THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: January 22, 2009 09:25 AM Thursday;
Rod Welch
Millie Kaiser Emergency dislocated shoulder fall during exercise class
1...Summary/Objective
2...Laboratory Blood Test Results Posted Kaiser's Computer
..............
Click here to comment!
CONTACTS
SUBJECTS
Shoulder Separation Fracture Right Side Had Cut Right Eye Injury Fa
0703 -
0703 - ..
0704 - Summary/Objective
0705 -
070501 - Follow up ref SDS 6 0000, ref SDS 5 0000.
070502 -
070503 - Excellent work today by Doctor Lilienstein and the ER team. Millie
070504 - suffered a severe fall during aerobic (step-class) exercise at the
070505 - gym. ref SDS 0 CW6J This caused a dislocated shoulder and deep cut
070506 - above the right eye. ref SDS 0 CW6J She was in severe pain for
070507 - several hours until the emergency team at Kaiser did administrative
070508 - documentation, ref SDS 0 W05P, and then provided medication.
070509 - ref SDS 0 PQ6X Very good work today by Lindsay in ER accessing
070510 - Millie's port. This has been a continual problem in the ER. Today
070511 - Lindsay got the job done without incident. ref SDS 0 03AG Initial
070512 - diagnosis from Xray testing was fracture and dislocated shoulder.
070513 - ref SDS 0 PR3U CT test showed no damage to the neck and head. Cut on
070514 - the forehead above the right eye was cleaned and stitched. The
070515 - stitches are scheduled to be removed in 5 days. ref SDS 0 4Y5K The ER
070516 - doctor performed a reduction procedure to reset the shoulder. Xray
070517 - test showed this failed. ref SDS 0 074F Decided to make a 2nd attempt
070518 - to reset the shoulder before passing the matter to orthopedic surgery.
070519 - ER doctor was assisted by a specialist from orthopedics for the 2nd
070520 - attempt to reset the arm. Xrays and clinical test moving the arm in
070521 - the socket under sedation indicated the 2nd reduction was successful.
070522 - Tests further indicated Millie did not suffer a fracture afterall.
070523 - ref SDS 0 LV3O This was good news. Blood test WBC 8.6. is higher
070524 - than at any time in the past several years. ref SDS 0 075H INR 3.7
070525 - was too high, ref SDS 0 PU7Y, so the doctor paused Coumadin for 2
070526 - days, ref SDS 0 FL6K and referred case managment to Gloria in the
070527 - Coagulation Control Clinic. ref SDS 0 LV86 Changes to Millie's
070528 - Coumadin need to be coordinated with instructions today from Glenna
070529 - for Millie to stop taking sunitinib and cyclophosphamide, since Doctor
070530 - Rugo plans to change treatment for IBC next week on 090129.
070531 - ref SDS 0 ZH9O The ER doctor scheduled Millie for follow up meeting
070532 - with primary care physician tomorrow. ref SDS 0 TQ8H There is a
070533 - follow up visit with Orthopedics Department scheduled 090129 1330,
070534 - ref SDS 0 LV9Y, after Millie returns from meeting with the medical
070535 - team at UCSF on 090129 0830 on changing treatment for IBC.
070536 -
070537 -
070538 -
070540 - ..
0706 -
0707 -
0708 - Progress
0709 -
070901 - Background - Millie was in Emergency previously on 080409 to treat
070902 - lymphedema relapse. ref SDS 6 0001
070904 - ..
070905 - Millie went to exercise class this morning for the first time in a
070906 - week or so. About 5 minutes into the aerobics class routine done to
070907 - music, Millie's foot landed wrong. She tripped and fell to the floor.
070908 - This may have been due to fatigue and tired muscles, evidenced by low
070909 - blood counts, and which are side effects of sunitinib, reported in
070910 - patient history on 090120. ref SDS 18 LF8M Millie later explained she
070911 - walked from the parking lot to to gym on wet ground from rain this
070912 - morning. She thinks her wet shoes may have slightly stuck to the
070913 - floor enough to and she lost her balance during the routine. On
070914 - 081219 1140 Doctor Johnson diagnosed cytopenia, and pancytopenia that
070915 - reduce energy because all blood elements fall below safe levels due to
070916 - chemotherapy. ref SDS 10 LS6K Millie's daughter, Pam, had recommended
070917 - not doing the step class in order to avoid pain from peripheral
070918 - neuropathy to Millie's toes, and instead just ride the stationary
070919 - bike. Millie went ahead and tried the step class.
070920 -
070921 - [On 090212 0017 Millie's letter to medical team reports
070922 - rising fatigue, ref SDS 29 1N3U, even after ending
070923 - chemotherapy on 090122, ref SDS 23 AT6N, and hoping does
070924 - not signal cancer cascading out of control with CA 15-3 303
070925 - at Kaiser on 090116, ref SDS 15 PQTQ, cited by primary care
070926 - physician at Kaiser on 090123. ref SDS 27 RK6O
070928 - ..
070929 - Previously, on 080125 Millie had a bad fall at home, which caused
070930 - severe lump and bruising. ref SDS 2 N65K At that time she did not
070931 - want medical care.
070933 - ..
070934 - Today, she suffered significant pain (scale 1 - 10 Millie says "15")
070935 - from dislocating or even breaking her right shoulder, and her head was
070936 - bleeding from a cut above the right eye.
070938 - ..
070939 - The staff at the exercise class bandaged the cut over her right eye.
070940 - It continued bleeding, so she used her left hand to hold a towel
070941 - compress to absorb the blood.
070943 - ..
070944 - Staff prepared a makeshipf sling to stabalize the shoulder and arm.
070946 - ..
070947 - Ice was applied to ease pain and prevent swelling.
070949 - ..
070950 - This was ineffective. Millie continued to suffer severe pain.
070952 - ..
070953 - A woman taking the aerobics class drove Millie home in Millie's car.
070954 - The woman's husband followed in their car. They simply dropped her
070955 - off and left, without any effort to ensure follow up care.
070957 - ..
070958 - Millie was bent over crying with pain. Her right arm was in a very
070959 - make-shift sling, and several bandages were red with blood seeping
070960 - from the cut above her right eye. Millie explained having an accident
070961 - that dislocated her shoulder. She described terrible pain in her
070962 - right shoulder and going down her right arm.
070964 - ..
070965 - At first, this sounded like an automobile accident. She was recently
070966 - driving in the wrong lane from fatigue caused by chemotherapy
070967 - treatment for cancer, reported on 081210?????
070969 - ..
070970 - Turned out the car was not damaged. We drove to Kaiser Emergency in
070971 - Walnut Creek. Millie explained she tripped during exercise class and
070972 - fell, causing serious injury.
070974 - ..
070975 - Today seems similar to the accident on 960927, when Millie broke her
070976 - ankle with a freak accident on a treadmill, and had to crawl
070977 - downstairs and outside. Lying on the grass a neighbor saw her, and
070978 - took Millie to Kaiser for care. ref SDS 1 0001
070979 -
070980 -
070982 - ..
0710 -
0711 -
0712 - 0953
0713 -
071301 - Arrived at Kaiser Emergency.
071302 -
071303 - Millie was screaming in pain from injuries. During the 30 minute
071304 - drive to the hospital, each time the car changed speed to stop or
071305 - start at street lights, Millie screamed in greater pain.
071307 - ..
071308 - There was a group of 3 nurses talking among themselves, and looking at
071309 - a computer screen at a reception booth.
071311 - ..
071312 - Requested immediated assistance to relieve pain.
071314 - ..
071315 - One of the nurses, or possibly administrative staff, said Millie had
071316 - to wait in line at an adjacent booth to be admitted into the Emergency
071317 - Department. Thankfully, there only one person being admitted ahead of
071318 - Millie. The time required for Millie to get care was indeterminate.
071320 - ..
071321 - Requested again immediated assistance to relieve pain.
071323 - ..
071324 - The staff attendant asked Millie to stop crying, because this
071325 - disturbes other patients in the lobby waiting their turn to get care;
071326 - she offered to get a security guard to help Millie, and said Millie
071327 - could sit down and wait until her turn came for the admitting clerk to
071328 - process Millie for initial evaluation in triage.
071330 - ..
071331 - Requested support from security guard to expedite care relieving
071332 - Millie's pain.
071334 - ..
071335 - The staff attendant went into the Emergency Department to find a
071336 - security guard to care for Millie immediately.
071337 -
071338 -
071340 - ..
0714 -
0715 -
0716 - 1015
0717 -
071701 - Admitting clerk in the lobby processed Millie. Rather than ask her to
071702 - wait, he took Millie immediately into the Emergency Department to see
071703 - Jessie a Triage nurse.
071705 - ..
071706 - Millie is crying in pain, and grossly hunched over sitting in a chair.
071708 - ..
071709 - Jessie asked Millie what's wrong?
071711 - ..
071712 - Millie at this point had difficulty talking because of extreme pain.
071713 - She asked for relief from pain so she can communicate?
071715 - ..
071716 - Jessie explained that before Millie gets treatment in order to talk,
071717 - she has to explain the nature of the problem, and other data needed to
071718 - properly care for the patient.
071720 - ..
071721 - The nature of Millie's accident was explained for Jessie to enter in
071722 - the computer, per above. ref SDS 0 CW6J
071724 - ..
071725 - Jessie said she has to take Millie's blood pressure. Explained cannot
071726 - use left arm due to lymphedema. Cannot use right arm because movement
071727 - will compound injury to shoulder.
071729 - ..
071730 - Jessie was able to get Millie's blood pressure using her right lower
071731 - leg.
071732 -
071733 - BP 212 74 63
071735 - ..
071736 - The computer monitor showed the blood pressure in red background and
071737 - flashing signaling severe distress.
071739 - ..
071740 - Jessie asked about prior patient history, whether Millie is currently
071741 - under doctor's care?
071743 - ..
071744 - Millie's patient history was summarized....
071745 -
071746 - Millie is under care by Doctor Johnson in Oncology here at
071747 - Kaiser, Walnut Creek.
071748 -
071749 - 73-year old stage-IV cancer patient with secondary IBC,
071750 - currently treated on referral from Kaiser at UCSF for 5th
071751 - relapse. Pulmonary embolism diagnosed 041104, and relapse
071752 - diagnosed 060930.
071754 - ..
071755 - Jessie saw on the computer Millie's treatment with...
071756 -
071757 - sunitinib
071758 - cyclophyosphamide
071759 - Methotexate
071760 -
071761 - Millie advised that Methotrexate has been ended
071763 - ..
071764 - Coumadin
071765 - Prilosec
071766 - Ativan
071767 -
071768 - Millie explained this is very intermediate, not daily.
071769 -
071770 -
071772 - ..
0718 -
0719 -
0720 - 1032
0721 -
072101 - Millie taken to waiting area for getting a room. She is crying in
072102 - great pain.
072103 -
072104 -
072106 - ..
0722 -
0723 -
0724 - 1043
0725 -
072501 - Millie taken to Yellow 2 Emergency Care Room.
072502 -
072503 - Ceryl is the nurse.
072505 - ..
072506 - She contacted the doctor and got approval for pain medication.
072507 -
072509 - ..
0726 -
0727 -
0728 - 1047
0729 -
072901 - Millie gets morphine for pain, a shot in the hip.
072902 -
072904 - ..
0730 -
0731 -
0732 - 1053
0733 -
073301 - Millie reports pain not relieved by morphine shot.
073302 -
073303 - Cheryl will ask the doctor about additional pain medication.
073304 -
073305 -
073307 - ..
0734 -
0735 -
0736 - 1059
0737 -
073701 - Cheryl advises that the doctor approved additional pain medication
073702 - with hydromorhone, that is 10x stronger than morphine.
073704 - ..
073705 - Millie gets additional pain mediation.
073706 -
073708 - ..
0738 -
0739 -
0740 - 1109
0741 -
074101 - Doctor David Lilienstein, MD arrives.
074102 -
074103 - Nurse Lindsay arrives to access Millie's port. Lindsay asks for the
074104 - length and guage of the needle typically used to access the port.
074106 - ..
074107 - Reviewed the record on 080724 showing that for the past 2 years every
074108 - week nurses in the Infusion clinic at UCSF use a 1 inch 20 guage
074109 - needle to access Millie's Power Port. ref SDS 7 N79U
074111 - ..
074112 - The doctor prescribes x-ray to evaluate shoulder and arm, and a CT
074113 - test to evaluate for neck and head injuries.
074115 - ..
074116 - The doctor orders CBC blood test.
074118 - ..
074119 - The doctor will collaborate with orthopedics on treating Millie's
074120 - shoulder.
074121 -
074123 - ..
0742 -
0743 -
0744 - 1115
0745 -
074501 - Lindsay completes accessing Millie's Power Port.
074502 -
074503 - This was a great relief, because on several previous visits to the ER
074504 - there were a lot of problems and mistakes accessing the port. Today,
074505 - Lindsay was successful on the first try, and got good blood flow.
074507 - ..
074508 - Lindsay draws blood for CBC.
074509 -
074510 - [...below at 1615 Millie asks for results of the lab.
074511 - ref SDS 0 LK8G
074512 -
074514 - ..
074515 - Laboratory Blood Test Results Posted Kaiser's Computer
074516 -
074517 - Follow up ref SDS 15 S65I, ref SDS 12 S65I.
074518 -
074519 - Previous lab at Kaiser on 090116, ref SDS 15 S65I, and 2 weeks earlier
074520 - at UCSF on 090108. ref SDS 13 FW5N
074522 - ..
074523 - Patient Provider Category View FR Date To Date
074537 - ..
074538 - 72/F Lab Results Summary
074540 - ..
074541 - Log#: 090122 11:15
074542 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
074543 - Type Results Units Normal Type Units Normal ACRO
074544 - CBC Manual differential CBCD
074545 - ..
074546 - WBC 8.6 K/uL 3.4 - 10.0 WBC x10-3 x10E9/L 3.4 - 10 WBC
074547 - RBC L 3.08 M/uL 3.60 - 5.70 RBC x10-6 x10E12/L 4 - 5.2 RBC
074548 - Hemoglobin L 10.2 g/dL 11.5 - 15.0 Hemoglobin g/dL 12 - 15.5 HGB
074549 - Hematocrit L 30.5 % 34.0 - 46.0 Hematocrit PERCENT 36 - 46 HCT
074550 - MCV 99 fL 80.0 - 100.0 MCV fL 80 - 100 MCV
074551 - RDW, RBC H 16.5 % 11.9 - 14.3 [Not Reported at UCSF]
074563 - ..
074564 - Platelets 153 K/uL 140 - 400 Plt x10-3 x10E9/L 140 - 450 PLT
074565 - Differential panel AUTO REV
074566 - Platelets bld ql man ct CONFIRMD
074567 - Platelets morphology LARGE (A)
074568 - Anisocytosis 1+(A)
074569 - Polychromasis 1+(A)
074570 -
074604 - ..
074605 - CBC blood test continues...
074606 -
074607 - Log#: 090122 11:15
074608 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
074609 - Type Results Units Normal Type Units Normal ACRO
074610 - PT, Patient H 35.8 sec 8.2 - 10.6 PT s 12.0 - 14.1 PT
074611 - PT INR H 3.7 INL NRM Ratio 0.9 - 1.1 INR
074612 -
074614 - ..
074615 - Log#: 090122 11:15
074616 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
074617 - Type Results Units Normal Type Units Normal ACRO
074618 - ELECTROLYTE PANEL
074619 - Sodium 140 mEq/L 133 - 145 SODIUM mmol/L 134 - 143 NA
074620 - Potassium 4.1 mEq/L 3.5 - 5.3 POTASSIUM mmol/L 3.4 - 4.9 K
074621 - Chloride 104 mEq/L 100 - 111 CHLORIDE mmol/L 98 - 107 CL
074622 - CO2 (Bicarb) 22 mEq/L 24 - 33 CARBON DIOX TOTAL mmol/L 23 - 32 CO2
074623 - ANION GAP 14 ANION GAP 3 - 14 ANGA
074624 - ..
074625 - BUN 17 mg/dL 10 - 20 UREA NITROGEN mg/dL 8 - 23 BUN
074626 - Glucose Random 100 mg/dL 60 - 159 GLUCOSE mg/dL 70 - 199 GLU
074638 - ..
074639 - Log#: 090122 11:15
074640 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
074641 - Type Results Units Normal Type Units Normal ACRO
074642 - Creat with GFR
074643 - Creatinine 0.73 mg/dL -< 1.11 CREATININE mg/dL 0.42 - 1.06 CR
074644 - GFR Non-Afr Am >60 mL/min > 60 - eGFR if Caucasian >60 mL/min GFRC
074645 - GFR African AM >60 mL/min > 60 eGFR if African Amer >60 mL/min GFRA
074646 - GFR Note **
074647 -
074648 -
074650 - ..
0747 -
0748 -
0749 - 1123
0750 -
075001 - Saline drip treament started to maintain fluids.
075003 - ..
075004 - Waiting for xray.
075006 - ..
075007 - Millie asks for more pain medication.
075008 -
075010 - ..
0751 -
0752 -
0753 - 1147
0754 -
075401 - Cheryl came and gave Millie pain medication. She advised that the
075402 - doctor has prescribed medication can be given every 15 minutes as
075403 - needed.
075405 - ..
075406 - Millie said she asked for medication 30 minutes ago?
075408 - ..
075409 - Cheryl said things are hectic in ER today. She thanked Millie for
075410 - standing by.
075411 -
075412 -
075413 -
075415 - ..
0755 -
0756 -
0757 - 1208
0758 -
075801 - Millie taken for X-ray to evaluate the extent of injuries.
075802 -
075804 - ..
0759 -
0760 -
0761 - 1239
0762 -
076201 - Millie returns from xray.
076202 -
076203 - Waiting for CT test.
076205 - ..
076206 - Millie asks for pain medication. She used the patient control panel
076207 - to call the nurse.
076209 - ..
076210 - No response.
076211 -
076213 - ..
0763 -
0764 -
0765 - 1250
0766 -
076601 - Visit Control Center. The attendant goes to look for Cheryl to give
076602 - Millie pain medication.
076603 -
076605 - ..
0767 -
0768 -
0769 - 1301
0770 -
077001 - Cheryl arrives and gives Millie pain medication.
077002 -
077003 -
077005 - ..
0771 -
0772 -
0773 - 1310
0774 -
077401 - Millie taken to CT Department for test of shoulder, neck, and head.
077402 -
077403 -
077405 - ..
0775 -
0776 -
0777 - 1353
0778 -
077801 - Millie returns from CT Department.
077802 -
077803 - She was nauscious and so threw up again.
077805 - ..
077806 - Millie asks for pain medication again.
077808 - ..
077809 - Chyeryl is nearby. She comes to Millie's cubical and gives her pain
077810 - medication.
077811 -
077812 -
077814 - ..
0779 -
0780 -
0781 - 1401
0782 -
078201 - Doctor Lilienstein arrives.
078202 -
078203 - Advises the X-ray shows a fracture and dislocated shoulder.
078205 - ..
078206 - The repair will be done here in the Emergency Department, rather
078207 - thanh take Millie to the Orthopedic Department.
078209 - ..
078210 - The doctor plans to first sew up (suture) the cut above the right eye.
078212 - ..
078213 - Doctor leaves.
078214 -
078216 - ..
0783 -
0784 -
0785 - 1417
0786 -
078601 - Millie asks for pain medication again.
078602 -
078603 - Visit the control center.
078605 - ..
078606 - Cheryl says she will be right over.
078607 -
078609 - ..
0787 -
0788 -
0789 - 1422
0790 -
079001 - Cheryl arrives to give Millie pain medication Hyudromorphone.
079002 -
079003 - She used Millie's port.
079005 - ..
079006 - Cheryl advises that the doctor now plans to do the work here in this
079007 - room, rather than take Millie to another room configured for
079008 - specialized care. They will bring additional equipment to Millie's
079009 - Emergency Room cubicled to support the work resetting Millie's
079010 - shoulder.
079011 -
079012 -
079014 - ..
0791 -
0792 -
0793 - 1441
0794 -
079401 - Millie reports relief from pain again; she is feeling more
079402 - comfortable now with medication taking effect.
079403 -
079405 - ..
0795 -
0796 -
0797 - 1443
0798 -
079801 - Vitals BP 186 77 53 Oxygen 88
079802 -
079803 - Cheryl administers oxygen while Millie is sleeping, waiting for the
079804 - doctor to arrive and set her dislocated shoulder, and treat the
079805 - fracture.
079806 -
079807 -
079809 - ..
0799 -
0800 -
0801 - 1452
0802 -
080201 - Jeffery Robinow, RN arrives.
080202 -
080203 - Explains orthopedic procedure for setting Millie's dislocated
080204 - shoulder.
080205 -
080207 - ..
0803 -
0804 -
0805 - 1508
0806 -
080601 - Doctor Lilienstein arrives. Explains more details and risks of
080602 - proposed "reduction" procedure.
080604 - ..
080605 - The doctor says the CT tests show no collateral damage to the head,
080606 - and spine.
080607 -
080608 -
080610 - ..
0807 -
0808 -
0809 - 1519
0810 -
081001 - Visit Cardiology Department.
081002 -
081003 - Talked to Bill Wilson, Advice Nurse.
081005 - ..
081006 - Bill was sorry to hear Millie dislocated her shoulder, per above,
081007 - ref SDS 0 CW6J, and was kind commenting how fit Millie looks, from the
081008 - meeting yesterday, when Millie drove to Kaiser to get the report on
081009 - the EKG test. ref SDS 20 4R7J
081011 - ..
081012 - Bill submits printed report for EKG test on 090112, planned in his
081013 - call yesterday on 090121. ref SDS 21 IT78
081015 - ..
081016 - Bill said the email he sent to Millie yesterday bounced back, so this
081017 - indicates he used the wrong email address. He made an error entering
081018 - the address in the email program.
081020 - ..
081021 - We reviewed the report issued by Cardiology for Millie's EKG test on
081022 - 080112.
081024 - ..
081025 - Nothing seems to stand out as a problem. There is nothing entered in
081026 - the impression area that flags a treatable problem.
081028 - ..
081029 - Bill confirmed that yesterday on 090121 he sent a copy to Glenna at
081030 - UCSF Breast Care Clinic, and he notfied Doctor Johnson, Millie's
081031 - primary care physician, that the report is on Kaiser's computer
081032 - system, as planned in the call yesterday on 090121. ref SDS 21 2K8L
081034 - ..
081035 - Thanked Bill for extra effort getting the report and making
081036 - distribution.
081037 -
081038 - [On 090122 received copy of cardiology report on Millie's
081039 - EKG test on 090112 from primary care physician, and entered
081040 - into the record of patient history. ref SDS 22 WA4F
081042 - ..
081043 - [On 090123 report for Millie's EKG test on 090112 was
081044 - submitted to UCSF. ref SDS 24 KR8V
081046 - ..
081047 - [On 090123 primary care physician called and seemed to
081048 - indicate that cardiology report for EKG test on 090112 does
081049 - not indicate evident heart problems. ref SDS 27 TF7O
081051 - ..
081052 - [On 090127 Millie received letter from Arlette asking for
081053 - Glenna's fax number to send the cardiology report to UCSF
081054 - for Millie's EKG test on 090112, ref SDS 28 OX6G, which was
081055 - previously sent to UCSF by Bill Wilson on 090121,
081056 - ref SDS 21 2K8L, and again by Millie's letter to the
081057 - medical team on 090123. ref SDS 24 KR8V
081058 -
081059 -
081060 -
081062 - ..
0811 -
0812 -
0813 - 1528
0814 -
081401 - Visit Oncology.
081402 -
081403 - Jennifer at the front desk says Doctor Johynson is out of the office,
081404 - and Arlette is still out sick with a cold. Becky who also assists
081405 - the doctor is in a meeting.
081407 - ..
081408 - Jennifer prepared a note explaining Millie is in the Emergency
081409 - Department for a dislocated shoulder and fracture, caused by a fall
081410 - during exercise class this morning, per above. ref SDS 0 CW6J
081412 - ..
081413 - Jennifer will notify the Chemotherapy Infusion Clinic that Millie will
081414 - not need Neupogen treatment this week (Friday and Saturday) because
081415 - her blood counts are now very high, per lab above. ref SDS 0 OT8J
081416 -
081417 -
081418 -
081420 - ..
0815 -
0816 -
0817 - 1536
0818 -
081801 - Walked back to Emergency Department on the other side of the
081802 - hospital.
081803 -
081805 - ..
081806 - Stopped in the cafeteria to call Glenna at UCSF. Left a message about
081807 - Millie's new problem today. ref SDS 0 CW6J
081809 - ..
081810 - Asked Glenna about results of her meeting with Doctor Rugo yesterday
081811 - to discuss follow on treatments for Millie. ref SDS 19 N976
081812 -
081813 - [On 090122 telephone message from Glenna reporting Doctor
081814 - Rugo schedules Millie to start new treatment on 090129.
081815 - ref SDS 23 K96F
081816 -
081817 -
081819 - ..
0819 -
0820 -
0821 - 1542
0822 -
082201 - Visit Emergency Room. Three people are working on Millie, including
082202 - Doctor Lilienstein. Jeffrey is working the computer to capture the
082203 - record on work in progress, find, and assess monitoring data on
082204 - Millie's condition.
082206 - ..
082207 - Went to the inside waiting room for the Emergency Department.
082208 -
082209 -
082210 -
082212 - ..
0823 -
0824 -
0825 - 1553
0826 -
082601 - Jeffrey came into the waiting room and advised that the procedure was
082602 - completed successfully.
082604 - ..
082605 - Jeffrey said the doctor will come by to visit Millie and explain
082606 - results of the procedure and follow on treatment.
082608 - ..
082609 - Visited Millie in the Emergency Room cubicle. She was awake. Said
082610 - she did not feel any pain during the procedure, so anesthesia was
082611 - effective.
082613 - ..
082614 - Cut above right eye brow was cleaned and sutured with 4 or 5 stitches,
082615 - per planning this morning, shown above. ref SDS 0 V446 Looks a lot
082616 - better than when Millie got home from exercise this morning, per
082617 - above. ref SDS 0 HI97
082619 - ..
082620 - Millie is beginning to feel pain again from the underlying injury.
082622 - ..
082623 - Visited the Control Center to look for Cheryl.
082625 - ..
082626 - Cheryl was not available. The attendant went to look for Cheryl or
082627 - someone else who can give Millie more pain medication, prescribed
082628 - every 15 minutes.
082629 -
082630 -
082632 - ..
0827 -
0828 -
0829 - 1611
0830 -
083001 - Doctor Lilienstein visited Millie.
083002 -
083003 - He advised that the operation was a success; the shoulder popped back
083004 - into place. He is concerned that when a dislocated should can be
083005 - easily restored, then it is at risk to become dislocated again.
083007 - ..
083008 - The doctor examined Millie. He is not satisfied that the sling and
083009 - positioning bandages are adequate. He felt with his hands the area
083010 - where the dislocation occurred and commented that he did not like the
083011 - feeling. He is concerned the shoulder may already be dislocated
083012 - again. The doctor has ordered an xray to verify the should is okay,
083013 - and if not then to schedule further treatment in orthopedics.
083015 - ..
083016 - The doctor will prescribe pain medication for Millie.
083018 - ..
083019 - The doctor leaves.
083020 -
083021 -
083022 -
083024 - ..
0831 -
0832 -
0833 - 1614
0834 -
083401 - Cheryl arrives.
083402 -
083403 - She checks the computer to see if the pain medication is still on
083404 - order for Millie.
083405 -
083407 - ..
0835 -
0836 -
0837 - 1617
0838 -
083801 - Cheryl returns and advises the hydromorphone medication is prescribed
083802 - for Millie's pain.
083804 - ..
083805 - Millie gets pain medication.
083807 - ..
083808 - Cheryl is going off-shift.
083810 - ..
083811 - Millie asks about results of the CBC blood test this morning at 1040.
083812 - ref SDS 0 LS69
083814 - ..
083815 - Cheryl says there is not enough time, and suggests asking her
083816 - replacement in about 15 minutes or so.
083818 - ..
083819 - We need reports on xray and CT tests.
083820 -
083822 - ..
0839 -
0840 -
0841 - 1635
0842 -
084201 - Millie still feeling pain in her shoulder. Says it may be less than
084202 - before, but not sure.
084203 -
084204 -
084206 - ..
0843 -
0844 -
0845 - 1647
0846 -
084601 - Attendant arrives to take Mille for the xray to evaluate success of
084602 - procedure.
084604 - ..
084605 - Christina, the replacement nurse for Cheryl arrives.
084607 - ..
084608 - Ask about results of CBC.
084610 - ..
084611 - Nurse says WBC 8+
084613 - ..
084614 - This may be another manifestation of eosophinals being 700% high,
084615 - reported to the team on 090118. ref SDS 13 PZ4Q
084617 - ..
084618 - The lab did not do a differential, so neutrophils were not reported.
084619 -
084621 - ..
0847 -
0848 -
0849 - 1650
0850 -
085001 - Went to cafeteria for a hamburger.
085002 -
085003 - Called Pam.
085005 - ..
085006 - She was on her way to the gym to work. Explained her mom fell and
085007 - dislocated her shoulder, per above. ref SDS 0 CW6J
085009 - ..
085010 - Pam recalled suggesting a few days ago that Millie ride the stationary
085011 - bike, rather than do a step class.
085013 - ..
085014 - Explained expect to bring Millie home in a few hours. Pam will call
085015 - after going to the gym in about an hour to get an update.
085017 - ..
085018 - Called and left a message for Ron Jr.
085020 - ..
085021 - Called Steve, and talked to Lilly. She said Steve planned to call
085022 - Millie for her birthday yesterday, but was busy.
085024 - ..
085025 - Called Janna.
085027 - ..
085028 - She asked shy Millie was going to the gym while suffering severe
085029 - fatigue side effects of cancer treatment?
085031 - ..
085032 - Janaa asked if there is anything she can do?
085034 - ..
085035 - Janna will feed the cats at 1700 or so.
085036 -
085038 - ..
0851 -
0852 -
0853 - 1743
0854 -
085401 - Pam called asking how things went?
085402 -
085403 - Advised will met with the medical team in a few minutes and let her
085404 - know status.
085405 -
085406 -
085408 - ..
0855 -
0856 -
0857 - 1753
0858 -
085801 - Went to Emergency Room to check on Millie.
085802 -
085803 - Talked to Doctor Lilienstein.
085805 - ..
085806 - Xray test shows "reduction" procedure failed to restore Millie's
085807 - dislocated shoulder. The doctor feels now he may have been mistaken
085808 - evaluating the first procedure as successful, and then feeling later
085809 - the shoulder had fallen out of joint. He thinks now that the shoulder
085810 - was never restored during the first reduction.
085812 - ..
085813 - The doctor wants to try a 2nd reduction procedure. If that fails to
085814 - solve the problem, then he will have to refer the case to orthopedic
085815 - surgery.
085817 - ..
085818 - The doctor has collaborated with orthopedics on Millie's case. A
085819 - specialist will come to the Emergency Department to assist Doctor
085820 - Lilienstein doing another "reduction" procedure to reset Millie's
085821 - shoulder.
085823 - ..
085824 - The doctor asked Christina to call nurse management to assign a
085825 - specialist nurse, like Jeffrey, to assist the reduction team.
085827 - ..
085828 - Doctor Lilienstein discussede prescribing treatment for high blood
085829 - pressure.
085831 - ..
085832 - Millie reviewed the record of patient history showing Millie has
085833 - never had high blood pressure. Consistent readings today reflect
085834 - trauma from injuries, and reaction to medications.
085836 - ..
085837 - The doctor will prescribe high blood pressure medication for the
085838 - Millie to take home. Millie can monitor blood pressure and if needed,
085839 - the medication will be available.
085841 - ..
085842 - Thanked Doctor Lilienstein for continuing his shift to lead the team
085843 - performing a 2nd reduction procedure.
085844 -
085845 -
085847 - ..
0859 -
0860 -
0861 - 1821
0862 -
086201 - Called Pam.
086202 -
086203 - Left message on results and plans to do a 2nd procedure. ref SDS 0
086204 - 074F
086205 -
086207 - ..
0863 -
0864 -
0865 - 1850
0866 -
086601 - Visited Millie in the ER cubicle. The ER team is just getting ready
086602 - to perform the reduction procedure, so did not stay.
086604 - ..
086605 - Lindsay, who accessed Millie's port earlier this afternoon, was a few
086606 - cubicles down the hallway. She asked if they got Millie's arm reset?
086608 - ..
086609 - Nice to see that patients are more than just a number.
086610 -
086611 -
086613 - ..
0867 -
0868 -
0869 - 2010
0870 -
087001 - Visited Millie in the ER. The procedure was completed, and
087002 - successful. The shoulder was xrayed again and showed correct setting.
087004 - ..
087005 - Saw Christina in the hallway. Asked for reports on...
087006 -
087007 - 1. Labs showing CBC and INR
087008 - 2. Xray showing fracture and dislocated shoulder
087009 - 3. CT test neck and head.
087010 - 4. Xray showing 1st reduction failed
087011 - 5. Xray showing successful reduction with shoulder in place
087013 - ..
087014 - Doctor Lilienstein was at a computer in the control center preparing
087015 - special instructions for Millie's release to go home.
087017 - ..
087018 - The doctor said Millie should go to Orthopedics Department next
087019 - Thursday on 090129 for follow up examination, and to remove the
087020 - stituches from the suture to close the wound above the right eye.
087021 -
087022 - [...below, doctor submitted letter to Millie with with Special
087023 - Instructions that say to visit Orthopedic Department on 090129
087024 - 1330. ref SDS 0 HW4H
087026 - ..
087027 - The doctor advised that the medical team, including consultation with
087028 - representative from Orthopedic Department, decided all of the evidence
087029 - shows Millie did not suffer a fractured arm or should after all. The
087030 - only injury is a dislocated shoulder, cited in the doctor's letter.
087031 - ref DRT 1 HP6W
087033 - ..
087034 - This will make recovery much faster and easier.
087036 - ..
087037 - The lab today shows INR about 3.7. ref SDS 0 PU7Y This continues
087038 - elevated blood counts managing Milllie's pulmonary embolism, reported
087039 - in labs at Kaiser on 010916. ref SDS 12 PU7Y
087041 - ..
087042 - The doctor wants Millie to pause Coumadin today and tomorrow, and to
087043 - get guidance from case manager (Gloria) in the Coagulation Control
087044 - Clinic on any changes to Coumadin treatment for pulmonary embolism,
087045 - ref DRT 1 HO5O from current prescription presented in Kaiser's letter
087046 - on 081219. ref SDS 8 EW3G
087047 -
087048 - [On 090123 Millie letter to medical team notified Gloria in
087049 - Kaiser Coagulation Control Clinic of Doctor Lilienstein's
087050 - prescription to recover from INR 3.7 in lab today on 090122.
087051 - ref SDS 21 KR5V
087053 - ..
087054 - [On 090123 Millie received a call from Gloria who concurred
087055 - with Doctor Lilienstein's order for Millie to hold Coumadin for
087056 - 2 days; Gloria prescribed continuing with current treatment
087057 - plan issued on 081219, and to get another INR blood test at
087058 - UCSF on 090129. ref SDS 22 MG5L
087060 - ..
087061 - Doctor Lilienstein said Millie is at risk of stroke because of high
087062 - blood pressure reported throughout the day with readings consistently
087063 - above 190 and 70, and pulse near 60. When Millie arrived today triage
087064 - reported BP 212 74. ref SDS 0 0G6Y The doctor proposed prescribing
087065 - treatment for high blood pressure.
087067 - ..
087068 - Upon discussion, the doctor considered that high blood pressure today
087069 - may relate to trauma from shoulder injury today, and medication
087070 - treatment in the Emergency Department. During discussion, the doctor
087071 - noticed the monitor now shows Millie's...
087072 -
087073 - BP 157 70................. ref DRT 1 LZ4H
087075 - ..
087076 - He feels this requires medication, and so remains concerned that
087077 - earlier diagnostics should be followed up carefully.
087079 - ..
087080 - Doctor Lilienstein wants the primary care physician to examine Millie
087081 - tomorrow and evaluate requirements for medication to treat high blood
087082 - pressure, which he called hypertension. ref DRT 1 PV6K
087083 -
087084 - [On 090123 nurse in Infusion Clinic feels there was a
087085 - misunderstanding by the patient, and that the ER doctor did not
087086 - intend for Millie to meet with the primary care physician on
087087 - 090123. ref SDS 25 MN77
087089 - ..
087090 - [On 090123 the primary care physician called Millie and advised
087091 - that medication for high blood pressure is not required by
087092 - Millie's patient history. ref SDS 27 ZI5I
087094 - ..
087095 - Asked the doctor to send a letter notifying the primary care physician
087096 - and the case manager for Millie's Coumadin of findings and
087097 - prescriptions today.
087099 - ..
087100 - Doctor Lilienstein explained that doctors at Kaiser have access to the
087101 - same information he does on patient care, so he feels sending a letter
087102 - is unnecessary overkill that takes extra time.
087104 - ..
087105 - Considered advantage of presenting context connecting data in the
087106 - computer to objectives, requirements, and commitments, which are now
087107 - fresh in the doctor's mind, for guiding performance of the work.
087109 - ..
087110 - Doctor Lilienstein sent a letter to Millie's primary care physician
087111 - explaining Millie's condition and work done to reset the shoulder.
087112 - The letter recommends the primary care physician examine Millie
087113 - tomorrow to evaluate medication for high blood pressure.
087115 - ..
087116 - Doctor Lilienstein submitted a letter to Millie, ref DRT 1 0001,
087117 - with Special Instructions.
087119 - ..
087120 - The doctor's "Special Instructions" for Millie's release from the
087121 - hospital today expressly say to visit the primary care physician
087122 - tomorrow for evaluation of high blood pressure. ref DRT 1 0001
087123 -
087124 - [On 090123 the primary care physician called Millie and advised
087125 - that medication for high blood pressure is not required by
087126 - Millie's patient history. ref SDS 27 ZI5I
087128 - ..
087129 - Special instructions further say for Millie to have stitches from
087130 - suture for cut above right eye brow, per above, ref SDS 0 W44N,
087131 - removed in 5 days. ref DRT 1 1Y5O
087133 - ..
087134 - Doctor Lilienstein also sent a letter to Gloria Clossen in the
087135 - Coagulation Control Clinic advising of prescription today for Millie
087136 - to miss Coumadin treatment today and tomorrow. Gloria will then give
087137 - instructions on Coumadin going forward.
087139 - ..
087140 - Doctor Lilienstein feels now that the medical team has a record that
087141 - makes sense of Millie's complex patient history today.
087143 - ..
087144 - The doctor explained to Millie that to control pain from her shoulder
087145 - injury, and the "reduction" procedures he prescribed...
087146 -
087147 - 1. Motrin
087148 - 2. Vicadin
087150 - ..
087151 - Millie reviewed patient history showing that Motrin was prescribed to
087152 - relieve pain from a previous fall on 080125. ref SDS 2 N65K At that
087153 - time, Millie did not suffer a dislocated shoulder, as occurred today;
087154 - she was treated a few days later on 080204 in the Minor Injury Clinic
087155 - for severe bruising, and complications with Coumadin medication for
087156 - pulmonary embolism. ref SDS 3 628N Motrin was listed for pain control
087157 - in the Kaiser Release Instructions. ref SDS 3 GV9H
087159 - ..
087160 - Today, Millie recalled that on 080204 Gloria in the Coagulation
087161 - Control Clinic advised that Motrin conflicts in some way with taking
087162 - Coumadin to treat pulmonary embolism, and suggested Millie take
087163 - Tylenol instead of Motrin to control pain. ref SDS 4 GO9K
087165 - ..
087166 - Doctor Lilienstein said he would change the prescription for Millie
087167 - today and said the medication should be taken at different intervals,
087168 - as needed...
087169 -
087170 - 1. Tylenol
087171 - 2. Vicadin
087173 - ..
087174 - However, after leaving the Emergency Department, review of Release
087175 - Special Instructions actually specify...
087176 -
087177 - 1. Ibuprofen (Motrin)................... ref DRT 1 HR7S
087178 - 2. Hydrocodone-acetaminophen (Vicadin).. ref DRT 1 HR7W
087180 - ..
087181 - There is nothing in the record indicating the doctor changed the
087182 - prescription, so evidently a commuication error occurred in preparing
087183 - the prescription sent to the Pharmacy.
087185 - ..
087186 - The prescription in the Release Special Instructions for Motrin and
087187 - Vicadin was filled at the Emergency Department Pharmacy, but this was
087188 - not discovered until Millie arrived at home. Turned out Millie has
087189 - Tylenol on hand, and so was able to get relief from pain as prescribed
087190 - by the doctor.
087191 -
087192 - [On 090123 Gloria, case manager for Millie's Coumadin
087193 - treatment to manage pulmonary embolism, noticed the error
087194 - in the prescription, and recommended that Millie not take
087195 - Motrin, and instead take Tylenol. ref SDS 26 JU7L
087197 - ..
087198 - Ice is prescribed for several days 15 minutes every 1-2 hours for 3
087199 - days to reduce swelling. ref DRT 1 Q29G
087201 - ..
087202 - Millie has a complicated sling to immobilize the right arm that is
087203 - close to a straight jacket or harness for a pack horse.
087205 - ..
087206 - Orthopedics meetings scheduled for follow up examination next Thursday
087207 - on 090129 1000.
087209 - ..
087210 - Millie meets with Doctor Rugo at UCSF next Thursday 090129 0830, shown
087211 - in the record on 090108, ref SDS 11 PN6F, so will not be able to get
087212 - back to Walnut Creek by 1000. Doctor Lilienstein changed the meeting
087213 - with Orthopedics to 090129 1330. ref DRT 1 HO6V That should provide
087214 - enough time to get back from San Francisco.
087216 - ..
087217 - Doctor Lilienstein says Millie can remove the sling to take a shower,
087218 - and can perform minor movement, but should leave the arm in the sling
087219 - as much as possible to avoid trauma that could reinjure the shoulder.
087221 - ..
087222 - The doctor said that rolling over in bed during sleep will not present
087223 - a problem to the arm.
087224 -
087225 -
087226 -
087228 - ..
0873 -
0874 -
0875 - 2033
0876 -
087601 - Took Millie to the car in a wheelchair. Got her in the car, and
087602 - took the wheelchair back to ER.
087604 - ..
087605 - Went to the ER Pharmacy to get Millie's pain medication.
087607 - ..
087608 - Pam called on Millie's cell phone while getting the prescription.
087609 - Explained favorable resutls, and that Millie will home in 30 minutes
087610 - and they can talk then.
087612 - ..
087613 - Received two (2) drugs for pain. Instructions to take every 6 hours,
087614 - as needed, and they do not affect eating.
087616 - ..
087617 - Back in the car, Millie advised that she cannot take Motrin, because
087618 - this conflicts with Coumadin.
087620 - ..
087621 - She understood the doctor planned to prescribe Tylonal. Evidently a
087622 - mixup occurred.
087624 - ..
087625 - Millie has Tylonal at home, so did not drive back to the hospital to
087626 - change the prescription.
087627 -
087628 -
087630 - ..
0877 -
0878 -
0879 - 2104
0880 -
088001 - Arrived home.
088002 -
088003 - Just before arriving home, Millie because nausious again and had to
088004 - throw up. Millie started to open the door while we were driving.
088005 - Avoided this problem. Got the door shut without hitting any traffic.
088006 - We used the hospital gown to catch the fluid, which was all water that
088007 - Millie had drank on the way home.
088009 - ..
088010 - The front porch light was on.
088012 - ..
088013 - Millie wondered if this was on all day wasting electricity? Turned
088014 - out that Janna left the porch light on when she came over to feed the
088015 - cats at 1700. ref SDS 0 QY7F
088017 - ..
088018 - Took things into the house, then got Millie out of the car and helped
088019 - her upstairs.
088021 - ..
088022 - Janna called about 2 minutes after we arrived home. She was glad to
088023 - hear there was no fracture, and the 2nd reduction was successful.
088024 - Janna volunteered to come over and help. She is an orthopedic surgeon
088025 - nurse/technician. She came over and was a big help getting Millie
088026 - dressed for bed.
088028 - ..
088029 - Had to remove the sling, and then put on a pajama top with buttons
088030 - because Millie cannot raise her right arm.
088032 - ..
088033 - Had difficulty figuring out how to put the sling back in place, but
088034 - eventually got it to work more or less.
088036 - ..
088037 - Made some rise and chicken soup. Millie ate a few bites to minimize
088038 - throwing up problem.
088040 - ..
088041 - Pam called and talked to Millie for few minutes. She asked why Millie
088042 - did a stop class today, instead of the stationary bike, since the step
088043 - class routine causes pressure on Millie's toes that are sensitive from
088044 - sunitinib.
088046 - ..
088047 - Millie called and talked to Lilly, and they to Steve. This was when
088048 - we were trying to get Millie configured in bed with the phone, and
088049 - other essentials within reach, so asked Steve to call back.
088051 - ..
088052 - Steve called back later and talked to his mother for a few mintues.
088053 - Wished her happy birthday for yesterday.
088054 -
088056 - ..
0881 -
0882 -
0883 - 2245
0884 -
088401 - Millie sleeping.
088402 -
088403 -
088405 - ..
0885 -
0886 -
0887 - 2332
0888 -
088801 - There was telephone message from Glenna responding to the call earlier
088802 - today, per above, ref SDS 0 W466, and further reported in another
088803 - record today. ref SDS 23 K96F
088805 - ..
088806 - Glenna met with Doctor Rugo today. The doctor wants Millie to stop
088807 - treatment with sunitinib tomorrow, so that toxicity can be eliminated
088808 - for a week. Millie will meet with the medical team at the schedule
088809 - time 090129 0830 after getting a blood draw currently scheduled at
088810 - 0830. Glenna seemed to indicate in the message that there would be
088811 - another doctor to meet with Millie in connection with starting a new
088812 - treatment. ref SDS 17 AT6N
088813 -
088814 - [On 090123 Millie's letter to medical team reports progress
088815 - at UCSF scheduling Millie to start on a new treatment.
088816 - ref SDS 21 KR4P
088817 -
088818 -
088820 - ..
0889 -
0890 -
0891 - 0015
0892 -
089201 - Millie wakes up and asks for pain medication.
089202 -
089203 - Took Tylonal and Vicadin for pain. By prescription, she can have
089204 - another treatment at 0600.
089205 -
089207 - ..
0893 -
0894 -
0895 - 0220
0896 -
089601 - Millie awake and reporting mild pain. She decides against taking pain
089602 - medication for at least another hour, since the prescription for
089603 - Vicadin calls for treatment 4 - 6 hours.
089605 - ..
089606 - Millie disucsses taking 500 mg Tylonal rather than 325 mg tablets.
089607 -
089608 -
089609 -
089610 -
089611 -
089612 -
089613 -
089614 -
089615 -
0897 -