CONTACTS
SUBJECTS
VA EGD Procedure Stricture Lower Esophageal Sphincter Valve LESV 15
4303 -
4303 - ..
4304 - Summary/Objective
4305 -
430501 - Follow up ref SDS C9 0000. ref SDS C1 0000.
430502 -
430503 -
430504 -
430505 -
430506 -
430507 -
430508 -
430509 -
430510 -
430512 - ..
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 A9 935L; a second
431169 - letter scheduled prodedure on 140509 0900. ref SDS A9 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 B0
431174 - 4P5M
431176 - ..
431177 - On 140509 0900 meeting Doctor Lee for EGD Dilation at VA medical
431178 - center in Sacramento, Mather. ref SDS B2 K37G Pre-op preperation went
431179 - well - IV setup on first stick. ref SDS B2 EP75 Doctor ordered refills
431180 - for Omeprazole. ref SDS B2 AW5O Doctor patient partnership continues
431181 - to progress with doctor reading up on patient history to be prepared
431182 - for effective meeting. ref SDS B2 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 B2 0N6I Reported
431185 - swallowing and vomitting problems reduced past 6 months with
431186 - triamcinolone steriod injections to resist contraction of LESV.
431187 - ref SDS B2 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 B2 5H5J, scheduled
431190 - next EGD dilation in 6 months since this worked well the past 6 months
431191 - with triamcinolone steriod injections. ref SDS B2 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 B2 I167 Progress notes report small tearing of
431195 - LESV during dilation procedure. ref SDS B2 P680
431197 - ..
431198 - On 140718 1017 planning for notifying VA to update current fill date
431199 - for Omeprazole. ref SDS B5 U88L Kathy visited VA in Sacramento, and
431200 - requested changing refill date for Omeprazole to 140718. ref SDS B5
431201 - OL5K VA representative called customer, and said Doctor Lee would
431202 - call back later that day to consider action on updating scheduled
431203 - refill date of Omeprazole to 140718. ref SDS B5 U76M
431205 - ..
431206 - On 140810 1839 letter to Doctor Lee requesting EGD dilation with
431207 - triamcinolone injection soonest, if cancellation occurs; but, not an
431208 - emergency, ref SDS B7 W83K, based on history rising vomitting
431209 - swallowing problems, shown in patient history case study on 120101,
431210 - beginning 140712. ref SDS 82 4E4M
431212 - ..
431213 - On 140819 0800 during meeting at VA Primary Care Clinic in Martinez,
431214 - Doctor Sandhu indicated Doctor Lee at VA Medical Center in Sacramento
431215 - will be notified about rising achalasia symptoms for consideration to
431216 - advance EGD dilation procedure. ref SDS B8 EX78
431218 - ..
431219 - On 141014 0943 Kathy visited VA Medical Center in Sacramento and met
431220 - with Lapria again, who advised that the VA responded in a letter on
431221 - 141001, to the letter on 140810, and further scheduled a meeting with
431222 - Doctor Lee on 141121 1530. ref SDS B9 QJ5N
431224 - ..
431225 - On 141103 2152 submitted agenda for meeting with Doctor Lee at VA
431226 - Sacramento Medical Center on 141107 0800, for next EGD dilation.
431227 - ref SDS C0 K37G Submit record showing normal swallowing occurs longer
431228 - with triamcinolone steriod injection to resist contraction of LESV.
431229 - ref SDS C0 3U97 Request schedule next EGD dilation in 4 months, and
431230 - if LESV does not contract, then schedule following EGD dilation in 6
431231 - months. ref SDS C0 3U66 Notified results of Half Dome hike.
431232 - ref SDS C0 3U6Y
431234 - ..
431235 - On 141107 0800 EGD dilation LESV from 15mm because triamcinalone
431236 - steriod was not injected during prior procedure on 140509. ref SDS C1
431237 - T55I
431239 - ..
431240 - On 150319 0800 meeting Doctor Lee in GI Clinic VA Medical Center
431241 - Sacramento report swallowing improved with triamcinalone steriod
431242 - injections on 141107 EGD dilation procedure. ref SDS C6 0M6I Doctor
431243 - Lee advised that increased orange juice consumption aids digestion,
431244 - and presents no health risks. ref SDS C6 YF5M Scheduled next EGD
431245 - dilation procedure on 150421 1300. ref SDS C6 PS4O Fundoplication
431246 - failure increases acid burn that caused ulceration with hiatal hernia
431247 - with increased recurrance achalasia. ref SDS C6 O56O Doctor Lee will
431248 - make referral to Doctor Stewart at General Surgery VA Medical Center
431249 - in San Francisco for consideration of "redo" fundaplicaiton.
431250 - ref SDS C6 JQ5J Doctor Lee completed Progress Notes for EGD dilation
431251 - on 141107. ref SDS C6 PS53 Doctor Lee will recommend Doctor Stewart
431252 - order CT test to evaluate recurrance achalasia due to failure
431253 - fundoplication. ref SDS C6 TH5M This test can include coronary CTA to
431254 - evaluate regression atherosclerosis. ref SDS C6 GB56
431256 - ..
431257 - On 150420 1752 submitted letter to Doctor Lee with agenda for meeting
431258 - the next day on 150421 1300 for EGD dilation. ref SDS C8 0M6I
431259 -
431260 -
431261 -
431262 -
431263 -
431265 - ..
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 C9 NU8L, ref SDS C1 NU8L.
431606 -
431607 - Checked VA Internet medical records system this evening, and found
431608 - Doctor Lee's Progress Notes are not available for the meeting on
431609 - 150421, EGD Dilation procedure. ref SDS C9 CY7I
431611 - ..
431612 - Submitted letter to Doctor Lee saying...
431613 -
431614 - 1. Subject: Prog Notes ED Dilation Apr 21, Referral Doctor Stewart
431615 - Date: 2015-05-14 02:18
431622 - ..
431623 - 2. Please file Progress Notes for EGD Dilation procedure on
431624 - 150421, needed to prepare for our meeting next week on 150521
431625 - at 0800. I checked this evening and found the VA Internet
431626 - system does not show these Progress Notes are available.
431627 -
431628 - [...below on 150514 0130 at 0944 called VA and talked to
431629 - Jessica - she said the doctor filed Progress Notes and
431630 - biopsy results yesterday on 150513, so they should be
431631 - available to customers on the VA Internet system OA 150516.
431632 - ref SDS 0 IY7X
431634 - ..
431635 - 3. Recall the work plan during the meeting on 150421 - you planned
431636 - to make referral to Doctor Stewart after you receive biopsy
431637 - results and file Progress Notes. ref SDS C9 DZ4I
431639 - ..
431640 - 4. Referral to Doctor Stewart is needed to consider remedies for
431641 - failed fundoplication causing ulceration of LESV and recurrence
431642 - of distorted ("bird beak") esophagus, initially reported as
431643 - "Hiatal hernia" in Progress Notes for EGD Dilation on 141107.
431644 -
431645 - [...below on 150514 0130 at 1326 received call from VA
431646 - Medical Center in San Francisco and scheduled meeting with
431647 - Doctor Stewart in General Surgery to review "redo"
431648 - fundoplication to recover from surgery failure in order to
431649 - prevent recurrence and compounding of ulcerations on LESV
431650 - that worsen achalasia swallowing problems. ref SDS 0 US53
431652 - ..
431653 - 5. I'll call Jessica in the morning to request another reminder
431654 - for you on this matter.
431656 - ..
431657 - 6. Look forward to seeing you next week.
431658 -
431666 -
431667 -
431668 -
431670 - ..
4317 -
4318 -
4319 - 0944
4320 -
432001 - Called Veteran Administration at Sacramento Medical Center...
432002 -
432003 - 916 366 5334
432005 - ..
432006 - Talked to Jessica.
432008 - ..
432009 - She remembered collaborating in January on getting progress notes for
432010 - procedure on 141107, e.g., on 150116 0813. ref SDS C4 MX5I
432012 - ..
432013 - Explained letter submitted this morning requesting Doctor Lee to file
432014 - Progress Notes for most recent procedure on 150421, per above.
432015 - ref SDS 0 625N
432017 - ..
432018 - Jessica checked the VA computer. She said the computer shows that
432019 - yesterday on 150513, Doctor Lee filed Progress Notes including biopsy
432020 - results, for EDG Dilation procedure performed on 150421.
432022 - ..
432023 - Since the VA system advises customers cannot get medical records until
432024 - 3 days filing by the doctor, these records are not listed on VA
432025 - Internet computer system, as reported earlier this morning, shown
432026 - above. ref SDS 0 K37G Hopefully, will get them tomorrow or Saturday.
432028 - ..
432029 - Thanked Jessica for good customer support.
432030 -
432031 -
432033 - ..
4321 -
4322 -
4323 - 1326
4324 -
432401 - Received call from May in the General Surgery Department at the VA
432402 - Medical Center in San Francisco.
432404 - ..
432405 - May scheduled meeting with Doctor Stewart on 150526 1300, to review
432406 - "rodo" for fundoplication failure, requested in the letter to Doctor
432407 - Lee earlier today, per above. ref SDS 0 RU67
432409 - ..
432410 - This referral meeting with Doctor Stewart implements planning during
432411 - the meeting with Doctor Lee on 150421 1210, ref SDS C9 DZ4I, and
432412 - previously meeting with Doctor Lee on 150319 0800. ref SDS C6 JQ5J
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