CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 29 0000. ref SDS 28 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 091202 Millie had the 3rd treatment in the 1st cycle of Navelbine.
040902 - ref SDS 17 625I
040904 -  ..
040905 - She is experiencing some possible recovery, but also evident worsening
040906 - of cancer due to lack of treatment targeted to her patient profile.
040908 -  ..
040909 - On 091203, Millie submitted a letter notifying the medical team about
040910 - possible progression of disease, and requesting treatment targeted to
040911 - her patient profile, ref SDS 18 4P7G, following up the letter on
040912 - 091112, ref SDS 13 IL8L, and meeting with Doctor Johnson at Kaiser
040913 - later that day on 091112. ref SDS 14 UT7M  The following letter
040914 - confirms understandings from meeting on 091112, and sets agenda for
040915 - meeting at Kaiser on 091210.
040917 -  ..
040918 - On 091211 0018 Millie letter confirms understandings from meeting at
040919 - Kaiser and thanks thanked medical team for excellent care, ref SDS 20
040920 - BW8I, based on Doctor Johnson's report in the meeting at Kaiser on
040921 - 091210 that Kaiser is collaborating with Doctor Rugo for UCSF to
040922 - prescribe treatment targeted to Millie's patient profile. ref SDS 20
040923 - XM3X
040925 -  ..
040926 - On 091211 1452 Doctor Johnson reports collaborating with Doctor Rugo
040927 - for UCSF as planned during the meeting yesterday. ref SDS 21 BW8I
040929 -  ..
040930 - On 091211 1648 Millie notifies Doctor Johnson to submit correspondence
040931 - of Kaiser collaborating with Doctor Rugo at UCSF on prescribing
040932 - treatment targeted to Millie's patient profile. ref SDS 22 BW8I
040934 -  ..
040935 - On 091214 1649 Doctor Johnson notifies Millie that Doctor Rugo has not
040936 - replied to Kaiser's letter on 091211. ref SDS 23 BW8I
040938 -  ..
040939 - On 091215 0852 Millie asks Doctor Johnson about sending a copy of
040940 - Kaiser's letter to Tara for assisting Doctor Rugo developing UCSF's
040941 - treatment plan targeted to Millie's patient profile. ref SDS 24 BW8I
040943 -  ..
040944 - On 091215 1557 Millie reports blood counts fall, still permit getting
040945 - 1st treatment 2nd cycle Navelbine, ref SDS 25 BW8I, asks about
040946 - progress collaborating on prescribing next treatment to recover from
040947 - 10th relapse of cancer.
040949 -  ..
040950 - On 100103 1147 Millie asks medical team about progress prescribing
040951 - treatment targeted to Millie's patient profile to recover from 10th
040952 - relapse of cancer. ref SDS 26 BW8I  Millie reports new symptom of rash
040953 - on right side of forehead, which is swelling the right eye; requests
040954 - examination tomorrow to prescribe immediate remedy. ref SDS 26 FZ6V
040956 -  ..
040957 - On 100103 1652 Millie receives automated reply that Doctor Johnson is
040958 - out of the office until 100105, and so cannot make examination
040959 - tomorrow on 100104 requested in Millie's letter this afternoon.
040960 - ref SDS 27 BW8I
040962 -  ..
040963 - On 100103 2023 Millie reponds to notice that Doctor Johnson is out of
040964 - the office tomorrow and so cannot make examination requested in
040965 - Millie's letter earlier today. ref SDS 28 BW8I
040967 -  ..
040968 - On 100104 0830 Millie needs examination of facial blisters today.
040969 - ref SDS 29 BW8I
040971 -  ..
040972 - On 100104 1115 Millie met with Doctor Zhang in Adult Primary Care,
040973 - ref SDS 0 BW8I, who diagnosed shingles, ref SDS 0 0P9S, and prescribed
040974 - treatment, which may yield full recovery in 2 weeks. ref SDS 0 QB5K
040975 - Doctor Zhang ordered lab to evaluate impact on immune system, and
040976 - asked Millie to coordinate with Coagulation Control Clinic on
040977 - adjusting Coumadin. ref SDS 0 0P4S  Doctor Zhang arranged meeting with
040978 - opthalmology to test for damage to eyes. ref SDS 0 EY8F  Doctor Zhang
040979 - recommended Millie meet with Doctor Johnson this week, rather than
040980 - wait for regularly scheduled meeting next week to review progress
040981 - recovering from shingles. ref SDS 0 0P4Y
040982 -
040983 -
040985 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - As planned in the letter yesterday on 100103, ref SDS 28 RH9W, since
041302 - symptoms increased this morning, and since Doctor Johnson, primary
041303 - care physician, was out of the office today, after a series of calls,
041304 - Millie with Doctor Yong Zhang in Adult Medicine across the way from
041305 - the Oncology Department, implementing coordination by Christine in the
041306 - Advice Nurse Department, reported earlier this morning. 100104 0830,
041307 - ref SDS 29 IZ99
041309 -  ..
041310 - Vitals were normal.
041312 -  ..
041313 - When Doctor Zhang entered the examination room, she immediately
041314 - diagnosed "shingles" for symptoms of severe blistering on the right
041315 - side of Millie's face and forehead, reported to the medical team
041316 - yesterday on 100103. ref SDS 28 RH7Y
041318 -  ..
041319 - Doctor Zhang was very concerned about swelling and pain in Millie's
041320 - right eye, reported to the medical team in Millie's letter on 100103
041321 - 2023, ref SDS 28 ET96, and citing the letter earlier in the day.
041322 - ref SDS 26 TS9M   The doctor feels shingles can cause permenant damage
041323 - to Millie's vision, and so needs immediate care.
041324 -
041325 -            [...below Doctor Zhang coordinated to schedule immediate
041326 -            meeting for Millie with Doctor Dossetor in Kaiser
041327 -            Opthamology Department. ref SDS 0 EY8F
041329 -             ..
041330 -            [On 100112 0830 during meeting at Kaiser, primary care
041331 -            physician, Doctor Johnson, diagnosed Millie has very severe
041332 -            case of shingles, ref SDS 39 3R3G, the doctor extended
041333 -            treatment for shingles another 10-days, and ordered
041334 -            delaying the 3rd cycle of treatment for Millie to recover
041335 -            from the 10th relapse of cancer, until after completing the
041336 -            2nd 10-day treatment to recover from shingles. ref SDS 39
041337 -            G65N
041339 -  ..
041340 - The doctor explained that shingles occurs in older patients from
041341 - chicken pox virus that suddenly activiates due to weakening immune
041342 - system after decades being dormant from having infection as children.
041343 - Doctor Zhang asked about Millie's patient history.
041344 -
041345 -            [On 110612 1948 Bob Welch, mother's husband, diagnosed with
041346 -            shingles on his back. ref SDS 47 L09G
041348 -             ..
041349 -            [On 110615 1308 Bob woke up 0300a with severe pain, went to
041350 -            ER and saw his doctor later that day at 1400.  Bulge on
041351 -            stomache initially diagnosed as a hernia, was actually
041352 -            caused by effects from shingles. ref SDS 48 1X5J
041354 -  ..
041355 - Summarized Millie's 8-year history of cancer, listed in the record on
041356 - 090213 1140. ref SDS 2 AC6G  Currently being treated for 9th relapse
041357 - with Navelbine chemotherapy prescribed on 091112.
041359 -  ..
041360 - Doctor Zhang explained Millie's severe shingles symptoms this morning,
041361 - diagnosed above, ref SDS 0 0P9P, reflect high vulnerability to fatal
041362 - infection for Millie's patient profile -- advanced age, cancer, and
041363 - chemotherapy all weaken the immune system.  Doctor Zhang indicated
041364 - Millie's many relapses make cancer more aggressive, causing increased
041365 - compromise to the immune system, and additionally, chemotherapy since
041366 - August, greatly increases risks of complications from shingles
041367 - infecting internal organs, leading to death.
041369 -             ..
041370 -            [On 100601 0830 Doctor Johnson diagnosed Phlebitis, which
041371 -            can be fatal causing blood clots; he ordered treatment with
041372 -            Relafen for 2 weeks, ref SDS 45 OP4G; this is the 2nd major
041373 -            infection from treating Millie with chemotherapy that
041374 -            conflicts with patient profile, reported on 090601 0818.
041375 -            ref SDS 6 FR8L
041387 -  ..
041388 - Doctor Zhang's concern about Millie getting chemotherapy, aligns with
041389 - Brad's call on 090601, from the Kaiser Oncology Pharmacy.  Brad warned
041390 - that chamotherapy is high risk for Millie's patient profile by
041391 - weakening the immune system, causing infection and death. ref SDS 6
041392 - FR8L   Millie's letter to the medical team the day before, on 090531,
041393 - cited Doctor Johnson's practice of prescribing "targeted treatments
041394 - for Millie that do not compromise the immune system. ref SDS 5 IH8Q
041396 -  ..
041397 - Research indicates there is a vaccine to protect vulnerable patients
041398 - from shingles including recurrence...
041399 -
041400 -            [On 100112 0301 during meeting at Kaiser, Doctor Johnson
041401 -            did not review research on Millie getting vaccinated;
041402 -            further research supplements findings today on advantages
041403 -            of shingles vaccine treatment to reduce risks of
041404 -            recurrence. ref SDS 39 OZ6O
041406 -             ..
041407 -            [On 100120 0301 Millie's letter to medical team submitting
041408 -            agenda for meeting at Kaiser on 100121 asks about getting
041409 -            shingles vaccine to reduce risk of recurrence. ref SDS 40
041410 -            HL4Q
041412 -             ..
041413 -            [On 100301 0418 VA medical team asked about requirements
041414 -            for shingles vaccine based on age and proximity to shingles
041415 -            patient. ref SDS 42 5T9W
041417 -     ..
041418 -    Johns Hopkins Medicine Health Alerts
041420 -     ..
041421 -    Shingles Vaccine Update
041422 -
041423 -              http://www.johnshopkinshealthalerts.com/alerts/prescription_drugs/JohnsHopkinsPrescriptionDrugsHealthAlert_1556-1.html
041424 -
041425 -    1.  No vaccine is 100% effective, but in people over 60 who have
041426 -        not had shingles, Zostavax has been shown to reduce the risk of
041427 -        a shingles outbreak by half and to help prevent painful
041428 -        postherpetic neuralgia in people who do get shingles.
041430 -         ..
041431 -    2.  People with a weakened immune system caused by treatments like
041432 -        radiation or corticosteroids or who have HIV/AIDS, leukemia,
041433 -        lymphoma, or untreated tuberculosis should not get the
041434 -        vaccine.
041436 -     ..
041437 -    Suite 101.com
041439 -     ..
041440 -    Pros and Cons of Shingles Vaccine
041441 -    Should Seniors Get the Herpes Zoster Vaccination?
041442 -
041443 -              http://seniors-health-medicare.suite101.com/article.cfm/pros_and_cons_of_the_shingles_vaccine
041445 -     ..
041446 -    July 11, 2009
041448 -     ..
041449 -    by Katrena Wells
041450 -
041451 -    1.  Zoster vaccine has been available in the U.S. since May 2006.
041453 -         ..
041454 -    2.  Americans 60 and older who do not have contraindications are
041455 -        encouraged to consider the vaccine.
041456 -
041457 -            [On 100301 0800 letter to medical team asks about shingles
041458 -            vaccination based on proximity of care giver for Millie to
041459 -            recover from severe shingles. ref SDS 42 5T9W
041461 -             ..
041462 -            [On 100302 0830 during meeting at Kaiser in Walnut Creek,
041463 -            Doctor Johnson recommends consideration of vaccination
041464 -            against shingles for care givers because Millie has a
041465 -            severe case of shingles. ref SDS 43 GS5J
041467 -         ..
041468 -    3.  People may receive the vaccine even if they have had a previous
041469 -        chicken pox and/or shingles infection.  There is some
041470 -        conflicting information regarding this as some sources say that
041471 -        people who have had a shingles infection are unlikely to get it
041472 -        again.  People can get a shingles infection multiple times, and
041473 -        many sources are now recommending the vaccine regardless of a
041474 -        past history of shingles and/or the chicken pox.
041475 -
041476 -            [On 100120 0301 Millie asks medical team about getting
041477 -            shingles vaccine to reduce risk of recurrence. ref SDS 40
041478 -            HL4Q
041480 -             ..
041481 -            [On 100305 1000 at 1545 received shingles vaccination at VA
041482 -            in Martinez. ref SDS 44 GT5G
041484 -     ..
041485 -    Risks to consider getting shingles vaccine...
041487 -         ..
041488 -    1.  People who have an altered immune system due to infection or
041489 -        treatments should discuss risks and timing of the vaccine.
041491 -         ..
041492 -    2.  Those who have a moderate to severe illness should wait to take
041493 -        the zoster vaccine, particularly if they have a high fever.
041495 -         ..
041496 -    3.  The vaccine has been shown to be approximately 50% effective in
041497 -        preventing a shingles infection and approximately 66% effective
041498 -        in preventing PHN.
041499 -
041500 -            [On 100120 0301 Millie asks medical team about getting
041501 -            shingles vaccine to reduce risk of recurrence. ref SDS 40
041502 -            HL4Q
041504 -     ..
041505 -    Side Effects...
041506 -
041507 -        Reported common side effects of the vaccine are usually mild
041508 -        and include a red, tender injection site (one in three) or
041509 -        headache (one in seventy).  If you have any negative effects to
041510 -        this vaccine, you should report them to your healthcare
041511 -        provider.  You may also report negative effects to the Food and
041512 -        Drug Administration (FDA) online.
041514 -  ..
041515 - Today, Doctor Zhang did not have time to discuss vaccination after
041516 - recovery from shingles, and in order to reduce risk of recurrence.
041518 -  ..
041519 - Doctor Zhang asked why Millie did not go to the ER yesterday for
041520 - immediate treatment?  She advised that delay getting treatment for
041521 - shingles increases pain during recovery.
041523 -  ..
041524 - Millie recalled symptoms occurred gradually on Friday.  On Saturday
041525 - there were discussions about going to the Emergency Department for
041526 - evaluation to identify this new affliction.  Millie resisted going to
041527 - Emergency because of past difficulties getting timely care, e.g., on
041528 - 090720 1437. ref SDS 9 EQ6K and ref SDS 9 RW43; further difficulties
041529 - on 090919 0742. ref SDS 10 MI9Q  Millie was hopeful rash and blister
041530 - symptoms were side effects of chemotherapy, possibly in combination
041531 - with other drugs she has been taking pain.
041533 -  ..
041534 - The medical team was notified yesterday afternoon about new symptoms
041535 - and asked if treatment in Emergency Room Department was needed,
041536 - reported on 100103 1147. ref SDS 26 FZ6V; follow up letter yesterday
041537 - reported rising symptoms; asked if immediate care was needed.
041538 - ref SDS 28 RH4R]
041540 -  ..
041541 - Since nobody responded yesterday, this indicated care could wait
041542 - another day, as presented in the work plan submitted to the medical
041543 - team late last night on 100103 2023. ref SDS 28 RH8Y
041545 -  ..
041546 - Today, Doctor Zhang prescribed 10-day treatment for shingles with
041547 - Zovirax - Acyclovir 800 mg tablets, and also, Prednisone 20 mg
041548 - tablets.
041549 -
041550 -            [On 100104 1216 Millie went to pharmacy on 2nd floor and
041551 -            filled prescription. ref SDS 30 BW8I
041553 -  ..
041554 - Doctor Zhang indicated that most patients recover in about 2 weeks
041555 - using the 10-day treatment prescribed today, per above. ref SDS 0 QB5K
041556 -
041557 -            [On 100112 0830 during meeting at Kaiser, Millie's primary
041558 -            care physician, Doctor Johnson, extended Millie's treatment
041559 -            another 10-days, and he ordered delaying the 3rd cycle of
041560 -            treatment for Millie to recover from the 10th relapse of
041561 -            cancer, until after completing the 2nd 10-day treatment to
041562 -            recover from shingles. ref SDS 39 G65N
041564 -             ..
041565 -            [On 100120 0301 Millie reported to medical team that
041566 -            shingles beginning to recover 3 weeks after initial
041567 -            symptoms, rather than resolved in 2 weeks, as expected
041568 -            today. ref SDS 40 HL3R
041570 -             ..
041571 -            [On 100128 2249 letter to medical team reports that 3rd
041572 -            10-day treatment for shingles prescribed during meeting at
041573 -            Kaiser on 100121, and this delayed again starting treatment
041574 -            with Navelbine chemotherapy to recover from cancer.
041575 -            ref SDS 41 FM4T
041577 -  ..
041578 - Millie asked about new medications for shingles conflicting with
041579 - warfarin (Coumadin) treatments for pulmonary embolism?
041581 -  ..
041582 - Doctor Zhang ordered an immediate blood test today for CBC to assess
041583 - immune system and infection on need for additional antibiotic
041584 - treatment, and also effects of shingles on Millie's INR status.
041585 -
041586 -            [On 100104 1216 Chemotherapy Infusion Clinic at Kaiser in
041587 -            Walnut Creek refused to perform emergency blood draw
041588 -            ordered by Doctor Zhang to evaluate diagnosis of severe
041589 -            shingles, ref SDS 30 4W56, and using Millie's Power Port
041590 -            with a 1" Huber needle to prevent trauma from needle
041591 -            penetrations into Millie's arms infected with IBC and
041592 -            lymphedema, ordered by Doctor Johnson during the meeting at
041593 -            Kaiser on 091112 0930, ref SDS 14 UN8F; as a result, blood
041594 -            draw was performed in the Lab with conventional needle
041595 -            penetration contrary to the doctor's order. ref SDS 30 4Q40
041597 -  ..
041598 - Doctor Zhang advised that she will prescribe an antibiotic if the
041599 - blood test shows likely infection, sometimes indicated by elevated
041600 - WBC, e.g., reported at VA on 091031. ref SDS 12 PQ5P
041601 -
041602 -            [On 100104 1355 Doctor Dossetor prescribed Polysporin
041603 -            antibiotic for Millie to ease pain and infection from
041604 -            shingels blisters bursting. ref SDS 31 GH51
041606 -  ..
041607 - Doctor Zhang further noted that Millie should advise her doctor, if
041608 - blisters burst and bleed, since this condition requires immediate
041609 - treatment with topical antibiotic.
041611 -  ..
041612 - Doctor Zhang asked Millie to notify the case manager in Kaiser's
041613 - Coagulation Control Clinic for adjusting Coumadin, based on results of
041614 - blood test today, and the change in medications.
041615 -
041616 -            [On 100104 2343 Millie's letter to medical team notifies
041617 -            Gloria, case manager in Coagulation Control Clinic about
041618 -            diagnosis of shingles, lab report today that INR 1.6
041619 -            dropped significantly below 2.0 - 3.0 target range, and
041620 -            requests advice on adjusting Coumadin. ref SDS 32 0P5T
041622 -             ..
041623 -            [On 100105 1523 Gloria sent a letter to Millie adjusting
041624 -            dose for Coumadin, and proposing follow up blood test on
041625 -            100114. ref SDS 33 VH9H
041627 -             ..
041628 -            [On 100105 1602 Millie submits schedule for blood draws on
041629 -            100111 and on 100119, required for evaluating getting
041630 -            chemotherapy to recover from 9th relapse of cancer, and
041631 -            plan to get INR checked according to the existing schedule.
041632 -            ref SDS 34 P75V
041634 -             ..
041635 -            [On 100111 0830 Beth advised that the blood draw at Kaiser
041636 -            failed to include the INR test; Millie decided to use the
041637 -            test the following week on 100119, ref SDS 37 AS6Q, noted
041638 -            in the letter today. ref SDS 34 P75V
041639 -
041640 -
041642 -  ..
0417 -
0418 -
0419 - 1134
0420 -
042001 - Doctor Zhang left the examination room to consult with Oncology and
042002 - schedule a meeting for meeting today with Opthalmology.
042003 -
042005 -  ..
0421 -
0422 -
0423 - 1201
0424 -
042401 - Doctor Zhang returned.
042403 -  ..
042404 - The doctor explained having talked to Doctor Johnson's backup in
042405 - Oncology, Doctor Sattar, to avoid treatment conflicts.
042407 -  ..
042408 - Doctor Zhang arranged a meeting with Doctor Dossetor in Opthalmology
042409 - at Kaiser Park Shadelands at 1350, to evaluate rising swelling on the
042410 - right eye, per above. ref SDS 0 QR5K
042411 -
042412 -            [On 100104 1355 Millie met with Doctor Dossetor in Kaiser
042413 -            Opthalmology, and examination found no injury nor infection
042414 -            to eyes from shingles. ref SDS 31 BW8I
042416 -             ..
042417 -            [On 100111 1120 follow up meeting with Doctor Dossetor
042418 -            finds shingles blisters worse than today on 100104, with
042419 -            forehead bloody from sores bursting, ref SDS 38 ML5G; this
042420 -            however reflects normal disease trajectory, and so signals
042421 -            recovery, ref SDS 38 6P8I; treatment with polysporin
042422 -            antibiotic prevents infection. ref SDS 38 ML7I  Examination
042423 -            by Doctor Dossetor found no injury to Millie's right eye
042424 -            from shingles infection. ref SDS 38 ML7M
042426 -  ..
042427 - Doctor Zhang seemed to indicated Millie should meet this week with
042428 - Doctor Johnson, the primary care physician, to evaluate recovery from
042429 - shingles, and assessment for starting next cycle of Navelbine
042430 - chemotherapy to recover from 9th relapse of cancer, rather than wait
042431 - for the meeting scheduled next week on 100112.
042432 -
042433 -            [On 100104 2144 Millie notified medical team that Doctor
042434 -            Zhang recommends meeting Doctor Johnson this week, rather
042435 -            than wait for meeting previously scheduled to occur o
042436 -            100112. ref SDS 32 0P4Y
042438 -             ..
042439 -            [On 100106 1324 Doctor Johnson called and discussed meeting
042440 -            with Millie for examination, ref SDS 35 BW8I, and decided
042441 -            that Millie is not feeling well enough for meeting a
042442 -            Kaiser; deferred meeting to previously schedule on 100112.
042443 -            ref SDS 35 TF4F
042444 -
042445 -
042446 -
042447 -
042448 -
042449 -
0425 -