CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 24 0000. ref SDS 23 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 12 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 13 4P7G, following up the letter on
040912 - 091112, ref SDS 8 IL8L, and meeting with Doctor Johnson at Kaiser
040913 - later that day on 091112. ref SDS 9 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 15
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 15
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 16 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 17 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 18 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 19 BW8I
040943 -  ..
040944 - On 091215 1557 Millie reports blood counts fall, still permit getting
040945 - 1st treatment 2nd cycle Navelbine, ref SDS 20 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 21 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 21 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 22 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 23 BW8I
040967 -  ..
040968 - On 100104 0830 Millie needs examination of facial blisters today.
040969 - ref SDS 24 BW8I
040971 -  ..
040972 - On 100104 1115 Millie met with Doctor Zhang in Adult Primary Care,
040973 - ref SDS 25 BW8I, who diagnosed shingles, ref SDS 25 0P9S, and prescribed
040974 - treatment, which may yield full recovery in 2 weeks. ref SDS 25 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 25 0P4S  Doctor Zhang arranged meeting with
040978 - opthalmology to test for damage to eyes. ref SDS 25 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 25 0P4Y
040983 -  ..
040984 - On 100104 1216 Kaiser Oncology Chemotherapy Infusion Clinic did not
040985 - have enough time to spend 5 minutes accessing Millie's Power Port
040986 - which was placed to facilitate blood draws, ref SDS 26 4P6K, in this
040987 - case ordered by Doctor Zhang to evaluate requirements for treating
040988 - shingles; Millie waited an hour and was fortunate that the lab
040989 - technician was successful on the 1st try placing an IV to perform the
040990 - blood draw today. ref SDS 26 4Q40
040992 -  ..
040993 - On 100104 1355 Millie meets Doctor Dossetor in Opthalmology at Kaiser
040994 - Park Shadelands; examination findings no injury nor infection to eyes
040995 - from shingles. ref SDS 27 BW8I  Doctor prescribed Polysporin antibiotic
040996 - to reduce pain and infection from bursting shingles blisters.
040997 - ref SDS 27 GH51
040999 -  ..
041000 - On 100104 2144 Mille notified medical team on results of meetings
041001 - today at Kaiser that diagnosed and prescirbed treatment for Shingles.
041002 - ref SDS 0 BW8I  Millie asked Gloria for any adjustments to Coumadin
041003 - (warfarin) needed to accomodate diagnosis and treatment for shingles.
041004 - ref SDS 0 0P5T
041005 -
041006 -
041008 -  ..
0411 -
0412 -
0413 - Progress
0414 -
041401 - Millie's letter follows up the letter yesterday on 100103, ref SDS 23
041402 - BW8I, and says today...
041403 -
041404 -    1.  Subject: Shingles Diagnosed Begin Treatment; INR Drops 1.6
041405 -        Date: Mon, 04 Jan 2010 23:42:02 -0800
041419 -         ..
041420 -    2.  As planned in the letter yesterday on 100103, ref SDS 23 RH9W,
041421 -        since symptoms increased this morning, and since you were out
041422 -        of the office today, I tried to meet with your backup, but was
041423 -        unable to make contact [reported on 100104 0830, ref SDS 24
041424 -        BW8I].  After a series of calls, I met today at 1115am with
041425 -        Doctor Yong Zhang in Adult Medicine across the way from your
041426 -        Oncology Department on the 2nd floor of Kaiser in Walnut Creek.
041427 -        Doctor Zhang was thorough and efficient.
041429 -         ..
041430 -    3.  Vitals were normal.
041432 -         ..
041433 -    4.  Doctor Zhang diagnosed "shingles" for symptoms of severe
041434 -        blistering on the right side of my face, reported to the
041435 -        medical team yesterday on 100103. ref SDS 23 RH7Y  She said I
041436 -        should have gone to the ER yesterday, because timely care
041437 -        reduces pain during recovery [...medical team was notified
041438 -        yesterday afternoon about new symptoms and asked if treatment
041439 -        in Emergency Room Department was needed, reported on 100103
041440 -        1147. ref SDS 21 FZ6V; follow up letter yesterday reported
041441 -        rising symptoms; asked again if immediate care needed; nobody
041442 -        responded, ref SDS 23 RH4R...].  Thankful that prognosis with
041443 -        treatment seems to be recovery in about 2 weeks.  In the
041444 -        meantime, I look like a mess, and feel worse.
041446 -         ..
041447 -    5.  During the meeting today, Doctor Zhang left the examination
041448 -        room for about 30 minutes, and on returning reported
041449 -        collaboration on care for stage V cancer [...she advised that
041450 -        chemotherapy is not appropriate for my patient profile causing
041451 -        risks of fatal infection, due to lowered immunity, 100104 1115,
041452 -        ref SDS 25 PS49...], with your backup in Oncology [Doctor
041453 -        Sattar], and to avoid treatment conflicts.  Doctor Zhang also
041454 -        arranged a meeting with my doctor in Opthalmology at Kaiser
041455 -        Park Shadelands at 1450, to evaluate rising swelling on the
041456 -        right eye (discussed below).
041458 -         ..
041459 -    6.  Treatment [10-day] prescribed:  Zovirax - Acyclovir 800 mg
041460 -        tablets, and also, Prednisone 20 mg tablets [reported on 100104
041461 -        1115. ref SDS 25 QB5K].
041462 -
041463 -            [On 100105 1523 Gloria's letter to Millie requests follow
041464 -            up blood test on 100114 to evaluate for impact of
041465 -            Prednisone on INR. ref SDS 28 VH9H
041467 -             ..
041468 -            [On 100112 0830 during meeting at Kaiser, Millie's primary
041469 -            care physician, Doctor Johnson, extended Millie's treatment
041470 -            another 10-days, and he ordered delaying the 3rd cycle of
041471 -            Navelbine chemotherapy for Millie to recover from the 10th
041472 -            relapse of cancer, until after completing the 2nd 10-day
041473 -            treatment to recover from shingles. ref SDS 34 G65N
041475 -             ..
041476 -            [On 100128 2249 letter to medical team reports that 3rd
041477 -            10-day treatment for shingles prescribed during meeting at
041478 -            Kaiser on 100121, and this delayed again starting treatment
041479 -            with Navelbine chemotherapy to recover from cancer.
041480 -            ref SDS 35 FM4T
041482 -         ..
041483 -    7.  Doctor Zhang ordered an immediate blood test for CBC to assess
041484 -        immune system on need for additional antibiotic treatment.  The
041485 -        Chemotherapy Infusion clinic did not have time for doing the
041486 -        blood draw from the power port.  I was referred to the Kaiser
041487 -        Martinez clinic.  Since time was short, I took a chance and had
041488 -        the work done in the basement lab.  After a 90 minute wait, was
041489 -        lucky to get the blood draw on the first poke.  So, it only
041490 -        took 5 minutes.
041492 -         ..
041493 -    8.  Results of the test seem good, at least for me, e.g., WBC 4.8,
041494 -        ANC 2.7.  Doctor Zhang therefore did not call this afternoon to
041495 -        prescribe an antibiotic.  She gave instructions for follow up
041496 -        if shingles blisters burst; however, I cannot recall what was
041497 -        said on this point, since the entire day was hectic.
041499 -         ..
041500 -    9.  Doctor Zhang did seem to say I should see you this week, rather
041501 -        than wait for the meeting scheduled next week on 100112.
041502 -        ref SDS 25 0P4Y  I'm not sure at this point why meeting with
041503 -        you should be advanced.  My preference is to optimize your time
041504 -        collaborating with Doctor Rugo at UCSF to prescribe my next
041505 -        treatment targeted to my patient profile, noted in your letter
041506 -        on 091211. ref SDS 16 BW8I
041507 -
041508 -            [On 100106 1324 Doctor Johnson called and discussed meeting
041509 -            with Millie for examination, ref SDS 30 BW8I, and decided
041510 -            that Millie is not feeling well enough for meeting a
041511 -            Kaiser; deferred meeting to previously schedule on 100112.
041512 -            ref SDS 30 TF4F
041514 -         ..
041515 -   10.  For Gloria Closson, case manager on Coagulation Control -- the
041516 -        lab today reports INR 1.6, well below 2.0 to 3.0 needed to
041517 -        manage my PE status.  This condition was occurred before taking
041518 -        any new medication, and so may reflect only effects of Shingles
041519 -        symptoms beginning on 100101 (what a way to start the new
041520 -        year!!).
041522 -         ..
041523 -   11.  Gloria, please let me know adjustments for warfarin (Coumadin),
041524 -        including additional medications shown above.  [Millie also
041525 -        called Kaiser and left a message for Gloria to report having
041526 -        missed taking Coumadin last night on 100103, due to hectic
041527 -        problems discovering and dealing with shingles symptoms.]
041528 -
041529 -            [On 100105 1523 Gloria sent a letter to Millie adjusting
041530 -            dose for Coumadin, and proposing follow up blood test on
041531 -            100114. ref SDS 28 VH9H
041533 -             ..
041534 -            [On 100105 1602 Millie submits schedule for blood draws on
041535 -            100111 and on 100119, required for evaluating getting
041536 -            chemotherapy to recover from 9th relapse of cancer, and
041537 -            plan to get INR checked according to the existing schedule.
041538 -            ref SDS 29 P75V
041540 -             ..
041541 -            [On 100111 0830 Beth advised that the blood draw at Kaiser
041542 -            failed to include the INR test; Millie decided to use the
041543 -            test the following week on 100119, ref SDS 32 AS6Q, noted
041544 -            in the letter today. ref SDS 29 P75V
041545 -
041547 -         ..
041548 -   12.  I then met in the afternoon at 1450 with my regular doctor in
041549 -        Opthalmology [Doctor Dossetor], at the Park Shadelands Kaiser
041550 -        Clinic [reported on 100104 1355, ref SDS 27 BW8I]  Testing
041551 -        seems to show no injury to my eye so far.  The doctor
041552 -        prescribed an antibiotic Polysporin.  She also provided eye
041553 -        drops - Ofloxacin ophthalmic solution 0.3% 5 ml, manufactured
041554 -        by Falcon Pharmaceuticals. ref SDS 27 GH4N  The doctor plans to
041555 -        notify me of follow up review, I believe within 2 weeks [Millie
041556 -        received a call in the afternoon from Mona, who advised that
041557 -        Doctor Dossetor scheduled follow up examination on 100118
041558 -        1100].
041559 -
041560 -            [On 100108 1057 Mona called and advised that Doctor
041561 -            Dossetor advanced the date for follow up meeting from
041562 -            100119 to 100111 1100. ref SDS 31 Z35H
041564 -             ..
041565 -            [On 100111 1120 follow up meeting with Doctor Dossetor
041566 -            finds shingles blisters worse than today on 100104, with
041567 -            forehead bloody from sores bursting, ref SDS 33 ML5G; this
041568 -            however reflects normal disease trajectory, and so signals
041569 -            recovery, ref SDS 33 6P8I; treatment with polysporin
041570 -            antibiotic prevents infection. ref SDS 33 ML7I  Examination
041571 -            by Doctor Dossetor found no injury to Millie's right eye
041572 -            from shingles infection. ref SDS 33 ML7M
041574 -         ..
041575 -   13.  Since the lab seems to show good blood counts, I am unsure
041576 -        about explanations today for the cause of this new malady.
041577 -        There was a general sense that chemotherapy and/or cancer
041578 -        creates vulnerabilities.  Age was cited as a factor.
041580 -         ..
041581 -   14.  I am hopeful the medical team will prescribe targeted treatment
041582 -        for cancer planned by Doctor Rugo during the meeting at UCSF on
041583 -        090616.  This will help avoid difficult side effects, which you
041584 -        warned would occur with conventional chemotherapy, during the
041585 -        meeting on 090515. ref SDS 4 658J
041587 -         ..
041588 -   15.  Please let me know if we should meet this week, as proposed by
041589 -        Doctor Zhang.
041590 -
041591 -            [On 100106 1324 Doctor Johnson called and discussed meeting
041592 -            with Millie for examination, ref SDS 30 BW8I, and decided
041593 -            that Millie is not feeling well enough for meeting at
041594 -            Kaiser; deferred meeting to previously scheduled on 100112.
041595 -            ref SDS 30 TF4F
041597 -         ..
041598 -   16.  Again, I am thankful for timely and comprehensive care at
041599 -        Kaiser today.
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