CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Doctor Daamen called this morning and said that the schedule in the
040902 - Head and Neck Department at Kaiser in Walnut Creek has changed.  The
040903 - core biopsy scheduled by Karen on 081027 1130 for 081117, ref SDS 10
040904 - 9941, can now be performed earlier.
040906 -  ..
040907 - The doctor's call this morning seems related to the letter on 081103
040908 - from the primary care physician advising that Kaiser will perform the
040909 - procedure to test Millie for status change. ref SDS 12 2M64
040911 -  ..
040912 - Doctor Daamen proposed doing the work with Doctor Kahn tomorrow in the
040913 - morning on 081107 1000.
040915 -  ..
040916 - We reviewed Millie's schedule meeting with UCSF in San Francisco
040917 - tomorrow at 0800, which may take an hour or so, and then has a CT test
040918 - at 1300 at Kaiser in Walnut Creek.   The doctor feels this does not
040919 - leave enough time for Millie to have the core biopsy tomorrw at 1000
040920 - in the Head and Neck Department.
040921 -
040923 -  ..
040924 - Core Biopsy Test Status Change at Kaiser 081107 1600
040925 -
040926 - Doctor Daamen scheduled the core biopsy for tomorrow with Doctor Kahn
040927 - 081107 1600.  She checked the doctor's schedule and indicated Doctor
040928 - Kahn may be able to take Millie a little earlier, but set the
040929 - procedure for 1600.
040930 -
040931 -        [On 081106 1213 letter notifies medical team that core biopsy
040932 -        to test for status change advanced from 081117 to 081107 1600.
040933 -        ref SDS 13 7P68
040935 -         ..
040936 -        [On 081119 Kaiser submits summary of final pathology
040937 -        report, ref SDS 16 5O8G, for the biopsy on 081107,
040938 -        ref SDS 15 496L, and it shows status unchanged, ER, PR,
040939 -        Her2neu still triple negative. ref SDS 16 UQ5P
040941 -  ..
040942 - This change extends UCSF planning by Doctor Rugo on 081016,
040943 - ref SDS 6 W26G, and revises the work plan for the medical team updated
040944 - on 081029. ref SDS 11 SF3P
040946 -  ..
040947 - Considered possible worry and stress for Millie doing so much on one
040948 - day, including the CT test at 1300.
040950 -  ..
040951 - Doctor Daamen explained the core biopsy in some respects is easier for
040952 - the patient thant the FNA biopsy on 081022.  The core biopsy needle is
040953 - 2 mm, which is larger than the needle for an FNA biopsy procedure.
040954 - However, the core biopsy takes less time, because it occurs quickly as
040955 - a "pop" from a "gun," and so avoids discomfort and risks of a probing
040956 - process required for FNA biopsies.
040958 -  ..
040959 - Discussed concerns about core biopsy for Millie's patient history
040960 - cited by Doctor Wong on 081024, ref SDS 9 W183, and mentioned risks of
040961 - blood clots and infection. ref SDS 9 7M57
040963 -  ..
040964 - Doctor Daamen noted this morning that Doctor Wong delayed core biopay
040965 - on 081024 until after Millie returns from vacation tomorrow, because
040966 - Millie is on Coumadin, and so delay was needed to pause Coumadin while
040967 - on vacation in order to reduce risk of bleeding with the core biopsy
040968 - procedure in combination with Coumadin treatment.
040970 -  ..
040971 - We reviewed discussion with Doctor Wong on 081024 citing elevated INR
040972 - 4.2 well above the target range on 081016, ref SDS 5 PU7Y, and that
040973 - the doctor was satisfied that INR 2.3 within the target range on the
040974 - next test performed at UCSF a week later (yesterday) on 081023,
040975 - ref SDS 8 PU7Y, was sufficient for doing the core biopsy on 081107.
040976 - ref SDS 9 7M64
040978 -  ..
040979 - There was nothing discussed on 081024 about pausing Coumadin during
040980 - Millie's vacation, and so Millie has continued with treatments while
040981 - on vacation.  Coumadin has been ordered paused 5 days previously for
040982 - surgery, reported on 080708. ref SDS 4 MF4K
040984 -  ..
040985 - Since Kaiser called on 081027 and moved the biopsy scheduled for
040986 - 081107 to 081117, ref SDS 10 CR8J, Millie had no reason to pause
040987 - Coumadin while on vacation until today.
040989 -  ..
040990 - Asked about pausing Coumadin this evening?
040992 -  ..
040993 - Doctor Daamen indicated this would not be effective so soon before the
040994 - core biopsy tomorrow, so advised not to pause Coumadin today.
040996 -  ..
040997 - Doctor Daamen will advise Doctor Kahn that Millie is being treated
040998 - with Coumadin for pulmonary embolism, and did not pause Coumadin 5
040999 - days ago.
041001 -         ..
041002 -        [On 081106 1213 letter to Kaiser confirms understandings on not
041003 -        having paused Coumadin in advance of doing core biopsy next day
041004 -        on 081107. ref SDS 13 WR9V
041006 -  ..
041007 - The doctor will further caution Doctor Kahn to take remedial measures
041008 - to avoid nerve damage in performing the core biopsy tomorrow.  Doctor
041009 - Daamen recalled today that Millie reported feeling a shock travel down
041010 - her left arm during the FNA biopsy performed at Kaiser on 081022.
041011 - ref SDS 7 6Q5J  She will discuss strategy with Doctor Kahn to access
041012 - the lump for the core biopsy at an angle in order to miss nerve tissue
041013 - found with the FNA biopsy on 081022.  She is concerned that the much
041014 - larger 2 mm needle used for core biopsy will cause more severe damage,
041015 - based on patient history on 081022. ref SDS 7 6Q67
041016 -
041017 -        [On 081107 during core biopsy procedure, Doctor Kahn selected
041018 -        core biopsy equipment with a smaller 1.67 mm needle, rather
041019 -        than 2 mm needle, and accessed the lump with the needle from an
041020 -        angle to minimize risks of nerve damage. ref SDS 15 765N
041022 -  ..
041023 - The doctor explained that Millie having continued Coumadin may require
041024 - applying pressure tomorrow to the biopsy wound for a few minutes to
041025 - prevent blood flow.
041027 -  ..
041028 - Decided to proceed with the core biopsy tomorrow with Doctor Kahn at
041029 - Kaiser on 081107 1600.
041031 -  ..
041032 - Doctor Daamen will cancel Millie's meeting on 081117 scheduled by
041033 - Karen on 081027, ref SDS 10 CR8J, and will enter the new schedule for
041034 - Millie to see Doctor Kahn tomorrow at 1600.
041036 -  ..
041037 - This changes the work plan on 081029. ref SDS 11 SF3P
041039 -  ..
041040 - Notified the medical team of this change.
041041 -
041042 -        [On 081106 letter notifies medical team that core biopsy to
041043 -        test for status change advanced from 081117 to 081107 1600.
041044 -        ref SDS 13 7P68
041045 -
041046 -
041048 -  ..
0411 -
0412 -
0413 - 1631
0414 -
041401 - Received call from Robin.
041403 -  ..
041404 - She called to change Millie's meeting with Doctor Wong tomorrow at
041405 - 0930.  Robin said the Doctor's schedule has changed, so we have to
041406 - change the meeting to 1000.
041408 -  ..
041409 - Discussed Doctor Daamen's call this morning scheduling Millie for
041410 - treatment by Doctor Kahn tomorrow at 1600, per above, ref SDS 0 BN3H;
041411 - she is not scheduled for a meeting with Doctor Wong tomorrow.  That
041412 - was scheduled on 081024, ref SDS 9 W159, and then changed to 08117 by
041413 - Karen on 081027. ref SDS 10 CR8J
041415 -  ..
041416 - Robin said there is nothing in the computer showing Karen changed
041417 - Millie's meeting from 081106 0930 with Doctor Wong to 081117; and,
041418 - there is nothing showing Doctor Daamen scheduled Millie for a meeting
041419 - tomorrow with Doctor Kahn at 1600.
041421 -  ..
041422 - Robin said that Doctor Kahn will not be in the Head and Neck
041423 - Department tomorrow at 1600.
041425 -  ..
041426 - She was told to schedule Millie tomorrow with Doctor Wong, but the
041427 - doctor's schedule has changed, so he does not have time to do the
041428 - core biopsy for Millie.
041430 -  ..
041431 - We reviewed the record showing that on 081024 Doctor Wong scheduled
041432 - Millie for a core biopsy on 081107 0930. ref SDS 9 W159  The following
041433 - Monday on 081027, Karen called and changed the meeting with Doctor
041434 - Wong to 081117 1130. ref SDS 10 G15K  This morning, Doctor Daamen
041435 - called and changed the meeting on 081117 to tomorrow 081107 1600 with
041436 - Doctor Kahn.
041438 -  ..
041439 - Robin said she does not know why there is a mixup in the computer.
041440 - They have been having problems with the new system.
041442 -  ..
041443 - Robin will call Doctor Daaemen at Kaiser in Antiock and ask about
041444 - this schedule matter.
041445 -
041447 -  ..
0415 -
0416 -
0417 - 1643
0418 -
041801 - Robin called back.
041802 -
041803 - She has talked to Doctor Daamen.  The doctor explained how to press
041804 - page down, or some other function to scroll the schedule program in
041805 - the computer to another level, and that shows Millie is scheduled to
041806 - meet with Doctor Kahn tomorrow at 1600 for core biopsy procedure.
041808 -  ..
041809 - Robin apologized for the trouble.  She said it was a mistake to say
041810 - Doctor Kahn would not be in the office tomorrow afternoon, but that is
041811 - an easy explanation based on not seeing anything scheduled for him in
041812 - the computer.
041814 -  ..
041815 - Problems using the computer for Knowledge Mangement occurred recently
041816 - in the Kaiser Pharmacy on 080607, when there was a mistake ordering
041817 - Neupogen for Millie. ref SDS 3 856H  This caused overcharge to Millie
041818 - and emotional trauma of Kaiser staff in a panic over how to use the
041819 - computer system. ref SDS 3 MG9N  Another example occurred on 060711
041820 - when Kaiser found 2 years later that biopsy on 040419 did not show
041821 - status change to increase chemotherapy treatments for Millie.
041822 - ref SDS 1 RK4L
041824 -  ..
041825 - As noted, problems using computers for health care case management are
041826 - shown in a case study on 061024. ref SDS 2 QJ4G
041827 -
041828 -     [On 081106 similar computer problem managing patient history on
041829 -     blood tests for Creatinine required Millie's brain MRI at Kaiser
041830 -     in Antioch. ref SDS 14 FR5H
041832 -      ..
041833 -     [On 081229 computer problem recurring in CT Department staff not
041834 -     aware of doctor's referral to perform test using Power Port for
041835 -     injecting contrast medium, and not aware accessing Power Port
041836 -     scheduled in Infusion Clinic, and requires coordinating support
041837 -     from IS. ref SDS 17 5G3I
041838 -
041839 -
041840 -
041841 -
041842 -
041843 -
0419 -