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: December 23, 2008 04:21 PM Tuesday;
Rod Welch
Millie letter from Doctor Stritter for 2nd opinioner treatment options.
1...Summary/Objective
2...Stritter Medical Consulting Beyond the Second Opinion
3...Please Complete and Return this Questionaire
..............
Click here to comment!
CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 41 0000. ref SDS 40 0000.
040502 -
040503 -
040504 -
040506 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Background on Millie meeting Doctor Stritter is reported on 081018 in
040902 - connection with a seminar presentation at the Wellness Community
040903 - cancer support group. ref SDS 34 PQ6X At that time, the doctor asked
040904 - for copies of Millie's correspondence with the medical team on
040905 - response to sunitinib targeted drug for cancer at UCSF that supports
040906 - Doctor Stritter's research on advanced cancer treatments. ref SDS 34
040907 - 1Y4G
040909 - ..
040910 - Background on 081219 Millie was confused, worried, and emotional about
040911 - plans to maintain strong recovery from cancer and reduce side effects
040912 - by adjusting treatments to tolerable levels next week on 081226,
040913 - presented during the meeting at UCSF on 081218, ref SDS 38 QW48, as set
040914 - out in the letter confirming understandings to the medical team.
040915 - ref SDS 39 GF4V
040917 - ..
040918 - Millie has been suffering with rising side effects of cancer
040919 - treatments for several weeks reported on 081218, ref SDS 37 6E7G, and
040920 - yesterday was even worse, which is why the doctor changed the
040921 - treatment on 081218, ref SDS 39 GF9X, responding to Millie's report the
040922 - day before on 081217. ref SDS 36 YJ6R
040924 - ..
040925 - Millie submitted a copy of the letter on 081218 to the medical team
040926 - reporting results of the examination at UCSF on 081218. ref SDS 39 4P7F
040928 - ..
040929 - Millie sent a letter to the primary care physician at Kaiser yesterday
040930 - morning to further guide discussion, ref SDS 40 KY8Q, with agenda
040931 - issues for meeting at 1140 with the doctor to perform regularly
040932 - scheduled oversight of Millie's care on referral to UCSF, and
040933 - complementing agenda issues from the letter sent to Kaiser and the
040934 - medical team on 081218 reporting understandings meeting with UCSF.
040935 - ref SDS 39 N55I
040937 - ..
040938 - On 081220, Millie sent a letter to Doctor Stritter transmitting the
040939 - report on meeting with the medical team at UCSF on 081218, and also
040940 - sending a copy of Millie's letter to the primary care physician to
040941 - discuss during a meeting at Kaiser in the late morning on 081219
040942 - complex decision on adjusting treatments for IBC, and further
040943 - explaining objectives for getting a second opinion on Millie's
040944 - treatment with sunitinib staying at full strength and reducing or
040945 - ending treatment with cyclophosphamide to reduce side effects.
040947 - ..
040948 - Today, Millie received a response from Doctor Stritter saying...
040949 -
040950 - 1. Subject: Re: Meeting Agenda at Kaiser Dec 19th
040951 - Date: Tue, 23 Dec 2008 15:04:57 -0800
040958 - ..
040959 - 2. The San Antonio Breast Cancer Symposium was awesome this year
040960 - as always.
040962 - ..
040963 - 3. Thank you for your interest in my services. I am sorry to hear
040964 - of your problems with breast cancer. I agree that your case is
040965 - quite complicated and I really look forward to helping you in
040966 - any way I can.
040968 - ..
040969 - 4. Attached you will find your information packet (2 .pdf files).
040970 - It will help you determine whether my style of practice will
040971 - work for you. It contains the following:
040972 -
040973 - a. A brief fact sheet
040974 -
040975 - b. A detailed overview of my practice
040977 - ..
040978 - c. A questionnaire
040979 -
040980 - [...below in the record today on 081223, information for
040981 - questionnaire. ref SDS 0 UK4O
040983 - ..
040984 - 5. Please read the practice overview carefully.
040985 -
040986 - If you then wish to make a phone appointment, please fill out
040987 - the enclosed questionnaire and return it at your earliest
040988 - convenience. A one-page summary of your health problem is
040989 - helpful (in particular, I need the names and dates of all
040990 - treatments to date). It is also very useful if I could have the
040991 - following medical records before your first appointment:
040992 -
040993 - a. All pathology reports
040995 - ..
040996 - b. The last 2 MRI or CT scan reports
040998 - ..
040999 - c. The last 2 PET or PET/CT scan reports, if done
041001 - ..
041002 - d. Any relevant operative reports
041004 - ..
041005 - 6. Do not send your complete medical records unless you would like
041006 - me to review them all (I charge extra for this service).
041008 - ..
041009 - I charge $300 for the first phone appointment. This includes
041010 - the preliminary research, a 60- to 90-minute phone appointment
041011 - and long-distance charges (I will call you). Please send in
041012 - your check beforehand (payable to "Stritter Medical
041013 - Consulting") as it prevents a high rate of last-minute
041014 - appointment cancellation or rescheduling. Sometimes people
041015 - wish a comprehensive evaluation of their medical records before
041016 - the first appointment. I charge separately for this service.
041017 -
041018 - [On 090106 Millie submitted payment to Stritter Medical
041019 - Consulting called out in this section. ref SDS 44 S34O
041021 - ..
041022 - At the end of the first appointment, you and I will decide
041023 - together whether you need further services. Sometimes, you are
041024 - on the right track and I may only add a few ideas. On the other
041025 - hand, I usually suggest other approaches or areas to research
041026 - and we will need to schedule a follow-up appointment. Fees for
041027 - the follow-up appointment and all services subsequent to the
041028 - first appointment are billed on an hourly basis. Please see
041029 - the practice overview for more information on my fees.
041031 - ..
041032 - Finally, I find that a photograph helps me put a face to the
041033 - person(s) with whom I am talking on the telephone. So, I
041034 - really appreciate it when people send a photo of themselves;
041035 - any photo of you will do whether it is before your illness,
041036 - with your family or while your are on vacation.
041038 - ..
041039 - <RO778
041040 - Take care and please do not hesitate to call if you have any
041041 - questions.
041043 - ..
041044 - 7. I hope you and your family have a meaningful and joyful holiday
041045 - season...
041047 - ..
041055 -
041056 -
041058 - ..
041059 - Stritter Medical Consulting Beyond the Second Opinion
041060 - Please Complete and Return this Questionaire
041061 -
041062 - The doctor attached a Questionnaire pdf file requesting case
041063 - management information, as cited in the doctor's letter today, per
041064 - above. ref SDS 0 AR6M Our computer is not configured for entering
041065 - information online in the pdf file. We need Adobe Acrobat software
041066 - for this level of support.
041068 - ..
041069 - [On 090106 7 year patient history was summarized for
041070 - Stritter Medical Consulting to issue an opinion about
041071 - treatments that may help Millie recover from IBC.
041072 - ref SDS 44 IP6H
041074 - ..
041075 - [On 090106 Millie's letter to Stritter Medical Consulting
041076 - submitted patient history and scope of services,
041077 - ref SDS 44 PQ6Q, along with payment of $300. ref SDS 44
041078 - 6G5Y
041080 - ..
041081 - [On 090120 telephone call Doctor Stritter requested Millie
041082 - fill out the questionnaire, ref SDS 47 CM66, received today
041083 - on 081223, per below. ref SDS 0 UK4O
041085 - ..
041086 - [On 090121 Millie submitted a letter transmitting
041087 - information, ref SDS 48 C57O, requested in the
041088 - questionnaire set out in this record on 081223 as
041089 - follows...
041091 - ..
041092 - Here is the information requested in the questionaire....
041093 -
041094 - 1. Today's date: 081223
041095 -
041097 - ..
041098 - 2. Person for whom help is being sought:
041099 -
041100 - Name................. Millie
041101 - Age.................. 73
041102 - Type of Work......... Secretary
041103 - Education............ High School degree (12 years)
041104 - Address..............
041105 - Phones...............
041106 -
041108 - ..
041109 - 3. Your name/information (if different from above):
041110 -
041112 - ..
041113 - 4. If you are not the person for whom help is being sought,
041114 - please indicate (by circling) which address/phone number(s) we
041115 - should use to set up the initial appointment.
041116 -
041118 - ..
041119 - 5. How or from whom did you hear about my practice?
041120 -
041121 - On 081018 at the Wellness Community, Pleasant Hill, CA, Doctor
041122 - Stritter gave an excellent presentation, ref SDS 34 IS5L, on
041123 - research identifying cutting edge treatments for cancer.
041124 - ref SDS 34 IT68
041125 -
041127 - ..
041128 - 6. What is the general nature of the medical problem(s) for which
041129 - you are seeking help? Give the diagnoses, if possible. At the
041130 - end of this questionnaire, you will be asked to describe in
041131 - more detail the specific problems you are seeking to resolve.
041133 - ..
041134 - Secondary Inflammatory Breast Cancer (IBC) diagnosed with
041135 - biopsy on 040419, and disclosed during a meeting at Kaiser a
041136 - month later on 040517. ref SDS 9 7D6F
041137 -
041138 - [On 090106 patient history summarized. ref SDS 44 IP6H
041140 - ..
041141 - Symptoms of IBC were first presented in a report for a PET scan
041142 - at Kaiser on 020218, later received during at meeting at Kaiser
041143 - on 030109. ref SDS 4 L66M At that time on 030109, red rash on
041144 - left breast was treated for Cellulitis. ref SDS 4 KW5F
041146 - ..
041147 - Pulmonary embolism was diagnosed with CT test on 041103,
041148 - reviewed with Kaiser on 041104. ref SDS 10 QP6S Millie is
041149 - currently treated with daily Coumadin to control pulmonary
041150 - embolism.
041152 - ..
041153 - Triple negative status, shown by biopsy from sentinel node
041154 - surgery on 020312, and reported in the record at Kaiser on
041155 - 020321. ref SDS 3 6Q6J UCSF ordered test for status change to
041156 - expand treatment options. On 081107 Kaiser performed core
041157 - biopsy, and on 081121 results shows not change in triple
041158 - negative status. ref SDS 35 5O8G
041160 - ..
041161 - Millie has recovered with treatment and relapsed 5 times since
041162 - 040517.
041163 -
041164 - [On 090114 Millie's treatment history is listed.
041165 - ref SDS 44 K87F
041166 -
041168 - ..
041169 - 7. How long has this problem been going on? (be specific)
041170 -
041171 - 7 years 0 months. February 2002 - January 2009
041173 - ..
041174 - 8. In total, how many physicians been seen for this problem?
041175 -
041176 - Answer: 9
041177 -
041179 - ..
041180 - 9. Please list their names and specialties, and approximately when
041181 - they were first seen. Circle the ones that are currently
041182 - involved with the case, with a star by the one(s) primarily in
041183 - charge of the case. (Don't worry, none of them will be
041184 - contacted without first clearing it with you.)
041186 - ..
041187 - Doctor Johnson is the primary care physician in Oncology at
041188 - Kaiser in Walnut Creek, and supervises care on referral to UCSF
041189 - in San Francisco, performed by Doctor Rugo.
041190 -
041191 - 1. Doctor Robert Johnson primary care physician Oncology Kaiser Walnut Creek
041192 - 2. Doctor Kara Riley-Paull surgeon at Kaiser
041193 - 3. Doctor Nicole Daamen head and neck specialist at Kaiser
041194 - 4. Doctor Christopher Benz at UCSF 2nd opinion IBC relapse 2004 and 2006
041195 - 5. Doctor Alice (Elly) Guardino at Stanford 2nd opinion IBC relapse treatment 2004
041196 - 6. Doctor Veronica Shim Kaiser in Oakland for mastectomy 2nd opinion 2005
041197 - 7. Doctor Lisa Bailey in Berkeley for mastectomy 2nd opinion 2005
041198 - 8. Doctor Nima Grissom San Francisco mastectomy 2nd opinion 2005
041199 - 9. Doctor Hope Rugo Oncology at UCSF referral from Kaiser 2007
041200 -
041202 - ..
041203 - 10. How good is the communication between you and the physician(s)
041204 - primarily in charge of your case (circle one)
041205 -
041206 - Not very good
041207 - Reasonably good
041208 - * Extremely good
041210 - ..
041211 - Communications among the patient, the primary care physician
041212 - at Kaiser, and Doctor Rugo on referral at UCSF are excellent
041213 - within limited time doctors have for coordination, explained
041214 - on 080403. ref SDS 26 S26I At that time, Doctor Rugo noted
041215 - advantates of patient support for UCSF to communicate with
041216 - Kaiser for coordinated care. ref SDS 26 4U9O
041217 -
041219 - ..
041220 - 11. From your viewpoint, which of the following describes the
041221 - physician(s) primarily in charge (circle all that apply):
041222 -
041223 - * Too busy
041224 - * Very patient
041225 - * Always in a hurry
041226 - Thorough
041227 - * Caring
041228 - * Goes the extra mile
041229 - Doesn't return phone calls
041230 - Too business-like
041231 - Other...
041233 - ..
041234 - Doctors are always in a hurry, illustrated by the scenario
041235 - in NWO. ref OF 15 VP7L This makes daily medical practice
041236 - too busy for thorough deliberation, since doctors are
041237 - scheduled to see patients every 15 minutes all day long,
041238 - shown by Kaiser's Healthwise Handbook reviewed on 990625.
041239 - ref SDS 2 5740 When doctors are not seeing patients, they
041240 - are meeting with colleagues, business managers, attending
041241 - conferences, and managing staff. This leaves no time for
041242 - deliberation.
041244 - ..
041245 - Within this framework, Millie has been blessed to get ample
041246 - time with her doctors at Kaiser and UCSF, averaging from 30
041247 - to 75 minutes per visit, reflecting complexity of her case
041248 - shown by 43 medical problems to track listed on 070330.
041249 - ref SDS 21 LU3J
041251 - ..
041252 - The primary care physician at Kaiser is supported by
041253 - Knowledge Management technology that leverages time with the
041254 - patient by enabling a stronger effort capturing medical
041255 - history during meetings with efficient access to test
041256 - reports, and case management data. Challenges learning to
041257 - use Kaiser technology that impair patient care were recently
041258 - reviewed on 081229. ref SDS 43 A46I
041260 - ..
041261 - Doctor Rugo has several assistants that do a great job
041262 - capturing a traditional manual record of daily work.
041263 - Technology at UCSF is less advanced than Kaiser, but labs
041264 - and schedules can be accessed efficiently on the UCSF
041265 - computer system. Frustrations from difficulty finding
041266 - patient history were cited by the doctor in a meeting on
041267 - 080219. ref SDS 25 L18L
041269 - ..
041270 - Doctor Johnson stands out for "going the extra mile." Often
041271 - doctors in a big hospital tell the patient to the tell the
041272 - nurse or an attendant that the doctor wants "xyz." Just as
041273 - often, staff resists performance and tells the patient they
041274 - cannot do "xyz" until the doctor issues a written order. An
041275 - attendant tells the patient "Doctor wants this or that." The
041276 - patient tells the attendant the doctor just said to do
041277 - "xyz," check with the doctor. The attendant says they
041278 - cannot disturb the doctor. They are afraid.
041280 - ..
041281 - This presents a management loop.
041283 - ..
041284 - Doctor Johnson has on many occassions taken time to leave a
041285 - meeting and go give direct instructions, so that treatment
041286 - is not delayed, and the patient, nurses, and admin staff do
041287 - not suffer emotional tramua coordinating work. An example
041288 - was coordinating Millie's CT test on 080627. At that time
041289 - the doctor was annoyed because of conflicting requirements,
041290 - and so went to the Infusion Clinic and developed a work plan
041291 - to resolve conflicts. ref SDS 27 GO3G
041292 -
041294 - ..
041295 - 12. Is there a primary care physician (general practitioner/family
041296 - physician)?
041297 -
041298 - * Yes:
041299 - No:
041301 - ..
041302 - If so, please give names and location:
041303 -
041304 - Doctor Robert A. Johnson
041305 - Kaiser Oncology Department
041306 - Walnut Creek, CA
041308 - ..
041309 - Are they still involved in the case?
041310 -
041311 - * Yes.......................... ref SDS 0 JE60
041312 - No
041314 - ..
041315 - 13. To your knowledge, in regard to this case, have your physicians
041316 - consulted with physician-specialists outside of the local
041317 - medical community (i.e. elsewhere in the country)?
041318 -
041319 - Yes
041320 - No
041321 - * Don't Know
041322 - Doubt it
041324 - ..
041325 - On 070610 the primary care physician reported good
041326 - communication within the medical team coordinating Millie's
041327 - care at UCSF by Doctor Rugo. ref SDS 22 OG7F
041329 - ..
041330 - There is nothing in the record showing substantive
041331 - consultations between UCSF and Kaiser, between UCSF and others,
041332 - nor between Kaiser and other doctors. There are no writings,
041333 - and no verbal expressions in several hundred meetings over
041334 - seven (7) years that indicate consultations.
041335 -
041337 - ..
041338 - 14. To your knowledge, has a medical literature search been done,
041339 - i.e. a computer or Medline search, or, if it applies, a PDQ
041340 - (Physician's Data Query, from the National Cancer Institute,
041341 - which has listings of possible treatment protocols)?
041342 -
041343 - Yes
041344 - No
041345 - * Don't Know
041346 - Doubt it
041348 - ..
041349 - Within the doctor patient partnership model, numerous computer
041350 - searches have been done to assist the medical team identify
041351 - treatment for IBC, i.e., on 040517. ref SDS 9 6M9H
041353 - ..
041354 - UCSF routinely uses the computer during meetings to research
041355 - issues in Millie's case. There is no record of search at
041356 - Kaiser nor at UCSF of computer search for IBC treatments. This
041357 - may have been done outside of meetings with the patient.
041358 -
041360 - ..
041361 - 15. Did the physician(s) provide you with articles or in-depth
041362 - information on the condition?
041363 -
041364 - Yes
041365 - * No....................... 040517, ref SDS 9 6T5G
041367 - ..
041368 - When Millie was diagnosed with breast cancer, during the first
041369 - meeting in Oncology on 020321, the doctor provided copies of
041370 - pages from "AJCC Cancer Staging Handbook" with guidance that
041371 - identified Millie was initially a stage II cancer patient.
041372 - ref SDS 3 6Q4U
041374 - ..
041375 - On 030508 Millie asked about rising cancer marker CA 15-3
041376 - indicates relapse that requires treatment, since at that time
041377 - she was off treatment during all of 2003? The doctor submitted
041378 - a Kaiser pamphlet with the title...
041379 -
041380 - Patient's Guide, Follow-up Care for Breast Cancer
041382 - ..
041383 - This was presented to support a representation during the
041384 - meeting that ASCO does not recognize the cancer marker CA 15-3
041385 - to assess breast cancer, and so not to worry about the rise
041386 - indicating treatment was needed. The content in the pamphlet
041387 - seems to say otherwise. ref SDS 5 M28G
041388 -
041390 - ..
041391 - 16. At any point, did you request the physician(s) to do more work
041392 - on your case (i.e. additional research, consultations, etc.)?
041393 -
041394 - * Yes
041395 - No
041397 - ..
041398 - If YES, what did you request?
041399 - If YES, what was the response to the request?
041400 -
041401 - a. On 030606 Millie requested a PET scan test and biopsy of
041402 - the left breast to evaluate rising inflammation along with
041403 - rising cancer marker. ref SDS 6 P97J
041405 - ..
041406 - This was deferred.
041408 - ..
041409 - b. On 030710 PET scan test descirbed symptoms of IBC which at
041410 - that time were not known by the patient. Millie requested
041411 - biopsy to "correlate clinically," recommended in the PET
041412 - scan report. ref SDS 7 XX4G
041414 - ..
041415 - This was deferred, ref SDS 7 WS3M, until 9 months later on
041416 - 040419, when the patient asked the surgeon to perform an
041417 - addon biopsy after minor procedure to implant a port
041418 - catheter, ref SDS 8 789F; a month later the biopsy report
041419 - diagnosed IBC on 040517. ref SDS 9 7D6F
041421 - ..
041422 - c. On 041130 Kaiser was asked for a written work up on
041423 - Millie's case listing treatment options, following
041424 - discovery on 041104 of pulmonary embolism that required
041425 - ending treatment for IBC on the bevecizumab and Taxol
041426 - clinical study. ref SDS 11 YR8F
041428 - ..
041429 - This was resisted. ref SDS 11 8P8F
041431 - ..
041432 - d. On 050329 the primary care physician planned to discuss
041433 - with the surgeon criteria for mastectomy surgery in
041434 - Millie's case. ref SDS 12 T89H
041436 - ..
041437 - Surgeon advised on 050724 that she has received several
041438 - telephone messages from the primary care physician, and has
041439 - returned calls and left messages, but so far there has not
041440 - been enough time for discussions. ref SDS 14 H85G
041442 - ..
041443 - e. On 050913 Kaiser was asked to perform Kaiser's
041444 - requirements, ref SDS 15 T46F, for "Time Out" review of
041445 - proposed surgery. ref SDS 15 Q95M
041447 - ..
041448 - This was resisted. ref SDS 15 5T5N
041450 - ..
041451 - f. On 050913 patient requests joint meeting between oncology
041452 - and surgery departments to aid collaboration that has been
041453 - difficult to accomplish previously; this was rejected
041454 - because team care practice and collaboration are not
041455 - practical due to conflicting schedules. ref SDS 15 6W4L
041457 - ..
041458 - On 050916 primary care physician reported during a brief
041459 - meeting with the patient in the Chemotherapy Clinic that he
041460 - had met and discussed Millie's case with the surgeon.
041461 - Results of the meeting were not presented. ref SDS 16 PF3G
041463 - ..
041464 - On 050923 the surgeon reported on meeting with the primary
041465 - care physician in the hallway for a brief discussion.
041466 - ref SDS 17 LP6H
041468 - ..
041469 - g. On 080109 UCSF was asked for written analysis of findings
041470 - from photographic review, as part of annual patient review,
041471 - prognosis, and planning, ref SDS 23 4P9K, similar to the
041472 - Benz report on 060929. ref SDS 19 KS8H Doctor Rugo updated
041473 - the Benz analysis in a report on 070130, and so set a
041474 - benchmark for annual review. ref SDS 20 795I
041476 - ..
041477 - This was refused on 080110. ref SDS 24 BF66
041479 - ..
041480 - h. On 080917 UCSF was asked for a work plan to provide follow
041481 - on treatment, ref SDS 31 SH5T, based on findings by the
041482 - primary care physician on 080829, ref SDS 30 RP8T, which
041483 - confirmed UCSF finding possible progression of disease a
041484 - week earlier on 080821. ref SDS 29 4C6O
041486 - ..
041487 - This was not performed.
041489 - ..
041490 - i. On 081015 UCSF was asked for future treatment options
041491 - proposed previously for discussion on 080918, ref SDS 32
041492 - 9W6H Is there a list, with analysis of pros and cons?
041493 - Would it be helpful to meet with Doctor Benz for a review
041494 - to get a written list of treatment options for the future?
041495 - ref SDS 33 K45V
041497 - ..
041498 - This was not performed.
041499 -
041501 - ..
041502 - 17. Please rate your level of frustration with the overall medical
041503 - system you have been dealing with (circle one):
041504 -
041505 - * Not frustrated
041506 - Somewhat frustrated
041507 - Very frustrated
041509 - ..
041510 - Timely care to recover from cancer has been frustrated by
041511 - limited resources of time, money, and expertise striving to
041512 - deliver the greatest care to the greatest number. Doctors,
041513 - nureses, administrative staff get very frustrated by the
041514 - growing number of patients and expanding treatment options that
041515 - extend life, which greatly complicates health care. Living
041516 - longer makes maintaining a well ordered record essential for
041517 - effective care more complicated, and eventually overwhelms all
041518 - business systems, reviewed on 970710. ref SDS 1 0108
041520 - ..
041521 - Everybody gets annoyed by the level of effort required for
041522 - accurate, timely care, noted by the surgeon on 080708.
041523 - ref SDS 28 O65F The surgeon noted that coordinating complex
041524 - case management becomes very annoying. ref SDS 28 OK8M This
041525 - becomes frustrating the longer a patient lives.
041526 -
041528 - ..
041529 - 18. Please describe what research, reading, and work you've done on
041530 - your own to try to solve this problem.
041532 - ..
041533 - Patient history in SDS records helps health care providers
041534 - understand complex problems.
041536 - ..
041537 - Examples of independent research include...
041538 -
041539 - Kaiser Healthwise Handbook
041540 - reviewed for case management
041541 - procedures........................ 990625, ref SDS 2 4185
041543 - ..
041544 - IBC............................... 040517, ref SDS 9 6M9H
041546 - ..
041547 - Pulmonary embolism relapse
041548 - close call........................ 060722, ref SDS 18 BP7M
041550 - ..
041551 - Pulmonary embolism wicked problem
041552 - disagnosis complex, very
041553 - difficult......................... 060722, ref SDS 18 346F
041555 - ..
041556 - Alternative treatments............ 050712, ref SDS 13 0001
041557 -
041559 - ..
041560 - 19. Please describe self-care approaches, groups,
041561 - alternative/complementary therapies that you may be using or
041562 - have tried in the past. Put a star by the ones that you feel
041563 - have helped.
041564 -
041565 - * Exercise........................ 081223, ref SDS 42 X64F
041566 - * Doctor patient/partnership...... 990625, ref SDS 2 4185
041567 - * Patient assistance.............. 990625, ref SDS 2 JY9J
041568 - * SDS technology for creating
041569 - a well ordered record........... POIMS, ref OF 5 XX6N
041570 -
041572 - ..
041573 - 20. Please state as simply and clearly as possible the problem(s)
041574 - you want help resolving. Include any additional comments to
041575 - further clarify the above answers and better explain the
041576 - situation. It also may be helpful for you to write and attach
041577 - to this questionnaire a brief summary of the medical history.
041578 - Please try to limit it to one page. If there are essential
041579 - medical documents, such as a biopsy or pathological reports,
041580 - include that as well, but, please, don't send a complete set of
041581 - medical records at this time.
041582 -
041583 - [On 090106 Millie submitted to Doctor Stritter...
041584 -
041585 - a. Patient history................... ref SDS 44 IP6H
041586 - b. Labs.............................. ref SDS 44 XD9M
041587 - c. Image tests....................... ref SDS 44 AJ8M
041588 - d. Treatment history................. ref SDS 44 K87F
041589 - e. Scope of services for Stritter
041590 - Consulting........................ ref SDS 44 PQ6Q
041592 - ..
041593 - [On 090114 Doctor Stritter requested Millie's pathology
041594 - history. ref SDS 45 U271
041595 -
041596 -
041597 -
041598 -
041599 -
041600 -
041601 -
041602 -
0417 -