Welch Company
San Francisco, CA


S U M M A R Y


DIARY: August 10, 2010 03:30 PM Tuesday; Rod Welch

VA Meeting Doctor Lee review throat infection problem from March test.

1...Summary/Objective


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CONTACTS 

SUBJECTS
Examination Heart Surgery Recovery Good Health Improved Achalasia He

2003 -
2003 -    ..
2004 - Summary/Objective
2005 -
200501 - Follow up ref SDS 48 0000, ref SDS 38 0000.
200502 -
200503 -
200504 -
200506 -  ..
2006 -
2007 -
2008 - Background
2009 -
200901 - On 090908 1130 Doctor Lee prepared work plan, ref SDS 9 BU6W, for
200902 - treating achalasia and including resolving new symptom of chest pains.
200903 - ref SDS 9 FT6M
200905 -  ..
200906 - On 091002 met with Doctor Egan, Cardiologist at the VA.  The doctor
200907 - advised that 10 of 11 test points in the stress test showed positive
200908 - for circulation problems, and so the doctor ordered angiogram.
200909 - ref SDS 10 1W5I
200911 -  ..
200912 - 091021 0716 Meeting at VA to complete angiogram test meeting,
200913 - ref SDS 11 01F9, and perform test. ref SDS 11 025B  Results show
200914 - requirement for heart bypass surgery. ref SDS 11 7L47
200916 -  ..
200917 - On 091022 0700 Doctor Tseng, Casey and others performed quadruple
200918 - heart bypass surgery at VA in San Francisco. ref SDS 12 01F9
200920 -  ..
200921 - On 091031 0730 discussed scheduling surgery to fix achalasia problem
200922 - as essential predicate to maintain nutrition required for recovering
200923 - from heart surgery. ref SDS 15 PW5H
200925 -  ..
200926 - On 091103 Paula reported the VA has scheduled a meeting today with
200927 - Doctor Stewart for planning Heller Myotomy surgery to correct
200928 - achalasia problem. ref SDS 17 PS60  On 091104 0718 Medical Chart
200929 - discharge guidance lists meeting with Doctor Stewart 091117 1300,
200930 - which conflicts with patient history today. ref SDS 18 Q03J  On 091119
200931 - 1000 Erick confirmed visit with Doctor Stewart on 091208, and is
200932 - reviewing date of surgery scheduled for 091217. ref SDS 20 935H
200934 -  ..
200935 - On 091104 0718 discharged from VA recovering from quadruple heart
200936 - bypass surgery, ref SDS 18 PR4V, performed on 091022 0700. ref SDS 12
200937 - PQWU; received medical record with list of medications, also on 091104
200938 - 0718, ref SDS 18 1Q6P, and follow up meetings. ref SDS 18 9T6O
200940 -  ..
200941 - On 091208 Doctor Stewart advanced the schedule for surgery one day to
200942 - 091216. ref SDS 22 6E41
200944 -  ..
200945 - On 091216 0600 meeting Doctor Stewart for Heller Myotomy surgery to
200946 - correct achalasia; check in at ASU. ref SDS 26 PP8W
200948 -  ..
200949 - On 091217 0600 meeting with Joe and Jon on recovring from Heller
200950 - Myotomy surgery; report of complication during surgery on 091216,
200951 - which was repaired, with plan for test to evaluate recovery. reported
200952 - on 091217 0600, ref SDS 27 0042  Doctor Stewart visited and expects
200953 - can start eating after favorable test. ref SDS 27 027A
200955 -  ..
200956 - On 091218 0600 xray with gastrogafin to evaluate repair for
200957 - complicaiton during Heller Myotomoy surgery Wednesday, ref SDS 28 PP8W,
200959 -  ..
200960 - On 091219 0600 doctor plans discharge tomorrow after evaluating
200961 - progress eating solid food today. ref SDS 29 PP5V  Since now eating
200962 - solid food, switched to oral pill medication to replace IV injections;
200963 - this relieved pain that has been increasing using IV catheters set on
200964 - Wednesday, ref SDS 29 PQPX, and also eliminated need to replace IV
200965 - catheters per TCU protocol. ref SDS 29 7Q55  Doctors prescribed hiking
200966 - to recover from Heller Myotomy surgery resolving achalasia.
200967 - ref SDS 29 7Q6P   Doctor Ratcliff and Neil visit and discussing doing a
200968 - small business trial to apply SDS technology for upgrading VA and UCSF
200969 - case management. ref SDS 29 0M6S  Nurse advises that patient approved
200970 - for moving to a ward for non-critical care, as a predicate to
200971 - discharge, but since there are no rooms available, patient will remain
200972 - in TCU untill a room is available. ref SDS 29 0M8S
200974 -  ..
200975 - On 091220 0527 discharge approved from hospital today. ref SDS 30 PP8W
200976 - Left the hospital about 1220. ref SDS 30 HB5O
200978 -  ..
200979 - On 091221 1532 Isagani called to schedule meeting with Doctor Stewart
200980 - at VA in San Francisco on 100105. ref SDS 31 PP8W
200982 -  ..
200983 - On 091222 1109 letter from Isagana says meeting with Doctor Stewart is
200984 - scheduled on 100112 1400. ref SDS 32 PP8W
200986 -  ..
200987 - On 091223 1452 letter came in regular mail scheduling a meeting with
200988 - Doctor Stewart on 100105 1400. ref SDS 33 PP8W
200990 -  ..
200991 - On 100104 0930 met with Doctor Sandhu to begin care for heart surgery
200992 - and follow up on Heller Myotomy surgery to recover from achalasia.
200993 - ref SDS 36 PP8W
200995 -  ..
200996 - On 100305 1000 reported to VA Martinez for endoscopy and colonoscopy
200997 - tests. ref SDS 38 PP8W  Doctor Lee ordered shingles vaccination,
200998 - ref SDS 38 4O4O, and this was performed. ref SDS 38 GT5G  Endoscopy
200999 - test found evidence of "acid burn" on "flap", ref SDS 38 PR6P;
201000 - treatment prescribed, and plan for follow up test. ref SDS 38 HB86
201001 - Colonoscopy test found no evidence of cancer or disease. ref SDS 38
201002 - K97H
201004 -  ..
201005 - On 100610 1046 went to VA in Martinez for blood draw to evaluate
201006 - cholesterol as a diagnostic of cardiovascular health. ref SDS 43 QV4F
201008 -  ..
201009 - On 100721 0800 visit Doctor Sandhu Martinez VA; patient demonstrates
201010 - continuing recovery from heart surgery last October, ref SDS 48 PP8W;
201011 - doctor concerned patient is not listening because Simvastatin
201012 - medication to control cholesterol was not continued after completing
201013 - initial prescription, ref SDS 48 3X4L, shown by lab results cholesterol
201014 - has not declined very much for lab on 100610. ref SDS 48 HY76; doctor
201015 - increased dose of Simvestatin and encourages continuing this
201016 - medication. ref SDS 48 RP4F  New lab ordered today shows cholesterol
201017 - reversed long-term decline and increased dramatically in just 30 days,
201018 - suggesting possibly error in lab testing process. ref SDS 48 E19L
201020 -  ..
201021 - On 100810 1530 meeting with Doctor Lee to schedule a meeting on 100827
201022 - to do another test to evaluate recovery from acid infection found in
201023 - the test last March. ref SDS 0 PP8W
201024 -
201025 -
201027 -  ..
2011 -
2012 -
2013 - Progess
2014 -
201401 - Meeting today with Doctor Lee reviewed findings from the test
201402 - performed by the doctor on 100305 1000. ref SDS 38 PR6P
201403 -
201404 -            [On 100827 1316 received CD with medical records,
201405 -            ref SDS 55 Y87U, for meeting with Doctor Sandhu at the VA
201406 -            in Martinez on 100721. ref DRP 1 JQ7H
201408 -  ..
201409 - Today, the doctor seemed to clarify that the test on 100305, found
201410 - acid burn for a length of 38 cm into the esophagus, which is about
201411 - 10".  This seems a very significant problem, and so seems to modify
201412 - understandings from testing on 100305, that only minor acid burn was
201413 - found. ref SDS 38 PR6P
201415 -  ..
201416 - Doctor Lee asked why the meeting today was not scheduled for several
201417 - months ago, after taking all of the pills for Omeprazole prescribed on
201418 - 100305 1000. ref SDS 38 HB86
201420 -  ..
201421 - We reviewed the record showing evident mixup on 100305.  After the EDG
201422 - test, the doctor met with the patient and indicated there would be a
201423 - follow up test in a few months.  The record shows nothing was
201424 - presented in the meeting on prescribing medication. ref SDS 38 HB86
201425 - Days later on 100308, Marcia called and advised that illigible
201426 - handwriting on the Discharge documents for the test on 100305,
201427 - prescribed treatment with Omeprazole. ref SDS 39 CH3O  Turned out the
201428 - medication had not been ordered, perhaps due to illigible handwriting,
201429 - so Marcia entered the order on 100308 1411. ref SDS 39 NL4J
201431 -  ..
201432 - After all of the pills were taken a few months later in May, the
201433 - patient was waiting for the VA to schedule the follow up test ordered
201434 - by Doctor Lee during the meeting on 100305 1000. ref SDS 38 HB86
201435 -
201436 -            [On 100827 0738 VA medical chart for follow up EGD test
201437 -            reports use of prescribed medication with Omeprazole was
201438 -            inconsistent, ref SDS 54 JE7X, and again in "Impression"
201439 -            section, ref SDS 54 JE9J, - clarification note appended on
201440 -            not getting instructions to use Omeprazole, and illegible
201441 -            handwriting was vague in Discharge documents. ref SDS 54
201442 -            JE7X
201444 -  ..
201445 - The period May - July was very hectic and focused on caring for Millie
201446 - to recover from Kaiser and UCSF medical mistakes, reported on 100713.
201447 - ref SDS 45 036C
201449 -  ..
201450 - After the meeting today, there seems still misunderstanding on the
201451 - scope of any problems discovered from testing on 100305.  Pathology on
201452 - the test was reported a week later on 100312, and seems only to say
201453 - that a speciman was take at 38 cm, ref SDS 40 FQ6M, which is much
201454 - different from impression during the meeting that disease occurred for
201455 - a length of 38 cm.
201457 -  ..
201458 - On 100331 1448 VA letter seems to expand understandings from meeting
201459 - on 100305, ref SDS 38 PR6P, and presented in feedback letter to the VA
201460 - on 100317 1213. ref SDS 41 PT6W, to relate test findings of general
201461 - reflux esophagitis, rather than or in addition to mere "acid burn" on
201462 - the flap for the esophageal sphincter valve. ref SDS 42 YW5S
201464 -  ..
201465 - Doctor Lee did not present analysis today on severity of reflux
201466 - esophagitis, ref SDS 42 XK5G, presented in questions from reviewing
201467 - the pathology report on 100312, ref SDS 40 QQ8M, for the endoscopy
201468 - test on 100305. ref SDS 38 PR6P
201470 -  ..
201471 - Reported continuing problems swallowing primarily meat related
201472 - products, discussed with Doctor Stewart on 100108. 100105 1300,
201473 - ref SDS 37 K842  Estimate swallowing problems occur 10-20% of the
201474 - time, and this can be very significant vomitting, comparable to
201475 - achalasia the past 5 years.
201477 -  ..
201478 - Doctor Lee explained his understanding that surgery on 091216 merely
201479 - sliced the esophageal sphincter valve on either side to help relax the
201480 - grip so that food can be swallowed and reach the stomach, rather than
201481 - get stuck and have to be vomitted.
201483 -  ..
201484 - Reviewed understandings from Doctor Stewart that the VA Medical Center
201485 - in San Francisco performed a new technique of cutting away half of the
201486 - espophageal valve to provide constand and affirmative passage into the
201487 - stomach, reported in meeting with the doctor on 091030 0810.
201488 - ref SDS 14 GM5I
201490 -  ..
201491 - The doctor decided to perform follow up test to evaluate effectivenss
201492 - of medication treatment for several months after the test in March.
201493 - Follow up test was schedule on 100827 0830.  Need to arrange for a
201494 - driver, because Millie will not be available.
201495 -
201496 -            [On 100825 0947 met with Kendal at VA to discuss timing
201497 -            requirements for a driver to support endoscopy test on
201498 -            100827. ref SDS 53 6N5J
201500 -  ..
201501 - Explained new difficulty of Millie passing on 100729 0510, ref SDS 49
201502 - EK4I, and this presents difficult adjustments, cited in memoriam on
201503 - 100731 2221, ref SDS 51 NL3I, and was further discussed during
201504 - services honoring Millie's life on 100807 1300. ref SDS 52 MY5O
201505 -
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201507 -
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201509 -
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