CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 9 0000. ref SDS 8 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 100203, Millie resumed treatment after a 3-week pause ordered by
040902 - Doctor Johnson, on 100112 0830, ref SDS 3 G68H, while Millie was
040903 - treated to recover from a very severe case of shingles infection,
040904 - reported earlier on 100104 1115. ref SDS 2 0P9S
040906 -  ..
040907 - On 100217 0730 Millie got the 3rd treatment of the 3rd cycle with
040908 - Navelbine for Millie to recover from the 9th relaspe of cancer.
040910 -  ..
040911 - On 100218 1000 Millie got Neupogen treatment at Kaiser to maintain
040912 - blood counts essential for getting Navelbine chemotherapy treatment
040913 - for cancer. ref SDS 4 ER95
040915 -  ..
040916 - On 100218 1000 Millie had emergency meeting with Doctor Johnson,
040917 - primary care physician at Kaiser, after getting Neupogen treatment;
040918 - the doctor diagnosed relapse of shingles, and prescribed a 4th cycle
040919 - of treatment, but only with Acyclovir (Zovirax) 800 MG tablets,
040920 - ref SDS 4 0Y6O; the doctor also diagnosed Millie's 10 relapse of
040921 - cancer, and ordered switching treatment from Navelbine to Abraxane,
040922 - beginning on 100303. ref SDS 4 023N   The doctor further ordered a CT
040923 - test to evaluate rising pain. ref SDS 4 ES40
040925 -  ..
040926 - On 100218 1230 Millie had emergency CT test. ref SDS 4 PQ6R
040928 -  ..
040929 - On 100301 0005 letter to medical team reports improvement from CT test
040930 - on 100218, and increased energy may indicate Navelbine can continue
040931 - another cycle. ref SDS 5 ER95
040933 -  ..
040934 - On 100302 0830 meeting at Kaiser, ref SDS 6 ER95; Doctor Johnson
040935 - prescribed Abraxane for Millie starting treatment tomorrow for
040936 - recovering from 10th relapse of cancer. ref SDS 6 FB67  Blood counts
040937 - dropped significantly, ref SDS 6 IC4N; since Abraxane side effects
040938 - reduce blood counts this increases chances of shingles recurrence; the
040939 - doctor advised that treatment for cancer will be paused again, if
040940 - shingles recurs. ref SDS 6 FC68  Only way for Millie to get treatment
040941 - for shinges concurrent with cancer is to switch from Abraxane to a
040942 - "targeted" treatment for cancer that does not injure bone marrow
040943 - producing blood. ref SDS 6 IC85
040945 -  ..
040946 - On 100303 0730 Millie received 1st treatment 1st cycle Abraxane at
040947 - Kaiser Oncology Chemotherapy Clinic in Walnut Creek. ref SDS 7 625I
040949 -  ..
040950 - On 100304 2251 Millie notifies medical team that 1st treatment of 1st
040951 - cycle started with Abraxane to recover from 10th relapse of cancer.
040952 - ref SDS 8 ER95  Reports possible recurrence of shingles. ref SDS 8
040953 - OP6W  Millie asks Kaiser for written report on trade-offs for
040954 - prescribing agents "targeted" to treat her cancer that do no injure
040955 - the bone marrow producing new blood. ref SDS 8 OQ4Y
040957 -  ..
040958 - On 100305 0822 Millie notifies medical team that shingles seems to
040959 - have subsided again, so that treatment with Abraxane can continue.
040960 - ref SDS 9 ER95  Millie requests prescription for medication to have
040961 - available in time to treat shingles recurrence so that treatment for
040962 - cancer can continue. ref SDS 9 0W3T  Millie further requests that the
040963 - medical team submit analysis of trade-offs for alternative oncologic
040964 - treatments. ref SDS 9 0W3W
040966 -  ..
040967 - On 100309 1238 Millie notifies medical team that Kaiser's Knowledge
040968 - Management system is off-line, and so requests results of blood test
040969 - to evaluate getting treatment with Abraxane chemotherapy tomorrow for
040970 - recovering from cancer. ref SDS 0 ER95
040971 -
040972 -
040974 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Millie's letter to medical team says...
041302 -
041303 -    1.  Subject: Kaiser KM System Down Need Blood Counts
041304 -        Date: Tue, 09 Mar 2010 13:04:47 -0800
041311 -         ..
041312 -    3.  Very happy that shingles does not seem to have recurred.  So,
041313 -        that hurdle has passed getting to the 2nd treatment of Abraxane
041314 -        scheduled for tomorrow. [following notice to the medical team
041315 -        on 090305 that shingles seemed to subside, ref SDS 9 ER95,
041316 -        after reporting the day before on 090304 that shingles seemed
041317 -        to recur, and which therefore threatened continuity getting
041318 -        treatment for cancer, ref SDS 8 OP6W, based on Doctor
041319 -        Johnson's notice during the meeting at Kaiser on 090302, that
041320 -        if shingles recurs, treatment for cancer will have to stop
041321 -        until after another 10-day treatment for shingles. ref SDS 6
041322 -        FC68].
041324 -         ..
041325 -    4.  Kaiser's Knowledge Management system has been down since our
041326 -        meeting last week.  [Kaiser] Could be making "improvements"
041327 -        which usually means "trouble ahead."  Recall this happened last
041328 -        November, I could not get your notes for the meeting 091112
041329 -        until just recently [reported in the letter to the medical team
041330 -        on 100301 0005. ref SDS 5 OO9S].
041331 -
041332 -            [On 100502 2143 Millie received another letter from the
041333 -            medical team at Kaiser which could not be opened again.
041334 -            ref SDS 12 HH4I
041336 -             ..
041337 -            [On 100503 1522 Millie notifies medical team of difficulty
041338 -            handling secure email. ref SDS 13 TD5T
041340 -             ..
041341 -            [On 100503 1945 Kaiser resubmitted letter sent initially
041342 -            with "secure email" for protecting patient confidentiality,
041343 -            and using public domain email with level of confidentiality
041344 -            acceptable to the patient for efficient communication.
041345 -            ref SDS 14 YL5N
041347 -         ..
041348 -    5.  So, cannot get blood counts for the lab today at Martinez.  Can
041349 -        I swing by later today and get a copy at the front desk?
041350 -
041351 -            [On 100309 1643 Millie notified medical team that Kaiser
041352 -            Oncology called at 1230, and reported that the lab has not
041353 -            processed Millie's blood draw, so results that influence
041354 -            getting treatment tomorrow are not available, ref SDS 10
041355 -            ER95; at 1643 Millie received a letter from Kaiser with a
041356 -            link to Kaiser's Knowledge Management email system, and
041357 -            this link enabled accessing Millie's medical records with
041358 -            results of the lab today on 100309; review shows Millie's
041359 -            blood counts increased substantially to well above levels
041360 -            safe for getting chemotherapy treatmet, and completely
041361 -            reversing the sudden decline last week that required
041362 -            approving Millie for treatment with immune system at risk
041363 -            because blood counts NEUTS 1.2 was well below standard of
041364 -            care at Kaiser which requires withholding treatment when
041365 -            NEUTS fall below 1.5. ref SDS 10 2O8Q
041367 -         ..
041368 -    6.  I also need your letter on 100208, which was sent with Kaiser's
041369 -        "securemail," and which I have been unable to access.  In a
041370 -        letter to the team on 100301, I asked [in a letter to the
041371 -        medical team on 090301] to get a copy of the 100208 letter
041372 -        during the meeting the next day at Kaiser on 100302.
041373 -        ref SDS 5 OP7T
041375 -         ..
041376 -    7.  Turned out the next day that there wasn't enough time when we
041377 -        met at Kaiser to get the copy of the letter on 100208 (see
041378 -        agenda items 12 and 13. ref SDS 6 ER95, [citing the record on
041379 -        100302 0830. ref SDS 6 FC61].
041381 -         ..
041382 -    8.  In any case, I need communication through regular email to see
041383 -        what has been presented to me on the record [and for reasons
041384 -        reported on 090205, ref SDS 1 HY4I].  During the meeting on
041385 -        100302, I submitted authorization for confidential end-of-life
041386 -        instructions. ref SDS 6 P58M [and confirmed in Millie's letter
041387 -        to the medical team on 100304 2251. ref SDS 8 ER95].  Please
041388 -        let me know how to submit instructions on getting confidential
041389 -        communications through regular email for accomplishing case
041390 -        management in time to be effective avoiding end-of-life issues.
041391 -
041392 -            [On 100310 0730 Doctor Johnson met with Millie in the
041393 -            Oncology Chemotherapy Infusion Clinic and explained that he
041394 -            checks Kaiser's internal proprietary email system more
041395 -            often than he sees mail in his public domain address at
041396 -            Kaiser; he recommends sending emergency communications to
041397 -            the Kaiser internal proprietary email address. ref SDS 11
041398 -            OR71
041399 -
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0415 -