CONTACTS 

SUBJECTS
Examination Treatment Cetuximab 3rd Treatment 4th Cycle Chemotherapy

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 83 0000. ref SDS 82 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Temperature not taken, seems okay.
040902 -
040903 - This continued no fever status of 98.3 from last night at 2141.
040904 - ref SDS 83 2Q7H
040906 -  ..
040907 - Today will be complete rest, no activities, shopping, working in the
040908 - garden etc.
040910 -  ..
040911 - Has not taken Tylenol since yesterday at 1841. ref SDS 83 PR4Y
040913 -  ..
040914 - Arm looks much better this morning, compared to yesterday morning when
040915 - it had also improved, ref SDS 83 1V7K; and, especially compared to
040916 - yesterday in the afternoon, when it seemed to worsen slightly.
040917 - ref SDS 83 PR4Y
040919 -  ..
040920 - The lower arm is nearly normal now.  The upper arm retains slight
040921 - reddish tinge, with IBC inflammation more prominent now than
040922 - Cellulitis.  The inner upper arm and tricep seem much improved
040923 - compared to yesterday.
040925 -  ..
040926 - While making breakfast, discussed not opening lids on jars, and things
040927 - that are tight, because this increases tension on the left arm, which
040928 - is evidently sensitive to exertion, reported in the record on 070607
040929 - at UCSF. ref SDS 81 ZH6I
040931 -  ..
040932 - Millie looks a little ill at ease this morning.  She does not feel
040933 - well.
040935 -  ..
040936 - Today there is no treatment, per planning at Kaiser on Friday, 070608.
040937 - ref SDS 82 AL39
040939 -  ..
040940 - Millie reading and watching television.
040941 -
040942 -
040943 -
040945 -  ..
0410 -
0411 -
0412 - 1051
0413 -
041301 - Temperature 97.8.
041302 -
041303 - Feeling tired.
041305 -  ..
041306 - Arm still looks improved; has not worsened.
041308 -  ..
041309 - Millie has 3 cold sores on her upper lip.  This may be reaction to
041310 - cetuximab treatments, or from antibiotic treatment for Cellulitis, or
041311 - simply from general weakness recovering from Cellulitis, possibly
041312 - nerves, shown by elevated pulse on 070607. ref SDS 81 AW4L
041313 -
041314 -        [On 070611 Millie reported cold sore problem to primary care
041315 -        physician. ref SDS 85 GJ5J
041317 -         ..
041318 -        [On 070611 Millie reported cold sore problem to UCSF and asks
041319 -        if this is reaction to cetuximab, to treatment for Cellulitis,
041320 -        or as aspect of Cellulitis, or something else. ref SDS 85 JP3O
041321 -
041322 -
041323 -
041324 -
041326 -  ..
0414 -
0415 -
0416 - 1238
0417 -
041701 - Lunch yogart and pineapple.
041702 -
041703 - Drinking cold liquids.
041705 -  ..
041706 - Watching television.
041707 -
041708 -
041709 -
0418 -

SUBJECTS
Kaiser UCSF Coordinating Referral Channels Now Open Communication Ef

2103 -
2104 - 1318
210501 -  ..
210502 - Kaiser UCSF Coordinating on Referral with Open Communication Channels
210503 -
210504 -
210505 - Millie received several letters from the primary care physician...
210506 -
210507 -        Subject:  Coordination UCSF Addition
210509 -         ..
210510 -        Date:  June 10, 2007 1214
210512 -         ..
210513 -        She had left me a message and her pager number and also FAX
210514 -        the culture reports.
210516 -  ..
210517 - Culture reports are from testing performed at UCSF on 070608 to assess
210518 - Millie's advancing condition of Cellulitis. ref SDS 81 8J51
210519 -
210520 -            [On 070611 Millie requests copy of report on results of the
210521 -            blood culture from UCSF. ref SDS 85 JP3G
210523 -  ..
210524 - This letter indicates Kaiser and UCSF are communicating to coordinate
210525 - referral issues, following Brigid's request on 060708 for contact
210526 - information at Kaiser, ref SDS 82 035H, and Millie's notification to
210527 - the primary care physician at Kaiser later on 070608. ref SDS 82 6Q7L
210528 -
210530 -     ..
210531 -    Doctor Getting Enough Information from Patient
210532 -    Kaiser Indicates IV Treatment Completed Start Oral Antibiotics
210533 -    Communication Channels Now Open Between Kaiser and UCSF on Referral
210534 -
210535 -
210536 - Another letter from the doctor says...
210537 -
210538 -        Subject:  Kaiser's Email Record
210540 -         ..
210541 -        Date:  June 10, 2007 1219
210543 -         ..
210544 -        No, I don't need more information and I believe the right
210545 -        channels for communication are now open. I hope your IV
210546 -        infusion went well and that you are now back on oral
210547 -        antibiotics.
210548 -
210549 -            [On 070611 Millie requested clarification of treatment for
210550 -            Cellulitis from primary care physician at Kaiser.
210551 -            ref SDS 85 OG7F
210553 -             ..
210554 -            [On 070612 primary care physician at Kaiser clarifies
210555 -            treatment plan to start Keflex oral antibiotics after
210556 -            completing IV medications. ref SDS 86 QE4M
210558 -  ..
210559 - This responds to Millie's letter on 070608 following up Arlette's
210560 - request to send email to the doctor. ref SDS 82 6S8K  Today, the
210561 - doctor indicates he has been getting enough information from the
210562 - patient.
210564 -  ..
210565 - Good to hear communication channels are established with UCSF for
210566 - referral case management.  Requirements for coordination between UCSF
210567 - and Kaiser were considered during the meeting with Doctor Rugo at UCSF
210568 - on 070130. ref SDS 36 RM4G  On 070222 Jackie talked about a
210569 - coordination plan. ref SDS 43 VK5N  At that time on 070222, scope for
210570 - coordination planning on referrals was listed. ref SDS 43 KL5G  A few
210571 - weeks later, Brigid discussed patient support for coordination.
210572 - ref SDS 46 O67N  On 070516 communication problems surfaced when Kaiser
210573 - reported cancer marker CA 15-3 from a recent blood test was "stable,"
210574 - which conflicted with more recent tests at UCSF. ref SDS 79 RH9H  A
210575 - week later, on 070524 emotional stress from sudden rise of cancer
210576 - marker was compounded when UCSF and Kaiser could not coordinate,
210577 - verify and reconcile differences in lab test results. ref SDS 80 X74O
210578 - The report today that the right communication channels are now in
210579 - place brings relief.
210580 -
210581 -        [On 080305 Doctor reports was unable to access and send
210582 -        communciation to UCSF on case managemet for Millie. ref SDS 87
210583 -        PZ6K
210585 -         ..
210586 -        [On 080305 Medical Chart at Kaiser still shows blood tests on
210587 -        071017 are most recent data for trend analysis, which omits 6
210588 -        months of test data at UCSF. ref SDS 87 417N
210590 -         ..
210591 -        [On 080306 during the meeting at UCSF, the medical team
210592 -        disclosed that UCSF management has mandated using a UCSF email
210593 -        channel for secure communication, rather than provide timely,
210594 -        accurate communication requested by the patient. ref SDS 88
210595 -        JT66
210597 -         ..
210598 -        [On 080403 UCSF reports that coordination referral with Kaiser
210599 -        takes a long time. ref SDS 89 IM87
210601 -         ..
210602 -        [On 080404 UCSF reports continuing difficulty communicating
210603 -        quickly and accurately to coordinate referral work with Kaiser
210604 -        ordering medications for Millie. ref SDS 90 OP69
210606 -         ..
210607 -        [On 080409 Millie treated in Kaiser Emergency Care
210608 -        Department for recurrent Cellulitis; nurse reports blood
210609 -        tests stable compared to prior testing in October 2007,
210610 -        which was incorrect, because Kaiser's computer omits test
210611 -        results performed for 6 months at UCSF on referral from
210612 -        Kaiser. ref SDS 91 439L
210614 -         ..
210615 -        [On 090213 1140 Doctor Johnson explains good communications
210616 -        integrate Kaiser's experience and team care with UCSF research
210617 -        and system of comprehensive care to optimize collaboration
210618 -        treating Millie for stage IV IBC. ref SDS 92 685I
210620 -  ..
210621 - The doctor's comment that Millie is "now back on oral antibiotics"
210622 - evidently refers to Keflex, which was initially prescribed by Doctor
210623 - Rugo at UCSF on on 070607, ref SDS 81 ZI37, following up an earlier
210624 - prescription by the primary care physician at Kaiser two (2) months
210625 - ago on 070330. ref SDS 65 R75M  Later in the morning on 070607 Arlette
210626 - indicated that the primary care physician concurred with prescribing
210627 - Keflex. ref SDS 81 0J70  However, in the late afternoon on 070607
210628 - Arlette called and advised that the doctor ordered outpatient IV for 5
210629 - days. ref SDS 81 8L46
210631 -  ..
210632 - The next day on 070608, Millie got IV treatment at Kaiser in Martinez.
210633 - The nurse submitted a schedule of 5-IV treatments that seemed to align
210634 - with the call from Arlette the day before. ref SDS 82 AL39  The next
210635 - day at Kaiser in Walnut Creek, Millie got the 2nd IV treatment, which
210636 - lined up with the schedule received at Kaiser on Friday.  At that time
210637 - on 060709, the nurse advised Millie that oral antibiotics, Keflex, has
210638 - not been prescribed in Kaiser's computer. ref SDS 83 W34O
210640 -  ..
210641 - Kaiser's letter today calling for Millie to "now" be back on oral
210642 - antibiotics, seems conflicting with a schedule for 5-days of IV
210643 - treatments that started 2 days ago.
210644 -
210645 -            [On 070612 primary care physician at Kaiser clarifies
210646 -            treatment plan to start Keflex oral antibiotics after
210647 -            completing IV medications. ref SDS 86 QE4M
210649 -  ..
210650 - On 061020 the doctor explained that patient medications are readily
210651 - accessible from Kaiser's computer for treatment planning by the
210652 - Coagulation Control Clinic, ref SDS 29 YQ8J, and demonstrated this
210653 - capability on Kaiser's computer in the examination room. ref SDS 29
210654 - M69H  Therefore, the basis for the doctor's notification today that
210655 - treatment has "now" been switched to oral antibiotics is not clear in
210656 - the record.
210658 -  ..
210659 - Need clarification of treatment plan:  whether to continue with the
210660 - remaining 3-IV treaments on Monday through Wednesday, and/or switch to
210661 - oral antibiotics, indicated by the doctor's letter today. ref SDS 0
210662 - OG7F  At this time, there have been no actual discussions of follow on
210663 - "oral antibiotics," nor prescription for medication.  Keflex is on
210664 - hand from the prescription in March.  Should this be started today, or
210665 - on Thursday?
210666 -
210667 -        [On 070611 Millie requested clarification of treatment for
210668 -        Cellulitis from primary care physician at Kaiser. ref SDS 85
210669 -        OG7F
210670 -
210671 -
210672 -
2107 -

SUBJECTS
Default Null Subject Account for Blank Record

2203 -
2204 - 1341
220501 -  ..
220502 - Millie sleeping.
220503 -
220505 -  ..
2206 -
2207 -
2208 - 1651
2209 -
220901 - Millie wakes up.
220902 -
220904 -  ..
220905 - Cellulitis Appears Mostly Resolved, IBC Also Seems Less Severe
220906 -
220908 -  ..
220909 - No temperature all day so far.  Millie seems energetic; back to
220910 - normal.
220912 -  ..
220913 - Arm looks nearly normal.  There is only a faint redness in the upper,
220914 - inner tricep area of the arm.  The entire arm remains swelled with
220915 - lymphedema, as it was prior to diagnosis of Cellulitis on 070607.  The
220916 - left forearm measures 11.5", which is much less than before, but
220917 - increased relative to recent patient history, shown in the case study
220918 - on 060509. ref SDS 13 HO7F
220920 -  ..
220921 - IBC rash on the upper left arm seems less severe than prior to onset
220922 - of Cellulitis diagnosed at UCSF on 070607. ref SDS 81 ZI35
220924 -  ..
220925 - Will continue with outpatient IV treatment tomorrow at Kaiser, per
220926 - schedule received on Friday, 060708, ref SDS 82 AK6H, and request
220927 - clarification of doctor's letter today, calling for Millie to be "now
220928 - back on oral antibiotics," per above. ref SDS 0 ST90
220929 -
220930 -
220931 -
220932 -
220933 -
220934 -
220935 -
220936 -
220937 -
2210 -