CONTACTS 

SUBJECTS
Agenda Meeting 101207 Planning EGD Test Schedule 101210 Doctor Lee G

6103 -
6103 -    ..
6104 - Summary/Objective
6105 -
610501 - Follow up ref SDS 5 0000.
610502 -
610503 -
610505 -  ..
6106 -
6107 -
6108 - Progress
6109 -
610901 - Sent letter to Kim for Doctor Lee saying...
610902 -
610903 -    1.  Subject: Agenda Meeting Doctor Lee Dec 7th Prepare EGD Dec 10
610904 -        Date: Mon, 06 Dec 2010 16:13:22 -0800
610913 -         ..
610914 -    2.  Agenda for meeting tomorrow...
610916 -             ..
610917 -        1.  Have regularized taking prescribed Omeprazole with dose
610918 -            doubled on 100827, as shown in case study on 101010.
610919 -            ref SDS 4 QJ5I
610921 -             ..
610922 -            The journal tracks medication, exercise, and vitals.
610923 -            Generally, blood pressure and heart rate seem strong,
610924 -            indicating recovery from cabg on 091022.
610925 -
610926 -               [On 101207 1000 VA did not have time to review agenda to
610927 -               prepare for meeting; used c16 notebook for Doctor Lee to
610928 -               guide discussion on agenda, ref SDS 8 IR8G, including
610929 -               review patient history in the SDS record on 101010.
610930 -               ref SDS 4 QJ5I
610932 -             ..
610933 -        2.  After EGD test on 100827, when esophagus was dilated,
610934 -            swallowing got worse for a day or so, then improved for
610935 -            several weeks.  Doctor Lee's suggestion on 101012, to break
610936 -            open the plastic Omeprazole pills and swallow the small
610937 -            pellets in water, has worked well.
610939 -             ..
610940 -            In the past few weeks beginning on 101123, swallowing has
610941 -            increasingly declined, reported in the case study.
610942 -            ref SDS 4 BT8N
610944 -             ..
610945 -            Acid reflux causing throat to swell seems conflicting with
610946 -            so little food getting into the stomach.
610947 -
610948 -               [On 101207 1000 Doctor Lee seemed to indicate rising
610949 -               problems swallowing reported beginning on 101123, set
610950 -               out in case study on 101010, ref SDS 4 BT8N, shows
610951 -               progress healing esophagitis, which when complete will
610952 -               relieve swallowing problems. ref SDS 8 WH4N
610954 -                ..
610955 -               [On 101210 0930 Doctor Lee dilated esophageal sphincter
610956 -               from 11 to 14 mm, and doubled dose for Omperazole 80 mg
610957 -               per day, to relieve swallowing problem, ref SDS 9 BF6L;
610958 -               and VA medical chart shows Recommendations doubling
610959 -               Omeprazole. ref SDS 9 XT5N
610961 -             ..
610962 -            By copy notifying Doctor Stewart's team that swallowing now
610963 -            seems regressed to level prior to Heller Myotomy surgery at
610964 -            the Medical Center on 091216. ref SDS 1 KE9U
610966 -             ..
610967 -            Good news - despite increase in vomiting, can still sleep
610968 -            laying down in bed, rather than sitting up in a chair, as
610969 -            in years prior to surgery on 091216.
610971 -             ..
610972 -        3.  Salt intake has been presented as possibly bloating the
610973 -            throat, causing increased vomiting problem [...discussed in
610974 -            the record on 101130 0400. ref SDS 6 GP5N...] Doctor Lee
610975 -            can comment in the meeting tomorrow.
610976 -
610977 -               [On 101207 1000 Doctor Lee indicted excessive salting
610978 -               food not likely to compound swelling esophagus that
610979 -               restricts swalloing. ref SDS 8 PD6O
610981 -             ..
610982 -        4.  Beginning 101130, sick with something causing initial
610983 -            sneezing and congestion.  Entire body ached for days.  Temp
610984 -            100, but only for a day.  Sneezing and aching subsided days
610985 -            ago, but congestion continues, although today (right now)
610986 -            seem fine.  Took two aspirin yesterday.  Relieving
610987 -            congestion caused bloody nose, very messy, as reported in
610988 -            case study on medication, exercise, vitals, and swallowing,
610989 -            shown in the record on 101010. ref SDS 4 EE6J
610991 -                ..
610992 -               [On 101223 1030 Doctor Sandhu diagnosed flu symptoms
610993 -               caused by excessive exercise cutting down 10 pine trees.
610994 -               ref SDS 10 KI5J
610996 -             ..
610997 -            Actually, was similarly sick earlier on 101103, but that
610998 -            only lasted a day or so - no bloody nose.
611000 -             ..
611001 -            Concern is WBC has been 11 +/- for years, and never got
611002 -            sick. Lab on 100721 reported sudden severe drop to WBC
611003 -            7.3. ref SDS 2 X19J
611005 -             ..
611006 -            Meeting is scheduled with Doctor Sandhu in Primary Care on
611007 -            101223 to review lab, so will get blood draw tomorrow.
611008 -            Results may be available to discuss for EGD on 101210.
611009 -            Hoping WBC has not further declined signaling some new
611010 -            issue, with rising exposure to infection and virus.
611012 -                ..
611013 -               [On 101207 0906 blood draw for lab to prepare for
611014 -               meeting with Doctor Lee on 101210, and Doctor Sandhu on
611015 -               101223. ref SDS 7 PP8W
611017 -             ..
611018 -        5.  VA has begun making the medical chart available to patients
611019 -            on a CD, which provides excellent communication on case
611020 -            management, e.g., see the record on 100827. ref SDS 3 LB6J
611022 -         ..
611023 -    3.  Looking forward to meeting tomorrow.
611024 -
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611035 -
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611038 -
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6111 -