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Cellulitis Relapse Left Arm Swollen Warm to Touch Inflammation Begin

1503 -
1503 -    ..
1504 - Summary/Objective
1505 -
150501 - Follow up ref SDS 27 0000. ref SDS 26 0000.
150502 -
150503 -
150504 -
150505 -
150506 -
150507 -
150509 -  ..
1506 -
1507 -
1508 - Progress
1509 -
150901 - Millie seems to have another relapse of cellulitis.  Her left arm is
150902 - not excessively swollen, but there is rising inflammation engulfing
150903 - the entire arm.  She does not have a temperature at this time, and the
150904 - severity of the rash is less than on 061027. ref SDS 19 WO6N
150906 -  ..
150907 - This could be a reaction to the cat bite on 061114, as reported on
150908 - 061115, ref SDS 28 6T5L, which considered possible complications of
150909 - Cellulitis in the left arm. ref SDS 28 WF9I  Millie's letter to Kaiser
150910 - on 061116 reported no adverse effects at that time, and cited prospect
150911 - of delayed reaction. ref SDS 29 MD6R  On 050212 she had a severe
150912 - reaction to cat bite while on chemotherapy.  She was treated in the
150913 - emergency room, and was hospitalized several days. ref SDS 11 0001
150914 - Since she is again on chemotherapy, there could be a delayed reaction
150915 - to the cat bite, as there was to the broken finger on 060914 that was
150916 - later attributed as the cause of Cellulitis on 061027.
150918 -  ..
150919 - Information on contacting Kasier is listed on 061112.
150920 - ref SDS 26 F66H
150921 -
150922 -           [On 070130 background on causation for Cellulitis and
150923 -           lymphedema beginning with surgery removing lymph nodes left
150924 -           axilla. ref SDS 35 VX6F
150926 -            ..
150927 -           [On 080606 surgeon advises that when lymph nodes are
150928 -           removed, eventually remaining lymphatic system grows more
150929 -           robust and reduces recurrence of lymphedema and Cellulitis
150930 -           from increased exercise. ref SDS 50 4P6L
150931 -
150933 -  ..
150934 - Cellulitis Lymphedema Treatment Keflex
150935 - Background prescribing Keflex to treat Cellulitis...
150936 -
150937 - There is a long history treating Cellulitis with Keflex antibiotics in
150938 - this case....
150939 -
150940 -    1.  Keflex prescribed to treat rash on
150941 -        left breast diagnosed as
150942 -        Cellulitis............................ 030109, ref SDS 1 GK7T
150943 -        rather than IBC, because at that
150944 -        time PET scan test findings of
150945 -        IBC symptoms not
150946 -        recognized............................ 030109, ref SDS 1 7F4N
150948 -         ..
150949 -    2.  Rash on left breast subsides after
150950 -        treatment with Keflex
150951 -        antibiotics........................... 030220, ref SDS 2 0T6N
150953 -         ..
150954 -    3.  Rash occurs again increased intensity;
150955 -        patient requests emergency examination;
150956 -        rash subsides; skin thickening
150957 -        observed; no treatment
150958 -        prescribed............................ 030606, ref SDS 3 7C6W
150960 -         ..
150961 -    4.  Rash distinguishing symptoms of Cellulitis
150962 -        treated with Keflex antibiotics from
150963 -        reaction to radiation treatments for
150964 -        cancer, and further distinguishing
150965 -        from cancer, i.e., IBC, takes a lot
150966 -        of hard work.......................... 030710, ref SDS 4 7C6W
150968 -         ..
150969 -    5.  Rash left breast appears again; Keflex
150970 -        prescribed to treat recurrent Cellulitis
150971 -        and delays starting treatment for
150972 -        breast cancer recurrence on Avastin
150973 -        drug trial............................ 040318, ref SDS 5 IM6J
150975 -         ..
150976 -    6.  Rash increases after treatment with
150977 -        Keflex; diagnosis changed to reaction
150978 -        from radiation; steriods prescribed
150979 -        for treatment......................... 040402, ref SDS 6 IM6J
150981 -         ..
150982 -    7.  Rash reported to have subsided slightly;
150983 -        treatment with steriods ended; patient
150984 -        approved to start treatment for
150985 -        breast cancer on Avastin
150986 -        (bevacizumab) drug
150987 -        trial................................. 040416, ref SDS 7 IM6J
150989 -         ..
150990 -    8.  Patient asks surgeon to examine left
150991 -        breast following procedure to install
150992 -        port catheter; surgeon observes rash,
150993 -        checks Kaiser's computer for patient
150994 -        history, and takes punch biopsy on
150995 -        left breast previously treated
150996 -        with Keflex for
150997 -        Cellulitis............................ 040419, ref SDS 8 789F
150999 -         ..
151000 -    9.  IBC diagnosed from biopsy of rash
151001 -        treated with Keflix for
151002 -        Cellulitis............................ 040517, ref SDS 9 6T5G
151004 -         ..
151005 -   10.  Cellulitis diagnosed on left breast
151006 -        and reaching toward neck.............. 041202, ref SDS 10 415Y
151007 -        diagnosis reaction to antibiotic
151008 -        treatment for IBC sore from punch
151009 -        biopsy on left
151010 -        breast................................ 041202, ref SDS 10 QQ4K
151012 -         ..
151013 -   11.  Cellulitis caused by cat bite treated
151014 -        in emergency department............... 050212, ref SDS 11 0001
151015 -        Millie admitted to hospital for care
151016 -        3 - 4 days............................ 050212, ref SDS 11 Z56V
151018 -         ..
151019 -   12.  Cellulitis diagnosed during treatment
151020 -        in the emergency room for high temperature
151021 -        of cancer patient on
151022 -        chemotherapy.......................... 061027, ref SDS 19 WO6N
151024 -         ..
151025 -   13.  Released from hospital after treatment
151026 -        with Keflex antibiotics completely
151027 -        relieves swelling and
151028 -        inflammation.......................... 061101. ref SDS 24 JR9N
151030 -         ..
151031 -   14.  10 days additional treatment with
151032 -        Keflex antibiotics
151033 -        prescribed............................ 061101, ref SDS 24 GX4I
151035 -         ..
151036 -   15.  Examination shows cellulitus still
151037 -        subsided after another 10 days
151038 -        treatment with
151039 -        Keflex................................ 061110, ref SDS 25 A640
151041 -         ..
151042 -   16.  Cellulitis relapse, call Kaiser to
151043 -        get prescription renewed to continue
151044 -        treatments with Keflex................ 061112, ref SDS 26 FP5O
151046 -         ..
151047 -   17.  Millie's letter notified doctor that
151048 -        Cellulitis relapsed and that she
151049 -        resumed treatments with
151050 -        Keflex................................ 061113, ref SDS 27 MF9H
151052 -         ..
151053 -   18.  Cat bite on 061114, patient history of
151054 -        bad reaction hospitalized in emergency
151055 -        room on 050212, ref SDS 11 0001; Millie's
151056 -        letter notifies Kaiser there is no
151057 -        evident reaction...................... 061116, ref SDS 29 MD6R
151059 -         ..
151060 -   19.  Cellulitis relapse possible reaction
151061 -        to cat bite on 061114................. 061203, ref SDS 0 MF9H
151063 -         ..
151064 -   20.  Keflex prescribed for Cellulitis
151065 -        recurrence; considered deferring
151066 -        treatment............................. 061204, ref SDS 33 ZS5N
151068 -         ..
151069 -   21.  Cellulitis seemed improved in morning
151070 -        then worsened, so Millie went
151071 -        ahead and took Keflex
151072 -        pills................................. 061205, ref SDS 34 MF9H
151074 -         ..
151075 -   22.  Cellulitis and lymphedema case study on
151076 -        causation in Millie's patient
151077 -        history............................... 070130, ref SDS 35 VX6F
151079 -         ..
151080 -   23.  Rash on upper left arm observed by primary
151081 -        care physician during examination at
151082 -        Kaiser after starting treatment on
151083 -        070201 for IBC on clinical
151084 -        study with cetuximab at
151085 -        UCSF.................................. 070202, ref SDS 36 JP6F
151087 -         ..
151088 -   24.  Doctor at Kaiser notified that rash
151089 -        persists; Millie asks about renewing
151090 -        prescription to treat Cellulitis
151091 -        with Keflex........................... 070214, ref SDS 37 R66P
151093 -         ..
151094 -   25.  Kaiser refers Keflex prescription matter
151095 -        to UCSF for coordinated review of treatments
151096 -        under the cetuximab clinical
151097 -        study................................. 070215, ref SDS 38 HK5O
151099 -         ..
151100 -   26.  UCSF notified about rash on left arm
151101 -        and referral by primary care physician
151102 -        at Kaiser to UCSF for coordinated
151103 -        review................................ 070215, ref SDS 38 LK8H
151105 -         ..
151106 -   27.  UCSF approves prescription
151107 -        for Keflex to treat
151108 -        Cellulitis............................ 070215, ref SDS 38 TU4M
151110 -         ..
151111 -   28.  Keflex treatment delayed while patient
151112 -        in transit; UCSF schedules meeting
151113 -        to investigate new rash on
151114 -        left arm.............................. 070216, ref SDS 39 UK5M
151116 -         ..
151117 -   29.  Tennis activity increased rash and
151118 -        swelling on left arm, Millie begins
151119 -        taking Keflex prescribed by
151120 -        UCSF.................................. 070218, ref SDS 40 N069
151122 -         ..
151123 -   30.  Exercise case study correlation causing
151124 -        Cellulitis and lymphedema after surgery
151125 -        removed lymph nodes, reduces
151126 -        capacity lymphatic
151127 -        system................................ 070218, ref SDS 40 3M3J
151129 -         ..
151130 -   31.  Rash on left arm diagnosed as IBC
151131 -        during examination at UCSF without
151132 -        biopsy................................ 070222, ref SDS 41 B64F
151134 -         ..
151135 -   32.  Keflex treatment continues in case rash
151136 -        on left arm presents compound
151137 -        problem of IBC and
151138 -        Cellulitis............................ 070222, ref SDS 41 IS5K
151140 -         ..
151141 -   33.  Keflex antibiotic prescribed by primary
151142 -        care physician at Kaiser to treat sudden
151143 -        increased intensity of rash on upper
151144 -        left arm, previously diagnosed as IBC
151145 -        on 070222, ref SDS 0 VZ3I, and new rash
151146 -        on upper right chest diagnosed as
151147 -        Cellulitis............................ 070330, ref SDS 42 474O
151149 -         ..
151150 -   34.  Keflex not taken because about 6 hours
151151 -        later, rash intensity on upper left arm
151152 -        subsided to prior improved conditions
151153 -        observed the day before at UCSF, and
151154 -        rash on upper right chest completely
151155 -        subsided.............................. 070330, ref SDS 42 KZ6L
151157 -         ..
151158 -   35.  Cellulitis diagnosed during examination
151159 -        to approve treatment for cancer at
151160 -        UCSF; home treatment prescribed with
151161 -        Keflex from prior prescription on
151162 -        070330 which was not
151163 -        used.................................. 070607, ref SDS 43 ZH6I
151165 -         ..
151166 -   36.  Cellulitis worsened and temperature
151167 -        increased during treatment for cancer
151168 -        at UCSF; prescription changed to
151169 -        treatment with IV
151170 -        at UCSF............................... 070607, ref SDS 43 8J37
151172 -         ..
151173 -   37.  Cellulitis treatment IV at UCSF with
151174 -        ceftriaxone IV 2gms................... 070607, ref SDS 43 8J9R
151176 -         ..
151177 -   38.  Cellulitis outpatient IV treatment
151178 -        ordered for 5 days at
151179 -        Kaiser................................ 070607, ref SDS 43 8L46
151181 -         ..
151182 -   39.  Keflex prescribed 80 pills 20 days as
151183 -        precaution to take on vacation in
151184 -        case Cellulitis and lymphedema
151185 -        occurs................................ 070720, ref SDS 44 SS5K
151187 -         ..
151188 -   40.  Cellulitis and lymphedema do not recur
151189 -        during vacation 80 pills for 20 days
151190 -        of Keflex remains on
151191 -        on hand............................... 070920, ref SDS 45 VS8L
151193 -         ..
151194 -   41.  Cellulitis recurrence begin treatment
151195 -        with Keflex left over from prior
151196 -        care; notify medical
151197 -        team.................................. 071214, ref SDS 46 V45J
151199 -         ..
151200 -   42.  Cellulitis recurrence begin treatment
151201 -        Keflex; no temperature; notify
151202 -        medical team.......................... 080304, ref SDS 47 V45J
151204 -         ..
151205 -   43.  Cellulitis recurrence temperature 101.9
151206 -        rapidly advancing rash treatment
151207 -        Kaiser Emergency department because
151208 -        Millie is on chemotherapy............. 080409, ref SDS 48 V45J
151209 -        notify medical
151210 -        team.................................. 080409, ref SDS 48 AP5J
151211 -        released same day for home care
151212 -        14-day treatment Keflex
151213 -        prescribed............................ 080409, ref SDS 48 F142
151215 -         ..
151216 -   44.  Cellulitis recurrence left arm, begins
151217 -        10 day treatment with
151218 -        Keflex................................ 080520, ref SDS 49 OU5J
151219 -
151220 -
151221 -
151222 -
151223 -
151224 -
151226 -  ..
1513 -
1514 -
1515 - 1919
1516 -
151601 - Cellulitis left arm inflammation seems steady; Millie thinks there
151602 - may be some improvement in the last hour.
151603 -
151605 -  ..
1517 -
1518 -
1519 - 1911
1520 -
152001 - She now has a slight temperature 99.2.
152003 -  ..
152004 - She does not feel well.  Millie feels this is worse than normal for
152005 - the 3rd day after chemotherapy treatment on 061201. ref SDS 30 407N
152007 -  ..
152008 - Millie thinks she might have overworked this morning.
152010 -  ..
152011 - She worked on trimming the Christmas tree.  She baked about 12 cup
152012 - cakes.  She did one load of laundry.  This is well below her normal
152013 - activity.  She came upstairs about 1300 and commented about feeling
152014 - very tired.  She was breathing heavily, and face was flushed.
152016 -  ..
152017 - Millie feels that Decadron taken yesterday makes her face flush, and
152018 - may also make her left arm inflammed with a red rash, and swell up.
152020 -  ..
152021 - Millie is also worried that IBC on the left chest is driving
152022 - Cellulitis or whatever it is in the left arm.
152024 -  ..
152025 - There is also possibility that the cat bite to the right hand that
152026 - occurred on 061114, could have had a delayed reaction and has begun to
152027 - impact the left arm with rising cellulitus today, as reviewed during
152028 - the meeting on 061201. ref SDS 32 ZW6M
152030 -  ..
152031 - Examination shows fine red lines running from inflammation in left
152032 - chest area to the top of the left shoulder, and then engulfs the
152033 - entire shoulder and arm, down to the hand.  This is similar to
152034 - examination by Doctor Jaine on 061027 in the Emergency Room.
152035 - ref SDS 19 V79M
152037 -  ..
152038 - The left arm is swelled, but not excessively compared to the ongoing
152039 - lymphedema condition.  The left hand shows no indication of swelling,
152040 - which is a slight improvement compared to normal condition of
152041 - lymphedema.  This may reflect that Millie has been in bed all
152042 - afternoon, and has had the left arm and hand elevated on pillows.
152043 -
152044 -
152046 -  ..
1521 -
1522 -
1523 - 2028
1524 -
152401 - Millie received a letter from the primary care physician at Kaiser
152402 - submitting the doctor's progress notes for the meeting this past
152403 - Friday.  This was entered into the record for patient history on
152404 - 061201. ref SDS 31 D64Q
152405 -
152406 -
152407 -
152409 -  ..
1525 -
1526 -
1527 - 2032
1528 -
152801 - Millie submitted ref DIT 1 0001 to the doctor at Kaiser and saying...
152802 -
152803 -    1.  Thanks for your letter earlier today submitting the record of
152804 -        meeting this past Friday.  Glad we are taking a week or so to
152805 -        develop treatment strategy. ref DIT 1 0001
152807 -         ..
152808 -    2.  This afternoon Cellulitis seems to have flared up again, as
152809 -        shown in the record for today, ref SDS 0 MF9H, including
152810 -        background on prior treatment. ref DIT 1 C854
152812 -         ..
152813 -    3.  Hopefully my temperature will not get any higher. ref DIT 1
152814 -        C860
152816 -         ..
152817 -    4.  If it does, I may wind up in the ER again. ref DIT 1 C863
152819 -         ..
152820 -    5.  Could you please arrange for another prescription of
152821 -        antibiotics for me to pick up first thing tomorrow, and/or call
152822 -        me to advise on a course of action (935 680 8947). ref DIT 1
152823 -        C866
152825 -         ..
152826 -    6.  Sorry to trouble you on the weekend. ref DIT 1 C93R
152827 -
152828 -
152829 -
152831 -  ..
1529 -
1530 -
1531 - 2115
1532 -
153201 - Temperature fell back to 98.8.
153202 -
153203 - Millie seems in better spirits.  Inflammation is steady, but has not
153204 - gotten worse, and swelling seems controlled.
153206 -  ..
153207 - Maybe this is the Decadron, and will wear off naturally??
153208 -
153210 -  ..
1533 -
1534 -
1535 - 2303
1536 -
153601 - Millie is asleep.
153602 -
153603 - Temperature still okay.
153605 -  ..
153606 - Rash seems stable, maybe less intense.
153607 -
153608 -
153609 -
153610 -
153611 -
153612 -
153613 -
153614 -
153615 -
153616 -
1537 -