CONTACTS 

SUBJECTS
Brain MRI Ordered Kaiser Screening Test  Prticipate Sunitinib Clinic

1603 -
1603 -    ..
1604 - Summary/Objective
1605 -
160501 - Follow up ref SDS 12 0000. ref SDS 11 0000.
160502 -
160503 -
160504 -
160505 -
160506 -
160508 -  ..
1606 -
1607 -
1608 - Progress
1609 -
160901 - We left early to allow time adjustng for problems implementing Monia's
160902 - instructions on 081031. ref SDS 12 NZ5L  Arrived on time after
160903 - discovering that directions to drive South from Highway 4 on Long Tree
160904 - Way and turn left onto Deer Valley Road was incorrect.  After arrivng
160905 - back at Highway 4, we turned around drove back on Deer Valley Road and
160906 - asked for directions at the Chevron gas station.  Learned the route to
160907 - Kaiser turns right onto Deer Valley Road from Lone Tree Way.  Found
160908 - Kaiser a mile or so from Lone Tree Way.
160910 -  ..
160911 - This is a huge, beautiful facility out in the middle of nowhere.
160912 - Kaiser saved money on parking.  The width of driving lanes borders on
160913 - dangerous, and is certainly difficult even for patients who are not
160914 - elderly and infirm, i.e., the people most likely to need medical care.
160916 -  ..
160917 - We found the CT and MRI department.  The attendant told Millie that
160918 - Kaiser could not do the test this morning because Kaiser does not have
160919 - a record of blood work for Creatinine.  The attendant said that on
160920 - 081006 she called and left a message for Millie to go to Kaiser and
160921 - get a blood test yesterday, on 081107.  Kaiser's computer shows this
160922 - morning that Millie did not get the blood test required for the MRI
160923 - test today.  She said Kaiser's computer shows Millie's last blood test
160924 - for Creatinine was on 080708, and that is too long ago to verify
160925 - Millie can safely get an MRI today.  The attendant discussed sending
160926 - Millie to the lab and getting the blood work today.  The MRI can then
160927 - be rescheduled for late November.
160929 -  ..
160930 - Millie handed a copy of the report for lab work at UCSF on 081023 to
160931 - the attendant.  Explained that on 081031 Kaiser's MRI test schedule
160932 - representative, Laura, advised that Millie's labs at UCSF on 081023
160933 - showing Creatinine 0.54, ref SDS 6 8U4N, satisfy Kaiser requirements
160934 - for the MRI test today. ref SDS 12 IO97  The attendant said she was
160935 - told Millie needed the blood test done at Kaiser.  She was not sure
160936 - the report from UCSF can be used at Kaiser.
160938 -  ..
160939 - At that time, Dinah, the MRI test Technician came into the lobby.  She
160940 - overhead the discussion, and asked to see the UCSF report for the lab
160941 - on 081023. ref SDS 6 8U4N  The attendant handed the report to Dinah.
160942 - Dinah said the UCSF report is adequate.  She agreed to do Millie's MRI
160943 - test today.
160944 -
160946 -  ..
1610 -
1611 -
1612 - 1050
1613 -
161301 - Millie was taken to a dressing area.  She stored her things in a
161302 - locker.
161304 -  ..
161305 - Millie asked if the patient assistant can support the test today?
161307 -  ..
161308 - Dinah said Kaiser's policy is for support people, e.g., family,
161309 - friends, to stay in the waiting room until after the test.  Dinah said
161310 - there is really no need for assistance, because the test only involves
161311 - technical use of equipment based on patient history, and Kaiser
161312 - Technicians are trained to do everything needed.
161314 -  ..
161315 - Millie related experience yesterday getting a CT test at Kaiser in
161316 - Walnut Creek.  Like today, the CT Technician resisted, and ultimately
161317 - refused to allow patient assistance to support the CT test, because
161318 - the test technicians were very experienced doing tests without patient
161319 - assistance, but had no experience using this support. ref SDS 13 MX6K
161320 - Significant problems then occurred that required accurate patiane
161321 - history of very detailed matters.  It took a long time to solve this
161322 - problem yesterday without the patient assistant. ref SDS 13 9J9M
161324 -  ..
161325 - Dinah decided to use patient assistance for the work today.
161326 -
161327 -        [...below, Dinah relies on patient assistance support to guide
161328 -        work of the MRI test.
161330 -  ..
161331 - This is a 2 part test, each with many cycles.  The first phase has
161332 - perhaps 10 cycles.  Phase 2 requires injecting contrast medium,
161333 - similar to CT tests, except this is done by hand, rather than high
161334 - pressure equipment.  The 2nd phase has perhaps 4 cycles, making a
161335 - total of about 15 or 16 over a 45 minute time span.
161337 -  ..
161338 - Everything went smoothly until phase 2.
161340 -  ..
161341 - Dinah said she is not qualified to inject contrast medium through
161342 - Millie's Power Port, used yesterday for the CT test at Kaiser in
161343 - Walnut Creek. ref SDS 13 7F40
161345 -  ..
161346 - Millie recalled that using the Power Port at Kaiser in Oakland on
161347 - 080911, and again yesterday in Walnut Creek was a lot faster and
161348 - easier than doing an IV and everything.  Last April it took the CT
161349 - tech 4 hours to do a test because they couldn't find a vein.  With
161350 - the Power Port, it's a 20 minute job.
161352 -  ..
161353 - Dinah said that may be but her boss says don't use a port for MRI test
161354 - contrast medium, so we need another solution today.
161356 -  ..
161357 - Millie explained that IV injection can only be done on her left arm.
161359 -  ..
161360 - Dinah examined Millie's left arm and said she has very good veins for
161361 - doing IV injections.  Dinah asked about the various scars on Millie's
161362 - arm?
161364 -  ..
161365 - Millie explained the scars on her arm, the top of her hand, and the
161366 - underside of the wrist are from prior attemtps to use IV injection for
161367 - various tests, blood draws, and cheotherapy, illustrated by the record
161368 - on 080425. ref SDS 1 FP6F  Dinah commented that Millie's veins are not
161369 - as good as they look for IV injections, because repeated access and
161370 - chemotherapy for 7 years have diminished capacity for injecting
161371 - contrast medium.  Evidently flow is constricted by scar tissue.
161373 -  ..
161374 - Dinah asked what can be done to complete the test?
161376 -  ..
161377 - Millie suggested that Dinah try a location on Millie's inner elbow of
161378 - the left arm.  She feels there might be a few more injections possible
161379 - at this location.  Another possibility that isn't immediate might be
161380 - to open a vein with surgery.  This presents other problems.
161382 -  ..
161383 - Dinah felt for a vein on the inner elbow, and said she cannot feel
161384 - anything.
161386 -  ..
161387 - Millie used her hand to put Dinah's fingers on a specific location
161388 - that might work for an injection IV today.  She said that this
161389 - location has sometimes worked before, but it is harder to find.  She
161390 - related how Kathi used a torunaquet to make the vein more accessible,
161391 - after problems developed using the Power Port for Millie's CT test on
161392 - 080718. ref SDS 3 RL74
161394 -  ..
161395 - Dinah said that's a good idea.  She has used this method for problem
161396 - cases.  Dinah placed a tourniquet above the elbow and below the bicep.
161397 - She asked Millie to make a fist.  Dinah was then able to feel a vein
161398 - with strong blood flow on the inner elbow.
161400 -  ..
161401 - Dinah told Millie to relax her hand.  She inserted the IV needle, but
161402 - hit an obstruction and stopped, initially thinking it would cause
161403 - harm to go further.
161405 -  ..
161406 - Millie explained this is likely scare tissue from prior IV's.  She
161407 - suggested Dinah press the needle a little further.  Dinah did so, and
161408 - the needle penetrated into the vein without going out the other side.
161410 -  ..
161411 - Dinah tested blood flow, and then did the injection.  Took about 20
161412 - seconds.
161414 -  ..
161415 - She then went back to the Control Room and completed the 2nd phase of
161416 - the brain MRI test, about 15 minutes.
161418 -  ..
161419 - Millie thanked Dinah for taking extra time today listening to the
161420 - patient and following medical history.  Maybe one day MRI tests can be
161421 - fast and easy like CT tests, shown by patient history at Kaiser in
161422 - Walnut Creek yesterday. ref SDS 13 2F56
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