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SUBJECTS
Cellulitus Relapse Left Arm Swollen Warm to Touch Inflammation Begin

0903 -
0903 -    ..
0904 - Summary/Objective
0905 -
090501 - Follow up ref SDS 14 0000. ref SDS 13 0000.
090502 -
090503 - Cellulitus complications of lymphedema symptoms relapsed this morning.
090504 - Fortunately no temperature. ref SDS 0 HP52  Called Kaiser and
090505 - explained background. ref SDS 0 PP5V  Met with Doctor Serier in the
090506 - Adult (Internal) Medicine Clinic. ref SDS 0 N24J  Prescription for
090507 - antibiotics was renewed. ref SDS 0 BX4G  Millie resumed treatment, by
090508 - late afternoon, and into the evening symptoms seem to subside.
090509 - ref SDS 0 PRRU
090510 -
090511 -    [On 061116 letter to Kaiser reports Cellulitus inflammation reduced
090512 -    and controlled with medication. ref SDS 17 MD5X
090514 -     ..
090515 -    [On 061203 patient relapses, ref SDS 18 MF9H, very slight
090516 -    temperature; notify primary care physician. ref SDS 18 5X3N
090517 -
090518 -
090519 -
090520 -
090522 -  ..
0906 -
0907 -
0908 - Progress
0909 -
090901 - This morning at 0815a, Millie's left arm measured below the elbow was
090902 - about 10.75 inches, which is marked improvmement compared to the past
090903 - week or so.
090905 -  ..
090906 - Later, undressing to take a shower, Millie noticed her upper left arm
090907 - is warm to the touch.  Examination shows inflammation has increased
090908 - again, indicating symptoms of cellulitus diagnosed on 061027.
090909 - ref SDS 9 WO6N
090911 -  ..
090912 - At this time she does not have a temperature.
090914 -  ..
090915 - The arm below the elbow now measures about 11.25 inches tracking rise
090916 - of cellulitus symptoms.
090917 -
090918 -    [On 061116 letter to Kaiser reports Cellulitus inflammation reduced
090919 -    and controlled with medication. ref SDS 17 MD5X
090920 -
090921 -    [On 061203 patient relapses, ref SDS 18 MF9H, very slight
090922 -    temperature; notify primary care physician. ref SDS 18 5X3N
090923 -
090924 -
090926 -  ..
0910 -
0911 -
0912 - 1010
0913 -
091301 - Called Kaiser advice nurse in Oncology.
091302 -
091303 -                      925 295 4030
091305 -  ..
091306 - Message said to call general number...
091307 -
091308 -                      925 295 4070
091310 -  ..
091311 - After many calls and buttons, finally...
091312 -
091314 -  ..
0914 -
0915 -
0916 - 1019
0917 -
091701 - Talked to Elizabeth.
091702 -
091703 -                   925 372 1999
091705 -  ..
091706 - She recorded the call and patient number.
091708 -  ..
091709 - Explained background and asked about getting refill on antibiotic
091710 - prescription for cellulitus ordered on 061101 by Doctor John Kim, when
091711 - Millie was discharged from the Central (ontology) section of the
091712 - hospital for treatment of cellulitus. ref SDS 14 JR9N
091714 -  ..
091715 - Judy transferred the call to an advice nurse.
091716 -
091718 -  ..
0918 -
0919 -
0920 - 1023
0921 -
092101 - Talked to advice nurse...
092102 -
092103 -        Judy Rolls
092105 -  ..
092106 - Explained background.
092107 -
092108 -        Cancer patient 5 years currently
092109 -        on chemotherapy; hospitialized for
092110 -        cellulitus and temperature
092111 -        102.6................................ 061027, ref SDS 9 V759
092113 -         ..
092114 -        Treated antibiotics, inflammation
092115 -        cleared; patient released from
092116 -        hospital with prescription to
092117 -        continue treatment with
092118 -        antibiotics for
092119 -        10 days.............................. 061101, ref SDS 14 JR9N
092121 -         ..
092122 -        Antibiotics treatment for cellulitus
092123 -        completed on 061110.................. 061110, ref SDS 15 A69K
092125 -  ..
092126 - Condition now seems to be relapsing. ref SDS 0 HP52  Patient history
092127 - shows severity of this condition can increase rapidly, reported on
092128 - 061027. ref SDS 9 WO6N  Therefore, patient requires review and
092129 - consideration of prescribing antibiotics again.
092130 -
092131 -        [On 061116 letter to Kaiser reports Cellulitus inflammation
092132 -        reduced and controlled with medication. ref SDS 17 MD5X
092134 -         ..
092135 -        [On 061203 patient relapses, ref SDS 18 MF9H, very slight
092136 -        temperature; notify primary care physician. ref SDS 18 5X3N
092138 -  ..
092139 - Judy proposed scheduling a meeting today with a doctor to evaluate
092140 - the condition, and prescribe refill of antibiotics treatment.
092142 -  ..
092143 - She schedued the following...
092145 -       ..
092146 -      Internal Medicine Adult Medicine
092148 -       ..
092149 -      Doctor Seier, Sandra
092151 -       ..
092152 -      1130
092153 -
092155 -  ..
0922 -
0923 -
0924 - 1047
0925 -
092501 - Millie and Janna are going shopping.  They will stop by the hosptial
092502 - for the meeting with Doctor Seier at 1130.
092503 -
092504 -
092506 -  ..
0926 -
0927 -
0928 - 1130
0929 -
092901 - Millie at Kaiser for examination and prescription refill.
092902 -
092903 - Doctor Sandra Seier met with Millie and Janna, who is a friend, and an
092904 - experienced surgical nurse.
092906 -  ..
092907 - The doctor found Doctor Overfeld's report of Millie's treatment for
092908 - cellulitus in the Emergency Room on 061027. ref SDS 9 V759
092910 -  ..
092911 - She found the record of blood cultures that Doctor Overfeld ordered to
092912 - aid diagnosis at that time. ref SDS 9 V77F
092914 -  ..
092915 - Evidently, the doctor could not find reports prepared by other doctors
092916 - who, also, treated Millie for cellulitus....
092917 -
092918 -        Doctor Jain.......................... 061027, ref SDS 9 V78N
092919 -        Doctor Annamaneni.................... 061028, ref SDS 10 Q235
092920 -        Primary care physician............... 061030, ref SDS 12 LU9J
092921 -        Doctor Kim........................... 061030, ref SDS 12 PRSV
092923 -  ..
092924 - This aligns with experience reported on 061020 showing challenges
092925 - relying on computers for patient history to guide case management.
092926 - ref SDS 7 YQ7F  The matter was presented again a few days later during
092927 - discussions with the Coagulation Treatment Clinic. ref SDS 8 TE6M
092928 -
092929 -            [On 061024 case study medical practice computer access
092930 -            limited even with everything on the computer, people can't
092931 -            find details stored in parts of the computer (software
092932 -            modules) that are not frequently used. ref SDS 8 JD9L
092934 -  ..
092935 - Doctor Seier feels the cellulitus has relapsed on Millie's left arm.
092937 -  ..
092938 - Antibiotics prescription was ordered originally by Doctor Kim on
092939 - 061101, ref SDS 14 GX4I, was renewed for another 10 days.
092941 -  ..
092942 - The doctor recommended that Millie be examined by primary care
092943 - physician on Monday, 061113.  She will submit notice to the primary
092944 - care physician on patient history for the examination today.
092946 -  ..
092947 - Millie purchased the antibiotics treatment from the Pharmacy on the
092948 - 2nd floor, adjacent to the Internal Medicine clinic, and began
092949 - treatment.
092950 -
092951 -     [On 061113 cellulitus inflammation has further subsided, and there
092952 -     is no additional swelling, and no temperature. ref SDS 16 MF9H
092954 -      ..
092955 -     [On 061113 notified primary care physician of cellulitus
092956 -     recurrence, that antibiotics treatment was prescribed, and that
092957 -     inflammation has subsided, with no temperature. ref SDS 16 ER66
092959 -      ..
092960 -     [On 061113 primary care physician advised there is no need for
092961 -     examination, since cellulitus seems to be responding to treatment.
092962 -     ref SDS 16 9B3F
092964 -      ..
092965 -     [On 061116 letter to Kaiser reports Cellulitus inflammation
092966 -     reduced and controlled with medication. ref SDS 17 MD5X
092967 -
092968 -
092970 -  ..
0930 -
0931 -
0932 - 1530
0933 -
093301 - Millie and Janna return from shopping.  Millie's arm has improved
093302 - slightly.  She has no temperature, and warmth in the upper arm has not
093303 - increased.
093304 -
093306 -  ..
0934 -
0935 -
0936 - 2241
0937 -
093701 - Millie's arm seems much better than this morning.
093702 -
093703 -        [On 061116 letter to Kaiser reports Cellulitus inflammation
093704 -        reduced and controlled with medication. ref SDS 17 MD5X
093706 -         ..
093707 -        [On 061203 patient relapses, ref SDS 18 MF9H, very slight
093708 -        temperature; notify primary care physician. ref SDS 18 5X3N
093709 -
093710 -
093711 -
093712 -
093713 -
093714 -
093715 -
0938 -