CONTACTS 

SUBJECTS
Johnson, Doctor Meeting at Kaiser
CA 15-3 66 Drops from 68 Reversing Trend of Past Few Months
CA 15-3 62 Drops from 66 Continuing Reverse Trend of Past 12 Months

0605 -
0605 -    ..
0606 - Summary/Objective
0607 -
060701 - Follow up ref SDS 48 0000. ref SDS 47 0000.
060702 -
060703 - CA 15-3 dropped again by a bigger margin, rather than repeat past
060704 - patterns of rising after a drop. ref SDS 0 SM6M  While the marker for
060705 - breast cancer remains elevated, a continued pause in the rise of CA
060706 - 15-3 signals the patient is "stable," where disease is not progressing
060707 - at the present time. ref SDS 0 GJ5M  Doctor Johnson summarized results
060708 - of the CT scan test as "great," which supports diagnosis of "stable."
060709 - ref SDS 0 LK5L  The doctor applauded patient's hard work to maintain
060710 - "quality of life, since this is the goal of treatment. ref SDS 0 GW8F
060711 - Prior symptoms of dizziness and stiff neck have declined. ref SDS 0
060712 - 435M  A new symptom of irregular and mild sensations above the elbow
060713 - in the left arm are normal reaction to cancer surgery that removes
060714 - infected lymph nodes, and so do not require intervention. ref SDS 0
060715 - WP7L  Discomfort in the right arm from continuing blood tests can be
060716 - redressed by drinking water prior to drawing blood so that finding an
060717 - appropriate blood vessel is easier for the technician, and by asking
060718 - for a higher skilled technician to perform the work. ref SDS 0 CO3G
060719 - At this time the patient appears to be headed toward complete response
060720 - (CR), which is more commonly called "remission." ref SDS 0 265M
060722 -         ..
060723 -        [On 040318 CA 15-3 rose from 60 to 70, and pathology report on
060724 -        neck shows recurrence of cancer, also confirmed by CT tests.
060725 -        ref SDS 53 WA4H
060726 -
060727 -
060728 -
060730 -  ..
0608 -
0609 -
0610 - Discussion
0611 -
061101 - Recovery Progress CA 15-3 Cancer Marker Drops from 68 to 66
061102 - CA 15-3 Cancer Marker Reverses Trend and Shows Slight Drop
061103 -
061104 - Follow up ref SDS 48 SM6M, ref SDS 47 SM6M.
061105 -
061106 - Blood test reported during the meeting today showed CA 15-3 cancer
061107 - marker fell from 66 to 62, continuing the drop from a high of 68 on
061108 - 030708, and doubling the drop from the prior test on 030915.  This may
061109 - signal an actual reversal of the rise from the low of 33 on 021023.
061110 - It seems to be below a level that indicates treatment has failed, as
061111 - reported on 030220. ref SDS 42 ZL4X
061113 -             ..
061114 -            [On 040318 CA 15-3 rose from 60 to 70, and pathology report
061115 -            on neck show recurrence of cancer, also confirmed by CT
061116 -            tests. ref SDS 53 WA4H
061118 -           ..
061119 -          031205......... 62 H............. 031205, ref SDS 0 SM6M
061120 -          030912......... 66 H............. 030915, ref SDS 48 SM6M
061121 -          030708......... 68 H............. 030710, ref SDS 47 SM6M
061122 -          030503......... 54 H............. 030508, ref SDS 43 SM6M
061123 -          030403......... 45 H............. 030508, ref SDS 43 SM6M
061124 -          030220......... 46 H............. 030220, ref SDS 42 5E6L
061125 -          030106......... 37 H............. 030109, ref SDS 40 SM6M
061126 -          021202......... 41 H?............ 021204, ref SDS 36 SP5G
061127 -          021102......... 36 H?............ 021113, ref SDS 35 Y65I
061128 -          021023......... 33 H?............ 021023, ref SDS 34 SQ5I
061129 -          020930......... 33 H?..29........ 021002, ref SDS 33 SQ5I
061130 -          020917......... 36 H?............ 020924, ref SDS 32 SQ5I
061131 -          020717......... 59 H?............ 020726, ref SDS 31 YN5K
061132 -          020629......... 75 H ............ 020705, ref SDS 29 UX6I
061133 -          020608........  67 H ............ 020614, ref SDS 25 0001
061134 -          020603........ 108 H ............ 020607, ref SDS 23 X67F
061135 -          020511........ 117 H ............ 020603, ref SDS 22 PJ4J
061136 -          020419......... 81 H ............ 020430, ref SDS 18 7N5H
061137 -          020321......... 85 H ............ 020405, ref SDS 8 6T8K
061138 -
061139 -
061140 -
061142 -  ..
0612 -
0613 -
0614 - Analysis
0615 -
061501 - Drops in CA 15-3 Cancer Marker Suggests Condition Stable
061502 -
061503 - Follow up ref SDS 48 GJ5M, ref SDS 47 GJ5M.
061504 -
061505 - Primary care physician explained that the halt, or pause, in the rise
061506 - of CA 15-3 shown by another drop from 66 to 62, per above, ref SDS 0
061507 - SM6M, suggests, in combination with the favorable CT test result,
061508 - shown below, ref SDS 0 LK5L, that cancer has "stabilized."
061510 -  ..
061511 - He described the patient condition as officially....
061512 -
061513 -                         Stable (S)
061514 -
061515 - ...because CA 15-3 is still well above the level that satisfies all
061516 - requirements for remission.
061517 -
061518 -     [On 040318 CA 15-3 rose from 60 to 70, and pathology report on
061519 -     neck show recurrence of cancer, also confirmed by CT tests.
061520 -     ref SDS 53 WA4H
061522 -  ..
061523 - Doctor Johnson listed two (2) other classifications for cancer
061524 - patients...
061525 -
061526 -                         Complete Response (CR)
061527 -                         Progression (P)
061528 -
061529 - ...where CR signifies recovery, or more commonly "remission," as a
061530 - result of having completely responded to treatment, and P means cancer
061531 - is spreading because treatment failed, so additional treatment must
061532 - commence.
061534 -  ..
061535 - Based on the prior history where CA 15-3 dropped to a low of 33, then
061536 - rose to 68 over the next 8 months, the small decline over the past few
061537 - months raises hope that the long term trend of rising CA 15-3 has
061538 - actually changed, since, if the rise continues toward 100 and above,
061539 - this would suggest further treatments are needed, as discussed on
061540 - 030730. ref SDS 47 WS42
061542 -  ..
061543 - Doctor Johnson wants another CA 15-3 test about half way to the date
061544 - of the next meeting in 3 months, which is about 6 weeks from now, and
061545 - then another test at the regular time just prior to meeting for follow
061546 - up work.
061547 -
061548 -     [On 040318 CA 15-3 rose from 60 to 70, and pathology report on
061549 -     neck show recurrence of cancer, also confirmed by CT tests.
061550 -     ref SDS 53 WA4H
061551 -
061552 -
061553 -
061554 -
061555 -
061556 -
061557 -
0616 -

SUBJECTS
PET Scan Findings Show Previous Metastatic Lymphadenopathy No Longer Ac
Metastasis New Nonspecific May be Post Treatment Trauma Inflammatory Ch
CT Scan Findings Show 2 New 1 CM Masses in Area of Prior Surgery for Ly
CT Scan Findings Show 1 CM Masses Increased to 1.5 CM 50% Growth
CT Scan Test Shows No Evidence Progression Distant Metastasis Stable Co
2 1.5 CM Lymph Node Nodules CT Report 031031 Received 031205 Marked

1608 -
160901 -  ..
160902 - CT Scan Shows No Evidence of Carcinoma Activity
160903 -
160904 - Follow up ref SDS 48 LK5L, ref SDS 47 LK5L.
160905 -
160906 - Yesterday, on 031204 received in the mail a copy of a report on the CT
160907 - test performed 031031, ref SDS 0 IG9K, and with the doctor's signature
160908 - block stamped at the bottom of the document.  There appears to be the
160909 - the doctor's signed initials written below the following handwritten
160910 - comment....
160912 -                          ..
160913 -                         great!
160914 -
160915 - ...indicating favorable assessment of the CT test, ref SDS 0 AA4T,
160916 - based on favorable "impression" presented by the analyst in the
160917 - report. ref SDS 0 GJ69
160919 -  ..
160920 - This CT test was ordered during the meeting on 030915, ref SDS 48
160921 - RT9K, and was performed on 031031, as shown below. ref SDS 0 IG9K
160923 -  ..
160924 - Today, the doctor confirmed the written assessment that the report on
160925 - the CT test indicates continuing recovery, and that there is no
160926 - evidence of progression, per above. ref SDS 0 WS9J
160927 -
160928 -            [On 040517 Millie diagnosed with inflammatory breast
160929 -            cancer, ref SDS 57 7D6F, research indicates swelled lymph
160930 -            nodes in the neck and swelled lymph nodes under the arm are
160931 -            symptoms of IBC. ref SDS 57 M67I
160933 -             ..
160934 -            [On 060428 read medical test findings - case study doctors
160935 -            limited time prevents reading findings to correlate
160936 -            clinically for discovering symptomatic trends that enable
160937 -            proactive case management; there is only enough time to
160938 -            read summaries that present the gist of findings.
160939 -            ref SDS 62 VG5L
160941 -  ..
160942 - The doctor explained findings of "...extensive calcification in the
160943 - splenic artery," ref SDS 0 GW62, represent normal degeneration from
160944 - the aging process, and so are not cause for intervention.  Patient's
160945 - continued investment to maintain fitness prolongs quality of life in
160946 - the face of normal effects of aging, noted below. ref SDS 0 GW8F
160948 -  ..
160949 - Implications of the report on future treatment are shown above
160950 - discussing CA 15-3 test results. ref SDS 0 GJ5M
160951 -
160953 -      ..
160954 -     Patient
160957 -      ..
160958 -     CT of the Chest
160962 -      ..
160963 -     History
160965 -      ..
160966 -     H/O breast CA.  Compare to 6/03 and previous
160968 -      ..
160969 -     Findings
160971 -      ..
160972 -     Comparison:  CT Chest dated 030626
160973 -
160974 -         On 030710 report CT scan on 030626, ref SDS 47 AL6N, and on
160975 -         030508 report prior CT test. ref SDS 43 LK5L
160977 -      ..
160978 -     Chest
160980 -      ..
160981 -     Images in the soft tissue window again show irregular density at
160982 -     the upper half of the left breast with distortion of the normal
160983 -     breast contour consistent with postsurgical changes.  There is
160984 -     also thickening of the overlying skin.  There is also an ill
160985 -     defined density in the left axilia appearing similar compared to
160986 -     previous exam.  A few of the left axillary lymph nodes have
160987 -     decreased in size since the previous.
160989 -      ..
160990 -     There is no evidence for hiliar, mediastinal, or right axillary
160991 -     lymphadenopathy.  There are a few subcentimeter pretracheal lymph
160992 -     nodes, not pathologic by size criteria (image #21).
160994 -      ..
160995 -     Stellate densities at the left apex are probably related to
160996 -     scarring or other iatrogenic changes.  There is a punctate
160997 -     calcified granuloma in the right upper lobe on image #22.  There
160998 -     are stable noncalcified pulmonary nodules in the right middle lobe
160999 -     on image #38.  There are no new pulmonary nodules.  There are no
161000 -     pleural effusions.
161002 -      ..
161003 -     Abdomen
161005 -      ..
161006 -     A stable low density lesion is seen in the dome of the liver
161007 -     consistent with simple cysts.  The liver is otherwise normal in
161008 -     density.  The gallbladder, pancreas, and adrenal glands are normal
161009 -     in density.  Multiple punctate calcifications are noted in the
161010 -     spleen representing granulomas.
161012 -      ..
161013 -     A 3 mm low density lesion is seen in the midpole of the left
161014 -     kideny, too small to characterize.  The kidneys are otherwise
161015 -     unremarkable.
161017 -      ..
161018 -     There is no evidence for retroperitoneal or mesenteric
161019 -     lymphadenopathy.  The visualized bowel loops are normal in
161020 -     appearance.  There is extensive calcification in the splenic
161021 -     artery.
161022 -
161023 -          [...above, the doctor comments. ref SDS 0 GW7H
161025 -      ..
161026 -     Degenerative changes are present in the spine with paravertebral
161027 -     osteophyte formation and hypertrophy of facets and multiple
161028 -     Schmorl's nodes.  The bony structures are otherwise unremarkable.
161030 -      ..
161031 -     Impression
161033 -      ..
161034 -     Relatively stable examination since 030626 with slight decrease
161035 -     in size of a few left axillary lymph nodes.
161037 -  ..
161038 - As noted, Millie received this pathology report from Kaiser with the
161039 - doctor's entry of "Great!" and initials, per above. ref SDS 0 LK5L
161041 -  ..
161042 - What is "great" about anlaysis that omits comprehensive review...
161044 -          ..
161045 -         Have two (2) lymph nodes disappeared that grew 50% cited in
161046 -         the prior report, or was a determination made these are
161047 -         "unremarkable"?  How does prior increasing adenopathy noted in
161048 -         the prior report on 030626 and received on 030710, ref SDS 47
161049 -         7M7M, change to a slight decrease in size of left axillary
161050 -         lymph nodes without any treatment?
161052 -          ..
161053 -         What happened to reporting in the previous CT test on 030626
161054 -         and discussed with the doctor on 030710 that cited persistant
161055 -         left breast and chest wall skin thickening may be from prior
161056 -         radiation therapy, but invasion of the dermal lymphatics from
161057 -         known breast cancer can present similarly.  Correlate
161058 -         clinically. ref SDS 47 GJ69
161060 -             ..
161061 -            [On 040517 Millie diagnosed with inflammatory breast
161062 -            cancer, ref SDS 57 7D6F, research indicates swelled lymph
161063 -            nodes in the neck and swelled lymph nodes under the arm are
161064 -            symptoms of IBC. ref SDS 57 M67I
161066 -          ..
161067 -         Omission of comment today in the current test on prior
161068 -         findings and recommendations may merely reflect different
161069 -         styles of writing reports.  The analyst on this occassion may
161070 -         not have read the report for the prior tests, and so visually
161071 -         comparing two small masses, correctly reported a decrease in
161072 -         size from the prior test, and without considering the
161073 -         customer's requirement for clarity about previously identified
161074 -         cancer growing by 50% that has suddenly reversed, and is now
161075 -         smaller.
161076 -
161077 -            [On 040227 the doctor was asked about evident conflict in
161078 -            the record; at that time computers were down, so the doctor
161079 -            will review the record when the computer is restored to
161080 -            service and report on the results. ref SDS 51 YE4F
161082 -             ..
161083 -            [On 040318 prior CT tests could not be found in Kaiser's
161084 -            computer nor in the medical chart to resolve conflicts on
161085 -            expanding axillary lymphadenopathy, ref SDS 53 ZE5O; new CT
161086 -            tests and a biopsy report showing regional metastatic
161087 -            disease in the neck change focus from diagnosis to planning
161088 -            for treatment. ref SDS 53 H28F
161090 -             ..
161091 -            [On 040402 protocol nurse discloses that Kaiser's records
161092 -            are audited for accuracy to ensure testing is effective.
161093 -            ref SDS 54 6E4N
161095 -             ..
161096 -            [On 040517 Millie diagnosed with inflammatory breast
161097 -            cancer, ref SDS 57 7D6F, research indicates swelled lymph
161098 -            nodes in the neck and swelled lymph nodes under the arm are
161099 -            symptoms of IBC. ref SDS 57 M67I
161101 -             ..
161102 -            [On 040811 comparing CT test reports seems to indicate
161103 -            conflicts, similar to today. ref SDS 58 WW6N
161105 -             ..
161106 -            [On 040812 doctor explains conflicts in test reports
161107 -            reflects medical practice has lower requirements for
161108 -            accuracy and precison than is common to engineering work.
161109 -            ref SDS 59 T761
161111 -             ..
161112 -            [On 060428 read medical test findings - case study doctors
161113 -            limited time prevents reading findings to correlate
161114 -            clinically for discovering symptomatic trends that enable
161115 -            proactive case management; there is only enough time to
161116 -            read summaries that present the gist of findings.
161117 -            ref SDS 62 VG5L
161118 -
161119 -
161120 -
161124 -  ..
161125 - As noted above, yesterday Millie received a letter from the doctor
161126 - transmitting the CT test on 031031, ref SDS 0 LK5L, and reviewed today
161127 - per above. ref SDS 0 GJ4S
161129 -      ..
161130 -     Dictated           Dictation Transcribed
161131 -     DD:  031103        DT:  031119  ERW
161132 -     *************************************************************
161133 -
161134 -                         Great!
161136 -                      ..
161138 -                     Oncology
161140 -      ..
161141 -     RAD.REP
161142 -     MTZRAJ  031134 0921
161144 -  ..
161145 - There was not enough time today to resolve possible errors and
161146 - omissions in the current test, compared to prior findings, per above.
161147 - ref SDS 0 GJ69
161148 -
161149 -            [On 040207 patient complains stiff neck and lump.
161150 -            ref SDS 50 WP7L
161152 -             ..
161153 -            [On 040227 examination showed only slight reduction in
161154 -            swelling, so biopsy ordered by Head and Neck specialist.
161155 -            ref SDS 51 0001
161157 -             ..
161158 -            [On 040309 biopsy diagnoses breast cancer recurrence.
161159 -            ref SDS 52 0001
161161 -             ..
161162 -            [On 040318 inflammation left breast treated for cellulitus;
161163 -            treatment for cancer delayed pending resolution of
161164 -            inflammation problem. ref SDS 53 IM6J
161166 -             ..
161167 -            [On 040402 diagnosis inflammation left breast changed from
161168 -            cellulitus to reacation from radiation; patient cleared to
161169 -            begin chemotherapy treatment for cancer. ref SDS 55 IM6J
161171 -             ..
161172 -            [On 040419 during minor surgery to install port catheter
161173 -            for chemotherapy treatments, patient asks surgeon to
161174 -            evaluate inflammation on left breast; surgeon performs
161175 -            punch biopsy left breast. ref SDS 56 789F
161177 -             ..
161178 -            [On 040517 Millie diagnosed with inflammatory breast
161179 -            cancer, ref SDS 57 7D6F, research indicates swelled lymph
161180 -            nodes in the neck and swelled lymph nodes under the arm are
161181 -            symptoms of IBC. ref SDS 57 M67I
161183 -             ..
161184 -            [On 040811 comparing CT test reports seems to indicate
161185 -            conflicts, similar to today. ref SDS 58 WW6N
161187 -             ..
161188 -            [On 040812 doctor explains conflicts in test reports
161189 -            reflects medical practice has lower requirements for
161190 -            accuracy and precison than is common to engineering work.
161191 -            ref SDS 59 T761
161193 -             ..
161194 -            [On 060428 read medical test findings - case study doctors
161195 -            limited time prevents reading findings to correlate
161196 -            clinically for discovering symptomatic trends that enable
161197 -            proactive case management; there is only enough time to
161198 -            read summaries that present the gist of findings.
161199 -            ref SDS 62 VG5L
161200 -
161201 -
161202 -
161203 -
161204 -
161205 -
1613 -

SUBJECTS
Buck, Millie Recovery from Cancer Fitness Exercise Improve General H
Buck, Millie Cancer Recovery Fitness Exercise Improve General Health
Fitness Exercise Improve General Health Positive Attitudes Doctors M
CA 15-3 Not Recommended for Use by ASCO Published Guidance
Recurrence Metastatic Cancer Cure Impossible Due to High Risk Factor
Testing Indicates Presence of Cancer Activity but No Clinical Observ
No Clinical Observable Symptoms of Cancer Delays Commencement of Sec
Fitness Exercise General Health Positive Attitude Millie Has Conditi
Tests Shows No Evidence Progression Distant Metastasis Stable Condit

2711 -
271201 -  ..
271202 - Great CT Test Report Shows Cancer Not Getting Out of Control
271203 - Symptoms Stable CA 15-3 Cancer Marker Does Not Require Treatment
271204 - Kaiser Relies on Patient Symptoms to Determine Treatment for Relapse
271205 -
271206 - Follow up ref SDS 48 7C6W, ref SDS 47 7C6W.
271207 -
271208 - Doctor's assessment based on analysis of CA 15-3 and "Great" CT test
271209 - report, ref SDS 0 AA4T, indicate patient condition is "stable," per
271210 - above. ref SDS 0 GJ5M  There is no evidence of cancer getting out of
271211 - control, reported on 031010 in an article that disclosed 50% of breast
271212 - cancer patients relapse within five (5) years. ref SDS 49 IM6N
271214 -  ..
271215 - The doctor commended patient involvement in recovery through good
271216 - general health and fitness from regular exercise, noted previously by
271217 - the doctor on 030606, ref SDS 44 N27L, reviewed again the following
271218 - month in July on 030710. ref SDS 47 FZ4N  In September, the doctor
271219 - again noted Millie's fitness and good health. 030915, ref SDS 48 GB3M,
271220 - At that time, the doctor related balancing strategy to stretch out
271221 - treatment of metastatic cancer to maintain potency of drugs, while
271222 - paying close attention to prevent cancer from cascading out of
271223 - control, ref SDS 47 L35L, to maintain "quality" of life with both
271224 - prolonged and active life. ref SDS 47 FZ55  Achieving goals for
271225 - "quality of life" redresses common infirmities of the aging process,
271226 - noted above, ref SDS 0 GW7H, and requires positive attitudes and
271227 - proactive exercise by the patient to maintain strength, range of
271228 - motion, weight to height ratio and cardio-pulmonary fitness.  On
271229 - 020924 the doctor related need for balance in maintaining physical
271230 - health when pain reported along left arm and leg resulted from cancer
271231 - patient going on 25 mile bike ride. ref SDS 32 RP4F
271232 -
271233 -          [...below, irregular, mild sensations in left arm caused by
271234 -          removal of lymph nodes. ref SDS 0 WP7L
271236 -           ..
271237 -          [On 041210 patient's daughter asks "Why mom's cancer cannot
271238 -          be cured?"  Doctor explains treatment goals for quality of
271239 -          life. ref SDS 60 9Q7H
271241 -           ..
271242 -          [On 070218 energy increases, shortness of breath, fatigue,
271243 -          weakness subside 10 weeks after ending treatment for 3rd
271244 -          relapse of IBC with Taxotere and cacecitabine; Millie
271245 -          exercising in the gym, playing tennis. ref SDS 63 MS7O
271247 -  ..
271248 - The doctor scheduled the next meeting for 3 months, and ordered the
271249 - next CA 15-3 test to occur about half way through that period, and
271250 - another test a few days before the meeting, per above. ref SDS 0 0A5L
271251 -
271252 -
271253 -
271254 -
2713 -

SUBJECTS
Dizziness Caused by Blockage in Ear Treatment Prescribed by Doctor Ro
Survivor Patients Dislike Phrase Survivor Feelings in Treatment Recov
Ear Blockage Causing Dizziness Treatment Prescribed by Doctor Robert
Johnson, Robert, MD Meeting at Kaiser Determined Dizziness Caused by
Neck Head Back of Neck Stiff Xrays Ordered to Investigate
Xrays Ordered to Investigate Head Back of Neck Stiff

3308 -
330901 -  ..
330902 - Neck Stiffness Dizziness Other Symptoms Abated
330903 -
330904 - Follow up ref SDS 48 WS47, ref SDS 47 WS47
330905 -
330906 - Patient advised that dizziness has not returned since the prior
330907 - meeting on 030915, indicating treatments prescribed on 030710,
330908 - ref SDS 47 LY6K, have been effective.
330910 -  ..
330911 - Stiffness in the neck has declined, and the xray prescribed during the
330912 - meeting on 030915, ref SDS 48 H84F, did not reveal any conditions that
330913 - require treatment.  This suggests the prior problem may be related to
330914 - lifestyle, e.g, sleeping in an awkward position, perhaps falling
330915 - asleep when sitting up reading in bed, watching television, etc.
330916 -
330917 -
330918 -
330919 -
3310 -

SUBJECTS
Arm Left Sensations Above Elbow Mild Irregular Short Duration Normal Sy
Sensations Left Arm Above Elbow Mild Irregular Short Duration Normal

3504 -
350501 -  ..
350502 - Lymph Node Removal Cause Short Mild Irregular Sensations Left Arm
350503 - Left Arm Short Mild Irregular Sensations from Removal Lymph Nodes
350504 -
350505 - Follow up ref SDS 32 RP4F.
350506 -
350507 - Patient reported occasional mild sensation like passing a feather
350508 - over the left arm above the elbow.
350510 -  ..
350511 - The doctor advised this condition likely results from surgery that
350512 - removed lymph nodes under the left arm.  Removal of lymph nodes causes
350513 - a variety of sensations in the affected arm that occur at irregular
350514 - intervals and with no evident cause.  Since the occurrence is of short
350515 - duration and does not cause discomfort there is no treatment required.
350516 -
350517 -     [On 050422 tingling again occurred for several days, then
350518 -     subsided, and so was not reported to the doctor during
350519 -     examination. ref SDS 61 5P6O
350520 -
350521 -
350522 -
350523 -
350524 -
3506 -

SUBJECTS
Blood Tests Cause Painful Conditions Requires Higher Skilled Technici
Drink Lots of Water Prior to Blood Tests to Cause Blood Vessels to Sw
Painful Blood Tests Requires Higher Skilled Technician to Find Favora
Blood Tests Painful Conditions Requires Higher Skilled Technician to

3806 -
380701 -  ..
380702 - Blood Tests Causing Painful Condition on Right Arm
380703 -
380704 - Patient showed a new condition developing as a result of blood tests
380705 - taken from inside the right elbow.  This area is now swollen and has a
380706 - blueish color as a result of difficulty the staff had finding a vein
380707 - to draw blood for tests, reported today, per above. ref SDS 0 SM6M
380709 -  ..
380710 - The primary care physician said this occurs when a nurse or other care
380711 - giver makes a mistake using a needle to give a shot, draw blood, or
380712 - set an IV.  When the practitioner cannot find a vien, then several
380713 - punctures/penetrations are required, and sometimes inexperienced staff
380714 - will probe for a vien.  These practices conflict with published
380715 - guidance and training, but doctors have limited control.
380717 -  ..
380718 - The doctor recommended drinking a lot of water prior to having blood
380719 - drawn, because evidently this causes blood vessels to swell, so it is
380720 - easier for the technician to locate new areas to draw blood.
380722 -  ..
380723 - The doctor further noted that patients can require through a verbal
380724 - request to attending staff that Kaiser to assign a higher skilled
380725 - technician for drawing blood in light of the condition caused by
380726 - continuing treatment.
380727 -
380728 -     [On 040318 continuing problem; doctor recommends again asking for
380729 -     experienced technicians to draw blood in light of frequency that
380730 -     makes drawing blood more difficult. ref SDS 53 CO3G
380732 -      ..
380733 -     [On 040318 primary care physician observes increasing trauma from
380734 -     rising needle penetrations for blood draws, IV infusion
380735 -     treatments, and image tests, ref SDS 53 CO3G; doctor explains
380736 -     solution using port catheter avoids injuring patient by
380737 -     eliminating needle punctures and penetrations. ref SDS 53 RX9O
380739 -      ..
380740 -     [On 040419 port catheter installed at Kaiser in Martinez CA;
380741 -     reported a success, expecting to relieve trauma from needle
380742 -     punctures and penetrations for blood draws and IV infusion
380743 -     treatments for chemotherapy. ref SDS 56 PPSW
380745 -      ..
380746 -     [On 110429 1230 case study on similar problems at VA getting
380747 -     adequate blood flow through IV catheter, related to dehydration
380748 -     from heavy exercise and low water intake hours before medical
380749 -     care; solved by getting another nurse to complete work.
380750 -     ref SDS 64 SR8M
380751 -
380752 -
380753 -
380754 -
380755 -
380756 -
380757 -
3808 -