Welch Company
San Francisco, CA


S U M M A R Y


DIARY: November 12, 2010 09:52 AM Friday; Rod Welch

VA schedule meeting Doctor Sandhu Dec 23 1030 lab 2 weeks earlier.

1...Summary/Objective
2...Cholesterol Assessment Meeting Scheduled 101223 Primary Care Physician
3...Schedule Meeting Primary Care Physician 101223 Cholesterol Assessment
4...EGD Consultation Schedule Dec 7 Verify Solution Driver Problem
5...Driver Not Needed EGD Patient Wait Anesthesia Subside Drive Home
6...EGD Move Test Medical Center San Francisco for Driver Requirement


..............
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CONTACTS 

SUBJECTS
Meeting Schedule 101223 Primary Care Physician Lab Blood Test 2 Week

2903 -
2903 -    ..
2904 - Summary/Objective
2905 -
290501 - Follow up ref SDS 41 0000. ref SDS 36 0000.
290502 -
290503 -
290504 -
290506 -  ..
2906 -
2907 -
2908 - Background
2909 -
290901 - On 090908 1130 Doctor Lee prepared work plan, ref SDS 9 BU6W, for
290902 - treating achalasia and including resolving new symptom of chest pains.
290903 - ref SDS 9 FT6M
290905 -  ..
290906 - On 091002 met with Doctor Egan, Cardiologist at the VA.  The doctor
290907 - advised that 10 of 11 test points in the stress test showed positive
290908 - for circulation problems, and so the doctor ordered angiogram.
290909 - ref SDS 10 1W5I
290911 -  ..
290912 - 091021 0716 Meeting at VA to complete angiogram test meeting,
290913 - ref SDS 11 01F9, and perform test. ref SDS 11 025B  Results show
290914 - requirement for heart bypass surgery. ref SDS 11 7L47
290916 -  ..
290917 - On 091022 0700 Doctor Tseng, Casey and others performed quadruple
290918 - heart bypass surgery at VA in San Francisco. ref SDS 12 01F9
290920 -  ..
290921 - On 091031 0730 discussed scheduling surgery to fix achalasia problem
290922 - as essential predicate to maintain nutrition required for recovering
290923 - from heart surgery. ref SDS 15 PW5H
290925 -  ..
290926 - On 091103 Paula reported the VA has scheduled a meeting today with
290927 - Doctor Stewart for planning Heller Myotomy surgery to correct
290928 - achalasia problem. ref SDS 17 PS60  On 091104 0718 Medical Chart
290929 - discharge guidance lists meeting with Doctor Stewart 091117 1300,
290930 - which conflicts with patient history today. ref SDS 18 Q03J  On 091119
290931 - 1000 Erick confirmed visit with Doctor Stewart on 091208, and is
290932 - reviewing date of surgery scheduled for 091217. ref SDS 20 935H
290934 -  ..
290935 - On 091104 0718 discharged from VA recovering from quadruple heart
290936 - bypass surgery, ref SDS 18 PR4V, performed on 091022 0700. ref SDS 12
290937 - PQWU; received medical record with list of medications, also on 091104
290938 - 0718, ref SDS 18 1Q6P, and follow up meetings. ref SDS 18 9T6O
290940 -  ..
290941 - On 091208 Doctor Stewart advanced the schedule for surgery one day to
290942 - 091216. ref SDS 22 6E41
290944 -  ..
290945 - On 091216 0600 meeting Doctor Stewart for Heller Myotomy surgery to
290946 - correct achalasia; check in at ASU. ref SDS 26 PP8W
290948 -  ..
290949 - On 091217 0600 meeting with Joe and Jon on recovring from Heller
290950 - Myotomy surgery; report of complication during surgery on 091216,
290951 - which was repaired, with plan for test to evaluate recovery. reported
290952 - on 091217 0600, ref SDS 27 0042  Doctor Stewart visited and expects
290953 - can start eating after favorable test. ref SDS 27 027A
290955 -  ..
290956 - On 091218 0600 xray with gastrogafin to evaluate repair for
290957 - complicaiton during Heller Myotomoy surgery Wednesday, ref SDS 28 PP8W,
290959 -  ..
290960 - On 091219 0600 doctor plans discharge tomorrow after evaluating
290961 - progress eating solid food today. ref SDS 29 PP5V  Since now eating
290962 - solid food, switched to oral pill medication to replace IV injections;
290963 - this relieved pain that has been increasing using IV catheters set on
290964 - Wednesday, ref SDS 29 PQPX, and also eliminated need to replace IV
290965 - catheters per TCU protocol. ref SDS 29 7Q55  Doctors prescribed hiking
290966 - to recover from Heller Myotomy surgery resolving achalasia.
290967 - ref SDS 29 7Q6P   Doctor Ratcliff and Neil visit and discussing doing a
290968 - small business trial to apply SDS technology for upgrading VA and UCSF
290969 - case management. ref SDS 29 0M6S  Nurse advises that patient approved
290970 - for moving to a ward for non-critical care, as a predicate to
290971 - discharge, but since there are no rooms available, patient will remain
290972 - in TCU untill a room is available. ref SDS 29 0M8S
290974 -  ..
290975 - On 091220 0527 discharge approved from hospital today. ref SDS 30 PP8W
290976 - Left the hospital about 1220. ref SDS 30 HB5O
290978 -  ..
290979 - On 091221 1532 Isagani called to schedule meeting with Doctor Stewart
290980 - at VA in San Francisco on 100105. ref SDS 31 PP8W
290982 -  ..
290983 - On 091222 1109 letter from Isagana says meeting with Doctor Stewart is
290984 - scheduled on 100112 1400. ref SDS 32 PP8W
290986 -  ..
290987 - On 091223 1452 letter came in regular mail scheduling a meeting with
290988 - Doctor Stewart on 100105 1400. ref SDS 33 PP8W
290990 -  ..
290991 - On 100104 0930 met with Doctor Sandhu to begin care for heart surgery
290992 - and follow up on Heller Myotomy surgery to recover from achalasia.
290993 - ref SDS 36 PP8W
290995 -  ..
290996 - On 100610 1046 went to VA in Martinez and had blood draw for
290997 - cholesterol. ref SDS 37 QV4F
290999 -  ..
291000 - On 100721 0800 visit Doctor Sandhu Martinez VA; patient demonstrates
291001 - continuing recovery from heart surgery last October, ref SDS 41 PP8W;
291002 - doctor concerned patient is not listening because Simvastatin
291003 - medication to control cholesterol was not continued after completing
291004 - initial prescription. ref SDS 41 3X4L
291005 -
291006 -
291008 -  ..
2911 -
2912 -
2913 - Progess
2914 -
291401 - Cholesterol Assessment Meeting Scheduled 101223 Primary Care Physician
291402 - Schedule Meeting Primary Care Physician 101223 Cholesterol Assessment
291403 -
291404 - Follow up ref SDS 45 6X5W.
291405 -
291406 - Met with Connie at the front desk of Primary Care.
291407 -
291408 - She said Doctor Sandhu is traveling.  Connie does not know if the
291409 - doctor has reviewed the letter submitted on Monday to coordinate
291410 - meeting with Doctor Lee on 101210, reported on 101108 0929.
291411 - ref SDS 45 6X5T
291413 -  ..
291414 - Connie said that Doctor Sandhu's schedule is already booked for
291415 - 101210.  The earliest she can schedule a meeting is 101223 1030.
291417 -  ..
291418 - Agreed to meeting on 101223 1030.  Connie scheduled the work.
291420 -  ..
291421 - Connie said she would order a full lab to compare with results for the
291422 - prior lab on 100721 0800, ref SDS 41 OT69, and as requested in the
291423 - letter to Doctor Sandhu on 101108 0929. ref SDS 45 6X6U
291425 -  ..
291426 - Connie said the lab can be done anytime 2 weeks prior to meeting with
291427 - Doctor Sandhu on 101223, including on 101210, the day of the EGD test
291428 - by Doctor Lee.
291430 -  ..
291431 - She said to "fast" for 12 hours prior to doing the lab.
291432 -
291433 -            [On 101207 0906 blood draw for lab to prepare for meeting
291434 -            with Doctor Lee on 101210, and Doctor Sandhu on 101223.
291435 -            ref SDS 49 PP8W
291436 -
291437 -
291438 -
291439 -
291440 -
2915 -

SUBJECTS
VA Meeting Schedule 101207 GI Department Martinez Clinic Consultatio

8603 -
860401 -  ..
860402 - EGD Consultation Schedule Dec 7 Verify Solution Driver Problem
860403 - Driver Not Needed EGD Patient Wait Anesthesia Subside Drive Home
860404 -
860405 - Connie also said that Doctor Lee has scheduled a consultation on
860406 - 101207 1000 3 days prior to performing EGD test scheduled for 101210
860407 - 0930.
860409 -  ..
860410 - Asked about arranging for transportation home after the EGD test on
860411 - 101210?  This was discussed recently in a letter to Kim for Doctor Lee
860412 - submitted to the VA on 101108 0929. ref SDS 45 6X4P  Explained that
860413 - the VA provided transportation home to Concord from San Francisco,
860414 - following discharge for heart surgery on 091104 0718. ref SDS 18 0P6C
860416 -  ..
860417 - Connie and a colleague who overheard the discussion, both indicated
860418 - that VA transportation is for taking patients from one VA facility to
860419 - another, but not home after tests or other procedures.
860421 -  ..
860422 - Connie said patients can wait at the VA for a few hours after an EGD
860423 - test and drive home after effects of anesthesia subside and patient
860424 - is fully alert.
860425 -
860426 -            [...below, letter to Kim for Doctor Lee asks about Connie's
860427 -            solution to drive home when anesthesia subsides after EGD
860428 -            test. ref SDS 0 KT3W
860430 -             ..
860431 -            [On 101116 1542 asked the GI Clinic about driving home
860432 -            after waiting a few hours; Kendall said VA requires
860433 -            patients getting anesthesia for EGD test to have a
860434 -            designated driver, so only solution in this case is to move
860435 -            the test to Medical Center in San Francisco. ref SDS 47
860436 -            FZ4H
860438 -             ..
860439 -            [On 101124 1625 telephone message confirms EGD test
860440 -            scheduled GI Department VA Clinic Martinez CA, does not
860441 -            report solution for driver requirement. ref SDS 48 PS4O
860443 -             ..
860444 -            [On 110105 1548 VA passenger van parked at Fry's advertises
860445 -            phone number to call 800 382 8387 (VETS) for Veteran
860446 -            Transportation services. ref SDS 50 NH5H
860447 -
860448 -
860449 -
860450 -
8605 -

SUBJECTS
EGD Test Move VA Medical Center San Francisco for Driver Requirement

BH03 -
BH04 - 1108
BH0501 -  ..
BH0502 - EGD Move Test Medical Center San Francisco for Driver Requirement
BH0503 -
BH0504 - Met with Rosie at the front desk for the GI Clinic.
BH0505 -
BH0506 - Asked to speak with Kim or Kendal about the letter to Doctor Lee on
BH0507 - Monday, asking for arrangements to satisfy VA requirements to have a
BH0508 - driver for the EGD test on 101210, as reported in the record on 101108
BH0509 - 0929. ref SDS 45 6X5Q
BH0511 -  ..
BH0512 - Rosie said that Jennifer is in the office today and she would ask her
BH0513 - about this issue.
BH0515 -  ..
BH0516 - Jennifer is excellent, because she scheduled the test with Doctor Lee
BH0517 - on 101210, and during a call on 101012 1449, ref SDS 43 KD5G, which
BH0518 - was confirmed in a letter from Jennifer saying the patient needs a
BH0519 - designated driver, received on 101015 1547. ref SDS 44 X18I
BH0521 -  ..
BH0522 - Rosie was in the patient treatment area for about 10 minutes.
BH0524 -  ..
BH0525 - When she returned, she said that Jennifer said that Doctor Lee would
BH0526 - work on this driver problem and advise of a solution.
BH0527 -
BH0529 -  ..
BH06 -
BH07 -
BH08 - 1322
BH09 -
BH0901 - Arrived home after hiking and visiting Fry's to ask about progress on
BH0902 - c17.
BH0904 -  ..
BH0905 - There was a message from Jennifer on the Comcast telephone system.
BH0907 -  ..
BH0908 - The message seemed to say that Doctor Lee approved trasferring EGD
BH0909 - test to San Francisco Medical Center in order to solve the driver
BH0910 - problem, as set out in the letter to the team on 101108 0929.
BH0911 - ref SDS 45 6X3U
BH0912 -
BH0913 -            [...below, letter to Kim for Doctor Lee asks about Connie's
BH0914 -            solution to drive home when anesthesia subsides after EGD
BH0915 -            test, and so that work can be done locally at VA in
BH0916 -            Martinez, rather than going to Medical Center in San
BH0917 -            Francisco. ref SDS 0 KT3W
BH0919 -             ..
BH0920 -            [On 101115 1624 drove to VA to meet with GI team and
BH0921 -            confirm that EGD test can be moved to Medical Center in San
BH0922 -            Francisco; the clinic was very busy so did not meet with
BH0923 -            anyone to avoid diverting time from caring for patients.
BH0924 -            ref SDS 46 SI5G  Called VA in afternoon, but they stopped
BH0925 -            taking calls after 1630. ref SDS 46 VZ7F
BH0927 -             ..
BH0928 -            [On 101124 1625 telephone message confimrs EGD test
BH0929 -            scheduled GI Department VA Clinic Martinez CA, does not
BH0930 -            report solution for driver requirement. ref SDS 48 PS4O
BH0931 -
BH0933 -  ..
BH10 -
BH11 -
BH12 - 1641
BH13 -
BH1301 - Sent letter to Kim at VA GI Department in Martinez, and for Doctor
BH1302 - Lee, saying...
BH1304 -         ..
BH1305 -    1.  Subject: Re: EGD Scheduled Dec 10 Doctor Lee Need Driver
BH1306 -        Date: Fri, 12 Nov 2010 16:56:17 -0800
BH1316 -         ..
BH1317 -    2.  Visited with Rosie at the front desk this morning.  She said
BH1318 -        Doctor Lee is working on the driver issue [...shown above,
BH1319 -        ref SDS 0 JS7K...] for the EGD test on 101210, as presented in
BH1320 -        the letter for him, which was sent to you on 101110.
BH1321 -        ref SDS 45 465I
BH1323 -         ..
BH1324 -    3.  Thanks very much for facilitating communication.
BH1326 -         ..
BH1327 -    4.  When I returned home this afternoon, there was a phone message
BH1328 -        from Jennifer saying Doctor Lee approved transferring the EGD,
BH1329 -        scheduled for 101210 0930, to the VA Med Center in San
BH1330 -        Francisco, as one of the options for solving the driver
BH1331 -        problem.
BH1333 -         ..
BH1334 -    5.  Before meeting with Rosie in the GI Clinic, I stopped at
BH1335 -        Primary Care downstairs.  Connie scheduled a meeting with
BH1336 -        Doctor Sandhu, and set up a lab later in December. ref SDS 0
BH1337 -        4R4G
BH1339 -         ..
BH1340 -    6.  I asked Connie about getting a driver for the EGD on 101210,
BH1341 -        and explained that the VA drove me home from San Francisco to
BH1342 -        Concord after discharge for heart surgery on 091104, because
BH1343 -        Mil had chemotherapy the day before, and side effects prevented
BH1344 -        her from coming to take me home. ref SDS 0 4S5G  Connie and a
BH1345 -        colleague (didn't get her name) said that I may not really need
BH1346 -        a driver for the EGD test after all, since the medical team
BH1347 -        could let me recover a bit longer and drive myself home.  That
BH1348 -        sounds like the best solution.  I could actually work outside
BH1349 -        in the waiting area for a few hours, since there is a desk
BH1350 -        along the wall that would be fine. ref SDS 0 ZT35
BH1351 -
BH1352 -            [On 110105 1548 VA passenger van parked at Fry's advertises
BH1353 -            phone number to call 800 382 8387 (VETS) for Veteran
BH1354 -            Transportation services. ref SDS 50 NH5H
BH1356 -         ..
BH1357 -    7.  In any case, can you please ask the doctor to let me know if
BH1358 -        the test really needs to be done in SF, or can we do it locally
BH1359 -        with a work-around on the driver issue?
BH1360 -
BH1361 -            [On 101115 1624 drove to VA to meet with GI team and
BH1362 -            confirm that EGD test can be moved to Medical Center in San
BH1363 -            Francisco; the clinic was very busy so did not meet with
BH1364 -            anyone to avoid diverting time from caring for patients.
BH1365 -            ref SDS 46 SI5G  Called VA in afternoon, but they stopped
BH1366 -            taking calls after 1630. ref SDS 46 VZ7F
BH1368 -             ..
BH1369 -            [On 101116 1542 meeting at VA asked GI Clinic about driving
BH1370 -            home after waiting a few hours; Kendall said VA requires
BH1371 -            patients getting anesthesia for EGD test to have a
BH1372 -            designated driver; he asks about Ron Junior who was the
BH1373 -            driver for prior test on 100827, ref SDS 47 FZ8N, since Ron
BH1374 -            is not available due to getting cancer, only solution in
BH1375 -            this case is to move the test to Medical Center in San
BH1376 -            Francisco. ref SDS 47 FZ4H
BH1378 -             ..
BH1379 -            [On 101124 1625 telephone message confirms EGD test
BH1380 -            scheduled GI Department VA Clinic Martinez CA, does not
BH1381 -            report solution for driver requirement. ref SDS 48 PS4O
BH1382 -
BH1388 -
BH1389 -
BH1390 -
BH1391 -
BH1392 -
BH1393 -
BH1394 -
BH1395 -
BH14 -