CONTACTS 

SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 18 0000. ref SDS 17 0000.
040502 -
040503 -
040504 -
040505 -
040962 -  ..
040963 - On 091104 left leg incision recovering better implemeting Jan's
040964 - suggestion to elevate after hiking, 091104 0718, ref SDS 17 I15I,
040965 - Paula visits and concurs left leg looks much better. ref SDS 17 4Z7N
040966 - lab reports WBC 12 droped from 19 the day before, reflecting
040967 - improvement in left leg incision recovery. ref SDS 17 PRPV  Doctor
040968 - Tseng and medical team visits and confirms patient can be discharged
040969 - today. ref SDS 17 PR4V
040971 -  ..
040972 - On 091117 1317 Ramone called to confirm meeting with Neal on Thursday
040973 - at 1000, and requested arriving early to get labs and tests done prior
040974 - to 1000 meeting; discussed coordinating with VA in Martinez to
040975 - consolidated labs being performed today to test INR. 091117 1317,
040976 - ref SDS 18 QF7O
040977 -
040978 -
040979 -
040981 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Visited VA in Martinez at the counter for Primary Care Physician.
041302 -
041303 - The attendant said that Doctor Sandhu is back from vacation in India,
041304 - but is not scheduled to visit today.  The attendant read the letter
041305 - from the VA scheduling the meeting today, and which included a
041306 - handwritten note in red ink that said to check with the Primary Care
041307 - Physician Department before getting labs.
041309 -  ..
041310 - Asked if Ramon called in additional labs and tests for the meeting on
041311 - 091119 with Neal in San Francisco, per telecon with Ramon on 091117
041312 - 1317. ref SDS 18 QF7O
041314 -  ..
041315 - The attendant said Ramon called and coordinated with Doctor Sandhu's
041316 - nurse on the scope of the blood draw today.
041318 -  ..
041319 - The attendant said that after the lab, there is a meeting with the
041320 - Coumadin Case Manager.
041322 -  ..
041323 - Went to the lab next door.
041325 -  ..
041326 - After about 10 minutes met with Coumadin Case Manager.
041328 -  ..
041329 - The case manager asked about orientation on Coumadin.  Reviewed
041330 - background working with Millie that makes the orientation unnecessary.
041332 -  ..
041333 - Doctor Sandhu's nurse joined the meeting.  She related discussions
041334 - with Ramone at VA in San Francisco.  Decided to do all the labs for VA
041335 - Martinez, and for the meeting on Thursday with Neal in San Francisco
041336 - today.  The order for the blood draw for today has been modified to
041337 - include requirements for the meeting in San Francisco.
041338 -
041339 -        [On 091118 1322 letter to medical team submits agenda for
041340 -        meeting on 091119, and thanks Ramon for coordinating to save
041341 -        time and money getting tests done in time for the team to be
041342 -        prepared for a productive meeting. ref SDS 19 Z69P
041344 -  ..
041345 - The nurse further advised, that afer completing the blood draw, and
041346 - meeting with the Coumadin Case Manager, can get 2 additional tests
041347 - needed for the meeting on Thursday...
041348 -
041349 -            1.  Xray to evaluate fluid on lungs.
041350 -
041351 -            2.  EKG to evaluate heart rate.
041353 -  ..
041354 - Got the blood draw in the lab.
041356 -  ..
041357 - Met again with the Case Manager.
041359 -  ..
041360 - She did a finger prick test that compliments the blood draw to
041361 - evaluate INR.  This was 1.5, which is too low.  All subsequent INR
041362 - blood tests can use the finger prick method, and this avoids getting a
041363 - blood draw every week.
041365 -  ..
041366 - Coumadin dose is modified as follows...
041367 -
041368 -        1.  Continue 2 mg tablets every day.
041369 -
041370 -        2.  Every other day add .5 tablets to 1.5.
041371 -
041372 -               [On 091124 0827 INR increased to only 1.7 after
041373 -               increasing Coumadin per guidance today, so Coumadin was
041374 -               increased again to 3 mg per day. ref SDS 21 NU5L
041376 -  ..
041377 - The nurse further feels that aspirin conflicts with Coumadin.  She
041378 - wants the team in San Francisco to comment on her idea to stop
041379 - aspirin while getting Coumadin.
041380 -
041381 -        [On 091118 1322 letter to medical team with agenda for meeting
041382 -        on 091019, asks about pausing aspirin during treatment with
041383 -        Coumadin. ref SDS 19 Z65T
041385 -         ..
041386 -        [On 091119 1000 Erick at Va in San Francisco advised that
041387 -        aspirin should not be paused while taking Coumadin for next 3
041388 -        weeks, and that instead Coumadin can be adjusted as needed to
041389 -        maintain INR between 2.0 - 3.0. ref SDS 20 934K
041391 -         ..
041392 -        [On 091124 0827 during meeting at VA in Martinez, Diana, the
041393 -        Coagulation Control Case Manager, was notified that the
041394 -        Cardiothoracic Surgery team wants to continue aspirin
041395 -        concurrent with Coumadin. ref SDS 21 D234
041396 -
041397 -
041399 -  ..
0414 -
0415 -
0416 - 1547
0417 -
041701 - Complete work in Lab and meeting with Coumadin Case Manager.
041702 -
041703 - Visit Radiology.
041705 -  ..
041706 - Got xray, full back, and one right side film.
041708 -  ..
041709 - Got EKG.
041711 -  ..
041712 - This completes tests required for meeting with Neal on Thursday in
041713 - San Francisco.
041714 -
041715 -        [On 091118 1322 letter to medical team submits agenda for
041716 -        meeting on 091119, and thanks Ramon for coordinating to save
041717 -        time and money getting tests done in time for the team to be
041718 -        prepared for a productive meeting. ref SDS 19 Z69P
041719 -
041720 -
041721 -
041722 -
041723 -
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0418 -