CONTACTS
SUBJECTS
VA EGD Procedure Stricture Lower Esophageal Sphincter Valve LESV 15
3503 -
3503 - ..
3504 - Summary/Objective
3505 -
350501 - Follow up ref SDS E1 0000. ref SDS E0 0000.
350502 -
350503 -
350504 -
350505 -
350506 -
350508 - ..
3506 -
3507 -
3508 - Background
3509 -
350901 - On 050629 meeting Primary Care swallowing and vomitting problems
350902 - reported. ref SDS 1 K78K
350904 - ..
350905 - On 050714 barrium swallow test, ref SDS 2 2I4S, showed esophagus
350906 - distorted by swallowing problems. ref SDS 2 WE4H
350908 - ..
350909 - On 050816 meeting Primary Care Doctor Sandhu diagnoses achalasia.
350910 - ref SDS 3 DG8G Ultrasound test ordered to verify initial diagnosis of
350911 - swallowing and vomitting problems. ref SDS 3 6E7H Primary Care made
350912 - referral to GI clinic for care to resolve swallowing problems.
350913 - ref SDS 3 0G7M
350915 - ..
350916 - On 050830 ultrasound test evaluate swallowing problems possible
350917 - diagnosis achalasia. ref SDS 4 DG8G
350919 - ..
350920 - On 050830 results received barrium swallow test performed on 050714,
350921 - findings in the lower espohagus and gastroesophageal junction are
350922 - consistent with achalasia - recommend endoscopic examination.
350923 - ref SDS 4 6H9S
350925 - ..
350926 - On 050906 report ultrasound test on 050830, finds no cause for
350927 - swallowing problems and does not diagnose achalasia. ref SDS 5 BM6R
350929 - ..
350930 - On 051202 meeting GI Clinic Doctor Lee diagnoses achalasia.
350931 - ref SDS 6 HP9H Orders endoscopy (EGD) test to verify diagnosis of
350932 - achalasia and assess for cancer. ref SDS 6 NZ5H
350934 - ..
350935 - On 051209 GI Clinic endoscopy examination preliminary findings no
350936 - evidence of cancer, ref SDS 7 0001; biopsy report should be submitted
350937 - in a few weeks to confirm status of cancer, ref SDS 7 PY5J, and if so,
350938 - then a procedure can be schedule for next month to dilate the
350939 - exophageal sphincter valve. ref SDS 7 NZ5H
350941 - ..
350942 - On 051222 biopsy reports no evidence of cancer. ref SDS 8 FT6M
350944 - ..
350945 - On 060111 received letter from Doctor Lee in the Gastrointestinal (GI)
350946 - Clinic reporting that the biopsy was negative for cancer and
350947 - infection; next step is manometry test to verify achalasia, then
350948 - treatment for achalasia. ref SDS 9 4Q3R
350950 - ..
350951 - On 060125 manomety test scheduled for 060209 0800. ref SDS 10 GG9I
350953 - ..
350954 - On 060209 meeting at VA Mather AFB in Sacramento, test was postponed
350955 - until 060223, due to equipment failure. ref SDS 11 OW6M
350957 - ..
350958 - On 060221 Jimmy in GI Department at Sacramento VA Medical Center
350959 - reports manometry equipment still broken; has been sent out for
350960 - repairs and there is no date at this time on when the equipment will
350961 - be available for use at the VA. ref SDS 12 ND7M
350963 - ..
350964 - On 060330 endoscopy follow up examination at GI Department Sacramento
350965 - Medical Center - Doctor Lee finds no evidence cancer performed at VA
350966 - Sacramento condition precedent treatment recover from achalasia.
350967 - ref SDS 13 VX4G
350969 - ..
350970 - On 060330 manometry test performed by Doctor Lee at VA in Sacramento,
350971 - ref SDS 13 MC7P, verifies diagnosis swallowing and vomitting problems
350972 - caused by achalasia, ref SDS 13 MD4N, patient meets criteria for
350973 - treatment with pneumatic dilation. ref SDS 13 MD5G
350975 - ..
350976 - On 060505 Martinez VA GI clinic Doctor Lee reported equipment and
350977 - pneumatic balloon materials on hand to perform dilation for treating
350978 - achalasia; treatment delayed until diagnostic data is received from
350979 - Sacramento VA Medical Center from manometry test performed on 060330;
350980 - doctor following up to obtain data; will submit test data to patient
350981 - during the week of 060508, along with a schedule to treat achalasia.
350982 - ref SDS 14 FT6M
350984 - ..
350985 - On 060614 Martinez VA GI clinic reports increased work load treating
350986 - soldiers returning from war in Iraq requires prioritizing; patient
350987 - advocate, Rubin Soto, will coordinate with the GI Clinic notifying the
350988 - customer of the schedule based on current priorities. ref SDS 15 J86N
350990 - ..
350991 - On 070220 letter to VA asks about progress getting test results from
350992 - VA in Sacramento, and scheduling surgery for achalasia, ref SDS 16
350993 - 5R5R
350995 - ..
350996 - On 090812 1030 continued vomitting achalasia causes weight loss 30
350997 - pounds in a few months, Primary Care physician notified GI clinic to
350998 - review schedule for dilation to relieve achalasia. ref SDS 17 7L5O
351000 - ..
351001 - On 090908 meeting GI Clinic in Martinez reports treatment for
351002 - achalasia still waiting to receive results for manometry test on
351003 - 060330, at Sacramento VA Medical Center. ref SDS 18 HX46 Prepared new
351004 - work plan to treat achalasia without manometry test results, because
351005 - the doctor performed the test 3 years ago, and is so knows results
351006 - consistent with achalasia, shown on 060330 0712, ref SDS 13 MD4N;
351007 - schedules treatment for achalasia after treadmill stress test,
351008 - ref SDS 18 BU6W, to evaluate new chest pains hiking hills at Lafayette
351009 - Reservoir which have not occurred doing extended exercise hiking 3 -
351010 - 14 miles a day over the past 5 years. ref SDS 18 MY4N
351012 - ..
351013 - On 091021 report history achalasia issue during meeting with
351014 - cardiothoracic surgery team to prepare for heart bypass surgery the
351015 - next day. ref SDS 20 NX6M Surgery team will coordinate with
351016 - anesthesia team to provide swallowing relief during heart surgery to
351017 - prevent choking. ref SDS 20 R78O
351019 - ..
351020 - On 091022 0700 meeting anesthesia team - Doctor Brezinski not familiar
351021 - with achalasia - asked if achalasia has been reported to the VA?
351022 - ref SDS 21 JF9K While being prepared with IVs for surgery, patient
351023 - assists anesthesia find VA records on achalasia, ref SDS 21 2W4K;
351024 - Doctor Brezenski makes plans for patient care and safety so that
351025 - achalasia does not risk death during heart surgery. ref SDS 21 GX4J
351027 - ..
351028 - On 091022 cabg x4 cardiothoracic surgery San Francisco Medical Center.
351029 - ref SDS 21 PQWU
351031 - ..
351032 - On 091030 0800 at 1406 meeting with Doctor Stewart at San Francisco
351033 - Medical Center during recovery from heart surgery, proposes Heller
351034 - Myotomy surgery rather than pneumatic (balloon) dilation as more
351035 - effective and longer lasting solution to recover from swallowing and
351036 - vomitting problems caused by achalasia. ref SDS 24 KE3B
351038 - ..
351039 - On 091030 0800 at 1430 received documentation from GI Department at
351040 - San Francisco Medical Center - review shows 3 different treatments for
351041 - achalasia - pills, pneumatic dilation, Heller Myotomy surgery.
351042 - ref SDS 24 495I
351044 - ..
351045 - On 091030 0800 at 1440 meeting cardiothoracic surgery team; Doctor
351046 - Ratcliff concerned about how to maintain nutrition for the patient to
351047 - recover from heart surgery while digestion remains problematic due to
351048 - achalasia; proposes feeding tube for several months until Heller
351049 - Myotomy surgery. ref SDS 24 03GF
351051 - ..
351052 - On 091216 Heller Myotomy surgery at San Francisco VA Medical Center to
351053 - recover from achalasia. 091216 0600, ref SDS 36 KE9U
351055 - ..
351056 - On 100202 meeting with Doctor Lee - report swallowing and vomitting
351057 - problems 3 months after Heller Myotomy surgery. Doctor explains
351058 - achalasia disease breaks nerve connections from the brain that
351059 - contract the esophagus to force food and liquid from the mouth through
351060 - the esophagus; as well broken nerve connections prevent the lower
351061 - esophageal sphincter valve (LESV) to relax so that content can pass
351062 - into the stomach. Without esophageal contractions, food and liquid
351063 - can only reach the stomach with gravity, but since the LESV won't
351064 - relax the patient continues to have swallowing and vomitting problems,
351065 - despite Heller Myotomy surgery on 091216, intended to maintain
351066 - adequate opening into the stomach. ref SDS 47 485W
351068 - ..
351069 - On 100305 meeting at GI Clinic in Martinez, EGD procedure dilated LESV
351070 - from 11 to 15 mm. ref SDS 48 WR6L
351072 - ..
351073 - On 100827 meeting at GI Clinic in Martinez, EGD procedure dilated LESV
351074 - from 11 to 15 mm. ref SDS 55 JE6X
351076 - ..
351077 - On 101210 EGD procedure dilated esophageal sphincter valve (LESV)
351078 - without sedation, ref SDS 67 BE7K - dilated LESV again from 11 to 14
351079 - mm. ref SDS 67 BF6L
351081 - ..
351082 - On 101216 1021 letter commends medical team for excellent work, and
351083 - confirms schedule next EGD on 110218 0730. ref SDS 69 K35G
351085 - ..
351086 - On 110218 0730 4th EGD procedure at VA in Martinez, and using
351087 - anesthesia with Fentanyl. ref SDS 71 PQWY LESV dilated 11 - 14 mm,
351088 - and added triamcinolone steriod injections to resist contraction of
351089 - LESV so that swallowing is maintained over the next 3 month cycle.
351090 - ref SDS 71 SR4G
351092 - ..
351093 - On 110429 0830 5th EGD dilation at VA in Martinez - triamcinolone
351094 - steriod injections worked well to resist contraction of LESV so that
351095 - swallowing was maintained over the prior 3 month cycle, ref SDS 75
351096 - FE3F, so LESV dilated from 13 - 16.5 mm, ref SDS 75 U23I, and
351097 - triamcinolone injections were continued. ref SDS 75 SS5N
351099 - ..
351100 - On 110607 1414 visited GI Department, ref SDS 77 HC5H, and Charlene
351101 - reported a computer mistakes requires scheduling next EGD dilation on
351102 - 110819 0830. ref SDS 77 N642 Requested meeting with Doctor Lee to
351103 - review pending action items. ref SDS 77 4P6J,
351105 - ..
351106 - On 110819 0830 EGD and Dilation of stricture at lower esphageal sphincter
351107 - valve. Triamcinolone steriod injections worked well to resist
351108 - contraction of LESV so that swallowing is maintained over the prior 3
351109 - month cycle, so LESV dilated from 15 - 16.5 mm, ref SDS 80 J978, and
351110 - triamcinolone injections were continued. ref SDS 80 J985
351112 - ..
351113 - On 111115 1300 EGD dilation procedure - triamcinolone steriod injections
351114 - worked well over the prior 3 month cycle, so LESV dilated from 16.5 -
351115 - 18 mm, ref SDS 81 IR57; for some reason triamcinolone injections to
351116 - resist contraction of LESV was not performed. ref SDS 81 IS6L
351118 - ..
351119 - On 120322 1030 EGD dilation procedure - swallowing and vomitting problems
351120 - increased without triamcinolone steriod injections on prior 3 month
351121 - cycle. ref SDS 83 UI9H LESV dilated from 16.5 - 18 mm. ref SDS 83
351122 - 516N Triamcinolone injections to resist contraction of LESV was not
351123 - performed. ref SDS 83 5179
351125 - ..
351126 - On 120925 0900 meeting Doctor Lee reported schedule mistake using new VA
351127 - business unit; reported patient history. ref SDS 86 RG9K Scheduled
351128 - EGD and dilation procedure for 1300; returned and performed procedure,
351129 - ref SDS 86 TB4J; dilated from 15 mm to 18 mm. ref SDS 86 XB51
351130 - Swallowing and vomitting problems increased after omitting
351131 - triamcinolone steriod injections to resist contraction of LESV after
351132 - dilation, ref SDS 86 TZ4M; therefore, injections were resumed to
351133 - complement dilation to enable and maintain effective swallowing.
351134 - ref SDS 86 R87N
351136 - ..
351137 - On 130110 0900 meeting Doctor Lee EGD dilation procedure found
351138 - improvement recovering from acalasia, LESV contracted only slightly
351139 - from 18 mm down to 15 mm. ref SDS 94 Q333
351141 - ..
351142 - On 130416 1100 meeting Doctor Lee EGD procedure no dilation required LESV
351143 - remained at 18 MM, ref SDS 99 CO5N, same as dialated 4 months earlier
351144 - on 130110 0900. ref SDS 94 Q333 Report CT test on 130117, shows
351145 - esophagus fully recovered from severe distortions caused by achalasia
351146 - 8 years earlier. ref SDS 99 MT6F Doctor Lee injected steriod again to
351147 - maintain swallowing. ref SDS 99 F38G Prescribed reducing Omeprazole
351148 - to 1 pill per day. ref SDS 99 R74M Scheduled next EDG dilation in 6
351149 - months, instead of 3. ref SDS 99 6P6G
351151 - ..
351152 - On 131115 0700 meeting Doctor Lee EGD prodecure dialation LESV from 16.5
351153 - to 18 mm. ref SDS A5 CO5N Triamcinolone steriod injected again to
351154 - maintain improved swallowing. ref SDS A5 I167 Omeprazole medication
351155 - maintained 20 mg taken morning and evening for 1 month, then reduce to
351156 - 20 mg once per day. ref SDS A5 R74M Biopsies taken. ref SDS A5 3N8L
351158 - ..
351159 - On 131121 1604 ordered refill of Omeprazole to aid digestion. There
351160 - is 1 refill remaining. ref SDS A6 YS4O
351162 - ..
351163 - On 131205 1443 received order for Omeprazole prescription placed on
351164 - 131121. ref SDS A7 5N3O
351166 - ..
351167 - On 140318 1043 received letter cancelling meeting scheduled for
351168 - EGD/Dilation procedure on 140425 1000, ref SDS A9 935L; a second
351169 - letter scheduled prodedure on 140509 0900. ref SDS A9 5D7H
351171 - ..
351172 - On 140401 1659 ordered refill Omeprazole; none are remaining; need
351173 - Doctor Lee to order new prescription to increase refills. ref SDS B0
351174 - 4P5M
351176 - ..
351177 - On 140509 0900 meeting Doctor Lee for EGD Dilation at VA medical
351178 - center in Sacramento, Mather. ref SDS B2 K37G Pre-op preperation went
351179 - well - IV setup on first stick. ref SDS B2 EP75 Doctor ordered refills
351180 - for Omeprazole. ref SDS B2 AW5O Doctor patient partnership continues
351181 - to progress with doctor reading up on patient history to be prepared
351182 - for effective meeting. ref SDS B2 ZZ6J Doctor Lee recalled today
351183 - having made timely referral for having heart surgery, enabling patient
351184 - to recover and Half Dome 4 years later. ref SDS B2 0N6I Reported
351185 - swallowing and vomitting problems reduced past 6 months with
351186 - triamcinolone steriod injections to resist contraction of LESV.
351187 - ref SDS B2 VV6N Doctor Lee dilated LESV contracted to only 16.5 MM
351188 - over past 6 months with triamcinolone steriod injections to resist
351189 - contraction; he dilated LESV back to 18 MMy, ref SDS B2 5H5J, scheduled
351190 - next EGD dilation in 6 months since this worked well the past 6 months
351191 - with triamcinolone steriod injections. ref SDS B2 549I The doctor
351192 - explained that since there was no tearing of LESV during procedure
351193 - today, triamcinolone steriod was not injected into LESV to resist
351194 - contraction. ref SDS B2 I167 Progress notes report small tearing of
351195 - LESV during dilation procedure. ref SDS B2 P680
351197 - ..
351198 - On 140718 1017 planning for notifying VA to update current fill date
351199 - for Omeprazole. ref SDS B6 U88L Kathy visited VA in Sacramento, and
351200 - requested changing refill date for Omeprazole to 140718. ref SDS B6
351201 - OL5K VA representative called customer, and said Doctor Lee would
351202 - call back later that day to consider action on updating scheduled
351203 - refill date of Omeprazole to 140718. ref SDS B6 U76M
351205 - ..
351206 - On 140810 1839 letter to Doctor Lee requesting EGD dilation with
351207 - triamcinolone injection soonest, if cancellation occurs; but, not an
351208 - emergency, ref SDS B8 W83K, based on history rising vomitting
351209 - swallowing problems, shown in patient history case study on 120101,
351210 - beginning 140712. ref SDS 82 4E4M
351212 - ..
351213 - On 140819 0800 during meeting at VA Primary Care Clinic in Martinez,
351214 - Doctor Sandhu indicated Doctor Lee at VA Medical Center in Sacramento
351215 - will be notified about rising achalasia symptoms for consideration to
351216 - advance EGD dilation procedure. ref SDS B9 EX78
351218 - ..
351219 - On 141014 0943 Kathy visited VA Medical Center in Sacramento and met
351220 - with Lapria again, who advised that the VA responded in a letter on
351221 - 141001, to the letter on 140810, and further scheduled a meeting with
351222 - Doctor Lee on 141121 1530. ref SDS C0 QJ5N
351224 - ..
351225 - On 141103 2152 submitted agenda for meeting with Doctor Lee at VA
351226 - Sacramento Medical Center on 141107 0800, for next EGD dilation.
351227 - ref SDS C1 K37G Submit record showing normal swallowing occurs longer
351228 - with triamcinolone steriod injection to resist contraction of LESV.
351229 - ref SDS C1 3U97 Request schedule next EGD dilation in 4 months, and
351230 - if LESV does not contract, then schedule following EGD dilation in 6
351231 - months. ref SDS C1 3U66 Notified results of Half Dome hike.
351232 - ref SDS C1 3U6Y
351234 - ..
351235 - On 141107 0800 EGD dilation LESV from 15mm because triamcinalone
351236 - steriod was not injected during prior procedure on 140509. ref SDS C2
351237 - T55I
351239 - ..
351240 - On 150319 0800 meeting Doctor Lee in GI Clinic VA Medical Center
351241 - Sacramento report swallowing improved with triamcinalone steriod
351242 - injections on 141107 EGD dilation procedure. ref SDS C7 0M6I Doctor
351243 - Lee advised that increased orange juice consumption aids digestion,
351244 - and presents no health risks. ref SDS C7 YF5M Scheduled next EGD
351245 - dilation procedure on 150421 1300. ref SDS C7 PS4O Fundoplication
351246 - failure increases acid burn that caused ulceration with hiatal hernia
351247 - with increased recurrance achalasia. ref SDS C7 O56O Doctor Lee will
351248 - make referral to Doctor Stewart at General Surgery VA Medical Center
351249 - in San Francisco for consideration of "redo" fundaplicaiton.
351250 - ref SDS C7 JQ5J Doctor Lee completed Progress Notes for EGD dilation
351251 - on 141107. ref SDS C7 PS53 Doctor Lee will recommend Doctor Stewart
351252 - order CT test to evaluate recurrance achalasia due to failure
351253 - fundoplication. ref SDS C7 TH5M This test can include coronary CTA to
351254 - evaluate regression atherosclerosis. ref SDS C7 GB56
351256 - ..
351257 - On 150420 1752 submitted letter to Doctor Lee with agenda for meeting
351258 - the next day on 150421 1300 for EGD dilation. ref SDS C9 0M6I
351259 -
351260 -
351261 -
351262 -
351263 -
351265 - ..
3513 -
3514 -
3515 - Progress
351601 - ..
351602 - Work Plan Redo Fundoplication and Correct Hiatal Hernia
351603 - Fundoplication Repair to Resolve Hiatal Hernia Ulceration
351604 -
351605 - Follow up ref SDS E1 NU8L, ref SDS E0 NU8L.
351606 -
351607 - Called Graciela at...
351608 -
351609 - 415-221-4810 Ext 2483
351611 - ..
351612 - Discussed with Graciela getting addendum filed for Progress Notes
351613 - requested in the letter to Isagani for Graciela on 150701 1057.
351614 - ref SDS D9 NU8L
351616 - ..
351617 - Graciela said Doctor Stewart will have to approve adding an addendum.
351619 - ..
351620 - She feels the doctor will not approve adding the addendum because the
351621 - matter should be addressed by the primary care provider, rather than
351622 - surgery.
351624 - ..
351625 - We reviewed the record showing on 091030, Doctor Stewart proposed
351626 - Heller Myotomy procedure to aid swallowing and expressly recommended
351627 - fundoplication surgery to prevent acid from washing back into the
351628 - esophagus. ref SDS 24 OY64 On 091216, Doctor Stewart performed Heller
351629 - Myotomy surgery. Progress Notes report fundoplication was performed
351630 - to prevent acid from washing back into the esophagus, shown in the
351631 - record on 100928 0706. ref SDS 56 2W4H
351633 - ..
351634 - Approximately, 5 years later Doctor Lee issued Progress Notes
351635 - beginning on 140509, reporting ulceration was found on LESV,
351636 - ref SDS B2 P396, and appearance of hiatal hernia indicates
351637 - fundoplication loosening. ref SDS B2 I93F
351639 - ..
351640 - Ulceration problem can be solved by increasing PPI or through redo
351641 - fundoplication.
351643 - ..
351644 - Doctor Stewart feels redo fundoplication is high risk. Proposes PPI
351645 - with H2 blocker treatment instead of surgical solution, shown in
351646 - Progress Notes on 150623 1300. ref SDS D8 FW9H
351648 - ..
351649 - Graciela cited Gastric Emptying study on 150603, reporting no reflux
351650 - observed, ref SDS D4 G25L, as grounds for contesting issue of acid
351651 - washing back into the esophagus causing ulceration of LESV.
351653 - ..
351654 - During the call we reviewed the difference between the Nuclear
351655 - Medicine testing reflux from eating a small amount of egg, cannot be
351656 - expected to adequately assess reflux from eating normal meals
351657 - day-to-day. Bioposies over the past 5 years havd diagnosed
351658 - esophagitis (GERD) from acid reflux.
351660 - ..
351661 - Graciela will print the proposed addendum for Progress Notes on
351662 - 150623. She will discuss this with Doctor Stewart and advise the
351663 - doctor I request a brief telephone consult.
351665 - ..
351666 - Graciela will submit a letter with results of her meeting with Doctor
351667 - Stewart on this matter. She has the email address for sending this
351668 - follow up letter.
351669 -
351671 - ..
3517 -
3518 -
3519 - 0915
3520 -
352001 - Doctor Stewart called back.
352002 -
352003 - Another approach on this would be for Doctor Stewart to visit with
352004 - Doctor Rao in the MP Department and discuss why we need a CCTA.
352005 -
352006 -
352007 -
352008 -
352009 -
352010 -
352011 -
352012 -
352013 -
3521 -