CONTACTS 

SUBJECTS
Meeting Agenda Primary Care Physician Examination Vitals Blood Blood

1703 -
1703 -    ..
1704 - Summary/Objective
1705 -
170501 - Follow up ref SDS 19 0000. ref SDS 12 0000.
170502 -
170503 - Doctor Sandhu advised that prior lab work in 2005 indicated treatment
170504 - may be needed for high cholesterol. ref SDS 0 MA6I  Today, he ordered
170505 - follow up lab to test again on need for medication to control bad
170506 - cholesterol. ref SDS 0 236F  The doctor further prescribed follow up
170507 - with GI clinic to schedule surgery that relieves achalasia, which is
170508 - causing weight loss. ref SDS 0 MH9H  The doctor also scheduled follow
170509 - up referral with Dermatology. ref SDS 0 J26M
170510 -
170511 -        [On 090813 1500 blood draw and urinalysis at VA in Martinez.
170512 -        ref SDS 30 OP3M
170513 -
170514 -
170516 -  ..
1706 -
1707 -
1708 - Progress
1709 -
170901 - Agenda Meeting Report New Issues and Progress on Medical Treatments
170902 -
170903 - Follow up ref SDS 19 R76I.
170904 -
170905 -    1.  Physical examination annual............... ref SDS 0 N83H
170906 -    2.  Manometry Test............................ ref SDS 0 FT6M
170907 -
170909 -  ..
170910 - Vitals Show Continued Improvement...
170911 -
170912 -                        Blood
170913 -                        Pressure   Pulse   Temp  Weight  OS2
170914 -
170915 -     090812...........  105 50      61    95.7     177    98
170916 -     060505...........  127 77      68    96.3     195
170917 -     060333...........   97 63      79    96.8     194
170918 -     050629...........  117 75      87    97.1     204
170919 -
170920 -
170921 -
170922 -
1710 -

SUBJECTS
Examination Planning Physical 090910 0930 Review High Cholesterol Es

3603 -
360401 -  ..
360402 - Physical Examination Not Performed Vitals Require Further Review
360403 -
360404 - Follow up ref SDS 19 N83H, ref SDS 7 HS5G.
360405 -
360406 - Doctor asked about progress since examination on 060505?  Follow up
360407 - physicial examination was considered for 070407, 060505 0830,
360408 - ref SDS 19 AS5O, but was not peformed.
360410 -  ..
360411 - Vitals today show possible problems, per above. ref SDS 0 L45N
360413 -  ..
360414 - The doctor noted loss of 20 pounds, per vitals above, ref SDS 0 L45N,
360415 - which shows progress on recommendation to lose 30 pounds, reported on
360416 - 060505 0830, ref SDS 19 H88L
360418 -  ..
360419 - The doctor ordered lab blood work for tomorrow and follow up
360420 - examination in 4 weeks to evaluate blood work results.
360422 -  ..
360423 - The lab can be done anytime tomorrow or the next day as a walk-in
360424 - procedure.
360426 -  ..
360427 - Follow up examination to evaluate lab results was scheduled by the
360428 - front desk for...
360429 -
360430 -            090910 0930
360432 -  ..
360433 - This is a Thursday, and so may conflict with Millie getting Neupogen
360434 - at Kaiser in Walnut Creek, because Millie changed her chemtherapy
360435 - treatments from Tuesday to Wedensday in order to get blood draws on
360436 - Tuesday that miss holidays on Mondays.
360437 -
360438 -
360439 -
360440 -
360441 -
3605 -

SUBJECTS
Cholesterol High 3 Years Ago Case Study Patient History Evaluate Vit

5703 -
570401 -  ..
570402 - Lab Ordered Test for Cholesterol Evaluate Treatment Requirements
570403 - Cholesterol Case Study Evaluate and Prescribe Treatment
570404 - Case Study Cholesterol Evaluate and Prescribe Treatment
570405 - Cholosteral High from Test 050801 Prescribe Exercise Diet Drugs
570406 -
570407 - Follow up ref SDS 19 MA6I, ref SDS 7 UY6M.
570408 -
570409 - The doctor looked through patient records on the VA computer for the
570410 - physical examination on 060505. ref SDS 19 N83H
570411 -
570412 -    1.  Physical examination ordered lab which
570413 -        was performed later the same
570414 -        day....................................... 050629 1000, ref SDS 7 G69K
570416 -         ..
570417 -    2.  Lab follow up ordered to test elevated
570418 -        WBC....................................... 050816 0830, ref SDS 8 G540
570420 -         ..
570421 -    3.  WBC still elevated doctor prescribed
570422 -        Amoxicillin Antibiotics................... 050818 1452, ref SDS 9 DG8G
570424 -         ..
570425 -    4.  Cholesterol high reported for 3 blood
570426 -        tests a year earlier; doctor orders
570427 -        follow up lab............................. 060505 0830, ref SDS 19 MA6I
570429 -         ..
570430 -    5.  Cholesterol; high in follow up blood test
570431 -        doctor prescribes treatment with Lovastatin;
570432 -        there is no record of receiving nor
570433 -        taking Lovastatin......................... 060623 0840, ref SDS 25 UO6K
570435 -         ..
570436 -    6.  Lab follow up ordered to test for high
570437 -        cholosterol............................... 090812 1030, ref SDS 0 236F
570439 -  ..
570440 - The doctor noticed improved blood pressure, and pulse, with lower
570441 - weight in vitals taken today, and compared with three (3) years ago
570442 - all showing improvement, per above. ref SDS 0 L45N
570444 -  ..
570445 - Doctor Sandhu ordered more lab work to assess cholesterol and other
570446 - factors that might explain sudden weight loss, besides improved
570447 - fitness.
570449 -  ..
570450 - Instructions for fasting to perform LIPID test of cholesterol are same
570451 - as for the prior test on 060505 0830. ref SDS 19 5E3H
570452 -
570453 -        [On 090813 1500 blood draw and urinalysis at VA in Martinez;
570454 -        ref SDS 30 OP3M; results show cholesterol high; bad cholesterol
570455 -        is too high, and good cholesterol is too low, indicating at
570456 -        risk condition. ref SDS 30 4N5H
570458 -         ..
570459 -        [On 091021 0716 angiogram test for blood flow restrictions was
570460 -        performed at VA in San Francisco; discovered 4 blockages; so,
570461 -        heart bypass surgery was prescribed. ref SDS 31 7L47
570463 -         ..
570464 -        [On 091022 0700 quadruple heart bypass surgery performed to
570465 -        recover from blood flow restrictions discovered in angiogram
570466 -        test the day before. ref SDS 32 01F9
570468 -         ..
570469 -        [On 091104 0718 VA San Francisco ordered Simvastatin 20 MG
570470 -        taken every day to control cholesterol, ref SDS 33 IA4H; and
570471 -        this duplicates prescription by Doctor Sandhu for Simvastatin
570472 -        40 MG to take one-half pill every day to control cholesterol.
570473 -        ref SDS 33 IA5W
570474 -
570475 -
570476 -
570477 -
5705 -

SUBJECTS
Achalasia Pneumatic Dilation Treatment Symptoms Rising Severe Weight

8503 -
850401 -  ..
850402 - Achalasia Schedule Treatment Rising Symptoms Severe Weight Loss
850403 -
850404 - Follow up ref SDS 19 FT6M, ref SDS 12 FT6M.
850405 -
850406 - Background...
850407 -
850408 -    1.  Manometry test evaluate pneumatic dilation
850409 -        recover swallowing problem achalasia
850410 -        performed at VA in
850411 -        Sacramento................................ 060330 0712, ref SDS 16 MC7P
850413 -         ..
850414 -    2.  Esophageal dilation to relieve achalasia
850415 -        ready to be performed because 2 weeks earlier
850416 -        Doctor Lee received pneumatic
850417 -        balloons needed for the
850418 -        procedure................................. 060505 0830, ref SDS 19 M25M
850420 -         ..
850421 -    3.  Esophageal dilation surgery for achalasia
850422 -        delayed because VA Mather AFB Sacramento has
850423 -        not yet submitted results of manometry test
850424 -        Doctor Lee performed on 060330, ref SDS 19 PU5J
850425 -        which the doctor needs to schedule a
850426 -        procedure to treat
850427 -        achalasia................................. 060505 0830, ref SDS 19 PU5J
850429 -         ..
850430 -    4.  Submitted letter to VA asking about schedule
850431 -        on submitting results of manometry testing on
850432 -        060330, and scheduling treatment
850433 -        for achalasia............................. 060529 1433, ref SDS 22 FT6M
850435 -         ..
850436 -    5.  Kim forwarded letter issued on 060529 to expedite
850437 -        scheduling treatment for
850438 -        achalasia................................. 060601 2013, ref SDS 23 FT6M
850440 -         ..
850441 -    6.  Renato reports during meeting at VA the the
850442 -        GI clinic in the VA at Martinez has experienced
850443 -        increased work load, which requires prioritizing
850444 -        care for soldiers returning from Iraq; patient
850445 -        advocate, Rubin Soto, will coordinate with GI
850446 -        Clinic and notifying the customer of the
850447 -        schedule for surgery to relieve
850448 -        achalasia based on current
850449 -        priorities................................ 060614 0937, ref SDS 24 J940
850451 -         ..
850452 -    7.  Letter to VA asks about progress getting test
850453 -        results from VA in Sacramento, and
850454 -        scheduling surgery for
850455 -        achalasia................................. 070220 0812, ref SDS 26 5R5R
850457 -  ..
850458 - Reported that since the last visit on 060505 when vitals showed weight
850459 - had dropped 10 pounds, there was a gain back to 205, but within the
850460 - past month, there has been a sudden loss of about 30 pounds.
850462 -  ..
850463 - Today, Doctor Sandhu made a referral to the GI clinic for Doctor Lee
850464 - to schedule pneumatic dialation surgery to relieve achalsasia symptoms
850465 - of chronic weight loss, per vitals above. ref SDS 0 L45N
850466 -
850467 -
850468 -
8505 -

SUBJECTS
Dermatology Referral Consultation with Rosacia Mohs Surgery Nose Rem

AG03 -
AG0401 -  ..
AG0402 - Mohs Surgery Follow Up Referral Consultation with Dermatology
AG0403 -
AG0404 - Follow up ref SDS 29 HS6G, ref SDS 28 N68Y.
AG0405 -
AG0406 - During the meeting today, Doctor Sandhu entered in the VA computer a
AG0407 - referral for consultation with Dermatology to evaluate nose surgery
AG0408 - performed on 080227, ref SDS 28 N68Y, and examined last on 080311.
AG0409 - ref SDS 29 HS6G
AG0410 -
AG0411 -
AG0412 -
AG0413 -
AG05 -

SUBJECTS
Case Management Improves Primary Care Physician Collaborate Coordina

BJ03 -
BJ0401 -  ..
BJ0402 - Case Management Referral Team Care Patient Challenge of Leadership
BJ0403 -
BJ0404 - Follow up ref SDS 19 P58H.
BJ0405 -
BJ0406 - Previously, the doctor advised that the primary care physician cannot
BJ0407 - perform case management to collaborate and coordinate follow up on
BJ0408 - referrals, in this case the GI Clinic treating achalasia.  Doctors
BJ0409 - resist support to get things done.  Coordination, collaboration,
BJ0410 - management and leadership are viewed as "interference," rather than
BJ0411 - timely reminders to avoid problems by treating the patient, reported
BJ0412 - on, 060505 0830, ref SDS 19 P58H
BJ0414 -  ..
BJ0415 - Today, the doctor made an exception notifying Doctor Lee to review the
BJ0416 - schedule for performing surgery to relieve achalasia, per above.
BJ0417 - ref SDS 0 MH9H
BJ0418 -
BJ0419 -
BJ0420 -
BJ0421 -
BJ0422 -
BJ05 -