CONTACTS
SUBJECTS
Meeting Agenda Head & Neck Gastro Intestinal GI Department Physicia 04
1903 -
1903 - ..
1904 - Summary/Objective
1905 -
190501 - Follow up ref SDS 37 0000. ref SDS 26 0000.
190502 -
190503 -
190505 - ..
1906 -
1907 -
1908 - Progress
1909 -
190901 - Agenda Meeting Report New Issues and Progress on Medical Treatments
190902 -
190903 - Follow up ref SDS 37 R76I, ref SDS 26 R76I.
190904 -
190905 - 1. Head & Neck Doctor Lee.................... 090908, ref SDS 0 FT6M
190906 - 2. Primary Care Meeting...................... 090812, ref SDS 37 N83H
190907 - 3. Manometry Test............................ 090812, ref SDS 37 FT6M
190908 -
190910 - ..
190911 - Vitals Show Continued Improvement...
190912 -
190913 - Blood
190914 - Pressure Pulse Temp Weight OS2
190915 -
190916 - 090908........... 106 68 73 175 94
190917 - 090812........... 105 50 61 95.7 177 98
190918 - 060505........... 127 77 68 96.3 195
190919 - 060333........... 97 63 79 96.8 194
190920 - 050629........... 117 75 87 97.1 204
190921 -
190922 -
190923 -
1910 -
SUBJECTS
Achalasia Pneumatic Dilation Treatment Symptoms Rising Severe Weight
5303 -
530401 - ..
530402 - Case Study Achalasia Treatment Plan Chest Pains Evaluate
530403 - Achalasia Schedule Treatment Rising Symptoms Severe Weight Loss
530404 -
530405 - Follow up ref SDS 37 FT6M, ref SDS 26 FT6M.
530406 -
530407 - Background...
530408 -
530409 - 1. Digestion problems swallowing food reported
530410 - to primary care physician; Doctor Sandhu orders
530411 - xray and barium test for hiatical
530412 - hernia.................................... 050629 1000, ref SDS 7 K78K
530414 - ..
530415 - 2. Barium xray test shows cause of swallowing
530416 - problem, described as "bird beak" condition
530417 - at lower esophageal sphincer valve,
530418 - and performed at VA
530419 - in Martinez............................... 050714 1000, ref SDS 8 2I4S
530421 - ..
530422 - 3. Meeting primary care physician, Doctor Sandhu
530423 - mentions Achalasia as initial
530424 - diagnosis................................. 050816 0830, ref SDS 9 DG8G
530425 - research found an explanation of "bird
530426 - beak" like constriction from failure of
530427 - esophageal sphincter valve in throat
530428 - similar to findings in barium
530429 - test...................................... 050816 0830, ref SDS 9 S69O
530431 - ..
530432 - 4. Ultrasound test ordered by primary care
530433 - physician to evaluate swallowing
530434 - problem................................... 050816 0830, ref SDS 9 6E7H
530436 - ..
530437 - 5. GI Clinic examination ordered by primary
530438 - care physician............................ 050816 0830, ref SDS 9 0G7M
530440 - ..
530441 - 6. Ultrasound sonogram test performed at VA in
530442 - Martinez to evaluate swallowing
530443 - problem................................... 050830 1000, ref SDS 11 DG8G
530445 - ..
530446 - 7. Radiology report received on barium
530447 - test; diagnosis findings consistent
530448 - with achalasia............................ 050830 1000, ref SDS 11 UR3M
530450 - ..
530451 - 8. Ultrasound radiology report finds no
530452 - problems and does not assess
530453 - achalasia................................. 050906 1204, ref SDS 12 BM6R
530455 - ..
530456 - 9. Meeting Doctor Lee GI Clinic VA in
530457 - Martinez; examination and
530458 - consultation.............................. 051202 1430, ref SDS 13 HP9H
530459 - achalasia diagnosed....................... 051202 1430, ref SDS 13 5B5K
530460 - doctor orders endoscopy to test
530461 - for cancer................................ 051202 1430, ref SDS 13 H25N
530463 - ..
530464 - 10. Endoscopy finds no evidence cancer in
530465 - test performed at VA Martinez condition
530466 - precedent treatment recover from
530467 - achalasia................................. 051209 1130, ref SDS 14 PRRT
530469 - ..
530470 - 11. Photographs show throat clear of
530471 - cancer.................................... 051209 1130, ref SDS 14 CZ6M
530473 - ..
530474 - 12. Biopsy taken on 061209 pathology report
530475 - negative findings for
530476 - cancer.................................... 051222 0803, ref SDS 15 FT6M
530478 - ..
530479 - 13. Letter from Doctor in VA Gastrointestinal (GI)
530480 - Clinic reporting biopsy on 051209 was negative
530481 - for cancer and infection; doctor schedules
530482 - manometry test on 060209 at VA in Sacramento
530483 - to verify diagnosis of achalasia
530484 - required for performing
530485 - treatment................................. 060111 1722, ref SDS 16 GG9I
530487 - ..
530488 - 14. Manometry test delayed to 060223 because
530489 - equipment broke and is being
530490 - repaired.................................. 060209 0800, ref SDS 17 GX6J
530492 - ..
530493 - 15. Manometry test delayed to 060330 because
530494 - equipment repairs not yet
530495 - completed................................. 060221 0800, ref SDS 18 5K5F
530497 - ..
530498 - 16. Endoscopy follow up finds no evidence
530499 - cancer performed at VA Sacramento
530500 - condition precedent treatment
530501 - recover from
530502 - achalasia................................. 060330 0712, ref SDS 23 VX4G
530504 - ..
530505 - 17. Manometry test evaluate pneumatic dilation
530506 - recover swallowing problem achalasia
530507 - performed at VA in
530508 - Sacramento................................ 060330 0712, ref SDS 23 MC7P
530510 - ..
530511 - 18. Esophageal dilation to relieve achalasia
530512 - ready to be performed because 2 weeks earlier
530513 - Doctor Lee received pneumatic
530514 - balloons needed for the
530515 - procedure................................. 060505 0830, ref SDS 26 M25M
530517 - ..
530518 - 19. Esophageal dilation surgery for achalasia
530519 - delayed because VA Mather AFB Sacramento has
530520 - not yet submitted results of manometry test
530521 - Doctor Lee performed on 060330, ref SDS 26 PU5J
530522 - which the doctor needs to schedule a
530523 - procedure to treat
530524 - achalasia................................. 060505 0830, ref SDS 26 PU5J
530526 - ..
530527 - 20. Submitted letter to VA asking about schedule
530528 - on submitting results of manometry testing on
530529 - 060330, and scheduling treatment
530530 - for achalasia............................. 060529 1433, ref SDS 29 FT6M
530532 - ..
530533 - 21. Kim forwarded letter issued on 060529 to expedite
530534 - scheduling treatment for
530535 - achalasia................................. 060601 2013, ref SDS 30 FT6M
530537 - ..
530538 - 22. Renato reports during meeting at VA the the
530539 - GI clinic in the VA at Martinez has experienced
530540 - increased work load, which requires prioritizing
530541 - care for soldiers returning from Iraq; patient
530542 - advocate, Rubin Soto, will coordinate with GI
530543 - Clinic and notifying the customer of the
530544 - schedule for surgery to relieve
530545 - achalasia based on current
530546 - priorities................................ 060614 0937, ref SDS 31 J940
530548 - ..
530549 - 23. Letter to VA asks about progress getting test
530550 - results from VA in Sacramento, and
530551 - scheduling surgery for
530552 - achalasia................................. 070220 0812, ref SDS 33 5R5R
530554 - ..
530555 - 24. Weight loss reported 30 pounds in 2 months
530556 - may be caused by Achalasia not swallowing
530557 - food; Primary Care Physician
530558 - made referral for further
530559 - consideration of
530560 - treatment................................. 090812 1030, ref SDS 37 7L5O
530562 - ..
530563 - Doctor Lee recalled that on 060505 0830 he had balloons in stock for
530564 - pneumatic dilation to treat achalasia. ref SDS 26 M25M
530566 - ..
530567 - The doctor reported today he was very sorry that he never received
530568 - results of manometry test performed at the VA in Sacramento on 060330
530569 - 0712. ref SDS 23 MC7P
530570 -
530571 - [On 091030 0810 at 1406 meeting with Doctor Stewart on
530572 - surgical solution for achalasia after recovering from
530573 - heart bypass surgery. ref SDS 43 KE3B
530575 - ..
530576 - [On 091217 0600 surgery successful for recovering from
530577 - achalasia; there was a slight complication of a small
530578 - tear in the esophagus, which was repaired during the
530579 - surgery procedure; so patient is NPO, can having nothing
530580 - by mouth to eat or drink. The repair will be tested the
530581 - next day on 091218, ref SDS 46 0042; Doctor Stewart
530582 - indicates that if the test is favorable can begin eating
530583 - and go home. ref SDS 46 027A
530585 - ..
530586 - Doctor Lee advised that pneumatic dilation can be performed
530587 - immediately without further testing, because he attended the manometry
530588 - test in Sacramento on 060330, and determined from direct observation
530589 - at that time that manometry test results were consistent with other
530590 - tests showing symptoms of achalasia, and including recent significant
530591 - weight loss from loss of digestion, reported in the record meeting
530592 - with Doctor Sandhu on 090812, ref SDS 37 7L5O, which was presented
530593 - Doctor Sandhu's referral for the meeting today. ref SDS 37 MH6O
530594 -
530596 - ..
530597 - Chest Pain Hiking Hills New Symptom Past 3 Days
530598 -
530599 - The doctor asked about any new symptoms?
530601 - ..
530602 - Presented chest pains the past few days while hiking at Lafayette
530603 - Reservoir 2.75 mile route, initially noticable only on 3 steep hills.
530605 - ..
530606 - There is often some chest pain from shortness of breath hiking up the
530607 - steep hills, particularly after taking time off, causing fitness to
530608 - decline. This pain goes away within half-a-mile to a mile, and
530609 - certainly by completing a lap; so, that there is no pain going up the
530610 - hills at most by the 2nd lap. Recently, however, chest pain has
530611 - continued through the 2nd and 3rd laps, and requires slowing down to
530612 - prevent excessive discomfort. Hiking slowly seems to avoid chest
530613 - pain even on the steep hills.
530615 - ..
530616 - This change in physiology has occurred the last three (3) days in a
530617 - row. Previously, for the past 5 years hiking at Lafayette Reservoir
530618 - from 1 up to 5 laps a day, has not caused this problem.
530619 -
530620 - [On 091002 0900 reported to Doctor Egan in Cardiology
530621 - Department patient history on chest pains going uphill
530622 - hiking, ref SDS 39 LF6O (and cited in the VA medical chart,
530623 - ref SDS 39 MU4O); scheduled for angiogram test on 091020,
530624 - at VA Medical Center in San Francisco. ref SDS 39 V86G
530626 - ..
530627 - [On 091021 0716 Doctor Shunk performed angiogram test at VA
530628 - Medical Center in San Francisco, findings severe
530629 - restrictions in at least 2 main arteries to the heart, and
530630 - feels this normally would cause patient severe pain or
530631 - "heart attack" just sitting or with mild effort.
530632 - ref SDS 40 7L6X
530634 - ..
530635 - [On 091022 0700 quadruple heart bypass surgery performed
530636 - by Doctor Tseng, and her team; took about 10 hours.
530637 - ref SDS 41 01F9
530638 -
530640 - ..
530641 - Esophagus Swallowing 10% Could Swell Esophagus Impact Lungs Chest Pain
530642 - Chest Pain Esophagus Swallowing 10% Could Swell Esophagus Impact Lungs
530643 -
530644 - Increased swallowing problems, now about 10%, and vomitting problems
530645 - about 90% from achalasia could be swelling the esophagus enough to
530646 - press on the lungs, causing reduced breathing capacity, which has been
530647 - pending solution since diagnosis on 050714 1000. ref SDS 8 WE4H
530648 -
530649 -
530650 -
530652 - ..
530653 - Work Plan Evaluate Chest Pains Predicate Treatment Achalasia
530654 -
530655 - Doctor Lee proposed the following work plan to perform pneumatic
530656 - dilation to resolve achalasia...
530657 -
530658 - 1. Xray chest.
530660 - ..
530661 - 2. EKG to evaluate chest pains.
530663 - ..
530664 - 3. Stress test evaluate chest pains condition precedent to
530665 - performing pneumatic dilation for achalasia.
530666 -
530667 - [On 091002 0900 Doctor Egan, Oncology Department reports
530668 - stress test shows failure on 10 of 11 probes tested,
530669 - ref SDS 39 1W5I; orders angiogram test to evaluate heart
530670 - problems. ref SDS 39 V86G
530672 - ..
530673 - [On 091021 0716 angiogram test discovers blockages in
530674 - multiple cornorary arteries, ref SDS 40 7L43, schedule
530675 - heart bypass surgery on 091222. ref SDS 40 WB3K
530677 - ..
530678 - [On 091021 0716 at 1429 case study VA 10+ doctors ask
530679 - for patient history achalasai and discovery of cornorary
530680 - artery disease (CAD), beginning with chest pains
530681 - reported today. ref SDS 40 LJ7L
530683 - ..
530684 - [On 091022 0600 quadruple heart bypass surgery also
530685 - called Cornorary Artery Bypass Graft (pronounced
530686 - "cabbage"). ref SDS 41 01F9
530688 - ..
530689 - [On 131017 1000 meeting Doctor Egan determined that
530690 - since patient is very active phyically, hiking 1200
530691 - miles past 5 months, including Half Dome on 130918, and
530692 - since the patient remains asymptomatic, there is no need
530693 - to perform another treadmill stress test to evaluate for
530694 - blocked arteries due to elevated cholesterol in the lab
530695 - on 131015. ref SDS 48 ZZ6N
530697 - ..
530698 - 4. Pneumatic dilation resolve achalasia, if steps 1 - 3 show
530699 - no heart or lung problems.
530700 -
530701 - [On 091002 0900 Doctor Egan, Oncology Department reports
530702 - that treatment to correct achalasia problem must be
530703 - deferred until after resolution of possible heart
530704 - issues. ref SDS 39 W679
530706 - ..
530707 - [On 091029 0700 meeting with CT surgery team reveals
530708 - complications recovering from heart surgery due to
530709 - continuing digestion problems from achalasia.
530710 - ref SDS 42 RE7I
530712 - ..
530713 - [On 091030 0810 at 1406 meeting with Doctor Stewart on
530714 - surgical solution for achalasia after recovering from
530715 - heart bypass surgery. ref SDS 43 KE3B
530717 - ..
530718 - [On 091030 0810 at 1440 medical team proposes feeding
530719 - tube to solve dilemma of low nutrition preventing
530720 - recovery from heart surgery due to achalasia problem.
530721 - ref SDS 43 8J5J
530723 - ..
530724 - [On 091208 1300 everything lined up for Heller Myotomy
530725 - surgery on 091216 to recover from achalasia, and
530726 - transform negative synergy to make nutrition a postive
530727 - factor recovery from heart surgery. ref SDS 44 C65G
530729 - ..
530730 - [On 091216 0600 Heller Myotomy surgery at VA in San
530731 - Francisco to resolve achalasia. ref SDS 45 PQ7S
530733 - ..
530734 - [On 091217 0600 surgery successful for recovering from
530735 - achalasia; there was a slight complication of a small
530736 - tear in the esophagus, which was repaired during the
530737 - surgery procedure; so patient is NPO, can having nothing
530738 - by mouth to eat or drink. The repair will be tested the
530739 - next day on 091218, ref SDS 46 0042; Doctor Stewart
530740 - indicates that if the test is favorable can begin eating
530741 - and go home. ref SDS 46 027A
530743 - ..
530744 - [On 091220 0527 discharged from VA hospital after
530745 - recovery from surgery, with ability to swallow food.
530746 - ref SDS 47 PP5V
530747 -
530748 -
530749 -
530750 -
530751 -
530752 -
530753 -
530754 -
530755 -
5308 -