CONTACTS
SUBJECTS
Photographs Submit Email Best Evidence EGD Dilations Assess Severity
1603 -
1603 - ..
1604 - Summary/Objective
1605 -
160501 - Follow up ref SDS D7 0000, ref SDS D5 0000.
160502 -
160503 - Had initial difficulty submitting photographs to Isagani at VAMCSF,
160504 - because total size 15 MB was over the limit for the VA's email server.
160505 - ref SDS 0 K37G Eventually solved this by converting Microsoft Word
160506 - docx files to pdf. ref SDS 0 JI76 Letter to Isagani transmitting 2
160507 - files with photographs showing changes to Dor fundopliction.
160508 - ref SDS 0 WP8J Include link to record meeting with Doctor Stewart on
160509 - 150526, and ask Isagani to glance through to see if anything should be
160510 - brought to her attention. ref SDS 0 SQ59
160511 -
160512 -
160513 -
160514 -
160515 -
160517 - ..
1606 -
1607 -
1608 - Background
1609 -
160901 - On 050629 meeting Primary Care swallowing and vomiting problems
160902 - reported. ref SDS 1 K78K
160904 - ..
160905 - On 050714 barium swallow test, ref SDS 2 2I4S, showed esophagus
160906 - distorted by swallowing problems. ref SDS 2 WE4H
160908 - ..
160909 - On 050816 meeting Primary Care Doctor Sandhu diagnoses achalasia.
160910 - ref SDS 3 DG8G Ultrasound test ordered to verify initial diagnosis of
160911 - swallowing and vomiting problems. ref SDS 3 6E7H Primary Care made
160912 - referral to GI clinic for care to resolve swallowing problems.
160913 - ref SDS 3 0G7M
160915 - ..
160916 - On 050830 ultrasound test evaluate swallowing problems possible
160917 - diagnosis achalasia. ref SDS 4 DG8G
160919 - ..
160920 - On 050830 results received barium swallow test performed on 050714,
160921 - findings in the lower esophagus and gastroesophageal junction are
160922 - consistent with achalasia - recommend endoscopic examination.
160923 - ref SDS 4 6H9S
160925 - ..
160926 - On 050906 report ultrasound test on 050830, finds no cause for
160927 - swallowing problems and does not diagnose achalasia. ref SDS 5 BM6R
160929 - ..
160930 - On 051202 meeting GI Clinic Doctor Lee diagnoses achalasia.
160931 - ref SDS 6 HP9H Orders endoscopy (EGD) test to verify diagnosis of
160932 - achalasia and assess for cancer. ref SDS 6 NZ5H
160934 - ..
160935 - On 051209 GI Clinic endoscopy examination preliminary findings no
160936 - evidence of cancer, ref SDS 7 0001; biopsy report should be submitted
160937 - in a few weeks to confirm status of cancer, ref SDS 7 PY5J, and if so,
160938 - then a procedure can be schedule for next month to dilate the
160939 - esophageal sphincter valve. ref SDS 7 NZ5H
160941 - ..
160942 - On 051222 biopsy reports no evidence of cancer. ref SDS 8 FT6M
160944 - ..
160945 - On 060111 received letter from Doctor Lee in the Gastrointestinal (GI)
160946 - Clinic reporting that the biopsy was negative for cancer and
160947 - infection; next step is manometry test to verify achalasia, then
160948 - treatment for achalasia. ref SDS 9 4Q3R
160950 - ..
160951 - On 060125 manometry test scheduled for 060209 0800. ref SDS 10 GG9I
160953 - ..
160954 - On 060209 meeting at VA Mather AFB in Sacramento, test was postponed
160955 - until 060223, due to equipment failure. ref SDS 11 OW6M
160957 - ..
160958 - On 060221 Jimmy in GI Department at Sacramento VA Medical Center
160959 - reports manometry equipment still broken; has been sent out for
160960 - repairs and there is no date at this time on when the equipment will
160961 - be available for use at the VA. ref SDS 12 ND7M
160963 - ..
160964 - On 060330 endoscopy follow up examination at GI Department Sacramento
160965 - Medical Center - Doctor Lee finds no evidence cancer performed at VA
160966 - Sacramento condition precedent treatment recover from achalasia.
160967 - ref SDS 13 VX4G
160969 - ..
160970 - On 060330 manometry test performed by Doctor Lee at VA in Sacramento,
160971 - ref SDS 13 MC7P, verifies diagnosis swallowing and vomiting problems
160972 - caused by achalasia, ref SDS 13 MD4N, patient meets criteria for
160973 - treatment with pneumatic dilation. ref SDS 13 MD5G
160975 - ..
160976 - On 060505 Martinez VA GI clinic Doctor Lee reported equipment and
160977 - pneumatic balloon materials on hand to perform dilation for treating
160978 - achalasia; treatment delayed until diagnostic data is received from
160979 - Sacramento VA Medical Center from manometry test performed on 060330;
160980 - doctor following up to obtain data; will submit test data to patient
160981 - during the week of 060508, along with a schedule to treat achalasia.
160982 - ref SDS 14 FT6M
160984 - ..
160985 - On 060614 Martinez VA GI clinic reports increased work load treating
160986 - soldiers returning from war in Iraq requires prioritizing; patient
160987 - advocate, Rubin Soto, will coordinate with the GI Clinic notifying the
160988 - customer of the schedule based on current priorities. ref SDS 15 J86N
160990 - ..
160991 - On 070220 letter to VA asks about progress getting test results from
160992 - VA in Sacramento, and scheduling surgery for achalasia, ref SDS 16
160993 - 5R5R
160995 - ..
160996 - On 090812 1030 continued vomiting achalasia causes weight loss 30
160997 - pounds in a few months, Primary Care physician notified GI clinic to
160998 - review schedule for dilation to relieve achalasia. ref SDS 17 7L5O
161000 - ..
161001 - On 090908 meeting GI Clinic in Martinez reports treatment for
161002 - achalasia still waiting to receive results for manometry test on
161003 - 060330, at Sacramento VA Medical Center. ref SDS 18 HX46 Prepared new
161004 - work plan to treat achalasia without manometry test results, because
161005 - the doctor performed the test 3 years ago, and is so knows results
161006 - consistent with achalasia, shown on 060330 0712, ref SDS 13 MD4N;
161007 - schedules treatment for achalasia after treadmill stress test,
161008 - ref SDS 18 BU6W, to evaluate new chest pains hiking hills at Lafayette
161009 - Reservoir which have not occurred doing extended exercise hiking 3 -
161010 - 14 miles a day over the past 5 years. ref SDS 18 MY4N
161012 - ..
161013 - On 091021 report history achalasia issue during meeting with
161014 - cardiothoracic surgery team to prepare for heart bypass surgery the
161015 - next day. ref SDS 20 NX6M Surgery team will coordinate with
161016 - anesthesia team to provide swallowing relief during heart surgery to
161017 - prevent choking. ref SDS 20 R78O
161019 - ..
161020 - On 091022 0700 meeting anesthesia team - Doctor Brzezinski not familiar
161021 - with achalasia - asked if achalasia has been reported to the VA?
161022 - ref SDS 21 JF9K While being prepared with IVs for surgery, patient
161023 - assists anesthesia find VA records on achalasia, ref SDS 21 2W4K;
161024 - Doctor Brzezinski makes plans for patient care and safety so that
161025 - achalasia does not risk death during heart surgery. ref SDS 21 GX4J
161027 - ..
161028 - On 091022 cabg x4 cardiothoracic surgery San Francisco Medical Center.
161029 - ref SDS 21 PQWU
161031 - ..
161032 - On 091030 0800 at 1406 meeting with Doctor Stewart at San Francisco
161033 - Medical Center during recovery from heart surgery, proposes Heller
161034 - Myotomy surgery rather than pneumatic (balloon) dilation as more
161035 - effective and longer lasting solution to recover from swallowing and
161036 - vomiting problems caused by achalasia. ref SDS 24 KE3B
161038 - ..
161039 - On 091030 0800 at 1430 received documentation from GI Department at
161040 - San Francisco Medical Center - review shows 3 different treatments for
161041 - achalasia - pills, pneumatic dilation, Heller Myotomy surgery.
161042 - ref SDS 24 495I
161044 - ..
161045 - On 091030 0800 at 1440 meeting cardiothoracic surgery team; Doctor
161046 - Ratcliff concerned about how to maintain nutrition for the patient to
161047 - recover from heart surgery while digestion remains problematic due to
161048 - achalasia; proposes feeding tube for several months until Heller
161049 - Myotomy surgery. ref SDS 24 03GF
161051 - ..
161052 - On 091216 Heller Myotomy surgery at San Francisco VA Medical Center to
161053 - recover from achalasia. 091216 0600, ref SDS 36 KE9U
161055 - ..
161056 - On 100202 meeting with Doctor Lee - report swallowing and vomiting
161057 - problems 3 months after Heller Myotomy surgery. Doctor explains
161058 - achalasia disease breaks nerve connections from the brain that
161059 - contract the esophagus to force food and liquid from the mouth through
161060 - the esophagus; as well broken nerve connections prevent the lower
161061 - esophageal sphincter valve (LESV) to relax so that content can pass
161062 - into the stomach. Without esophageal contractions, food and liquid
161063 - can only reach the stomach with gravity, but since the LESV won't
161064 - relax the patient continues to have swallowing and vomiting problems,
161065 - despite Heller Myotomy surgery on 091216, intended to maintain
161066 - adequate opening into the stomach. ref SDS 47 485W
161068 - ..
161069 - On 100305 meeting at GI Clinic in Martinez, EGD procedure dilated LESV
161070 - from 11 to 15 mm. ref SDS 48 WR6L
161072 - ..
161073 - On 100827 meeting at GI Clinic in Martinez, EGD procedure dilated LESV
161074 - from 11 to 15 mm. ref SDS 55 JE6X
161076 - ..
161077 - On 101210 EGD procedure dilated esophageal sphincter valve (LESV)
161078 - without sedation, ref SDS 68 BE7K - dilated LESV again from 11 to 14
161079 - mm. ref SDS 68 BF6L
161081 - ..
161082 - On 101216 1021 letter commends medical team for excellent work, and
161083 - confirms schedule next EGD on 110218 0730. ref SDS 70 K35G
161085 - ..
161086 - On 110218 0730 4th EGD procedure at VA in Martinez, and using
161087 - anesthesia with Fentanyl. ref SDS 72 PQWY LESV dilated 11 - 14 mm,
161088 - and added triamcinolone steroid injections to resist contraction of
161089 - LESV so that swallowing is maintained over the next 3 month cycle.
161090 - ref SDS 72 SR4G
161092 - ..
161093 - On 110429 0830 5th EGD dilation at VA in Martinez - triamcinolone
161094 - steroid injections worked well to resist contraction of LESV so that
161095 - swallowing was maintained over the prior 3 month cycle, ref SDS 76
161096 - FE3F, so LESV dilated from 13 - 16.5 mm, ref SDS 76 U23I, and
161097 - triamcinolone injections were continued. ref SDS 76 SS5N
161099 - ..
161100 - On 110607 1414 visited GI Department, ref SDS 78 HC5H, and Charlene
161101 - reported a computer mistakes requires scheduling next EGD dilation on
161102 - 110819 0830. ref SDS 78 N642 Requested meeting with Doctor Lee to
161103 - review pending action items. ref SDS 78 4P6J,
161105 - ..
161106 - On 110819 0830 EGD and Dilation of stricture at lower esophageal sphincter
161107 - valve. Triamcinolone steroid injections worked well to resist
161108 - contraction of LESV so that swallowing is maintained over the prior 3
161109 - month cycle, so LESV dilated from 15 - 16.5 mm, ref SDS 81 J978, and
161110 - triamcinolone injections were continued. ref SDS 81 J985
161112 - ..
161113 - On 111115 1300 EGD dilation procedure - triamcinolone steroid injections
161114 - worked well over the prior 3 month cycle, so LESV dilated from 16.5 -
161115 - 18 mm, ref SDS 82 IR57; for some reason triamcinolone injections to
161116 - resist contraction of LESV was not performed. ref SDS 82 IS6L
161118 - ..
161119 - On 120322 1030 EGD dilation procedure - swallowing and vomiting problems
161120 - increased without triamcinolone steroid injections on prior 3 month
161121 - cycle. ref SDS 84 UI9H LESV dilated from 16.5 - 18 mm. ref SDS 84
161122 - 516N Triamcinolone injections to resist contraction of LESV was not
161123 - performed. ref SDS 84 5179
161125 - ..
161126 - On 120925 0900 meeting Doctor Lee reported schedule mistake using new VA
161127 - business unit; reported patient history. ref SDS 87 RG9K Scheduled
161128 - EGD and dilation procedure for 1300; returned and performed procedure,
161129 - ref SDS 87 TB4J; dilated from 15 mm to 18 mm. ref SDS 87 XB51
161130 - Swallowing and vomiting problems increased after omitting
161131 - triamcinolone steroid injections to resist contraction of LESV after
161132 - dilation, ref SDS 87 TZ4M; therefore, injections were resumed to
161133 - complement dilation to enable and maintain effective swallowing.
161134 - ref SDS 87 R87N
161136 - ..
161137 - On 130110 0900 meeting Doctor Lee EGD dilation procedure found
161138 - improvement recovering from achalasia, LESV contracted only slightly
161139 - from 18 mm down to 15 mm. ref SDS 95 Q333
161141 - ..
161142 - On 130416 1100 meeting Doctor Lee EGD procedure no dilation required LESV
161143 - remained at 18 MM, ref SDS A0 CO5N, same as dilated 4 months earlier
161144 - on 130110 0900. ref SDS 95 Q333 Report CT test on 130117, shows
161145 - esophagus fully recovered from severe distortions caused by achalasia
161146 - 8 years earlier. ref SDS A0 MT6F Doctor Lee injected steroid again to
161147 - maintain swallowing. ref SDS A0 F38G Prescribed reducing Omeprazole
161148 - to 1 pill per day. ref SDS A0 R74M Scheduled next EGD dilation in 6
161149 - months, instead of 3. ref SDS A0 6P6G
161151 - ..
161152 - On 131115 0700 meeting Doctor Lee EGD procedure dilation LESV from 16.5
161153 - to 18 mm. ref SDS A6 CO5N Triamcinolone steroid injected again to
161154 - maintain improved swallowing. ref SDS A6 I167 Omeprazole medication
161155 - maintained 20 mg taken morning and evening for 1 month, then reduce to
161156 - 20 mg once per day. ref SDS A6 R74M Biopsies taken. ref SDS A6 3N8L
161158 - ..
161159 - On 131121 1604 ordered refill of Omeprazole to aid digestion. There
161160 - is 1 refill remaining. ref SDS A7 YS4O
161162 - ..
161163 - On 131205 1443 received order for Omeprazole prescription placed on
161164 - 131121. ref SDS A9 5N3O
161166 - ..
161167 - On 140318 1043 received letter cancelling meeting scheduled for
161168 - EGD/Dilation procedure on 140425 1000, ref SDS B1 935L; a second
161169 - letter scheduled procedure on 140509 0900. ref SDS B1 5D7H
161171 - ..
161172 - On 140401 1659 ordered refill Omeprazole; none are remaining; need
161173 - Doctor Lee to order new prescription to increase refills. ref SDS B2
161174 - 4P5M
161176 - ..
161177 - On 140509 0900 meeting Doctor Lee for EGD Dilation at VA medical
161178 - center in Sacramento, Mather. ref SDS B4 K37G Pre-op preparation went
161179 - well - IV setup on first stick. ref SDS B4 EP75 Doctor ordered
161180 - refills for Omeprazole. ref SDS B4 AW5O Doctor patient partnership
161181 - continues to progress with doctor reading patient history to be
161182 - prepared for effective meeting. ref SDS B4 ZZ6J Doctor Lee recalled
161183 - today having made timely referral for heart surgery, enabling patient
161184 - to recover and hike Half Dome 4 years later. ref SDS B4 0N6I Reported
161185 - swallowing and vomiting problems reduced past 6 months with
161186 - triamcinolone steroid injections to resist contraction of LESV.
161187 - ref SDS B4 VV6N Doctor Lee dilated LESV contracted to only 16.5 MM
161188 - over past 6 months with triamcinolone steroid injections to resist
161189 - contraction; he dilated LESV back to 18 MMy, ref SDS B4 5H5J,
161190 - scheduled next EGD dilation in 6 months since this worked well the
161191 - past 6 months with triamcinolone steroid injections. ref SDS B4 549I
161192 - The doctor explained that since there was no tearing of LESV during
161193 - procedure today, triamcinolone steroid was not injected into LESV to
161194 - resist contraction. ref SDS B4 i067 Progress notes report small
161195 - tearing of LESV during dilation procedure. ref SDS B4 P680
161197 - ..
161198 - On 140718 1017 planning for notifying VA to update current fill date
161199 - for Omeprazole. ref SDS B8 U88L Kathy visited VA in Sacramento, and
161200 - requested changing refill date for Omeprazole to 140718. ref SDS B8
161201 - OL5K VA representative called customer, and said Doctor Lee would
161202 - call back later that day to consider action on updating scheduled
161203 - refill date of Omeprazole to 140718. ref SDS B8 U76M
161205 - ..
161206 - On 140810 1839 letter to Doctor Lee requesting EGD dilation with
161207 - triamcinolone injection soonest, if cancellation occurs; but, not an
161208 - emergency, ref SDS C0 W83K, based on history rising vomiting
161209 - swallowing problems, shown in patient history case study on 120101,
161210 - beginning 140712. ref SDS 83 4E4M
161212 - ..
161213 - On 140819 0800 during meeting at VA Primary Care Clinic in Martinez,
161214 - Doctor Sandhu indicated Doctor Lee at VA Medical Center in Sacramento
161215 - will be notified about rising achalasia symptoms for consideration to
161216 - advance EGD dilation procedure. ref SDS C1 EX78
161218 - ..
161219 - On 141014 0943 Kathy visited VA Medical Center in Sacramento and met
161220 - with Lapria again, who advised that the VA responded in a letter on
161221 - 141001, to the letter on 140810, and further scheduled a meeting with
161222 - Doctor Lee on 141121 1530. ref SDS C2 QJ5N
161224 - ..
161225 - On 141103 2152 submitted agenda for meeting with Doctor Lee at VA
161226 - Sacramento Medical Center on 141107 0800, for next EGD dilation.
161227 - ref SDS C3 K37G Submit record showing normal swallowing occurs longer
161228 - with triamcinolone steroid injection to resist contraction of LESV.
161229 - ref SDS C3 3U97 Request schedule next EGD dilation in 4 months, and
161230 - if LESV does not contract, then schedule following EGD dilation in 6
161231 - months. ref SDS C3 3U66 Notified results of Half Dome hike.
161232 - ref SDS C3 3U6Y
161234 - ..
161235 - On 141107 0800 EGD dilation procedure - setting IV for conscious
161236 - sedation required 3 sticks. ref SDS C4 5W5I Meeting Doctor Lee guided
161237 - by agenda facilitated collaboration through doctor patient
161238 - partnership. ref SDS C4 VV6N Doctor explained increased difficulty
161239 - swallowing due to experiment omitting triamcinolone steroid injection
161240 - on prior procedure, ref SDS C4 4U8I, shown by LESV contracting back to
161241 - from 15 mm. ref SDS C4 T55I Progress Notes report finding ulceration
161242 - and hiatal hernia. ref SDS C4 MG6N Photographs seem to show
161243 - significantly different condition of fundoplication from a year
161244 - earlier. ref SDS C4 I74I
161246 - ..
161247 - On 150319 0800 meeting Doctor Lee in GI Clinic VA Medical Center
161248 - Sacramento report swallowing improved with triamcinolone steroid
161249 - injections on 141107 EGD dilation procedure. ref SDS C9 0M6I Doctor
161250 - Lee advised that increased orange juice consumption aids digestion,
161251 - and presents no health risks. ref SDS C9 YF5M Scheduled next EGD
161252 - dilation procedure on 150421 1300. ref SDS C9 PS4O Fundoplication
161253 - failure increases acid burn that caused ulceration with hiatal hernia
161254 - with increased recurrence achalasia. ref SDS C9 O56O Doctor Lee will
161255 - make referral to Doctor Stewart at General Surgery VA Medical Center
161256 - in San Francisco for consideration of "redo" fundoplication.
161257 - ref SDS C9 JQ5J Doctor Lee completed Progress Notes for EGD dilation
161258 - on 141107. ref SDS C9 PS53 Doctor Lee will recommend Doctor Stewart
161259 - order CT test to evaluate recurrence achalasia due to failure
161260 - fundoplication. ref SDS C9 TH5M This test can include coronary CTA to
161261 - evaluate regression atherosclerosis. ref SDS C9 GB56
161263 - ..
161264 - On 150420 1752 submitted letter to Doctor Lee with agenda for meeting
161265 - the next day on 150421 1300 for EGD dilation. ref SDS D1 0M6I
161267 - ..
161268 - On 150421 0800 Met with Doctor Lee for EGD Dilation procedure
161269 - ref SDS D2 GD4H Reported pain level 2 right knee MCL. ref SDS D2 LO9K
161270 - Doctor Lee advised referral to San Francisco will be filed after EGD
161271 - dilation procedure to evaluate loosening fundoplication. ref SDS D2
161272 - DZ4I Patient reported difficulty swallowing this cycle did not occur
161273 - until 4 weeks or so, because triamcinolone steroid injected during
161274 - prior procedure on 141107, ref SDS D2 P55L, and shown by EGD dilation
161275 - LESV from 16.5 mm back to 18 mm. ref SDS D2 HU42 Progress Notes
161276 - report findings of hiatal hernia. ref SDS D2 QD6O Impression
161277 - ulceration subsided to mere erosions. ref SDS D2 PXXY
161279 - ..
161280 - On 150521 0800 met with Doctor Lee at VA MC in Sacramento (Mather) to
161281 - review EGD Dilation procedure last month on 140421. The doctor
161282 - accessed on VA computer system photographs from procedure on 140521,
161283 - which showed bubbles. ref SDS D4 0M6I Doctor Lee explained recent
161284 - vomiting may be due to relaxation of practice eating procedures.
161285 - ref SDS D4 WT9L Reviewed photographs showing current loosened
161286 - condition of fundoplication markedly different from condition a year
161287 - ago. ref SDS D4 FV5O Fundoplication occurs below LESV, causing hiatal
161288 - hernia to push stomach into esophagus. ref SDS D4 IA5O Plan to
161289 - request CT barium swallow test to evaluate recurrence distortion
161290 - esophagus above LESV. ref SDS D4 OG6L
161292 - ..
161293 - On 150526 1300 excellent meeting Doctor Stewart General Surgery VA MC
161294 - San Francisco options laparosonic Dor fundoplication and correct hiatal
161295 - hernia toward resolution of ulceration to LESV. ref SDS D5 NN6J Doctor
161296 - clarified redo Nissen fundoplication with full wrap high success rate,
161297 - but redo Dor fundoplication with partial wrap for Heller Myotomy
161298 - surgery is more complicated. ref SDS D5 L44F 50% chance laparosonic
161299 - would damage tissue so immediate switch to invasive surgery causing
161300 - higher risk of complications. ref SDS D5 GT5G Doctor Stewart asked if
161301 - swallowing problems were resolved after Heller Myotomy surgery on
161302 - 091219? Recurrent swallowing problems past 6 years improved EGD
161303 - dilations every 4 months by Doctor Lee, improvement increased to 6
161304 - months on adding triamcinolone steroid injections to LESV. ref SDS D5
161305 - M28L Significant burping (reflux) persistent symptom gastroesophageal
161306 - issues. ref SDS D5 F65K Pictures from EGD dilations show progression
161307 - of Dor fundoplication loosening beginning on 140509. ref SDS D5 RV3G
161308 - VA computer system unable to access pictures showing changes to
161309 - fundoplication. ref SDS D5 F65O Doctor Stewart work plan staff support
161310 - to retrieve photographic evidence on VA computer system. Ordered CT
161311 - barium swallow and gastric emptying tests to further assess severity
161312 - of ulceration, hiatal hernia and failure of fundoplication, and
161313 - further analyse remedies, including redo Dor fundoplication.
161314 - ref SDS D5 KQ5M Doctor Stewart scheduled follow up meeting on 150602
161315 - to review this additional evidence and consider best course of care.
161316 - ref SDS D5 GG4G Went to Radiology and scheduled CT Barium Swallow
161317 - study for 150527 0930. ref SDS D5 WY3O Then went to Nuclear Medicine
161318 - and scheduled Gastric Emptying test for 150603 0800. ref SDS D5 A74F
161319 - Since this test on 150603, will be after 150602, returned to Module #2
161320 - and re-scheduled meeting with Doctor Stewart on 150623. ref SDS D5 SO3F
161321 - Scheduling mix-ups were resolved, ensuring Doctor Stewart's
161322 - comprehensive work plan is aligned with all relevant VA elements.
161323 - ref SDS D5 QS3X
161325 - ..
161326 - On 150527 0930 CT barium swallow test, ref SDS D7 K37G; seems to have
161327 - favorable results, similar to prior test on 130117. ref SDS D7 QB3I
161328 - This resolves recent concern that swallowing problems reported on
161329 - 141107, due to omitting triamcinalone steriod injections to LESV have
161330 - not distorted esophagus causing recurrent achalasia "bird beak"
161331 - problem. ref SDS D7 UO9K After the test, visited Isagani's office,
161332 - ref SDS D7 GU5O, and developed work plan to submit with email
161333 - photographs Doctor Stewart requested yesterday showing Dor
161334 - fundoplication has loosened. ref SDS D7 2X5N
161336 - ..
161337 - On 150529 1202 initial difficulty submitting photographs to Isagani at
161338 - VAMCSF, because total size 15 MB was over the limit for the VA's email
161339 - server. ref SDS 0 K37G Eventually solved this by converting Microsoft
161340 - Word docx files to pdf. ref SDS 0 JI76 Letter to Isagani transmitting
161341 - 2 files with photographs showing changes to Dor fundopliction.
161342 - ref SDS 0 WP8J Include link to record meeting with Doctor Stewart on
161343 - 150526, and ask Isagani to glance through to see if anything should be
161344 - brought to her attention. ref SDS 0 SQ59
161345 -
161346 -
161347 -
161348 -
161349 -
161351 - ..
1614 -
1615 -
1616 - Progress
161701 - ..
161702 - Work Plan Review Photographic Evidence Barium and Gastric Emptying Test
161703 -
161704 - Follow up ref SDS D7 GU5O, ref SDS D5 KQ5M.
161705 -
161706 - Today, sent letter to Isagani transmitting 2 attached files with
161707 - pictures showing failure of fundoplication, discussed with Doctor
161708 - Stewart on 150526 1300. ref SDS D5 E44L This implemented planning
161709 - with Isagani the next day on Wednesday, 150527 0930. ref SDS D7 2X64
161711 - ..
161712 - The letter was returned undelivered with message the VA server
161713 - refused to accept a letter with files attached that exceeded the
161714 - limits of the computer system.
161716 - ..
161717 - Investigation showed the problem was the VA MC in Sacramento
161718 - submitted files of pictures for the EDG Dilation on 131115, as
161719 - Windows Word 7 (docx) files. This has 4 sets of 4 pictures each, and
161720 - the total size is 13 MB. Tried converting to jpg, and this failed.
161722 - ..
161723 - After hours of trying various approaches, used cut and past to remove
161724 - the set of 4 photographs that contains the picture of fundoplication,
161725 - and pasted this into a separate Word file. Then saved the file as
161726 - pdf. This reduced the size of the file to submit with the mail from
161727 - 13 MB to 131 KB.
161729 - ..
161730 - Was then able to submit the following letter to Isanani, and was not
161731 - returned, so assume he will get it, although calling his office today
161732 - there was a message he does not work on Friday...
161733 -
161734 - 1. Subject: Redo Dor Fundoplication Photographs Requested by Doctor Stewart
161735 - Date: 2015-05-29 22:25
161743 - ..
161744 - 2. Here is the record meeting with Doctor Stewart on Tuesday,
161745 - 150526 1300. ref SDS D5 0001 As you and I discussed on
161746 - Wednesday, the doctor,wanted to see pictures taken during EGD
161747 - dilation procedures the past 6 years that show Dor
161748 - fundoplication unraveling, which she originally constructed on
161749 - 091216, and in order to evaluate need and prospects for repair
161750 - surgery. ref SDS D5 RV3G
161752 - ..
161753 - 3. All 30 or so EGD Dilation photographs for 6 years are stored on
161754 - the VA computer server in Sacramento. During the meeting with
161755 - Doctor Stewart on Tuesday, the system was very slow, so she was
161756 - unable to access them. ref SDS D5 F65O
161758 - ..
161759 - 4. The next day on Wednesday, recall your colleague tried again,
161760 - but was still unable to access the VA server in Sacramento
161761 - (Mather). She planned to keep trying access so the full
161762 - inventory of pictures are available to support Doctor Stewart's
161763 - review. [... 150527 0930, ref SDS D7 2X5N...]. Hopefully, by
161764 - now this has been done.
161766 - ..
161767 - 5. In any case, attached are 2 files (pdf) with 4 pictures taken
161768 - during EGD dilations performed a year apart. One of the 4
161769 - pictures in each file shows fundoplication view. The picture
161770 - on 131115, shows fundoplication appears "in tact." The picture
161771 - on 141107, shows fundoplication seemingly flat and smooth, i.e.
161772 - unraveled. I have not received pictures for the most recent
161773 - EGD dilation last month on 150421. I saw them in a meeting a
161774 - week ago on 150521, with Doctor Lee at VA MC Sacramento
161775 - (Mather). They seemed to show fundoplication further unraveled,
161776 - but that is a call for professional judgement. Hopefully, you
161777 - have by now accessed them from the VA server at Mather.
161779 - ..
161780 - 6. Doctor Stewart may be too busy to review the record of the
161781 - meeting on 150526. If you have a few minutes, you might glance
161782 - through to decide what, if anything further, should be brought
161783 - to her attention besides the attached photographs. For one
161784 - thing, May, the Scheduling Clerk in Module #2, changed follow
161785 - up meeting with Doctor Stewart from 150602, which the doctor
161786 - scheduled, to 150623, ref SDS D5 198N, due to a conflict with
161787 - Nuclear Medicine scheduling the gastric emptying study to
161788 - 150603.
161790 - ..
161791 - 7. Here is a "Summary" of the meeting, below that is "Background"
161792 - with 10 year history of the case - you might skip it.
161793 - Discussion with the doctor begins at "Progress" line 3816.
161794 - ref SDS D5 0001
161796 - ..
161797 - 8. It's always a pleasure working with the VA. Doctor Stewart and
161798 - her patients are fortunate to have high caliber support.
161799 -
161808 - ..
161809 - 11. Attachments:
161810 -
161811 - F:\05\00003\SM\CC\AGMJ\20131115-080024\Welch_11-22-13-photograph.pdf
161812 -
161813 - F:\05\00003\SM\CC\AGMJ\20141107-080000\EGD-11_07_2014-10_19-04-photograph.pdf
161814 -
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161816 -
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161821 -
161822 -
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1619 -