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: August 30, 2005 10:00 AM Tuesday; Rod Welch

VA ultrasound test for digestion issue.

1...Summary/Objective
2...Ultrasound Test Schedule, and Instructions to Prepare for Examination
3...Cancer Not Evident from Test Higher in Achalactic Patients
4...Radiology Report Received Barium Esophagus Test No Firm Diagnosis
5...Achalasia Possible Diagnosis Impression Radiology Report Barium Test
6...Barium Test Report Received No Cancer Achlasia Like Symptoms Observed


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CONTACTS 

SUBJECTS
Ultrasound Sonograph Test Performed to Diagnose Digestion Gastric Di

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 19 0000. ref SDS 18 0000.
060502 -
060503 - Went to the VA and got a ultrasound test on internal organs to
060504 - evaluate digestion problem.
060505 -
060506 -
060508 -  ..
0606 -
0607 -
0608 - Progress
0609 -
060901 - Ultrasound Test Schedule, and Instructions to Prepare for Examination
060902 -
060903 - Follow up ref SDS 19 BM6R, ref SDS 18 6E7H.
060908 -  ..
060909 - The sonographer performed a sonograph test on the internal organs, as
060910 - planned in the letter from the VA dated 050818. ref SDS 19 BM6R  This
060911 - implements planning by the primary care physician on 050816 to test
060912 - with ultrasound for a cause of blocked digestion, ref SDS 18 6E7H,
060913 - based on the earlier test on 050714, ref SDS 15 WE50, and which was
060914 - discussed with the primary care physician on 050816. ref SDS 18 AK5M
060916 -  ..
060917 - Vicky advised that professional practice does not permit calling out
060918 - what is observed during the examination.  An analyst will prepare a
060919 - written report.  The report can be obtained from the records release
060920 - department probably in a few days.
060921 -
060922 -     [On 050906 received radiology report on ultrasound test.
060923 -     ref SDS 20 BM6R
060924 -
060925 -
060926 -
060927 -
0610 -

SUBJECTS
Imaging Barium Sulfate Evalute Digestion Discovered Possible Duodena
Duodenal Obstruction Pylorus Constricted Gastric Examination Digesti
Radiology Report Barium Imaging Test Esophagus Upper GI Tract Report

1205 -
120601 -  ..
120602 - Cancer Not Evident from Test Higher in Achalactic Patients
120603 - Radiology Report Received Barium Esophagus Test No Firm Diagnosis
120604 - Achalasia Possible Diagnosis Impression Radiology Report Barium Test
120605 - Barium Test Report Received No Cancer Achlasia Like Symptoms Observed
120606 -
120607 - Follow up ref SDS 18 DG8G, ref SDS 15 0001.
120608 -
120609 - Received ref DRT 1 0001 from Nicol in the Medical Records Department,
120610 - which is a transmittal letter for the report on the radiology imaging
120611 - test performed on 050714, ref SDS 15 2I9J, and later discussed during
120612 - a meeting with Doctor Sandhu on 050816. ref SDS 18 DG8G
120613 -
120614 -    1.  Radiology Report, ref DRT 1 P074
120615 -
120616 -        ESOPHAGUS
120617 -        Examination Date:  July 14, 2005 1003
120618 -        Requesting Physician:  Harkesh S. Sandhu, MD
120619 -        (Case 1826 COMPLETE) ESOPHAGUS
120620 -        (RAD Detailed) CPT:74220
120621 -        Contrast Media:  Barium
120623 -         ..
120624 -    2.  Clinical History
120626 -         ..
120627 -        Patient with h/o likely hiatal hernia and stomach problem will
120628 -        need xray for that.
120630 -         ..
120631 -        Report Status:  Verified
120632 -        Date Reported:  July 14, 2005<BR>
120633 -        Date Verified:  July 14, 2005
120634 -        Verifier:  E-Sig:/ES/ILKWON KIM, MD
120636 -         ..
120637 -    3.  Report:
120639 -         ..
120640 -        Upper GI tract was studied by means of barium meal.  Initial
120641 -        scout views of the abdomen and chest were unremarkable except
120642 -        for mild cardiomegaly.  Deglutition was initiated on a normal
120643 -        fashion.  Flow of barium was stopped at the gastroesophageal
120644 -        junction causing marked dialation of the mid and lower
120645 -        espohagus and this is secondary to lack of organized esophageal
120646 -        peristalis and smooth symmetrical narrowing at the GE junction.
120647 -        Temporary transit of small amounts of barium was noted with
120648 -        increased hydrostatic pressure in the espohagus.  Delayed
120649 -        images showed only a small amount of barium opacifying the
120650 -        stomach and proximal small bowel which showed no evidence of
120651 -        abnormal filling defect, extrinsic compression or significant
120652 -        mucosal irregularity.
120654 -  ..
120655 - Findings from the VA report today align with the report from the test
120656 - at the VA on 050714. ref SDS 15 Q869
120658 -  ..
120659 - VA radiology report for test on 050713 concludes...
120660 -
120661 -    4.  Impression
120662 -
120663 -        1.  Findings in the lower espohagus and gastroesophageal
120664 -            junction are consistent with achalasia.  Although no
120665 -            obvious filling defect was demonstrated in the esophagus,
120666 -            incidence of esophageal carcinoma is higher in achalactic
120667 -            patients and I recommend endoscopic examination.
120668 -
120669 -                [On 051202 examination by doctor in GI clinic initially
120670 -                diagnoses primary achalasia. ref SDS 21 DX8K
120672 -                 ..
120673 -                [On 051209 endoscopy test and biopsies performed by
120674 -                Doctor Lee, ref SDS 22 CY5M; finding no evidnece of
120675 -                throat cancer, and confirming diagnosis of achalasia.
120676 -                ref SDS 22 PRRT
120678 -                 ..
120679 -                [On 051222 cancer negative findings pathology report on
120680 -                biopsies taken today consistant with achalasia.
120681 -                ref SDS 23 FT6M
120683 -         ..
120684 -        Primary Diagnostic Code:  ABORNAMLITY, ATTN NEEDED
120686 -         ..
120687 -    5.  Primary Interpreting Staff:
120688 -
120689 -        ILKWON KIM, MD, Radiologist (Verifier)
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