CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 34 0000. ref SDS 29 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - Recent background is listed on 100301 0005. ref SDS 27 625I
040903 -  ..
040904 - On 100302 0830 Doctor Johnson made another examination and confirmed
040905 - diagnosis that Millie's cancer has progressed, and so he ended
040906 - treatment with Navelbine, and ordered treatment to start today with
040907 - Abraxane. ref SDS 28 FC34
040909 -  ..
040910 - On 100302 0830 Doctor Johnson ended Millie's treatment for shingles
040911 - with Acyclovir (Zovirax). ref SDS 28 FU5F  He advised that Abraxane
040912 - causes low blood counts, and low blood counts weaken the immune
040913 - system, making Millie more likely for shingles to recur. ref SDS 28
040914 - IC4N
040916 -  ..
040917 - On 100303 CA 15-3 426 from blood test on 100301 showed another 100
040918 - point rise over the past 2 weeks, while Millie was off treatment for
040919 - the bye-week.
040921 -  ..
040922 - On 100303 Anne confirmed that Abraxane chemotherapy causes low
040923 - blood counts. ref SDS 29 8U95
040925 -  ..
040926 - On 100309 1238 Millie notifies medical team that shingles seems not to
040927 - have recurred despite side effects of Abraxane that lower immunity by
040928 - degrading bone marrow that replenishes blood counts. ref SDS 32 ER95
040929 - Millie further reported that Kaiser's Knowledge Management system was
040930 - of -line and so could not access results of blood test. ref SDS 32
040931 - HL4V
040933 -  ..
040934 - On 100309 1643 Millie notifies medical team that blood counts from the
040935 - lab at Kaiser in the morning of 100309 show significant recovery above
040936 - requirements for getting chemotherapy treatment; since shingles has
040937 - not recurred, Millie is "good-to-go" for treatment on 100310 0730.
040938 - ref SDS 33 2O8W
040940 -  ..
040941 - On 100309 1643 Millie notifies medical team commending Doctor Johnson
040942 - for prescribing only 1 Neupogen treatment to recover from low blood
040943 - counts caused by Abraxane. ref SDS 33 2O9P
040945 -  ..
040946 - On 100310 0730 Millie received the 2nd treatment for the first cycle
040947 - of Abraxane. ref SDS 34 KE4K  Doctor Johnson visited Millie and
040948 - approved treatment based on bood blood counts and no signs of shingles
040949 - recurrence. ref SDS 34 OR3H   The doctor repeated prior notice that
040950 - Kaiser's internal proprietary email system is faster for emergency
040951 - communications. ref SDS 34 OR71
040953 -  ..
040954 - On 100310 1350 Millie notified the medical team that 2nd treatment
040955 - with Abraxane was completed at Kaiser, ref SDS 35 ER95, Millie
040956 - reported that Kaiser's internal proprietary email system has been out
040957 - of service for a week. ref SDS 35 GY4U  Millie further explained that
040958 - faster emergency communications using Kaiser's internal proprietary
040959 - email system is less beneficial than using commercial public domain
040960 - email addresses for doctors at Kaiser that enable timely coordination
040961 - and collaboration among the medical team, which is more advantages to
040962 - survival than improving emergency communications, which rarely occur
040963 - in Millie's case. ref SDS 35 GY6P
040965 -  ..
040966 - On 100317 0730 Millie received the 3rd treatment that completes the
040967 - 1st cycle with Abraxane to recover from the 10th relapse of cancer.
040968 - At this time, Millie is experiencing rising pain from progressing IBC,
040969 - and rising lymphedema, most noticably in the right arm, which has been
040970 - free of disease for 10 years. ref SDS 0 KE4K
040971 -
040972 -
040974 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Today starts 3rd treatment that completes the 1st cycle with Abraxane
041302 - for Millie to recover from the 10th relaspe of cancer, diagnosed on
041303 - 100218 during emergency meeting with Doctor Johnson. ref SDS 26 PP5Y
041305 -  ..
041306 - Anne is Millie's nurse today.
041308 -  ..
041309 - Vitals are very good this morning.
041311 -  ..
041312 - The lab did not have time to post all of the results for Millie's
041313 - blood draw yesterday, on 100316 0830. ref SDS 36 AS5H
041315 -  ..
041316 - Anne called the lab and got verbal explanation that Neutrophils are
041317 - at 70%, which makes NEUTS very high, because WBC 9.9 is very high.
041319 -  ..
041320 - Anne made examination and confirmed there is no evidence of shingles
041321 - recurrence on Millie's right forehead.
041323 -  ..
041324 - Since Millie passed the two criteria Doctor Johnson set during the
041325 - meeting at Kaiser on 100302 for Millie to get chemotherapy, i.e., good
041326 - blooc counts and no evidence of shingles, ref SDS 28 FC68, Anne
041327 - started Millie's treatment with Abraxane.
041329 -  ..
041330 - Millie reported side effects of Abraxane and Neupogen so far are
041331 - extreme fatigue; although this week her energy has been up.  On
041332 - Saturday, Millie hiked for nearly 3 miles, and on Monday, Millie
041333 - hiked about 3.2 miles.  Yesterday, however, was not a good day.
041335 -  ..
041336 - Last night Millie was very discouraged, considering ending treatment
041337 - for the 10th relapse of cancer.  This reverses being "encouraged" last
041338 - week, reported to the medical team on 100310 1350. ref SDS 35 ER95
041340 -  ..
041341 - Pain yesterday was between 8 - 10 from progressing IBC and Millie's
041342 - head that still suffers after effects of shingles.  Millie had to take
041343 - 2 Percocet pills every 3 hours yesterday in order to control pain.
041345 -  ..
041346 - Today, she feels better and so only needs 1 Percocet pill every 4
041347 - hours or so.
041349 -  ..
041350 - This morning, Anne used Millie's lower right leg to obain pulse and
041351 - blood pressure diagnostics, because Millie's right arm is swelled with
041352 - lymphedema.  There is still no direct appearance of IBC rash, but the
041353 - rise of lymphedema signals IBC has travelled into the right arm.
041355 -  ..
041356 - Anne said that the Kaiser Oncology Chemotherapy Infusion Department
041357 - staff in Walnut Creek is confused about how to reconcile recent policy
041358 - changes to avoid drawing blood from Millie's Power Port and standing
041359 - policy to avoid drawing blood through IV needle penetrations in
041360 - Millie's arms swelled with lymphedema due to cancer.  She indicated
041361 - somebody is on the "war path" about Millie getting special treatment
041362 - drawing blood from her Power Port for medical necessity, as occurred
041363 - on 100104. ref SDS 15 ZX4J  Millie has assisted the Kaiser Walnut
041364 - Creek team to avoid emotional trauma from choosing care for medical
041365 - necessity rather than policy that conflicts with Millie's patient
041366 - profile, by getting blood draws using her Power Port at Kaiser in
041367 - Martinez, where the staff is not conflicted, cited in Millie's letter
041368 - to the medical team on 100204 1325. ref SDS 23 SB8U
041369 -
041370 -            [On 100330 0830 Doctor Johnson again observed rising
041371 -            lymphedema in Millie's right arm, signaling beginning of
041372 -            IBC, and which Kaiser protocol prevents needle penetrations
041373 -            for blood draws, taking blood pressure on the right arm, as
041374 -            well as the left arm. ref SDS 37 C54N
041376 -             ..
041377 -            [On 100427 0830, during examination at Kaiser Doctor
041378 -            Johnson entered in Millie's medical chart work plan
041379 -            instruction to use Power Port for blood draws due to
041380 -            bilateral lymphedema. ref SDS 38 X74Q
041381 -
041382 -
041383 -
041385 -  ..
0414 -
0415 -
0416 - 0830
0417 -
041701 - Visited Millie in the treatment clinic.  She explained that Zan forgot
041702 - to prepare the chemotherapy treatment ordered for today.  Somehow, the
041703 - order from Anne got misplaced, or Zan placed another paper on top of
041704 - the order for Millie.  As a result, Anne just started her treatment
041705 - with Abraxane, and hour later than scheduled.
041706 -
041707 -
041709 -  ..
0418 -
0419 -
0420 - 0909
0421 -
042101 - Cisi came into the Oncology Conference Room and expressed a worry that
042102 - working in the Conference Room to support Millie's care presents a
042103 - severe security risk.  She waved her arm saying that patient
042104 - confidentiality was at risk from all of the documents laying open in
042105 - the room.  Cisi claimed she would get in trouble, if a Kaiser manager
042106 - or quality care auditor came through the Conference Room and saw
042107 - someone rifling through documents on other patient, or working to
042108 - extend the life of a patient.
042110 -  ..
042111 - Previously, Doctor Johnson was concerned about getting in trouble for
042112 - violating Kaiser policy by prescribing Gemzar or Navelbine because
042113 - these treatments conflict with Millie's patient profile, reported on
042114 - 090515 1140. ref SDS 4 658J
042116 -  ..
042117 - We looked around the room and actually saw no documents of any kind in
042118 - the room.  None on the desk, none pinned to the walls, nothing written
042119 - on marking boards, none on any adjacent tables.  Nothing.
042121 -  ..
042122 - Apologized for taking up time in the Conference Room.  Normally,
042123 - Millie completes treatment by 0800, before any activity occurs that
042124 - might present a conflict.  Today, Zan was an hour or so late preparing
042125 - Millie's treatment, per above, ref SDS 0 TX5E, and this extended time
042126 - in the Conference Room.
042127 -
042128 -
042129 -
042131 -  ..
0422 -
0423 -
0424 - 1537
0425 -
042501 - Arlette called.
042502 -
042503 - Cancer marker CA 14-3 369 was reported for Millie's blood test
042504 - yesterday on, ref SDS 36 AS5H
042506 -  ..
042507 - This shows a near 60 point decline from CA 15-3 426 reported for
042508 - Millie's blood test 2 weeks ago, staring the 2nd cycle of Abraxane.
042510 -  ..
042511 - The falling cancer marker signals signaficant recovery following 200
042512 - point rise over the past month.
042513 -
042514 -
042515 -
0426 -