria proposes adding INR (PT) to the blood test for treatment
250988 - a week from tomorrow on 080717 in order to verify INR has
250989 - reached target levels. Giving UCSF a heads up, since normally
250990 - the blood test on the 4th week of the cycle does not include
250991 - INR. ref SDS 19 BU5Y, ref DIT 1 WP8U
250992 -
250993 - [On 080717 UCSF included INR in blood test. ref SDS 25 IL75
250995 - ..
250996 - 9. I received a Power Port Patient Discharge Packet yesterday at
250997 - Kaiser. ref SDS 19 DZ5O, ref DIT 1 G39K
250999 - ..
251000 - 10. It has a lot of details on using the Power Port, which I assume
251001 - are familiar to staff at UCSF and Kaiser. The section on Power
251002 - Injection Procedures for CT tests applies at Kaiser, and seems
251003 - complicated. By copy to [the primary care physician], asking
251004 - Kaiser to verify everyone is comfortable with requirements, and
251005 - will be ready to go for the test scheduled on 080718.
251006 - ref SDS 19 JE7N, ref DIT 1 WP9T
251007 -
251008 - [On 080711 meeting with the Infusion Clinic; they did not
251009 - get a copy of Millie's coordination letter, and so have not
251010 - reviewed Power Port "Instructions for Use," Director of
251011 - Services recommended Millie check with the CT Test
251012 - Department to verify everything is ready go go for Millie's
251013 - test scheduled for 080708 1100. ref SDS 22 RW42
251015 - ..
251016 - [On 080711 meeting with CT Test Department they did not get
251017 - a copy of the coordination letter today, ref SDS 22 JQ49,
251018 - ref SDS 22 RH5O, seemed not to have reviewed Bard's
251019 - "Instructions..." for using the Power Port. ref SDS 22 RH5O
251021 - ..
251022 - [On 080712 Millie's letter asks CT Department to review
251023 - manufacturer's Instructions for Use on Power Injection of
251024 - contrast medium. ref SDS 23 K13Q
251026 - ..
251027 - [On 080718 Nora with Kaiser Interventionary Radiology
251028 - assigned to access the Power Port for Millie's CT test,
251029 - ref SDS 27 2U8V; during procedure, Nora requests
251030 - manufacturer's Instructions for Use on Power Injection
251031 - procedures, ref SDS 27 NM5V, which was submitted to Kaiser
251032 - on 080709, ref SDS 20 TR9X, review was requested on 080712,
251033 - ref SDS 23 K13Q, and again on 080715, ref SDS 24 RB3T;
251034 - complications occurred on power injection when contrast
251035 - medium overflowed; CT test with Power Port failed.
251036 - ref SDS 27 LK3R
251038 - ..
251039 - 11. Currently, I am scheduled to visit the Infusion Clinic on
251040 - 080718 1030 for a nurse to access the port with a Huber needle.
251041 - Someone "certified" to work with Huber needle and Power Port
251042 - activities must then go with me to the CT test department. If
251043 - no one is available, [the primary care physician] will be
251044 - called to perform this task of oversight and support.
251045 - ref DIT 1 WP4T
251046 -
251047 - [On 080711 Bella in the Infusion Clinic did not receive
251048 - this letter, ref SDS 22 RW4R; Paula, Director of Infusion
251049 - Clinic Services, disclosed that nobody has contacted the
251050 - Infusion Clinic with assignments for Millie's CT test on
251051 - 080718. ref SDS 22 RW42
251053 - ..
251054 - [On 080711 CT Test Department indicates primary care
251055 - physician cannot support the test on 080718, requires
251056 - doctor certified to use CT test equipment. ref SDS 22 JQ87
251058 - ..
251059 - 12. I will call Kaiser on 080717 the day before the test to remind
251060 - of these coordination issues. At 1100 the CT technician will
251061 - connect the test equipment to the Huber needle, and the
251062 - observer will verify or otherwise assist performing correct
251063 - procedures, and will observe injection of the contrast medium.
251064 - When the test is completed, the observer will remove the Huber
251065 - needle, or I will return to the Infusion Clinic for a nurse to
251066 - remove the Huber needle.
251068 - ..
251069 - 13. As people gain experience with Power Port procedures, this
251070 - initial complex process will shake out and become routine.
251071 - ref DIT 1 W45J
251072 -
251073 - [On 080718 CT test failed with Power Port, ref SDS 27 LK3R,
251074 - post-procedure review will yield lessons learned to improve
251075 - the work. ref SDS 27 A44K
251077 - ..
251078 - [On 080718 Millie thanks Kaiser CT Technologist for trying
251079 - difficult first test with Power Port, and completing the
251080 - test with conventional IV. ref SDS 27 FM74
251082 - ..
251083 - [On 080801 Bard asks about Huber needle used for the CT
251084 - test today - could be defective, ref SDS 28 OV5I; Kaiser
251085 - was trained a year earlier, but adopted policy not to use
251086 - Power Ports for CT tests, so nobody has experience,
251087 - ref SDS 28 OV9H, Julie offes to consult during Millie's
251088 - next CT test. ref SDS 28 OW41
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2511 -