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: April 10, 2009 01:43 AM Friday;
Rod Welch
Millie notifies medical team Kaiser referral amended for labs at UCSF.
1...Summary/Objective
2...Coordinate Care Millie's 8th Relapse Treat Cancer Chronic Disease
..............
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS E4 0000. ref SDS E3 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - The letter today follows up patient history...
040902 -
040903 - Patient history of 106 tasks from 081219 to 090331 arranging care for
040904 - Millie to recover from 8th relapse of cancer by treating cancer as a
040905 - "chronic disease" is reported in the record on 090409 1520 telecon
040906 - with Doctor Johnson. ref SDS E4 4W5I
040908 - ..
040909 - 1. Doctor Hsu letter asks beside fever and
040910 - chill any other symptoms? cough, pain, etc.
040911 - Did Silvadine help with the skin
040912 - pain.............................. 090401, ref SDS C0 E54L
040914 - ..
040915 - 2. Doctor Hsu letter says rash on
040916 - lower left arm likely
040917 - IBC............................... 090401, ref SDS C0 R24X
040919 - ..
040920 - 3. Millie reports to medical team temperature
040921 - came down to 97.8 with aspirin, and
040922 - drinking water; no other symptoms
040923 - of cough and pain responding
040924 - to Doctor Hsu's
040925 - inquiry........................... 090401, ref SDS C1 AE4G
040927 - ..
040928 - 4. Millie advises medical team that UCSF
040929 - instructions on 090330 to apply generous
040930 - thickness of Silvadine cream may relieve
040931 - pain slightly from radiation
040932 - side effects...................... 090401, ref SDS C1 RE6V
040934 - ..
040935 - 5. Millie more resolved to tolerate severe
040936 - side effects from radiation and hyperthermia
040937 - in order to recover from 6th relapse of
040938 - IBC because examination at UCSF shows
040939 - results; and further side effects are
040940 - subsiding in some areas; signs of recovery
040941 - helps overcome the trauma of dressing
040942 - the wound several times a day;
040943 - which is very scary to
040944 - observe............................ 090401, ref SDS C1 RE6Y
040946 - ..
040947 - 6. Millie's letter to medical team reports
040948 - UCSF has not clarified schedule for meeting
040949 - with Doctor Rugo on Thursday 090402,
040950 - which seems like a
040951 - mistake............................ 090401, ref SDS C1 RE8S
040953 - ..
040954 - 7. Doctor Rugo advises Millie will not be
040955 - ready for examination on 090402 to plan
040956 - treatment for 7th relapse of IBC; proposes
040957 - meeting at UCSF on 090416; notes Millie
040958 - suffering wound from radiation
040959 - side effects, and advises
040960 - treatment will be very
040961 - effective.......................... 090401, ref SDS C2 K56O
040963 - ..
040964 - 8. Millie's letter to medical team explains
040965 - Kaiser's schedule for medical tests on
040966 - on 090413 to support meetings at
040967 - 090423............................. 090401, ref SDS C3 R43V
040969 - ..
040970 - 9. Millie cites concern about new IBC on
040971 - lower left arm and asks UCSF to
040972 - confirm meetings on
040973 - 090423............................. 090401, ref SDS C3 R43V
040975 - ..
040976 - 10. Telecon Kaiser Outside Referral Department
040977 - advises the referral for Millie's treatment
040978 - at UCSF expires on 090602 is automatically
040979 - extended 1 year to 100202 in order
040980 - to implement Kaiser prescription
040981 - for UCSF to treat Millie's
040982 - cancer as a chronic
040983 - disease............................ 090401, ref SDS C4 KT8G
040985 - ..
040986 - 11. Kaiser Outside Referral Department lists
040987 - UCSF professionals providing services
040988 - for Millie's care to ensure
040989 - continuity of treatment to
040990 - resolve IBC........................ 090401, ref SDS C4 5W4G
040992 - ..
040993 - 12. Kaiser Outside Referral Department explains
040994 - primary care physician can amend referral for
040995 - Millie's treatment with hyperthermia and
040996 - radiation to have labs done at UCSF in order
040997 - to reduce mistakes and save lives,
040998 - time and money..................... 090401, ref SDS C4 RG5K
041000 - ..
041001 - 13. Millie's letter notifies medical team
041002 - Kaiser Outside Referrals indicates
041003 - current authorization enables continuity
041004 - of care at UCSF from Doctor Rugo in Breast
041005 - Care Clinic, and Doctor Hsu in
041006 - Radiation Oncology................. 090401, ref SDS C5 LG4G
041008 - ..
041009 - 14. Millie's letter notifies team that Kaiser
041010 - Outside Referrals authorizes continuity
041011 - of care by automatically extending
041012 - payment for 6 months until
041013 - 100202............................. 090401, ref SDS C5 WC6Y
041015 - ..
041016 - 15. Millie's letter notifies team that
041017 - referral for Millie's hyperthermia and
041018 - ratiation can be amended by primary care
041019 - physician to add labs at UCSF in order
041020 - streamline care for medical necessity
041021 - to reduce mistakes and save
041022 - time and money..................... 090401, ref SDS C5 WC7Y
041024 - ..
041025 - 16. Doctor Rugo thanks Millie for facilitating
041026 - Kaiser clarifying referral authorization
041027 - for UCSF to treat Millie's 7th relapse
041028 - of cancer as a chronic disease; and
041029 - advises information should be sent
041030 - to the UCSF authorization
041031 - person............................. 090402, ref SDS C6 LA6H
041033 - ..
041034 - 17. Doctor Rugo advises that clarifying
041035 - confusion in scheudling next meeting
041036 - should be resolved by UCSF schedule
041037 - department because UCSF has a
041038 - complex schedule system............ 090402, ref SDS C6 117O
041040 - ..
041041 - 18. Millie letter asks Doctor Rugo if Lena
041042 - who called Millie in February about
041043 - scheduling meetings with the doctor
041044 - can clarify the schedule in
041045 - April, as requested by
041046 - the doctor......................... 090402, ref SDS C7 WM8M
041048 - ..
041049 - 19. Millie sent a letter to Glenna who
041050 - coordinated Millie's treatment on pior
041051 - sunitinib clinical trial, and asking
041052 - for assistance finding who to notify
041053 - about Kaiser referral authorization,
041054 - who can assist clarifying the
041055 - schedule for meeting with
041056 - Doctor Rugo........................ 090402, ref SDS C8 WM8M
041058 - ..
041059 - 20. Glenna called and advised she coordinated
041060 - contacts at UCSF for Millie's referral
041061 - authorization, and to clarify schedule
041062 - for Millie to meet with Doctor
041063 - Rugo on planning treatment
041064 - for the 7th relapse
041065 - of IBC............................. 090402, ref SDS C9 JA6L
041067 - ..
041068 - 21. Millie letter notified medical team
041069 - elevated temperature 99.7 fever occurred
041070 - again; icing upper left arm, and is
041071 - monitoring fever to
041072 - evaluate........................... 090402, ref SDS D0 684J
041074 - ..
041075 - 22. Millie letter to medical team thanks Doctor
041076 - Rugo for Glenna's support coordinating case
041077 - management on referral authorizations,
041078 - and on scheduling a meeting to plan
041079 - treatment for recovering from 7th
041080 - relapse of IBC..................... 090402, ref SDS D0 H94R
041082 - ..
041083 - 23. Millie letter to Doctor Rugo's assistant
041084 - requests confirmation of schedule to
041085 - with the doctor at UCSF on 090423
041086 - for planning treatment of
041087 - Millie's 8th relapse of
041088 - cancer............................. 090403, ref SDS D1 375Y
041090 - ..
041091 - 24. Millie letter notifies medical team that
041092 - temperature 99.7 subsided by midnight;
041093 - cough and shortness of breath persisted
041094 - and prevented sleep; evantually
041095 - recovered about
041096 - 0400............................... 090403, ref SDS D2 XZ6I
041098 - ..
041099 - 25. Doctor Hsu letter asks Millie to get
041100 - examination at Kaiser for
041101 - pneumonia.......................... 090403, ref SDS D3 Z66M
041103 - ..
041104 - 26. Doctor Rugo letter asks Millie to
041105 - get examination at Kaiser for
041106 - shortness of breath................ 090403, ref SDS D4 3G3N
041108 - ..
041109 - 27. Millie notifies medical team that UCSF
041110 - recommends examination for pneumonia
041111 - with symptoms of shortness of
041112 - breath............................. 090403, ref SDS D5 NW4N
041114 - ..
041115 - 28. Millie notifies medical team fever occurs
041116 - for 3rd time with temperature 99.4; explains
041117 - home care has previously been
041118 - effective.......................... 090403, ref SDS D5 DX7S
041120 - ..
041121 - 29. Millie notifies medical team side effects
041122 - of radiation and hyperthermia skin "burn"
041123 - healing, and pain subsides
041124 - substantially...................... 090403, ref SDS D5 DX8R
041126 - ..
041127 - 30. Millie letter to Doctor Johnson 090403
041128 - 2012 supplements letter sent 20 minutes
041129 - earlier 1941 to explain symptoms subside
041130 - proposes monitoring and then assess
041131 - need for examination at
041132 - Kaiser............................. 090403, ref SDS D6 ZG7H
041134 - ..
041135 - 31. Letter from Doctor Johnson responds to
041136 - Mil's first letter sent 090403 1954,
041137 - ref SDS D5 NW4N, but not this 2nd letter
041138 - sent 20 minutes later, and reporting symptoms
041139 - subside, see 090403 2012, ref SDS D6 OA4R;
041140 - doctor evidently did not see the 2nd letter;
041141 - asks Millie to call Kaiser and schedule
041142 - a meeting, recommends medical team use
041143 - Kaiser's internal proprietary Knowledge
041144 - Management system for email to
041145 - increase efficiency
041146 - performing case
041147 - management......................... 090406, ref SDS D7 M19I
041149 - ..
041150 - 32. Millie letter to medical team relates
041151 - report in Millie's 2nd letter on 090403
041152 - that symptoms have not repeated, and
041153 - so proposes deferring examination
041154 - at Kaiser.......................... 090406, ref SDS D8 OC5F
041156 - ..
041157 - 33. Called UCSF talked to Roy, who advises
041158 - there is no record scheduling meeting
041159 - on 090423; Roy plans to notify Amanda,
041160 - who is another assistant for Doctor Rugo,
041161 - about scheduling meeting on 090423
041162 - 0830, which Doctor Rugo
041163 - ordered............................ 090407, ref SDS D9 PP8X
041165 - ..
041166 - 34. Amanda called, she assists Doctor Rugo;
041167 - advised UCSF cannot find Millie's letter
041168 - to medical team on 090401 1520, ref SDS C5
041169 - LG4G, and further advised that UCSF has no
041170 - record Kaiser has authorized referral for
041171 - Millie to meet with Doctor Rugo on 090423,
041172 - and so a meeting has not been scheduled;
041173 - Millie's letter on 090401 1520 was
041174 - resubmitted to Amanda
041175 - at UCSF............................ 090407, ref SDS E1 MV5K
041177 - ..
041178 - 35. Amanda called after receiving Millie's
041179 - letter on 090401 1520, and schedules
041180 - Millie for another meeting with Tara,
041181 - because Doctor Rugo will be
041182 - out of town again
041183 - on 090423 0830..................... 090407, ref SDS E1 4N3F
041185 - ..
041186 - 36. Called Kaiser CT Department Loretta confirmed
041187 - test scheduled on 090413 allows 10 days
041188 - for Kaiser to send report in time to meet
041189 - at UCSF 090423; CT Department changes time
041190 - for test from 1520 to 1500 requested by
041191 - Interventional Radiology Services to avoid
041192 - overtime for Millie's CT test; Loretta
041193 - asks Millie to coordinate with Chemotherpay
041194 - Infusion Department to change the time
041195 - for Millie's blood on 090413 from
041196 - 1500 to 1430, so that the CT Department
041197 - can make use of the nurse accessing
041198 - Millie's Power Port with a Huber
041199 - needle that can be used to
041200 - inject contrast medium
041201 - for the CT test
041202 - at 1500............................ 090407, ref SDS E2 L76N
041204 - ..
041205 - 37. Kaiser CT Department discloses the
041206 - computer indicates somebody changed
041207 - doctor's order for consolidating findings
041208 - into single report to correct mistakes
041209 - in past reports; Loretta to investigate
041210 - why doctor's order was
041211 - changed............................ 090407, ref SDS E2 1163
041213 - ..
041214 - 38. Called Kaiser Oncology Department and
041215 - changed time for blood draw from 090413
041216 - 1500 to 1430 to facilitate request by
041217 - IS to avoid overtime
041218 - expense............................ 090407, ref SDS E0 R16X
041220 - ..
041221 - 39. Kaiser CT Department called back; Katie
041222 - advised that the doctor's order for Millie's
041223 - CT test was changed by the department
041224 - to eliminate requirement for consolidated
041225 - findings because government regulations
041226 - require separate reports for scans above
041227 - the neck from scans below the
041228 - neck............................... 090407, ref SDS E2 L87J
041230 - ..
041231 - 40. CT Department called back and Katie advised
041232 - test scheduled on 090414 1500, which
041233 - conflicted with doctor's order for
041234 - test on 090413..................... 090407, ref SDS E2 YK64
041236 - ..
041237 - 41. CT Department called back and advised
041238 - an error occurred in data entry changing
041239 - the time for the test on 090413 from 1520
041240 - to 1500, resulting to scheduling the
041241 - test on 090414; Katie corrected
041242 - mistake............................ 090407, ref SDS E2 W47V
041244 - ..
041245 - 42. CT Department investigates why doctor's
041246 - order for consolidating findings into
041247 - a single report for each CT test
041248 - was changed........................ 090407, ref SDS E2 YZ95
041250 - ..
041251 - 43. UCSF notified Millie will be examined
041252 - in breast care clinic on 090423 0830
041253 - evaluate progression IBC 7th
041254 - relapse and plan for next
041255 - treatment.......................... 090408, ref SDS E3 E54L
041257 - ..
041258 - 44. Medical team notified Kaiser CT Department
041259 - changed time of test on 090413 to accomodate
041260 - IS overtime cost containment objectives;
041261 - requires coordinating with Chemotherapy
041262 - Infusion Clinic to correlate time of
041263 - blood draw with revised time
041264 - for CT test........................ 090408, ref SDS E3 QW4X
041266 - ..
041267 - 45. Fever high temperature occurred for several
041268 - days during 3 - 5 hours in late evening
041269 - but this stopped several days ago, and other
041270 - symptoms cough and shortness of breath
041271 - subside, so no need for examination at
041272 - Kaiser by primary care physician
041273 - requested by Doctor Hsu and
041274 - Doctor Rugo at
041275 - UCSF............................... 090408, ref SDS E3 QW6R
041277 - ..
041278 - 46. Arlette coordinated with Bella to change
041279 - time of blood test to 1330 that aligns
041280 - with CT Department changing time of CT
041281 - test on 090413 from 1520 to
041282 - 1500............................... 090409, ref SDS E4 E54L
041284 - ..
041285 - 47. Examination to evaluate treatment of
041286 - radiation side effects requested by
041287 - Doctor Hsu and Doctor Rugo at UCSF
041288 - was deferred by Doctor Johnson because
041289 - patient reports symptoms
041290 - subsided........................... 090409, ref SDS E4 TH61
041292 - ..
041293 - 48. Notified Doctor Johnson on progress with
041294 - coordination he requested for CT Department
041295 - to consolidate findings into single report
041296 - for each CT test in order to enable
041297 - efficient case management; under
041298 - review by Doctor
041299 - Davidson........................... 090409, ref SDS E4 FU6J
041301 - ..
041302 - 49. Doctor Johnson amended Kaiser referral
041303 - authorization for Millie's treatment
041304 - at UCSF with hyperthermia and related
041305 - modalities to include labs at UCSF
041306 - required for efficient case
041307 - management......................... 090409, ref SDS E4 6O6N
041309 - ..
041310 - 50. Doctor Davidson Director of Radiology
041311 - for Kaiser Diablo Service Region disclosed
041312 - CT Department made mistakes issuing multiple
041313 - reports for a single CT test in order to
041314 - increase revenues from billings; advised
041315 - this practice would be changed to consolidate
041316 - findings that enable efficient patient
041317 - care for saving lives time
041318 - and money.......................... 090409, ref SDS E5 L14I
041320 - ..
041321 - 51. Letter to Doctor Davidson with copy to
041322 - medical team confirms Kaiser will correct
041323 - CT test reports for efficient
041324 - patient care....................... 090409, ref SDS E6 WB6G
041325 -
041326 -
041327 -
041328 -
041329 -
0414 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Coordinate Care Millie's 8th Relapse Treat Cancer Chronic Disease
050403 -
050404 - Follow up ref SDS E4 6O6N, ref SDS C5 WC7Y.
050405 -
050406 - Background on Doctor Johnson asking Millie to coordinate with UCSF on
050407 - arrangements for treating Millie's 8th relaspe of cancer as a chronic
050408 - disease, as listed in the record yesterday on 090409. ref SDS E4 4W5I
050410 - ..
050411 - Millie notifed the medical team in a letter on 090401 1520 about
050412 - progress of the work conforming referral authorization to patient
050413 - needs. ref SDS C5 LG4G She received a response from Doctor Rugo on
050414 - 090402 0119 saying thanks for coordinating to facilitate effective
050415 - case management. ref SDS C6 LA6H
050417 - ..
050418 - Millie sent a letter to the medical team following up Doctor Rugo's
050419 - letter received on 090402 0119, and reporting progress on work to
050420 - implement Doctor Johnson's treatment plan...
050421 -
050422 - 1. Subject: Kaiser Referral Authorization A023242470 Amended to Include Payment for Labs
050423 - Date: Fri, 10 Apr 2009 02:00:43 -0700
050434 - ..
050435 - 2. This confirms telecon [on 090409 1537] with Doctor Johnson. He
050436 - reported submitting an amendment to subject referral
050437 - authorization for my care at UCSF, to include the cost of labs
050438 - performed at UCSF, ref SDS E4 PG7I, and for reasons discussed
050439 - at Kaiser during the meeting on 090213. ref SDS 78 ZN5J [...to
050440 - reduce mistakes and delays noted by Doctor Johnson during
050441 - meeting at Kaiser on 090325 0830, so that Millie has timely
050442 - accurate lab data, which patient history shows has not been
050443 - accomplished doing labs at Kaiser and transmitting to UCSF.
050444 - ref SDS A1 KZ6N
050446 - ..
050447 - 3. This further implements planning presented in the letter to the
050448 - medical team on 090401 1520, ref SDS C5 LG4G, citing telecon
050449 - with Pam in Kaiser's Outside Referrals Department [also on
050450 - 090401 1214, ref SDS C4 KT9G].
050452 - ..
050453 - 4. UCSF can now continue ordering lab tests to evaluate my
050454 - progress, and can order same day interim tests, as necessary,
050455 - and can access results on UCSF computers, and draw trend
050456 - reports for realtime analysis, as done the past 2 years.
050457 -
050458 - [On 090412 2042 Millie notifies medical team cancer getting
050459 - worse, requests treatment. ref SDS E7 9S8Y
050461 - ..
050462 - [On 090413 1330 Millie went to Kaiser for lab to evaluate
050463 - progression of cancer, and suitability for treatment, and
050464 - to access the port for a CT test also on 090413 needed to
050465 - assess cancer. ref SDS E8 VF6G
050467 - ..
050468 - [On 090413 1500 Millie had CT test at Kaiser. ref SDS E9
050469 - 0E4I
050471 - ..
050472 - [On 090415 0949 Millie notifies medical team IBC spreading,
050473 - ref SDS F1 KG8Q; assists Kaiser coordinating with UCSF on
050474 - getting results of the blood test and CT test on 090413 to
050475 - UCSF for meeting on 090423 to plan next treatment of 8th
050476 - relapse. ref SDS F1 KG8Y
050478 - ..
050479 - 5. Additionally, Rod received a letter today from Doctor Davidson,
050480 - Chief of Radiology and Imaging for Kaiser Diablo Region
050481 - advising that the CT Department will prepare consolidated
050482 - reports for each test, rather than multiple reports.
050483 - ref SDS E5 XZ6U This responds to Doctor Rugo's request in the
050484 - meeting on 081113. ref SDS 43 8Q8V
050486 - ..
050487 - 6. Good news - quick update, the large sore in the middle of my
050488 - chest has now healed to about the size of a nickel. Hopeful
050489 - will get a good inspection on 090423, and that CA 15-3 for the
050490 - lab at Kaiser on 090413 will further decline from 251 reported
050491 - a month ago at Kaiser on 090317.
050492 -
050493 - [On 090412 2241 Millie's letter to medical reports IBC
050494 - worsening on left arm, ref SDS E7 XN8J, requests treatment
050495 - next week to prevent cancer from cascading out of control.
050496 - ref SDS E7 9S9Y
050498 - ..
050499 - [On 090413 lab report CA 15-3 271 increased only sightly to
050500 - second highest level in patient history. ref SDS E8 PQTQ
050502 - ..
050503 - [On 090512 lab report CA 15-3 320 cancer marker increases
050504 - to highest level in patient history. ref SDS F3 PQTQ
050506 - ..
050507 - 7. Doctor Rugo can order a test to compare CA 15-3 at UCSF, which
050508 - is considerably different from the Kaiser calibration. My
050509 - sense is that labs after I get back from vacation in mid-May
050510 - can resume at UCSF. However, this is Doctor Rugo's and Doctor
050511 - Hsu's call under the Kaiser amended authorization.
050513 - ..
050514 - 8. Have not taken pain medication for a week, temperature has
050515 - likewise been normal for 4 or 5 days.
050517 - ..
050518 - 9. My energy is up. Went to the gym again today, and for the
050519 - first time since my accident on 090122, I did an aerobics
050520 - class. This included a lot of arm movement, so my right
050521 - shoulder got a good work out to extend range of motion. [makes
050522 - Millie good candidate for aggressive cancer treatment, based on
050523 - Karnofsky assessment, reported on 090205. ref SDS 73 LH3O,
050524 - which aligns with Kaiser's evaluation showing ECOG score 0 from
050525 - examination on 090325. ref SDS A1 ME6M
050527 - ..
050528 - 10. Please let me know if anything further is needed to perform
050529 - case management at UCSF of my cancer situation [implementing
050530 - instructions by primary care physician at Kaiser for treating
050531 - my cancer as a chronic disease, discussed recently at Kaiser on
050532 - 090325. ref SDS A1 L15M]
050534 - ..
050535 - 11. Looking forward to meeting Tara on 090423 at 0830, and Doctor
050536 - Hsu later in the afternoon. Please let me know if these
050537 - meetings can be consolidated for collaboration on response to
050538 - treatment and follow up.
050539 -
050547 -
050548 -
050549 -
050550 -
050551 -
050552 -
050553 -
050554 -
050555 -
050556 -
0506 -