CONTACTS 

SUBJECTS
102+ Temperature Severe Red Rash Left Arm Cellulitis Complications L

1303 -
1303 -    ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS 10 PR5R
130502 -
130503 - This morning about 0900 the physicial therapyst treating Millie for
130504 - lymphedema at Kaiser this morning noticed a few, isolated dots of red
130505 - rash on inner, lower left arm, and suggested Millie notify the doctor.
130506 - ref SDS 0 HP52  Since the rash seemed very minor, Millie did not
130507 - notify the doctor at 1100 after returning from Kaiser, and running
130508 - errands.  About 1230 Millie began feeling chilled, and used a blanket
130509 - to keep warm; by then she had a slight temperature, so she notified
130510 - the doctor of minor rash, chills, and fever. ref SDS 0 3N8K  At 1600,
130511 - Millie's temperature increased to 101.5, well above standing criteria
130512 - for chemotherapy patients to get treatment in the Emergency Room.
130513 - Called Kaiser and confirmed guidance to take Millie to the emergency
130514 - room. ref SDS 0 LM9O  Arrived at hospital at 1630, and discovered that
130515 - very minor, few dots of rash observed this morning at 0900 had greatly
130516 - increased.  Millie's entire left arm was swollen and engulfed in deep
130517 - inflammation.  This was diagnosed as Cellulitis. ref SDS 0 WO6N
130518 - Millie was examined by a doctor at 2030.  Cellulitis diagnosis was
130519 - confirmed and likely cause was trauma to the left from breaking her
130520 - finger on 060914. ref SDS 0 V759  Millie was admitted to the hospital
130521 - Oncology Central 3 for further treatment. ref SDS 0 V78N
130523 -         ..
130524 -        [On 061028 notified family and friends of Millie's situation.
130525 -        ref SDS 15 0001
130527 -         ..
130528 -        [On 061203 patient relapses, ref SDS 20 MF9H, very slight
130529 -        temperature; notify primary care physician. ref SDS 20 5X3N
130530 -
130531 -
130532 -
130534 -  ..
1306 -
1307 -
1308 - Progress
1309 -
130901 - Millie went to physical therapy at Kaiser this morning at 0900 for
130902 - treatment of lymphedema.
130904 -  ..
130905 - She returned about 1100, after running some errands.  Millie mentioned
130906 - that the physical therapyst, Mary, noticed a light rash on the inner
130907 - part of her left arm, and suggested that Millie notify the doctor.
130909 -  ..
130910 - Millie was reluctant to bother the doctor about minor rash, maybe
130911 - from an alergy of some kind.
130912 -
130913 -     [...see below for slight rash compounding into solid inflammation
130914 -     of entire left arm with severe swelling. ref SDS 0 WO6N
130916 -  ..
130917 - About 1230 Millie was chilled, so we wrapped her in a blanket.
130919 -  ..
130920 - Took her temperature about 1230.  It was 99.8.  Took it again about 90
130921 - minutes later and it dropped to 99.3.
130923 -  ..
130924 - She finally decided to notify the doctor, and this notice is reported
130925 - in another record today. ref SDS 14 MS3Q
130926 -
130928 -  ..
1310 -
1311 -
1312 - 1555
1313 -
131301 - Temperature 101.5.
131303 -  ..
131304 - Kaiser's instructions for cancer patients are to call the hospital
131305 - advice nurse when the temperature rises above 100.5, reported
131306 - originally on 041202. ref SDS 1 IX9N  Most recently Millie was treated
131307 - in the Emergency Room with elevated temperature, and then hospitalized
131308 - for pneumonia on 060607, with background to Kaiser policies.
131309 - ref SDS 10 H565
131310 -
131311 -    [On 070216 instructions call UCSF for emergency high fever
131312 -    spreading rash IBC cellulitis; conflicts with Kaiser instructions.
131313 -    ref SDS 21 UW9I
131315 -  ..
131316 - Called Kaiser Advice Nurse at the Oncology clinic...
131317 -
131318 -                       925 295 4030
131319 -
131320 -                           295 4070
131322 -  ..
131323 - Talked to Arlette.
131325 -  ..
131326 - She has not received the email reporting a new rash on Millie's left
131327 - arm, reported in another record earlier today. ref SDS 14 QC5K
131328 -
131329 -        [...in another record, later this evening, Arlette responded
131330 -        reporting she received Millie's letter. ref SDS 14 SG6H
131332 -  ..
131333 - Millie feels like she might be getting pneumonia again.  She was
131334 - treated for pneumonia on 060607. ref SDS 10 PT7S
131336 -  ..
131337 - Arlette transferred the call to Becky, who is a registered nurse.
131339 -  ..
131340 - Becky took Mil's Kaiser number, and then put the call on hold to
131341 - investigate.
131342 -
131344 -  ..
1314 -
1315 -
1316 - 1552
1317 -
131701 - Becky came back on line.  She was familiar with Millie's medical
131702 - record.  Becky said Millie should go to the Emergency Room for
131703 - treatment to bring her temperature down.  Becky will notify primary
131704 - care physician of this change in Millie's condition.
131705 -
131706 -
131707 -
131709 -  ..
1318 -
1319 -
1320 - 1616
1321 -
132101 - Drove to Kaiser Emergency Room.
132102 -
132103 - Before leaving tempeature climbed to 101.8.
132105 -  ..
132106 - Millie feels the symptoms are very similar to when she had pneumonia
132107 - on 060607. ref SDS 10 HB7I
132109 -  ..
132110 - Right now she has the chills with elevated temperature, and seems very
132111 - tired and weak. a bit disoriented, which are symptoms of pulmonary
132112 - emboli that caused her fall on 060914. ref SDS 11 ZQ5I, but was not
132113 - diagnosed until 061002. ref SDS 12 0001
132115 -  ..
132116 - Assembled things she will need in the hospital, including medications
132117 - for cancer (capecitabine), and pulmonary embolism (Coumadin), which
132118 - are arranged in an organizer for the entire week to take the correct
132119 - dose at the correct times, twice a day for both capecitabine (Xeloda)
132120 - that treates cancer, and Coumadin that treats pulmonary emboli.
132121 -
132122 -
132123 -
132125 -  ..
1322 -
1323 -
1324 - 1623
1325 -
132501 - Arrived at Kaiser Emergency Room.
132502 -
132503 - Checked in at the front desk.  The attendant, Nichole, started
132504 - registration, and took Millie's Kaiser card.
132506 -  ..
132507 - She said that Millie's Kaiser membership card will be returned after
132508 - registration, which occurs after Millie is examined initially, as
132509 - occurred previously on 060607. ref SDS 10 044G
132510 -
132511 -     [...below membersip card returned. ref SDS 0 Z16V
132512 -
132513 -
132514 -
132516 -  ..
1326 -
1327 -
1328 - 1705
1329 -
132901 - Triage Examination Evaluate Elevated Temperature 102
132902 -
132903 - Follow up ref SDS 10 4G5N.
132904 -
132905 - Initial evaluation by Doctor Katz.  He seems to be focusing on the
132906 - new rash, but will schedule an xray to also check for pneumonia.
132907 -
132908 -
132909 -
132911 -  ..
1330 -
1331 -
1332 - 1728
1333 -
133301 - Registration for Admittance to Emergency Room Examination
133302 - Left Arm Extremely Inflammed Swelled Red Rash Envelopes Entire Arm
133303 -
133304 - Follow up ref SDS 10 PS6Q.
133305 -
133306 - Craig Dill, RN examined Millie again, and took vitals.  Her
133307 - temperature has climbed to 102.4.
133308 -
133309 -                     Blood
133310 -    Date   Time      Pressure   Pulse  Temprtr  Weight   So2
133312 -     ..
133313 -    061027 1734.....                   102.4
133314 -    061020 1534..... 140  79     67     99.8    151      97
133315 -    060929 1452..... 141  78     66     98.3
133316 -    060908 1335..... 139  79     73     98.1
133317 -    060814 1610..... 139  80     59     98.2
133318 -    060722 1440..... 142  74     67     98.1
133319 -    060711.......... 172  87     54     97.5    147
133320 -    060623.......... 141  87     71     98.0    147
133321 -    060607..........                   104.2
133322 -    060428.......... 129  73     80     99.4    149
133323 -    060217.......... 153  81     61     98.6    150
133324 -    050916.......... 120  80     80     98.5
133325 -
133327 -  ..
133328 - Millie took her coat off for vitals.
133330 -  ..
133331 - Her left arm is now completely enveloped and swollen with a solid and
133332 - continuous red rash.  The appearance is kind of frightening, since the
133333 - this morning there was no inflammation or swelling of the arm, and
133334 - only a few very slight red dots, per above. ref SDS 0 HP52
133336 -  ..
133337 - Craig indicated this has the appearance of cellulitis.
133338 -
133339 -        [...below, attending physician, Doctor Overfeld, diagnoses
133340 -        cellulitis; treatment with antibiotics. ref SDS 0 V759
133342 -  ..
133343 - Previously, on 041202 Millie was diagnosed with cellulitis as a
133344 - reaction to an antibiotic prescribed on 041130 to treat the punch
133345 - biopsy that failed to heal on the left breast. ref SDS 1 415Y
133346 -
133347 -        [On 061101 after treatment for cellulitis, patient released
133348 -        from hospital with contiuing antibiotics treatment for 10 days.
133349 -        ref SDS 17 JR9N
133351 -         ..
133352 -        [On 061110 cellulitis treatment with antibiotics ends;
133353 -        examination by primary care physician indicates recovery
133354 -        satisfactory. ref SDS 18 MW8J
133356 -         ..
133357 -        [On 061112 patient relapses, ref SDS 19 HP52, examined by
133358 -        Doctor Seier at Internal Medicine Clinic, Kaiser in Walnut
133359 -        Creek. ref SDS 19 FP67
133361 -         ..
133362 -        [On 061203 patient relapses, ref SDS 20 MF9H, very slight
133363 -        temperature; notify primary care physician. ref SDS 20 5X3N
133364 -
133365 -
133366 -
133368 -  ..
1334 -
1335 -
1336 - 1748
1337 -
133701 - Blood Draw Evaluate Symptoms
133702 -
133703 - Follow up ref SDS 10 YS6O.
133704 -
133705 - Cellia taking blood again, who worked with Millie previously on
133706 - 060607. ref SDS 10 YS6O  She completed registration documentation.
133708 -  ..
133709 - Millie provided a urine specimin.
133711 -  ..
133712 - Cellia returned Millie's Kaiser Membership card, taken initially by
133713 - Nichole, per above. ref SDS 0 HG9O
133714 -
133715 -
133716 -
133717 -
1338 -

SUBJECTS
ER Staff Busy Difficulty Assist Cancer Patient Rising Symptoms Medic

2503 -
2504 - 1800
250501 -  ..
250502 - ER Staff Busy Difficulty Assisting Cancer Patient Rising Symptoms
250503 -
250504 - Waiting to be admitted for treatment.
250505 -
250506 - Millie was very tired.  After about 20 minutes, someone came into the
250507 - waiting room and made a general announcement.  He identified himself
250508 - as the lead nurse for the Emergency Room.  He said that the Emergency
250509 - Room Department has 20 or so rooms for treating patients, and they are
250510 - all being used.  There is a full complement of doctors and staff
250511 - working at this time.  He said there are about 10 more people who need
250512 - rooms and attention.  As patients are released from the Emergency
250513 - Room, more patients can be seen by a doctor.  Patients will seen based
250514 - on seriousness of problems.
250516 -  ..
250517 - The nurse asked for questions.
250519 -  ..
250520 - Asked about Millie taking her chemotherapy medication for cancer,
250521 - which requires eating food.  She also has to take Coumadin for
250522 - pulmonary emboli.  Eating conflicts with notice posted on the wall in
250523 - the waiting room that says patients should not eat or drink anything
250524 - until after they are examined by a doctor.
250526 -  ..
250527 - The nurse asked when Millie normally eats and takes her chemotherapy
250528 - treatments?
250530 -  ..
250531 - Explained that the regular schedule is 0600 in the morning, and 1800,
250532 - every 12 hours, so she is a little behind schedule now.
250534 -  ..
250535 - The nurse will investigate about Millie complying with cancer
250536 - treatment protocol or holding off until she is seen by a doctor.  The
250537 - nurse appreciates that the length of time before Millie is seen by a
250538 - doctor could be 20 minutes, or 2 - 3 hours, presenting a problem of
250539 - balancing priorities.
250540 -
250541 -
250542 -
250543 -
250544 -
250546 -  ..
2506 -
2507 -
2508 - 1818
2509 -
250901 - Payment Efficient Thorough Staff Not Too Busy to Attend Patient
250902 -
250903 - An administrator came into the Waiting area and asked Millie for a
250904 - credit card to pay for the examination and treatment today by the
250905 - Emergency Room team.
250907 -  ..
250908 - Millie gave her a credit card.
250910 -  ..
250911 - Asked again about Millie eating and taking her cancer treatment, and
250912 - Coumadin for pulmonary emboli, per above. ref SDS 0 ZO6F
250914 -  ..
250915 - When the attendant returned with Millie's credit card and to get her
250916 - signature paying for the work today, she said that the doctor in the
250917 - Triage department was asked about Millie taking her chemotherapy
250918 - treatment for cancer, and Coumadin for pulmonary emboli, and was told
250919 - this would be investigated, and the patient would be advised of
250920 - Kaiser's recommentations.
250921 -
250922 -
250924 -  ..
2510 -
2511 -
2512 - 1825
2513 -
251301 - Immediate Assistance Emergency Care Patient Resting on Gurney
251302 -
251303 - Mil is falling asleep in her chair.  Does not look well.  Her elbow
251304 - slipped from the chair arm and she came alert.  Millie asked for a
251305 - blanket so she could lie down on the floor.  This indicated she is
251306 - becoming a bit disoriented.  Discussed hanging in there for a few more
251307 - minutes while help is rounded up.
251309 -  ..
251310 - Talked to a nursing attendant in the room across the hall where Cellia
251311 - does the blood draws.  She will get a gurney for Millie to lie down,
251312 - and some blankets to make her comfortable.
251313 -
251314 -
251316 -  ..
2514 -
2515 -
2516 - 1849
2517 -
251701 - Still no gurney, and the attendant is not around.
251702 -
251703 - Talked to Dave Joveliette (spelling).  He was at the workstation just
251704 - outside the Waiting room in the hallway.  There were a lot of people,
251705 - staff, doctors talking to him, and he was filling out documents and
251706 - giving instructions.  When there was a moment available, mentioned
251707 - that we still need a gurney for Millie to lie down.  The attendant
251708 - working the problem seems to have been assigned another task.
251710 -  ..
251711 - Dave got a gurney and assisted Millie to lie down, and got her
251712 - covered up.  She was wheeled into the Green hallway, and positioned
251713 - under a marker E, around the corner from the entrance to the Waiting
251714 - room.
251716 -  ..
251717 - There are a lot of patients on gurneys in the hallways waiting for
251718 - treatment.  This explains why there were so few people in the waiting
251719 - room.
251720 -
251721 -
251722 -
251724 -  ..
2518 -
2519 -
2520 - 1855
2521 -
252101 - Saw Doctor Katz in the hallway outside the Waiting room.  He had done
252102 - the initial work in the Triage Department admitting Millie for
252103 - examination, per above. ref SDS 0 HG6F
252105 -  ..
252106 - The Doctor remembered being asked by the payment attendent, per above,
252107 - ref SDS 0 0376, about Millie eating and taking her medication.  He
252108 - apologized for not yet having time to follow up.
252110 -  ..
252111 - Doctor Katz feels Millie should delay eating and taking medications
252112 - until results on her blood work are available.  He said that if WBC is
252113 - very low, then she should not take chemotherapy.
252115 -  ..
252116 - This has been true for Taxotere and othr drip treatments.  Millie has
252117 - never been tested for blood counts in connection with taking
252118 - capecitabine (Xeloda).
252119 -
252120 -
252121 -
252123 -  ..
2522 -
2523 -
2524 - 1935
2525 -
252501 - Still waiting in the hallway with Millie to get a room.
252502 -
252503 - She did not look well, but was sleeping.
252505 -  ..
252506 - Checked her forhead.  She seemed very hot.
252508 -  ..
252509 - Discussed with Doctor Katz when he walked by the next time Kaiser
252510 - policy on monitoring patients with rising temperature and waiting for
252511 - treatment.  The doctor said that in this case of prolonged wait,
252512 - someone should check to see if Millie's temperature is spiking
252513 - dangerously high.  Doctor Katz apologized for not following up; he
252514 - said things have been hectic this shift.
252516 -  ..
252517 - About this time Audra, who later treated Millie in the examination
252518 - room, per below, ref SDS 0 ZP43, was walking by in the hallway.
252519 - Doctor Katz asked Audra to have someone check Millie's temperature.
252520 - Audra asked another nurse, who was walking by in the other direction
252521 - to get the equipment and take Mil's temperature.
252523 -  ..
252524 - The nurse came back about 10 minutes later and took Millie's
252525 - temperature.  It has ticked up but not a lot to 102.9, ref SDS 0 Q265,
252526 - so felt better about continuing to wait for Millie to get examined and
252527 - treated.
252528 -
252529 -
252530 -
252532 -  ..
2526 -
2527 -
2528 - 2010
2529 -
252901 - Nurse came and moved Millie into a treatment room.
252902 -
252903 - Alex introduced himself as Millie's lead nurse.
252905 -  ..
252906 - Doctor Overfeld came in and examined Millie.  We reviewed patient
252907 - history, confirming the doctor's understanding from Kaiser's medical
252908 - chart on the computer, main issues...
252909 -
252910 -            1.  Secondary IBC relapse treatment post mastectomy
252911 -                surgery.
252913 -                 ..
252914 -            2.  Treatment for IBC Taxotere and Xeloda, beginning on
252915 -                060721, and most recent cycle began on 061020; Millie
252916 -                begins her 2nd week of capecitiabine (Xeloda) for this
252917 -                current cycle.
252919 -                 ..
252920 -            3.  Patient treated for pneumonia in ER on 060607.
252922 -                 ..
252923 -            4.  Patient has lymphedima on left arm, post mastectomy
252924 -                surgery; and presents with complications, temperature
252925 -                102.4 and rising, ref SDS 0 ZP7M, possibly cellulitis,
252926 -                with severe red rash and swelling of left arm.
252928 -  ..
252929 - The doctor initially noted that Millie's white blood cells and other
252930 - blood tests are good, so she can go ahead and take her treatment of
252931 - capecitabine (Xeloda) for cancer, and her treatment of Coumadin for
252932 - pulmonary emboli.
252934 -  ..
252935 - The doctor feels Millie has cellulitis.  He prescribed a long list of
252936 - antibiotics for treatment.
252938 -  ..
252939 - He will order food for Millie, because she needs to eat before taking
252940 - her medicines.
252941 -
252942 -
252944 -  ..
252945 - Port Catheter IV Kaiser Training with Millie Sample Patient
252946 -
252947 - Audra and Elza came in and connected an IV to Millie's port.  They
252948 - drew blood for more tests.  Previously, on 060607, the 2nd set of
252949 - blood tests is for quality control, ref SDS 10 LN9P, that cross checks
252950 - the initial blood draw by Cellia, per above. ref SDS 0 028C
252952 -  ..
252953 - Audra was new using the port catheter.  She was training Elza.
252955 -  ..
252956 - A task that normally takes a few minutes performed by staff assigned
252957 - to the Infusion Clinic, illustrated by the record on 061020,
252958 - ref SDS 13 P66O, took Audra and Elza at least 20 minutes.  Audra
252959 - explained each step, and had Elza doing various tasks, e.g., holding
252960 - clips, changing position, then starting over.  Fortunately, the actual
252961 - step of inserting the needle was done correctly in a single step.
252962 - Overall this was good training session for Elza.
252963 -
252964 -     [On 061029 problem with port; connection had to be changed.
252965 -     ref SDS 16 FN4O
252967 -  ..
252968 - An IV was started with Saline that helps bring down the temperature.
252970 -  ..
252971 - This aligns with prior work in the ER on 060607. ref SDS 10 K645
252972 -
252973 -
252974 -
252975 -
2530 -

SUBJECTS
Cellulitis Lymphedema Complications 102+ Temperature Severe Red Rash

3203 -
3204 - 2020
320501 -  ..
320502 - Cellulitis Diagnosed Left Arm Trauma from Fall Breaking Finger
320503 -
320504 - Doctor Overfeld confirmed initial impression by Craig, per above.
320505 - ref SDS 0 WO6N  He feels the rash on Millie's arm is cellulitis, that
320506 - can be treated with antibiotics, ref SDS 1 4256, which was successful
320507 - on 041202, allowing Millie to be released from the hospital the same
320508 - day. ref SDS 1 MW5L
320510 -  ..
320511 - The doctor does not want to release Millie this time until the rash
320512 - that envelopes her entire left arm subsides substantially.
320513 -
320514 -        [On 061101 after treatment for cellulitis, patient released
320515 -        from hospital with contiuing antibiotics treatment for 10 days.
320516 -        ref SDS 17 JR9N
320518 -         ..
320519 -        [On 061110 cellulitis treatment with antibiotics ends;
320520 -        examination by primary care physician indicates recovery
320521 -        satisfactory. ref SDS 18 MW8J
320523 -         ..
320524 -        [On 061112 patient relapses, ref SDS 19 HP52, examined by
320525 -        Doctor Seier at Internal Medicine Clinic, Kaiser in Walnut
320526 -        Creek. ref SDS 19 FP67
320528 -         ..
320529 -        [On 061203 patient relapses, ref SDS 20 MF9H, very slight
320530 -        temperature; notify primary care physician. ref SDS 20 5X3N
320532 -  ..
320533 - The doctor ordered an xray to test for pneumonia, which occurred
320534 - previously on 060607. ref SDS 10 PT7S
320535 -
320536 -
320538 -  ..
3206 -
3207 -
3208 - 2027
3209 -
320901 - Portable xray machine was wheeled into Millie's room, and the
320902 - technician took an xray.
320904 -  ..
320905 - Checked with Doctor Overfeld about dinner for Millie, so that she can
320906 - take her medications for cancer and pulmonary embolims, per discussion
320907 - earlier today, per above. ref SDS 0 ZO6F
320909 -  ..
320910 - The doctor was at a workstation using the computer in the Control
320911 - Center.  The doctor asked more questions about Millie's patient
320912 - history.
320914 -  ..
320915 - Blood cultures were ordered by Doctor Overfeld to aid diagnosis.
320917 -  ..
320918 - Doctor Overfeld feels that Millie's fall, which broke her finger on
320919 - the left hand, and occurred on 060914, ref SDS 11 ZQ5I, introduced
320920 - trauma that gradually increased, then suddently exploded with
320921 - complications of lymphedema in her left arm, because the lymphatic
320922 - system was diminished by surgery on 020312, and more recently with
320923 - mastectomy surgery on 051021. ref SDS 9 QU5I  Doctor Overfeld
320924 - indicated these conditions can cause Cellulitis, resulting in the
320925 - exaggerated swelling and red rash observed today. ref SDS 0 WO6N
320926 -
320927 -     [...Doctor Jain confirms Cellulitis likely due to loss of
320928 -     lymphatics from mastectomy surgery. ref SDS 0 714I
320930 -      ..
320931 -     [On 061112 Millie treated on exigent examination of cellulitis
320932 -     relapse; Doctor Seier found Doctor Overfeld's report on Kaiser's
320933 -     computer to review patient history on diagnosis and treatment.
320934 -     ref SDS 19 XS5J
320936 -      ..
320937 -     [On 061203 patient relapses, ref SDS 20 MF9H, very slight
320938 -     temperature; notify primary care physician. ref SDS 20 5X3N
320940 -  ..
320941 - The doctor then walked to another attendant and asked that someone get
320942 - dinner for Millie.
320943 -
320944 -
320946 -  ..
3210 -
3211 -
3212 - 2047
3213 -
321301 - Dinner arrived for Millie.  They served chicken and mixed vegetables,
321302 - with a green salad.  Millie ate some of everything.  She had not
321303 - eaten since breakfast this morning.
321305 -  ..
321306 - She finally took her pills for chemotherapy to treat cancer, and
321307 - Coumadin for pulmonary emboli.
321309 -  ..
321310 - Doctor Overfeld had said the hospital would provide these medications,
321311 - but later found out they are not readily available in the Emergency
321312 - Room Department, so since Millie had brought her pills, she used that
321313 - supply.
321314 -
321315 -
321316 -
321317 -
3214 -

SUBJECTS
Admitted Oncology Ward Kaiser Hospital 3 Central Jain Doctor Meeting

4703 -
4704 - 2105
470501 -  ..
470502 - Cellulitis Mastectomy Removed Lymphatics Reaction Finger Injury
470503 - Oncology Ward 3 Central Millie Admitted to Hospital for Treatment
470504 -
470505 - Doctor Jain came into Millie's ER room.  She had reviewed Millie's
470506 - chart and decided to admit her into the hospital for continuing
470507 - treatment.
470509 -  ..
470510 - She seemed to indicate that IV anbitiotic treatment, started earlier,
470511 - ref SDS 0 KZ49, has reduced Millie's temperature to normal.
470513 -  ..
470514 - Since Millie is a stage IV cancer patient, she will be admitted into
470515 - the oncology ward, formally called...
470516 -
470517 -                           3 Central
470518 -
470520 -  ..
470521 - Cellulitis Lymphedema Side Effects Mastectomy Surgery 051021
470522 - Due Diligence Mastectomy Surgery Warn Side Effects Cellulitis
470523 - Mastectomy Surgery What Can Wrong Lymphedema Cellulitis Side Effects
470524 -
470525 - The doctor seemed to indicate that severe Cellulitis in the left arm
470526 - diagnosed by Doctor Overfeld, per above, ref SDS 0 V65J, and which
470527 - rapidly advanced today, also, per above, ref SDS 0 WO6N, is a
470528 - complication of lymphedema reacting to a lymphatic system that was
470529 - severely diminished by left breast mastectomy surgery on 051021,
470530 - ref SDS 9 E74F, and now fighting to recover from the broken finger
470531 - Millie suffered on 060914, also, noted by Doctor Overfeld. ref SDS 0
470532 - V759
470533 -
470534 -    [On 061112 Millie treated on exigent examination of cellulitis
470535 -    relapse; Doctor Seier could not find on Kaiser's computer results
470536 -    of this examination today for patient history on diagnosis and
470537 -    treatment. ref SDS 19 XS5J
470539 -     ..
470540 -    [On 070607 Cellulitis and lymphedema recurrence again, Millie
470541 -    treated at UCSF after treatment for cancer, ref SDS 23 ZH6I, Millie
470542 -    suffers significant emotional stress. ref SDS 23 R46O
470544 -  ..
470545 - Lymphedema and Cellulitis caused by routine use of left arm and minor
470546 - injury that arise regularly in daily life, e.g., bruise, sprain from a
470547 - fall at BART, were not presented as risks of what can go wrong from
470548 - side effects with mastectomy surgery, during meeting with the surgeon
470549 - on 050923. ref SDS 3 G49M  This was not presented during the earlier
470550 - meeting at Kaiser on 050913, ref SDS 2 5T4J, nor later on 051007.
470551 - ref SDS 5 P64J  On 051019 considered submitting a letter asking Kaiser
470552 - to perform due diligence by taking a "Time Out," ref SDS 8 DY6Q, to
470553 - address questions proposed in the Kaiser's Healthwise Handbook to
470554 - assess risks of surgery, i.e., What can go wrong? ref SDS 8 HX5N  For
470555 - some reason this letter was never sent, and so Kaiser never had a
470556 - chance to perform due diligence.
470557 -
470558 -
470560 -  ..
470561 - Swelled Lymphatics Fine Lines from IBC to Left Shoulder
470562 - Cellulitis Lymphatics Red Lines from IBC Left Chest to Left Shoulder
470563 - Left Breast Areas Fine Red Lines Extending to Left Shoulder Cellulitis
470564 -
470565 - Doctor Jain examined Millie's left arm.  She lowered the gown on her
470566 - left shoulder.  There are clear, prominent fine red or pink lines of
470567 - swelled lymphatics from the rash and swelling near the top of the
470568 - shoulder and down the arm, to the rash area on the left breast.  This
470569 - evident linkage suggests possible causal relationship in several
470570 - ways...
470572 -               ..
470573 -              [On 061203 Cellulitis relapses left arm, similar fine
470574 -              lines from IBC left chest running to left shoulder.
470575 -              ref SDS 20 RS6O
470576 -
470577 -        1.  If the rash on the left arm is cellulitis then possibly
470578 -            the rash on the left breast in not IBC, but is cellulitis.
470580 -             ..
470581 -        2.  If the rash on the left breast is IBC, then possibly the
470582 -            rash on the arm is IBC, and not cellulitis.
470584 -  ..
470585 - Possibly IBC rash on the left breast can drive lymphedema in the left
470586 - arm into complications fo cellulitis.
470587 -
470588 -            [On 070222 Cellulitis diagnosed on left arm spread from
470589 -            left chest, significant progression of disease. ref SDS 22
470590 -            1R4V
470592 -  ..
470593 - It seems very unlikely that the rash in the left arm is IBC, because
470594 - treatment with antibiotics clears the rash in the arm, but not on the
470595 - left chest.
470597 -  ..
470598 - If the rash on the left breast turns out to be Cellulitis, this would
470599 - not necessarily be a good condition for Millie, because it would mean
470600 - that cancer elsewhere is driving up the CA 15-3 cancer marker, but is
470601 - still too small for recognition by image testing.  This has potential
470602 - for widespread problems, rather the current diagnosis of localized
470603 - cancer to treat.
470605 -  ..
470606 - If the rash on the left breast is Cellulitis, this would explain slow
470607 - response to chemotherapy treatment.  Another cause of slow response to
470608 - treatment could be the mastectomy surgery that removed blood vessels
470609 - that enable normal healing by bringing chemotherapy drugs to the skin
470610 - tissue, reported on 050928, ref SDS 4 248I, and was cited again by
470611 - Doctor Bailey on 051011. ref SDS 6 G65S  The next day, on 051012 a
470612 - letter was drafted to assist with Kaiser's "Time Out" requirements for
470613 - due diligence verifying that surgery is the best course of treatment.
470614 - ref SDS 7 IC37
470616 -  ..
470617 - Doctor Jain plans to biopsy the left arm to establish pathology of
470618 - the disease.
470620 -  ..
470621 - Should also biopsy the right breast at the same time.  Maybe this can
470622 - be a skin scraping rather than a punch technique.
470624 -  ..
470625 - The doctor further plans to perform a sonar test of some kind that
470626 - will further determine pathology.
470627 -
470628 -
470629 -
4707 -

SUBJECTS
Bladder Infection Diagnosed Treated Kaiser Emergency Room Antibiotic

5003 -
500401 -  ..
500402 - Bladder Infection Diagnosed Treated Antibiotics
500403 -
500404 - Doctor Jain advised that the urinary specimen shows a bladder
500405 - infection.  The doctor will treat this with antibiotics as well.
500406 -
500407 -     [On 061029 testing indicates that antibiotics has cleared the
500408 -     urinary infection found today. ref SDS 16 WX3J
500410 -  ..
500411 - Mil advised that she has not had any pain urinating, which is a common
500412 - symptom of urinary infection.  She has had trouble the past week or so
500413 - feeling an urge to urinate, and nothing coming out.
500415 -  ..
500416 - Doctor Jain said this is a less common symptom of uninary infection,
500417 - and that in Millie's condition of stage IV cancer patient, she should
500418 - notify her primary care physician for examination and treatment when
500419 - these small problems first occur.
500421 -  ..
500422 - Thus, Millie seems to have a compound condition today.
500423 -
500424 -        1.  Urinary infection.
500425 -
500426 -        2.  Swelled and rash enveloped left arm, likely cellulitis,
500427 -            possibly due to broken finger 6 weeks ago, or possibly
500428 -            spread of IBC from the area on the left breast.
500429 -
500430 -
500432 -  ..
5005 -
5006 -
5007 - 2232
5008 -
500801 - Left the hospital with Millie waiting to get a room.  She was asleep.
500802 -
500803 -        [On 061028 Millie admission to hospital delayed until patients
500804 -        discharged. ref SDS 15 HP52
500805 -
500806 -
500807 -
500808 -
500809 -
500810 -
500811 -
500812 -
500813 -
5009 -