CONTACTS
SUBJECTS
VA EGD Procedure Stricture Lower Esophageal Sphincter Valve LESV 16.
4303 -
4303 - ..
4304 - Summary/Objective
4305 -
430501 - Follow up ref SDS B1 0000. ref SDS A5 0000.
430502 -
430503 -
430504 -
430505 -
430506 -
430508 - ..
4306 -
4307 -
4308 - Background
4309 -
430901 - On 050629 meeting Primary Care swallowing and vomitting problems
430902 - reported. ref SDS 1 K78K
430904 - ..
430905 - On 050714 barrium swallow test, ref SDS 2 2I4S, showed esophagus
430906 - distorted by swallowing problems. ref SDS 2 WE4H
430908 - ..
430909 - On 050816 meeting Primary Care Doctor Sandhu diagnoses achalasia.
430910 - ref SDS 3 DG8G Ultrasound test ordered to verify initial diagnosis of
430911 - swallowing and vomitting problems. ref SDS 3 6E7H Primary Care made
430912 - referral to GI clinic for care to resolve swallowing problems.
430913 - ref SDS 3 0G7M
430915 - ..
430916 - On 050830 ultrasound test evaluate swallowing problems possible
430917 - diagnosis achalasia. ref SDS 4 DG8G
430919 - ..
430920 - On 050830 results received barrium swallow test performed on 050714,
430921 - findings in the lower espohagus and gastroesophageal junction are
430922 - consistent with achalasia - recommend endoscopic examination.
430923 - ref SDS 4 6H9S
430925 - ..
430926 - On 050906 report ultrasound test on 050830, finds no cause for
430927 - swallowing problems and does not diagnose achalasia. ref SDS 5 BM6R
430929 - ..
430930 - On 051202 meeting GI Clinic Doctor Lee diagnoses achalasia.
430931 - ref SDS 6 HP9H Orders endoscopy (EGD) test to verify diagnosis of
430932 - achalasia and assess for cancer. ref SDS 6 NZ5H
430934 - ..
430935 - On 051209 GI Clinic endoscopy examination preliminary findings no
430936 - evidence of cancer, ref SDS 7 0001; biopsy report should be submitted
430937 - in a few weeks to confirm status of cancer, ref SDS 7 PY5J, and if so,
430938 - then a procedure can be schedule for next month to dilate the
430939 - exophageal sphincter valve. ref SDS 7 NZ5H
430941 - ..
430942 - On 051222 biopsy reports no evidence of cancer. ref SDS 8 FT6M
430944 - ..
430945 - On 060111 received letter from Doctor Lee in the Gastrointestinal (GI)
430946 - Clinic reporting that the biopsy was negative for cancer and
430947 - infection; next step is manometry test to verify achalasia, then
430948 - treatment for achalasia. ref SDS 9 4Q3R
430950 - ..
430951 - On 060125 manomety test scheduled for 060209 0800. ref SDS 10 GG9I
430953 - ..
430954 - On 060209 meeting at VA Mather AFB in Sacramento, test was postponed
430955 - until 060223, due to equipment failure. ref SDS 11 OW6M
430957 - ..
430958 - On 060221 Jimmy in GI Department at Sacramento VA Medical Center
430959 - reports manometry equipment still broken; has been sent out for
430960 - repairs and there is no date at this time on when the equipment will
430961 - be available for use at the VA. ref SDS 12 ND7M
430963 - ..
430964 - On 060330 endoscopy follow up examination at GI Department Sacramento
430965 - Medical Center - Doctor Lee finds no evidence cancer performed at VA
430966 - Sacramento condition precedent treatment recover from achalasia.
430967 - ref SDS 13 VX4G
430969 - ..
430970 - On 060330 manometry test performed by Doctor Lee at VA in Sacramento,
430971 - ref SDS 13 MC7P, verifies diagnosis swallowing and vomitting problems
430972 - caused by achalasia, ref SDS 13 MD4N, patient meets criteria for
430973 - treatment with pneumatic dilation. ref SDS 13 MD5G
430975 - ..
430976 - On 060505 Martinez VA GI clinic Doctor Lee reported equipment and
430977 - pneumatic balloon materials on hand to perform dilation for treating
430978 - achalasia; treatment delayed until diagnostic data is received from
430979 - Sacramento VA Medical Center from manometry test performed on 060330;
430980 - doctor following up to obtain data; will submit test data to patient
430981 - during the week of 060508, along with a schedule to treat achalasia.
430982 - ref SDS 14 FT6M
430984 - ..
430985 - On 060614 Martinez VA GI clinic reports increased work load treating
430986 - soldiers returning from war in Iraq requires prioritizing; patient
430987 - advocate, Rubin Soto, will coordinate with the GI Clinic notifying the
430988 - customer of the schedule based on current priorities. ref SDS 15 J86N
430990 - ..
430991 - On 070220 letter to VA asks about progress getting test results from
430992 - VA in Sacramento, and scheduling surgery for achalasia, ref SDS 16
430993 - 5R5R
430995 - ..
430996 - On 090812 1030 continued vomitting achalasia causes weight loss 30
430997 - pounds in a few months, Primary Care physician notified GI clinic to
430998 - review schedule for dilation to relieve achalasia. ref SDS 17 7L5O
431000 - ..
431001 - On 090908 meeting GI Clinic in Martinez reports treatment for
431002 - achalasia still waiting to receive results for manometry test on
431003 - 060330, at Sacramento VA Medical Center. ref SDS 18 HX46 Prepared new
431004 - work plan to treat achalasia without manometry test results, because
431005 - the doctor performed the test 3 years ago, and is so knows results
431006 - consistent with achalasia, shown on 060330 0712, ref SDS 13 MD4N;
431007 - schedules treatment for achalasia after treadmill stress test,
431008 - ref SDS 18 BU6W, to evaluate new chest pains hiking hills at Lafayette
431009 - Reservoir which have not occurred doing extended exercise hiking 3 -
431010 - 14 miles a day over the past 5 years. ref SDS 18 MY4N
431012 - ..
431013 - On 091021 report history achalasia issue during meeting with
431014 - cardiothoracic surgery team to prepare for heart bypass surgery the
431015 - next day. ref SDS 20 NX6M Surgery team will coordinate with
431016 - anesthesia team to provide swallowing relief during heart surgery to
431017 - prevent choking. ref SDS 20 R78O
431019 - ..
431020 - On 091022 0700 meeting anesthesia team - Doctor Brezinski not familiar
431021 - with achalasia - asked if achalasia has been reported to the VA?
431022 - ref SDS 21 JF9K While being prepared with IVs for surgery, patient
431023 - assists anesthesia find VA records on achalasia, ref SDS 21 2W4K;
431024 - Doctor Brezenski makes plans for patient care and safety so that
431025 - achalasia does not risk death during heart surgery. ref SDS 21 GX4J
431027 - ..
431028 - On 091022 cabg x4 cardiothoracic surgery San Francisco Medical Center.
431029 - ref SDS 21 PQWU
431031 - ..
431032 - On 091030 0800 at 1406 meeting with Doctor Stewart at San Francisco
431033 - Medical Center during recovery from heart surgery, proposes Heller
431034 - Myotomy surgery rather than pneumatic (balloon) dilation as more
431035 - effective and longer lasting solution to recover from swallowing and
431036 - vomitting problems caused by achalasia. ref SDS 24 KE3B
431038 - ..
431039 - On 091030 0800 at 1430 received documentation from GI Department at
431040 - San Francisco Medical Center - review shows 3 different treatments for
431041 - achalasia - pills, pneumatic dilation, Heller Myotomy surgery.
431042 - ref SDS 24 495I
431044 - ..
431045 - On 091030 0800 at 1440 meeting cardiothoracic surgery team; Doctor
431046 - Ratcliff concerned about how to maintain nutrition for the patient to
431047 - recover from heart surgery while digestion remains problematic due to
431048 - achalasia; proposes feeding tube for several months until Heller
431049 - Myotomy surgery. ref SDS 24 03GF
431051 - ..
431052 - On 091216 Heller Myotomy surgery at San Francisco VA Medical Center to
431053 - recover from achalasia. 091216 0600, ref SDS 36 KE9U
431055 - ..
431056 - On 100202 meeting with Doctor Lee - report swallowing and vomitting
431057 - problems 3 months after Heller Myotomy surgery. Doctor explains
431058 - achalasia disease breaks nerve connections from the brain that
431059 - contract the esophagus to force food and liquid from the mouth through
431060 - the esophagus; as well broken nerve connections prevent the lower
431061 - esophageal sphincter valve (LESV) to relax so that content can pass
431062 - into the stomach. Without esophageal contractions, food and liquid
431063 - can only reach the stomach with gravity, but since the LESV won't
431064 - relax the patient continues to have swallowing and vomitting problems,
431065 - despite Heller Myotomy surgery on 091216, intended to maintain
431066 - adequate opening into the stomach. ref SDS 47 485W
431068 - ..
431069 - On 100305 meeting at GI Clinic in Martinez, EGD procedure dilated LESV
431070 - from 11 to 15 mm. ref SDS 48 WR6L
431072 - ..
431073 - On 100827 meeting at GI Clinic in Martinez, EGD procedure dilated LESV
431074 - from 11 to 15 mm. ref SDS 55 JE6X
431076 - ..
431077 - On 101210 EGD procedure dilated esophageal sphincter valve (LESV)
431078 - without sedation, ref SDS 67 BE7K - dilated LESV again from 11 to 14
431079 - mm. ref SDS 67 BF6L
431081 - ..
431082 - On 101216 1021 letter commends medical team for excellent work, and
431083 - confirms schedule next EGD on 110218 0730. ref SDS 69 K35G
431085 - ..
431086 - On 110218 0730 4th EGD procedure at VA in Martinez, and using
431087 - anesthesia with Fentanyl. ref SDS 71 PQWY LESV dilated 11 - 14 mm,
431088 - and added triamcinolone steriod injections to resist contraction of
431089 - LESV so that swallowing is maintained over the next 3 month cycle.
431090 - ref SDS 71 SR4G
431092 - ..
431093 - On 110429 0830 5th EGD dilation at VA in Martinez - triamcinolone
431094 - steriod injections worked well to resist contraction of LESV so that
431095 - swallowing was maintained over the prior 3 month cycle, ref SDS 75
431096 - FE3F, so LESV dilated from 13 - 16.5 mm, ref SDS 75 U23I, and
431097 - triamcinolone injections were continued. ref SDS 75 SS5N
431099 - ..
431100 - On 110607 1414 visited GI Department, ref SDS 77 HC5H, and Charlene
431101 - reported a computer mistakes requires scheduling next EGD dilation on
431102 - 110819 0830. ref SDS 77 N642 Requested meeting with Doctor Lee to
431103 - review pending action items. ref SDS 77 4P6J,
431105 - ..
431106 - On 110819 0830 EGD and Dilation of stricture at lower esphageal sphincter
431107 - valve. Triamcinolone steriod injections worked well to resist
431108 - contraction of LESV so that swallowing is maintained over the prior 3
431109 - month cycle, so LESV dilated from 15 - 16.5 mm, ref SDS 80 J978, and
431110 - triamcinolone injections were continued. ref SDS 80 J985
431112 - ..
431113 - On 111115 1300 EGD dilation procedure - triamcinolone steriod injections
431114 - worked well over the prior 3 month cycle, so LESV dilated from 16.5 -
431115 - 18 mm, ref SDS 81 IR57; for some reason triamcinolone injections to
431116 - resist contraction of LESV was not performed. ref SDS 81 IS6L
431118 - ..
431119 - On 120322 1030 EGD dilation procedure - swallowing and vomitting problems
431120 - increased without triamcinolone steriod injections on prior 3 month
431121 - cycle. ref SDS 83 UI9H LESV dilated from 16.5 - 18 mm. ref SDS 83
431122 - 516N Triamcinolone injections to resist contraction of LESV was not
431123 - performed. ref SDS 83 5179
431125 - ..
431126 - On 120925 0900 meeting Doctor Lee reported schedule mistake using new VA
431127 - business unit; reported patient history. ref SDS 86 RG9K Scheduled
431128 - EGD and dilation procedure for 1300; returned and performed procedure,
431129 - ref SDS 86 TB4J; dilated from 15 mm to 18 mm. ref SDS 86 XB51
431130 - Swallowing and vomitting problems increased after omitting
431131 - triamcinolone steriod injections to resist contraction of LESV after
431132 - dilation, ref SDS 86 TZ4M; therefore, injections were resumed to
431133 - complement dilation to enable and maintain effective swallowing.
431134 - ref SDS 86 R87N
431136 - ..
431137 - On 130110 0900 meeting Doctor Lee EGD dilation procedure found
431138 - improvement recovering from acalasia, LESV contracted only slightly
431139 - from 18 mm down to 15 mm. ref SDS 94 Q333
431141 - ..
431142 - On 130416 1100 meeting Doctor Lee EGD procedure no dilation required LESV
431143 - remained at 18 MM, ref SDS 99 CO5N, same as dialated 4 months earlier
431144 - on 130110 0900. ref SDS 94 Q333 Report CT test on 130117, shows
431145 - esophagus fully recovered from severe distortions caused by achalasia
431146 - 8 years earlier. ref SDS 99 MT6F Doctor Lee injected steriod again to
431147 - maintain swallowing. ref SDS 99 F38G Prescribed reducing Omeprazole
431148 - to 1 pill per day. ref SDS 99 R74M Scheduled next EDG dilation in 6
431149 - months, instead of 3. ref SDS 99 6P6G
431151 - ..
431152 - On 131115 0700 meeting Doctor Lee EGD prodecure dialation LESV from 16.5
431153 - to 18 mm. ref SDS A5 CO5N Triamcinolone steriod injected again to
431154 - maintain improved swallowing. ref SDS A5 I167 Omeprazole medication
431155 - maintained 20 mg taken morning and evening for 1 month, then reduce to
431156 - 20 mg once per day. ref SDS A5 R74M Biopsies taken. ref SDS A5 3N8L
431158 - ..
431159 - On 131121 1604 ordered refill of Omeprazole to aid digestion. There
431160 - is 1 refill remaining. ref SDS A6 YS4O
431162 - ..
431163 - On 131205 1443 received order for Omeprazole prescription placed on
431164 - 131121. ref SDS A7 5N3O
431166 - ..
431167 - On 140318 1043 received letter cancelling meeting scheduled for
431168 - EGD/Dilation procedure on 140425 1000, ref SDS A8 935L; a second
431169 - letter scheduled prodedure on 140509 0900. ref SDS A8 5D7H
431171 - ..
431172 - On 140401 1659 ordered refill Omeprazole; none are remaining; need
431173 - Doctor Lee to order new prescription to increase refills. ref SDS A9
431174 - 4P5M
431176 - ..
431177 - On 140509 0900 meeting Doctor Lee for EGD Dilation at VA medical
431178 - center in Sacramento, Mather. ref SDS B1 K37G Pre-op preperation went
431179 - well - IV setup on first stick. ref SDS B1 EP75 Doctor ordered refills
431180 - for Omeprazole. ref SDS B1 AW5O Doctor patient partnership continues
431181 - to progress with doctor reading up on patient history to be prepared
431182 - for effective meeting. ref SDS B1 ZZ6J Doctor Lee recalled today
431183 - having made timely referral for having heart surgery, enabling patient
431184 - to recover and Half Dome 4 years later. ref SDS B1 0N6I Reported
431185 - swallowing and vomitting problems reduced past 6 months with
431186 - triamcinolone steriod injections to resist contraction of LESV.
431187 - ref SDS B1 VV6N Doctor Lee dilated LESV contracted to only 16.5 MM
431188 - over past 6 months with triamcinolone steriod injections to resist
431189 - contraction; he dilated LESV back to 18 MMy, ref SDS B1 5H5J, scheduled
431190 - next EGD dilation in 6 months since this worked well the past 6 months
431191 - with triamcinolone steriod injections. ref SDS B1 549I The doctor
431192 - explained that since there was no tearing of LESV during procedure
431193 - today, triamcinolone steriod was not injected into LESV to resist
431194 - contraction. ref SDS B1 I167 Progress notes report small tearing of
431195 - LESV during dilation procedure. ref SDS B1 P680
431197 - ..
431198 - On 140805 letter to Doctor Lee requests consideration for early EGD
431199 - dilation with triamcinolone injection to resist contraction of LESV,
431200 - and if cancellation arises, but not emergency. ref SDS 0 K37G
431201 -
431202 -
431203 -
431204 -
431205 -
431206 -
431208 - ..
4313 -
4314 -
4315 - Progress
431601 - ..
431602 - Esophagogastroduodenoscopy (EGD) and Dilation LESV Administration
431603 - GI Department VA Sacramento Medical Center Administration EGD Dilation
431604 -
431605 - Follow up ref SDS B1 NU8L, ref SDS A5 NU8L.
431607 - ..
431608 - VA website is at...
431609 -
431610 - https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=mhvHome
431612 - ..
431613 - Customer....
431617 -
431625 - ..
431626 - Sent letter to VA saying...
431627 -
431628 - 1. Dear Doctor Lee:
431630 - ..
431631 - 2. Vomiting has increased faster than past 2 dilations. This is
431632 - mostly inconvenience, and so does not require immediate action.
431633 - However, if a cancellation arises, I would like to do another
431634 - dilation soonest, and with triamcinolone injection, which
431635 - worked well with the prior dilations to resist contraction of
431636 - LESV, as shown in patient history in the record on 140509 at
431637 - line 550520, reviewing your progress notes. ref SDS B1 P680
431638 -
431639 - [On 140819 0800 during meeting at VA Primary Care Clinic in
431640 - Martinez, Doctor Sandhu indicated Doctor Lee at VA Medical
431641 - Center in Sacramento will be notified about rising
431642 - achalasia symptoms for consideration to advance EGD
431643 - dilation procedure. ref SDS B5 EX78
431645 - ..
431646 - [On 141014 0943 Kathy visited EGD Clinic at VA Medical
431647 - Center in Sacramento and talked to Lapria, who advised that
431648 - on 141001, the VA responded to the letter on 140810, saying
431649 - EGD dilation is scheduled on 141121 1500 to implement order
431650 - for 6 months after prior procedure on 140509, which would
431651 - be on 141109. ref SDS B6 NU8L
431653 - ..
431654 - 3. You can track increased daily vomiting beginning last month on
431655 - 140712, shown in patient history see line 107301 (this may take
431656 - a minute to read into your browser. [...shown in case study on
431657 - 120101 0900. ref SDS 82 4E4M
431659 - ..
431660 - 4. You can see as well, training for Half Dome scheduled next
431661 - month on 140917, has been interrupted by feet problems. Met
431662 - with Podiatry last week on 140805. Radiology report that day
431663 - does not sound good. Scheduled to meet the team again on
431664 - 140820, to get further guidance. Did 14 miles today, and made
431665 - that okay with Motrin, prescribed by Doctor Tang.
431667 - ..
431668 - 5. Again, if feasible, would like to do LESV dilation with
431669 - triamcinolone injection soonest to relieve rising vomiting, but
431670 - not emergency.
431672 - ..
431673 - 6. Hope things are going well with you.
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