CONTACTS 

SUBJECTS
VA Meeting GI Department Martinez Clinic Consultation Planning EDG T

5203 -
5203 -    ..
5204 - Summary/Objective
5205 -
520501 - Follow up ref SDS 48 0000. ref SDS 41 0000.
520502 -
520503 - Excellent meeting using patient history to assess recent increased
520504 - swallowing problems. ref SDS 0 IR8G  The doctor feels EGD test
520505 - scheduled Friday to dilate the esophagus is critical for recovery.
520506 - ref SDS 0 WH6J  If a driver is not available for the test on Friday,
520507 - the doctor has scheduled a test for next Tuesday, and if a driver
520508 - cannot be arranged for Tuesday, then the doctor will make a referral
520509 - to do the EGD test at the VA Medical Center in San Francisco, where a
520510 - driver is not needed, because patients can stay overnight and drive
520511 - home safely the next day. ref SDS 0 WA6K  Significant decline in WBC
520512 - and sudden flu symptoms do not signal weakened immunity. ref SDS 0
520513 - HN9K
520515 -             ..
520516 -            [On 101208 1924 letter transmits the record to the medical
520517 -            team confirming understandings. ref SDS 56 QJ8T
520518 -
520519 -
520520 -
520522 -  ..
5206 -
5207 -
5208 - Progress
5209 -
520901 - Omeprazole Critical Resolve Esophagitis Interim Swelling Expected
520902 - EGD Dilation Aids Omeprazole Resolve Esophagitis Restore Swallowing
520903 -
520904 - Follow up ref SDS 54 NP5G.
520905 -
520906 - During the meeting today, Doctor Lee indicated the agenda had not yet
520907 - been posted to the medical chart on the VA computer system, so the
520908 - doctor used c16 notebook computer to review the letter submitted to
520909 - the medical team yesterday on 101206 1542. ref SDS 54 NP5G
520911 -  ..
520912 - Case study on 101010 shows treatment with Omeprazole has been
520913 - implemented according to prescription, and provides correlation with
520914 - other treatment using Simvastatis, exercise and vitals. ref SDS 44
520915 - QJ5I  This record corrects issue presented in the medical chart for
520916 - the meeting on 100827 0738. ref SDS 43 JE7X
520918 -  ..
520919 - The doctor read through the record showing swallowing problems
520920 - increased beginning OA 101123, reported in case study on 101010 0744,
520921 - ref SDS 44 BT8N, and cited in the letter to the medical team yesterday
520922 - on 101206 1542. ref SDS 54 7Q8X
520924 -  ..
520925 - The doctor indicated that increased vomitting beginning on 101123,
520926 - which suggests reduced food reaching the stomach does not reduce
520927 - esophagitis that causes swallowing problems, as cited in the agenda
520928 - letter on 101206 1542. ref SDS 54 7Q4R
520930 -  ..
520931 - Doctor Lee explained a counterintuitive theory that recent increased
520932 - swallowing difficulty signals effective treatment to recover from
520933 - swallowing problems due to swelled throat from esophagitis.  Very
520934 - broadly, recent increased swallowing problems result from Omeprazole
520935 - getting into the stomach, as prescribed.  The medication breaks down
520936 - in the stomach causing acidic congestion to backup into the throat.
520937 - This "congestion" from the stomach heals esophagitis but causes
520938 - interim swelling during the healing process.
520940 -  ..
520941 - Doctor Lee will enter analysis in the medical chart for the meeting
520942 - today that clarifies this diagnosis suggesting favorable prognosis for
520943 - recovery.
520945 -  ..
520946 - The doctor emphasized today that EGD procedure scheduled Friday is
520947 - therefore critical to again dilate the esohagus so that more
520948 - medication reaches infected tissue, and to further make swallowing
520949 - less problematic, i.e., reduce chronic vomitting that occurred the
520950 - past few weeks, cited in the letter to the team yesterday on 101206
520951 - 1542. ref SDS 54 7Q9Q
520953 -  ..
520954 - Doctor Lee indicated that currently prescribed Omeprazole with EGD
520955 - dilation (scheduled for Friday) is the only treatment to recover from
520956 - evident rising swallowing problems.
520957 -
520958 -            [On 101210 0930 Doctor Lee prescribes doubling dose again
520959 -            to Omeprazole 80 mg per day after EGD and dilation found
520960 -            continuing esophagael sphincter severely restricts
520961 -            swallowing, ref SDS 57 ZN4M, and shown in medical chart
520962 -            Recommendations. ref SDS 57 XT5N
520964 -  ..
520965 - Fasting Thursday 24-hours prior to the procedure on Friday will
520966 - largely clear the throat so the EGD procedure can complete quickly;
520967 - and further implementing diet guidance for Wednesday, as set out in
520968 - Jennifer's Progress Notes shown in the record on 101015 1547.
520969 - ref SDS 46 6F8M
520970 -
520971 -
520972 -
520973 -
520974 -
5210 -

SUBJECTS
Default Null Subject Account for Blank Record

5303 -
530401 -  ..
530402 - Driver Logistics VA Solution EGD Friday Tuesday or Transfer to SFMC
530403 -
530404 - Doctor Lee was aware of extensive discussions with the team on getting
530405 - a driver for the EDG test scheduled on Friday, reported in the letter
530406 - to the VA on 101112 0952, ref SDS 48 KT3W, and reviewed again with
530407 - Iris and Kendal at the VA Clinic on 101116 1542. ref SDS 50 SI5G
530409 -  ..
530410 - VA has reduced flexibility for patients to get care who do not have
530411 - transportation support for driver requirements cited in Jennifer's
530412 - Progress Notes dated 101012, received from the VA in a letter dated
530413 - 101013, and entered in patient history on 101015 1547. ref SDS 46 X18I
530414 - including para 8c. ref SDS 46 YL4J
530415 -
530416 -            [On 110105 1548 VA passenger van parked at Fry's advertises
530417 -            phone number to call 800 382 8387 (VETS) for Veteran
530418 -            Transportation services. ref SDS 58 NH5H
530420 -  ..
530421 - The doctor feels dose reduction on anesthesia is not possible, and
530422 - that extending post-procedure supervised recovery for the patient to
530423 - drive home cannot be approved in the current risk averse climate.  The
530424 - doctor further explained the VA prohibits patients being transported
530425 - by cab following anesthesia.
530427 -  ..
530428 - Considered deferring EGD test until after the first of the year to
530429 - allow more time for making driver arrangements.
530431 -  ..
530432 - Doctor Lee indicated the test should be done within the next few weeks
530433 - to maintain progress, otherwise recovery can be compromised causing
530434 - increased cost, time, and suffering, perhaps escalating out of
530435 - control.
530437 -  ..
530438 - Driver flexibility can occur getting to the VA early enough to arrive
530439 - at work on time, and picking the patient up after work, so long as the
530440 - driver has cell phone communication to coordinate timing with the GI
530441 - clinic.
530443 -  ..
530444 - Doctor Lee proposed following work plan...
530445 -
530446 -    1.  Maintain current schedule EGD Friday 101210 0930, and hope a
530447 -        driver materializes.
530448 -
530449 -    2.  Schedule EGD next Tuesday 101214 (time uncertain), in event
530450 -        driver cannot be arranged for Friday, and hope driver can be
530451 -        found for the Tuesday schedule.
530452 -
530453 -            [On 110105 1548 VA passenger van parked at Fry's advertises
530454 -            phone number to call 800 382 8387 (VETS) for Veteran
530455 -            Transportation services. ref SDS 58 NH5H
530457 -         ..
530458 -        This schedule will require Doctor Lee's colleague to perform
530459 -        the work, who is well qualified, but does not have Doctor Lee's
530460 -        experience with the case.
530462 -         ..
530463 -    3.  Failing to arrange driver for Friday or Tuesday, Doctor Lee
530464 -        will make a referral for doing the work at the VA Medical
530465 -        Center in San Francisco, so that a driver is not needed since
530466 -        the Hoptel provides overnight facilities for the patient to
530467 -        avoid driving for the 24-hour periord following anesthesia.
530468 -        This would implment the meeting and collaboration on 101117
530469 -        0530. ref SDS 51 0P71
530471 -         ..
530472 -        This schedule will require another doctor to do the work, who
530473 -        is well qualified, but does not have Doctor Lee's experience
530474 -        with the case.
530475 -
530476 -            [On 101208 1924 letter thanks Doctor Lee for flexibiity
530477 -            scheduling the EGD test around availability of driver.
530478 -            ref SDS 56 QJ8T
530479 -
530480 -
530481 -
530482 -
5305 -

SUBJECTS
Default Null Subject Account for Blank Record

5403 -
540401 -  ..
540402 - Flue Symptoms Does Not Signal Decline CBC Immunity
540403 - WBC Decline Normal Range Signals Successful Surgery Correct Achalasia
540404 -
540405 - During the meeting the doctor looked at patient history on WBC from
540406 - the CBC for thet blood draw earlier this morning, reported on 101207
540407 - 0906. ref SDS 55 PP8W
540409 -  ..
540410 - Doctor Lee feels significant decline of WBC (from 12 - 7) compared
540411 - with past 5 years, suddenly shown in the lab on 100721, occurred
540412 - because Doctor Stewart's Heller Myotomy surgery on 091216, ref SDS 26
540413 - KE8T, effectively treated former Achalasia.  This Achalasia condition
540414 - caused a low grade infection that elevated WBC above norms for 5
540415 - years.  The test on 100721 shows WBC within normal range at 7.3, and
540416 - the test today continues to show strong WBC at 6+.
540418 -  ..
540419 - Doctor Lee reviewed severe flu symptoms beginning 7 days ago on
540420 - 101130, reported in patient history listed on 101010 0744. ref SDS 44
540421 - EE6J  He feels that examination today, and the lab report indicate
540422 - diagnosis of flu and cited a recent rise of cases, including himself,
540423 - and despite having received a flu shot.
540424 -
540425 -
5405 -

SUBJECTS
Default Null Subject Account for Blank Record

5503 -
550401 -  ..
550402 - Salt Not Likely Cause Swelled Throat to Block Swallowing
550403 -
550404 - Reviewed theory that salting food in excess can influence swelling of
550405 - throat to compound swallowing problems from achalasia, related in the
550406 - agenda for the meeting on 101206 1542. ref SDS 54 7Q4U
550408 -  ..
550409 - Doctor Lee said that excessive salting of food is not likely to cause
550410 - esophagus to swell causing a restriction to swallowing, as occurringin
550411 - this case.  He indicated taking 2 or 3 tablespoons of salt at once
550412 - might have a short term impact, but would quickly dissipate from
550413 - drinking water.
550415 -  ..
550416 - Research at the time of heart surgery (coronary artery bypass graft -
550417 - cabg), found that salt is critical to life, reported on 091104 0718,
550418 - ref SDS 18 D58G
550419 -
550420 -            [On 101207 0906 lab earlier today shows sodium (NA - salt)
550421 -            is very near to being too low for good health. ref SDS 55
550422 -            KW3N
550424 -             ..
550425 -            [On 110314 1022 Ross letter asks again about feedback from
550426 -            the doctor on correlations between salting food and
550427 -            swallowing problems. ref SDS 60 NT3V
550428 -
550429 -
550430 -
550431 -
5505 -

SUBJECTS
Default Null Subject Account for Blank Record

5603 -
560401 -  ..
560402 - Medical Chart Meeting with VA December 7, 2010
560403 -
560404 - Follow up ref SDS 43 LB6J.
560405 -
560406 - Have not received the VA record for meeting today with Doctor Lee on
560407 - 101207, per above. ref SDS 0 0001
560408 -
560409 -            [On 110114 1309 records received from VA for work today
560410 -            included report on the lab, but not meeting with the doctor
560411 -            today. ref SDS 59 1Y9K
560412 -
560413 -
560414 -
560415 -
560416 -
560417 -
560418 -
5605 -