CONTACTS 

SUBJECTS
Birthday 65th Congratulations Fond Memories Growing Up Cupertino Fam

0703 -
0703 -    ..
0704 - Summary/Objective
0705 -
070501 - Follow up ref SDS 11 0000. ref SDS 10 0000.
070502 -
070503 -
070504 -
070505 -
070507 -  ..
0706 -
0707 -
0708 - Background
0709 -
070901 - On 100211 0752 letter sending congratulations and wishing Rob Happy
070902 - Birthday on reaching 65. ref SDS 9 6I6I
070904 -  ..
070905 - On 100211 1438 received letter from Rob saying he has had a good life,
070906 - and has had minimal health problems, ref SDS 10 6I6I, and reporting he
070907 - got married last year. ref SDS 10 4P56
070909 -  ..
070910 - On 100217 1952 called Ed and Kathy, Ed has been sick since October.
070911 - Yesterday on 100217 Kathy took Ed to the Emergency Care Department at
070912 - the VA.  He was diagnosed with pneumonia. ref SDS 11 6I6I
070914 -  ..
070915 - On 100218 0009 letter to Ed and Kathy with background on working with
070916 - VA the past 5 years. ref SDS 0 6I6I
070917 -
070918 -
070920 -  ..
0710 -
0711 -
0712 - Progress
0713 -
071301 - Letter to Ed and Kathy says...
071302 -
071303 -    1.  Subject: Recovery from Pneumonia
071304 -        Date: Thu, 18 Feb 2010 00:07:38 -0800
071312 -         ..
071313 -    2.  Sorry to hear in our call this evening that you have been sick
071314 -        since October, and rising symptoms landed you in Emergency Care
071315 -        on Tuesday.  Diagnosis of pneumonia, with complications of
071316 -        dental and GI issues present a complex problem.
071317 -
071318 -            [On 100301 0253 Ed back in hospital at VA in Sacramento,
071319 -            because treatment with antibiotics at home did not reduce
071320 -            symptoms of pneumonia, especially pain from coughing.
071321 -            ref SDS 13 M44F
071323 -             ..
071324 -            [On 100313 0823 Kathy called and said that Ed died
071325 -            yesterday at home from his battle with cancer, and without
071326 -            ever getting any treatment, ref SDS 14 6I6I; called and
071327 -            notified family members. ref SDS 14 084A
071329 -         ..
071330 -    3.  As I said, Millie was diagnosed with pneumonia and hospitalized
071331 -        for a week to recover.  She left the hospital after 3 days due
071332 -        to poor service at Kaiser.  Millie fully recovered after a
071333 -        2-week treatment, which sounds like what has been prescribed in
071334 -        your case.  Hopefully, you will get better as well.
071335 -
071336 -            [On 100218 1302 received letter from Ed responding to the
071337 -            letter today. ref SDS 12 E63P
071339 -         ..
071340 -    4.  Your symptoms seem much worse than Millie's, including
071341 -        significant loss of weight and strength.
071343 -         ..
071344 -    5.  Performance varies in big organizations at different locations
071345 -        and between departments.  So, don't be surprised if you start
071346 -        "falling through the cracks," because the VA is a very big
071347 -        organization.
071349 -         ..
071350 -    6.  My brief experience with the VA in Sacramento was problematic.
071351 -        They delayed a test twice due to broken equipment.  When the
071352 -        test was finally performed, they lost the results.  This
071353 -        delayed getting care for 2 years, as shown in case study on
071354 -        090908. ref SDS 5 8P4G
071356 -         ..
071357 -    7.  My primary care doctor at the VA in Martinez is excellent.  He
071358 -        basically orders tests and makes referrals for specific
071359 -        treatment.  That is how I was sent to the VA in San Francisco
071360 -        for  evaluation of heart issues.  Once I was under their care,
071361 -        they took control of the achalasia issue, and got that fixed.
071362 -        As I mentioned, I was also seen by an Internist to evaluate
071363 -        diagnosis of aspiration pneumonia. ref SDS 8 ER3K
071365 -         ..
071366 -    8.  This diagnosis turned out to be incorrect.  I mention all this
071367 -        for perspective on case management.  If time permits, glance
071368 -        through the record on 091102 to see how patients can be
071369 -        partners for effective care. ref SDS 7 PQ5P
071371 -         ..
071372 -    9.  Keep in mind, you have ultimate control over all procedures you
071373 -        receive.  If you and Kathy feel a prescribed treatment is not
071374 -        justified by the evidence, you can refuse it, while continuing
071375 -        to get treatment which seems appropriate to you.  Refusing a
071376 -        particular treatment doesn't mean your care ends.  Your medical
071377 -        team will come up with other ideas.
071379 -         ..
071380 -   10.  You mentioned this evening consideration to avoid getting a CT
071381 -        test in order to avoid learning about medical maladies that may
071382 -        be severe and require extensive care [reported on 100217 1952.
071383 -        ref SDS 11 4W8H].  As above, you can refuse to get a CT or any
071384 -        test. ref SDS 0 TK5P  That is a viable approach, which many
071385 -        take.  My thought would be to get all the tests, and then
071386 -        decide with your doctor, and with Kathy on the best course of
071387 -        action or inaction.
071389 -         ..
071390 -   11.  Kathy having a medical background is a huge asset for you.  It
071391 -        also helps to keep a record of work in progress, because often
071392 -        small details make a big difference in outcomes, and these
071393 -        small matters often "fall through the cracks" of busy doctors
071394 -        and nurses.   Writing up the record gives you a deeper
071395 -        understanding of correlations and implications required to
071396 -        guide the work.
071398 -         ..
071399 -   12.  You can also get copies from the VA of all work performed for
071400 -        you.  The VA is ahead of other health care providers in
071401 -        creating good records on tests and examinations, including the
071402 -        reasoning for prescribed care.  You can get these records to
071403 -        guide your analysis and support for your medical team.
071405 -         ..
071406 -   13.  You might consider asking your primary care physician about
071407 -        getting care at the VA in San Francisco.  Your case seems more
071408 -        complex than simply pneumonia, and so requires strong team care
071409 -        effort.
071410 -
071411 -            [On 100218 1302 received letter from Ed responding to the
071412 -            letter today. ref SDS 12 E63P
071414 -             ..
071415 -            [On 100301 0253 Ed back in hospital at VA in Sacramento,
071416 -            because treatment with antibiotics at home did not reduce
071417 -            symptoms of pneumonia, especially pain from coughing.
071418 -            ref SDS 13 M44F
071420 -         ..
071421 -   14.  Many, if not most, or even all of the doctors at the VA Medical
071422 -        Center in San Francisco are on contract from UCSF , which is
071423 -        among the top 10 medical centers in the country.  All of my
071424 -        doctors at the VA in San Francisco had UCSF identification
071425 -        tags.  These doctors are supported by an extensive intern
071426 -        group.  This support is very helpful for complex cases,
071427 -        compared to being seen by a single practitioner, who has many
071428 -        patients.
071430 -         ..
071431 -   15.  You may have the same sort of arrangements at the Sacramento
071432 -        VA; but, if not, this may be a good reason to get care at the
071433 -        VA Medical Center in San Francisco, if it is feasible for your
071434 -        situation.
071436 -         ..
071437 -   16.  Enough...
071439 -         ..
071440 -   17.  Kathy sounds great, as always!  Her trip to Greece scheduled
071441 -        for late May fits Millie's plans for a cruise with her
071442 -        daughter, and daughter-in-law.  Too bad, Millie can't mover her
071443 -        trip from May 10, so they can visit in Greece or somewhere over
071444 -        there.
071446 -         ..
071447 -   18.  Below is a letter from Rob, reporting his marriage last year.
071448 -        Didn't know that.  Wonderful to hear he is doing well [reported
071449 -        on 100211 1438. ref SDS 10 6I6I
071450 -
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0715 -