W had this meeting 10 days before her stroke. I was at my wits end with her and her pain. We were getting ready to put her on a major drug to try and quell the pain. And I was going to move her closer to us.

11/6/2012          Dr. Nugyen

Items Discussed

·       Feet                     - Embrel will help

·       Infusion              - go with Embrel weekly injections, first then try Rituxan later (3-8 hours infusion) they give Tylenol, benderyl to prevent side effects, nurse monitor entire time and adjust as required           

·       Lung Doctor       - get lung doc appt for clearance to take Embrel

·       Psoriasis             - steroid cream for leg, use T-gel on head

·       Shaking all over - nerves

·       Abdomen CT     - for a good look at everything inside top to bottom, front to back, left to right.  Left side pain since 2207 nothing found.

·       Gave her a Kaplog injection for pain in the mean time

Items to do before next appt:

·       Blood work                      - TB & Hep clearance for Embrel

·       Get Abdomen CT scan

·       Pulmonary Appt              - 11/27/ 2:00 Scripps Rancho Bernardo Robert Sarnoff  general check up to clear for Embrel, 3:15 called Dr. Nugyen to tell her who to fax the referral to.

·       Records from Litner to Pulmonary Doc (get from MyChart) sent message 11/6 request to FAX to 858-605-7182

Next appt:

Get Embrel pens- weekly injections at home

Other issues:

Talked about me taking over the workers; once she find someone she likes I need to be involved to get the baths and the food and the coordination done.

Moving

Finances