THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: July 24, 2008 08:00 AM Thursday;
Millie meeting UCSF 6th cycle cetuximab Carboplatin treat IBC.
Click here to comment!
Meeting Examination Doctor Review Strategy Work Plan 3rd Cycle 1st T
CT Testcle 3rd Relapse IBC 5th Cycle 1st Treatment Chemotherapy Agen
1504 - ..
1505 - Summary/Objective
150601 - Follow up ref SDS E7 0000. ref SDS D7 0000.
150608 - ..
1509 - Progress
151001 - Millie went to the 5th floor Infusion Clinic at 0750 and got a blood
151002 - draw.
151004 - ..
151005 - Azita said the medical team submitted orders for the blood draw today,
151006 - but not the vials for the study. Getting the order for the blood draw
151007 - corrected problems last month on 080626. ref SDS E7 YY4X
151009 - ..
151010 - Millie met with Brigid at 0810 on the 2nd floor.
151012 - ..
151013 - Jonathon is the new study coordinator taking the place of Thomas, who
151014 - replaced Megan last month on 080626. ref SDS E7 YY5U
151016 - ..
151017 - Jonathon explained that he planned to submit blood vials for the study
151018 - after Millie had the blood draw this morning in the Infusion Clinic.
151019 - on the 5th floor for meeting with the medical team on the 2nd floor.
151020 - Jonathon left the meeting, and returned in about 5 minutes with the
151021 - blood vials for the study.
151023 - ..
151024 - Brigid arrived while Jonathon was out of the examination room getting
151025 - blood vials for Millie's labs.
151027 - ..
151028 - Brigid advised that she received Millie's letters submitted to the
151029 - medical team reporting problems with the CT test performed 080718...
151031 - 1. Letter reports CT test on 080718 using Power Port failed
151032 - with complications, ref SDS F0 I43R, and was performed by
151033 - conventional IV. ref SDS F0 A363
151035 - ..
151036 - 2. Letter dated 080721 reports Power Port serviced at Kaiser
151037 - Oncology Infusion Clinic on 080719, ref SDS F3 9W9I, and
151038 - seems in good working order. ref SDS F1 0001
151041 - ..
151042 - Brigid asked Millie how she feels today following stress and anxiety
151043 - from difficulties getting the CT test on 080718? ref SDS F0 FM74
151045 - ..
151046 - Millie explained emotional stress and anxiety from events on 080718,
151047 - ref SDS F0 A54W, are improved because of excellent work in the Kaiser
151048 - Infusion Clinic the next day on 080719 to help recover from problems
151049 - with the CT test the day before. ref SDS F1 SR37 She confirmed during
151050 - the meeting today feeling better, reported on 080719. ref SDS F1 LD8J
151051 - Since then, results of the CT test on 080718 received from Kaiser
151052 - yesterday on 080723, ref SDS F4 R45G, seem to have more good news.
151053 - ref SDS F4 4K5H
151055 - ..
151056 - Brigid apologized for not being prepared today because UCSF did not
151057 - get the report from Kaiser yesterday in time to make a careful review
151058 - of the CT test for discussion this morning. Scope of referral
151059 - coordination, discussed in the record on 070222. ref SDS 67 KL5G Case
151060 - study on 070130 shows challenges of health care professionals face
151061 - performing complex referral coordination that cause stress,
151062 - frustration, anxiety, and worry.
151064 - [On 080821 emotional roller coaster increases trauma from
151065 - ups and downs of cancer care. ref SDS G1 MM5N
151067 - ..
151068 - During the meeting, Brigid looked in the medical chart, and said the
151069 - report for the CT test is missing. Earlier, Doctor Rugo cited
151070 - frustrations because data was missing from the medical chart on
151071 - 080219. ref SDS B9 L18L More recently, on 080529 Lynn and Megan
151072 - filled in data from the lab that Lynn discovered was missing from
151073 - Millie's medical chart. ref SDS D7 L255 At that time, an error was
151074 - reported in the Chemotherapy Order affecting the dose of Carboplatin
151075 - to treat IBC, but this was not discovered until 080605, further
151076 - increasing furstration, stress, and worry about accuracy of medical
151077 - records. ref SDS D8 PVUQ
151079 - ..
151080 - [On 080821 UCSF does not discuss results of CT test which
151081 - were subject of considerable discussion to expedite,
151082 - ref SDS G1 MF9K; only review of findings reported in
151083 - patient record on 080723. ref SDS F4 4K5H
151085 - ..
151086 - [On 080915 Jill, new Clinical Research Coordinator, submits
151087 - letter requesting results of CT test to prepare for meeting
151088 - with Millie at UCSF a few days later on 080918. ref SDS G2
151089 - 4P88
151091 - ..
151092 - Brigid asked Jonathon, the new study coordinator, for the CT test
151093 - report, noting a copy should be filed in the medical chart. Jonathon
151094 - looked through the clinical study file folder for Millie's case, and
151095 - could not find the CT test report. Brigid asked if Johathon ordered
151096 - the report from Kaiser? Jonathan explained he recently came on board
151097 - taking the place of Thomas for Study Coordinator in Millie's case.
151098 - Thomas was introduced last month on 080626, as taking the place of
151099 - Megan, who had replaced Jackie beginning with the meeting on 080501.
151100 - ref SDS E7 YY5U Jackie had done an outstanding job as study
151101 - coordinator for Millie the past 18 months, beginning on 070116.
151102 - Jonathon recalled this morning that nothing was presented in his
151103 - assignment orientation on referral coordination to obtain CT test
151104 - reports from Kaiser for the meeting today. Poor coordination and
151105 - communication increases stress, frustration, and worry for health care
151106 - professionals that affects patient care, including emotional trauma.
151108 - ..
151109 - Brigid recalled receiving Millie's letter to Kaiser dated 080718 with
151110 - a copy to the medical team at UCSF asking Kaiser to submit the report
151111 - on the CT test in time to review a few days before the meeitng today.
151112 - ref SDS F0 I96L Several days later on 080721 Millie sent a follow up
151113 - letter confirmjng referral coordination requesting the CT test report.
151114 - ref SDS F2 CW9R
151116 - ..
151117 - Yesterday, in a telephone call responding to correspondence on 080718
151118 - and 080721, Arlette advised that the Lab at Kaiser was late reading
151119 - the CT test on 080718, so the report has been delayed. In the late
151120 - afternoon, the report was received on 080723, ref SDS F4 EO8F, from
151121 - Millie's primary care physician, according to past practice.
151123 - ..
151124 - The report states in part...
151126 - a. There is a large collection of contrast material in the
151127 - right chest wall, apparently due to injection of contrast
151128 - outside the venous system. ref SDS F4 EO8F
151130 - b. A RRF form was completed. ref SDS F4 4M3L
151132 - ..
151133 - Brigid was not familiar with an "RRF form".
151135 - ..
151136 - CT test on 080718 continues...
151138 - c. Right auxilla is compared in the report for the test on
151139 - 080718 with the prior scan on 080425, reviewed yesterday on
151140 - 080723. ref SDS F4 YH41 A broader comparson including the
151141 - past three tests shows...
151143 - Current Test Prior Test Prior Test
151144 - 080718 080425 080212
151146 - 1. 1.70 x 1.50 cm .... 1.90 x 1.10 cm .... 1.90 x 0.90
151147 - 2. 1.30 x 1.30 cm .... 1.30 x 1.20 cm .... 1.27 x 1.13
151148 - 3. 1.10 x 0.80 cm .... 1.00 x 1.00 cm .... 1.00 x 1.00
151150 - ..
151151 - d. Left axilla shows no significant lymphadenopathy, also
151152 - reviewed on 080723. ref SDS F4 WM9L
151154 - ..
151155 - Brigid feels these results are favorable because they do not indicate
151156 - progression of IBC disease. She explained UCSF practice protocol
151157 - requires getting CT test results from Kaiser for direct, independent
151158 - review in relation to patient symptoms and findings from examinations.
151159 - Brigid asked Jonathon to call Kaiser and ask the Oncology Department
151160 - to submit another copy via fax of the report showing results of
151161 - Millie's CT test on 080718. Jonathon asked for the telephone number.
151163 - ..
151164 - [...below examination clinical palpation seems to align
151165 - with CT test finding no strong evidence indicating
151166 - progressoin of adenopathy. ref SDS 0 FH8P
151168 - ..
151169 - [On 080821 UCSF does not discuss results of CT test which
151170 - were subject of considerable discussion to expedite,
151171 - ref SDS G1 MF9K; only review of findings reported in
151172 - patient record on 080723. ref SDS F4 4K5H
151174 - ..
151175 - The number for Arlette was provided with suggestion to cite her call
151176 - to Millie yesterday on 080723. ref SDS F4 6V5I
151178 - [On 080915 Jill, new Clinical Research Coordinator, submits
151179 - letter requesting results of CT test to prepare for meeting
151180 - with Millie at UCSF a few days later on 080918. ref SDS G2
151181 - 4P88
151183 - ..
151184 - During the meeting, Brigid tried to display on the computer in the
151185 - examination room results for the blood draw this morning performed in
151186 - the Infusion Clinic earlier this morning at 0750. ref SDS F5 OK5N
151187 - Brigid advised that today the lab was unable to complete the test and
151188 - present results, as done on all previous meetings for the past 18
151189 - months, in time for review during the 30 - 60 minutes of the meeting
151190 - this morning.
151192 - ..
151193 - [On 080821 results from the lab on the 5th floor for the blood
151194 - draw performed at 0800 by the Infusion Clinic were available in
151195 - time to guide work during the meeting at 0830 with the medical
151196 - team on the 2nd floor. ref SDS G1 7R5J
151198 - ..
151199 - Brigid will work on getting the report from Kaiser for the CT test on
151200 - 080718, and also results from the lab for the blood test today. She
151201 - will then prepare the Chemotherapy Order. Jonathon will bring it to
151202 - the Infusion Clinic to guide treatment with Carbopltin chemotherapy.
151203 - Since treatment with cetuximab is not affected by blood counts, the
151204 - Infusion Clinic can start on this part of Millie's treatment, while
151205 - the data that controls Carboplatin is obtained, and reviewed.
151207 - ..
151208 - Brigid will include the prescription for Neupogen in the Chemotherapy
151209 - Order to correct omission in the Chemo Order last month on 080626.
151210 - ref SDS E8 PWSY
151212 - ..
151213 - Brigid reported this morning that the medical team has not had time to
151214 - request the Chemotherapy Order on 080529 from the Infusion Clinic to
151215 - investigate the error on the dose of Carboplatin, which had been
151216 - planned for review last month on 080626. ref SDS E7 RF53
151218 - ..
151219 - Brigid looked at the printed report Millie received this morning from
151220 - the staff at the front desk showing her current medications listed by
151221 - Brigid starting cycle #3 on 080501, ref SDS D0 QK4G, and reviewed
151222 - again with Lynn at UCSF starting cycle #4, reported on 080529,
151223 - ref SDS D7 8A9G This is the same list Brigid reviewed last month
151224 - starting the 5th cycle on 080626. ref SDS E7 8A9G She asked today if
151225 - the list is correct?
151227 - ..
151228 - Millie explained again that Kaiser submitted a complete list of
151229 - current medications prescribed for her care, explained in the record
151230 - on 080502, ref SDS D1 SQ5M, and including comments on frequency of
151231 - use. ref SDS D1 N84O As noted on 080502, "current medications" is a
151232 - complex issue that requires review by medical professionals. UCSF's
151233 - list presents an impression of incomplete compared to Kaiser.
151235 - ..
151236 - Brigid made an examination.
151238 - ..
151239 - There were again no findings of adenopathy on the left axilla and left
151240 - supraclavicular, and no indications from palpation of lumps in the
151241 - right axillary, repeating favorable findings from the prior
151242 - examination on 080626. ref SDS E7 FH8P This seems to align with the
151243 - CT test on 080718, reviewed on 080723, ref SDS F4 4K5H, and discussed
151244 - during the meeting this morning, per above. ref SDS 0 4D4K Brigid
151245 - reserved comment until UCSF receives the CT test report from Kaiser,
151246 - being pursued by Jonathon, also per above. ref SDS 0 2X7I
151248 - [On 080821 Lynn reports feeling some slight swelling in the
151249 - left supraclavicular region, ref SDS G1 E37N; Millie has not
151250 - complained of stiffness in the neck, nor finding any lumps.
151251 - ref SDS G1 E34I
151253 - ..
151254 - Brigid noted intensity of IBC disease at all locations, e.g., left
151255 - arm, left chest, right breast, lower left abdomen, and the left lower
151256 - rib area, have all continued to subside from prior examination
151257 - starting the 5th cycle on 080626, ref SDS E7 FH8P, extending favorable
151258 - findings from examination for the 3rd cycle on 080501. ref SDS D0 JJ3N
151259 - Brigid did not perform examination for 4th cycle on 080529.
151261 - [On 080725 Millie notified NP she will return to work on
151262 - 080811. ref SDS F6 645J
151264 - ..
151265 - [On 080804 Millie notified the doctor at UCSF that NP requests
151266 - physician release to work. ref SDS F7 GU4W
151268 - ..
151269 - [On 080807 UCSF responded; Brigid approved Millie for return to
151270 - work. ref SDS F8 SX4O
151272 - ..
151273 - [On 080807 Millie thanks UCSF for timely response, and
151274 - submitted to NP the UCSF letter with physician release for
151275 - return to work from medical leave. ref SDS F9 AF5J
151277 - ..
151278 - Brigid submitted a document with handwriting to schedule Millie's
151279 - meetings with the medical team through December. After the meeting,
151280 - visited with the schedule attendant at the front desk in the Breast
151281 - Care Clinic. The attendant scheduled Millie's meetings.
151283 - ..
151284 - During the meeting in the Infusion Clinic for treatment, Millie
151285 - received a printed schedule from Nola showing her schedule of care at
151286 - UCSF. ref SDS F5 1K7H This seems to have gaps that require further
151287 - coordination. ref SDS F5 SO8F
151289 - [On 080807 Lena at the front desk in the Breast Care Clinic
151290 - advised that the doctor scheduled to see Millie at 1130 on
151291 - 080918 and on 081016 after Millie gets treatment at 0900,
151292 - understanding this is a change in the protocol for previous
151293 - meetings prior to Millie getting treatments. ref SDS F8 U15Y
151295 - ..
151296 - [On 080815 Millie's letter to the medical team requested
151297 - clarification of the UCSF schedule. ref SDS G0 P96Y