CONTACTS 

SUBJECTS
Endoscopy Colonoscopy Test Follow Up Complications None Reported Med

2803 -
2803 -    ..
2804 - Summary/Objective
2805 -
280501 - Follow up ref SDS 50 0000. ref SDS 49 0000.
280502 -
280503 -
280505 -  ..
2806 -
2807 -
2808 - Background
2809 -
280901 - Background on endoscopy and colonoscopy tests reported on 100305 1000.
280902 - ref SDS 49 5R5H
280904 -  ..
280905 - On 100308 1411 Marcia called to discuss results of endoscopy and
280906 - colonoscopy tests. ref SDS 50 CG6K  Reported no complications, and
280907 - that quality of care was excellent. ref SDS 50 H244  Marcia clarified
280908 - that illegible handwriting on discharge orders for work on 100305
280909 - prescribed treatment for acid burn, and asked if medication has been
280910 - received.  Since medication has not been received, Marcia re-ordered
280911 - the prescription. ref SDS 50 CH3O  Marcia advised that the
280912 - prescription and instructions for medication to treat acid burn are
280913 - shown in the doctor's Progress Notes for work on 100305. ref SDS 50
280914 - NL58  Requested the computer file for VA Progress Notes, including the
280915 - call today.  Marcia explained patients can get in the care and drive
280916 - 20 miles to the VA, stand in line at the Release of Information Window
280917 - and fill out a form.  Then an attendant will print the computer file,
280918 - which the patient can take home 20 miles away, and then type up the
280919 - file again to a computer record for efficient case management.
280920 - ref SDS 50 CH58
280922 -  ..
280923 - On 100308 1411 record of VA Progress Notes for telecon with Marcia
280924 - today shows emotional resistance to efficient case management.
280925 - ref SDS 50 ES50 and, ref SDS 50 ES59
280927 -  ..
280928 - On 100312 1119 VA letter transmits Progress Notes and pathology
280929 - reports on biopsies taken during medical tests on 100305, ref SDS 51
280930 - EY4F; transmittal letter explains patient medical records are
280931 - confidential to protect patient identify theft, avoid patient
280932 - embarrassment, and enhance patient convenience. ref SDS 51 MN81
280933 -
280934 -
280935 -
280937 -  ..
2810 -
2811 -
2812 - Progress
2813 -
281301 - Letter to VA feedback on medical tests...
281302 -
281303 -    1.  Subject: Endoscopy Test Findings Acid Burn Treatment Prescribed; Colonoscopy No Evident Disease
281304 -        Date: Wed, 17 Mar 2010 01:24:04 -0700
281315 -         ..
281316 -    3.  This is feedback for endoscopy and colonoscopy tests performed
281317 -        by Doctor Lee at VA Clinic in Martinez on 100305.  Very pleased
281318 -        to report excellent medical services. ref SDS 49 0001
281320 -         ..
281321 -    4.  Progress Notes Nurses Checklist (see section 3) report that the
281322 -        customer does not have an Advanced Directive on file with the
281323 -        VA. ref SDS 49 MV6M
281325 -         ..
281326 -    5.  The record on 091023 shows an Advance Directive was signed
281327 -        electronically at the VA Medical Center in San Francisco, the
281328 -        day after heart surgery. ref SDS 17 WO5Y
281330 -         ..
281331 -    6.  Please let me know if this document is still active, or needs
281332 -        to be re-signed.
281334 -         ..
281335 -    7.  On awakening from sedation after the tests on 100305, Doctor
281336 -        Lee advised that endoscopy found evidence of "acid burn" on the
281337 -        "flap" that reduces reflux [through the esophageal sphincter
281338 -        valve], which Doctor Stewart constructed during Heller Myotomy
281339 -        surgery at the VA Medical Center in San Francisco on 091216.
281340 -        ref SDS 49 PR6P
281341 -
281342 -            [On 100331 1448 VA letter seems to expand understandings
281343 -            from meeting on 100305, ref SDS 49 PR6P, and presented in
281344 -            feedback letter to the VA on 100317 1213. ref SDS 0 PT6W,
281345 -            to relate test findings of general reflux esophagitis,
281346 -            rather than or in addition to mere "acid burn" on the flap
281347 -            for the esophageal sphincter valve. ref SDS 52 YW5S
281349 -         ..
281350 -    8.  Progress Notes for the endoscopy test do not seem to make
281351 -        findings of acid burn. ref SDS 49 Y65G  [Similarly, pathology
281352 -        for biopsies do not present findings of "acid burn," nor any
281353 -        malady, reported on 100312 1119, ref SDS 51 VY4I].
281355 -         ..
281356 -    9.  GI Discharge documentation has illegible handwriting.  Marcia
281357 -        called on 100308 and explained the doctor prescribed Omeprazole
281358 -        20 mg 90 capsules RX #10797503 - take one capsule daily 15
281359 -        minutes before 1st meal to relieve severe acid reflux and
281360 -        esophageal narrowing.  At that time, on 100308 this medication
281361 -        had not been received, so Marcia replaced the order.
281362 -        ref SDS 50 CH3O
281364 -         ..
281365 -   10.  Yesterday, received the medication and began treatment, as
281366 -        prescribed.  Doctor Lee plans follow up examination in a few
281367 -        months to evaluate recovery from acid burn.
281368 -
281369 -            [On 100810 1530 Doctor Lee asked why meeting to perform
281370 -            follow up EGD was delayed more than 2 months, ref SDS 53
281371 -            M18F, planned in the meeting today, per above, ref SDS 49
281372 -            HB86, and was advised there were no instructions on taking
281373 -            Omeprazole, and Marcia reported on 100308, ref SDS 50 NB7H,
281374 -            that illegible handwriting in Discharge papers, noted
281375 -            below, ref SDS 49 HC7K, delayed the VA ordering medication.
281376 -            ref SDS 53 M18K
281378 -             ..
281379 -            [On 100827 0738 VA medical chart for follow up EGD test
281380 -            reports use of prescribed medication with Omeprazole was
281381 -            inconsistent - clarification note appended on not getting
281382 -            instructions to use Omeprazole, and illegible handwriting
281383 -            was vague in Discharge documents. ref SDS 54 JE7X
281385 -         ..
281386 -   11.  By copy to Isagani, giving Doctor Stewart the opportunity to
281387 -        review the record in relation to her surgery on 091216, with
281388 -        understanding that VA Progress Notes on CRPS released to the
281389 -        customer do not make findings of "acid burn" nor report
281390 -        prescription and plans for further testing.  Doctor Lee showed
281391 -        photographs (8), and pointed to one as signaling acid burn on
281392 -        the "flap."  Photographs received from VA ROI Department were
281393 -        rendered in black and white, so "acid burn" issue is difficult
281394 -        to recognize. ref SDS 49 XI5O
281396 -         ..
281397 -   12.  Color photographs on file at VA may show the problem more
281398 -        clearly.
281400 -         ..
281401 -   13.  Colonoscopy test was negative for disease. ref SDS 49 K97H
281403 -         ..
281404 -   14.  Isagani and Doctor Stewart might consider sharing test results
281405 -        with the GI team in San Francisco, who closely reviewed
281406 -        achalasia issue and signed off on Heller Myotomy surgery, e.g.,
281407 -        on 091030. ref SDS 19 0345
281409 -         ..
281410 -   15.  Recovery from heart surgery seems well advanced.  No evident
281411 -        complications.
281413 -         ..
281414 -   16.  Have maintained pulse in the range of 55 - 65 and blood
281415 -        pressure 105 - 115 / 65 - 75 on waking in the morning.  Blood
281416 -        pressure remains fairly steady through the day 100 - 130, and
281417 -        65 - 75.  Only concern is heart rate seems to jump to 100 +/-
281418 -        with only minor activity.  While working doing computer stuff,
281419 -        which is most of the day, pulse settles back into 55 - 75
281420 -        range.  Virtually any physical activity causes immediate
281421 -        increase to 100 +/-.  Good news is that strong activity hiking
281422 -        hills pulse only goes to 125, and eventually to max of 170,
281423 -        though averaging about 135.  Additionally, recovery after
281424 -        exercise is now much faster.  As reported previously, this is a
281425 -        big improvement following heart surgery by Doctor Tseng, and
281426 -        the Ct team on 091022. ref SDS 16 LO3G
281428 -         ..
281429 -   17.  These diagnostics have occurred while not taking aspirin and
281430 -        Metoprolol Tartrate, which are listed in the discharge document
281431 -        for heart surgery received on 091104. ref SDS 23 UN6L
281433 -         ..
281434 -   18.  I took Metoprolol for a month or so after surgery, and noticed
281435 -        BP was consistently between 90 110 and 60 70.  Therefore with
281436 -        rise of exercise, stopped this treatment, yielding results
281437 -        reported above.
281439 -         ..
281440 -   19.  On 100305, Doctor Lee prescribed vaccination to reduce risk of
281441 -        shingles, presented to the medical team on 100301.  Work was
281442 -        performed at the VA Clinic in Martinez after completion of
281443 -        endoscopy and colonoscopy tests. ref SDS 49 GT5G
281445 -         ..
281446 -   20.  Very pleased and thankful for the VA providing outstanding
281447 -        health care services.
281448 -
281455 -
281456 -
281457 -
281458 -
281459 -
281460 -
281461 -
2815 -