CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 69 0000, ref SDS 39 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - The meeting today follows up patient history...
040902 -
040903 - 1. Examination at Kaiser found significant
040904 - recovery with sunitinib protocol
040905 - at UCSF........................... 081219, ref SDS 39 QW5J
040907 - ..
040908 - 2. Primary care physician calls about
040909 - Millie's fall and treatment in ER for
040910 - separated shoulder, and explains rise
040911 - in Millie's cancer marker signals
040912 - severe relapse for the 6th time,
040913 - and Millie needs immediate treatment
040914 - for her cancer as chronic
040915 - disease........................... 090123, ref SDS 51 RK6O
040917 - ..
040918 - 3. Sudden reversal with severe relapse
040919 - of IBC that requires immediate
040920 - change of treatment reported
040921 - from examination at
040922 - UCSF.............................. 090130, ref SDS 54 4S8O
040924 - ..
040925 - 4. Doctor Rugo prescribes immediate
040926 - treatment at UCSF in radiation
040927 - oncology department for
040928 - 7th relapse....................... 090130, ref SDS 54 TZ6H
040930 - ..
040931 - 5. Urgent treatment was delayed a week
040932 - due to communication problems
040933 - at UCSF........................... 090130, ref SDS 54 AY8Q
040935 - ..
040936 - 6. Approval for Kaiser referral to UCSF
040937 - was delayed by documentation
040938 - errors............................ 090202, ref SDS 56 SP6H
040940 - ..
040941 - 7. Kaiser expedites referral authorization
040942 - in order for UCSF to provide urgent
040943 - treatment quickly enough for
040944 - Millie to recover................. 090202, ref SDS 55 LC7H
040946 - ..
040947 - 8. UCSF proposes 3-week delay to begin
040948 - planning Millie's treatment for
040949 - recovering from 6th relapse of
040950 - of IBC............................ 090202, ref SDS 56 SP7M
040952 - ..
040953 - 9. Doctor Rugo notifies medical team
040954 - Millie needs urgent treatment quickly
040955 - in time to be effective recovering
040956 - from 6th relapse of
040957 - IBC............................... 090202, ref SDS 57 Y15J
040959 - ..
040960 - 10. Millie's letter to UCSF implements Doctor
040961 - Johnson's requests for UCSF strategy
040962 - to treat Millie's cancer as a
040963 - chronic disease................... 090203, ref SDS 58 278T
040965 - ..
040966 - 11. Doctor Rugo's letter explains planning
040967 - to evaluate response to hyperthermia
040968 - treatment and arrange continuing
040969 - care based on another
040970 - CT scan........................... 090204, ref SDS 60 278T
040972 - ..
040973 - 12. UCSF advances Millie's care in Radiation
040974 - Oncology Department 3 weeks; scope of
040975 - radiation and hyperthermia evaluated
040976 - by Dcotor Hsu and Doctor
040977 - Chang............................. 090205. ref SDS 62 0001
040979 - ..
040980 - 13. CT and xray tests taken, and layout
040981 - of treatment fields performed to
040982 - build molds for Millie's
040983 - radiation......................... 090209. ref SDS 67 9R61
040985 - ..
040986 - 14. Examination primary care physician
040987 - at Kaiser finds severe progression
040988 - of IBC in 6th
040989 - relapse........................... 090213, ref SDS 69 4W5I
040991 - ..
040992 - 15. Millie lucky to survive stage IV cancer
040993 - for 8 years because cancer mutates to
040994 - defeat treatments; and medical maladies
040995 - increase which makes recovery
040996 - more difficult to
040997 - achieve........................... 090213, ref SDS 69 NY7L
040999 - ..
041000 - 16. Complexity of case management grows
041001 - during long term survival prevents
041002 - keeping a well ordered record
041003 - essential for effective
041004 - care.............................. 090213, ref SDS 69 9L8O
041006 - ..
041007 - 17. Emotional trauma occurs from surprise
041008 - by medical professionals that Kaiser
041009 - and UCSF have enabled long term surivial
041010 - for a disease that normally is
041011 - difficult to control.............. 090213, ref SDS 69 ML4I
041013 - ..
041014 - 18. Communication leverages synergy
041015 - for Millie's care at Kaiser and UCSF
041016 - which helps prevent problems from
041017 - "falling through the cracks; fewer
041018 - mistakes, and timely response
041019 - helps the medical team
041020 - increase longevity,
041021 - also seems very
041022 - annoying.......................... 090213, ref SDS 69 FZ4H
041024 - ..
041025 - 19. Doctor urges proactive management to
041026 - plan Millie's next treatment because
041027 - there will be less time to recover
041028 - before cancer gets out of control
041029 - for Millie's next
041030 - relapse........................... 090213, ref SDS 69 UP6L
041032 - ..
041033 - 20. Millie's efforts the past 8 years to
041034 - combine medical treatment with vigorous
041035 - exercise was supported by research
041036 - showing exercise can be a strong
041037 - component of cancer
041038 - care.............................. 090213, ref SDS 69 GC40
041040 - ..
041041 - 21. Indian fable illustrates long-term survival
041042 - getting continuous treatment for cancer
041043 - becomes increasingly difficult to perform
041044 - complex clinical, logistical, and financial
041045 - case management; study of Millie's patient
041046 - history shows level of effort to maintain
041047 - well ordered record for effective
041048 - management increases exponentially
041049 - into a crushing burden
041050 - for patients and
041051 - providers......................... 090213, ref SDS 69 IG5O
041053 - ..
041054 - 22. Graph prepared by primary care physician
041055 - shows Millie's good fortune surviving a
041056 - very aggressive cancer with relatively
041057 - high quality of life into an 8th year
041058 - of continuous treatment that normally
041059 - causes early demise due to emotional
041060 - trauma and clincial failures from
041061 - complex case management........... 090213, ref SDS 69 4W72
041063 - ..
041064 - 23. Millie felt life was slipping away in
041065 - October when the 5th relapse was diagnosed
041066 - leading Millie to ask what was going to
041067 - happen to her; Doctor Rugo provided
041068 - encouragement saying "We're not
041069 - going to let anything happen
041070 - to you"........................... 090213, ref SDS 69 F148
041072 - ..
041073 - 24. Collaboration between Kaiser and UCSF
041074 - combines experience with research;
041075 - communication optimizes Millie's care
041076 - beating the odds for long-term survival
041077 - by integrating Kaiser's team care
041078 - practice with UCSF model
041079 - of comprehensive
041080 - care.............................. 090213, ref SDS 69 685I
041082 - ..
041083 - 25. Multiple relapse of cancer causes cells
041084 - to mutate into disease that resists
041085 - treatment; Millie surviving 6 relapses
041086 - needs highly specialized care and
041087 - so should ask Doctor Rugo to begin
041088 - planning for the next relapse
041089 - to treat Millie's cancer as
041090 - a chronic disease................. 090213, ref SDS 69 R75G
041092 - ..
041093 - 26. Doctor Rugo has responded by scheduling
041094 - a meeting with Millie at UCSF on
041095 - 090312............................ 090213, ref SDS 69 6P7G
041097 - ..
041098 - 27. Doctor Johnson underscored importance
041099 - timely care for Millie by offering
041100 - religious perspective on transition
041101 - from a vigorous life that may end
041102 - for Millie in less than a
041103 - year.............................. 090213, ref SDS 69 646L
041105 - ..
041106 - 28. Hospice care helps patients and families
041107 - cope with final days of life without
041108 - suffering significant physical
041109 - and emotional pain................ 090213, ref SDS 69 VW63
041111 - ..
041112 - 29. Life ending scenarios have been presented
041113 - to Millie many times the past 5 years;
041114 - case study reflects Millie's physical
041115 - resiliance and strength of character
041116 - that enables exceptional longevity
041117 - for her aggressive
041118 - cancer............................ 090213, ref SDS 69 L19H,
041120 - ..
041121 - 30. Collaboration on case management for
041122 - long-term survivors of cancer becomes
041123 - frustrating because everybody loses
041124 - control of increasingly
041125 - complex medical
041126 - records........................... 090213, ref SDS 69 JL9L
041128 - ..
041129 - 31. Lab and CT test reports illustrate
041130 - frustration, because providers do not
041131 - have enough time to enter results
041132 - from other doctorsrs in the medical
041133 - chart, because doctors prefer to
041134 - rely on local diagnostics
041135 - rather than referral
041136 - data.............................. 090213, ref SDS 69 NY4H
041138 - ..
041139 - 32. Cancer marker CA 15-3 wide disparities
041140 - between Kaiser and UCSF illustrates
041141 - why doctor's rely on local data
041142 - rather than referral
041143 - diagnostics....................... 090213, ref SDS 69 A46O
041145 - ..
041146 - 33. Case management takes a lot of will
041147 - power for due diligence to
041148 - maintain a well ordered
041149 - record............................ 090213, ref SDS 69 J27J
041151 - ..
041152 - 34. Meeting at Kaiser changed to 4 week
041153 - interval, rather than 8, as done the
041154 - past 2 years, provides effective support
041155 - for UCSF to start next treatment in
041156 - time to avoid losing control of
041157 - Millie's cancer................... 090213, ref SDS 69 QX5O
041159 - ..
041160 - 35. Millie requests explanation of treatment
041161 - plan. Doctor Rugo's letter to Kaiser on
041162 - 090129 discussed hyperthermia with Doxil,
041163 - reported on 090130. Has the plan changed
041164 - to use "lower dose" radiation rather
041165 - than Doxil. Will both be
041166 - used, or some other
041167 - agent............................. 090218, ref SDS 70 TH5W
041169 - ..
041170 - 36. Millie reports to medical team meeting
041171 - with Doctor Johnson at Kaiser on 090213
041172 - was optimistic Millie might have 3 - 6
041173 - months of recovery, but will need
041174 - treatment from Doctor Rugo for
041175 - cancer as a "chronic
041176 - disease".......................... 090218, ref SDS 70 TH6U
041178 - ..
041179 - 37. Millie requests reponse from UCSF to the
041180 - letter on 090209 requesting explanation
041181 - of treatments for side effects from
041182 - radiation and hyperthermia described by
041183 - Doctor Hsu during the meeting on
041184 - 090205. Does the treatment
041185 - plan address side effects
041186 - prospectively..................... 090218, ref SDS 70 TH7V
041188 - ..
041189 - 38. Radiation and hyperthermia begins
041190 - at UCSF for Millie to recover from
041191 - 6th relapse of
041192 - IBC............................... 090219, ref SDS 71 E57G
041194 - ..
041195 - 39. Millie's letter to UCSF requests
041196 - explanation of radiation and hyperthermia
041197 - treatments for recovering from
041198 - IBC............................... 090220, ref SDS 72 EA4Q
041200 - ..
041201 - 40. Hyperthermia treatment planning
041202 - on 090209 report received
041203 - from UCSF......................... 090220, ref SDS 73 PR4Y
041205 - ..
041206 - 41. Hyperthermia science, theraputic
041207 - rationale and applications with
041208 - other modalities presented in
041209 - BSD professional paper received
041210 - from UCSF......................... 090220, ref SDS 73 GK6F
041212 - ..
041213 - 42. Millie's letter to UCSF requests work
041214 - plan for radiation treatments to
041215 - recover from 6th relapse of
041216 - IBC............................... 090223, ref SDS 74 3N9J
041217 - and asks for scientific paper
041218 - using radiation to treat
041219 - IBC............................... 090223, ref SDS 74 T49U
041221 - ..
041222 - 43. Radiation combined with hyperthermia
041223 - treatment plan received from
041224 - UCSF.............................. 090226, ref SDS 75 D452
041226 - ..
041227 - 44. Blood test at Kaiser for meeting
041228 - at UCSF on 090312 to evaluate
041229 - effectiveness of radiation
041230 - and hyperthermia after
041231 - 3 weeks........................... 090309, ref SDS 77 6Z4F
041233 - ..
041234 - 45. Agenda submitted to medical team to
041235 - be prepared for productive meetings
041236 - at UCSF scheduled on 090312 to evaluate
041237 - response to treatment after getting
041238 - 3 weeks of radiation and hyperthermia
041239 - to recover from 6th relapse
041240 - of IBC............................ 090310, ref SDS 78 PR4Y
041242 - ..
041243 - 46. Called Kaiser to get results of blood
041244 - test on 090309 for submission to medical
041245 - team for being prepared to meet at
041246 - UCSF on 090312; Florida says results
041247 - pending from lab; says to call back
041248 - on 090311 to get the report
041249 - for distribution.................. 090310, ref SDS 79 JH4H
041251 - ..
041252 - 47. UCSF letter from Tara proposed canceling
041253 - meeting scheduled by Doctor Rugo for
041254 - 090312 to evaluate response to
041255 - treatment, and also Millie's
041256 - concern about growing
041257 - side effects...................... 090310, ref SDS 80 PR4Y
041259 - ..
041260 - 48. Millie letter to primary care physician
041261 - at Kaiser coordinates getting report
041262 - for blood test on 090309 for
041263 - meeting at UCSF on
041264 - 090312............................ 090311, ref SDS 81 S84F
041266 - ..
041267 - 49. Blood test report for Millie's lab on
041268 - 090209 was not submitted by Kaiser to
041269 - UCSF due to telephone and fax machine
041270 - problems; UCSF relied on backup
041271 - copy hand delivered by
041272 - Millie............................ 090312, ref SDS 84 XE3K
041274 - ..
041275 - 50. Examination at UCSF Breast Care Clinic
041276 - finds signs of recovery from 6th relapse
041277 - of IBC; Millie responding well after
041278 - 3 weeks of treatment with radiation
041279 - and hyperthermia; severe side
041280 - effects observed.................. 090312, ref SDS 84 YX9F
041282 - ..
041283 - 51. Cancer marker CA 15-3 missing from
041284 - blood test for Millie's lab at Kaiser
041285 - on 090309; missing diagnostic
041286 - complicates evaluating
041287 - response to treatment............. 090312, ref SDS 84 YX5F
041289 - ..
041290 - 52. Doctor Rugo planning to implement
041291 - request by Doctor Johnson at Kaiser
041292 - for UCSF to treat Millie's cancer
041293 - as a chronic disease.............. 090312, ref SDS 84 QQ9L
041295 - ..
041296 - 53. Examination at UCSF Radiation Oncology
041297 - department concurs Millie recovering
041298 - from 6th relapse of IBC by responding
041299 - to radiation and
041300 - hyperthermia...................... 090312, ref SDS 84 F88K
041301 - discloses side effects severely
041302 - blistering skin will worsen for a
041303 - month, and then gradually
041304 - recover........................... 090312, ref SDS 84 F860
041305 - that radiation and hyperthermia
041306 - will continue to destroy cancer cells
041307 - for weeks and even months after ending
041308 - treatments on
041309 - 090317............................ 090312, ref SDS 84 VL4O
041311 - ..
041312 - 54. After meeting with UCSF at 0800, called
041313 - Kaiser at 1437; was on "hold" for 90
041314 - minutes; Cisi in the Chemotherapy
041315 - Clinic came online and advised that
041316 - CA 15-3 was not listed in Kaiser's
041317 - for Millie's lab on
041318 - 090309............................ 090312, ref SDS 85 JO8O
041320 - ..
041321 - 55. Millie's letter to medical team reports
041322 - productive meetings at UCSF on 090312
041323 - with favorable findings that Millie
041324 - is recovering from 6th
041325 - relapse of
041326 - IBC............................... 090313, ref SDS 86 Q49L
041328 - ..
041329 - 56. Millie's final treatment at UCSF with
041330 - radiation and hyperthermia to
041331 - recover from 6th relapse
041332 - IBC............................... 090317, ref SDS 88 9L7K
041334 - ..
041335 - 57. Millie received at UCSF orientation and
041336 - medications for home care to treat severe
041337 - side effects from radiation treatments
041338 - that will get worse for a few weeks
041339 - before starting to get
041340 - better............................ 090317, ref SDS 88 M442
041342 - ..
041343 - 58. Arlette checked the computer and
041344 - concluded a mistake occurred at the
041345 - lab not testing for the cancer marker
041346 - on the blood test for 090309. Arlette
041347 - entered a supplemental order for
041348 - Millie to get another blood
041349 - draw at no charge
041350 - later today....................... 090317, ref SDS 89 Y04R
041352 - ..
041353 - 59. Kaiser reported CA 15-3 251 for blood
041354 - test on 090317 that corrected problems
041355 - with lab on 090309 which omitted cancer
041356 - marker needed for the meeting at UCSF
041357 - on 090312 to evaluate response to
041358 - treatment; results today indicate
041359 - strong recovery from 6th relapse
041360 - of IBC............................ 090323, ref SDS 90 Y077
041362 - ..
041363 - 60. Millie's letter notifies medical team
041364 - radiation and hyperthermia treatments
041365 - were completed on 090317; submits agenda
041366 - for meeting today evaluating response
041367 - to treatment with, and recovery from
041368 - side effects from radiation
041369 - and hyperthermia on
041370 - referral to
041371 - UCSF.............................. 090324, ref SDS 91 PR4Y
041372 -
041373 -
041374 -
0414 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Dislocated Shoulder Recovering Extensive Brusing Subsides
050403 -
050404 - Follow up ref SDS 69 PQTX.
050405 -
050406 - The doctor received Millie's letter sent yesterday on 090324 with an
050407 - agenda for the meeting today evaluating response to treating Millie's
050408 - 6th relapse of IBC, and planning treatment for next relapse.
050409 - ref SDS 91 HE8F
050411 - ..
050412 - Doctor Johnson initially discussed Millie's recovery from injury on
050413 - 090122 that dislocated the right shoulder, ref SDS 48 WS5K, and was
050414 - treated in the Emergency Room (ER) Department. On 090213 the doctor
050415 - discussed Millie's injury and recovery extensively. ref SDS 69 PQTX
050417 - ..
050418 - Today, the doctor seemed familiar with favorable progress on recovery
050419 - reported by examination at Kaiser on 090303, as shown in the medical
050420 - chart for the Orthopedic Department. ref SDS 76 6X9H
050422 - ..
050423 - Examination today in the Oncology Department shows marked reduction of
050424 - bruising that was very severe for several weeks following the injury,
050425 - observed during prior visit on 090213. ref SDS 69 8V5N
050427 - ..
050428 - Millie explained feeling very lucky that her shoulder seems to be
050429 - responding rapidly to physicial therapy. She is now able to drive the
050430 - care using her right hand. Millie is planning to start weight
050431 - exercises in the gym to strengthen the right arm. She hopes to be
050432 - doing aerobics again within a few weeks.
050434 - ..
050435 - Doctor Johnson asked how Millie accomodated prolonged pressures on the
050436 - right shoulder to accomodate radiation and hyperthermia treatments?
050437 - Previously, on 090213 Millie reported UCSF did an excellent job
050438 - allowing deference to doctor discretion for medical necessity moving
050439 - her right arm contrary to Kaiser policy for immobilization, and in
050440 - order to provide treatment of Millie's 6th relapse of IBC in time to
050441 - be effective. ref SDS 69 826K Today, Millie explained the injury to
050442 - the right shoulder made positioning for extended periods up to 20
050443 - minutes very painful for certain of the radiation and hyperthermia
050444 - sessions. Suffering prolonged discomfort was emotionally traumatic;
050445 - she is glad now that the treatments have ended.
050447 - ..
050448 - There was discussion that rise in blood counts since ending treatment
050449 - with sunitinib on 090122 indicates recovery of energy and vitality
050450 - that enables Millie to begin exercise in the gym again that will
050451 - further aid recovery of mobility and strength to the right arm and
050452 - shoulder.
050453 -
050454 - [...below medical chart "Review of Systems" reports same
050455 - status for examination last month on 090213; does not
050456 - mention progress with recovery discussed during the
050457 - meeting. ref SDS 0 WE7K
050458 -
050459 -
050460 -
0505 -
SUBJECTS
Default Null Subject Account for Blank Record
0603 -
060401 - ..
060402 - Examination IBC 6th Relapse Subsiding after Radiation Hyperthermia
060403 -
060404 - Follow up ref SDS 69 S66M.
060405 -
060406 - Millie submitted a printed copy of the UCSF radiation treatment plan
060407 - dated 090209, and received from UCSF on 090226. ref SDS 75 D452 This
060408 - was cited in Millie's letter to the medical team on 090310.
060409 - ref SDS 78 O56P
060411 - ..
060412 - Millie also submitted a printed copy of the report Tara prepared on
060413 - results of examination at UCSF on 090312. ref SDS 84 R45H
060415 - ..
060416 - Doctor Johnson was very pleased seeing reduced IBC nodularity in all
060417 - of the treated areas listed in Doctor Hsu's UCSF radiation treatment
060418 - plan, received in the record on 090226 1342. ref SDS 75 D452
060420 - ..
060421 - The doctor also examined the breastbone area where IBC got worse in
060422 - December, January, and February, reported in patient history on
060423 - 090120. ref SDS 46 124N He carefully pulled aside the large bandage
060424 - covering the open wound in the breastbone area caused by radiation
060425 - treatments, and revealing an approximate 4" diameter pussy and
060426 - bleeding "mess." After thorough examination, the doctor restored the
060427 - dressing. This locus of previous severe IBC was presented at UCSF by
060428 - Glenna on 090121, ref SDS 47 AJ3J, and leading to Doctor Rugo's letter
060429 - to Kaiser on 090129 diagnosing recurrence, reported in Millie's letter
060430 - on 090130. ref SDS 54 4S8O Today, Doctor Johnson indicated that IBC
060431 - nodules seem significantly less severe after completing treatment with
060432 - radiation and hyperthermia at UCSF on 090317, than when he examined
060433 - Millie at Kaiser on 090213, ref SDS 69 4W5I, before treatments started
060434 - on 090219.
060435 -
060436 - [On 090328 0909 Millie reports continuing recovery from IBC
060437 - with reduced nodularity; but increased pain from radiation
060438 - side effects. ref SDS 97 4S4V
060440 - ..
060441 - The doctor also noted severe radiation "burn" side effects in other
060442 - sites following the end of treatment at UCSF on 090317. At this time,
060443 - this extensive rash reaction to radiation looks very much like the
060444 - rash of IBC disease, and so prevents definitive assessment of
060445 - recovery, noted in the letter to the medical team yesterday on 090324,
060446 - ref SDS 91 CT5Q, citing Doctor Hsu's comments on 090312. ref SDS 84
060447 - PU5N Tara also described limitations evaluating recovery because IBC
060448 - symptoms are similar to radiation burn. ref SDS 84 YX40
060450 - ..
060451 - [...below medical chart "Review of Systems" reports 2nd
060452 - degree burns on chest wall; does not attribute to side
060453 - effects of radiation and hyperthermia begun on 090219 and
060454 - ending on 090317, and which appears to have been effective
060455 - treating stage IV IBC. ref SDS 0 EF8U
060457 - ..
060458 - Doctor Johnson palpated reduced lymphadenopathy in the right axilla
060459 - and left supraclavicular, where cancer increased during January and
060460 - February, shown by examination at UCSF on 090205, ref SDS 62 OH88, and
060461 - also at Kaiser a week later on 090213. ref SDS 69 4M5Y
060462 -
060463 - [...below medical chart "Physical Examination" reports only
060464 - palpable LN in left suprclavicular area; does not clarify
060465 - LN seems reduced from examiantion on 090213. ref SDS 0 YD5U
060467 - ..
060468 - The doctor indicated that findings today suggest strong response to
060469 - treatment for Millie's 6th relapse of IBC (see relapse history on
060470 - 090122, ref SDS 49 J34U), and achieved with radiation and
060471 - hyperthermia, which started at UCSF on 090219, and ended last week on
060472 - 090317. ref SDS 88 9L7K Doctor Johnson feels evident recovery from
060473 - IBC observed today aligns with Kaiser's report on the cancer marker a
060474 - few days ago for the make-up lab on 090317, performed in the afternoon
060475 - after Millie returned from UCSF. On 090323, Kaiser reported the
060476 - cancer marker dropped significantly for the first time in a year with
060477 - CA 15-3 251. ref SDS 90 Y077
060479 - ..
060480 - Research indicates hyperthermia can reduce IBC by 40%, 80%, sometimes
060481 - close to 100%, reported on 090129. ref SDS 53 SQ6L Hopefully, Doctor
060482 - Hsu and Chris can submit a written report estimating results in
060483 - Millie's case responding to treatment at UCSF, and how this is
060484 - determined. Will assessment use a special form of CT and/or CT/PET
060485 - technology that shows where IBC still exists in patient tissue?
060486 -
060487 - [On 090326 0058 Millie's letter to medical team confirms
060488 - understandings on favorable examiantion at Kaiser finding
060489 - strong response to treatment and reports success with treatment
060490 - with radiation and hyperthermia at UCSF is very encouraging.
060491 - ref SDS 93 DV4Q
060493 - ..
060494 - [On 090326 0058 Millie's letter to the medical team asks about
060495 - performing radiology diagnostics with speical form of CT and/or
060496 - PET testing to assess response to treatment. ref SDS 93 DW6X
060498 - ..
060499 - [On 090326 0844 Doctor Johnson plans visual assessment with
060500 - CT tests, and advises PET/CT not needed. ref SDS 94 W75V
060502 - ..
060503 - [On 090328 0909 Millie reports continuing recovery from IBC
060504 - with reduced nodularity; but increased pain from radiation
060505 - side effects. ref SDS 97 4S4V
060506 -
060507 -
060508 -
060509 -
0606 -
SUBJECTS
Default Null Subject Account for Blank Record
0703 -
070401 - ..
070402 - Cancer Marker Decline First Time in Over a Year Shows Response
070403 -
070404 - The doctor indicated that CA 15-3 251 likely represents a greater
070405 - recovery from starting radiation and hyperthermia treatment at UCSF on
070406 - 090219, than indicated by the previous lab on 090116 when Kaiser
070407 - reported CA 15-3 303, ref SDS 45 PQTQ, because at that time on 090116,
070408 - the cancer marker was on a steep rising trajectory correlated with
070409 - advancing IBC disease. Doctor Rugo's letter on 090202 notified the
070410 - medical team that Millie needed urgent treatment quickly. ref SDS 57
070411 - Y15J Timely response by Doctor Hsu advancing treatment at UCSF by 3
070412 - weeks significantly reduced risks of Millie's cancer cascading out of
070413 - control, explained in the record on 090323. ref SDS 90 NR4G
070415 - ..
070416 - Doctor Johnson concurred with Millie's assessment in a letter to the
070417 - medical team yesterday on 090324 that decline of the cancer marker for
070418 - the first time in over a year is a positive sign of favorable
070419 - response, ref SDS 91 CT6X, treating Millie's cancer as a chronic
070420 - disease, shown by case study of the cancer marker on 090323
070421 - correlating CA 15-3 with history of prescribed treatments, ref SDS 90
070422 - J13O, and cited in Millie's letter to the medical team yesterday on
070423 - 090324. ref SDS 91 CT5W
070424 -
070425 - [...below medical chart "Physical Examination" reports
070426 - decline of cancer marker for test on 090309, actually
070427 - performed a week later on 090317. ref SDS 0 KG6O
070428 -
070430 - ..
070431 - Millie Medical Miracle Survival Quality of Life Extended 400%
070432 - Cancer Trajectory Millie Unique Amazing Medical Miracle
070433 - 7th Relapse Increases Risks of Rapid Decline Timely Care Critical
070434 -
070435 - Follow up ref SDS 69 4W72.
070436 -
070437 - Doctor Johnson noted that Millie's patient history is amazing. In
070438 - many ways it is unique because surviving stage 4 cancer in continuous
070439 - treament for over 8 years is a medical miracle.
070441 - ..
070442 - The doctor drew another graph today, similar to examination on 090213.
070443 - ref SDS 69 4W72 At that time, Doctor Johnson described Millie's
070444 - surivival 400% longer than disease trajectory was attributed to good
070445 - case management through communication support for the doctor/patient
070446 - partnership. ref SDS 69 FZ4H
070454 - ..
070455 - The doctor drew a vertical y axis with an "F" variable for "falling
070456 - quality of life," and a horizontal x axis for the number of years
070457 - getting continuous treatment...
070459 - ..
070460 - IBC Rare Aggressive Cancer
070461 - Cancer Patient quality of life with continuous treatment...
070463 - ..
070464 - Most patients +-- Millie is here
070465 - | |
070466 - | V V
070467 - 100% |---------------------------
070468 - | \ \
070469 - Quality | \ \
070470 - of Life | | |
070471 - | | |
070472 - | | |
070473 - +-----+-----+-----+-----+-----+-----+----- Years
070474 - 2 4 6 8 10 12
070476 - ..
070477 - F = Falling quality of life
070478 - T = Treatment over Time - years
070479 -
070480 - [On 090725 Doctor Johnson described doctor/patient
070481 - partnership in Millie's case doing yeoman's work to keep a
070482 - well ordered record for effective case management.
070483 - ref SDS C2 T58R
070485 - ..
070486 - [On 090725 "evidence based" medical practice requires a
070487 - well ordered record, which takes yeoman's work that
070488 - complements mainstream technology for health care case
070489 - management. ref SDS C2 MP8O
070491 - ..
070492 - Doctor Johnson explained that in the beginning most cancer patients
070493 - have a fairly normal quality of life with chemotherapy treatments.
070494 - Suddenly there is precipitous decline from both side effects and
070495 - progression of disease, as shown in the graph. Stage IV cancer
070496 - patients in continuous treatment for "chronic disease," like Millie,
070497 - reach a point of rapid decline within months or at best a few years.
070498 - As noted during the meeting last month on 090213, Millie has sustained
070499 - a relatively high quality of life with good care from Kaiser and UCSF
070500 - for going on 9 years. ref SDS 69 NY7L Today, the doctor added to the
070501 - graph a representation that Millie may now be nearing the point of
070502 - sudden decline, also, discussed on 090213. ref SDS 69 9L7N
070503 -
070504 - [On 100728 Millie suffered sudden decline due to lack of
070505 - prescribed treatment to recover from medical mistakes for
070506 - over a year. ref SDS C4 036C
070508 - ..
070509 - [On 170314 0930 Doctor Tang drew graph showing patient
070510 - hiking 11 - 15 miles per day past 5 years is "off the
070511 - chart" for extended endurance exercise reported by patients
070512 - at VAMCSF. ref SDS C5 E98H
070513 -
070514 -
070515 -
070516 -
070517 -
0706 -
SUBJECTS
Default Null Subject Account for Blank Record
0803 -
080401 - ..
080402 - Hospice Care Patients Avoid Discomfort of Decline
080403 -
080404 - Follow up ref SDS 69 VW63.
080405 -
080406 - The doctor discussed again Kaiser Hospice services to assist patients
080407 - through decline of terminal cancer, presented initially during the
080408 - prior meeting on 090213. ref SDS 69 VW63 Today, Doctor Johnson
080409 - indicated patients can contact Hospice services to order to meet a
080410 - case worker and begin to get familiar with how the service works, and
080411 - so Kaiser can begin to plan a program tailored to Millie's home and
080412 - circumstances.
080413 -
080414 - [...below medical chart "Assessment" omits section on
080415 - disease trajectory and hospice care. ref SDS 0 KU3N
080416 -
080417 -
080418 -
0805 -
SUBJECTS
Default Null Subject Account for Blank Record
0903 -
090401 - ..
090402 - UCSF Schedules Meeting for Post Radiation Hyperthermia Care
090403 - Steeamline Delivery Care Reduce Risks Small Delays Denying Treatment
090404 - Proactive Management Essential Treat Next Relapse as Chronic Disease
090405 - Complex Case Management 8-years Treatment Magnifies Small Mistakes
090406 -
090407 - Follow up ref SDS 69 WZ6K.
090408 -
090409 - The doctor explained that the updated graph today, per above,
090410 - ref SDS 0 P39M, illustrates that streamlining procedures for timely
090411 - delivery of care to treat Millie's cancer as a "chronic disease" for
090412 - her next relapse of IBC (#7) will be essential, because with each
090413 - relapse cancer becomes more aggressive and resistant to treatment.
090414 - This makes delay an effective denial of care going forward to treat
090415 - Millie's next relapse, as discussed during the prior examination on
090416 - 090213. ref SDS 69 K36J
090417 -
090418 - [On 090104 0143 Millie's letter notifies Doctor Rugo that
090419 - Kaiser feels starting Millie's treatment for the next relapse
090420 - will be critical for recovery. ref SDS 42 R43V
090422 - ..
090423 - Requirements to streamline procedures for timely delivery of care by
090424 - reducing mistakes is shown in the study on compounding level of effort
090425 - required by expanding complexity of long-term care listed on 090213.
090426 - ref SDS 69 IG5O The study on transitioning from sunitinib to the
090427 - radiation and hyperthermia treatment shows arrangements are needed
090428 - that ordinary people can accomplish routinely on the job.
090430 - ..
090431 - The study on coordinating lab work at Kaiser for use at UCSF shows
090432 - level of work impossible to sustain. ref SDS 0 KZ6N
090434 - ..
090435 - The study today on level of effort getting Millie through the 6th
090436 - relapse, and consideration for treating the 7th relapse, further shows
090437 - requirements to streamline delivery of care, per above. ref SDS 0 4W5I
090438 -
090439 -
090440 -
090441 -
0905 -
SUBJECTS
Default Null Subject Account for Blank Record
1003 -
100401 - ..
100402 - Stress Relieved Successful Case Management and Treatment on Vacation
100403 - Vacation Relieves Stress Overwhelming Level of Effort Case Management
100404 -
100405 - The doctor feels that emotional stress and low energy reported in the
100406 - letter to the medical team yesterday on 090324, ref SDS 91 CT6X, will
100407 - improve now that treatments have ended with radiation and hyperthermia
100408 - at UCSF. Together with falling cancer marker, per above, ref SDS 0
100409 - WU6L, rising energy is another positive signal of recovery that lifts
100410 - patient spirits. This is welcome relief from stressful and exhausting
100411 - 3-months working long hours, per case study above, ref SDS 0 4W5I,
100412 - assisting Kaiser and UCSF on complex clincial, logistical, and
100413 - financial issues, discussed previously on 090213, ref SDS 69 IG5O, and
100414 - illustrated again today by patient history on getting lab work done
100415 - for referral care at UCSF, per below. ref SDS 0 ML6I Rising energy
100416 - and relief from anxiety come just in time to enjoy recovering from the
100417 - 6th relapse of IBC.
100419 - ..
100420 - Doctor Johnson was pleased Millie is taking a vacation beginning on
100421 - 090424, to get much needed rest from health care case management,
100422 - again per study above. ref SDS 0 4W5I
100423 -
100424 - [...below medical chart "Review of Systems" reports patient
100425 - emotional anxiety reduced, planning cruise. ref SDS 0 EF9R
100427 - ..
100428 - [...below medical chart "Physical Examination" reports
100429 - elevated vitals compared to patient norms, illustrates
100430 - emotional stress. ref SDS 0 N26J
100432 - ..
100433 - [...below medical chart "Plan" shows return for next
100434 - meeting in 4 weeks, which conflicts with schedule for
100435 - starting vacation on 090424. ref SDS 0 TR52
100436 -
100437 -
100439 - ..
100440 - Changing Doctor's Orders Places Stage IV Cancer Patient High Risk
100441 - Lab Mistakes Delays Hamper Referral Care Providers Angry Stressed
100442 -
100443 - The doctor was disappointed about continuing mix-ups and delay getting
100444 - test data submitted to UCSF for the most recent meetings on 090312, as
100445 - reported in the letter to the medical team on 090313, ref SDS 86 B26V,
100446 - and further shown by case study below. ref SDS 0 JM8H He indicated
100447 - problems in the lab are puzzeling that require rework to test the
100448 - cancer marker 2 weeks late, also, shown in case study above.
100449 - ref SDS 0 XM4M Doctor Johnson feels lab results delivered 14 days
100450 - late increases risks for Millie's patient profile of stage IV cancer
100451 - recovering from 6th relapse of IBC. Delayed lab work and complicated,
100452 - confusing reports on CT tests, that occurred again on 090109,
100453 - ref SDS 44 UE6X, conflict with the doctor's treatment plan on 090213
100454 - to streamline care in order to treat Millie's cancer at UCSF as a
100455 - "chronic disease." ref SDS 69 WZ6K
100457 - ..
100458 - We reviewed the record on 090213 when the doctor ordered the lab on
100459 - 090309, and expressly added the cancer marker in the computer.
100460 - ref SDS 69 6P3F This conflicts with the report on 090312 when the
100461 - Chemotherapy Infusion Clinic reported the computer did not show CA
100462 - 15-3 was ordered for the test on 090309. ref SDS 85 EM9F
100464 - ..
100465 - Doctor Johnson feels something funny may be going on again, similar to
100466 - prior reports of people changing doctor's order for medical care,
100467 - especially for CT testing, shown by patient history in the case study
100468 - on 061012. ref SDS 9 A55J
100469 -
100470 -
100471 -
100472 -
1005 -
SUBJECTS
Default Null Subject Account for Blank Record
1103 -
110401 - ..
110402 - Labs Chronic Delays Coordinating Referral Care
110403 - Case Study Delivering Labs to UCSF in Time for Effective Care
110404 - Chronic Problems Coordinating Labs at Kaiser for Referral Care at UCSF
110405 -
110406 - The doctor feels that going forward timely test data is critical for
110407 - Doctor Rugo to treat Millie's cancer as a chronic disease. discussed
110408 - below. ref SDS 0 L15M Continual delays submitting test results to
110409 - UCSF place Millie at high risk because 90% of her health care is for
110410 - oncology, and Doctor Rugo is performing 90% of this work at UCSF to
110411 - treat Millie's cancer. Doctor Johnson is concerned that Millie's
110412 - expanding patient profile narrows the margin for error, reported on
110413 - 090213. ref SDS 69 PL5K
110414 -
110415 - [...below doctor orders tests 10 days before next meeting
110416 - at UCSF so there is time to adjust for mistakes and still
110417 - deliver data on time for the doctor at UCSF. ref SDS 0 LX5I
110419 - ..
110420 - The doctor asked Millie to coordinate with Kaiser's Outside Referrals
110421 - Department about doing labs at UCSF in order to relieve stress on
110422 - Kaiser shown by Millie's patient history in this case...
110423 -
110424 - 1. Lab ordered at Kaiser to evaluate Millie
110425 - participating in cetuximab and
110426 - Carboplatin clinical
110427 - study................................. 070105, ref SDS 10 YW6O
110429 - ..
110430 - 2. Blood test report received via fax from
110431 - Kaiser missing data due to incomplete
110432 - transmission; does not meet requirements
110433 - for cetuximag Carboplatin protocol
110434 - prescribed by Kaiser for Millie's
110435 - treatment on referral
110436 - to UCSF............................... 070119, ref SDS 11 AS6M
110438 - ..
110439 - 3. Jackie advises mistakes occur often
110440 - with fax transmission, because machines
110441 - breakdown, run out of paper, transmissions
110442 - are fuzzy and have to be done over,
110443 - papers get separated when the bin fills
110444 - up and spills on the floor; mistakes
110445 - occur from multiple handling when
110446 - people have a hectic schedule;
110447 - hurrying to catch up at the
110448 - last minute causes more
110449 - mistakes.............................. 070119, ref SDS 11 AT4J
110451 - ..
110452 - 4. Millie asks Kaiser about missing
110453 - parts of blood work report sent
110454 - to UCSF............................... 070119, ref SDS 11 TH6Q
110456 - ..
110457 - 5. Kaiser determines scope of blood test
110458 - ordered on 010705 was incomplete;
110459 - primary care physician interrupts
110460 - vacation, comes into Kaiser's office
110461 - to avoid delays and mistakes ordering
110462 - another blood test for treatment
110463 - prescribed on referral
110464 - at UCSF............................... 070122, ref SDS 12 AS6M
110466 - ..
110467 - 6. Millie went to Kaiser for another
110468 - blood test............................ 070123, ref SDS 13 AS6M
110470 - ..
110471 - 7. Millie suffering progression of cancer
110472 - because there has been no treatment
110473 - for 2 months due to delays
110474 - with referral and blood
110475 - work documentation.................... 070130, ref SDS 14 N96O
110477 - ..
110478 - 8. UCSF requests another blood test because
110479 - referral issues delayed
110480 - treatment again to
110481 - 070201................................ 070131, ref SDS 15 NZ4N
110483 - ..
110484 - 9. Kaiser Lab technician warns about internal
110485 - bleeding from needle penetration for
110486 - blood draws; need plan to minimize using
110487 - needles, use Millie's port to reduce
110488 - risk of bleeding while on Coumadin
110489 - (warfarin) for pulmonary
110490 - embolism.............................. 070131, ref SDS 15 E87I
110492 - ..
110493 - 10. UCSF submits order for labs at Kaiser today
110494 - for evaluating Millie's suitability for
110495 - treatment tomorrow per protocol; Jackie
110496 - faxes request to Arlette at
110497 - Kaiser in Walnut
110498 - Creek.......................... 071017, ref SDS 17 Q45F
110500 - ..
110501 - 11. Arlette is at lunch, delay finding
110502 - out where to get blood
110503 - draw.................................. 071017, ref SDS 17 4Q5M
110505 - ..
110506 - 12. Arlette reached by telephone at 1332 and
110507 - advises UCSF blood draw request for Millie's
110508 - treatment tomorrow was ordered by the doctor;
110509 - Arlette asks Millie to coordinate with Infusion
110510 - Clinic to schedule blood draw using Millie's
110511 - port, because Millie's arm has been damaged
110512 - by excessive needle penetrations and so
110513 - blood draws cannot be done in the lab,
110514 - because staff is not trained
110515 - to use port catheter
110516 - technology............................ 071017, ref SDS 17 4Q7G
110518 - ..
110519 - 13. Millie coordinates and discovers Kaiser
110520 - in Walnut Creek cannot do blood draw
110521 - until next week; Millie is told that
110522 - since the doctor has already placed
110523 - the order it is up to the stage IV cancer
110524 - patient being treated for a 4th relapse
110525 - of IBC to coordinate with Kaiser in
110526 - Martinez on scheduling a blood draw
110527 - in the next few hours needed
110528 - for treatment tomorrow at
110529 - UCSF.................................. 071017, ref SDS 17 YE9G
110531 - ..
110532 - 14. Since treatment is needed tomorrow at UCSF,
110533 - Millie goes to Kaiser in Martinez for blood
110534 - draw; Clinic reports the order submitted
110535 - via fax from UCSF to Kaiser in Walnut Creek
110536 - has not been entered in Kaiser's computer;
110537 - nurse at Kaiser in Martinez tried to call
110538 - Kaiser in Walnut Creek, and could not get
110539 - through; nurse tried to call Jackie to
110540 - get the order for the blood draw
110541 - directly from UCSF; but could
110542 - not get through....................... 071017, ref SDS 17 OS3F
110544 - ..
110545 - 15. Blood draw performed using prior order found
110546 - in the computer for a blood draw last January,
110547 - 10 months ago so that UCSF would have
110548 - something to approve Millie
110549 - for treatment tomorrow
110550 - morning............................... 071017, ref SDS 17 OS5K
110552 - ..
110553 - 16. Results of blood test at Kaiser were
110554 - not available for review during
110555 - examination at
110556 - UCSF.................................. 071018, ref SDS 18 HL7O
110558 - ..
110559 - 17. Treatment at UCSF delayed for an hour or
110560 - so until Kaiser submitted blood test
110561 - results via fax....................... 071018, ref SDS 18 6N9F
110563 - ..
110564 - 18. UCSF staff confuses Neutrophils in Kaiser's
110565 - blood test report on 071017, for NEUTS
110566 - used by UCSF to assess patient
110567 - safety for treatment.................. 071019, ref SDS 19 EU4J
110569 - ..
110570 - 19. Doctor Rugo explained difficulty coordinating
110571 - patient care with Kaiser; asks Millie to
110572 - do coordination under Kaiser's
110573 - doctor/patient partnership
110574 - model................................. 080403, ref SDS 21 SG7I
110576 - ..
110577 - 20. Kaiser frantically ordered blood test the
110578 - day before Millie's CT test on 081107;
110579 - ignored prior plans on 081024 to use test
110580 - results at UCSF on 081023 to save time and
110581 - money at Kaiser by avoiding rework doing
110582 - another lab; but, since the computer was
110583 - not posted by the CT Department on 081024,
110584 - the attendant was frustrated on 081106
110585 - being forced to take time from a hectic
110586 - schedule for rewok to discover
110587 - another lab was not
110588 - needed................................ 081106, ref SDS 33 ED6H
110590 - ..
110591 - 21. UCSF clinical trial coordinator, Glenna,
110592 - frustrated after 6 calls to Kaiser unable
110593 - to schedule Millie for labs needed for
110594 - evaluating effects of neupogen on
110595 - Millie's ability to have cancer
110596 - treatments; asks Millie to
110597 - coordinate with Kaiser................ 081210, ref SDS 35 633K
110599 - ..
110600 - 22. Fax problems for lab reports similar to
110601 - delay faxing the report for Millie's CT
110602 - test on 081230 for examination at UCSF
110603 - on 090108; even calling could not
110604 - resolve the problem in time for
110605 - the meeting........................... 090109, ref SDS 44 UE6U
110607 - ..
110608 - 23. To prepare for examination at UCSF on 090312,
110609 - called Kaiser and was on hold for an hour
110610 - trying to request that Kaiser fax a report
110611 - for the blood test on 090309 to
110612 - UCSF.................................. 090311, ref SDS 83 6Z4F
110614 - ..
110615 - 24. Kaiser advised that new procedures prevented
110616 - talking to Florida about faxing the report
110617 - to UCSF, even though Florida had
110618 - requested a call back the
110619 - day before............................ 090311, ref SDS 83 G68F
110621 - ..
110622 - 25. Finally talked to Lupe who advised that the
110623 - Oncology Department was having fax machine
110624 - problems; some faxes were not getting through;
110625 - she offered to print the report, and Millie
110626 - drive over today and pick up a copy
110627 - at the hospital, and take to
110628 - the meeting at UCSF as
110629 - backup................................ 090311, ref SDS 83 E64O
110631 - ..
110632 - 26. Next day at UCSF, Tara reported that Kaiser
110633 - did not fax the blood test report. UCSF
110634 - efforts to call Kaiser for the report
110635 - were unsuccessful, so used copy that
110636 - Lupe printed for Millie the day
110637 - before................................ 090312, ref SDS 84 XE3K
110639 - ..
110640 - 27. Report from Kaiser on the lab test omitted
110641 - results for cancer marker
110642 - CA 15-3............................... 090312, ref SDS 84 337K
110644 - ..
110645 - 28. Missing cancer marker data on Kaiser's lab
110646 - report caused problems evaluating response
110647 - to treatment during examination at
110648 - UCSF.................................. 090312, ref SDS 84 YX5F
110650 - ..
110651 - 29. After meeting with UCSF at 0800, back in
110652 - Concord called Kaiser at 1437 and was on
110653 - "hold" for 90 minutes; Cisi in the
110654 - Chemotherapy Clinic came online and
110655 - advised that CA 15-3 was not
110656 - listed in Kaiser's
110657 - computer.............................. 090312, ref SDS 85 JO8O
110659 - ..
110660 - 30. Called Kaiser and Arlette planned to check
110661 - with Doctor Johnson about getting results
110662 - of CA 15-3 for the blood draw
110663 - on 090309 and sending to
110664 - UCSF.................................. 090313, ref SDS 87 3R7J
110666 - ..
110667 - 31. Called Kaiser - Arlette apologized about
110668 - forgetting to ask Doctor Johnson for
110669 - CA 15-3 results on Millie's blood
110670 - test on 090309 that needs to be
110671 - sent to UCSF.......................... 090317, ref SDS 89 Y077
110673 - ..
110674 - 32. Arlette checked the computer and concluded
110675 - a mistake occurred not testing for the cancer
110676 - marker on the lab for 090309. Arlette entered
110677 - a supplemental order for Millie to get
110678 - another blood draw at no charge
110679 - later today........................... 090317, ref SDS 89 Y04R
110681 - ..
110682 - 33. Arlette was unable to get through on the
110683 - telephone, similar to problems the week
110684 - before, ref SDS B0 UY4M, to coordinate
110685 - with the Chemotherapy Infusion Clinic on
110686 - scheduling Millie's blood draw using the
110687 - Power Port; so she walked over to the
110688 - clinic and coordinated with Bella
110689 - who scheduled the work later
110690 - in the day............................ 090317, ref SDS 89 YP6S
110692 - ..
110693 - 34. Called Millie; she had completed her
110694 - treatments at UCSF with radiation and
110695 - hyperthermia; she will stop af Kaiser on
110696 - the way home from San Francisco and have
110697 - another blood draw to test the cancer
110698 - marker that was omitted in the
110699 - test at Kaiser on
110700 - 090309................................ 090317, ref SDS 89 Y07Y
110702 - ..
110703 - 35. Anne appologized for glitch with the blood
110704 - test on 090309 that required make up test
110705 - today, and cited re-org and training
110706 - new staff takes time to get
110707 - everyone working together
110708 - efficiently........................... 090317, ref SDS 89 NM7F
110710 - ..
110711 - 36. Connie called from Kaiser with results of
110712 - blood test on 090317 that corrected problems
110713 - with lab on 090309 which omitted cancer
110714 - marker CA 15-3 needed for the meeting
110715 - at UCSF on 090312 to evaluate response
110716 - to treatment; results today indicate
110717 - strong recovery from 6th relapse
110718 - of IBC................................ 090323, ref SDS 90 Y077
110720 - ..
110721 - 37. Doctor Johnson explains difficulties
110722 - coordinating lab work between institutions
110723 - compounds delay for Millie's care on
110724 - referral to treat cancer as a
110725 - chronic disease....................... 090325, ref SDS 0 EI8J
110727 - ..
110728 - 38. Delay treating Millie's next relapse will
110729 - be more critical because with each relapse
110730 - cancer mutates into more aggressive and
110731 - robust disease; this reduces the time
110732 - for providing treatment; since Millie
110733 - has relapsed 7 times, margin for
110734 - error narrorows; small delays
110735 - magnify into denial of
110736 - effective care........................ 090325, ref SDS 0 RQ6K
110738 - ..
110739 - 39. Kaiser Outside Referrals explains Millie's
110740 - doctor can amend referral to prescribe
110741 - labs at UCSF for cost effective
110742 - care.................................. 090401, ref SDS 98 RG5K
110744 - ..
110745 - 40. Doctor Johnson amended authorization for
110746 - Millie's treatment with radiation and
110747 - hyperthermia to include doing lab work
110748 - at UCSF in order to save lives,
110749 - time and money........................ 090409, ref SDS A0 6O6N
110751 - ..
110752 - 41. Millie had problems getting the report for
110753 - the blood test at Kaiser on 090413 for meeting
110754 - at Kaiser on 090423; the first report was
110755 - incorrect omitting 90% of the
110756 - data.................................. 090415, ref SDS A6 RY4Y
110758 - ..
110759 - 42. After getting the full report for the lab
110760 - on 090413, it was still missing ANC required
110761 - for evaluating ability to get
110762 - treatment............................. 090415, ref SDS A6 QP68
110764 - ..
110765 - 43. Called Kaiser and Arlette provided ANC
110766 - diagnostic............................ 090415, ref SDS A6 RZ4U
110768 - ..
110769 - 44. Millie requests assistance from doctor
110770 - to get CT and lab test results from
110771 - Kaiser sent to UCSF for meeting
110772 - at UCSF requested by
110773 - Kaiser................................ 090415, ref SDS A7 JT7H
110775 - ..
110776 - 45. Doctor Johnson frustrated by chronic delays
110777 - submitting test datat for Millie's care at
110778 - UCSF; commands patient coordination finding
110779 - procedure to amend referral for performing
110780 - lab work at UCSF to support Doctor Rugo
110781 - treating Millie's cancer as a
110782 - chronic disease....................... 090415, ref SDS A8 MJ4G
110784 - ..
110785 - 46. Doctor Mason reported that last week he sent
110786 - a denial changing the doctor's amended order
110787 - on 090409 for Millie's care at UCSF because
110788 - he believes other patients do not have
110789 - problems getting lab reports from
110790 - Kaiser for referral work
110791 - at UCSF............................... 090420, ref SDS B0 Q57H
110793 - ..
110794 - 47. Doctor Mason explained Kaiser policy to
110795 - support effective care by providing timely,
110796 - easy access for busy doctors of complex
110797 - and voluminous lab data on local
110798 - computers that benefits
110799 - patients.............................. 090420, ref SDS B0 2H41
110801 - ..
110802 - 48. Millie received denial of services 3 weeks
110803 - late, showing growing problem of congestion
110804 - in Outside Referral Department similar to
110805 - problems in delivering labs to UCSF
110806 - that justifies deference to doctor
110807 - discretion prescribing labs
110808 - for Millie at UCSF.................... 090508, ref SDS B1 RF4N
110809 -
110810 -
110811 -
110812 -
110813 -
110814 -
1109 -
SUBJECTS
Default Null Subject Account for Blank Record
1203 -
120401 - ..
120402 - Stage V Complex Patient Profile Treat Cancer Chronic Disease
120403 - Kaiser Has No Treatments for Millie's Complex Patient Profile
120404 - Case Study Treat Millie's Cancer as Chronic Disease at UCSF
120405 - Chronic Disease Case Study Doctor Orders Treat Millie's Cancer at UCSF
120406 -
120407 - Follow up ref SDS 69 PL5K.
120408 -
120409 - Doctor Johnson was pleased with Millie's letter on 090218 notifying
120410 - the medical team that Kaiser authorizes Doctor Rugo to treat Millie's
120411 - cancer as a "chronic disease." ref SDS 70 TH6U
120413 - ..
120414 - The doctor asked about progress arranging for Millie's next treatment
120415 - while there is time for planning, and emphasized that early planning
120416 - is essential at UCSF because Kaiser has no more treatments for
120417 - Millie's next relapse, discussed previously on 090213 1140.
120418 - ref SDS 69 PL5K Now that Millie has completed radiation and
120419 - hyperthermia on 090317, her complex patient profile cannot be treated
120420 - with single-agent chemotherapy drugs. He explained again that Kaiser
120421 - only has single-agent Gemzar and Navelbine to treat Millie's breast
120422 - cancer, and they are not appropriate for Millie's 8th relapse of
120423 - cancer, also reviewed on 090213, ref SDS 69 ES7I, showing Millie's
120424 - treatment history presents narrowing margin for error which magnifies
120425 - small delays into denial of effective care.
120427 - ..
120428 - The doctor indicated Millie's coordination with UCSF to arrange the
120429 - next treatment is essential because Millie's next progression of
120430 - cancer will leave little time to commence treatment...
120432 - ..
120433 - 1. Medical chart calls for UCSF to treat next
120434 - relapse with double agent protocol because
120435 - Kaiser has only single agent regimens for
120436 - Millie's patient profile that has mutated
120437 - cancer to resist chemotherapy at Kaiser;
120438 - Doctor Johnson asked Millie to notify Doctor
120439 - Rugo that Kaiser will approve continued
120440 - care for Millie at UCSF for
120441 - next relapse......................... 080829, ref SDS 27 PX5V
120443 - ..
120444 - 2. Doctor Johnson emphasized Millie has
120445 - suffered relapse of IBC 5 times; he wants
120446 - to prevent administrative problems that
120447 - delayed treatment in January 2007 when
120448 - cancer was worsening for weeks; he asked
120449 - Millie in August to notify Doctor Rugo
120450 - to start planning for Millie's next
120451 - treatment, because IBC has mutated into
120452 - a more aggressive disease that resists
120453 - treatment with standard chemotherapy
120454 - agents available at Kaiser, and so
120455 - delaying treatment can be very
120456 - critical because there is
120457 - less time to prevent losing
120458 - local control........................ 081024 ref SDS 31 BO9F
120460 - ..
120461 - 3. Millie's cancer has now mutated through
120462 - multiple relapses into a more aggressive
120463 - disease; treatment for the next relapse
120464 - of IBC must be started quickly to
120465 - prevent losing control of
120466 - rapidly expanding cancer
120467 - cancer............................... 081219 ref SDS 39 5D6H
120469 - ..
120470 - 4. Telephone call from Doctor Johnson recommends
120471 - UCSF prescribe treatment for Millie's cancer
120472 - as chronic disease, and requires immediate
120473 - care for 6th relapse because IBC suddenly
120474 - expanding severely shown by cancer marker
120475 - 300% increase; implements Kaiser treatment
120476 - plan in medical chart for meeting on
120477 - 081219 with primary care
120478 - physician............................ 090123 ref SDS 51 OZ6N
120480 - ..
120481 - 5. Doctor Johnson advises Millie that recovery
120482 - from 6th relapse of IBC with radiation and
120483 - hyperthermia may last 3 - 6 months and so
120484 - Millie should meet with Doctor Rugo at UCSF
120485 - to plan timely care of 7th relapse for stage
120486 - IV cancer because delays are magnified when
120487 - critical details slip through the cracks;
120488 - requires streamlining delivery of care
120489 - shown in the doctor's graph to treat
120490 - Millie's cancer as a chronic
120491 - disease.............................. 090213 ref SDS 69 WZ6K
120493 - ..
120494 - 6. Doctor Johnson explains worsening patient
120495 - profile narrows the margin for error delivering
120496 - treatment in time to be effective; requires
120497 - a new phase to treat Millie's cancer
120498 - as a chronic disease at
120499 - UCSF.................................. 090213 ref SDS 69 PL5K
120501 - ..
120502 - 7. Primary care physician meets with Millie
120503 - at Kaiser, finds sudden reversal from strong
120504 - recovery in December to rapid progression
120505 - in January 2009 signals mutation of cancer
120506 - cells into a very aggressive disease that
120507 - resists treatments available
120508 - at Kaiser............................. 090213 ref SDS 69 GC6N
120510 - ..
120511 - 8. Letter notifies UCSF that primary care
120512 - physician at Kaiser prescribed continued
120513 - care at UCSF to treat Millie's cancer
120514 - as a chronic disease, and reports
120515 - UCSF schedules meeting to plan
120516 - treatment in time to be
120517 - effective............................. 090218 ref SDS 70 TH6U
120519 - ..
120520 - 9. Letter to medical team cites Kaiser's
120521 - notice of urgency for UCSF planning to be
120522 - prepared for treating Millie's cancer as
120523 - chronic disease and in time to be
120524 - effective when the next
120525 - relapse occurs........................ 090311 ref SDS 82 O15X
120527 - ..
120528 - 10. Letter to Kaiser reports agenda for meeting
120529 - with UCSF the next day on 090312 will present
120530 - request by primary care pysician to treat
120531 - Millie's cancer as chronic
120532 - disease............................... 090311 ref SDS 81 TE4U
120534 - ..
120535 - 11. Doctor Rugo planning to treat Millie's
120536 - IBC as a chronic disease, requested by
120537 - Doctor Johnson at Kaiser, reported
120538 - during meeting at
120539 - UCSF.................................. 090312 ref SDS 84 QQ9L
120541 - ..
120542 - 12. Letter to primary care physician at Kaiser
120543 - reports UCSF planning treatment for next
120544 - relapse as requested by
120545 - Kaiser................................ 090313 ref SDS 86 B24T
120547 - ..
120548 - 13. Millie's letter thanks Kaiser and UCSF
120549 - completing radiation and hyperthermia on
120550 - 090317 to rstore local control; cites
120551 - Doctor Johnson's work plan for UCSF to
120552 - prepare for timely care of next relapse
120553 - becasue Millie's cancer has mutated
120554 - into very aggressive disease
120555 - through 7 treatment
120556 - regimens.............................. 090324 ref SDS 91 CT6R
120558 - ..
120559 - 14. Millie notifies medical team referral
120560 - arrangements support Kaiser's request
120561 - to treat Millie's cancer as
120562 - chronic disease....................... 090410, ref SDS A3 JT7H
120563 - and asks if anything else is needed
120564 - to implement Kaiser's
120565 - strategy.............................. 090410, ref SDS A3 JT5V
120567 - ..
120568 - 15. Doctor Johnson confirms that single-agent
120569 - Gemzar and Navelbine are the only remaining
120570 - treatments Millie has not already received
120571 - and which are available at Kaiser for breast
120572 - cancer, and they are not appropriate for
120573 - Millie's patient profile, so he would
120574 - get in trouble from an audit
120575 - showing Gemzar or Navelbine
120576 - was prescribed for
120577 - Millie................................ 090515, ref SDS B5 658J
120579 - ..
120580 - 16. Millie's letter to medical team asks if
120581 - Doctor Johnson's revised treatment plan
120582 - changes prior guidance that single-agent
120583 - Gemzar and Navelbine modalities
120584 - conflicts with Millie's
120585 - patient profile....................... 090522, ref SDS B6 7Z5W
120587 - ..
120588 - 17. Millie asks medical team for expected
120589 - results from treatment with single-agent
120590 - chemotherapy that conflicts with Millie's
120591 - patient profile - will this be weeks of
120592 - agony then progression of cancer at
120593 - Kaiser - rather than recovery with
120594 - MPA "targeted" to treat Millie's
120595 - patient profile at UCSF Cancer
120596 - Center and no adverse
120597 - side effects?......................... 090522, ref SDS B0 2T4S
120599 - ..
120600 - 18. Kaiser discloses that Millie's doctor has
120601 - "no idea" how treatment which Kaiesr proposes
120602 - for Millie with Gemzar and Navelbine will affect
120603 - Millie's complex patient profile; the doctor
120604 - says these single-agent chemotherapy
120605 - treatments may not work at all
120606 - for Millie to recover
120607 - from 8th relapse of
120608 - cancer................................ 090522, ref SDS B8 UW6G
120610 - ..
120611 - 19. Kaiser Pharmacy reported that Doctor Johnson
120612 - prescribed treatment for Millie with Gemzar;
120613 - that side effects of Gemzar will be very
120614 - difficult for Millie to tolerate, and present
120615 - significant risks for Millie's patient
120616 - profile, and asked Millie to therefore
120617 - verify she agrees to get
120618 - this treatment........................ 090601, ref SDS C0 8J8L
120620 - ..
120621 - 20. Gemzar Kaiser discloses for the first time
120622 - in 5 years published guidance that says to
120623 - use "extreme caution" after patient has
120624 - radation - Millie had high dose radiation
120625 - at UCSF, and has strong continuing treatment
120626 - effects; Gemzar requires not giving patient
120627 - blood thinners, but Millie is on Coumadin
120628 - (Warfarin) blood thinner for life; Gemzar
120629 - causes low blood counts which weakens
120630 - immunity system making patient vulnerable
120631 - to death from infection, and Millie
120632 - has history of low counts
120633 - the past 4
120634 - years................................. 090605, ref SDS C1 V34K
120636 - ..
120637 - 21. Kaiser has not had time to collaborate with UCSF
120638 - on planning treatment of Millie's cancer as a
120639 - chronic disease, as Doctor Johnson proposed on
120640 - 080829; Doctor Johnson recognizes urgency to
120641 - complete this research with UCSF in order to
120642 - be prepared for switching treatments in time
120643 - to be effective over the next 4 - 8 weeks,
120644 - when cancer will likely progress, and so
120645 - treatment must be changed for
120646 - Millie to live........................ 091027, ref SDS C3 BK9M
120647 -
120648 -
120649 -
120650 -
1207 -
SUBJECTS
Default Null Subject Account for Blank Record
1303 -
130401 - ..
130402 - Radiation Side Effects Increased Request Pain Relief from Burn
130403 - Side Effects Radiation Burn Increased Significantly Request Relief
130404 - Domeboro Prescribed Treat Radiation Side Effects Supplement Silvadene
130405 - Linck Prescribed Treat Radiation Side Effects Supplement Silvadene
130406 -
130407 - Millie's letter yesterday on 090324 reported to the medical team side
130408 - effects have increased significantly, since treatment ended last week
130409 - on 090317. ref SDS 88 9L7K She suffers physicially and emotionally
130410 - due to reaction from radiation treatments. ref SDS 91 CT6X
130411 -
130412 - [On 090326 1028 Millie's letter to Doctor Stritter reports
130413 - not feeling well after 4 weeks of radiation and
130414 - hyperthermia. ref SDS 96 PX6Y
130416 - ..
130417 - Doctor Johnson observed severe radiation "burn" side effects, and
130418 - recalled Millie's letter to the medical team on 090313, ref SDS 86
130419 - B25R, reporting Doctor Hsu's prognosis during the meeting at UCSF the
130420 - day before on 090312, saying that severe radiation side effects will
130421 - get worse for several weeks to more than a month, before starting to
130422 - heal. ref SDS 84 F860
130423 -
130424 - [...below medical chart "Review of Systems" reports 2nd
130425 - degree burns on chest wall; does not attribute to side
130426 - effects of radiation and hyperthermia begun on 090219 and
130427 - ending on 090317, and which appears to have been effective
130428 - treating stage IV IBC. ref SDS 0 EF8U
130430 - ..
130431 - [On 090328 0909 Millie notifies medical team pain and
130432 - suffering rising from radiation side effects 2 weeks after
130433 - ending treatments at UCSF on 090317; side effects have been
130434 - tolerated in order to benefit from treating IBC; Millie
130435 - considering adding zink and Domeboro to increase relief
130436 - from radiation "burn" side effects. ref SDS 97 4S4P
130438 - ..
130439 - [On 090328 0909 Millie notifies medical team considering
130440 - adding zink and Domeboro treatment prescribed by Kaiser to
130441 - supplement treatment with Silvadene prescribed by UCSF to
130442 - reduce pain and suffering side effects from radiation
130443 - treatments, and asks Doctor Hsu again of any conflicts with
130444 - Silvadene cream prescribed by UCSF for treating radiation
130445 - side effects. ref SDS 97 4S4P
130447 - ..
130448 - The doctor asked about treatment UCSF prescribed for radiation side
130449 - effects?
130451 - ..
130452 - During the meeting at UCSF on 090317, Doctor Hsu prescribed Silvadene
130453 - Cream 1%, ref SDS 88 M442, reported in the letter to the medical team
130454 - yesterday on 090324. ref SDS 91 CT9W
130456 - ..
130457 - Millie asked if Kaiser has treatments that supplement Silvadene Cream
130458 - to help relieve rising discomfort?
130460 - ..
130461 - Doctor Johnson advised that patients getting radiation at Kaiser have
130462 - had good success using Domeboro recovering from side effects radiation
130463 - treatment. The doctor also mentioned zink tablets can strengthen the
130464 - immune system to hasten recovery from radiation burn. These are
130465 - available from over-the-counter pharmacies, like Long's Drugs.
130466 -
130467 - [...below medical chart "Plan" calls for adding Zinc and
130468 - considering Domeboro. ref SDS 0 UW9M
130470 - ..
130471 - [On 090328 0909 Millie notifies medical team pain and
130472 - suffering rising from radiation side effects 2 weeks after
130473 - ending treatments at UCSF on 090317; side effects have been
130474 - tolerated in order to benefit from treating IBC; Millie
130475 - considering adding zink and Domeboro to increase relief
130476 - from radiation "burn" side effects. ref SDS 97 4S4P
130478 - ..
130479 - [On 090328 0909 Millie notifies medical team considering
130480 - adding zink and Domeboro treatment prescribed by Kaiser to
130481 - supplement treatment with Silvadene prescribed by UCSF to
130482 - reduce pain and suffering side effects from radiation
130483 - treatments, and asks Doctor Hsu again of any conflicts with
130484 - Silvadene cream prescribed by UCSF for treating radiation
130485 - side effects. ref SDS 97 4S4P
130486 -
130487 -
130488 -
130489 -
130490 -
130491 -
1305 -
SUBJECTS
Default Null Subject Account for Blank Record
1403 -
140401 - ..
140402 - Proactive Case Management Treat Cancer Chronic Disease
140403 - Medical Tests Ordered at Kaiser for Millie's Examinations at UCSF
140404 - Research Solves Diminshing Treatments with Proactive Case Management
140405 -
140406 - Examination today finding evidence that suggests strong response to
140407 - treatment, per above, ref SDS 0 P369, aligns with the agenda for
140408 - scheduling medical tests in time for meeting with UCSF, ref SDS 91
140409 - CT6U, to implement Kaiser's plan on 090213 for proactive management at
140410 - UCSF Cancer Center treating Millie's cancer as a chronic disease.
140411 - ref SDS 69 PL5K
140413 - ..
140414 - Millie corrected the date meeting with Doctor Rugo and Doctor Hsu for
140415 - follow up examination at UCSF will be 090423, rather than 090416,
140416 - listed incorrectly in the letter to the team yesterday on 090324.
140417 - ref SDS 91 CT9R
140419 - ..
140420 - Doctor Johnson feels meeting with UCSF on 090423 to discuss continuing
140421 - treatment aligns with proactive case management prescribed on 090213
140422 - to cope with Millie's difficult and complex patient profile.
140423 - ref SDS 69 ES7I
140424 -
140425 - [On 090326 0058 Millie's letter to the medical team asks
140426 - about performing radiology diagnostics with speical form of
140427 - CT and/or PET testing to assess response to treatment.
140428 - ref SDS 93 DW6X
140430 - ..
140431 - [On 090326 0844 Doctor Johnson plans visual assessment with
140432 - CT tests, and advises PET/CT not needed. ref SDS 94 W75V
140434 - ..
140435 - Millie reported 2nd opinion research on 090204 addresses diminishing
140436 - treatment options, ref SDS 59 4R3S, reported by the doctor at Kaiser
140437 - on 081219, ref SDS 39 V93O, again on 090123, ref SDS 51 RK6O, and more
140438 - recently on 090213. ref SDS 69 PL5K
140440 - ..
140441 - Doctor Johnson asked for a copy of the research for collaboration with
140442 - Doctor Rugo at UCSF on Millie's next treatment.
140443 -
140444 - [...below Doctor Johnson's work plan in the medical chart
140445 - to consider Hospice is premature while the medical team is
140446 - reviewing treatments targeted to Millie's patient profile,
140447 - with Millie ECOG performance score 0, and demonstrating
140448 - strong response to treatment with examination and cancer
140449 - marker. ref SDS 0 QT9V
140451 - ..
140452 - [On 090326 0058 Millie's letter to medical team submits
140453 - research on treatments for IBC that fit her patient
140454 - profile. ref SDS 93 DW5S
140456 - ..
140457 - [On 090326 0844 Millie received letter from Doctor Johnson
140458 - responding to the letter this morning on the issue of
140459 - assessing response to treatment, but did not indicate
140460 - having reveiwed research submitted as he requested in the
140461 - meeting yesterday. ref SDS 94 5V7O
140463 - ..
140464 - [On 090326 0947 Millie responds to Kaiser on diagnostic
140465 - modalities to assess IBC recovery, and asks if the doctor
140466 - has reviewed the research submitted to Kaiser on treating
140467 - Millie's next relapse. ref SDS 95 QM3V
140469 - ..
140470 - [On 090326 1028 Millie notified Doctor Stritter that the
140471 - 2nd opinion treatment research was submitted to the medical
140472 - team. ref SDS 96 PY3R
140474 - ..
140475 - [On 090528 1238 Millie re-submitted comprehensive list of
140476 - treatments cited by the medical team targeted to Millie's
140477 - patient profile for treating her cancer as a chronic
140478 - disease, ref SDS B9 4N5U, as shown in the record on 090121,
140479 - ref SDS 47 EV53, and including clinical trials researched
140480 - on 090205 1523, ref SDS 59 4R3S, and submitted to the
140481 - medical team on 090326 0054, at the request of Doctor
140482 - Johnson, the primary care physician at Kaiser. ref SDS 93
140483 - DW5S
140485 - ..
140486 - The doctor scheduled Millie's next blood draw on 090413 1500. He,
140487 - also, ordered a CT test at 1520, based on Kaiser's computer Knowledge
140488 - Management system showing 1520 is available for a test on 090413. He
140489 - scheduled the blood draw 20 minutes earlier to allow time for Millie
140490 - to walk from the 2nd floor in the Oncology Department Chemotherapy
140491 - Infusion Clinic, about .25 miles through the halls to the basement
140492 - location of the CT Department.
140494 - ..
140495 - The order for a blood draw is a standing order, which can be used
140496 - each month to support review at UCSF.
140498 - ..
140499 - [...below medical chart "Plan" reports labs ordered on
140500 - 090413 for meeting at UCSF on 090423 to begin treating
140501 - Millie's cancer as a chronic disease. ref SDS 0 TR7K
140503 - ..
140504 - The CT test implements planning in Doctor Rugo's letter on 090204 for
140505 - another scan to evaluate response to treatment, and design a program
140506 - to treat Millie's cancer as a chronic disease. ref SDS 60 MW5F
140508 - ..
140509 - Doctor Johnson asked for the scope of the blood test Doctor Rugo
140510 - needs for examinations at UCSF?
140512 - ..
140513 - The record on 090129 shows the normal list of tests for Millie's labs,
140514 - ref SDS 52 075H, that UCSF uses to evaluate treatment response and
140515 - planning, which is the purpose of this test on 090413 scheduled to
140516 - support meeting at UCSF on 090423 0830.
140517 -
140518 - [On 090511 2013 Doctor Rugo notifies medical team that
140519 - scope of blood tests at Kaiser performed to support
140520 - examinations by Doctor Rugo at UCSF should be determined by
140521 - Doctor Johnson at Kaiser. ref SDS B3 RF4J
140523 - ..
140524 - [On 090511 2313 Millie notifies Doctor Rugo that patient
140525 - history shows UCSF specifies scope of lab work at Kaiser to
140526 - support Millie's treatment at UCSF, and this is performed
140527 - as a component of referral coordination. ref SDS B4 4Q6H
140529 - ..
140530 - Millie asked the doctor to "double check" ordering CA 15-3 because
140531 - Arlette reported on 090317 that the doctor did not order this test,
140532 - ref SDS 89 YM4K, for the lab at Kaiser on 090309, despite patient
140533 - history including CA 15-3 on every lab Millie has had at Kaiser for 8
140534 - years. Doctor Johnson verified CA 15-3 was ordered today. He feels
140535 - CA 15-3 was ordered during the meeting on 090213 for the test at
140536 - Kaiser on 090309. This aligns with the record of patient history for
140537 - the meeting at that time on 090213. ref SDS 69 WY5M
140539 - ..
140540 - The doctor advised that sometimes test tubes get misplaced from
140541 - handling in the Chemotherapy Infusion Clinic, or at the laboratory.
140542 - When problems of this kind are discovered at the time patients are
140543 - getting treatment in the Chemotherapy Clinic, nurses and staff can
140544 - take immediate action to correct the problem, so that treatment can be
140545 - given with minimal delay. Referral work coordinating between medical
140546 - institutions at a distance makes coordination more difficult. Delay
140547 - is compounded, as shown in patient history, per above, ref SDS 0 KZ6N,
140548 - because nurses cannot take immediate action to correct problems. This
140549 - aligns with Doctor Johnson's letter on 090205 that diligence is needed
140550 - to prevent critical details from "falling through the cracks" for
140551 - treating Millie's next relapse. ref SDS 63 278T
140553 - ..
140554 - On 090213 the doctor indicated treating Millie's cancer as a chronic
140555 - disease at UCSF is essential at this time, because Millie has received
140556 - all of the treatments available at Kaiser. ref SDS 69 WZ6K He urged
140557 - timely planning at UCSF because each relapse increases cancer cells
140558 - that resist chemotherapy. ref SDS 69 GC6N (see as well case study on
140559 - treating cancer as a chronic disease, per above, ref SDS 0 L15M
140560 -
140562 - ..
140563 - CT Test Ordered 090413 Allow 10 Days Issue Consolidated Findings
140564 -
140565 - Decided a sepearate order will not be needed today to access the Power
140566 - Port for the CT test on 090413, because this will be accomplished with
140567 - the blood draw at that time.
140569 - ..
140570 - Scope for the CT test on 090413 is shown in patient history on 081219
140571 - when the doctor order the prior test, ref SDS 39 WP30, and which was
140572 - performed on 081230. ref SDS 41 3G5I
140574 - ..
140575 - Millie asked that the e-consult referral to the CT Department specify
140576 - using the Power Port, that the test will include the neck, chest,
140577 - abdomen, and pelvis, the same as prior tests, and that the Radiology
140578 - Department prepare a consolidated report, rather than publish a report
140579 - for the neck, and another report for below the neck.
140580 -
140581 - [...below medical chart "Plan" reports CT test ordered on
140582 - 090413 10 for meeting at UCSF on 090423 to begin treating
140583 - Millie's cancer as a chronic disease. ref SDS 0 TR7K
140585 - ..
140586 - [On 090407 1442 called Kaiser to implement planning and
140587 - resolve problems for Millie's CT test scheduled on 090413.
140588 - ref SDS 99 WB6G
140590 - ..
140591 - [On 090415 1642 CT test report consolidates findings for
140592 - scans above neck and below the neck in single report, as
140593 - ordered by the doctor today. ref SDS A9 RU6R
140595 - ..
140596 - Millie further requested the doctor order a different oral contrast
140597 - medium for the test on 090413, because severe gastrointestinal side
140598 - effects using Barium Sulfate Suspension for the prior 2 tests, caused
140599 - significant delays for the last test on 081230. This cost money and
140600 - caused stress for staff and other customers waiting for Millie's test
140601 - to complete on 081230. ref SDS 41 FF4K
140603 - ..
140604 - The doctor advised there is not another option listed in Kaiser's
140605 - computer for CT contrast medium. Gastrogafin used for Millie's prior
140606 - tests before 081107 is not listed. The doctor decided to select
140607 - Barium Sulfate Suspension in order to complete the transaction and
140608 - secure Millie's schedule for the CT test on 090413. He will
140609 - investigate to try finding another contrast medium acceptable to the
140610 - CT Department.
140611 -
140612 - [...below medical chart "Review of Systems" reports Barium
140613 - Sulfate suspension for oral contrast medium caused
140614 - gastrointestinal problems. ref SDS 0 EF7U
140616 - ..
140617 - [On 090409 2347 letter to Doctor Davidson, Chief Radiology
140618 - Imaging Services Diablo Service Area asks for alternate
140619 - contrast medium using Gastrogafin, or equivalent, rather
140620 - than Barium Sulfate Suspension that causes medical
140621 - problems. ref SDS A2 OW5Q
140623 - ..
140624 - [On 090413 1500 Kaiser did not provide a solution; Millie
140625 - suffered recurrent multiple health problems using Barium
140626 - Sulfate Suspension contrast medium. ref SDS A5 QO9M
140628 - ..
140629 - Doctor Johnson recalled that getting a consolidated report has been a
140630 - continuing problem, discussed on 090213. ref SDS 69 YG4F
140632 - ..
140633 - Today, he specified the scope for the CT test on 090413 in the same
140634 - detail used on 081219, ref SDS 39 PU4H, and requested by Millie today,
140635 - including consolidating findings into a single report, ref SDS 0 LX5J,
140636 - and in order to solve problems coordinating the work with the CT
140637 - Department cited by the doctor during the meeting at Kaiser on 090213.
140638 - ref SDS 69 YG4F
140640 - ..
140641 - The doctor feels that ordering tests on 090413, 10 days, before
140642 - meeting at UCSF on 090423, gives the CT Department and the laboratory
140643 - time to correct chronic mistakes, shown in case study today, per
140644 - above, ref SDS 0 KZ6N, so that accurate findings can be submitted in
140645 - time for the medical team to prepare for a productive meeting at UCSF
140646 - to plan Millie's next treatment.
140647 -
140648 - [...below medical chart "Plan" reports labs and CT test
140649 - ordered on 090413 10 for meeting at UCSF on 090423 to begin
140650 - treating Millie's cancer as a chronic disease. ref SDS 0
140651 - TR7K
140653 - ..
140654 - The doctor asked Millie to assist him coordinating with CT Department
140655 - on consolidating findings into a single report, as specified in the
140656 - referral for the test on 090413, per above. ref SDS 0 LX5J This will
140657 - strengthen Millie's care on referral to UCSF, as requested by Doctor
140658 - Rugo during the meetings on 081218, ref SDS 38 QX44, and again on
140659 - 090108, reported in Millie's letter to the team on 090109. ref SDS 44
140660 - UE6X
140662 - ..
140663 - [On 090407 1442 coordinated with CT Department to
140664 - consolidate findings in a single report for Millie's test
140665 - on 090413, ref SDS 99 M46K; Katie advised that somebody
140666 - changed the doctor's order for a consolidated report,
140667 - ref SDS 99 YK5O; Katie asked Doctor Davidson to decide
140668 - about consolidating findings for efficient care.
140669 - ref SDS 99 YZ95
140671 - ..
140672 - [On 090409 2018 Doctor Davidson, Director fo Radiology of
140673 - Kaiser Mt Diablo Service Area, advised that Kaiser CT
140674 - Department Walnut Creek made a mistake issuing multiple
140675 - reports for the CT test on 090413, ref SDS A1 L14I, and
140676 - advised that findings for future CT tests will consolidate
140677 - findings into a single report for each test for efficient
140678 - case management essential to save lives, time, and money.
140679 - ref SDS A1 XZ6U
140681 - ..
140682 - [On 090409 2018 Millie received from Doctor Davidson a copy
140683 - of Katie's letter requesting the doctor to notify the
140684 - patient assistant on resolving errors in CT test reporting.
140685 - ref SDS A1 5P5N
140687 - ..
140688 - [On 090409 2347 letter to Doctor Davidson commends Katie
140689 - for facilitating communication that corrects mistakes in
140690 - Kaiser issuing multiple reports rather than consolidate
140691 - findings for each CT test in a single report. ref SDS A2
140692 - OW4P
140694 - ..
140695 - [On 090515 1140 Doctor Johnson asked Millie for a draft to
140696 - assist him filing a claim with Member Services for
140697 - deferrence to doctor discretion prescribing Millie's
140698 - treatment in a clinical trial for medical necessity.
140699 - ref SDS B5 655Y
140701 - ..
140702 - Doctor Johnson indicated that doing blood tests 10 days in advance is
140703 - not a good long-term solution for Millie's care on referral to UCSF
140704 - for a 7th relapse of IBC.
140705 -
140706 -
140707 -
140708 -
1408 -
SUBJECTS
Default Null Subject Account for Blank Record
1503 -
150401 - ..
150402 - Thinking Through Writing Advancing at Kaiser
150403 - Medical Chart Reports Examination Diagnosis Prescription Prognosis
150404 -
150405 - Follow up ref SDS 69 YT5N, ref SDS 39 YT5N.
150406 -
150407 - Millie received through Kaiser's Knowledge Management system the
150408 - doctor's medical chart from meeting this morning on 090325 0830...
150410 - ..
150411 - 1. Received: 3/25/09 9:31 AM
150413 - ..
150414 - 2. Subject: Office visit 090325 0830
150416 - ..
150417 - 3. Patient presents with: recheck - r/s 1mo ret
150419 - ..
150420 - 4. History of Present Illness:
150421 -
150422 - Follow up ref SDS 69 4R7J, ref SDS 39 4R7J.
150423 -
150424 - Mildred A Buck is a 73 Y female with a history of IBC of left
150425 - breast who was initially diagnosed 03/04/02. S/P AC x's 4 from
150426 - 04/23/02 through 07/01/02 followed by Taxotere ending 12/04/02.
150427 - She had recurrent disease noted initially in the cervical LN's
150428 - 03/03/04. On E2100 Study with Taxol/Avastin, but she had a PE
150429 - noted on CT 11/03/2004. Then, because of progression of
150430 - disease, the patient was started on Taxotere and Xeloda
150431 - 4/15/05. She had a total of 8 cycles ending 9/16/05. She had
150432 - a palliative left mastectomy performed 10/21/05. Then her left
150433 - chest lesions began expanding again. The patient started
150434 - Taxotere and Xeloda again 07/21/06 for 7 cycles. She was
150435 - started on a Clinical Trial 02/01/07 at UCSF and was randomized
150436 - to the Erbitux only (no Carbo) Arm. She had weekly Carboplatin
150437 - added 03/13/08 because of progression of disease. Her disease
150438 - progressed again and she began a Phase I/II Study of Sunitinib
150439 - (SU11248) at UCSF 11/14/08. Lengthy discussion about current
150440 - status and response to therapy. Because of cytopenia, MTX to
150441 - be D/C'd and Sutent and CTX held and then dose reduced. The
150442 - patient started hyperthermia/XRT at UCSF 02/19/09 and completed
150443 - it 03/17/09.
150445 - ..
150446 - Clarifications entered for the medical chart on 090213, continue to
150447 - apply for the medical chart today. ref SDS 69 694F
150449 - ..
150450 - UCSF planning for hyperthermia dated 090209 was submitted to the
150451 - patient on 090220, ref SDS 73 PR4Y UCSF also submitted a professional
150452 - paper published by BSD on theory and applications of hyperthermia for
150453 - treating cancer. ref SDS 73 GK6F
150455 - ..
150456 - On 090226 UCSF submitted the radiation treatment plan to the patient.
150457 - ref SDS 75 D452
150459 - ..
150460 - On 090223 0237 Millie's letter to the medical team submitted the UCSF
150461 - treatment planning memo on 090209, and the BSD paper on hyperthermia
150462 - applications to Kaiser for the medical chart record of patient care.
150463 - ref SDS 74 T47U
150465 - ..
150466 - On 090310 0351 Millie's letter to the medical team transmits the UCSF
150467 - radiation treatment plan to Kaiser via link to patient history.
150468 - ref SDS 78 O56P During the meeting today, Millie submitted printed
150469 - documents for the UCSF treatment plan, per above. ref SDS 0 D452
150471 - ..
150472 - Medical Chart continues...
150474 - ..
150475 - 5. Current Medications
150476 -
150477 - Follow up ref SDS 69 EX3M, ref SDS 39 UF6L.
150478 -
150479 - A lot of prior medications ended because Millie stopped
150480 - chemotherapy on 090122, ref SDS 49 AT6N, and then beginning on
150481 - 090219 was treated with radiation and hyperthermia that did not
150482 - entail medications.
150484 - ..
150485 - HYDROCODONE/ACETAMINOPHEN 5 5
150486 - combined in tablets of...... Vicodin/Lortab...... 080708, ref3SDS 37 BT8C
150487 - WARFARIN 4 MG TABLETS....... Coumadin............ 061002, ref2SDS 20 MI5I
150488 - TIMOLOL MALEATE 0.5% EYE.... Eye drops
150489 - LORAZEPAM 1 MG.............. Ativan.............. 070921, ref2SDS 28 3N8J
150491 - ..
150492 - On 090324 Kaiser was notified, ref SDS 91 CT9W, that on 090317 UCSF
150493 - prescribed treatment for radiation side effects, ref SDS 88 M442,
150494 - discussed during the meeting today, per above. ref SDS 0 6E4M,
150496 - ..
150497 - Today, during the meeting the doctor additionally prescribed Domeboro
150498 - to supplement treatment for radiation side effects. ref SDS 0 6E5I
150500 - ..
150501 - These transactions may add the following to current medications...
150502 -
150503 - SILVADENE CREAM 1% 20 grams
150504 - prevent infection radiation burn................. 090317, ref8SDS 88 M442
150505 - DOMEBORO for radiation burn...................... 090325, ref SDS 0 FW5O
150507 - ..
150508 - Medical Chart continues...
150510 - ..
150511 - 6. Review of systems:
150512 -
150513 - Follow up ref SDS 69 E15I, ref SDS 39 6L6I.
150514 -
150515 - Seems to be same scope for prior exam on 081216.
150516 -
150517 - a. Constitutional: Appetite and energy level are good.
150519 - ..
150520 - b. Eyes: Vision is OK.
150522 - ..
150523 - c. ENT: No mucositis or nose bleeds.
150525 - ..
150526 - d. Cardiovascular: No SOB, palpitations or chest pain
150528 - ..
150529 - e. Respiratory: No hemoptysis or cough
150531 - ..
150532 - f. GI: Diarrhea from ReadiCat
150534 - ..
150535 - The doctor records Millie's report that Barium Sulfate Suspension for
150536 - CT test oral contrast medium causes severe discomfort and delayed work
150537 - in CT department on 081230; Doctor ordered same agent for CT test on
150538 - 090413, because Kaiser's computer required this selction in order to
150539 - schedule a test on 090413 required for Millie's care; Doctor planning
150540 - to investigae alternate agent that does not harm the patient nor delay
150541 - the work in time for the test on 090413, per above. ref SDS 0 G58N
150543 - ..
150544 - [On 090409 2347 letter to Doctor Davidson, Chief
150545 - Radiology Imaging Services Diablo Service Area asks for
150546 - alternate contrast medium using Gastrogafin, or
150547 - equivalent, rather than Barium Sulfate Suspension that
150548 - causes medical problems. ref SDS A2 OW5Q
150550 - ..
150551 - Medical Chart continues...
150552 -
150553 - g. GU: No hematuria or dysuria
150555 - ..
150556 - h. Musculoskeletal: Recent dislocation, right shoulder with
150557 - fracture right humeral head
150559 - ..
150560 - This entry repeats what is reported in the medical chart for the
150561 - meeting 6 weeks ago on 090213, ref SDS 69 WE7K, during the meeting
150562 - today, the doctor seemed familiar with Millie's progress recovering,
150563 - as reported in the Orthopedics Department, per above. ref SDS 0 YU6K
150565 - ..
150566 - Medical Chart continues...
150567 -
150568 - i. Skin: 2nd degree burns on chest wall
150570 - ..
150571 - This report updates status in the medical chart for meeting at Kaiser
150572 - on 090213 prior to starting treatment on 090219 at UCSF with radiation
150573 - and hyperthermia. ref SDS 69 EF8U Aligns with examination today
150574 - showing strong response to treatment at UCSF that began on 090219 and
150575 - ended a week ago on 090317, per above, ref SDS 0 WU5H, and which
150576 - caused severe side effects of a "burn" condition that appears similar
150577 - to IBC rash, per above. ref SDS 0 P39I
150579 - ..
150580 - Medical Chart continues...
150581 -
150582 - j. Neurological: No confusion, sensory changes or motor
150583 - weakness
150585 - ..
150586 - k. Psychiatric: Less anxiety; going on cruise 04/24/09
150588 - ..
150589 - Doctor commented on Millie's report in a letter to the medical team on
150590 - 090324. Millie reported very low energy, and high emotional stress
150591 - working long hours for 3 months to assist Kaiser and UCSF with case
150592 - management, but starting to feel better with postivie news from
150593 - falling cancer marker; doctor feels attitude will improve further as
150594 - energy rises after ending treatments, ref SDS 0 M35H; and, doctor
150595 - pleased Millie is taking a cruise for needed rest. ref SDS 0 U65I
150597 - ..
150598 - Medical Chart continues...
150600 - ..
150601 - 7. Physical Exam:
150602 -
150603 - Follow up ref SDS 69 YF9L, ref SDS 39 CS5G.
150604 -
150605 - a. ECOG Performance Score 0
150607 - ..
150608 - Millie's ECOG performance score 0 is highest evaluation for
150609 - aggressively treating cancer, including clinical trials, reported on
150610 - 090205. ref SDS 64 JG5I This is similar to Karnsofsky scale, also,
150611 - reviewed on 090205. ref SDS 64 LH3O
150612 -
150613 - [On 090510 1553 after tiring flight home from vacation,
150614 - Millie goes hiking at Lafayette Reservoir 3 miles
150615 - difficult hills, demonstrating ECOG performance score 0,
150616 - reported in the medical chart today. ref SDS B2 CN5T
150618 - ..
150619 - Medical Chart continues...
150620 -
150621 - b. BP 149/86
150622 - Pulse 73
150623 - Temp (Src) 98.8 øF (37.1 øC) (Oral)
150624 - Wt 140 lb 9.6 oz (63.776 kg)
150625 - SpO2 97%
150627 - ..
150628 - Severely elevated vitals for Millie's patient history align with her
150629 - letter to the medical team yesterday, ref SDS 91 CT6X, reporting
150630 - physical and emotional exhaustion working the past 3 months to recover
150631 - from 6th relapse of IBC, and cited by the doctor during examination
150632 - today, per above. ref SDS 0 M35H
150634 - ..
150635 - Medical Chart continues...
150636 -
150637 - c. Eyes: normal conjunctiva
150639 - ..
150640 - d. Mouth: normal mucosa
150642 - ..
150643 - e. Lymph: palpable LN in left suprclavicular area
150645 - ..
150646 - Doctor seemed to clarify during examination today that palpation of LN
150647 - in left supraclavicular and right axilla are reduced. ref SDS 0 P36J
150648 -
150649 - [On 090515 1140 examination at Kaiser on 090515 finds no
150650 - palpable LNs. ref SDS B5 YD5U
150652 - ..
150653 - Medical Chart continues...
150654 -
150655 - f. Breasts: 2nd degree radiation burn on predominantly left
150656 - chest wall
150658 - ..
150659 - Doctor changes description from "Chest Wall" for medical chart on
150660 - prior meeting 090213. ref SDS 69 YD5X
150662 - ..
150663 - Medical chart "Physical examination Breasts" aligns with "Review of
150664 - Systems Skin," per above, ref SDS 0 EF8U, and further reflects
150665 - examination today, per above, ref SDS 0 WU5H, including discussion of
150666 - treatment for side effects prescribing Domeboro. ref SDS 0 P39I
150668 - ..
150669 - Medical Chart continues...
150670 -
150671 - g. Lungs: clear to percussion and auscultation
150673 - ..
150674 - h. Heart: regular without murmur or gallop
150676 - ..
150677 - i. Abd: soft with normal bowel sounds. No masses or
150678 - organomegaly
150680 - ..
150681 - Slight change in description from medical chart on 090213 that
150682 - mentions "Liver edge palpated," and does not report "No masses or
150683 - organomegaly." ref SDS 69 YD6W
150685 - ..
150686 - Medical Chart continues...
150687 -
150688 - j. Ext: R shoulder dislocation
150690 - ..
150691 - Right shoulder was dislocated on 090122, ref SDS 48 0001, and was
150692 - described in the medical chart on 090213 a few weeks after the event
150693 - as " right upper arm bruised and tender," which was accurate, but
150694 - omitted fact of dislocation that explains cause of symptoms.
150695 - ref SDS 69 YE3P
150697 - ..
150698 - During examination today doctor discussed progress recovering from
150699 - dislocated shoulder, which showed significantly reduced bruising.
150700 - ref SDS 0 YU6K
150702 - ..
150703 - k. Skin: no rashes or palpable masses
150705 - ..
150706 - l. Bones: no tenderness
150708 - ..
150709 - m. Neuro: awake, alert, and oriented. Moves all extremities well. Normal gait.
150711 - ..
150712 - 8. Lab:
150713 -
150714 - Follow up ref SDS 69 YE3Y, ref SDS 39 WW6O.
150715 -
150716 - Bili, Tot Adult 0.2 mg/dL
150717 - Creatinine 0.73 mg/dL
150718 - ALT (SGPT) 28 U/L
150720 - ..
150721 - WBC 4.0 K/uL
150722 - RBC L 3.29 M/uL
150723 - Hemoglobin L 10.3 g/dL
150724 - Hematocrit L 31.8 %
150725 - MCV 97 fL
150726 - RDW 14.0 %
150727 - Plt 245 K/uL
150729 - ..
150730 - PT, Patient H 21.6 Sec
150731 - PT INR 2.2 Ratio
150732 -
150734 - ..
150735 - CA 15-3
150736 - ----------
150737 - 251 H
150738 - 303 H
150739 - 202 H
150740 - 197 H
150741 - 141 H
150742 - 75 H
150743 - 74 H
150744 - 56 H
150745 - 52 H
150746 - 55 H
150747 - 56 H
150748 -
150750 - ..
150751 - 9. Imaging:
150752 -
150753 - Follow up ref SDS 69 WO8H, ref SDS 39 NS3H.
150754 -
150755 - a. 03/17/09 DXA BONE DENSITY, AXIAL - report pending
150756 -
150757 - b. 01/29/09 SHOULDER, COMPLETE 2+ VIEWS
150758 -
150759 - This is follow up examination evaluaing separated shoulder
150760 - on 090122 that was evaluated with image test at Kaiser on
150761 - 090129. Shoulder was xrayed. Mike advised that xray scan
150762 - test today shows no fracture, and that Millie's shoulder
150763 - appears correctly positioned in the socket for effective
150764 - healing and recovery. ref SDS 79 ZF7J
150766 - ..
150767 - c. 01/22/09 SHOULDER, COMPLETE 2+ VIEWS
150768 -
150769 - Second and third xrays on 090122 found that 1st reduction
150770 - procedure attempt to restor shoulder failed, ref SDS 73
150771 - 074F, and second attempt was successful, reported on
150772 - 090122. ref SDS 73 LV3O
150774 - ..
150775 - d. 01/22/09 SHOULDER, ONE VIEW - Dislocation, right shoulder.
150776 - Fracture right humeral head
150778 - ..
150779 - First xray at Emergency Room Department on 090122 found
150780 - dislocated shoulder. ref SDS 73 PR3U
150782 - ..
150783 - e. 01/22/09 CT CERV SPINE W/O CONTRAST - Degenerative changes
150784 - of the cervical spine without evidence of acute C spine
150785 - fracture or loss in alignment.
150787 - ..
150788 - CT test in Emergency Room to evaluate scope of injury that
150789 - caused dislocated shoulder. ref SDS 73 PP8S
150791 - ..
150792 - f. 01/22/09 CT HEAD W/O CONTRAST -
150793 -
150794 - 1. No evidence of acute infarct or hemorrhage.
150795 -
150796 - 2. Sinus disease. Mild nasal septal deviation to the
150797 - right.
150799 - ..
150800 - CT test in Emergency Room to evaluate scope of injury that
150801 - caused dislocated shoulder. ref SDS 73 W16E
150803 - ..
150804 - g. 09/11/08 CT THORAX, ABDOMEN, PELVIS W CONTRAST - Status
150805 - post left mastectomy. There has been little interval
150806 - change. Prominent right axillary lymph nodes are again
150807 - noted, little changed in size, which could be accounted for
150808 - by sampling variability. Reticular densities and tiny
150809 - punctate densities in the lungs are not significantly
150810 - changed, and there are no new identifiable lesions. No new
150811 - adenopathy or ascites.
150813 - ..
150814 - Complete history of imaging tests shows no evidence distant metastsis,
150815 - listed on 090107, ref SDS 66 GM3N, and shows that after the test on
150816 - 080911, ref SDS 40 DA6Q, Millie has had 2 CT tests to evaluate cancer
150817 - (1) on 081107, which was published in 2 parts, the first received on
150818 - 081112, ref SDS 52 DA6Q, and a second report received on 081113.
150819 - ref SDS 55 DA6Q; and the next report (2) on 081230 also issued in 2
150820 - parts, but received on the same day, 090107. ref SDS 66 DA6Q
150822 - ..
150823 - Medical Chart continues...
150825 - ..
150826 - 10. Assessment:
150827 -
150828 - Follow up ref SDS 69 KG6O, ref SDS 39 345N.
150829 -
150830 - 1. Metastatic breast cancer (IBC) lung, lymph node and chest
150831 - wall; S/P hyperthermia/XRT with decreasing CA 15-3.
150833 - ..
150834 - During the meeting today, the doctor was very pleased with decline of
150835 - cancer marker for first time in a year, per above, ref SDS 0 WU6L, and
150836 - aligns with the medical chart Labs section, which does not show dates.
150837 - ref SDS 0 6H6V Patient history on 090323 shows dates of labs and CA
150838 - 15-3 increased steadily at UCSF and more sharply at Kaiser for the
150839 - past year. ref SDS 90 J13O
150841 - ..
150842 - Medical Chart continues...
150843 -
150844 - 2. Anemia due to chemotherapy
150846 - ..
150847 - This assessment was accurate for examination on 090213, because at
150848 - that time Millie was still recovering blood counts after ending
150849 - chemotherapy on 090122.
150851 - ..
150852 - Today, another 40 days have passed without having chemotherapy, making
150853 - a total of about 60 days since the last systemic treatment. The most
150854 - recent lab on 090309 indicates blood counts have mostly recovered.
150855 - ref SDS 77 OT8J Most notably ANC has increased to 2120 for the test
150856 - on 090309. ref SDS 77 B35J
150858 - ..
150859 - Medical Chart continues...
150860 -
150861 - 3. ACD
150863 - ..
150864 - Unclear what is being reported for ACD?
150866 - ..
150867 - Medical Chart continues...
150868 -
150869 - 4. Dislocation, right shoulder with fracture right humeral
150870 - head
150872 - ..
150873 - Discussed current disease trajectory and Hospice
150875 - ..
150876 - This was in the medical chart for the prior meeting on 090213, and is
150877 - missing from the medical chart for examination today. The doctor in
150878 - fact discussed disease trajectory by drawing another graph and adding
150879 - a notation showing Millie may be near the point of precipitous
150880 - decline. ref SDS 0 P34Q The doctor also advised that cancer patients
150881 - can contact hospice at Kaiser prior to actual start of service,
150882 - because this provides time for people to get acquainted, and become
150883 - familiar with working together, per above. ref SDS 0 JS5I
150884 -
150885 - [...below, the doctor added to the work plan considering
150886 - Hospice in the future, per below. ref SDS 0 QT9V
150888 - ..
150889 - Medical Chart continues...
150890 -
150891 - 5. Anticoagulation monitoring
150893 - ..
150894 - This is a new category for assessment, that has not been in the
150895 - medical chart for any prior meetings with the doctor. There was
150896 - extensive discussion of coagulation control during the prior meeting
150897 - on 090213, ref SDS 69 8W4G, because bruising from Millie's fall on
150898 - 090122 was compounded by Coumadin blood thinner. ref SDS 69 8V5N At
150899 - that time on 090122, the ER doctor paused Coumadin for several days,
150900 - ref SDS 48 F56L, and Millie coordinated with the Cogaulation Control
150901 - case manager, reported in a letter to the medical team the next day on
150902 - 090123. ref SDS 50 KR5V
150904 - ..
150905 - There was no discussion of Coumadin nor Coagulation Control today,
150906 - because examination today shows brusing from the fall no 090122 has
150907 - nearly healed. ref SDS 0 TF7N
150909 - ..
150910 - Medical Chart continues...
150911 -
150912 - 6. Depression stable
150914 - ..
150915 - This appears misleading if it suggests stable emotionally, since
150916 - Millie reported in a letter yesterday not feeling well physically and
150917 - emotionally, per above. ref SDS 0 M35H The doctor may be saying
150918 - Millie suffers depression that has not increased to a point of
150919 - requiring medical support.
150921 - ..
150922 - There is depression about prospects of inevitable decline that cannot
150923 - be controlled, but only managed within the meaning of palliation,
150924 - discussed under disease trajectory, per above. ref SDS 0 P39M
150926 - ..
150927 - There is also depression about delay being denial of treatment that
150928 - causes premature departure for patients who require timely care in
150929 - order to live, and which may be susceptible to human control with good
150930 - management using cooperation and diligence. ref SDS 0 P43G On 090213
150931 - Millie explained being emotionally crushed by efforts required to make
150932 - arrangements for treating the 6th relapse in time to be effective.
150933 - ref SDS 69 NY8H Case study on 090213 provides opportunities to
150934 - relieve dpresssion by improving the work to reduce mistakes that delay
150935 - care. ref SDS 69 IG5O
150937 - ..
150938 - Doctor Johnson discussed today ways to streamline delivery of care by
150939 - avoiding little mistakes that slip through the cracks, per above.
150940 - ref SDS 0 EI8J
150942 - ..
150943 - Medical Chart continues...
150945 - ..
150946 - 11. Plan:
150947 -
150948 - Follow up ref SDS 69 TR7K, ref SDS 39 UN8M.
150949 -
150950 - 1. Continue serial CBC and CA 15-3
150951 - 2. FU CT's Apr 13, 2009
150953 - ..
150954 - Labs were ordered today for Millie's meeting at UCSF on 090423,
150955 - ref SDS 0 P36O, aligned with requirements for Doctor Rugo to evaluate
150956 - Millie's next treatment at UCSF, ref SDS 0 V86J, and discussed during
150957 - the meeting today for implementing Doctor Johnson's plan to treat
150958 - Millie's next relapse as a chronic disease, per above, ref SDS 0 L15M,
150959 - and related in the meeting on 090213. ref SDS 69 WZ6K
150961 - ..
150962 - CT test was also ordered today, ref SDS 0 LX54, requeted by Doctor
150963 - Rugo in a letter to the medical team on 090204. ref SDS 60 MW5F
150965 - ..
150966 - Labs and CT test scheduled 10 days before meeting at UCSF on 090423 in
150967 - order to allow time for adjusting to delays and mistakes, so that test
150968 - data will availabe on time. ref SDS 0 LX5I
150969 -
150970 - [On 090407 1442 called Kaiser to implement planning and
150971 - resolve problems for Millie's CT test scheduled on 090413.
150972 - ref SDS 99 WB6G
150974 - ..
150975 - Medical Chart continues...
150976 -
150977 - 3. FU Dr. Hsu 04/23/09
150979 - ..
150980 - Kaiser's work plan on 090213 calls for follow up with Doctor Rugo
150981 - after treatment in radiation oncology. ref SDS 69 J54K Doctor Johnson
150982 - added meeting with Doctor Hsu to the work plan for follow up on 090423
150983 - to evaluate recovery from IBC after completing radiation and
150984 - hyperthermia on 090317, and working on referral from Doctor Rugo
150985 - managing Millie's care at UCSF, as cited in Millie's letter to the
150986 - medical team yesterday on 090324, ref SDS 91 CT9R, and implementing
150987 - Doctor Hsu's planning during the meeting on 090317. ref SDS 88 5Q42
150989 - ..
150990 - Follow up with Doctor Rugo implements the doctor's discussion today
150991 - about urgency of UCSF treating Millie's cancer as a chronic disease
150992 - because timely treatment will be critical for Millie to recover from
150993 - the 7th relapse. ref SDS 0 GD3I
150994 -
150995 - [On 090324 0548 Millie's letter implemented Kaiser's
150996 - treatment plan scheduling follow up with Doctor Rugo and
150997 - Doctor Hsu to evaluate response to treatment and develop
150998 - the next steps for treatment. re* SDS 9* CT9R
151000 - ..
151001 - Medical Chart continues...
151002 -
151003 - 4. Add Zinc
151004 - 5. Consider Domeboro
151006 - ..
151007 - This was proposed during the meeting today for relieving pain and
151008 - suffering from radiation side effects, by supplementing UCSF
151009 - prescription of Silvadene, per above. ref SDS 0 FW5O
151011 - ..
151012 - Medical Chart continues...
151013 -
151014 - 6. Consider Hospice in the future
151016 - ..
151017 - Hospice was discussed again today, ref SDS 0 JS5I, based on the
151018 - doctor's discussion of disease trajectory that Millie has less than 1
151019 - year to live. ref SDS 0 P39M
151021 - ..
151022 - At this time, Hospice for palliative care to relieve pain and
151023 - suffering while the patient foregos treatment and declines into death,
151024 - conflicts with examination finding in the medical chart today ECOG
151025 - perfomance score 0, per above. ref SDS 0 YF9L Abandoning treatment
151026 - further conflicts with examination showing substantial recovery from
151027 - 6th relapse of cancer, following treatment at UCSF, reported above.
151028 - ref SDS 0 W13H
151030 - ..
151031 - Consideration of Hospice should therefore come after the medical team
151032 - has evaluated available treatments and explained trade-offs on
151033 - extending Millie's high quality of life accoplished the past 2 years
151034 - with the cetuximab and Carboplatin protocols.
151036 - ..
151037 - Since Doctor Johnson requested today the list of treatments for
151038 - Millie's patient profile, per above, ref SDS 0 GO4O, before
151039 - considering Hospice, the medical team should consider which treatments
151040 - are best for Millie.
151041 -
151042 - [On 090326 0058 Millie's letter to medical team submits
151043 - research on treatments for IBC that fit her patient
151044 - profile. ref SDS 93 DW5S
151046 - ..
151047 - Medical Chart continues...
151048 -
151049 - 7. RTC 4 weeks
151051 - ..
151052 - Since Millie is going on vacation on 090424, per above, ref SDS 0
151053 - U65I, the next meeting will actually be in about 8 weeks. Increased
151054 - time between visits at Kaiser reflects plan for at UCSF to treat
151055 - Millie's cancer as a chronic disease, per above, ref SDS 0 L15M, and
151056 - schedule for Millie to meet with Doctor Rugo and Doctor Hsu on 090423
151057 - for evaluation, ref SDS 0 P36O, the day before leaving on vacation on
151058 - 090424. This is further evident from the medical chart "Plan" for
151059 - follow up at UCSF on 090423. ref SDS 0 TR88
151060 -
151061 -
151062 -
151063 -
151064 -
151065 -
151066 -
151067 -
151068 -
151069 -
151070 -
1511 -