THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: April 13, 2009 01:30 PM Monday;
Rod Welch
Millie Blood test at Kaiser and access port for CT test at 1500.
1...Summary/Objective
2...Lab Blood Test CBC to Evaluate Neupogen and Cancer Treatment Plan
3...Laboratory Blood Test Results Posted Kaiser's Computer
..............
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 62 0000. ref SDS 52 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - 1. On 090108 Millie's blood counts were very low at UCSF.
040902 - ref SDS 48 YN8O Millie had a follow up blood draw at Kaiser on
040903 - 090116, showing further decline in blood counts. ref SDS 52
040904 - 075H A week later on 090122, Doctor Rugo stopped treatment
040905 - with sunitinib clinical study, ref SDS 57 AT6N; she scheduled
040906 - Millie for meeting at UCSF a week later to begin new treatment
040907 - for recovering from a 6th relapse of IBC.
040909 - ..
040910 - 2. On 090129 Millie had a blood draw at UCSF to guide examination
040911 - by the medical team in the Breast Care Clinic. ref SDS 58 075H
040913 - ..
040914 - Millie did not start a new treatment on 090129 due a
040915 - communication glitch, reported in the letter to the medical
040916 - team on 090130. ref SDS 59 AY8Q
040918 - ..
040919 - 3. On 090210 Doctor Rugo's office scheduled Millie to meet with
040920 - the doctor at UCSF on 090312 to evaluate response to treatment
040921 - which was delayed from 090129 to 090219. ref SDS 60 XU5N
040923 - ..
040924 - 4. On 090213 1140 Doctor Johnson ordered a blood draw for 090310
040925 - (today) testing INR, and other diagnostics, including CA 15-3,
040926 - and to flush Milli'e port according to Kaiser requirements.
040927 - ref SDS 61 6P3F
040929 - ..
040930 - 5. On 090309 1500 after getting radiation and hyperthermia
040931 - treatmnet in San Francisco at UCSF, Millie went to Kaiser on
040932 - the way home for the lab. ref SDS 62 VF6G
040934 - ..
040935 - 6. On 090317 1120 called Kaiser and talked to Arlette; hectic
040936 - schedule on 090313 prevented following up on plans to
040937 - discuss CA 15-3 results for blood test on 090309.
040938 - ref SDS 65 Y077
040940 - ..
040941 - 7. On 090317 1120 Arlette ordered make up blood draw to test CA
040942 - 15-3. ref SDS 65 YP6S
040944 - ..
040945 - 8. On 090317 1120 Millie went to Kaiser on the way home from
040946 - treatment at UCSF and got another blood draw to test CA 15-3.
040947 - ref SDS 65 PQ6R
040949 - ..
040950 - 9. On 090323 results of blood draw on 090317 shows CA 15-3 251,
040951 - ref SDS 66 Y077, significant decline from 303 for the test on
040952 - 090116. ref SDS 52 A16M
040954 - ..
040955 - 10. On 090325 Doctor Johnson ordered a blood draw for 090413 1500,
040956 - and to also access Millie's Power Port required to inject
040957 - contrast medium for a test in the CT Department at 1520. This
040958 - also requires coordinating with Interventional Radiology
040959 - Services to support connecting contrast medium to the Power
040960 - Port for injection required for the CT test. ref SDS 67 TE4O
040962 - ..
040963 - On 090407 1442 called Kaiser CT Department; Loretta said that
040964 - Interventional Radiology Services (IS) had not been notified to
040965 - support the test; she did this during the call, ref SDS 69
040966 - WB6G; Loretta advised that IS requested to change the time of
040967 - the test from 1520 to 1500, because the nurses work day ends at
040968 - 1530; IS wants to avoid overtime; so the time was changed to
040969 - 1500. ref SDS 69 1163
040971 - ..
040972 - On 090407 1442 called Kaiser CT Department; Loretta said that
040973 - the CT consult referral dos not specify a consolidated report
040974 - for the CT test.
040975 -
040976 -
040978 - ..
040979 - Lab Blood Test CBC to Evaluate Neupogen and Cancer Treatment Plan
040980 -
040981 - Follow up ref SDS 62 6Z4F, ref SDS 52 6Z4F.
040982 -
040983 - This afternoon Millie went to the Chemotherapy Infusion Clinic in the
040984 - Oncology Department at Kaiser in Walnut Creek, CA, for the blood draw
040985 - ordered by the doctor on 090325. ref SDS 67 TE4O
040987 - ..
040988 - On 090407 1442 the CT Department asked to change the time for the CT
040989 - test from 1520 to 1500 in order to avoid overtime for the IS nurse to
040990 - observe the test that requires connecting injection equipment to the
040991 - Power Port that is access in the Chemotherapy Infusion Clinic.
040992 - ref SDS 69 L76N This required changing the time for the blood draw
040993 - that includes the process of accessing Millie's Power Port from 1500
040994 - to 1430. On 090407 1503 there was coordination with the clinic to
040995 - make this change. ref SDS 69 W43J Since the change could not be
040996 - confirmed at that time, ref SDS 69 FP7M, also, discussed with Arlette
040997 - on 090407 1009 and learned that Chemotherapy Infusion Clinic stops
040998 - taking calls on their answering machine after 1600. ref SDS 68 YO8L
040999 - The next day on 090408 visited the Chemotherapy Infusion Clinic and
041000 - talked to Bella. She advised that doing the CT test at 1500 requires
041001 - doing a blood draw at 1330 so there is enough time to get results on
041002 - Creatinine test that is needed to for the CT test.
041004 - ..
041005 - Barbara is Millie's nurse today.
041007 - ..
041008 - Barbara asked Millie about the scope of the test in order to
041009 - determine the number of test tubes to draw.
041011 - ..
041012 - Millie suggested checking the computer for the doctor's order prepared
041013 - on 090325. ref SDS 67 TE4O
041015 - ..
041016 - Barbara checked the computer. The list on the computer screen monitor
041017 - was visible to customers. It did not look complete, compared to the
041018 - list discussed on 090325 citing the record at UCSF on 090129.
041019 - ref SDS 58 075H
041021 - ..
041022 - Barbara scheduled Millie's next blood draw on 090511 to comply with
041023 - requirements for monthly INR tests, and to flush the port.
041025 - ..
041026 - After the blood draw, Barbara taped and configured the Huber needle
041027 - for use in the CT Department at 1500 for Millie's test.
041028 -
041029 - [On 090413 1500 Chris in the CT Department reported results of
041030 - the test today were reported in time for Millie to get the CT
041031 - test today. ref SDS 70 PU3N
041033 - ..
041034 - Millie advised that she will return about 1530 to remove the Huber
041035 - needle after getting the CT test at 1500.
041036 -
041038 - ..
041039 - Laboratory Blood Test Results Posted Kaiser's Computer
041040 -
041041 - Follow up ref SDS 62 S65I, ref SDS 52 S65I.
041042 -
041043 - Previous lab at Kaiser on 090309, ref SDS 62 OT8J, and a week later on
041044 - 090317 to get CA 15-3 that was omitted on 090309. ref SDS 65 Y04R
041045 - Prior test at UCSF on 090129, ref SDS 58 075H, and 2 weeks earlier at
041046 - Kaiser on 090116. ref SDS 52 S65I
041047 -
041048 - [On 090512 follow up blood test at Kaiser to prepare for
041049 - meeting with Doctor Rugo on 090514. ref SDS 72 6Z4F
041051 - ..
041052 - Patient Provider Category View FR Date To Date
041066 - ..
041067 - 72/F Lab Results Summary
041069 - ..
041070 - Log#: 510910302564 090413 13:45
041071 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
041072 - Type Results Units Normal Type Units Normal ACRO
041073 - ..
041074 - CBC with DIFF & PLT CT CBCD
041075 - ..
041076 - WBC 3.7 K/uL 3.4 - 10.0 WBC x10-3 x10E9/L 3.4 - 10 WBC
041077 - RBC L 3.68 M/uL 3.60 - 5.70 RBC x10-6 x10E12/L 4 - 5.2 RBC
041078 - Hemoglobin L 10.9 g/dL 11.5 - 15.0 Hemoglobin g/dL 12 - 15.5 HGB
041079 - Hematocrit L 33.9 % 34.0 - 46.0 Hematocrit PERCENT 36 - 46 HCT
041080 - MCV 92 fL 80.0 - 100.0 MCV fL 80 - 100 MCV
041081 - RDW, RBC 13.9 % 11.9 - 14.3 [Not Reported at UCSF]
041082 - MCH [Not Reported] MCH pg 26 - 34 MCH
041083 - MCHC [Not Reported] MCHC g/dL 31 - 36 MCHC
041084 - Lymphocytes 32 % 13 - 46 LYMPHS x10E9/L 0.9 - 2.9 L-A
041085 - Monocyte H 22 % 4 - 12 MONOS x10E9/L 0.2 - 0.8 M-A
041086 - ..
041087 - Eosinophils H 6 % 0 - 4 EOS x10E9/L 0.0 - 0.4 E-A
041089 - ..
041090 - On 090118 Millie letter to medical team asks about eosinophils 700%
041091 - high. ref SDS 54 PZ4Q
041093 - ..
041094 - Lab report continues...
041095 -
041096 - Basophil 1 % 0 - 1 BASOS x10E9/L 0.0 - 0.1 B-A
041097 - Diff Method MAN DIFF
041098 - Atypical Lymph 1 %
041099 - Anisocytosis * 1+
041100 - PLT Estimate CONFIRMED
041101 - PLT Morphology NORMAL
041102 - RBC Morphology [Not Reported]
041104 - ..
041105 - Platelets 252 K/uL 140 - 400 Plt x10-3 x10E9/L 140 - 450 PLT
041106 -
041108 - ..
041109 - CBC blood test continues...
041110 -
041111 - Log#: 510910302564 090413 13:45
041112 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
041113 - Type Results Units Normal Type Units Normal ACRO
041114 - (posted 090323, ref SDS 66 Y077 for test on 090317, ref SDS 65 PQ6R,
041115 - CA 15-3 H* 271 U/mL < 39 CA 15-3 U/mL < 33 CA153
041117 - ..
041118 - Cancer marker increased slightly from 251 for the test on 090317,
041119 - listed in the test on 090309. ref SDS 62 PQTQ
041121 - ..
041122 - May reflect cancer spreading to the lower left arm, and new nodularity
041123 - on the left of the right breast.
041124 -
041125 - [On 090415 0949 Millie reports to medical team IBC
041126 - worsening on left arm, aligns with worsening cancer marker.
041127 - ref SDS 71 KG8V
041129 - ..
041130 - [On 090512 lab report CA 15-3 320 cancer marker increases
041131 - to highest level in patient history. ref SDS 72 PQTQ
041133 - ..
041134 - CBC blood test continues...
041135 -
041136 - Log#: 510910302564 090413 13:45
041137 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
041138 - Type Results Units Normal Type Units Normal ACRO
041139 - (calculated with formula on 081205. ref SDS 23 JG6F)
041140 - ANC 1406 -> 1500 NEUTS x10E9/L 1.8 - 6.8 N-A
041141 - Seg...
041142 - Neutrophils L 37 % 41 - 81 Neutrophils
041143 - Bands 1 % 0 - 5
041144 -
041145 - ANC = WBC x 1000 x (Neutrophils + Bands)
041147 - ..
041148 - 3.7 x 1000 x (.37 + .01) = 1406
041150 - ..
041151 - Unclear why ANC (NEUTS 1.406 at UCSF) should have fallen from ANC 2120
041152 - for the test last month on 090309, ref SDS 62 B35J, since Millie has
041153 - not had chemotherapy since 090122.
041154 -
041155 - [On 090512 0830 Kaiser seems to have added automated
041156 - calculation of ANC to standard blood test report; it is
041157 - called "Neutrophils Absolute Automated Count" ref SDS 72
041158 - B35J
041160 - ..
041161 - CBC blood test continues...
041162 -
041163 - Log#: 510910302564 090413 13:45
041164 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
041165 - Type Results Units Normal Type Units Normal ACRO
041166 - PT, Patient H 21.8 sec 8.2 - 10.6 PT s 12.0 - 14.1 PT
041167 - PT INR H 2.2 INL NRM Ratio 0.9 - 1.1 INR
041168 -
041170 - ..
041171 - Log#: 510910302564 090413 13:45
041172 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
041173 - Type Results Units Normal Type Units Normal ACRO
041174 - Total Protein [No Report] g/dL 6.0 - 7,7 PROTEIN, TOTAL g/dL 5.8 - 8.0 TP
041175 - ALBUMIN [No Report] g/dL 3.3 - 4.7 ALBUMIN g/dL 3.4 - 4.7 ALB
041176 - Alkaline Phos 52 U/L 37 - 117 ALKALINE PHOSPHATASE U/L 29 - 111 ALKP
041177 - Calcium 9.4 mg/dL 8.5 - 10.3 CALCIUM mg/dL 8.7 - 10.1 CA
041178 - ..
041179 - Magnesium 2.2 mg/dL 1.7 - 2.3 MAGNESIUM mg/dL 1.8 - 2.3 MG
041180 - Glucose Random [No Report] mg/dL 60 - 159 GLUCOSE mg/dL 70 - 199 GLU
041181 - ALT (SGPT) [No Report] U/L -< 36 ALT U/L 11 - 54 ALT
041182 - AST (SGOT) 34 U/L -< 36 ALT U/L 11 - 54 ALT
041184 - ..
041185 - Log#: 510910302564 090413 13:45
041186 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
041187 - Type Results Units Normal Type Units Normal ACRO
041188 - Bili Tot Adult 0.4 mg/dL 0.2 - 1.3 CALCIUM mg/dL 8.7 - 10.1 CA
041189 - Creat with GFR
041190 - Creatinine 0.69 mg/dL -< 1.11 CREATININE mg/dL 0.42 - 1.06 CR
041192 - ..
041193 - Note: Creatinine assay changed to IDMS standardization on
041194 - February 4, 2008 causing decrease in results of approximately
041195 - 0.09 mg/dL
041197 - ..
041198 - GFR Non-Afr Am >60 mL/min > 60 - eGFR if Caucasian >60 mL/min GFRC
041199 - GFR African AM >60 mL/min > 60 eGFR if African Amer >60 mL/min GFRA
041200 - GFR Note **
041201 -
041202 -
041203 -
041204 -
041205 -
041206 -
041207 -
041208 -
041209 -
041210 -
0413 -