CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 12 0000. ref SDS 11 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 090916 VA performed stress test, which indicated possible heart
040902 - and circulation problems.
040904 - ..
040905 - On 091002 met with Doctor Egan, Cardiologist at the VA. The doctor
040906 - advised that 10 of 11 test points in the stress test showed positive
040907 - for circulation problems, and so the doctor ordered angiogram.
040908 - ref SDS 4 1W5I
040910 - ..
040911 - On 091006 0843 Karen called and scheduled angiogram test on 091020 at
040912 - the VA in San Francisco. ref SDS 5 1W5I Received a letter from Karen
040913 - on 091006 at 1045 confirming schedule for the test which requires
040914 - arriving at the VA on 091019 to do prep for the test on 091020.
040915 - ref SDS 5 GK8L
040917 - ..
040918 - On 091007 0021 sent a letter notifying the medical team that Doctor
040919 - Egan's treatment plan is being implemented, and asked a question about
040920 - the cause of pain based on level of effort. ref SDS 6 4Z75
040922 - ..
040923 - On 091007 0818 received letter from Karen at VA in San Francisco
040924 - responding to the letter this morning asking the medical team for
040925 - cause of chest pain that correlates to level of effort. Doctor Egan
040926 - has not had time to respond. Karen attributes pain to possible
040927 - angina, but does not explain what causes pain. ref SDS 7 A68H
040929 - ..
040930 - 091019 1300 meeting at VA in Cardiology for blood test to prepare for
040931 - angiogram test tomorrow, ref SDS 8 X59F, per Karen's letter on 091007
040932 - 0818. ref SDS 7 A68H
040934 - ..
040935 - 091020 0700 meeting at VA in San Francisco for angiogram test delayed,
040936 - ref SDS 9 01F9, explained in the record on 091019 1300. ref SDS 8 VH6Q
040938 - ..
040939 - 091021 0716 Meeting at VA for angiogram test, ref SDS 10 7L69,
040940 - positive for heart injury, ref SDS 10 7L43, medical team recommends
040941 - heart bypass surgery tomorrow, which was agreed, ref SDS 10 WB3K;
040942 - pre-op orientation meeting with cardiothroacic surgery team, led by
040943 - Doctor Tseng. ref SDS 10 FB5N
040945 - ..
040946 - On 091022 0700 Doctor Tseng, Neil, Paula, KC, and others performed the
040947 - quadruple heart by-pass surgery (4x cabg). ref SDS 11 01F9
040949 - ..
040950 - On 090123 0445 Recovery from heart bypass surgery yesterday presented
040951 - some challenges. ref SDS 12 01F9
040953 - ..
040954 - On 091024 0600 continue recovery from heart bypass surgery; bath in
040955 - bed; bedding changed; visit from Millie, then Bob and Peggy. Calls
040956 - from family. KC removed tubes from surgery; had 2 afib events.
040957 - ref SDS 0 01F9
040958 -
040959 -
040960 -
040962 - ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Througout the night, woke up several times with severe pain. Whenever
041302 - I asked, Joe gave immediate Fentynal injections through one the
041303 - several IVs in both arms. This provided immediate relief, and so was
041304 - able to sleep. As reported yesterday, Fentynal is very effective and
041305 - very fast to relieve pain. reported on 091023 0445, ref SDS 12 N45M
041306 -
041307 - [On 111101 0930 Bob not getting Fentynal injections for
041308 - pain following knee replacement surgery. ref SDS 16 QC9H
041310 - ..
041311 - Joe tried oxycodone (Percocet) pills a couple times today. This did
041312 - not relieve pain, so he went back to Fentynal. Swallowing problems
041313 - from achalasia may have affected transition to oxycodone.
041315 - ..
041316 - Joe gave a bed bath first thing. Still cannot eat, because achalasia
041317 - will cause vomitting, because cannot sit up. Food does not taste good
041318 - anyway.
041319 -
041320 -
041322 - ..
0414 -
0415 -
0416 - 0630
0417 -
041701 - Joe, the doctor, came in and was all smiles.
041702 -
041703 - Joe gave a thumbs up sign and said that he has been monitoring the
041704 - patient all night from the Control Room, and everything looks great
041705 - for strong recovery being on track, and following the visit with the
041706 - team yesterday on 091023 0445. ref SDS 12 VR4G
041708 - ..
041709 - Joe then said... "When did this happen?"
041711 - ..
041712 - Joe was looking up at vitals on the monitor in the ICU room.
041714 - ..
041715 - Joe, the nurse, said "Just now!!"
041717 - ..
041718 - They explained that the heart fell out of rythm (i.e., arrhythmia) and
041719 - into what is called "Atrial fibrillation" (also, "a-fibrillation" or
041720 - "a-fib"), and may beat faster than normal, sometimes called
041721 - "palpitations." (below, see research on the Internet.
041723 - ..
041724 - Experienced a strange feeling of the entire chest and head seeming to
041725 - rock or sway back and forth.
041727 - ..
041728 - Joe, the doctor, explained that heart bypass patients often experience
041729 - a-fibulation. Requires experimenting with drugs to cause the heart
041730 - beat rythm to re-stabalize, called "sinus."
041732 - ..
041733 - Joe, the nurse, tried several drug combinations. After about 40
041734 - minutes, he was satisfied that sinus was achieved.
041736 - ..
041737 - A-fib occurred again near or after mid-night, and took 4 hours or so
041738 - of medication combinations to restore normal heart rythm (sinus).
041739 -
041740 - [On 100928 0758 received medical records on heart surgery,
041741 - and found report on 091021 of mild left ventricular
041742 - hypertrophy. ref SDS 14 YJ4N This has occurred several
041743 - times since surgery and while laying flat in bed.
041744 - ref SDS 14 A25K
041745 -
041747 - ..
0418 -
0419 -
0420 - 0843
0421 -
042101 - Tried using the computer, but still a little groggy. Joe was great
042102 - helping to set things up.
042104 - ..
042105 - Research on the Internet shows...
042106 -
042107 - Emedicinehealth.com
042108 -
042109 - http://www.emedicinehealth.com/atrial_fibrillation/article_em.htm
042110 -
042111 - Atrial Fibrillation
042113 - ..
042114 - This source presents an overview, causes, symptoms.
042115 -
042116 - [On 101115 1624 Internet research found Emedicinehealth.com
042117 - again, says Atrial fibrillation frequently occurs after
042118 - cardiothoracic (open heart) surgery, but often resolves in
042119 - a few days. ref SDS 15 PY5I
042120 -
042122 - ..
042123 - Called Millie. She is coming to the hospital for another visit this
042124 - morning. Great!!!
042125 -
042127 - ..
0422 -
0423 -
0424 - 0917
0425 -
042501 - Got a call from Kathy and Ed. They were very encouraging, and talked
042502 - about coming for a visit. Ed discussed the Yankees win last night,
042503 - after losing the first game in Philidelphia.
042504 -
042505 -
042507 - ..
0426 -
0427 -
0428 - 0930
0429 -
042901 - Joe explained standard of care to recover from heart surgery is for
042902 - the patient to get up from bed and move the body, so all the internal
042903 - systems will function. He said the first step is to simply sit in the
042904 - chair next to the bed. Initially there will be some pain getting up.
042905 - If the patient tolerates this well, then the next day, after some of
042906 - the tubes are removed, he will help use a walker to take a few steps.
042908 - ..
042909 - Joe pointed to another patient who happened to be pushing a walker
042910 - around the ward. He explained that one of the criteria for releasing
042911 - patients to go home is being able to walk around the ward twice.
042913 - ..
042914 - As we talked, saw several other patients walking by our ICU station.
042915 - One looked in and smiled.
042917 - ..
042918 - Asked how long this takes?
042920 - ..
042921 - Joe said most patients go home in 5 days.
042923 - ..
042924 - Joe then rolled the computer setup aside. He elevated the bed, and
042925 - lowered the legs. He then assisted with me raising to a vertical
042926 - position and helped swing my legs off the bed, this despite having a
042927 - lot of tubes attached at various places. Joe lowered the bed so my
042928 - feet touched the floor. He lifted me to a standing position. This
042929 - hurt a lot everywhere. We just stayed there for 30 seconds or so.
042930 - The pain subsided a little. Joe then helped me twist around and then
042931 - gently lowered me onto the chair.
042933 - ..
042934 - After this I was quite out breath, and hurt everywhere.
042936 - ..
042937 - Might have been in this position for 30 seconds, maybe even 2
042938 - minutes, but asked to lay back down in bed. Joe helped with this.
042940 - ..
042941 - Once back in bed Joe was kind enough to provide more Fentynl for pain
042942 - releif.
042943 -
042944 -
042945 -
042946 -
042947 -
042949 - ..
0430 -
0431 -
0432 - 1100
0433 -
043301 - Millie came for a visit, and was here when lunch was served. She ate
043302 - some of this for lunch, still cannot eat, per above.
043303 -
043305 - ..
0434 -
0435 -
0436 - 1415
0437 -
043701 - Bob and Peggy Chapman arrived for a visit.
043702 -
043703 - They just missed Millie. Bob said he thought he saw Millie walking
043704 - down another hallway, but wasn't sure. After they got in the room,
043705 - and confirmed it was Mil, Bob ran down he hall, but by that time he
043706 - could not find Millie.
043708 - ..
043709 - Had a good visit. Peggy commented that the surgery incision just
043710 - looks like a "rug burn."
043711 -
043712 -
043714 - ..
0438 -
0439 -
0440 - 1622
0441 -
044101 - KC who was on the surgery team visited. She removed tubes protruding
044102 - from the chest.
044104 - ..
044105 - She was very supportive, and brought something additional to eat.
044106 - Tried to do this to please her, knowing it would not stay down with
044107 - achalasia.
044108 -
044109 -
044111 - ..
044112 - 20 Years CABG Treatment Durability
044113 -
044114 - Asked KC about durablity of CABG performed on Thursday, and cited by
044115 - Doctor Shunk saying bypass grafts are more reliable than stents,
044116 - reported on 091021 0716. ref SDS 10 7L61
044118 - ..
044119 - KC indicated that some studies have shown artery bypass grafts are
044120 - effective for a many years.
044122 - ..
044123 - Research on the Internet later found an article...
044124 -
044125 - Innovaro Pharmalicensing
044126 -
044127 - http://pharmalicensing.com/public/articles/view/1051520884_3eacef7414601/will-drug-eluting-stents-replace-need-for-cabg-a-cardiovascular-surgeons-viewpoint
044129 - ..
044130 - Will Drug Eluting Stents Replace Need for CABG
044131 - A Cardiovascular Surgeon's Veiwpoint
044133 - ..
044134 - By Lawrence M Prescott, PhD
044136 - ..
044137 - 39ths Annual Meeting
044138 - Society of Thoracic Surgeons
044139 - San Diego, CA
044140 - January 31 - February 2, 2003
044142 - ..
044143 - Article says in part....
044144 -
044145 - The achilles heel of CABG was vein graft failure, with the
044146 - time-limiting factor being vein graft atherosclerosis. It was
044147 - found, however, that the rate of vein graft failure could be
044148 - decreased somewhat by technical procedures, platelet
044149 - inhibitors and statins.
044151 - ..
044152 - Next came the discovery of the internal mammary graft approach
044153 - leading to fewer cardiac events, a better survival rate, and
044154 - the grafts lasting at least 20 years. In point of fact, this
044155 - is the major incremental benefit of CABG surgery over
044156 - percutaneous coronary intervention (PCI) grafts that stay
044157 - patent are better than vessels that don't.
044158 -
044159 -
044160 -
044161 -
044162 -
044164 - ..
0442 -
0443 -
0444 - 1819
0445 -
044501 - Got a call from Rob. He is traveling on the East Coast. Rob plans to
044502 - visit when he returns from the business trip at the end of the week.
044503 -
044505 - ..
0446 -
0447 -
0448 - 1853
0449 -
044901 - Jerry called from Utah on assignment to help someone build a house.
044902 - He was freezing calling from a phone booth.
044904 - ..
044905 - Thanked Jerry for calling and said to get inside and get warm.
044906 -
044907 -
044908 -
044909 -
044910 -
044911 -
044912 -
0450 -