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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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
251089 -
251090 -
251091 -
251092 -
251093 -
251094 -
2511 -