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: September 12, 2008 07:42 PM Friday; Rod Welch

Millie letter asks Kaiser omission of CT reporting cancer in neck shows prior findings resolved?

1...Summary/Objective


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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 8 0000. ref SDS 7 0000.
040502 -
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040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie had a CT test at Kaiser in Oakland yesterday. ref SDS 6 358L
040902 - Everything went well. ref SDS 6 LK3R  Problems that occurred on the
040903 - previous CT test on 080718, ref SDS 1 LK3R, at Kaiser in Walnut Creek
040904 - did not occur yesterday in Oakland.
040906 -  ..
040907 - This afternoon, the primary care physician submitted the pathology
040908 - report for the test.  It was transmitted through Kaiser's Knowledge
040909 - Management dedicated email system.  This was reviewed carefully in
040910 - another record later in the evening today 080912. ref SDS 9 6V5I
040912 -  ..
040913 - Initial review showed the analyst did not follow up Interstitional
040914 - lung disease, ref SDS 9 TS4J, which was reported as a new issue in the
040915 - CT test on 080718, reviewed a week later on 080723. ref SDS 2 TS4J
040917 -  ..
040918 - Millie sent a letter to the doctor using the dedicated email program
040919 - in Kaiser's Knowledge Mangaement system asking if failure of the
040920 - report to mention Interstitional Lung disease indicates the condition
040921 - is resolved, or that the analyst did not look for it. ref SDS 7 LO9U
040923 -  ..
040924 - Millie received a letter from the primary care physician indicating
040925 - that omission of findings in the CT test indicate good news that
040926 - Interstitional Lung disease is not worsening and is negligible.
040927 - ref SDS 8 HI8N
040929 -  ..
040930 - Millie responded in a letter thanking the doctor for clarification of
040931 - test findings, and asking if the same analysis applies to lympth
040932 - adenopathy in the left supraclavicular which was also not mentioned in
040933 - the CT test on 08011 after findings reported at UCSF on 080821, and
040934 - coorborated by the primary care physician at Kaiser on 080829...
040935 -
040936 -    1.  Subject:  CT Chest resultsPrinter-friendly version
040937 -        Date Sent: 9/12/08 7:49 PM
040944 -         ..
040945 -    2.  Is it correct then to conclude [from Kaiser's response earlier
040946 -        today on 080912 saying omission of findings in the report for
040947 -        the CT test on 080911 shows Interstitional Lung disease has not
040948 -        worsened since the prior test on 080718, or is negigible,
040949 -        ref SDS 8 HI8N] that nothing in the report for the CT test on
040950 -        080911 conveys any discussion of "interstitional disease"?
040951 -        Whatever was there 8 weeks ago has now been resolved, i.e., too
040952 -        small for a CT test to detect.  Very good news.
040954 -  ..
040955 - This asks if the report received on 080912 for the CT test on 080911
040956 - that may present findings on Interstitional Lung disease using other
040957 - language which is recognizable by a a professional health care
040958 - provider?
040959 -
040960 -            [On 080915 the primary care physician responds to this
040961 -            letter without clarifying understandings from the CT test
040962 -            on 080911 with respect to Interstitional Lung disease.
040963 -            ref SDS 10 XE9M
040964 -
040966 -  ..
040967 - Millie's letter to Kaiser continues...
040968 -
040969 -    3.  Similarly, since there is no discussion in the CT report of
040970 -        swelling nodes in the left supraclavicular [reported in the
040971 -        record reviewing the test on 080911 later today on 080912,
040972 -        ref SDS 9 5O6N], does this show that swelling which you noticed
040973 -        on 080829, ref SDS 4 RP8T, and which Lynn reported palpating
040974 -        at UCSF on 080821, ref SDS 3 4C6O, has subsequently subsided?
040975 -
040976 -           [On 080915 primary care physician at Kaiser responds to
040977 -           Millie's letter on 080912 and does not answer the request
040978 -           today asking if omission of findings on in the report on
040979 -           080912 (today) for the CT test on 08911 shows cancer in left
040980 -           supraclavicular has been resolved. ref SDS 10 XE9M
040982 -            ..
040983 -           [On 080918 Brigid could not find swelling in the left
040984 -           supraclavicular, which may align with the CT test not
040985 -           reporting findings in this area. ref SDS 11 N65G
040987 -            ..
040988 -           [On 081022 Doctor Daamen takes biopsy of swelled lymph node
040989 -           in left supraclavicular, and reviews CT test on 080911, and
040990 -           says the scans did not include enough of the neck to
040991 -           evaluate the node in the left supraclavicular. ref SDS 9
040992 -           516F
040994 -            ..
040995 -           [On 081023 Kaiser reports pathology of biopsy positive for
040996 -           breast cancer. ref SDS 12 4Q9Q
040998 -            ..
040999 -           [On 081113 report for CT test of the neck on 081107 finds
041000 -           cancer in right supraclavicular "increased" from prior test,
041001 -           ref SDS 13 4K5H, which is incorrect, because the prior test
041002 -           on 080718 reviewed on 080723, ref SDS 2 EO8F, and referenced
041003 -           in the report for the test on 081107 does not present
041004 -           findings of anything in the right supraclavicular,
041005 -           ref SDS 13 SE9H, and neither does any other test in
041006 -           patient's 7 year history of testing, including the report
041007 -           today for the test on 080911. ref SDS 9 5O6N
041009 -         ..
041010 -    4.  Thanks too for following up on doing CT tests at WC, rather
041011 -        than Oakland.  Melissa, the head of Interventionary Radiology
041012 -        at Oakland said today that it is still pretty rare to do the
041013 -        tests with Power Ports.  The key seems to be having the
041014 -        Infusion Clinic nurses access the port.  May still need to
041015 -        assign a nurse from Interventionary Radiology to be on hand for
041016 -        the test, but not to access the port.  Looks like all the
041017 -        pieces are in place for a solution.
041018 -
041019 -            [On 080915 the primary care physician reported receiving no
041020 -            feedback from the CT Department on upgrading services for
041021 -            patients getting tests using Power Port technology for
041022 -            injecting contrast medium. ref SDS 10 9I5N
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