CONTACTS
SUBJECTS
Esophagus Swallow CT Test Substantial Recovery LESV Achalasia Barriu
1103 -
1103 - ..
1104 - Summary/Objective
1105 -
110501 - Follow up ref SDS 8 0000, ref SDS 7 0000.
110502 -
110503 -
110504 -
110506 - ..
1106 -
1107 -
1108 - Background
1109 -
110901 - On 121016 background achalasia, ref SDS 5 HS7L, meeting Doctor Stewart
110902 - on achalasia, ref SDS 5 AE9G, and schedule barium swallow test
110903 - evaulate surgery eliminate dilation procedures. ref SDS 5 FN4G
110905 - ..
110906 - On 121113 1100 radiology barium swallow CT test. ref SDS 6 4X5H
110908 - ..
110909 - On 121113 1330 meeting Doctor Stewart review barium swallow test on
110910 - resolving achalasia. ref SDS 6 EI9M
110912 - ..
110913 - On 130110 0900 EGD Dilation Doctor Lee VA Sacramento resolve
110914 - achalasia. 130110 0900, ref SDS 9 RG9K
110916 - ..
110917 - On 130107 VA called left message procedure scheduled, and to call back
110918 - for details. ref SDS 7 RY5H Called back and left message that VA's
110919 - earlier call was returned.
110921 - ..
110922 - On 130108 VA called and advised medical procedure scheduled on 130117
110923 - 0900 in Radiology Department at VA in Martinez. ref SDS 8 T068 Grace
110924 - will try to determine what procedure has been ordere, who ordered the
110925 - work, and why.
110927 - ..
110928 - On 130110 Grace called back and said that Doctor Lee ordered another
110929 - barium swallow test. ref SDS 9 JH6N This will compare with results on
110930 - similar test 2 months ago on 121113 1100, ref SDS 6 4X5H to assess
110931 - improvement after EDG dilation on 130110.
110932 -
110933 -
110935 - ..
1110 -
1111 -
1112 - Progress
1113 -
111301 - Meeting at VA Clinic in Martinez.
111302 -
111303 - Met the doctor - Jim.
111305 - ..
111306 - Jim had a copy of the report for the test in San Francisco on 121113
111307 - 1100. ref SDS 6 4X5H
111309 - ..
111310 - The test today was a more extensive barium swallow test than was
111311 - performed at the VA in San Francisco on 121113 1100, ref SDS 6 4X5H,
111312 - and cited in Progress Notes for a meeting later that day. 121113 1100,
111313 - ref SDS 6 H63N It was also more extensive than testing after Heller
111314 - Myotomy surgery on 091218, 2 days after Heller Myotomy surgery, and
111315 - later reported in the record on 100928 0706. ref SDS 4 R43F
111317 - ..
111318 - The technician took a chest xray.
111320 - ..
111321 - Barium studies were done....
111322 -
111323 - 1. Chest frontal numerous images
111324 -
111325 - 2. Partial left side
111326 -
111327 - 3. Partial right side
111329 - ..
111330 - 4. Horizontal frontal image
111331 -
111332 - Could not do entirely flat horizontal position, but the
111333 - doctor layed the table at about a 30% angle.
111335 - ..
111336 - Jim said he sees swallowing restrictions at LESV.
111338 - ..
111339 - Jim also said there is swallowing restriction in the upper esophageal
111340 - sphincter valve. This is a new finding in patient history.
111342 - ..
111343 - Jim asked about pain for discomfort in swallowing?
111345 - ..
111346 - Explained have never had pain or discomfort swallowing. The only
111347 - symptom is vomitting. Esophagus backs up and creates drowning
111348 - sensation. Urge to vomit occurs suddenly and requires immediate
111349 - relief.
111351 - ..
111352 - Live images on the monitor show swollowing seems significantly
111353 - improved from the original study on 050714 1000. ref SDS 1 6136 The
111354 - esophagus seems much less distorted. There is slight distoration
111355 - above LESV, but there is no big bulge nor long string-like structure
111356 - that was in the original study nearly 8 years ago, 050714 1000,
111357 - ref SDS 1 B94J, and shown again by Doctor Lee in a meeting at the VA
111358 - on 051202 1430. ref SDS 2 5B5K Images today look relatively normal...
111359 -
111360 -
111361 - | |
111362 - | |
111363 - | |
111364 - | | Esophagus
111365 - | |
111366 - | |
111367 - | |
111368 - | |
111369 - | |
111370 - | |
111371 - | |
111372 - | |
111373 - \ | Lower Esophageal Spincter Valve (LESV)
111374 - \ \
111375 - / -----------\
111376 - / \
111377 - | \ Stomach
111378 - | |
111379 - | |
111380 - / /
111381 - / ------------ /
111382 - | /
111383 - \ \
111384 - \ --------------
111385 - -- ----------------
111386 -
111388 - ..
111389 - [On 130122 1330 meeting with Doctor Stewart at VAMC in San
111390 - Francisco, the doctor was pleased CT scan today shows
111391 - esophagus has recovered from extreme distortion, commonly
111392 - called "bird beak" symptom of acalasia, and now shows
111393 - perfectly normal vertical alignment, following Heller
111394 - Myotomy surgery on 091216, and then 3 years of EGD dilation
111395 - procedures with triamcinalone injections 3 - 4 times per
111396 - year. ref SDS 10 OH6G
111398 - ..
111399 - [On 130416 1100 Doctor Lee interpreted CT test on 130117,
111400 - shows remarkable recovery from achalasia; he attributes
111401 - favorable results reflects combination therapy with Heller
111402 - Myotomy surgery performed by Doctor Stewart at VA Medical
111403 - Center in San Francisco on 091216, and subsequent
111404 - persistent EGD dilation protocols every 3 months together
111405 - with Omeprazole medication, and then a year later enhanced
111406 - albeing intermittantly with triamcinolone steriod
111407 - injections to resist contractions of LESV that aid
111408 - swallowing and so avoid ballooning effect of esophagus.
111409 - ref SDS 11 E23K
111411 - ..
111412 - [On 150527 0930 VA Medical Center in San Francisco
111413 - performed another CT Barium Swallow test - preliminary
111414 - results are favorable indicating patient has not suffered
111415 - recurrent achalasia symtom of distorted esophagus, commonly
111416 - called "bird beak," rather esophagus looks normal.
111417 - ref SDS 12 V56N
111418 -
111419 -
111420 -
111421 -
111422 -
111423 -
111424 -
111425 -
111426 -
1115 -
SUBJECTS
CT Test Left Hip Shoulder Degenerative Arthritis Radiology Departmen
2503 -
250401 - ..
250402 - Hip and Shoulder Left Side Degenerative Arthritis
250403 - Degenerative Arthritis Hip and Shoulder Left Side
250404 - Arthritis Hip and Shoulder Left Side Degenerative
250405 -
250406 - Jim noticed there seems to be some degenerative wear in the left
250407 - shoulder and left hip joints. This helps explain recent pain during
250408 - hiking, and why this is relieved with Glucosamine Chondroitin, as with
250409 - the left knee.
250410 -
250411 -
250412 -
250413 -
250414 -
250415 -
250416 -
250417 -
250418 -
2505 -
SUBJECTS
Esophagus Swallow CT Test Substantial Recovery LESV Achalasia Barriu
3803 -
3804 - 2315
380501 - ..
380502 - Previously, Isagani facilitated communication with Doctor Stewart,
380503 - reported on 091228 1049. ref SDS 3 PP8W
380505 - ..
380506 - Submitted notice to Isagani for Doctor Stewart saying...
380507 -
380508 - 1. Subject: Meeting Doctor Stewart Jan 22
380509 - Date: Thu, 17 Jan 2013 23:27:49 -0800
380517 - ..
380518 - 2. On 121113, barium swallow test assessed achalasia after Heller
380519 - Myotomy surgery on 091216, and subsequent quarterly EGD
380520 - dilations. Doctor Stewart reviewed test results later the same
380521 - day on 121113. The doctor further scheduled follow up meeting
380522 - next week on 130122 1330.
380524 - ..
380525 - 3. On 121222 0830 I met with Doctor Pross and Trish Cavenaugh in
380526 - ENT to review voice disorder, and on referral from Doctor
380527 - Stewart.
380529 - ..
380530 - 4. On 130110 0900 Doctor Lee performed another EGD Dilation
380531 - procedure at VA in Sacramento.
380533 - ..
380534 - 5. Today, on 130117 0900, the VA in Martinez performed another
380535 - barium swallow test, ordered by Doctor Lee.
380537 - ..
380538 - 6. This notice enables review of the barium swallow test today at
380539 - VA in Martinez, to prepare for meeting with Doctor Stewart next
380540 - Tuesday on 131022 1330.
380542 - ..
380543 - 7. Thanks very much for facilitating communication with the doctor.
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