CONTACTS
SUBJECTS
Fundoplication Loosening Explain Hiatal Hernia and Ulceration LESV M
3503 -
3503 - ..
3504 - Summary/Objective
3505 -
350501 - Follow up ref SDS 22 0000. ref SDS 21 0000. ref SDS 20 0000.
350502 -
350503 - Met with Doctor Lee at VA MC in Sacramento (Mather) to review EGD
350504 - Dilation procedure last month on 140421. The doctor accessed on VA
350505 - computer system photographs from procedure on 140521, which showed
350506 - bubbles. ref SDS 0 0M6I Doctor Lee explained recent vomitting may be
350507 - due to relaxation of practicle eating procedures. ref SDS 0 WT9L
350508 - Reviewed photographs showing current loosened condition of
350509 - fundoplication markedly different from condition a year ago.
350510 - ref SDS 0 FV5O Fundoplication occurs below LESV, causing hiatal
350511 - hernia to puch stomach into esophagus. ref SDS 0 IA5O Plan to request
350512 - CT barrium swallow test to evaluate recurrence distortion esophagus
350513 - above LESV. ref SDS 0 OG6L
350514 -
350515 -
350516 -
350517 -
350519 - ..
3506 -
3507 -
3508 - Background
3509 -
350901 - Progress Notes have been missing longer than 4 months, from the VA
350902 - computer that stores patient medical records, for the EGD procedure on
350903 - 141107 0800. ref SDS 11 SY6M Last night checked again and found they
350904 - are still missing, despite notice to the doctor on 141125 0942.
350905 - ref SDS 12 OL6F
350907 - ..
350908 - On 150116 0813 met with Jessica at GI Clinic VA Medical Center in
350909 - Sacramento, she has notified Doctor Lee that Progress Notes are
350910 - missing for EGD Dilation on 141107, ref SDS 15 MX5I; later that day at
350911 - 0922 Doctor Lee called and left voicemail message that his Progress
350912 - Notes for the EGD Dilation procedure on 141107, are missing from VA
350913 - medical records computer system; he further said the missing Progresss
350914 - Notes can be restored by scanning another source; he will have the
350915 - records restored and submit notice to the patient when his Progress
350916 - Notes can be downloaded using the Internet to access the VA computer
350917 - system. ref SDS 14 ZX6I
350919 - ..
350920 - On 150116 0813 at 0922 Doctor Lee called and left voicemail message
350921 - that his Progress Notes for the EGD Dilation procedure on 141107, are
350922 - missing from VA medical records computer system; he further said the
350923 - missing Progresss Notes can be restored from scanning another source;
350924 - he will have the records restored and submit notice to the patient
350925 - when his Progress Notes can be downloaded using the Internet to access
350926 - the VA computer system. ref SDS 14 ZX6I
350928 - ..
350929 - On 150120 1636 letter to Doctor Lee confirms understandings meeting
350930 - with Jessica on 150116, and voicemail message from Doctor Lee later on
350931 - 150116, saying he will post Progress Notes for EGD Dilation procedure
350932 - on 141107. ref SDS 16 VE95
350934 - ..
350935 - On 150130 1609 called and left message for Jessica to follow up again
350936 - with Doctor Lee to post Progress Notes for EDG Dilation procedure at
350937 - VA Sacramento Medical Center on 141107. ref SDS 17 MX5I
350939 - ..
350940 - On 150211 1239 called EGD Department VA in Sacramento and talked to
350941 - Jennifer; she coordinated with Jessica and recommended scheduling
350942 - meeting with Doctor Lee on preparing Progress Notes, ref SDS 19 6J9L,
350943 - for the meeting with the doctor to perform EGD dilation procedure on
350944 - 141107. ref SDS 11 K37G
350945 -
350946 -
350947 -
350948 -
350949 -
350950 -
350952 - ..
3510 -
3511 -
3512 - Progress
3513 -
351301 - Ulceration Acid Burn LESV Fundoplication Failed Causing Hiatal Hernia
351302 - Fundoplication Failed Cause Hiatal Hernia Ulceration LESV Needs Surgical Repair
351303 - Surgical Repair Fundoplication Resolve Ulceration LESV and Hiatal Hernia in Stomach
351304 - Hiatal Hernia Ulceration Caused by Failure Fundoplication Needs Surgery
351305 -
351306 - Follow up ref SDS 22 P396. ref SDS 21 TB5I.
351307 -
351308 - Asked about seemingly excessive bubbles that are continually forming
351309 - and have to be vomitted, especially when hiking the 11 mile route.
351311 - ..
351312 - Doctor Lee showed photographs with saliva bubbles in the throat, near
351313 - the upper esophageal sphincter valve, indicating this has been common
351314 - symptom of LESV contracting.
351316 - ..
351317 - Forgot to ask the doctor about the document he filed during
351318 - examination on 150421 1210. ref SDS 22 N15L
351320 - ..
351321 - Discussed agenda for meeting today shown in letter to the doctor
351322 - yesterday on 150520 1107, ref SDS 23 NJ74, and reporting sudden, mild
351323 - vomitting past few days beginning on 150514, reported in case study on
351324 - diet, medication, exercise and vitals in the record on 140101 0600.
351325 - ref SDS 8 6G5L Just 2 days ago there was a major vomitting episode
351326 - of 80% on 150519. ref SDS 8 OP5N
351328 - ..
351329 - There was concensus that uncharacteristic vomitting a month after EGD
351330 - dilation procedure in 150421, is due to patient not exercising
351331 - practices developed the past 3 years of eating slowly with small bites
351332 - and drinking liquids frequently, especially when eating meat products
351333 - that have high viscocity with esophageal tissue, and so tends to
351334 - stick.
351336 - ..
351337 - Requested explanation of hiatal hernia in relation to fundoplication
351338 - loosening, presented in Progress Notes for EGD dilation procedure on
351339 - 140509 0900, ref SDS 9 I93F, and discussed with the doctor during a
351340 - meeting at VAMC in Sacramento on 150319 0800. ref SDS 21 N535
351342 - ..
351343 - Doctor Lee used the computer in the office to display several
351344 - photographs taken during EGD dilation procedures over the past years.
351345 - The most recent pictures from EGD dilation last month on 150421, show
351346 - fundoplication appears flat and smooth, markedly different from the
351347 - wrinkled and wrapped appearance in the picture for the EDG dilation 18
351348 - months ago, on 131115, when Progress Notes report "Fundoplication
351349 - remains in tact." ref SDS 7 JW4I
351350 -
351351 - [On 150526 1300 meeting with Doctor Stewart VA MCSF
351352 - requested pictures showing Dor fundoplication unraveling,
351353 - ref SDS 24 RV3G; was unable to access VA server at MC
351354 - Sacramento (Mather). ref SDS 24 F65O
351356 - ..
351357 - [On 150527 0930 meeting with support staff - they could not
351358 - access VA computer system server at Sacramento server;
351359 - Isagani suggested the patient submit relevant photographs
351360 - with email to assist Doctor Stewart in evaluating patient
351361 - history toward deciding remedies for failed Dor
351362 - fundoplication. ref SDS 25 2X5F
351364 - ..
351365 - Requested photographs taken during EGD dilation. They are not
351366 - included with Progress Notes on 150421 1210, ref SDS 22 HU90, as
351367 - downloaded from VA Interent server.
351369 - ..
351370 - Today, Doctor Lee explained failed fundoplication loosening -
351371 - unravelling causes hiatal hernia with stomach tissue below LESV
351372 - protruding into the esophageal (throat) tube, reported in Progress
351373 - Notes for EGD dilation procedure last month on 150421 1210,
351374 - ref SDS 22 QD6O, further causing ulceration of LESV and possibly
351375 - distortion - expansion of esophagus above LESV commonly called "bird
351376 - beak" with LESV constricted - commonly called achalasia.
351378 - ..
351379 - Doctor Lee drew 4 sketches to illustrate these conditions. For some
351380 - reason the paper did not scan well, so did not save it. Some of the
351381 - sketches are diagramed here...
351382 -
351383 - | |
351384 - | |
351385 - | | N O R M A L C O N D I T I O N
351386 - | |
351387 - | |
351388 - | |
351389 - | |
351390 - | | Esophagus
351391 - | |
351392 - | |
351393 - | |
351394 - | |
351395 - \ | Lower Esophageal Spincter Valve (LESV)
351396 - \ \
351397 - / -----------\
351398 - / ========== \ Fundoplicaion protection reduces acid reflux
351399 - | \ avoid ulceration LESV and hiatal hernia
351400 - | | constructed by Doctor Stewart at VAMC
351401 - | Stomach | on 091216 0600. ref SDS 1 KE9U
351402 - / /
351403 - / ------------ /
351404 - | /
351405 - \ \
351406 - \ --------------
351407 - -- ----------------
351408 -
351410 - ..
351411 - Fundoplication observed loosened with EGD dilation procedure on 140509
351412 - 0900. ref SDS 9 I93F
351413 -
351414 -
351415 - | |
351416 - | | H I A T A L H E R N I A
351417 - | |
351418 - | | Stomach pushes up into the esophagus
351419 - | |
351420 - | |
351421 - |\ /|
351422 - |/ \| Lower Esophageal Spincter Valve (LESV)
351423 - / \ pushed up higher into esophagus
351424 - /| |\
351425 - | | | \
351426 - | | | |
351427 - | | | | Stomach distorts and pushes into stomach
351428 - | | | |
351429 - | | | |
351430 - \ \ | |
351431 - \ \ / \ Normal LESV pushed higher into esophagus, per above
351432 - \ \\ \
351433 - | / ------------\
351434 - |/ \ Fundoplication unravelled no protection
351435 - | \ increased acid reflux causes ulceration LESV
351436 - | Stomach | hiatal hernia progresses reported
351437 - | | on 140509 0900. ref SDS 9 I93F
351438 - / /
351439 - / ------------ /
351440 - | /
351441 - \ \
351442 - \ --------------
351443 - -- ----------------
351444 -
351446 - ..
351447 - During the meeting with Doctor Stewart next week on 150526, we can
351448 - discuss doing another CT test to evaluate esophagus for distortion,
351449 - which was completely resolved with CT study on 130117 0900,
351450 - ref SDS 5 OH6G, noted by Doctor Stewart during the meeting at the VAMC
351451 - in San Francisco on 130122 1330. ref SDS 6 OH6G
351452 -
351453 - [On 150527 0930 VA Medical Center in San Francisco
351454 - performed another CT Barium Swallow test - preliminary
351455 - results are favorable indicating patient has not suffered
351456 - recurrent achalasia symtom of distorted esophagus, commonly
351457 - called "bird beak," rather esophagus looks normal.
351458 - ref SDS 25 V56N
351460 - ..
351461 - Will further ask Doctor Stewart about ordering coronary CTA to
351462 - evaluate recovery from CVD, discused with Doctor Lee on 150319 0800.
351463 - ref SDS 21 TH5M
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