CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
3703 -
3703 - ..
3704 - Summary/Objective
3705 -
370501 - Follow up ref SDS 41 0000. ref SDS 38 0000.
370502 -
370503 -
370504 -
370505 -
370507 - ..
3706 -
3707 -
3708 - Background
3709 -
370901 - On 090908 1130 Doctor Lee prepared work plan, ref SDS 14 BU6W, for
370902 - treating achalasia and including resolving new symptom of chest pains,
370903 - based on case study of diagnosis and treatment for achalasia.
370904 - ref SDS 14 FT6M
370906 - ..
370907 - On 091002 met with Doctor Egan, Cardiologist at the VA. The doctor
370908 - advised that 10 of 11 test points in the stress test showed positive
370909 - for circulation problems, and so the doctor ordered angiogram.
370910 - ref SDS 15 1W5I
370912 - ..
370913 - 091021 0716 Meeting at VA to complete angiogram test meeting,
370914 - ref SDS 16 01F9, and perform test. ref SDS 16 025B Results show
370915 - requirement for heart bypass surgery. ref SDS 16 7L47
370917 - ..
370918 - On 091022 0700 Doctor Seng, Casey and others performed quadruple heart
370919 - bypass surgery at VA in San Francisco. ref SDS 17 01F9
370921 - ..
370922 - On 091029 0700 CT surgery team concernec about nutrition, and
370923 - considers using feeding tube, while waiting for patient to recover
370924 - from achalasia. ref SDS 18 RE6J
370926 - ..
370927 - On 091030 0810 at 1406 met with Doctor Stewart to consider options for
370928 - recovering from achalasia. ref SDS 19 KE3B Received explanation of
370929 - Heller Myotomy surgery. ref SDS 19 GM5I
370931 - ..
370932 - On 091030 0810 at 1440 met with Doctor Ratcliffe and CT surgery team
370933 - to review solutions for nutrition required to recover from heart
370934 - surgery, while waiting to resolve achalasia problem. ref SDS 19 03GF
370936 - ..
370937 - On 091031 0730 discussed scheduling surgery to fix achalasia problem
370938 - as essential predicate to maintain nutrition required for recovering
370939 - from heart surgery. ref SDS 20 I15I
370941 - ..
370942 - On 091103 Paula reported the VA has scheduled a meeting today with
370943 - Doctor Stewart for planning Heller Myotomy surgery to correct
370944 - achalasia problem. ref SDS 22 PS60 On 091104 0718 Medical Chart
370945 - discharge guidance lists meeting with Doctor Stewart 091117 1300,
370946 - which conflicts with patient history today. ref SDS 23 Q03J On 091119
370947 - 1000 Erick confirmed visit with Doctor Stewart on 091208, and is
370948 - reviewing date of surgery scheduled for 091217. ref SDS 25 935H
370950 - ..
370951 - On 091104 0718 discharged from VA recovering from quadruple heart
370952 - bypass surgery, ref SDS 23 PR4V, performed on 091022 0700. ref SDS 17
370953 - PQWU; received medical record with list of medications, also on 091104
370954 - 0718, ref SDS 23 1Q6P, and follow up meetings. ref SDS 23 9T6O
370956 - ..
370957 - On 091208 Doctor Stewart advanced the schedule for surgery one day to
370958 - 091216. ref SDS 27 6E41
370960 - ..
370961 - On 091216 0600 meeting Doctor Stewart for Heller Myotomy surgery to
370962 - correct achalasia; check in at ASU. ref SDS 31 PP8W
370964 - ..
370965 - On 091217 0600 meeting with Joe and Jon on recovring from Heller
370966 - Myotomy surgery; report of complication during surgery on 091216,
370967 - which was repaired, with plan for test to evaluate recovery. reported
370968 - on 091217 0600, ref SDS 32 0042 Doctor Stewart visited and expects
370969 - can start eating after favorable test. ref SDS 32 027A
370971 - ..
370972 - On 091218 0600 xray with gastrogafin to evaluate repair for
370973 - complicaiton during Heller Myotomoy surgery Wednesday, ref SDS 33 PP8W,
370975 - ..
370976 - On 091219 0600 doctor plans discharge tomorrow after evaluating
370977 - progress eating solid food today. ref SDS 34 PP5V Since now eating
370978 - solid food, switched to oral pill medication to replace IV injections;
370979 - this relieved pain that has been increasing using IV catheters set on
370980 - Wednesday, ref SDS 34 PQPX, and also eliminated need to replace IV
370981 - catheters per TCU protocol. ref SDS 34 7Q55 Doctors prescribed hiking
370982 - to recover from Heller Myotomy surgery resolving achalasia.
370983 - ref SDS 34 7Q6P Doctor Ratcliff and Neil visit and discussing doing a
370984 - small business trial to apply SDS technology for upgrading VA and UCSF
370985 - case management. ref SDS 34 0M6S Nurse advises that patient approved
370986 - for moving to a ward for non-critical care, as a predicate to
370987 - discharge, but since there are no rooms available, patient will remain
370988 - in TCU untill a room is available. ref SDS 34 0M8S
370990 - ..
370991 - On 091220 0527 discharge approved from hospital today. ref SDS 35 PP8W
370992 - Left the hospital about 1220. ref SDS 35 HB5O
370994 - ..
370995 - On 091221 1532 Isagani called to schedule meeting with Doctor Stewart
370996 - at VA in San Francisco on 100105. ref SDS 36 PP8W
370998 - ..
370999 - On 091222 1109 letter from Isagana says meeting with Doctor Stewart is
371000 - scheduled on 100112 1400. ref SDS 37 PP8W
371002 - ..
371003 - On 091223 1452 letter came in regular mail scheduling a meeting with
371004 - Doctor Stewart on 100105 1400. ref SDS 38 PP8W
371006 - ..
371007 - On 100104 0930 met with Doctor Sandhu to begin care for heart surgery
371008 - and follow up on Heller Myotomy surgery to recover from achalasia.
371009 - ref SDS 41 PP8W
371011 - ..
371012 - On 100105 1300 meeting with Jan and Doctor Stewart; examination finds
371013 - good progress recovering from Heller Myotomy surgery on 091216, and
371014 - surgery effective resolving achalasia problem, swallowing improved.
371015 - ref SDS 42 PP8W
371017 - ..
371018 - On 100127 1210 submitted agenda in a letter to the medical team for
371019 - the meeting at the VA in Martinez scheduled for 100202; primary
371020 - objective to evaluate recovery from achalasia following Heller Myotomy
371021 - surgery at the VA in San Fancisco on 091216 0700. ref SDS 43 PP8W
371023 - ..
371024 - On 100202 1400 met with Doctor Lee in GI Department VA Martinez, and
371025 - to follow up heart surgery and Heller Myotomy surgery to recover from
371026 - achalasia. ref SDS 0 PP8W
371027 -
371028 -
371029 -
371031 - ..
3711 -
3712 -
3713 - Progress
3714 -
371401 - Issues reviewed during the meeting today...
371402 -
371403 - 1. Doctor Lee asked about patient history of heart surgery
371404 - performed on 091022, because he had not received the record
371405 - submitted to Doctor Sandhu [on 100127, ref SDS 43 PP8W] to
371406 - prepare for the meeting today. Summarized the record, per
371407 - above. ref SDS 0 5R5H
371409 - ..
371410 - 2. Heller Myotomy surgery performed on 091216 to recover from
371411 - achalasia, ref SDS 31 KE8T, with follow up examination by
371412 - Doctor Stewart at VA in San Francisco on 100105.
371413 - ref SDS 42 PP8W
371415 - ..
371416 - 3. Swallowing problems continue. Doctor Stewart expects
371417 - problems to resolve over time, reported on 100105 1300.
371418 - ref SDS 42 K842
371420 - ..
371421 - Revised assessment of swallowing 90% and vomitting 10%
371422 - eating meals. Actually closer to 80% and 20%.
371423 -
371425 - ..
371426 - Achalasia Breaks Nerves Brain LESV Swallow Only with Gravity
371427 -
371428 - Doctor Lee seemed to explain that achalasia disease has broken nerves
371429 - from the brain that control the swallowing process, which normally
371430 - contracts the esophagus and opens the lower esophagual sphincter valve
371431 - (LESV), thereby pushing food and liquid taken by mouth down the
371432 - esophagus and into the stomach. As a result, there is less control of
371433 - affirmative swallowing in the esophagus. This aligns closely with
371434 - research on 051202 1430. ref SDS 6 K55N
371436 - ..
371437 - Swallowing now can only occur from gravity, which is better than the
371438 - past 5 years, but not fully functional. Dilation of LESV is therefore
371439 - essential to open the LESV for near-normal swallowing that avoids food
371440 - and liquid backing up, expanding the esophagus, as shown in radiology
371441 - barrium swallow test on 050714 1000, ref SDS 5 Q869, and causing
371442 - vomitting, as discussed with Doctor Lee 5 years ago, on 051202 1430.
371443 - ref SDS 6 Q55N
371445 - ..
371446 - [On 100827 0738 at 1333 during post procedure meeting,
371447 - Doctor Lee reported condition of LESV is about 11 mm,
371448 - unchanged from initial EGD dilation on 100305, so there has
371449 - been no evident improvement. ref SDS 46 0466
371451 - ..
371452 - This supplements original explanation presented when Doctor Lee
371453 - diagnosed achalasia on 051202 1430. ref SDS 6 5B5K
371455 - ..
371456 - Scheduled endoscopy and colonoscopy for 100305.
371458 - ..
371459 - These two (2) tests will be performed same day and evaluate for
371460 - cancer, following up prior endoscopy on 051209. ref SDS 7 4F6H At
371461 - that time, preliminary results were negagive, which as favorable for
371462 - finding no signs of cancer. ref SDS 7 PRRT On 051222 Doctor Lee
371463 - confirmed biopsy findings showed no throat cancer. ref SDS 8 FT6M
371465 - ..
371466 - The doctor will order pre-test medium to flush bowels, which requires
371467 - drinking a gallon of water with suspended agent the day before the
371468 - procedure.
371469 -
371470 - [On 100304 1819 performed pre-procedure preparations for e
371471 - endoscopy and colonoscopy tests. ref SDS 44 R54I
371473 - ..
371474 - [On 100305 1000 EGD with dilation. ref SDS 45 Y65G
371475 -
371476 -
371477 -
371478 -
371479 -
371480 -
371481 -
3715 -