CONTACTS
SUBJECTS
Fundoplication Dor Failed Redo Complicated High Risk Correct Ulcerat
3803 -
3803 - ..
3804 - Summary/Objective
3805 -
380501 - Follow up ref SDS D7 0000. ref SDS D5 0000.
380502 -
380503 -
380504 -
380505 -
380506 -
380507 -
380508 -
380510 - ..
3806 -
3807 -
3808 - Background
3809 -
380901 - On 050629 meeting Primary Care swallowing and vomiting problems
380902 - reported. ref SDS 1 K78K
380904 - ..
380905 - On 050714 barium swallow test, ref SDS 2 2I4S, showed esophagus
380906 - distorted by swallowing problems. ref SDS 2 WE4H
380908 - ..
380909 - On 050816 meeting Primary Care Doctor Sandhu diagnoses achalasia.
380910 - ref SDS 3 DG8G Ultrasound test ordered to verify initial diagnosis of
380911 - swallowing and vomiting problems. ref SDS 3 6E7H Primary Care made
380912 - referral to GI clinic for care to resolve swallowing problems.
380913 - ref SDS 3 0G7M
380915 - ..
380916 - On 050830 ultrasound test evaluate swallowing problems possible
380917 - diagnosis achalasia. ref SDS 4 DG8G
380919 - ..
380920 - On 050830 results received barium swallow test performed on 050714,
380921 - findings in the lower esophagus and gastroesophageal junction are
380922 - consistent with achalasia - recommend endoscopic examination.
380923 - ref SDS 4 6H9S
380925 - ..
380926 - On 050906 report ultrasound test on 050830, finds no cause for
380927 - swallowing problems and does not diagnose achalasia. ref SDS 5 BM6R
380929 - ..
380930 - On 051202 meeting GI Clinic Doctor Lee diagnoses achalasia.
380931 - ref SDS 6 HP9H Orders endoscopy (EGD) test to verify diagnosis of
380932 - achalasia and assess for cancer. ref SDS 6 NZ5H
380934 - ..
380935 - On 051209 GI Clinic endoscopy examination preliminary findings no
380936 - evidence of cancer, ref SDS 7 0001; biopsy report should be submitted
380937 - in a few weeks to confirm status of cancer, ref SDS 7 PY5J, and if so,
380938 - then a procedure can be schedule for next month to dilate the
380939 - esophageal sphincter valve. ref SDS 7 NZ5H
380941 - ..
380942 - On 051222 biopsy reports no evidence of cancer. ref SDS 8 FT6M
380944 - ..
380945 - On 060111 received letter from Doctor Lee in the Gastrointestinal (GI)
380946 - Clinic reporting that the biopsy was negative for cancer and
380947 - infection; next step is manometry test to verify achalasia, then
380948 - treatment for achalasia. ref SDS 9 4Q3R
380950 - ..
380951 - On 060125 manometry test scheduled for 060209 0800. ref SDS 10 GG9I
380953 - ..
380954 - On 060209 meeting at VA Mather AFB in Sacramento, test was postponed
380955 - until 060223, due to equipment failure. ref SDS 11 OW6M
380957 - ..
380958 - On 060221 Jimmy in GI Department at Sacramento VA Medical Center
380959 - reports manometry equipment still broken; has been sent out for
380960 - repairs and there is no date at this time on when the equipment will
380961 - be available for use at the VA. ref SDS 12 ND7M
380963 - ..
380964 - On 060330 endoscopy follow up examination at GI Department Sacramento
380965 - Medical Center - Doctor Lee finds no evidence cancer performed at VA
380966 - Sacramento condition precedent treatment recover from achalasia.
380967 - ref SDS 13 VX4G
380969 - ..
380970 - On 060330 manometry test performed by Doctor Lee at VA in Sacramento,
380971 - ref SDS 13 MC7P, verifies diagnosis swallowing and vomiting problems
380972 - caused by achalasia, ref SDS 13 MD4N, patient meets criteria for
380973 - treatment with pneumatic dilation. ref SDS 13 MD5G
380975 - ..
380976 - On 060505 Martinez VA GI clinic Doctor Lee reported equipment and
380977 - pneumatic balloon materials on hand to perform dilation for treating
380978 - achalasia; treatment delayed until diagnostic data is received from
380979 - Sacramento VA Medical Center from manometry test performed on 060330;
380980 - doctor following up to obtain data; will submit test data to patient
380981 - during the week of 060508, along with a schedule to treat achalasia.
380982 - ref SDS 14 FT6M
380984 - ..
380985 - On 060614 Martinez VA GI clinic reports increased work load treating
380986 - soldiers returning from war in Iraq requires prioritizing; patient
380987 - advocate, Rubin Soto, will coordinate with the GI Clinic notifying the
380988 - customer of the schedule based on current priorities. ref SDS 15 J86N
380990 - ..
380991 - On 070220 letter to VA asks about progress getting test results from
380992 - VA in Sacramento, and scheduling surgery for achalasia, ref SDS 16
380993 - 5R5R
380995 - ..
380996 - On 090812 1030 continued vomiting achalasia causes weight loss 30
380997 - pounds in a few months, Primary Care physician notified GI clinic to
380998 - review schedule for dilation to relieve achalasia. ref SDS 17 7L5O
381000 - ..
381001 - On 090908 meeting GI Clinic in Martinez reports treatment for
381002 - achalasia still waiting to receive results for manometry test on
381003 - 060330, at Sacramento VA Medical Center. ref SDS 18 HX46 Prepared new
381004 - work plan to treat achalasia without manometry test results, because
381005 - the doctor performed the test 3 years ago, and is so knows results
381006 - consistent with achalasia, shown on 060330 0712, ref SDS 13 MD4N;
381007 - schedules treatment for achalasia after treadmill stress test,
381008 - ref SDS 18 BU6W, to evaluate new chest pains hiking hills at Lafayette
381009 - Reservoir which have not occurred doing extended exercise hiking 3 -
381010 - 14 miles a day over the past 5 years. ref SDS 18 MY4N
381012 - ..
381013 - On 091021 report history achalasia issue during meeting with
381014 - cardiothoracic surgery team to prepare for heart bypass surgery the
381015 - next day. ref SDS 20 NX6M Surgery team will coordinate with
381016 - anesthesia team to provide swallowing relief during heart surgery to
381017 - prevent choking. ref SDS 20 R78O
381019 - ..
381020 - On 091022 0700 meeting anesthesia team - Doctor Brzezinski not familiar
381021 - with achalasia - asked if achalasia has been reported to the VA?
381022 - ref SDS 21 JF9K While being prepared with IVs for surgery, patient
381023 - assists anesthesia find VA records on achalasia, ref SDS 21 2W4K;
381024 - Doctor Brzezinski makes plans for patient care and safety so that
381025 - achalasia does not risk death during heart surgery. ref SDS 21 GX4J
381027 - ..
381028 - On 091022 cabg x4 cardiothoracic surgery San Francisco Medical Center.
381029 - ref SDS 21 PQWU
381031 - ..
381032 - On 091030 0800 at 1406 meeting with Doctor Stewart at San Francisco
381033 - Medical Center during recovery from heart surgery, proposes Heller
381034 - Myotomy surgery rather than pneumatic (balloon) dilation as more
381035 - effective and longer lasting solution to recover from swallowing and
381036 - vomiting problems caused by achalasia. ref SDS 24 KE3B
381038 - ..
381039 - On 091030 0800 at 1430 received documentation from GI Department at
381040 - San Francisco Medical Center - review shows 3 different treatments for
381041 - achalasia - pills, pneumatic dilation, Heller Myotomy surgery.
381042 - ref SDS 24 495I
381044 - ..
381045 - On 091030 0800 at 1440 meeting cardiothoracic surgery team; Doctor
381046 - Ratcliff concerned about how to maintain nutrition for the patient to
381047 - recover from heart surgery while digestion remains problematic due to
381048 - achalasia; proposes feeding tube for several months until Heller
381049 - Myotomy surgery. ref SDS 24 03GF
381051 - ..
381052 - On 091216 Heller Myotomy surgery at San Francisco VA Medical Center to
381053 - recover from achalasia. 091216 0600, ref SDS 36 KE9U
381055 - ..
381056 - On 100202 meeting with Doctor Lee - report swallowing and vomiting
381057 - problems 3 months after Heller Myotomy surgery. Doctor explains
381058 - achalasia disease breaks nerve connections from the brain that
381059 - contract the esophagus to force food and liquid from the mouth through
381060 - the esophagus; as well broken nerve connections prevent the lower
381061 - esophageal sphincter valve (LESV) to relax so that content can pass
381062 - into the stomach. Without esophageal contractions, food and liquid
381063 - can only reach the stomach with gravity, but since the LESV won't
381064 - relax the patient continues to have swallowing and vomiting problems,
381065 - despite Heller Myotomy surgery on 091216, intended to maintain
381066 - adequate opening into the stomach. ref SDS 47 485W
381068 - ..
381069 - On 100305 meeting at GI Clinic in Martinez, EGD procedure dilated LESV
381070 - from 11 to 15 mm. ref SDS 48 WR6L
381072 - ..
381073 - On 100827 meeting at GI Clinic in Martinez, EGD procedure dilated LESV
381074 - from 11 to 15 mm. ref SDS 55 JE6X
381076 - ..
381077 - On 101210 EGD procedure dilated esophageal sphincter valve (LESV)
381078 - without sedation, ref SDS 68 BE7K - dilated LESV again from 11 to 14
381079 - mm. ref SDS 68 BF6L
381081 - ..
381082 - On 101216 1021 letter commends medical team for excellent work, and
381083 - confirms schedule next EGD on 110218 0730. ref SDS 70 K35G
381085 - ..
381086 - On 110218 0730 4th EGD procedure at VA in Martinez, and using
381087 - anesthesia with Fentanyl. ref SDS 72 PQWY LESV dilated 11 - 14 mm,
381088 - and added triamcinolone steroid injections to resist contraction of
381089 - LESV so that swallowing is maintained over the next 3 month cycle.
381090 - ref SDS 72 SR4G
381092 - ..
381093 - On 110429 0830 5th EGD dilation at VA in Martinez - triamcinolone
381094 - steroid injections worked well to resist contraction of LESV so that
381095 - swallowing was maintained over the prior 3 month cycle, ref SDS 76
381096 - FE3F, so LESV dilated from 13 - 16.5 mm, ref SDS 76 U23I, and
381097 - triamcinolone injections were continued. ref SDS 76 SS5N
381099 - ..
381100 - On 110607 1414 visited GI Department, ref SDS 78 HC5H, and Charlene
381101 - reported a computer mistakes requires scheduling next EGD dilation on
381102 - 110819 0830. ref SDS 78 N642 Requested meeting with Doctor Lee to
381103 - review pending action items. ref SDS 78 4P6J,
381105 - ..
381106 - On 110819 0830 EGD and Dilation of stricture at lower esophageal sphincter
381107 - valve. Triamcinolone steroid injections worked well to resist
381108 - contraction of LESV so that swallowing is maintained over the prior 3
381109 - month cycle, so LESV dilated from 15 - 16.5 mm, ref SDS 81 J978, and
381110 - triamcinolone injections were continued. ref SDS 81 J985
381112 - ..
381113 - On 111115 1300 EGD dilation procedure - triamcinolone steroid injections
381114 - worked well over the prior 3 month cycle, so LESV dilated from 16.5 -
381115 - 18 mm, ref SDS 82 IR57; for some reason triamcinolone injections to
381116 - resist contraction of LESV was not performed. ref SDS 82 IS6L
381118 - ..
381119 - On 120322 1030 EGD dilation procedure - swallowing and vomiting problems
381120 - increased without triamcinolone steroid injections on prior 3 month
381121 - cycle. ref SDS 84 UI9H LESV dilated from 16.5 - 18 mm. ref SDS 84
381122 - 516N Triamcinolone injections to resist contraction of LESV was not
381123 - performed. ref SDS 84 5179
381125 - ..
381126 - On 120925 0900 meeting Doctor Lee reported schedule mistake using new VA
381127 - business unit; reported patient history. ref SDS 87 RG9K Scheduled
381128 - EGD and dilation procedure for 1300; returned and performed procedure,
381129 - ref SDS 87 TB4J; dilated from 15 mm to 18 mm. ref SDS 87 XB51
381130 - Swallowing and vomiting problems increased after omitting
381131 - triamcinolone steroid injections to resist contraction of LESV after
381132 - dilation, ref SDS 87 TZ4M; therefore, injections were resumed to
381133 - complement dilation to enable and maintain effective swallowing.
381134 - ref SDS 87 R87N
381136 - ..
381137 - On 130110 0900 meeting Doctor Lee EGD dilation procedure found
381138 - improvement recovering from achalasia, LESV contracted only slightly
381139 - from 18 mm down to 15 mm. ref SDS 95 Q333
381141 - ..
381142 - On 130416 1100 meeting Doctor Lee EGD procedure no dilation required LESV
381143 - remained at 18 MM, ref SDS A0 CO5N, same as dilated 4 months earlier
381144 - on 130110 0900. ref SDS 95 Q333 Report CT test on 130117, shows
381145 - esophagus fully recovered from severe distortions caused by achalasia
381146 - 8 years earlier. ref SDS A0 MT6F Doctor Lee injected steroid again to
381147 - maintain swallowing. ref SDS A0 F38G Prescribed reducing Omeprazole
381148 - to 1 pill per day. ref SDS A0 R74M Scheduled next EGD dilation in 6
381149 - months, instead of 3. ref SDS A0 6P6G
381151 - ..
381152 - On 131115 0700 meeting Doctor Lee EGD procedure dilation LESV from 16.5
381153 - to 18 mm. ref SDS A6 CO5N Triamcinolone steroid injected again to
381154 - maintain improved swallowing. ref SDS A6 I167 Omeprazole medication
381155 - maintained 20 mg taken morning and evening for 1 month, then reduce to
381156 - 20 mg once per day. ref SDS A6 R74M Biopsies taken. ref SDS A6 3N8L
381158 - ..
381159 - On 131121 1604 ordered refill of Omeprazole to aid digestion. There
381160 - is 1 refill remaining. ref SDS A7 YS4O
381162 - ..
381163 - On 131205 1443 received order for Omeprazole prescription placed on
381164 - 131121. ref SDS A9 5N3O
381166 - ..
381167 - On 140318 1043 received letter cancelling meeting scheduled for
381168 - EGD/Dilation procedure on 140425 1000, ref SDS B1 935L; a second
381169 - letter scheduled procedure on 140509 0900. ref SDS B1 5D7H
381171 - ..
381172 - On 140401 1659 ordered refill Omeprazole; none are remaining; need
381173 - Doctor Lee to order new prescription to increase refills. ref SDS B2
381174 - 4P5M
381176 - ..
381177 - On 140509 0900 meeting Doctor Lee for EGD Dilation at VA medical
381178 - center in Sacramento, Mather. ref SDS B4 K37G Pre-op preparation went
381179 - well - IV setup on first stick. ref SDS B4 EP75 Doctor ordered
381180 - refills for Omeprazole. ref SDS B4 AW5O Doctor patient partnership
381181 - continues to progress with doctor reading patient history to be
381182 - prepared for effective meeting. ref SDS B4 ZZ6J Doctor Lee recalled
381183 - today having made timely referral for heart surgery, enabling patient
381184 - to recover and hike Half Dome 4 years later. ref SDS B4 0N6I Reported
381185 - swallowing and vomiting problems reduced past 6 months with
381186 - triamcinolone steroid injections to resist contraction of LESV.
381187 - ref SDS B4 VV6N Doctor Lee dilated LESV contracted to only 16.5 MM
381188 - over past 6 months with triamcinolone steroid injections to resist
381189 - contraction; he dilated LESV back to 18 MMy, ref SDS B4 5H5J,
381190 - scheduled next EGD dilation in 6 months since this worked well the
381191 - past 6 months with triamcinolone steroid injections. ref SDS B4 549I
381192 - The doctor explained that since there was no tearing of LESV during
381193 - procedure today, triamcinolone steroid was not injected into LESV to
381194 - resist contraction. ref SDS B4 i067 Progress notes report small
381195 - tearing of LESV during dilation procedure. ref SDS B4 P680
381197 - ..
381198 - On 140718 1017 planning for notifying VA to update current fill date
381199 - for Omeprazole. ref SDS B8 U88L Kathy visited VA in Sacramento, and
381200 - requested changing refill date for Omeprazole to 140718. ref SDS B8
381201 - OL5K VA representative called customer, and said Doctor Lee would
381202 - call back later that day to consider action on updating scheduled
381203 - refill date of Omeprazole to 140718. ref SDS B8 U76M
381205 - ..
381206 - On 140810 1839 letter to Doctor Lee requesting EGD dilation with
381207 - triamcinolone injection soonest, if cancellation occurs; but, not an
381208 - emergency, ref SDS C0 W83K, based on history rising vomiting
381209 - swallowing problems, shown in patient history case study on 120101,
381210 - beginning 140712. ref SDS 83 4E4M
381212 - ..
381213 - On 140819 0800 during meeting at VA Primary Care Clinic in Martinez,
381214 - Doctor Sandhu indicated Doctor Lee at VA Medical Center in Sacramento
381215 - will be notified about rising achalasia symptoms for consideration to
381216 - advance EGD dilation procedure. ref SDS C1 EX78
381218 - ..
381219 - On 141014 0943 Kathy visited VA Medical Center in Sacramento and met
381220 - with Lapria again, who advised that the VA responded in a letter on
381221 - 141001, to the letter on 140810, and further scheduled a meeting with
381222 - Doctor Lee on 141121 1530. ref SDS C2 QJ5N
381224 - ..
381225 - On 141103 2152 submitted agenda for meeting with Doctor Lee at VA
381226 - Sacramento Medical Center on 141107 0800, for next EGD dilation.
381227 - ref SDS C3 K37G Submit record showing normal swallowing occurs longer
381228 - with triamcinolone steroid injection to resist contraction of LESV.
381229 - ref SDS C3 3U97 Request schedule next EGD dilation in 4 months, and
381230 - if LESV does not contract, then schedule following EGD dilation in 6
381231 - months. ref SDS C3 3U66 Notified results of Half Dome hike.
381232 - ref SDS C3 3U6Y
381234 - ..
381235 - On 141107 0800 EGD dilation procedure - setting IV for conscious
381236 - sedation required 3 sticks. ref SDS C4 5W5I Meeting Doctor Lee guided
381237 - by agenda facilitated collaboration through doctor patient
381238 - partnership. ref SDS C4 VV6N Doctor explained increased difficulty
381239 - swallowing due to experiment omitting triamcinolone steroid injection
381240 - on prior procedure, ref SDS C4 4U8I, shown by LESV contracting back to
381241 - from 15 mm. ref SDS C4 T55I Progress Notes report finding ulceration
381242 - and hiatal hernia. ref SDS C4 MG6N Photographs seem to show
381243 - significantly different condition of fundoplication from a year
381244 - earlier. ref SDS C4 I74I
381246 - ..
381247 - On 150319 0800 meeting Doctor Lee in GI Clinic VA Medical Center
381248 - Sacramento report swallowing improved with triamcinolone steroid
381249 - injections on 141107 EGD dilation procedure. ref SDS D0 0M6I Doctor
381250 - Lee advised that increased orange juice consumption aids digestion,
381251 - and presents no health risks. ref SDS D0 YF5M Scheduled next EGD
381252 - dilation procedure on 150421 1300. ref SDS D0 PS4O Fundoplication
381253 - failure increases acid burn that caused ulceration with hiatal hernia
381254 - with increased recurrence achalasia. ref SDS D0 O56O Doctor Lee will
381255 - make referral to Doctor Stewart at General Surgery VA Medical Center
381256 - in San Francisco for consideration of "redo" fundoplication.
381257 - ref SDS D0 JQ5J Doctor Lee completed Progress Notes for EGD dilation
381258 - on 141107. ref SDS D0 PS53 Doctor Lee will recommend Doctor Stewart
381259 - order CT test to evaluate recurrence achalasia due to failure
381260 - fundoplication. ref SDS D0 TH5M This test can include coronary CTA to
381261 - evaluate regression atherosclerosis. ref SDS D0 GB56
381263 - ..
381264 - On 150420 1752 submitted letter to Doctor Lee with agenda for meeting
381265 - the next day on 150421 1300 for EGD dilation. ref SDS D2 0M6I
381267 - ..
381268 - On 150421 0800 Met with Doctor Lee for EGD Dilation procedure
381269 - ref SDS D3 GD4H Reported pain level 2 right knee MCL. ref SDS D3 LO9K
381270 - Doctor Lee advised referral to San Francisco will be filed after EGD
381271 - dilation procedure to evaluate loosening fundoplication. ref SDS D3
381272 - DZ4I Patient reported difficulty swallowing this cycle did not occur
381273 - until 4 weeks or so, because triamcinolone steroid injected during
381274 - prior procedure on 141107, ref SDS D3 P55L, and shown by EGD dilation
381275 - LESV from 16.5 mm back to 18 mm. ref SDS D3 HU42 Progress Notes
381276 - report findings of hiatal hernia. ref SDS D3 QD6O Impression
381277 - ulceration subsided to mere erosions. ref SDS D3 PXXY
381279 - ..
381280 - On 150521 0800 met with Doctor Lee at VA MC in Sacramento (Mather) to
381281 - review EGD Dilation procedure last month on 140421. The doctor
381282 - accessed on VA computer system photographs from procedure on 140521,
381283 - which showed bubbles. ref SDS D6 0M6I Doctor Lee explained recent
381284 - vomiting may be due to relaxation of practice eating procedures.
381285 - ref SDS D6 WT9L Reviewed photographs showing current loosened
381286 - condition of fundoplication markedly different from condition a year
381287 - ago. ref SDS D6 FV5O Fundoplication occurs below LESV, causing hiatal
381288 - hernia to push stomach into esophagus. ref SDS D6 IA5O Plan to
381289 - request CT barium swallow test to evaluate recurrence distortion
381290 - esophagus above LESV. ref SDS D6 OG6L
381292 - ..
381293 - On 150526 1300 excellent meeting Doctor Stewart General Surgery VA MC
381294 - San Francisco options laparosonic Dor fundoplication and correct hiatal
381295 - hernia toward resolution of ulceration to LESV. ref SDS D7 NN6J Doctor
381296 - clarified redo Nissen fundoplication with full wrap high success rate,
381297 - but redo Dor fundoplication with partial wrap for Heller Myotomy
381298 - surgery is more complicated. ref SDS D7 L44F 50% chance laparosonic
381299 - would damage tissue so immediate switch to invasive surgery causing
381300 - higher risk of complications. ref SDS D7 GT5G Doctor Stewart asked if
381301 - swallowing problems were resolved after Heller Myotomy surgery on
381302 - 091219? Recurrent swallowing problems past 6 years improved EGD
381303 - dilations every 4 months by Doctor Lee, improvement increased to 6
381304 - months on adding triamcinolone steroid injections to LESV. ref SDS D7
381305 - M28L Significant burping (reflux) persistent symptom gastroesophageal
381306 - issues. ref SDS D7 F65K Pictures from EGD dilations show progression
381307 - of Dor fundoplication loosening beginning on 140509. ref SDS D7 RV3G
381308 - VA computer system unable to access pictures showing changes to
381309 - fundoplication. ref SDS D7 F65O Doctor Stewart work plan staff support
381310 - to retrieve photographic evidence on VA computer system. Ordered CT
381311 - barium swallow and gastric emptying tests to further assess severity
381312 - of ulceration, hiatal hernia and failure of fundoplication, and
381313 - further analyse remedies, including redo Dor fundoplication.
381314 - ref SDS D7 KQ5M Doctor Stewart scheduled follow up meeting on 150602
381315 - to review this additional evidence and consider best course of care.
381316 - ref SDS D7 GG4G Went to Radiology and scheduled CT Barium Swallow
381317 - study for 150527 0930. ref SDS D7 WY3O Then went to Nuclear Medicine
381318 - and scheduled Gastric Emptying test for 150603 0800. ref SDS D7 A74F
381319 - Since this test on 150603, will be after 150602, returned to Module #2
381320 - and re-scheduled meeting with Doctor Stewart on 150623. ref SDS D7 SO3F
381321 - Scheduling mix-ups were resolved, ensuring Doctor Stewart's
381322 - comprehensive work plan is aligned with all relevant VA elements.
381323 - ref SDS D7 QS3X
381325 - ..
381326 - On 150527 0930 VA Medical Center in San Francisco performed another CT
381327 - Barium Swallow test - preliminary results are favorable indicating
381328 - patient has not suffered recurrent achalasia symtom of distorted
381329 - esophagus, commonly called "bird beak," rather esophagus looks normal.
381330 - ref SDS E0 V56N
381332 - ..
381333 - On 150529 1202 letter to Isagani submits the record meeting with
381334 - Doctor Stewart the day before on 150526, and transmits photographs she
381335 - requested, as planned meeting with Isagani the next day on 150527.
381336 - ref SDS E2 SQ50
381338 - ..
381339 - On 150601 0823 letter from Isagani reports the letter sent to him for
381340 - Doctor Stewart on 150529, reporting on meeting with Doctor Stewart on
381341 - 150526, and further transmitting photographs shown Dor fundoplication
381342 - failed after 131115 and by 141107, were submitted to Doctor Stewart.
381343 - ref SDS E4 HX9O
381345 - ..
381346 - On 150603 0800 visit VA Medical Center in San Francisco and met
381347 - Charissa for Gastric Emptying test. ref SDS E6 K37G
381348 -
381349 -
381350 -
381351 -
381352 -
381354 - ..
3814 -
3815 -
3816 - Progress
381701 - ..
381702 - Evaluate Redo Fundoplication and Correct Hiatal Hernia
381703 - Fundoplication Evaluate Redo Resolve Hiatal Hernia Ulceration
381704 -
381705 - Follow up ref SDS D7 NU8L, ref SDS D5 NU8L.
381706 -
381707 - The PLOS One study reported today correlation between taking PPI
381708 - (Omeprazole) and 16% - 21% increase myocardial infarction (heart
381709 - attack) due to damaging endothelial lining blood vessels, shown in
381710 - another record on 150611 0713, ref SDS E9 ZB96
381712 - ..
381713 - Progress Notes for EGD dilation procedure on 150421 reported
381714 - impression that ulceration of LESV has reduced to mere erosions,
381715 - 150421 1210, ref SDS D3 PXXY, reflecting occasional increased dose of
381716 - Omeprazole to reduce reflux. ref SDS D3 1J3K
381718 - ..
381719 - Subsequently, patient history in case study on 140101, shows more
381720 - regular increased dose of Omeprazole...
381721 -
381722 - 150205........... ref SDS B0 ER7K
381723 - 150213........... ref SDS B0 2Z7I
381724 - 150214........... ref SDS B0 2Z7I
381725 - 150220........... ref SDS B0 OC6K
381726 - 150307........... ref SDS B0 773J
381727 - 150308........... ref SDS B0 6F5H
381728 - 150418........... ref SDS B0 V64N
381729 - 150504........... ref SDS B0 HD5J
381730 - 150508........... ref SDS B0 5B4I
381731 - 150513........... ref SDS B0 JX6K
381732 - 150517........... ref SDS B0 FO7O
381733 - 150518........... ref SDS B0 IQ4M
381734 - 150519........... ref SDS B0 OP5N
381735 - 150521........... ref SDS B0 GI3K
381736 - 150522........... ref SDS B0 HO5O
381737 - 150527........... ref SDS B0 208G
381738 - 150528........... ref SDS B0 SX4J
381739 - 150529........... ref SDS B0 SC3F
381740 - 150531........... ref SDS B0 E26J
381741 - 150601........... ref SDS B0 RG5F
381742 - 150606........... ref SDS B0 OT5M
381744 - ..
381745 - This record indicates increasing Omeprazole may help relieve damage
381746 - from relux that can no longer be protected by Dor fundoplication.
381748 - ..
381749 - The PLOS One study reporting PPI side effects damage endothelial
381750 - lining of blood vessels, ref SDS E9 VC5O, seems aligned with
381751 - correlation between taking PPI and 16% - 21% increase in myocarcial
381752 - infraction rates tends to reduce viability of increasing Omeprazole to
381753 - solve the Dor fundoplication issue.
381754 -
381755 -
381757 - ..
381758 - Letter to Doctor Stewart through Isagani and copy to Doctor Lee
381759 - says...
381760 -
381761 - 1. Subject: Agenda Meeting Doctor Stewart Dor Fundoplication
381762 - Date: 2015-06-11 12:06
381768 - ..
381769 - 2. Isagani,
381771 - ..
381772 - 3. Thanks for coordinating communications with Doctor Stewart.
381773 - ...[referencing Isagani's letter on 150608 0842. ref SDS E8
381774 - HX9O...]. I am copying Doctor Lee at VAMC Sacramento,
381775 - collaborating with Doctor Stewart on prescribing PPI
381776 - (Omeprazole) and/or surgery to resolve Dor fundoplication
381777 - issue.
381779 - ..
381780 - 4. To prepare for meeting Doctor Stewart on 150623, an article
381781 - published today reports PLOS One study correlating PPI with 16%
381782 - - 21% increased risk of myocardial infarction. ref SDS E9 5N3O
381784 - ..
381785 - 5. The study team earlier found PPI damages endothelial lining of
381786 - blood vessels, which drives atherosclerotic plaques, along with
381787 - elevated LDL particles. ref SDS E9 VC5O
381789 - ..
381790 - 6. Over the past months I have increased Omeprazole to reduce
381791 - reflux in response to reduced protection from Dor
381792 - fundoplication. Doctor Lee found reduced ulceration on LESV,
381793 - see Progress Notes for EGD dilation on 150421 (line 510741.
381794 - ref SDS D3 PXXY
381796 - ..
381797 - 7. On 150526, Doctor Stewart indicated repairing Dor
381798 - fundoplication to protect against reflux presents
381799 - complications. ref SDS D7 L44F Therefore, I regularized
381800 - increased dose of Omeprazole with hope of avoiding surgery.
381801 - ...[see above, ref SDS 0 WV6L...]. The report today that
381802 - increasing PPI can damage endothelial cells, leading to 21%
381803 - increased risk of heart attack indicates, further testing may
381804 - help resolve the Hobson's Choice between surgery and increasing
381805 - Omeprazole.
381807 - ..
381808 - 8. Since extended endurance exercise increases production of both
381809 - EPCs and HDL that protect and repair endothelial lining, hiking
381810 - 300 miles per month the past few years may offset effects of
381811 - increasing Omeprazole, thus reducing the need to repair Dor
381812 - fundoplication. Labs for the past year show elevated HDL, most
381813 - recently Labcorp test on 150603 reported HDL 69. VA reported
381814 - HDL 70 on 150209.
381816 - ..
381817 - 9. Adding EPCs to the next lab, and ordering coronary CT
381818 - angiography may yield evidence that Omeprazole in this case has
381819 - not elevated risk of heart attack, as reported in the study.
381820 - This evidence might support prescribing a regimen of continuing
381821 - extended endurance exercise with increasing Omeprazole for
381822 - resolving the Dor fundoplication issue without resort to a
381823 - surgical solution.
381824 -
381825 - [On 150618 1347 Doctor Lee called and left message that he
381826 - saw Doctor Stewart's "note" indicating reluctance to
381827 - perform corrective surgery to repair failed Dor
381828 - fundoplication, but Doctor Lee did not report having
381829 - reviewed this letter on 150611, reporting increased
381830 - Omeprazole may obviate requirement for corrective surgery,
381831 - provided the patient is not suffering adverse side effects
381832 - of increased risk for myocardial infarction. ref SDS F0
381833 - K37G
381834 -
381842 -
381843 -
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381845 -
381846 -
381847 -
381848 -
381849 -
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381851 -
381852 -
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381854 -
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381856 -
381857 -
3819 -