CONTACTS
SUBJECTS
Heller Myotomy Surgery Recover Achalasia Doctor Lygia Stewart Chief
0603 -
0603 - ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 16 0000.
060502 -
060503 -
060504 -
060506 - ..
0606 -
0607 -
0608 - Background
0609 -
060901 - On 091103 Paula reported the VA has scheduled a meeting today with
060902 - Doctor Stewart for planning Heller Myotomy surgery to correct
060903 - achalasia problem. ref SDS 11 PS60 On 091104 0718 Medical Chart
060904 - discharge guidance lists meeting with Doctor Stewart 091117 1300,
060905 - which conflicts with patient history today. ref SDS 12 Q03J On 091119
060906 - 1000 Erick confirmed visit with Doctor Stewart on 091208, and is
060907 - reviewing date of surgery scheduled for 091217. ref SDS 14 935H
060909 - ..
060910 - On 091208 Doctor Stewart advanced the schedule for surgery one day to
060911 - 091216. ref SDS 16 6E41
060913 - ..
060914 - On 091216 0600 meeting Doctor Stewart for Heller Myotomy surger to
060915 - correct achalasia; check in at ASU. ref SDS 0 PP8W
060916 -
060917 -
060918 -
060920 - ..
0610 -
0611 -
0612 - Progess
0613 -
061301 - Guidance received on 091208 says do not eat or drink anything after
061302 - midnight before the surgery.
061304 - ..
061305 - Report at 0600 to Ambulatory Surgical Unit (ASU) Building 200 3rd
061306 - floor 3A-122.
061308 - ..
061309 - Left the house in Concord at 0430; arrived at VA in San Francisco at
061310 - 0530. Millie returned immediately in order to arrive at Kaiser in
061311 - Walnut Creek for chemotheapy treatment at 0730 to recover from 9th
061312 - relapse of cancer.
061314 - ..
061315 - ASU was not yet open. There was another patient waiting in the
061316 - hallway.
061318 - ..
061319 - Went down the hall to Telemetry in TCU. Worked in the Family Waiting
061320 - Lounge until 0630. The furniture worked well using the notebook
061321 - computer and the keyboard.
061322 -
061324 - ..
0614 -
0615 -
0616 - 0630
0617 -
061701 - Checked in, per Renee's call yesterday on 091215 1548, ref SDS 19
061702 - 5R5H, and planning in the letter to the medical team on 091215 1017.
061703 - ref SDS 18 5R5H
061705 - ..
061706 - Prepared form listing clothing and belongings.
061707 -
061708 -
061710 - ..
0618 -
0619 -
0620 - 0632
0621 -
062101 - Called into ASU to begin preparations for surgery.
062102 -
062103 - Kimberly took vitals...
062105 - ..
062106 - Vitals
062107 -
062108 - Weight................. 173
062109 - Temperature............ 97
062110 - Blood pressure......... 106 61
062111 - Pulse.................. 59
062112 - Oxygen................. 96%
062113 - Resperation rate....... 20 per minute
062115 - ..
062116 - Dressed into gown for surgery.
062118 - ..
062119 - Kimberly helped setup c16 in gurney to wait for blood draw, and other
062120 - prep for surgery.
062122 - ..
062123 - Gina reviews recent medication history.
062125 - ..
062126 - Since blood pressure is low, Gina decided not to give Metoprolol this
062127 - morning to maintain low blood pressure. The medical team will decide
062128 - later whether to give Metoprolol as an IV.
062129 -
062131 - ..
0622 -
0623 -
0624 - 0716
0625 -
062501 - This morning having some stomach gas. The nurse advised that
062502 - anesthesia team will assess and treat the problem.
062503 -
062505 - ..
0626 -
0627 -
0628 - 0720
0629 -
062901 - Gina wheeled the gurney to move from ASU to the surgery recovery area,
062902 - which may be the same location where recovery occurred after heart
062903 - surgery on 091022 and 23.
062905 - ..
062906 - Kimberly will put the computer and keyboard into the patient
062907 - belongings container and log for storage.
062908 -
062910 - ..
0630 -
0631 -
0632 - 0734
0633 -
063301 - Alex introduces himself; seemed to explain being a Nurse Practitioner
063302 - on the VA Surgery Anesthesia team. This morning all other members of
063303 - the team are in a meeting at UCSF. He missed the meeting in order to
063304 - get started placing IV catheters for patients scheduled for early
063305 - morning surgeries, like this case.
063307 - ..
063308 - Alex has difficulty getting blood flow for an IV catheter in left arm
063309 - at the inner elbow.
063311 - ..
063312 - Explained that Joy was successful in TCU using a "trick" that applied
063313 - a tournaquet and hot towel to increase blood flow in the arm, reported
063314 - on 091101 0910. ref SDS 9 M46N Alex tried this procedure assisted by
063315 - Renee. Finally got the IV catheter to draw blood for another lab to
063316 - follow up the lab on Monday, 091214 1100. ref SDS 17 5R5H
063318 - ..
063319 - Alex proposes setting a 2nd IV catheter at the inner wrist of the
063320 - right arm.
063322 - ..
063323 - He explains that two (2) IV catheters, one in each arm, aids surgery
063324 - with blood transfusions, medication infusion, and blood draws.
063326 - ..
063327 - Discuss prospects that IV catheter on the inner right wrist will
063328 - present problems during recovery with writing the record using a
063329 - keyboard, and other tasks like grasping things, twisting a door knob,
063330 - pushing to get in and out of bed, etc.
063332 - ..
063333 - Alex advised that these problems do not arise in VA practice working
063334 - with other patients.
063336 - ..
063337 - Alex set IVs below near inner elbow both arms. He applied hot wet
063338 - towels and tornaquets to both arms, as discussed above. ref SDS 0 1G6J
063340 - ..
063341 - [On 091219 0600 at 0815 coordinate with nurse on transitioning
063342 - from IV to oral medication treatments, and to reduce continuing
063343 - pain using IV catheters, ref SDS 22 PQPX; inspection by nurse
063344 - finds infection at IV catheter penetration on right wrist 4
063345 - days after Heller Myotomy surgery; since planning discharge,
063346 - standard protocol to replace IV catheter not followed to avoid
063347 - expense and inconvenience to patient. ref SDS 22 0L46
063348 -
063349 -
063351 - ..
0634 -
0635 -
0636 - 0819
0637 -
063701 - Wheeled into the OR for Heller Myotomy surgery to recover from
063702 - achalasia, planned by Doctor Stewart on 091030 0810. ref SDS 7 GM5I
063703 - The operation today includes surgical construction of a "flap," called
063704 - "Dor Fundoplication". Fundoplication prevents ulceration of the
063705 - esophagus by blocking acid reflux from the stomach into the esophagus,
063706 - ref SDS 7 OY64, as discussed with Doctor Stewart and Doctor Tabrizi on
063707 - 091208 1300. ref SDS 16 PQ4Y Pre-op was on 091214 1100. ref SDS 17
063708 - GI9L
063710 - ..
063711 - [On 100305 1000 endoscopy test identifies "acid burn" evident
063712 - on only the "flap" tissue, ref SDS 23 PR6P; requested that the
063713 - VA in Martinez notify Doctor Stewart at the VA Medical Center
063714 - in San Francisco that the "flap" created during Heller Myotomy
063715 - surger to resolve achalasia shows "acid burn" during endoscopy
063716 - test, ref SDS 23 HB4K; Doctor Lee advised that the VA relies on
063717 - referral doctors using proactive case management to discover
063718 - possible problems related to their work by reviewing the
063719 - computer system.
063721 - ..
063722 - [On 100827 0738 Doctor Lee comments prior to 2nd EGD and
063723 - indicating effectiveness of surgery on 091216, to resolve
063724 - achalasia reduced by severe swelling that closes the throat due
063725 - to severe reflux causing "acid burn" in the esophagus that
063726 - clogs the throat making swallowing a continuing problem.
063727 - ref SDS 24 OP9O
063729 - ..
063730 - [On 100928 0706 VA medical chart Progress Notes prepared by
063731 - Doctor Stewart for Heller Myotomy procedure, which includes
063732 - fundolipation (folding the stomach to prevent acid reflux).
063733 - ref SDS 26 SO4N
063735 - ..
063736 - [On 101210 0930 photographs taken during 3rd EGD continue to
063737 - indicate esophabus, including flap constructed during Heller
063738 - Myotomy surgery appear health without signs of disease.
063739 - ref SDS 27 BF6M
063741 - ..
063742 - [On 150521 0800 planning meeting with Doctor Stewart at VAMC in
063743 - San Francisco on 150526 1300, to reivew remedies for evident
063744 - loosening of fundoplication which causes hiatal hernia and
063745 - ulceration of LESV, ref SDS 28 P59F, illustrated by diagrams in
063746 - the same record. ref SDS 28 M83N
063747 -
063749 - ..
063750 - Anesthesia applied.
063751 -
063752 - [On 100928 review of operation report. ref SDS 25 SO4N
063753 -
063755 - ..
0638 -
0639 -
0640 - 1650
0641 -
064101 - Wake up in the ASU Recovery area.
064102 -
064103 - Was moved to TCU with NPO status, pending initial recovery from
064104 - surgery.
064106 - ..
064107 - This means nothing to eat or drink, similar to the situation
064108 - recovering from heart surgery reported on 091102 0642. ref SDS 10 IV9M
064109 - Previously, the CT surgery team considered using a feeding tube to
064110 - prevent anemia. ref SDS 10 J43F Today, in this case, water can be
064111 - consumed by mouth, but only with a small sponge on a stick, until
064112 - approval by the doctor to begin normal eating, hopefully tomorrow.
064114 - ..
064115 - [On 091217 0600 surgery successful for recovering from
064116 - achalasia; there was a slight complication of a small
064117 - tear in the esophagus, which was repaired during the
064118 - surgery procedure; so patient is NPO, can having nothing
064119 - by mouth to eat or drink. The repair will be tested the
064120 - next day on 091218, ref SDS 20 0042; Doctor Stewart
064121 - indicates that if the test is favorable can begin eating
064122 - and go home. ref SDS 20 027A
064124 - ..
064125 - [On 091218 0541 at 1336 xray study performed, ref SDS 21
064126 - PQ5Q; results seem to show repair was effective, indicating
064127 - successful Heller Myotomy surgery to recover from
064128 - achalasia. ref SDS 21 ES5H
064130 - ..
064131 - [On 091218 0541 at 1647 Doctor Stewart advises that Heller
064132 - Myotomy surgery successful; patient NPO status ends, can
064133 - begin eating and drinking, and go home tomorrow or Sunday.
064134 - ref SDS 21 ER4F
064135 -
064136 -
064137 -
064138 -
064139 -
064140 -
064141 -
064142 -
064143 -
064144 -
0642 -