THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: January 4, 2010 12:16 PM Monday;
Millie emergency lab at Kaiser evaluate shingles impact on immune system.
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Default Null Subject Account for Blank Record
0403 - ..
0404 - Summary/Objective
040501 - Follow up ref SDS 27 0000. ref SDS 26 0000.
040507 - ..
0408 - Background
040901 - On 091202 Millie had the 3rd treatment in the 1st cycle of Navelbine.
040902 - ref SDS 14 625I
040904 - ..
040905 - She is experiencing some possible recovery, but also evident worsening
040906 - of cancer due to lack of treatment targeted to her patient profile.
040908 - ..
040909 - On 091203, Millie submitted a letter notifying the medical team about
040910 - possible progression of disease, and requesting treatment targeted to
040911 - her patient profile, ref SDS 15 4P7G, following up the letter on
040912 - 091112, ref SDS 10 IL8L, and meeting with Doctor Johnson at Kaiser
040913 - later that day on 091112. ref SDS 11 UT7M The following letter
040914 - confirms understandings from meeting on 091112, and sets agenda for
040915 - meeting at Kaiser on 091210.
040917 - ..
040918 - On 091211 0018 Millie letter confirms understandings from meeting at
040919 - Kaiser and thanks thanked medical team for excellent care, ref SDS 17
040920 - BW8I, based on Doctor Johnson's report in the meeting at Kaiser on
040921 - 091210 that Kaiser is collaborating with Doctor Rugo for UCSF to
040922 - prescribe treatment targeted to Millie's patient profile. ref SDS 17
040923 - XM3X
040925 - ..
040926 - On 091211 1452 Doctor Johnson reports collaborating with Doctor Rugo
040927 - for UCSF as planned during the meeting yesterday. ref SDS 18 BW8I
040929 - ..
040930 - On 091211 1648 Millie notifies Doctor Johnson to submit correspondence
040931 - of Kaiser collaborating with Doctor Rugo at UCSF on prescribing
040932 - treatment targeted to Millie's patient profile. ref SDS 19 BW8I
040934 - ..
040935 - On 091214 1649 Doctor Johnson notifies Millie that Doctor Rugo has not
040936 - replied to Kaiser's letter on 091211. ref SDS 20 BW8I
040938 - ..
040939 - On 091215 0852 Millie asks Doctor Johnson about sending a copy of
040940 - Kaiser's letter to Tara for assisting Doctor Rugo developing UCSF's
040941 - treatment plan targeted to Millie's patient profile. ref SDS 21 BW8I
040943 - ..
040944 - On 091215 1557 Millie reports blood counts fall, still permit getting
040945 - 1st treatment 2nd cycle Navelbine, ref SDS 22 BW8I, asks about
040946 - progress collaborating on prescribing next treatment to recover from
040947 - 10th relapse of cancer.
040949 - ..
040950 - On 100103 1147 Millie asks medical team about progress prescribing
040951 - treatment targeted to Millie's patient profile to recover from 10th
040952 - relapse of cancer. ref SDS 23 BW8I Millie reports new symptom of rash
040953 - on right side of forehead, which is swelling the right eye; requests
040954 - examination tomorrow to prescribe immediate remedy. ref SDS 23 FZ6V
040956 - ..
040957 - On 100103 1652 Millie receives automated reply that Doctor Johnson is
040958 - out of the office until 100105, and so cannot make examination
040959 - tomorrow on 100104 requested in Millie's letter this afternoon.
040960 - ref SDS 24 BW8I
040962 - ..
040963 - On 100103 2023 Millie reponds to notice that Doctor Johnson is out of
040964 - the office tomorrow and so cannot make examination requested in
040965 - Millie's letter earlier today. ref SDS 25 BW8I
040967 - ..
040968 - On 100104 0830 Millie needs examination of facial blisters today.
040969 - ref SDS 26 BW8I
040971 - ..
040972 - On 100104 1115 Millie met with Doctor Zhang in Adult Primary Care,
040973 - ref SDS 27 BW8I, who diagnosed shingles, ref SDS 27 0P9S, and
040974 - prescribed treatment, which may yield full recovery in 2 weeks.
040975 - ref SDS 27 QB5K Doctor Zhang ordered lab to evaluate impact on immune
040976 - system, and asked Millie to coordinate with Coagulation Control Clinic
040977 - on adjusting Coumadin. ref SDS 27 0P4S Doctor Zhang arranged meeting
040978 - with opthalmology to test for damage to eyes. ref SDS 27 EY8F Doctor
040979 - Zhang recommended Millie meet with Doctor Johnson this week, rather
040980 - than wait for regularly scheduled meeting next week to review progress
040981 - recovering from shingles. ref SDS 27 0P4Y
040983 - ..
040984 - On 100104 1216 Kaiser Oncology Chemotherapy Infusion Clinic did not
040985 - have enough time to spend 5 minutes accessing Millie's Power Port
040986 - which was placed to facilitate blood draws, ref SDS 0 4P6K, in this
040987 - case ordered by Doctor Zhang to evaluate requirements for treating
040988 - shingles; Millie waited an hour and was fortunate that the lab
040989 - technician was successful on the 1st try placing an IV to perform the
040990 - blood draw today. ref SDS 0 4Q40
040994 - ..
0412 - Progress
041301 - After meeting with Doctor Zhang, Millie went to the pharmacy down the
041302 - hall from Adult Medicine to fill the prescription for treating
041303 - shingels, reported on 100104 1115. ref SDS 27 QB5K
041305 - ..
041306 - While Millie was in the Pharmacy, met with Laurie in the Oncology
041307 - Chemotherapy Infusion Clinic, also, on the 2nd floor. Reported
041308 - diagnosis of shingles by Doctor Zhang, reported on 100104 1115.
041309 - ref SDS 27 0P9S, and that the doctor has ordered an emergency lab for
041310 - Millie. ref SDS 27 0P4S
041312 - ..
041313 - Laurie was shocked, since she saw Millie last Wednesday for treatment,
041314 - and she looked wonderful. Laurie was aware that shinges was a very
041315 - severely painful skin affliction.
041317 - ..
041318 - Laurie said that since a blood draw using Millie's Power Port only
041319 - takes 5 minutes, Cisi would do the blood draw in about 10 minutes
041320 - after she returns from lunch at 1230, using a doctor's examination
041321 - room, to avoid exposing other chemotherapy patients to Millie's
041322 - shingles.
041324 - ..
041325 - Went to the Pharmacy to get Millie.
041327 - ..
041328 - After filling the prescription for medication to recover from
041329 - shingles, we went back to the Oncology Chemotherapy Infusion Clinic to
041330 - get the blood draw ordered by Doctor Zhang, and scheduled by Laurie,
041331 - per above. ref SDS 0 ZX4J
041333 - ..
041334 - Laurie advised that when Cisi returned from lunch at 1230, she
041335 - discovered that her schedule was full, and none of the other nurses in
041336 - the clinic could spare 5 minutes to access Millie's Power Port for the
041337 - emergency blood draw ordered by Doctor Zhang.
041339 - ..
041340 - Millie was referred to the Kaiser Infusion Clinic in Martinez,
041341 - California for accessing her Power Port to get the blood draw, and in
041342 - order to implement Doctor Johnson's order for the Chemotherapy
041343 - Infusion Clinic at Kaiser in Walnut Creek to perform blood draws using
041344 - Millie's Power Port with a 1" Huber Needle, because Millie cannot get
041345 - blood draws in her arms, reported on 091112 0930. ref SDS 11 UN8F
041347 - [On 100119 0830 Mary Beth in the Infusion Clinic at Kaiser
041348 - in Martinez, CA reported a new policy to avoid using port
041349 - catheter technology for blood draws because some may
041350 - patients may have a small risk of complications caused by
041351 - using Heperin to maintain the port catheter, ref SDS 36
041352 - X56L; Millie cited the record of having zero (0) risk since
041353 - she never suffered complications from the medical team
041354 - using Heperin to maintain her Power Port for hundreds of
041355 - procedures over an 8-year period, and further explained
041356 - Doctor Johnson's order for Kaiser to use Millie's Power
041357 - Port for blood draws and infusion procedures in order to
041358 - avoid the high risk of compounding Millie's cancer and
041359 - lymphedema which now infect both arms, ref SDS 36 QR72; as
041360 - a result, Kaiser's Infusion Clinic in Martinez used
041361 - Millie's Power Port to perform blood draws to minimize the
041362 - risk of complications. ref SDS 36 QR8G
041364 - ..
041365 - [On 100203 1410 Arlette called and advised she received
041366 - Millie's letter notifying the medical team that Gloria
041367 - ordered an interim blood draw to test INR on Friday,
041368 - 100205, and in order to make timely adjustment to Millie's
041369 - Coumadin prescription on Friday to reduce the risk of
041370 - pulmonary embolism, ref SDS 37 QJ85; Arlette reported that
041371 - Chemotherapy Infusion Clinic in Walnut Creek refuses to
041372 - perform the doctor's order to use Millie's Power Port for
041373 - blood draws, because of new general policy to reduce the
041374 - risk of complications which some patients have from using
041375 - Heperin to maintain port catheters. ref SDS 37 124J
041377 - ..
041378 - [On 100204 1325 Millie's letter to the medical team asks
041379 - the primary care physician to enter in Millie's medical
041380 - chart and notify the Chemotherapy Infusion Clinic that
041381 - Millie's patient profile requires drawing blood from
041382 - Millie's Power Port rather than use IV needle penetration
041383 - balancing very low risks of Heprin contamination in the
041384 - Power Port which has never occurred in Millie's case over 8
041385 - years, against lymphedema recently diagnosed in the right
041386 - arm which, has prevented IV needle penetrations in the left
041387 - arm for 8 years. ref SDS 38 SB6S
041389 - ..
041390 - [On 100205 0938 Doctor Johnson did not have time to align
041391 - Kaiser practices for Millie's blood draws, with Millie's
041392 - patient profile, so Millie was forced to get the blood draw
041393 - with an IV in her right arm despite rising IBC and
041394 - lymphedema; fortunately, the lab was successful on the
041395 - first needle penetration, ref SDS 39 IS6R, and the lab
041396 - reported the test shows INR 3.2, significant improvement
041397 - after pausing Coumadin for 2 days; Millie asks Gloria for
041398 - guidance from Coagulation Control Clinic on adjusting
041399 - Coumadin medicattion. ref SDS 39 IS7Q
041401 - ..
041402 - [On 100427 0830 Doctor Johnson entered in medical chart
041403 - another order for blood draws to be performed using only
041404 - Millie's Power Port because both arms are infected with
041405 - cancer, and needle punctures cause cancer to spread.
041406 - ref SDS 40 X74Q
041408 - ..
041409 - [On 100529 0930 blood draw went smoothly correcting past
041410 - problems, because nurse relied on instructions in
041411 - medical chart on 100427, directing use of Millie's Power
041412 - Port for blood draws, ref SDS 40 X74Q, and restating
041413 - directions in the doctor's letter to the Kaiser Walnut
041414 - Creek Infusion Clinic on 091112, ref SDS 11 UN8F, and so
041415 - in Millie's case overrules the new policy change a few
041416 - months ago that prevented nurses from drawing blood
041417 - using Millie's port, thereby forcing Millie to get blood
041418 - drawn from her arms infected with cancer, causing her
041419 - cancer to spread, e.g., on 100104, ref SDS 28 4Q30, and
041420 - which conflicted with the doctor's order to avoid blood
041421 - draws and blood pressure procedures on Millie's arms
041422 - infected with cancer. ref SDS 41 SK8M
041424 - ..
041425 - Explained there is not enough time get in the car and drive to Kaiser
041426 - in Martinez, because Millie has a meeting with the eye doctor at
041427 - Kaiser at Park Shadelands, scheduled for today by Doctor Zhang,
041428 - reported in another record today. 100104 1115, ref SDS 27 PRRT
041430 - ..
041431 - Lauris said there is nothing she can do to implement Doctor Johnson's
041432 - order to perform blood draws using Millie's Power Port. She said
041433 - Millie can call and ask Kaiser to schedule the blood draw, sometime
041434 - later this week.
041436 - ..
041437 - Explained understanding that Doctor Zhang ordered an immediate blood
041438 - draw today, reported on 100104 1115, ref SDS 27 0P4S
041440 - ..
041441 - Lauris said there is nothing she can do, because Cisi feels there is
041442 - not enough time for the Clinic to perform an emergency blood draw
041443 - using Millie's Power Port.
041445 - ..
041446 - Since time was short, Millie went to the Kaiser Laboratory in the
041447 - basement lab to try and do the blood draw with a conventional IV.
041449 - ..
041450 - After a 90 minute wait, Millie was lucky to get the blood draw on the
041451 - first needle penetration. So, it only took 5 minutes.