CONTACTS 

SUBJECTS
Meeting VA Martinez CA Imaging Barium Sulfate Evalute Digestion Disc
Meeting Doctor Reports Achlasia Preliminary Diagnosis Possible Cance
Achlasia Preliminary Diagnosis Possible Cancer Blocking Pylorus at D

0805 -
0805 -    ..
0806 - Summary/Objective
0807 -
080701 - Follow up ref SDS 16 0000. ref SDS 15 0000.
080702 -
080703 - Preliminary diagnosis on digestion problems is achlasia. ref SDS 0
080704 - DG8G Research seems to indicate this is not extremely serious;
080705 - treatment is not indicated.  Possible cancer could be blocking pylorus
080706 - and duodenum. ref SDS 0 DG89  PSA test for prostate cancer is
080707 - negative.  Blood tests benign, except WBC is high; doctor orders
080708 - another blood test. ref SDS 0 G540  Ultrasound test ordered to further
080709 - investigate stomache digestion issue. ref SDS 0 6E7H  Patient advises
080710 - that JJ's prescription to correct salivary duct stone problem seems to
080711 - be successful. ref SDS 0 DG94  Examination showed that surgery on the
080712 - neck is healing normally. ref SDS 0 DG9W  Jerry in the Eligibility
080713 - department corrected problem in VA computer that had previously
080714 - disrupted service. ref SDS 0 4N5M
080715 -
080716 -     [On 050818 WBC still elevated; antibiotics prescribed, and follow
080717 -     up blood test. ref SDS 18 BM8O
080719 -      ..
080720 -     [On 050819 relapse salivary duct stone problem, could be source of
080721 -     infection driving elevated WBC. ref SDS 19 JO4H
080723 -      ..
080724 -     [On 051202 doctor in GI Clinic confirms initial diagnosis primary
080725 -     achalasia. ref SDS 27 5B5K
080726 -
080727 -
080728 -
080729 -
080730 -
080732 -  ..
0808 -
0809 -
0810 - Progress
0811 -
081101 - Achalasia Possible Cause Digestion Gastric Distress No Diagnosis Yet
081102 -
081103 - Follow up ref SDS 15 2I4S.
081104 -
081105 - The doctor discussed findings from a radiology report on barium image
081106 - testing performed on 050714. ref SDS 15 2I9J  The report was not
081107 - submitted, so the discussion was from memory.
081108 -
081109 -     [On 050830 received radiology report on barium imaging test
081110 -     performed today. ref SDS 21 UR3M
081112 -  ..
081113 - At this time a specific diagnosis for digestion problems has not been
081114 - determined.  There are several possibilities, including combinations
081115 - of problems.
081116 -
081117 -     [On 050818 WBC still elevated; antibiotics prescribed, and follow
081118 -     up blood test. ref SDS 18 BM8O
081120 -      ..
081121 -     [On 050819 relapse salivary duct stone problem, could be source of
081122 -     infection driving elevated WBC. ref SDS 19 JO4H
081124 -      ..
081125 -     [On 050822 taking antibiotics for possible infection to reduce
081126 -     elevated WBC. ref SDS 20 XZ4F
081128 -  ..
081129 - The doctor advised that the initial diagnosis is possibly Achalasia,
081130 - which afflicts the gastric system, following up image tests on 050714
081131 - that seemed to show a digestion constriction into the intestine system
081132 - at the pylorus and duodenum. ref SDS 15 WE50
081134 -      ..
081135 -     [On 050906 clinical history for sonograph ultrasound test
081136 -     describes patient with aclasia, ref SDS 22 2V4I, which has not
081137 -     been diagnosed at this time, per above. ref SDS 0 DG8G
081139 -      ..
081140 -     [On 051202 doctor in GI Clinic confirms initial diagnosis primary
081141 -     achalasia. ref SDS 27 5B5K
081143 -  ..
081144 - Research after the meeting today found many sources that mention
081145 - Achalasia, but only a single explanation at...
081146 -
081147 -        http://themusctiger.com/blog/2005/05/bas-gastrointestinal/
081148 -
081149 - ...describes Achalasia as...
081150 -
081151 -        ...failure of esophageal sphincter relaxation due to loss of
081152 -        myenteric plexus. "Bird Beak" barium swallow; incr. risk of
081153 -        esophageal cancer; assoc. w/ Chagas disease.
081155 -  ..
081156 - "Bird Beak" aligns with the doctor's comments during the imaging test
081157 - on 050714. ref SDS 15 WE4H
081159 -  ..
081160 - There is nothing on treatment in this research.
081162 -  ..
081163 - Achlasia is associated with Chagas disease.  Research at...
081164 -
081165 -        http://www.thedoctorslounge.net/infections/diseases/chagas.htm
081166 -
081167 - ...says in part...
081168 -
081169 -        Chagas' disease is caused by infection with protozoan parasite
081170 -        Trypanosoma cruzi.
081172 -         ..
081173 -        T cruzi is transmitted among its mammalian hosts by
081174 -        hematophagous triatomine insects, often called reduviid bugs.
081175 -        The insects become infected by sucking blood from animals or
081176 -        humans who have circulating parasites.  It can also be
081177 -        transmitted through blood transfusion of infected blood, from
081178 -        the pregnant mother mother to her fetus, and in lab lab
081179 -        accidents.  Chagas' disease is only a problem in the Americas
081180 -        (South America mainly).
081182 -  ..
081183 - Symptoms include...
081184 -
081185 -        This phase is usually followed by malaise, fever, generalized
081186 -        edema, a rash may develop as well as generalized
081187 -        lymphadenopathy and hepatosplenomegaly.
081189 -  ..
081190 - These symptoms have not presented, and the most likely source, South
081191 - America, generally suggests this is not likely an actual association
081192 - in this case, if Aclasia is eventually diagnosed.
081193 -
081194 -
081195 -
081196 -
081197 -
081198 -
081199 -
0812 -

SUBJECTS
Cancer Possible Diagnosis Digestion Problem Preliminary Idea Achlasi

1103 -
110401 -  ..
110402 - Cancer Growth May be Causing Digestion Problems
110403 -
110404 - Today, the doctor discussed possibility of a cancer growth blocking
110405 - the pylorus or duodenum (see discussion with John on 050714 following
110406 - image testing by Doctor Kim, ref SDS 15 WE50), but this is not
110407 - established by evidence so far.  Could, also, be a cancer growth in
110408 - the gallbladder region that is squeezing the pylorus and deodenum,
110409 - which constricts digestion.
110410 -
110411 -
110412 -
110413 -
1105 -

SUBJECTS
PSA Test Normal Indicates No Evidence Prostate Cancer
Blood Test Shows No Obvious Problem WBC High Another Blood Test Orde

1404 -
140501 -  ..
140502 - PSA Test Normal Indicates No Evidence Prostate Cancer
140503 - Blood Tests Benign Show Not Evident Problems WBC Unusually High
140504 - WBC Unusually High Blood Tests Benign Show Not Evident Problems
140505 -
140506 - The doctor advised that initial blood tests performed on 050629,
140507 - ref SDS 13 G69K, are benign, all within norms, except WBC and
140508 - phosphates both a little high, which again is generally benign.
140509 -
140510 -        [On 050818 WBC still elevated; antibiotics prescribed, and
140511 -        follow up blood test. ref SDS 18 BM8O
140513 -         ..
140514 -        [On 060505 doctor reports cholesterol was high in one or more
140515 -        of the blood tests a year earlier in 2005; orders follow up
140516 -        test, and may have ordered medication. ref SDS 28 MA6I
140518 -         ..
140519 -        [On 060623 0840 Teri reports results of lab show continued
140520 -        high cholesterol; doctor prescribes treatment with
140521 -        Lovastatin to reduce cholesterol. ref SDS 29 UO5N
140523 -         ..
140524 -        [On 090812 1030 Doctor orders another lab to test cholesterol
140525 -        and other factors that may explain sudden weight loss, besides
140526 -        improve fitness. ref SDS 30 NF4G
140527 -
140529 -  ..
140530 - PSA test is good, no signs of prostrate cancer.
140532 -  ..
140533 - Nothing jumps out from tests and examinations that requires treatment.
140534 - The doctor wants to investigate further to avoid overlooking a
140535 - diagnosis.
140537 -  ..
140538 - At this time, there is no diagnosis.
140540 -  ..
140541 - We reviewed the record in Millie's case showing that PET scan tests
140542 - have proven effective identifying cancer where other methods have
140543 - failed, e.g., on 030109. ref SDS 3 L66M
140545 -  ..
140546 - The doctor prepared Clinic Instructions for the following...
140547 -
140548 -        Laboratory...
140549 -
140550 -           Blood work
140551 -
140552 -              This provides a cross-check on tests performed 050629,
140553 -              which showed WBC and something else high. ref SDS 0 G540
140554 -
140555 -                  [On 050818 WBC still elevated; antibiotics
140556 -                  prescribed, and follow up blood test. ref SDS 18 BM8O
140558 -                   ..
140559 -                  [On 050906 1204 another blood test to evaluate
140560 -                  treatment for elevated WBC, and also checked
140561 -                  cholesterol again. ref SDS 22 DG8G
140562 -
140563 -
140564 -
140565 -
1406 -

SUBJECTS
Ultrasound Test Ordered for Image Testing of Stomache Disgestion Gas
Gastrointestinal (GI) Clinic Referral for Direct Imaging of Stomach

2004 -
200501 -         ..
200502 -        Ultrasound Test Ordered for Internal Organs
200503 -        Gastrointestinal GI Clinic Referral for Direct Imaging Stomach
200504 -
200505 -        Xray Radiology
200506 -
200507 -           Ultrasound test
200508 -
200509 -               [On 050818 test scheduled for 050830 1030 and
200510 -               instructions submitted. ref SDS 18 BM6R
200512 -                ..
200513 -               [On 050830 ultrasound sonograph test performed at VA in
200514 -               Martinez. ref SDS 21 DG8G
200516 -                ..
200517 -               [On 050906 received radiology report on ultrasound test.
200518 -               ref SDS 22 BM6R
200520 -         ..
200521 -        Referral
200522 -
200523 -              The doctor set a meeting with the Gastrointenstinal (GI)
200524 -              Department to perform radiologic investigation for direct
200525 -              imaging of the esophagus, stomach, and areas of interest
200526 -              toward diagnosis and treatment of digestion problem.
200527 -
200528 -                  [On 050912 GI clinic referral scheduled for 051115
200529 -                  1530 and no instructions for patient to be prepared.
200530 -                  ref SDS 23 0001
200532 -                   ..
200533 -                  [On 051115 Doctor in GI clinic had a conflict;
200534 -                  deferred meeting. ref SDS 25 HP9H
200536 -                   ..
200537 -                  [On 051122 meeting scheduled at GI clinic on 051202.
200538 -                  ref SDS 26 I45O
200540 -                   ..
200541 -                  [On 051202 examination confirms diagnosis achalasia,
200542 -                  ref SDS 27 0001; schedule endoscopy test to verify
200543 -                  diagnosis for due diligence. ref SDS 27 NZ5H
200545 -  ..
200546 - We will receive notice of dates for ultrasound test, and referral to
200547 - GI clinic.
200548 -
200549 -
200550 -
200551 -
200552 -
2006 -

SUBJECTS
Salivary Duct Stone Patient Reports Success Treating Meeting Doctor

2203 -
220401 -  ..
220402 - Salivary Duct Stone Problem Seems Resolved by JJ's Prescription
220403 -
220404 - The doctor asked about results of JJ's recommendations on 050809 to
220405 - treat the saliva duct stone, ref SDS 17 6G3H, and was pleased to hear
220406 - that favorable results occurred.  He will mention to JJ that I said
220407 - thanks.
220408 -
220409 -     [On 050819 salivary duct stone symptoms relapse; trying same
220410 -     remedy. ref SDS 19 ZX5S
220411 -
220412 -
220413 -
220414 -
220415 -
2205 -

SUBJECTS
Dermatology Surgery Wound Healing Normally No Evident Problems from

2403 -
240401 -  ..
240402 - Dermatology Surgery Wound Healing Normally
240403 -
240404 - The doctor made a quick examination of the surgery wound to remove the
240405 - mole from work last week on 050809. ref SDS 17 WH7F  He agreed with
240406 - Millie that the wound is healing normally.
240407 -
240408 -
240409 -
240410 -
240411 -
2405 -

SUBJECTS
Elegibility VA Investigated by Jerry Clears Problem Patient Reported

2603 -
260401 -  ..
260402 - Eligiblity Problem Resolved Computer Error
260403 -
260404 - While waiting this morning to see the doctor, the receptionist said
260405 - that Jerry in the Elegibility Department wants to meet prior to
260406 - meeting with the doctor this morning.
260408 -  ..
260409 - Visiting with Jerry, he noted that someone has entered into the VA
260410 - computer that elegibility has not been established.  Further
260411 - examination on the computer indicated that the DD214 has not been
260412 - filed.  Jerry at first did not recall processing the DD214 on 050610.
260413 - ref SDS 10 KH6I  He then remembered that Millie was in the meeting, and
260414 - seemed like a very nice person who was helpful in getting registration
260415 - information for the computer.
260417 -  ..
260418 - Jerry spent about 10 minutes using the VA computer system, and seemed
260419 - frustrated traveling in a loop getting back to the same place showing
260420 - that someone entered in the computer that the patient is not elegible
260421 - for service.  Jerry then related that this notice was entered in
260422 - 030219.
260424 -  ..
260425 - We reviewed the record showing a meeting with Michale in the patient
260426 - registration department on 030219, who planned to obtain information
260427 - on the DD214 form to complete a registration. ref SDS 5 I180  At that
260428 - time, Michael likely entered into the VA computer that the patient was
260429 - not eligible, because he was later not able to get information from
260430 - the DD214 form.  Two (2) years later, when conditions required
260431 - treatment, a DD214 form was obtained and submitted to Jerry on 050610,
260432 - as noted above. ref SDS 0 DG6H  Evidently, the prior entry showing the
260433 - patient is not eligible was not removed from the system on 050610, and
260434 - so continues to show up now.
260436 -  ..
260437 - Jerry called a colleague, who confirmed that the VA in Martinez has a
260438 - DD214 on file for the patient.  The colleague sent a copy of the form
260439 - to Jerry via fax, which he showed during the meeting.  Jerry said he
260440 - can use this form DD214 to clear the prior hold on elegibility, so
260441 - this problem does not happen again.  He called Latti in the Primary
260442 - Care check in department and advised that the patient is now eligible
260443 - for treatment.
260444 -
260445 -     [On 050919 attendant in VA Administration ordered another VA card,
260446 -     based on determining that Jerry resolved eligibility problem.
260447 -     ref SDS 24 GD7J
260449 -  ..
260450 - Went back to the Primary Care department, and shortly saw the doctor,
260451 - per above. ref SDS 0 DG8G
260452 -
260453 -
260454 -
260455 -
260456 -
260457 -
260458 -
260459 -
260460 -
260461 -
260462 -
2605 -