CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 13 0000. ref SDS 12 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 5 G68H, while Millie was
040903 - treated to recover from a very severe case of shingles infection,
040904 - reported earlier on 100104 1115. ref SDS 4 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 6 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 6 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 6 023N   The doctor further ordered a CT
040923 - test to evaluate rising pain. ref SDS 6 ES40
040925 -  ..
040926 - On 100218 1230 Millie had emergency CT test. ref SDS 6 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 7 ER95
040933 -  ..
040934 - On 100302 0830 meeting at Kaiser, ref SDS 8 ER95; Doctor Johnson
040935 - prescribed Abraxane for Millie starting treatment tomorrow for
040936 - recovering from 10th relapse of cancer. ref SDS 8 FB67  Blood counts
040937 - dropped significantly, ref SDS 8 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 8 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 8 IC85
040945 -  ..
040946 - On 100303 0730 Millie received 1st treatment 1st cycle Abraxane at
040947 - Kaiser Oncology Chemotherapy Clinic in Walnut Creek. ref SDS 9 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 10 ER95  Reports possible recurrence of shingles. ref SDS 10
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 10 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 11 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 11 0W3T  Millie further requests that the
040963 - medical team submit analysis of trade-offs for alternative oncologic
040964 - treatments. ref SDS 11 0W3W
040966 -  ..
040967 - On 100309 1238 Millie notifies medical team that shingles seems not to
040968 - have recurred despite side effects of Abraxane that lower immunity by
040969 - degrading bone marrow that replenishes blood counts. ref SDS 12 ER95
040971 -  ..
040972 - On 100309 1238 Millie notifies medical team that Kaiser's Knowledge
040973 - Management system is off-line, and so requests results of blood test
040974 - to evaluate getting treatment with Abraxane chemotherapy tomorrow for
040975 - recovering from cancer. ref SDS 12 HL4V
040977 -  ..
040978 - On 100309 1643 Millie notifies medical team that results of lab today
040979 - show "good-to-go" for getting 2nd Abraxane treatment tomorrow.
040980 - ref SDS 13 ER95
040982 -  ..
040983 - On 100310 0730 Millie gets 2nd treatment 1st cycle of Abraxane to
040984 - recover from 10th relapse of cancer. ref SDS 14 KE4K; Doctor Johnson
040985 - visits Millie at 0810, during treatment, and approves getting
040986 - treatment. ref SDS 14 OR3H
040988 -  ..
040989 - On 100310 1350 Millie thanks Doctor Johnson for visiting during
040990 - treatment today, ref SDS 0 ER95; notifies medical team that Kaiser
040991 - completed the 2nd treatment of the 1st cycle with Abraxane for
040992 - recovering from the 10th relapse of cancer. ref SDS 0 ER95  Doctor
040993 - Johnson advised that Kaiser's Knowledge Management internal email
040994 - system makes communication faster for emergency communications on
040995 - patient care. ref SDS 0 GY4U  Millie reported that Kaiser's Knowledge
040996 - Management system has been off-line for more than a week. ref SDS 0
040997 - GY4X; Millie explains that public domain email addresses for doctors
040998 - at Kaiser enable comprehensive care that optimizes patient outcome,
040999 - even though it may be a little slower for emergencies. ref SDS 0 GY6P
041000 - Millie will continue to support the medical team through continuity of
041001 - communications for the doctor/patient partnership. ref SDS 0 GZ3U
041002 -
041003 -
041005 -  ..
0411 -
0412 -
0413 - Progress
0414 -
041401 - Millie's letter to medical team says...
041402 -
041403 -    1.  Subject:  2nd Treatment Abraxane Completed Today
041404 -        Date: Wed, 10 Mar 2010 14:29:10 -0800
041416 -         ..
041417 -    2.  Thanks for visiting this morning during my treatment in the
041418 -        Oncology Chemotherapy Infusion Clinic.
041420 -         ..
041421 -    3.  I am greatly encouraged by your visit and being able to get the
041422 -        2nd treatment of Abraxane.  Last week on Thursday and on
041423 -        Friday, when it looked like shingles was recurring, and with
041424 -        doubts about holding blood counts, I was questioning what the
041425 -        future might hold.  By Sunday, side effects of chemo and
041426 -        Neupogen began to subside.
041428 -         ..
041429 -    4.  Now, thanks to you, fortune has smiled again, at least for the
041430 -        moment.
041432 -         ..
041433 -    5.  As you observed today, shingles seems not to have recurred, and
041434 -        my blood counts have miraculously increased well above
041435 -        requirements with NEUTS 4.34, showing a complete recovery from
041436 -        1.2 last week.
041438 -         ..
041439 -    6.  You said during the meeting this morning that Kaiser has a
041440 -        Knowledge Management email system, which you check more often
041441 -        than regular email, like this letter, and so you see emergency
041442 -        communications through Kaiser's proprietary email system faster
041443 -        than using regular email.  Previously, your letter on 090205,
041444 -        also, maintained that Kaiser's internal email is faster for
041445 -        emergency communication.
041447 -         ..
041448 -    7.  When I returned home after treatment today, I checked and found
041449 -        that Kaiser's Knowledge Management email system is still
041450 -        reporting the following message...
041451 -
041452 -        "You'll be signed on shortly.
041454 -         ..
041455 -        Not getting a confirmation that you're signed on? Try again."
041457 -         ..
041458 -    8.  My letter to you yesterday reported getting this same message
041459 -        to "Try again," for more than a week.  Please let me know, when
041460 -        Kaiser is back online for emergency communications [Millie's
041461 -        review on 090205 cited poor reliability as one of many problems
041462 -        using Kaiser's proprietary, internal email system. ref SDS 1
041463 -        NQ4I].  As reported yesterday [on 100309 1238. ref SDS 12
041464 -        HL4V], similar problems occurred last year after the meeting at
041465 -        Kaiser on 091112 [citing Millie's letter to the medical team on
041466 -        100301 0005. ref SDS 7 OO9S]
041467 -
041468 -            [On 100311 0811 Doctor Johnson Millie that Kaiser may need
041469 -            to issue a new password to resolve problems accessing
041470 -            Kaiser's Knowledge Management system. ref SDS 15 ER95
041472 -         ..
041473 -    9.  Many doctors and staff support the "medical team."  Uniform
041474 -        communication coordinating "team care" requires timely notice
041475 -        of correlations, implications, and nuance affecting clinical,
041476 -        logistical, and cost decisions that optimize care.  Kaiser's
041477 -        internal email that optimizes emergency communication does not
041478 -        support comprehensive team care [for reasons also presented in
041479 -        the record on 090302. ref SDS 1 GM4H].  Comprehensive care for
041480 -        Millie has been accomplished for nearly 10 years using public
041481 -        domain email that avoids weaknesses of Kaiser's proprietary
041482 -        email system.  You reported in the meeting on 100302, that
041483 -        comprehensive case management by Kaiser and UCSF has extended
041484 -        my survival 3 - 4 times longer than other patients achieve.
041485 -        ref SDS 8 FC67
041487 -         ..
041488 -   10.  You noted during the meeting on 090724 that a well ordered
041489 -        record of case management is "yoemen's work" keeping everyone
041490 -        on the "same page" for evidence-based medical practice at
041491 -        Kaiser [reported the next day in Millie's letter to the medical
041492 -        team on 090725 2017. ref SDS 3 T58R]
041494 -         ..
041495 -   11.  Your assessment aligns with Doctor Rugo's report a month
041496 -        earlier on 090616 that everybody at Kaiser and UCSF is "on
041497 -        board" for treating my cancer as a chronic disease. ref SDS 2
041498 -        D647
041500 -         ..
041501 -   12.  I will continue to support the team providing excellent care at
041502 -        Kaiser and UCSF by keeping everybody "on board" and on the
041503 -        "same page."  Maintaining continuity of communication for a
041504 -        well ordered record of nearly 10 years implements the
041505 -        "doctor/patient partnership" called out in Kaiser's Healthwise
041506 -        Handbook for optimizing patient outcomes.
041507 -
041514 -
041515 -
041516 -
041517 -
041518 -
041519 -
041520 -
0416 -